Ability Of Health Care Providers Research Articles

Worry as Important “Feelers” in Clinical Anesthesia Practice: A Mixed-Methods Study

PurposeWorry is an intuitive sense that goes beyond logical reasoning and is valuable in situations where patients’ conditions are rapidly changing or when objective data may not fully capture the complexity of a patient’s situation. Nurse anesthetists’ subjective reasons for worry are quite vague as they are valued inconsistently and not accurately expressed. This study aimed to identify factors playing a role in the emergence of worry during anesthesia practice to clarify its concept. DesignMixed-methods design consisting of quantitative online surveys followed by qualitative focus group interviews including Dutch nurse anesthetists. MethodsBoth quantitative and qualitative thematic analyses were performed, followed by data and methodological triangulation to enhance the validity and credibility of findings and mitigate the presence of bias. FindingsSurveys (N = 102) were analyzed, and 14 nurse anesthetists participated in the focus group interviews. A total of 89% of the survey respondents reported that at least once have had the feeling of worry, of which 92% use worry during clinical anesthesia practice. Worry was mentioned to be a vital element during anesthesia practice that makes it possible to take precautionary actions to change the anesthetic care plan in a changing situation or patient deterioration. ConclusionsWhile a clear definition of worry could not be given, it is a valuable element of anesthesia practice as it serves as a catalyst for critical thinking, problem-solving, clinical reasoning, and decision-making. Use of the feeling of worry alongside technological systems to make an informed decision is crucial. Technology has significantly improved the ability of health care providers to detect and respond to patient deterioration promptly, but it is crucial for nurse anesthetists to use their feeling of worry or intuition alongside technological systems and evidence-based practice to ensure quick assessments or judgments based on experience, knowledge, and observations in clinical practice.

The Exploration of the GWOT Combat Amputee's Experience With Longitudinal Care: A Qualitative Study.

Contemporary advances in combat medicine have allowed greater numbers of wounded service members to survive their injuries. An estimated 1,705 combat veterans sustained major lower or upper extremity amputations between 2001 and 2017 during the Global War on Terror. This study intends to answer the following question utilizing a qualitative study design: What were the common and abnormal experiences of the Global War on Terror combat amputees relative to their mechanism of injury, perception of injury, and systems of care utilized during their recovery and rehabilitation process?. During the months of December 2022 and January 2023, individual semi-structured interviews were conducted with U.S. Marines that served in the Global War on Terror (total n = 10). Deductive and inductive approaches were employed to identify codes, themes, and meta-themes in the data. All participants deployed to Afghanistan between the years 2010 and 2014 and were assigned to the following military occupational specialties: Explosive Ordnance Disposal technicians (total n = 2); combat engineers (total n = 2); and infantrymen (total n = 6). Analysis of data collected from interviews highlighted these key observations: (1) Themes in the combat amputee experience include support, systems of care, and mindset and (2) the themes synergistically contribute to the meta-themes mental health and pain and vice versa. As all participants were subjected to a blast mechanism of injury, it is difficult to determine if this played a role in deviating rehabilitation and recovery processes. Perception of injury and how well participants adapted to their new lifestyle, meaning how optimistic they were, appeared to play a significant role in recovery. Participants had mixed feelings about the care they had received but generally spoke favorably of military hospitals and were frustrated with the Veteran Affairs, and there was no clear consensus on their relationship with civilian health care, though most participants chose to seek most of their care through the Veteran Affairs. Based on the research question, this study found an intricate relationship between mental health, pain, and the experiences of the participants regarding their care and rehabilitation. However, the nature of qualitative research makes it impossible to determine generalizations that can be used to create meaningful change to address improving combat amputee veteran care. Further research into long-term health outcomes based on hypotheses not evaluated in existing literature would further improve the ability of health care providers to care for this unique patient population.

