scholarly journals Identifying human papillomavirus vaccination practices among primary care providers of minority, low-income and immigrant patient populations

Vaccine ◽  
2014 ◽  
Vol 32 (33) ◽  
pp. 4149-4154 ◽  
Author(s):  
Denise M. Bruno ◽  
Tracey E. Wilson ◽  
Francesca Gany ◽  
Abraham Aragones
Keyword(s):  
Primary Care ◽  
Human Papillomavirus ◽  
Low Income ◽  
Primary Care Providers ◽  
Care Providers ◽  
Human Papillomavirus Vaccination ◽  
Immigrant Patient

To reduce the average age of autism diagnosis, screen preschoolers in primary care

Autism ◽  
2020 ◽  
pp. 136236132096897
Author(s):  
Katharine E Zuckerman ◽  
Sarabeth Broder-Fingert ◽  
R Christopher Sheldrick
Keyword(s):  
Primary Care ◽  
Autism Spectrum Disorder ◽  
Low Income ◽  
Primary Care Providers ◽  
Autism Spectrum ◽  
Additional Treatment ◽  
Spectrum Disorder ◽  
Screening Tools ◽  
Care Providers ◽  
Minority Children

The American Academy of Pediatrics recommends autism spectrum disorder screening at the 18- and 24-month well-child visits. However, despite widespread toddler screening, many children are not diagnosed until school age, and delayed diagnosis is more common among low-income and minority children. Offering autism spectrum disorder screening at preschool well-child checks might reduce disparities and lower the overall age of diagnosis and service initiation. However, screening tools that span the preschool ages and are tailored for primary care are needed. Lay abstract Pediatric primary care providers check for autism signs, usually using a standard checklist, at 18- and 24-month well-child visits. When the checklist shows possible autism, children should be referred for additional treatment and evaluation with an autism specialist. However, many children with autism spectrum disorder are not detected as toddlers. Low-income and minority children are particularly likely to have a late autism spectrum disorder diagnosis. Checking for autism at preschool-aged well-child visits might be one way to identify autism spectrum disorder earlier, especially for low-income and minority children.

Healthy Habits Questionnaire Feasibility and Utility for High-Risk Children

2020 ◽  
Vol 59 (11) ◽  
pp. 978-987
Author(s):  
Nadine L. Camp ◽  
Rebecca C. Robert ◽  
Katherine P. Kelly
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Primary Care Providers ◽  
Overweight And Obesity ◽  
Care Practice ◽  
Healthy Weight ◽  
Care Providers ◽  
Minority Children ◽  
Healthy Habits ◽  
Intervention Protocol

The American Academy of Pediatrics provides guidance for pediatric primary care providers to promote healthy weight during childhood. Screening questions on diet and activity habits can help provider assessment and assist counseling for targeted behavior change. We implemented the parent completed, 10-item 5210 Healthy Habits Questionnaire (Ages 2-9 year) in our primary care practice serving low-income minority children with high rates of overweight and obesity. Adherence to the intervention protocol was high, and providers found the content and method of assessment useful for their counseling of individual patients. The aggregate Healthy Habits Questionnaire data provided a snapshot of the health habits in our local clinic population of children, prompting greater awareness for providers and informing their patient care.

scholarly journals Development of a Tool to Identify Poverty in a Family Practice Setting: A Pilot Study

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Vanessa Brcic ◽  
Caroline Eberdt ◽  
Janusz Kaczorowski
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Low Income ◽  
Poverty Line ◽  
Primary Care Providers ◽  
Case Finding ◽  
Care Providers ◽  
Convenience Sample ◽  
Rural Primary Care ◽  
Housing Security

Objective. The goal of this pilot study was to develop and field-test questions for use as a poverty case-finding tool to assist primary care providers in identifying poverty in clinical practice. Methods. 156 questionnaires were completed by a convenience sample of urban and rural primary care patients presenting to four family practices in British Columbia, Canada. Univariate and multivariate logistic regression analyses compared questionnaire responses with low-income cut-off (LICO) levels calculated for each respondent. Results. 35% of respondents were below the “poverty line” (LICO). The question “Do you (ever) have difficulty making ends meet at the end of the month?” was identified as a good predictor of poverty (sensitivity 98%; specificity 60%; OR 32.3, 95% CI 5.4–191.5). Multivariate analysis identified a 3-item case-finding tool including 2 additional questions about food and housing security (sensitivity 64.3%; specificity 94.4%; OR 30.2, 95% CI 10.3–88.1). 85% of below-LICO respondents felt that poverty screening was important and 67% felt comfortable speaking to their family physician about poverty. Conclusions. Asking patients directly about poverty may help identify patients with increased needs in primary care.

