scholarly journals Linkage to Hepatitis C Care After Incarceration in Jail: A Prospective, Single Arm Clinical Trial

2019 ◽  
Author(s):  
Matthew Jiro Akiyama ◽  
Devin Columbus ◽  
Ross MacDonald ◽  
Alison O Jordan ◽  
Jessie Schwartz ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hepatitis C ◽  
Patient Navigation ◽  
Transitional Care ◽  
Public Health Problem ◽  
Linkage To Care ◽  
Major Public Health Problem ◽  
Hcv Treatment ◽  
Community Healthcare

Abstract Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods: We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. Results: During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78%. Expressing a preference to be linked to the participant’s existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant’s wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. Conclusion: We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement.

scholarly journals Linkage to Hepatitis C Care After Incarceration in Jail: A Prospective, Single Arm Clinical Trial

2019 ◽  
Author(s):  
Matthew Jiro Akiyama ◽  
Devin Columbus ◽  
Ross MacDonald ◽  
Alison O Jordan ◽  
Jessie Schwartz ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hepatitis C ◽  
Patient Navigation ◽  
Transitional Care ◽  
Public Health Problem ◽  
Linkage To Care ◽  
Major Public Health Problem ◽  
Hcv Treatment ◽  
Community Healthcare

Abstract Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods: We conducted a single arm clinical trial of a combined transitional care coordination (TCC) and patient navigation intervention and assessed the linkage rate and factors associated with linkage to HCV care after incarceration. Results: During the intervention, 84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years. Of those who returned to the community, 26 (31%) linked to HCV care within a median of 20.5 days; 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, 9 (11%) had a follow-up lab drawn to confirm sustained virologic response (SVR), and 7 (8%) had a documented SVR. Among those with follow-up labs the known SVR rate was (7/9) 78%. Expressing a preference to be linked to the participant’s existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant’s wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. Conclusion: We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement.

scholarly journals Linkage to Hepatitis C Care Following Release from Jail: A Prospective, Single Arm Clinical Trial

2019 ◽  
Author(s):  
Matthew Jiro Akiyama ◽  
Devin Columbus ◽  
Ross MacDonald ◽  
Alison O Jordan ◽  
Jessie Schwartz ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hepatitis C ◽  
Patient Navigation ◽  
Transitional Care ◽  
Public Health Problem ◽  
Linkage To Care ◽  
Virologic Response ◽  
Major Public Health Problem ◽  
Hcv Treatment ◽  
Community Healthcare

Abstract Background: Hepatitis C virus (HCV) is a major public health problem in correctional settings. HCV treatment is often not possible in U.S. jails due to short lengths of stay. Linkage to care is crucial in these settings, but competing priorities complicate community healthcare engagement and retention after incarceration. Methods: We conducted a single arm clinical trial to assess the rate and factors associated with linkage to HCV care after incarceration associated with a combined transitional care coordination (TCC) and patient navigation intervention. Results: During the intervention, n=84 participants returned to the community after their index incarceration. Most participants were male and Hispanic, with a history of mental illness and a mean age of 45 years (SD=12). Of those who returned to the community, 26 (31%) linked to HCV care within a mean of 29 days (SD=25); 17 (20%) initiated HCV treatment, 15 (18%) completed treatment, and 7 (8%) had documentation of sustained virologic response. Expressing a preference to be linked to the participant’s existing health system, being on methadone prior to incarceration, and feeling that family or a loved one were concerned about the participant’s wellbeing were associated with linkage to HCV care. Reporting drinking alcohol to intoxication prior to incarceration was negatively associated with linkage to HCV care. Conclusion: We demonstrate that an integrated strategy with combined TCC and patient navigation may be effective in achieving timely linkage to HCV care. Additional multicomponent interventions aimed at treatment of substance use disorders and increasing social support could lead to further improvement.

scholarly journals The Role of Patient Navigators in Ambulatory Care: Overview of Systematic Reviews

2021 ◽  
Author(s):  
Hannah Budde ◽  
Gemma Williams ◽  
Juliane Winkelmann ◽  
Laura Pfirter ◽  
Claudia Bettina Maier
Keyword(s):  
Health Services ◽  
Health System ◽  
Ambulatory Care ◽  
Systematic Reviews ◽  
Patient Navigation ◽  
Transitional Care ◽  
Emergency Department Visits ◽  
Patient Navigators