The Framework for Value Based Purchasing in Health Care

Supporting the health needs of populations of people has become a complex and expensive endeavor. As health systems have evolved around the world, the cost of care has become increasingly unsustainable, leading to gaps in care, financial hardship, and worsening measures of clinical effectiveness. Many nations around the world have begun migrating to a system of “value-based care,” which relies heavily on the ability of health care providers to deliver data-driven, high quality care that meets budgetary guidelines. To be effective in this effort, providers must revamp their business models to accommodate measurements of quality and cost to ensure that services that are provided to populations of people are not only cost effective but also meet higher standards of quality and equity. This new model of value-based purchasing relies on approaches to care and measurement that exceed those in current practice. This paper discusses the key components of value-based purchasing, from the business model to measurement systems and the impact expected on provider economics. All sectors of the health care industry will be impacted by this new approach, creating an imperative for physicians and other health care leaders to understand the new model and align incentives to achieve high levels of performance. Implementation of the new system of care is proceeding rapidly in many countries, including the Kingdom of Saudi Arabia and the United States, and the adjustments needed to conform in this new era will continue to drive change and alter traditional practice patterns. The foundational elements of the new system comprise the subject of this report.

Meeting Quality Metrics in Oral Squamous Cell Carcinoma Surgery: A Single-Center Experience

Patient-centered quality metrics have been proposed to evaluate and optimize hospital processes, aiming to improve patient outcomes. Furthermore, they can be used to objectively rate and compare the ability of health care providers to meet the needs of their patients. In patients with advanced resectable oral squamous cell carcinoma, optimal surgical treatment of the neck and timely initiation of both surgical and adjuvant therapy, when indicated, are crucial for recurrence-free and overall survival.
 This retrospective analysis included 160 patients who received primary resection of oral squamous cell carcinoma and concurrent neck dissection.It aimed to investigate how well quality metrics were met during a 6-year period in the department of oral and maxillofacial surgery at a university hospital. 93.1% of patients were seen in the specialist's office within 21 days after referral. Resection was classified as R0 in 94.4%. A lymph node yield >= 18 was achieved in 82.5%. The lymph node ratio was <= 6% in 43.3% of nodal-positive necks. Readmission and unplanned revision surgery were rare (6.9%). Adjuvant radiotherapy was started <= 6 weeks after surgery in 45.3%, and the indication was in accordance with international guidelines in all cases. Quality metrics are an effective tool for planning process optimization in a hospital. Moreover, nodal quality metrics such as lymph node yield and lymph node ratio could, after validation, complement existing and well-established prognostic parameters for patient-specific adaptation of adjuvant treatment plans.
 Accepted for publication: November 29, 2022
 Published online: December 15, 2022

Meeting Quality Metrics in Oral Squamous Cell Carcinoma Surgery: A Single-Center Experience.

Patient-centered quality metrics have been proposed to evaluate and optimize hospital processes, aiming to improve patient outcomes. Furthermore, they can be used to objectively rate and compare the ability of health care providers to meet the needs of their patients. In patients with advanced resectable oral squamous cell carcinoma, optimal surgical treatment of the neck and timely initiation of both surgical and adjuvant therapy, when indicated, are crucial for recurrence-free and overall survival. This retrospective analysis included 160 patients who received primary resection of oral squamous cell carcinoma and concurrent neck dissection. It aimed to investigate how well quality metrics were met during a 6-year period in the department of oral and maxillofacial surgery at a university hospital. 93.1% of patients were seen in the specialist's office within 21 days after referral. Resection was classified as R0 in 94.4%. A lymph node yield ≥ 18 was achieved in 82.5%. The lymph node ratio was ≤6% in 43.3% of nodal-positive necks. Readmission and unplanned revision surgery were rare (6.9%). Adjuvant radiotherapy was started ≤ 6 weeks after surgery in 45.3%, and the indication was in accordance with international guidelines in all cases. Quality metrics are an effective tool for planning process optimization in a hospital. Moreover, nodal quality metrics such as lymph node yield and lymph node ratio could, after validation, complement existing and well-established prognostic parameters for patient-specific adaptation of adjuvant treatment plans.

