scholarly journals Innovative Multidisciplinary Care Models Provided via Telehealth During the COVID Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 280-280
Author(s):  
Shahla Baharlou ◽  
Lee Lindquist
Keyword(s):  
Primary Care ◽  
Health Care ◽  
New York ◽  
Collaborative Care ◽  
Care Delivery ◽  
Behavioral Therapy ◽  
Multidisciplinary Care ◽  
Holistic Approach ◽  
Health Care Planning ◽  
Care Needs

Abstract Integrated and collaborative care lead to better care. Addressing the behavioral and mental health care needs of patients results in better health outcomes. Interdisciplinary and multi-disciplinary approaches to health care delivery yield more effective health care planning. A holistic approach to healthcare sees the individual as more than the sum of diseases. Research studies have supported these assertions and yet, in actual practice, they are often more aspirational than actualized. The COVID-19 pandemic has made it even more difficult to implement collaborative care delivered by varied professional disciplines. This symposium describes efforts to provide more holistic and multidisciplinary care in the primary care geriatrics practice of the Dept. of Geriatrics & Palliative Medicine, Icahn School of Medicine. This New York City practice has 4,500 patients with diverse backgrounds and a median age of 85. In the first paper, Baharlou and her colleagues describe the establishment of an IMPACT collaborative care depression model in the middle of the COVID-19 pandemic. It was adapted to be provided by telephone and uses a different psychosocial intervention than is usually implemented. Hinrichsen and Leipzig outline the successful integration of Cognitive Behavioral Therapy for Insomnia into geriatrics primary care to improve insomnia in older adults and deprescribe sleep medications. Munoz and her colleagues describe the ALIGN program which is an interdisciplinary team effort, informed by the social determinants of health framework, to facilitate access to an array of services delivered virtually because of the pandemic.

scholarly journals Primary Care for Transgender Individuals: A Review of the Literature Reflecting a Canadian Perspective

SAGE Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 215824402096282
Author(s):  
Erin Ziegler ◽  
Ruta Valaitis ◽  
Nancy Carter ◽  
Cathy Risdon ◽  
Jennifer Yost
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Access To Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Care Needs ◽  
Care Services ◽  
Primary Care Delivery ◽  
Canadian Perspective ◽  
Primary Care Practitioners

Literature related to transgender health in adults has focused on definitions, hormone therapy, and transgender-sensitive care provision. Further understanding is needed on the delivery of primary care for transgender adults. The aim of this review was to understand the primary-care needs and access to health care services for transgender adults in Canada. A state-of-the-art literature review was conducted. Thirteen research studies were included. There is limited literature on the delivery of primary care for transgender adults, particularly in Canada. Health care issues and access to care have been explored. However, there remains minimal Canadian content on primary-care delivery for transgender adults. Additional studies are needed to understand transgender primary-care needs in Canada. Further understanding can reduce the invisibility and disparities experienced by transgender individuals. With better understanding of transgender primary health care issues, primary-care practitioners can advocate for the heath needs of their patients and improve care delivery.

Raising burden of non-communicable diseases: importance of integrating Yoga and Naturopathy at primary care level

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Hyndavi Salwa ◽  
Pradeep M.K. Nair
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Care Delivery ◽  
Total Mortality ◽  
Holistic Approach ◽  
Communicable Diseases ◽  
Care Level ◽  
Primary Care Level ◽  
Non Communicable Diseases ◽  
The People

AbstractPrimary health care is a vital component in health care delivery. Non-communicable diseases (NCD’s) are rising like a major threat to human survival, which is expected to account for 75% of the total mortality by 2030. Lifestyle and behavioural changes are reckoned as the way ahead. Yoga and Naturopathy, a drugless system of medicine has intersecting paradigms which addresses all planes of health effectively. Yoga and Naturopathy through its holistic approach educate and make the people responsible for their own health. It has shown its efficacy in alleviating and preventing various NCD’s. A systematic approach should be initiated, which can channelize the integration of Yoga and Naturopathy at the primary care level considering its cost-effectiveness and efficacy over NCD’s.

