Abstract TP356: Post-Acute Stroke Experience Survey- Development and Pilot Testing

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jane A Anderson ◽  
Barbara Kimmel ◽  
Kirt Martin ◽  
Anette Ovalle ◽  
Chizoba Ifeorah ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Care Provider ◽  
Primary Care Provider ◽  
Claims Data ◽  
Stroke Care ◽  
Insurance Status ◽  
Stroke Survivors ◽  
Health Insurance Status

Background: Administrative claims data show variability in post-acute stroke care. Stroke survivors without health insurance are not included in claims data statistics. The PASES survey was developed and tested to describe stroke care experience of underserved survivors participating in V-STOP a telehealth self-management program. Methods: Semi-structured interviews were completed to elicit feedback from survivors on experiences during their stroke event, emergency and hospital care, and after discharge. Items on PASES were established based on participants’ responses and survey was piloted in a sample of underserved survivors (N=95). Descriptive statistics and Chi-square analysis were applied to describe stroke survivors’ experiences and differences based on health insurance status. Results: The sample was 45% female, mean age 57, 18% Black and 60% Hispanic. Most (60%) had an annual income of less than $25,000 and 44% had no insurance. Only 25% reported calling 911. However (60%) report presenting to a hospital within 2 hours of stroke symptoms recognition. Nearly half (42%) reported not knowing whether they received a “clot dissolving” medication. Fifty-four percent did not receive rehabilitation after discharge. Eighty-percent reported seeing a healthcare provider after discharge. Most (61%) saw a primary care provider and 22% saw a neurologist. However, only 24% reported seeing a provider within one month of hospital discharge. No significant differences were identified between insured vs. uninsured with respect to race, ethnicity, income, calling 911, receiving inpatient rehab, seeing a provider after discharge and follow up with primary care provider vs. neurologist. Significant differences were identified between insured vs. uninsured with respect to presenting to a hospital within 2 hours of stroke symptoms (35 vs 18 [p=0.023]) and in receiving no rehab after discharge (27 vs 12 [p=0.02]). Conclusion: Results suggest low utilization of EMS, delayed presentation to hospital, limited access to rehabilitation after discharge and limited access to timely follow-up with stroke specialist among underserved stroke survivors. Health insurance status may influence delayed hospital presentation and access to rehabilitation services.

scholarly journals Integrating Genomic Screening into Primary Care: Provider Experiences Caring for Latino Patients at a Community-Based Health Center

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
Tarika Srinivasan ◽  
Erica J. Sutton ◽  
Annika T. Beck ◽  
Idali Cuellar ◽  
Valentina Hernandez ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Patient Care ◽  
Health Center ◽  
Care Provider ◽  
Primary Care Provider ◽  
Genomic Sequencing ◽  
Community Based ◽  
Genomic Screening

Introduction: Minority communities have had limited access to advances in genomic medicine. Mayo Clinic and Mountain Park Health Center, a Federally Qualified Health Center in Phoenix, Arizona, partnered to assess the feasibility of offering genomic screening to Latino patients receiving care at a community-based health center. We examined primary care provider (PCP) experiences reporting genomic screening results and integrating those results into patient care. Methods: We conducted open-ended, semi-structured interviews with PCPs and other members of the health care team charged with supporting patients who received positive genomic screening results. Interviews were recorded, transcribed, and analyzed thematically. Results: Of the 500 patients who pursued genomic screening, 10 received results indicating a genetic variant that warranted clinical management. PCPs felt genomic screening was valuable to patients and their families, and that genomic research should strive to include underrepresented minorities. Providers identified multiple challenges integrating genomic sequencing into patient care, including difficulties maintaining patient contact over time; arranging follow-up medical care; and managing results in an environment with limited genetics expertise. Providers also reflected on the ethics of offering genomic sequencing to patients who may not be able to pursue diagnostic testing or follow-up care due to financial constraints. Conclusions: Our results highlight the potential benefits and challenges of bringing advances in precision medicine to community-based health centers serving under-resourced populations. By proactively considering patient support needs, and identifying financial assistance programs and patient-referral mechanisms to support patients who may need specialized medical care, PCPs and other health care providers can help to ensure that precision medicine lives up to its full potential as a tool for improving patient care.

