Integrative Group Medical Visits: A National Scoping Survey of Safety-Net Clinics

Identifying intimate partner violence (IPV) in clinics allows for early intervention. We tested a comprehensive approach in five safety-net clinics to encourage female victims to self-identify and providers to screen. The main components were (a) short, multilingual videos for female patients; (b) provider training; and (c) management tools. Although videos were viewed 2,150 times, only 9% of eligible patients watched them. IPV disclosure increased slightly (6%). Lack of internal champions, high turnover, increased patient load, and technological challenges hindered outcomes. Safety-net clinics need feasible methods to encourage IPV screening. Management champions and IT support are essential for video-based activities.

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4063 Glycemic control in a weight management-focused group medical visits (WM/GMV) intervention: examining the moderating effects of body mass index (BMI)

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.130 ◽

2020 ◽

Vol 4 (s1) ◽

pp. 31-31

Author(s):

Elizabeth Kobe ◽

Cynthia J. Coffman ◽

Amy S. Jeffreys ◽

William S. Yancy ◽

Jennifer Zervakis ◽

...

Keyword(s):

Type 2 Diabetes ◽

Weight Management ◽

Glycemic Response ◽

Targeted Interventions ◽

Group Medical Visits ◽

Low Carbohydrate Diet ◽

Medical Visits ◽

The Impact ◽

Baseline Bmi

OBJECTIVES/GOALS: The impact of baseline BMI on glycemic response to group medical visits (GMV) and weight management (WM)-based interventions is unclear. Our objective is to determine how baseline BMI class impacts patient responses to GMV and interventions that combine WM/GMV. METHODS/STUDY POPULATION: We will perform a secondary analysis of Jump Start, a randomized, controlled trial that compared the effectiveness of a GMV-based low carbohydrate diet-focused WM program (WM/GMV) to traditional GMV-based medication management (GMV) on diabetes control. The primary and secondary outcomes will be change in hemoglobin A1c (HbA1c) and weight at 48 months, respectively. Study participants will be stratified into BMI categories defined by BMI 27-29.9kg/m2, 30.0-34.9kg/m2, 35.0-39.9kg/m2, and ≥40.0kg/m2. Hierarchical mixed models will be used to examine the differential impact of the WM/GMV intervention compared to GMV on changes in outcomes by BMI class category. RESULTS/ANTICIPATED RESULTS: Jump Start enrolled 263 overweight Veterans (BMI ≥ 27kg/m2) with type 2 diabetes. At baseline, mean BMI was 35.3 and mean HbA1c was 9.1. 14.5% were overweight (BMI 27–29.9) and 84.5% were obese (BMI ≥ 30). The proposed analyses are ongoing. We anticipate that patients in the higher BMI obesity classes will demonstrate greater reductions in HbA1c and weight with the WM/GMV intervention relative to traditional GMV. DISCUSSION/SIGNIFICANCE OF IMPACT: This work will advance the understanding of the relationship between BMI and glycemic response to targeted interventions, and may ultimately provide guidance for interventions for type 2 diabetes.

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Medicaid Managed Care's Impact On Safety-Net Clinics In California

Health Affairs ◽

10.1377/hlthaff.19.1.194 ◽

2000 ◽

Vol 19 (1) ◽

pp. 194-202 ◽

Cited By ~ 5

Author(s):

Andrew B. Bindman ◽

Kevin Grumbach ◽

Susannah Bernheim ◽

Karen Vranizan ◽

Michael Cousineau

Keyword(s):

Safety Net ◽

Safety Net Clinics

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Exercise as medicine—the use of group medical visits to promote physical activity and treat chronic moderate depression: a preliminary 14-week pre–post study

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2015-000036 ◽

2015 ◽

Vol 1 (1) ◽

pp. e000036 ◽

Cited By ~ 5

Author(s):

David J Adams ◽

Ronald A Remick ◽

Jennifer C Davis ◽

Sara Vazirian ◽

Karim M Khan

Keyword(s):

Physical Activity ◽

Group Medical Visits ◽

Medical Visits ◽

Moderate Depression

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Assessing the Delivery of Cessation Services to Smokers in Urban, Safety-Net Clinics

Journal of Community Health ◽

10.1007/s10900-014-9843-9 ◽

2014 ◽

Vol 39 (5) ◽

pp. 879-885 ◽

Cited By ~ 6

Author(s):

Martin C. Mahoney ◽

Annamaria Masucci Twarozek ◽

Frances Saad-Harfouche ◽

Christy Widman ◽

Deborah O. Erwin ◽

...

