Journal of Primary Care and Community Health最新文献

{"title":"The Associations Between Sleep Duration and Various Metabolic Health Indices Among Adults in the United States: A Multivariate Analysis of Variance (MANOVA) Using National Health and Nutrition Examination Survey (NHANES) 2021 to 2023 Dataset.","authors":"Shuo Feng, Jeong-Hui Park, Qiyue Zhang, Ping Ma, Jung-Min Lee, Jong Cheol Shin","doi":"10.1177/21501319251315599","DOIUrl":"10.1177/21501319251315599","url":null,"abstract":"<p><strong>Objective: </strong>This study explores the associations between various sleep durations and metabolic health indices, including systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol levels, high-density lipoprotein (HDL) cholesterol, and waist circumference.</p><p><strong>Methods: </strong>Data from the National Health and Nutrition Examination Survey (NHANES) 2021 to 2023, were analyzed. MANOVA and Bonferroni-adjusted ANOVAs were conducted to examine the relationships between sleep duration (sleep deprivation (≤5 h), short sleep (5-7 h), recommended sleep (7-9 h), and long sleep (>9 h)) and metabolic health indices.</p><p><strong>Results: </strong>MANOVA revealed significant group differences between sleep duration and metabolic health indices, with Wilks' Lambda (Λ) = .98, <i>F</i> (3, 5095) = 4.26, <i>P</i> < .001. Compared to recommended sleep duration, both sleep deprivation and short sleep were associated with higher DBP (<i>P</i>s < .01) and waist circumference (<i>P</i>s < .001), and lower HDL levels (<i>P</i>s < .05) Long sleep was associated with lower HDL levels (<i>P</i> < .01) and lower total cholesterol (<i>P</i> < .01).</p><p><strong>Conclusion: </strong>The study highlights the detrimental associations of both sleep deprivation and short sleep with metabolic health, such as elevated blood pressure and waist circumference, and lowered HDL cholesterol. Long sleep may also negatively impact metabolic health by reducing HDL.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251315599"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061097","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":"Transportation Barriers and Diabetes Outcomes: A Longitudinal Analysis.","authors":"Seth A Berkowitz, Aileen Ochoa, Myklynn LaPoint, Marlena L Kuhn, Jenine Dankovchik, Jenna M Donovan, Mufeng Gao, Sanjay Basu, Michael G Hudgens, Rachel Gold","doi":"10.1177/21501319251320709","DOIUrl":"10.1177/21501319251320709","url":null,"abstract":"<p><strong>Objective: </strong>To estimate associations between transportation barriers and diabetes outcomes.</p><p><strong>Methods: </strong>Longitudinal cohort study; 86 977 adults with type 2 diabetes mellitus in community-based health centers were assessed for transportation barriers, with up to 36 months of follow-up after initial assessment. We compared scenarios in which individuals did not experience transportation barriers to scenarios in which they did, to estimate differences in mean hemoglobin a1c (HbA1c), systolic and diastolic blood pressure (SBP and DBP), and LDL cholesterol. For analysis, we used targeted minimum loss estimation at the following timepoints after initial transportation barrier assessment: 12 (primary), 6, 18, 24, 30, and 36 months. The study period was June 24, 2016 to April 30, 2023.</p><p><strong>Results: </strong>We estimated that if participants did not experience transportation barriers, mean HbA1c would have been 0.09% lower (95% CI = -0.14% to -0.04%, <i>P</i> = .0002) at 12 months, compared to a scenario in which they did experience transportation barriers. These results were similar at other time points. We also estimated that absence of transportation barriers was associated with, at 12 months, lower SBP (-0.6mm Hg, 95% CI = -1.0mm Hg to -0.2mm Hg, <i>P</i> = .004) and DBP (-0.3mm Hg, 95% CI = -0.5mm Hg to -0.1mm Hg, <i>P</i> = .02), but not LDL (-1.1mg/dL, 95% CI = -2.6 mg/dL to 0.5 mg/dL, <i>P</i> = .19). Results at other time points for SBP, DBP, and LDL outcomes were similar.</p><p><strong>Conclusions: </strong>Absence of transportation barriers was associated with slightly lower hemoglobin A1c and blood pressure, but the small magnitude of the differences suggests that also addressing other factors may be needed to improve diabetes outcomes more meaningfully.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251320709"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459861","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":"Impact of Multi-Disciplinary Team in Implementing Clinical Audit Recommendations to Improve Health Educators' Practice at Primary Care in Qatar.","authors":"Ansif Pallath Majeed, Kiran Harikumar, Hanan Al Mujalli, Abdul Ali Shah, Noora Alkubaisi, Sharifullah Khan, Faiza Aiman","doi":"10.1177/21501319241279656","DOIUrl":"10.1177/21501319241279656","url":null,"abstract":"<p><strong>Background: </strong>Health educators play a vital role in primary care by educating patients on the significance of maintaining good health and preventive measures, especially in the case of chronic illnesses. Evaluating the impact of their efforts is essential to ensure the delivery of high-quality patient care.