Pub Date : 2024-01-01DOI: 10.1177/21501319241281211
Arisara Ritngam, Surintorn Kalampakorn, Sunee Lagampan, Ann Jirapongsuwan
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.
{"title":"Effectiveness of a Nurse-Led Workplace Intervention in Reducing Cardiovascular Risks Among Thai Workers: A Randomized Controlled Trial.","authors":"Arisara Ritngam, Surintorn Kalampakorn, Sunee Lagampan, Ann Jirapongsuwan","doi":"10.1177/21501319241281211","DOIUrl":"10.1177/21501319241281211","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>The intervention group showed significant improvements compared to the control group in CVD risk score (<i>F</i> = 4.827, <i>P</i> = .017) and SBP (<i>F</i> = 12.136, <i>P</i> < .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; <i>P</i> = .030). However, BMI differences between the groups were not statistically significant.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/21501319241234586
Whitney R Garney, Sara A Flores, Kristen M Garcia, Sonya Panjwani, Kelly L Wilson
Introduction: Adolescent access to quality healthcare is key to prevention and early intervention for health risk behaviors. This paper provides a healthcare provider perspective on barriers and facilitators to youth accessing care.
Methods: Five focus groups were conducted from November to December 2020 with providers from a variety of healthcare settings. Participants were asked to describe their respective adolescent patient populations, adolescent-specific health concerns, and organizational accommodations specific for youth services. Transcripts were analyzed using Inductive Thematic Analysis and themes were grouped using a social-ecological framework.
Results: At an individual level, providers noted that an adolescent's knowledge and ability to navigate services varied greatly across settings. Providers identified provider trust and parent/guardian support as key interpersonal factors that support adolescents' access to services. Organizational factors included bureaucratic barriers and the clinic's reputation among youth. Community factors centered on mistrust within healthcare systems and stigmatization of seeking certain types of services. Participants also described how state-level policies influence parent/guardian consent requirements, which can limit adolescents' access to care.
Conclusion: Adolescent access to and utilization of healthcare in the United States is a complex problem requiring systems-level change. Healthcare organizations and providers have the opportunity and capacity to positively influence adolescents' healthcare access and experiences, however a lack of standardized, clinic-level priorities and guidelines can limit adolescent-centered care.
{"title":"Adolescent Healthcare Access: A Qualitative Study of Provider Perspectives.","authors":"Whitney R Garney, Sara A Flores, Kristen M Garcia, Sonya Panjwani, Kelly L Wilson","doi":"10.1177/21501319241234586","DOIUrl":"10.1177/21501319241234586","url":null,"abstract":"<p><strong>Introduction: </strong>Adolescent access to quality healthcare is key to prevention and early intervention for health risk behaviors. This paper provides a healthcare provider perspective on barriers and facilitators to youth accessing care.</p><p><strong>Methods: </strong>Five focus groups were conducted from November to December 2020 with providers from a variety of healthcare settings. Participants were asked to describe their respective adolescent patient populations, adolescent-specific health concerns, and organizational accommodations specific for youth services. Transcripts were analyzed using Inductive Thematic Analysis and themes were grouped using a social-ecological framework.</p><p><strong>Results: </strong>At an individual level, providers noted that an adolescent's knowledge and ability to navigate services varied greatly across settings. Providers identified provider trust and parent/guardian support as key interpersonal factors that support adolescents' access to services. Organizational factors included bureaucratic barriers and the clinic's reputation among youth. Community factors centered on mistrust within healthcare systems and stigmatization of seeking certain types of services. Participants also described how state-level policies influence parent/guardian consent requirements, which can limit adolescents' access to care.</p><p><strong>Conclusion: </strong>Adolescent access to and utilization of healthcare in the United States is a complex problem requiring systems-level change. Healthcare organizations and providers have the opportunity and capacity to positively influence adolescents' healthcare access and experiences, however a lack of standardized, clinic-level priorities and guidelines can limit adolescent-centered care.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10901052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/21501319241233198
Jennifer Boyd, Martha Carter, Adam Baus
Introduction: Access to medication assisted treatment (MAT) for opioid use disorder (OUD) in the United States is a significant challenge for many individuals attempting to recover and improve their lives. Access to treatment is especially challenging in rural areas characterized by lack of programs, few prescribers, and transportation barriers. This study aims to better understand the roles that transportation, Medicaid-funded non-emergency medical transportation (NEMT), and telehealth play in facilitating access to MAT in West Virginia (WV).
Methods: We developed this survey using an exploratory sequential mixed methods approach following a review of current peer-reviewed literature plus information gained from 3 semi-structured interviews and follow-up discussions with 5 individuals with lived experience in MAT. Survey results from 225 individuals provided rich context on the influence of transportation in enrolling and remaining in treatment, use of NEMT, and experiences using telehealth. Data were collected from February through August 2021.
