Community-based Health Care Providers Research Articles

Perspectives from community-based pediatric healthcare providers on sleep health practices among children in economically stressed urban environments

Perspectives from community-based pediatric healthcare providers on sleep health practices among children in economically stressed urban environments

Abstract A033: Use of a novel healthtech platform to record patient-reported needs in real time

Abstract Background: Financial toxicity refers to the challenges that a patient faces due to the high costs of medical care. BIPOC (Black, Indigenous, and People of Color), rural, and other vulnerable populations often bear a disproportionate burden when diagnosed with a chronic disease. As a result, these populations often experience financial toxicity at higher rates. The estimated annual costs of health disparities in the U.S. are $1.24 trillion. Financial toxicity and logistical barriers that affect daily life, such as transportation, family care, rent, and home maintenance, can negatively affect a patient’s life. Many clinical trial sponsors and patient advocacy groups focus on providing support to patients around these barriers, but services are often generalized and provided in a ‘one-size-fits-all’ format, which may not be beneficial on an individual level for each patient. In 2023, together with health IT provider The WiTT Group, Tigerlily launched the innovative web-based Resources and AssIstance for Support and Empowerment (RAISE) platform, which brings together the best of wedding registry, crowdsourcing, and digital payment concepts and tools to match patients with the non-clinical services they need in real time as they go through treatment. With RAISE, Tigerlily empowers Black women with breast cancer to specify needs in their registry in real time, delineated by the time and urgency of each need. Our research question is, “What is the relationship between patient informed financial and non- financial stressors and patient's geographical location, age, cancer sub type and staging?" Methods: Tigerlily captured the “voice of the patient” using user-generated profiles and patient-identified needs on the RAISE platform. Patient-submitted data during the months of May through July 2023 was analyzed. Results: Patients (n=60) documented current financial and non-financial stressors and challenges, as well as other impacted areas of their daily life. Preliminary results indicate that financial costs associated with groceries, insurance copays, and out-of-pocket medication costs were the most requested needs. Additionally, patients reported rent/mortgage, groceries, and childcare as the most financially necessary needs. Conclusions: RAISE allows breast cancer patients from BIPOC, rural, and other vulnerable populations to specify their needs on an individual basis. The most urgent and frequent patient-reported needs were. This approach will be used to inform community-based organizations, advocacy partners, and healthcare providers about patient-reported needs in their communities in order to guide the development of support programs and services. Future research will compare the impact of meeting patient-reported needs on outcomes such as quality of life and the impact of patient-identified stressors. Citation Format: Katherine Cornish, Mary Stober Murray, Maimah Karmo, Jeanne Regnante, Virginia Leach. Use of a novel healthtech platform to record patient-reported needs in real time [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A033.

The role community-based healthcare providers play in managing hard-to-heal wounds.

It is common for community-based healthcare providers (CHPs)-many of whom have not received specialised training in wound care-to deliver initial and ongoing management for various wound types and diverse populations. Wounds in any setting can rapidly transition to a stalled, hard-to-heal wound (HTHW) that is not following a normal healing trajectory. Failure to recognise or address issues that cause delayed healing can lead to increased costs, healthcare utilisation and suffering. To encourage early intervention by CHPs, a panel of wound care experts developed actionable evidence-based recommendations for CHPs delineating characteristics and appropriate care in identifying and treating HTHWs. A HTHW is a wound that fails to progress towards healing with standard therapy in an orderly and timely manner and should be referred to a qualified wound care provider (QWCP) for advanced assessment and diagnosis if not healed or reduced in size by 40%-50% within 4 weeks. HTHWs occur in patients with multiple comorbidities, and display increases in exudate, infection, devitalised tissue, maceration or pain, or no change in wound size. CHPs can play an important initial role by seeing the individual's HTHW risk, addressing local infection and providing an optimal wound environment. An easy-to-follow one-page table was developed for the CHP to systematically identify, evaluate and treat HTHWs, incorporating a basic toolkit with items easily obtainable in common office/clinic practice settings. A flow chart using visual HTHW clinical cues is also presented to address CHPs with different learning styles. These tools encourage delivery of appropriate early interventions that can improve overall healthcare efficiency and cost.

