Community-based Referrals Research Articles

Digitizing community resources and closed-loop referral system to identify top sought health-related social needs (HRSN) in a community cancer center.

154 Background: Prior to implementation of a digital closed-loop referral system, community resources were not centralized, and knowledge of resources varied between clinic staff within a community cancer center treating patients throughout the Willamette Valley of Oregon. Referrals to community-based organizations (CBO) were found in the electronic health record as unstructured data and were difficult to track manually. As an organization, the medical care team needed to identify top sought HRSNs to better understand health equity needs in our community. Methods: 2023 Q1: Partnered with Findhelp, a social needs closed-loop referral platform. 2023 Q2-4: Attended Findhelp train-the-trainer education and began building a customized oncology database of local, regional, and national resources. Developed a process to log community-based referrals, update the referral status, and close the referral loop within Findhelp for individual patients. Educated and trained support services staff. 2024 Q1: Utilized Findhelp data analytics to review and evaluate closed-loop referral system and top sought HRSNs. Results: We describe our results to date (Table). Conclusions: Digitizing community resources and establishing a closed-loop referral process between the community cancer center and CBOs allowed accurate data tracking and increased access to data to ensure patients’ needs were met. After eight months, financial toxicity, housing insecurity, and food insecurity were identified as the top three sought HRSNs. In the future, increased data will help evaluate gaps in resources and leverage stronger relationships with CBOs to meet patients’ HRSNs in a community cancer center. Month % Closing the Referral Loop (patients with closed-loop referrals/total patient referrals) Top Sought HRSN Needs July 2023 74% (50/68) Help pay for healthcare August 2023 68% (51/75) Help pay for healthcare September 2023 80% (59/74) Housing October 2023 67% (66/98) Help pay for healthcare November 2023 78% (51/65) Food December 2023 86% (55/64) Support/Counseling January 2024 83% (52/63) Help pay for healthcare February 2024 65% (56/86) Food

Social prescribing for suicide prevention: a rapid review.

This rapid review delves into the realm of social prescribing as a novel approach to suicide prevention by addressing the social determinants of health. Through an exploration of various databases including MEDLINE, PsychInfo, WILEY, and Sage, a total of 3,063 articles were initially identified as potentially relevant to the research. Following a meticulous screening process, 13 articles were included in the final review, shedding light on the potential effectiveness and impact of social prescribing interventions on suicide prevention. Key findings indicate the need for additional monitoring and support for individuals at risk of suicide, emphasising warm referrals and sustained connections after referral to enhance the efficacy of social prescribing models. The review also highlights the importance of social capital and trust among vulnerable populations, underscoring the significance of community-based referrals in suicide prevention initiatives. Overall, this review identifies the potential of social prescribing as a valuable tool in mitigating suicide risk factors and promoting mental health and wellbeing in diverse populations.

Improved Detection of Fibrotic Nonalcoholic Fatty Liver Disease in Community-Based Referrals.

Background: Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease with increasing rates globally. Patients with type 2 diabetes mellitus have higher risk of developing NAFLD. Patients with a higher degree of liver fibrosis in NAFLD are at an increased risk for liver-related mortality, but get missed easily during the referral process. This project aims to improve early detection and linkage-to-care of fibrotic NAFLD patients. Methods: We utilized a combination of automated electronic health record (EHR)-based fibrosis (FIB)-4 score and directed provider education. A health-system wide FIB-4 score calculator that providers can easily add to their workflow for NAFLD patient triaging. Data were analyzed at 6 and 12 months after implementation. Results: Postimplementation, there was an increase in patients referred to hepatology with higher degree of liver fibrosis and decreased referral to hepatology with low risk of liver fibrosis, measured by FIB-4 score. At baseline, ∼55% of referred patient to hepatology had FIB-4 score <1.3 compared to 38% at 12 months postimplementation. There was an increase in referral of patients with FIB-4 scores >1.3 when compared to preinterventions, 62% versus 45%. This is most pronounced in patients with severe fibrotic disease with FIB-4 score >2.67, 30% versus 12%. Conclusions: Automated FIB-4 score in EHR can improve appropriate linkage-to-care for at-risk fibrotic NAFLD, especially when coupled with targeted provider education. The durability of such improvement is essential to study along with the need to increase broad acceptance across health systems.

Identifying Family and Unpaid Caregivers in Electronic Health Records: Descriptive Analysis.

