Journal of Primary Care and Community Health最新文献

Background: In addition to the morbidity and mortality associated with acute infection, COVID-19 has been associated with persistent symptoms (>30 days), often referred to as Long COVID (LC). LC symptoms often cluster into phenotypes, resembling conditions such as fibromyalgia, postural orthostatic tachycardiac syndrome (POTS), and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). LC clinics have been established to best address the needs of LC patients and continuity of care. We developed a cross-sectional survey to assess treatment response through our LC Clinic (LCC).

Methods: A 25-question survey (1-10 Likert scale) was expert- and content-validated by LCC clinicians, patients, and patient advocates. The survey assessed LC symptoms and the helpfulness of different interventions, including medications and supplements. A total of 852 LCC patients were asked to complete the survey, with 536 (62.9%) responding.

Results: The mean time from associated COVID-19 infection to survey completion was 23.2 ± 6.4 months. The mean age of responders was 52.3 ± 14.1 (63% females). Self-reported symptoms were all significantly improved (P < .001) from the initial visit to the LCC (baseline) to the time of the follow-up survey. However, only 4.5% (24/536) of patients rated all symptoms low (1-2) at the time of the survey, indicating low levels of full recovery in our cohort. The patients rated numerous interventions as being helpful, including low-dose naltrexone (45/77; 58%), vagal nerve stimulation (18/34; 53%), and fisetin (28/44; 64%).

Conclusions: Patients report general improvements in symptoms following the initial LCC visit, but complete recovery rates remain low at 23.2 ± 6.4 months.

Introduction/objectives: Companion animals (CAs) may benefit human health, but few studies have examined their impact on stroke survivors. This study examines participation, quality of life (QoL), attachment, cognition, and executive function differences between stroke survivors living with and without CAs.

Methods: In this cross-sectional, community-setting study, 25 stroke survivors with a CA and a matched group of 27 without a CA completed standard tools.

Results: Stroke survivors with a CA scored significantly higher in participation and 1 cognitive performance test. No significant differences were found in other cognitive measures or QoL, and attachment to a CA was not correlated with participation or QoL within the research group. However, lower attachment avoidance correlated with better participation in survivors living with dogs.

Conclusion: Living with CAs, especially dogs, might be associated with some cognitive function and participation benefits among stroke survivors. The link between CAs and cognitive function is unclear: Survivors with higher cognitive functioning might be more capable of caring for a CA, or having and caring for a CA might promote better cognitive function. Attachment patterns also might explain stroke survivors' participation levels. Further study is warranted.

Purpose: Few studies have examined the relationship between the intersections of lesbian, gay, and bisexual (LGB) sexual orientation, Latine ethnicity, and lifetime suicide attempts in Latine individuals with substance use disorder. This study examines this intersection and controls for social determinants of health, mental health disorder symptoms, and substance use disorder symptoms in a sample of Latine adults entering treatment for co-occurring disorders.

Method: Bivariate statistics and multivariate logistic regression were used to analyze assessment data (n = 360) from a bilingual/bicultural integrated behavioral health system serving Latine communities in Massachusetts to examine the relationship between sexual orientation, Latine ethnicity, and history of lifetime suicide attempts. We controlled for social determinants of health, mental health disorders, and substance use disorder (SUD) factors significantly associated with lifetime suicide attempts at the bivariate level.

Results: Over 27% of the sample and 35% of Puerto Ricans (PR) reported lifetime suicide attempts. The logistic regression identified that PR clients were 78% more likely to have attempted suicide in a lifetime compared to non-PR clients. Clients identifying as LGB were 3.2 times more likely to report having attempted suicide in their lifetime compared to heterosexual clients. Unemployed clients were 2.4 times more likely to report having attempted suicide in their lifetime compared to employed clients.

Conclusion: Findings identify high rates of lifetime suicide attempts among LGBs and PRs entering SUD treatment. Targeted outreach and treatment efforts designed to address intersectionality for this underserved population are needed.

Introduction: Venous thromboembolism (VTE) is a multifactorial condition and one of the leading causes of mortality and disability. The present study explores the factors associated with hospitalization duration among different types of venous thromboembolism diagnoses, such as deep vein thrombosis (DVT), pulmonary embolism (PE), and other forms of thrombosis.

Methods: The data included participants with VTE admitted to 13 hospitals within pan-India from June 2022 to December 2023 to the i-RegVed registry, where socio-demographic data, clinical history, and various factors associated with hospital length of stay (LOS) were included for analyses. Multilinear regression was performed to explore the factors associated with hospital LOS among VTE conditions such as DVT, PE, forms of thrombosis other than PE and DVT, and all VTE diagnoses.

