The importance of dialogue: communication strategy for empowerment of low-income African American patients via in-depth interviews of primary care providers at inner-city health clinics

2019 ◽  
Vol 12 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Rania W. Frederick ◽  
Moon J. Lee
Keyword(s):  
Primary Care ◽  
African American ◽  
Inner City ◽  
Low Income ◽  
Primary Care Providers ◽  
Communication Strategy ◽  
Care Providers ◽  
Health Clinics ◽  
Depth Interviews

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 Racial disparities in health care access among pediatric patients with craniosynostosis

2016 ◽  
Vol 18 (3) ◽  
pp. 269-274 ◽  
Author(s):  
Zackary D. Brown ◽  
Amita K. Bey ◽  
Christopher M. Bonfield ◽  
Ashly C. Westrick ◽  
Katherine Kelly ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
African American ◽  
Parental Education ◽  
Care Facility ◽  
Primary Care Providers ◽  
Family Characteristics ◽  
Care Providers ◽  
Time To Surgery ◽  
Significant Difference

OBJECTIVE Disparities in surgical access and timing to care result from a combination of complex patient, social, and institutional factors. Due to the perception of delayed presentation for overall health care services and treatment in African American patients on the part of the senior author, this study was designed to identify and quantify these differences in access and care between African American and Caucasian children with craniosynostosis. In addition, hypotheses regarding reasons for this difference are discussed. METHODS A retrospective study was conducted of 132 children between the ages of 0 and 17 years old who previously underwent operations for craniosynostosis at a tertiary pediatric care facility between 2010 and 2013. Patient and family characteristics, age at surgical consultation and time to surgery, and distance to primary care providers and the tertiary center were recorded and analyzed. RESULTS Of the 132 patients in this cohort, 88% were Caucasian and 12% were African American. The median patient age was 5 months (interquartile range [IQR] 2–8 months). African Americans had a significantly greater age at consult compared with Caucasians (median 341 days [IQR 192–584 days] vs median 137 days [IQR 62–235 days], respectively; p = 0.0012). However, after being evaluated in consultation, there was no significant difference in time to surgery between African American and Caucasian patients (median 56 days [IQR 36–98 days] vs median 64 days [IQR 43–87 days], respectively). Using regression analysis, race and type of synostoses were found to be significantly associated with a longer wait time for surgical consultation (p = 0.01 and p = 0.04, respectively, using cutoff points of ≤ 180 days vs > 180 days). Distance traveled to primary care physicians and to the tertiary care facility did not significantly differ between groups. Other factors such as parental education, insurance type, household income, and referring physician type also showed no significant difference between racial groups. CONCLUSIONS This study identified a correlation between race and age at consultation, but no association with time to surgery, distance, or family characteristics such as household income, parental education, insurance type, and referring physician type. This finding implies that delays in early health-seeking behaviors and subsequent referral to surgical specialists from primary care providers are the main reason for this delay among African American craniofacial patients. Future studies should focus on further detail in regards to these barriers, and educational efforts should be designed for the community and the health care personnel caring for them.

scholarly journals Primary care provider prep prescribing practices : southern United States

2021 ◽  
Author(s):  
◽  
Daryl Traylor
Keyword(s):  
Primary Care ◽  
African American ◽  
Patient Adherence ◽  
Stage Of Change ◽  
Primary Care Providers ◽  
Southern United States ◽  
Prior Authorization ◽  
Care Providers ◽  
Prescribing Practices ◽  
Clinical Leadership

The Southern United States (U.S.) accounts for more than half of new HIV cases annually and African Americans make up the majority of new HIV diagnoses in this region. Pre-Exposure Prophylaxis (PrEP) is an effective biomedical HIV prevention strategy that is underutilized. Few studies have examined the PrEP prescribing practices of primary care providers (PCPs), particularly in the Southern U.S. This cross-sectional survey, driven by the Transtheoretical Model (TTM), examined the prescribing practices of Southern U.S. PCPs. Relationships between PCPs personal and practice variables were examined, together with TTM decisional balance variables. Participants (n=223) who had more African American patients in their practice were more likely to be in a higher TTM stage of change (p = .002) and were more likely to have written a PrEP prescription (p = .001). Access to PrEP resources (OR = 1.85, p = .001), streamlined insurance prior authorization processes (OR = 1.52, p = .010), working with staff who have PrEP knowledge (OR = 1.51, p = .033), having PrEP training (OR = 40.26, p < .001) and having patients who are motivated to take PrEP (OR = 2.19, p = .007) were significant facilitators to PrEP prescribing. Significant barriers to PrEP prescribing included a lack of provider PrEP training (OR = 0.43, p = .003), lack of clinical leadership regarding PrEP (OR = 0.65, p = .018), lack of insurance (OR = 2.74, p = .002), and likelihood of low patient adherence to PrEP (OR = 0.53, p = .001). Findings indicate that this sample of PCPs were more likely to be at a higher TTM stage of change and have written a PrEP prescription if they saw more African American patients in their practice. Further, significant facilitators of PrEP prescribing included access to PrEP resources, streamlined insurance prior authorization processes, working with staff who have PrEP knowledge, having PrEP training, and having patients who are motivated to take PrEP. Significant barriers to PrEP prescribing included a lack of PrEP training, a lack of clinical leadership regarding PrEP, patient lack of insurance, and likelihood of low patient adherence. This study contributes to the body of knowledge regarding PCP PrEP prescribing practices. Findings from this study may inform future interventions that aim to enhance PrEP prescribing among primary care providers who serve Southern African American individuals at risk for acquisition of HIV disease.

