Community-based Health Care Settings Research Articles

Foot and ankle problems in children and young people: a population-based cohort study.

The aim of this research was to describe the epidemiology, presentation and healthcare use in primary care for foot and ankle problems in children and young people (CYP) across England. We undertook a population-based cohort study using data from the Clinical Practice Research Datalink Aurum database, a database of anonymised electronic health records from general practices across England. Data was accessed for allCYP aged 0-18 years presenting to their general practitioner between January 2015 and December 2021 with a foot and/or ankle problem. Consultation rates were calculated and used to estimate numbers of consultations in an average practice. Hierarchical Poisson regression estimated relative rates of consultations across sociodemographic groups and logistic regression evaluated factors associated with repeat consultations. A total of 416,137 patients had 687,753 foot and ankle events, of which the majority were categorised as "musculoskeletal" (34%) and "unspecified pain" (21%). Rates peaked at 601 consultations per 10,000 patient-years among males aged 10-14 years in 2018. An average practice might observe 132 (95% CI 110 to 155) consultations annually. Odds for repeat consultations were higher among those with pre-existing diagnoses including juvenile arthritis (OR 1.73, 95% CI 1.48 to 2.03). Conclusions: Consultations for foot and ankleproblems were high among CYP, particularly males aged 10 to 14 years. These data can inform service provision to ensure CYP access appropriate health professionals for accurate diagnosis and treatment. What is Known: • Foot and ankle problems can have considerable impact on health-related quality of life in children and young people (CYP). • There is limited data describing the nature and frequency of foot and ankle problems in CYP. What is New: • Foot and ankle consultations were higher in English general practice among CYP aged 10 to 14 years compared to other age groups, and higher among males compared to females. • The high proportion of unspecified diagnoses and repeat consultations suggests there is need for greater integration between general practice and allied health professionals in community-based healthcare settings.

Community paramedicine in Central Oregon: A promising model to reduce non-urgent emergency department utilization among medically complex Medicaid beneficiaries.

Community paramedicine has emerged as a promising model to redirect persons with nonmedically emergent conditions to more appropriate and less expensive community-based health care settings. Outreach through community paramedicine to patients with a history of high hospital emergency department (ED) use and chronic health conditions has been found to reduce ED use. This study examined the effect of community paramedicine implemented in 2 rural counties in reducing nonemergent ED use among a sample of Medicaid beneficiaries with complex medical conditions and a history of high ED utilization. A cluster randomized trial approach with a stepped wedge design was used to test the effect of the community paramedicine intervention. ED utilization for non-urgent care was measured by emergency medicine ED visits and avoidable ED visits. The community paramedicine intervention reduced ED utilization among a sample of 102 medically complex Medicaid beneficiaries with a history of high ED utilization. In the unadjusted models, emergency medical ED visits decreased by 13.9% (incidence rate ratio [IRR], 0.86; 95% confidence interval [CI], 0.76-0.98) or 6.1 visits saved for every 100 people. Avoidable emergency department visits decreased by 38.9% (IRR, 0.61; 95% CI, 0.44-0.84) or 2.3 visits saved for every 100 people. Our results suggest community paramedicine is a promising model to achieve a reduction in ED utilization among medically complex patients by managing complex health conditions in a home-based setting.

Pharmacist, prescriber, and drug policy expert opinions on gabapentinoid misuse.

Gabapentinoids (gabapentin and pregabalin) are widely used in clinical practice, but recent evidence indicates that they carry an increased risk of misuse. As healthcare professionals (HCPs) and policymakers plan different strategies to promote harm reduction, it is important to understand different interested party viewpoints. To explore prescriber, pharmacist, and drug policy expert (DPE) awareness, opinions, and experiences regarding gabapentinoid misuse. A qualitative description study using individual semi-structured virtual interviews was conducted between February and April 2021. Participants included prescribers (physicians, physician assistants [PA], or nurse practitioners [NP]) and pharmacists practicing in outpatient, ambulatory, or community-based healthcare settings; individuals with relevant drug policy expertise were also included. Qualtrics (Provo, Utah) and Zoom (San Jose, California) were used to facilitate quantitative (for initial screening and participant characteristics) and qualitative (interview) data collection. Data were coded and organized into themes in NVivo (QSR International; Burlington, Massachusetts) using thematic analysis steps. A total of 43 individuals participated in this study, including 16 (37.2%) pharmacists, 13 (30.2%) physicians, seven (16.3%) NPs, four (9.3%) DPEs, two (4.7%) pharmacist/DPEs, and one (2.3%) PA. Results were organized along four themes: (1) challenges/opportunities in gabapentinoid use; (2) gabapentinoid misuse awareness; (3) solutions to gabapentinoid misuse and (4) contributing barriers in pain management. Participants invoked different opinions in their consideration of gabapentinoid misuse, including the desire for harm reduction, the limitations of the current healthcare and insurance system, the lack of options for pain and substance use disorder treatment, and the influence of patient expectations. Gabapentinoid misuse was commonly framed in comparative fashion to ongoing concerns with opioids, and proposed solutions often focused less on regulatory control and more toward patient and HCP education and an overhaul of the health system approach to substance use and healthcare overall.