NeuroMeasures-Implementation of a Web-Based, Real-Time Quality Metric Tool to Improve Provider Practices in an Epilepsy Clinic.

The retrospective nature of most available epilepsy quality improvement (QI) tools focuses on changing health care provider (HCP) clinical habits and documentation practices rather than a focus on real-time patient interventions. Furthermore, patient-reported outcome data are often not available to determine the efficacy of these tools. Our primary objective was to demonstrate the improvement of HCPs' documentation and review of epilepsy quality measures (EQMs) during the patient visit with the implementation of a novel web application, NeuroMeasures. Our secondary objective was to improve the percentage of point-of-care counseling and interventions based on quality measures during the patient encounter based on the results of the NeuroMeasures tool. Our QI study focused on comparing a preintervention and postintervention cohort of patients with epilepsy (PWE) before the implementation of NeuroMeasures, a web-based application that takes a self-guided patient survey through self-scoring algorithms focused on the American Academy of Neurology (AAN)'s 2017 EQMs. This e-tool then provides the HCP a tool to directly review the EQMs highlighted and perform any necessary counseling or interventions at the point-of-care visit. After intervention, EQMs were gained from the review of the NeuroMeasures HCP quality measures tool and a chart review for physician documentation. Patients with language barriers and severe cognitive disabilities were excluded from the study. The preintervention cohort consisted of 150 unique PWE, and the postintervention cohort included 379 unique adult PWE and 515 total encounters. Overall percentages of review/adherence of EQMs were significantly improved between the preintervention and postintervention group for counseling for women of childbearing potential (91.7%), intractable epilepsy referral to a comprehensive epilepsy center (74%), quality of life assessment (80%), improvement of quality of life measurements (41.7%), and depression and anxiety screening (85.6%), demonstrating a significant increase when compared with the preintervention group (p < 0.00001). A web-based point-of-care EQM application demonstrated significant improvement of the HCP's ability to perform and review EQMs at the point-of-care patient visit. Furthermore, the application was successful in creating opportunities for direct intervention based on the EQMs and chances for better patient education and provider-patient communication. Further considerations would include automated survey requests and expansion into other AAN QMs.

Brief behaviour change counselling in non-communicable diseases in Mangochi, Southern Malawi: a hypothetical acceptability study

IntroductionBrief behaviour change counselling (BBCC) approaches have shown some potential in reversing and/or decreasing the effects of behavioural risk factors (harmful alcohol, smoking, physical inactivity and unhealthy diets). However, BBCC is new in Malawi. Thus, we explored the acceptability of brief behaviour change counselling using 5 As and a guiding style from motivational interviewing (BBCC + 5 As + GS) among health providers, policy-makers and patients living with noncommunicable diseases (NCDs) in the Mangochi district located in Malawi.MethodsAn exploratory qualitative cross-sectional study used purposive sampling to select 44 respondents. We conducted group discussions with five focus groups that included patients. We also carried out nine key-informant interviews with healthcare providers and policy-makers. Data were managed and organized with Atlas.ti. cloud and analysed using the thematic framework approach.FindingsSeveral themes, categories, and their subcategories emerged from the interviews. Participants perceived the introduction and delivery of BBCC + 5As + GS in Mangochi as smooth. However, they predicted a few challenges such as time and space to conduct the intervention, cultural bottlenecks caused by low education level, age differences between healthcare providers and patients, low provider- to- patient ratio and high provider turnover. For this method to be adopted, a simplified format is deemed necessary to improve effectiveness with patients. This technique can only be sustained if training opportunities are provided and if positive testimonies are given by beneficiaries. Incorporation of a continuous quality improvement cycle targeting challenges must be part of the intervention. Participants perceived that BBCC will contribute to developing the listening ability of healthcare providers. This would help in providing personalized and cost-effective care relevant to Mangochi. The participants also perceived that BBCC + 5As + GS will be affordable, credible and useful.ConclusionWe found a high acceptability rate of BBCC among stakeholders in NCDs clinics in Mangochi. There are a number of areas where BBCC + 5As + GS could be improved to increase the acceptability. Accordingly, a study of feasibility and preliminary efficacy is warranted to determine other prerequisites for the implementation of a large-scale trial using this BBCC+ 5 As + GS, and to fully understand the implementation requirements of a full trial in Mangochi.

