Healthy Habits Questionnaire Feasibility and Utility for High-Risk Children

2020 ◽  
Vol 59 (11) ◽  
pp. 978-987
Author(s):  
Nadine L. Camp ◽  
Rebecca C. Robert ◽  
Katherine P. Kelly
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Primary Care Providers ◽  
Overweight And Obesity ◽  
Care Practice ◽  
Healthy Weight ◽  
Care Providers ◽  
Minority Children ◽  
Healthy Habits ◽  
Intervention Protocol

The American Academy of Pediatrics provides guidance for pediatric primary care providers to promote healthy weight during childhood. Screening questions on diet and activity habits can help provider assessment and assist counseling for targeted behavior change. We implemented the parent completed, 10-item 5210 Healthy Habits Questionnaire (Ages 2-9 year) in our primary care practice serving low-income minority children with high rates of overweight and obesity. Adherence to the intervention protocol was high, and providers found the content and method of assessment useful for their counseling of individual patients. The aggregate Healthy Habits Questionnaire data provided a snapshot of the health habits in our local clinic population of children, prompting greater awareness for providers and informing their patient care.

To reduce the average age of autism diagnosis, screen preschoolers in primary care

Autism ◽  
2020 ◽  
pp. 136236132096897
Author(s):  
Katharine E Zuckerman ◽  
Sarabeth Broder-Fingert ◽  
R Christopher Sheldrick
Keyword(s):  
Primary Care ◽  
Autism Spectrum Disorder ◽  
Low Income ◽  
Primary Care Providers ◽  
Autism Spectrum ◽  
Additional Treatment ◽  
Spectrum Disorder ◽  
Screening Tools ◽  
Care Providers ◽  
Minority Children

The American Academy of Pediatrics recommends autism spectrum disorder screening at the 18- and 24-month well-child visits. However, despite widespread toddler screening, many children are not diagnosed until school age, and delayed diagnosis is more common among low-income and minority children. Offering autism spectrum disorder screening at preschool well-child checks might reduce disparities and lower the overall age of diagnosis and service initiation. However, screening tools that span the preschool ages and are tailored for primary care are needed. Lay abstract Pediatric primary care providers check for autism signs, usually using a standard checklist, at 18- and 24-month well-child visits. When the checklist shows possible autism, children should be referred for additional treatment and evaluation with an autism specialist. However, many children with autism spectrum disorder are not detected as toddlers. Low-income and minority children are particularly likely to have a late autism spectrum disorder diagnosis. Checking for autism at preschool-aged well-child visits might be one way to identify autism spectrum disorder earlier, especially for low-income and minority children.

scholarly journals Challenging the status quo: results of an acceptability and feasibility study of hypertensive disorders of pregnancy (HDP) management pathways in Indonesian primary care

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fitriana Murriya Ekawati ◽  
Ova Emilia ◽  
Jane Gunn ◽  
Sharon Licqurish ◽  
Phyllis Lau
Keyword(s):  
Primary Care ◽  
Health Care Professionals ◽  
Primary Care Practice ◽  
Scale Up ◽  
Primary Care Providers ◽  
Care Practice ◽  
Local Health ◽  
Care Providers ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders

Abstract Background Hypertensive disorders of pregnancy (HDP) are the leading cause of maternal mortality in Indonesia. Focused HDP management pathways for Indonesian primary care practice have been developed from a consensus development process. However, the acceptability and feasibility of the pathways in practice have not been explored. This study reports on the implementation process of the pathways to determine their acceptability and feasibility in Indonesian practice. Methods The pathways were implemented in three public primary care clinics (Puskesmas) in Yogyakarta province for a month, guided by implementation science frameworks of Medical Research Council (MRC) and the Practical Robust Implementation and Sustainability Model (PRISM). The participating providers (general practitioners (GPs), midwives, and nurses) were asked to use recommendations in the pathways for a month. The pathway implementation evaluations were then conducted using clinical audits and a triangulation of observations, focus groups (FGs), and interviews with all of the participants. Clinical audit data were analysed descriptively, and qualitative data were analysed using a mix of the inductive-deductive approach of thematic analysis. Results A total of 50 primary care providers, four obstetricians, a maternal division officer in the local health office and 61 patients agreed to participate, and 48 of the recruited participants participated in evaluation FGs or interviews. All of the providers in the Puskesmas attempted to apply recommendations from the pathways to various degrees, mainly adopting preeclampsia risk factor screenings and HDP monitoring. The participants expressed that the recommendations empowered their practice when it came to HDP management. However, their practices were challenged by professional boundaries and hierarchical barriers among health care professionals, limited clinical resources, and regulations from the local health office. Suggestions for future scale-up studies were also mentioned, such as involving champion obstetricians and providing more patient education toolkits. Conclusion The HDP management pathways are acceptable and feasible in Indonesian primary care. A further scale-up study is desired and can be initiated with investigations to minimise the implementation challenges and enhance the pathways’ value in primary care practice.

