Journal of Primary Care and Community Health最新文献

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.

Community Health Workers (CHWs) are members of healthcare teams that are integrated in, and often share language, beliefs, and lived experiences with their communities. They use their formal and informal social networks to promote healthy behavior, to connect community members to resources, and to build more resilient community networks. We propose a framework to conceptualize CHW interventions aiming to operationalize and optimize CHW social relations and networks. CHW-mediated network interventions can focus on the dissemination and diffusion of health messages, using the channels of trust and formal and informal relations, as well as, engaging communities to enhance the cascade of spreading/diffusion. Network interventions can also focus on network-building and community dialog, relying on the role of CHWs in bringing the community members together in facilitating conversation, promoting social justice and inclusion, and mobilizing the community in collective action. In addition, the network interventions can aim for boundary-spanning and bridging activities, to facilitate the community's access to health services and external resources, as well as bringing the community voice to health systems to influence priorities and policies. Similar to any other complex interventions, CHW network interventions should be fine-tuned and adapted to local and community needs, capacities, and network structures, and actively involve community members in the conceptualization, delivery, and evaluation.

Background: Despite increased access to HIV pre-exposure prophylaxis (PrEP) in Canada, familiarity and experience among primary care providers (PCPs)-including family doctors and those working with key populations-remains limited. To understand the barriers and facilitators of PrEP familiarity and experience, we conducted a situational analysis in PCPs in sub-urban and rural Ontario.

Methods: We surveyed a non-probabilistic sample of PCPs using an online questionnaire, designed with the Consolidated Framework for Implementation Research (CFIR). Poisson regressions with robust variance were used to assess the relationship between CFIR domains, sociodemographic, and practice characteristics on both PrEP familiarity and experience.

Results: A total of 54 PCPs participated (6% response rate), comprising 80% physicians and 20% nurses. Nearly 30% of the sample worked with key populations, including sexual health clinics and community care centers, 18% of respondents reported high familiarity with PrEP, and 44% reported PrEP experience (referred, started a conversation, or prescribed). PrEP familiarity and experience were associated with working in an organization serving key populations, working with gender minorities, and having colleagues providing PrEP. Providers with a positive perception of PrEP and its necessity for populations at risk were more likely to have PrEP-related experience. Higher familiarity and experience were reported by PCPs with specific clinical skills related to PrEP, and with the perception that PrEP was compatible with their practice as primary provider.

Conclusions: Our findings suggest that organizational support, and additional training and education would facilitate PrEP provision by PCPs in suburban/rural Ontario.

Introduction/objectives: Nurse practitioners (NPs) improve access to care in community-based primary care. Determining an appropriate workload for NPs is complex. The number of patients seen by NPs represents an important consideration. We sought to determine the feasibility, acceptability and appropriateness of implementing the online NP workload measurement index (NP-WI).

Methods: Feasibility study supported by the Theoretical Framework of Acceptability, conducted across 3 health regions in Québec, Canada. Data were collected from January to July 2024 using the online NP-WI (n = 66), 8-item acceptability questionnaire (n = 47), weekly implementation team meetings with NPs and decision-makers (n = 11), field notes and interviews (n = 13). Data analysis completed using descriptive statistics and content analysis, with data integration using joint displays.

Results: NPs indicated that the NP-WI was easy to use. Acceptability scores were positively rated. Daily data entry took 5 to 7 min to complete. NPs deemed a 4-week collection period sufficient to capture a representative workload sample. The NP-WI captured patient, provider and organizational characteristics and the number of patients seen by NPs.

Conclusions: NP-WI implementation was feasible. The instrument can support healthcare workforce planning with more adequate estimations of NP workload in community-based primary care, and provide greater equity in resource allocation and distribution of NP workload.

The optimal patient panel size (PPS) in primary care and the factors determining it remain unclear. We conducted a meta-narrative review of the literature to evaluate factors influencing PPS and assess its association with patient outcomes. A comprehensive search of electronic databases was performed from inception through December 2023, focusing on original studies reporting factors used to determine PPS and related outcomes (eg, clinical outcomes, process measures, and resource utilization). A total of 48 studies were included, identifying 7 key factors influencing PPS. Smaller panels were associated with improved patient satisfaction, continuity of care, and health promotion, while clinical outcomes, utilization, and costs showed minimal impact by PPS. Panel size was primarily associated with patient age, sex, comorbidities, and practice type and structure. Community-based centers typically managed smaller panels, often staffed by female clinicians and serving socioeconomically disadvantaged populations with greater health needs than hospital-based practices. Female clinicians were also independently associated with managing smaller panels, higher quality care indicators, fewer emergency department visits, and improved patient satisfaction. Determining the ideal PPS is a multifaceted process influenced by practice setting, patient demographics, and clinician characteristics. While practice-related factors showed limited association with PPS, patient-reported outcomes were more closely linked to it. Primary care practices should tailor panel sizes to their patient populations, emphasizing a patient-centered approach and ensuring adequate infrastructure support to optimize care delivery.