Results: We found that transportation is a significant factor in entering into and remaining in treatment, with 170 (75.9%) respondents agreeing or strongly agreeing that having transportation was a factor in deciding to go into a MAT program, and 176 (71.1%) agreeing or strongly agreeing that having transportation helps them stay in treatment. NEMT was used by one-quarter (n = 52, 25.7%) of respondents. Only 13 (27.1%) noted that they were picked up on time and only 14 (29.2%) noted that it got them to their appointment on time. Two thirds of respondents (n = 134, 66.3%) had participated in MAT services via telehealth video or telephone visits. More preferred in-person visits to telehealth visits but a substantial number either preferred telehealth or reported no preference. However, 18 (13.6%) reported various challenges in using telehealth.
Conclusions: This study confirms that transportation plays a significant role in many people's decisions to enter and remain in treatment for OUD in WV. Additionally, for those who rely on NEMT, services can be unreliable. Finally, findings demonstrate the need for individualized care and options for accessing treatment for OUD in both in-person and telehealth-based modalities. Programs and payers should examine all possible options to ensure access to care and recovery.
导言:在美国,获得阿片类药物使用障碍(OUD)的药物辅助治疗(MAT)是许多试图康复和改善生活的人面临的重大挑战。在缺乏项目、处方医生少、交通不便的农村地区,获得治疗尤其具有挑战性。本研究旨在更好地了解交通、医疗补助资助的非紧急医疗运送(NEMT)和远程医疗在促进西弗吉尼亚州(WV)获得 MAT 方面所发挥的作用:我们采用探索性顺序混合方法制定了本调查,在此之前,我们查阅了当前的同行评议文献,并与 5 名具有 MAT 生活经验的个人进行了 3 次半结构式访谈和后续讨论,从中获得了相关信息。来自 225 人的调查结果提供了丰富的背景信息,包括交通对加入和坚持治疗的影响、NEMT 的使用以及使用远程医疗的经验。数据收集时间为 2021 年 2 月至 8 月:我们发现,交通是加入和坚持治疗的一个重要因素,170 名受访者(75.9%)同意或非常同意交通是决定加入 MAT 项目的一个因素,176 名受访者(71.1%)同意或非常同意交通有助于他们坚持治疗。四分之一(n = 52,25.7%)的受访者使用过非紧急医疗运送服务。只有 13 位受访者(27.1%)表示他们被准时接走,只有 14 位受访者(29.2%)表示他们能准时赴约。三分之二的受访者(n = 134,66.3%)曾通过远程医疗视频或电话访问参与过 MAT 服务。与远程医疗相比,更多的受访者更喜欢面谈,但也有相当多的受访者更喜欢远程医疗或表示没有偏好。然而,有 18 人(13.6%)报告了在使用远程保健时遇到的各种挑战:这项研究证实,在西弗吉尼亚州,交通在许多人决定是否接受和继续接受 OUD 治疗中起着重要作用。此外,对于那些依赖 NEMT 的人来说,服务可能并不可靠。最后,研究结果表明,有必要提供个性化的护理和选择,以便通过面对面和基于远程医疗的方式获得对 OUD 的治疗。计划和付款人应研究所有可能的选择,以确保获得护理和康复。
{"title":"Access to MAT: Participants' Experiences With Transportation, Non-Emergency Transportation, and Telehealth.","authors":"Jennifer Boyd, Martha Carter, Adam Baus","doi":"10.1177/21501319241233198","DOIUrl":"10.1177/21501319241233198","url":null,"abstract":"<p><strong>Introduction: </strong>Access to medication assisted treatment (MAT) for opioid use disorder (OUD) in the United States is a significant challenge for many individuals attempting to recover and improve their lives. Access to treatment is especially challenging in rural areas characterized by lack of programs, few prescribers, and transportation barriers. This study aims to better understand the roles that transportation, Medicaid-funded non-emergency medical transportation (NEMT), and telehealth play in facilitating access to MAT in West Virginia (WV).</p><p><strong>Methods: </strong>We developed this survey using an exploratory sequential mixed methods approach following a review of current peer-reviewed literature plus information gained from 3 semi-structured interviews and follow-up discussions with 5 individuals with lived experience in MAT. Survey results from 225 individuals provided rich context on the influence of transportation in enrolling and remaining in treatment, use of NEMT, and experiences using telehealth. Data were collected from February through August 2021.</p><p><strong>Results: </strong>We found that transportation is a significant factor in entering into and remaining in treatment, with 170 (75.9%) respondents agreeing or strongly agreeing that having transportation was a factor in deciding to go into a MAT program, and 176 (71.1%) agreeing or strongly agreeing that having transportation helps them stay in treatment. NEMT was used by one-quarter (n = 52, 25.7%) of respondents. Only 13 (27.1%) noted that they were picked up on time and only 14 (29.2%) noted that it got them to their appointment on time. Two thirds of respondents (n = 134, 66.3%) had participated in MAT services via telehealth video or telephone visits. More preferred in-person visits to telehealth visits but a substantial number either preferred telehealth or reported no preference. However, 18 (13.6%) reported various challenges in using telehealth.</p><p><strong>Conclusions: </strong>This study confirms that transportation plays a significant role in many people's decisions to enter and remain in treatment for OUD in WV. Additionally, for those who rely on NEMT, services can be unreliable. Finally, findings demonstrate the need for individualized care and options for accessing treatment for OUD in both in-person and telehealth-based modalities. Programs and payers should examine all possible options to ensure access to care and recovery.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10906046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/21501319241264168
Pamela Torresdey, Jacob Chen, Hector P Rodriguez
Introduction/objectives: More time spent with interpreters may support clinician-patient communication for patients with limited English proficiency (LEP), especially when interpreter support before and after clinical encounters is considered. We assessed whether more time spent with interpreters is associated with better patient-reported experiences of clinician-patient communication and interpreter support among patients with LEP.
