Journal of Public Health Management and Practice最新文献

Context: Public health programs promote numerous tickborne disease (TBD) prevention measures. However, measures are not frequently or consistently performed.

Objective: Describe barriers to consistent use of 4 commonly promoted TBD prevention measures.

Design: We conducted an online survey (n = 1883) evaluating behaviors regarding TBD prevention measures including conducting tick checks, applying insect repellents, showering/bathing, and applying chemical or natural pesticides to residential yards. Respondents could select reasons for never, rarely, or sometimes performing these measures. Descriptive analysis and logistic regression modeling evaluated associations between the 3 most cited barriers for each measure and select demographic variables.

Setting: The survey was administered to residents in high Lyme disease incidence counties of Connecticut and Maryland, 2016-2017.

Results: For tick checks (n = 800), the most cited barriers were forgetting (63%), not spending time in tick habitat (28%), and too much trouble (11%). For applying insect repellents (n = 1303), the most cited barriers were forgetting (38%), personal safety concerns (24%), and too much trouble (19%). For showering/bathing 2 hours after outdoor activity in tick habitat (n = 1080), the most cited barriers were being unaware of the prevention measure (51%), too much trouble (18%), and forgetting (18%). For applying chemical pesticides to yards (n = 1320), the most cited barriers were having environmental (45%), pet safety (31%), and personal safety concerns (28%). Lastly, for applying natural pesticides to yards (n = 1357), the most cited barriers were being unaware of natural pesticides (31%), having cost concerns (23%), and not being concerned about ticks on property (16%).

Conclusions: Forgetting, too much trouble, unawareness, and safety concerns were primary barriers to using several TBD prevention measures. Education regarding effectiveness, safety, and timing may increase uptake of certain measures. These challenges can be difficult to address, highlighting the need for passive TBD prevention measures, such as a Lyme disease vaccine.

Objective: To measure the longitudinal effect of opioid restrictions on prescribing patterns at the state and regional levels.

Design: Health policy evaluation using a Poisson regression of opioid metrics from federal repositories to model what the estimated opioid counts are for the next fiscal year.

Setting: State-specific prescribed opioid counts between 2006 and 2018 from CDC reports; population data were obtained from the U.S. Census Bureau for 2006-2018; and opioid prescribing restrictions were extracted from published reports and state regulatory databases.

Intervention: Poisson regression models were fitted to assess the relationship of statewide restrictions on opioid prescribing counts adjusting for states' population.

Main outcome measure: Estimated opioid counts provided by the Poisson regression model.

Results: Per capita rates of prescribed opioids peaked in 2012 at 86.2 per 100 population. Prescribing restrictions are associated with statistically significant decreases in opioid prescribing. Controlling for population and year, we found for every 100 opioid prescriptions in a state without restrictions, only 98 opioid prescriptions are expected for every additional year in a state with restrictions in place.

Conclusions: Contrary to other research conducted over a shorter study period, we found that restrictions do reduce opioid prescribing; however, a statistically significant change in rates may not be detectable in the early years after restrictions are enacted.

Introduction: People with disabilities were left behind in the beginning of the COVID-19 vaccination rollout. More work needs to be done to connect people with disabilities to public health initiatives. Centers for Independent Living (CILs) are an important and under-utilized community partner for health departments and should be engaged as a trusted source when working to reach people with disabilities and improve access to public health programs and services.

Methods: The National Foundation for the Centers for Disease Control and Prevention (CDC Foundation), through funding from the CDC, launched the Leveraging CILs to Increase Vaccine Access for People with Disabilities project. The primary goal was to increase accessibility of the COVID-19 vaccination among people with disabilities through (1) outreach and education, (2) service linkage and barrier removal through increasing accessible, (3) widespread education about the vaccine, and (4) improved partnerships between disability-led organizations and local health care providers.