Overcoming the challenges of recruiting and interviewing patients following critical illness.

The strict restrictions implemented in England during the COVID-19 pandemic meant it was no longer possible to recruit or interview participants in person. However, virtual recruitment and interviews are not without their challenges, particularly when exploring sensitive topics. To discuss how to overcome some of the challenges involved in recruiting and interviewing participants who have been critically ill with COVID-19. An exploratory, descriptive study was conducted involving interviews with 20 people who had been critically ill with COVID-19 and had been discharged from two community-based healthcare settings in London, England. Participants were interviewed at home after being discharged from hospital after at least one month. The sensitivity of the research topic meant strategies for recruiting and interviewing needed to be adapted, including involving patient experience facilitators, using virtual interviews, managing the distress of participants and self-care for the researchers. The adaptations used in this study can be used in research involving people who have been critically ill. Researchers can explore innovative ways to recruit participants using hospital or community staff who are not usually involved in research. Virtual interviews require additional skills, such as building rapport with participants, so may require additional training. A distress protocol for participants should always be considered when discussing sensitive topics. Self-care and debrief strategies for interviewers are also critical.

Priority topics for child and family health research in community-based paediatric health care according to caregivers and health care professionals.

Patient-oriented research (POR) aligns research with stakeholders' priorities to improve health services and outcomes. Community-based health care settings offer an opportunity to engage stakeholders to determine the most important research topics to them. Our objectives were to identify unanswered questions that stakeholders had regarding any aspect of child and family health and prioritize their 'top 10' questions. We followed the James Lind Alliance (JLA) priority setting methodology in partnership with stakeholders from the Northeast Community Health Centre (NECHC; Edmonton, Canada). We partnered with stakeholders (five caregivers, five health care professionals [HCPs]) to create a steering committee. Stakeholders were surveyed in two rounds (n = 125 per survey) to gather and rank-order unanswered questions regarding child and family health. A final priority setting workshop was held to finalize the 'top 10' list. Our initial survey generated 1,265 submissions from 100 caregivers and 25 HCPs. Out of scope submissions were removed and similar questions were combined to create a master list of questions (n = 389). Only unanswered questions advanced (n = 108) and were rank-ordered through a second survey by 100 caregivers and 25 HCPs. Stakeholders (n = 12) gathered for the final workshop to discuss and finalize the 'top 10' list. Priority questions included a range of topics, including mental health, screen time, COVID-19, and behaviour. Our stakeholders prioritized diverse questions within our 'top 10' list; questions regarding mental health were the most common. Future patient-oriented research at this site will be guided by priorities that were most important to caregivers and HCPs.

Patients' perspectives of recovery after COVID-19 critical illness: An interview study.

Critical illness is a traumatic experience, often resulting in post-intensive care syndrome, affecting people's physical, psychological, emotional, and social well-being. The early recovery period is associated with increased risk, negatively impacting longer-term outcomes. The aims of this study were to understand the recovery and rehabilitation needs of people who survive a COVID-19 critical illness. An exploratory descriptive qualitative interview study with 20 survivors of COVID-19 critical illness from two community-based healthcare settings in London, England. Data collection took place September 2020-April 2021, at least 1 month after hospital discharge by telephone or virtual platform. Data were subjected to inductive thematic analysis and mapped deductively to the three core concepts of self-determination theory: autonomy, competence and relatedness. Three key themes emerged: traumatic experience, human connection and navigating a complex system. Participants described how societal restrictions, fear and communication problems caused by the pandemic added to their trauma and the challenge of recovery. The importance of positive human connections, timely information and support to navigate the system was emphasized. Whilst findings to some extent mirror those of other qualitative pre-pandemic studies, our findings highlight how the uncertainty and instability caused by the pandemic add to the challenge of recovery affecting all core concepts of self-determination (autonomy, competence, relatedness). Understanding survivors' perspectives of rehabilitation needs following COVID-19 critical illness is vital to delivery of safe, high-quality care. To optimize chances of effective recovery, survivors desire a specialist, co-ordinated and personalized recovery pathway, which reflects humanized care. This should be considered when planning future service provisions.