Methods: Patients with LEP (n = 338) were surveyed about their experiences with both the clinician and interpreter. Duration of interpreter support during the encounter (in min) and auxiliary time spent before and after encounters supporting patients (in min) were documented by interpreters. Multivariable linear regression models were estimated to assess the association of the time duration of interpreter support and patient experiences of (1) clinician-patient communication, and (2) interpreter support, controlling for patient and encounter characteristics.
Results: The average encounter duration was 47.7 min (standard deviation, SD = 25.1), the average auxiliary time was 43.8 min (SD = 16.4), and the average total interpreter time was 91.1 min (SD = 28.6). LEP patients reported better experiences of interpreter support with a mean score of 97.4 out of 100 (SD = 6.99) compared to clinician-patient communication, with a mean score of 93.7 out of 100 (SD = 14.1). In adjusted analyses, total patient time spent with an interpreter was associated with better patient experiences of clinician-patient communication (β = 7.23, P < .01) when auxiliary time spent by interpreters supporting patients before and after the encounter was considered, but not when only the encounter time was considered.
Conclusions: Longer duration of time spent with an interpreter was associated with better clinician-patient communication for patients with LEP when time spent with an interpreter before and after the clinician encounter is considered. Policymakers should consider reimbursing health care organizations for time interpreters spend providing patient navigation and other support beyond clinical encounters.
{"title":"Patient Time Spent With Professional Medical Interpreters and the Care Experiences of Patients With Limited English Proficiency.","authors":"Pamela Torresdey, Jacob Chen, Hector P Rodriguez","doi":"10.1177/21501319241264168","DOIUrl":"10.1177/21501319241264168","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>More time spent with interpreters may support clinician-patient communication for patients with limited English proficiency (LEP), especially when interpreter support before and after clinical encounters is considered. We assessed whether more time spent with interpreters is associated with better patient-reported experiences of clinician-patient communication and interpreter support among patients with LEP.</p><p><strong>Methods: </strong>Patients with LEP (n = 338) were surveyed about their experiences with both the clinician and interpreter. Duration of interpreter support during the encounter (in min) and auxiliary time spent before and after encounters supporting patients (in min) were documented by interpreters. Multivariable linear regression models were estimated to assess the association of the time duration of interpreter support and patient experiences of (1) clinician-patient communication, and (2) interpreter support, controlling for patient and encounter characteristics.</p><p><strong>Results: </strong>The average encounter duration was 47.7 min (standard deviation, SD = 25.1), the average auxiliary time was 43.8 min (SD = 16.4), and the average total interpreter time was 91.1 min (SD = 28.6). LEP patients reported better experiences of interpreter support with a mean score of 97.4 out of 100 (SD = 6.99) compared to clinician-patient communication, with a mean score of 93.7 out of 100 (SD = 14.1). In adjusted analyses, total patient time spent with an interpreter was associated with better patient experiences of clinician-patient communication (β = 7.23, <i>P</i> < .01) when auxiliary time spent by interpreters supporting patients before and after the encounter was considered, but not when only the encounter time was considered.</p><p><strong>Conclusions: </strong>Longer duration of time spent with an interpreter was associated with better clinician-patient communication for patients with LEP when time spent with an interpreter before and after the clinician encounter is considered. Policymakers should consider reimbursing health care organizations for time interpreters spend providing patient navigation and other support beyond clinical encounters.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11265237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/21501319241245275
Jin E Kim-Mozeleski, Madeline C Castele, Pooja Nambiar, Kevin M Chagin, Stephanie Pike Moore, Patricia Hardy, Karen Cook, Ashwini R Sehgal
Many low-income adults who smoke also have unmet social needs, such as food insecurity, which can serve as a barrier to smoking cessation. We developed a novel intervention to jointly address smoking cessation and food insecurity and assessed its feasibility, acceptability, and preliminary outcomes. We enrolled participants who screened for food insecurity, reported smoking daily, and were ready to quit. All participants received 3 months of resources navigation from a community health worker through monthly telephone calls for referrals and check-ins for smoking cessation and food access resources. Participants randomized to the intervention group received an economic intervention equivalent to the cost of 1 week of groceries/month for 3 months. We randomized 55 participants who were smoking on average 13 cigarettes/day. The trial was feasible and acceptable based on 3-month retention rates (80%) and end-of-study qualitative feedback (91% would recommend the study to others). At 3 months, participants in the intervention versus control group reported a longer length of abstinence from smoking and had a higher proportion of serious quit attempts. Results from this pilot study suggest the importance of attending to social needs, particularly food insecurity, as a strategy to promote smoking cessation among low-income adults who smoke.