COVID 19 and Special Care Dentistry: A Narrative Review

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1473-1476
Author(s):  
Ashwika Datey ◽  
Soumya Singhai ◽  
Gargi Nimbulkar ◽  
Kumar Gaurav Chhabra ◽  
Amit Reche
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Services ◽  
Care Delivery ◽  
Special Care ◽  
World Health ◽  
Healthcare Sector ◽  
Health Care Needs ◽  
Oral Diseases ◽  
Care Needs

The COVID 19 outbreak has been declared a pandemic by the world health organisation. The healthcare sector was overburdened and overstretched with the number of patient increasing and requiring health services. The worst-hit population always are the people with special needs, whether it is children, pregnant females or the geriatric population. The need for the emergency kind of health services was so inflated that the other special population which required them equally as those patients with the COVID 19 suffered a lot. Dentistry was not an exception, and even that is also one of the important components of the health care delivery system and people requiring oral health care needs were also more. Those undergoing dental treatments would not have completed the treatment, and this would have resulted in various complications. In this situation, some dental emergency guidelines have been released by Centres for Disease Control (CDC) for the urgent dental care those requiring special care dentistry during the COVID 19 pandemic. Children with special care needs were considered more vulnerable to oral diseases; hence priority should have been given to them for dental treatments moreover in the future also more aggressive preventive measures should be taken in order to maintain oral hygiene and prevent many oral diseases. Guardians/caregivers should be made aware and motivated to maintain the oral health of children with special health care needs. This review mainly focuses on the prevention and management of oral diseases in children's with special care needs.

scholarly journals Preprocedural SARS-CoV-2 Testing to Sustain Medically Needed Health Care Delivery During the COVID-19 Pandemic: A Prospective Observational Study

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Ghady Haidar ◽  
Ashley Ayres ◽  
Wendy C King ◽  
Mackenzie McDonald ◽  
Alan Wells ◽  
...  
Keyword(s):  
Health Care ◽  
New York ◽  
Prospective Observational Study ◽  
Care Delivery ◽  
Community Hospitals ◽  
Symptom Screening ◽  
Academic Hospitals ◽  
Hospital Patients ◽  
Polymerase Chain ◽  
A Prospective Study

Abstract Background We implemented a preprocedural severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening initiative designed to sustain health care during a time when the extent of SARS-CoV-2 infection was unknown. Methods This was a prospective study of patients undergoing procedures at 3 academic hospitals in Pittsburgh, Pennsylvania (April 21–June 11), and 19 community hospitals across Middle/Western Pennsylvania and Southwestern New York (May 1–June 11). Patients at academic hospitals underwent symptom screening ≤7 days preprocedure, then SARS-CoV-2 nasopharyngeal polymerase chain reaction (PCR) testing 1–4 days preprocedure. A subset also underwent day-of-procedure testing. Community hospital patients underwent testing per local protocols. We report SARS-CoV-2 PCR positivity rates, impact, and barriers to testing encountered through June 11. PCR positivity rates of optional preprocedural SARS-CoV-2 testing for 2 consecutive periods following the screening initiative are also reported. Results Of 5881 eligible academic hospital patients, 2415 (41.1%) were tested (April 21–June 11). Lack of interest, distance, self-isolation, and nursing home/incarceration status were barriers. There were 11 PCR-positive patients (10 asymptomatic) among 10 539 patients tested (0.10%; 95% CI, 0.05%–0.19%): 3/2415 (0.12%; 95% CI, 0.02%–0.36%) and 8/8124 (0.10%; 95% CI, 0.04%–0.19%) at academic and community hospitals, respectively. Procedures were performed as scheduled in 40% (4/10) of asymptomatic PCR-positive patients. Positivity increased during subsequent coronavirus disease 2019 (COVID-19) surges: 54/34 948 (0.15%; 95% CI, 0.12%–0.20%) and 101/24 741 (0.41%; 95% CI, 0.33%–0.50%) PCR-positive patients from June 12–September 10 and September 11–December 15, respectively (P < .0001). Conclusions Implementing preprocedural PCR testing was complex and revealed low infection rates (0.24% overall), which increased during COVID-19 surges. Additional studies are needed to define the COVID-19 prevalence threshold at which universal preprocedural screening is warranted.

Direct Primary Care: A Successful Financial Model for the Clinical Practice of Lifestyle Medicine

2021 ◽  
pp. 155982762110066
Author(s):  
Amy R. Mechley
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Well Being ◽  
The United States ◽  
Fee For Service ◽  
Financial Model ◽  
Lifestyle Medicine ◽  
Direct Primary

Primary care has been shown to significantly decrease the overall cost of a population’s health care while improving the quality of each person’s well-being. Lifestyle medicine (LM) is ideally positioned to be delivered via primary care and has been shown to improve short- and long-term health outcomes of patients and populations. Direct primary care (DPC) represents a viable alternative to the fee-for-service reimbursement model. It has been shown to be economically and financially sustainable. Furthermore, it has the potential to fulfill the Quadruple Aim of health care in the United States. LM practiced in a DPC model has the potential to transform health care delivery. This article will discuss the need for health care systems change, provide an overview of the DPC model, demonstrate a basic understanding of the benefits, and review the steps needed to de-risk the investment of time, money, and resources for our future DPC providers.

scholarly journals Demographic Characteristics, Care, and Outcomes for Children with Oral Clefts in Three States Using Participants from the National Birth Defects Prevention Study

