Journal of Primary Care and Community Health最新文献

{"title":"The Impact of Trusted Community Navigators in Improving Care Utilization Patterns for a Population With Chronic Kidney Disease Enrolled in Medicare Advantage: A Longitudinal Claims Based Study.","authors":"Claude Pinnock, Francesca Gordon, Jordan Ziskin, Tom Carlough, Ken Wake","doi":"10.1177/21501319251347133","DOIUrl":"10.1177/21501319251347133","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Enrollees in the peer support program, Connect For Life (CFL) generated significantly lower costs of $461 pmpm (95% CI = -1037 to -10 037; <i>P</i> = .016) significantly lower inpatient utilization of 172 per 1000 (95% CI = -10 to -330; <i>P</i> = .037) and significantly higher outpatient utilization of 1212 per 1000 (95% CI = 90 to 2340; <i>P</i> = .035). No differences were found in available quality metrics.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251347133"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Approaches to Addressing Burnout and Moral Injury: Experiences from Four Community Health Centers.","authors":"Patricia Pittman, Samantha Meeker","doi":"10.1177/21501319251342103","DOIUrl":"10.1177/21501319251342103","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>This exploratory qualitative study investigates strategies used by four leading CHCs to address perceived drivers of burnout among their providers.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251342103"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Primary Care Physicians' Adjustment of Oral Anti-Diabetic Drugs in Patients with Type 2 Diabetes Mellitus: A Qualitative Research Study.","authors":"Natasha Sheng Yeng Leng, Shera Chaterji, Aminath Shiwaza Moosa, Patricia Ching Yen Chia, Lay Geok Lian, ZhengHua Li, Natalie Ming Foong Hooi, Beth Shin Rei Lau, Ngiap Chuan Tan","doi":"10.1177/21501319251348973","DOIUrl":"10.1177/21501319251348973","url":null,"abstract":"<p><strong>Background: </strong>Primary care physicians' (PCPs) prescription of oral anti-diabetic drugs (OADs) is pivotal to optimise glycaemic control of patients with type 2 diabetes mellitus (T2DM). Their decision-making process is not well-understood and is postulated to be multi-factorial. The study aimed to explore the factors influencing the prescribing behaviour of PCPs managing patients with T2DM in an urban setting.</p><p><strong>Methods: </strong>A qualitative methodology using a descriptive-interpretive approach was employed for this study. Qualitative data from 23 PCPs was collected via 3 focus group discussions and 10 in-depth interviews using a semi-structured topic guide. PCPs with various experiences, qualifications and backgrounds were purposively recruited from public and private primary care clinics in Singapore. The audio-recorded interviews were transcribed verbatim and audited for accuracy. Thematic analysis was conducted and the emergent themes were grouped under the domains of the 'Generalist Wheel of Knowledge, Understanding and Inquiry' framework. The data was managed using Nvivo qualitative management software.</p><p><strong>Results: </strong>The 4 main themes identified were clinician experience and knowledge, patient clinical risk stratification and preference, diabetes severity and drug factors, and healthcare system. PCPs' prior experience with OADs, years of practice, academic roles and knowledge resources influenced their decision-making when prescribing OADs. Their prescription was guided by patient preferences and comorbidities, such as selecting sodium-glucose cotransporter-2 inhibitors for patients with proteinuria. Disease severity, OADs safety profile, efficacy, stipulations in the drug formulary, cost and availability of OADs in their pharmacy, and social worker support were other factors affecting PCPs' prescribing habits of OADs. Clinical decision support functionality in the electronic medical record (EMR) system prompted PCPs to select the type of OADs during the consultation.</p><p><strong>Conclusions: </strong>The study highlights the multifaceted factors influencing PCPs' prescribing of OADs, including clinical experience, patient preferences, drug formulary limitations, medication costs and EMR utilisation. To enhance prescribing habits, interventions should focus on continuous education for PCPs, expanding drug formularies, addressing patients' preferences, cost and access barriers through subsidies and promoting the adoption of EMRs with clinical decision support systems in both public and private sectors.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251348973"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender and Health in Asia: Toward Gender-Affirming Care in the ASEAN Region.","authors":"Rowalt Alibudbud","doi":"10.1177/21501319251316667","DOIUrl":"10.1177/21501319251316667","url":null,"abstract":"","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251316667"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Ambulatory Care Pharmacists Into Value-Based Primary Care: A Scalable Solution to Chronic Disease.","authors":"Alexander J Blood, Harry Saag, Adam Chesler, Dalia Ameripour, Max Gutierrez, Van Nguyen, Cassandra Richardson, Clive Fields, Jen Clair, Aaron Yao, Sashi Moodley","doi":"10.1177/21501319241312041","DOIUrl":"10.1177/21501319241312041","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Patients living with chronic diseases require more medical attention, including more visits to primary care. However, primary care providers are overburdened, and this specialty is attracting fewer new providers than before. Clinical pharmacists can augment these efforts by improving disease state control. In this cohort study, we aimed to demonstrate a retail pharmacy hired and trained clinical pharmacist within a value-based primary care clinic network can improve hypertension (HTN) and type 2 diabetes mellitus (T2DM) control.