Journal of Primary Care and Community Health最新文献

In response to persistently low enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) across Tennessee, the WIC Champions group conducted a statewide survey to evaluate healthcare providers' practices and barriers in screening for food insecurity and referring patients to WIC. The survey, conducted from November 2023 to February 2024, included 70 diverse healthcare professionals across 28 Tennessee counties. Findings revealed that 88% of providers screen for food insecurity and 95% believe it is vital to patient health. However, only 67% felt familiar with local resources for referrals, and significant barriers including limited staff, time, and resource availability were reported. Despite 90% of respondents being familiar with WIC, only 39% made direct referrals, with many relying on less structured methods such as verbal encouragement or providing contact information. Surveyed providers identified the need for improved outreach materials, better integration with electronic health records, and dedicated referral staff. The findings highlight the critical role of healthcare settings in addressing food insecurity but underscore systemic barriers that impede effective WIC referrals. Enhanced support, training, and infrastructure are necessary to empower providers and expand WIC access, aligning with key national strategies to combat hunger and improve public health outcomes.

Maternal mortality in the U.S. remains a pressing public health issue, with African American and Indigenous populations experiencing significantly higher rates. In Arizona, maternal mortality reached 30.0 deaths per 100,000 births in 2023, well above the national average. To address persistent maternal and child health (MCH) inequities, the Arizona Department of Health Services, in collaboration with a university and other strategic partners, conducted the 2025 Arizona Statewide Title V Maternal and Child Health Needs Assessment using community-engaged research (CeNR) approaches. Qualitative methods, including the River of Life (ROL) and Community Forums (CF), were employed to elevate diverse community voices, particularly from underserved rural, border, and minoritized populations. Key priorities identified included improving access to mental health care, addressing childcare shortages, expanding transportation and healthcare access, and strengthening culturally and linguistically appropriate services. The ROL approach revealed 8 social drivers of health, while CFs highlighted actionable solutions rooted in lived experience. Findings underscore the need for upstream policy investments and community-informed strategies to reduce maternal health disparities and improve statewide MCH outcomes. This participatory process demonstrates the value of engaging historically marginalized communities in shaping programs and policies that directly impact their health and well-being.

Introduction/objectives: The purpose of this descriptive study was to strengthen understanding of the human-animal bond and the impact of One Health Clinics (OHCs) on the communities they serve. We aimed to assess how joint access to veterinary care and human health services enables community members to engage with healthcare for themselves.

Methods: Individuals attending 2 OHCs in the United States were surveyed to gain insight into reasons for attending OHCs, attitudes on the human-animal bond, healthcare access and utilization, and pet owner satisfaction and trust toward medical and veterinary professionals. Both clinics operated in areas with limited medical and veterinary healthcare access, but varied in clinic structure and availability of human healthcare volunteers.

Results: A total of 175 surveys were analyzed. Most participants attended primarily for veterinary services (Clinic A: 91%, Clinic B: 75%). However, a significantly higher proportion of Clinic B participants received health screenings (91% vs 32%, P < .0001), learned new health information (48% vs 31%, P = .0129), and were provided with follow-up health resources (84% vs 51%, P = .000007). Across both sites, the majority expressed high trust in medical and veterinary providers (Clinic A: 84%-95%, Clinic B: 90%-98%) and reported high satisfaction with the care received. Most participants considered their pets vital family members (Clinic A: 81%, Clinic B: 93%), and many credited their pets with supporting physical activity and reducing feelings of depression and loneliness. Importantly, a majority of respondents at both clinics indicated they were more likely to seek healthcare for themselves if veterinary services were also available (Clinic A: 56%, Clinic B: 72%).

Conclusions: These findings suggest that OHCs have the potential to enhance access to human healthcare in underserved communities by utilizing veterinary services as a point of engagement. Participants reported a strong bond with their pet. Based on reported levels of trust and satisfaction, the OHC model may help strengthen relationships between underserved communities and human healthcare and veterinary professionals.

Poor dietary habits are a major contributor to chronic disease burden, yet nutrition counseling remains underutilized in primary care settings despite proven effectiveness. This article presents a novel adaptation of the 5 A's framework (Assess, Advise, Agree, Assist, Arrange) titled 'The 5 A's Approach to Promoting Nutrition Counseling in Primary Care', by incorporating validated assessment tools and evidence-based strategies to support implementation in clinical settings. To address practical challenges, implementation approaches are proposed including alternative delivery and payment models. The 5 A's adaptation can be a tool used to address the critical need for standardized nutrition counseling in primary care.

Background: Type 2 Diabetes Mellitus (T2DM) presents a significant public health challenge, particularly in developing countries, where healthcare resources are limited. Community-Based Interventions (CBIs) have been explored as a strategy to improve glycemic control, yet evidence regarding their efficacy in reducing HbA1c levels in these settings remains limited.

Aim: This study aimed to evaluate the efficacy of community-based interventions in improving HbA1c levels among patients with T2DM in developing countries.

Methods: A systematic review and meta-analysis were performed following PRISMA guidelines. A comprehensive literature search was conducted in PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Ovid-Medline, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for full-text randomized controlled trials (RCTs) published between 2015 and 2024. Studies conducted in developing countries focusing on community-based interventions targeting HbA1c outcomes were included. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) critical appraisal tools. Statistical analysis employed a random-effects model to calculate the pooled mean difference (MD) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic. Potential publication bias was assessed using Egger's test, the Trim-and-Fill method, and a funnel plot.

