Journal of Primary Care and Community Health最新文献

Background: Individuals living in poverty often visit primary healthcare clinics for health problems stemming from unmet legal needs. We examined the impact of a medical-legal partnership on improving the social determinants of health (SDoH), health-related quality of life, and perceived health status of attendees of a Legal Clinic Program (LCP).

Methods: This was a pre-post program evaluation of a weekly LCP established within an urban primary healthcare clinic to provide free legal consultation. Patients aged 18 years or older were either approached or referred to complete a screening tool to identify potential legal needs. Those identified with potential legal needs were offered an appointment with LCP lawyers who provided legal counsel, referrals, and services. For those who attended the LCP, changes in SDoH and health indicators were collected via a self-reported survey 6 months after they attended the LCP and compared to their baseline scores using paired t-tests, McNemar's test for paired proportions, and the Wilcoxon Signed Rank Test for related samples.

Results: During the 6-month evaluation period, 31 participants attended the LCP and completed both the baseline and 6-month surveys; 67.8% were female, 64.5% were white, 90.3% were not working full-time, and 61.3% had a household income of $700 to 1800 per month. At follow-up, 25.8% were receiving at least 1 new benefit and there was a statistically significant reduction in food insecurity (35.5% vs 9.7%, P < .05). Also, perceived health status using the visual analog scale (ranges from 0 to 100) significantly improved from 42.5 points (SD = 25.3) at baseline to 56.6 points (SD = 19.6) after 6 months (P < .05).

Conclusions: The LCP has the potential to improve the health and wellbeing of patients in primary healthcare clinics by addressing unmet legal needs and SDoH.

Introduction/objectives: Primary care organizations are increasingly collecting data on patients' social risks, bringing forth an unprecedented opportunity to present combined health and social data that clinical and social care providers could leverage to improve patient care and outcomes. Little is known, however, about how these data could be used and what combinations of specific data elements are most helpful. We explored how primary care staff who provide clinical or social care services view potential benefits of and use cases for combined patient-level clinical and social data.

Methods: We conducted qualitative interviews or focus groups with 39 social and clinical care providers representing 6 healthcare organizations in San Diego County, California. Interviews were transcribed and analyzed using a deductive thematic analysis approach.

Results: Overall, both clinical and social care providers noted the value of access to both types of data. Participants highlighted 3 benefits from integrating social and clinical data. The data could: (1) offer providers a more holistic view of patients' circumstances; (2) strengthen their ability to tailor care to patients' medical and social conditions concurrently; and (3) enhance coordination across care team members. Interviewees cited specific examples of ways social and clinical data could be paired to improve care.

Conclusions: Social and clinical care providers alike envisioned multiple uses and benefits of accessing combined individual-level clinical and social data, highlighting the potential for practice and policy innovations to facilitate access and uptake of combined data. Future research should focus on ways to increase accessibility of cross-sector data and evaluate the impact of care informed by combined data on patient social and health outcomes.

Introduction: People experiencing health-related social needs (HRSNs), such as transportation insecurity, are less likely to undergo preventive health screenings. They are more likely to have worse health outcomes overall, including a higher rate of late-stage cancer diagnoses. If primary care clinicians are aware of HRSNs, they can tailor preventive care, including cancer screening approaches. Accordingly, recent guidelines recommend that clinicians "adjust" care based on HRSNs. This study assessed the level of clinician awareness of patient-reported HRSNs and congruence between clinician perception and patient-reported HRSNs.

Methods: We surveyed patients aged 50 to 85 years and their clinicians in 3 primary care clinics that routinely screen patients for HRSNs. Patients and clinicians reported the presence/absence of 6 HRSNs, including food, transportation, housing and financial insecurity for medications/healthcare, financial insecurity for utilities, and social isolation. Kappa statistics assessed the concordance of reported HRSNs between patients and clinicians.

