scholarly journals Spatial analysis of colorectal cancer outcomes and socioeconomic factors in Virginia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Esther J. Thatcher ◽  
Fabian Camacho ◽  
Roger T. Anderson ◽  
Li Li ◽  
Wendy F. Cohn ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Spatial Distribution ◽  
Spatial Analysis ◽  
Healthcare Access ◽  
Population Group ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Cross Sectional ◽  
Cold Spots

Abstract Background Colorectal cancer (CRC) disparities vary by country and population group, but often have spatial features. This study of the United States state of Virginia assessed CRC outcomes, and identified demographic, socioeconomic and healthcare access contributors to CRC disparities. Methods County- and city-level cross-sectional data for 2011–2015 CRC incidence, mortality, and mortality-incidence ratio (MIR) were analyzed for geographically determined clusters (hotspots and cold spots) and their correlates. Spatial regression examined predictors including proportion of African American (AA) residents, rural-urban status, socioeconomic (SES) index, CRC screening rate, and densities of primary care providers (PCP) and gastroenterologists. Stationarity, which assesses spatial equality, was examined with geographically weighted regression. Results For incidence, one CRC hotspot and two cold spots were identified, including one large hotspot for MIR in southwest Virginia. In the spatial distribution of mortality, no clusters were found. Rurality and AA population were most associated with incidence. SES index, rurality, and PCP density were associated with spatial distribution of mortality. SES index and rurality were associated with MIR. Local coefficients indicated stronger associations of predictor variables in the southwestern region. Conclusions Rurality, low SES, and racial distribution were important predictors of CRC incidence, mortality, and MIR. Regions with concentrations of one or more factors of disparities face additional hurdles to improving CRC outcomes. A large cluster of high MIR in southwest Virginia region requires further investigation to improve early cancer detection and support survivorship. Spatial analysis can identify high-disparity populations and be used to inform targeted cancer control programming.

scholarly journals Stressors Facing Home-Based Primary Care Providers

Geriatrics ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 17 ◽  
Author(s):  
Katherine O’Brien ◽  
Sara Bradley ◽  
Vanessa Ramirez-Zohfeld ◽  
Lee Lindquist
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Cross Sectional ◽  
Home Setting ◽  
Caregiver Support ◽  
Qualitative Survey ◽  
Home Based Primary Care ◽  
Home Based

The numbers of homebound patients in the United States are increasing. Home-based primary care (HBPC) is an effective model of interdisciplinary care that has been shown to have high patient satisfaction rates and excellent clinical outcomes. However, there are few clinicians that practice HBPC and clinicians that do face additional stressors. This study sought to better understand the stressors that HBPC providers face in caring for homebound patients. This was a cross-sectional qualitative survey and analysis of HBPC providers. Responses were categorized into four themes: The patient in the home setting, caregiver support, logistics, and administrative concerns. This research is the first to analyze the stressors that providers of HBPC face in serving the needs of complex homebound patients. Awareness and attention to these issues will be important for the future sustainability of home-based primary care.

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 Colorectal Cancer Screening

2011 ◽  
Vol 6 (3) ◽  
pp. 196-203 ◽  
Author(s):  
Joseph A. Diaz ◽  
Teresa Slomka
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Primary Care Providers ◽  
The United States ◽  
Average Risk ◽  
Care Providers ◽  
Screening Guidelines ◽  
Emerging Issues

Although colorectal cancer is the third leading cause of cancer-related deaths in the United States, the burden of this disease could be dramatically reduced by increased utilization of screening. Evidence-based recommendations and guidelines from national societies recommend screening all average risk adults starting at age 50 years. However, the myriad screening options and slight differences in screening recommendations between guidelines may lead to confusion among patients and their primary care providers. In addition, varied colorectal cancer incidence and screening rates among different racial/ethnic groups, inconsistent screening recommendations based on family history and/or age, and increasing awareness of the role of nonadenomatous and nonpolypoid lesions also pose potential challenges to primary care providers when counseling patients. The goal of this review, therefore, is to briefly summarize the colorectal cancer screening guidelines issued by 3 major organizations, compare their recommendations, and address emerging issues in colorectal cancer screening.

The National Residency Exchange: A Proposal to Restore Primary Care in an Age of Microspecialization

2012 ◽  
Vol 38 (1) ◽  
pp. 158-195 ◽  
Author(s):  
Glen Cheng
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Primary Care Physicians ◽  
Healthcare Access ◽  
Medical Specialty ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Loan Repayment ◽  
Patient Protection

Healthcare deficiencies in the United States have long been perpetuated by a shortage of primary care providers. A core purpose of the Patient Protection and Affordable Care Act (PPACA) is to provide health insurance for America's approximately fifty million uninsured. Implementation of universal health insurance, however, does not mean sufficient healthcare access for all, since the supply of physicians does not and will not meet demand. For reasons reviewed in this Article, the current physician shortage mainly impacts primary care providers. This shortage is particularly troubling because increased provision of primary care relative to specialty care has been associated with improvement in health outcomes, disease prevention, cost effectiveness, and coordination of care. This Article highlights provisions in the PPACA that impact primary care physicians. Finally, this Article proposes the creation of a universal primary care loan repayment program and a national residency exchange designed to alleviate the U.S. primary care crisis by facilitating optimal distribution of resident physicians in each medical specialty based on community need.

