Health Services Administration Research Articles

LGBTQ+ Supportive and Inclusive Care Practices: Survey Data From the T1D Exchange Quality Improvement Collaborative

OBJECTIVE Living with type 1 diabetes is challenging, but more barriers exist when one also identifies as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or other gender-expansive identities). Acknowledging the importance of identifying this population and providing personalized care, the Health Resources and Services Administration mandated institutions to document sexual orientation and gender identity (SOGI) data. To understand the current state of SOGI documentation in the T1D Exchange Quality Improvement Collaborative, a survey assessing LGBTQ+ supportive and inclusive care practices was given to affiliated sites. RESEARCH DESIGN AND METHODS Thirty-three pediatric and 21 adult care centers were surveyed via Qualtrics. The survey included questions about their electronic health record documentation of patient-identified gender, pronouns, sexual orientation, and sex assigned at birth (SAAB). Care centers also reported on the legality of gender-affirming care in their municipalities, as well as their willingness to change SAAB after patients meet requirements. Fisher’s exact tests were used to evaluate response frequencies. RESULTS All 33 of the pediatric centers and 81% (17 of 21) of the adult centers responded to the survey. Sixty-four percent of pediatric centers had established strategies to support SOGI documentation, whereas only 50% of adult centers had implemented strategies. Some adult centers could not confirm whether they documented SOGI. Differences were seen between the pediatric and adult endocrinology centers in their documentation of gender identity (P = 0.04) and pronouns (P = 0.02). CONCLUSION Although most endocrinology centers documented gender identity and pronouns, fewer documented sexual orientation. Further work is needed to improve SOGI documentation and assess its impact on LGBTQ+ patients with diabetes.

Clinician Staffing and Quality of Care in US Health Centers

Health centers are vital primary care safety nets for underserved populations, but optimal clinician staffing associated with quality care is unclear. Understanding the association of clinician staffing patterns with quality of care may inform care delivery, scope-of-practice policy, and resource allocation. To describe the association of clinician staffing models and ratios with quality-of-care metrics in health centers. This cross-sectional study of US health centers used data from the 2022 Health Resources and Services Administration Uniform Data System (UDS). Clinician staffing ratios, expressed as the fraction of full-time equivalents (FTEs) per 1000 visits of physicians, advanced practice registered nurses (APRNs), and physician associates (PAs) to total clinician FTEs at each health center. Percentage of eligible patients receiving the corresponding service or outcome for 14 individual clinical quality metrics collected by the UDS, including infant immunizations; screening for cancer, depression, tobacco use, hypertension, HIV, and glycated hemoglobin levels; weight and body mass index (BMI) assessment; and appropriate statin, aspirin, and/or antiplatelet therapy. This analysis of 791 health centers serving 16 114 842 patients (56.6% female) identified 5 clinician staffing models: balanced (similar FTEs of physicians, APRNs, and PAs; 152 [19.2%] of health centers), higher FTEs of APRNs than physicians (174 [22.0%]), higher FTEs of physicians than APRNs (160 [20.2%]), approximately equal FTEs of physicians and APRNs (263 [33.2%]), and large scale (42 [5.3%]). Adjusted linear models showed positive associations between physician FTEs per 1000 visits and cervical (β, 14.9; 95% CI, 3.1-26.7), breast (β, 15.7; 95% CI, 3.2-28.1), and colorectal (β, 18.3; 95% CI, 6.0-30.6) cancer screening. Generalized additive models showed nonlinear positive associations beginning at a physician FTE ratio of 0.45 (95% CI, 0.02-6.22) for infant vaccinations, 0.39 (95% CI, 0.05-2.21) for cervical cancer screening, 0.39 (95% CI, 0.02-1.67) for breast cancer screening, 0.47 (95% CI, 0.00-5.76) for HIV testing, and 0.70 (95% CI, 0.18-19.96) for depression in remission; APRN FTE ratio of 0.45 (95% CI, 0.17-7.46) for adult BMI assessment; and PA FTE ratio of 0.16 (95% CI, 0.11-3.88) for infant vaccinations. Staffing models were not associated with 7 of the 14 metrics analyzed. In this cross-sectional study of health centers, physician FTE ratio was associated with higher performance in cancer screening, infant vaccinations, and HIV testing; APRN FTE ratio was associated with higher performance in preventative health assessments; and PA FTE ratio was associated with higher performance in infant vaccination. These findings suggest that targeted staffing strategies may be associated with quality of care in certain domains and that tailored approaches to health center staffing based on community-specific needs are warranted.

