“B in IT” - a community-based model for the management of hepatitis B patients in primary care clinics using a novel web-based clinical tool

The PREMM5 model is a web-based clinical prediction algorithm that estimates the gene-specific risk of an individual carrying a Lynch syndrome germline mutation based on targeted family history questions. The objectives of our study were to determine the feasibility of screening for LS in an urban, minority patient population in a primary care setting using the PREMM5 model and characterize patient barriers associated with difficulty completing the questions. Participants were recruited from Tulane Internal Medicine primary care clinics on 9 random collection dates. Our data illustrates the difficulty patients have in recalling important details necessary to answer the PREMM questionnaire.

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Innovative Partnership Between Primary Care, AAA, and Academia Connects 4Ms and Social Determinants of Health

Innovation in Aging ◽

10.1093/geroni/igaa057.352 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 107-107

Author(s):

Suzanne Leahy ◽

Katie Ehlman ◽

Lisa Maish ◽

Brad Conrad ◽

Jillian Hall ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Health System ◽

Preliminary Evaluation ◽

Language And Literacy ◽

Community Based ◽

Primary Care Clinics ◽

College Of Nursing ◽

Value Based Care ◽

The University

Abstract Nationally, there is a growing focus on addressing geriatric care in primary care settings. HRSA’s Geriatric Workforce Enhancement Program (GWEP) has called for academic and health system partners to develop a reciprocal, innovative, cross-sector partnership that includes primary care sites and community-based agencies serving older adults. Through the University of Southern Indiana’s GWEP, the College of Nursing and Health Professions, the Deaconess Health System, three primary care clinics, and two Area Agencies on Aging (AAA) have joined to transform the healthcare of older adults regionally, including rural residents in the 12-county area. Core to the project is a value-based care model that “embeds” AAA care managers in primary care clinics. Preliminary evaluation indicates early success in improving the healthcare of older adults at one primary clinic, where clinical teams have referred 64 older adult patients to the AAA care manager. Among these 64 patients, 80% were connected to supplemental, community-based health services; 22% to programs addressing housing and transportation; and, nearly 10% to a range of other services (e.g., job training; language and literacy; and technology). In addition to presenting limited data on referred patients and referral outcomes, the presentation will share copies of the AAA referral log, to illustrate how resources were categorized by SDOH and added to support integration of the 4Ms.

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Abstract P052: The Effect of Re-designing Workflow and Introducing Automated Blood Pressure Devices in Community-based Primary Care Clinics

Circulation ◽

10.1161/circ.125.suppl_10.ap052 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Romsai T Boonyasai ◽

Greg P Prokopowicz ◽

Jeanne Charleston ◽

Kathryn A Carson ◽

Gary J Noronha ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Blood Pressure Measurement ◽

Clinical Inertia ◽

Intervention Period ◽

Post Intervention ◽

Community Based ◽

Primary Care Clinics ◽

Clinic Staff ◽

Measurement Protocol

BACKGROUND: Prior studies report that poor technique and terminal digit preference (TDP) can distort blood pressure (BP) estimates in clinical settings. These limitations may bias population BP estimates, increase clinician workload, and contribute to clinical inertia. HYPOTHESIS: We hypothesized that BP measurement training with an automated blood pressure measurement (aBPM) device would reduce TDP, reduce the number of times clinicians repeat staff-obtained measurements, and reduce average BP estimates within each site. METHODS: We replaced aneroid BP measurement devices in 6 community-based primary care clinics with aBPM devices (Omron HEM-907XL) and trained clinic staff with a standardized BP measurement protocol using 1 hour presentations and follow-up visits. We report mean weekly BP measured in the 8 weeks pre- and 4 weeks post-intervention at the first intervention site. Results are analyzed using chi-squared and paired t-tests. RESULTS: Clinic staff recorded 5796 BP readings in the 8 week pre-intervention period and 2321 readings in the 4 weeks post-intervention period. TDP and clinician workload improved after the intervention. Pre-intervention, 1941 of 4833 (40.2%) of systolic BP and 2199 of 4833 (45.5%) of diastolic BP ended in zero, in contrast to 216 of 2158 (10.0%) of systolic and 219 of 2158 (10.2%) of diastolic readings post-intervention (P<.001 for both SBP and DBP). Clinicians repeated BP obtained by staff in 963 of 5796 (16.6%) of visits pre-intervention but only in 163 of 2321 (7.0%) of visits post-intervention (P<.001). TDP persisted when clinicians repeated staff-obtained BP readings post-intervention: 58 of 163 (35.6%) systolic and 65 of 163 (35.7%) diastolic BP ended in zero (P=.32 for SBP and P=.35 for DBP in comparison with pre-intervention BP readings). Overall, BP estimates changed modestly following the intervention. Post-intervention, mean systolic BP rose 1.4 mmHg (P=.004) and diastolic BP declined 3.1 mmHg (P<.001). Among clinician-repeated BP readings, systolic BP rose 2.4 mmHg (P=.12 for pre/post change) and diastolic BP declined 0.4 mmHg (P=.72 for pre/post change). CONCLUSIONS: A standardized BP measurement protocol used with an aBPM device in community-based primary care settings can reduce TDP and clinician workload but is associated with only modest change in population BP estimates.