scholarly journals Follow-Up Rates at a Free Ophthalmology Clinic at a Homeless Shelter

2021 ◽  
Vol 13 (01) ◽  
pp. e51-e56
Author(s):  
Lauren Hennein ◽  
Kimberly A. Spaulding ◽  
Veronika Karlegan ◽  
Ogonna N. Nnamani Silva ◽  
Alejandra G. de Alba Campomanes
Keyword(s):  
High School ◽  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
Nonprofit Organization ◽  
County Hospital ◽  
Categorical Variables ◽  
Homeless Shelter ◽  
High School Diploma

Abstract Objective Eye health among the homeless community is important, as poor vision makes this population vulnerable and adds significantly to the social and health burden. There is limited knowledge on patient follow-up rates for their eye conditions and barriers to accessing care in this population. The purpose of this retrospective chart review study is to examine follow-up rates and barriers to care for patients referred from a free, medical-student run ophthalmology clinic at a homeless shelter. Methods All patients evaluated at a free ophthalmology clinic from September 2017 to September 2018 were included; no patients were excluded. If indicated, patients were referred for advanced ophthalmologic care at a local county hospital and free eyeglasses at a nonprofit organization. Primary outcomes were follow-up rates at the county hospital and nonprofit organization. Secondary outcomes included prespecified baseline variables hypothesized to be associated with follow-up rates. These categorical variables were compared with Chi-square testing to determine their association with follow-up rates. The hypothesis being tested was formulated before data collection. Results Of the 68 patients, 84% were males with a mean age of 50 years. Overall, 40 patients were referred for free eyeglasses and 17 to the county hospital. Of those referred, 14 patients presented for free eyeglasses and 7 presented to the county hospital. About 79% of patients with a pre-established primary care provider presented to their appointment compared with 20% of those without one (p = 0.03). The 44% of patients with a high school diploma presented while all patients without a high school diploma failed to present (p = 0.04). Vision-threatening conditions identified at the shelter clinic did not affect follow-up rates (p = 0.79). Conclusion Less than half of referred patients in our study presented to their appointments. Barriers to presentation included no primary care provider and lower educational status, with no improvement in follow-up rates among those referred for vision-threatening conditions. Interventions such as health coaching with particular attention to educating patients on the effects of vision-threatening conditions may be warranted, particularly for those not looped into the health care system and those of lower educational attainment.

scholarly journals Community Primary Care Provider Preferences for Emergency Department Follow-up Recommendations

2017 ◽  
Vol 33 (10) ◽  
pp. 690-693
Author(s):  
Marissa A. Hendrickson ◽  
Eta Obeya ◽  
Andrew R. Wey ◽  
Philippe R. Gaillard
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Provider ◽  
Primary Care Provider

Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up

2010 ◽  
Vol 5 (7) ◽  
pp. 392-397 ◽  
Author(s):  
Gregory J. Misky ◽  
Heidi L. Wald ◽  
Eric A. Coleman
Keyword(s):  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider

scholarly journals Having a Primary Care Provider and Receipt of Recommended Preventive Care Among Men in New York City

2010 ◽  
Vol 5 (3) ◽  
pp. 225-235 ◽  
Author(s):  
John P. Jasek
Keyword(s):  
Primary Care ◽  
New York ◽  
New York City ◽  
Care Provider ◽  
York City ◽  
Primary Care Provider ◽  
Seasonal Influenza ◽  
Pneumococcal Vaccination ◽  
Preventive Services ◽  
Insurance Status

To assess the role of having a primary care provider (PCP) in men’s up-to-date receipt of recommended preventive services (colonoscopy, pneumococcal and seasonal influenza vaccination, cholesterol and blood pressure screenings), data from the 2005 and 2006 New York City Community Health Surveys ( N = 3,728 [2006], 2,810 [2005]) were analyzed. PCP prevalence and men’s uptake of each service, overall and by age, race/ethnicity, education, income, insurance status, marital status, and nativity, were evaluated. After controlling for insurance status and other factors, having a PCP significantly predicted receipt of each service (adjusted prevalence ratio from 1.12 [1.08, 1.16] to 1.72 [1.35, 2.22]) and total services. Colonoscopy and seasonal influenza and pneumococcal vaccination receipt were below 70% with or without a PCP. Efforts to increase the proportion of men having a PCP are needed to improve receipt of recommended services. Maximizing awareness and provision of low-use preventive services may be useful.

