The Neighborhood Deprivation Index and Provider Geocoding Identify Critical Catchment Areas for Diabetes Outreach

Abstract Purpose In designing a Project ECHO™ type 1 diabetes (T1D) program in Florida and California, the Neighborhood Deprivation Index (NDI) was used in conjunction with geocoding of primary care providers (PCPs) and endocrinologists in each state to concurrently identify areas with low endocrinology provider density and high health risk/poverty areas. The NDI measures many aspects of poverty proven to be critical indicators of health outcomes. Methods The data from the 2013-2017 American Community Survey (ACS) 5-year estimates were used to create NDI maps for California and Florida. In addition, geocoding and 30-minute drive-time buffers were performed using publicly available provider directories for PCPs and endocrinologists in both states by Google Geocoding API and the TravelTime Search Application Programming Interface (API). Results Based on these findings, we defined high-need catchment areas as areas with (1) more than a 30-minute drive to the nearest endocrinologist but within a 30-minute drive to the nearest PCP; (2) an NDI in the highest quartile; and (3) a population above the median (5199 for census tracts, and 1394 for census block groups). Out of the 12 181 census tracts and 34 490 census block groups in California and Florida, we identified 57 tracts and 215 block groups meeting these criteria as high-need catchment areas. Conclusion Geospatial analysis provides an important initial methodologic step to effectively focus outreach efforts in diabetes program development. The integration of the NDI with geocoded provider directories enables more cost-effective and targeted interventions to reach the most vulnerable populations living with T1D.

Download Full-text

1673-P: The Neighborhood Deprivation Index and Provider Geocoding Identify Critical Catchment Areas for Diabetes Outreach Programs

Diabetes ◽

10.2337/db19-1673-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 1673-P

Author(s):

ASHBY F. WALKER ◽

HUI HU ◽

NICOLAS CUTTRISS ◽

MICHAEL J. HALLER ◽

C. JASON WANG ◽

...

Keyword(s):

Deprivation Index ◽

Neighborhood Deprivation ◽

Outreach Programs ◽

Catchment Areas

Download Full-text

The impact of working conditions on the health of taxi drivers in an urban metropolis

International Journal of Workplace Health Management ◽

10.1108/ijwhm-03-2020-0027 ◽

2020 ◽

Vol 13 (6) ◽

pp. 671-686

Author(s):

Husayn Marani ◽

Brenda Roche ◽

Laura Anderson ◽

Minnie Rai ◽

Payal Agarwal ◽

...

Keyword(s):

Mental Health ◽

Working Conditions ◽

Health Management ◽

Primary Care Providers ◽

Care Providers ◽

Convenience Sample ◽

Content Type ◽

Taxi Drivers ◽

Targeted Interventions ◽

The Impact

PurposeThis descriptive qualitative study explores how working conditions impact the health of taxi drivers in Toronto, Canada.Design/methodology/approachDrivers were recruited between September 2016 and March 2017. A total of 14 semi-structured qualitative interviews and one focus group (n = 11) were conducted. Transcripts were analyzed inductively through a socioecological lens.FindingsThe findings of this study are as follows: drivers acknowledged that job precariousness (represented by unstable employment, long hours and low wages) and challenging workplace conditions (sitting all day and limited breaks) contribute to poor physical/mental health. Also, these conditions undermine opportunities to engage in health-protective behaviors (healthy eating, regularly exercising and taking breaks). Drivers do not receive health-enabling reinforcements from religious/cultural networks, colleagues or their taxi brokerage. Drivers do seek support from their primary care providers and family for their physical health but remain discreet about their mental health.Research limitations/implicationsAs this study relied on a convenience sample, the sample did not represent all Toronto taxi drivers. All interviews were completed in English and all drivers were male, thus limiting commentary on other experiences and any gender differences in health management approaches among drivers.Practical implicationsGiven the global ubiquity of taxi driving and an evolving workplace environment characterized by growing competition, findings are generalizable across settings and may resonate with other precarious professions, including long-haul truck operators and Uber/Lyft drivers. Findings also expose areas for targeted intervention outside the workplace setting.Originality/valueHealth management among taxi drivers is understudied. A fulsome, socioecological understanding of how working conditions (both within and outside the workplace) impact their health is essential in developing targeted interventions to improve health outcomes.