The Greek version of the Australian Pelvic Floor Questionnaire: Cross-cultural adaptation and validation amongst women with urinary incontinence

ObjectivesAs in Greek settings there is a need to develop validated patient-reported outcomes (PROs) for pelvic floor dysfunction, this study’s aim was to cross-culturally adapt and validate the Australian Pelvic Floor Questionnaire (APFQ) into Greek, a 42-item PRO for routine urogynaecological evaluation of four domains; bladder, bowel, prolapse and sexual function. Study designCross-cultural translation was completed through official multistage forward and back-translation process. Validation involved administering the adapted APFQ (APFQ_GR) to women visiting Greek community-based healthcare settings. International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was also administered. Comparison between women with and without pelvic floor dysfunction (symptomatic versus control) was also undertaken for exploring discriminatory validity. Test-retest reliability was explored by re-administering APFQ_GR 10–15 days following initial testing and internal consistency was explored against each domain separately as well as total items’ score. ResultsGreek APFQ translation was successfully performed and piloted to a women sample with varying levels of education for comprehensibility, thus, satisfying the questionnaire’s face validity. 100 women (53.7 ± 13.1 years-old) participated in validation, 63 of which predominantly complained of urinary incontinence (UI) and 37 were asymptomatic. There were no ceiling effects. Floor effects were detected for women without symptoms. Moderate to very strong correlations were yielded between APFQ_GR total score and bladder domain, respectively, with ICIQ-UI SF single-item and total score (ρ = 0.403–0.758, p < 0.001), indicating satisfactory criterion-related validity. Moderate correlations were yielded for the sexual function domain with APFQ_GR total score and weaker correlations were found in the other two domains. Independent samples t-test yielded significant differences across the questionnaire’s scores (p < 0.001), indicating good discriminatory validity between symptomatic and asymptomatic women. Test-retest reliability was excellent (ICC3,1 = ≥0.998). Internal consistency was very good for each domain and total items’ score (Cronbach’s α = 0.714–0.924). ConclusionsThe Greek APFQ was proven appropriate, comprehensible, valid and reliable for women with urinary incontinence and can thus, be used across Greek healthcare settings. Prolapse and bowel domains merit further research.

Forensic Mental Health Assessment as a Critical Intercept for Enhancing Mental Health Care.

Rates of psychiatric diagnosis, medical morbidity, and suicide risk are notably high among incarcerated individuals. However, engaging these individuals in community-based health care settings can be a challenge. Among justice-involved individuals who do access services, community-based health care settings may lack available resources to effectively conduct comprehensive assessments that inform evidence-based conceptualization. We propose forensic mental health assessment (FMHA) as a critical opportunity to enhance service delivery for this at-risk population. In particular, within the scope of their role, forensic mental health evaluators are able to conduct a comprehensive review of records across health (eg, inpatient and outpatient health care settings), social (eg, homeless shelter), and correctional (eg, jail or prison) settings. Moreover, FMHA often includes specialized batteries that are able to assess and differentially diagnose myriad clinical presentations that may have overlapping symptomatology. We present 2 case vignettes to illustrate the utility of FMHA for enhancing service delivery. Finally, we conclude by noting challenges to integrating FMHA into conceptualization and necessary next steps in research and programing.

Association between gut MIcrobiota, GROWth and Diet in peripubertal children from the TARGet Kids! cohort (The MiGrowD) study: protocol for studying gut microbiota at a community-based primary healthcare setting.

IntroductionThe gut microbiota interacts with diet to affect body health throughout the life cycle. Critical periods of growth, such as infancy and puberty, are characterised by microbiota remodelling and changes in dietary habits. While the relationship between gut microbiota and growth in early life has been studied, our understanding of this relationship during puberty remains limited. Here, we describe the MIcrobiota, GROWth and Diet in peripubertal children (The MiGrowD) study, which aims to assess the tripartite growth-gut microbiota-diet relationship at puberty.Methods and analysisThe MiGrowD study will be a cross-sectional, community-based study involving children 8–12 years participating in the TARGet Kids! cohort. TARGet Kids! is a primary healthcare practice-based research network in Canada. Children will be asked to provide a stool sample, complete two non-consecutive 24-hour dietary recalls and a pubertal self-assessment based on Tanner Stages. Anthropometry will also be conducted. The primary outcome is the association between gut microbiota composition and longitudinal growth from birth until entry into the study. Anthropometrics data from birth will be from the data collected prospectively through TARGet Kids!. Body mass index z-scores will be calculated according to WHO. The secondary outcome is the association between gut microbiota, diet and pubertal stage.Ethics and disseminationEthics approval has been obtained by the Hospital for Sick Children and St. Michael’s Hospital—Unity Health, and the University of Toronto. Results will be disseminated in the public and academic sector, including participants, TARGet Kids! primary healthcare physicians teams, scientists via participation in the TARGet Kids! science and physician meetings, conferences and publications in peer-reviewed journals. The MiGrowD study results will help researchers understand the relationships underlying growth, gut microbiota and pubertal maturation in children.

