scholarly journals Quantifying the social distancing privilege gap: a longitudinal study of smartphone movement

2020 ◽  
Author(s):  
Nabarun Dasgupta ◽  
Michele Jonsson Funk ◽  
Allison Lazard ◽  
Benjamin Eugene White ◽  
Stephen W. Marshall
Keyword(s):  
Negative Binomial ◽  
Disease Incidence ◽  
External Validation ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Location Services ◽  
Social Distancing ◽  
Incidence And Mortality ◽  
At Home

BackgroundIn response to the coronavirus pandemic, social distancing became a widely deployed countermeasure in March 2020. We examined whether healthier and wealthier places more successfully implemented social distancing.MethodsMobile device location data were used to quantify declines in movement by county (n=2,633) in the United States of America, comparing April 15–17 (n=65,544,268 traces) to baseline of February 17 - March 7. Negative binomial regression was used to estimate gradients of privilege across eleven healthcare and economic indicators, adjusting for rurality and stay-at-home mandates. External validation used separate venue-specific data from Google Location Services.FindingsCounties without stay-at-home orders showed a mobility decline of −52·3% (95% CI: −50·3%, −54·3%), slightly less than the decline in mandated areas (−60·8%; 95% CI: −60·0%, −61·6%). Strong linear gradients in privilege were observed. After adjusting for rurality and stay-at-home orders, counties in the highest quintile of social distancing mobility restriction had: 52% less uninsured, 47% more primary care providers, 29% more exercise space, 27% less food insecurity, 26% less child poverty, 17% higher incomes, 14% less overcrowding, 9·6% more racial segregation, 8·2% less youth, 7·4% more elderly, and 6·2% less influenza vaccination, compared to least social distancing areas.InterpretationHealthier and wealthier counties displayed a social distancing privilege gap, measured via smartphone mobility change. Structural inequities in this key countermeasure will influence immunity, and disease incidence and mortality.FundingNone

scholarly journals Monitoring Older Adult Blood Pressure Trends at Home as a Proxy for Brain Health

2021 ◽  
Vol 13 (3) ◽  
Author(s):  
Nicole Cassarino ◽  
Blake Bergstrom ◽  
Christine Johannes ◽  
Lisa Gualtieri
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Design Thinking ◽  
Digital Health ◽  
Primary Care Providers ◽  
The United States ◽  
Warning Signs ◽  
Care Providers ◽  
Brain Health ◽  
At Home

Even when older adults monitor hypertension at home, it is difficult to understand trends and share them with their providers. MyHealthNetwork is a dashboard designed for patients and providers to monitor blood pressure readings to detect hypertension and ultimately warning signs of changes in brain health. A multidisciplinary group in a Digital Health course at Tufts University School of Medicine used Design Thinking to formulate a digital solution to promote brain health among older adults in the United States (US). Older adults (aged 65 and over) are a growing population in the US, with many having one or more chronic health conditions including hypertension. Nearly half of all American adults ages 50-64 worry about memory loss as they age and almost all (90%) wish to maintain independence and age in their homes. Given the well-studied association between hypertension and dementia, we designed a solution that would ultimately promote brain health among older adults by allowing them to measure and record their blood pressure readings at home on a regular basis. Going through each step in the Design Thinking process, we devised MyHealthNetwork, an application which connects to a smart blood pressure cuff and stores users’ blood pressure readings in a digital dashboard which will alert users if readings are outside of the normal range. The dashboard also has a physician view where users’ data can be reviewed by the physician and allow for shared treatment decisions. The authors developed a novel algorithm to visually display the blood pressure categories in the dashboard in a way straightforward enough that users with low health literacy could track and understand their blood pressure over time. Additional features of the dashboard include educational content about brain health and hypertension, a digital navigator to support users with application use and technical questions. Phase 1 in the development of our application includes a pilot study involving recruitment of Primary Care Providers with patients who are at risk of dementia to collect and monitor BP data with our prototype. Subsequent phases of development involve partnerships to provide primary users with a rewards program to promote continued use, additional connections to secondary users such as family members and expansion to capture other health metrics.

scholarly journals County-level exposures to greenness and associations with COVID-19 incidence and mortality in the United States

