Journal of Health Care for the Poor and Underserved最新文献

Objectives: This study evaluated how high versus low-intensity community wellness coaching and health behaviors were associated with changes in depression screen results over one year.

Methods: This was an analysis of secondary data collected in a 12-month obesity-related community health worker (CHW) program for 485 Utah women of color. Depression screen (Patient Health Questionnaire-2 score ³3) and self-reported fruit/vegetable consumption and physical activity (FV/PA) were recorded quarterly. Associations between FV/PA and changes in depression screen over time were evaluated in multivariable models.

Results: Positive depression screen prevalence declined over 12 months (21.7% to 9.5%) with no difference between study arms. Overall, FV ³5 times/day (AOR=1.5; 95% CI 1.0-2.2), any PA (AOR=3.1; 95% CI 1.5-6.4), and muscle strengthening activities (AOR=1.13; 95% CI 1.01-1.26) were associated with improved depression screen results over time.

Conclusion: These results indicate value in addressing and evaluating depression in obesity-related interventions in underserved communities.

Introduction: Hunger Vital SignTM (HVS) and Food Insufficiency Tool (FIT) are two screeners of food insecurity that have not been extensively researched against the well-known 10-item Household Food Security Survey (HFSS-10) Module in large population settings such as New York City (NYC).

Methods: We calculated sensitivity and specificity of the HVS compared with the HFSS-10-based food-insecurity measure and of the FIT compared with the very low food security category of the HFSS-10 using data from the June 2022 New York City Health Panel food access survey.

Results: Overall, the HVS had a sensitivity of 98.1% and a specificity of 72.1%. The FIT had a sensitivity of 53.8% and a specificity of 94.5%. Specificity varied for the HVS while sensitivity varied for the FIT when stratified by sociodemographic subgroups.

Conclusion: The HVS captured people experiencing or at risk of experiencing food insecurity. The FIT underestimated the prevalence of people experiencing very low food security. These screeners may be measuring different constructs of food insecurity.

Children in immigrant families (CIF) constitute 25% of all children in the United States. Known barriers to accessing and navigating the health care system for immigrants (i.e., poverty, fear, limited English proficiency, lack of insurance) lead to decreased medical home establishment among CIF, although the ways in which these obstacles affect medical home access are less studied. With a focus on Congolese, Afghan, Syrian/Iraqi, and Central American immigrants, key informant interviews and focus groups were conducted to identify mothers' perceptions of and experiences with pediatric primary health care. Five common themes emerged: mothers' critical role in children's health, uniqueness of the U.S. health care system, logistical challenges, influence of prior clinical experiences, and importance of culturally appropriate communication. Few, but distinct, differences among the groups revealed specific obstacles for individual populations. Improving rates of medical home use among CIF requires targeted, immigrant-informed approaches that involve population outreach as well as systems-level changes.

In 2022, Penn State College of Medicine launched the LION Mobile Clinic, a teaching mobile health clinic offering preventive health services in rural Snow Shoe, Pennsylvania. We outline four challenges the clinic team faced in implementation, along with adaptations made to tailor the model to Snow Shoe's needs and opportunities.

Background Black individuals with chronic musculoskeletal (MSK) pain tend to experience worse pain and opioid use-related outcomes, including other substance co-use, compared with non-Hispanic White individuals. Co-using cannabis with opioids could instigate a cascade of pain-related vulnerabilities and poor outcomes. Here, we test associations between cannabis/opioid co-use and pain-related outcomes among Black individuals with chronic MSK pain. Methods Black adults with chronic MSK pain who use opioids (N=401; 51.62% female, Mage=35.90, SD=11.03) completed online measures of pain intensity/interference, emotional distress, opioid dependence, and risky use of other substances. Results Compared with opioid use alone, opioid and cannabis co-use was associated with elevated anxiety and depression symptoms, opioid dependence, and risky substance use, but not pain. Conclusions Black individuals with chronic MSK pain who co-use opioids and cannabis warrant targeted interventions that address their needs. Tailored interventions could help address disparities in pain-related outcomes and opioid morbidity and mortality rates.

