scholarly journals Quitting the quitline: a qualitative study of patient experience of electronic referrals to quitlines

2020 ◽  
Author(s):  
Elizabeth L. Albert ◽  
Jeanmarie C. Rose ◽  
India J. Gill ◽  
Susan A. Flocke
Keyword(s):  
Primary Care ◽  
Program Analysis ◽  
Community Health Centers ◽  
Large Scale ◽  
Phenomenological Approach ◽  
Safety Net ◽  
Primary Care Visit ◽  
Quit Smoking ◽  
Culturally Adapted ◽  
Electronic Referrals

Abstract Background: The use of electronic referrals (eReferrals) to state quitlines (QLs) for tobacco-using patients is a promising approach for addressing smoking cessation on a large scale. However, QL contact, enrollment, and completion rates are low. The purpose of this study was to examine the eReferral to QL process from the patient’s perspective in order to inform strategies for improving QL engagement.Methods: We conducted interviews with 55 patients who agreed to an eReferral at a primary care visit to 1 of 8 safety-net community health centers in Cuyahoga County, Ohio (September 2017-August 2018). Interviews were designed to explore the experiences of three subgroups of patients who subsequently: 1) declined participation in the QL; 2) were unreachable by the QL; or 3) were enrolled in or had completed the QL program. Analysis was guided by a phenomenological approach designed to identify emergent themes.Results: Reasons for QL program non-completion included changing life circumstances and events making cessation unviable; misunderstandings about the QL; discomfort with telephonic counseling; perceived lack of time for counseling; cell phone barriers; and having already quit smoking. We found that some individuals who were no longer receiving QL support because they had been classified as program complete, unreachable, or declined - desired continued support from the QL.Conclusions: Integrating QL care with community-based resources that address the socio-economic mediators of tobacco use, and/or incorporating culturally adapted interventions could be promising strategies. Follow up by the referring primary care provider to encourage engagement and offer support is recommended.

scholarly journals Quitting the quitline: a qualitative study of patient experience of electronic referrals to quitlines

2020 ◽  
Author(s):  
Elizabeth Albert ◽  
Jeanmarie C Rose ◽  
India J Gill ◽  
Susan A Flocke
Keyword(s):  
Low Socioeconomic Status ◽  
Program Analysis ◽  
Community Health Centers ◽  
Large Scale ◽  
Phenomenological Approach ◽  
Safety Net ◽  
Primary Care Visit ◽  
Low Socioeconomic ◽  
Quit Smoking ◽  
Electronic Referrals

Abstract Background: The use of electronic referrals (eReferrals) to state quitlines (QLs) for tobacco-using patients is a promising approach for addressing smoking cessation on a large scale. However, QL contact, enrollment, and completion rates are low. The purpose of this study was to examine the eReferral to QL process from the patient’s perspective in order to inform strategies for improving QL engagement. Methods : We conducted interviews with 55 patients who agreed to an eReferral at a primary care visit to 1 of 8 safety-net community health centers in Cuyahoga County, Ohio (September 2017-August 2018). Interviews were designed to explore the experiences of three subgroups of patients who subsequently: 1) declined participation in the QL; 2) were unreachable by the QL; or 3) were enrolled in or had completed the QL program. Analysis was guided by a phenomenological approach designed to identify emergent themes. Results: Reasons for QL program non-completion included changing life circumstances and events making cessation unviable; misunderstandings about the QL; discomfort with telephonic counseling; perceived lack of time for counseling; cell phone barriers; and having already quit smoking. We found that some individuals who were no longer engaged with the QL still desired continued support from the QL. Conclusions: Participants intentionally and unintentionally disengage from the QL for a wide variety of reasons, several of which are mediated by low socioeconomic status. Integrating QL care with community-based resources that address these mediators could be a promising strategy.

scholarly journals Quitting the quitline: a qualitative study of patient experience of electronic referrals to quitlines

2020 ◽  
Author(s):  
Elizabeth L Albert ◽  
Jeanmarie C Rose ◽  
India J Gill ◽  
Susan A Flocke
Keyword(s):  
Low Socioeconomic Status ◽  
Program Analysis ◽  
Community Health Centers ◽  
Large Scale ◽  
Phenomenological Approach ◽  
Safety Net ◽  
Primary Care Visit ◽  
Low Socioeconomic ◽  
Quit Smoking ◽  
Electronic Referrals