Changes are good for OTPs and patients

Not for the first time, the changes opioid treatment programs (OTPs) must make to comply with new regulations have been praised by OTPs themselves. Mark Parrino, president of the American Association for the Treatment of Opioid Dependence told ADAW last week that most of the states' OTPs are already in compliance. Patti Juliana, Ph.D., who heads the federal Division of Pharmacologic Therapies at the Substance Abuse and Mental Health Services Administration, told him that 44 states are in alignment and compliance with the new rules. She meets with the State Opioid Treatment Authorities regularly. We caught up with Parrino at the COMPA Symposium in Schenectady, New York this month.

Importance of good sleep in helping prevent subsequent suicidal behaviors

Suicide is a leading cause of death among youths in the U.S., and rates have doubled over the past 20 years. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), sleep disturbances are one of the 10 warning signs of suicide, even after adjusting for depression. Sleep difficulties are unique among other risk factors, however, as being “modifying, nonstigmatizing, and highly treatable,” researchers of a study looking at the association between sleep problems and suicide write.

The Underuse of Clozapine and Long-Acting Injectable Antipsychotics.

Schizophrenia is among the most devastating and costly human diseases. The public face of the failure to appropriately treat schizophrenia includes approximately 100,000 homeless individuals with schizophrenia and related psychoses and 200,000 incarcerated individuals with similar diagnoses. Clozapine and long-acting injectable antipsychotics are among the most effective treatments, but both are markedly underused. The following organizations should take responsibility for fixing this problem: National Institute of Mental Health, Patient-Centered Outcomes Research Institute, Substance Abuse and Mental Health Services Administration, Centers for Medicare and Medicaid Services, U.S. Food and Drug Administration, American Psychiatric Association, and patient and family advocacy groups.

8765 Assessment of the Social Vulnerability Index of a 10-Year Retrospective Cohort of Youth with Prediabetes

Abstract Disclosure: D. Somerville: None. R.H. Kolagani, MHS: None. C.E. McCrory: None. S. Budakoti: None. V.M. Chinchilli, PhD: None. J. Joseph: None. D.E. Hale: None. N. Raja-Khan: None. L.P. Huerta Saenz: None. Background: The incidence of prediabetes (preD) is rising among youth in the US. While there are known metabolic risk factors linked to preD development, we were interested in exploring the role of social determinants of health (SDoH) in the development of pediatric preD. The social vulnerability index (SVI) is a tool developed by the CDC to stratify SDoH risk for communities based on 14 factors such socioeconomic status (SES), household composition, race and transportation access. By understanding the role of SVI in the development of preD in youth, we may be able to plan interventions to prevent progression to Type 2 Diabetes (T2D). Objective: Our study goal was to determine the relationship between SVI and preD in youth receiving care at our institution, a large pediatric referral center in Central Pennsylvania. Methods: We conducted a 10-year retrospective chart review of electronic medical records (EMRs) to identify children/youth aged 6-17 years old diagnosed with preD at our pediatric health system between 01/2010 and 01/2020. We used the American Diabetes Association definitions of preD (one or more sub-type): 1) Impaired fasting glucose (IFG), 2) Impaired glucose tolerance (IGT), and 3) Elevated hemoglobin A1c (HA1C). ICD10 codes were used for initial chart identification (R73.01, R73.02, R73.03 and R73.09). The second phase of identification of youth with preD included the review of biological measures of glycemia of the initial identified charts to support the reported ICD10 diagnosis (either isolated subtypes or combinations). Social, demographic characteristics, and residence setting (urban vs. rural) were also investigated. SVI was assessed on a 0-1 scale, with high SVI (0.5-1) indicating greater social vulnerability and low SVI (0-0.49) indicating lower social vulnerability. Rurality was determined per the Health Resources and Services Administration Tool (HRSA). SAS frequencies were calculated. Fisher’s exact tests were applied to compare the frequencies of the aforementioned groups with respect to IFG, IGT, and HA1C. Results: We identified 2700 charts of youth with preD per ICD10 codes search, but only 552 had confirmed preD diagnosis supported by biological data registered in EMRs. The most common preD isolated subtype was HA1C (87.3%), while 12% and 4% had isolated IFG and IGT, respectively. Most youth had high SVI (66.9%) and only 5.8% were rural (p > 0.05). Neither SVI or rurality were associated with isolated preD subtypes, but 8.2% of low-SVI youth had composite [IFG +HA1C] subtypes compared to 3.5% of high-SVI youth (p=0.02). Conclusions: SVI was not significantly associated with any isolated preD subtype. However, youth with the combined preD subtypes [IFG + HA1C] had lower SVI. As T2D is more prevalent in youth from low SES, addressing SDoH at earlier stages of T2D (preD phase) is needed in the effort to prevent the progression of the disease. Presentation: 6/1/2024

