scholarly journals Understanding the processes that Federally Qualified Health Centers use to select and implement colorectal cancer screening interventions: a qualitative study

2019 ◽  
Vol 10 (2) ◽  
pp. 394-403 ◽  
Author(s):  
Jennifer Leeman ◽  
Natoshia Askelson ◽  
Linda K Ko ◽  
Catherine L Rohweder ◽  
Jade Avelis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Qualitative Study ◽  
Health Care Systems ◽  
Change Agents ◽  
Crc Screening ◽  
Implementation Processes ◽  
Factors Influencing ◽  
Effective Interventions ◽  
Care Systems ◽  
External Change Agents

Abstract Colorectal cancer (CRC) screening is highly effective at reducing cancer-related morbidity and mortality, yet screening rates remain suboptimal. Evidence-based interventions can increase screening rates, particularly when they target multiple levels (e.g., patients, providers, health care systems). However, effective interventions remain underutilized. Thus, there is a pressing need to build capacity to select and implement multilevel CRC screening interventions. We report on formative research aimed at understanding how Federally Qualified Health Center (FQHC) staff select and implement CRC screening interventions, which will inform development of capacity-building strategies. We report the qualitative findings from a study that used a mixed methods design, starting with a quantitative survey followed by a qualitative study. In-depth interviews were conducted with 28 staff from 14 FQHCs in 8 states. The Consolidated Framework for Implementation Research (CFIR) guided interview questions and data analysis. Related to the CFIR process domain, few respondents described conducting formal assessments of factors contributing to low screening rates prior to planning their interventions. Many described engaging champions, implementation leaders, and external change agents. Few described a systematic approach to executing implementation plans beyond conducting plan-do-study-act cycles. Reflection and evaluation consisted primarily of reviewing Uniform Data System performance measures. Findings also include themes related to factors influencing these implementation processes. Although FQHCs are implementing CRC screening interventions, they are not actively targeting the multilevel factors influencing their CRC screening rates. Our findings on gaps in FQHCs’ implementation processes will inform development of strategies to build capacity to select and implement multilevel CRC screening interventions.

scholarly journals Society of Behavioral Medicine Update: retain support for the National Colorectal Cancer Roundtable’s call to action to reach 80% colorectal cancer screening

2020 ◽  
Author(s):  
Lisa Tussing-Humphreys ◽  
Joanna Buscemi ◽  
Jacqueline M Kanoon ◽  
Elizabeth A Watts ◽  
Karriem Watson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Behavioral Medicine ◽  
Health Care Systems ◽  
Call To Action ◽  
Crc Screening ◽  
Screening Uptake ◽  
Legislative Action ◽  
The Third ◽  
Care Systems ◽  
The Usa

Abstract Colorectal cancer (CRC) remains the third most commonly diagnosed cancer and the third leading cause of cancer-related death in the USA. CRC can be prevented through regular screening and removal of precancerous polyps. However, roughly one third of eligible adults in the USA are not up to date with recommended CRC screening. To increase timely CRC screening uptake in the USA, in 2014, the National Colorectal Cancer Roundtable (NCCRT) launched 80% by 2018. This multilevel effort involved more than 1,500 pledged organizations targeting patients, providers, health care systems, and policymakers to increase U.S. CRC screening rates to 80% by 2018. Concurrent with this campaign, between 2012 and 2018, CRC screening rates increased nationwide by 3.6% from 65.2% to 68.8%, meaning that about 9.3 million more U.S. adults are being screened. NCCRT attributes these successes to widespread implementation of center- and system-wide evidence-based interventions to increase screening uptake, including direct patient communication, provider reminders via electronic health records, and patient navigation, among others. Moving beyond 2018, NCCRT has rebranded the initiative as the 80% Pledge and has since identified several targeted campaigns, including increased outreach to Hispanics, Latinos, and Asians, whose CRC screening uptake remains less than 50%; encouragement of Medicaid outreach activities around CRC screening in all 50 states; and advocacy for screening right at 50 years of age. Society of Behavioral Medicine continues to support NCCRT and encourages policymakers to do the same by taking legislative action to assure funding for Medicaid outreach, research innovations, and clinical quality improvement that supports the 80% Pledge.

scholarly journals Identification and management of prediabetes: results of the Latin America Strategic Prediabetes Meeting