{"title":"A Randomized Trial to Address Food Insecurity and Promote Smoking Cessation Among Low-Income Adults.","authors":"Jin E Kim-Mozeleski, Madeline C Castele, Pooja Nambiar, Kevin M Chagin, Stephanie Pike Moore, Patricia Hardy, Karen Cook, Ashwini R Sehgal","doi":"10.1177/21501319241245275","DOIUrl":"https://doi.org/10.1177/21501319241245275","url":null,"abstract":"<p><p>Many low-income adults who smoke also have unmet social needs, such as food insecurity, which can serve as a barrier to smoking cessation. We developed a novel intervention to jointly address smoking cessation and food insecurity and assessed its feasibility, acceptability, and preliminary outcomes. We enrolled participants who screened for food insecurity, reported smoking daily, and were ready to quit. All participants received 3 months of resources navigation from a community health worker through monthly telephone calls for referrals and check-ins for smoking cessation and food access resources. Participants randomized to the intervention group received an economic intervention equivalent to the cost of 1 week of groceries/month for 3 months. We randomized 55 participants who were smoking on average 13 cigarettes/day. The trial was feasible and acceptable based on 3-month retention rates (80%) and end-of-study qualitative feedback (91% would recommend the study to others). At 3 months, participants in the intervention versus control group reported a longer length of abstinence from smoking and had a higher proportion of serious quit attempts. Results from this pilot study suggest the importance of attending to social needs, particularly food insecurity, as a strategy to promote smoking cessation among low-income adults who smoke.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Health emergency outbreaks such as the COVID-19 pandemic make it challenging for healthcare systems to ration medical resources and patient care. Such disastrous events have been increasing over the past years and are becoming inevitable, necessitating the need for healthcare to be well-prepared and resilient to unpredictable rises in demand. Quantitative and qualitative based decision support systems increase the effectiveness of planning, alleviating uncertainties associated with the crisis. This study aims to understand how the COVID-19 pandemic has affected the performance of healthcare systems in different areas and to address the associated disruption. A cross-sectional online survey was conducted in the Kingdom of Saudi Arabia and the United Arab Emirates among healthcare workers who worked during the pandemic. The pandemic-related disruption and its psychometric properties were assessed using Structural Equations Modeling (SEM) with 5 latent factors: Staff Mental Health, Communication Level, Planning and Readiness, Healthcare Supply Chain, and Telehealth. Responses from highly qualified participants with many years of experience in hospital settings were collected and analyzed. Results show that the model satisfactorily fits the data with a CLI of 0.91 and TLI of 0.88. The model indicates that enhancing supply chain management, planning, telehealth usage, and communication level across the healthcare system can mitigate the disruption. However, the lack of mental health management for healthcare workers can significantly disrupt the quality of delivered care. Staff mental health and healthcare supply chain, respectively, are the highest contributors to varying degrees of disruption in healthcare delivery. This study provides a direction for more research focusing on determinants of healthcare efficiency. It also provides decision-makers insights into the main factors leading to disruptions in healthcare systems, allowing them to shape their outbreak response and better prepare for future health emergencies.