340B Participation and Safety Net Engagement Among Federally Qualified Health Centers

The 340B program provides discounts on outpatient drugs to certain hospitals and federally supported clinics (covered entities) that can be used to generate revenue to fund safety net care. While numerous studies have found no association between 340B and safety net care provision for most hospital covered entities, less is known about whether federally qualified health centers (FQHCs), the largest group of covered entities after hospitals, use the program to enhance safety net care. To assess whether a proxy for 340B revenue was associated with increased safety net care provision among FQHCs. This descriptive, retrospective cohort study examined care provided from 2005 to 2022 by 1468 FQHCs that submitted to the Health Resources and Services Administration Uniform Data System. FQHC and year-level fixed effects were included, as well as a control for differential Medicaid expansion over time. The data were analyzed between March and December 2023. One-year lagged number of locations registered to dispense or administer 340B-discounted drugs (registered locations), which included child sites, in-house pharmacies, and contract pharmacies in the 340B Outpatient Pharmacy Affairs Database. Natural logarithm of patient volume by payer, low-income status, and use of enabling services. Natural logarithm of visits in which low-profit preventive services were provided. An additional registered location was associated with increased patient volume, especially for uninsured (0.4%; 95% CI, 0.3%-0.5%) and privately insured (0.4%; 95% CI, 0.2%-0.5%) patients and low-income (0.4%; 95% CI, 0.2%-0.6%), unhoused (0.3%; 95% CI, 0.1%-0.5%), and non-English-speaking (0.3%; 95% CI, 0.1%-0.5%) patients. An additional registered location was associated with increased visits with an HIV test (0.7%; 95% CI, 0.4%-0.9%), serum lead test (0.8%; 95% CI, 0.6%-1.1%), seasonal influenza shot (0.4%; 95% CI, 0.3%-0.5%), Papanicolaou smear (0.5%; 95% CI, 0.4%-0.7%), and tobacco cessation counseling (1.0%; 95% CI, 0.5%-1.4%). Across the study period, the average annual increase in locations was 1.5. The results of this cohort study suggest that there are statistically significant increases in the provision of low-profit but high-value preventive services and care to safety net populations (those who lack insurance, have a low income, or require enabling services) and that, like public hospitals, FQHCs might use 340B revenues to enhance safety net care. This finding may inform debates on the 340B program by supporting differential 340B reforms across hospital and nonhospital covered entities.

Tools for Success in Experiential Education for PharmD Students With Trauma and Adverse Childhood Events (ACEs)

In the past 5 years, new priorities for student wellness, burnout prevention, and improved mental health have become top priorities for experiential learning. Individual students' academic resilience is a critical aspect of these student factors. Self-regulatory skills like emotion regulation and executive functioning are vital underlying resilience processes. Preceptors, faculty, and administration should assess threats to academic resilience, such as adverse childhood experiences (ACEs) and trauma, to ensure students' optimal outcomes in experiential learning. This article uses the recognizing, responding, and preventing re-traumatization principles from the Substance Abuse and Mental Health Services Administration (SAMHSA) concept of a trauma-informed approach to provide tools for success for pharmacy students living with trauma and ACEs. Preceptor tools for students living with trauma and ACEs are designed to proactively recognize trauma responses, whether they occur in isolated incidences or of a chronic nature. Screening and assessment can identify students preemptively who may need extra support, resources, and tools for academic resilience. Responding to a student's disclosure with a disclosure plan will lay the groundwork for a safe and productive encounter. During the encounter, prevent re-traumatization by being up to date on sensitive and appropriate language while providing daily logistical tools for success in an experiential practice rotation. Little is known about the specific effects of ACEs on self-regulation, resilience, and executive function in Doctor of Pharmacy students. However, preceptors can provide tools to develop students' academic resilience and improve their educational outcomes in experiential learning.

Geographic residence of patients with medication-related osteonecrosis of the jaw.

