Care Outreach Research Articles

Enacting Fall Prevention in Community Outreach Care.

Despite increased international concern about fall prevention throughout the past 20 years, only limited attention has been paid to the experiences and perspectives of health care providers who deliver fall prevention programs. The purpose of this interpretive phenomenological study was to explore the meaning of the experience of enacting fall prevention, through individual semistructured interviews, among 6 members of an interprofessional geriatric outreach team in Ontario, Canada. Findings suggest that enacting careful practice was essential to the experience of enacting fall prevention, represented by four interrelated phenomenological themes: caring fully for older clients, carefully seeing older clients in their life contexts, enacting therapeutic relationships, and experiential learning in interprofessional teams. We discuss findings in relation to literature on emotional labor, leading to suggestions for the policy and practice of fall prevention.

Caring With Compassion, Domain 2: Bio-Psychosocial Care of Uninsured, Homeless, Underserved, and At-Risk Populations

Abstract Introduction The Caring with Compassion series provides core background information to support bio-psychosocial clinical care for homeless, underserved, uninsured, and at-risk populations....

Abstract P302: Longitudinal Evaluation of Impact and Results of the Mississippi Kidney Foundation’s Renal Evaluation and Assessment Program (REAP)

Introduction: Health fair-type screenings are one of the most recognizable forms of community-based health promotion. Though these screenings offer benefits in theory, little evidence supports their value. Through REAP, Mississippi Kidney Foundation routinely provides screenings for cardiovascular and renal disease risk factors. At each screening, participants obtain blood pressure, height, weight, laboratory assessments (metabolic/renal blood chemistries, complete blood count, total cholesterol, urinalysis) and complete a questionnaire regarding risk factors and disease history. Participants also receive written information about values/goals and consultation with a healthcare provider. Without a systematic evaluation, the overall value of this program is unknown. The purpose of this study was to review the impact and results of REAP and identify any changes that could improve outreach and patient care. Methods: We reviewed demographics and prevalence of cardiovascular and renal disease risk factors among participants over the previous 4 years (2010-2013). Screening sites were classified as urban or rural, according to census data. Risk factors were defined as elevated blood pressure (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg), cholesterol (total > 200 mg/dL), or blood glucose (fasting ≥ 100 mg/dL); reduced kidney function (elevated BUN/Cr and/or eGFR < 60 ml/min); and proteinuria (≥ 30 mg/dL). Results: Over the review period, 57 screenings were performed at 34 sites, 15 classified as rural. Of the 5,545 participants, 4,299 were at urban and 1,246 at rural sites. Overall, 1,760 (32%) had elevated blood pressure (36% vs 31%, rural vs urban, respectively), 2,013 (36%, 40% vs 35%) elevated cholesterol and 1,046 (19%, 23% vs 18%) elevated glucose. Reduced kidney function was identified in 762 (14%, 15% vs 13%) participants, while 1,423 (26%, 29% vs 25%) had proteinuria. Among those reporting ethnicity (n=1,948) and gender (n=3,164), 614 (32%) were Caucasian, 1,290 (66%) African-American, and 2,270 (72%) female. Conclusions: Through this review, we determined that though REAP appears to target at risk populations, further efforts are needed to improve participation of males and those in rural areas. Elevated risk factors were more prevalent in rural areas; however, this may reflect differences in treatment rates, not absolute values. To better assess the impact of REAP, define risk factors, and influence patient care, we identified that more rigorous tracking, review of disease and treatment history, and further assessments are needed (i.e. full lipid panel). A graded system targeting patient follow-up is necessary, particularly among those at greatest risk. Based on these findings, these changes will be implemented, along with a post-screening evaluation of participants’ perceived benefits and result utilization.

