Community Health Centers Research Articles

Implementation and improvement of a routine suicidal ideation screening process for an ambulatory, academic NCCN-designated center.

294 Background: From May – August 2021, outpatient suicidal ideation-related safety events nearly doubled from the three years prior at an academic NCCN center. This rise in events challenged staff and revealed improvement opportunities for suicide prevention, such as routine screening for suicidal ideation (SI) in the ambulatory setting. In addition, the COVID pandemic introduced an added layer of vulnerability to cancer patients, who are at an increased SI risk compared to the general population. Methods: From August 2021 - 2023, a multidisciplinary team developed and implemented a routine SI screening, intervention and escalation process that included a staff education program, a process-aligned EHR build, a metric dashboard, and a quality improvement-control plan. The vision was to identify all patients experiencing SI and support them with timely and compassionate care. A step-up metric target approach was used to set quarterly goals. The overarching goal was to screen at least 70% of eligible patients by the end of fiscal year 2024. The new process went live organization-wide on July 31, 2023. Following implementation, various improvement opportunities were identified with indicators including performance metrics, process audits, patient case reviews, and stakeholder feedback. Initial improvement efforts focused on clinics and sites that were screening < 25% between FY24 Q1 and Q2. Continued collaboration between Quality Improvement and clinic leaders revealed improvement opportunities in identifying eligible patients and staff screening practices. Impactful interventions addressed patient identification and staff coaching. Results: As a new process, the overall screening rate started at 0% and increased to 48% over FY24*. Conclusions: Overall, a new SI screening process was successfully implemented, and improved with diligent PDSA work, yet metric goals were not achieved. Many factors may have contributed to underperformance. Ongoing evaluation and collaboration with stakeholders are crucial for continued improvement. Beyond these efforts exists the social and cultural stigma of suicide, which may have limited the impact of improvement endeavors. Results may demonstrate further need for open and supportive discussion with staff, patients, and the larger healthcare community. Data time range: 7/31/23-5/21/24.* FY24 + Quarter Metric Goal Screening Rate Q1 40% 35.7% Q2 50% 34.5% Q3 60% 41.2% Q4 70% 47.8%

PENGARUH KONSELING APOTEKER TERHADAP KEPATUHAN TERAPI PASIEN DIABETES MELITUS DI BEBERAPA PUSKESMAS DAN RUMAH SAKIT

Diabetes mellitus is a global health issue that requires a comprehensive management approach. Pharmacist interventions have proven effective in enhancing patient adherence to medication and improving clinical outcomes. This study aims to systematically review pharmacist interventions for diabetes mellitus patients and their impact on medication adherence and glycemic control. The research method used was a narrative literature review, analyzing 188 articles from PubMed and 200 articles from Google Scholar, with 20 studies meeting the inclusion criteria, including 12 studies conducted in community health centers (puskesmas) and 8 studies in hospitals. The findings indicate that pharmacist counseling interventions significantly improve medication adherence and lower HbA1c levels. In community health centers, adherence increased from 9.2% to 61%, and HbA1c decreased from 8.5% to 7.2%. In hospitals, the average HbA1c reduction was between 1.5% and 2%. The multifaceted counseling approach was more effective compared to telephone counseling, which showed an HbA1c reduction of 0.3%. These findings highlight the critical role of pharmacists in managing type 2 diabetes mellitus.

Efektifitas Komsumsi Tablet Fe dengan Air Jeruk Nipis terhadap Peningkatan Kadar HB Ibu Hamil Anemia Ringan Trimester III

Background: Anemia is a body condition where the hemoglobin level in red blood cells is lower than the normal standard. Pregnant women are said to be anemic if their Hb content is <11gr/dL. According to WHO, the prevalence of pregnant women throughout the world who experience anemia is 41.8%. The percentage of anemia in pregnant women in Indonesia is 37.1%. For the Special Region of Yogyakarta, the prevalence in pregnant women is 19.01%, and the highest incidence of anemia is in Bantul Regency (27.67%). Data from the Bantul District Health Service, from 27 Community Health Centers, there are 5 Community Health Centers with the highest number of anemia, namely at Sewon II Community Health Center. From this data, Sewon II Community Health Center is in second place. Objective: To determine the effectiveness of consuming fe tablets with lime juice on increasing Hb levels in mildly anemic pregnant women at the Sewon II Bantul Community Health Center, Yogyakarta. Method: This quasi-experiment research uses a one group pretest-posttest design. The sample in the study consisted of 30 pregnant women. The sampling technique uses total sampling. The research instrument gave lime to pregnant women with mild anemia for 2 weeks. Then the hemoglobin level was checked before and after drinking lime using a hemoglobin meter checking device in collaboration with the Puskesmas lab section. Results: The results of this research are based on univariate analysis of the characteristics of respondents aged 20-35 years as many as 26 (86.3%) respondents, the majority have a high school education as many as 26 (86.7%) respondents, the occupation of respondents is housewives 28 (93.3%) ) respondents. The results of the bivariate analysis showed that there was a significant effect on the average value of increasing hemoglobin levels before (10.21) and after drinking lime (11.23) with an average of (1.02). Conclusion: Based on the research results, it can be concluded that there is an effect of giving lime juice on hemoglobin levels in pregnant women in the second trimester at the Sewon II Bantul Community Health Center.