135 Background: Bone-modifying agents (BMAs) are utilized to reduce the risk of skeletal-related events in patients with bone metastases. Medication-related osteonecrosis of the jaw (MRONJ) is a rare but difficult to treat adverse event of BMAs. There are known patient and treatment related risk factors for development of ONJ, however, little is known on social and geographic risks. In patients with bone metastases and concurrent MRONJ, we seek to describe differences in patient's geographic residence (rural versus urban) with other social factors as secondary outcomes. Methods: We conducted a retrospective chart review of Atrium Health Wake Forest Baptist Comprehensive Cancer Center patients in the date range of 01/01/2013 to 11/01/2023. Included were patients with metastatic breast cancer, metastatic prostate cancer or multiple myeloma who had a diagnosis of MRONJ. We recorded Rural-Urban Commuting Area (RUCA) codes, the Area Deprivation Index (ADI), age, race, ethnicity, smoking status, alcohol use, body mass index, insurance status, type of cancer, type of BMA, and cumulative dosing of BMAs. Patients were defined as rural or urban based on criteria from the health resources and services administration website. Relative socioeconomic advantage versus disadvantage was determined by the patients’ ADIs with a decile rank from 1-10 for state ADIs and a percentile rank of 1-100 for national ADIs. SAS software (version 9.4) was used for data analysis (2023, SAS Institute Inc, Cary, NC). Results: A total of 88 patients met inclusion criteria. 64% of patients lived in urban areas and 36% in rural. Demographic features of the identified patients are listed in table 1. MRONJ patients from both urban and rural areas had an above average national and state ADI, with a trend toward higher ADIs in rural locations compared to urban locations; mean of 6.7 vs 5.3 state ADI and mean 70.6 vs 62.0 national ADI, for rural and urban patients respectively. There were no statistically significant differences between rural and urban patients in any of the demographic or health-related characteristics we examined. Conclusions: Patients with bone metastases and MRONJ in our cohort demonstrate relative socioeconomic disadvantage in comparison to national and state averages. In comparing the rural with urban patients, however, we observed relatively similar profiles. Patient characteristics by rural/urban status. Rural (n=32) Urban (n=56) Age in years (mean, sd) 64 (11.3) 65 (10.9) Sex, N (%) Male 19 (59) 29 (52) Female 13 (41) 27 (48) Race, N (%) Non-Hispanic White 30 (93.8) 40 (71.4) Non-Hispanic Black 1 (3.1) 11 (19.6) Hispanic 1 (3.1) 3 (5.4) Non-Hispanic Asian 0 (0.0) 1 (1.8) Other 0 (0.0) 1 (1.8) State ADI (mean, sd) 6.7 (2.4) 5.5 (2.7) National ADI (mean, sd) 70.6 (16.9) 62.0 (23.8) Former/current smoker, N (%) 18 (56.3) 25 (44.6) Medicaid/Medicare, N (%) 16 (50.0) 16 (28.6) Months on BMA (mean, sd) 37.2 (35.5) 40.3 (38.2)

Primary care physician density and mortality in the United States

BackgroundGeographic physician availability differences are associated with healthcare outcomes. However, the association between primary care physician (PCP) density and mortality outcomes is less well-established. MethodsThe study analyzed 2019 county-level nonfederal PCP data from the Health Resources and Services Administration Area Health Resource File and mortality data using the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research). All-cause and cardiovascular disease (CVD)- related age-adjusted mortality rates (AAMR) per 100,000 population stratified by the number of PCPs per 100,000 quartiles were extracted. Using AAMRs as continuous variables, linear regression was performed to determine the association of AAMRs with PCPs per 100,000 (reference, first quartile), adjusting for the social vulnerability index (SVI). ResultsA total of 3142 counties were included in the analysis. Among counties stratified by PCPs per 100,000 quartiles, all-cause AAMRs were 828 (95% CI, 824-832) in the first quartile, 798 (95% CI, 796-801) in the second quartile, 737 (95% CI, 735-739) in the third quartile, and 679 (95% CI, 678-680) in the fourth quartile. Similar trends were seen in CVD-related AAMRs, which were 446 (95% CI, 443-449),439(95% CI, 437-441), 403 (95% CI, 402-404), and 365 (95% CI, 364-366), respectively. Counties without PCP (221, included in first quartile) had all-cause and CVD-related AAMR of 797 (95%CI, 783-812) and 430 (95%CI, 419-440), respectively. Compared with the first quartile, SVI-adjusted analyses showed β-coefficient (95%CI) of all-cause mortality for the second, third, and fourth quartiles of -4.11 (95% CI, -18.31, 10.08), -35.37 (95% CI, -49.57, -21.17) and -85.79 (95% CI, -100.10, -71.48). Similar results were observed for CVD-related AAMR. ConclusionHigher PCP per 100,000 is generally associated with better all-cause and CVD-associated mortality outcomes, however complex factors likely play a role in determining these outcomes in counties with lower PCP per 100,000, which warrant further investigation.