2017 ◽  
Vol 41 ◽  
pp. 1 ◽  
Author(s):  
Patricio López-Jaramillo ◽  
Ramfis E. Nieto-Martínez ◽  
Gestne Aure-Fariñez ◽  
Carlos O. Mendivil ◽  
Rodolfo A. Lahsen ◽  
...  
Keyword(s):  
Latin America ◽  
Health Care Systems ◽  
Public Health Problem ◽  
Preventive Treatment ◽  
Cost Effective ◽  
Lifestyle Changes ◽  
Diagnosis And Treatment ◽  
Effective Interventions ◽  
The Status ◽  
Care Systems

To understand the status of prediabetes diagnosis and treatment in Latin America and to evaluate the use of metformin for diabetes prevention in this context. A panel of 15 diabetes experts from seven countries in Latin America met on 14 – 15 August 2014 in Lima, Peru, to review the available literature, discuss the role of prediabetes in type 2 diabetes mellitus and cardiovascular disease, analyze collected information, and make conclusions for prediabetes diagnosis and treatment in Latin America. Prediabetes diagnosis, screening, and treatment, including lifestyle changes, pharmacological treatment, and cost-effectiveness were discussed. Five resulting statements were issued for Latin America: prediabetes is a clinical and public health problem; health care systems do not currently diagnose/treat prediabetes; use of prediabetes risk detection tools are needed region-wide; treatment includes lifestyle changes, multidisciplinary education, and metformin; and registries of patient records and further studies should be supported. The expert panel concluded that in Latin America, preventive treatment through lifestyle changes and metformin are cost-effective interventions. It is important to improve prediabetes identification and management at the primary care level.

scholarly journals Factors Influencing Colorectal Cancer Screening Participation

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Antonio Z. Gimeno García
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care System ◽  
Population Based ◽  
Average Risk ◽  
Major Health Problem ◽  
Crc Screening ◽  
Screening Uptake ◽  
Factors Influencing ◽  
Care System

Colorectal cancer (CRC) is a major health problem worldwide. Although population-based CRC screening is strongly recommended in average-risk population, compliance rates are still far from the desirable rates. High levels of screening uptake are necessary for the success of any screening program. Therefore, the investigation of factors influencing participation is crucial prior to design and launches a population-based organized screening campaign. Several studies have identified screening behaviour factors related to potential participants, providers, or health care system. These influencing factors can also be classified in non-modifiable (i.e., demographic factors, education, health insurance, or income) and modifiable factors (i.e., knowledge about CRC and screening, patient and provider attitudes or structural barriers for screening). Modifiable determinants are of great interest as they are plausible targets for interventions. Interventions at different levels (patient, providers or health care system) have been tested across the studies with different results. This paper analyzes factors related to CRC screening behaviour and potential interventions designed to improve screening uptake.

HSR19-105: The Role of Chemotherapy in Elderly Colorectal Cancer Survivors: An Observational Study

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-105
Author(s):  
Pamala A. Pawloski ◽  
Gabriela Vazquez-Benitez ◽  
Jeanette Y. Ziegenfuss ◽  
Terese A. DeFor ◽  
Elisabeth M. Seburg
Keyword(s):  
Colorectal Cancer ◽  
Observational Study ◽  
Cancer Survivors ◽  
Health Care Systems ◽  
Cancer Registries ◽  
Factors Associated ◽  
Colon Cancers ◽  
Chart Abstraction ◽  
Care Systems ◽  
Chemotherapy Initiation

Background: Older patients diagnosed with colorectal cancer are not routinely included in clinical trials and are frequently treated with less aggressive chemotherapy. To identify factors associated with treatment initiation in older adults, we conducted an observational study of patients diagnosed with stage I–IV colon or rectal cancer at 65 years and older between 2010 and 2014 across 6 integrated health care systems. Methods: Data were obtained from cancer registries based on chart abstraction and medical records. Time from diagnosis to surgery, chemotherapy, and radiation was measured in weeks and censored when disenrollment, death, or the end of the study period occurred. We assessed patient factors associated with time to chemotherapy initiation using survival analysis methods. Results: Among 8,088 patients diagnosed after the age of 65 with colon cancer, the mean age at diagnosis was 76 years (SD 7.7), 4,150 (51%) were female, and 34% were stage 3 or greater. More than half, 55% (n=4,434) of colon cancers were right-sided (RCC), 23% (n=1833) were left-sided (LCC), and 19% (n=1,559) were rectal cancers. Two-thirds (n=5,201) had moderately differentiated disease. Most (57%) received surgery within 4 weeks and 89% within 6 months of diagnosis (median, 3.4 weeks). At 6 months following diagnosis, 33% of patients had received chemotherapy, and only 4% received radiation. Factors associated with the receipt of chemotherapy were assessed in a multivariable survival model that included age, gender, stage, and site. Patients of older age were less likely to receive chemotherapy (HR, 0.49; 95%CI, 0.45–.53 for 75–79 vs 65–69 years), and more likely for advanced stage, and rectal site. No difference was observed between men and women. Refusal of chemotherapy was reported for only 6% of patients and was associated with age, stage, and site. Six month mortality was 13.3%. Conclusions: Factors associated with the receipt of treatment among older cancer survivors are similar to those in the general population.