Disaster preparedness of Hiroshima community health nurses: A mixed-method study

The number of natural disasters has increased globally as a result of climate change. Community nurses become frontline workers in disaster-struck areas, protecting their clients from harm and risk. The number of community-based healthcare providers in Japan has increased in recent years, along with the shift from cure-focused acute healthcare to home-based care settings. Many studies have investigated the preparedness and willingness to provide care in the aftermath of a disaster. However, there is still a dearth of knowledge on disaster preparedness among community-based healthcare professionals globally. This study investigated the preparedness of community nurses in Hiroshima, Japan, focusing on nurses providing home-based care. A mixed method design was employed, and data were collected through surveys and interviews. The survey results indicated a positive association between disaster experience and training, as well as training and the existence of a disaster plan. Further, participants reported that healthcare providers neglected the preparation of disaster plans due to time constraints and a lack of incentives; our results suggest that incentives may promote disaster preparedness.

Comprehensive coordinated community based palliative care (C3PaC) model for cancer patients in North India: a mixed-method implementation research study protocol

BackgroundCancer remains an escalating and challenging public health issue. The management, especially palliative care (PC), is disintegrated and out of reach of in need patients. The overall aim of the project is to develop a feasible and scalable Comprehensive Coordinated Community based PC model for Cancer Patients (C3PaC); congruent with socio-cultural, context and unmet needs in north India.MethodsA mixed method approach will be used for three-phased pre- and post-intervention study in one of the districts of North India, having a high incidence of cancer. During phase I, validated tools will be used for quantitative assessment of palliative needs among cancer patients and their caregivers. Barriers and challenges for provision of palliative care will be explored using in-depth interviews and focus group discussions among participants and health care workers. The findings of phase I along with inputs from national experts and literature review will provide inputs for the development of the C3PAC model in phase II. During phase III C3PAC model will be deployed over a period of 12 months and its impact assessed. Categorical and continuous variables will be depicted as frequency (percentages) and mean ± SD/median (IQR) respectively. Chi-square test/Fischer test, independent samples Student t-tests and Mann–Whitney U tests will be used for categorical, normally and non-normally distributed continuous variables, respectively. Qualitative data will be analyzed using thematic analysis using Atlas.ti 8 software.DiscussionThe proposed model is designed to address the unmet palliative care needs, to empower community-based healthcare providers in comprehensive home-based PC and to improve the quality of life of cancer patients and caregivers. This model will provide pragmatic scalable solutions in comparable health systems particularly in low- and lower-middle Income countries.Trial registrationThe study has been registered with the Clinical Trial Registry-India (CTRI/2023/04/051357).

Extension for Community Healthcare Outcomes (ECHO) Chronic Pain & Opioid Stewardship in Northwestern Ontario: A Thematic Analysis of Patient Cases

ABSTRACT Background Chronic pain (CP) is a debilitating disease that reduces quality of life, decreases productivity, and has become a primary cause of health care resource consumption. Despite this, many Canadian family physicians have received little formal education in managing CP, making it one of the most challenging areas of practice in primary care. Project Extension for Community Healthcare Outcomes Chronic Pain & Opioid Stewardship St. Joseph’s Care Group (Project ECHO-SJCG) is an evidence-based educational program connecting community-based health care providers (HCPs) with an interprofessional team by videoconference to learn about management of CP in rural, remote, and underserved areas. Aims To explore key learning points from cases presented at Project ECHO-SJCG, identify and analyze themes and improve future sessions of continuing professional development for HCPs. Methods We completed a thematic analysis of forty cases and key learning points using the constant comparison method. We also summarized descriptive statistics for patient and provider characteristics. Results Forty cases were presented by 31 HCPs, who received suggestions focused on assessment and diagnosis, pharmacological and non-pharmacological pain symptom management, interventional management, attention to biopsychosocial factors, and appropriate referral to other HCPs. Conclusion Project ECHO-SJCG cases allow HCPs to gain a broad knowledge base to evaluate and manage CP in their practice. Identified themes highlight common gaps in HCPs’ knowledge and will guide future sessions.

