Impact on Primary Care and Specialty Care

Primary care practices (PCP) and specialty practices stopped most routine care and suffered major financial loss during the pandemic. Family practice, small PCP practices, and pediatrics were hit the hardest and are still having difficulty recovering. Increased use of virtual care, team management, and integration with community and public health were each utilized effectively during the pandemic and should continue to be incorporated in ambulatory medical practices.

Rebuilding Community-Based and Public Health Nursing in the Wake of COVID-19

The COVID-19 pandemic has reset the table for a dialogue about health equity, public health, and the future of nursing. Experts anticipated that payment reforms would lead to a much-needed increase in community and public health nursing. Despite calls for the profession of nursing to take a leadership role in addressing the social determinants of health and health equity, data show that jobs for nurses in community-based clinics and public health have actually declined in the last decade. This article offers background on the ongoing decline in public health infrastructure in the United States, an analysis of workforce data on nursing jobs using the National Sample Survey of Registered Nurses from the years 2000, 2004, 2008, and 2018, and the National Association of County and City Health Officials from 2008 to 2019, as well as a discussion of why these findings are so troubling. We discuss policy implications for nurse educators related to curricula and clinical experiences, and for professional nursing organizations as they set goals to increase and improve nursing jobs in community clinics and public health settings. In conclusion, we note that the federal investments in community health centers and public health nursing provide a short window of opportunity to reverse the historic and ongoing decline and rebuild a stronger community and public health nurse workforce.

Exploring Community Mental Health Systems – A Participatory Health Needs and Assets Assessment in the Yamuna Valley, North India

Background: In India and global mental health, a key component of the care gap for people with mental health problems is poor system engagement with the contexts and priorities of community members. This study aimed to explore the nature of community mental health systems by conducting a participatory community assessment of the assets and needs for mental health in Uttarkashi, a remote district in North India. Methods: The data collection and analysis process were emergent, iterative, dialogic and participatory. Transcripts of 28 in-depth interviews (IDIs) with key informants such as traditional healers, people with lived experience and doctors at the government health centres (CHCs), as well as 10 participatory rural appraisal (PRA) meetings with 120 people in community and public health systems, were thematically analysed. The 753 codes were grouped into 93 categories and ultimately nine themes and three meta-themes (place, people, practices), paying attention to equity. Results: Yamuna valley was described as both ‘blessed’ and limited by geography, with bountiful natural resources enhancing mental health, yet remoteness limiting access to care. The people described strong norms of social support, yet hierarchical with entrenched exclusions related to caste and gender, and social conformity that limited social accountability of services. Care practices were porous, pluralist and fragmented, with operational primary care services that acknowledged traditional care providers, and trusted resources for mental health such as traditional healers (malis) and government health workers (accredited social health activists. ASHAs). Yet care was often absent or limited by being experienced as disrespectful or of low quality. Conclusion: Findings support the value of participatory methods, and policy actions that address power relations as well as social determinants within community and public health systems. To improve mental health in this remote setting and other South Asian rural locations, community and public health systems must dialogue with the local context, assets and priorities and be socially accountable.

Physicians who use substances: what does it look like and what to do about it?

Substance use disorders in physicians is a serious problem of the medical community and public health. The prevalence of substance use disorders depends on gender, age and medical specialty. The substance abuse impairs physical and mental health of physicians and affects the quality of patient care. Treatment of chemically addicted physicians involves the use of conventional therapeutic approaches adopted in addiction medicine, but requires compliance with certain special principles.

Accelerating Use of Self-measured Blood Pressure Monitoring (SMBP) Through Clinical-Community Care Models

Self-measured blood pressure monitoring (SMBP), the regular measurement of blood pressure by a patient outside the clinical setting, plus additional support, is a proven, cost-effective but underutilized strategy to improve hypertension outcomes. To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National Association of Community Health Centers, the YMCA of the USA, and Association of State and Territorial Health Officials to develop cross-sector care models to offer SMBP to patients with hypertension. The project aimed to increase the use of SMBP through the coordinated action of health department leaders, community organizations and clinical providers. From 1/31/2017 to 6/30/2018, nine health centers in Kentucky, Missouri, and New York partnered with seven local Y associations (local Y) and their local health departments to design and implement care models that adapted existing primary care SMBP practices by leveraging capacities and resources in community and public health organizations. Nine collaborative care models emerged, shaped by available community assets, strategic priorities, and organizational culture. Overall, 1421 patients were recommended for SMBP; of those, 795 completed at least one cycle of SMBP (BP measurements morning and evening for at least three consecutive days). Of those recommended for SMBP, 308 patients were referred to a local Y to receive additional SMBP and healthy lifestyle support. Community and public health organizations can be brought into the health care delivery process and can play valuable roles in supporting patients in SMBP.

Public health nursing: regulation and public health policies

ABSTRACT Objective: To analyze regulation and public policies related to nursing and the specialist nurse in community and public health nursing. Methods: Analysis of the legal and normative framework of community and public health nursing in Portugal, as well as current public health policies, regarding the competences and intervention of this nurse, articulated with the attributions of the Public Health Unit. Results: The intervention of this nurse deserves a broad reflection, in the sense of maximizing the activities of community and public health, essential for the implementation of public policies and obtaining health gains. Final considerations: This nurse has competences foreseen in the regulations and standards for public health interventions, in line with the attributions of the Public Health Unit, of the National Health Service, in which specialties are identified for their performance in the current structure.