On the Move against Tuberculosis

Tuberculosis (TB) poses formidable challenges to global health at the public health, scientific and political level. The current tools to combat TB are out of the date and not accurate enough to identify many TB infections. Though recent and ongoing advancements in drug therapies offer great promise for saving lives, the unfortunate fact is that they are drug resistant to both first and second line anti-TB medicines. The key challenge in the fight against TB is to innovate and adapt promising innovations to achieve protection and eradication. Making faster and more accurate diagnosis, and effective treatment and widespread use in the developing world where they are needed most, will vastly reduce TB cases worldwide and save millions of lives. New international efforts have now started to address move against TB which is the theme for World TB Day 2011–12. This article attempts to examine the steps on the move against tuberculosis in terms of safe and reliable prevention, development of new tools for diagnosis and drugs for treatment, access of quality care and community outreach activities.

Abstract T P273: Development and Impact of the Midwest Stroke Action Alliance

Background: Illinois has approximately 54 certified stroke centers serving the metropolitan Chicago area. It is understood that certified centers impact stroke care and community outreach, but a greater impact could be gained through collaboration and shared resources. Purpose: To describe the development and contributions of the Midwest Stroke Action Alliance (MSAA) around the Chicago metropolitan area. Methods: In 2007 an informal group gathered to promote stroke community awareness. In 2011 the group decided a greater impact could be made on the community and stroke care through incorporation, formalizing membership and setting goals. Membership was individual, not tied to organizations. An election for the board/committee chairs took place and committees (quality improvement, professional growth/networking, and education) were established. Mission: The MSAA is dedicated to utilizing evidence based practice to reduce the risk and burden of stroke by increasing stroke awareness in the broader community and providing a strong united voice for stroke advocacy. Goals: 1).Support quality stroke care through evidence based practice and clinical research, 2).Provide coordinated professional and community education,and 3).Provide an environment that promotes professional growth and problem solving. Results: As of July 2013 MSAA has 42 active members and 52 members at large. Membership includes representation from acute care, rehabilitation, industry and stroke advocacy. MSAA meets quarterly and the board/committees meet monthly. To date, the impact of MSAA on community and quality of stroke care includes: Biannual education/networking events, Annual conference for stroke care professionals, GWTG-Stroke registry benchmark group, Best practice sharing, Stroke Awareness month and National Stroke Alert Day activities, and 2012 & 2013 “Strike Out Stroke” Cellular Field-Chicago White Sox. Conclusions: The development of the MSAA has lead to improved collaboration through use of pooled resources in the Chicago metropolitan area and resulted in enhanced community outreach and professional development. The GWTG-Stroke benchmark group will continue to measure the overall impact on stroke care.

Street outreach and shelter care elective for senior health professional students: an interprofessional educational model for addressing the needs of vulnerable populations.

University of New Mexico Health Sciences Center (UNMHSC), located in Albuquerque, New Mexico, USA, has an international reputation for developing and implementing curricular initiatives addressing health inequities. The Street Outreach and Shelter Care elective is designed to provide interprofessional service learning opportunities for senior pharmacy and medical students addressing the needs of our nation's most marginalized population-those experiencing homelessness. Our institution collaborated with multiple community partners serving the homeless to develop, implement and teach a 4-week senior elective for health professions students. During this elective, senior pharmacy and medical student teams provide individualized health care to men in local homeless shelter facilities. Students also participate in street outreach programs across a continuum of homeless populations. Weekly interprofessional education (IPE) faculty-facilitated sessions allow students to reflect on their experiences and learn from other discipline perspectives. Student evaluations uniformly reflect the transformative nature of the rotation since its inception, April 2009. Our outcomes corroborated the findings of similar service learning models developed to sensitize health professions students to the complex challenges of homeless populations. Academic centers can play a central role in health education reform by instituting curricula focusing on the primacy of population welfare and just distribution of resources. Senior year is an opportune time to reinforce social accountability among health professions before graduation. This elective is based on adult principles of learning and can serve as an international educational model for developing interprofessional curricular innovations addressing the healthcare needs of vulnerable populations.

Indigenous Respiratory Outreach Care: the first 18 months of a specialist respiratory outreach service to rural and remote Indigenous communities in Queensland, Australia.