{"title":"Assessing the Disruption Impact on Healthcare Delivery.","authors":"Maymunah Fatani, Abdulrahim Shamayleh, Hussam Alshraideh","doi":"10.1177/21501319241260351","DOIUrl":"10.1177/21501319241260351","url":null,"abstract":"<p><p>Health emergency outbreaks such as the COVID-19 pandemic make it challenging for healthcare systems to ration medical resources and patient care. Such disastrous events have been increasing over the past years and are becoming inevitable, necessitating the need for healthcare to be well-prepared and resilient to unpredictable rises in demand. Quantitative and qualitative based decision support systems increase the effectiveness of planning, alleviating uncertainties associated with the crisis. This study aims to understand how the COVID-19 pandemic has affected the performance of healthcare systems in different areas and to address the associated disruption. A cross-sectional online survey was conducted in the Kingdom of Saudi Arabia and the United Arab Emirates among healthcare workers who worked during the pandemic. The pandemic-related disruption and its psychometric properties were assessed using Structural Equations Modeling (SEM) with 5 latent factors: Staff Mental Health, Communication Level, Planning and Readiness, Healthcare Supply Chain, and Telehealth. Responses from highly qualified participants with many years of experience in hospital settings were collected and analyzed. Results show that the model satisfactorily fits the data with a CLI of 0.91 and TLI of 0.88. The model indicates that enhancing supply chain management, planning, telehealth usage, and communication level across the healthcare system can mitigate the disruption. However, the lack of mental health management for healthcare workers can significantly disrupt the quality of delivered care. Staff mental health and healthcare supply chain, respectively, are the highest contributors to varying degrees of disruption in healthcare delivery. This study provides a direction for more research focusing on determinants of healthcare efficiency. It also provides decision-makers insights into the main factors leading to disruptions in healthcare systems, allowing them to shape their outbreak response and better prepare for future health emergencies.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11193933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/21501319241259905
Anjay Rastogi, Ashté Collins, Ellie Kelepouris, Wayne Kotzker, John P Middleton, Minesh Rajpal, Prabir Roy-Chaudhury, Glenn M Chertow
Introduction: There remains an unmet need to reduce kidney and cardiovascular risk in patients with chronic kidney disease (CKD). This report is therefore intended to provide real-world clinical guidance to primary care providers on sodium-glucose co-transporter-2 (SGLT2) inhibitor use in patients with CKD, focusing on practical considerations. Initially developed as glucose-lowering drugs, SGLT2 inhibitors preserve kidney function and reduce risks of cardiovascular events and mortality. Clinical benefits of SGLT2 inhibitors in CKD have been demonstrated in multiple clinical trials, yet utilization in practice remains relatively low, likely due to the complexity of labeled indications (past and present) and misconceptions about SGLT2 inhibitors as a class.
Methods: A panel of 8 US-based nephrologists convened in August 2022 to develop consensus guidance for the primary care community surrounding risk assessment as well as initiation and implementation of SGLT2 inhibitors in patients with CKD. Here, we provide an adapted version of the Kidney Disease: Improving Global Outcomes (KDIGO) heatmap and a treatment-decision algorithm.
Conclusions: We advocate SGLT2 inhibitors as co-first-line therapy with renin-angiotensin-aldosterone system (RAAS) inhibitors, where RAAS inhibitor dose titration need not be completed before initiation of an SGLT2 inhibitor. In fact, SGLT2 inhibitor therapy may facilitate up-titration or maintenance of optimal RAAS inhibitor dosing. We describe potential strategies to aid implementation of an SGLT2 inhibitor in clinical practice, including improving education and awareness among care providers and patients and dispelling misconceptions about the safety of SGLT2 inhibitors. In summary, we support the use of SGLT2 inhibitors with RAAS inhibitors as co-first-line therapy in most patients with CKD.
{"title":"Practical Considerations and Implementation of Sodium-Glucose Co-Transporter-2 Inhibitors in Chronic Kidney Disease: Who, When, and How? A Position Statement by Nephrologists.","authors":"Anjay Rastogi, Ashté Collins, Ellie Kelepouris, Wayne Kotzker, John P Middleton, Minesh Rajpal, Prabir Roy-Chaudhury, Glenn M Chertow","doi":"10.1177/21501319241259905","DOIUrl":"10.1177/21501319241259905","url":null,"abstract":"<p><strong>Introduction: </strong>There remains an unmet need to reduce kidney and cardiovascular risk in patients with chronic kidney disease (CKD). This report is therefore intended to provide real-world clinical guidance to primary care providers on sodium-glucose co-transporter-2 (SGLT2) inhibitor use in patients with CKD, focusing on practical considerations. Initially developed as glucose-lowering drugs, SGLT2 inhibitors preserve kidney function and reduce risks of cardiovascular events and mortality. Clinical benefits of SGLT2 inhibitors in CKD have been demonstrated in multiple clinical trials, yet utilization in practice remains relatively low, likely due to the complexity of labeled indications (past and present) and misconceptions about SGLT2 inhibitors as a class.</p><p><strong>Methods: </strong>A panel of 8 US-based nephrologists convened in August 2022 to develop consensus guidance for the primary care community surrounding risk assessment as well as initiation and implementation of SGLT2 inhibitors in patients with CKD. Here, we provide an adapted version of the Kidney Disease: Improving Global Outcomes (KDIGO) heatmap and a treatment-decision algorithm.</p><p><strong>Conclusions: </strong>We advocate SGLT2 inhibitors as co-first-line therapy with renin-angiotensin-aldosterone system (RAAS) inhibitors, where RAAS inhibitor dose titration need not be completed before initiation of an SGLT2 inhibitor. In fact, SGLT2 inhibitor therapy may facilitate up-titration or maintenance of optimal RAAS inhibitor dosing. We describe potential strategies to aid implementation of an SGLT2 inhibitor in clinical practice, including improving education and awareness among care providers and patients and dispelling misconceptions about the safety of SGLT2 inhibitors. In summary, we support the use of SGLT2 inhibitors with RAAS inhibitors as co-first-line therapy in most patients with CKD.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11327967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/21501319241235594
Manasseh B Wireko, Jacobus Hendricks, Kweku Bedu-Addo, Marlise Van Staden, Emmanuel A Ntim, John A Larbi, Isaac K Owusu
Background: The effect of hypertension is aggravated by lifestyle factors such as alcohol consumption. This study sought to determine the association between alcohol consumption and the level of blood pressures among HIV seronegative and seropositive cohorts.