Fostering Hope: Comprehensive Accessible Mother-Infant Dyad Care for Neonatal Abstinence (CAIN).

Hospital and community healthcare providers have expressed concerns around the continuity and quality of care for infants with neonatal abstinence syndrome (NAS) during hospitalization and transition home. This qualitative study explored the experiences of hospital and community-based healthcare providers and identified themes related to the management of NAS for mothers and infants. Healthcare providers that cared for women with substance use disorders and/or cared for newborns with NAS in a large urban setting in Canada met inclusion criteria for this study and were interviewed in groups or as individuals. Interview transcripts were reviewed iteratively using inductive thematic analysis to identify an overarching theme linked with primary themes. In total, 45 healthcare providers were interviewed. Qualitative analysis of their experiences derived the overarching theme of hope with five primary themes being: mother/infant, mental health, system, judgement, and knowledge. The study identified gaps in NAS care including fear, stigma, and language. This research demonstrates that programs and interventions that work with mothers and newborns with NAS must foster hope in mothers, families, and in the extended care provider team and improve communication between hospital and community networks.

Key factors predicting suspected severe malaria case management and health outcomes: an operational study in the Democratic Republic of the Congo

BackgroundEvidence suggests that pre-referral Rectal Artesunate (RAS) can be a life-saving intervention for severe malaria in remote settings in Africa. Recognition of danger signs indicative of severe malaria is critical for prompt and appropriate case management.MethodsThis was an observational study conducted in three Health Zones of the Democratic Republic of the Congo to determine the distribution of dangers signs for severe malaria and assess their impact on RAS use, referral completion, injectable treatment and ACT provision, and health outcomes including death. An individual-level analysis was carried out, using multilevel-mixed effects logistic regression models. Severely ill febrile children < 5 years seeking care from community-based healthcare providers were recruited into a patient surveillance system based on the presence of key danger signs. Clinical and case management data were collected comprehensively over a 28 days period. Treatment seeking was elicited and health outcomes assessed during 28 days home visits.ResultsOverall, 66.4% of patients had iCCM general danger signs. Age of 2–5 years and iCCM general danger signs predicted RAS use (aOR = 2.77, 95% CI 2.04–3.77). RAS administration positively affected referral completion (aOR = 0.63, 95% CI 0.44–0.92). After RAS rollout, 161 children died (case fatality ratio: 7.1%, 95% CI 6.1–8.2). RAS improved the health status of the children on Day 28 (aOR = 0.64, 95% CI 0.45–0.92) and there was a non-significant trend that mortality was higher in children not receiving RAS (aOR = 1.50, 95% CI 0.86–2.60). Full severe malaria treatment at the RHF including injectable anti-malarial and a course of ACT was highly protective against death (aOR = 0.26, 95% CI 0.09–0.79).ConclusionsThe main findings point towards the fact that danger signs are reasonably well recognized by health provider at the primary care level, and that RAS could influence positively health outcomes of such severe disease episodes and death. Its effectiveness is hampered by the insufficient quality of care at RHF, especially the provision of a full course of ACT following parenteral treatment. These are simple but important findings that requires urgent action by the health system planners and implementers.

Modeling the Probability of COVID-19 Based on Symptom Screening and Prevalence of Influenza and Influenza-Like Illnesses.

Background:The importance of various patient-reported signs and symptoms to the diagnosis of coronavirus disease 2019 (COVID-19) changes during, and outside, of the flu season. None of the current published studies, which focus on diagnosis of COVID-19, have taken this seasonality into account.Objective:To develop predictive algorithm, which estimates the probability of having COVID-19 based on symptoms, and which incorporates the seasonality and prevalence of influenza and influenza-like illness data.Methods:Differential diagnosis of COVID-19 and influenza relies on demographic characteristics (age, race, and gender), and respiratory (eg, fever, cough, and runny nose), gastrointestinal (eg, diarrhea, nausea, and loss of appetite), and neurological (eg, anosmia and headache) signs and symptoms. The analysis was based on the symptoms reported by COVID-19 patients, 774 patients in China and 273 patients in the United States. The analysis also included 2885 influenza and 884 influenza-like illnesses in US patients. Accuracy of the predictions was calculated using the average area under the receiver operating characteristic (AROC) curves.Results:The likelihood ratio for symptoms, such as cough, depended on the flu season—sometimes indicating COVID-19 and other times indicating the reverse. In 30-fold cross-validated data, the symptoms accurately predicted COVID-19 (AROC of 0.79), showing that symptoms can be used to screen patients in the community and prior to testing.Conclusion:Community-based health care providers should follow different signs and symptoms for diagnosing COVID-19 during, and outside of, influenza season.