Evidenced-Based Approaches States and Territories Can Implement to Advance Adult Immunization Uptake During the COVID-19 Pandemic and Beyond.

The COVID-19 vaccine has highlighted adult vaccination and vaccine hesitancy, particularly in communities of color. Prior to the COVID-19 pandemic, influenza, pneumonia, shingles, and hepatitis A and B vaccination rates were well below federal goals, with participation even lower across racial and ethnic groups.1,2 Key drivers of these rates include barriers to health care access, limited trust in the government and the medical establishment, as well as a lack of sufficient data to better understand racial and ethnic disparities. As we work to maximize COVID-19 vaccination and increase participation in routine adult vaccinations, we must be both strategic and cautious. In this column, we outline a summary of our adult immunization technical package of interventions for state and territorial health agencies (S/THA) to strengthen data management and improve adult vaccination. ASTHO reviewed data on effective vaccination interventions that included an internal literature review of evidence-based approaches compiled by the Guide to Community Preventive Services, the US Preventive Services Task Force, and the Centers for Disease Control and Prevention. These evidence-based approaches were divided into 4 categories: community interventions, health care systems, data-driven strategies, and policy and regulatory approaches. On the basis of recent experience with the COVID-19 vaccination efforts, we prioritized 2 approaches ASTHO is well positioned to advocate for and assist or advise S/THA leaders with adult vaccination efforts: Increasing vaccination efforts in community-based health care settings; and Enhancing immunization information systems data sharing and reporting capacity. Strengthen Partnerships With Community-Based Health Care Settings Health care systems and medical providers are our traditional vaccination partners and are effective in addressing vaccine hesitancy on an individual level. Early in the COVID-19 vaccination effort, states channeled vaccine administration through high-volume community sites (ie, mass vaccination events). As demand for COVID-19 vaccine has decreased, many jurisdictions transitioned to increase vaccine administration in health care settings to better address vaccine hesitancy. Community-based health care settings, such as Federally Qualified Health Centers (FQHCs), can help states understand barriers to vaccine uptake and implement focused and tailored strategies that address concerns and foster trust in communities of color. FQHCs receive most of their funding from designated federal grants and state Medicaid programs.3 They provide care to around 30 million medically underserved patients each year, with 63% of those patients belonging to a racial or ethnic minority group.4 During the pandemic, people of color made up the majority (64%) of those who received a COVID-19 vaccine in FQHCs.5 Working more closely with community-based health centers is an effective way for public health agencies to increase adult vaccination, particularly in underserved communities. During the pandemic, FQHCs received direct allocations of COVID-19 vaccines from the federal government.6 Many states augmented FQHC vaccine supply with state allocations and engaged them in community outreach efforts. Some states also developed or expanded Medicaid reimbursement systems for vaccine counseling and administration. In the future, public health agencies can build on this momentum by continuing to work with FQHCs and networks, state primary care associations, and state Medicaid programs to expand clinical capacity and engage providers in a wide range of evidence-based practices to improve vaccination participation in health care settings.7 ASTHO and other national associations can work at the federal level to expand existing immunization benchmarks for children to include standardized adult vaccination measures and reimbursement systems that are recognized by the Health Resources & Services Administration, the National Committee for Quality Assistance, and the Centers for Medicare & Medicaid Services. Enhancing Immunization Information Systems Data Reporting and Sharing Capacity Perhaps, the greatest emerging challenge to increasing effective and equitable adult vaccination efforts is our lack of complete, interoperable data. As states enhance their immunization information systems (IISs), it is important to provide leadership on issues such as data exchange with clinical practice and to address our long-standing need to capture accurate and comprehensive data on race and ethnicity. A number of states are now reporting more complete race and ethnicity data in their IISs. These improvements have required multiple strategies, including changes to existing laws barring the collection of federal reporting of race and ethnicity data; matching incomplete immunization data to electronic health records (EHRs), Health Information Exchange (HIE), and other data sets; state laws requiring providers to report race and ethnicity; incentives to encourage providers to improve collection and submission of these data; and widespread training of staff in both the public health and private health care workforce. Continued leadership on this issue as we implement data modernization efforts and expand the public health workforce could allow us to overcome a long-standing barrier to understanding and improving racial and ethnic health disparities for a wide range of public health issues beyond COVID-19. Ultimately, IIS interoperability needs to be ubiquitous with the many other systems engaged across the immunization ecosystem, including EHRs, pharmacy systems, and HIEs, as well as other IISs. Interstate access to immunization records has been a long-standing challenge. However, many states are now addressing laws that prohibit IIS data sharing across borders, with multiple states working closely with HIEs and participating in the Immunization Gateway to increase interstate access to immunization records.8 In addition, state IISs could be more interoperable with health care providers. Most EHRs now upload vaccinations directly into the IISs, while also querying for information back to the practice for patients who have received vaccination elsewhere; ideally, this near-real time bidirectional data exchange would be available in every setting where immunization information was needed. Universal implementation of immunization data exchange with IISs would allow every provider to have immunization status on hand so that the right immunization can be given at the right time at every patient encounter. In parallel, IISs could work with HIEs or with larger health care system patient rosters to update this information on a regular basis so that practices can target patient outreach efforts. Conclusion Public health leaders are tasked with addressing many areas of public health and oftentimes have a short tenure to make an impact on the health of their state. Many public health agencies focus on improving vaccination rates because of the significant and avoidable human burden and cost of infectious disease. ASTHO's adult immunization technical package represents an approach to technical assistance at ASTHO that is evidence based, policy oriented, and proactive. It will be used as a guide to prioritize our technical assistance efforts with S/THA to address adult vaccination and demonstrate tangible health outcomes.