Primary Care Providers' Attitudes Towards Recommending Cancer Screening to Patients With Intellectual Disability: A Cross-Sectional Survey

Inclusion ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 185-193
Author(s):  
Genevieve Breau ◽  
Sally Thorne ◽  
Jennifer Baumbusch ◽  
T. Greg Hislop ◽  
Arminee Kazanjian
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Intellectual Disability ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Primary Care Providers ◽  
Survey Study ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Individuals with intellectual disability (ID) obtain breast, cervical, and colorectal cancer screening at lower rates, relative to the general population. This cross-sectional survey study explored how primary care providers and trainees recommend cancer screening to patients with ID, using a standardized attitudes questionnaire and vignettes of fictional patients. In total, 106 primary care providers and trainees participated. Analyses revealed that participants' attitudes towards community inclusion predicted whether participants anticipated recommending breast and colorectal cancer screening to fictional patients. Further research is needed to explore these factors in decisions to recommend screening, and how these factors contribute to cancer screening disparities.

scholarly journals Colorectal Cancer in the Young: Epidemiology, Prevention, Management

2020 ◽  
pp. e75-e88 ◽  
Author(s):  
Rebecca L. Siegel ◽  
Christopher Dennis Jakubowski ◽  
Stacey A. Fedewa ◽  
Anjee Davis ◽  
Nilofer S. Azad
Keyword(s):  
Colorectal Cancer ◽  
Young Patients ◽  
Treatment Protocol ◽  
Primary Care Providers ◽  
The United States ◽  
Rectal Disease ◽  
Care Providers ◽  
Early Screening ◽  
Related Factors ◽  
Cancer Management

Colorectal cancer (CRC) incidence rates in the United States overall have declined since the mid-1980s because of changing patterns in risk factors (e.g., decreased smoking) and increases in screening. However, this progress is increasingly confined to older adults. CRC occurrence has been on the rise in patients younger than age 50, often referred to as early-onset disease, since the mid-1990s. Young patients are more often diagnosed at an advanced stage and with rectal disease than their older counterparts, and they have numerous other unique challenges across the cancer management continuum. For example, young patients are less likely than older patients to have a usual source of health care; often need a more complex treatment protocol to preserve fertility and sexual function; are at higher risk of long-term and late effects, including subsequent primary malignancies; and more often suffer medical financial hardship. Diagnosis is often delayed because of provider- and patient-related factors, and clinicians must have a high index of suspicion if young patients present with rectal bleeding or changes in bowel habits. Educating primary care providers and the larger population on the increasing incidence and characteristic symptoms is paramount. Morbidity can further be averted by increasing awareness of the criteria for early screening, which include a family history of CRC or polyps and a genetic predisposition.

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 COVID-19 Vaccine Acceptance among Health Care Workers in the United States

Vaccines ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 119 ◽  
Author(s):  
Rahul Shekhar ◽  
Abu Baker Sheikh ◽  
Shubhra Upadhyay ◽  
Mriganka Singh ◽  
Saket Kottewar ◽  
...  
Keyword(s):  
Final Analysis ◽  
The United States ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Cross Sectional ◽  
Vaccine Acceptance ◽  
Care Workers ◽  
Vaccination Acceptance ◽  
Study Population ◽  
To Receive

Background: Acceptance of the COVID-19 vaccine will play a major role in combating the pandemic. Healthcare workers (HCWs) are among the first group to receive vaccination, so it is important to consider their attitudes about COVID-19 vaccination to better address barriers to widespread vaccination acceptance. Methods: We conducted a cross sectional study to assess the attitude of HCWs toward COVID-19 vaccination. Data were collected between 7 October and 9 November 2020. We received 4080 responses out of which 3479 were complete responses and were included in the final analysis. Results: 36% of respondents were willing to take the vaccine as soon as it became available while 56% were not sure or would wait to review more data. Only 8% of HCWs do not plan to get vaccine. Vaccine acceptance increased with increasing age, education, and income level. A smaller percentage of female (31%), Black (19%), Lantinx (30%), and rural (26%) HCWs were willing to take the vaccine as soon as it became available than the overall study population. Direct medical care providers had higher vaccine acceptance (49%). Safety (69%), effectiveness (69%), and speed of development/approval (74%) were noted as the most common concerns regarding COVID-19 vaccination in our survey.

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.

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