Implementation and Outcomes of a Maternal Smoking Cessation Program for a Multi-ethnic Cohort in California, USA, 2012-2019.

Smoking during pregnancy remains one of the most significant risk factors for poor birth outcomes. During 2012–2019, the Loma Linda University Health Comprehensive Tobacco Treatment Program (CTTP) used a multicomponent behavioral intervention for tobacco cessation for 1402 pregnant smokers with components of known efficacy (i.e., incentives, biomarker testing, feedback, and motivational interviewing). The CTTP cohort includes a multi-ethnic sample of pregnant women with a mean age of 27 years referred by collaborating community-based healthcare providers in San Bernardino county. Evaluation of program outcomes from 7 years of follow-up (2012–2019) creates a rich cohort dataset for implementation science research to examine the real-world effectiveness of the program. In this report, we provide a cohort profile, and 8-week prolonged abstinence (8-week PA) and relapse findings from the first year of follow-up (n = 233). We found: (1) 28.4% achieved 8-week PA, (2) At a median of 6.2 months of follow-up after achieving 8-week PA, 23.2% of enrolled subjects reported tobacco cessation, and (3) a high rate of loss to follow-up (44%). In addition, our modeling indicated that the odds of relapse/smoking after enrollment was significantly higher in young mothers, non-Hispanic mothers (White, Black/African-American), mothers in the first and third trimester, and rural mothers. Formative quantitative and qualitative research on the CTTP cohort will consider the effects of a range of implementation science (number of intervention sessions, addition of a mHealth component, distance to care) and individual (partner/household smoking, birth outcomes, NICU) outcome measures for the purpose of scaling up the CTTP model.

Recruitment in Health Services Research-A Study on Facilitators and Barriers for the Recruitment of Community-Based Healthcare Providers.

In health services research, the recruitment of patients is oftentimes conducted by community-based healthcare providers. Therefore, the recruitment of these healthcare providers is a crucial prerequisite for successful patient recruitment. However, recruiting community-based healthcare providers poses a major challenge and little is known about its influencing factors. This qualitative study is conducted alongside a health services research intervention trial. The aim of the study is to investigate facilitators and barriers for the recruitment of community-based healthcare providers. A qualitative text analysis of documents and semi-structured interviews with recruiting staff is performed. An inductive–deductive category-based approach is used. Our findings identify intrinsic motivation and interest in the trial’s aims and goals as important facilitating factors in healthcare provider recruitment. Beyond that, extrinsic motivation generated through financial incentives or collegial obligation emerged as a conflicting strategy. While extrinsic motivation might aid in the initial enrollment of healthcare providers, it rarely resulted in active trial participation in the long run. Therefore, extrinsic motivational factors should be handled with care when recruiting healthcare providers for health services research intervention trials.

Development of an educational intervention to reduce the burden of adult chronic lung disease in rural India: Inputs from a qualitative study.

BackgroundChronic respiratory diseases (CRDs) are major causes of mortality and morbidity worldwide with a substantial burden of the disease being borne by the low and middle income countries (LMICs). Interventions to change health behaviour which aim to improve the quality of life and reduce disease burden due to CRD require knowledge of the problem and factors influencing such behaviour. Our study sought to appreciate the lived experiences of people with CRD, their understanding of the disease and its risk factors, and usual practice of health behaviour in a rural low-literate community in southern India.MethodsQualitative data were collected between September and December 2018 through eight focus group discussions (FGDs), five in-depth interviews and four key-informant interviews from patients and community members. Community engagement was undertaken prior to the study and all interviews and discussions were recorded with permission. Inductive coding was used to thematically analyse the results.ResultsMajor themes included understanding of chronic lung disease, health behaviours, lived experiences with the disease and social norms, attitudes and other factors influencing health behaviour.DiscussionPoor understanding of CRDs and their risk factors affect health seeking behaviour and/or health practices. Stigma associated with the disease and related health behaviours (e.g. inhaler use) creates emotional challenges and mental health problems, besides influencing health behaviour. However barriers can be circumvented by increasing community awareness; communication and connection with the community through community based health care providers can turn challenges into opportunities for better health care.