Results: Across 237 paired patient-clinician surveys, mean patient age was 65 years, and 62% and 13% of patients were female and Latinx/Hispanic, respectively. Concordance between clinician- and patient-reported HRSNs varied by HRSN, with the lowest agreement for food insecurity (kappa = .08; 95% CI: 0.00, 0.17; P = .01) and highest agreement for transportation insecurity (kappa = .39; 95% CI: 0.18, 0.59; P < .001). The other HRSNs assessed were housing insecurity (kappa = .30; 95% CI: 0.05, 0.55; P < .001), social isolation (kappa = .24; 95% CI: 0.03, 0.45; P < .001), financial insecurity for utilities (kappa = .21; 95% CI: -0.02, 0.45; P < .001), and financial insecurity for healthcare/medications (kappa = .12; 95% CI: -0.02, 0.27; P < .001). In particular, discrepancies were noted in food insecurity prevalence: patient-reported food insecurity was 29% whereas clinician-reported food insecurity was only 3%.

Discussion: Clinician awareness of patients' social needs was only modest to fair, and varied by specific HRSN. In order to adjust care for HRSNs, clinics need processes for increased sharing of patient-reported HRSNs screening information with the entire clinical team. Future research should explore options for sharing HRSN data across teams and evaluate whether better HRSN data-sharing impacts outcomes.

Background: The prevalence of cardiovascular diseases (CVD) is continuously increasing. A nurse-led workplace health promotion program (NWHPP) has demonstrated potential in reducing cardiovascular risks among employees. This study aimed to evaluate the effectiveness of the NWHPP in reducing CVD risks among at-risk workers.

Methods: Sixty workers from 2 factories in Thailand, each with an estimated 10-year cardiovascular risk of 5% or higher (determined by the WHO/ISH cardiovascular risk prediction chart), were enrolled. Participants were randomly assigned to either the intervention or control group based on their factory. The intervention group received an 8-week program comprising 3 core components: redesigning healthcare services, strengthening self-management, and obtaining organizational support. Evaluations of the estimated 10-year CVD risk, systolic blood pressure (SBP), smoking status, and body mass index (BMI) were conducted at baseline and at 1- and 3-month follow-ups.

Results: The intervention group showed significant improvements compared to the control group in CVD risk score (F = 4.827, P = .017) and SBP (F = 12.136, P < .001). Moreover, non-smokers were significantly higher in the intervention group (75.0%) compared with the control group (46.2%) after the 3-month follow-up (OR = 3.50; 95%CI 1.11-11.07; P = .030). However, BMI differences between the groups were not statistically significant.

Conclusion: The nurse-led workplace health promotion program effectively improved cardiovascular risk scores among at-risk workers. Developing workplace policies and environments that promote healthy behaviors is essential for reducing CVD risks among at-risk workers.

Background: Engagement with general practice is a requirement of Australia's Primary Health Networks (PHNs). We propose a model for engagement that draws on principles of stakeholder and clinician engagement, tailored to meet the needs of PHNs and general practitioners (GPs).

Methods: A comprehensive literature review was undertaken to identify components, challenges, and approaches to optimizing clinician engagement. Interviews with GPs (n = 18), other practice staff (n = 12), PHN staff, and other stakeholders (n = 15) across 3 PHN regions in Victoria, Australia, were used to identify perceived needs of GPs and opportunities for engagement with PHNs. Interview transcripts, notes, and contact summaries were collated and organized using QSR NVivo to support the process of coding and identification of common themes and perspectives. Information from the literature and interviews was synthesized to inform development of a model for GP engagement that could guide GP strategy and engagement activities undertaken by PHNs.

Findings: PHNs engaged with GPs for accreditation, quality improvement, data sharing, continuing professional development, commissioning, and population health initiatives, among others. GPs were motivated to engage with PHNs, however, the roles of PHNs and benefits of engagement were not always clear. A model to support PHN engagement with general practice was developed comprising: (1) Organizational values for engagement; (2) Needs of GPs; (3) Areas of engagement; (4) Stages of engagement; (5) Communication planning; and (6) Monitoring and Evaluation.