Outputs: A grant program resulted in 39 awards distributed to CILs across the United States totaling $2 955 294.00 between November 2021 and March 2023. The project successfully resulted in reported improvements in partnerships between funded CILs and local health providers and a reported reduction in barriers to accessing vaccinations faced by people with disabilities. A suite of resources was also created to address targeted needs identified throughout partner implementation. Successful outreach to the targeted population resulted in 27 044 consumers being directly reached by CILs and 3 675 655 people reached through communication and outreach activities.

Discussion: Catalytic funding to disability-led organizations during public health emergency response and including people with disabilities as subject matter experts in program design can successfully strengthen access to care via trust building, message dissemination, and partnership. Building the capacity of community-based and consumer-led partners to implement evidence-based public health programming can provide a foundation for improved care for people with disabilities, particularly during an emergency response.

Context: Drug checking, defined as the use of instruments (e.g. spectrometers), test strips, and other technologies to provide information on drug composition for harm reduction purposes, has emerged as a promising intervention to reduce harms of illicit drugs linked to overdose deaths. While demonstrating potential, these interventions remain limited in reach amid questions of how to reach the full population of people who use drugs and are at risk of overdose, including those outside urban areas. In response to these limitations, Substance, a drug checking project based in Victoria, Canada, developed a Distributed Model of Drug Checking and a concomitant training program.

Program: The Distributed Drug Checking Training program eliminates need for point-of-care spectrometry technicians, instead capacitating harm reduction workers to provide drug checking using software developed by the project, infrared spectrometers, and immunoassay test strips. The training includes 5 hours of group content that can be delivered virtually, and 2 hours of practice time per learner.

Implementation: Training and data collection took place between May 2022 and March 2024 with learners from 6 locations across Vancouver Island, Canada. We offered 13 training sessions, with evaluation data collected from 54 learners.

Evaluation: The training was evaluated across Kirkpatrick's 4 levels of training evaluation. The training was highly acceptable to learners, attributable to intended changes in knowledge and skill related to drug checking, resulted in competence to deliver drug checking through the project's Distributed Model, and facilitated expansion of drug checking services to 6 geographically distant locations.

Discussion: After completing the 7-hour training program, harm reduction workers were able to deliver drug checking without need for on-site drug checking technicians. The short duration of the training and its demonstrated success with the Distributed Model of Drug Checking make this a promising approach for expanding the reach of drug checking services.

Context: In the emergency department (ED) setting, prioritizing triage and patient care may lead to challenges in capturing detailed documentation necessary for specific International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding in medical records. Consequently, the prevalent use of the "unspecified head injury" code poses concerns about the precision of ED-based administrative billing claims data when analyzed for public health surveillance of nonfatal traumatic brain injuries (TBIs). Understanding the perspective of medical coders can illuminate coding processes and opportunities to enhance coding accuracy for TBI and other head injuries in the ED.

Objective: This evaluation explores medical coders' perspectives and challenges when assigning ICD-10-CM codes to head injuries in the ED.

Design: This qualitative evaluation utilized a phenomenological approach, which employed semi-structured interviews to understand medical coders' perspectives, processes, and coding determinations for head injuries in the ED.

Setting: Interviews were conducted using a HIPAA-compliant video-based platform between July 2022 and January 2023.

Participants: Seventeen medical coders with ED coding experience were interviewed. Their backgrounds were diverse, though most had more than 15 years of experience.

Main outcomes: Four qualitative themes emerged, which highlighted challenges with lack of detailed documentation, defaulting to unspecified codes, time, and productivity pressure, and additional insights into coders' assumptions and code determination processes.

Results: Medical coders expressed challenges assigning ICD-10-CM codes to the highest level of specificity, citing issues including insufficient documentation by ED providers and terminology variations. Workplace time constraints and pressure for expedited claims also led to defaulting to unspecified codes.

Conclusions: This evaluation highlights the need for improved documentation consistency and detail in ED records to facilitate accurate ICD-10-CM coding. Alleviating time pressures, improving algorithms, and offering specialized training opportunities to medical coders could be helpful steps to improve coding specificity and data accuracy for head injuries in the ED.

Objective: To examine the association between local health department (LHD) accreditation and COVID-19 community outcomes, including rates of adult vaccination, hospitalization, and death.

