Associations Between Patients’ Unmet Social Needs and Self-Reported Health Confidence at One Primary Care Clinic

Social determinants of health affect a person’s health at least as much as their interactions with the healthcare system. Increased patient activation and self-efficacy are associated with decreased cost and improved quality. Patient-reported health confidence has been proposed as a more easily measured proxy for self-efficacy. Evaluation of the association between unmet social needs and health confidence is limited. Our objective was to identify and address our patients’ unmet social needs and assess health confidence levels. From November 2017 through July 2018 we screened 2018 patients of an urban academic family medicine residency practice for unmet social needs, measured their health confidence, and made referrals to community resources if desired. Patients reporting the presence of any social need reported lower health confidence scores on average than those with no needs (8.49 vs 9.30, median 9 vs 10, Wilcoxon test P < .001). Low health confidence scores (<7) were strongly associated with number of needs ( P < .001) after adjusting for age, gender, race, ethnicity, payer, and visit type (1 vs 0 needs, odds ratio [OR] = 2.566, 95% CI 1.546-4.259; 2 or more vs 0 needs, OR = 6.201, 95% CI 4.022-9.561). Results of this quality improvement project suggest that patients with unmet social needs may have decreased perceived ability to manage health problems. Further study is needed to determine if this finding is generalizable, and if interventions addressing unmet social needs can increase health confidence.

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When a Ciliate Meets a Flagellate: A Rare Case of Colpoda spp. and Colpodella spp. Isolated from the Urine of a Human Patient. Case Report and Brief Review of Literature

Biology ◽

10.3390/biology10060476 ◽

2021 ◽

Vol 10 (6) ◽

pp. 476

Author(s):

Vlad S. Neculicioiu ◽

Ioana A. Colosi ◽

Dan A. Toc ◽

Andrei Lesan ◽

Carmen Costache

Keyword(s):

Respiratory Insufficiency ◽

Combined Treatment ◽

Primary Care Clinic ◽

Clinical Signs ◽

Heart Association ◽

Chronic Obstructive ◽

Human Patient ◽

Care Clinic ◽

Morphological Criteria ◽

Patient Reported

An often-overlooked side of the population aging process and the steady rise of non-communicable diseases reflects the emergence of novel infectious pathogens on the background of an altered host immune response. The aim of this article was to present the first record of a ciliate and flagellate protozoa recovered from the urine of an elderly patient and to review the existing medical literature involving these parasites. A 70-year-old female patient was admitted for breathing difficulties on the basis of an acute exacerbation of COPD (Chronic obstructive pulmonary disease) with respiratory insufficiency. The patient reported a long history of multiple comorbidities including COPD Gold II, chronic respiratory insufficiency, chronic heart failure NYHA III (New York Heart Association Functional Classification), type 2 diabetes and morbid obesity. During routine examinations, we ascertained the presence of two unusual protozoa, a ciliate and a flagellate, in the patient’s urine samples, identified on morphological criteria to be most likely Colpoda spp. and Colpodella spp., with similarities to C. steinii and C. gonderi. The presence of these parasites was not associated with any clinical signs of urinary disease. Following a combined treatment with ceftriaxone and metronidazole, we observed the disappearance of these pathogens upon discharge from the primary care clinic. This study highlights the importance of including unusual pathogens in the differential diagnosis of cases which involve immunosuppression.

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Feasibility of Mobile Technology to Identify and Address Patients' Unmet Social Needs in a Primary Care Clinic

Population Health Management ◽

10.1089/pop.2020.0059 ◽

2020 ◽

Author(s):

Deepak Palakshappa ◽

Andrew J. Benefield ◽

Katherine F. Furgurson ◽

Michael G. Harley ◽

Richa Bundy ◽

...

Keyword(s):

Primary Care ◽

Mobile Technology ◽

Primary Care Clinic ◽

Social Needs ◽

Care Clinic

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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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Evaluation of the intensive outpatient clinic: study protocol for a prospective study of high-cost, high-need patients in the University of Utah Health system

BMJ Open ◽

10.1136/bmjopen-2018-024724 ◽

2019 ◽

Vol 9 (1) ◽

pp. e024724 ◽

Cited By ~ 2

Author(s):

Brittany L Bannon ◽

Michelle Lucier ◽

Angela Fagerlin ◽

Jaewhan Kim ◽

Bernadette Kiraly ◽

...