scholarly journals 148 Sustainability of a Benzodiazepine Deprescribing Intervention with Primary Care Providers in a University-Based Community Clinic

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 294-295
Author(s):  
Lois M. Platt ◽  
Teresa A. Savage
Keyword(s):  
Primary Care ◽  
Pharmaceutical Company ◽  
Low Income ◽  
Primary Care Providers ◽  
The United States ◽  
Health Concern ◽  
Current Evidence ◽  
Academic Detailing ◽  
Care Providers ◽  
Community Clinic

Abstract:Study Objectives:In light of the opioid crisis, less attention has been focused on the long-term misuse of benzodiazepines (BZD) for anxiety and sleep disorders. The purpose of this study was to determine the sustainability of positive results (an 80% decrease in BZD prescribing) following a deprescribing intervention with primary care providers working with a low-income population at a Midwestern university-based community clinic.Method:All de-identified BZD prescriptions written by providers at the community clinic were captured using the electronic medical record. A BZD equivalency chart was used to compare the relative potencies of BZD commonly prescribed by the clinic. Each prescription was converted to a single number: the diazepam equivalent (DE). This number takes into account the potency of the drug (using diazepam as the standard), the dose of the drug, number of tablets dispensed and number of refills. The number of DE prescribed was tallied every 30 days for 6 months following the completion of a quality improvement BZD deprescribing intervention. The original intervention was implemented in 2018, with the goal of decreasing the prescription of BZD by clinic primary care providers to outpatients for insomnia or anxiety. The brief intervention combined academic detailing and pharmaceutical company detailing with a deprescribing message. Providers were given current evidence about alternatives to BZD, deprescribing schedules, and brain-storming opportunities about the management of patient concerns and resistance to change. Posters with alternatives to BZD were hung in the main provider office at the clinic. Food and “No Benzo” logo merchandise (mugs, pens) were provided to attendees of the intervention and clinic nurses. Thirty days after the intervention, the number of DE prescribed decreased by 80%.Results:Benzodiazepine prescribing (measured in DE) continued to decrease every 30 days for six months to 92-93% of pre-intervention numbers.Conclusions:Follow up of a 2018 intervention revealed sustainability of the effect of a significant decrease in benzodiazepine (BZD) prescribing in a community clinic. A brief BZD deprescribing intervention using a combination of academic detailing and pharmaceutical company detailing designed to persuade prescribers to change their behavior was effective in influencing providers to decrease the amount of BZD they prescribe. The desired result (an 80% decrease in BZD prescribing) was achieved following the original 30-day intervention. Prescription numbers continued to decrease over the next six months (to 92-93% of pre-intervention numbers), which indicates that the deprescribing intervention may have had a sustainable positive effect on provider prescribing behavior. This intervention is easy to implement and may decrease BZD prescribing, which addresses the overuse/misuse of BZD, a significant public health concern in the United States.Funding Acknowledgements: Personal funds only

scholarly journals Pediatric primary care and subspecialist providers’ comfort, attitudes and practices screening and referring for social determinants of health

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yonit Lax ◽  
Eleanor Bathory ◽  
Sandra Braganza
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Primary Care Physicians ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Pediatric Primary Care ◽  
Care Providers ◽  
Low Income Children ◽  
Academic Medical

Abstract Background Early detection and management of poverty-related disorders is a recommended pediatric practice; however, little is known about variations of practice between pediatric primary care physicians and subspecialists. The objectives of this study were to assess (1) provider perceptions and attitudes toward caring for low-income children in an urban academic medical center, and (2) variations between primary care physicians and subspecialists in social and financial needs screening and referral practices for low-income children. Design/Methods Primary care providers (pediatric and family medicine) and subspecialists providing direct patient care in an urban academic medical center (response rate = 24 %, n = 85/356) completed a 24-item survey (adapted with permission from the AAP Periodic Survey of Fellows No.90) assessing feasibility and comfort screening and addressing social and financial needs, rates of screening for financial hardship, and referrals to local resources. Chi-square tests were performed. Results Among respondents, 88 % (75/85) reported comfort caring for low-income children, while 28 % (24/85) reported comfort inquiring about social and financial needs and 34 % (29/85) referring to community resources. Primary care providers more commonly than subspecialists screened for childcare (80 % vs. 59 %, p = 0.04), parental: employment (84 % vs. 59 %, p = 0.01), education (40 % vs. 17 %, p = 0.02) and mental health (86 % vs. 46 %, p = 0.0001), and less commonly screened for transportation (47 % vs. 73 %, p = 0.01). Primary care providers more commonly referred for public health insurance (74 % vs. 39 %, p = 0.001), public food assistance (30 % vs. 12 %, p = 0.04), and adult mental health services (65 % vs. 44 %, p < 0.05). Conclusions In an urban academic institution serving a population with high poverty rates, pediatric providers feel comfortable providing medical care for low-income children but lack comfort screening and addressing SDH. Though most feel it is their job to refer to resources, less than half felt it was feasible to screen for or address financial needs. Pediatric primary care providers report higher rates of screening and referring than subspecialists. Understanding variations in practice and perceptions among primary care providers and subspecialists may aid in creating interventions to increase screening and referral rates.

