Journal of Primary Care and Community Health最新文献

{"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}

{"title":"The Mental Health Paradox of COVID-19 Prevention: Adherence, Fatigue, and Depression in a Longitudinal Perspective.","authors":"Jiahui Jin, Daniel W L Lai, Elsie Yan, Vincent W P Lee","doi":"10.1177/21501319251334207","DOIUrl":"https://doi.org/10.1177/21501319251334207","url":null,"abstract":"<p><strong>Objectives: </strong>The COVID-19 pandemic presented significant challenges, particularly the psychological impact of prolonged preventive measures. This study aimed to explore the longitudinal relationships among adherence, anti-pandemic fatigue, and depression, focusing on how these dynamics evolved.</p><p><strong>Methods: </strong>A prospective longitudinal survey was conducted among 627 adults in Hong Kong during the pandemic across 3 waves. Repeated measures ANOVA, cross-lagged path modeling, and mediation model were employed to assess temporal relationships among adherence, anti-pandemic fatigue, and depression.</p><p><strong>Results: </strong>Adherence at T3 significantly predicted T4's anti-pandemic fatigue (<i>B</i> = 0.196, SE = 0.055) and depression (<i>B</i> = 1.690, SE = 0.247), and anti-pandemic fatigue significantly predicted T4's depression (<i>B</i> = 0.684, SE = 0.260). These effects diminished at later waves, reflecting psychological relief as restrictions eased. Notably, adherence was found to increase anti-pandemic fatigue, which in turn exacerbated depressive symptoms.</p><p><strong>Conclusion: </strong>While relationships varied over the 3 time points, the longitudinal design has clarified the causal inference. The study highlights the mental toll of prolonged restrictions and emphasizes the importance of designing integrative strategies that support adherence while addressing fatigue and depression. These findings offer actionable insights for primary care and community health programs in managing future public health emergencies.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251334207"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024387","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":"Shifting Patterns in Primary Care Telehealth Utilization Among Medicare Beneficiaries and Providers.","authors":"Yunxi Zhang, Lincy S Lal, Saurabh Chandra, John Michael Swint","doi":"10.1177/21501319251323983","DOIUrl":"https://doi.org/10.1177/21501319251323983","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic accelerated telehealth adoption, but disparities in its utilization persist. This study examines primary care patient sociodemographic characteristics, telehealth utilization patterns, and provider adoptions before and during the pandemic.</p><p><strong>Methods: </strong>A retrospective cohort study analyzed data from Mississippi Medicare beneficiaries continuously enrolled in Parts A, B, and D who accessed primary care services from 2019 to 2021.</p><p><strong>Results: </strong>Among 201 677 Medicare beneficiaries accessing primary care, 1364 used telehealth before the pandemic, compared to 73 994 during the pandemic. Telehealth utilization shifted during the pandemic to younger, female, White beneficiaries, and those enrolled in Medicare due to disability or End Stage Renal Disease. During the pandemic, telehealth users exhibited higher Charlson Comorbidity Index and Social Vulnerability Index but lower Digital Divide Index scores compared to non-telehealth users. Telehealth was associated with more primary care visits, broader access, and higher continuity of care. Primary care physicians increased their share of telehealth services to 39%, while specialties such as neuropsychiatry and psychiatry showed the highest adoption rates, reaching 55% and 38%, respectively.</p><p><strong>Conclusions: </strong>Telehealth demonstrated a growing role in primary care during the pandemic. Future efforts must address digital divides and advance health equity when integrating telehealth into primary care services.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251323983"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024439","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":"Digital Platforms in Primary Care: Leveraging Asynchronous Consultations to Support Management of Cardiometabolic Diseases and Risk Factors.","authors":"Mohammad S Razai, Hajira Dambha-Miller, Simon Griffin","doi":"10.1177/21501319251345721","DOIUrl":"10.1177/21501319251345721","url":null,"abstract":"","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251345721"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188268","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":"Changing Our Mental and Emotional Trajectory (COMET): The Feasibility and Acceptability of a Rural Community-Based Strategy to Prevent Mental and Emotional Health Problems.","authors":"Linda Zittleman, Maret