EVALUASI PENGGUNAAN OBAT ANTITUBERKULOSIS PARU DIPUSKESMAS: NARRATIVE LITERATURE REVIEW

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. While it primarily affects the lungs, it can also impact other organs. In Indonesia, pulmonary TB remains a significant health issue. This study aims to evaluate the use of anti-tuberculosis medications at various community health centers (puskesmas) in Indonesia through a literature review. The research method employed involves a literature review with searches conducted on Google Scholar and PubMed databases. Out of 360 articles found on Google Scholar and 13,026 articles on PubMed, 8 relevant articles were identified for this study. The results indicate that the most commonly used treatment regimen is Category 1, which includes a 2-month intensive phase with a combination of Isoniazid 75 mg, Rifampicin 150 mg, Pyrazinamide 400 mg, and Ethambutol 275 mg, followed by a 4-month continuation phase with Rifampicin 150 mg and Isoniazid 150 mg. This medication regimen aligns with the Tuberculosis Control Guidelines issued by the Indonesian Ministry of Health in 2016. The evaluation shows that Indonesian puskesmas generally adhere to the established treatment guidelines but still require further monitoring to ensure adherence and effectiveness of the treatment.

Variability of Hepatitis C Treatment Cascade Outcomes among People Who Inject Drugs across Geographically Diverse Clinics in the US: The HERO Study.

Heterogeneity of outcomes across different clinical trial study sites is often inevitable. Understanding how outcomes differ by site is important for planning future programs and studies. We examined the extent of heterogeneity of hepatitis C virus (HCV) treatment cascade outcomes among persons who inject drugs (PWIDs) across sixteen clinical sites utilized in the HERO Study-a pragmatic randomized trial of HCV treatment support. Treatment cascade outcomes included averages of overall treatment adherence and proportions of treatment initiation, treatment completion, sustained virologic response (SVR) test completion, and SVR achievement. The HERO study utilized 16 clinical sites across the United States (US): eight opioid treatment programs (OTPs) and eight community health centers (CHCs). Variability of the outcomes across the 16 clinical sites was assessed using ranges and intraclass correlation coefficients (ICC) estimated from mixed-effects linear or logistic regression models. Treatment initiation was analyzed in the intention-to-treat (ITT) sample (N = 755); treatment completion, adherence, and SVR test completion in the modified ITT (mITT) sample, which is the sample that initiated treatment (N = 623); and SVR achievement in the mITT and per-protocol (PP, N = 501) samples. Across the 16 clinical sites, the range observed in the averages of overall treatment adherence was from 68% to 81% [ICC = 0.026 (0.005, 0.054)], and the ranges of proportions observed were from 68% to 96% for treatment initiation [ICC (95% CI) = 0.086 (0.051, 0.155)], 60% to 100% for treatment completion [ICC = 0.049 (0.008, 0.215)], 54% to 95% for SVR test completion [ICC = 0.096 (0.006, 0.177)], 46% to 90% for SVR achievement in the mITT sample [ICC = 0.070 (0.014, 0.122)], and 76% to 100% for SVR achievement in the PP sample [ICC = 0.143 (0.021, 0.422)]. The variability of the outcomes across 16 US sites treating HCV among PWIDs appears to be substantial in view of the ranges and ICC values of the outcomes. It is imperative to develop tailored interventions to target the sources of variability and reduce barriers at the patient, provider, clinic, and state policy levels to facilitate more equitable access to HCV treatment and reduce heterogeneity in treatment outcomes.

Nurses' Experiences and Perspectives Caring for People With Substance Use Disorder and Their Families: A Qualitative Descriptive Study.