Abstract Background: Patient navigators have been introduced across various countries to enable timely access to healthcare services and ensure completion of diagnosis and follow-up of care. There is an increasing amount of evidence on the positive effect of patient navigation for patients. The aim of this study was to analyse the evidence on patient navigation interventions in ambulatory care and to evaluate their effects on individuals and health system outcomes.Methods: An overview of reviews was conducted, based on a prespecified protocol. All patients in ambulatory care or transitional care setting were included in this review as long as it was related to the role of patient navigators. The study analysed all roles of patient navigators covering a wide range of health professionals such as physicians, nurses, pharmacists, social workers as well as lay health workers or community-based workers with no or very limited training. Studies including patient-related measures and health system-related outcomes were eligible for inclusion. A rigorous data collection was performed in multiple data bases. After reaching an inter-rater agreement, title and abstract screening was independently performed. Of an initial 8362 search results a total of 673 articles were eligible for full-text screening. An extraction form was used to analyse the nine included review.Results: Nine systematic reviews were included covering various patient navigation roles in cancer care, disease screening and transitional care. Seven systematic reviews primarily tailored services to ethnic minorities or other disadvantaged groups. Patient navigators performed tasks such as providing education and counselling, translations, home visits, outreach, scheduling of appointments and follow-up. Six reviews identified positive outcomes in expanding access to care, in particular for vulnerable patient groups. Two reviews on patient navigation in transitional care reported improved patient outcomes and hospital readmission rates and mixed evidence on quality of life and emergency department visits.Conclusions: Patient navigators have shown to expand access to screenings and health services for vulnerable patients or population groups who tend to underuse health services.

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.

Opt-out screening for HIV, hepatitis B and hepatitis C: observational study of screening acceptance, yield and treatment outcomes

2019 ◽  
Vol 37 (2) ◽  
pp. 102-105 ◽  
Author(s):  
Conor Grant ◽  
Sarah O'Connell ◽  
Darren Lillis ◽  
Anne Moriarty ◽  
Ian Fitzgerald ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Hepatitis B ◽  
Screening Programme ◽  
Linkage To Care ◽  
Opt Out ◽  
B Virus ◽  
Lost To Follow Up ◽  
The Impact ◽  
Test Result

BackgroundWe initiated an emergency department (ED) opt-out screening programme for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) at our hospital in Dublin, Ireland. The objective of this study was to determine screening acceptance, yield and the impact on follow-up care.MethodsFrom July 2015 through June 2018, ED patients who underwent phlebotomy and could consent to testing were tested for HIV, HBV and HCV using an opt-out approach. We examined acceptance of screening, linkage to care, treatment and viral suppression using screening programme data and electronic health records. The duration of follow-up ranged from 1 to 36 months.ResultsOver the 36-month study period, there were 140 550 ED patient visits, of whom 88 854 (63.2%, 95% CI 63.0% to 63.5%) underwent phlebotomy and 54 817 (61.7%, 95% CI 61.4% to 62.0%) accepted screening for HIV, HBV and HCV, representing 41 535 individual patients. 2202 of these patients had a positive test result. Of these, 267 (12.1%, 95% CI 10.8% to 13.6%) were newly diagnosed with an infection and 1762 (80.0%, 95% CI 78.3% to 81.7%) had known diagnoses. There were 38 new HIV, 47 new HBV and 182 new HCV diagnoses. 81.5% (95% CI 74.9% to 87.0%) of known patients who were not linked were relinked to care after screening. Of the new diagnoses, 86.2% (95% CI 80.4 to 90.8%) were linked to care.ConclusionAlthough high proportions of patients had known diagnoses, our programme was able to identify many new infected patients and link them to care, as well as relink patients with known diagnoses who had been lost to follow-up.

scholarly journals 297. Accessible Care Intervention for Engaging People Who Inject Illicit Drugs in Hepatitis C Virus Care: Preliminary Results from a Randomized Clinical Trial

