Community Health Care Centers Research Articles

Integrated institutional care based on comprehensive assessment – a case study of Yanda Long-term Care Centre in China

Introduction: Long-term elderly care institutions in China usually solely provide care for daily living to the residents. In response to the multiple needs of the elderly and the policies of integrating health and care by the government, some elderly care institutions started exploring new care models.Yanda Long-term Care Centre is a private institution with more than 5000 beds participating in the interRAI initiative in China. Partnering with a built-in community health care center, it explored integrated institutional care based on interRAI assessment.
 Practice change implemented: The Centre has established a service model of ""integrated multidisciplinary care based on comprehensive assessment"" to provide integrated health and social care for the elderly. The main concept of the model is to provide comprehensive and effective care through care management and multi-professional teamwork. This care model started its official operation in 2010 and the development is ongoing.
 Targeted population and stakeholders:The targeted population is all residents in the center especially those with disability or other chronic conditions. Key stakeholders include the management team of the facility, the case managers, the multi-disciplinary care team, the interRAI company in China and the residents’ families. 
 Highlights
 
 Yanda Long-term Care Centre adopted a three-tier assessment model. A basic ADL assessment was conducted as initial screening, with disabled residents entering into the next comprehensive assessment which used Long Term Care Facility Assessment Scale (InterRAI-LTCF) as the tool. Specialist assessment scales measuring functional, cognitive, nutritional, spiritual and other dimensions will be employed for specific conditions, such as mini nutritional assessment (MNA), Braden scale for predicting pressure score risk etc.
 The case managers are responsible for assessing the needs of the elderly and the quality of long-term care services, developing and guiding the implementation of integrated long-term care plans, integrating care resources.
 Multi-disciplinary care team supported by the built-in community health center，include physician, nurse, therapist, nutritionist, pharmacist, physical and occupational therapist , social worker and so on. They provide comprehensive services, including medical, nursing and rehabilitation services, health management upon needed.
 
 
 Comments on sustainability and transfer-ability: The service model could be sustainable if the current management team of the facility remains stable. The service procedures, assessment methods, case management and multidisciplinary team formation based on the built-in health care center all provide valuable experiences for other elderly care facilities to learn and practice in China.
 Discussion: Despite progress made, there are still some barriers, including the lack of training systems for professional assessors, underdevelopment of the insurance system for integrated long-term care services.
 Conclusion: The model develops individualised service plans based on comprehensive assessment and establishes a case management system, providing integrated interventions and services to high-needs residents. It reduces the incidence of risk, improves residents’ quality of life and acquires high satisfaction from both residents and their families. Attention should be given to a more standardised implementation pathway for comprehensive assessment, cultivation of professional talents and further development of financing and payment systems for integrated long-term care services.
 

The Effects of Diabetes and Being Overweight on Patients with Post-COVID-19 Syndrome.

In the aftermath of the COVID-19 pandemic, post-COVID-19 syndrome (PCS) remains a challenge and may continue to pose a major health problem in the future. Moreover, the influences of type 2 diabetes and being overweight on PCS remain unclear. This study aimed to assess these influences. We performed an observational study from October 2020 to July 2022, which included 466 patients (269 males and 197 females) with a median age of 65. They were hospitalized due to COVID-19 pneumonia and had persistent symptoms after 1 month of COVID-19 infection. The patients were divided into four groups according to the study objectives: patients with type 2 diabetes, overweight patients, overweight patients with type 2 diabetes, and average-weight patients without type 2 diabetes. The clinical and demographic data collected during hospitalization and regular visits to the Community Healthcare Center dr. Adolf Drolc Maribor were analyzed. Our results showed that type 2 diabetes patients had more difficult courses of treatment and longer hospitalizations. Moreover, more type 2 diabetes patients underwent rehabilitation than the other study groups. The prevailing symptoms of our patients with PCS were dyspnea and fatigue, mostly among female patients with type 2 diabetes. Our study also showed that more women with type 2 diabetes and overweight women with type 2 diabetes suffered from secondary infections. Furthermore, more overweight patients were treated in the intensive care unit than patients from the other groups. However, our study showed an interesting result: patients with type 2 diabetes had the shortest PCS durations. Type 2 diabetes and being overweight are risk factors for PCS onset and prolonged duration. Therefore, our data that revealed a shorter duration of PCS in type 2 diabetes patients than the other investigated groups was unexpected. We believe that answering the questions arising from our unexpected results will improve PCS treatment in general.

