Journal of Primary Care and Community Health最新文献

Background: The hypertriglyceridemic-waist phenotype (HTWP), defined by concurrent hypertriglyceridemia and increased waist circumference, is a recognized marker of metabolic and cardiovascular risk. While extensively studied across populations, data on Amerindian communities remain scarce. This study examines HTWP prevalence and its association with type 2 diabetes mellitus in middle-aged and older adults of Amerindian ancestry in rural Ecuador.

Methods: This population-based cross-sectional study was conducted in 3 ethnically homogeneous villages. Participants aged ≥40 years underwent standardized assessments, including structured interviews and fasting blood tests. HTWP was defined using serum triglyceride levels ≥150 mg/dL together with increased waist circumference determined by 2 criteria: Amerindian-specific (men ≥ 89 cm, women ≥83 cm) and NCEP-ATP III (men ≥102 cm, women ≥88 cm). Logistic regression models assessed associations between HTWP and diabetes indicators, adjusting for demographics and cardiovascular risk factors.

Results: Among 1354 participants, HTWP prevalence was 47% by Amerindian-specific, and 30% using NCEP-ATP III criteria. Hypertriglyceridemia was frequent (55%), particularly in men. In multivariate models, HTWP was associated with fasting glucose ≥126 mg/dL under both Amerindian-specific (OR 1.32, 95% CI 1.02-1.71) and NCEP-ATP III (OR 1.50, 95% CI 1.12-2.01) criteria. When HTWP components were separately included in the models, only hypertriglyceridemia remained significantly associated with diabetes risk. No significant association was observed between HTWP and HbA1c levels.

Conclusion: HTWP prevalence is high in this population. Hypertriglyceridemia drives diabetes risk more than waist circumference. Findings underscore the need for ethnicity-specific cardiovascular risk assessments and targeted health interventions for indigenous communities.

Introduction/objective: This study evaluates 4 years of data from the Seattle One Health Clinic (OHC), a novel model for clinical care which integrates human and animal health care services for youth and young adults experiencing homelessness (YPEH) and their pets.

Methods: We analyzed deidentified data from standardized OHC visit forms, electronic medical records, and veterinary records from 2019 to 2022. We assessed the overlaps between human and animal healthcare provided and the impact of environmental stressors on both human and animal patients.

Results: Over 50% of all human clients established healthcare for the first time in 2 years, with 85% attending one or more follow-up appointments with non-emergency healthcare services within 2 years following their initial OHC appointment. All animals received care during their visit. Needs addressed at the human-animal interface included zoonotic infections, animal allergies, and mental/behavioral health. The most common client-pet reported environmental concerns were food insecurity, heat, and cold.

Conclusion: Our results suggest integrated human and animal healthcare is a feasible and acceptable model of care for YPEH to access acute and preventative care at the human-animal-environmental interface. This approach holds promise for increasing health-seeking behaviors, and engagement in preventative, therapeutic, and follow-up care.

Background: Opioid-related overdoses remain a critical concern in Arkansas, where Primary Care Providers (PCPs) play a key role in overdose prevention through naloxone education and prescribing. Academic Detailing (AD) is a promising strategy to improve provider knowledge, confidence, and adoption of naloxone-related practices, yet feasibility in rural primary care remains underexplored.

Aim: To evaluate the feasibility and impact of a brief, continuing education (CE)-accredited AD intervention on naloxone prescribing confidence and behavior among rural PCPs over 2 years.

Methodology: The University of Arkansas for Medical Sciences (UAMS) delivered a 30-minute virtual AD session, "Preventing Opioid Overdose with Naloxone," to 15 PCPs within a large Federally Qualified Health Center network. A matched control group of 15 PCPs was included. Implementation service outcomes (via prescribing) were assessed using repeated measures multivariate analysis of variance (MANOVA). Immediate post-session and 2-year follow-up surveys examined confidence, practice changes, and implementation experiences.

Results: Naloxone prescribing increased in both groups; however, there was no significant group-by-time interaction. All post-session respondents reported increased confidence. At 2 years, 92% indicated the AD session continued to influence their practice. Qualitative feedback identified barriers (stigma, cost, and limited patient update) and facilitators (peer support and institutional policies) shaping prescribing.