Evolving perceptions regarding receiving orthopaedic care during the Coronavirus 2019 (COVID-19) pandemic: a follow-up survey.

Background:As the Coronavirus 2019 (COVID-19) pandemic evolves, it is critical to understand how patients’ feelings and perceptions have changed. The aim of this study was to understand current feelings and concerns about seeking and receiving orthopaedic care 9 mo into the global pandemic.Methods:Utilizing a survey developed to evaluate the attitudes and beliefs from healthcare respondents about receiving care during the COVID-19 pandemic, an updated and revised version, evaluating changes in perception of respondents 9 mo into the pandemic, was distributed to a group of panelists by email.Results:Out of 1200 individuals, 197 (16%) completed the survey. A majority of respondents reported high level of comfort in the immediate or near-term receiving care in an orthopaedic clinic, urgent care clinic specifically for orthopaedics, or in an emergency room. Six percent of respondents reported a delay in seeking orthopaedic care despite COVID-19 concerns that occurred between studies. Respondents reported their primary reason for delaying care was because of concerns for risk of COVID-19 exposure from other patients (83%). More than 75% of respondents stated they are “extremely” or “very” likely to get the COVID-19 vaccine when it becomes available to the public. Respondents had a generally negative outlook on pandemic efforts locally to globally.Conclusions:Despite dismal overall perceptions regarding the outlook of the pandemic; consumers are becoming increasingly comfortable obtaining orthopaedic care. The ability of healthcare providers and practices to adherence to safety protocols will remain essential to maintaining consumer trust and confidence.Level of Evidence:Level IV.

Dietary Management of Heart Failure: DASH Diet and Precision Nutrition Perspectives.

Heart failure (HF) is a major health care burden increasing in prevalence over time. Effective, evidence-based interventions for HF prevention and management are needed to improve patient longevity, symptom control, and quality of life. Dietary Approaches to Stop Hypertension (DASH) diet interventions can have a positive impact for HF patients. However, the absence of a consensus for comprehensive dietary guidelines and for pragmatic evidence limits the ability of health care providers to implement clinical recommendations. The refinement of medical nutrition therapy through precision nutrition approaches has the potential to reduce the burden of HF, improve clinical care, and meet the needs of diverse patients. The aim of this review is to summarize current evidence related to HF dietary recommendations including DASH diet nutritional interventions and to develop initial recommendations for DASH diet implementation in outpatient HF management. Articles involving human studies were obtained using the following search terms: Dietary Approaches to Stop Hypertension (DASH diet), diet pattern, diet, metabolism, and heart failure. Only full-text articles written in English were included in this review. As DASH nutritional interventions have been proposed, limitations of these studies are the small sample size and non-randomization of interventions, leading to less reliable evidence. Randomized controlled interventions are needed to offer definitive evidence related to the use of the DASH diet in HF management.

Efficacy of Hypertension Self-Management Classes Among Patients at a Federally Qualified Health Center.

Structural racism has contributed to persistent racial disparities in hypertension control, with Black men suffering the highest prevalence of uncontrolled hypertension. Lincoln Community Health Center, our urban Federally Qualified Health Center (FQHC), aimed to use hypertension self-management classes to improve hypertension control among our clinic patients, particularly Black men. Patients attending classes learned about hypertension, were given blood pressure cuffs to use at home, and had the opportunity to speak to physicians in a group setting. We used a nonexperimental quality improvement intervention design to identify baseline differences between participants who attended multiple classes and those who attended only 1 class. Participants who attended multiple classes, most of whom were Black men, achieved an average blood pressure reduction of 19.1/14.8 mm Hg. Although the classes were effective, current policies around health insurance reimbursement and federal quality reporting standards hamper the ability of health care providers to implement such patient education initiatives.