Development of a Quality Assessment Tool for Hypertension Management by Public Healthcare Providers: A Cross-Sectional Survey

Purpose: This study aimed to develop and assess the validity of a quality assessment tool for hypertension management (QAT-HTN), to evaluate the quality of hypertension management by public healthcare providers working in community healthcare centers. Methods: The QAT-HTN was distributed to 528 patients with HTN. The construct validity (exploratory and confirmatory factor analyses), internal consistency reliability, and concurrent validity of the QAT-HTN were evaluated. Results: A six-subscale measurement model of the QAT-HTN involving blood pressure (BP) control, regular checkups and medicine education, complication prevention and assessment, BP measurement, and lifestyle management was validated using exploratory and confirmatory factor analyses. Concurrent validity was evaluated based on correlations with HTN self-care behavior. The Cronbach’s ⍺ coefficient for internal consistency was .92. Conclusion: The QAT-HTN was found to be a reliable and valid measure of the quality of HTN management in Korean community healthcare centers.

Fecal carriage of extended-spectrum β-lactamase-producing enterobacterales from hospitals and community settings in Gaza Strip, Palestine

BackgroundThe fecal carriage of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) is a major driver of the global spread of these antibiotic resistance determinants. Here we determined the rate of fecal ESBL-PE carriage in pediatric hospitals and community-serving healthcare centers serving adults and children in the Gaza Strip, Palestine.MethodsA total of 373 fecal and rectal samples were collected from different hospitals and clinics in Gaza. The antibiotic susceptibility was determined using the disk diffusion method and interpreted according to CLSI guidelines. The bacterial isolates were tested for ESBL production using phenotypic methods (double disk synergy test and growth on selective chromogenic media). BlaCTX−M, blaSHV, and blaTEM genes were sought by PCR.ResultsOut of the 373 isolates tested, 138 (37%) were considered ESBL positive as revealed by phenotypic tests. The prevalence of ESBLs among hospitalized patients was 39.1% (hospital setting) whereas, among outpatients attending community healthcare centers, it was 35.1% (community setting). ESBL production among Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, Proteus mirabilis, and Klebsiella aerogenes isolates was 52.8%, 39.1%, 26.7%, 2.8%, and 2.1% respectively. Meropenem and amikacin were the most effective antibiotics against ESBL producers (68.9% and 73.6% susceptibility, respectively), while only 15.2%, 22.5%, and 24.6% remained susceptible to ceftazidime, cefotaxime, and ceftriaxone, respectively. Out of 138 phenotypically ESBL-positive isolates, 98 randomly chosen were screened for blaCTX−M, blaTEM, and blaSHV genes. The prevalence rate of blaCTX−M was 45.9%, while blaTEM and blaSHV genes were detected in 16.8% and 5.2% of CTX-M-negative isolates (corresponding mostly for K. pneumoniae isolates in the case of SHV-PCR), respectively.ConclusionsThe study revealed an alarmingly high prevalence of fecal carriage of ESBL-producing Enterobacterales among hospitalized children but also in the community of the Gaza Strip. In addition, 30% of ESBL-producers were already resistant to carbapenems, the treatment of choice of infections with ESBL-producers.

SOURCE, a learned resourcefulness program to reduce caregiver burden and improve quality of life for older family caregivers