Design: We examined county level rates of adult vaccination, hospitalization, and death by LHD accreditation status over the course of the COVID pandemic. Additional independent variables included time period, COVID-19 Community Vulnerability Index (CCVI), state public health governance structure, and state policy environment. We used hierarchal linear mixed modeling with random intercept for county level data to account for repeated observations and fixed effects for all other variables.

Setting: This study examined all communities in the United States of America.

Participants: LHDs and the communities they serve.

Main outcome measures: Rates of adult vaccination, hospitalization, and death due to COVID-19.

Results: Among accredited LHDs, the adult population was more likely to be fully vaccinated when compared to unaccredited LHDs (P < .01). Additional variables in the model, which were also significant, included time period, CCVI, state policy environment, and state public health governance structure. There were no significant differences in the hospitalization rates in jurisdictions with an accredited LHD compared to jurisdictions where the LHD is not accredited. Death rates in jurisdictions with an accredited LHD were statistically significantly lower than death rates in jurisdictions where the health department was not accredited (P < .001). This relationship was significant with other key variables in the model, including time, CCVI, state policy environment, and state public health governance structure.

Conclusions: This study demonstrates that there is an association between LHD accreditation and community health outcomes. Furthermore, we found that other factors, such as social determinants of health, state policy environment, and state public health governance structure impact community health outcomes.

Context: The Coronavirus disease 2019 (COVID-19) pandemic occurred during a time of political tension in the United States. County-level political environment may have been influential in COVID-19 outcomes.

Objective: This study examined the association between county-level political environment and age-adjusted COVID-19 mortality rates from 2020 to 2022.

Design setting: Political environment was measured by the 2020 Presidential election results and compared with age-adjusted COVID-19 mortality rates by county in Colorado.

Main outcome measures: Rate ratios (RR) and 95% confidence intervals (CI) were estimated using negative binomial regression incorporating a population offset term. Models adjusted for populational differences using the demographics percentile from Colorado's EnviroScreen Environmental Justice Tool.

Results: Age-adjusted county mortality rates ranged from 14.3 to 446.8.0 per 100 000. 2021 COVID-19 mortality rates were nearly twice as high in counties voting for Donald Trump compared to those voting for Joseph Biden (adjusted RR = 1.98, 95% CI: 1.59, 2.47). Results for 2020 and 2022 mortality models were also in the positive direction, though the confidence intervals crossed null values.

Conclusion: These results build on a growing body of evidence that political environment may have been influential for COVID-19 mortality, helping to understand the drivers of health outcomes. Implications for the public health system as we shift into the endemic period of COVID-19 include motivation for collaborative work to restore and rebuild trust among and between stakeholders and the community, as well as increase health education given its' influence on both individual and community behaviors.

Context: Over 200 000 people seeking asylum have arrived in New York City from 2022 to 2024.

Program: As the safety net hospital system for our city, New York City (NYC) Health + Hospitals (H + H) has taken the lead in caring for newly arrived asylum seekers. We used electronic medical record data to gain early insights into utilization and needs among these patients.

Implementation: We developed a hybrid definition to identify patients who are asylum seekers and examined their demographics, insurance, utilization, primary billing diagnoses, and immunizations from the Epic EMR. We included data on other patients as a point of comparison and analyzed data separately for adult and pediatric patients.

Evaluation: In 2023, 15 233 or 1.4% of H + H patients were asylum seekers. Asylum seekers had fewer visits than other patients in 2023, and utilization was particularly driven by pregnancy and childbirth. Children seeking asylum were engaged in primary care at high rates. Documented childhood vaccinations were higher among asylum-seeking children engaged in primary care compared to those who were not. The majority of adults and children were insured. Adult primary care engagement was low, as were visits for those seeking care for behavioral health issues.

Discussion: For adult asylum seekers, pregnancy and childbirth are key needs for adults. Increasing vaccination rates among children is critical and promoting engagement in primary care is a promising way to do so. Coordinated efforts are required to meet the varied needs of migrant arrivals, and safety net hospitals can play a key role in addressing their health care needs.