Using Intervention Mapping to Develop a Provider Intervention to Increase HPV Vaccination in a Federally Qualified Health Center.

Introduction: A healthcare provider's ability to give a strong recommendation for the HPV vaccine is of utmost importance in increasing HPV vaccination. To reduce the burden of HPV-related cancers, there is a critical need to develop and implement theory-based interventions aimed at strengthening healthcare providers' communication about the HPV vaccine.Methods: We used Intervention Mapping (IM) steps 1–5 to develop and implement a provider-level intervention that aligns with the priorities and needs of a large, urban Federally Qualified Health Center (FQHC).Results: In step 1, a diverse planning group identified barriers to HPV vaccination in clinical settings and generated process maps and a logic model of the problem. Step 2 outlined outcomes and provider performance objectives of the intervention and identified knowledge, skills, self-efficacy, outcome expectations, and normative beliefs as modifiable targets that need to change for providers to deliver strong recommendations for the HPV vaccine to parents and patients. In step 3, the planning group mapped the methods of persuasive communication, information, and modeling and skills training to behavioral targets and outlined the program practical applications (strategies) components, scope, and sequence. In steps 4 and 5, the planning group produced the intervention and planned for program implementation. The iterative and participatory process of IM resulted in modifications to the initial intervention that aligned with the needs of the FQHC.Discussion: IM provided a systematic, participatory, and iterative approach for developing a theory-based provider-level intervention aimed at strengthening healthcare providers' ability to provide a strong recommendation for the HPV vaccine to eligible patients and parents served by a large FQHC. IM assisted with the identification of behavioral targets and methods that move beyond HPV knowledge and reminders to create behavior change. IM can help researchers and planners describe the processes and rational behind developing interventions and may help to facilitate implementation in real-world clinical settings by tailoring intervention components to the needs of the population.

Perspectives on the COVID-19 pandemic impact on cardio-oncology: results from the COVID-19 International Collaborative Network survey

BackgroundRe-allocation of resources during the COVID-19 pandemic has resulted in delays in care delivery to patients with cardiovascular disease and cancer. The ability of health care providers to provide optimal care in this setting has not been formally evaluated.ObjectivesTo assess the impact of COVID-19 resource re-allocation on scheduling, testing, elective procedures, telemedicine access, use of new COVID-19 therapies, and providers’ opinions on healthcare policies among oncology and cardiology practitioners.MethodsAn electronic survey was conducted by a cardio-oncology collaborative network through regional and state chapters of the American College of Cardiology, American Society of Clinical Oncology, and the International Cardio-Oncology Society. Descriptive statistics were reported by frequency and proportion for analyses, and stratified categorically by geographic region and specialty.ResultsOne thousand four hundred fifteen providers (43 countries) participated: 986 cardiologists, 306 oncologists, and 118 trainees/internal medicine. 63% (195/306) of oncologists vs 92% (896/976) of cardiologists reported cancellations of treatments/elective procedures (p = 0.01). 46% (442/970) of cardiologists and 25% (76/303) of oncologists modified the scope of their practice (p = < 0.001). Academic physicians (74.5%) felt better supplied with personal protective equipment (PPE) vs non-academic (74.5% vs 67.2%; p = 0.018). Telemedicine was less common in Europe 81% (74/91), and Latin America 64% (101/158), than the United States, 88% (950/1097) (p = < 0.001). 95% of all groups supported more active leadership from medical professional societies.ConclusionsThese results support initiatives to promote expanded coverage for telemedicine, increased access to PPE, better testing availability and involvement of medical professional societies to help with preparedness for future health care crisis.

Adverse Childhood Experiences and Trauma-Informed Care.