scholarly journals Real-world Drivers Behind Communication, Medication Adherence, and Shared Decision Making In Minority Adults with Asthma

2020 ◽  
Vol 11 ◽  
pp. 215013272096780
Author(s):  
Allison A. Norful ◽  
Ani Bilazarian ◽  
Annie Chung ◽  
Maureen George
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Low Income ◽  
Primary Care Providers ◽  
Future Research ◽  
Shared Decision ◽  
Care Providers ◽  
Uncontrolled Asthma ◽  
Black Adults

Background: Inhaled corticosteroids (ICS) are the foundation of asthma management. However, ICS non-adherence is common. Black adults have lower ICS adherence than white adults, which likely contributes, in part, to the asthma disparities that Black adults experience. Objective: To explore how Black adults with uncontrolled asthma and their primary care providers communicated about ICS non-adherence and used shared decision-making to identify strategies to increase ICS use. Design: Eighty routine clinical visits for uncontrolled asthma were audio recorded and inductively analyzed using methods adapted from grounded theory methodology. Participants: Study participants included 80 Black adults (83% female) largely low-income (83% Medicaid) and their 10 primary care providers. The study settings were 2 Federally Qualified Health Centers. Key Results: Three overarching themes were identified: (1) ICS misuse and lack of knowledge; (2) external influences informed personal misconceptions about ICS; and (3) patient-provider communication to individualize plan of care. Conclusions: Reasons for ICS non-adherence in Black adults with uncontrolled asthma offer potential targets for interventions that facilitate enhanced adherence. Future research should include PCP training on strategies that support patient-centered care, such as communication, shared decision-making and patient engagement.

scholarly journals Awareness, Attitudes and Clinical Practices Regarding Human Papillomavirus Vaccination among General Practitioners and Pediatricians in Switzerland

Vaccines ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 332
Author(s):  
Levy Jäger ◽  
Oliver Senn ◽  
Thomas Rosemann ◽  
Andreas Plate
Keyword(s):  
Human Papillomavirus ◽  
General Practitioners ◽  
Primary Care Providers ◽  
Coverage Rate ◽  
Care Providers ◽  
Clinical Practices ◽  
Human Papillomavirus Vaccination ◽  
Web Based ◽  
Number Of Patients ◽  
Male Patients

In Switzerland, the human papillomavirus vaccination (HPVv) coverage rate lies below a desirable threshold. General practitioners (GPs) and pediatricians have been recognized as important providers of the HPVv, but there is little known about their self-attributed role and its relationship with their actual HPVv behavior. Therefore, the objective of this study was to explore the awareness, attitudes, and clinical practices of Swiss GPs and pediatricians concerning HPVv by means of a web-based questionnaire. We analyzed the responses of 422 physicians (72% GPs, 28% pediatricians). A substantial proportion of respondents considered the HPVv “absolutely essential” (54.2% of pediatricians, 30.6% of GPs). GPs indicated spending more time and effort on HPVv counseling for female rather than male patients more often compared to pediatricians (44.0% versus 13.9%, p < 0.001). The weekly number of patients aged 18–26 years seen in practice (p = 0.002) and whether the HPVv was deemed “absolutely essential” (adjusted odds ratio 2.39, 95% confidence interval 1.12–5.08) were factors associated with GPs administering HPVv in their practice. Shortcomings in terms of awareness, effort in the identification of potential vaccination candidates, and the role of male patients were revealed. By addressing these gaps, Swiss primary care providers could contribute to an increase in the national HPVv coverage rate.

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