BackgroundMost efforts to identify caregivers for research use passive approaches such as self-nomination. We describe an approach in which electronic health records (EHRs) can help identify, recruit, and increase diverse representations of family and other unpaid caregivers.ObjectiveFew health systems have implemented systematic processes for identifying caregivers. This study aimed to develop and evaluate an EHR-driven process for identifying veterans likely to have unpaid caregivers in a caregiver survey study. We additionally examined whether there were EHR-derived veteran characteristics associated with veterans having unpaid caregivers.MethodsWe selected EHR home- and community-based referrals suggestive of veterans’ need for supportive care from friends or family. We identified veterans with these referrals across the 8 US Department of Veteran Affairs medical centers enrolled in our study. Phone calls to a subset of these veterans confirmed whether they had a caregiver, specifically an unpaid caregiver. We calculated the screening contact rate for unpaid caregivers of veterans using attempted phone screening and for those who completed phone screening. The veteran characteristics from the EHR were compared across referral and screening groups using descriptive statistics, and logistic regression was used to compare the likelihood of having an unpaid caregiver among veterans who completed phone screening.ResultsDuring the study period, our EHR-driven process identified 12,212 veterans with home- and community-based referrals; 2134 (17.47%) veteran households were called for phone screening. Among the 2134 veterans called, 1367 (64.06%) answered the call, and 813 (38.1%) veterans had a caregiver based on self-report of the veteran, their caregiver, or another person in the household. The unpaid caregiver identification rate was 38.1% and 59.5% among those with an attempted phone screening and completed phone screening, respectively. Veterans had increased odds of having an unpaid caregiver if they were married (adjusted odds ratio [OR] 2.69, 95% CI 1.68-4.34), had respite care (adjusted OR 2.17, 95% CI 1.41-3.41), or had adult day health care (adjusted OR 3.69, 95% CI 1.60-10.00). Veterans with a dementia diagnosis (adjusted OR 1.37, 95% CI 1.00-1.89) or veteran-directed care referral (adjusted OR 1.95, 95% CI 0.97-4.20) were also suggestive of an association with having an unpaid caregiver.ConclusionsThe EHR-driven process to identify veterans likely to have unpaid caregivers is systematic and resource intensive. Approximately 60% (813/1367) of veterans who were successfully screened had unpaid caregivers. In the absence of discrete fields in the EHR, our EHR-driven process can be used to identify unpaid caregivers; however, incorporating caregiver identification fields into the EHR would support a more efficient and systematic identification of caregivers.Trial RegistrationClincalTrials.gov NCT03474380; https://clinicaltrials.gov/ct2/show/NCT03474380

Management of Dementia.

This article describes an approach to managing patients following a diagnosis of dementia, including medical management, nonpharmacologic strategies, safety interventions, caregiver support, mobilization of community resources, and advanced care planning. Dementia clinical syndromes are frequently caused by mixed pathologies, leading to varied clinical presentations that include memory loss, behavioral changes, communication challenges, safety concerns, and loss of independent function. Medications for treating dementia currently target cognitive and behavioral symptoms, although disease-modifying therapies for Alzheimer disease may be making their way into widespread clinical practice soon. Identification and treatment of co-occurring medical problems, such as obstructive sleep apnea, adverse medication effects, mood disorders, hearing loss, pain, alcohol misuse, and vascular risk factors, may mitigate the impact of these conditions on cognitive decline. Mobilization of clinical and community-based interprofessional teams will ensure that people with dementia and their care partners have the expertise, support, and access to resources they need. Addressing goals of care early in the disease course will allow people with dementia to contribute to their care plan by expressing their wishes. Developing a structured approach to treating common causes of dementia and related comorbid medical conditions, identifying a local network of interprofessional clinical and community-based referrals, and providing readily available educational resources will help clinicians provide quality dementia care management that extends beyond the clinic visit. Encouraging patients and families to engage in clinical research will advance the identification of effective therapies, preventive strategies, and quality care models for the future.