AbstractBackgroundFamily members often undertake caregiving responsibilities over long periods of time, which could lead to caregiving burden. A theory‐based and culturally sensitive learned resourcefulness program may help family caregivers mitigate stress by learning and using self‐help strategies.ObjectivesThis study's aim is to use rigorous methods to investigate the effects of a learned resourcefulness program called SOURCE (Chen et al., Geriatric Nursing, 2021, 45, 1129) to reduce caregiver burden and improve quality of life (QOL) for family caregivers. SOURCE is an acronym for the six self‐help behaviors at the core of this theory‐based learned resourcefulness program, developed by the Principal Investigator (PI) in collaboration with other researchers (Chen et al., Geriatric Nursing, 2021, 45, 1129). These behaviors are: seeking problem‐solving strategies, organizing daily actions, using self‐regulation, reframing positive situations, changing negative self‐thinking, and exploring new thinking and skills.MethodsWe used a quasi‐experimental design with repeated measures for this study. The potential subjects were family caregivers whose family member was receiving home care. PI recruited 94 family caregivers (60 years old or older) who were caring for disabled and/or ill family members who also were 60 years old or older and living at home at the time of the study. The PI recruited these caregivers through the home care services department of a hospital and two community healthcare centers in Taiwan. The experimental group (n = 46) received the four‐week in‐person SOURCE while their family member continued to receive home care services, whereas the control group (n = 48) did not receive the SOURCE program while their family member received home care services. We collected data from the participants using the Caregiver Burden Scale, EuroQol‐5 Dimension, and Rosenbaum's Self‐Control Scale at baseline (T0, Week 1), after the intervention (T1, Week 5), and at follow‐up (T2, Week 9). We analyzed the data using paired‐sample t‐tests and used the generalized estimating equation method to compare paired data between the baseline and follow‐up.ResultsOf the 94 recruited family caregivers, 90.4% (n = 85) completed the study. We found no significant differences between the experimental and control groups in terms of demographic, caregiver burden, and QOL variables at baseline. Compared to the control group, the experimental group had significantly improved caregiver burden scores (indicating a reduction in caregiver burden) at the end of the intervention and at follow‐up. The experimental group had significantly improved QOL scores at follow‐up only. The experimental group also showed high levels of adherence to and satisfaction with the intervention. The paired‐sample t‐test results show significantly improved learned resourcefulness between T0 and T1 and between T0 and T2 (t = −5.84, p < 0.001; t = −6.77, p < 0.001) for the experimental group.ConclusionThe SOURCE program helped family caregivers develop and use self‐help behaviors during their daily caregiving tasks. The family caregivers reported satisfaction with the program as well as reduced caregiver burden and improved QOL after the program ended.Implications for practiceThe SOURCE program can be implemented to improve family caregivers' caregiver burden and QOL. Community health nurses can improve self‐help abilities of family caregivers by helping them to acquire abilities and skills that allow them to effectively handle stress and reduce their caregiver burden.

Abstract 14018: Prevalence of Cardiac Arrhythmias in Transgender and Nonbinary Adult Community Health Center Patients

Background: Sex differences in cardiac arrhythmias are well-established and partly attributed to sex hormones. Aim: We aimed to explore the prevalence of arrhythmias in transgender and nonbinary ( TGNB ) adults. Methods: This cross-sectional study utilized patient electronic medical records from a single community healthcare center specializing in TGNB care. Adults aged ≥18 years with ≥2 medical visits between January 1, 2010, and December 31, 2021, were categorized into self-reported gender groups as TGNB (transgender man[TGM], transgender woman[TGW], nonbinary-assigned male at birth, nonbinary-assigned female at birth) and cisgender (cisgender man[CisM] or cisgender woman[CisW]). We categorized arrhythmias as atrial, ventricular, or other. Descriptive statistics characterized the prevalence of arrhythmias by gender group. Age- and race-adjusted Firth-type logistic regression models compared TGNB patients to CisM and CisW. The prevalence of arrhythmias was also descriptively explored in nonbinary people and in TGNB people with a gender-affirming hormone therapy (GAHT) prescription. Results: Among 49,862 adults, 7121 (14%) identified as TGNB persons. Participants were young (median age 28 years-old) and prevalence of arrhythmias was low (0.7-1.4% in nonbinary persons, 1.4-1.5% in transgender persons). Adjusting for age and race, TGM and TGW had a similar risk of arrhythmias compared to CisM (TGW: OR=0.89 (0.63-1.24), p=0.52; TGM: OR=1.17 (0.82-1.62), p=0.37), but statistically significantly higher odds of arrhythmias compared to CisW (TGW: OR=1.65 (1.13-2.34), p=0.01; TGM: OR=2.15 (1.48-3.04), p<0.01). Prevalence of arrhythmias appeared similar among TGNB adults who used GAHT and those who did not (1.5% vs 1.9% in TGM, 1.2% vs 2.1% in TGW). Conclusion: Further research examining arrhythmias in TGNB patients and across gender minority subgroups is warranted, including longitudinal studies evaluating the potential impact of GAHT.