Respiratory diseases are a leading cause of morbidity and mortality in Indigenous Australians. However, there are limited approaches to specialist respiratory care in rural and remote communities that are culturally appropriate. A specialist Indigenous Respiratory Outreach Care (IROC) program, developed to address this gap, is described. The aim of the present study was to implement, pilot and evaluate multidisciplinary specialist respiratory outreach medical teams in rural and remote Indigenous communities in Queensland, Australia. Sites were identified based on a perception of unmet need, burden of respiratory disease and/or capacity to use the clinical service and capacity building for support offered. IROC commenced in March 2011 and, to date, has been implemented in 13 communities servicing a population of approximately 43000 Indigenous people. Clinical service delivery has been possible through community engagement and capacity building initiatives directed by community protocols. IROC is a culturally sensitive and sustainable model for adult and paediatric specialist outreach respiratory services that may be transferrable to Indigenous communities across Queensland and Australia.

Comparative Effectiveness of Fecal Immunochemical Test Outreach, Colonoscopy Outreach, and Usual Care for Boosting Colorectal Cancer Screening Among the Underserved

Colorectal cancer (CRC) screening saves lives, but participation rates are low among underserved populations. Knowledge on effective approaches for screening the underserved, including best test type to offer, is limited. To determine (1) if organized mailed outreach boosts CRC screening compared with usual care and (2) if FIT is superior to colonoscopy outreach for CRC screening participation in an underserved population. We identified uninsured patients, not up to date with CRC screening, age 54 to 64 years, served by the John Peter Smith Health Network, Fort Worth and Tarrant County, Texas, a safety net health system. Patients were assigned randomly to 1 of 3 groups. One group was assigned to fecal immunochemical test (FIT) outreach, consisting of mailed invitation to use and return an enclosed no-cost FIT (n = 1593). A second was assigned to colonoscopy outreach, consisting of mailed invitation to schedule a no-cost colonoscopy (n = 479). The third group was assigned to usual care, consisting of opportunistic primary care visit–based screening (n = 3898). In addition, FIT and colonoscopy outreach groups received telephone follow-up to promote test completion. Screening participation in any CRC test within 1 year after randomization. Mean patient age was 59 years; 64% of patients were women. The sample was 41% white, 24% black, 29% Hispanic, and 7% other race/ethnicity. Screening participation was significantly higher for both FIT (40.7%) and colonoscopy outreach (24.6%) than for usual care (12.1%) (P < .001 for both comparisons with usual care). Screening was significantly higher for FIT than for colonoscopy outreach (P < .001). In stratified analyses, screening was higher for FIT and colonoscopy outreach than for usual care, and higher for FIT than for colonoscopy outreach among whites, blacks, and Hispanics (P < .005 for all comparisons). Rates of CRC identification and advanced adenoma detection were 0.4% and 0.8% for FIT outreach, 0.4% and 1.3% for colonoscopy outreach, and 0.2% and 0.4% for usual care, respectively (P < .05 for colonoscopy vs usual care advanced adenoma comparison; P > .05 for all other comparisons). Eleven of 60 patients with abnormal FIT results did not complete colonoscopy. CONCLUSIONS AND REVELANCE: Among underserved patients whose CRC screening was not up to date, mailed outreach invitations resulted in markedly higher CRC screening compared with usual care. Outreach was more effective with FIT than with colonoscopy invitation. clinicaltrials.gov Identifier: NCT01191411.

O12.3 Evaluation of a Community-Based HIV Preventive Intervention For Female Sex Workers in Rural Areas of Karnataka State, South India

BackgroundTo examine changes in behavioural outcomes among rural female sex workers (FSWs) involved in a community-based HIV preventive intervention in south India.Methods14,284 rural FSWs from 1,253 villages that were selected...