</p><p><strong>Method: </strong>A multi-layered process involves pre-intervention analysis of 180 health records, followed by a SWOT analysis to identify necessary interventions, facilitated by a multidisciplinary team to enhance the quality of practice. Subsequently, a post-intervention re-audit is conducted with a sample size of 236 health records to assess any changes in measured parameters.</p><p><strong>Results: </strong>The initial health education and learning needs assessment compliance was 41% during the baseline evaluation but increased to 81% (<i>P</i> = .001) post-intervention. Social history review improved from 54% to 75% (<i>P</i> = .198) following the intervention. Mental health screening for anxiety and depression was done on 67% of patients initially, but compliance rose to 98% (<i>P</i> ≤ .001) post-intervention. Problem list documentation reached 100%(<i>P</i> ≤ .001) compliance post-intervention, up from 44% during the baseline assessment. In the initial evaluation, it was found that 56% of patients were provided with health education and follow-up guidance. After the intervention, this number increased to 79%(<i>P</i> = .013). During the baseline assessment, 35% of patients underwent follow-up assessments, including a review of previous goals and their achievement status. This percentage significantly improved to 92%(<i>P</i> = .001) after the intervention. Additionally, 47% of patients received a follow-up plan with new goals and instructions before the intervention, but this improved to 90% (<i>P</i> = .004) afterwards. The overall compliance rate during the baseline assessment was 51%, which increased to 88% following the intervention, indicating a significant improvement in the health educator's practice.</p><p><strong>Conclusion: </strong>The involvement of a multidisciplinary team in implementing multifaceted post baseline recommendations was instrumental in enhancing the overall performance of health educators. The study results underscore the positive impact of this cooperation among different departments on the efficacy of health educators' practice. The SWOT analysis helped to examine various possibilities for implementing interventions to address existing gaps and enhance the quality of practice through positive changes.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319241279656"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755226","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":"Concierge-Level Care for Underserved Communities: Not a Pipe Dream.","authors":"Donald T Erwin, Alexandria Fischer, Mark Litvak, Eugene Litvak","doi":"10.1177/21501319251332458","DOIUrl":"https://doi.org/10.1177/21501319251332458","url":null,"abstract":"<p><strong>Introduction: </strong>St. Thomas (STCHC) has a long history of serving an urban, uninsured, and underinsured (Medicaid) population in the greater New Orleans area. Beginning in 2010, STCHC faced financial danger when Louisiana did not expand Medicaid coverage. Partnering with the nonprofit Institute for Healthcare Optimization (IHO), we increased patient throughput by balancing the clinic's resources between two modalities of care: urgent (same/next day) appointments in which patients were seen by whichever provider was available; and less urgent, in which patients saw their preferred PCP at the provider's availability. Assessing patient's appointment preferences was crucial in directing this innovation.</p><p><strong>Methods: </strong>We analyzed 8913 appointments and patients' priorities between being cared for by a preferred provider or being seen on the same/next day. Appointment outcomes (i.e., occurred, no-show, canceled, or rescheduled) were matched to each preference group and no-show rates were calculated.</p><p><strong>Results: </strong>When 80% to 90% of same-day requests were satisfied, the proportion of no-shows declined significantly, and patients' satisfaction with access to care reached 97%. Clinic appointment kept rate became 87% (95% CI [0.869975, 0.870025]).</p><p><strong>Conclusions: </strong>Disseminating these results nationwide would result in many lives and millions of dollars saved. Large-scale educational and implementation efforts are needed.