Prevalence and factors associated with anaemia among pregnant women attending antenatal care in a district hospital and its feeder community healthcare centre of the Limpopo Province, South Africa.

Pregnancy anaemia is a significant public health concern in South Africa (SA), particularly in rural areas, but little is known about its prevalence and risk factors in rural areas. The objective of the study was to determine the prevalence and identify risk factors of pregnancy anaemia in the public health facilities of Limpopo Province (LP), SA. A cross-sectional study was conducted among a consecutive sample of 211 pregnant women attending antenatal care at Seshego Hospital and its feeder health centre (May to June 2019). Anaemia was defined as haemoglobin (Hb) <11 g/dL and classified as mild (10-10.9 g/dL), moderate (7-9.9 g/dL) and severe anaemia (<7 g/dL). A multiple logistic regression analysis was used to identify predictors of anaemia. The mean age of the women was 28.4 ± 5.7 years (range from 18 to 41 years). Over half (52%) had secondary education, 65% were unmarried, 72% were unemployed, 34% were nulliparous, 15% were human immunodeficiency virus (HIV) infected and 67% were in the third trimester. The anaemia prevalence was 18.0% and was significantly associated with parity, HIV status and body mass index (BMI) in a multivariate logistic regression analysis. This study found that less than one-third of pregnant women were affected by anaemia, associated with parity, HIV infected and BMI. It is essential to promote routine screening for anaemia, health education and prompt treatment of infections to reduce this burden. In addition, further studies on risk factors for anaemia during pregnancy in both urban and rural communities should be conducted to strengthen these findings.

Mental Health Care Use by Ethnicity and Preferred Language in a National Cohort of Community Health Center Patients.

Disparities in U.S. mental health care by race and ethnicity have long been documented. The authors sought to compare specialty mental health service use among non-Hispanic White, English-preferring Hispanic, and Spanish-preferring Hispanic patients who accessed care in community health centers (CHCs). Retrospective electronic medical records data were extracted for patients ages ≥18 years who received care in 2012-2020 at a national CHC network. Zero-inflated Poisson regression models were used to estimate the likelihood of receiving mental health services, which was compared with expected annual rates of mental health service use. Of the 1,498,655 patients who received care at a CHC during the study, 14.4% (N=215,098) received any specialty mental health services. English- and Spanish-preferring Hispanic patients were less likely to have had a mental health visit (OR=0.69, 95% CI=0.61-0.77, and OR=0.65, 95% CI=0.54-0.78, respectively). Compared with non-Hispanic White patients, Spanish-preferring Hispanic patients had an estimated annualized rate of 0.59 (95% CI=0.46-0.76) mental health visits. Among patients who were likely to receive specialty mental health services, Spanish-preferring patients had a significantly lower rate of mental health care use. Although overall access to mental health care is improving, unequal access to recurring specialty mental health care remains among patients who do not prefer to use English.

Potential roles of gut microbiota in metal mixture and bone mineral density and osteoporosis risk association: an epidemiologic study in Wuhan.

Few studies have focused on the effects of multiple metal mixtures on bone health and the underlying mechanisms related to alterations in the gut microbiota. This study aimed to examine the potential roles of gut microbiota alterations in metal mixtures and their association with osteoporosis traits. Adults aged ≥ 55years were recruited from two community healthcare centers in Wuhan City during 2016-2019. The plasma concentrations of six metals (zinc, iron, selenium, lead, cadmium, and arsenic) were measured using an inductively coupled plasma mass spectrometer. The k-means clustering method was employed to explore the exposure profiles of metal mixtures for all participants. 16S rRNA gene sequencing was used to profile the gut microbiota of participants. Combining these results with those of our previous study, we identified overlapping taxa and evaluated their potential roles. A total of 806 participants (516 females), with an average age of 67.36years were included. The participants were grouped into three clusters using k-means clustering: Cluster 1 (n = 458), Cluster 2 (n = 199), and Cluster 3 (n = 149). The high-exposure group for iron, zinc, lead, and cadmium (Cluster 3) showed a negative association with lumbar spine 1-4 bone mineral density (BMD). A total of 201 individuals (121 females) underwent sequencing of the gut microbiota. Both alpha and beta diversities were statistically different among the three groups. Bacteroidaceae, Lachnospiraceae, Bifidobacteriaceae, Bacteroides, and Lachnospiraceae_incertae_sedis were identified as overlapping taxa associated with the metal mixtures and BMD. Interaction analysis revealed that Cluster 3 interacted with Bacteroidaceae/Bacteroides, resulting in a positive effect on LS1-4 BMD (β = 0.358g/cm2, 95% CI: 0.047 to 0.669, P = 0.025). Our findings indicate associations between multiple metal mixtures and BMD as well as gut microbiota alterations. Exploring the interaction between metal mixtures and the gut microbiota provides new perspectives for the precise prevention and treatment of osteoporosis.