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S161-S161
Author(s):  
Benjamin Eckhardt ◽  
Yesenia Aponte-Meledez ◽  
Chunki Fung ◽  
Shashi Kapadia ◽  
La Davis ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hepatitis C ◽  
Usual Care ◽  
Randomized Clinical Trial ◽  
Illicit Drugs ◽  
Treatment Initiation ◽  
Linkage To Care ◽  
Hcv Rna ◽  
Service Program ◽  
Care Intervention

Abstract Background To achieve hepatitis C elimination, treatment programs need to be developed to engage, treat, and cure people who are actively injecting drugs. Methods We present preliminary data from the first 65 participants in the Accessible Care intervention for engaging people who inject illicit drugs (PWID) in hepatitis C (HCV) care. The randomized clinical trial compares the effectiveness of Accessible Care (low-threshold care in a syringe service program located in New York City) with Usual Care (referral to existing services) in facilitating linkage, engagement, and retention in HCV care. Eligible participants were HCV RNA positive and had injected drugs in the past 90 days. We compared the percentage of participants in each arm linked to HCV care (defined as one visit with HCV treatment provider), and initiated direct-acting antiviral (DAA) treatment within 6 months of enrollment. Results Among the 65 participants, the mean age is 41.2 years; 28% are females; 73% homeless; 6% black, 51% Latina/o and 39% white. 82% of participants had injected drugs in the last 30 days, with an average of 13.2 injections/month (median 10). Nearly all participants had health insurance, 88% public insurance, 6% uninsured. Thirty-two participants were randomized to the Accessible Care arm. Within 6 months of enrollment 79% of the Accessible Care arm and 25% of the Usual Care arm had linked to HCV care, and 69% and 13% had been started on DAA therapy, respectively. Of the 26 participants in the Accessible Care arm started on DAA therapy, the median time from enrollment to treatment initiation was 87.5 days [range 22–180]. Conclusion Among HCV-infected PWID enrolled at a syringe service program, higher rates of linkage to care and treatment initiation were seen in the Accessible Care arm where stigma- and shame-free treatment was located within a community-based location. Disclosures All authors: No reported disclosures.

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 Implementation of a Large System-Wide Hepatitis C Virus Screening and Linkage to Care Program for Baby Boomers

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Mariana Castrejón ◽  
Kara W. Chew ◽  
Marjan Javanbakht ◽  
Romney Humphries ◽  
Sammy Saab ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Baby Boomers ◽  
Linkage To Care ◽  
Care Program ◽  
Hcv Rna ◽  
Care Coordinator ◽  
Hcv Antibody ◽  
Hcv Screening

Abstract Background We implemented and evaluated a large health system-wide hepatitis C virus (HCV) screening and linkage to care program for persons born between 1945 and 1965 (“baby boomers”). Methods An electronic health record (EHR) clinical decision support (CDS) tool for HCV screening for baby boomers was introduced in August 2015 for patients seen in the outpatient University of California, Los Angeles healthcare system setting. An HCV care coordinator was introduced in January 2016 to facilitate linkage to HCV care. We compared HCV testing in the year prior (August 2014–July 2015) to the year after (August 2015–July 2016) implementation of the CDS tool. Among patients with reactive HCV antibody testing, we compared outcomes related to the care cascade including HCV ribonucleic acid (RNA) testing, HCV RNA positivity, and linkage to HCV specialty care. Results During the study period, 19606 participants were screened for HCV antibody. Hepatitis C virus antibody screening increased 145% (from 5676 patients tested to 13930 tested) after introduction of the CDS intervention. Screening increased across all demographic groups including age, sex, and race/ethnicity, with the greatest increases among those in the older age groups. The addition of an HCV care coordinator increased follow-up HCV RNA testing for HCV antibody positive patients from 83% to 95%. Ninety-four percent of HCV RNA positive patients were linked to care postimplementation. Conclusions Introduction of an EHR CDS tool and care coordination markedly increased the number of baby boomers screened for HCV, rates of follow-up HCV RNA testing, and linkage to specialty HCV care for patients with chronic HCV infection.

scholarly journals Efficacy and Safety of Iranian Poly Herbal Formulation (Compound Honey Syrup) in Pediatric Patients with Mild to Moderate Asthma: A Randomized Clinical Trial

