Journal of Primary Care and Community Health最新文献

{"title":"Early Prevention of Critical Illness in Older Adults: Adaptation and Pilot Testing of an Electronic Risk Score and Checklist.","authors":"Christopher L Boswell, Sarah A Minteer, Svetlana Herasevich, Juan P Garcia-Mendez, Yue Dong, Ognjen Gajic, Amelia K Barwise","doi":"10.1177/21501319241231238","DOIUrl":"10.1177/21501319241231238","url":null,"abstract":"<p><strong>Objective: </strong>Given limited critical care resources and an aging population, early interventions to prevent critical illness are vital. In this work, we measured post-implementation outcomes after introducing a novel electronic scoring system (Elders Risk Assessment-ERA) and a risk-factor checklist, Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN), to detect older patients at high risk of critical illness in a primary care setting.</p><p><strong>Methods: </strong>The study was conducted at a family medicine clinic in Kasson, MN. The ADAPT-ITT framework was used to modify the CERTAIN checklist for primary care during 2 co-design workshops involving interdisciplinary clinicians, held in April 2023. The ERA score and modified CERTAIN checklist were implemented between May and July 2023 and identify and assess all patients age ≥60 years at risk of critical illness during their primary care visits. Implementation outcomes were evaluated at the end of the study via an anonymous survey and EHR data extraction.</p><p><strong>Results: </strong>Fourteen clinicians participated in 2 co-design workshops. A total of 19 clinicians participated in a post-pilot survey. All survey items were rated on a 5-point Likert type scale. Mean acceptability of the ERA score and checklist was rated 3.35 (SD = 0.75) and 3.09 (SD = 0.64), respectively. Appropriateness had a mean rating of 3.38 (SD = 0.82) for the ERA score and 3.19 (SD = 0.59) for the checklist. Mean feasibility was rated 3.38(SD = 0.85) and 2.92 (SD = 0.76) for the ERA score and checklist, respectively. The adoption rate was 50% (19/38) among clinicians, but the reach was low at 17% (49/289) of eligible patients.</p><p><strong>Conclusions: </strong>This pilot study evaluated the implementation of an intervention that introduced the ERA score and CERTAIN checklist into a primary care practice. Results indicate moderate acceptability, appropriateness, and feasibility of the ERA score, and similar ratings for the checklist, with slightly lower feasibility. While checklist adoption was moderate, reach was limited, indicating inconsistent use.</p><p><strong>Recommendations: </strong>We plan to use the open-ended resurvey responses to further modify the CERTAIN-FM checklist and implementation process. The ADAPT-ITT framework is a useful model for adapting the checklist to meet the primary care clinician needs.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10863481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724499","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":"Social Media Behaviors and Lifestyle Changes in Young Adults (Ages 18-28 years) During the COVID-19 Pandemic: Analysis From an International Cross-Sectional Study.","authors":"Michelle Teresa Wiciak, Omar Shazley, Daphne Santhosh","doi":"10.1177/21501319241228117","DOIUrl":"10.1177/21501319241228117","url":null,"abstract":"<p><strong>Background: </strong>Screen time (ST), mainly social media (SM), has increased during the coronavirus 2019 (COVID-19) pandemic, impacting mental and physical health. This study aims to analyze SM use in young adults ages 18 to 28 years and lifestyle changes during COVID-19 to provide a baseline on pandemic habits in the younger population.</p><p><strong>Methods: </strong>An international cross-sectional observational study was conducted from September 2020 to January 2021. Participants responded about their SM behavior, and activities they noticed they did less and more during COVID-19. A total of 183 responses were analyzed.</p><p><strong>Results: </strong>The top reason respondents increased SM was for entertainment. Many respondents increased ST, physical activity (PA), and sleeping habits during COVID-19, while many decreased socialization, PA, and going outdoors. PA had mixed results among participants, indicating some increased PA and some decreased. Evidence suggests that timing of quarantining during the pandemic significantly influenced variables, like ST (<i>P</i> = .004) and socialization (<i>P</i> = .037).