Substance use disorder is a public health crisis that is a financial strain to many healthcare systems and communities, but more importantly, it costs lives. Nurses interact with people experiencing substance use disorders and their families in many settings. Nurses can provide insights into the experiences of working with this population. This descriptive qualitative study aimed to examine nurses' experiences and perspectives on caring for people with substance use disorder and their families. After receiving institutional review approval, purposive sampling was used to recruit registered nurses (n = 16) who worked in a variety of settings, and interviews were conducted. Constant comparison analysis was conducted concurrently with data collection until saturation was reached. Code development and refinement was an iterative process. Three themes were generated from the data. Personal Experiences Affect Professional Practice represented participants varied personal experiences and included two subthemes: Reflecting on Personal Experiences and Seeing the Person Beyond the Substance Use Disorder. A second theme is Professional Experiences Affect Professional Practice, which included two subthemes: Professional Experiences are Stressful and Rewarding and Substance Use Disorder Education Increases Confidence. Finally, Stigma Affects Substance Use Disorder Care is the third theme. Future implications range from the individual engaging in self-reflection, to nursing leadership establishing a framework to incorporate reflection and creating a culture that supports and reinforces these activities. The findings of this study support the need for stigma awareness/reduction education starting in undergraduate nursing programmes, throughout practice, with extension to inter-professional groups and the community.

The Relationship between Maternal Education Level, Exclusive Breastfeeding and History of Infectious Diseases with the Incident of Stunting in Toddlers

Stunting is a problem of chronic malnutrition caused by insufficient nutritional intake over a long period of time due to intake that is not in accordance with nutritional needs. Stunting can occur from the fetus in the womb and only appears when the child is two years old. Nutritional status not only describes the problem of deficiencies in certain nutrients, but is also related to the level of health and chronic diseases a person has. This research aims to determine the relationship between maternal education, exclusive breastfeeding and a history of infectious diseases with the incidence of stunting in toddlers in the working area of the Teluk Tiram Community Health Center, Banjarmasin. This type of analytical observational research with a cross sectional design. The population in this study were all mothers of toddlers in Teluk Tiram Village, totaling 770 toddlers. Samples were taken using accidental sampling of 20 people. Primary data in the form of respondent characteristics, mother's education level, exclusive breastfeeding and history of infectious diseases were obtained through interviews using questionnaires and nutritional status was obtained by anthropometric measurements (PB/U or TB/U). Data analysis using the Spearman's rho test. The results of research using the Spearman's rho test showed that there was no relationship between maternal education and the incidence of stunting (p=0.652), there was no relationship between exclusive breastfeeding and the incidence of stunting (p=0.126) and there was no relationship between a history of infectious diseases. with the incidence of stunting (p=0.643).

ANALYSIS BETWEEN KNOWLEDGE AND ATTITUDES OF PARENTS REGARDING PROVIDING DOUBLE IMMUNIZATION AT THE MINASA UPA COMMUNITY HEALTH CENTER

Immunization is the act of providing immunity against a disease by introducing specific substances into the body. The completeness of immunization can be influenced by several factors such as knowledge, attitudes, number of children, health worker attitudes, family support, distance from home, education, socio-cultural factors, and community trust. This study aims to determine the relationship between parental knowledge and attitudes toward administering double immunization in infants conducted at the Minasa Upa Community Health Center. The research method used was quantitative research with an observational analytic design with a cross-sectional approach and a non-probability sampling method with a purposive sampling technique, resulting in 85 samples. The study results found that most respondents had good levels of knowledge, with 46 respondents or 54.1%, and exhibited positive attitudes, with 43 respondents or 50.6%. The highest number of respondents who administered double immunization to infants were found to have good knowledge, accounting for 67.4%, with a P-value of 0.003. Meanwhile, the number of respondents who administered double immunization and had positive attitudes was 69.8%, with a P-value of 0.001. Based on this research, it can be concluded that there is a significant relationship between parental knowledge and attitudes towards the administration of double immunization in infants.