Primary care physicians' work conditions and their confidence in managing multimorbidity: a quantitative analysis using Job Demands-Resources Model.

Multimorbidity is a global issue that presents complex challenges for physicians, patients, and health systems. However, there is a lack of research on the factors that influence physicians' confidence in managing multimorbidity within primary care settings, particularly regarding physicians' work conditions. Drawing on the Job Demands-Resources Model, this study aims to investigate the level of confidence among Chinese primary care physicians in managing multimorbidity and examine the predictors related to their confidence. Data were collected from 224 physicians working in 38 Community Healthcare Centres (CHCs) in Shanghai, Shenzhen, Tianjin, and Jinan, China. Work-family conflict (WFC) perceived organizational support (POS), self-directed learning (SDL), and burnout were measured. Physicians' confidence was assessed using a single item. Mediation effect analysis was conducted using the Baron and Kenny method. The results showed that the mean confidence score for physicians managing multimorbidity was 3.63 out of 5, only 20.10% rating their confidence level as 5. WFC negatively related physicians' confidence and POS positively related physicians' confidence in multimorbid diagnosis and treatment. Burnout fully mediated the relationship between WFC and physicians' confidence, and SDL partially mediated the relationship between POS and physicians' confidence. The confidence level of Chinese primary care physicians in managing multimorbidity needs improvement. To enhance physicians' confidence in managing multimorbid patients, CHCs in China should address WFC and burnout and promote POS and SDL.

Predictors of medicine redistribution at public healthcare facilities in King Cetshwayo District, KwaZulu-Natal, South Africa

BackgroundEffective pharmaceutical inventory management is essential for optimizing healthcare outcomes and supply chain performance. However, challenges such as stockouts, overstocking, and wastage can hinder this process. This study examines the interrelationships between overstocking, stockouts, and wastage in eight healthcare facilities in Northern KwaZulu-Natal, South Africa. It also explores the extent of these challenges and investigates the use of medicine redistribution as a strategy to address inventory management issues.MethodsA retrospective quantitative analysis was conducted using pharmacy inventory records from public healthcare facilities. Eight facilities, including hospitals and a community healthcare center in King Cetshwayo District, were purposively sampled. Linear regression analysis was used to examine the association between medicine redistribution as the outcome and the predictors - stockouts, overstocking, and wastage. Pearson’s correlation was utilized to evaluate associations between the predictors. Descriptive statistics were employed to quantify the levels and extent of overstocking, stockouts, and wastage related to expiry.ResultsThe study included eight healthcare facilities with pharmacy warehouses managed by pharmacists. A total of 392 medicines were analyzed (49 per facility). Stockouts affected 85.6% of medicines, while overstocking and expiry-related wastage impacted 50.6% and 15.2% of medicines, respectively. The most common stock-out medicines were salbutamol 200mcg inhalant (4.0%), paracetamol 500 mg tablets (3.5%), and azithromycin 500 mg tablets (3.3%). Overstocking, stock with short-dated expiry, and expired medicines explained 68% of redistribution transactions to other facilities (r² = 0.68). A moderate, statistically significant correlation was observed between overstocking and expiry-related wastage (r² = 0.47, p-value = 0.020). Stockouts had a weak correlation with redistribution, accounting for only 4.5% (p-value < 0.01). A weak correlation was found between stockouts and overstocking (r = 0.10), as well as between stockouts and expired medicines (r = -0.20).ConclusionThis study highlights significant challenges in inventory management, particularly regarding stockouts, overstocking, and expiry-related wastage in the evaluated healthcare facilities. Medicine redistribution emerged as a viable strategy to address these challenges. Improving inventory management practices and implementing targeted interventions are crucial for optimizing pharmaceutical supply chain performance and enhancing healthcare delivery outcomes in this setting.