</p><p><strong>Discussion and conclusion: </strong>Respondents generally noticed increased SM use for various reasons, including socialization, potentially explaining why respondents feel they socialize less. ST use increased; some people reported increased PA while others reported a decrease. Altogether, this provides vital context on young adults' SM and lifestyle habits, highlighting potential areas for further research.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10832443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139643063","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":"Anticoagulation Patterns Among Community-Dwelling Older Adults With Atrial Fibrillation.","authors":"Meaghan Costello, Ericka E Tung, Karen M Fischer, Thomas M Jaeger","doi":"10.1177/21501319241243005","DOIUrl":"10.1177/21501319241243005","url":null,"abstract":"<p><strong>Objectives: </strong>To assess clinicians' prescribing practices for anticoagulation in older adults with atrial fibrillation or atrial flutter (AF/F) and determine factors common among those without anticoagulation.</p><p><strong>Methods: </strong>We performed a community-based retrospective cohort study of adults aged 65 years and older with a history of nonvalvular AF/F to determine the rate of oral anticoagulation utilization. We also assessed for associations between anticoagulation use and comorbid conditions and common geriatric syndromes.</p><p><strong>Results: </strong>A total of 3832 patients with a diagnosis of nonvalvular AF/F were included (mean [SD] age, 79.9 [8.4] years), 2693 (70.3%) of whom were receiving anticoagulation (51.7%, a vitamin K antagonist; 48.1%, a direct-acting oral anticoagulant). Patients with higher Elderly Risk Assessment index (ERA) scores, a surrogate for health vulnerability, received anticoagulation less often than patients with lower scores. The percentage of patients with a history of falling was higher among those who did not receive anticoagulation than among those who did (44.4% vs 32.8%; <i>P</i> < .001). Similarly, a diagnosis of dementia was more common in the no-anticoagulation group than the anticoagulation group (18.5% vs 12.7%; <i>P</i> < .001).</p><p><strong>Conclusions: </strong>A substantial proportion of older adults with AF/F do not receive anticoagulation. Those without anticoagulation had higher risk of health deterioration based on higher ERA scores and had a higher incidence of dementia and fall history. This suggests that the presence of geriatric syndromes may influence the decision to withhold anticoagulation.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10989041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337160","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":"Promoting the Wellness of Older Adults through Integrated Health-Promoting Programs and Supportive Peers: A Quasi-Experimental Study in Semi-Urban Communities of Northeastern Thailand.","authors":"Tassanee Silawan, Arpaporn Powwattana, Phurithat Ponsen, Nuttawat Ninkarnjanakun","doi":"10.1177/21501319241241456","DOIUrl":"10.1177/21501319241241456","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Thailand has approached an aged society in which the proportion of older adults rose from 5% in 1995 to 20.7% in 2022 and is projected to increase to 27.2% in 2030. Older adults face health risks and challenges, requiring supportive care. This research aimed to promote the wellness of older adults through Integrated Health-Promoting Programs and Supportive Peers (IHPP-SP) in semi-urban communities.</p><p><strong>Methods: </strong>A one-group pretest-posttest quasi-experimental study was conducted among 229 older adults from 22 communities. The interventions covered analyzing community situations and determinants, designing and developing IHPP-SP, enhancing the capabilities of supportive peers, and establishing a support system. Mean and proportion differences were analyzed using the paired <i>t</i>-test and McNemar test.</p><p><strong>Results: </strong>After implementing IHPP-SP, the mean score significantly increased for happiness (<i>P</i> = .004), Activities of Daily Living: ADLs (<i>P</i> = .034), and family support (<i>P</i> < .001), but did not differ regarding depression (<i>P</i> = .413). The proportion of healthy behaviors significantly increased for tobacco use (<i>P</i> = .035), dietary intake (<i>P</i> = .018), and physical activity (<i>P</i> < .001), but not for alcohol consumption (<i>P</i> = .377).</p><p><strong>Conclusions: </strong>The IHPP-SP provided potential benefits to promote the wellness of older adults.