Journal of Primary Care and Community Health最新文献

This study conducted a validation of the piloted Positive Psychology Intervention (PPI) program, which was empirically designed based on the character strengths and virtues (CSV) of the Person Who Use Drugs (PWUDs) and aims to improve their life satisfaction, mental wellbeing, and overall psychological functioning. Forty male residents of the Mega Drug Abuse Treatment and Rehabilitation Center were randomly assigned in treatment or control group using a between-subject experimental pretest-posttest design. Results showed significant improvement in PWUDs' mental wellbeing (M = -0.63, SD = 0.25; t(20) = -2.5, P < .02921), overall psychological functioning (M = -1.25, SD = 0.22; t(20) = -5.71, P < .00013) but not in their life satisfaction (M = -1.55, SD = 0.4; t(20) = -1.55, P > .15033); this could be attributed to their habituated lifestyle brought by their prolonged stay in the center due to the series of nationwide restrictions. However, the vibrant documented accounts of the PWUDs about the perceived impact of the PPI program showed a very high rating coupled with substantial data supporting impactful effects on their overall personhood that are essential to their drug abuse treatment and rehabilitation efforts. Putting the data altogether, it is validated that the PPI program was practical, effective, and functionally responsive to the drug abuse treatment and rehabilitation of the PWUDs. Pertinent conclusions were drawn, and recommendations were provided accordingly.

Purpose: To examine whether primary care visit frequency (PVF) is associated with non-urgent emergency department visits (NU-EDVs) at a large urban medical center, and to identify determinants of higher PVF among Emergency Department patients.

Methods: We conducted a cross-sectional survey of adult ED patients (ESI ≥4 considered NU-EDV) at a Southern California Level I trauma center (September 2021-April 2024). Undergraduate research associates administered a 29-item instrument capturing demographics, utilization, barriers, trust in primary care, and comorbidities. Bivariate tests and multivariable logistic regression estimated adjusted odds ratios (aOR) for NU-EDV and for PVF ≥3 visits/year.

Results: Among 964 patients with a primary care provider, 62.9% reported <3 PCP visits/year; 59.2% presented with NU-EDV. After adjustment, PVF ≥3/year was associated with lower odds of NU-EDV (aOR 0.64, 95% CI 0.48-0.87). Medicaid/Cal insurance was associated with higher odds of NU-EDV versus private insurance (aOR 1.53, 95% CI 1.12-2.08). Determinants of PVF ≥3/year included female sex (aOR 1.39, 95% CI 1.04-1.86), older age (aOR 1.01 per year, 95% CI 1.00-1.02), Black race (aOR 2.21, 95% CI 1.17-4.19), Medicaid/Cal coverage (aOR 1.70, 95% CI 1.22-2.37), more chronic conditions (aOR 1.53 per condition, 95% CI 1.35-1.71), and lower odds with PCP distrust (aOR 0.54, 95% CI 0.30-0.96).

Conclusions: Greater primary care engagement is independently associated with fewer NU-EDVs; however, Medicaid beneficiaries remain at elevated risk for non-urgent ED use. Improving after-hours access, care coordination, and Medicaid-eligible unscheduled primary care may further reduce avoidable ED utilization.

The Model for Understanding Success in Quality (MUSIQ) is a framework designed to understand the contextual factors that can influence healthcare quality improvement (QI) initiative implementation. The MUSIQ calculator was originally developed to help clinics identify contextual factors that may affect QI success. This retrospective study adapted the MUSIQ calculator to serve as an evaluative tool for practice facilitators engaged in a colorectal cancer screening initiative. Eight primary care clinics were scored in 6 contextual factors categories using the adapted MUSIQ calculator. Average MUSIQ scores were used to identify high and low contextual factors clinics, and their colorectal cancer screening rates were assessed across a 4-year period of active engagement with the colorectal cancer screening initiative. There were statistically significant, strong, correlations between overall contextual factors scores and colorectal cancer screening rates across all 4 years. There was a statistically significant difference between screening rate changes during the period of active engagement and high or low contextual factors scores (P = .047). There were statistically significant correlations between 3 contextual factors and colorectal cancer screening rate changes with "Microsystem" and "QI Support" having the strongest associations (P < .001). Low or high contextual factors classification statistically significantly predicted colorectal cancer screening rate changes across the observed timeframe (P = .047). By adapting existing tools with a strong track record of success, like MUSIQ, practice facilitators can identify potential challenges earlier in the QI process providing an important opportunity to intervene to prompt greater success.

Introduction: Continuous Glucose Monitors (CGMs) offer critical insight into glucose trends, aiding significantly in overall type 2 diabetes (T2DM) management. Few studies have evaluated pharmacist involvement in CGM management.

Methods: This was a retrospective study, conducted at two primary care offices within a community health system. The aim of this study was to assess pharmacist impact on the deprescribing of high-risk medications in patients with T2DM utilizing CGM data. The primary outcome was the percentage of patients that experienced deprescribing of a high-risk medication (defined as reduction or discontinuation in total daily dosage of insulin, sulfonylureas, and thiazolidinediones). The secondary outcomes were rate of hospitalizations and changes in total daily insulin dose. Chi-square tests and t-tests were utilized to analyze primary and secondary outcomes.

