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

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.

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

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.

scholarly journals Promoting cross-jurisdictional primary health care research: developing a set of common indicators across 12 community-based primary health care teams in Canada

2018 ◽  
Vol 20 ◽  
Author(s):  
Sabrina T. Wong ◽  
Julia M. Langton ◽  
Alan Katz ◽  
Martin Fortin ◽  
Marshall Godwin ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Working Group ◽  
Scale Up ◽  
Data Sources ◽  
Knowledge Generation ◽  
Community Based ◽  
Primary Health ◽  
The Impact

AbstractAimTo describe the process by which the 12 community-based primary health care (CBPHC) research teams worked together and fostered cross-jurisdictional collaboration, including collection of common indicators with the goal of using the same measures and data sources.BackgroundA pan-Canadian mechanism for common measurement of the impact of primary care innovations across Canada is lacking. The Canadian Institutes for Health Research and its partners funded 12 teams to conduct research and collaborate on development of a set of commonly collected indicators.MethodsA working group representing the 12 teams was established. They undertook an iterative process to consider existing primary care indicators identified from the literature and by stakeholders. Indicators were agreed upon with the intention of addressing three objectives across the 12 teams: (1) describing the impact of improving access to CBPHC; (2) examining the impact of alternative models of chronic disease prevention and management in CBPHC; and (3) describing the structures and context that influence the implementation, delivery, cost, and potential for scale-up of CBPHC innovations.FindingsNineteen common indicators within the core dimensions of primary care were identified: access, comprehensiveness, coordination, effectiveness, and equity. We also agreed to collect data on health care costs and utilization within each team. Data sources include surveys, health administrative data, interviews, focus groups, and case studies. Collaboration across these teams sets the foundation for a unique opportunity for new knowledge generation, over and above any knowledge developed by any one team. Keys to success are each team’s willingness to engage and commitment to working across teams, funding to support this collaboration, and distributed leadership across the working group. Reaching consensus on collection of common indicators is challenging but achievable.

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

Circulation ◽  
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.

scholarly journals ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable

2021 ◽  
Vol 8 ◽  
Author(s):  
Michaela A. Riddell ◽  
G. K. Mini ◽  
Rohina Joshi ◽  
Amanda G. Thrift ◽  
Rama K. Guggilla ◽  
...  
Keyword(s):  
Program Implementation ◽  
Scale Up ◽  
Complex Interventions ◽  
Implementation Process ◽  
Rural India ◽  
Supportive Supervision ◽  
Culturally Appropriate ◽  
Clinical Trial Registry ◽  
Community Based ◽  
Middle Income

Background: To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program, in three economically and developmentally diverse settings in rural India. We evaluated the program's implementation and scalability.Methods: Our mixed methods process evaluation was guided by the United Kingdom Medical Research Council guidelines for complex interventions. Meeting attendance reports, as well as blood pressure and weight measures of attendees and adherence to meeting content and use of meeting tools were used to evaluate the implementation process. Thematic analysis of separate focus group discussions with participants and ASHAs as well as meeting reports and participant evaluation were used to investigate the mechanisms of impact.Results: Fifteen ASHAs led 32 community-based groups in three rural settings in the states of Kerala and Andhra Pradesh, Southern India. Overall, the fidelity of intervention delivery was high. Six meetings were delivered over a 3-month period to each of the intervention groups. The mean number of meetings attended by participants at each site varied significantly, with participants in Rishi Valley attending fewer meetings [mean (SD) = 2.83 (1.68)] than participants in West Godavari (Tukeys test, p = 0.009) and Trivandrum (Tukeys test, p &lt; 0.001) and participants in West Godavari [mean (SD) = 3.48 (1.72)] attending significantly fewer meetings than participants in Trivandrum [mean (SD) = 4.29 (1.76), Tukeys test, p &lt; 0.001]. Culturally appropriate intervention resources and the training of ASHAs, and supportive supervision of them during the program were critical enablers to program implementation. Although highly motivated during the implementation of the program ASHA reported historical issues with timely remuneration and lack of supportive supervision.Conclusions: Culturally appropriate community-based group programs run by trained and supported ASHAs are a successful and potentially scalable model for improving the control of hypertension in rural India. However, consideration of issues related to unreliable/insufficient remuneration for ASHAs, supportive supervision and their formal role in the wider health workforce in India will be important to address in future program scale up.Trial Registration: Clinical Trial Registry of India [CTRI/2016/02/006678, Registered prospectively].

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

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

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

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.

scholarly journals 1350. Characterization of the Type of Specimen Used for Testing of Sexually Transmitted Infections in Outpatient Clinics

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S762-S762
Author(s):  
Katherine Sittig ◽  
Victoria C Cunningham ◽  
Rossana Rosa ◽  
Lisa A Veach
Keyword(s):  
Primary Care ◽  
Sexually Transmitted Infections ◽  
Urgent Care ◽  
Outpatient Clinics ◽  
Sexually Transmitted ◽  
Primary Care Clinics ◽  
Female Patients ◽  
Exposure Site ◽  
Male Patients ◽  
Sex With Men

Abstract Background Screening and diagnosis of Sexually Transmitted Infections (STIs) requires use of nucleic acid amplifications tests (NAATs) on optimal anatomical specimens. Vaginal or cervical swabs are preferred in women and first-catch urine in men. Furthermore, extra-genital testing is recommended for men who have sex with men (MSM) and for men who have sex with women (MSW) based on exposure history. Increasingly, STI care is being provided in non-STI specialized settings such as Urgent Care (UC) and Primary Care clinics (PC). Therefore, we aimed to characterize the types of anatomical specimens being utilized for the diagnosis of STIs in non-STI specialized clinics. Methods We conducted a retrospective analysis of all Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) tests obtained at 46 adult outpatient clinics (PC, UC and Obstetrics & Gynecology [OB/Gyn]) part of an integrated health system in Des Moines, Iowa, between January 1, 2019 and December 31, 2019. In this database, no information was available regarding patient history of sexual exposure site(s). Descriptive statistics, including counts, percentages, and differences in proportions were estimated and stratified by outpatient clinic type. Results We identified a total of 18,503 encounters involving 2,802 men and 15,701 women. Rates of extragenital testing were overall low, but higher in male patients (14.6%) than in female patients (0.20%). Among male patients, extra-genital testing was obtained in 21.1% of patients seen in PCs compared to 5.2% in UCs (p&lt; 0.0001) (Table 1). Notably, 177 (50.9%) of the extra-genital samples collected at PCs were obtained at a clinic specializing in the care of MSM. Among female patients, the proportion of urine-based tests was highest in PC (32%), while non-urine genitourinary samples were more frequently obtained at Ob-Gyn clinics (92.7%) (p&lt; 0.0001) (Table 2). Conclusion Extragenital site testing for GC and CT remains an uncommon practice across all clinic setting types, and high proportions of female patients evaluated at PC and UC clinics were tested using urine specimens. Our results indicate a need for effective education and implementation processes for optimal testing modalities in primary care clinics. Disclosures All Authors: No reported disclosures

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