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140207907","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":"Knowledge and Behavior of Primary Care Physicians Regarding Utilization of Standardized Tools in Screening and Assessment of Anxiety, Depression, and Mood Disorders at a Large Integrated Health System.","authors":"Abdul Waheed, Asif Khan Afridi, Masooma Rana, Mobeena Arif, Trajan Barrera, Feroza Patel, Muhammad Nausherwan Khan, Erum Azhar","doi":"10.1177/21501319231224711","DOIUrl":"10.1177/21501319231224711","url":null,"abstract":"<p><strong>Introduction: </strong>Standardized screening, objective evaluation, and management of behavioral health conditions are major challenges in primary care. The Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Mood Disorder Questionnaire (MDQ) provide standardized screening and symptom management tools for generalized anxiety disorder (GAD), major depressive disorder (MDD), and Mood Disorders (MD), respectively. This study explores family physicians' knowledge, attitudes, and practices regarding the utilization of GAD-7, PHQ-9, and MDQ in outpatient primary care offices.</p><p><strong>Methods: </strong>The study method was a cross-sectional electronic and paper survey utilizing a self-administered questionnaire that assessed primary care physicians' demographics, knowledge, attitudes, and practices in rural and urban outpatient clinical settings regarding GAD-7, PHQ-9, and MDQ. Statistical software SAS 9.4 was used for descriptive and Chi-Square statistics.</p><p><strong>Results: </strong>Out of 320 total participants,145 responded (45.3%). Responding family physicians demonstrated a high level of familiarity with the GAD-7 (97.9%), PHQ-9 (97.9%), and MDQ (81.3%) assessment tools. However, the reported utilization rates were relatively lower than knowledge, with 62.7%, 73.1%, and 31.9% extremely likely or likely to utilize the GAD-7, PHQ-9, and MDQ as screening and monitoring tools, respectively. Less than a quarter of the total respondents use the objective score for the future management of GAD, with significantly more residents utilizing the score for GAD-7 compared to attendings (<i>P</i> < .05). There was no statistical significance difference between residents and attendings for the objective evaluation of Major Depressive Disorder (<i>P</i> = .26) and Mood Disorders (<i>P</i> = .05).</p><p><strong>Conclusions: </strong>Despite being knowledgeable of the utility of GAD-7, PHQ-9, and MDQ, the primary care physicians in a large integrated health system in Central Pennsylvania and Northern Maryland report inconsistent utilization in their practice. Further studies are needed to determine the underlying factors contributing to the suboptimal usage of these screening tools and ways to increase it.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139703706","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 Analysis of Tobacco and Marijuana Use by Middle School and High School Bisexual and Homosexual Students Surveyed by the National Youth Tobacco Survey From 2020 to 2022.","authors":"Derrick Williams, Shengping Yang, Kenneth Nugent","doi":"10.1177/21501319241276790","DOIUrl":"10.1177/21501319241276790","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to analyze tobacco and marijuana use by middle and high school students identifying as bisexual, gay, lesbian, or heterosexual using data from the National Youth Tobacco Survey (NYTS) spanning from 2020 to 2022. By comparing substance use patterns among different sexual orientation groups, the study sought to identify disparities and potential socioeconomic factors influencing these behaviors.</p><p><strong>Methods: </strong>Data from the 2020 to 2022 NYTS were analyzed, focusing on responses regarding ever use of cigarettes, e-cigarettes, and marijuana by students of varying sexual orientations. Descriptive statistics and chi-square tests were employed to analyze differences in substance use and socioeconomic indicators between sexual orientation groups.</p><p><strong>Results: </strong>Of the 37 541 students included in the analysis, significant differences in substance use were observed among bisexual, gay, lesbian, and heterosexual students. Bisexual and gay/lesbian students exhibited higher rates of ever use of cigarettes, e-cigarettes, and marijuana compared to heterosexual students. In addition, socioeconomic differences, such as lower rates of family vehicle ownership and reduced access to vacations, were noted among bisexual and gay/lesbian students.