What happens after the funding ends?: A qualitative sustainability investigation of emergency department-based peer support programs implemented as part of Indiana's opioid state targeted response initiative

Introduction: In 2017, funding disseminated through the US Substance Abuse and Mental Health Services Administration's Opioid State Targeted Response (STR) program accelerated the expansion of peer recovery support services across several states to engage emergency department patients presenting with opioid use disorder. While there is some literature on the initial implementation of these programs, little is known about their sustainability after the STR funding's end. Identifying what happened to these programs is a key component of understanding their ultimate impact and can inform future activities to develop, fund, or sustain similar efforts. Methods: We collected qualitative data from six organizations that participated in Indiana's STR-funded Recovery Coaching and Peer Support Initiative (RCPSI). The semi-structured interview guide was designed to gather data related to eight domains of sustainability (i.e., environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, program evaluation, communications, and strategic planning). The analysts followed a deductive-inductive analysis approach, using the eight domains as an a priori coding structure and developing higher-level inductive themes. Results: A total of ten individuals (roles included 4 Program Supervisors, 2 Nurse Administrators, a Psychiatric Social Worker, a Mobile Treatment Manager, a Grant Coordinator, and a Vice President of Planning) participated in six interviews. Two programs did not sustain services, primarily because they lacked a sufficient volume of eligible patients to justify services. Factors identified as supporting sustainability in the other four programs included (1) identification of alternate funding sources, (2) evolving internal support for ED-based opioid use disorder treatment, and (3) investment in internal and external relationships. Furthermore, these themes operated across multiple sustainability domains. Conclusions: The findings illustrate a dynamic interplay between program context and multiple theorized sustainability domains that impacted the viability of RCPSI programs after the end of STR funding. Results indicate a need for a better understanding of the factors influencing the sustainability of programs supported by federal funding to mitigate the opioid crisis, and such findings will likely apply to a broader range of grant-supported programs.

Examining the Popularity, Content, and Intersections With the Substance Abuse and Mental Health Services Administration's Definition of Recovery in a Nonclinical Online Cannabis Cessation Community: Infodemiology Study of Reddit Posts.

Cannabis consumption has increased in recent years, as has cannabis use disorder. While researchers have explored public online community discussions of active cannabis use, less is known about the popularity and content of publicly available online communities intended to support cannabis cessation. This study aims to examine the level of engagement and dominant content of an online community for cannabis cessation through 3 specific aims. First, we examine the use of a subreddit cannabis cessation community (r/leaves) over time to evaluate the popularity of this type of resource for individuals who want to stop using cannabis. Second, we examine the content of posts in the community to identify popular topics related to cessation. Third, we compare the thematic findings relative to the 4 domains of recovery defined by the Substance Abuse and Mental Health Services Administration (SAMHSA). By examining these 3 gaps, we take the initial steps toward understanding the experiences being shared online among individuals interested in cannabis cessation and compare them with the principles outlined in the SAMHSA definition of recovery. Using the Pushshift application programming interface, we collected the count of posts by year between 2011 and 2021 and the narrative of the 100 posts with the most comments per year in a popular cannabis cessation-focused subreddit (r/leaves). A linear model and a nonlinear model were compared to evaluate change in the number of posts by year. Mixed natural language processing and qualitative analyses were applied to identify top terms, phrases, and themes present in posts over time. Overlap between themes and the 4 SAMHSA domains of recovery (health, purpose, community, and home) were examined. The number of annual posts in r/leaves increased from 420 in 2011 to 34,841 in 2021 (83-fold increase), with exponential growth since 2018. The term that was the most common across posts was "smoke" (2019 posts). Five major themes were identified, and a narrative arc was represented, from motivations and perceived benefits of cannabis use to the negative consequences of use, strategies to change behaviors, and the positive and negative consequences of change. There was substantial overlap between these 5 themes and 3 of SAMHSA's 4 domains of recovery: health, purpose, and community. However, the domain of home was less commonly identified. Engagement in this online cannabis support community appears to be increasing. Individuals using this forum discussed several topics, including multiple aspects of recovery defined by the SAMHSA. Online communities, such as this one may, serve as an important pathway for individuals seeking to reduce or cease their consumption of cannabis.