Drug safety awareness and rational use of medicines among university students in greater Bandung: A cross-sectional survey

Background: In Indonesia, compliance to the rational use of medicines (RUM) was 47.08% in community healthcare centers, and so might the university students. Objectives: The study aims to evaluate students' knowledge and attitude toward the RUM and identify the correlation between these parameters and drug safety awareness. Method: A cross-sectional study used the online questionnaire among university students in Greater Bandung Area from March-April 2022. Spearman’s rank was carried out in correlation analysis between the parameters. Result: In 342 subjects, 54.1% of students have moderate knowledge of RUM and drug safety awareness (56.7%). However, 80.1% of students have a high attitude towards RUM. Attitude toward RUM formed a significant, weak, and unidirectional correlation with knowledge (r = 0.292) and so did with safety awareness (r = 0.345). Conclusion: Students have a positive attitude towards RUM while having moderate knowledge of RUM and drug safety awareness.

Factors associated with recommendation behaviors of four non-National Immunization Program vaccines: a cross-sectional survey among public health workers in China

BackgroundImmunization is a crucial preventive measure to safeguard children under five years old against a range of diseases. In China, the coverage rate of non-National Immunization Program (non-NIP) vaccines can be improved by leveraging the recommendation from public health workers. Hence, understanding the influencing factors of recommendation behaviors assume paramount importance. This study aims to investigate influencing factors of public health workers' recommendation behaviors towards non-NIP vaccines, with a particular emphasis on financial incentives.MethodsA cross-sectional survey was conducted using a multi-stage sampling method in 2019 from August to October. 627 public health workers were recruited from 148 community healthcare centers in ten provincial-level administrative divisions in China. An anonymous questionnaire was used to collect demographic information, attitudes towards vaccination, and recommendation behaviors towards non-NIP vaccines, including Haemophilus influenzae type b (Hib) vaccine, pneumococcal conjugate vaccine, varicella vaccine, and rotavirus vaccine. Descriptive analysis and multivariate logistic regression analysis were adopted in this study.ResultsOf the 610 public health workers with complete survey data, 53.8%, 57.4%, 84.1%, and 54.1% often recommended Hib vaccine, pneumococcal pneumonia vaccine (PCV), varicella vaccine, and rotavirus vaccine, respectively. Logistic regression revealed that gender (Hib vaccine: OR = 0.4, 95% CI: 0.2–0.8; PCV: OR = 0.4, 95% CI: 0.2–0.8; rotavirus vaccine: OR = 0.3, 95% CI: 0.2–0.6), financial incentives for non-NIP vaccination (Hib vaccine: OR = 1.9, 95% CI: 1.1–3.6; PCV: OR = 2.1, 95% CI: 1.1–3.9; rotavirus vaccine: OR = 2.0, 95% CI: 1.1–3.8) and perception of vaccine safety (Hib vaccine: OR = 2.7, 95% CI: 1.1–7.0; PCV: OR = 3.2, 95% CI: 1.2–8.0; rotavirus vaccine: OR = 3.0, 95% CI: 1.2–7.7) were associated with public health workers’ recommendation towards Hib vaccine, PCV and rotavirus vaccine.ConclusionsThe findings highlighted public health workers’ recommendation behaviors of non-NIP vaccines in China and revealed strong association between vaccine recommendation and financial incentives. This highlights the importance of financial incentives in public health workers’ recommendation toward non-NIP vaccines in China. Proper incentives are recommended for public health workers to encourage effective health promotion in immunization practices.Graphical

Reproductive care in community health centers: Multi-method evaluation of the Illinois Contraceptive Access Now (ICAN!) demonstration program

