Community Health Workers as an Extension of Care Coordination in Primary Care

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.

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Saúde mental na atenção primária: um estudo sobre a atuação dos agentes comunitários de saúde / Mental health in primary care: a study of the performance of community health workers

Brazilian Journal of Health Review ◽

10.34119/bjhrv4n4-249 ◽

2021 ◽

Vol 4 (4) ◽

pp. 17615-17639

Author(s):

Carlos Gabriel de Souza Soares ◽

Maheli Giovanna Amaro ◽

Eduardo Jorge Sant’Ana Honorato ◽

Sônia Maria Lemos

Keyword(s):

Mental Health ◽

Primary Care ◽

Community Health ◽

Community Health Workers ◽

Health Workers

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

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.598857 ◽

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.

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

Academic Pediatrics ◽

10.1016/j.acap.2020.04.003 ◽

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

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

Journal of the Royal Society of Medicine ◽

10.1177/0141076818803443 ◽

2018 ◽

Vol 111 (12) ◽

pp. 453-461 ◽

Cited By ~ 5

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.

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

Frontiers in Public Health ◽

10.3389/fpubh.2021.681128 ◽

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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An Innovative Approach to Improve the Detection and Treatment of Risk Factors in Poor Urban Settings: A Feasibility Study in Argentina

10.21203/rs.3.rs-131798/v1 ◽

2021 ◽

Author(s):

Rosana Poggio ◽

Goodarz Danaei ◽

Laura Gutierrez ◽

Ana Cavallo ◽

María Lopez ◽

...

Keyword(s):

Risk Factors ◽

Primary Care ◽

Community Health ◽

Community Health Workers ◽

Feasibility Study ◽

Health Workers ◽

Public Healthcare ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Clinical Visit

Abstract Background The effective management of cardiovascular (CVD) prevention among the uninsured population 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 being uninsured, 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 the eligible participants, 82.2% of eligible participants attended to 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 in improving the detection and treatment of risk factors in the uninsured and poor population with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs not only stimulated 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.

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A Participatory Curricula for Community Health Workers and Supervisors to Increase HIV Health Outcomes

Frontiers in Public Health ◽

10.3389/fpubh.2021.689798 ◽

2021 ◽

Vol 9 ◽

Author(s):

Serena Rajabiun ◽

Allyson Baughman ◽

Marena Sullivan ◽

Beth Poteet ◽

Alicia Downes ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Care Team ◽

Specific Content ◽

Training And Supervision ◽

Training Approach ◽

Care And Treatment

Community Health Workers (CHWs) are becoming essential members of the HIV workforce as emerging evidence demonstrates their effectiveness in engaging people with HIV into care and treatment. In 2018, among the estimated 37,000 persons who received an HIV diagnosis, the majority were from racial ethnic minority communities. CHWs serve as a bridge between the community and health care system and have the potential to address structural inequities and reduce the stigma, discrimination and other barriers that prevent people with HIV from seeking and staying in care and treatment. Effective CHW integration into the HIV primary care team requires a training and supervision system that is culturally responsive to the complex social and medical needs of people with HIV. This article describes a comprehensive training approach and curricula for CHWs and supervisors and its impact on the health care team. Grounded in a Popular Education model and using the CHW core consensus competency (C3) framework, a team of experts in HIV, training and supervision, including CHWs working in HIV care and treatment developed an 80-h CHW and 20-h supervisor curricula. The trainings were delivered via in-person and virtual sessions over the course of 2 years. Using a mixed method evaluation, 23 CHWs and 22 supervisors across 10 clinic sites in eight states participated in the training sessions. Measures included knowledge and confidence related to HIV-specific content, supporting clients with managing stigma and discrimination, ability to communicate with other team members and helping clients navigate the services system. CHWs reported improved skills with documentation in the electronic health record, helping clients with treatment adherence challenges and educating on lab results. Supervisors reported learning strategies for assigning clients to CHWs, self-care techniques, providing strengths-based feedback, and mentoring and coaching. The participatory practice-based curricula allowed supervisors and CHWs to share experiences and solicit input from peers for problem resolution and implementation of new policies and practices. This training approach focused on HIV specific content with core competency training could serve as a model for CHWs working in primary care settings and with populations experiencing multiple chronic health conditions and social needs.

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