Aya—a digital tool co-designed with Venezuelan women to safely facilitate self-managed medication abortion and contraception access

Objectives The ongoing complex humanitarian crisis in Venezuelahas disproportionately affected access to sexual and reproductive health (SRH) services. Restrictive abortion laws lead to unsafe abortions and increased maternal mortality/morbidity. We sought to understand whether a digital tool that safely facilitates self-managed abortion and contraception access would be acceptable and feasible for Venezuelan women and their community. Our study aimed to: Understand how Venezuelan women access SRH information and services; Understand their preferences for design of a digital tool that will safely facilitate self-managed abortions and contraception access; Co-design a user-centered digital tool, Aya, that includes their preferences and experiences. Methods This is a mixed-methods implementation research study with a focus on co-design with Venezuelan women, grassroots community-based organizations, healthcare providers, SRH advocates and program experts: Results 30% of surveyed Venezuelan women had an abortion, half used unsafe methods. 83% own a smartphone, 77% have internet access. Qualitative interviews highlighted the impact of the humanitarian crisis and COVID-19 on access to SRH services, safe abortion, and contraceptive methods. Venezuelan women were supportive of a digital tool that would safely facilitate self-managed abortion and contraception access. Aya is being co-designed and will be ready for pilot testing in Spring 2021. Conclusions We conducted user-centered research to understand the complexities around safe abortion care and contraception access in a humanitarian setting. We are co-designing Aya to ensure successful implementation, sustainability, and scalability within Venezuela.

Developmental Screening and Monitoring are Associated with Increased Preschool Special Education Receipt

To appropriately route children with developmental disabilities to appropriate early interventions, those children must first be identified via developmental screening and/or developmental monitoring. Most early identification research emphasizes the relationship between developmental screening and Part C early intervention (EI) receipt for children birth to two. The relationship between developmental monitoring and service receipt is understudied, particularly for 3 to 5-year-old children are routed to Part B (619) early childhood special education services. Thus, this study used data from the National Surveys of Children’s Health (2007, 2012) to investigate the relationship between community-based health care providers (HCP) developmental screening and/or monitoring and the odds of early childhood special education receipt for preschool aged children (3 to 5). Across years, children whose HCP provided both developmental screening and monitoring, or developmental monitoring alone, had substantially greater odds of receiving special education compared to those who did not receive screening or monitoring. Receipt of developmental screening alone was associated with special education receipt in 2012, but not 2007. Developmental monitoring is understudied compared to developmental screening. Data presented here indicate that monitoring is associated with Part B 619 special education receipt and warrants further investigation to better understand how, with developmental screening, developmental monitoring might improve the identification of young children in need of 619 services. In particular, longitudinal analyses capturing data across systems, from screening and monitoring to assessment and service receipt, is needed to understand the effectiveness of monitoring for early identification and appropriate routing of children to relevant care systems.

Gap analysis of pharmacist communication with community-based oral health care providers

