scholarly journals OPTIMAL HEALTH PROFESSIONAL STAFFING OF PRIMARY CARE AND GERIATRIC PRACTICES SERVING FRAIL OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S66-S66
Author(s):  
Karen Donelan ◽  
Joanne Spetz
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Community Health ◽  
Community Health Workers ◽  
Large Scale ◽  
Assessment Tool ◽  
Health Workers ◽  
Site Assessment ◽  
Frail Older Adults ◽  
Frail Elders

Abstract This symposium will include 3 papers that provide critical interprofessional and interdisciplinary perspectives on our work to understand and measure staffing in health care teams caring for older adults, and frail older adults. The Health Teams for Frail Elders project was funded by the Gordon and Betty Moore Foundation from August 2016 to October 2018. Dr. Karen Donelan, project Principal Investigator, will chair the session, providing a brief project overview of project aims and activities. A survey and health services researcher, Dr. Donelan will set the context for this large scale project. Dr. Barbara Roberge, a geriatric nurse practitioner who established one of the first senior health programs in the nation along with Dr. Kenneth Minaker at Mass General Hospital, was our primary care and nursing lead on our site visits. She will talk about the care settings we visited, her development of a site assessment tool that covered a range of frail elder needs, and will summarize professional roles and staffing observed within different site types. Dr. Julie Berrett-Abebe, a junior investigator on our team (PhD 2017), will present a paper on the competencies and roles of social workers and community health workers in primary and geriatric practices, as well as the roles of community health workers. Dr. David Auerbach, a national expert in health policy and workforce analysis, will present 4 models of staffing of practices, demonstrating efficiencies in optimizing services for frail elders while minimizing costs.Dr. Joanne Spetz will be the discussant of cross-cutting themes.

scholarly journals Brief interventions for older adults (BIO) delivered by non-specialist community health workers to reduce at-risk drinking in primary care: a study protocol for a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e043918
Author(s):  
Tassiane Cristine Santos Paula ◽  
Camila Chagas ◽  
Ana Regina Noto ◽  
Maria Lucia Oliveira Souza Formigoni ◽  
Tiago Veiga Pereira ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Primary Care ◽  
At Risk ◽  
Alcohol Consumption ◽  
Usual Care ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Brief Interventions

IntroductionEvidence suggests that brief interventions are effective in reducing alcohol consumption among older adults. However, the effectiveness of these interventions when delivered by community health workers (non-specialists) in a primary healthcare setting is unknown. To our knowledge, this will be the first randomised trial to examine this.Methods and analysisTwo hundred and forty-two individuals considered at-risk drinkers (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C score ≥4) will be recruited and randomly allocated to usual care (waiting-list) or usual care plus an intervention delivered by trained community health workers (non-specialists). Seven primary care units (PCUs) in Sao José dos Campos, Brazil. PCUs are part of the Brazilian public healthcare system (Sistema Único de Saúde).Follow-up6 months.OutcomesThe primary outcome will be the proportion of participants considered at-risk drinkers (AUDIT-C score ≥4). Secondary outcomes will include alcohol consumption in a typical week in the last 30 days (in units per week) assessed by the AUDIT, service use questionnaire, cognitive performance—assessed by The Health and Retirement Study Harmonised Cognitive Assessment, physical activity—assessed by the International Physical Activity Questionnaire, depression—assessed by the Geriatric Depression Scale and quality of life—assessed by the Control, Autonomy, Self-realisation and Pleasure-16 instrument. The analysis will be based on intention-to-treat principle.Ethics and disseminationThis study has been approved by the Ethics Committee of the Universidade Federal de São Paulo, CEP/UNIFESP Project n: 0690/2018; CAAE: 91648618.0.0000.5505. All eligible participants will provide informed consent prior to randomisation. The results of this study will be published in relevant peer-reviewed journals and in conference presentations.Trial registration numberRBR-8rcxkk.

scholarly journals An innovative approach to improve the detection and treatment of risk factors in poor urban settings: a feasibility study in Argentina

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Poggio Rosana ◽  
Goodarz Danaei ◽  
Laura Gutierrez ◽  
Ana Cavallo ◽  
María Victoria Lopez ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Primary Care ◽  
Community Health ◽  
Community Health Workers ◽  
Feasibility Study ◽  
Health Workers ◽  
Health Coverage ◽  
Cvd Risk Factors ◽  
Cvd Risk

Abstract Background The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC’s catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC’s staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs). Results A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%. Conclusion The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.

scholarly journals Exploring the Role of Community Health Workers in Providing Cancer Navigation: Perceptions of African American Older Adults

2012 ◽  
Vol 39 (3) ◽  
pp. E288-E298 ◽  
Author(s):  
Jennifer Wenzel ◽  
Randy Jones ◽  
Rachel Klimmek ◽  
Sarah Szanton ◽  
Sharon Krumm
Keyword(s):  
Older Adults ◽  
African American ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
African American Older Adults

scholarly journals Cultural Adaptation of Community Informant Tool for Detection of Maternal Depression in Rural Pakistan

