A Simple Pre-Exposure Prophylaxis (PrEP) Optimization Intervention for Health Care Providers Prescribing PrEP: Pilot Study (Preprint)

BACKGROUND Pre-exposure prophylaxis (PrEP) has been shown to be highly effective for the prevention of HIV in clinical trials and demonstration projects, but PrEP uptake and adherence outside of these settings in the United States has been limited. Lack of knowledge and willingness of health care providers (HCPs) to prescribe PrEP is an important barrier to implementation. OBJECTIVE The objective of this study was to describe and examine the feasibility and acceptability of a PrEP Optimization Intervention (PrEP-OI) targeted at HCPs. The ultimate purpose of this intervention was to increase PrEP uptake, adherence, and persistence among those at risk for HIV acquisition. METHODS This intervention included the following: (1) a Web-based panel management tool called PrEP-Rx, which provides comprehensive HIV risk assessment, automates reminders for follow-up, and reports patients’ history of PrEP use; and (2) centralized PrEP coordination by a clinical support staff member (ie, the PrEP coordinator) who can identify individuals at risk for HIV, provide medical insurance navigation, and support multiple HCPs. Feasibility was evaluated based on HCPs’ ability to log in to PrEP-Rx and use it as needed. Acceptability was assessed via individual formative qualitative interviews with HCPs after 1 month of the intervention. RESULTS The intervention was feasible and acceptable among HCPs (N=6). HCPs identified system-level barriers to PrEP provision, many of which can be addressed by this intervention. HCPs noted that the intervention improved their PrEP knowledge; increased ease of PrEP prescription; and was likely to improve patient engagement and retention in care, enhance communication with patients, and improve patient monitoring and follow-up. CONCLUSIONS Given the critical role HCPs serve in disseminating PrEP, we created an easy-to-use PrEP optimization intervention deemed feasible and acceptable to providers. Further research on this tool and its ability to impact the PrEP continuum of care is needed.

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Health Care Utilization Among Homeless Veterans in Chicago

Military Medicine ◽

10.1093/milmed/usz264 ◽

2019 ◽

Vol 185 (3-4) ◽

pp. e335-e339

Author(s):

Jason H Raad ◽

Elizabeth Tarlov ◽

Abel N Kho ◽

Dustin D French

Keyword(s):

Health Care ◽

At Risk ◽

Health Care Utilization ◽

Health Care Providers ◽

The United States ◽

Chronic Health Conditions ◽

Health Conditions ◽

Care Utilization ◽

Care Providers ◽

Chronic Health

Abstract Introduction The U.S. Department of Veterans Affairs (VA), the single largest health care system in the United States, provides comprehensive medical and behavioral health services to more than 9 million Veterans. The size and scope of the VA’s system of care allow health care providers, policymakers, and community stakeholders to conduct detailed analyses of health care utilization among Veterans; however, these analyses do not include health care encounters that occur outside VA. Although many Veterans obtain care in non-VA settings, understanding health care utilization among vulnerable populations of Veterans, including those who are homeless or at risk of becoming homeless, is needed to identify potential opportunities to enhance access and reduce fragmentation of care. Materials and Methods VA administrative data were merged with data from the Chicago HealthLNK Data Repository to identify Veterans eligible for VA services who were homeless, or at risk of becoming homeless, in the greater Chicago metropolitan area for the years 2010–2012. Results During the 3-year study period, about 208,554 Veterans were registered for care at two VA medical centers located in the City of Chicago and an adjacent suburb. Of those, 13,948 were identified as homeless or at risk of becoming homeless. Results suggest that 17% (n = 2,309) of Veterans in this sample received some or all of their care in the community. Much of the care these Veterans received was for chronic health conditions, substance use, and mental health disorders. Conclusions Veterans eligible for VA servicers who are homeless, or at risk of becoming homeless, frequently sought care in the community for a variety of chronic health conditions. Health information exchanges and partner-based registries may represent an important tool for identifying vulnerable Veteran populations while reducing duplication of care.