Abstract B027: Adapting communication resources for clinic staff in a multisite FQHC to improve HPV vaccination encounters with Spanish-speaking parents of adolescents

Abstract Introduction: Adopting evidenced-based strategies (EBS) targeting clinic staff in safety-net settings can improve adolescent HPV vaccination rates. Still, adaptations of EBS are needed to reach racial/ethnic minority patients and families effectively. As part of a larger implementation study on HPV vaccination, we examined and addressed adaptation needs for HPV vaccine communication resources to support clinic staff serving Hispanic adolescent FQHC patients. Methods: In October 2022-January 2023, we partnered with a large multi-site FQHC in Los Angeles, CA to deliver two clinic staff trainings designed to i) improve HPV knowledge and communication strategies; and ii) discuss HPV vaccine workflow. Informed by the Practice Change Model, we completed baseline qualitative interviews with clinic team members (providers, clinic staff, and leadership) and provider and clinic staff surveys to inform the development, implementation, and adaptation of clinic staff training on HPV vaccine knowledge and communication strategies. We then conducted site visits and key-informant interviews with clinic staff immediately post-training. Notes from site visits and key-informant interviews were transcribed to identify potential barriers to adoption and opportunities for adaptation. Results: Baseline data indicated 95% of clinic staff identified as Hispanic and 94% reported speaking a language other than English. Notes from site visits and key-informant interviews with clinic staff indicated clinic staff identified the need for Spanish language messaging to communicate HPV and cancer prevention messages to monolingual Spanish families. As a result, we adapted Spanish-language messages from the 2023 Health Resources and Services Administration toolkit and American Cancer Society to develop a handout with scripts that address top concerns about HPV vaccination with monolingual Spanish-speaking parents of adolescents to that were identified from baseline data collection. Bilingual-bicultural staff then validated messages and confirmed cultural relevance. Developed materials were then presented to clinic leadership to review and suggest further refinement before delivering them to clinic staff. Discussion: Key-informant interviews and post-training site visits played an important role in identifying opportunities to adapt EBS designed to improve HPV vaccination among culturally diverse patients. To better serve diverse communities disproportionately impacted by HPV-associated cancers, clinic staff need resources with HPV vaccine communication messages available in languages that reflect the needs of their patient population. Citation Format: Samantha Garcia, Adrienne Martinez-Hollingsworth, Sheila Salinas Navarro, Sharon Hudson, Zehui He, Emily Dang, Lawrence Palinkas, Lourdes Baezconde-Garbanati, Jennifer Tsui. Adapting communication resources for clinic staff in a multisite FQHC to improve HPV vaccination encounters with Spanish-speaking parents of adolescents [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B027.

Longitudinal analysis of social and community factors effective in increasing the number of liver donors in the United States.

In this research, it was aimed to evaluate of social and community factors effective in increasing the number of liver donors. Descriptive and relational scanning models were used to conduct the research. Data on liver donors was gathered from the USA Health Resources & Services Administration's Organ Procurement and Transplantation Network between 1988 and 2023. The United States (USA) World Bank Country Reports provided the mortality rates. The data was analyzed using Spearman rho correlation, year-controlled partial correlation, and Generalized Linear Model-Logit analysis. Deceased donor numbers were significantly and negatively correlated with government health expenditure (r = -0.816; P < .01), current health expenditure (r = -0.768; P < .01), female education attainment (r = -0.804; P < .01) and Gini index (r = 0.434; P < .05). Living donor numbers were significantly and negatively correlated with government health expenditure (r = -0.731; P < .01), current health expenditure (r = -0.781; P < .01), male percentage (r = -0.786; P < .01), female education attainment (r = -0.640; P < .05), employment (r = 0.751; P < .01), GDP (r = -0.792; P < .01) and Gini index (r = -0.486; P < .01). Living donor numbers were significantly and positively correlated with age dependency (r = 0.815; P < .01). Generalized Linear Model-Logit (GLM-L) results showed that effect of female education attainment had significant contribution on deceased liver donor (B = -3290.605; P < .01). Effects of significantly correlated community factors on living liver donor numbers were found to be statistically insignificant (P > .05). Research findings reveal that among community factors, especially women's participation in education has a statistically significant effect on liver donors. These results show that the health expenditures made over the years do not provide any added value for liver donors, and role of women on liver donor is significantly dominant.

Potential Gaps in Eye Care Based on Evaluation of Federally Qualified Health Centers

Federally qualified health centers (FQHCs) are federally funded community health clinics that provide comprehensive care to underserved populations, making them potential opportunities to offer eye care and address unmet health care needs. Evaluating the presence of eye care services at FQHCs in Florida is important in understanding and addressing possible gaps in care for the state's large uninsured and underserved populations. To determine whether FQHCs in Florida are currently offering eye care services, where they are available, what services are being offered, and who provides them. This study used a cross-sectional design conducted within 1 year (from November 2023 to February 2024). FQHCs listed in the US Health Resources and Services Administration database were contacted by telephone to inquire about the presence of eye care services. The FQHCs were located in both urban and rural areas in Florida to assess accessibility of eye care services in the state. School-based health centers and nonophthalmic specialty care health centers were excluded. A total of 437 FQHCs were included. Primary outcomes included the presence of eye care services, types of services offered, clinician type (optometrists or ophthalmologists), frequency of services, and availability of pediatric services. Among 437 FQHCs contacted, only 39 (8.9%) reported offering eye care services. These services primarily included vision examinations, glasses prescriptions, and dilated eye examinations. Optometrists were the primary providers of services at all clinics, with no clinics reporting care by ophthalmologists. The frequency of services varied considerably, ranging from daily to bimonthly. Thirty-seven (94.9%) of the 39 clinics offered pediatric eye care services. The low prevalence of FQHCs with eye care services and the absence of ophthalmologist-provided care highlight a gap in access to eye care for underserved populations in Florida. These findings support investigations into implementing eye care services and interventions at FQHCs that might enhance access and equity in eye care.