Abstract Background: The use of electronic referrals (eReferrals) to state quitlines (QLs) for tobacco-using patients is a promising approach for addressing smoking cessation on a large scale. However, QL contact, enrollment, and completion rates are low. The purpose of this study was to examine the eReferral to QL process from the patient’s perspective in order to inform strategies for improving QL engagement. Methods: We conducted interviews with 55 patients who agreed to an eReferral at a primary care visit to 1 of 8 safety-net community health centers in Cuyahoga County, Ohio (September 2017-August 2018). Interviews were designed to explore the experiences of three subgroups of patients who subsequently: 1) declined participation in the QL; 2) were unreachable by the QL; or 3) were enrolled in or had completed the QL program. Analysis was guided by a phenomenological approach designed to identify emergent themes. Results: Reasons for QL program non-completion included changing life circumstances and events making cessation unviable; misunderstandings about the QL; discomfort with telephonic counseling; perceived lack of time for counseling; cell phone barriers; and having already quit smoking. We found that some individuals who were no longer engaged with the QL still desired continued support from the QL.Conclusions: Participants intentionally and unintentionally disengage from the QL for a wide variety of reasons, several of which are mediated by low socioeconomic status. Integrating QL care with community-based resources that address these mediators could be a promising strategy.

scholarly journals Quitting the quitline: a qualitative study of patient experience of electronic referrals to quitlines

2020 ◽  
Author(s):  
Elizabeth L Albert ◽  
Jeanmarie C Rose ◽  
India J Gill ◽  
Susan A Flocke
Keyword(s):  
Low Socioeconomic Status ◽  
Program Analysis ◽  
Community Health Centers ◽  
Large Scale ◽  
Phenomenological Approach ◽  
Safety Net ◽  
Primary Care Visit ◽  
Low Socioeconomic ◽  
Quit Smoking ◽  
Electronic Referrals

Abstract Background: The use of electronic referrals (eReferrals) to state quitlines (QLs) for tobacco-using patients is a promising approach for addressing smoking cessation on a large scale. However, QL contact, enrollment, and completion rates are low. The purpose of this study was to examine the eReferral to QL process from the patient’s perspective in order to inform strategies for improving QL engagement. Methods : We conducted interviews with 55 patients who agreed to an eReferral at a primary care visit to 1 of 8 safety-net community health centers in Cuyahoga County, Ohio (September 2017-August 2018). Interviews were designed to explore the experiences of three subgroups of patients who subsequently: 1) declined participation in the QL; 2) were unreachable by the QL; or 3) were enrolled in or had completed the QL program. Analysis was guided by a phenomenological approach designed to identify emergent themes. Results: Reasons for QL program non-completion included changing life circumstances and events making cessation unviable; misunderstandings about the QL; discomfort with telephonic counseling; perceived lack of time for counseling; cell phone barriers; and having already quit smoking. We found that some individuals who were no longer engaged with the QL still desired continued support from the QL. Conclusions: Participants intentionally and unintentionally disengage from the QL for a wide variety of reasons, several of which are mediated by low socioeconomic status. Integrating QL care with community-based resources that address these mediators could be a promising strategy.

scholarly journals Not Perfect, but Better: Primary Care Providers’ Experiences with Electronic Referrals in a Safety Net Health System

2009 ◽  
Vol 24 (5) ◽  
pp. 614-619 ◽  
Author(s):  
Yeuen Kim ◽  
Alice Hm Chen ◽  
Ellen Keith ◽  
Hal F. Yee ◽  
Margot B. Kushel
Keyword(s):  
Primary Care ◽  
Health System ◽  
Primary Care Providers ◽  
Safety Net ◽  
Care Providers ◽  
Electronic Referrals

scholarly journals No moment wasted: the primary-care visit for adults with diabetes and low socio-economic status

2015 ◽  
Vol 17 (01) ◽  
pp. 18-32 ◽  
Author(s):  
Shari D. Bolen ◽  
Paulette Sage ◽  
Adam T. Perzynski ◽  
Kurt C. Stange
Keyword(s):  
Primary Care ◽  
Health Behavior ◽  
Low Income ◽  
Care Delivery ◽  
Economic Status ◽  
Safety Net ◽  
Low Ses ◽  
Primary Care Visit ◽  
Health Issues ◽  
Socio Economic Status

AimTo better understand the type and range of health issues initiated by patients and providers in ‘high-quality’ primary-care for adults with diabetes and low socio-economic status (SES).BackgroundAlthough quality of care guidelines are straightforward, diabetes visits in primary care are often more complex than adhering to guidelines, especially in adults with low SES who experience many financial and environmental barriers to good care.MethodsWe conducted a qualitative study using direct observation of primary-care diabetes visits at an exemplar safety net practice in 2009–2010.FindingsIn a mainly African American (93%) low-income population with fair cardiovascular control (mean A1c 7.5%, BP 134/81 mmHg, and low-density lipoprotein cholesterol 100 mg/dL), visits addressed a variety of bio-psychosocial health issues [median: 25 problems/visit (range 13–32)]. Physicians most frequently initiated discussions about chronic diseases, prevention, and health behavior. Patients most frequently initiated discussions about social environment and acute symptoms followed by prevention and health behavior.ConclusionsPrimary-care visits by diabetes patients with low SES address a surprising number and diversity of problems. Emerging new models of primary-care delivery and quality measurement should allow adequate time and resources to address the range of tasks necessary for integrating biomedical and psychosocial concerns to improve the health of socio-economically disadvantaged patients.