We evaluated outcomes from a telephone-based transitional patient navigation (TPN) service for people living with hepatitis C virus (HCV) upon returning to the community after incarceration in New York City (NYC) jails. NYC Health + Hospitals/Correctional Health Services offered referrals for TPN services provided by the NYC local health department patient navigation staff. We compared rates of connection to care among people referred for TPN services with those who were not referred. People living with HIV had a higher connection to care rate at three months (65.0% vs 39.8%, p≤.05) and people with opioid use disorder had a higher connection rate at six months (55.1% vs 36.1%, p≤.05) compared with people without these conditions. However, there was not an improved connection to HCV care associated with referral to TPN services for the overall cohort. Further research, including qualitative studies, may inform improved strategies for connection to HCV care after incarceration.

Objective: To determine the impact of adverse social and behavioral determinants of health (SBDH) on health care use in a safety-net community hospital (SNCH) heart failure (HF) population.

Methods: We performed a retrospective analysis of HF patients at a single SNCH between 2018-2019 (N= 4594).

Results: At least one adverse SBDH was present in 21% of the study population. Patients with at least one adverse SBDH were younger (57 vs. 68 years), more likely to identify as Black (50% vs. 36%), be male (68% vs. 53%), and have Medicaid insurance (48% vs. 22%), p<.001. Presence of at least one adverse SBDH (homelessness, substance use, or incarceration) correlated with increased hospitalizations (2.3 vs 1.4/patient) and ED visits (5.1 vs 2.1/patient), p<.0001. Adverse SBDH were independent predictors of HF readmissions. Prescribing of guideline-directed medical therapy was similar among all patients.

Conclusions: In a SNCH HF cohort, adverse SBDH predominantly afflict younger Black men on Medicaid and are associated with increased utilization.

The American Diabetes Association (ADA) guidelines prioritize Sodicum-glucose transporter-2-inhibitors (SGLT2i) given cardio-renal and glycemic benefits. This study was conducted to observe clinical factors associated with initial SGLT2i prescription in type 2 diabetes patients eligible for SGLT2i by the ADA.

Methods: A retrospective case-control study was performed in a safety-net clinic and consisted of the initial SGLT2i prescriptions group and the group without. The data from the electronic medical records between July 2021 and December 2022 were analyzed in the regressional models.

Results: There was a significant association between A1c ≥8% (OR 3.7, p=.01), heart failure (OR 19.3, p<.0001), a history of hypotension (OR 11.9, p=.01), and sulfonylureas (OR 6.5, p=.003) with the SGLT2i prescription.

Conclusion: Patients with high A1c levels, heart failure, a history of hypotension, and sulfonylureas were more likely than their counterparts to receive SGLT2i prescriptions. Future research should investigate adherence and provider prescribing behaviors related to SGLT2i to further assess optimal drug use.

This quality improvement initiative aimed to increase first dose of COVID-19 vaccinations during pediatric/adolescent clinic visits. Four plan-do-study-act cycles were performed with creation of eligibility lists and increasing health educator (HE) engagement. Statistical process control analysis assessed vaccine receipt over time. Logistic regression modeling evaluated odds of receipt. Among 6,740 visits, 52.2% of patients were eligible for first COVID-19 vaccine; 17.9% of eligible patients accepted it. First-vaccine improvements from 13.1% to 21.7% were not sustained. Odds of receipt increased in each cycle compared with baseline (1: Odds Ratio=1.99 [95% Confidence Interval 1.49-2.67], 2: OR=2.22 [1.58-3.14]), 3: OR=2.15 [1.51-3.05]), 4: OR=1.48 [1.11-1.96]), and with HE discussion versus no HE discussion (OR=1.64 [1.16-1.90]). First COVID-19 vaccine receipt increased with vaccine-eligible patient lists and HE-initiated discussions, although improvements diminished over time. Health educator versus no HE discussion led to improved vaccinations, supporting further quality improvement research on HE role to improve vaccine uptake.

Food insecurity is a mechanism through which the mental health impacts of systemic social inequities multiply across the lifespan. Federally administered food assistance programs improve food security, but their impact on mental health is less clear. We conducted a systematic review of all studies that reported an association between food assistance participation and mental health (N = 34), and a multilevel meta-analysis among studies that met inclusion criteria and reported sufficient statistical results (n = 21; k = 44). The overall effect of food assistance on mental health was not significant (d = -0.025, p = .724). However, follow-up moderator analyses indicated that receipt of food assistance mitigated developmental risk among children (F = 7.73, p = .008). Our results highlight the importance of addressing systemic problems, such as insufficient funds and outdated nutrition guidelines, that limit the potential of food assistance programs to positively affect public health.