Download Full-text

Rethinking Obesity Counseling: Having the French Fry Discussion

Journal of Obesity ◽

10.1155/2014/525021 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Jonathan Bonnet ◽

Aaron George ◽

Pippa Evans ◽

Mina Silberberg ◽

Diana Dolinsky

Keyword(s):

Family Medicine ◽

Fast Food ◽

Primary Care Providers ◽

Perceived Barriers ◽

Care Providers ◽

Fast Foods ◽

French Fry ◽

Targeted Interventions ◽

Well Child Visit ◽

Child Visit

Childhood obesity is a complex problem that warrants early intervention. General recommendations for obesity prevention and nutrition counseling exist. However, these are notably imprecise with regard to early and targeted interventions to prevent and treat obesity in pediatric populations. This study examines family medicine primary care providers’ (PCPs) perceived barriers for preventing and treating pediatric obesity and their related practice behavior during well-child visits.Methods.A written survey addressing perceived barriers and current practices addressing obesity at well-child visits were administered to PCPs at eleven family medicine clinics in the Duke University Health System.Results.The most common perceived barriers identified by PCPs to prevention or treatment of obesity in children were families not getting enough exercise (93%) and families too often having fast food meals (86%). Most PCPs do not discuss fast foods at or prior to the twelve-month well-child visit. The two-year visit is the first well-child visit at which a majority of PCPs (68%) discuss fast food.Conclusion.No clear consensus exists as to when PCPs should discuss fast food in early well-child checks. Previous research has shown a profound shift in children’s dietary habits toward fast foods, such as French fries, that occurs between the one- and two-year well-child checks. Consideration should be given to having a “French Fry Discussion” at every twelve-month well-child care visit.

Download Full-text

Protocol for a Systematic Review of the Effectiveness of Provider-targeted Interventions to Improve Opioid Prescribing in Primary Care

10.21203/rs.3.rs-266226/v1 ◽

2021 ◽

Author(s):

Pallavi Prathivadi ◽

Natalie Connell ◽

Louisa Picco ◽

Karleen F Giannitrapani ◽

Hong-nei Wong ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Primary Care Providers ◽

Cochrane Library ◽

Narrative Synthesis ◽

Care Providers ◽

Strict Adherence ◽

Targeted Interventions ◽

Opioid Prescribing ◽

Wide Range

Abstract Background: Improving primary care opioid prescribing is a public health priority in many western nations. Governments, policymakers and key stakeholders are intervening on multiple levels to address patient, prescriber and systems factors contributing to opioid over-prescription in primary care. Many opioid prescribing interventions specifically target primary care providers (PCPs); however, the overall effectiveness of these interventions is not known. Identifying effective components of PCP-targeted behaviour change interventions may help inform scalability and translation of prescribing interventions across countries and varying primary healthcare settings. The aim of this systematic review is to assess the effectiveness of provider-targeted interventions to improve opioid prescribing in primary care. This protocol reports the methods of the proposed narrative synthesis review that will be guided by the Theoretical Domains Framework (TDF). Methods: The study will follow Cochrane methods for conducting a narrative synthesis. Reporting is compliant with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocols. The review will conduct searches in PubMed, EMBASE, PsychInfo, CINAHL, and the Cochrane Library databases for studies published in the English language from 2010 onwards. Reference lists of accepted articles will be also screened for additional studies meeting inclusion. Any opioid prescribing behaviour will be measured as an outcome. Intervention components will be mapped to domains of the TDF. No geographic limits will be applied. All stages of screening and data extraction will involve a dual review with gold standard adjudication. The Cochrane Risk of Bias tool will be used to evaluate quality and risk. Discussion: This review is being conducted in strict adherence to Cochrane principles. The protocol was submitted for registration to Prospero prior to publication for transparency and to avoid duplication of research. Formal ethics approval is not required for this research. The findings of this review will inform the delivery and implementation of PCP targeted opioid prescribing interventions. Findings will be disseminated to a wide range of stakeholders involved in quality improvement, prescribing interventions, education and training; professional groups, policymakers, researchers and PCPs.Systematic review registration: Submitted to Prospero 22 December 2020; pending registration