2020 ◽  
Author(s):  
Jochem O Klompmaker ◽  
Jaime E Hart ◽  
Isabel Holland ◽  
M Benjamin Sabath ◽  
Xiao Wu ◽  
...  
Keyword(s):  
United States ◽  
Population Density ◽  
Vegetation Index ◽  
Negative Binomial ◽  
The United States ◽  
Systems Science ◽  
County Level ◽  
Incidence And Mortality ◽  
The Us ◽  
At Home

AbstractBackgroundCOVID-19 is an infectious disease that has killed more than 246,000 people in the US. During a time of social distancing measures and increasing social isolation, green spaces may be a crucial factor to maintain a physically and socially active lifestyle while not increasing risk of infection.ObjectivesWe evaluated whether greenness is related to COVID-19 incidence and mortality in the United States.MethodsWe downloaded data on COVID-19 cases and deaths for each US county up through June 7, 2020, from Johns Hopkins University, Center for Systems Science and Engineering Coronavirus Resource Center. We used April-May 2020 Normalized Difference Vegetation Index (NDVI) data, to represent the greenness exposure during the initial COVID-19 outbreak in the US. We fitted negative binomial mixed models to evaluate associations of NDVI with COVID-19 incidence and mortality, adjusting for potential confounders such as county-level demographics, epidemic stage, and other environmental factors. We evaluated whether the associations were modified by population density, proportion of Black residents, median home value, and issuance of stay-at-home order.ResultsAn increase of 0.1 in NDVI was associated with a 6% (95% Confidence Interval: 3%, 10%) decrease in COVID-19 incidence rate after adjustment for potential confounders. Associations with COVID-19 incidence were stronger in counties with high population density and in counties with stay-at-home orders. Greenness was not associated with COVID-19 mortality in all counties; however, it was protective in counties with higher population density.DiscussionExposures to NDVI had beneficial impacts on county-level incidence of COVID-19 in the US and may have reduced county-level COVID-19 mortality rates, especially in densely populated counties.

scholarly journals 145. Monthly Antibiotic Prescribing Peer Comparison Combined with In-person Education Decreases Antibiotic Prescribing for Acute Respiratory Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S83-S83
Author(s):  
Shelby J Kolo ◽  
David J Taber ◽  
Ronald G Washburn ◽  
Katherine A Pleasants
Keyword(s):  
Primary Care ◽  
Respiratory Infections ◽  
Primary Care Providers ◽  
The United States ◽  
Delivery Mode ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Care Providers ◽  
Intervention Period ◽  
Provider Education

Abstract Background Inappropriate antibiotic prescribing is an important modifiable risk factor for antibiotic resistance. Approximately half of all antibiotics prescribed for acute respiratory infections (ARIs) in the United States may be inappropriate or unnecessary. The purpose of this quality improvement (QI) project was to evaluate the effect of three consecutive interventions on improving antibiotic prescribing for ARIs (i.e., pharyngitis, rhinosinusitis, bronchitis, common cold). Methods This was a pre-post analysis of an antimicrobial stewardship QI initiative to improve antibiotic prescribing for ARIs in six Veterans Affairs (VA) primary care clinics. Three distinct intervention phases occurred. Educational interventions included training on appropriate antibiotic prescribing for ARIs. During the first intervention period (8/2017-1/2019), education was presented virtually to primary care providers on a single occasion. In the second intervention period (2/2019-10/2019), in-person education with peer comparison was presented on a single occasion. In the third intervention period (11/2019-4/2020), education and prescribing feedback with peer comparison was presented once in-person followed by monthly emails of prescribing feedback with peer comparison. January 2016-July 2017 was used as a pre-intervention baseline period. The primary outcome was the antibiotic prescribing rate for all classifications of ARIs. Secondary outcomes included adherence to antibiotic prescribing guidance for pharyngitis and rhinosinusitis. Descriptive statistics and interrupted time series segmented regression were used to analyze the outcomes. Results Monthly antibiotic prescribing peer comparison emails in combination with in-person education was associated with a statistically significant 12.5% reduction in the rate of antibiotic prescribing for ARIs (p=0.0019). When provider education alone was used, the reduction in antibiotic prescribing was nonsignificant. Conclusion Education alone does not significantly reduce antibiotic prescribing for ARIs, regardless of the delivery mode. In contrast, education followed by monthly prescribing feedback with peer comparison was associated with a statistically significant reduction in ARI antibiotic prescribing rates. Disclosures All Authors: No reported disclosures

scholarly journals Complementary and Integrative Health Knowledge and Practice in Primary Care Settings: A Survey of Primary Care Providers in the Northwestern United States