scholarly journals Working on the Frontlines of the COVID-19 Pandemic: A Qualitative Study of Physical Therapists’ Experience in Spain

2021 ◽  
Author(s):  
Domingo Palacios-Ceña ◽  
César Fernández-de-las-Peñas ◽  
María Palacios-Ceña ◽  
Ana I de-la-Llave-Rincón ◽  
Lidiane L Florencio
Keyword(s):  
Health Care ◽  
Qualitative Study ◽  
Health Care Professionals ◽  
Physical Therapists ◽  
Health Care Systems ◽  
Public Hospitals ◽  
Purposeful Sampling ◽  
Care Systems ◽  
Field Notes ◽  
Depth Interviews

Abstract Objective Knowledge of the experiences of health care professionals who have actively worked on the first line of the COVID-19 pandemic could help in identifying specific professional duties focused on health assistance objectives. No qualitative study has yet been published describing the experience of physical therapists during the COVID-19 pandemic. The purpose of this study was to describe and explore the experiences and perspectives of physical therapists working in public hospitals in Madrid, Spain, during the COVID-19 pandemic. Methods A qualitative exploratory study was conducted based on an interpretive framework. Thirty physical therapists working at 11 national public hospitals during the COVID-19 outbreak were recruited by purposeful sampling and snowball techniques. In-depth interviews and researchers’ field notes were used to collect data. Interviews were transcribed verbatim. Inductive thematic analysis was used to identify emerging themes. Results After identifying 3912 codes and 13 categories, 3 themes emerged. First theme was “Call of Duty,” COVID-19 infection dramatically spread, the hospitals were contaminated and overwhelmed, and all floors were converted into COVID-19 wards. Second theme was “Working in War Time.” Every day, therapists were given “the war report,” receiving their orders, meeting protective personal equipment requirements, and doing a job with fear. Third theme was “When I Arrive at Home.” Working during the pandemic had an impact on the therapists’ families and the information shared with them. Conclusions Physical therapists described the COVID-19 outbreak as an apocalyptic and unexpected war. Comprehensive support is needed for all frontline health care professionals. The COVID-19 outbreak revealed that health care systems were not prepared for a pandemic. Impact This is the first qualitative study to be published describing the experience of physical therapists during the COVID-19 pandemic.

scholarly journals Adaptive platform trials using multi-arm, multi-stage protocols: getting fast answers in pandemic settings

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1109
Author(s):  
Nurulamin M. Noor ◽  
Sarah L. Pett ◽  
Hanif Esmail ◽  
Angela M. Crook ◽  
Claire L. Vale ◽  
...  
Keyword(s):  
Global Health ◽  
International Collaboration ◽  
Health Care Systems ◽  
Standard Of Care ◽  
Therapeutic Agents ◽  
Effective Interventions ◽  
Multi Stage ◽  
Large Numbers ◽  
Care Systems

Global health pandemics, such as coronavirus disease 2019 (COVID-19), require efficient and well-conducted trials to determine effective interventions, such as treatments and vaccinations. Early work focused on rapid sequencing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), subsequent in-vitro and in-silico work, along with greater understanding of the different clinical phases of the infection, have helped identify a catalogue of potential therapeutic agents requiring assessment. In a pandemic, there is a need to quickly identify efficacious treatments, and reject those that are non-beneficial or even harmful, using randomised clinical trials. Whilst each potential treatment could be investigated across multiple, separate, competing two-arm trials, this is a very inefficient process. Despite the very large numbers of interventional trials for COVID-19, the vast majority have not used efficient trial designs. Well conducted, adaptive platform trials utilising a multi-arm multi-stage (MAMS) approach provide a solution to overcome limitations of traditional designs. The multi-arm element allows multiple different treatments to be investigated simultaneously against a shared, standard-of-care control arm. The multi-stage element uses interim analyses to assess accumulating data from the trial and ensure that only treatments showing promise continue to recruitment during the next stage of the trial. The ability to test many treatments at once and drop insufficiently active interventions significantly speeds up the rate at which answers can be achieved. This article provides an overview of the benefits of MAMS designs and successes of trials, which have used this approach to COVID-19. We also discuss international collaboration between trial teams, including prospective agreement to synthesise trial results, and identify the most effective interventions. We believe that international collaboration will help provide faster answers for patients, clinicians, and health care systems around the world, including for future waves of COVID-19, and enable preparedness for future global health pandemics.