2021 ◽  
Vol 12 ◽  
Author(s):  
Shamaila Mohsin ◽  
Najia Atif ◽  
Waqas Rabbani ◽  
Ahmaren Tariq ◽  
Shahzad Ali Khan ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Maternal Depression ◽  
Community Health ◽  
Community Health Workers ◽  
Cultural Adaptation ◽  
Health Workers ◽  
Primary Care Providers ◽  
Detection Tool ◽  
Health Experts

Background: Evidence indicates that mental health issues like depression, epilepsy, and substance misuse can be detected with reasonable accuracy in resource-poor settings. The Community Informant Detection Tool (CIDT) is one such approach used for detecting mental health problems, including depression. We adapted this community informant approach for detecting maternal depression in Pakistan.Methods: Adaptation of Community Informant Detection Tool for Maternal Depression (CIDT-MD) involved five steps. First, a scoping review of the literature was conducted to select an appropriate tool for adaptation. Second, in-depth interviews were conducted to explore the idioms of depression and distress, perceived causes, and the effects of maternal depression among currently depressed and recovered mothers (n = 11), mothers in law (n = 6), and Primary Care Providers (Primary Care Physicians and Lady Health Supervisors) (n = 6). Third, case vignettes and illustrations were created with input from a panel of mental health experts, incorporating the idioms of depression and distress used, causes, and effects for each symptom described. Fourth, to assess the comprehensibility of the illustrations and level of understanding, Focus Group Discussions (n = 4) were done with purposely selected community health workers (Lady Health Workers and Lay Peers, n = 28) trained in delivering maternal depression intervention. The final step was reflection and inputs by a panel of mental health experts on all steps to finalize the content of the tool.Results: Context-specific cultural adaptation in the presentation and format of CIDT-MD was conducted successfully. Lady Health Workers (LHW) and Lay Peers (LP) were found to be the most appropriate persons to use the tool and function as the informants. The adapted tool with all its vignettes and illustrations was found to be easily understandable, comprehensible, and culturally appropriate, meaningful, and contextually relevant by the community health workers and peers working in the relevant settings. They easily relate to and identify potentially depressed such women lining up with the tool. Lastly, the coding of the tool was found easy to follow as well.Conclusion: The Community Informant Detection Tool for Maternal Depression (CIDT-MD) is a culturally acceptable, easy to use, and comprehensible tool for detecting maternal depression in community settings of Pakistan. The community informants found the content and approach highly relevant to the local needs.

Deploying Community Health Workers to Support Medically and Socially At-Risk Patients in a Pediatric Primary Care Population

2020 ◽  
Vol 20 (8) ◽  
pp. 1213-1216
Author(s):  
Susan Stiles ◽  
Ronay Thomas ◽  
Andrew F. Beck ◽  
Allison Parsons ◽  
Nora Buzek ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Pediatric Primary Care ◽  
Primary Care Population ◽  
Risk Patients

scholarly journals Integrating a nationally scaled workforce of community health workers in primary care: a modelling study

2018 ◽  
Vol 111 (12) ◽  
pp. 453-461 ◽  
Author(s):  
Benedict Hayhoe ◽  
Thomas E Cowling ◽  
Virimchi Pillutla ◽  
Priya Garg ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Community Health Worker ◽  
Health Workers ◽  
Pilot Studies ◽  
Cancer Screenings ◽  
Home Based

Objective To model cost and benefit of a national community health worker workforce. Design Modelling exercise based on all general practices in England. Setting United Kingdom National Health Service Primary Care. Participants Not applicable. Data sources Publicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake. Main outcome measures We estimated numbers of community health workers needed, anticipated workload and likely benefits to patients. Results Conservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing £2.22bn annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease. Conclusion A scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.

scholarly journals Formerly Incarcerated Community Health Workers Engaging Individuals Returning From Incarceration Into Primary Care: Results From the Transition Clinic Network

2021 ◽  
Vol 9 ◽  
Author(s):  
Jenerius A. Aminawung ◽  
Tyler D. Harvey ◽  
Jerry Smart ◽  
Joseph Calderon ◽  
Anna Steiner ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Primary Care Clinic ◽  
Social Needs ◽  
Care Clinic ◽  
Primary Care Teams ◽  
Improve Health

Over half a million individuals return from United States prisons and millions more from jails every year, many of whom with complex health and social needs. Community health workers (CHWs) perform diverse roles to improve health outcomes in disadvantaged communities, but no studies have assessed their role as integrated members of a primary care team serving individuals returning from incarceration. Using data from participants who received primary care through the Transitions Clinic Network, a model of care that integrates CHWs with a lived experienced of incarceration into primary care teams, we characterized how CHWs address participant health and social needs during interactions outside of clinic visits for 6 months after participants established primary care. Among the 751 participants, 79% had one or more CHW interactions outside of the clinic documented. Participants with more comorbid conditions, longer stays during their most recent incarceration, and released with a prescription had more interactions with CHWs compared to those with fewer comorbidities, shorter stays, and no prescription at release. Median number of interactions was 4 (interquartile range, IQR 2–8) and 56% were in person. The most common issues addressed (34%) were social determinants of health, with the most common being housing (35%). CHWs working in interdisciplinary primary care teams caring for people with histories of incarceration perform a variety of functions for clients outside of scheduled primary care visits. To improve health outcomes among disadvantaged populations, CHWs should be able to work across multiple systems, with supervision and support for CHW activities both in the primary care clinic and within the community.

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