</p><p><strong>Methods: </strong>In this cohort study, a pharmacist, enabled by a collaborative drug therapy management agreement, prescribed and titrated therapies for HTN and T2DM. Primary outcomes were pre- to post-index changes in hemoglobinA1c, systolic, and diastolic blood pressure (BP) measures.</p><p><strong>Results: </strong>The HTN cohort consisted of 43 patients and the T2DM cohort consisted of 125 patients. The difference-in-differences (β) in the HTN group was -10.2 mmHg (<i>P</i> < .01) for systolic BP and -2.0 mmHg (<i>P</i> = .42) for diastolic BP. The β in the T2DM group was -1.16% (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>Statistically significant reductions in systolic BP and hemoglobinA1c were observed in the pharmacist-managed group compared with matched controls. These results demonstrate that pharmacist integration into a value based primary care clinic may improve measures of chronic disease associated with morbidity and mortality.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319241312041"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Providers' Beliefs and Values: Understanding Their Approach to Gender-Affirming Care.","authors":"Ahona Shirin, Maya Daniello, Laura Stamm","doi":"10.1177/21501319241312574","DOIUrl":"10.1177/21501319241312574","url":null,"abstract":"<p><strong>Objectives: </strong>This qualitative study explored the beliefs and values influencing healthcare providers' delivery of gender-affirming care (GAC) to transgender and gender-diverse (TGD) youth amidst current social and political dynamics.</p><p><strong>Methods: </strong>The study PI conducted 43 semi-structured interviews with providers across states with varying GAC legislation. Responses from 41 providers were analyzed in this paper. A thematic approach to data analysis was employed using qualitative coding.</p><p><strong>Results: </strong>Key themes emerged: criteria for treatment, ethical and moral considerations, and professional and personal responsibility. Providers widely endorsed GAC as evidence-based and essential for alleviating distress and promoting autonomy. They emphasized the importance of respecting patients' gender identities and viewing GAC as life-saving.</p><p><strong>Conclusion: </strong>Despite legislative challenges, the study highlights a strong consensus among providers on the medical necessity of GAC for TGD youth.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319241312574"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Integrating Tobacco Dependence Treatment into Lung Cancer Screening: A Qualitative Assessment.","authors":"Deborah L Pestka, Megan E Campbell, Naomi A Schmulewitz, Anne C Melzer","doi":"10.1177/21501319251321608","DOIUrl":"10.1177/21501319251321608","url":null,"abstract":"<p><strong>Introduction/objective: </strong>We qualitatively assessed current practices and perceived barriers surrounding the integration of tobacco dependence treatment (TDT) into lung cancer screening (LCS).</p><p><strong>Methods: </strong>Informed by the Practical, Robust Implementation and Sustainability Model, we conducted semi-structured interviews with clinicians (<i>n</i> = 18) at 6 Veterans Affairs medical centers in the Midwest.</p><p><strong>Results: </strong>TDT was usually addressed at an initial shared decision-making visit but often not with subsequent rounds of screening or nodule follow-up. No site was aware that any TDT-related outcomes were tracked within their program. While the LCS clinical reminders included some aspects of tobacco use (eg, tobacco pack-years), they did not support clinicians in offering TDT or capture outcomes and were perceived as \"checkboxes to nowhere.\" This was contrasted with other clinical reminders linked to dashboards that provide rolling feedback for important clinical outcomes (eg, diabetes care). Interviewees reported competing demands and limited expertise in motivational interventions as additional barriers. A dedicated team for TDT and a \"one-click referral\" were perceived as key success factors.</p><p><strong>Conclusions: </strong>TDT remains poorly integrated into LCS. Addressing identified barriers will require considerable investment in TDT resources and improvements to LCS tools to support the provision of cessation support.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251321608"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Innovative Clinic-Based Intervention to Improve Adolescent Access to Sexual and Mental Health Services: The Total Teen Program.","authors":"Whitney Garney, Gan Han, Christi Esquivel, Kristen Garcia, Kobi V Ajayi, Kelly Wilson","doi":"10.1177/21501319251315307","DOIUrl":"10.1177/21501319251315307","url":null,"abstract":"<p><strong>Objective: </strong>Adolescents encounter numerous healthcare access barriers, leading to poor health outcomes. Researchers developed the Total Teen (TT) program to improve access to sexual and reproductive health (SRH) and mental health (MH) services in settings providing adolescents and young adults (12-25) health services. This pilot study assessed the TT's impact on care across three settings: school-based health clinics, a federally qualified health center, and an adolescent health clinic for 12 weeks.