Conclusion: This pilot demonstrates the feasibility of delivering AD in rural primary care and provides evidence of early penetration within an FQHC network. While prescribing increases could not be attributed solely to the intervention, AD was associated with sustained improvements in provider knowledge, confidence, and perceived relevance of naloxone prescribing. These findings highlight the limitations of brief educational sessions when implemented without complementary system-level supports, underscoring the need for multilevel approaches to expand naloxone access in underserved communities.

Background: Chronic Kidney disease (CKD) accounts for approximately 82 billion dollars of Medicare spend. Implementing culturally competent, community-based programs may be a strategy for changing utilization behaviors and lowering cost while maintaining quality in this population.

Methods: A longitudinal claims based study was carried out from April 2023 to August 2024 in the state of CA to assess the impact of the program on cost, utilization, and quality metrics. A propensity matched approach was leveraged yielding of 203 pairs of CKD Medicare Advantage (MA) enrollees. A comparison of the difference of differences was performed between utilization, and available claims-based quality metrics.

Results: Enrollees in the peer support program, Connect For Life (CFL) generated significantly lower costs of $461 pmpm (95% CI = -1037 to -10 037; P = .016) significantly lower inpatient utilization of 172 per 1000 (95% CI = -10 to -330; P = .037) and significantly higher outpatient utilization of 1212 per 1000 (95% CI = 90 to 2340; P = .035). No differences were found in available quality metrics.

Conclusions: For CKD MA enrollees in the intervention population, more efficient utilization patterns and lower costs while maintaining quality were observed. The tight propensity match left the study underpowered to detect significant changes for other care settings or individual stages of CKD.

Background: Burnout among Community Health Center (CHC) providers has worsened post-COVID-19, exacerbated by understaffing and heightened recruitment challenges due to competition from higher-paying hospitals and private practices.

Objective: This exploratory qualitative study investigates strategies used by four leading CHCs to address perceived drivers of burnout among their providers.

Methods: The study used qualitative interviews with CHC staff to explore approaches to mitigating burnout. Focus was placed on organizational strategies, staff engagement, and operational changes aimed at enhancing provider wellbeing.

Results: Key challenges included low funding and rapid growth, leading to staffing shortages and strained relationships between staff and leadership. Common strategies to combat burnout involved: (1) emphasizing the CHC mission of supporting staff wellbeing, (2) creating onboarding and workforce development programs focused on support, (3) implementing operational changes to reduce workloads and maximize patient care time, (4) fostering staff involvement in decision-making, and (5) using wellness surveys with the expectation of visible changes based on feedback.

Conclusion: The study found that employee voice is crucial in addressing burnout, contrasting with wellness approaches that focus solely on individual staff members. Involving staff in decision-making and addressing systemic issues are viewed by participants as essential strategies for mitigating burnout in CHCs.

Introduction: During catastrophes, physicians face significant stress and emotional challenges. This review explored existing evidence about the challenges family physicians face during infectious catastrophes, and their perceived well-being needs.

Materials and methods: We conducted a mixed studies literature review using 2 databases, Ovid MEDLINE ALL (1946 to February 2023) and PsycInfo on Ovid (1806 to February 2023). To assess methodological quality, we used Mixed Methods Appraisal Tool. The extracted data were analyzed employing a data-based convergent mixed methods design.

Results: Thirty-four (34) studies met the criteria for data extraction. Line-by-line coding for thematic analysis was applied to Result and Discussion sections of included articles. Findings were categorized into 4 levels: Societal, Institutional, Organizational, and Individual. Seven themes were identified in total.

Discussion: Public health authorities should focus on systemic changes, including organizational development to improve coordination within and across organizations. Clinician involvement in decision-making, clear communication, mental health support, and adequate resources are crucial. Policy implications underscore the necessity for healthcare policies prioritizing physician well-being, and organizational support during infectious catastrophes. Improving work conditions extends beyond personal protective equipment (PPE) access, requiring swift betterment of service innovations, with ongoing reassessment for sustainable care planning, financing, and delivery beyond emergencies.