Background: The purpose of this study is to examine workplace violence (WPV) toward primary care physicians (PCPs), including prevalence, associated factors, impacts, and response to WPV in Chengdu, China.

Methods: We used an online cross-sectional design to collect data from October to November 2022 with a structured self-administered questionnaire from a purposive sample of 568 PCPs in Chengdu city.

Results: Among the 490 valid questionnaires, 44.3% of respondents reported at least encountered 1 type of WPV in the preceding year, with 38.0% experiencing emotional abuse, 24.5% threats, 9.8% experiencing physical assault, 5.5% verbal sexual harassment, and 1.6% sexual abuse. The common perpetrators of WPV were patients (81.6%) and their relatives (44.2%). A multilevel analysis showed that PCPs without night shift had lower odds of experiencing WPV (odds ratios [OR] = 0.461, 95% confidence interval [CI] = 0.299-0.700, P = .0004), while higher education levels were associated with increased odds (OR = 1.835, 95% CI = 1.126-3.005, P = .015). The common reasons of causing WPV perceived by PCPs were "rejected unreasonable demands" (81.6%), "unmet the expectations" (51.2%), and "waiting too long" (47.9%). In response to WPV, 80.6% of PCPs had communicated positively with patients, 61.8% informed superiors, and 23.5% called security guards/police officers, but still 10.6% took no action. Most respondents (82.9%) did not receive training on how to deal with WPV. After experiencing WPV, PCPs reported low work efficiency (56.2%), decreased patient trust (32.7%), and anxious feelings (32.7%).

Conclusions: This study revealed a moderate prevalence of violence against PCPs in primary care settings. Most PCPs lack coping strategies to handle WPV and suffer many negative effects. It is imperative that PCPs receive formal training in WPV management, and our study provides evidence to support such training programs.

Introduction/objectives: Vaccination rates in the United States have seen a concerning decline in recent years. Primary care, as the front line of healthcare for most individuals, is critical in reversing this trend. This study investigates trends in vaccine delivery amongst healthcare providers before and after Coronavirus Disease 2019 (COVID-19).

Methods: The delivery of vaccinations were enumerated by provider type using a combination of 2017 to 2021 Medicare Part B Fee-For-Service claims and the 2013 to 2021 Medical Expenditure Panel Survey (MEPS).

Results: Our findings reveal a notable decline in primary care physician (PCP)-administered vaccinations, with mass immunizers and non-physician providers increasingly assuming this role. Medicare claims showed that the vaccine delivery by PCPs decreased over time, from 46.2% in 2017 to 32.3% in 2021, while the vaccine delivery by mass immunizers increased over time, from 45.2% in 2017 to 60.5% in 2021. Similarly, MEPS data showed that PCPs accounted for 53.6% of vaccination visits in the pre-pandemic period but only 22.9% during the pandemic.

Conclusions: The COVID-19 pandemic profoundly disrupted vaccine delivery, reshaping the roles of PCPs and other providers. This study highlights the need to better integrate primary care into future vaccine distribution frameworks to ensure broad and equitable access in the post-pandemic era.

Introduction/objectives: Little is known about the prevalence of patient-reported social risk factors and the use of the HOUSES Index, a simple, reliable method of assessing socioeconomic status (SES) based on publicly available housing data, in a predominantly rural, primary care population.

Methods: We conducted a cross-sectional analysis of adult patients paneled to family medicine clinicians in a US Midwest health system as of December 31, 2022. Patients' listed address determined HOUSES Index as quartile rank (Q1 lowest SES) and rural/urban status. Social risk data including housing, food, transportation, finances, and violence were collected from health record questionnaires. A mixed effect model was used to assess associations between social risk, HOUSES Index, and rurality.

Results: Of the 352 355 patients included, rural patients were more likely than urban patients to report all social risk factors and had lower SES as measured by HOUSES quartiles. In the mixed effects analysis, HOUSES quartile was independently predictive of reporting an at-risk social risk factor (Q1 vs Q4 OR = 2.27, 95% CI = 2.19-2.37), but rurality was not (OR = 1.02, 95% CI = 0.97-1.07) after adjusting for HOUSES.

Conclusions: The increased prevalence of social risk factors among rural residents is largely explained by individual SES measured by HOUSES Index.