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251332458"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050217","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 Burden of Comorbid Depression and Type 2 Diabetes: An Empirical Study Using Commercial Insurance Data.","authors":"SangNam Ahn, Gang Han, McKenzie Beck, Wan-Ling Hsu, Samuel D Towne, Matthew Lee Smith, Marcia G Ory","doi":"10.1177/21501319251336629","DOIUrl":"https://doi.org/10.1177/21501319251336629","url":null,"abstract":"<p><strong>Introduction: </strong>Despite rising rates of depression and diabetes, assessments of depression's burden on diabetes management and its economic burden remain limited. In this study, we evaluate the burden of depression on diabetes management and quantify the financial implications of comorbid depression and diabetes.</p><p><strong>Methods: </strong>We performed propensity score matching on Texas commercial claims data (2016-2019) to match type 2 diabetes patients with depression (n = 613) to those without (n = 583). Depression flagged in 2016/2017 indicated initial depression, and an A1C level of ≥8% in 2018/2019 indicated follow-up uncontrolled diabetes. Healthcare costs included total, diabetes-related, outpatient, and inpatient costs incurred during 2018/2019.</p><p><strong>Results: </strong>A depression flag in the initial period was linked to a 2.7 percentage point increase (<i>P</i> = .031) in the probability of having an A1C level of ≥8% in the follow-up, compared to individuals without a depression flag. Having both a depression flag and uncontrolled A1C in the initial period was associated with $2,037 higher total medical costs (<i>P</i> = .004), $494 higher diabetes-related costs (<i>P</i> = .020), and $336 higher outpatient costs (<i>P</i> = .008) in the follow-up, compared to the respective averages of $6,900, $474, and $583 for individuals without a depression flag or uncontrolled A1C.</p><p><strong>Conclusions: </strong>Our findings highlight the detrimental effect of depression on uncontrolled diabetes and the subsequent increase in healthcare costs. Further research is warranted to determine the effectiveness of proactive treatments for depression in managing diabetes, improving glycemic control, and reducing healthcare costs.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251336629"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040971","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":"Exploring Problematic TikTok Use and Mental Health Issues: A Systematic Review of Empirical Studies.","authors":"Lakshit Jain, Luis Velez, Surya Karlapati, Mary Forand, Rajasekhar Kannali, Rao Ahmed Yousaf, Rizwan Ahmed, Zouina Sarfraz, Pearl A Sutter, Christian Anthony Tallo, Saeed Ahmed","doi":"10.1177/21501319251327303","DOIUrl":"10.1177/21501319251327303","url":null,"abstract":"<p><strong>Background: </strong>Since its launch in 2017, TikTok has rapidly emerged as a major player in the digital landscape, amassing over a billion active users. Its engaging features have raised concerns about potential problematic use and negative mental health outcomes. Despite increasing scholarly attention, a consolidated understanding of TikTok's problematic use potential and implications remains elusive This systematic review synthesizes empirical research on problematic TikTok use and its impact on mental health.</p><p><strong>Methods: </strong>This review followed PRISMA Statement 2020 guidelines and conducted a comprehensive search across PubMed, Embase, Scopus, Web of Science, and PsycINFO databases until July 10, 2024. Keywords included terms related to TikTok use, addiction, and problematic use. Studies were included based on empirical focus and publication in peer-reviewed journals. Data extraction comprised study characteristics, measures of TikTok problematic use, and related mental health outcomes. Quality assessment used JBI, Cochrane's RoB 2, MMAT, CASP, and NOS tools. The protocol was registered in OSF: https://osf.io/cjf97.</p><p><strong>Results: </strong>This review included 26 studies, involving a total of 11 462 participants. The pooled prevalence of TikTok use was estimated at 80.19%, with the highest rates observed among people aged 18 to 29 years, where it reached 85.4%. Frequent use of TikTok was closely linked with an increase in symptoms of anxiety and depression, especially in users aged under 24 years. Female users were more likely to experience problematic TikTok use, with 67.3% of such cases found among female university students. Moreover, higher addiction scores were noted among individuals from lower socioeconomic backgrounds and those who had higher levels of neuroticism.</p><p><strong>Conclusion: </strong>The findings of this review highlight the growing concern surrounding the impact of problematic TikTok use on mental health, particularly among younger and more vulnerable populations. It is imperative for stakeholders to prioritize the integration of digital literacy and media literacy into educational curricula. Moreover, the involvement of caregivers through guided mediation and the establishment of clear usage parameters could play a crucial role in managing screen time, particularly for younger users. To improve the current landscape of empirical research, longitudinal and interventional research is warranted.