Incentives for mothers, health workers and \u201cboda\u2013boda\u201d riders to improve community-based referral process and deliveries in the rural community: a case of Busoga Region in Uganda

BackgroundThis study set out to investigate how incentives for mothers, health workers and boda–boda riders can improve the community-based referral process and deliveries in the rural community of Busoga region in Uganda. Both the monetary and non-monetary incentives have been instrumental in the improvement of deliveries at health centres.MethodsThe study was a 2 arm cluster non-randomized control trial study design; with intervention and control groups of mothers, health workers and boba–boda (commercial motor-cycle) riders from selected health centres and communities in Busoga region. Among the study interventions was the provision of incentives to mothers, health workers (midwives and VHTs) and boda–boda riders for a duration of 6 months. Monetary and non-monetary incentives were applied in this study, namely; provision of training, training allowances, refreshments during the training, payment of transport fares by mothers to boda–boda riders, free telephone calls through establishment of a pre-paid Closed Caller User Group (CUG) and provision of bonus airtime to all registered CUG participants and rewards to best performers. The study used a mixed methods design. Descriptive statistical analysis was computed using STATA version 14 for the quantitative data and thematic analysis for qualitative data.ResultsFindings revealed that incentives improved community-based referrals and health facility deliveries in the rural community of Busoga. The proportion of mothers who delivered from health centres and used boda–boda transport were 70.5% in the intervention arm and only 51.2% in the control arm. Of the mothers who delivered from the health centres, majority (69.4%) were transported by trained boda–boda riders while only 30.6% were transported by un-trained boda–boda riders. And of the mothers transported by the boda boda riders, 21.3% in the intervention arm reported that the riders responded to their calls within 20 min, an improvement from 4.3% before the intervention. Mothers who were responded to between 21–30 min increased from 31.4% to 69.6% in the intervention arm while in the control arm, it only increased from 37.1% to a dismal 40.3%. Interestingly, as the time interval increased, the number of boda–boda riders who delayed to respond to mothers’ calls reduced. In the intervention arm, only 6.2% of the mothers stated that boda–boda riders took as many as 31–60 min’ time interval to respond to their calls in post intervention compared to a whopping 54.9% in the pre intervention time. There was little change in the control arm from 53.2% in the pre intervention to 41.2% in the post intervention.ConclusionIncentives along the maternal health chain are key and the initiative of incentivising the categories of stakeholders (mothers, midwives, the VHTs and the boda–boda riders) has demonstrated that partnerships are very critical in achieving better maternal outcomes (health facility-based deliveries) as a result of proper referral processes.

Patient Characteristics Associated With Admission to Low-Safety Inpatient Psychiatric Facilities: Evidence for Racial Inequities.

The author examined patient demographic, clinical, payment, and geographic factors associated with admission to low-safety inpatient psychiatric facilities. Massachusetts all-payer 2017 discharge data (N=39,128 psychiatric patients) were linked to facility-level indicators of safety (N=38 facilities). A composite of safety was created by averaging standardized measures of restraint and seclusion as well as 5-year averages of overall, substantiated, and abuse-related (i.e., verbal, physical, or sexual) complaints per 1,000 discharges (α=0.73). This composite informed quintile groups of safety performance. A series of multinomial regression models were fit, with payment and geography added separately. Notable factors independently associated with admission to low-safety facilities were belonging to a racial or ethnic minority group compared with being a White patient (for non-Hispanic Black, relative risk ratio [RRR]=1.71, p<0.01; for non-Hispanic Asian, RRR=5.60, p<0.01; for non-Hispanic "other" race, RRR=2.17, p<0.01; and for Hispanic-Latinx, RRR=1.29, p<0.01) and not having private insurance (for self-pay or uninsured, RRR=2.40, p<0.01; for Medicaid, RRR=1.80, p<0.01; and for Medicare, RRR=1.31, p<0.01). To the best of the author's knowledge, this is the first study to examine differences in admission to low-safety inpatient psychiatric facilities. Even after accounting for potential clinical, geographic, and insurance mediators of structural racism, stark racial and ethnic inequities were found in admission to low-safety inpatient psychiatric facilities. In addition to addressing safety performance, policy makers should invest in gaining a better understanding of how differences in community-based referrals, mode of transport (e.g., police or self), and deliberate or unintentional steering and selection affect admissions and outcomes.

