Retaining VA Women’s Health Primary Care Providers: Work Setting Matters

Introduction: Preexposure prophylaxis (PrEP) is an effective biomedical intervention that has the potential to dramatically decrease the incidence of HIV but remains an underutilized method of HIV prevention. The Philadelphia Department of Public Health administered an online survey to health care providers in the Philadelphia area with the aim of characterizing PrEP attitudes, knowledge, and prescribing practices. Methods: Online surveys were distributed to 1000 providers who were recruited through distribution lists of Philadelphia medical providers between September and December 2017. A Likert-type response scale was utilized to analyze participant self-reported responses. Participant practice settings included HIV/ID, family and internal medicine, women’s health, and pediatric/adolescent clinics. Results and Discussion: The response rate of the survey was 9%. Of 81 complete responses, 75% (N = 61) felt comfortable providing PrEP and 77% (N = 62) had ever written a PrEP prescription. Compared with primary care providers, HIV care providers were significantly more knowledgeable about required laboratory testing for prescribing PrEP ( P = .03) and were more likely to have prescribed PrEP to more than 10 patients ( P = .006). Women’s health and pediatric providers reported feeling less comfortable providing PrEP to their patients ( P = .0003). Conclusion: The majority of health care providers in the Philadelphia area who responded to the survey reported experience with providing PrEP to their patients. In the present study, HIV care providers were significantly more comfortable and knowledgeable about prescribing PrEP compared with providers in primary care, women’s health, and/or adolescent/pediatric medicine. Results were limited by sampling bias, as providers who responded to the survey may have prior experience with PrEP. Future Health Department educational trainings need to target primary and preventive care providers, providers who have never prescribed PrEP, and providers who see few patients living with HIV.

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The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽

10.1027/0227-5910/a000511 ◽

2018 ◽

Vol 39 (5) ◽

pp. 397-405 ◽

Cited By ~ 3

Author(s):

Steven Vannoy ◽

Mijung Park ◽

Meredith R. Maroney ◽

Jürgen Unützer ◽

Ester Carolina Apesoa-Varano ◽

...

Keyword(s):

Primary Care ◽

Low Socioeconomic Status ◽

Thematic Analysis ◽

Older Men ◽

Primary Care Providers ◽

Depression Treatment ◽

Care Providers ◽

Low Socioeconomic ◽

Self Image ◽

The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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