Conclusion: The proposed model represents contemporary understanding in clinician engagement, drawing upon concepts from community and stakeholder engagement, and extending established models for engagement into the setting of general practice.

This report seeks to discuss sequelae of chronic cellulitis that is commonly treated in the ambulatory setting, as exacerbated by the conditions of living outside. Further we hope to identify etiologic factors that contribute to complication development. Additionally, this article will touch on unique treatment plan considerations for unhoused patients with the intention to educate providers and reduce mortality and morbidity relating to pedal skin and soft tissue infections in this population. This piece examines the case of a 52-year-old man with a history of chronic diseases, substance use disorder, and recurrent cellulitis. We highlight systemic issues in healthcare delivery for unhoused patients, including inadequate discharge planning, limited access to medication, and challenges in shelter placement. The discussion section emphasizes the importance of accurate diagnosis and tailored treatment plans for cellulitis in houseless individuals, the importance of a multidisciplinary approach incorporating social work services, and addressing chronic illnesses, substance use disorder, and housing issues. The report advocates for heightened awareness of bilateral cellulitis in unhoused populations, emphasizing the need for comprehensive, individualized treatment plans.

Objectives: Frequency of emergency department (ED) use for nontraumatic dental conditions (NTDC) is a well-researched community health concern. However, research predominately relies on ambulatory ED discharge records. This explanatory sequential mixed methods study reviewed NTDC ED use in hot-spot counties and assessed perceptions around preventable and appropriate use among EDs and dental clinics.

Methods: Tooth pain data (2015-2021) were drawn from State Medicaid, and the Early Notification of Community-Based Epidemics (ESSENCE). NTDC data were compiled using International Classification of Disease, Ninth and Tenth Revisions. Employing extreme case sampling, providers in counties with the highest per-capita NTDC ED use were interviewed.

Results: North Dakota experienced a decline in NTDC ED visits between 2017 and 2020, though the rate is now increasing. The greatest proportion of NTDC ED visits were among persons ages 20 to 34 and 35 to 44. ED and dental care staff have misconceptions around each other's roles in reducing NTDC ED visits, but unanimously suggest community-level prevention as a solution.

Conclusions: NTDC ED use was perceived as "appropriate" care. However, there is consensus that improved access to, and utilization of, affordable and quality preventative dental care would reduce NTDC ED visits and improve overall community health, especially among populations experiencing greater inequities.

Introduction: Self-efficacy in individuals optimizes their hypertension management. Electronic patient portals are being increasingly used to support chronic disease management, as they raise the health literacy of patients and enable them in self-management. However, the association between the use of patient portals and self-efficacy in hypertension management remains unclear. The study aimed to determine the association between self-efficacy among patients with hypertension who are managed in primary care and their demographic characteristics and usage patterns of patient portals.

Method: A cross-sectional survey was conducted at a public primary care clinic in urban Singapore. Multi-ethnic adult patients with hypertension were invited to participate in a self-administered electronic questionnaire. Chi-square test was performed for bivariate analysis; adjusted logistic regression models were used for factors with P value <.1.

Results: A total of 310 patients (66.8% Chinese, 55.5% males, mean age of 63.1 years) completed the survey. Patient portal users had higher self-efficacy scores than non-users (mean score=63 vs 60, maximum = 80, P = .011). The factors associated with increased patient portal access included younger age <65 years (absolute odds ratio [AOR] = 2.634, 95%CI = 1.432-4.847; P = .002), monthly income >$5000 (AOR = 2.324, 95%CI = 1.104-4.892; P = .026), and post-secondary education level (AOR = 3.128, 95%CI = 1.675-5.839; P < .001). Most patients (93.1%) used the portal to check medical appointments but only1.3% of them used it to record home blood pressure measurements (HBPM).

Conclusions: Patient portal usage was associated with higher self-efficacy scores in patients with hypertension. These users were younger, more educated, and earned more than the non-users, but only 1.3% of them used it for HBPM documentation.