Effect of Training “Boda-boda” Riders on Community-Based Referrals for Maternal Outcome: A Case of Busoga Region, Uganda

Many pregnant mothers miss antenatal care attendance and health facility deliveries despite several interventions either due to knowledge gap on the benefits or lack of transport means to reach the health centre. Therefore, training of “boda-boda” (motor-cycle) riders in Busoga Region in Uganda was conducted to determine its effect on health facility-based deliveries. The study was a non-randomized control trial with intervention and control groups from selected health centers and communities in Busoga Region. Interventions included the training of boda-boda riders for 5 days to give them knowledge; with a six months follow-up to determine the impact of training. Questionnaires, interviews and focus group discussions were used to collect quantitative and qualitative data. Descriptive statistical analysis was computed for the quantitative data and thematic analysis for qualitative data. Findings revealed improved knowledge of boda-boda riders on maternal referrals from 49.1% to 79.0% in the intervention arm compared to 43.8% to 45.2% in the control arm. Use of boda-boda transport by mothers improved from 0% to 70.5% in the intervention arm compared to only 0% to 51.2% in the control arm. Also, of the 70.5% of the mothers who used boda-boda transport, 69.4% were transported by trained boda-boda riders and only 30.6% by un-trained boda-boda riders. Apart from age (p=0.000; CI=2.785 – 53.284) and ownership of the motorcycle (p=0.002; CI=0.992 – 8.658), the rest of the socio-demographic determinants of health facility-based deliveries were not statistically significant. Age of boda-boda riders (25–34 years, p=0.000) and ownership of the play a pivotal role in the improvement of health facility-based deliveries. Training of boda-boda riders and other key stakeholders impacted on the community based maternal referrals in the study area.

Social prescribing in a time of Covid‐19 and social isolation…

Social prescribing in a time of Covid‐19 and social isolation…

4025 Fall Risk Screening and Referrals to Community-Based Programs among Physical Therapy Professionals

OBJECTIVES/GOALS: To describe trends in fall risk screening and referrals to community-based programs among physical therapy professionals.To compare fall risk screening practices to clinical practice guidelines amongTo identify gaps in fall risk screening and referrals to community-based programs among physical therapy professionals.METHODS/STUDY POPULATION: A panel of experts between the American Physical Therapy Association (APTA) - Geriatrics, and the National Council on Aging (NCOA) developed a web-based survey to identify practices among physical therapy professionals (PTs) for fall risk screenings and community-based referrals for older adults. The web-based survey was disseminated to PTs via email, e-blasts, and social media. The survey focused on questions related to knowledge of fall risk screening tools, fall risk management for older adults, and knowledge of and referrals to community-based interventions. RESULTS/ANTICIPATED RESULTS: To date, 453 PTs representing 50 states completed the survey. The majority of PTs (50.9%) had over 20 years of experience in various settings. Eighty-three percent regularly screen older adults for fall risk. Approximately 40% conduct community-based screenings. The majority (81.3%) were somewhat to very familiar with the CDC-recommended STEADI (Stopping Elderly Accidents, Deaths, and Injuries) screening toolkit. Despite familiarity, only 32% responded to the question if they used STEADI for screening. Of those, 83.4% used the tool. The majority (73.4%) of PTs were aware that NCOA recommends evidence-based programs to address health needs of aging adults and 59.6% refer. PTs did not refer due to lack of knowledge that programs existed (21.3%) or lack of knowledge of availability (33.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: Although PTs are have some familiarity with the STEADI for fall risk screening, the tool is not common in practice. PTs are lacking awareness of local evidence-based community programs to address health needs of aging adults. Educational efforts should target these knowledge gaps and provide additional resources to improve referrals.

Financial incentives to Medicaid smokers for engaging tobacco quit line treatment: maximising return on investment

BackgroundLow-income smokers experience greater difficulty in quitting smoking than do other smokers. Providing financial incentives for treatment engagement increases smoking cessation success. This study models the cost-effectiveness of varying levels...

2870 Flexible Endoscopic Diverticultomy: Development of a Community-Based Referral Program and Ways to Improve Efficiency and Outcomes