Hormone Prescription and HIV Screening/Preventive Practices Among Clinicians Providing Care for Transgender Individuals.

Through a survey-based approach, we sought to investigate regional differences in gender-affirming hormone therapy (GAHT) prescribing practices, as well as HIV screening and prevention practices among clinicians providing care to transgender individuals. Our survey was disseminated between December 2019 and January 2021 to clinicians who prescribe GAHT within New England (United States). Between-group differences in GAHT prescribing and HIV screening/prevention practices were evaluated by practice setting and subspecialty. Of the 20 survey respondents, 55% practiced in health care settings affiliated with an academic institution, 45% practiced in a community-based health care setting, and 30% were Endocrinologists. Clinicians in community-based health care settings reported more frequently prescribing oral 17β-estradiol (p=0.02) and spironolactone (p=0.007) for feminizing GAHT compared with clinicians in health care settings affiliated with an academic institution, who reported more frequently prescribing leuprolide (p=0.03). For masculinizing GAHT, clinicians from health care settings affiliated with an academic institution reported more frequently prescribing topical testosterone (p=0.03). There were no significant between-group differences in reported barriers to initiation or reasons for stopping GAHT. While non-Endocrinologists reported "often" or "always" offering HIV screening, most Endocrinologists reported "rarely" or "never" offering HIV screening and "rarely" or "never" offering pre-exposure or postexposure prophylaxis to their transgender patients. Regional GAHT prescribing practices varied by setting. Additional research is needed to better understand whether these differences translate to differences in GAHT efficacy and side-effects. Further, HIV screening/prevention practices varied by subspecialty. Integrated GAHT and HIV screening/prevention across subspecialties could help reduce the disproportionate burden of HIV faced by the transgender community.

“Doing our best for patient safety”: An international and interprofessional qualitative study with spinal manipulative therapy providers in community-based settings

BackgroundPatient safety research is expanding from hospitals to community-based healthcare settings. Knowledge gaps persist among manual therapy professions that may impede patient safety initiatives within musculoskeletal care settings. ObjectivesTo describe perceptions of patient safety among chiropractors and physiotherapists who provide spinal manipulation therapy (SMT). DesignQualitative descriptive study. MethodCross-sectional data were collected using the SafetyNET Survey to Support Quality Improvement. SMT providers (n = 705) in 3 countries completed surveys, with 84 providing written responses to an open-ended question about patient safety. Qualitative thematic analysis described providers’ perceptions about patient safety within their practice. ResultsSMT providers’ perceptions were influenced by professional, patient, and practice setting factors. Five themes and 10 supporting categories were developed. Doing Our Best for Patient Safety concerned Avoiding Mistakes and Prioritizing Safety.Putting Patients First focused on Developing Relationships and Individualizing Care.Working and Learning Together advocated for Interprofessional Communication and Collaborative Learning. Organizing Practice Processes emphasized Standardizing Procedures and Benchmarking Progress.Considering Practitioner Identity highlighted how Recognizing Difference among SMT providers and Challenging Fears of other healthcare professionals and patients about SMT were important for enhancing patient safety. ConclusionFindings align with World Health Organization guiding principles that the nature of healthcare settings influence patient safety strategies. Most responses focused on individual strategies to prevent adverse events. However, this approach may overlook the benefits of identifying and documenting adverse events, setting time to discuss adverse events with clinic members, standardizing clinical practices, and building transparent patient safety cultures across healthcare professions and settings.