Results: A total of 633 participants were included in the study, with 55% being males, and 28.9% being homemakers. Longer hospital LOS was significantly associated with age (β = -.09, P < .05), sex (β = 3.21, P < .05), and non-communicable diseases (β = 3.51, P < .05) among participants with DVT and among participants with at least one of the VTE diagnoses, age (β = -.12, P < .001) and anticoagulant use (β = -2.49, P < .05) was significantly associated.

Conclusion: The findings provide insights into the factors influencing hospital outcomes among participants with different types of VTE, highlighting the importance of age and comorbidities in predicting the hospital LOS.

Purpose: Family physicians are increasingly more likely to encounter transgender and gender-diverse (TGD) patients requesting gender-affirming care. Given the significant health inequities faced by the TGD community, this study aimed to assess changes in military-affiliated clinicians' perspectives toward gender-affirming care over time.

Methods: Using a serial cross-sectional survey design of physicians at the 2016 and 2023 Uniformed Services Academy of Family Physicians conferences, we studied participants' perception of, comfort with, and education on gender-affirming care using Fisher's Exact tests and logistic regression.

Results: Response rates were 68% (n = 180) and 69% (n = 386) in 2016 and 2023, respectively. Compared to 2016, clinicians in 2023 were significantly more likely to report receiving relevant education during training, providing care to >1 patient with gender dysphoria, and being able to provide nonjudgmental care. In 2023, 26% reported an unwillingness to prescribe gender-affirming hormones (GAH) to adults due to ethical concerns. In univariable analysis, female-identifying participants were more likely to report willingness to prescribe GAH (OR = 2.6, 95%CI = 1.7-4.1) than male-identifying participants. Willingness to prescribe was also associated with ≥4 h of education (OR = 2.2, 95%CI = 1.1-4.2) compared to those with fewer than 4 h, and those who reported the ability to provide nonjudgmental care compared to those who were neutral (OR = 0.09, 95%CI = 0.04-0.2) or disagreed (OR = 0.11, 95%CI = 0.03-0.39). Female-identifying clinicians were more likely to agree additional training would benefit their practice (OR = 5.3, 95%CI = 3.3-8.5).

Conclusions: Although military-affiliated family physicians endorsed more experience with and willingness to provide nonjudgmental gender-affirming care in 2023 than 2016, profound gaps in patient experience may remain based on the assigned clinician. Additional training opportunities should be available, and clinicians unable to provide gender-affirming care should ensure timely referrals. Future research should explore trends across clinical specialties.

Introduction: Given the increase in youth mental health concerns, the American Academy of Pediatrics (AAP) recommends universal suicide screening for ages 12 and older, with positive screens followed by a brief suicide risk assessment. However, it is unclear how pediatric clinicians incorporate this recommendation into practice. Therefore, the objective of this qualitative study was to identify pediatric clinicians' current practice, attitudes, and barriers to implement the updated universal suicide screening recommendation in primary care.

Methods: Community-based pediatric primary care providers (PCPs) in the St. Louis Metropolitan area who by self-report provide mental health care for patients participated. Participants completed a 30-minute semi-structured interview with invitations extended through an electronic listserv in a local Pediatric PCP Learning Collaborative. Interviews were transcribed and analyzed using consensual deductive and inductive approaches until data saturation.

Results: Eighteen PCPs participated in the interviews. Interviews described themes related to acceptability of the recommendations, PCPs' current screening practices, and perceived barriers for implementing the recommendations. Overall, PCPs agreed with, but expressed hesitancy about, the recommendation. Frequently mentioned barriers to suicide screening included time, training, and inadequate access to resources for follow-up care for at-risk patients. Yet, PCPs were optimistic they could learn with support and were interested in working in this subject area through quality improvement interventions.

Conclusions: PCPs agree with the AAP recommendation about suicide screening but need support to implement into practice. Specifically, PCPs need time sensitive strategies, resources, training, and practice change support to assist these efforts.

We examined healthcare costs at HonorHealth, a community-based academic health center comprised of 5 hospitals and numerous ambulatory care facilities. Patient encounters that resulted in admission in 2019 were included in the study. Mean costs in 2019 for high costs and high needs (HCHN) patients were compared with all remaining patients using a framework developed by the National Academy of Medicine. HCHN patients were older (71 vs 52 years), with a lower percentage of females (41.7% vs 59.8%), more frequently White (90.1% vs 87.5%), less frequently married (52.4% vs 54.5%), with a longer length of stay (6.5 vs 3.0 days) and higher mean charges ($134 743 vs $16 414). The mean cost per patient in the HCHN group decreased by age group ($192, 963, $165 200, $144 584, $134 795, and $108 356) for 0 to 18, 19 to 44, 45 to 64, 65 to 84, and 85+ years, respectively. HCHN patients were more publicly insured (49% vs 38%). Targeted interventions to treat HCHN may lead to lower healthcare costs and improved health outcomes within this system.