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Applying the AFIX Quality Improvement Model to Increase Adult Immunization in Wisconsin

Public Health Reports ◽

10.1177/0033354920974661 ◽

2021 ◽

pp. 003335492097466

Author(s):

Stephanie M. Borchardt ◽

Kailynn Mitchell ◽

Taylor Larson ◽

Ellen Ehlers ◽

Stephanie L. Schauer

Keyword(s):

Health Care ◽

Quality Improvement ◽

Health Care Providers ◽

Paper Copy ◽

The United States ◽

Human Papillomavirus Vaccine ◽

Care Providers ◽

Immunization Rates ◽

Adult Immunization

Objectives Assessment, Feedback, Incentives, and eXchange (AFIX) is a quality improvement model used to increase childhood and adolescent immunization rates in the United States. We evaluated implementation of a similar quality improvement model to boost adult immunization rates. Methods During November 2016 through May 2017, adult immunization outreach specialists conducted 124 in-person visits to clinics in Wisconsin that immunize adults, submit immunization information to the Wisconsin Immunization Registry (WIR), and agreed to participate in adult AFIX. Outreach specialists ran immunization assessment reports using the WIR and showed a paper copy of the report during the visit. Health care providers were encouraged to implement at least 1 of 18 strategies (eg, reminder-and-recall intervention, giving adult immunization resources to patients) to increase adult immunization rates. Outreach specialists conducted follow-up with health care providers at 3, 6, and 9-18 months after the initial visit to encourage strategy implementation. We compared AFIX sites with control clinics on practice type, geographic location, and clinic size. Results Clinics that participated in adult AFIX had a significantly larger increase in median adult immunization rates for completion of the human papillomavirus vaccine series at the 9- to 18-month follow-up than control clinics did (10.4% vs 7.7%; P = .02). The median immunization rate for 13-valent pneumococcal conjugate vaccine/23-valent pneumococcal polysaccharide vaccine completed in series was higher, but not significantly so, among adult AFIX clinics than among control clinics (12.6% vs 10.7%; P = .18). Conclusions Adult AFIX resulted in increased awareness about adult immunization recommendations and may be a useful tool for increasing adult immunization rates.

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Knowledge, attitudes and practices of health care providers trained in responding to violence against women: a pre- and post-intervention study

BMC Public Health ◽

10.1186/s12889-021-12042-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sanjida Arora ◽

Sangeeta Rege ◽

Padma Bhate-Deosthali ◽

Soe Soe Thwin ◽

Avni Amin ◽

...

Keyword(s):

Health Care ◽

Violence Against Women ◽

Health Care Providers ◽

Intervention Study ◽

System Level ◽

Care Providers ◽

Post Intervention ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices

Abstract Background Violence against women is a serious public health concern, and is highly prevalent globally, including in India. Health-care providers [HCPs] can play an important role in addressing and reducing negative consequences of violence against women. We implemented a pre-post intervention study of HCP training in three tertiary care facilities in Maharashtra, India. Methods The study used a pre-post intervention design with assessment of HCPs’ (n = 201) knowledge, attitudes, perceived preparedness and practice at three time points: before training, after training and at 6 months follow- up. Results Total median score of knowledge about common signs and symptoms of violence (8.89 vs, 10.00), attitudes towards acceptability of violence (9.05 vs. 10.00), individual (6.74 vs. 10.00) and system level preparedness (6.11 vs. 8.14) improved from pre to post- training. The generalized estimating equation [GEE] model, adjusted for age, sex, site and department, showed an improvement in knowledge, attitudes and preparedness post- training. The change from pre to 6 months follow- up was not significant for attitude. Conclusions This package of interventions, including training of HCPs, improved HCPs’ knowledge, attitudes and practices, yet changes in attitudes and preparedness did not sustain over time. This study indicates feasibility and positive influence of a multi-component intervention to improve HCP readiness to respond to violence against women in a low-resource setting. Future phases of intervention development include adapting this intervention package for primary and secondary health facilities in this context, and future research should assess these interventions using a rigorous experimental design. Finally, these results can be used to advocate for multi-layered, systems-based approaches to strengthening health response to violence against women.