Implications of the shift to DSM-5 for alcohol use disorder prevalence estimates in the National Survey on Drug Use and Health.

The Substance Abuse and Mental Health Services Administration's annual National Survey on Drug Use and Health (NSDUH) is a commonly used source for estimating trends in alcohol use disorders (AUD) in the United States. From 2015 to 2019 the annual prevalence of people diagnosed with either Diagnostic and Statistical Manual 4th edition (DSM-IV) alcohol abuse or dependence ranged from 5.3 to 5.9%. More recent estimates, using the DSM 5th edition (DSM-5) AUD diagnostic formulation, have been higher, with AUD base rates ranging from 10.1 to 10.7% from 2020 to 2022. This study aimed to compare the past 12-month base rates of AUD in the United States general population when using the DSM-5 versus DSM-IV AUD (i.e. abuse or dependence) and assess the AUD severity of individuals captured with each diagnostic formulation using DSM-5 AUD symptom counts. We examined descriptive trends in the rate of past-year NSDUH AUD diagnoses from 2015 to 2022. We contrasted them with trends in drinking behavior: the percentage of individuals who had ever reported drinking and the number of drinking days and binge drinking days for those who drink. We also analyzed the concordance between DSM-IV and DSM-5 AUD diagnoses in the 2020 NSDUH, which concurrently assessed AUD with both diagnostic formulations. The transition to DSM-5 AUD formulation coincided with a drastic increase in AUD prevalence rates that occurred without increases in drinking behavior. In 2020 NSDUH data, the estimated past-year DSM-5 AUD prevalence rate was 10.1% compared with a 5.4% rate of past-year DSM-IV abuse or dependence. The DSM-5 AUD formulation captured more mild-severity individuals than the DSM-IV formulation. Higher recent base rates of alcohol use disorders (AUD) in the National Survey on Drug Use and Health are likely, at least partially, explained by measurement changes in AUD; specifically, the shift from DSM-IV abuse or dependence to DSM-5 AUD. The DSM-5 formulation appears substantially more inclusive than the DSM-IV formulation, leading to a larger number of mild severity individuals being captured.

The dangerous precedent of censoring scientific dissemination

The American Transplant Congress (ATC) is the largest national transplant meeting in the United States jointly sponsored by the American Society of Transplantation and the American Society of Transplant Surgeons. The 2024 ATC was held in Philadelphia, Pennsylvania during which a number of peer-reviewed scientific abstracts were censored from the program by the Health Resources and Services Administration. These abstract presentations were redacted from the program for perceived conflict with current government policy effectively restricting dissemination of highly rated findings and discussion in a scientific forum. In this viewpoint, we describe the content of the abstracts that were withdrawn from the annual ATC meeting and the implications of this censorship by the Health Resources and Services Administration. We further consider the ramifications of this action for the prospective evaluation of government policy and the relationship of the contract agency with the transplant community in the context of ongoing discussions of modernizing the transplant system which has previously been critiqued for lack of transparency.

Lessons learned from the Health Resources and Services Administration health workforce well-being grantees.

Burnout and moral injury are among the most pressing issues facing healthcare and public safety today. In 2021, Congress provided $120 million through the American Rescue Plan Act for 44 Health Resources and Services Administration grants to implement evidence-informed strategies to address burnout and improve mental health among the health workforce. This article examines facilitators and barriers to implementation and reported impact of grantees' interventions. Key informant interviews (n = 39) and surveys (n = 36) with grantees were conducted between May and August 2023 and qualitatively analyzed using inductive and deductive approaches. This study found grantees were adapting their program modality, timing, and content to meet the needs of their workforce. Many grantees were increasingly focused on training/engaging leadership, establishing structures for worker engagement, and allowing worker voice and priorities to guide operational changes. Though many grantees could not yet report program impact, those who could provide early data documented decreases in staff turnover, burnout, and moral distress. A common challenge was ongoing resource constraints, including staff and leadership turnover. Findings suggest health and public safety organizations continued to struggle with staffing post-COVID, increasing the challenges of implementing their programs to improve burnout and well-being. However, just 18 months into their activities, grantees reported their efforts were leading to changes in organizations, culture, and the experiences of individuals. Key lessons include the importance of engaging workers, building trust, and developing intentional communication, evaluation, and feedback strategies to advance organizational-level efforts to improve worker and learner well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Thirty Years of Midwifery Education in the Rural and Diverse State of New Mexico.