Introduction/objective: Chronic pain disorders affect about 20% of adults in the United States, and it disproportionately affects individuals living in the neighborhoods of extreme socioeconomic disadvantage. In many instances, chronic pain has been noted to arise from an aggregation of multiple risk factors and events. Therefore, it is of importance to recognize the modifiable risk factors. The aim of this study was to investigate the comorbid medical conditions and risk factors associated with chronic pain disorders in patients aged 65 years and older.

Methods: Our team retrospectively reviewed medical records of elderly patients (65 years and older) who were evaluated in our outpatient medicine office between July 1, 2020 and June 30, 2021 for acute problems, management of chronic medical problems, or well visits. We divided our patients into a group who suffered from chronic pain disorder, and another group who did not have chronic pain disorder. The association of variables were compared between those groups.

Results: Of the 2431 patients, 493 (20.3%) had a chronic pain disorder. A higher frequency of females in the group with chronic pain disorder was found compared to the group without a chronic pain disorder (60.6% vs 55.2%; P = .033). The mean ages between the two groups were similar in the group with a chronic pain disorder compared to the group without (76.35 ± 7.5 year vs 76.81 ± 7.59 year; P = .228). There were significant associations of certain comorbidities in the group with a chronic pain disorder compared to the group without a chronic pain disorder, such as depression (21.9% vs 15.2%; P < .001), anxiety (27.0% vs 17.1%; P < .001), chronic obstructive pulmonary disease (8.7% vs 6.1%; P = .036), obstructive sleep apnea (16.8% vs 11.6%; P = .002), gastroesophageal reflux disease (40.8% vs 29.0%; P < .001), osteoarthritis (49.3% vs 26.1%; P < .001), other rheumatologic diseases (24.9% vs 19.4%; P = .006), and peripheral neuropathy (14.4% vs 5.3%; P < .001).

Conclusion: Female sex, depression, anxiety, chronic obstructive pulmonary disease, obstructive sleep apnea, gastroesophageal reflux disease, osteoarthritis, other rheumatologic diseases, and peripheral neuropathy were significantly associated with chronic pain disorder in elderly patients, while BMI was not associated with chronic pain disorder.

Objective: The pandemic contributed to increased mental and cognitive health concerns as well as reduced utilization of preventive and treatment focused care. Deferred care can contribute to negative clinical outcomes, including increased acuity of mental and cognitive health concerns that benefit from early intervention. A new visit type was launched with the aim of reaching patients who may need care and supporting early identification of cognitive and mental health issues.

Methods: We developed the Healthy Mind visit, a preventative visit administered by Primary Care Providers (PCPs) within outpatient clinics. The Healthy Mind visit included use of a pre-visit mental health screener as well as a brief computerized cognitive assessment. The clinical interaction focused on identifying mental and cognitive health concerns and developing a plan for wellness. Outcomes data collection occurred over nearly 2.5 years and focused on analyzing booking patterns, depression screening and follow-up, and clinical outcomes such as health confidence and post-visit motivation.

Results: The visit was effective in supporting depression screening and follow-up with 29.6% of those participating in a Healthy Mind visit receiving a PHQ-9, and 82.5% of patients with elevated PHQ-9 scores attending a subsequent visit with their PCP. Improvements in health confidence and high patient reported motivation post-visit represent other notable clinical outcomes. The visit also promoted care utilization, with 73.5% of patients who attended a Healthy Mind visit being new to the practice or those who had not attended an appointment in the past 6 months.

Conclusions: The Healthy Mind visit, with a focus on mental and cognitive health, was successful in reaching patients who may not have otherwise sought care and supported positive clinical outcomes including early identification and treatment of depression and increased health confidence.

Recommendations: These findings reflect the importance of developing innovative programs to connect patients with care, especially those who may have deferred care due to a variety of factors. Focusing on mental and cognitive health with the use of innovative tools such as a computerized assessment, can drive patient interest in care offerings and support positive clinical outcomes.