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Mo1896 Chronic Hepatitis B (CHB) Treatment Eligibility and Actual Treatment Rates at Community Gastroenterology Clinics and Primary Care Clinics

Gastroenterology ◽

10.1016/s0016-5085(12)63850-5 ◽

2012 ◽

Vol 142 (5) ◽

pp. S-993 ◽

Cited By ~ 1

Author(s):

Vincent G. Nguyen ◽

Kenton Wan ◽

Huy N. Trinh ◽

Jiayi Li ◽

Jian Q. Zhang ◽

...

Keyword(s):

Primary Care ◽

Chronic Hepatitis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Actual Treatment ◽

Primary Care Clinics

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PrEP in Primary Care; Health Care Worker Adaptations to PrEP Delivery in Eswatini

10.21203/rs.3.rs-73560/v1 ◽

2020 ◽

Author(s):

Kate Barnighausen ◽

Sarah Dalglish ◽

Sindy Matse ◽

Allison Hughey ◽

Anita Hettema ◽

...

Keyword(s):

Primary Care ◽

Public Sector ◽

Southern Africa ◽

Program Implementation ◽

Real World ◽

Scale Up ◽

Community Based ◽

Sexually Transmitted ◽

Primary Care Clinics ◽

Fast Tracking

Abstract BackgroundImplementation evidence for pre-exposure prophylaxis (PrEP) for the general population in primary-care clinics in Southern Africa is limited. Perspective from those providing PrEP in ‘real world’ settings is needed to better inform future programming, policy, and scale up. MethodsFrom September 2017 to January 2019 we conducted 54 semi-structured in-depth interviews with purposively selected healthcare workers (HCWs) from six public sector, nurse-led, primary-care clinics in Eswatini. Data from observational notes, daily debriefing sessions and interview transcripts were analyzed using Nvivo 12 following the tenets of Grounded Theory. We present our results within six domains of a modified Consolidated Framework for Implementation (CFIR). ResultsHCWs said that they adapted implementation guidelines in order to inform more people of PrEP. HCWs said that clinic and community based PrEP education and promotion was essential for demand creation, uptake and continued PrEP use. Clinic modifications included conducting PrEP risk assessments during existing TB screening services, and targeting PrEP counselling for pregnant women and clients with sexually transmitted infections. HCWs described streamlining the PrEP initiation process by fast-tracking at-risk clients for initiation and pill collection. HCW said they emphasised PrEP as being for ‘everyone’ to avoid stigma. ConclusionsIntegration of PrEP delivery into existing screening and treatment services may help reach those most vulnerable to HIV infection, avoid time-consuming referrals, and prevent loss of clients between different components of the care continuum. PrEP education and promotion should be both clinic and community based to ensure potential clients have enough information before reaching the clinic, prevent PrEP-associated stigma and assist in family and partner understanding of PrEP use. HCWs providing PrEP in public-sector clinics have first-hand knowledge of implementation in ‘real world’ settings in a field where policy and program implementation is largely undefined. Integrating their feedback into future programming and policy may support effective PrEP delivery in Eswatini and other high prevalence settings in Southern Africa.

