scholarly journals Qualitative research study on addressing barriers to healthy diet among low-income individuals at an urban, safety-net hospital

2020 ◽  
pp. bmjnph-2020-000064
Author(s):  
Erin Cahill ◽  
Stacie R Schmidt ◽  
Tracey L Henry ◽  
Gayathri Kumar ◽  
Sara Berney ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Healthy Eating ◽  
Low Income ◽  
Dietary Habits ◽  
Qualitative Interviews ◽  
Safety Net ◽  
Nutritional Knowledge ◽  
Adequate Food ◽  
Safety Net Hospital ◽  
Urban Safety

BackgroundSome American households experience food insecurity, where access to adequate food is limited by lack of money and other resources. As such, we implemented a free 6-month Fruit and Vegetable Prescription Program within a large urban safety-net hospital .Methods32 participants completed a baseline and postintervention qualitative evaluation about food-related behaviour 6 months after study completion. Deductive codes were developed based on the key topics addressed in the interviews; inductive codes were identified from analytically reading the transcripts. Transcripts were coded in MAXQDA V.12 (Release 12.3.2).ResultsThe information collected in the qualitative interviews highlights the many factors that affect dietary habits, including the environmental and individual influences that play a role in food choices people make. Participants expressed very positive sentiments overall about their programme participation.ConclusionsA multifaceted intervention that targets individual behaviour change, enhances nutritional knowledge and skills, and reduces socioeconomic barriers to accessing fresh produce may enhance participant knowledge and self-efficacy around healthy eating. However, socioeconomic factors remain as continual barriers to sustaining healthy eating over the long term. Ongoing efforts that address social determinants of health may be necessary to promote sustainability of behaviour change.

scholarly journals Neurologic findings among inpatients with COVID-19 at a safety-net US hospital

2020 ◽  
pp. 10.1212/CPJ.0000000000001031
Author(s):  
Pria Anand ◽  
Lan Zhou ◽  
Nahid Bhadelia ◽  
Davidson H. Hamer ◽  
David M. Greer ◽  
...  
Keyword(s):  
Low Income ◽  
Medical Center ◽  
Altered Mental Status ◽  
Safety Net ◽  
Nasopharyngeal Swab ◽  
Neurologic Complications ◽  
Safety Net Hospital ◽  
Urban Safety ◽  
Record Review ◽  
Neurologic Findings

ObjectiveTo characterize the breadth of neurologic findings associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a diverse group of inpatients at an urban, safety-net US medical center.MethodsPatients were identified through an electronic medical record review from April 15, 2020, until July 1, 2020, at a large safety-net hospital in Boston, MA, caring primarily for underserved, low-income, and elderly patients. All hospitalized adult patients with positive nasopharyngeal swab or respiratory PCR testing for SARS-CoV-2 during their hospitalization or in the 30 days prior to admission who received an inpatient neurologic or neurocritical care consultation or admission during the study period were enrolled.ResultsSeventy-four patients were identified (42/57% male, median age 64 years). The majority of patients self-identified as Black or African-American (38, 51%). The most common neurologic symptoms at presentation to the hospital included altered mental status (39, 53%), fatigue (18, 24%), and headache (18, 18%). Fifteen patients had ischemic strokes (20%). There were 10 in-hospital mortalities, with moderately severe disability among survivors at discharge (14%, median modified Rankin Scale score of 4).ConclusionsNeurologic findings spanned inflammatory, vascular pathologies, sequelae of critical illness and metabolic derangements, possible direct involvement of the nervous system by SARS-CoV-2, and exacerbation of underlying neurologic conditions, highlighting a broad range of possible etiologies of neurologic complications in patients with coronavirus disease 2019 (COVID-19). Further studies are needed to characterize the infectious and post-infectious neurologic complications of COVID-19 in diverse patient populations.

Hospital-acquired Clostridioides difficile infection among patients at an urban safety-net hospital in Philadelphia: Demographics, neighborhood deprivation, and the transferability of national statistics

2020 ◽  
pp. 1-7
Author(s):  
Daniel T. Vader ◽  
Chelsea Weldie ◽  
Seth L. Welles ◽  
Michele A. Kutzler ◽  
Neal D. Goldstein
Keyword(s):  
Low Income ◽  
Private Insurance ◽  
Antibiotic Use ◽  
Safety Net ◽  
University Hospital ◽  
National Surveillance ◽  
National Data ◽  
Clostridioides Difficile ◽  
Safety Net Hospital ◽  
Urban Safety