Keyword(s):

Outpatient Clinic ◽

Primary Care Clinic ◽

Healthcare Utilisation ◽

Care Quality ◽

Care Clinic ◽

University Of Utah ◽

Patient Reported ◽

Secondary Outcomes ◽

Intensive Outpatient ◽

The University

IntroductionThe University of Utah (UofU) Health intensive outpatient clinic (IOC) is a primary care clinic for medically complex (high-cost, high-need) patients with Medicaid. The clinic consists of a multidisciplinary care team aimed at providing coordinated, comprehensive and patient-centred care. The protocol outlines the quantitative design of an evaluation study to determine the IOC’s effects on reducing healthcare utilisation and costs, as well as improving patient-reported health outcomes and quality of care.Methods and analysisHigh-risk patients, with high utilisation and multiple chronic illnesses, were identified in the Medicaid ACO population managed by the UofU Health plans for IOC eligibility. A prospective, case-control study design is being used to match 100 IOC patients to 200 control patients (receiving usual care within the UofU) based on demographics, health utilisation and medical complexity for evaluating the primary outcome of change in healthcare utilisation and costs. For the secondary outcomes of patient health and care quality, a prepost design will be used to examine within-person change across the 18 months of follow-up (ie, before and after IOC intervention). Logistic regression and hierarchical, longitudinal growth modelling are the two primary modelling approaches.Ethics and disseminationThis work has received ethics approval by the UofU Institutional Review Board. Results from the evaluation of primary and secondary outcomes will be disseminated in scientific research journals and presented at national conferences.

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HIV Care for Patients With Complex Needs: A Controlled Evaluation of a Walk-In, Incentivized Care Model

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz294 ◽

2019 ◽

Vol 6 (7) ◽

Cited By ~ 5

Author(s):

Julia C Dombrowski ◽

Sean R Galagan ◽

Meena Ramchandani ◽

Shireesha Dhanireddy ◽

Robert D Harrington ◽

...

Keyword(s):

Viral Suppression ◽

Primary Care Clinic ◽

Social Needs ◽

Hiv Care ◽

Relative Risk Ratio ◽

Adjusted Relative Risk ◽

Engagement In Care ◽

Care Model ◽

Care Clinic ◽

Complex Needs

Abstract Background New approaches are needed to provide care to persons with HIV who do not engage in conventionally organized HIV clinics. The Max Clinic in Seattle, Washington, is a walk-in, incentivized HIV care model located in a public health STD clinic that provides care in collaboration with a comprehensive HIV primary care clinic (the Madison Clinic). Methods We compared outcomes in the first 50 patients enrolled in Max Clinic and 100 randomly selected matched Madison Clinic control patients; patients in both groups were virally unsuppressed (viral load [VL] >200 copies/mL) at baseline. The primary outcome was any VL indicating viral suppression (≥1 VL <200 copies/mL) during the 12 months postbaseline. Secondary outcomes were continuous viral suppression (≥2 consecutive suppressed VLs ≥60 days apart) and engagement in care (≥2 medical visits ≥60 days apart). We compared outcomes in the 12 months pre- and postbaseline and used generalized estimating equations to compare changes in Max vs control patients, adjusting for unstable housing, substance use, and psychiatric disorders. Results Viral suppression improved in both groups pre-to-post (20% to 82% Max patients; P < .001; and 51% to 65% controls; P = .04), with a larger improvement in Max patients (adjusted relative risk ratio [aRRR], 3.2; 95% confidence interval [CI], 1.8–5.9). Continuous viral suppression and engagement in care increased in both groups but did not differ significantly (continuous viral suppression: aRRR, 1.5; 95% CI, 0.5–5.2; engagement: aRRR, 1.3; 95% CI, 0.9–1.9). Conclusions The Max Clinic improved viral suppression among patients with complex medical and social needs.

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Efficacy Evaluation Study for Microburst Insulin Infusion: A Novel Model of Care

Frontiers in Public Health ◽

10.3389/fpubh.2021.600906 ◽

2021 ◽

Vol 9 ◽

Author(s):

Steven W. Howard ◽

Zidong Zhang ◽

Jacob Linomaz ◽

Wing Lam ◽

Zhengmin Qian ◽

...

Keyword(s):

Health Status ◽

Insulin Infusion ◽

Infusion Therapy ◽

Diabetic Patients ◽

Linear Modeling ◽

Efficacy Evaluation ◽

Patient Reported ◽

Patient Health ◽

Reported Health ◽

The Impact

Objectives: This study aims to evaluate the impact of Microburst Insulin Infusion (MII) treatment on Type 1 and 2 diabetic patients' HbA1c, lipids, peripheral neuropathy, and patient-reported health status.Methods: We reviewed clinical charts, including lab results, for more than 80 diabetic and pre-diabetic patients treated at one U.S. outpatient clinic in St. Louis, Missouri between February 2017 and December 2019. Data included patient demographics, treatment data, lab and neuropathy tests, and self-reported patient health status questions.The explanatory variable was number of months of MII treatment. Treatments are 3–4 h in length, with two intensive infusions the first week and one treatment each week thereafter, usually for 12 weeks total. Lab tests were at 12-week intervals.Generalized linear modeling and t-tests assessed the significance of differences between patients' baseline lab values, neuropathy measures, and health status before treatment vs. after final treatment.Results: Number of MII treatments per patient ranged from 1 to 262, over 1–24 months. Time in MII treatment was significantly associated with reductions in HbA1c by nearly 0.04 points per month, and triglycerides declined 3 points per month. Neuropathy measures of large toe vibratory sensation (clanging tuning fork) improved significantly, as did patient-reported health and feelings of improvement since beginning treatment.Discussion: The MII therapy appears to be efficacious in treating diabetic patients, particularly those with complications like neuropathy. Our findings affirmed several other studies. We uniquely incorporated patient health questionnaires, and empirically studied MII treatment efficacy for diabetes in a population large enough to permit statistically valid inferences. With multiple waves of data for over 80 patients, this is one of the most extensive quantitative studies of microburst insulin infusion therapy conducted to date, with protocols more uniformly implemented and survey instruments more consistently administered by the same clinical team. Given the advances in insulin infusion therapy brought by MII, and early indications of its efficacy, the time is right for more in-depth studies of the outcomes patients can achieve, the physiological mechanisms by which they occur, MII's comparative effectiveness vis-à-vis traditional treatments, and cost-effectiveness.