INTRODUCTION: Until recently Flexible endoscopic diverticulotomy (FED) has not gained momentum among GI endoscopists in USA due to a variety of reasons including new skill set, referral patterns, procedural risks and complexity. Thus far it has been limited to select university hospitals, restricting its availability. We present a case series of FED performed in our community hospital system. METHODS: Retrospective review was performed from the start of the FED program over 3 months in 2018. We established a new multi-disciplinary Advanced GERD &amp; Esophageal Services (PAGES) program through which patients were reviewed and selected. All were performed by a single interventional ESD (endoscopic submucosal dissection) trained endoscopist. RESULTS: Mean age 69yrs; mean Eckardt score (EDS) 5. Prominent symptoms were dysphagia and weight loss. Diagnosis was established by imaging or EGD. ESD knives were used. Clips were placed on the diverticular base. The thickness and length of the cricopharyngeal bar varied from 0.7- 3 cm (mean: 1.8) and 3- 5 cm (mean: 3.6) respectively. Total operative time depended on the length of the septum, thickness, the type of knife used and varied from 25-168 min (mean:62). The transition from other ESD knives to scissor type knives reduced our operative time by 50% (168 down to 40min) (Table 1). Patients were discharged home 6 hrs post-procedure. A routine predischarge esophagogram was obtained to document complete excision of cricopharyngeal bar. One case of intraoperative bleeding was controlled using a coagrasper. No blood transfusions or second endoscopic procedures were required to control bleeding. One patient was readmitted within 24 hrs of discharge for control of N/V. The success of the procedure was measured using 4 week post-operative EDS. Three of five patients achieved complete symptom resolution at week 1. Two patients had occasional dysphagia (EDS:1) and regurgitation (EDS:1) respectively. All were symptom free at the end of week 4 (EDS: 0 -1) (Table 2). CONCLUSION: Transoral FED gives the gastroenterologists the opportunity to be the forerunners in managing ZD. The vast majority of these patients present to GI physicians with a complaint of dysphagia. The development of the multi-disciplinary program to identify and triage patients, scissor type ESD knife, and a fellowship trained advanced endoscopist are the recipe to success for a tertiary community program.

Improving Access to Care Through Community Engagement: Zambian Case

Background and context: Zambia has total population of 16,405,229, life expectancy at birth is 53.3% and HIV prevalence rate is 13.3%. Though established in November 1977, the Zambia National Cancer Registry was only enhanced in 2015 leading to the publication of the 2008-2012 report. The overall age-standardized cancer incidence rate for both sexes in 2012 was 136.2 per 100,000 for all cancers, mortality rate was 104.9 per 100,000 71% these being new cancer cases due to patients presenting late with advanced disease. Aim: Increasing awareness and access to cancer care services within the existing health care and community-based systems in addressing the barriers to accessing care. Strategy/Tactics: Designed village-based screening program to provide services to the women in rural and hard to reach areas. Formulate a multisectoral approach engagement of the Ministry of Chiefs and Traditional Affairs (MOCTA) and Ministry of Local Government and Ministry of Education Formulated a VBS national roadmap based on: National Cancer Register Report (2012) and national geographical mapping of breast and cervical cancer clinics. Program/Policy process: Developed and signed a memorandum of understanding with Ministry of Chiefs and Traditional Affairs (MOCTA). Outcomes: Community engagement enabled easy flow of communication to all key stakeholders on the upcoming VBS activities within their area at all levels. Enabled easy acceptance of health education meetings by all key stakeholders to seek leadership buying and support, share VBS objectives and strategic planning of a successful community-based screening program in their area. Community awareness process: training/orientation: community health care workers (CHW) are trained on key messages on breast and cervical cancer and community-based referrals to health centers. Community sensitization: conducted by trained CHW and program staff through: PA announcing, one-to-one and focused group discussions. Developed referral systems: community based: trained community health care workers sensitize clients, clients who accepts to undergo screening are referred to the nearest screening clinic. Clinic based: trained health care workers screen clients those with positive findings are referred. Breast cancer screening: referred to the provincial hospital. Cervical cancer screening: eligible treated. Not eligible referred for further investigation (LEEP/biopsy) to the provincial hospital. What was learned: Engagement of key community stakeholders, multisectoral approach, strategic scale up of breast and cervical cancer services (HR, diagnostic equipment, pathology), standardized referrals systems at all levels (community, district and provincial), strategic continuous health promotion activities and advocacy, implementation of National Cancer Control Strategic Plan, monitoring and evaluation.

Perceptions of exercise screening among older adults.