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Addressing Decision Making in Progesterone Treatment for History of Preterm Delivery

American Journal of Perinatology Reports ◽

10.1055/s-0039-1688776 ◽

2019 ◽

Vol 09 (03) ◽

pp. e244-e250 ◽

Cited By ~ 1

Author(s):

Jacqueline Zuponcic ◽

Connie Cottrell ◽

Justin Lavin ◽

Wendy Facchini ◽

Marissa Li

Keyword(s):

Health Care ◽

Preterm Birth ◽

Health Care Providers ◽

The United States ◽

Phone Call ◽

Premature Delivery ◽

Care Providers ◽

Patient Counseling ◽

History Of

Introduction The United States ranks 27th among nations worldwide for infant mortality with a rate of 6.1 deaths per 1,000 live births. The majority of perinatal morbidity and mortality is related to preterm birth, defined as delivery prior to 37 weeks' gestation. Among the risk factors for preterm birth is prior preterm birth, which is associated with a 1.5- to 2.0-fold increase in risk. At the present time, there is only one Food and Drug Administration approved treatment for the prevention of preterm birth among women with a history of prior spontaneous premature delivery, intramuscular 17-α-hydroxyprogesterone caproate (17-OHP), administered once weekly from 20 to 36 weeks' gestation. However, many eligible pregnant patients decline this therapy. Methods This was a prospective, cohort study involving patients who were identified as candidates for 17-OHP treatment at their first obstetric visit and asked to complete a short survey regarding their history of preterm birth. Those patients who consented to a follow-up phone call were asked to participate in a focus group discussion regarding their experience with progesterone and the health care system. Results During the 1-year study period, 55 progesterone candidates were identified, 43 accepted treatment, 7 refused, and 5 either initiated prenatal care too late to receive injections or did not follow-up. Those who accepted treatment appeared to cope better with treatment side effects, and/or had traumatic emotional reactions regarding their prior premature birth outcomes. Women who declined treatment often cited pain with injection, had fatalistic beliefs regarding their care, and/or had personal concerns related to full-term pregnancy. Discussion Maternal health care providers should always discuss the implications of prematurity at the time of the index premature delivery and again at the first prenatal visit of the subsequent pregnancy. Providers need to be prepared to employ various techniques for patient counseling and education. Small changes in office practice, like having fewer care providers involved in patient care or providing distractions for children, may make the difference between a patient who is open or closed to treatment options.

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The Special Perils of Being Old and Sick in Prison

Federal Sentencing Reporter ◽

10.1525/fsr.2020.32.5.276 ◽

2020 ◽

Vol 32 (5) ◽

pp. 276-284

Author(s):

William J. Jefferson

Keyword(s):

United States ◽

Health Care ◽

Medical Care ◽

Health Care Providers ◽

The United States ◽

United States Constitution ◽

Care Providers ◽

Medical Practitioners ◽

Medical Needs ◽

Access To Medical Care

The United States Supreme Court declared in 1976 that deliberate indifference to the serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain…proscribed by the Eighth Amendment. It matters not whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards intentionally denying or delaying access to medical care or intentionally interfering with treatment once prescribed—adequate prisoner medical care is required by the United States Constitution. My incarceration for four years at the Oakdale Satellite Prison Camp, a chronic health care level camp, gives me the perspective to challenge the generally promoted claim of the Bureau of Federal Prisons that it provides decent medical care by competent and caring medical practitioners to chronically unhealthy elderly prisoners. The same observation, to a slightly lesser extent, could be made with respect to deficiencies in the delivery of health care to prisoners of all ages, as it is all significantly deficient in access, competencies, courtesies and treatments extended by prison health care providers at every level of care, without regard to age. However, the frailer the prisoner, the more dangerous these health care deficiencies are to his health and, therefore, I believe, warrant separate attention. This paper uses first-hand experiences of elderly prisoners to dismantle the tale that prisoner healthcare meets constitutional standards.

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Nurse Practitioner Challenges to the Orthodox Structure of Health Care Delivery: Regulation and Restraints on Trade

American Journal of Law & Medicine ◽

10.1017/s0098858800008686 ◽

1985 ◽

Vol 11 (2) ◽

pp. 195-225

Author(s):

Karla Kelly

Keyword(s):

Health Care ◽

Health Care Providers ◽

Health Care Delivery ◽

Nurse Practitioners ◽

Nurse Practitioner ◽

Allied Health ◽

Care Delivery ◽

The United States ◽

Care Providers ◽

Allied Health Care

AbstractUntil recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse.This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners’ dilemma.

