Barriers to weight loss among community health center patients: qualitative insights from primary care providers

Loss of mobility in older adults (65 and older) is associated with falling, loss of independence, and mortality. This paper, which to the author's knowledge is the first of its kind, summarizes findings of Federally Qualified Health Center (FQHC) case reports and how FQHCs minimize the impacts of mobility loss in older adult patients (who would not receive primary services without these transportation programs) by providing access to primary care services through transportation programs. This paper features the transportation programs of four FQHCs located in both urban and rural United States areas: LifeLong Medical Care (Oakland, CA); Hudson Headwaters Health Network (Queensbury, NY); North End Community Health Center (Boston, MA); Aaron E. Henry Community Health Services Center, Inc. (Clarksdale, MS). This paper is beneficial to primary care providers and public health officials in outlining how transportation may be used to minimize the effects of mobility loss in older adult patients.

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Evaluation of an Interdisciplinary Controlled Substance Review Committee on Opioid Prescribing in a Community Health Center

Pain Medicine ◽

10.1093/pm/pnaa075 ◽

2020 ◽

Vol 21 (9) ◽

pp. 1840-1846 ◽

Cited By ~ 2

Author(s):

Holly C Bourgeois ◽

Rachel C Proteau ◽

Cassandra V Vielma ◽

Daniel M Hartung ◽

Adriane N Irwin

Keyword(s):

Primary Care ◽

Health Center ◽

Community Health Center ◽

Primary Care Providers ◽

Patient Specific ◽

Future Research ◽

Care Providers ◽

Opioid Dose ◽

Opioid Prescribing ◽

Controlled Substance

Abstract Objective To describe recommendations made by an interdisciplinary controlled substance committee and acceptance by primary care providers. Design Retrospective cohort study. Setting Multisite federally qualified health center using an interdisciplinary committee to provide patient-specific recommendations to prescribers with patients using prescription opioids and other controlled substances. Subjects Patients prescribed long-term opioids. Methods We identified and characterized committee recommendations to prescribers between January 1, 2013, and December 31, 2016. We manually reviewed electronic medical records to determine if recommendations were accepted at eight months. The primary outcome was the overall acceptance rate of recommendations. Secondary outcomes were the acceptance of recommendations to reduce opioid doses and change in opioid dose from baseline. Results The committee made 337 recommendations for 94 patients. Of those, 169 recommendations (50.1%) were accepted within eight months. The most common recommendation was to change opioid prescribing (N = 53, 56.4%), but recommendations varied. For patients with a recommendation to change opioid prescribing, this was accepted in 31 of 53 patients (58.5%). Overall, opioid doses decreased from 60 morphine equivalents per day (interquartile range [IQR] = 27.5–135, range = 5–1,260) at baseline to 40 morphine equivalents per day (IQR = 15–105, range = 0–1,260) at eight months (P < 0.001). Conclusions An interdisciplinary committee was well positioned to offer primary care providers with nonopioid options to manage chronic nonmalignant pain and provide support in reducing opioid doses. About half of recommendations were accepted by primary care providers. Future research should focus on strategies to improve the utility of this approach and its impact on clinical outcomes.

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A web-based intervention to increase weight loss treatment initiation: results of a cluster randomized feasibility and acceptability trial

Translational Behavioral Medicine ◽

10.1093/tbm/ibz143 ◽

2019 ◽

Cited By ~ 2

Author(s):

Megan A McVay ◽

William S Yancy ◽

Gary G Bennett ◽

Erica Levine ◽

Seung-Hye Jung ◽

...