Abstract Objective: To investigate associations between healthcare-associated Clostridioides difficile infection and patient demographics at an urban safety-net hospital and compare findings with national surveillance statistics. Methods: Study participants were selected using a case-control design using medical records collected between August 2014 and May 2018 at Hahnemann University Hospital in Philadelphia. Controls were frequency matched to cases by age and length of stay. Final sample included 170 cases and 324 controls. Neighborhood-level factors were measured using American Community Survey data. Multilevel models were used to examine infection by census tract, deprivation index, race/ethnicity, insurance type, referral location, antibiotic use, and proton-pump inhibitor use. Results: Patients on Medicare compared to private insurance had 2.04 times (95% CI, 1.31–3.20) the odds of infection after adjusting for all covariables. Prior antibiotic use (2.70; 95% CI, 1.64–4.46) was also associated with infection, but race or ethnicity and referral location were not. A smaller proportion of hospital cases occurred among white patients (25% vs 44%) and patients over the age of 65 (39% vs 56%) than expected based on national surveillance statistics. Conclusions: Medicare and antibiotics were associated with Clostridioides difficile infection, but evidence did not indicate association with race or ethnicity. This finding diverges from national data in that infection is higher among white people compared to nonwhite people. Furthermore, a greater proportion of hospital cases were aged <65 years than expected based on national data. National surveillance statistics on CDI may not be transportable to safety-net hospitals, which often disproportionately serve low-income, nonwhite patients.

scholarly journals Comparing Once- versus Twice-Weekly Yoga Classes for Chronic Low Back Pain in Predominantly Low Income Minorities: A Randomized Dosing Trial

2013 ◽  
Vol 2013 ◽  
pp. 1-13 ◽  
Author(s):  
Robert B. Saper ◽  
Ama R. Boah ◽  
Julia Keosaian ◽  
Christian Cerrada ◽  
Janice Weinberg ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Low Income ◽  
Chronic Low Back Pain ◽  
Community Health Centers ◽  
Safety Net ◽  
Low Back ◽  
Related Function ◽  
Safety Net Hospital ◽  
Urban Safety

Background. Previous studies have demonstrated that once-weekly yoga classes are effective for chronic low back pain (cLBP) in white adults with high socioeconomic status. The comparative effectiveness of twice-weekly classes and generalizability to racially diverse low income populations are unknown.Methods. We conducted a 12-week randomized, parallel-group, dosing trial for 95 adults recruited from an urban safety-net hospital and five community health centers comparing once-weekly (n=49) versus twice-weekly (n=46) standardized yoga classes supplemented by home practice. Primary outcomes were change from baseline to 12 weeks in pain (11-point scale) and back-related function (23-point modified Roland-Morris Disability Questionnaire).Results. 82% of participants were nonwhite; 77% had annual household incomes <$40,000. The sample’s baseline mean pain intensity [6.9 (SD 1.6)] and function [13.7 (SD 5.0)] reflected moderate to severe back pain and impairment. Pain and back-related function improved within both groups (P<0.001). However, there were no differences between once-weekly and twice-weekly groups for pain reduction [-2.1(95% CI-2.9,-1.3) versus −2.4 (95% CI-3.1,-1.8),P=0.62] or back-related function [-5.1(95% CI-7.0,-3.2) versus −4.9 (95% CI-6.5,-3.3),P=0.83].Conclusions. Twelve weeks of once-weekly or twice-weekly yoga classes were similarly effective for predominantly low income minority adults with moderate to severe chronic low back pain. This trial is registered with ClinicalTrials.govNCT01761617.

scholarly journals COVID-19 Pandemic and the Cholecystitis Experience at a Major Urban Safety-Net Hospital

2021 ◽  
Vol 264 ◽  
pp. 117-123
Author(s):  
Katherine F Vallès ◽  
Miriam Y Neufeld ◽  
Elisa Caron ◽  
Sabrina E Sanchez ◽  
Tejal S Brahmbhatt
Keyword(s):  
Safety Net ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals Homelessness and discharge delays from an urban safety net hospital

Public Health ◽  
2014 ◽  
Vol 128 (11) ◽  
pp. 1033-1035 ◽  
Author(s):  
J. Feigal ◽  
B. Park ◽  
C. Bramante ◽  
C. Nordgaard ◽  
J. Menk ◽  
...  
Keyword(s):  
Safety Net ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals 338 Factors Associated With Colonoscopy No-Show Among African Americans in an Urban Safety-Net Hospital

