scholarly journals Protocol for comparing two training approaches for primary care professionals implementing the Safe Environment for Every Kid (SEEK) model

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Howard Dubowitz ◽  
Lisa Saldana ◽  
Laurence A. Magder ◽  
Lawrence A. Palinkas ◽  
John A. Landsverk ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Medical Training ◽  
Scale Up ◽  
Public Health Problem ◽  
Pediatric Primary Care ◽  
Successful Implementation ◽  
Major Public Health Problem ◽  
Improvement Project ◽  
Safe Environment

Abstract Background Child maltreatment (CM) is a major public health problem, affecting many lives, in the short and long term, and costing individuals, families, and society dearly. There is a need for broad implementation of evidence-based preventive interventions, such as the Safe Environment for Every Kid (SEEK) model, developed for pediatric primary care. Primary care offers an excellent opportunity to help address prevalent psychosocial problems (e.g., parental depression) that are risk factors for CM. By addressing such problems, SEEK can strengthen families and support parents; promote children’s health, development, and safety; help prevent CM; and benefit the health of the US population. This study will examine intervention strategies for optimizing SEEK’s adoption, implementation, and sustainment, and its effectiveness in preventing CM. Despite strong evidence from two federally funded randomized controlled trials, SEEK has not been widely adopted. The goal of this study is to examine technology-driven implementation strategies to scale-up SEEK—in pediatric and family medicine primary care settings. The aims are to (1) evaluate the effectiveness of training strategies on SEEK’s implementation in primary care practices, (2) evaluate barriers and facilitators to successful implementation and sustainment of SEEK, and (3) examine the model’s effectiveness in preventing CM and the economic costs of implementing SEEK. Methods This randomized type III hybrid mixed methods design will examine how advances in medical training can bolster SEEK’s adoption and implementation in pediatric and family medicine practices in different regions of the USA. These are independent online training and in-depth structured training via a quality improvement project, approved by the American Boards of Pediatrics and of Family Medicine. We will also evaluate SEEKonline, software that assists primary care practitioners implement the model, and a “Traditional” paper and pencil strategy for their impact on implementation. The study uses the EPIS framework and the Universal Stages of Implementation Completion, quantitative measures, qualitative interviews, and data abstracted from electronic health records. Discussion The knowledge gained should improve pediatric primary care to better address prevalent social determinants of health, benefiting many children and families. The outcomes should enhance the field of implementation science and guide future interventions in primary care. Trial registration NCT03642327, Clinical Trials, registered August 21, 2018.

scholarly journals Protocol for Comparing Two Training Approaches for Primary Care Professionals Implementing the Safe Environment for Every Kid (SEEK) Model

2020 ◽  
Author(s):  
Howard Dubowitz ◽  
Lisa Saldana ◽  
Lawrence Magder ◽  
Lawrence Palinkas ◽  
John Landsverk ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Medical Training ◽  
Scale Up ◽  
Public Health Problem ◽  
Pediatric Primary Care ◽  
Successful Implementation ◽  
Major Public Health Problem ◽  
Improvement Project ◽  
Safe Environment

Abstract Background: Child maltreatment (CM) is a major public health problem, affecting many lives, in the short-and long-term, and costing individuals, families and society dearly. There is a need for broad implementation of evidence-based preventive interventions, such as the Safe Environment for Every Kid (SEEK) model, developed for pediatric primary care. Primary care offers an excellent opportunity to help address prevalent psychosocial problems (e.g., parental depression) that are risk factors for CM. By addressing such problems, SEEK can strengthen families and support parents, promote children’s health, development and safety, help prevent CM, and benefit the health of the US population. This study will examine intervention strategies for optimizing SEEK’s adoption, implementation and sustainment, and its effectiveness in preventing CM. Despite strong evidence from two federally funded randomized controlled trials, SEEK has not been widely adopted. The goal of this study is to examine technology driven implementation strategies to scale-up SEEK - in pediatric and family medicine primary care settings. The aims are to: 1) evaluate the effectiveness of training strategies on SEEK’s implementation in primary care practices; 2) evaluate barriers and facilitators to successful implementation and sustainment of SEEK; and 3) examine the model’s effectiveness in preventing CM and the economic costs of implementing SEEK.Methods: This randomized Type III hybrid mixed methods design will examine how advances in medical training can bolster SEEK’s adoption and implementation in pediatric and family medicine practices in different regions of the U.S. These are independent online training and in-depth structured training via a Quality Improvement project, approved by the American Boards of Pediatrics and of Family Medicine. We will also evaluate SEEKonline, software that assists primary care practitioners implement the model, and a “Traditional” paper and pencil strategy for their impact on implementation. The study uses the EPIS framework and the Universal Stages of Implementation Completion, quantitative measures, qualitative interviews and data abstracted from electronic health records. Discussion: The knowledge gained should improve pediatric primary care to better address prevalent social determinants of health, benefiting many children and families. The outcomes should enhance the field of implementation science, and guide future interventions in primary care.Trial Registration: NCT03642327, Clinical Trials, registered 8/21/18, https://register.clinicaltrials.gov