Prephysical activity screening is important for older adults' participating in physical activity. Unfortunately, many older adults face barriers to exercise participation and thus, may not complete proper physical activity screening. The purpose of this project was to conduct a thematic analysis of perceptions and experiences of community-dwelling older adults regarding prephysical activity screening (i.e., Get Active Questionnaire (GAQ) and a standardized exercise stress test). A convenience sample of adults (male n = 58, female n = 54) aged 75 ± 7 years living in the City of London, Ontario, Canada, was used. Participants completed a treadmill stress test and the GAQ at a research laboratory for community-based referrals. One week later, participants completed the GAQ again and were asked questions by a research assistant about their perceptions of the screening process. Thematic analysis of the responses was conducted. The results indicated that older adults view physical activity screening as acceptable, but not always necessary. Also, the experiences expressed by this sample of older adults indicated that physical activity screening can contribute to continued confidence (through reassurance) and can contribute to increased motivation (through yearly fitness results) in exercise participation. In conclusion, older adults may perceive screening as supportive in exercise adoption, if screening is simple, convenient, and supports older adults' motivation and confidence to exercise.

Social prescribing: community-based referral in public health.

Social prescribing is a term used with increasing frequency to describe the process of enabling healthcare professionals to refer patients to a link worker, to co-design a non-clinical social prescription to improve their health and wellbeing.1 Original descriptions of social prescribing involved three components to a scheme: a referral from a healthcare professional, a consultation with a link worker and an agreed referral into the third sector.2–4 Social prescribing has developed to incorporate referrals into the arts, the natural environment, reading on prescription schemes and schemes to support health behaviour changes especially for long-term conditions. Other social prescribing schemes work to develop community cohesion such as time-banking, or address the social determinants of health by providing support for welfare, debt advice, housing and employment. In recent years, social prescribing has emerged as a strategy for tackling health inequities through partnerships between primary care and third sector organisations, and augmenting standard health and social care services. In practice, social prescribing provides an architecture to allow a person to move between professional sectors into their community; this was recently recognised in the General Practice Forward View which listed social prescribing as one of the 10 high-impact actions.5 Social prescribing is, therefore, able to address physiological, physical, psychological, psychosocial or socioeconomic issues, as well as enhancing community wellbeing and social inclusion.

Proactive tobacco cessation outreach to smokers of low socioeconomic status: a randomized clinical trial.

Widening socioeconomic disparities in mortality in the United States are largely explained by slower declines in tobacco use among smokers of low socioeconomic status (SES) than among those of higher SES, which points to the need for targeted tobacco cessation interventions. Documentation of smoking status in electronic health records (EHRs) provides the tools for health systems to proactively offer tobacco treatment to socioeconomically disadvantaged smokers. To evaluate a proactive tobacco cessation strategy that addresses sociocontextual mediators of tobacco use for low-SES smokers. This prospective, randomized clinical trial included low-SES adult smokers who described their race and/or ethnicity as black, Hispanic, or white and received primary care at 1 of 13 practices in the greater Boston area (intervention group, n = 399; control group, n = 308). We analyzed EHRs to identify potentially eligible participants and then used interactive voice response (IVR) techniques to reach out to them. Consenting patients were randomized to either receive usual care from their own health care team or enter an intervention program that included (1) telephone-based motivational counseling, (2) free nicotine replacement therapy (NRT) for 6 weeks, (3) access to community-based referrals to address sociocontextual mediators of tobacco use, and (4) integration of all these components into their normal health care through the EHR system. Self-reported past-7-day tobacco abstinence 9 months after randomization ("quitting"), assessed by automated caller or blinded study staff. The intervention group had a higher quit rate than the usual care group (17.8% vs 8.1%; odds ratio, 2.5; 95% CI, 1.5-4.0; number needed to treat, 10). We examined whether use of intervention components was associated with quitting among individuals in the intervention group: individuals who participated in the telephone counseling were more likely to quit than those who did not (21.2% vs 10.4%; P < .001). There was no difference in quitting by use of NRT. Quitting did not differ by a request for a community referral, but individuals who used their referral were more likely to quit than those who did not (43.6% vs 15.3%; P < .001). Proactive, IVR-facilitated outreach enables engagement with low-SES smokers. Providing counseling, NRT, and access to community-based resources to address sociocontextual mediators among smokers reached in this setting is effective. clinicaltrials.gov Identifier: NCT01156610.