</p><p><strong>Methods: </strong>Sociodemographic data, including age, race/ethnicity, gender, and insurance status, were collected. MH was assessed using patient health questionnaire (PHQ)-9 and generalized anxiety disorder (GAD)-2 scales, and sexual health was evaluated based on CDC guidelines and additional evidence-based questions. One-on-one time, confidential consultations, SRH and MH micro visits, and referrals measured access. Descriptive statistics, Pearson Chi-square tests, and Kruskal-Wallis tests compared site outcomes, while logistic regression models adjusted for age, gender, race, and site.</p><p><strong>Results: </strong>Four hundred and fifty-one participated in the TT program across the three sites. Concerning micro visits and referrals, being male was associated with lower depression rates (<i>P</i> = .0003) and generalized anxiety disorder (<i>P</i> = .0099). Being males also predicted micro visit receipt (<i>P</i> = .0199). Concerning SRH micro visits, higher sexual behavior scores (<i>P</i> < .0001) were significantly associated with a greater likelihood of utilizing SRH micro visits.</p><p><strong>Conclusions: </strong>Results indicate that TT improves access to SRH and MH services and referrals for at-risk adolescents. Findings underscore the importance of integrating SRH and MH services into routine adolescent care and involving health organizations and providers as key stakeholders in enhancing preventive healthcare access.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251315307"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SNAP and/or WIC Participation and Diet Quality in Mother-Child Dyads living in Greater Boston after Pandemic: A Mixed-Method Study.","authors":"Thanit Vinitchagoon, Fang Fang Zhang, Rebecca C Fauth, Erin Hennessy, Ana G Maafs, Emma M Browning, Christina D Economos","doi":"10.1177/21501319251317334","DOIUrl":"10.1177/21501319251317334","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Since the COVID-19 pandemic, few studies have examined how participation in Supplemental Nutrition Assistance Program (SNAP) and/or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) impacts diet quality in families with young children. This study aims to explore the association between SNAP and/or WIC participation and diet quality in mother-child dyads in Greater Boston, MA.</p><p><strong>Methods: </strong>A mixed-method approach involving cross-sectional surveys and in-depth interviews were utilized. Participants included 69 mother-child dyads for quantitative and 18 mothers for qualitative data collection. Analysis of covariance using generalized linear models was employed to compare differences in Healthy Eating Index-2015 (HEI-2015) scores based on SNAP and/or WIC participation, and thematic analysis was used for coding themes.</p><p><strong>Results: </strong>Mothers who participated in SNAP and/or WIC were more from lower socioeconomic backgrounds. After adjusting for age, race/ethnicity, and education, no significant differences in diet quality were found for both mothers and their children. However, qualitative results showed that mothers prioritized their children's nutrition, used benefits to buy fruits and vegetables, and experienced stress that impacted their own diet quality.</p><p><strong>Conclusions: </strong>Since the pandemic, SNAP and WIC appeared to support families experiencing socioeconomic disadvantage (e.g., lower income and educational attainment) to improve diet quality, particularly through increased access to fruits and vegetables. However, these programs have not fully eliminated persistent disparities in diet quality, which seems to continue even the pandemic's immediate effects have subsided.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251317334"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Information Seeking Behavior and Health Information Preferences Among Ethnically and Socioeconomically Diverse Patients and Communities: A Qualitative Study.","authors":"Bryn Hummel, Dinah L van Schalkwijk, Paula M C Mommersteeg, Irene G M van Valkengoed","doi":"10.1177/21501319251332048","DOIUrl":"10.1177/21501319251332048","url":null,"abstract":"<p><strong>Introduction: </strong>Early recognition of ischemic heart disease (IHD) is important, yet, delays still occur due to low symptom recognition. Accessible information may improve symptom recognition, however, it is unclear how information should be provided to reach different populations. Hence, we studied health information seeking behavior (HISB) and preferences, in ethnically-diverse women and men in the Netherlands.</p><p><strong>Methods: </strong>We conducted 31 patients interviews, seven key figure interviews and one focus group with key figures (community leaders and physicians), and eight focus groups with non-patients (N = 44) about HISB and health information preferences. We thematically analyzed the data using inductive coding.</p><p><strong>Results: </strong>We found minimal variation in HISB, as most patients did not seek information about symptoms. Participants required information about cardiac symptoms, risk factors, when to seek care, prevention, and navigating the Dutch healthcare system. Several information provision strategies emerged, with preferences varying somewhat across ethnic groups and age groups. Ethnic minority participants described a preference for culturally-sensitive community-based live information provision. Other strategies included media, social media, and native Dutch participants mentioned public spaces and healthcare settings.</p><p><strong>Conclusion: </strong>HISB was limited in this ethnically-diverse population. Different strategies may be employed to promote symptom recognition, particularly co-created culturally-sensitive interventions.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251332048"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}