scholarly journals Louisiana Geriatric Workforce Enhancement Program: Analysis of Learning Outcomes From Dementia Training

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 58-58
Author(s):  
Katherine Kirsch ◽  
Catherine Lemieux ◽  
Laura Ainsworth ◽  
Sarah Choate ◽  
Ashleigh Borgmeyer ◽  
...  
Keyword(s):  
Primary Care ◽  
Program Analysis ◽  
Training Session ◽  
Cohen’S D ◽  
Response Formats ◽  
Cohen's D ◽  
Item Knowledge ◽  
South Louisiana ◽  
Severe Shortage ◽  
Primary Care Professionals

Abstract A recent Alzheimer’s Association report noted that by year 2050, the number of Americans diagnosed with Alzheimer’s disease and related dementias (ADRD) will triple to over 15 million. The report referred to primary care as the front line for meeting this demand, yet the nation faces a severe shortage of ADRD trained, primary care professionals (PCPs). Louisiana Geriatric Workforce Enhancement Program (LA-GWEP) addresses this demand. The purpose of this study was to examine preliminary data respective to LA-GWEP effectiveness with interdisciplinary education and training seminars, primarily aimed at medical, nursing, and social work PCPs. Three seminars were conducted in south Louisiana: Seminars 1 and 2 addressed effective communication, verbal and nonverbal, among persons with ADRD and caregivers; Seminar 3 offered basic overview of dementia symptomology, stages, and behaviors. Pre- and post-training session data were collected on-site. Participants completed questionnaires that included a 10-item knowledge assessment and 20-item Dementia Attitudes Scale (DAS). These measures contained Likert response formats; higher scores indicating greater levels of ADRD knowledge, in patient and caregiver contexts. Paired sample t-tests were conducted to observe any significant pre-to-post improvement, Cohen’s d for effect size. Seminar 1 revealed no significant pre-to-post difference: t = -1.019, p = 0.320. Adjusting content from audience feedback, Seminar 2 revealed significant pre-to-post difference: t = -7.516, p < .001, Cohen’s d = 1.2. Seminar 3 yielded significant improvement on DAS scores: t = -2.96, p < .01, Cohen’s d = 0.34. Implications for seminars in future years of LA-GWEP are discussed.

scholarly journals 140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S200-S200
Author(s):  
Michael Hansen ◽  
Barbara Trautner ◽  
Roger Zoorob ◽  
George Germanos ◽  
Osvaldo Alquicira ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Primary Care Clinic ◽  
Antibiotic Use ◽  
Safety Net ◽  
Care Clinic ◽  
Primary Care Clinics ◽  
Primary Care Patients ◽  
Emergency Department Patients

Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures

scholarly journals Improving the management of type 2 diabetes through large-scale general practice: the role of a data-driven and technology-enabled education programme

2021 ◽  
Vol 10 (1) ◽  
pp. e001087
Author(s):  
Tarek F Radwan ◽  
Yvette Agyako ◽  
Alireza Ettefaghian ◽  
Tahira Kamran ◽  
Omar Din ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Large Scale ◽  
Education Programme ◽  
Educational Programme ◽  
Data Driven ◽  
Treatment Targets ◽  
Care Processes ◽  
Data Driven Approach

A quality improvement (QI) scheme was launched in 2017, covering a large group of 25 general practices working with a deprived registered population. The aim was to improve the measurable quality of care in a population where type 2 diabetes (T2D) care had previously proved challenging. A complex set of QI interventions were co-designed by a team of primary care clinicians and educationalists and managers. These interventions included organisation-wide goal setting, using a data-driven approach, ensuring staff engagement, implementing an educational programme for pharmacists, facilitating web-based QI learning at-scale and using methods which ensured sustainability. This programme was used to optimise the management of T2D through improving the eight care processes and three treatment targets which form part of the annual national diabetes audit for patients with T2D. With the implemented improvement interventions, there was significant improvement in all care processes and all treatment targets for patients with diabetes. Achievement of all the eight care processes improved by 46.0% (p<0.001) while achievement of all three treatment targets improved by 13.5% (p<0.001). The QI programme provides an example of a data-driven large-scale multicomponent intervention delivered in primary care in ethnically diverse and socially deprived areas.

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