Evaluating the Impact of Nabila Cantika’s Innovation on Reducing Stunting in the Kawedanan Community Health Center, Magetan, Indonesia

Background: Nabila Cantika is an innovation to overcome the problem of stunting. This innovation is in the form of toddler class training involving grandmothers. The training was conducted twice, each lasting 120 minutes. The novelty of the study lies in the involvement of grandmothers in the Toddler class. The purpose of the study was to evaluate the effectiveness of the Nabila Cantika innovation in reducing stunting rates. Methods: This study was descriptive and was conducted at the Kawedanan Health Center, Magetan, Indonesia, from February to May 2024. The study population consisted of 90 stunted toddlers cared for by their grandmothers. Samples were taken from the entire population that met the inclusion criteria. The independent variable was grandmothers who attended the Toddler class. Data collection used observation sheets and secondary data in the form of reports from nutrition officers. Data analysis was carried out descriptively, and the effectiveness of this innovation was tested using the McNemar test. Results: The results showed that the effectiveness of the Nabila Cantika program varied in each village. Before the innovation was implemented, 71 toddlers (78.9%) were classified as short, and 19 toddlers (21.1%) were classified as very short. After the innovation was implemented, out of 71 toddlers who were classified as short, 48 toddlers (67.6%) increased to the normal category, while 23 toddlers (32.4%) were still classified as short. Out of 19 toddlers who were classified as very short, 8 toddlers (42.2%) remained in that category, while 10 toddlers (57.8%) increased to the short category. This program has proven effective in reducing stunting rates with a significance value of 0.000. Conclusion: Nabila Cantika's innovation has proven very effective in reducing stunting rates in the Kawedanan Health Center area. This program needs to be continued and monitored until it reaches the target of zero stunting.

Synergistic Activity of Antibiotics and Bio Active Plant Extract: Astudy Against Mdr Gram Negative Bacteria in Kirkuk City

Increasing multidrug resistance (MDR) is becoming a problematic issue worldwide. Finding alternatives to cope with this rising problem is becoming crucial for community healthcare. The present study aimed to investigate the antibacterial activityCopper oxide nanoparticles (CuONPs) synthesised using hawthorn fruit extract against different MDR gram-negative bacteria isolates. CuoNPs were synthesized from Fresh hawthorn fruits (Crataegus). The biosynthesized copper oxide nanoparticles were Characterization of the synthesised nanoparticles was performed using UV-visible spectroscopy, Scanning Electron Microscopy (SEM), Fourier-transform infrared spectroscopy (FT-IR), and X-ray diffraction (XRD) to confirm CuONP production and assess their properties. Antibacterial activity was determined by disc diffusion and the healthy diffusion method. The considerable inhibitory action of hawthorn fruit extract was observed in gram-negative bacteria isolates. Also, the green synthesised CuoNPs demonstrated remarkable antibacterial activity against two human pathogenic bacteria when combined with commercially available antibiotics. The current study suggested that CuoNPs have become an essential approach for nanobiotechnology applications in the development of antibacterial treatments for different bacterial infections, particularly for non-treatable antibiotic resistance pathogen.

BALANCED SCORECARD DESIGN AS A MODEL FOR MEASUREMENT OF PUSKESMAS PERFORMANCE IN EAST LOMBOK DISTRICT

The objective of this study is to develop a performance measuring model based on the balanced scorecard framework at the UPT Puskesmas Suela in East Lombok Regency, using the Analytic Hierarchy Process (AHP) technique. This research employed qualitative approaches. Data were gathered with a paired comparison questionnaire employing the Analytic Hierarchy Process (AHP) scale. The performance evaluation of community health centers is conducted using four reference standards, including the financial perspective, community perspective, internal business process perspective, and development and learning perspective. Utilizing this technique for data processing is beneficial in making judgments based on many factors. The research findings indicate that the primary criterion of utmost importance for community health centers is finance, with a weight of 0.465450. The subsequent prioritization criterion is society, assigned a weight of 0.214555. Additionally, both the internal business process criteria and development and learning criteria hold equal significance, each with a weight of 0.112321. Related indicates that Puskesmas as a public sector agency focuses on improving performance on financial perspectives.

Evaluation of the Implementation of the National Community Health Policy in the Bembèrèkè-Sinendé Health District, 2023

In a context shaped by the Sustainable Development Goals and the pursuit of Universal Health Coverage, the National Community Health Policy (NCHP) stands as a crucial pillar to achieve these goals by redirecting healthcare systems towards primary healthcare. The aim of this study was to assess the implementation of the NCHP in the Bembèrèkè-Sinendé health district (BSHD). This was an evaluative cross-sectional observational study with an analytical approach. A census of all active healthcare facilities in the two municipalities of the health district was conducted. A total of 28 health establishments, were included. Activity coverage rates ranged from high for home visits (46.9%) to low for other activities. Awareness raising (89.3%) and educational discussions (100%) are well conducted, while practical demonstrations and home visits encounter challenges. No significant association was found between the independent variables and the quality of the activities implemented. The results of this study provide valuable insight into the implementation of the NCHP in the BSHD. They highlight the need to strengthen the training of heads of posts. In addition, they point to the neglect of home visits in the delivery of community health care.