Results: Twenty RCTs involving 4914 participants across developing countries were included. CBIs significantly reduced HbA1c levels compared to usual care, with a pooled MD of -0.54 (95% CI = -0.71, -0.36; P < .00001; I² = 92%). Subgroup analysis showed that education-focused interventions (MD = -0.67; 95% CI = -1.02, -0.31) and physical activity-focused interventions (MD = -0.67; 95% CI = -1.14, -0.20) were the most effective. Analysis by income level revealed no significant differences in efficacy between lower-middle-income and upper-middle-income countries (P = .29). The greatest HbA1c reduction was observed during the 0- to 3-month measurement period (MD = -0.56; 95% CI = -0.90, -0.23).

Conclusion: CBIs are an effective strategy for reducing HbA1c levels among patients with T2DM in developing countries, with significant benefits across diverse economic contexts and intervention models. These findings highlight the adaptability and scalability of CBIs, underscoring their potential to enhance diabetes management in resource-limited settings.

Objective: To identify competencies required for effective collaborative working within Primary Care Networks (PCNs).

Methods: An online questionnaire about roles within PCN teams, importance of collaboration and experiences of connection and conflict within teams, was sent to Mental Health Practitioners (MHPs) and PCN/Practice Managers from several teams across Lancashire. Semi-structured interviews with similarly themed questions were conducted with MHPs, General Practitioners (GPs), and PCN/Practice Managers and analysed using reflexive thematic analysis. Questionnaire and interview data were combined, and themes were mapped onto 3 competency constructs (knowledge, skills and abilities, and personal characteristics).

Results: Subthemes that were considered important to effective collaborative working in PCNs included: knowledge around shared goals, expectations, and role clarity; skills in communication and relationship building; embodiment of personal characteristics such as being engaged, accepting, and supportive.

Conclusion: Clinical implications for promoting collaboration between staff working within PCN settings include meetings and joint training between PCN and NHS Trusts to establish network goals and expectations, regular team meetings and opportunities for face-to face activity to promote understanding of different roles and relationship building.

Arkansas faces significant health disparities, including high rates of chronic diseases and limited healthcare access, especially in rural and underserved communities. Community Health Workers (CHWs) serve as essential links between the healthcare system and these communities and address the state's significant health disparities through culturally appropriate care. This article describes the development of CHW programs in Arkansas, including early CHW training initiatives, the formation of the Arkansas Community Health Workers Association (ARCHWA), the state's adoption of standardized CHW training, the establishment of a CHW certification process, including an apprenticeship program and college credit, and the introduction of upskilling opportunities. The article describes both failed and successful legislative efforts. By detailing how collaborative efforts among healthcare organizations, community stakeholders, and public health entities have supported ongoing education, career development, and policy advocacy, this article may provide an example for other states striving to enhance their CHW workforce.

Background: Identifying circulating biomarkers that reflect cerebrovascular health may help clarify underlying mechanisms associated with brain damage. Serum albumin, a multifunctional protein with antioxidant, anti-inflammatory, and endothelial-stabilizing properties, could serve as a marker of cerebral integrity. We examined the association between albumin levels and neuroimaging markers of cerebral small vessel disease (cSVD) in a rural population of older adults.

Methods: We conducted a cross-sectional study among community-dwelling individuals aged ≥ 60 years in rural Ecuador. Participants were invited to undergo brain MRI and laboratory testing as part of the study protocol. Inclusion was based on completion of these procedures and serum albumin levels within the physiological range of 3.0-5.0 g/dL. Logistic regression models were fitted to assess the association between serum albumin and cSVD markers, adjusting for demographics and cardiovascular health metrics .

Results: Among 409 participants (mean age: 66.2 ± 6.1 years; 60% women), moderate-to-severe white matter hyperintensities (WMH) were present in 34% of participants. Serum albumin showed a non-linear inverse association with WMH. Only participants in the highest albumin quartile (4.42-5.0 g/dL) showed significantly lower odds of moderate-to-severe WMH (adjusted OR: 0.48; 95% CI: 0.25-0.93). No significant associations emerged with other cSVD markers.

Conclusion: Higher physiological albumin levels were associated with a lower burden of WMH, consistent with a threshold-dependent protective effect on the cerebral microvasculature. These findings support serum albumin as a candidate biomarker of brain health in aging populations. Albumin may capture systemic processes - such as endothelial integrity and vascular inflammation - that contribute to cSVD. Its accessibility and affordability underscore its potential utility in community-based aging research and population-level screening.

Background: Direct Primary Care (DPC) offers an alternative healthcare delivery model with potential benefits for patient-centered care. However, concerns remain about its equity and accessibility, particularly in urban settings. This study examines the utilization patterns and patient engagement within a DPC clinic in Houston, Texas, and whether subscription duration impacts patient-provider interactions in an urban healthcare environment.

Methods: Deidentified data from a Houston-based DPC clinic (January 2023-January 2024) were analyzed. Patient demographics, subscription details, and interaction data (including in-person appointments and audio-visual calls) were collected. Descriptive statistics summarized utilization patterns, while logistic regression models assessed relationships between demographic factors and DPC utilization.

Results: The sample included 71% Non-Hispanic Black patients, 21% Non-Hispanic White, and 77% females. Most patients resided in urban areas (79%) and paid over $125 monthly (44%). Subscription duration positively correlated with engagement: patients subscribed for ≥21 months had higher yearly averages for chart interactions and appointments compared to those who subscribed for ≤5 months. Regression analysis revealed significant dose-response increases in patient engagement among those with longer subscription durations across all interaction types. No other demographic characteristics were significant predictors of DPC utilization.

Conclusion: Subscription duration strongly influences DPC utilization, suggesting sustained enrollment fosters deeper patient engagement and more frequent provider interactions. While DPC may enhance patient-provider relationships, cost and urban-centric accessibility may pose barriers to equity.