Felzien, Kristen Curcija, Christopher Bennett, Kaitlyn Bennett, Joseph Carrica, Christin Sutter, Ashley Sherrill, John M Westfall","doi":"10.1177/21501319251317337","DOIUrl":"10.1177/21501319251317337","url":null,"abstract":"<p><strong>Introduction: </strong>People in rural regions frequently lack resources for mental health support. Changing Our Mental and Emotional Trajectory (COMET) is a universal, community-based program designed to address mental and emotional health issues early and prevent crises. COMET Community Training is a short, interactive training that teaches people how to initiate a supportive and potentially emotional conversation using the simple, 7-item COMET Conversational Gravity Assist. This article describes and reports on the feasibility and acceptability of COMET and its Community Training.</p><p><strong>Methods: </strong>COMET was developed using a participatory research approach by community members and health professionals living in a rural region and their research partners. COMET Community Trainings were conducted over a 22-month period. Surveys were administered to attendees before and after training to describe attendees' characteristics, view on content, and impact on intention to use COMET components. Field notes were completed by trainers to document the date and number of attendees.</p><p><strong>Results: </strong>Over 700 people attended 60 Community Trainings. Questionnaires were completed by 644 trainees before and 580 after training. Of pre-survey respondents, 25% worked in education and 15% in farming/ranching. Post-survey respondents were 62% female, and 32% were between age 18 and 36. High levels of training satisfaction were reported. Average likelihood of using items in the COMET conversational guide increased significantly from pre to post training. On a scale of 1 to 10, nearly 80% of respondents rated their likelihood of using COMET in the next 3 months a 7 or higher.</p><p><strong>Conclusions: </strong>COMET Community Training is a feasible program that effectively reaches a range of community members and improves the likelihood that they will initiate conversations when concerned about someone else's mental health. Results lay the groundwork for COMET as an intervention that promotes mental and emotional well-being to address inequality in mental health for people living in rural communities.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251317337"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190793","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":"The Use of an Artificial Intelligence Platform OpenEvidence to Augment Clinical Decision-Making for Primary Care Physicians.","authors":"Ryan T Hurt, Christopher R Stephenson, Elizabeth A Gilman, Christopher A Aakre, Ivana T Croghan, Manpreet S Mundi, Karthik Ghosh, Jithinraj Edakkanambeth Varayil","doi":"10.1177/21501319251332215","DOIUrl":"https://doi.org/10.1177/21501319251332215","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) platforms can potentially enhance clinical decision-making (CDM) in primary care settings. OpenEvidence (OE), an AI tool, draws from trusted sources to generate evidence-based medicine (EBM) recommendations to address clinical questions. However, its effectiveness in real-world primary care cases remains unknown.</p><p><strong>Objective: </strong>To evaluate the performance of OE in providing EBM recommendations for five common chronic conditions in primary care: hypertension, hyperlipidemia, diabetes mellitus type 2, depression, and obesity.</p><p><strong>Methods: </strong>Five patient cases were retrospectively analyzed. Physicians posed specific clinical questions, and OE responses were evaluated on clarity, relevance, evidence support, impact on CDM, and overall satisfaction. Four independent physicians provided ratings using a 0 to 4 scale.</p><p><strong>Results: </strong>OE provided accurate, evidence-based recommendations in all cases, aligning with physician plans. OE was scored on a scale of zero to four, where zero was very unclear, and four was very clear. Mean scores across cases were clarity (3.55 ± 0.60), relevance (3.75 ± 0.44), support (3.35 ± 0.49), and satisfaction (3.60 ± 0.60). However, the impact on CDM was limited (1.95 ± 1.05), as OE primarily reinforced rather than modified plans.</p><p><strong>Conclusion: </strong>OE was rated high in clarity, relevance, and evidence-based support, reinforcing physician decisions in common chronic conditions. While the impact on CDM was minimal due to the study's retrospective nature, OE shows promise in augmenting the primary care physician. Prospective trials are needed to evaluate its utility in complex cases and multidisciplinary settings.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251332215"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021266","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}