LUNG CANCER SCREENING PARTICIPATION IN COMMUNITY-BASED HEALTH SYSTEMS FROM THE PROSPR-LUNG CONSORTIUM

TOPIC: Imaging TYPE: Original Investigations PURPOSE: From 2013 through 2020, the US Preventive Services Task Force recommended annual lung cancer screening (LCS) via low-dose computed tomography (LDCT) for 55- to 80-year-olds with 30+ pack-years of smoking history who currently smoke or quit smoking within the last 15 years. Because the population-level impact of LCS on reducing lung cancer mortality depends on high LCS participation among eligible populations, it is important to determine LCS participation in community settings and to track participation changes over time. METHODS: Study participants were patients ages 55-80 years old who received care within the five systems in the Population-based Research to Optimize the Screening Process (PROSPR) Lung Consortium from 2014 through 2019. Data on LCS participation and patient characteristics (age, sex, race/ethnicity, and cigarette smoking history) were obtained via electronic health records (EHR). In this population, we used smoking history according to EHR data as a proxy for LCS eligibility and calculated the percent of individuals who completed LCS via LDCT by year, overall and by health system. We also evaluated differences in the percent screened by age (55-64 years old vs. 65+), sex, and race/ethnicity using chi-square tests with the significance level of < 0.05. RESULTS: The number of patients who were ages 55-80 years old with EHR documentation of 30+ pack-years of smoking and who currently smoked or had a quit date within the past 15 years ranged from 21,234 in 2013 to 39,881 in 2019. Of these, 3% completed LCS via LDCT in 2014, 7% in 2015, 12% in 2016, 17% in 2017, 21% in 2018, and 23% in 2019. Among those with 30+ pack-years in 2019 (N=51,579), 77% had current or former smoking within the past 15 years and were considered eligible for LCS in 2019. Of these individuals, 27% overall had ever received LCS, but there was variation in the percent ever screened by health system, that ranged from 16% to 45%. Among those eligible for LCS, the percent having ever received LCS LDCT also varied by age (24% of those ages 55-64 years old vs. 29% of those ages 65-80 years old; p-value < 0.01). Within each health system, the percent of eligible individuals who received LCS LDCT was not significantly different by sex or by race/ethnicity. CONCLUSIONS: Although the percent of high-risk individuals receiving LCS via LDCT increased every year from 2014 to 2019, LCS rates in community-based healthcare settings remain well below screening rates for other types of cancer. Also, there is wide variation in LCS rates by health system. CLINICAL IMPLICATIONS: To optimize the impact of LCS for reducing lung cancer mortality in the United States, health systems will need to increase LCS participation. Additional research to understand how differences in health system implementation and maintenance of LCS programs impact LCS participation is needed. DISCLOSURES: No relevant relationships by Andrea Burnett-Hartman, source=Web Response No relevant relationships by Nikki Carroll, source=Web Response Spouse, stock holder relationship with Johnson and Johnson Please note: >10 years Added 04/28/2021 by Jennifer Croswell, source=Web Response, value=Stock No relevant relationships by Robert Greenlee, source=Web Response No relevant relationships by Stacey Honda, source=Web Response No relevant relationships by Christine Neslund-Dudas, source=Web Response No relevant relationships by Katharine Rendle, source=Web Response No relevant relationships by Debra Ritzwoller, source=Web Response Grant relationship with MagArray Inc. Please note: >$100000 by Anil Vachani, source=Web Response, value=Grant/Research Support Removed 04/17/2021 by Anil Vachani, source=Web Response Grant relationship with Broncus Medical Please note: $20001 - $100000 by Anil Vachani, source=Web Response, value=Grant/Research Support Removed 04/17/2021 by Anil Vachani, source=Web Response Scientific Medical Advisor relationship with Johnson and Johnson Please note: 2020 - present Added 04/22/2021 by Anil Vachani, source=Web Response, value=Consulting fee Grant relationship with Precyte Please note: 01/2021 to present Added 04/17/2021 by Anil Vachani, source=Web Response, value=Grant/Research Removed 04/17/2021 by Anil Vachani, source=Web Response

Primary care providers\u2019 perceptions and experiences of family-centered care for older adults: a qualitative study of community-based diabetes management in China