2021 ◽  
Vol 10 ◽  
pp. 216495612110233
Author(s):  
Malaika R Schwartz ◽  
Allison M Cole ◽  
Gina A Keppel ◽  
Ryan Gilles ◽  
John Holmes ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Knowledge ◽  
Care Delivery ◽  
Primary Care Providers ◽  
The United States ◽  
Research Network ◽  
Care Providers ◽  
Integrative Health ◽  
And Training

Background The demand for complementary and integrative health (CIH) is increasing by patients who want to receive more CIH referrals, in-clinic services, and overall care delivery. To promote CIH within the context of primary care, it is critical that providers have sufficient knowledge of CIH, access to CIH-trained providers for referral purposes, and are comfortable either providing services or co-managing patients who favor a CIH approach to their healthcare. Objective The main objective was to gather primary care providers’ perspectives across the northwestern region of the United States on their CIH familiarity and knowledge, clinic barriers and opportunities, and education and training needs. Methods We conducted an online, quantitative survey through an email invitation to all primary care providers (n = 483) at 11 primary care organizations from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network (WPRN). The survey questions covered talking about CIH with patients, co-managing care with CIH providers, familiarity with and training in CIH modalities, clinic barriers to CIH integration, and interest in learning more about CIH modalities. Results 218 primary care providers completed the survey (45% response rate). Familiarity with individual CIH methods ranged from 73% (chiropracty) to 8% (curanderismo). Most respondents discussed CIH with their patients (88%), and many thought that their patients could benefit from CIH (41%). The majority (89%) were willing to co-manage a patient with a CIH provider. Approximately one-third of respondents had some expertise in at least one CIH modality. Over 78% were interested in learning more about the safety and efficacy of at least one CIH modality. Conclusion Primary care providers in the Northwestern United States are generally familiar with CIH modalities, are interested in referring and co-managing care with CIH providers, and would like to have more learning opportunities to increase knowledge of CIH.

scholarly journals VitalSign6: A Primary Care First (PCP-First) Model for Universal Screening and Measurement-Based Care for Depression

2019 ◽  
Vol 12 (2) ◽  
pp. 71 ◽  
Author(s):  
Madhukar Trivedi ◽  
Manish Jha ◽  
Farra Kahalnik ◽  
Ronny Pipes ◽  
Sara Levinson ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Universal Screening ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Similar Treatment ◽  
Measurement Based Care

Major depressive disorder affects one in five adults in the United States. While practice guidelines recommend universal screening for depression in primary care settings, clinical outcomes suffer in the absence of optimal models to manage those who screen positive for depression. The current practice of employing additional mental health professionals perpetuates the assumption that primary care providers (PCP) cannot effectively manage depression, which is not feasible, due to the added costs and shortage of mental health professionals. We have extended our previous work, which demonstrated similar treatment outcomes for depression in primary care and psychiatric settings, using measurement-based care (MBC) by developing a model, called Primary Care First (PCP-First), that empowers PCPs to effectively manage depression in their patients. This model incorporates health information technology tools, through an electronic health records (EHR) integrated web-application and facilitates the following five components: (1) Screening (2) diagnosis (3) treatment selection (4) treatment implementation and (5) treatment revision. We have implemented this model as part of a quality improvement project, called VitalSign6, and will measure its success using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. In this report, we provide the background and rationale of the PCP-First model and the operationalization of VitalSign6 project.