scholarly journals Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fitriana Murriya Ekawati ◽  
Sharon Licqurish ◽  
Jane Gunn ◽  
Shaun Brennecke ◽  
Phyllis Lau
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Delphi Survey ◽  
Care Practice ◽  
Free Text ◽  
Care Providers ◽  
Hypertensive Disorders Of Pregnancy ◽  
Implementation Barriers ◽  
Primary Care Settings ◽  
Hypertensive Disorders

Abstract Background Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care. Methods Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants’ agreement and further suggestions. The participants’ agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants’ responses and suggestions to the free text questions were analysed thematically. Results A total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8–100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Conclusions Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice.

Analysis of Body Mass Index (BMI) Trends Among a Pediatric Dental Patient Population: A Pilot Study. (Preprint)

2021 ◽  
Author(s):  
Tengfei Su ◽  
Mac Jackson ◽  
Keaton Sacry ◽  
Karl Kingsley MPH
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Low Income ◽  
Patient Population ◽  
Pediatric Population ◽  
Primary Care Providers ◽  
Overweight And Obesity ◽  
Dental School ◽  
Care Providers ◽  
Over Time

BACKGROUND Over the past few decades, a growing trend of overweight and obesity has emerged among the pediatric population. This is a cause of significant concern as these are significantly correlated to other negative oral and systemic health outcomes over time. Although measurement of body mass index (BMI) is common among pediatric physicians and primary care providers, few studies have explored the feasibility of BMI measurement and analysis from pediatric dental providers. OBJECTIVE The primary objective of this study was to compile and analyze pediatric BMI measurements taken from a pediatric dental school patient population. METHODS This study was a retrospective analysis of previously collected data of pediatric patients between 2012 and 2019 (N=451), which was reviewed and approved by the Institutional Review Board (IRB). Descriptive statistics and trend analysis were compiled to determine the trends in pediatric BMI over time. RESULTS Nearly equal percentages of females and males were represented in the study (P=0.432), with the overwhelming majority identified as racial/ethnic minorities (84.5%), P=0.0075. These data revealed that pediatric BMI increased significantly from 25.6 in 2012 to 31.3 in 2018 (22.1%), P=0.031. No significant differences between males and females were observed (P=0.4824) or between minority and non-minority patients (P=0.8288). CONCLUSIONS This study provides significant novel temporal information regarding pediatric BMI among this low-income, minority patient population and highlights the need for expanding the dental school (and pediatric dental residency) curriculum to include more topics related to measuring and tracking overweight and obese children and the most appropriate methods for use in the pediatric dental office.

Predictors and Outcomes of Burnout Among Primary Care Providers in the United States: A Systematic Review

2019 ◽  
Vol 77 (5) ◽  
pp. 387-401 ◽  
Author(s):  
Cilgy M. Abraham ◽  
Katherine Zheng ◽  
Lusine Poghosyan
Keyword(s):  
United States ◽  
Primary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Organizational Level ◽  
Care Practice ◽  
Practice Environment ◽  
Care Providers ◽  
Cross Sectional ◽  
Study Designs

Primary care providers (PCPs) in the United States work in challenging environments and may be at risk for burnout. This article identifies the predictors and outcomes of burnout among PCPs in the United States. A comprehensive literature search of eight databases was conducted to identify studies investigating predictors or outcomes of PCP burnout. The Joanna Briggs Institute’s critical appraisal checklists for cross-sectional and cohort studies were used for quality appraisal. Overall, 21 studies met inclusion criteria, had sufficient quality, reported personal and/or organizational predictors of burnout, and described burnout outcomes at the patient, provider, or organizational level. Prevalence of PCP burnout ranged from 13.5% to 60%. The primary care practice environment was the most common predictor of PCP burnout. In conclusion, developing interventions to improve the practice environment may help reduce PCP burnout. Future studies using robust study designs and standardized instruments to consistently measure burnout are needed.

