Cognition in Primary Care Community Resource Directory for Individuals, Caregivers, and Providers

Abstract A KAER Model recommendation is to refer individuals diagnosed with dementia to resources that help them prepare for the future and services that provide ongoing support. The purpose of this project was to locate local quality services and develop a resource directory for persons with cognitive impairment for use by providers, staff, individuals, families, and caregivers. We worked with a Community Advisory Board and interviewed individuals and caregivers to understand what resources are useful and important to include in the resource directory. We built a web-based resource directory that allows users to query resources based on specific needs. We integrated the resource directory within the electronic health record for providers to include after visit summaries. A resource directory was deployed for community use, with goals of sustainability and longevity after this project is completed.

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Development of a multilevel intervention to increase colorectal cancer screening in Appalachia

Implementation Science Communications ◽

10.1186/s43058-021-00151-8 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Aaron J. Kruse-Diehr ◽

Jill M. Oliveri ◽

Robin C. Vanderpool ◽

Mira L. Katz ◽

Paul L. Reiter ◽

...

Keyword(s):

Colorectal Cancer ◽

Primary Care ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

The United States ◽

Advisory Board ◽

Community Advisory Board ◽

Primary Care Clinics ◽

Crc Screening ◽

Multilevel Intervention

Abstract Background Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of “Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia,” a 5-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics. Methods Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs. Results Key informant interviews identified multiple barriers to CRC screening, including fear of screening, test results, and financial concerns (patient level); lack of time and competing priorities (provider level); lack of reminder or tracking systems and staff burden (clinic level); and cultural issues, societal norms, and transportation (community level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events, all of which promoted stool-based screening (i.e., FIT or FIT-DNA). Variability among clinics, including differences in EHR systems, was the most salient barrier to EBI implementation, particularly in terms of tracking follow-up of positive screening results, whereas the development of clinic-wide screening protocols was found to promote fidelity to EBI components. Conclusions Lessons learned from year 1 included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years. Trial registration Trial NCT04427527 is registered at https://clinicaltrials.gov and was registered on June 11, 2020.

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Mental Health Research in Primary Care: Mandates from a Community Advisory Board

The Annals of Family Medicine ◽

10.1370/afm.260 ◽

2005 ◽

Vol 3 (1) ◽

pp. 70-72 ◽

Cited By ~ 10

Author(s):

R. Chene

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Research ◽

Mental Health Research ◽

Advisory Board ◽

Community Advisory Board

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Development of a Multilevel Intervention to Increase Colorectal Cancer Screening in Appalachia

10.21203/rs.3.rs-44851/v1 ◽

2020 ◽

Author(s):

Aaron J. Kruse-Diehr ◽

Jill M. Oliveri ◽

Robin C. Vanderpool ◽

Mira L. Katz ◽

Paul L. Reiter ◽

...

Keyword(s):

Colorectal Cancer ◽

Primary Care ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

The United States ◽

Advisory Board ◽

Community Advisory Board ◽

Primary Care Clinics ◽

Crc Screening ◽

Multilevel Intervention

Abstract Background: Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from Year One of ‘Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia,’ a five-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics.Methods: Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs. Results: Key informant interviews identified multiple barriers to CRC screening, including fear of screening , test results, and financial concerns (patient-level); lack of time and competing priorities (provider-level); lack of reminder or tracking systems and staff burden (clinic-level); and cultural issues, societal norms, and transportation (community-level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events. Conclusions: Lessons learned from Year One included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years.

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Longitudinal Cohort Study of Gender Affirmation and HIV-Related Health in Transgender and Gender Diverse Adults: The LEGACY Project Protocol (Preprint)

10.2196/preprints.24198 ◽

2020 ◽

Author(s):

Sari L. Reisner ◽

Madeline B. Deutsch ◽

Kenneth H. Mayer ◽

Jennifer Potter ◽

Alex Gonzalez ◽

...

Keyword(s):

Primary Care ◽

Hiv Infection ◽

Health Outcomes ◽

Community Health ◽

Advisory Board ◽

Community Advisory Board ◽

Gender Diverse ◽

Gender Affirmation ◽

Primary Care Patients ◽

And Gender

BACKGROUND Transgender and gender diverse (TGD) adults in the U.S. experience health disparities, especially in HIV infection. Medical gender affirmation such as hormone replacement therapy and gender-affirming surgeries is known to be medically necessary and to improve some health conditions. To our knowledge, however, no studies have assessed the effect of gender-affirming medical care on HIV-related health outcomes. OBJECTIVE This study aims to evaluate effects of medical gender affirmation on HIV-related health outcomes among TGD primary care patients. Secondary objectives include characterizing mental health, quality of life, and unmet medical gender affirmation needs. METHODS LEGACY is a longitudinal, multisite, clinic-based cohort of adult TGD primary care patients from two U.S. federally qualified community health centers: Fenway Health in Boston, MA and Callen-Lorde Community Health Center in New York, NY. Eligible adult TGD patients contribute electronic health record data to the LEGACY research data warehouse (RDW). Patients are also offered the option to participate in patient-reported surveys for one-year of follow-up (baseline, 6month, 12-month assessments) with optional HIV/STI testing. Biobehavioral data from the RWD, surveys, and biospecimen collection are linked. HIV-related clinical outcomes include PrEP uptake (patients without HIV); viral suppression (patients with HIV), and anogenital STI diagnoses (all patients). Medical gender affirmation includes hormones, surgeries, and non-hormonal and non-surgical interventions (e.g., voice therapy). RESULTS The contract began in April 2018. The design of the cohort was informed by focus groups with TGD patients (n=28) conducted between August-October 2018, and in collaboration with a Community Advisory Board, Scientific Advisory Board, and site-specific Research Support Coalitions. Prospective cohort enrollment began at Fenway Health in February 2019, and at Callen-Lorde in August 2019. The study is underway with enrollment expected to continue through August 2020. As of April 2020, 7821 patients are enrolled in the LEGACY RDW and 1756 have completed a baseline survey. Participants have a median age of 29 (IQR=11; range=18-82). More than one-third (39.7%) are racial/ethnic minorities (13.7% Black, 6.1% Multiracial, 5.6% Asian/ Pacific Islander, 14.3% other/missing) and 13.7% are Hispanic/Latinx. By gender identity, 33.8% identify as male, 37.1% as female, 21.7% as nonbinary, and 7.4% are unsure or have missing data. Approximately half (52.0%) the cohort was assigned female at birth, and 5.4% are living with HIV infection. CONCLUSIONS The LEGACY cohort is an unprecedented opportunity to evaluate the impact of medical gender affirmation on HIV-related health. The study utilizes a comprehensive research methodology linking TGD patient biobehavioral longitudinal data from multiple sources. Patient-centeredness and scientific rigor are assured through ongoing engagement of TGD communities, clinicians, scientists, and site clinical staff undergirded by epidemiological methodology. Findings will inform evidence-based clinical care for TGD patients, including optimal interventions to improve HIV-related outcomes.

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