Methods: This secondary analysis was performed on a cross-sectional survey data of 17 922 participants during the period between 2018 and 2020. A questionnaire was used to obtain participants' alcohol consumption history, which was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy alcohol consumers. A linear regression model was used to establish relationships among participants with raised blood pressure (BP ≥ 140/90 mmHg).
Results: Out of the total participants, 3553 (19.82%) were hypertensives. Almost 13% of the hypertensives (n = 458; 12.89%) were undiagnosed, and 12.44 % (442) had uncontrolled hypertension. About 14.52% of the hypertensives (3553) were not on any antihypertensive medication. Male non-consumers of alcohol had the highest systolic and diastolic BP; uncontrolled systolic BP (165.53 ± 20.87 mmHg), uncontrolled diastolic BP (102.28 ± 19.21mmHg). Adjusted for covariates, moderate alcohol consumption was associated with HTN among participants who were HIV seropositive [unadjusted (RR = 1.772, P = .006, 95% CI (1.178-2.665)], [RR = 1.772, P = .005, 95% CI (1.187-2.64)]. [unadjusted RR = 1.876, P = .036, 95% CI (1.043-3.378)], adjusted RR = 1.876, P = .041, 95% CI (1.024-3.437). Both moderate and heavy alcohol consumption were significantly related to hypertension among HIV sero-negative [unadjusted model, moderate consumption RR = 1.534 P = .003, 95% CI (1.152-2.044)], [adjusted model, moderate alcohol consumption RR = 1.535, P = .006, 95% CI (1.132-2.080)], [unadjusted model, heavy alcohol consumption, RR = 2.480, P = .030, 95% CI (1.091-5.638)], [adjusted model RR = 2.480, P = .034, 95% CI (1.072-5.738)].
Conclusion: Alcohol consumption is significantly related to increase BP regardless of HIV infection.
背景:饮酒等生活方式因素会加重高血压的影响。本研究旨在确定 HIV 血清阴性和血清阳性人群中饮酒与血压水平之间的关联:这项二次分析是对 2018 年至 2020 年期间 17 922 名参与者的横断面调查数据进行的。调查问卷用于获取参与者的饮酒史,并将其分为非饮酒者、非重度饮酒者和重度饮酒者。采用线性回归模型确定参与者与血压升高(血压≥ 140/90 mmHg)之间的关系:在所有参与者中,有 3553 人(19.82%)是高血压患者。近 13% 的高血压患者(n = 458;12.89%)未经诊断,12.44%(442 人)的高血压未得到控制。约 14.52% 的高血压患者(3553 人)没有服用任何降压药物。不饮酒的男性收缩压和舒张压最高;未控制的收缩压为(165.53 ± 20.87 mmHg),未控制的舒张压为(102.28 ± 19.21 mmHg)。经协变量调整后,在艾滋病毒血清反应呈阳性的参与者中,中度饮酒与高血压相关[未经调整(RR = 1.772,P = .006,95% CI (1.178-2.665)],[RR = 1.772,P = .005,95% CI (1.187-2.64)]。[未调整 RR = 1.876,P = .036,95% CI (1.043-3.378)],调整 RR = 1.876,P = .041,95% CI (1.024-3.437)。在艾滋病毒血清阴性者中,中度和重度饮酒均与高血压明显相关[未调整模型,中度饮酒 RR = 1.534,P = .003,95% CI (1.152-2.044)],[调整模型,中度饮酒 RR = 1.535,P = .006,95% CI (1.132-2.080)],[未调整模型,大量饮酒,RR = 2.480,P = .030,95% CI (1.091-5.638)],[调整模型 RR = 2.480,P = .034,95% CI (1.072-5.738)]:结论:无论是否感染艾滋病毒,饮酒都与血压升高密切相关。
{"title":"Association Between Alcohol Consumption and Blood Pressure Levels Among HIV Sero-Positive and Sero-Negative Cohorts: A Secondary Analysis of the Vukuzazzi Study.","authors":"Manasseh B Wireko, Jacobus Hendricks, Kweku Bedu-Addo, Marlise Van Staden, Emmanuel A Ntim, John A Larbi, Isaac K Owusu","doi":"10.1177/21501319241235594","DOIUrl":"10.1177/21501319241235594","url":null,"abstract":"<p><strong>Background: </strong>The effect of hypertension is aggravated by lifestyle factors such as alcohol consumption. This study sought to determine the association between alcohol consumption and the level of blood pressures among HIV seronegative and seropositive cohorts.