Results: Among 317 participants, 58% of patients on CGMs had pharmacists involved in their care. Of patients in the pharmacist-led group, 11.4% experienced deprescribing of a high-risk medication compared to about 8.3% in the usual care group. Overall, hospitalizations were 3.2% lower in the pharmacist-led group compared to the usual care group during the study period. In addition, patients in the pharmacist-led group experienced a reduction in total daily insulin dose, while an increase in total daily insulin dosage for the usual care group was observed.

Conclusion: While our study did not find a statistically significant difference in pharmacist-led deprescribing, there was a trend towards reduction in high-risk medication use. This suggests potential clinical significance, emphasizing the role of pharmacist involvement in prescribing practices of medications used to treat T2DM, including deprescribing high-risk medications and initiating non-high-risk medications with additional benefits. Further studies are needed to determine a difference in prescribing practice in pharmacist-led management of T2DM.

Introduction: Integrated Behavioral Health (IBH) clinics in primary care offer cost-effective options for receiving mental health (MH) support for Black patients. By tracking specific aspects of social determinants of health (SDOH), more commonly assessed in primary care, IBH programs can provide helpful insights to both MH and primary care providers.

Methods: This retrospective study examined the impact of IBH care delivery on MH and social needs variables in a Black adult patient population. MH outcomes were assessed using the PHQ9 and GAD7, with a positive score being greater than 5.

Results: There were N = 119 Black patients included in analysis. The sample was 83% female and the average age at first visit was 41. There was a significant reduction in both GAD7 (change = -1.8, P < .001) and PHQ9 (change = -2.3, P < .001) scores for patients receiving IBH services. There were no significant differences between those who had a SDOH screen and having an initial elevated GAD7/PHQ9 score.

Conclusion: More culturally inclusive research on the impact of IBH implementation where Black patients receive their primary care is needed to maximize treatment possibilities among this group.

Introduction: Many patients with sore throat receive antibiotics from their general practitioners (GPs); however, only a minority are affected by bacterial infection, often streptococcal A (Strep A). Rapid diagnostic test can improve diagnosis, guide treatment decisions and direct patients when required for appropriate self-care. This study investigates the potential benefit of Strep A rapid tests in pharmacies for sore throat patients, with the aim of maximising healthcare resources.

Methods: Participants over 16 years old were screened using FeverPAIN scores, and those with high scores were tested for Strep A. To estimate avoided GP visits, participants completed a questionnaire on treatment choice (Accident & Emergency (A&E) GP visit, pharmacist, self-care) if the diagnostic service was unavailable.

Results and conclusion: Majority (86%) tested negative. The questionnaire revealed that 67% could avoid GP visits. When extrapolated to the UK, this could result in an estimated annual saving of £263 million for the National Health Service (NHS) Despite not being recommended for routine use by NICE, the study suggests that such rapid diagnostic testing for Strep A, combined with FeverPAIN screening, could prevent antimicrobial misuse, alleviate NHS pressure and empower pharmacists. This is particularly relevant considering the recent implementation of the pharmacy-first service.

Introduction: Screening for osteoporosis is mainly done by measuring bone mineral density using dual-energy X-ray absorptiometry (DXA) scan. Screening does not usually start until 65 years. Many people 50 to 65 years may unknowingly suffer from progressive bone loss and may be at risk of osteoporosis. Opportunistic use of chest X-rays obtained for other indications could potentially be used to identify patients with signs of bone demineralization and at risk of osteoporosis in primary care settings particularly where DXA may not be readily available. We aimed at comparing the prevalence of bone demineralization using chest radiographs obtained for any indication in patients 50 to 65 years seen at an emergency department, as assessed from their radiology reports and by independent review by a radiologist. We also sought to explore clinical and demographic associates of low bone mass (LBM) among this population.

Methods: We conducted a cross-sectional review of electronic medical records of patients 50 to 65 years, who had obtained a chest X-ray at the emergency department of a large Level 1 trauma center in an urban teaching hospital between May 1, 2021, and May 31, 2021. We estimated the prevalence of "bone demineralization" from the X-rays reports and compared it with that obtained by an independent radiologist's review. We also used the 2020 US population census figures to estimate the number of people 50 to 65 years potentially at risk of LBM and investigated demographic and clinical correlates of LBM.

Results: We reviewed 390 patient records, comprising 201 (51.5%) males and 189 (48.5%) females. Bone demineralization comment was found in 4 (1.0%) reports while radiologist review found 49 (12.6%). Applying sex-adjusted prevalence of 13.1% (using the direct method, with the 2020 US population as standard) to the 64.1 million adults 50 to 64 years in the US population, we estimated that approximately 8.4 million people will have bone demineralization in the population group. LBM was associated with hypertension in women (OR = 2.41, 95% CI = 1.03-5.64).