BackgroundCurrent communication techniques among different types of health professionals are often inefficient and ineffective, leading to provider frustration and suboptimal patient care that can have community-wide implications. Oral health care providers (OHCPs) in the United States prescribe high numbers of antibiotics and immediate-release opioids and have practice sites that are physically isolated from those of other health professionals, making communication more challenging. ObjectiveThis study was conducted to identify barriers to effective communication between community pharmacists and OHCPs to inform the processes for improving provider education and the methods for training future pharmacists. MethodsA mixed-methods approach was used. Community pharmacists with an active license were eligible to participate and were recruited via e-mail. The participants received an electronic survey that assessed current communication methods, obstacles to optimal communication, and comparisons of OHCPs with other prescribers. The survey participants were asked to self-identify their interest in telephone interviews, which were analyzed using thematic coding to assess the role of the pharmacist in combating public health issues such as opioid abuse through interprofessional collaboration. ResultsThere were 125 participants (response rate 9%) for the survey and 7 participants for the interviews. The most common reasons for which the pharmacists contacted OHCPs were to address incomplete prescriptions (40%) and medication-related problems (35%), with the most common medication-related problems being adverse drug reactions (35%) or cost issues (25%). The most challenging obstacles to communication included lack of time and lack of professional relationships. The pharmacists’ impressions of OHCPs were largely positive. ConclusionPossible strategies to address the identified communication barriers include creation of a universal communication system and establishment of networks between pharmacists and community providers. This study lays the groundwork for future efforts in the field of interprofessional education research and practice, which can be used to improve delivery of community-based care.

Israel\u2019s rapid rollout of vaccinations for COVID-19

As of the end of 2020, the State of Israel, with a population of 9.3 million, had administered more COVID-19 vaccine doses than all countries aside from China, the US, and the UK. Moreover, Israel had administered almost 11.0 doses per 100 population, while the next highest rates were 3.5 (in Bahrain) and 1.4 (in the United Kingdom). All other countries had administered less than 1 dose per 100 population.While Israel’s rollout of COVID-19 vaccinations was not problem-free, its initial phase had clearly been rapid and effective. A large number of factors contributed to this early success, and they can be divided into three major groups.The first group of factors consists of long-standing characteristics of Israel which are extrinsic to health care. They include: Israel’s small size (in terms of both area and population), a relatively young population, relatively warm weather in December 2020, a centralized national system of government, and well-developed infrastructure for implementing prompt responses to large-scale national emergencies.The second group of factors are also long-standing, but they are health-system specific. They include: the organizational, IT and logistical capacities of Israel’s community-based health care providers, the availability of a cadre of well-trained, salaried, community-based nurses who are directly employed by those providers, a tradition of effective cooperation between government, health plans, hospitals, and emergency care providers – particularly during national emergencies; and support tools and decisionmaking frameworks to support vaccination campaigns.The third group consists of factors that are more recent and are specific to the COVID-19 vaccination effort. They include: the mobilization of special government funding for vaccine purchase and distribution, timely contracting for a large amount of vaccines relative to Israel’s population, the use of simple, clear and easily implementable criteria for determining who had priority for receiving vaccines in the early phases of the distribution process, a creative technical response that addressed the demanding cold storage requirements of the Pfizer-BioNTech COVID-19 vaccine, and well-tailored outreach efforts to encourage Israelis to sign up for vaccinations and then show up to get vaccinated.While many of these facilitating factors are not unique to Israel, part of what made the Israeli rollout successful was its combination of facilitating factors (as opposed to each factor being unique separately) and the synergies it created among them. Moreover, some high-income countries (including the US, the UK, and Canada) are lacking several of these facilitating factors, apparently contributing to the slower pace of the rollout in those countries.

Community-based health care providers as research participant recruitment gatekeepers: ethical and legal issues in a real-world case example

Community-based mental health care providers (CBMHCPs) are increasingly contacted by external researchers for research study recruitment. Unfortunately, many do not possess the resources or personnel with the skills required to successfully evaluate research proposals for risks. Providing access to clients and client health information can result in harmful personal and legal consequences if the proper safeguards do not exist. This article discusses the legal requirements and practical implications for CBMHCPs when acting as gatekeepers. A case study from a large CBMHCP is presented as an illustration of steps that can be taken to protect clients and avoid risk. Additional recommendations for establishing protective safeguards and research evaluation protocols are discussed.