ObjectivesNearly one-third of low-income women of reproductive age in the U.S. receive care in federally qualified community health centers, but comprehensive reproductive care is not consistently provided. Illinois Contraceptive Access Now (ICAN!) is an initiative addressing the access gap to high-quality contraceptive care with a focus on normalizing reproductive health screening for patients in federally qualified community health centers (FQHCs). Study designThis multi-method program evaluation used the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, with retrospective and prospective data collection from three Illinois FQHCs who participated as Quality Hubs, and from a Community Advisory Board. We conducted descriptive analysis of patient surveys using the Person-Centered Contraceptive Counseling (PCCC) measure (n = 142); clinician and staff pre-and post-training surveys (n = 210); and Community Advisory Board surveys (n = 8) collecting quantitative and qualitative feedback. We ran logistic regression on claims data from 15- to 49-year-old patients identified as female at birth (n = 103,756). ResultsReach assessment showed patients receiving contraceptive or preconception care increased from 1063 per month in 2020 to 1236 per month in 2021 (16% increase), while general volume increased 2%. Effectiveness showed most patients (78%) described the quality of contraceptive counseling as “excellent” on the PCCC. Adoption assessment showed knowledge increases after clinical training on Modern Contraception (85% pre-training, 95% post-training) and Reproductive Justice (RJ) (58% pre-training, 70% post-training). Implementation assessment found that most Community Advisory Board members felt ICAN! was responsive to community needs. ConclusionsThe ICAN! demonstration year increased provider knowledge and volume of reproductive care at three Illinois FQHCs. ImplicationsContraceptive access initiatives that operationalize same day access to birth control methods while training FQHC providers on RJ and modern contraception, show promise on several measures. Early evidence from ICAN! indicates increased reproductive health service provision, as well as increases in provider knowledge of RJ and modern contraceptive care.

Impact of Health Insurance Patterns on Chronic Health Conditions Among Older Patients.

Patients have varying levels of chronic conditions and health insurance patterns as they become Medicare age-eligible. Understanding these dynamics will inform policies and reforms that direct capacity and resources for primary care clinics to care for these aging patients. This study 1) determined changes in chronic condition rates following Medicare age eligibility among patients with different insurance patterns and 2) estimated the number of chronically ill patients who remain inadequately insured post-Medicare eligibility among patients receiving care in community health centers. We used retrospective electronic health record data from 45,527 patients aged 62 to 68 from 990 community health centers in 25 states in 2014 to 2019. Insurance patterns (continuously insured, continuously uninsured, uninsured/discontinuously insured who gained insurance after age 65, lost insurance after age 65, discontinuously insured) and diagnosis of chronic conditions were defined at each visit pre- and post-Medicare eligibility. Difference-in-differences Poisson GEE models estimated changes of chronic condition rates by insurance groups pre- to post-Medicare age eligibility. Post-Medicare eligibility, 72% patients were continuously insured, 14% gained insurance; and 14% were uninsured or discontinuously insured. The prevalence of multimorbidity (≥2 chronic conditions) was 77%. Those who gained insurance had a significantly larger increase in the rate of documented chronic conditions from pre- to post-Medicare (DID: 1.06, 95%CI:1.05-1.07) compared with the continuously insured group. Post-Medicare age eligibility, a significant proportion of patients were diagnosed with new conditions leading to high burden of disease. One in 4 older adults continue to have inadequate health care coverage in their older age.

The Impact of Servant Leadership on Job Satisfaction and Turnover Intention Using Employee Engagement as a Mediating Variable at Community Health Care Centers in Bengkayang

Aims: Leadership in health care centers is crucial and it has been facing challenges. Servant leadership is a type of leadership application in the health care sector. This study aims to determine the impact of servant leadership on job satisfaction and turnover intention using employee engagement as a mediating variable.&#x0D; Study Design: Explanatory research&#x0D; Place and Duration of Study: The study was conducted in April 2023 to May 2023 at community health care centers in Bengkayang. The authors began by identifying phenomena and problems, assessing object- related problems, developing a conceptual framework, conducting interviews, and distributing questionnaires.&#x0D; Methodology: This study was done using a quantitative method. The data was collected through a questionnaire involving a total of 155 respondents using a targeted purposive sampling technique. The data was analyzed usingSEM – PLS (Stuctural Equation Model - Partial Least Square).&#x0D; Result: The servant leadership has a negative and significant impact on turnover intention and a positive and significant effect on job satisfaction. Meanwhile, the servant leadership also has a significant relationship with job satisfaction and turnover intention when mediated by employee engagement.&#x0D; Conclusion: The servant leadership has a direct or indirect relationship with job satisfaction and turnover intention.