Adverse childhood experiences (ACEs) refer to the abuse, neglect, and traumatic experiences in childhood that directly affect long-term adolescent and adult health. Understanding the ACE Pyramid and the physiological stress response has guided research toward a better understanding of the long-term mental and physical health consequences from psychological impacts early in life. Trauma-informed care becomes critical for pediatric clinicians to operationalize in practice. The four R's approach-realize, recognize, respond, and resist re-traumatization-can be used by pediatric providers as guidance. The trauma-informed care approach includes the realization of how ACEs affect health, the recognition of pediatric clinical symptom presentation and screening protocols for ACEs, and the health care provider's ability to respond and not re-traumatize patients when delivering evidence-based care. As recent events have triggered worldwide mental and emotional trauma in youth, clinicians must start operationalizing trauma-informed care into practice, as future presentations of trauma are expected.

Choosing the right inhaler for the right patient: Considerations for effective management of patients with chronic obstructive pulmonary disease or asthma.

Effective management of chronic respiratory disorders such as chronic obstructive pulmonary disease and asthma necessitates that patients inhale their medication. However, lack of detailed guidelines on the technological and mechanical functions of inhalers limits the ability of health care providers (HCPs) to personalize inhaler choice for patients. Numerous types of inhalers are currently available which offer their own distinct advantages and disadvantages. Independent of the drug class, the choice of inhaler may be influenced by many factors (e.g., inhaler attributes and the efficiency with which it delivers the medication, patient characteristics and preferences, dosing regimen, clinical setting, and support available for both patients and HCPs). This article attempts to summarize the inhalation technology and factors influencing inhaler choice and use and to provide an approach for matching the right inhaler to the right patient. Identifying factors related to inhaler choice is critical to ensuring adherence to treatment and patients' ability to use their inhaler correctly. This review will help HCPs engage their patients in decision-making for inhaler choice and facilitate selection of the correct inhaler for each patient (i.e., one that they will use).

Interventions to Enhance Empathy and Person-Centered Care for Individuals With Dementia: A Systematic Review.

Empathy, or the ability to imagine what someone else may be feeling or thinking, is a crucial component of meaningful care provision, including person-centered care (PCC), and has been shown to enhance care provider and patient well-being. The purpose of the current review was to examine the impact of interventions focused on improving the ability of health care providers or students to experience and/or communicate with empathy. Of 1,427 publications reviewed, 18 articles met inclusion criteria. All studies incorporated empathy or empathic communication competencies in their training or intended variables of change. PCC concepts were used in guiding the development of most interventions. Some interventions significantly improved participant empathy, attitudes toward patients with dementia, and certain verbal and nonverbal communication skills. Current study reports on improved positive interpersonal communication skills by nursing assistants are promising. Future study to improve therapeutic communication and delivery of dementia care with empathy using enhanced study design and measurement are needed. [Research in Gerontological Nursing, 13(3), 158-168.].

The development and implementation of a gynecologic cancer survivorship tool.

98 Background: To assess the implementation and use of an electronic survivorship tool to enhance patient/clinician communication and intervention of survivorship concerns in women treated for gynecologic cancer. Methods: The clinical survivorship tool was developed using evidence-based data, multidisciplinary expert input, and patient feedback. The tool is composed of 17 questions encompassing 6 main categories: gynecologic health (abnormal bleeding/pain), lymphedema, vaginal/vulvar dryness, sexual health concerns, menopause (hot flushes, sleep difficulties), and bowel/urinary issues. The electronic tool was piloted and incorporated into clinic for endometrial and cervical cancer patients. Patients were introduced to the tool at their first postop visit and emailed an introduction form before their 3-month follow-up visit. The form could be completed at home or at the time of scheduled visit. Results: From 6/1/18 to 6/1/19, 1269 patients were eligible to complete at least one survivorship tool survey. Compliance rates increased over the year and reached 67% (1,015/1,525 assigned surveys completed) with the addition of clinic coordinator, staff and nurse training; the initiation of daily emails screening for survey respondents; clinic coordinator feedback and modification of screening emails; and the addition of nurses to daily screening emails. Of those who completed surveys between 01/1/19 and 06/1/19, the most common survivorship concerns noted were bowel (48%, n=484) and urinary function (35%,n=352) issues, menopausal symptoms such as trouble sleeping (33%, n=333) and hot flashes (25%, n=249), lower extremity symptoms (heaviness 17%, n=175; swelling 17%, n=171; numbness 17%, n=171), and vaginal dryness (26%, n=263), with actionable items of education and referrals, as needed. Conclusions: This survivorship tool enhanced the ability of healthcare providers to identify, monitor, and address survivorship concerns over the continuum of care. Patients and healthcare providers found this tool to be clinically feasible with potential to promote communication and education to enhance clinical care. Our multidisciplinary approach and training were key to implementation success.