41 Fostering Hope: The Comprehensive Accessible care for Infants with Neonatal abstinence (CAIN) Study

Abstract Introduction/Background Neonatal Abstinence Syndrome (NAS) occurs in newborns exposed to drugs in-utero. In Canada, maternal opiate use in pregnancy has been steadily rising resulting in as many as 1850 babies born with NAS per year. Management of babies born with NAS requires supportive, interdisciplinary care. Depending on the severity of NAS, babies may be cared for with non-pharmacological interventions or some may need to be admitted to the Neonatal Intensive Care Unit for extended hospital stays to receive medication and management of ongoing complex health care needs. Hospital and community health care providers have expressed concerns around the continuity of care for these babies in their stay in hospital and their transition to home. Objectives This study examined the experiences of hospital and community-based health care providers and families regarding the management of babies with NAS. The driving force behind our inquiry related to our interest in streamlining care for these babies in highly complex health and social systems. Design/Methods In total, 47 interdisciplinary participants were interviewed over a four-month period with individuals from Women’s and Child Health, Community, and family members. Interviewed transcripts were reviewed over several months and were completed in December 2019 using an inductive thematic analysis which culminated in the identification of an overarching theme linked with primary themes. ​ Results The study identified existing gaps in the management of these patients, determined how to improve communication between hospital and community networks, and provided a better understanding of the attitudes, perceptions and experiences of hospital and community personnel. The overarching theme identified was hope, with the primary themes being: system, mental health, mother/baby, judgement, and knowledge (see Figure 1). Several gaps identified in the system included fear, stigma, and language. Certain solutions proposed for improvement included focused care in a rooming in model for the mother and baby dyad, supporting mothers’ well-being, involving mothers and families, and supporting care providers in a family centered care model. In Figure 1, green lines indicate themes that are linked with and support hope, and red lines indicate themes that are barriers to hope. Conclusion This research demonstrates that programs and interventions implemented when working with mothers and babies with NAS must foster hope in mothers, families, and in the extended care provider team.

Effects of Perceived Risk and Patient Anxiety on Intention to Use Community Healthcare Services in a Big Modern City

In Shanghai, one of the biggest modern cities in the world, community-based health care providers are largely underutilized. As a result, valuable medical resources are wasted. The present study examined the relationship between the variables of perceived risk and patient anxiety on intentions to use community health clinics, because these two variables are closely related to decision making. A survey measuring these variables was distributed near community health clinics in Shanghai ( n = 869), and structural equation models were constructed to analyze the data. Results show that patient anxiety was associated with contracting diseases and positively related to the intention to seek services from community-based providers, whereas their perceived risk of these providers had a negative relationship with such an intention. Moreover, the knowledge that some community clinics were not as good as large hospitals was positively related to perceived risk. Policy implications are discussed based on the findings.

\u201cIt\u2019s like I was out there by myself\u201d: The receipt of reentry support among HIV-infected formerly incarcerated individuals in New York City

BackgroundIn the U.S., approximately one in seven HIV-infected individuals experience incarceration at least once in their lifetime. While HIV-infected individuals experience positive health outcomes during periods of incarceration, they tend to experience treatment disruption as they return to their community after custody which results in poor health outcomes. The purpose of this study was to explore the transitional support received from the Department of Corrections during the reentry period.MethodsWe conducted in-depth interviews with 20 HIV-infected formerly incarcerated individuals in New York City. Interviews were audio recorded and transcribed. Three researchers performed line-by-line reading of the transcripts to identify dominant codes and themes that emerged. A mixture of deductive and inductive techniques was used to identify patterns that emerged in the data.ResultsMost of the participants were male and racial and ethnic minorities. There were five dominant themes that emerged during our analysis: 1) variations in the quantity of antiretroviral medication received during transition; 2) linkages to community-based physical health care providers was not well-coordinated; 3) insufficient housing and social resources; 4) structural and social challenges to post-release well-being; and 5) family as a source of resilience.ConclusionsDischarge support planning should include sufficient medication to prevent treatment disruption and a more comprehensive approach to linkage to community-based healthcare services. Such planning should also include thorough pre-release assessments to identify appropriate levels of support needed, including employment and housing assistance, which will be useful for resource allocation. Broadening public health partnerships may also increase availability and promote accessibility to the most appropriate healthcare services and programs, which may provide better opportunities to receive coordinated care and ensure continuity of care. Finally, ties to family members and other loved ones should be leveraged to help facilitate the achievement of optimal health outcomes among this population.