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Complexity in partnerships: A qualitative examination of collaborative depression care in primary care clinics and community‐based organisations in California, United States

Health & Social Care in the Community ◽

10.1111/hsc.12953 ◽

2020 ◽

Vol 28 (4) ◽

pp. 1199-1208

Author(s):

Stuart Henderson ◽

Jenny L. Wagner ◽

Melissa M. Gosdin ◽

Theresa J. Hoeft ◽

Jürgen Unützer ◽

...

Keyword(s):

United States ◽

Primary Care ◽

Depression Care ◽

Community Based ◽

Primary Care Clinics

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Provider-Related Linkages Between Primary Care Clinics and Community-Based Senior Centers Associated With Diabetes-Related Outcomes

Journal of Applied Gerontology ◽

10.1177/0733464818782853 ◽

2018 ◽

Vol 39 (6) ◽

pp. 635-643

Author(s):

Polly Hitchcock Noël ◽

Chen-Pin Wang ◽

Erin P. Finley ◽

Sara E. Espinoza ◽

Michael L. Parchman ◽

...

Keyword(s):

Primary Care ◽

Primary Care Providers ◽

Institute Of Medicine ◽

Management Support ◽

Care Providers ◽

Community Based ◽

Senior Centers ◽

Care Community ◽

Primary Care Clinics ◽

Primary Care Practices

The Institute of Medicine (IOM) suggests that linkages between primary care practices and community-based resources can improve health in lower income and minority patients, but examples of these are rare. We conducted a prospective, mixed-methods observational study to identify indicators of primary care–community linkage associated with the frequency of visits to community-based senior centers and improvements in diabetes-related outcomes among 149 new senior center members (72% Hispanic). We used semistructured interviews at baseline and 9-month follow-up, obtaining visit frequency from member software and clinical assessments including hemoglobin A1c (HbA1c) from colocated primary care clinics. Members’ discussion of their activities with their primary care providers (PCPs) was associated with increased visits to the senior centers, as well as diabetes-related improvements. Direct feedback from the senior centers to their PCPs was desired by the majority of members and may help to reinforce use of community resources for self-management support.

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Increasing Colorectal Cancer Screening at Community-Based Primary Care Clinics in San Francisco

Journal of Public Health Management and Practice ◽

10.1097/phh.0000000000000275 ◽

2016 ◽

Vol 22 (5) ◽

pp. 466-471 ◽

Cited By ~ 1

Author(s):

Rani Marx ◽

Winnie M. Tse ◽

Lisa Golden ◽

Elizabeth C. Johnson

Keyword(s):

Colorectal Cancer ◽

Primary Care ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

San Francisco ◽

Community Based ◽

Primary Care Clinics

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The Trans Primary Care Guide: A Community-Based Approach to Developing a Web-based, Illustrated Resource for Primary Health Care Providers (Preprint)

10.2196/preprints.11469 ◽

2018 ◽

Author(s):

Kelly Katharina Speck ◽

Shelley L Wall

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Care Providers ◽

Successful Implementation ◽

Care Providers ◽

Design And Development ◽

Community Based ◽

Web Based ◽

Basic Care ◽

Training Resources

BACKGROUND There is a large gap in educational and training resources on trans-sensitive care in health professional curricula. In-person continuing medical education training sessions are often limited by time, place, and instructor availability. Web-based technologies offer the potential to easily reach primary care providers across the province. However, existing online training resources are lengthy in content, lack visual communication strategies, and do not encompass the multitude of different transition options sought by trans individuals. OBJECTIVE This article describes a community-based, participatory approach to the design and development of a web-based, illustrated resource guide with non-sequential access to medical and basic care protocols and guidelines to improve primary care providers' knowledge and confidence in caring for trans clients. METHODS The design and development of the Trans Primary Care Guide was informed by a participatory design research strategy focused on iterative improvement of the resource through iterative review by an advisory committee, formative evaluations with trans participants and primary care providers, and usability testing. RESULTS A web-based, illustrated resource (Trans Primary Care Guide) was developed to educate primary care providers on the health care needs of trans and gender-diverse people. CONCLUSIONS Successful implementation of the web-based resource was in part due to the utilization of design strategies to help primary care providers contextualize trans-competencies, the community-academic partnership and due to the early engagement of trans participants to ensure that information is gender affirming and culturally specific to regional community needs. CLINICALTRIAL Not applicable.

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