scholarly journals Determinants of Successful Weight Loss in Low-Income African American Women: A Positive Deviance Analysis

2018 ◽  
Vol 9 ◽  
pp. 215013271879213 ◽  
Author(s):  
Elaine Seaton Banerjee ◽  
Sharon J. Herring ◽  
Katelyn Hurley ◽  
Katherine Puskarz ◽  
Kyle Yebernetsky ◽  
...  
Keyword(s):  
Weight Loss ◽  
African American ◽  
African American Women ◽  
Low Income ◽  
Primary Care Providers ◽  
Positive Deviance ◽  
Care Providers ◽  
Chi Square ◽  
American Women ◽  
Successful Weight Loss

Objective: We set out to investigate the behaviors of low-income African American women who successfully lost weight. Methods: From an urban, academic, family medicine practice, we used a mixed methods positive deviance approach to evaluate 35 low-income African American women who were obese and lost at least 10% of their maximum weight, and maintained this loss for 6 months, comparing them with 36 demographically similar control participants who had not lost weight. Survey outcomes included demographics and behaviors that were hypothesized to be related to successful weight loss. Interviews focused on motivations, barriers, and what made weight loss successful. Survey data were analyzed using t tests and linear regression for continuous outcomes and chi-square tests and logistic regression for categorical outcomes. Interviews were analyzed using a modified approach to grounded theory. Results: In adjusted analyses, women in the positive deviant group were more likely to be making diet changes compared with those women who did not lose at least 10% of their initial body weight. Major themes from qualitative analyses included ( a) motivations (of health, appearance, quality of life, family, and epiphanies), ( b) opportunity (including time and support), ( c) adaptability. Conclusions: The findings of this study may be useful in developing motivational interviewing strategies for primary care providers working with similar high-risk populations.

Abstract P453: Keep Your Heart Healthy: Engaging Medical Students to Reduce Cardiovascular Disease Risk in Low Income Communities

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
David A Klein ◽  
Allison L Ducharme-Smith ◽  
Jasmine Rassiwala ◽  
Nilay S Shah ◽  
Claudia L Leung ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Weight ◽  
African American ◽  
Medical Students ◽  
Community Health ◽  
Low Income ◽  
Primary Care Providers ◽  
Care Providers ◽  
Cvd Risk ◽  
Convenience Sample

Background: Cardiovascular diseases (CVD) are largely preventable yet remain leading causes of morbidity and mortality in Chicago, especially in minority neighborhoods. Hypothesis: Medical schools can engage students to conduct community CVD screening and consultation to reduce risks in low income Chicago communities with high CVD mortality rates. Objectives: Keep Your Heart Healthy (KYHH) initiative is a collaboration of the Feinberg School of Medicine, Chicago Department of Public Health, and community partners. The KYHH pilot aims to engage medical students to determine current CVD risks through screening and consultation in primarily Hispanic (Humboldt Park) and African American (North Lawndale) Chicago communities. We report on the pilot: August 1, 2013 to date. Methods: A total of 54 medical students volunteered, including 26% of the first-year class. A convenience sample of adults was recruited by community health workers. Medical student volunteers, trained by Feinberg faculty, conducted interviews to assess CVD risk by participant self report, measured body weight and blood pressure, and provided brief, personalized counseling based on the American Heart Association’s “Life’s Simple 7.” Participants with blood pressure ≥ 140/90 were referred to their primary care providers or a Federally Qualified Health Center. Randomly selected participants provided post-event survey feedback. Results: At 17 events, students (mean = 8) screened 650 participants in Humboldt Park (further data n=329 at time of submission) and 119 participants in North Lawndale. Demographics (Humboldt Park vs North Lawndale) were as follows: race/ethnicity (82% Latino vs 94% African American); age (63% vs 54% 40-65 years old); gender (62% vs 75% women). Self-reported CVD risk factors included cigarette smoking (31% vs 21%), diabetes (33% vs 17%), hypertension (47% vs 34%), and prior heart attack (8% vs 7%) or stroke (5% vs 1%). Obesity (42% vs 57%) and uncontrolled hypertension (20% vs 23%) rates were high. Humboldt Park and North Lawndale participants rarely (19% vs 15%) or sometimes (41% vs 43%) ate fruit/vegetables, and sometimes (42% vs 50%) or often (20% vs 22%) ate high-salt foods. Participants often lacked insurance or a usual source of care (32% vs 34%). The most common participant-identified goals were achieving a healthier body weight (51% vs 42%) or diet (41% vs 34%). Of 131 participants who provided post-event feedback, 95% indicated they learned something new about their heart health, 92% made goals to improve it, 99% indicated they understood their own personal risks, and 99% indicated they would recommend the screening to others. Conclusion: CVD risk factor burden is high in low income Chicago communities. KYHH is a model for engaging medical students to advance community health by conducting personalized screening and consultation. Early efforts have been well received by community residents.

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