</p><p><strong>Methods: </strong>This secondary analysis was performed on a cross-sectional survey data of 17 922 participants during the period between 2018 and 2020. A questionnaire was used to obtain participants' alcohol consumption history, which was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy alcohol consumers. A linear regression model was used to establish relationships among participants with raised blood pressure (BP ≥ 140/90 mmHg).</p><p><strong>Results: </strong>Out of the total participants, 3553 (19.82%) were hypertensives. Almost 13% of the hypertensives (n = 458; 12.89%) were undiagnosed, and 12.44 % (442) had uncontrolled hypertension. About 14.52% of the hypertensives (3553) were not on any antihypertensive medication. Male non-consumers of alcohol had the highest systolic and diastolic BP; uncontrolled systolic BP (165.53 ± 20.87 mmHg), uncontrolled diastolic BP (102.28 ± 19.21mmHg). Adjusted for covariates, moderate alcohol consumption was associated with HTN among participants who were HIV seropositive [unadjusted (RR = 1.772, <i>P</i> = .006, 95% CI (1.178-2.665)], [RR = 1.772, <i>P</i> = .005, 95% CI (1.187-2.64)]. [unadjusted RR = 1.876, <i>P</i> = .036, 95% CI (1.043-3.378)], adjusted RR = 1.876, <i>P</i> = .041, 95% CI (1.024-3.437). Both moderate and heavy alcohol consumption were significantly related to hypertension among HIV sero-negative [unadjusted model, moderate consumption RR = 1.534 <i>P</i> = .003, 95% CI (1.152-2.044)], [adjusted model, moderate alcohol consumption RR = 1.535, <i>P</i> = .006, 95% CI (1.132-2.080)], [unadjusted model, heavy alcohol consumption, RR = 2.480, <i>P</i> = .030, 95% CI (1.091-5.638)], [adjusted model RR = 2.480, <i>P</i> = .034, 95% CI (1.072-5.738)].</p><p><strong>Conclusion: </strong>Alcohol consumption is significantly related to increase BP regardless of HIV infection.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10938620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: To determine the prevalence and contributing factors of depression and suicidal ideations among stroke survivors in Nigeria.
Methods: This was a cross-sectional study comprising 75 consenting stroke survivors who were purposively recruited from 2 tertiary hospitals. Suicidal ideations and depression were measured using standard questionnaires. Obtained data was analyzed with appropriate statistical tools.
Results: 9.3% of the participants had depression while 4% reported suicidal ideations. Significant correlation existed between suicidal ideations and depression (ρ = .31, P = .01), and levels of depression and suicidal ideations (χ2 = 85.76; P < .01). Depression had a significant relationship with gender and marital status, while suicidal ideations had a significant relationship with marital status. Females were significantly more depressed than their male counterparts (U = 512.50, P = .04) and also had a higher score on suicidal ideations. The widowed/divorced recorded the highest scores on depression (χ2 = 8.77, P = .01) and suicidal ideations (χ2 = 6.62; P = .04).
Conclusion: A worrisome prevalence of depression was reported among the study participants. The level of suicidal ideations was quite low. Depression and suicidal ideations were higher among females and those who lost their life partners (either by divorce or death).