scholarly journals The Hospitalization Costs of Diabetes and Hypertension Complications in Zimbabwe: Estimations and Correlations

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Mutsa P. Mutowo ◽  
Paula K. Lorgelly ◽  
Michael Laxy ◽  
Andre M. N. Renzaho ◽  
John C. Mangwiro ◽  
...  
Keyword(s):  
Linear Models ◽  
Wound Care ◽  
Health Care Systems ◽  
Secondary Data ◽  
Cost Effective ◽  
Effective Interventions ◽  
Hospitalization Costs ◽  
Patients With Diabetes ◽  
Care Systems ◽  
Mean Cost

Objective. Treating complications associated with diabetes and hypertension imposes significant costs on health care systems. This study estimated the hospitalization costs for inpatients in a public hospital in Zimbabwe.Methods. The study was retrospective and utilized secondary data from medical records. Total hospitalization costs were estimated using generalized linear models.Results. The median cost and interquartile range (IQR) for patients with diabetes, $994 (385–1553) mean $1319 (95% CI: 981–1657), was higher than patients with hypertension, $759 (494–1147) mean $914 (95% CI: 825–1003). Female patients aged below 65 years with diabetes had the highest estimated mean costs ($1467 (95% CI: 1177–1828)). Wound care had the highest estimated mean cost of all procedures, $2884 (95% CI: 2004–4149) for patients with diabetes and $2239 (95% CI: 1589–3156) for patients with hypertension. Age below 65 years, medical procedures (amputation, wound care, dialysis, and physiotherapy), the presence of two or more comorbidities, and being prescribed two or more drugs were associated with significantly higher hospitalization costs.Conclusion. Our estimated costs could be used to evaluate and improve current inpatient treatment and management of patients with diabetes and hypertension and determine the most cost-effective interventions to prevent complications and comorbidities.

scholarly journals When Public Policy Is Guided by Misinformation: A Case Study in the Consequences of Fake News

2018 ◽  
Author(s):  
Mickey Keenan ◽  
Karola Dillenburger
Keyword(s):  
Public Policy ◽  
Health Care Systems ◽  
Scientific Discipline ◽  
The Body ◽  
The Past ◽  
Effective Interventions ◽  
Health And Social Care ◽  
Care Systems ◽  
The Uk

Since autism was first recognised, prevalence has increased rapidly. The growing economic as well as social cost to society can only be mitigated by effective interventions and supports. It is therefore not surprising that most governments have developed public policy documents to address the management of autism. Over the past 40-50 years, meaningful evidence has accrued showing that interventions based on the scientific discipline of Applied Behaviour Analysis (ABA) can help people with autism reach their potential. In view of this, nearly all of North America has laws to mandate that ABA-based interventions are available through the health care systems. In contrast, across Europe there are no such laws. In fact, the National Institute for Health and Care Excellence (NICE), the body guiding health and social policy in the UK, concluded that it could not find any evidence to support ABA, and therefore could not recommend it. This paper addresses the reasons for these diametrically opposed perspectives. In particular, it examines what happens when health and social care policy is misinformed about effective autism intervention.

EXERCISE: AN IMPORTANT KEY TO PREVENT PHYSICAL AND COGNITIVE FRAILTY

2015 ◽  
pp. 1-3
Author(s):  
M.C. DULAC ◽  
M. AUBERTIN-LEHEUDRE
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Health Care Systems ◽  
Cost Effective ◽  
Older Individuals ◽  
Cognitive Frailty ◽  
Western Population ◽  
Effective Interventions ◽  
Care Systems ◽  
Aging People

The life expectancy of older individuals continues to increase with persons aged 70 years and more representing the fastest growing proportion of the western population (1). At the same time, this extended life should involve the preservation of autonomy through the maintenance of physical and cognitive function. However, with normal aging, people will develop frailty. Thus, identifying cost-effective interventions, which prevent frailty, is one of the most important challenges of health care systems. The difficulty in developing specific interventions to prevent or delay frailty is due to the complexity of the phenomenon, which involves many different physiological, cognitive, and psychological systems. Because no single manifestation of frailty can encompass the whole of the symptoms or signs present, consensual exercise training guidelines remain paradoxically difficult. Therefore, the aim of this review is to address an overview of the literature regarding the effect of exercise/physical activity in the prevention of physical and cognitive frailty.

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