scholarly journals Longitudinal Observation of Outcomes and Patient Access to Integrated Care Following Point-of-Care Glycemic Screening in Community Health Center Dental Safety Net Clinics

2021 ◽  
Vol 2 ◽  
Author(s):  
Ingrid Glurich ◽  
Richard Berg ◽  
Aloksagar Panny ◽  
Neel Shimpi ◽  
Annie Steinmetz ◽  
...  

Introduction: Rates of diabetes/prediabetes continue to increase, with disparity populations disproportionately affected. Previous field trials promoted point-of-care (POC) glycemic screening in dental settings as an additional primary care setting to identify potentially at-risk individuals requiring integrated care intervention. The present study observed outcomes of POC hemoglobin A1c (HbA1c) screening at community health center (CHC) dental clinics (DC) and compliance with longitudinal integrated care management among at-risk patients attending dental appointments.Materials and Methods: POC HbA1c screening utilizing Food and Drug Administration (FDA)-approved instrumentation in DC settings and periodontal evaluation of at-risk dental patients with no prior diagnosis of diabetes/prediabetes and no glycemic testing in the preceding 6 months were undertaken. Screening of patients attending dental appointments from October 24, 2017, through September 24, 2018, was implemented at four Wisconsin CHC-DCs serving populations with a high representation of disparity. Subjects meeting at-risk profiles underwent POC HbA1c screening. Individuals with measures in the diabetic/prediabetic ranges were advised to seek further medical evaluation and were re-contacted after 3 months to document compliance. Longitudinal capture of glycemic measures in electronic health records for up to 2 years was undertaken for a subset (n = 44) of subjects with available clinical, medical, and dental data. Longitudinal glycemic status and frequency of medical and dental access for follow-up care were monitored.Results: Risk assessment identified 224/915 (24.5%) patients who met inclusion criteria following two levels of risk screening, with 127/224 (57%) qualifying for POC HbA1c screening. Among those tested, 62/127 (49%) exhibited hyperglycemic measures: 55 in the prediabetic range and seven in the diabetic range. Moderate-to-severe periodontitis was more prevalent in patients with prediabetes/diabetes than in individuals with measures in the normal range. Participant follow-up compliance at 3 months was 90%. Longitudinal follow-up documented high rates of consistent access (100 and 89%, respectively), to the integrated medical/DC environment over 24 months for individuals with hyperglycemic screening measures.Conclusion: POC glycemic screening revealed elevated HbA1c measures in nearly half of at-risk CHC-DC patients. Strong compliance with integrated medical/dental management over a 24-month interval was observed, documenting good patient receptivity to POC screening in the dental setting and compliance with integrated care follow-up by at-risk patients.

2009 ◽  
Vol 15 (6) ◽  
pp. 529-534 ◽  
Author(s):  
Susan A. Primo ◽  
Roger Wilson ◽  
James W. Hunt ◽  
Jan L. Cooper ◽  
Daniel Desrivieres ◽  
...  

2021 ◽  
Author(s):  
Marwan Haddad ◽  
Lauren Bifulco ◽  
Jeannie McIntosh ◽  
Meghan McClain Garcia

Abstract Purpose: Rectal self-collection increases detection of asymptomatic chlamydia and gonorrhea among at-risk men who have sex with men and transgender women. This feasibility study assessed patient and primary care provider (PCP) perceptions of implementing rectal self-collection at a large, general practice community health center.Methods: PCPs offered rectal self-collection to at-risk patients due for routine or risk-based screening. Patients and PCPs completed brief cross-sectional assessments.Results: Rectal screening was feasible in a large primary care setting despite clinical time and resource constraints and was universally accepted when offered (n=36; 91.6% of whom opted for self-collection). Both PCPs and patients preferred self-collection over clinician-collection.Conclusions: Rectal self-collection can increase screening and improve extra-genital chlamydia and gonorrhea diagnoses. Adoption of rectal self-collection in primary care is a scalable, useful, and acceptable strategy to increase extra-genital screening among medically underserved sexual and gender minority patients and combat the current sexually-transmitted infection epidemic.


2021 ◽  
Vol 21 (1) ◽  
pp. 39-43
Author(s):  
Sara K Muli-Kinagwi ◽  
Meshack Ndirangu ◽  
Onesmus Gachuno ◽  
Samuel Muhula

Background: In 2011, 3.4 million children were living with HIV worldwide1. Objectives: Describe the characteristics of pediatric patients enrolled into the HIV program at the Kibera community health center between January 2012 and March 2013. Determine the proportion of enrolled paediatric patients lost to follow up. Determine the correlates associated with retention and loss to follow up. Methods: The study was a retrospective cohort study of program data of all pediatric patients enrolled into the HIV pro- gram in the facility between January 2012 and March 2013. The data was analyzed using SPSS. Results: Of the 100 pediatric patients enrolled during the study period, 79 and 21 were HIV negative and positive respec- tively. Only 4 (5%) of the HIV exposed Infants and 11 (52%) of the HIV positive children were started on ART within the study period. The retention rate of the children at 3 months was 87% while the retention at both 12 and 15 months was 79%. There was an association between the mother or guardian disclosing their status and the retention of the child (p-value 0.026). Conclusion: The disclosure of the HIV status by parent/guardian to the child was associated with better retention of the children in the program. Keyword: Pediatric patients in care; Kibera community health center; HIV/AIDS.


2008 ◽  
Vol 19 (2) ◽  
pp. 550-561 ◽  
Author(s):  
Elizabeth Miller ◽  
Kristin M. Wieneke ◽  
J. Michael Murphy ◽  
Sheila Desmond ◽  
Andrew Schiff ◽  
...  

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