</p><p><strong>Conclusions: </strong>The findings underscore significant differences in tobacco and marijuana use by adolescents based on sexual orientation, mirroring differences observed in LGBTQ adults. These results highlight the importance of targeted interventions, educational initiatives, and support systems tailored to the unique needs of LGBTQ youth. Addressing socioeconomic disparities and fostering inclusive environments are crucial steps in promoting the health and well-being of LGBTQ adolescents. Continued research and collaborative efforts are essential in mitigating health disparities and creating equitable environments for all adolescents.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126944","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":"Evaluation of Interprofessional Delivery of Diabetes Medication Management Training Among Family Medicine Residents.","authors":"Amanda Davis, Katherine Davis, Elise Moore, Britanee Samuelson, Lauren Stonerock, Nathaniel E Miller","doi":"10.1177/21501319241276801","DOIUrl":"10.1177/21501319241276801","url":null,"abstract":"<p><strong>Objective: </strong>Diabetes-related care makes up approximately 24% of outpatient clinic visits. Therefore, confidence and understanding of diabetes management is necessary for family medicine residents.</p><p><strong>Methods: </strong>We developed a combined lecture and simulation lab curriculum utilizing a registered nurse and pharmacist to deliver education to 20 family medicine learners. Pre and post surveys of the educational material were completed in 2 sections including one gauging medical knowledge and a second part gauging level of comfort.</p><p><strong>Results: </strong>Of the learners who participated, fourteen completed the pre-post surveys. Most (53%) respondents improved their scores, while 20% scored the same 27% scored worse. The overall average score increased 57% to 70% and improvement was statistically significant (<i>P</i> < .05). All learners improved confidence by at least 1 point.</p><p><strong>Conclusion: </strong>An interprofessional team utilizing a lecture curriculum focusing on providing education on effective prescribing, medication safety profiles, and resource availability, showed improvement in confidence but mixed knowledge benefit. Further modifications to the curriculum may yield further educational gains.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126945","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":"Suicide in Healthcare Workers: An Umbrella Review of Prevalence, Causes, and Preventive Strategies.","authors":"Lakshit Jain, Zouina Sarfraz, Surya Karlapati, Sibtain Kazmi, Muhammad Jamal Nasir, Noor Atiq, Danya Ansari, Darshini Shah, Urooj Aamir, Kashaf Zaidi, Aarij Shakil Zubair, Pallawi Jyotsana","doi":"10.1177/21501319241273242","DOIUrl":"10.1177/21501319241273242","url":null,"abstract":"<p><strong>Background: </strong>The medical profession faces a critical challenge with the mental health of its practitioners, leading to an alarming increase in suicide rates among healthcare workers (HCW). Factors such as the culture of perfectionism, excessive workloads, and stigma against seeking help exacerbate this issue. This umbrella review synthesizes the existing literature on HCW suicide, exploring the prevalence, causes, and potential preventive strategies.</p><p><strong>Methods: </strong>This study conducted a search of the literature from PubMed/Medline, Scopus, Web of Science, Cochrane Library, PsycINFO, and Google Scholar until April 2, 2024. The non-exhaustive search terms used were \"doctor suicide,\" \"physician suicide,\" \"medical professional suicide,\" \"suicide in healthcare,\" \"healthcare worker suicide prevention,\" and \"causes of healthcare worker suicide.\" Hand-searches were also conducted. Of the 487 studies initially identified, a total of 10 systematic reviews/meta-analyses were included.</p><p><strong>Results: </strong>This umbrella review collates findings from 400 primary clinical studies conducted between the years 2004 and 2023. With a focus on mental health factors contributing to suicide in HCW, there are regional and specialty-specific variations in stress prevalence in the populace. Further, anesthesiologists and psychiatrics depicted higher rates of burnout compared to other HCW; causative factors such as seeking perfection and challenging work-life balance were key when assessing suicidal behaviors in these groups. Job demand level was found to correlate directly with suicidal thoughts, specifically among psychiatric ward HCW, where access to drugs and sharp instruments is readily available. In specific contexts, female HCWs showed a standardized mortality ratio (SMR), indicating that the rate of suicide was higher among them as compared to the general female population. Interventions such as cognitive behavioral therapy (CBT) and mindfulness were effective in decreasing depression, psychological distress, and anxiety in several included studies. This umbrella review also identified major obstacles to seeking help, including stigma and the fear of professional consequences.