Introduction/objectives: Individually rare, rare diseases are collectively common resulting in frequent health system use. Navigating the health system persists as a challenge. Primary care provides longitudinal contact with the health system and is placed to provide integrated rare-disease-care.

Methods: This scoping review used Joanna Briggs Institute and PRISMA methods with a Consolidated Framework for Implementation Research based data extraction tool to find how integrated rare-disease-care is delivered, enablers and barriers to the same, in primary care settings in contemporary literature in OECD countries.

Results: The Primary Care Provider (PCP) role varies from routine primary care to shared-rare-disease-care models. In the 26 papers, the most frequently cited PCP roles included involvement in diagnosis (n = 14), care coordination (n = 16), primary and preventative care (n = 18), management of components of rare-disease-care (n = 13), and treatment monitoring (n = 10). Individuals whose PCP was actively involved in their care were reported to have shortened diagnostic delay, improved transitions of care across the lifespan, reduced unplanned utilization of emergency and hospital services, comprehensive psychosocial care, improved quality of life across environments including home, school and work and improved palliative care experiences.

Conclusions: Sufficient communication from specialists, information, resources, time and reimbursement for complex care are still needed. Future integrated-rare-disease-care models should be developed by, or with, PCPs.

Introduction/objectives: Patients returning to the community from incarceration (ie, reentry) are at heightened risk of experiencing trauma when interacting with the healthcare system. Healthcare professionals may not recognize patients' trauma reactions or know how to effectively respond. This paper describes the development and pilot evaluation of a single-session training to prepare primary care teams to deliver trauma-informed care (TIC) to patients experiencing reentry.

Methods: A multidisciplinary team including community members with lived experience engaged in a multiphase human-centered design process that incorporated interviews, discussions, and a participatory process to design and evaluate a single-session interactive pilot training targeting providers' attitudes toward formerly incarcerated patients and confidence to deliver TIC.

Results: Both pre- and post-training surveys were completed by 12 TIC training attendees, which included primary care providers and staff. Trainees reported significant increases in confidence to reduce potentially re-traumatizing practices and improved attitudes toward formerly incarcerated individuals. They also expressed interest in receiving additional TIC training and learning how best to care for and meet the needs of persons with a history of incarceration. Trainees described the panel of community members with lived experience as one of the most rewarding aspects of the training.

Conclusion: Centering people with lived experience in the training design and delivery produced a single-session TIC training that was both well-received and effective. Our TIC training helped primary care providers and staff move from being merely informed on trauma to having the self-efficacy to prevent and respond to trauma reactions during encounters with all patients, particularly those with a history of incarceration.

Background: Readmission can be be related to the work of several stakeholders involved in the care of individuals throughout the community, including, for example, primary care and social care providers. A narrative review was performed to assess definitions and frequency of readmission for older adults found in previous research. In addition, a dataset for a cohort of older adults in Stockholm, Sweden, was used to quantify how different definitions of readmission affect frequency.

Materials and methods: The review was based on pre-specified search criteria within PubMed and Embase databases. All studies based on a cohort of older adults with a primary objective to assess readmission to inpatient care, were included for the assessment of readmission criteria. The dataset was based on a cohort of older adults treated at a geriatric department in Stockholm during 2016. Estimations of readmission were performed with the most common criteria found in the narrative review.

Results: The narrative review showed that definitions of readmission included predominantly time-based criteria, either alone or combined with additional criteria such as medical condition or readmitting department. Frequency of readmission based on different definitions varied substantially; a 14-day time interval implied a rate of 8.0% whilst a 30-day interval-more commonly used-rendered a rate of 12.6%. The density of readmissions per day was higher during the first weeks after discharge, and then dropped continuously.

Conclusion: Transparency on definitions is imperative in studies that include rates of readmission. The levels of readmission rates are highly dependent on the study population and its context. Furthermore, the actual value of readmission monitoring is dependent on what purpose it is supposed to fulfill, and it is essential to put it into context of all relevant stakeholders including, for example, the primary care providers and different social care providers throughout the community.