Mo1088 Influence of Race and Ethnicity on Response to Fecal Immunochemical Test Outreach Colonoscopy Outreach and Usual Care As Part of a Randomized Controlled Trial in a Safety-Net Setting

Mo1088 Influence of Race and Ethnicity on Response to Fecal Immunochemical Test Outreach Colonoscopy Outreach and Usual Care As Part of a Randomized Controlled Trial in a Safety-Net Setting

A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV antibiotic requirements in children with moderate–severe cystic fibrosis

At our hospital the current model of care for children with moderate-severe CF is focused on intensive inpatient intervention, regular outpatient clinic review and specialist outreach care as required. An alternative model providing more regular physiotherapy and dietetic outreach support, in addition to these specialist services, may be more effective. 16 children (4 male; 12 female; mean age 10.9±2.93; range 4-15 years) who required >40days of IV antibiotics in the 12-months pre-intervention were enrolled. Physiotherapy included weekly-supervised exercise sessions, alongside regular review of home physiotherapy regimens. Dietetic management included 1-2 monthly monitoring of growth, appetite, intake and absorption, and nutrition education sessions. There was a 23% reduction in inpatient IV antibiotic requirement and 20% reduction in home IV antibiotic requirement during the intervention year. Cost-benefit analyses showed savings of £113,570. VO(2Peak) increased by 4.9 ml·kg·min(-1) (95%CI 1.01 to 8.71; p=0.02), and 10 m-MSWT distance and increment achieved increased by 229 m (95%CI 109 to 350; p<0.001) and 2 levels (95%CI 1 to 3; p<0.002) respectively. No significant differences in physiological and patient reported outcomes were demonstrated, although there was a possible trend towards improvement in outcomes when compared to the pre-intervention year. This pilot programme demonstrated a reduction in IV and admission requirements with a cost benefit in a small group of children with moderate-severe CF. A fully powered clinical trial is now warranted.

Community Outreach and Engagement Strategies from the Wisconsin Study Center of the National Children's Study

The purpose of this methods article was to describe and evaluate outreach and engagement strategies designed to initially build county-wide awareness and support for the National Children's Study (NCS or the study) and subsequently to target the segment communities where recruitment for the study occurred. Selected principles from community outreach, social marketing, and health care system and personal referral formed the foundation for the strategies. The strategies included a celebration event, community advisory board, community needs assessment, building relationships with health care providers and systems, eliciting a network of study supporters, newsletters, appearances at local young family-oriented events (health fairs, parades), presentations to local community leaders, community forums, "branding" with assistance from a women-owned local marketing firm, and mailings including an oversized, second-touch postcard. Six months after study launch, approximately 4,600 study-eligible women were asked in a door-to-door survey if and how they became aware of the study. On average, 40% of eligible women reported being aware of the study. The most frequently cited strategy to cultivate their awareness was study-specific mailings. Awareness of the NCS increased by 7.5% among those receiving a second-touch postcard relative to controls (95% CIs [4.9, 10.7] z=5.347, p<0.0000, d=0.16). Community outreach and engagement strategies, in particular the oversized postcard as a second-touch effort, may be used effectively by researchers for participant recruitment and by public health nurses for delivery of important population-focused messages.

Intersection of Smoking, Human immunodeficiency virus/acquired immunodeficiency syndrome and Cancer: Proceedings of the 8thAnnual Texas Conference on Health Disparities

The Texas Center for Health Disparities, a National Institute on Minority Health and Health Disparities Center of Excellence, presents an annual conference to discuss prevention, awareness education and ongoing research about health disparities both in Texas and among the national population. The 2013 Texas Conference on Health Disparities brought together experts, in research, patient care and community outreach, on the “Intersection of Smoking, Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and Cancer”. Smoking, HIV/AIDS and cancer are three individual areas of public health concern, each with its own set of disparities and risk factors based on race, ethnicity, gender, geography and socio-economic status. Disparities among patient populations, in which these issues are found to be comorbid, provide valuable information on goals for patient care. The conference consisted of three sessions addressing “Comorbidities and Treatment”, “Public Health Perspectives”, and “Best Practices”. This article summarizes the basic science, clinical correlates and public health data presented by the speakers.

The social paediatrics initiative: a RICHER model of primary health care for at risk children and their families.