</p><p><strong>Conclusion: </strong>To reduce suicide rates among HCWs, it is the need of the hour to implement evidence-based interventions and create supportive work environments that encourage mutual care for each other's emotional health. Further research is necessary to determine the effectiveness of various measures in preventing suicide among HCW.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126946","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":"Building Authentic Connection in the Patient-Physician Relationship.","authors":"Sheryl Fuehrer, Amy Weil, Lars G Osterberg, Donna M Zulman, Matthew R Meunier, Rachel Schwartz","doi":"10.1177/21501319231225996","DOIUrl":"10.1177/21501319231225996","url":null,"abstract":"<p><strong>Introduction/objectives: </strong>Delivering optimal patient care is impacted by a physician's ability to build trusting relationships with patients. Identifying techniques for rapport building is important for promoting patient-physician collaboration and improved patient outcomes. This study sought to characterize the approaches highly skilled primary care physicians (PCPs) use to effectively connect with diverse patients.</p><p><strong>Methods: </strong>Using an inductive thematic analysis approach, we analyzed semi-structured interview transcripts with 10 PCPs identified by leadership and/or colleagues for having exceptional patient communication skills. PCPs practiced in 3 diverse clinic settings: (1) academic medical center, (2) Veterans Affairs clinic, and (3) safety-net community clinic.</p><p><strong>Results and conclusions: </strong>The thematic analysis yielded 5 themes that enable physicians to establish connections with patients: Respect for the Patient, Engaged Curiosity, Focused Listening, Mutual Participation, and Self-Awareness. Underlying all of these themes was a quality of authenticity, or a state of symmetry between one's internal experience and external words and actions. Adopting these communication techniques while allowing for adaptability in order to remain authentic in one's interactions with patients may facilitate improved connection and trust with patients. Encouraging physician authenticity in the patient-physician relationship supports a shift toward relationship-centered care. Additional medical education training is needed to facilitate authentic connection between physicians and patients.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10823846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571858","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":"Adolescent Substance Use Disorder in Primary Care: Challenges in Treatment Referral Beyond Access Availability.","authors":"Benjamin Lai, Jonathan Good, Gagandeep Singh, Meghan Deyo, Rachel Marshall, Tyler Oesterle","doi":"10.1177/21501319241276817","DOIUrl":"10.1177/21501319241276817","url":null,"abstract":"<p><strong>Objective: </strong>Fatal overdoses are the third leading cause of death in the pediatric population. Substance use disorders (SUD) screening is not routinely done in primary care practices. Early screening and intervention for adolescent SUD could mitigate future harm.</p><p><strong>Methods: </strong>We conducted a 3-month pilot adapting universal screening using the CRAFFT tool in patients aged 12 to 17 presenting to an urban and a rural primary care practice during well-child and acute/sick-child visits. We collaborated with our pediatric addiction service to ensure access availability for further assessment and treatment for all positively screened patients; this was broadly communicated to primary care providers.</p><p><strong>Results: </strong>There was a higher CRAFFT completion rate in the urban site (90%, vs 52.6% in our rural site). The majority of CRAFFT questionnaires were completed during acute/sick-child visits in both study sites. Moreover, we found a higher positive screen rate in our rural practice (14.6%, vs 2.4% in our urban practice). Only 27% of positively screened patients had substance use addressed by their providers. No pediatric addiction referrals were made.</p><p><strong>Conclusions: </strong>Findings suggest provider-level barriers exist despite having adequate specialty referral sources and institutional encouragement. Future work is needed to explore these barriers.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141335","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}