2019 ◽  
Vol 114 (1) ◽  
pp. S200-S200
Author(s):  
Suaka Kagbo-Kue ◽  
Iloabueke Chineke ◽  
Taiwo Ajose ◽  
Keerthi Padooru ◽  
Florence Iloh ◽  
...  
Keyword(s):  
African Americans ◽  
Safety Net ◽  
Factors Associated ◽  
Safety Net Hospital ◽  
Urban Safety

scholarly journals Implementation of a Continuous Glucose Monitoring Program at a Safety Net Hospital During Covid 19 Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A345-A346
Author(s):  
Erin E Finn ◽  
Lindsay Schlichting ◽  
Rocio Ines Pereira
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Continuous Glucose Monitoring ◽  
Monitoring Program ◽  
Glucose Monitoring ◽  
Safety Net ◽  
Surgical Intensive Care Unit ◽  
Close Monitoring ◽  
Safety Net Hospital ◽  
Urban Safety

Abstract Background: COVID 19 disproportionately impacts individuals with diabetes leading to increased morbidity and mortality. Hyperglycemia is common in hospitalized patients with COVID requiring intensive monitoring and management. Close monitoring of glucoses requires increased use of personal protective equipment (PPE), which has been in limited supply since the beginning of the pandemic. The FDA granted conditional allowance for use of continuous glucose monitors (CGM) in hospital settings during the COVID pandemic to allow for preservation of PPE. We present the process of implementing a continuous glucose monitoring program in an urban safety net hospital. Methods: The program was implemented at a county urban safety net hospital. Patients were eligible to be started on Dexcom G6 CGM if they had hyperglycemia requiring multiple insulin injections daily, were in contact isolation, and were located in 1 of 3 units of the hospital (medical intensive care unit [MICU], surgical intensive care unit, COVID 19 floor unit). Initial program was started in the MICU and subsequently expanded. Nurses and staff underwent training using videos, in-person demonstrations, and written guides. Informational Technology modified the electronic medical system to allow for ordering and documentation of CGM values by nurses. Supplies were stored both on unit and in central supply allowing for primary team to initiate monitoring independent of diabetes team. Records of patients participating in program were maintained by the diabetes team. Amount of PPE saved was estimated to be 10 instances/day while on insulin drip and 3/day when using subcutaneous insulin. Results: A total of 69 patients used a CGM during their hospital course. Average age was 56 years old, 69 % were male, average BMI 31, and 84% had known diabetes prior to admission. The majority of patients were critically ill with 68% intubated, 48% on vasopressors, 6% requiring dialysis, 38% on insulin drip, 46% were on tube feeds, and 74% received steroids. The racial demographics of the patients were 72% White, 3% Black, 4% Native American, 4% Asian, and 14% other. For ethnicity, 73% identified as Hispanic and half spoke Spanish as their primary language. An estimated 2600 instances of PPE were saved. Challenges that were faced in implementing the program included consistent training of large numbers of staff, maintaining supplies in stock, troubleshooting discordant values, and restricting use of CGM to patients who met qualifications. Conclusion: Overall, the implementation of CGM was successful and received a positive response. Staff in the primary units quickly became comfortable with the application of the technology. Potential challenges in the future include ongoing training, improving troubleshooting of technology, validating the accuracy of the devices, and developing funding for CGM equipment and interpretation.

Behavioral Health Patient Engagement in Video-based Visits through a Patient Portal at an Urban Safety-Net Hospital During COVID-19: Direct Patient Outreach and Case-Control Study (Preprint)

2021 ◽  
Author(s):  
Han Yue ◽  
Victoria Mail ◽  
Maura DiSalvo ◽  
Christina Borba ◽  
Joanna Piechniczek-Buczek ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Behavioral Health ◽  
Patient Engagement ◽  
Safety Net ◽  
Patient Portal ◽  
Patient Portals ◽  
Safety Net Hospital ◽  
Urban Safety

BACKGROUND Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the coronavirus disease 2019 (COVID-19) pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial, and technological barriers, termed the “digital divide,” prevent some patients from accessing the technology needed to utilize telepsychiatry services. OBJECTIVE As part of an outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital’s patient portal among adult behavioral health patients at an urban safety net hospital, we aimed to assess patient preference for patient portal-based video visits or telephone-only visits, and to identify the demographic variables associated with their preference. METHODS Patients in an outpatient psychiatry clinic were contacted by phone and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. RESULTS One hundred and twenty-eight patients were reached by phone. Seventy-nine patients (61.7%) chose video-based visits and 69.6% of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. CONCLUSIONS Among behavioral health patients at a safety-net hospital, there was a relatively low engagement with video-based visits through the hospital’s patient portal, particularly among older adults.

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