BackgroundThe Responsive Interdisciplinary Child-Community Health Education and Research (RICHER) initiative is an intersectoral and interdisciplinary community outreach primary health care (PHC) model. It is being undertaken in partnership with community based organizations in order to address identified gaps in the continuum of health services delivery for ‘at risk’ children and their families. As part of a larger study, this paper reports on whether the RICHER initiative is associated with increased: 1) access to health care for children and families with multiple forms of disadvantage and 2) patient-reported empowerment. This study provides the first examination of a model of delivering PHC, using a Social Paediatrics approach.MethodsThis was a mixed-methods study, using quantitative and qualitative approaches; it was undertaken in partnership with the community, both organizations and individual providers. Descriptive statistics, including logistic regression of patient survey data (n=86) and thematic analyses of patient interview data (n=7) were analyzed to examine the association between patient experiences with the RICHER initiative and parent-reported empowerment.ResultsRespondents found communication with the provider clear, that the provider explained any test results in a way they could understand, and that the provider was compassionate and respectful. Analysis of the survey and in-depth interview data provide evidence that interpersonal communication, particularly the provider’s interpersonal style (e.g., being treated as an equal), was very important. Even after controlling for parents’ education and ethnicity, the provider’s interpersonal style remained positively associated with parent-reported empowerment (p<0.01).ConclusionsThis model of PHC delivery is unique in its purposeful and required partnerships between health care providers and community members. This study provides beginning evidence that RICHER can better meet the health and health care needs of people, especially those who are vulnerable due to multiple intersecting social determinants of health. Positive interpersonal communication from providers can play a key role in facilitating situations where individuals have an opportunity to experience success in managing their and their family’s health.

Home care by outreach nursing for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction, worsening exercise performance and health deterioration. It is associated with significant morbidity, mortality and health system burden. To evaluate the effectiveness of outreach respiratory health care worker programmes for COPD patients in terms of improving lung function, exercise tolerance and health related quality of life (HRQL) of patient and carer, and reducing mortality and medical service utilisation. The Cochrane Airways Group Specialised Register of Trials was searched (November 2011). Study references were hand-searched for additional studies we contacted study authors to identify other unpublished studies. We included only randomised controlled trials of COPD patients. We included interventions involving an outreach nurse visiting patients in their homes, providing support, education, monitoring health and liaising with physicians. Studies in which the therapeutic intervention under test was physical training were not included. Two reviewers independently assessed trial quality and extracted data. We contacted study authors for additional information. We pooled mortality data from eight studies and found a non-significant reduction in mortality at 12 months (OR 0.72, 95% CI 0.45 to, 1.15).We pooled four studies that assessed disease-specific heath-related quality of life (HRQL) and found a statistically significant improvement in HRQL (mean difference -2.61, 95% CI -4.82 to -0.40).Hospitalisations were reported in five studies. Although there was no statistically significant difference in the number of hospitalisations (OR 1.01, 95% CI 0.71 to 1.44), there was significant heterogeneity. Although this heterogeneity appeared to be caused by one outlying study with a statistically significant decrease in hospitalisations in patients receiving home care, whereas the other studies showed a non-significant increase in hospitalisations, we could not draw firm conclusions about why this heterogeneity exists. Data on GP visits and emergency department presentations were available, however no consistent effect in these was observed with the intervention. The intervention also incurred higher health care costs than standard care as reported in a single study.Very few studies provided data on lung function or exercise performance, so there was insufficient evidence to assess impact on these outcomes. Outreach nursing programmes for COPD improved disease-specific HRQL. However the effect on hospitalisations was heterogeneous, reducing admissions in one study, but increasing them in others, therefore we could not draw firm conclusions for this outcome.

Young Native American Men and Their Intention to Use Family Planning Services

This study examines the extent to which age, fatherhood, relationship status, self-control of birth control method, and the use of birth control influence young Native American men's intention to use family planning services. Data were collected for this study during in-depth interviews with 112 Native American men between the ages of 18 and 24 years. The mean age reported was 21. Thirty-eight percent of the young men reported having children. Almost 70% of the young men reported being in a steady relationship. Eighty-eight percent reported that it was very important that they have self-control of the type of birth control that they use. In addition, 88% of the young men reported that they would use some type of birth control within the next year to prevent a pregnancy with their partner. Logistic regression analysis indicated that as age increased, young men were less likely to seek family planning services for birth control. The young men who reported being fathers were more likely than the young men who did not report being fathers to seek family planning services for birth control. Findings from this study suggest that public health efforts to educate Native American men about family planning services are most effective in their adolescence, before they transition into young adulthood. Fatherhood may also be considered a protective factor that may increase the likelihood that young Native American men will seek family planning services for birth control. Public health efforts that address reproductive health among young Native American men may be effective with Native American men in adolescence, prior to their transition to young adulthood. Family planning services that provide outreach education and care to Native American fathers may also be effective.