BackgroundFamily-centered care, as a contemporary model of health service delivery, involves a mutually beneficial partnership between healthcare providers, patients and their families. Although evidence on the positive effects of family-centered care on older adults and their families is accumulating, less is known about the providers’ beliefs, attitudes and practices related to family-centeredness, especially regarding community-based primary healthcare services for the rapidly-ageing Chinese population.MethodsThis study investigated Chinese primary care providers’ perceptions and experiences of family-centered care for older adults, using community-based diabetes management services as an example. Ten focus-group interviews involving 48 community health professionals were conducted. Major themes were identified using thematic analysis.ResultsThe interviews revealed that the providers acknowledged the importance of the family in older patients’ diabetes management, while their current scope of practice with the patients’ families was limited and informal. The barriers to implementing family-centered care were attributed to structural and environmental obstacles associated with the patients’ families and the community healthcare context and culture. To engage patients’ families more effectively, the providers suggested that family-centered values endorsed by their healthcare organizations and reinforced by policies, a trained interdisciplinary team of health professionals and community social workers, and also that the utilization of technology would be beneficial.ConclusionsOur study extends the evidence of family-centered care for older adults in Chinese community-based healthcare settings, contributing to the design of a tailored healthcare delivery model embodying ageing in place.

Quantifying Lumbar Movement Patterns of Allied Health Professionals in an Australian Health Care Facility.

Health professionals responsible for return to work plans have little data about allied health movement to guide recommendations following lower back injury. This study aimed to quantify the lumbar movement patterns of allied health professionals within a health care facility throughout a normal workday. An observational case study was undertaken at a public health care facility with 122 allied health professionals. The lumbar movements were recorded with the ViMove together with pain scale measurement. The mean (SD) recording time for allied health was 7.7 (0.7)hours. A mean (SD) 3 (1.4)hours total were spent in standing, 3.8 (1.7)hours in sitting, and 0.8 (0.4)hours in locomotion. Forty-nine flexions were recorded on average per session, most identified as short term (<30s) within low range (0°-20°). Lumbar movement patterns differed among professions. Thirty-seven (31%) participants reported a history of lower back injury, and 57 (47%) reported low back pain at the end of their workday. This study provides an insight into allied health professionals' back movement in a hospital or community-based health care setting. These data may inform those who make return to work recommendations or provide rehabilitation services for allied health professionals working with a lower back injury.

Assessing spirometry competence through certification in community-based healthcare settings in Australia and New Zealand: A position paper of the Australian and New Zealand Society of Respiratory Science.

Spirometry has been established as an essential test for diagnosing and monitoring respiratory disease, particularly asthma and COPD, as well as in occupational health surveillance. In Australia and New Zealand, there is currently no pathway for spirometry operators in community-based healthcare settings to demonstrate spirometry competence. The Australia and New Zealand Society of Respiratory Science (ANZSRS) has identified a need for developing a pathway for operators working in community-based practices in Australia and New Zealand to demonstrate spirometry competence and certification. Spirometry certification provides evidence to patients, clients, employers and organizations that an individual has participated in an assessment process that qualifies them to perform spirometry to current international spirometry standards set out by the American Thoracic Society and the European Respiratory Society (ATS/ERS). This document describes a competence assessment pathway that incorporates a portfolio and practical assessment. The completion of this pathway and the award of certification confer an individual is competent to perform spirometry for 3 years, after which re-certification is required. The adoption of this competency assessment and certification process by specialist organizations, and the commitment of operators performing spirometry to undergo this process, will enhance spirometry quality and practice in community-based healthcare settings.

Retrospective review of cesarean hysterectomy outcomes utilizing uterine intravascular interventions in a large, community-based healthcare setting