scholarly journals Early Primary Care Provider Follow-up and Readmission After High-Risk Surgery

JAMA Surgery ◽  
2014 ◽  
Vol 149 (8) ◽  
pp. 821 ◽  
Author(s):  
Benjamin S. Brooke ◽  
David H. Stone ◽  
Jack L. Cronenwett ◽  
Brian Nolan ◽  
Randall R. DeMartino ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Care Provider ◽  
Primary Care Provider ◽  
Early Primary

scholarly journals Structural Inequities in Seasonal Influenza Vaccination Rates

2020 ◽  
Author(s):  
Lara Brewer ◽  
Mark Ommerborn ◽  
Augustina Nguyen ◽  
Cheryl Clark
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Influenza Vaccination ◽  
Geographic Location ◽  
Behavioral Risk ◽  
Insurance Status ◽  
Vaccination Rates ◽  
Health Insurance Status ◽  
Access To Primary Care ◽  
Structural Inequities

Abstract BackgroundInfluenza immunization is a highly effective method of reducing illness, hospitalization and mortality from this disease. However, influenza vaccination rates in the U.S. remain below public health targets. MethodsWe analyzed correlates of influenza vaccination rates using the 2019 Behavioral Risk Factor Surveillance System (BRFSS) in the year 2020. Our analysis compared influenza vaccination as the outcome of interest with the variables age, sex, race, education, income, geographic location, health insurance status, access to primary care, and history of delaying care due to cost.ResultsOur results showed that several persistent structural inequities predict influenza vaccination, within and across racial and ethnic groups, including geographic location, health insurance status, regular access to primary care, and the need to delay medical care due to cost.ConclusionWith the impending rollout of a COVID-19 vaccine, it is important for physicians and policymakers to recognize and eliminate structural racism and inequities in U.S. influenza vaccination rates so that future vaccination campaigns are not impeded by these barriers to immunization.

scholarly journals “She knows me best”: a qualitative study of patient and caregiver views on the role of the primary care physician follow-up post-hospital discharge in individuals admitted with chronic obstructive pulmonary disease or congestive heart failure

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sarah Griffiths ◽  
Gaibrie Stephen ◽  
Tara Kiran ◽  
Karen Okrainec
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
Hospital Discharge ◽  
Care Provider ◽  
Primary Care Provider ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Abstract Background Patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are at high-risk of readmission after hospital discharge. There is conflicting evidence however on whether timely follow-up with a primary care provider reduces that risk. The objective of this study is to understand the perspectives of patients with COPD and CHF, and their caregivers, on the role of primary care provider follow-up after hospital discharge. Methods A qualitative study design with semi-structured interviews was conducted among patients or their family caregivers admitted with COPD or CHF who were enrolled in a randomized controlled study at three acute care hospitals in Ontario, Canada. Participants were interviewed between December 2017 to January 2019, the majority discharged from hospital at least 30 days prior to their interview. Interviews were analyzed independently by three authors using a deductive directed content analysis, with the fourth author cross-comparing themes. Results Interviews with 16 participants (eight patients and eight caregivers) revealed four main themes. First, participants valued visiting their primary care provider after discharge to build upon their longitudinal relationship. Second, primary care providers played a key role in coordinating care. Third, there were mixed views on the ideal time for follow-up, with many participants expressing a desire to delay follow-up to stabilize following their acute hospitalization. Fourth, the link between the post-discharge visit and preventing hospital readmissions was unclear to participants, who often self-triaged based on their symptoms when deciding on the need for emergency care. Conclusions Patients and caregivers valued in-person follow-up with their primary care provider following discharge from hospital because of the trust established through pre-existing longitudinal relationships. Our results suggest policy makers should focus on improving rates of primary care provider attachment and systems supporting informational continuity.

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