scholarly journals Primary health care policy and vision for community pharmacy and pharmacists in Indonesia

2020 ◽  
Vol 18 (3) ◽  
pp. 2085
Author(s):  
Andi Hermansyah ◽  
Luh Wulandari ◽  
Susi A. Kristina ◽  
Sherly Meilianti
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Community Pharmacy ◽  
Health Care Policy ◽  
Primary Care Providers ◽  
Good Evidence ◽  
Care Practice ◽  
Health Coverage ◽  
Care Providers ◽  
Care System

The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the “Smart Use of Medicines” program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice.

scholarly journals Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices

2020 ◽  
Vol 17 (6) ◽  
pp. 2154 ◽  
Author(s):  
Sung Eun Choi ◽  
Lisa Simon ◽  
Jane R. Barrow ◽  
Nathan Palmer ◽  
Sanjay Basu ◽  
...  
Keyword(s):  
Primary Care ◽  
Dental Care ◽  
Primary Care Providers ◽  
Care Practice ◽  
First Year ◽  
Dental Practice ◽  
Care Providers ◽  
Net Revenue ◽  
Publicly Insured ◽  
The Impact

Given the widespread lack of access to dental care for many vulnerable Americans, there is a growing realization that integrating dental and primary care may provide comprehensive care. We sought to model the financial impact of integrating dental care provision into a primary care practice. A microsimulation model was used to estimate changes in net revenue per practice by simulating patient visits to a primary dental practice within primary care practices, utilizing national survey and un-identified claims data from a nationwide health insurance plan. The impact of potential changes in utilization rates and payer distributions and hiring additional staff was also evaluated. When dental care services were provided in the primary care setting, annual net revenue changes per practice were −$92,053 (95% CI: −93,054, −91,052) in the first year and $104,626 (95% CI: 103,315, 105,316) in subsequent years. Net revenue per annum after the first year of integration remained positive as long as the overall utilization rates decreased by less than 25%. In settings with a high proportion of publicly insured patients, the net revenue change decreased but was still positive. Integrating primary dental and primary care providers would be financially viable, but this viability depends on demands of dental utilization and payer distributions.

The Gene Pool: The Ethics of Genetics in Primary Care

2016 ◽  
Vol 34 (1) ◽  
pp. 119-154 ◽  
Author(s):  
Karen J. Whitt ◽  
McKenna Hughes ◽  
Elizabeth (Betsy) S. Hopkins ◽  
Ann Maradiegue
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Ethical Issues ◽  
Primary Care Providers ◽  
Ethical Principles ◽  
Research Articles ◽  
Care Practice ◽  
Care Providers ◽  
Primary Research ◽  
Genetics And Genomics

Aim: The purpose of this integrative review is to critically analyze the research literature regarding ethical principles that surround the integration of genetics and genomics in primary care clinical practice. Background: Advanced practice nurses (APRNs) play an important role in the provision of primary care services, in the areas of obstetrics, pediatrics, family practice, and internal medicine. Advances in genetic and genomic science are infiltrating these day-to-day health-care systems and becoming an integral part of health-care delivery. It is imperative for primary care providers to understand the ethical, legal, and social implications of genetics and genomics. Methods: A comprehensive multistep search of CINAHL, MEDLINE, Academic Search Premier, PsycINFO, Web of Science, and Scopus databases was conducted to identify primary research articles published from 2003 to 2015 that evaluated ethical issues related to genetics and genomics in U. S. primary care practice. A sample of 26 primary research articles met the inclusion criteria. Whittemore and Knafl's (2005) revised framework for integrative reviews was used to guide the analysis and assess the quality of the studies. Key findings from the studies are discussed according to Beauchamp and Childress's (2009) ethical principles of autonomy, beneficence, nonmaleficence, and justice. Results: Research conducted to date is mainly qualitative and descriptive and the analysis revealed several ethical challenges to implementing genetics and genomics in primary care settings. Conclusion: The review suggests that there are several implications for research, education, and the development of primary care practice that support APRNs delivering genetic and genomic care while incorporating knowledge of ethical principles. More research needs to be conducted that evaluates the actual genetic/genomic ethical issues encountered by primary care providers.

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