ObjectiveTo explore outcomes of women with planned cesarean hysterectomies, with or without use of internal iliac intravascular occlusive balloon catheter or uterine artery embolization (UAE). Study DesignWe retrospectively reviewed adult women who underwent a planned cesarean hysterectomy, 2004-2019. All planned cases were included, regardless of indication. Planned surgeries were divided into three groups: balloon placement, UAE, or no intervention. Patients with balloon placement were further subdivided into: balloons placed but not deployed or balloons placed and deployed intraoperatively. Hemorrhage was defined as estimated blood loss (EBL) ≥1,500 mL. An adverse outcome was defined as one or more of the following: intensive care unit admission, thromboembolism, ureteral stent placement, amputation, or reoperation. Basic descriptive and inferential statistics were used to explore differences among groups and adverse outcomes. ResultsA total of 34 patients underwent planned cesarean hysterectomy. Ten patients (29.4%) had balloons placed, nine (26.5%) had UAE, and 15 (44.1%) had no intervention. Risk of hemorrhage was clinically higher among those with balloon placement (80% vs. 33% UAE vs. 60% no intervention; P = 0.14), with mean EBL (3,605.0 mL vs. 1,488.9 mL vs. 2,289.3 mL; P = 0.05) and mean transfusion requirements (9.3 units vs. 2.8 vs. 4.4; P = 0.01) being significantly higher. Adverse outcomes were also significantly higher among those with balloon placement (80.0% vs. 66.7% UAE vs. 20.0% no intervention; P ≤ 0.01). Of the ten patients with balloons placed, four were deployed. Among those with balloons placed and deployed, mean EBL (5,250.0 mL vs. 2,508.3 mL balloons placed but not deployed vs. 2,289.3 mL no intervention; P=0.04) and mean transfusion requirements (11 units vs. 7.5 units balloons placed but not deployed vs. 4.4 units no intervention; P = 0.05) were significantly higher. Adverse outcomes were also significantly higher among those who had balloons placed and deployed (100.0% vs. 66.7% balloons placed but not deployed vs. 20.0% no intervention; P ≤ 0.01). ConclusionsBalloon placement, regardless of deployment, may not be beneficial to women undergoing a planned cesarean hysterectomy. Although UAE was also associated with adverse outcomes, it may be a better option for reducing intraoperative blood loss among patients with a planned cesarean hysterectomy.

Early Symptoms of Patients With COVID-19 in Family Medicine Centers in South India: A Retrospective Study

Introduction: A recent Cochrane review on the diagnostic accuracy of initial signs and symptoms of COVID-19 reported on the lack of evidence from studies conducted in community-based health-care settings. Since a broad spectrum of patients present to primary health-care services, testing for patients with noninfluenza-like illness and atypical presentations is debatable. Hence, there is an urgent need for documenting the early presenting symptoms of COVID-19 among patients seeking medical care in primary health-care settings. Aim: In this study, we aim to document the early symptoms of patients with COVID-19 and the proportion of asymptomatic infection in family medicine centers in South India. Design: This is a retrospective study of the early symptoms of patients who tested positive between June and December 2020. The data and clinical notes of patients were retrieved from the hospital information system. Setting: This study was undertaken by the Department of Family Medicine (DFM) in a private not-for-profit academic institution in South India. The DFM provides primary and secondary health-care services to nearly 1,50,000 patients from the local urban communities. Results: A total of 330 patients were tested for COVID-19 and the study included 94 patients who tested positive. Around 37% participants were asymptomatic. The commonest symptom was fever (58.6%), followed by tiredness/myalgia (48.3%), loss of taste or smell or appetite (43.1%), and cough or cold (37.9%). Most participants (78.2%) were hospitalized and the rest (21.8%) were home-quarantined. Only 5 (5.7%) of them died due to COVID-19 infection. Conclusion: The results of the study reiterates the role of social distancing, self-isolation, proper masking, and greater vaccination coverage as significant public health interventions.

'I had to tell my GP I had lung cancer': patient perspectives of hospital- and community-based lung cancer care.

Lung cancer care spans both hospital- and community-based healthcare settings, and suboptimal communication between healthcare providers impacts on continuity and quality of care. Patients' experiences regarding: (1) communication between healthcare providers; and (2) the role of their GP during cancer treatment was explored in interviews with 47 Western Australian lung cancer patients. Thematic analysis using a phenomenological approach was undertaken to derive key themes regarding participant experiences. Poor communication between hospital cancer specialists (HCSs) influenced participants' treatment choices and perceptions of the quality of their care. Information provided by HCSs to GPs was often delayed or incomplete, and many participants perceived themselves as a messenger between healthcare settings. Participants' opinions about the GP role during cancer treatment ranged from 'no role' to an 'active member of the treating team'. A new model of cancer care is needed where the GP is considered part of the treating team. Early involvement of GPs and two-way communication between hospital and primary care during the disease continuum is required for this to occur.

Arrest and Trait Aggression Correlates of Emergency Department Use.

This study examined the associations between arrest and incarceration, trait aggression, and emergency department (ED) use. Data were collected from 525 clients who visited the Center for Behavioral Research and Services in Long Beach, CA, using the following instruments: Risk Behavior Assessment, Risk Behavior Follow-Up Assessment, the Aggression Questionnaire (AQ), the Displaced AQ, and the parole and Legal Status section of the Addiction Severity Index. The bivariate analysis suggested that ED use was significantly associated with trait aggression and trait-displaced aggression among those with a history of incarceration. In the logistic regression, weapons offenses, manslaughter/homicide, being male, and being Black were significantly associated with ED use. Identification and management of aggressive trait personality are important in improving the management of postrelease care in transition to clinical networks and community-based health care settings.