Dysmenorrhea in the Adolescent

2020 ◽  
Author(s):  
Rebecca H. Evans ◽  
Courtney N. Knill
Keyword(s):  
Pelvic Pain ◽  
Medical Management ◽  
Primary Care Providers ◽  
The United States ◽  
Second Line ◽  
Primary Dysmenorrhea ◽  
Care Providers ◽  
Menstrual Suppression ◽  
Secondary Dysmenorrhea ◽  
Medical Advances

As a common medical issue for adolescents both in the United States and worldwide, dysmenorrhea is a leading cause of visits to primary care providers and gynecologic specialists. The prevalence of dysmenorrhea in women is highest in the adolescent population affecting 20-90% of females in this age group. Primary dysmenorrhea is the most common form of dysmenorrhea and is defined as painful menstruation in the absence of pelvic pathology. Secondary dysmenorrhea is explained by an underlying pathology such as endometriosis or genital tract obstruction. The differential diagnosis of dysmenorrhea includes other etiologies of pelvic pain such as gastrointestinal, genitourinary, or other gynecologic pathologies. Symptoms refractory to first and second line treatments warrant further evaluation and management. As the second most common cause of pelvic pain in adolescents after primary dysmenorrhea, endometriosis may manifest itself differently in adolescents when compared to adults. Non-steroidal anti-inflammatory agents (NSAIDS) are first line medical management for dysmenorrhea. Hormonal agents are second line medical management though are often initiated concomitantly with NSAID therapy. Complex imaging and surgery are reserved for refractory cases of pelvic pain. This document outlines the recommended evaluation and management of adolescents with dysmenorrhea and highlights important medical advances that have contributed to treatment.   This review contains 5 figures, 8 tables, and 34 references. Keywords: dysmenorrhea, pelvic pain, endometriosis, menstruation, menses, Premenstrual Syndrome, tranexamic acid, menstrual suppression, menstrual disorders  

scholarly journals A Scoping Review of Trauma-Informed Curricula for Primary Care Providers

2021 ◽  
Vol 53 (10) ◽  
pp. 843-856
Author(s):  
Constance Gundacker ◽  
Tyler W. Barreto ◽  
Julie P. Phillips
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Health Outcomes ◽  
Primary Care Providers ◽  
The United States ◽  
Traumatic Experiences ◽  
Search Term ◽  
Care Providers ◽  
Trauma Informed ◽  
The Impact

Background and Objectives: Traumatic experiences such as abuse, neglect, and household dysfunction have a lifetime prevalence of 62%-75% and can negatively impact health outcomes. However, many primary care providers (PCPs) are inadequately prepared to treat patients with trauma due to a lack of training. Our objective was to identify trauma-informed approach curricula for PCPs, review their effectiveness, and identify gaps. Methods: We systematically identified articles from Medline, Scopus, Web of Science, Academic Search Premier, Cochrane, PsycINFO, MedEd Portal, and the STFM Resource Library. Search term headings “trauma-informed care (TIC),” “resilience,” “patient-centered care,” “primary care,” and “education.” Inclusion criteria were PCP, pediatric and adult patients, and training evaluation. Exclusion criteria were outside the United States, non-English articles, non-PCPs, and inpatient settings. We used the TIC pyramid to extract topics. We analyzed evaluation methods using the Kirkpatrick Model. Results: Researchers reviewed 6,825 articles and identified 17 different curricula. Understanding health effects of trauma was the most common topic (94%). Evaluation data revealed overall positive reactions and improved knowledge, attitudes, and confidence. Half (53%) reported Kirkpatrick level 3 behavior change evaluation outcomes with increased trauma screening and communication, but no change in referrals. Only 12% (2/17) evaluated Kirkpatrick level 4 patient satisfaction (significant results) and health outcomes (not significant). Conclusions: Pilot findings from studies in our review show trauma-informed curricula for PCPs reveal positive reactions, an increase in knowledge, screening, communication, and patient satisfaction, but no change in referrals or health outcomes. Further research is needed to examine the impact of trainings on quality of care and health outcomes.

scholarly journals Disease Prevalence, Disease Incidence, and Mortality in the United States and in England

Demography ◽  
2010 ◽  
Vol 47 (S) ◽  
pp. S211-S231 ◽  
Author(s):  
James Banks ◽  
Alastair Muriel ◽  
James P. Smith
Keyword(s):  
United States ◽  
Disease Incidence ◽  
The United States ◽  
Disease Prevalence ◽  
Incidence And Mortality
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