Introduction: Patients and clinicians face challenges in participating in video telehealth visits. Patient navigation has been effective in other settings in enhancing patients' engagement with clinical programs. Our objective was to assess whether implementing a telehealth navigator program to support patients and clinicians affected video visit scheduling, video usage, and non-attendance.

Methods: This was a quasi-experimental quality improvement project using difference-in-differences. We included data from 17 adult primary care sites at a large, urban public healthcare system from October 1, 2021 to October 31, 2022. Six sites received telehealth navigators and 11 sites were used as comparators. Navigators contacted patients (by phone) with upcoming video visits to assess and address potential barriers to successful video visit completion. They also provided on-site support to patients and clinicians regarding telehealth visits and usage of an electronic patient portal. The primary outcomes were difference-in-differences for the proportion of telehealth visits scheduled and, separately, completed as video visits and non-attendance for visits scheduled as video visits.

Results: There were 65 488 and 71 504 scheduled telehealth appointments at intervention and non-intervention sites, respectively. The adjusted difference-in-differences for the proportion of telehealth visits scheduled as video was -9.1% [95% confidence interval -26.1%, 8.0%], the proportion of telehealth visits completed as video visits 1.3% [-4.9%, 7.4%], and non-attendance for visits scheduled as video visits -3.7% [-6.0%, -1.4%].

Conclusions: Sites with telehealth navigators had comparatively lower video visit non-attendance but did not have comparatively different video visit scheduling or completion rates. Despite this, navigators' on-the-ground presence can help identify opportunities for improvements in care design.

Objectives: This study aims at exploring the effects of physicians' communication behaviors on patients' satisfaction in primary care medical consultations in Chattogram, Bangladesh. The study used a quantitative research approach designed with a cross-sectional survey.

Methods: Data were collected using post-consultation and facilitator administered questionnaire from the patients who visited the physician for medical consultation in different hospitals and clinics in Chattogram city. Seven hundred patients were included as the study participants. A hierarchical linear regression analysis was performed to examine the factors contributing to the outcome variables.

Results: A statistically significant difference (P < .001) appeared regarding patients' perception of adequate consultation, physicians' nonverbal behavior, inhibiting behavior and patients' participating behavior in private and public settings. However, R² value shows that physicians' patient-centered behaviors appeared as the stronger predictors of patient satisfaction toward medical interviews, followed by socioeconomic variables of patients and physicians and patients' participation during the consultation. Presence of a third person with patients during consultation (β = -.05, P = .040), physicians' private setting of consultation (β = .16, P < .001), physicians' seniority (β = .05, P = .042), patients' participating behavior during consultation (β = .20, P < .001), physicians' nonverbal behavior (β = .10, P < .001), physicians' inhibiting behavior (β = -.39, P < .001), and physicians' facilitating behavior with patients (β = .32, P < .001) were reported as the influencing factors of patients' satisfaction with medical consultation.

Conclusion: This study suggests the profound impact of physicians' patient-centered communication behaviors on patient satisfaction in primary care settings, overshadowing even socioeconomic factors and patient participation.

Background: Telemonitoring for COVID-19 has gained much attention due to its potential in reducing morbidity, healthcare utilization, and costs. However, its benefit with regard to economic outcomes has yet to be clearly demonstrated.

Objective: To analyze the costs associated with the use of the Opal portal to monitor COVID-19 patients during their 14-day confinement in Quebec and compare them to those of non-users of any home telemonitoring technology.

Methods: A cost analysis was conducted through a cross-sectional study between COVID-19 patients who used (PU) the Opal platform during their 14-day confinement at home and those who did not use (PNU) any home remote monitoring technology. Data was collected between June 2021 to April 2022. An individual interview with each participant using an adapted questionnaire was conducted by telephone or online using a teleconferencing platform. A micro-costing approach was undertaken using a dual patient and Quebec's health-care system perspective.

Results: 27 telemonitoring participants, 29 non-users, 8 clinicians, and 4 managers were included. Telemonitoring reduced the average total costs incurred by PU by 82% ($537.3CAD) between PU ($117.2CAD) and PNU ($654.5CAD). Telemonitoring enrollees used healthcare less intensely with fewer emergency room visits (1 PU compared to 6 PNU), which translated to an average savings of $253.3CAD per patient.

Conclusion: This is the first study to demonstrate that telemonitoring through the Opal platform is a viable strategy to reduce healthcare costs and utilization for patients and the healthcare system. The evidence provides strong support for introducing telemonitoring as a component of case management.