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251327303"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659054","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":"Predicting Long-Term Health-Related Quality of Life in Individuals With Prior SARS-CoV-2 Infection: A 12-Month Prospective Study.","authors":"Ali A Weinstein, Leyla de Avila, Maria Stepanova, Jillian K Price, Carey Escheik, Lynn H Gerber, Zobair M Younossi","doi":"10.1177/21501319251342650","DOIUrl":"10.1177/21501319251342650","url":null,"abstract":"<p><strong>Objective: </strong>To identify predictors of clinically meaningful declines in health-related quality of life (HRQoL) among COVID-19 patients over a 12-month period in a prospective, natural history investigation.</p><p><strong>Methods: </strong>We conducted a longitudinal study involving individuals who had tested positive for SARS-CoV-2, assessing various factors and their impact on HRQoL after 12 months. Key potential predictors examined included demographic information, medical history, and symptom reporting. HRQoL was measured using the validated EuroQoL Dimension 5 level scale at baseline and at the 12-month follow-up.</p><p><strong>Results: </strong>The analysis revealed that shortness of breath, a diagnosis of COPD, lower BMI, and a history of anxiety at the initial visit were all significantly associated with clinically meaningful worsening of HRQoL at 12 months. Specifically, individuals with these factors experienced more pronounced declines in HRQoL compared to those without. Notably, the small number of COPD cases within our sample (4 total) limited the reliability of this predictor.</p><p><strong>Conclusions: </strong>Shortness of breath, lower BMI, and a history of anxiety are important predictors of deteriorated HRQoL in COVID-19 patients over the long term. Although the association with COPD is less reliable due to sample size limitations, these findings highlight the need for targeted interventions and continued support for patients exhibiting these risk factors to improve long-term HRQoL outcomes. Future research with larger samples is needed to confirm these results and further investigate the role of these factors in post-COVID HRQoL declines.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251342650"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162855","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":"Primary Care Physician Use of Elastic Scattering Spectroscopy on Skin Lesions Suggestive of Skin Cancer.","authors":"Stephen P Merry, Ivana T Croghan, Kimberly A Dukes, Brian C McCormick, Gerard T Considine, Michelle J Duvall, Curtis T Thompson, David J Leffell","doi":"10.1177/21501319251344423","DOIUrl":"https://doi.org/10.1177/21501319251344423","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the performance of noninvasive, elastic scattering spectroscopy, algorithm-powered device (DermaSensor) to detect melanoma and basal and squamous cell cancers in the primary care setting.</p><p><strong>Patients & methods: </strong>DERM-SUCCESS, a blinded, prospective, multicenter pivotal study, enrolled adult patients between August 17, 2020, and December 9, 2021, with lesions that their primary care physicians (PCPs) suspected of skin cancer at clinics in the US (n = 18) and Australia (n = 4). These lesions were assessed by PCPs and scanned with the DermaSensor device. Biopsy specimens were collected, and histopathologic analysis was performed by dermatopathologists. The diagnostic performance of the device, dermatopathologist discordance, and subgroup analyses of clinical interest were calculated.</p><p><strong>Results: </strong>Of the 1579 skin lesions enrolled, dermatopathologic analysis identified 224 (14.2%) cancers. Device sensitivity was 95.5% (95% CI, 91.7%-97.6%) overall and 96.3% (92.9%-98.4%) for patients in the FDA-approved age group 40 years and older (90.2% for melanoma, 97.8% for basal cell carcinoma, and 97.7% for squamous cell carcinoma). Device specificity was 20.7%. The negative predictive value was 96.6%, and the positive predictive value was 16.6% (NNB 6). The device misclassified as \"<i>monitor</i>\" rather than \"<i>investigate further</i>\" 4 keratinocyte carcinomas and 4 melanomas in patients aged 40 years or older (n = 8, 0.5% of lesions, 3.7% of cancers biopsied).</p><p><strong>Conclusions: </strong>The DermaSensor device is an easy-to-use, point-of-care, hand-held skin cancer adjunctive diagnostic device with high sensitivity and NPV to help inform PCP decision-making about skin lesions suspicious for cancer that need further evaluation and those that may be monitored.