Evaluation of a hospital-based cancer information and support centre

Although information seeking is encouraged by health care professionals as a positive coping strategy evidence suggests information needs of those affected by cancer are not always fully met. In response to the need for novel models of information provision and educational support for people affected by cancer, a hospital-based cancer information and support centre (CISC) was introduced into a tertiary cancer hospital. Professional support is provided by a cancer support nurse (CSN) with the clinical experience of working with cancer patients, whilst peer support is provided by volunteers. A survey was developed to ascertain the perceptions and experiences of consumers (users) of a hospital-based CISC. The aim was to understand what information and support patients and families consider important and helpful in order to develop the service to reflect the needs of its users. During a 12-month period 111 surveys were distributed to users of the centre. Sixty-nine surveys were returned (62.1%). Nearly all visits were motivated by the need to access (58/84.0%) information, indicating an unmet or changing need. The CSN initiated referrals to support services, both internal and community based, for 21 (53.9%) participants with whom there was contact. Contact with the CISC volunteers also resulted in internal or community-based referrals for 15 (32.6%) of participants. Of note, half of the participants (35/50.7%) reported seeking additional information from the internet as a consequence of having visited the CISC and/or having contact with the CSN or volunteer, in contrast to the six (8.7%) who had reported internet use for information prior to their first visit. Participants indicated a desire for the service to provide additional support to enhance self-care capacity and to do so alongside other people affected by cancer. Our study results support the capacity of a hospital-based CISC to provide a highly valued service that can broaden information options and meet changing information and support needs of people affected by cancer in an ongoing capacity. An experienced, qualified CSN in this setting is ideally positioned to screen for unmet information and support needs and deliver tailored education to support both inpatient and ambulatory care services. Information prescriptions have the potential to provide a 'directed information seeking approach' to those who visit a CISC. Through the use of information technology there is scope to develop information and support that expands beyond pamphlets and booklets.

Identifying adolescents at risk through voluntary school-based mental health screening

This study compares referrals for mental health services among high school students randomized to two means of referral to mental health services: referral via systematic identification through a brief mental health screening procedure (n = 365) or referral via the usual process of identification by school personnel, parents, or students themselves (n = 291). Screened students were significantly more likely than control students (AOR: 21.64 95%CI 6.66–70.36) to receive a referral for mental health services, whether it be to school-based services (AOR: 11.68 95%CI 3.52–8.73) or community-based services (AOR: 20.02 95%CI 2.66–150.41). Post-study, for those screened, 95.5% of school-based mental health services referrals, and 39.3% of community-based referrals were accessed. School based mental health screening identified a significantly greater proportion of youth to be in clinical need of mental health services than would have likely been identified without screening, and increased rates of referral resulted in greater access to mental health services.

Prevalence of Intimate Partner Violence Among an Abortion Clinic Population

In this cross-sectional, clinic-based study, we estimated 1-year prevalence of intimate partner violence among 986 patients who had elective abortions. We assessed physical, sexual, and battering intimate partner violence via self-administered, computer-based questionnaires. Overall, physical and sexual intimate partner violence prevalence was 9.9% and 2.5%, respectively; 8.4% of those in a current relationship reported battering. Former partners perpetrated more physical and sexual assaults than did current partners. Violence severity increased with frequency. Abortion patients experience high intimate partner violence rates, indicating the need for targeted screening and community-based referral.

Community-based care of children with HIV in Potchefstroom, South Africa

Children contract HIV infection largely through vertical transmission and are vulnerable to AIDS illness due to an immature immune system. In South Africa, hospitals are often overburdened and thus children with HIV may be directed to the community for care. As a result, non-professional caregivers are a predominant source of care for children living with HIV. Various authors, including the Department of Health, have stipulated the importance of establishing the knowledge and needs of non-professional caregivers of children with HIV. Our research has investigated the extent of non-professional caregivers' knowledge and needs, specifically those within the Potchefstroom district of the North-West Province. The objectives included formulating guidelines for a training programme that can enhance relevant knowledge and skills among these caregivers. Quantitative data were gathered using a questionnaire, which was developed following a literature study. The 109 non-professional caregivers who responded to the questionnaire displayed some knowledge and skills concerning specifically the care of children with HIV or AIDS, although gaps existed concerning their knowledge of community-based referral, caring needs specific to children, and precautionary measures to prevent HIV transmission. Recommendations are made with specific reference to a training programme. We surmise that non-professional caregivers play a pivotal role in the care of children with HIV in the Potchefstroom district — a service that is sometimes rendered in perilous conditions. This study improves our understanding of the support and training needed for non-professional caregivers in their pursuit to care for children with HIV in resource-limited communities, and thus it contributes to the field of nursing science. The findings may generate ideas for future research on this important topic.