The purpose of this article is to discuss the evolution of the University of New Mexico (UNM) Nurse-Midwifery Education Program, its impact on New Mexico communities, and the vision moving forward for the program in a rural and culturally diverse state. New Mexico has a rich history of community-based midwifery and the UNM Nurse-Midwifery Education Program, founded in 1991, is rooted in this tradition. Graduates are prepared to practice in rural and underserved communities, advance birth equity, and decrease perinatal health disparities. Faculty have advanced the program mission to improve the health and well-being of New Mexico families through diversifying the midwifery workforce, growing community collaboration, and engaging in research and scholarship activities aimed at promoting access to care. Program faculty recognize the critical need to address factors underpinning the rising maternal morbidity and mortality crisis, including rurality, poverty, and structural racism. These efforts have yielded positive results, with 60% of program graduates serving New Mexico communities and increasingly diverse midwifery student cohorts (70% of currently enrolled students). Efforts to support midwifery student success are bolstered through a recently awarded Health Resources and Services Administration Maternity Care Nursing Workforce Expansion grant. Through such endeavors, the program will continue to strive toward social justice and human dignity.

Comparison of Use Rates of Telehealth Services for Substance Use Disorder During and Following COVID-19 Safety Distancing Recommendations: Two Cross-Sectional Surveys.

The COVID-19 social distancing guidelines resulted in a dramatic transition to telephone and video technologies to deliver substance use disorder (SUD) treatment. Before COVID-19, the question was "Will telehealth ever take hold for SUD services?" Now that social distancing guidelines have been lifted, the question is "Will telehealth remain a commonly used care modality?" The principal purpose of this investigation was to examine the extent to which telehealth use in SUD service settings persisted following the lifting of COVID-19 safety distancing recommendations. Additionally, the study aimed to explore practitioners' perceptions of telehealth convenience and value after its regular implementation during the pandemic. Specifically, the goal of this study was to compare telehealth activity between time intervals: May-August 2020 (during peak COVID-19 safety distancing recommendations) and October-December 2022 (following discontinuation of distancing recommendations). Specifically, we compared (1) telehealth technologies and services, (2) perceived usefulness of telehealth, (3) ease of use of telephone- and video-based telehealth services, and (4) organizational readiness to use telehealth. An online cross-sectional survey consisting of 108 items was conducted to measure the use of telehealth technologies for delivering a specific set of SUD services in the United States and to explore the perceived readiness for use and satisfaction with telephonic and video services. The survey took approximately 25-35 minutes to complete and used the same 3 sets of questions and 2 theory-driven scales as in a previous cross-sectional survey conducted in 2020. Six of 10 Regional Addiction Technology Transfer Centers funded by the Substance Abuse and Mental Health Services Administration distributed the survey in their respective regions, collectively spanning 37 states. Responses of administrators and clinicians (hereafter referred to as staff) from this 2022 survey were compared to those obtained in the 2020 survey. Responses in 2020 and 2022 were anonymous and comprised two separate samples; therefore, an accurate longitudinal model could not be analyzed. A total of 375 staff responded to the 2022 survey (vs 457 in 2020). Baseline organizational characteristics of the 2022 sample were similar to those of the 2020 sample. Phone and video telehealth utilization rates remained greater than 50% in 2022 for screening and assessment, case management, peer recovery support services, and regular outpatient services. The perceived usefulness of phone-based telehealth was higher in 2022 than in 2020 (mean difference [MD] -0.23; P=.002), but not for video-based telehealth (MD -0.12; P=.13). Ease of use of video-based telehealth was perceived as higher in 2022 than in 2020 (MD-0.35; P<.001), but no difference was found for phone-based telehealth (MD -0.12; P=.11). From the staff's perspective, patients had greater readiness for using telehealth via phone than video, but the staff perceived their personal and organizational readiness for using telehealth as greater for video-based than for phone-based telehealth. Despite lower telephone and video use in 2022 for telehealth services than in 2020, both modalities continue to be perceived positively. Future research may further determine the relative cost and clinical effectiveness of video-based services and thereby help to address some sources of the noted challenges to implementation by SUD organizations.