{"title":"Post-Stroke Depression and Suicidal Ideations: Relationship with Gender and Marital Status: A Cross Sectional Study.","authors":"Mgbeojedo Ukamaka Gloria, Osiri Emmanuel Jonah, Akosile Christopher Olusanjo, Okoye Emmanuel Chiebuka, John Jeneviv Nene, Akobundu Uzoamaka Nwakego, Anyaene Chiamaka Chinyere","doi":"10.1177/21501319241233172","DOIUrl":"10.1177/21501319241233172","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the prevalence and contributing factors of depression and suicidal ideations among stroke survivors in Nigeria.</p><p><strong>Methods: </strong>This was a cross-sectional study comprising 75 consenting stroke survivors who were purposively recruited from 2 tertiary hospitals. Suicidal ideations and depression were measured using standard questionnaires. Obtained data was analyzed with appropriate statistical tools.</p><p><strong>Results: </strong>9.3% of the participants had depression while 4% reported suicidal ideations. Significant correlation existed between suicidal ideations and depression (ρ = .31, <i>P</i> = .01), and levels of depression and suicidal ideations (χ<sup>2</sup> = 85.76; <i>P</i> < .01). Depression had a significant relationship with gender and marital status, while suicidal ideations had a significant relationship with marital status. Females were significantly more depressed than their male counterparts (<i>U</i> = 512.50, <i>P</i> = .04) and also had a higher score on suicidal ideations. The widowed/divorced recorded the highest scores on depression (χ<sup>2</sup> = 8.77, <i>P</i> = .01) and suicidal ideations (χ<sup>2</sup> = 6.62; <i>P</i> = .04).</p><p><strong>Conclusion: </strong>A worrisome prevalence of depression was reported among the study participants. The level of suicidal ideations was quite low. Depression and suicidal ideations were higher among females and those who lost their life partners (either by divorce or death).</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10878211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1177/21501319241246359
Sarah Alexandra Marshall, Lachan E Siebenmorgen, Katherine Youngen, Tyrone Borders, Nickolas Zaller
Background: The COVID-19 pandemic catalyzed a rapid shift in healthcare delivery towards telehealth services, impacting patient care, including opioid use disorder (OUD) treatment. Regulatory changes eliminated the in-person evaluation requirement for buprenorphine treatment, encouraging adoption of telehealth. This study focused on understanding experiences of primary care providers in predominantly rural areas who used telehealth for OUD treatment during the pandemic.
Methods: Semi-structured interviews were conducted with 22 primary care providers. Participants practiced in 13 rural and 9 urban counties in Kentucky and Arkansas. Data were analyzed using conventional content analysis.
Results: The pandemic significantly impacted healthcare delivery. While telehealth was integrated for behavioral health counseling, in-person visits remained crucial, especially for urine drug screenings. Telehealth experiences varied, with some facing technology issues, while others found it efficient. Telehealth proved valuable for behavioral health counseling and sustaining relationships with established patients. Patients with OUD faced unique challenges, including housing, internet, transportation, and counseling needs. Stigma surrounding OUD affected clinical relationships. Building strong patient-provider relationships emerged as a central theme, emphasizing the value of face-to-face interactions. Regarding buprenorphine training, most found waiver training helpful but lacked formal education.
Conclusion: This research offers vital guidance for improving OUD treatment services, especially in rural areas during crises like the COVID-19 pandemic. It highlights telehealth's value as a tool while acknowledging its limitations. The study underscores the significance of strong patient-provider relationships, the importance of reducing stigma, and the potential for training programs to elevate quality of care in OUD treatment.
{"title":"Primary Care Providers' Experiences Treating Opioid Use Disorder Using Telehealth in the Height of the COVID-19 Pandemic.","authors":"Sarah Alexandra Marshall, Lachan E Siebenmorgen, Katherine Youngen, Tyrone Borders, Nickolas Zaller","doi":"10.1177/21501319241246359","DOIUrl":"https://doi.org/10.1177/21501319241246359","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic catalyzed a rapid shift in healthcare delivery towards telehealth services, impacting patient care, including opioid use disorder (OUD) treatment. Regulatory changes eliminated the in-person evaluation requirement for buprenorphine treatment, encouraging adoption of telehealth. This study focused on understanding experiences of primary care providers in predominantly rural areas who used telehealth for OUD treatment during the pandemic.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 22 primary care providers. Participants practiced in 13 rural and 9 urban counties in Kentucky and Arkansas. Data were analyzed using conventional content analysis.</p><p><strong>Results: </strong>The pandemic significantly impacted healthcare delivery. While telehealth was integrated for behavioral health counseling, in-person visits remained crucial, especially for urine drug screenings. Telehealth experiences varied, with some facing technology issues, while others found it efficient. Telehealth proved valuable for behavioral health counseling and sustaining relationships with established patients. Patients with OUD faced unique challenges, including housing, internet, transportation, and counseling needs. Stigma surrounding OUD affected clinical relationships. Building strong patient-provider relationships emerged as a central theme, emphasizing the value of face-to-face interactions. Regarding buprenorphine training, most found waiver training helpful but lacked formal education.</p><p><strong>Conclusion: </strong>This research offers vital guidance for improving OUD treatment services, especially in rural areas during crises like the COVID-19 pandemic. It highlights telehealth's value as a tool while acknowledging its limitations. The study underscores the significance of strong patient-provider relationships, the importance of reducing stigma, and the potential for training programs to elevate quality of care in OUD treatment.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11008087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}