General practitioner residents’ experiences and perceptions of outpatient training in primary care settings in China: a qualitative study

ObjectivesThe implementation of outpatient training in primary care settings is an essential part of residency training for general practitioner (GP) residents. However, limited research exists on their experiences and perceptions...

Characteristics Of Training Room Users And Adverse Events At A Community Healthcare Center

Characteristics Of Training Room Users And Adverse Events At A Community Healthcare Center

Better adherence to childhood Haemophilus influenzae type b vaccination with combination vaccines compared to single-antigen vaccines: Evidence from China.

The coverage of Haemophilus influenzae type b (Hib) vaccination remains suboptimal in China, and this study aimed to investigate the influencing factors of caregivers' Hib-containing vaccine choices and the association between combination vaccine use and adherence to Hib immunisation schedule among Chinese children. From August to October 2019, a cross-sectional survey was conducted in 148 community health care centres from ten provinces in China, which collected vaccination records from 5294 children aged 6-59 months. The children were categorised into three groups based on their Hib-containing vaccine receipt: unvaccinated group, monovalent vaccine group, and combination vaccine group. The outcome measures included: (1) receipt and choice of Hib-containing vaccines, and (2) completion of the three-dose schedule. Multinomial logistic regression was used to evaluate the influencing factors of Hib-containing vaccine receipt and choice, and logistic regression was adopted to investigate the associations between vaccine choice and schedule completion. Of the 5294 children, 19.53% received monovalent vaccines only, 22.59% received at least one dose of combination vaccines, and 57.88% were not vaccinated against Hib. The overall three-dose completion rate was 27.03%. The multinomial logistic (mlogit) regression findings indicated strong associations of socioeconomic status and Hib-containing vaccine supply with vaccination status. Multiple logistic regression among those who received at least one Hib-containing dose demonstrated a 3-fold increase in the likelihood of three-dose schedule completion by children who received any combination dose compared with those received single-antigen vaccines only (adjusted odds ratio (aOR) = 3.97 (95% CI = 3.14-5.03)). Findings from the current study provide a more comprehensive understanding of the strong relationship between combination vaccine receipt and completion outcomes. Facing the suboptimal Hib vaccination rate in China, the use of combination vaccines could help increase vaccination compliance, and appropriate government actions to reduce out-of-pocket burden of immunisation are encouraged to address inequities in vaccine choices.

Evaluating the Agreement between k-median and Latent Class Analysis for Clustering of Psychological Distress Prevalence

Introduction: Psychological distress (PD) is one of the most common mental disorders in the general population. Psychological distress is considered a public health priority due to its adverse effects on quality of life, health, performance, and productivity. It can also predict several serious mental illnesses, such as depressive disorder and anxiety. In this study, we intend to identify the behavioral pattern of PD in the population of 18 to 65 years old in Mashhad using two methods, K-median and Latent Class Analysis (LCA), and evaluate the agreement between the two methods.&#x0D; Methods: This cross-sectional study was performed on 38058 individuals referred to community health care centers in Mashhad of Iran in 2019. The information used in this study was extracted from Sina Electronic Health Record System (SinaEHR) database. A demographic information checklist and a 6-item Kessler psychological distress scale (K-6) were used for data collection. K-median and LCA were used for data analysis.&#x0D; Results: Out of 38058 participants, 49.3% were women, 86.1% were married, and 63.6% had a diploma and under diploma education. The LCA identified three patterns of PD in answering the items of the K-6 questionnaire, including severe PD (19.7%), low PD (36.7%), and no PD (43.5%). Three clusters were identified by the K-Median method: 1) severe PD (22.0%), 2) low PD (31.1%), and 3) and no PD (46.9%). The agreement between K-Median and LCA was kappa = 0.862.&#x0D; Conclusion: About 20% of people were classified as having severe PD. Both LCA and k-median methods can reasonably identify the latent pattern of PD with significant entropy, and there was almost complete agreement between the two methods in data clustering. Considering the advantages of the LCA, this method is recommended to identify the latent pattern of PD based on the k-6 questionnaire.