Keyword(s):

Primary Care ◽

Weight Loss ◽

Treatment Initiation ◽

Primary Care Providers ◽

Feasibility Trial ◽

Care Providers ◽

Behavioral Weight Loss ◽

Weight Loss Treatment ◽

Primary Care Patients ◽

Cluster Randomized

Abstract Evidence-based behavioral weight loss treatment is under-utilized. To increase initiation of treatment, we developed a single-session, online, primary care-based intervention (“mobilization tool”). We evaluated the mobilization tool's acceptability for primary care patients with obesity, trial design feasibility, and signal of an effect of the tool on treatment initiation. In this cluster randomized feasibility trial, primary care providers (PCPs) were randomized to a mobilization tool or comparator tool arm. Patients with obesity and a scheduled appointment with a randomized PCP were assigned to complete the mobilization or comparator tool prior to their appointment. The online mobilization tool asks patients to answer questions about a variety of weight-related topics and then provides automated, tailored feedback that addresses psychosocial determinants of weight loss treatment initiation. The comparator tool provided a nontailored description of treatments. All participants were offered free enrollment in behavioral weight loss treatments. Six PCPs were randomized. Sixty patients (57% female; 66% white; aged 55 ± 13 years) participated in this study of 296 contacted for eligibility evaluation (20.2%). Six-month follow-up assessments were completed by 65% (22/34) of the mobilization and 73% (19/26) of comparator tool participants. Participants completing the acceptability survey reported that the mobilization tool was usable, enjoyable, informative, and useful. Weight loss treatment was initiated by 59% (n = 19) of mobilization and 33% (n = 8) of comparator tool participants. The mobilization tool shows promise for increasing treatment initiation among primary care patients, which may increase population weight loss. Trial Registration: Clinicaltrials.gov identifier: NCT02708121.

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Use of seven types of medical jargon by male and female primary care providers at a university health center

Patient Education and Counseling ◽

10.1016/j.pec.2021.08.018 ◽

2021 ◽

Author(s):

Ann Neville Miller ◽

Ajay Bharathan ◽

Venkata Naga Sreelalitapriya Duvuuri ◽

Vanessa Navas ◽

Lisvet Luceno ◽

...

Keyword(s):

Primary Care ◽

Health Center ◽

Primary Care Providers ◽

Care Providers ◽

Male And Female ◽

Medical Jargon

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Primary Care Providers’ Perspectives on Online Weight-Loss Programs: A Big Wish List

Journal of Medical Internet Research ◽

10.2196/jmir.1955 ◽

2012 ◽

Vol 14 (1) ◽

pp. e16 ◽

Cited By ~ 13

Author(s):

Kevin O Hwang ◽

Heather L Stuckey ◽

Monica C Chen ◽

Jennifer L Kraschnewski ◽

Samuel N Forjuoh ◽

...

Keyword(s):

Primary Care ◽

Weight Loss ◽

Primary Care Providers ◽

Care Providers ◽

Weight Loss Programs

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Capturing Relevant Patient Data in Clinical Encounters Through Integration of an Electronic Patient-Reported Outcome System Into Routine Primary Care in a Boston Community Health Center: Development and Implementation Study (Preprint)

10.2196/preprints.16778 ◽

2019 ◽

Author(s):

Stephanie Loo ◽

Chris Grasso ◽

Jessica Glushkina ◽

Justin McReynolds ◽

William Lober ◽

...

Keyword(s):

Primary Care ◽

Community Health ◽

Health Center ◽

Community Health Centers ◽

Community Health Center ◽

Improve Patient Care ◽

Patient Reported Outcome ◽

Patient Reported ◽

Patient Provider Communication ◽

Improve Patient

BACKGROUND Electronic patient-reported outcome (ePRO) systems can improve health outcomes by detecting health issues or risk behaviors that may be missed when relying on provider elicitation. OBJECTIVE This study aimed to implement an ePRO system that administers key health questionnaires in an urban community health center in Boston, Massachusetts. METHODS An ePRO system that administers key health questionnaires was implemented in an urban community health center in Boston, Massachusetts. The system was integrated with the electronic health record so that medical providers could review and adjudicate patient responses in real-time during the course of the patient visit. This implementation project was accomplished through careful examination of clinical workflows and a graduated rollout process that was mindful of patient and clinical staff time and burden. Patients responded to questionnaires using a tablet at the beginning of their visit. RESULTS Our program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model in terms of applying technological innovation to streamline clinical processes and improve patient care. CONCLUSIONS Our program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model for application of technological innovation to streamline clinical processes and improve patient care.

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