A Novel Model to Deliver Advanced Eye Care for People With Diabetes Living in Resource-Poor Settings: Results of Care Provided to Date

An estimated 50.7 million people in India have diabetes (1), and 70% of the Indian population live in rural areas (2). Diabetic retinopathy (DR) develops in more than 75% of patients with diabetes within 15–20 years of diagnosis (3,4). We have developed a model of distributive advanced outreach care designed to bring screening and treatment of DR to rural and semi-urban areas of the state of Karnataka in India. Nicknamed Nayana—or beautiful eyes in Hindi—the specially designed advanced eye care treatment unit (AETU) van is custom-built on a cargo chassis from Ashok Leyland Ltd. of India. The van has a 2 + 1 driver's cabin and an insulated air-conditioned treatment chamber. The van carries its own 7-kVA generator, which powers all of the equipment on the van. It also carries routine clinical furniture, a fundus camera with …

Volunteers and Collections as Viewed from the Museum Mission Statement

Museum mission statements typically mandate provisions for collections care and public outreach. As museums continue to transition into more fully participatory and audience-centered institutions, the role that volunteers and interns play with collections extends beyond simple hands-on experiential tasks. Rather, these individuals increasingly play roles in the creation and voicing of museum exhibits and programs. The relationship between the museum as a public institution and volunteers becomes more reciprocal and symbiotic. Through this process, the volunteer position moves from passive to active, as they increasingly take on a stakeholder's role in the museum operation. This paper uses Simon's scheme of contributory, collaborative, and co-creative projects coupled with Worts’ Critical Assessment Framework to consider these relationships. Their approaches are applied to the volunteer program at the C. H. Nash Museum at Chucalissa, an institution that interprets the Native American and traditional cultures of the Memphis, Tennessee region. Case studies based on collections curated at the Museum showed that the schemes of Simon and Worts proved useful in evaluating the mission mandates of the Museum's volunteer programs.

Evaluation of Place of Care at Time of Death at One United Kingdom Principal Treatment Centre for Children with Cancer

We review the success of a specialist Children and Young People's Oncology Outreach and Symptom Care Nursing Service (CYPOONS) in determining place of death for children with cancer treated at one United Kingdom Principal Treatment Centre (PTC). The service includes proactive provision of individualised symptom guidelines, blood product support and an emergency box in the home and coordination of local services.

The needs of problematic drug misusers not in structured treatment – a qualitative study of perceived treatment barriers and recommendations for services

Aims: Little is currently known regarding treatment barriers amongst problematic drug users not in structured treatment. Much previous work accessed samples entering treatment or predates recent service changes. This study sought to access a ‘hard to reach’ out of structured treatment population, exploring reasons for not seeking treatment.Methods: A total of 43 drug users, self-selected as problematic and not currently in structured treatment, were identified via advertising at low-threshold services in Norfolk, and using snowballing methods. Qualitative focus groups and interviews were conducted. Data were thematically analysed aided by NVivo software.Findings: Key reported barriers to treatment are organized around system, social and personal/interpersonal dimensions. Barriers included perception of a long waiting time, stigma, and a perceived lack of understanding. Social barriers relating to localized group membership were particularly important.Conclusions: Identified barriers confirm previous research, sampling a new out of structured treatment rural population. Perceived barriers persist despite recent changes to treatment services. This could be addressed by improved advertising of service expectations and waiting times. Participants suggested, amongst other things, drop in clinics, increased primary care provision and outreach services to capture problematic drug users not in treatment. Simple practices including appointment reminders and flexibility over urine testing may improve treatment retention.