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251344423"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227184","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":"An Evaluation of the Decline in Primary Care Physician Visits, 2010 to 2021.","authors":"Anuradha Jetty, Marie Ezran, Alison N Huffstetler, Yalda Jabbarpour","doi":"10.1177/21501319251321618","DOIUrl":"10.1177/21501319251321618","url":null,"abstract":"<p><strong>Introduction: </strong>Primary care is the backbone of the United States healthcare system, yet it continues to be underfunded and inaccessible to many. Previous studies explored primary care visit patterns until 2016, leaving gaps in our understanding of how recent factors like state Medicaid expansions, the Coronavirus Disease 2019 (COVID-19) pandemic, and population growth have influenced these patterns. Hence, the objective of the current study was to analyze the trends in primary care visits provided by outpatient clinicians over time and by visit type and contextualize study findings within the changing healthcare landscape.</p><p><strong>Methods: </strong>The Medical Expenditure Panel Survey data (2010-2021) were used to examine trends in the total number and share of ambulatory, preventive, acute, and chronic care visits and investigate sociodemographic factors associated with a given clinician visit. The outcome variable was the clinician type: Primary Care Physicians (PCPs), Internal Medicine (IM) subspecialists, and Nurse Practitioners or Physician Assistants or Registered Nurses (NP/PA/RNs). Explanatory variables included gender, age, race/ethnicity, education, region of respondent's residence, income-to-poverty ratio, insurance coverage, number of chronic conditions, and survey year. Univariate, bivariate, and multinomial logistic regression analyses were performed.</p><p><strong>Results: </strong>The visits led by PCPs and IM subspecialists declined by 43% and 23% between 2010 and 2021, respectively. However, visits led by NP/PA/RNs increased by 98%. From 2010 to 2021, the proportion of preventive care visits provided by PCPs, IMs, and NP/PA/RNs increased by 25%, 7%, and 4%, respectively. PCPs provided fewer acute and chronic care visits in 2021 than in 2010. Regression analyses illustrated that relative to Non-Hispanic White patients, non-White patients had a higher likelihood of seeing PCPs. Patients reporting 1 chronic condition were more likely to obtain care from an IM or NP/PA/RN than a PCP. In contrast, those with 2 or more chronic conditions had a greater propensity to see PCP than NP/PA/RN.</p><p><strong>Conclusion: </strong>Despite a growing need for primary care services, the decrease in visits to PCPs is concerning and requires further examination. The declining trends in acute and chronic care visits raise questions as to whether primary care, in its current form, can continue to provide its essential attributes and services.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251321618"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459617","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":"The Impact of Medicaid Expansion on Acute Diabetes Complication by Care Delivery Settings.","authors":"Danielle Kulbak, Dang Dinh, Annie E Larson, Andrew Suchocki, Rachel Springer, Miguel Marino, Jennifer E DeVoe, Jun Hwang, Nathalie Huguet","doi":"10.1177/21501319251320161","DOIUrl":"10.1177/21501319251320161","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates whether gaining Medicaid following the Affordable Care Act (ACA) expansion led to changes in the rate of acute diabetes complications diagnosed in primary care settings, relative to in inpatient, emergency department (ED), or urgent care (UC) settings.</p><p><strong>Methods: </strong>This retrospective cohort study used Medicaid administrative claims data linked to electronic health records for 3767 patients, aged 19 to 64 years, who experienced acute preventable complications of diabetes between 2014 and 2019 diagnosed in inpatient, ED, UC, or primary care settings in the state of Oregon. These patients were classified as either continuously Medicaid-insured or having gained Medicaid.</p><p><strong>Results: </strong>Annual rates of acute complications diagnosed in primary care and inpatient/ED/UC settings increased for both continuously [Adjusted Rate Ratio (aRR) = 2.20, 95% CI = 1.65-2.91] and newly Medicaid-insured patients (aRR = 2.67, 95% CI = 2.05-3.47) after the ACA. Among newly Medicaid-insured, annual rates of abnormal blood glucose diagnosed in primary care settings significantly increased with time while those diagnosed in inpatient/ED/UC decreased (2014 vs 2016 aRR = 3.36, 95% CI = 1.60-7.09).</p><p><strong>Conclusion: </strong>We found a significantly greater rate of abnormal blood glucose diagnosed in primary care clinics among patients who gained Medicaid post-ACA and a corresponding decline in diagnosis in inpatient/ED/UC settings.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":"16 ","pages":"21501319251320161"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415817","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}