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Patients' Perceptions of Different Information Exchange Mechanisms: An Exploratory Study in the United States

Methods of Information in Medicine ◽

10.1055/s-0040-1721784 ◽

2020 ◽

Vol 59 (04/05) ◽

pp. 162-178

Author(s):

Pouyan Esmaeilzadeh

Keyword(s):

United States ◽

Health Care ◽

Health Information ◽

Health Care Providers ◽

Information Exchange ◽

The United States ◽

Exchange Mechanism ◽

Care Providers ◽

Security Risks ◽

Direct Exchange

Abstract Background Patients may seek health care services from various providers during treatment. These providers could serve in a network (affiliated) or practice separately (unaffiliated). Thus, using secure and reliable health information exchange (HIE) mechanisms would be critical to transfer sensitive personal health information (PHI) across distances. Studying patients' perceptions and opinions about exchange mechanisms could help health care providers build more complete HIEs' databases and develop robust privacy policies, consent processes, and patient education programs. Objectives Due to the exploratory nature of this study, we aim to shed more light on public perspectives (benefits, concerns, and risks) associated with the four data exchange practices in the health care sector. Methods In this study, we compared public perceptions and expectations regarding four common types of exchange mechanisms used in the United States (i.e., traditional, direct, query-based, patient-mediated exchange mechanisms). Traditional is an exchange through fax, paper mailing, or phone calls, direct is a provider-to-provider exchange, query-based is sharing patient data with a central repository, and patient-mediated is an exchange mechanism in which patients can access data and monitor sharing. Data were collected from 1,624 subjects using an online survey to examine the benefits, risks, and concerns associated with the four exchange mechanisms from patients' perspectives. Results Findings indicate that several concerns and risks such as privacy concerns, security risks, trust issues, and psychological risks are raised. Besides, multiple benefits such as access to complete information, communication improvement, timely and convenient information sharing, cost-saving, and medical error reduction are highlighted by respondents. Through consideration of all risks and benefits associated with the four exchange mechanisms, the direct HIE mechanism was selected by respondents as the most preferred mechanism of information exchange among providers. More than half of the respondents (56.18%) stated that overall they favored direct exchange over the other mechanisms. 42.70% of respondents expected to be more likely to share their PHI with health care providers who implemented and utilized a direct exchange mechanism. 43.26% of respondents believed that they would support health care providers to leverage a direct HIE mechanism for sharing their PHI with other providers. The results exhibit that individuals expect greater benefits and fewer adverse effects from direct HIE among health care providers. Overall, the general public sentiment is more in favor of direct data transfer. Our results highlight that greater public trust in exchange mechanisms is required, and information privacy and security risks must be addressed before the widespread implementation of such mechanisms. Conclusion This exploratory study's findings could be interesting for health care providers and HIE policymakers to analyze how consumers perceive the current exchange mechanisms, what concerns should be addressed, and how the exchange mechanisms could be modified to meet consumers' needs.

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Patient Suffering in Chronic Digestive Diseases: Will Primary Care-Specialist Collaboration With Effective Interactive Communication and Integrative Medicine in the Plan of Care Improve Quality of Life?

Journal of Patient Experience ◽

10.1177/2374373520967798 ◽

2020 ◽

Vol 7 (6) ◽

pp. 989-993

Author(s):

Andrew Thomas ◽

Annie Thomas

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Health Care ◽

Health Care Providers ◽

The United States ◽

Care Providers ◽

Physician Visits ◽

Digestive Diseases ◽

Care Specialist

Acute and chronic digestive diseases are causing increased burden to patients and are increasing the United States health care spending. The purpose of this case report was to present how nonconfirmatory and conflicting diagnoses led to increased burden and suffering for a patient thus affecting quality of life. There were many physician visits and multiple tests performed on the patient. However, the primary care physician and specialists could not reach a confirmatory diagnosis. The treatment plans did not offer relief of symptoms, and the patient continues to experience digestive symptoms, enduring this burden for over 2 years. The central theme of this paper is to inform health care providers the importance of utilizing evidence-based primary care specialist collaboration models for better digestive disease outcomes. Consistent with patient’s experience, the authors propose to pilot/adopt the integrative health care approaches that are proven effective for treating digestive diseases.

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