2017 ◽  
Vol 6 (4) ◽  
pp. 291-301
Author(s):  
Saeed Sadr ◽  
Shahpar Kaveh ◽  
Rasool Choopani ◽  
Houman Bayat ◽  
Mahmoud Mosaddegh
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Pediatric Asthma ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Efficacy And Safety ◽  
Asthma Control Questionnaire ◽  
Moderate Asthma ◽  
Herbal Formulation ◽  
Significant Difference

Background: Asthma is a chronic relapsing airways disease that represents a major public health problem worldwide. With the high incidence of asthma, there has been a surge in the use of complementary therapies, such as compound honey syrup in Traditional Persian Medicine, in the treatment of asthma. The aim of this study was to evaluate the efficacy and safety of Iranian poly herbal formulation (compound honey syrup) in the treatment of mild to moder­ate pediatric asthma. Materials and Methods: The study was a randomized clinical trial that was conducted on 80 patients with mild to moderate asthma assigned to two groups (n=40 for each group) for eight weeks. Control and experimental groups received classical treatment of asthma with fluticasone spray; in case of worsening of symptoms, salbutamol spray was used for short term. The experimental group also received compound honey syrup (the combina­tion of honey and an extract of the following five medicinal plants: ginger, cinnamon, saf­fron, cardamom, and galangal). Asthma Control Questionnaire (ACQ) items and total scores of ACQ were evaluated before and after treatment. Results: To this end, 72 patients complet­ed this study. There was no significant difference between the experimental and the control groups in baseline data such as age, sex, body mass index, ACQ items, and ACQ scores. Total scores and all items of ACQ, with the exception of forced expiratory volume in one second (FEV1%), were significant between groups (P<0.05). No serious adverse effects were ob­served in the two groups. Conclusions: The results of this study reveal that compound honey syrup can be a safe and effective complementary drug for the treatment of pediatric asthma [GMJ.2017;6(4):291-301] DOI: 10.22086/gmj.v6i3.884

scholarly journals Study of association and prognostic correlation of cardiac troponin I estimation in acute decompensated heart failure patients

2020 ◽  
Vol 8 (1) ◽  
pp. 26
Author(s):  
Sunil Kumar Tripathi ◽  
Vikas A. Mishra ◽  
Amit B. Kinare ◽  
Vishwa Deepak Tripathi ◽  
Ravi Shankar Sharma
Keyword(s):  
Heart Failure ◽  
Troponin I ◽  
Acute Decompensated Heart Failure ◽  
Public Health Problem ◽  
Decompensated Heart Failure ◽  
Major Public Health Problem ◽  
Positive Group ◽  
Medical College ◽  
Follow Up Study

Background: Heart failure is a major public health problem since last few decades affecting significant number of people worldwide. Acute decompensated heart failure is a major cause of hospitalization in elderly people with a high mortality rate. Heterogeneity and non-specificity of symptoms makes diagnosis of heart failure by clinical presentation alone more challenging. Aim of current study was to investigate troponin biomarkers in diagnosis, prognosis and management of acute decompensated heart failure.  Methods: Present study was a prospective observational study conducted on 100 patients at Department of Cardiology, Superspeciality hospital, NSCB medical college Jabalpur and Department of cardiology Superspeciality hospital, SS medical college Rewa from October 2019 to August 2020. Patients were investigated for clinical, echocardiographic parameters and NYHA classification. Cardiac functions were analyzed by color doppler echocardiography. Results: According to study findings, 65.2% of TnI positive patients were males whereas 34.8% were females. Mean age of TnI positive group was observed to be higher. Majority of troponin positive patients were in NYHA class IV. Recurrent hospitalization was observed more in TnI positive group. Logistic regression analysis depicted systolic blood pressure reduced significantly (p<0.001) on follow up study in TnI positive patients, FBS was significantly more in TnI positive patients (131.4+42.9 mg/dl) (p=0.049). LVID was significantly more in TnI positive patients (p=0.022). Reduction in EF was statistically significant (p=0.03) at the three months follow up study.  Conclusions: A positive prognostic correlation was established between ADHF and troponin positivity, large prospective randomized trials are necessary to recommend quantitative troponin I determination in all patients of acute decompensated heart failure for prognosis and guiding therapy.

Sign in / Sign up

Export Citation Format

Share Document