2009 ◽  
Vol 46 (6) ◽  
pp. 575-582 ◽  
Author(s):  
Peter Damiano ◽  
Margaret Tyler ◽  
Paul A. Romitti ◽  
Charlotte Druschel ◽  
April A. Austin ◽  
...  
Keyword(s):  
Health Care ◽  
New York ◽  
Health Status ◽  
Birth Defects ◽  
Population Based ◽  
Primary Objective ◽  
Demographic Characteristics ◽  
Prevention Study ◽  
Care Needs ◽  
Oral Clefts

Objective: The primary objective of this study was to evaluate whether there were differences in the characteristics and outcomes of care for children with oral clefts (OCs) among population-based samples in three states. Design: Data on the health status and on speech and esthetic outcomes were collected using structured telephone interviews conducted during 2005–2006 with mothers of children with OCs aged 2 to 7 in Arkansas, Iowa, and New York. Participants: Mothers of children born with nonsyndromic OCs on or after January 1, 1998, and on or before December 31, 2003, in Arkansas, Iowa, or New York. Subjects were identified through their participation in the ongoing National Birth Defects Prevention Study. Main Outcome Measures: Demographic characteristics, rating of cleft care, severity of condition, health status, esthetic outcomes, and speech problems were evaluated by state of residence. Results: Children with OCs from Arkansas were from lower income families, and their parents were less likely to be married. Children with OCs from Arkansas were more likely to have special health care needs and to require mental health care. Few differences were found across states in type of cleft, severity of cleft, or outcomes of cleft care. Conclusions: Combining results from population-based samples across multiple studies increases the variability of sample characteristics. Including multiple states can be an efficient way to learn more about the outcomes of medical care for less common conditions such as oral cleft.

scholarly journals Primary care teams’ experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rachelle Ashcroft ◽  
Catherine Donnelly ◽  
Maya Dancey ◽  
Sandeep Gill ◽  
Simon Lam ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Qualitative Study ◽  
Mental Health Care ◽  
Focus Groups ◽  
Care Delivery ◽  
Virtual Care ◽  
Primary Care Teams ◽  
The Impact

Abstract Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond.

Evaluating Child Health Plus in Upstate New York: How Much Does Providing Health Insurance to Uninsured Children Increase Health Care Costs?

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_E1) ◽  
pp. 728-732 ◽  
Author(s):  
Jack Zwanziger ◽  
Dana B. Mukamel ◽  
Peter G. Szilagyi ◽  
Sarah Trafton ◽  
Andrew W. Dick ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
New York ◽  
Health Insurance ◽  
Care Utilization ◽  
Average Change ◽  
Uninsured Children ◽  
Primary Care Utilization ◽  
Care Costs ◽  
Child Health Plus

Background. In response to the increase in the number of American children without health insurance, new federal and state programs have been established to expand health insurance coverage for children. However, the presence of insurance reduces the price of care for families participating in these programs and stimulates the use of medical services, which leads to an increase in health care costs. In this article, we identified the additional expenditures associated with the provision of health insurance to previously uninsured children. Methods. We estimated the expenditures on additional services using data from a study of children living in the Rochester, New York, area who were enrolled in the New York State Child Health Plus (CHPlus) program. CHPlus was designed specifically for low-income children without health insurance who were not eligible for Medicaid. The study sample consisted of 1910 children under the age of 6 who were initially enrolled in CHPlus between November 1, 1991 and August 1, 1993 and who had been enrolled for at least 9 continuous months. We used medical chart reviews to determine the level of primary care utilization, parent interviews for demographic information, as well as specialty care utilization, and we used claims data submitted to CHPlus for the year after enrollment to calculate health care expenditures. Using this information, we estimated a multivariate regression model to compute the average change in expenditures associated with a unit of utilization for a cross-section of service types while controlling for other factors that independently influenced total outpatient expenditures. Results. Expenditures for outpatient services were closely related to primary care utilization—more utilization tended to increase expenditures. Age and the presence of a chronic condition both affected expenditures. Children with chronic conditions and infants tended to have more visits, but these visits were, on average, less expensive. Applying the average change in expenditures to the change in utilization that resulted from the presence of insurance, we estimated that the total increase in expenditures associated with CHPlus was $71.85 per child in the year after enrollment, or a 23% increase in expenditures. The cost increase was almost entirely associated with the provision of primary care. Almost three-quarters of the increase in outpatient expenditures was associated with increased acute and well-child care visits. Conclusions. CHPlus was associated with a modest increase in expenditures, mostly from additional outpatient utilization. Because the additional primary care provided to young children often has substantial long-term benefits, the relatively modest expenditure increases associated with the provision of insurance may be viewed as an investment in the future.

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