Conclusion: Use of opportunistic chest X-rays may be feasible in identifying patients at risk of bone loss outside the traditional screening age particularly in areas where DXA may not be readily available.

Introduction: Community Health Centers (CHCs) care for nearly a third of all pregnant Medicaid enrollees. Given that Medicaid covers 41% of childbirths, CHCs play a critical role in ensuring pregnant enrollees' access to perinatal services. Despite their importance, little is known about the CHC workforce serving these patients. This study uses multi-state Medicaid claims data to analyze the providers caring for pregnant Medicaid enrollees at CHCs.

Methods: Our primary data source was the Transformed Medicaid Statistical Information System (T-MSIS) Analytical File (TAF), 2016 to 2021. We identified all pregnant and postpartum Medicaid enrollees that received care at CHCs and examined the workforce serving this population from the following specialties: Obstetricians and Gynecologists (OBGYNs), Nurse Practitioners (NPs), Family Physicians (FPs), and Physician Associates (PAs). We summarized the annual number of providers from each specialty and total number of pregnant and postpartum enrollees served per year. Since the study period overlapped with the COVID-19 pandemic, we also examined the provision of telehealth by this workforce.

Results: The workforce serving pregnant Medicaid enrollees at CHCs each year grew 23% during the study period (22 027-28 668 providers), and that serving postpartum enrollees increased by 20% (25 655-32 026). Total annual number of NPs experienced faster growth than FPs for both pregnant (31% vs 17%) and postpartum enrollee care (27% vs 17%). OBGYN and PA counts remained relatively stable during the study period. The number of providers that served pregnant and postpartum Medicaid enrollees via telehealth peaked in April 2020. Each year, OBGYNs served about 140 pregnant enrollees per provider, compared to 30 for FPs, 20 for NPs, and 10 for PAs. Similarly, the average number of postpartum enrollees served was steady during the study period: OBGYNs served around 70, FPs 20, and both NPs and PAs approximately 10 postpartum enrollees each year.

Discussion: This unique analysis of data from Medicaid claims showed growth in the CHC perinatal workforce and highlighted the role played by providers from certain specialties and professions in caring for pregnant Medicaid enrollees. Policymakers could leverage these findings to design targeted investments for high-impact provider groups within the CHC perinatal workforce.

Background: Hispanics/Latinos (H/L) are the largest minority group in rural areas in the United States. Although childhood obesity represents a growing burden for this population, there is a lack of culturally relevant interventions designed for Latino children and their families.

Objective: This study evaluates the relevance and acceptability of Hispanic Family Connections, a technology-delivered and family-based childhood obesity prevention program for Hispanic/Latino families in rural Nebraska. The program's materials include a workbook with activities for home completion and interactive voice response (IVR) calls.

Methods: A qualitative exploratory study was developed through Focus Groups. Participants were adults who self-identified as H/L, caregivers to children aged 6 to 12, and Spanish literate. A bilingual mediator used a script with 12 questions, based on the project's conceptual and methodological frameworks: i-PARIHS, Cultural Relevance Questionnaire, and FRAME. We used PowerPoint presentations to share samples of the materials that comprise the Hispanic Family Connection intervention. Sessions were recorded, and we applied thematic content analysis with the support of a codebook based on the constructs of Innovation, Facilitation, Beneficiaries, and Adaptations.

Results: Twenty-six H/L who lived in rural Nebraska participated in 8 Focus Groups (FG). We conducted 7 FG in Spanish and 1 in English. Participants highlighted the program's delivery mode using automated personalized technology, which could give them more freedom to engage. They considered the images and wording culturally relevant and easy to understand. Also, the involvement of all family members was a positive note, with parents working as role models. Factors such as workload and weather conditions could act as barriers to participation.

Conclusion: Overall, the intervention was considered relevant among rural Hispanic/Latinos, and the program design and materials were accepted with few adaptations suggested.

Background: Shortages of pediatric mental health (MH) specialty providers have left pediatric primary care providers (PPCP) to care for the influx of youth with MH needs. This study examined trends in prescription of antidepressants and antianxiety medication in pediatric primary care clinics from 2015 to 2023.

Methods: Annual rates of prescription of antidepressant and/or antianxiety medication orders were calculated by race/ethnicity, sex, and practice type. Adjusted mean differences (AMD) were calculated and compared for the beginning and end of the study period.

Results: Prescription orders for antianxiety and/or antidepressant medications increased between 2015 and 2023 across all patients but was greatest among Hispanic youth (AMD = 50.9, 95% CI = 15.3-86.4) and among females irrespective of race (AMD = 29.3, 95% CI = 16.8-41.7). Despite these increases, non-Hispanic White youth were more likely to receive prescriptions than Hispanic and non-Hispanic Asian or Black youth across time periods. Family practices (treating adults and children) had the highest rates of prescription across time periods.

Conclusions: While prescription rates for antidepressant and antianxiety medications have increased overall, treatment gaps between White and ethnoracially minoritized pediatric patients have persisted. Differences in prescribing patterns between practice environments suggest PPCPs may be more comfortable prescribing MH medications in family practices relative to pediatric practices.