Keyword(s):

Safety Net ◽

Safety Net Clinics ◽

Urban Safety

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Experiences and Perspectives on Adopting New Practices for Social Needs-targeted Care in Safety-net Settings: A Qualitative Case Series Study

Journal of Primary Care & Community Health ◽

10.1177/21501327211017784 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110177

Author(s):

Eileen Nehme ◽

Sierra Castedo de Martell ◽

Hannah Matthews ◽

David Lakey

Keyword(s):

Safety Net ◽

Community Action ◽

Social Needs ◽

Screening Tools ◽

System Level ◽

Community Partner ◽

Community Resource ◽

Case Series Study ◽

Outer Setting ◽

Safety Net Clinics

Introduction Clinical settings are being encouraged to identify and address patients’ social needs within the clinic or through partner organizations. The purpose of this qualitative study was to describe the current practice of social needs-targeted care in 3 Texas safety net clinics, and facilitators and barriers to adopting new social needs-targeted care tools and practices. Methods Interviews were conducted with staff at 3 safety net clinics serving small and mid-sized communities. Analysis focused on perspectives and decisions around adopting new tools or practices related to social needs-targeted care, including standardized screening tools and community resource referral platforms. Results Nine staff across 3 organizations were interviewed. Two organizations were currently using a standard social needs screening tool in their routine practice, and a third was considering doing so. One organization had adopted a community resource referral platform in partnership with a large community collaboration. Three case studies illustrate a range of facilitators, barriers, perceived benefits, and drawbacks influencing social needs-targeted practices. Benefits of systematic data collection on social needs included the generation of data for community action. Drawbacks include concerns about data privacy. Community resource referral platforms were seen as valuable for creating accountability, but required an influential community partner and adequate community resources. Concerns about disempowering clients and blurring roles were voiced, and potential to increase provider job satisfaction was identified. Conclusions Benefits and drawbacks of adopting new tools and practices related to social needs-targeted care are strongly influenced by the community context. For the adoption of community resource referral platforms, the outer setting is particularly relevant; adoption readiness is best assessed at the community or regional level rather than the clinic system level. While screening tools are much easier than referral platforms for clinics to adopt, the ability to address identified needs remains heavily based on the outer setting.

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Abstract 15988: Heart Failure Group Medical Visits to Improve Quality of Life: A Feasibility Study

Circulation ◽

10.1161/circ.142.suppl_3.15988 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Iniya Rajendran ◽

Patricia Williams ◽

Pei-Chun McGregor

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

High Risk ◽

Medication Compliance ◽

Exercise Stress ◽

Retention Data ◽

Group Medical Visits ◽

Medical Visits ◽

The Mean

Introduction: Group Medical Visits (GMV) are medical appointments where patients with similar medical conditions are seen in a group setting. Heart Failure (HF) is an ideal fit for the GMV model of healthcare delivery. HF guidelines emphasize the need for a self-care regimen including symptom knowledge, medication adherence, dietary and lifestyle modifications and social support. We conducted an intervention with these elements in a GMV setting to assess feasibility and improvement in quality of life (QoL). Methods: We enrolled a convenience sample of high-risk veterans with HF who required frequent follow up. Veterans participated in a longitudinal GMV for eight sessions lasting two hours each and occurring once a month. A curriculum was prepared a priori, and each session was led by an invited guest facilitator and focused on nutrition, exercise, stress, holistic health among others. Feasibility was assessed through recruitment and retention data. We also collected pre-post medication compliance data and QoL change using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). We gathered feedback after each session. Results: Twelve patients were invited to the program and nine patients attended the first session. The average attendance was 6 participants each week with 4 participants attending all eight sessions. All were men, 22% identified as Black and 8 of 9 participants had preserved ejection fraction and obesity. At baseline, the mean KCCQ was 49.2. At the end of the intervention, the mean change in KCCQ-12 score was +9 (p=0.39). The largest change (+12, p=0.13) was seen on the QoL subscale. No significant improvement was seen in medication compliance. Participants listed community building, peer to peer education, learning about hospital services and continued contact with their provider as highlights of the program. Due to invitation of high-risk individuals, we had one death and seven hospitalizations during the study period. Conclusions: Longitudinal GMVs for high risk patients has a role in HF education and management. It may improve QoL and provider-patient relationship. It is well accepted by the veteran population and has the potential to be routinely integrated into clinical practice.

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