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Intersecting systemic and personal barriers to accessing social services: qualitative interviews in northern California

BMC Public Health ◽

10.1186/s12889-021-11981-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hilary Placzek ◽

Stephanie Cruz ◽

Michelle Chapdelaine ◽

Mary Carl ◽

Sara Levin ◽

...

Keyword(s):

Social Services ◽

Social Issues ◽

Safety Net ◽

Social Needs ◽

Qualitative Assessment ◽

Community Resources ◽

Northern California ◽

Care Clinic ◽

Social Risks ◽

Patient Reported

Abstract Background Addressing social risks in the clinical setting can increase patient confidence in the availability of community resources and may contribute to the development of a therapeutic alliance which has been correlated with treatment adherence and improved quality of life in mental health contexts. It is not well understood what barriers patients face when trying to connect to community resources that help address social risks. This paper aims to describe patient-reported barriers to accessing and using social needs-related resources to which they are referred by a program embedded in a safety net primary care clinic. Methods This is a qualitative assessment of patient-reported barriers to accessing and using social needs assistance programs. We conducted over 100 in-depth interviews with individuals in Northern California who participated in a navigation and referral program to help address their social needs and describe a unique framework for understanding how policies and systems intersect with an individual’s personal life circumstances. Results Individuals described two distinct domains of barriers: 1) systems-level barriers that were linked to the inequitable distribution of and access to resources, and 2) personal-level barriers that focused on unique limitations experienced by each patient and impacted the way that they accessed services in their communities. While these barriers often overlapped or manifested in similar outcomes, this distinction was key because the systems barriers were not things that individuals could control or overcome through their own initiative or by increasing individual capacity. Conclusions Respondents describe intersecting systemic and personal barriers that compound patients’ challenges to getting their social needs met; this includes both a picture of the inequitable distribution of and access to social services and a profile of the limitations created by individual life histories. These results speak to the need for structural changes to improve adequacy, availability, and accessibility of social needs resources. These findings highlight the need for advocacy to address systems barriers, especially the stigma that is faced by people who struggle with a variety of health and social issues, and investment in incentives to strengthen relationships between health care settings and social service agencies.

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The Association of Social Support, Self-Efficacy with the Duration and Complications of Type 2 Diabetes Mellitus (T2DM) in Patients of a Malaysian Primary Care Clinic

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v0i0.173 ◽

2019 ◽

pp. 55

Author(s):

Aneesa Abdul Rashid ◽

Zuhra Hamzah ◽

Chai Eng Tan ◽

Navin Kumar Devaraj

Keyword(s):

Social Support ◽

Primary Care ◽

Self Efficacy ◽

Primary Care Clinic ◽

Significant Negative Correlation ◽

Cardiovascular Complications ◽

Cross Sectional ◽

Care Clinic ◽

Mortality And Morbidity

Introduction: T2DM is a major cause of mortality and morbidity worldwide. Many factors need to be considered when managing patients with T2DM. Social support and self-efficac y are among the components associated with good diabetic self-care, which in turn lead to good diabetic outcomes. These factors are often overlooked but play an important role in patients’ management. This study aimed to determine the association of social support and diabetic selfefficacy of T2DM patients with the duration and complications of T2DM in a governme nt primary care clinicMethods: This is a cross sectional questionnaire study, involving 329 patients with T2DM in an urban Malaysian primary care clinic, using the Medical Outcome Study (MOS) Social Support Survey and Diabetic Management Self-Efficacy Scale (DMSES). The scores were analysed with clinical characteristic of the patients (duration and complications of T2DM) using descriptive and inferential statistics.Results: The mean duration of T2DM were 6.2 + 4.8 years, 57.8% of patients had no complications. Majority of patients had only 1 complication (33.1%) and 1 patient had 4 complications (0.3%). The complications were retinopathy (18.2%), nephropathy (14.6%), peripheral neuropathy (12.8%) and cardiovascular complications (4.3%). There was a significant correlation for social support with the duration of T2DM (r= -0.129, p = 0.02). There were no significant findings for the diabetic self-efficacy scores with duration and complications of T2DM.Conclusion: We found a significant negative correlation between the duration of T2DM and social support, which suggests that those with a longer duration of diabetes usually requires lesser social support.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 55

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