scholarly journals Validation and Psychometric Properties of the Spanish Version of the Hopkins Symptom Checklist-25 Scale for Depression Detection in Primary Care

2021 ◽  
Vol 18 (15) ◽  
pp. 7843
Author(s):  
María Rodríguez-Barragán ◽  
María Isabel Fernández-San-Martín ◽  
Ana Clavería-Fontán ◽  
Susana Aldecoa-Landesa ◽  
Marc Casajuana-Closas ◽  
...  
Keyword(s):  
Primary Care ◽  
Psychometric Properties ◽  
Public Health Problem ◽  
Composite International Diagnostic Interview ◽  
Spanish Version ◽  
Major Public Health Problem ◽  
Symptom Checklist ◽  
Validity And Reliability ◽  
Cross Sectional ◽  
Hopkins Symptom Checklist

Depression constitutes a major public health problem due to its high prevalence and difficulty in diagnosis. The Hopkins Symptom Checklist-25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use in primary care (PC). The purpose of the study was to assess the psychometric properties of the HSCL-25 and validate its Spanish version. A multicenter cross-sectional study was carried out at six PC centers in Spain. Validity and reliability were assessed against the structured Composite International Diagnostic Interview (CIDI). Out of the 790 patients, 769 completed the HSCL-25; 738 answered all the items. Global Cronbach’s alpha was 0.92 (0.88 as calculated for the depression dimension and 0.83 for the anxiety one). Confirmatory factor analysis (CFA) showed one global factor and two correlated factors with a correlation of 0.84. Area under the curve (AUC) was 0.89 (CI 95%, 0.86–0.93%). For a 1.75 cutoff point, sensibility was 88.1% (CI 95%, 77.1–95.1%) and specificity was 76.7% (CI 95%, 73.3–79.8%). The Spanish version of the HSCL-25 has a high response percentage, validity, and reliability and is well-accepted by PC patients.

scholarly journals Justification and active guideline implementation for spine radiography referrals in primary care

2016 ◽  
Vol 58 (5) ◽  
pp. 586-592 ◽  
Author(s):  
Pirita Tahvonen ◽  
Heljä Oikarinen ◽  
Jaakko Niinimäki ◽  
Esa Liukkonen ◽  
Seija Mattila ◽  
...  
Keyword(s):  
Primary Care ◽  
Lumbar Spine ◽  
Guideline Implementation ◽  
Public Health Problem ◽  
Further Education ◽  
Major Public Health Problem ◽  
Spine Radiography ◽  
Cervical Spine Radiography ◽  
Active Implementation

Background Spinal disorders are a major public health problem. Appropriate diagnostic imaging is an essential part in the management of back complaints. Nevertheless, inappropriate imaging increases population collective dose and health costs without improving outcome. Purpose To determine the effects of active implementation of referral guidelines on the number and justification of spine radiography in primary care in one city. Material and Methods Specified guidelines for spine radiography were distributed to referring practitioners altogether three times during the study period. Educational lectures were provided before the guidelines were taken into use. The guidelines were also made available via the intranet. The number of spine radiography referrals during similar 6-month periods in the year preceding the interventions and the following 2 years was analyzed. Justification of 448 spine radiographs was assessed similarly. Results After interventions, the total number of spine radiography examinations decreased by 48% (P < 0.001) and that of cervical spine radiography by 46% ( P < 0.001), thoracic spine by 53% ( P < 0.001), and lumbar spine by 47% ( P < 0.001). The results persisted after 1-year follow-up. Before interventions, 24% of the cervical, 46% of the thoracic, and 32% of the lumbar spine radiography referrals were justified. After interventions, only justification of lumbar spine radiography improved significantly, 64% being justified ( P = 0.005). Conclusion Spine radiography in primary care can be reduced significantly by active referral guideline implementation. The proportion of inappropriate radiography was unexpectedly high. Thus, further education and studies concerning the appropriate use of spinal radiography seems to be needed.

Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model

PEDIATRICS ◽  
2009 ◽  
Vol 123 (3) ◽  
pp. 858-864 ◽  
Author(s):  
H. Dubowitz ◽  
S. Feigelman ◽  
W. Lane ◽  
J. Kim
Keyword(s):  
Primary Care ◽  
Child Maltreatment ◽  
Pediatric Primary Care ◽  
Safe Environment

scholarly journals A Hepatitis C Educational Needs Assessment of Canadian Healthcare Providers

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Reza Naghdi ◽  
Karen Seto ◽  
Carolyn Klassen ◽  
Didi Emokpare ◽  
Brian Conway ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Needs Assessment ◽  
Primary Care Physicians ◽  
Healthcare Providers ◽  
Public Health Problem ◽  
Primary Care Providers ◽  
Educational Needs ◽  
Major Public Health Problem ◽  
Care Providers

Background and Aim. Despite advances in the treatment of chronic hepatitis C infection (CHC), it remains a major public health problem in Canada and globally. The knowledge of healthcare providers (HCPs) is critical to improve the care of CHC in Canada. To assess the current knowledge and educational needs of healthcare providers (HCPs) in the area of CHC management a national online survey was conducted. Method. An interprofessional steering committee designed a 29-question survey distributed through various direct and electronic routes. The survey assessed several domains (e.g., participant and practice demographics, access to resources, knowledge of new treatments, and educational preferences). Results. A total of 163 HCPs responded to the survey. All hepatologists and 8% of primary care providers (PCPs) reported involvement in treatment of CHC. Physicians most frequently screened patients who had abnormal liver enzymes, while nurses tended to screen based on lifestyle factors. More than 70% of PCPs were not aware of new medications and their mechanisms. Conclusion. Overall, the needs assessment demonstrated that there was a need for further education, particularly for primary care physicians, to maximize the role that they can play in screening, testing, and treatment of hepatitis C in Canada.

scholarly journals The Role of Primary Care Physicians (DLP) in Community Care

2018 ◽  
Vol 1 (1) ◽  
pp. 3
Author(s):  
Dhanasari Vidiawati Trisna Sanyoto ◽  
Nur Afrainin Syah
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Medical Training ◽  
The United States ◽  
Care Physician ◽  
Main Body ◽  
Family Doctors ◽  
Postgraduate Medical Training ◽  
Care Services

Dokter Layanan Primer (DLP) or Primary Care Physician (PCP) is a newly introduced term by the Indonesian government in 2013 since the enforcement of Medical Education Law 20/2013. DLP is a physician who solidifies his/ her education and career in primary care. They have postgraduate medical training in primary care and are experts in this field. In most countries, to be a generalist physician practising at primary care facilities such as health centres and primary care clinics, medical school graduates have to take postgraduate medical training to be proficient in terms of knowledge and skills in primary care services. Family medicine is the main body of knowledge of the primary care postgraduate training program in those countries even though their graduates are called differently among countries. These physicians are called family doctors or family physicians in the United States of America (USA), general practitioners (GPs) in Commonwealth countries, huisarts in the Netherlands. In Indonesia, where social, economic, and cultural diversity is very high in various regions, in addition to Family Medicine, Community Medicine and Public Health....

scholarly journals Six Year Trend Analysis of Malaria Prevalence in Bati District, Northeastern Ethiopia: A Retrospective Study

2021 ◽  
Author(s):  
Chala Daba ◽  
Edosa Kebede ◽  
Amanuel Atamo ◽  
Semere Reda
Keyword(s):  
Retrospective Study ◽  
Trend Analysis ◽  
Prevention And Control ◽  
Control Method ◽  
Malaria Incidence ◽  
Scale Up ◽  
Public Health Problem ◽  
Malaria Prevalence ◽  
Major Public Health Problem ◽  
And Control