Opening the Floodgates: Repealing Certificate of Needs Laws Could Drown Nursing Home Care

At a time of record-low nursing home occupancy, and with federal data showing the average nursing home margin at .5 percent, the Trump Administration is advocating more nursing home beds. Arguing that competition will drive consumer choice and quality, the Administration has proposed that states eliminate Certificate of Need (CON) laws that, in states like Ohio, restrict the ability of health care providers to build new infrastructure such as hospitals or nursing homes. Opposition to CON laws has been driven by conservative think tanks. This article focuses on the precarious economics of the nursing home sector to argue that a free market approach cannot be taken to a sector that is so heavily-regulated and under-funded by government. It warns that the repeal of CON laws could have disastrous consequences for an already-beset health care sector, and even adversely impact home-and-community-based services.

Battered and Brain Injured: Assessing Knowledge of Traumatic Brain Injury Among Intimate Partner Violence Service Providers.

Background: Traumatic brain injury (TBI) as a result of intimate partner violence (IPV) is a significant health concern; yet, little is known about the intersection between the two. Existing research is scarce, limiting the ability of health care providers to develop effective supports. This pilot project surveyed the IPV support community in Toronto, Canada to understand the degree of existing TBI-specific knowledge and relevant services available among these service providers and to seek to bridge the divide between research and practice by developing a national knowledge-to-practice network to support brain-injured women survivors of IPV.Materials and Methods: In phase 1, 68 agencies providing IPV support services were invited to complete an anonymous online survey. In phase 2, 22 stakeholders attended a workshop held to disseminate existing knowledge, develop a national knowledge-to-practice network, and determine next steps in research and practice.Results: The results highlighted a general lack of TBI awareness and understanding among IPV service providers. In addition, participants stated that frontline workers and women survivors of IPV alike do not recognize signs or symptoms of TBI. Recommendations addressing research gaps, professional and public education, and service development were identified and are discussed herein.Conclusions: The identified lack of TBI knowledge among IPV service providers highlights the immediate need to increase education among management and frontline workers. Further investigation identifying best practices for knowledge transfer are suggested. The development of a national strategy addressing education, research, and funding is critical for successful uptake and integration of TBI-sensitive services within the IPV sector.