Download Full-text

What Is the Willingness to Receive Vaccination Against COVID-19 Among the Elderly in Italy? Data From the PASSI d'Argento Surveillance System

Frontiers in Public Health ◽

10.3389/fpubh.2021.736976 ◽

2021 ◽

Vol 9 ◽

Author(s):

Benedetta Contoli ◽

Valentina Possenti ◽

Valentina Minardi ◽

Nancy J. Binkin ◽

Mauro Ramigni ◽

...

Keyword(s):

Risk Factors ◽

Surveillance System ◽

The Elderly ◽

Primary Care Providers ◽

Vaccine Hesitancy ◽

Care Providers ◽

Multinomial Regression ◽

Targeted Interventions ◽

Ongoing Surveillance ◽

To Receive

Introduction: Italy was one of the earliest countries to experience a severe COVID-19 epidemic and vaccinating the elderly, who constitute 23% of the population and have experienced the highest mortality rates, is a top priority. Estimating prevalences and understanding risk factors for COVID-19 vaccine hesitancy or refusal are important for development of targeted interventions.Methods: We used data from a specially developed COVID-19 module of PASSI D'Argento, an ongoing surveillance system of residents 65+ years of age to measure the prevalence and identify risk factors for hesitancy and refusal to receive the COVID-19 vaccine. We calculated multinomial regression relative risk ratios to examine the association between demographic characteristics, health status, COVID-19 attitudes and experiences and likely vaccine hesitancy and refusal.Results: Of the 1876 respondents, 55% reported they would accept vaccination and 16% would likely refuse; the remaining 29% were categorized as hesitant. Compared with the acceptance group, we identified several risk factors in common between the hesitancy group and the refusal group, including not having received vaccination against influenza during the previous flu season (hesitancy: RRR = 2.0; 95% CI 1.4–2.9; refusal: RRR = 12.1; 95%CI 7.6–19.4) and lower risk of having had a death from COVID-19 among family or friends (hesitancy: RRR = 4.8; 95%CI 2.0–11.4; refusal: RRR = 15.4; 95%CI 3.7–64.5). The hesitancy group was significantly more likely being worried and they did not know if consequences of the disease would be serious for them.Conclusion: Our findings show the importance of establishing and maintaining active contact between the preventive services, primary care providers and the population because trust is difficult to establish during an emergency like the COVID-19 pandemic. Italian public health is based on a capillary network of general practitioners and having them reach out to their patients who have not previously received influenza vaccine may be a useful strategy for targeting efforts to further encourage uptake of COVID-19 vaccination.

Download Full-text

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽

10.1027/0227-5910/a000511 ◽

2018 ◽

Vol 39 (5) ◽

pp. 397-405 ◽

Cited By ~ 3

Author(s):

Steven Vannoy ◽

Mijung Park ◽

Meredith R. Maroney ◽

Jürgen Unützer ◽

Ester Carolina Apesoa-Varano ◽

...

Keyword(s):

Primary Care ◽

Low Socioeconomic Status ◽

Thematic Analysis ◽

Older Men ◽

Primary Care Providers ◽

Depression Treatment ◽

Care Providers ◽

Low Socioeconomic ◽

Self Image ◽

The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

Download Full-text