Abstract Background: Malaria is still the leading cause of morbidity and mortality in developing countries including Ethiopia. Ethiopia is planned to minimize forty percent of malaria incidence at the end of 2020 by applying different prevention and control method. There is limited information about trend of malaria in the study area. Therefore, this study was designed to address this gap. Methods: Institutional based retrospective study was conducted from to determine a six-year trend analysis of malaria prevalence in the Bati district. All malaria cases were carefully reviewed by trained laboratory technologists from the laboratory record books of Bati hospital and health center. The data was entered in to excel 2013 and descriptive statistics were used to determine frequencies and percentages of malaria cases, trends of malaria transmission in terms of years and seasonal distribution. Result: A total of 84,269 and 22,185 malaria suspected patients were requested for blood films and Rapid diagnostic tests (RDT) respectively. Of this, 12,032 (11.3%) malaria cases were microscopically confirmed. Plasmodium falciparum were the most dominant parasite detected, which accounted for 57.6 %. The highest peak of malaria cases was reported during the summer season. The majority of the cases (57.2%) were reported among the >15 years age groupConclusion: Malaria is still a major public health problem in the study area. In order to decrease the number of malaria cases further, government, all healthcare workers, and community should strengthen and scale up malaria prevention and control strategies in the study area.

scholarly journals An assessment of implementation of Community Oriented Primary Care in Kenyan family medicine postgraduate medical education programmes

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Ian J. Nelligan ◽  
Jacob Shabani ◽  
Stephanie Taché ◽  
Gulnaz Mohamoud ◽  
Megan Mahoney
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Focus Groups ◽  
Learning Outcomes ◽  
Care Delivery ◽  
The United States ◽  
Community Empowerment ◽  
Successful Implementation ◽  
Community Based ◽  
Postgraduate Students

Background and objectives: Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC) curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya. Method: Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC educators, practitioners and academic stakeholders in two family medicine postgraduate programmes in Kenya. Discussions were transcribed, inductively coded and thematically analysed. Results: Two focus groups with eight family medicine postgraduate students and interviews with five faculty members at two universities were conducted. Two broad themes emerged from the analysis: expected learning outcomes and important community-based enablers. Three learning outcomes were (1) making a community diagnosis, (2) understanding social determinants of health and (3) training in participatory research. Three community-based enablers for sustainability of COPC were (1) partnerships with community health workers, (2) community empowerment and engagement and (3) institutional financial support. Conclusions: Our findings illustrate the expected learning outcomes and important communitybased enablers associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development in Kenya.

A pilot project on the management of osteoporosis in primary care: results of the audit cycle

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711653
Author(s):  
Sindhuja Jothimurugan ◽  
Subramanian Jothimurugan ◽  
Deepali Sanganee ◽  
Thushani Wickramaratne ◽  
Myo Lynn
Keyword(s):  
Primary Care ◽  
Fragility Fracture ◽  
Public Health Problem ◽  
Fragility Fractures ◽  
Osteoporosis Treatment ◽  
Pilot Project ◽  
Major Public Health Problem ◽  
Ageing Population ◽  
Treatment Pathway ◽  
Audit Cycle

BackgroundOsteoporosis is a major public health problem with the ageing population in the UK. However, there is no known national algorithm for the management of osteoporosis in primary care. Therefore, a treatment pathway was developed in secondary care for patients in the community.AimThis audit cycle investigates whether patients at a GP practice with a population of 14 000 have been appropriately identified, coded as osteoporosis, treated, and have followed the recommended pathway.MethodA search of the practice clinical system was undertaken for three groups of patients coded as: patients currently on the existing osteoporosis register; patients with a code of ‘osteoporosis’ or ‘fragility fracture’ but not prescribed an osteoporosis treatment; and patients currently prescribed an osteoporosis treatment with no coding for ‘osteoporosis’ or ‘fragility fracture’. The words ‘osteoporosis’, ‘fragility fracture’, ‘QOF’, and all individual drug names were used in the search engine.ResultsThe completed audit cycle shows an increase in the proportion of patients following the local guidelines pathway, from 75% in 2018 to 81% in 2019, emphasising the importance of having a guideline for GPs to follow in order to optimise treatment and prevent future fragility fractures.ConclusionThis is a pilot project to assess the ability to identify patients who have osteoporosis and review their treatment pathway. The results are promising as the analysed data indicate that GP practice lists can be used to identify and treat high-risk patients for osteoporosis and assess the adherence to the pathway. Using the pathway, GPs can more efficiently diagnose and manage patients.

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