Judge Blocks Abortion ‘Gag Rule’ for Title X Providers

Back to table of contents Previous article Next article Government NewsFull AccessJudge Blocks Abortion ‘Gag Rule’ for Title X ProvidersLinda M. RichmondLinda M. RichmondSearch for more papers by this authorPublished Online:9 May 2019https://doi.org/10.1176/appi.pn.2019.5b26AbstractThe Trump administration’s “gag rule” on abortion referrals or counseling for health care professionals who accept federal Title X funding was blocked in federal court April 29.A federal district court judge in Oregon blocked a Trump administration rule that would have barred health care professionals accepting federal funding from counseling women on abortion.iStock/Worawee Meepian“At the heart of these rules is an arrogant assumption that the government is better suited to direct women’s health care than their providers,” said Judge Michael McShane of the U.S. District Court in the District of Oregon, before announcing his plans to issue a preliminary injunction to block the rule from taking effect.Federal laws have long prohibited the use of taxpayer funds to pay for most abortions, but the Trump administration’s new policy, which had been set to take effect May 3, would go much further. It would have barred health care professionals who counsel patients on or refer them for abortion from receiving Title X funding, a program for low-income women under the Public Health Service Act. It also included a costly new requirement that clinics be physically and financially separate from facilities that provide abortions and added new requirements around involving families in the family planning decisions of minors.Title X is the only federal reproductive-health services program for low-income and underinsured women. Each year it provides more than 4 million women with family planning and contraceptive care, preventive health screenings for breast and cervical cancers, and treatment for sexually transmitted infections.Since the rule was issued in February (Psychiatric News, March 29, 2019), half a dozen lawsuits have been filed around the country, including one by the AMA and Planned Parenthood that called the policy a government-imposed “gag rule” and said it would be illegal and unethical and threaten the health care of millions of women. Planned Parenthood, which serves 41% of patients served by the Title X program, said it will leave the program if Trump’s rule takes effect. California also filed suit, as did 20 Democrat-led states and the District of Columbia.APA joined with 17 other physician leaders and medical specialty organizations representing 4.3 million health care professionals to denounce the rule, saying it disregards the expertise of the medical and scientific communities and evidence-based standards.“To allow this gag rule to take effect would interfere with our fundamental right as physicians to discuss the full range of options for care with our patients based on their individual medical situation and personal wishes,” said Maureen Sayres Van Niel, M.D., president of APA’s Caucus of Women Psychiatrists and a reproductive psychiatrist in Cambridge, Mass. “This is a blatant attempt to politicize a fundamental right of women patients, and, like many other national medical associations, we condemn these efforts.”In 1996 Congress mandated that patients receiving information about their pregnancies through Title X receive “nondirective” counseling. And in 2010 Congress mandated that the Department of Health and Human Services cannot impose rules that create unreasonable barriers to care, interfere with doctors giving their patients a full range of options, restrict the ability of health care providers to disclose all relevant information to patients, or violate the ethical standards of health care professionals.“The gag rule blatantly violates Congress’ mandate by forcing doctors to withhold information from their patients and imposing unreasonable barriers to care,” Planned Parenthood wrote in a statement.Leana Wen, M.D., president of Planned Parenthood Federation of America, said this latest ruling represents a victory for patients and doctors.“Because of this, our patients across the country can still access life-saving health care,” she said. “However, while this is a victory for patients and doctors, this relief is preliminary, and we will continue to fight the Trump-Pence administration in court and in Congress to ensure our patients’ health and rights are protected.”AMA President Barbara L. McAneny, M.D., expressed similar sentiments. “Judge McShane got it exactly right when he called the new Title X rule a ‘ham-fisted’ approach to health care,” she said. “The judge repeatedly asked how the new gag rule would improve health outcomes. The government was unable to answer. The new rule would have placed obstacles to health care for low-income patients. We are pleased the judge shared the AMA’s concern about the physician-patient relationship.” ■The coalition’s statement can be accessed here. ISSUES NewArchived

Privacy Risks of Interoperable Electronic Health Records: Segmentation of Sensitive Information Will Help.

The proposed interoperability rules for electronic health records (EHRs) issued on March 4, 2019, by the Centers for Medicare and Medicaid Services address the last major element of the nation’s system of EHRs. The ability of health care providers and other users to supplement, exchange, and access comprehensive EHRs is essential to achieve efficient and high quality medical care. Interoperability, however, also increases the privacy risks of EHRs by enabling the unnecessary disclosure of sensitive health information to individuals and entities without a need to access them. This article reviews some leading proposals to protect health privacy within an interoperable system, highlighting the proposal from the National Committee on Vital and Health Statistics to permit patients to segment certain fields of sensitive information from the main body of their EHRs.