Losing the Postcode Lottery: An Observational Study Examining the Association Between Patient Address and Delayed Discharge in a Rehabilitation Centre

Abstract Background Quality and Fairness: A Health System for You published by the HSE in 2001 stated, as one of its core principles “Access to healthcare should be fair. The system must respond to people’s needs rather than have access dependent on geographic location or ability to pay.”1 Twenty years on, experience at our rehab unit suggests that inequality exists in accessing care in the community for older persons based on their residential address. The aim of our study was to examine and quantify this inequity of access. Methods A retrospective study was designed. Using the local patient information management system, all discharges in 2023 were identified. Baseline demographics, admission and discharge date and residential address were recorded. Delayed discharges were defined as patients for whom their rehabilitation programme is complete as agreed at the multi-disciplinary team meeting. Delayed discharge data was obtained from medical social work department who input this data to the HSE weekly. Patients were assigned a community healthcare organisation (CHO) based on address. CHO ‘A’ included two CHOs with predominantly rural areas whilst CHO ‘B’ comprised of one predominantly urban CHO. Results 167 patients were included. 24 discharges were delayed (14.4%). Median age was 84. Total bed days lost: 935 (mean 40.6, range 3 – 232). All nine CHOs were represented. Patients living in CHO A had increased likelihood of having discharge delayed (OR: 4.82, CI 2.86 – 8.13). Conversely, those living in CHO B were less likely to have had a discharge delayed (OR: 0.39, CI 0.15 – 0.96) Conclusion Our study demonstrates that health inequity does exist. Patients residing in rural communities are 4 times more likely to have their discharge delayed awaiting community supports compared to urban dwellers. Ending of the discrimination of patients based on their postcode and ensuring access based on need is the very essence of Sláintecare.

Right Care, Right Time, Right Place: Real-life Challenges in Delivering Sláintecare – A Multi-Centre Survey of Multidisciplinary Team Members

Abstract Background Sláintecare launched in 2018 seeks to reform the delivery of healthcare services in Ireland towards equity of access based on patient need1. However, delivering the right care, in the right place at the right time is, as yet an aspirational goal. We sought to identify the on-the ground challenges that exist in delivering Sláintecare in the day-to-day practice of multidisciplinary team members. Methods An online survey questionnaire was distributed to medical social workers, occupational therapists, and physiotherapists. Respondents were asked about their experience in applying for community-based care in their practice including home care packages, community occupational therapy and home equipment. Descriptive statistics were applied to numerical data and a thematic analysis was performed on free text responses. Results There were 31 respondents from 10 clinical sites including acute and rehabilitation settings. All nine community healthcare organisations (CHOs) were represented. 29/31 (94%) felt that access to community-based care differed based on the patient’s residential address. 23/31 (74%) stated the referral documentation and process for home care packages varied depending on the patients’ CHO. Qualitative analysis identified three core themes; Unfulfilled care hours due to dearth of carer availability differed across CHOs; inconsistencies in the application process that exists between CHO’s and incongruities in the availability of and accessibility to publicly funded services on hospital discharge. Conclusion Our survey highlights the practical challenges of delivering Sláintecare currently. It reinforces the health inequities that limits patients’ ability to access quality healthcare because of their geographical location.

Effect of Taichi Exercise on Blood Pressure in a Family with Hypertension in Banjarsengon Village: A Case Study

Hypertension is a critical global health issue that affects quality of life and increases the risk of cardiovascular disease. The purpose of this case study is to assess the efficacy of Taichi exercise as a nonpharmacological therapy for decreasing blood pressure in the family with hypertension. Mrs. H, a 49-year-old single mother with a history of hypertension lived in Banjarsengon Village, Jember. The Taichi exercise intervention was performed twice a week for three weeks. Following six sessions of Taichi exercise, total systolic blood pressure decreased by 10 mmHg and diastolic by 6 mmHg. Family empowerment through the participation of Mrs. H's children in supporting the implementation of Taichi exercise is key in this therapeutic approach. The results of this study suggest that Taichi exercise has potential as a safe and effective alternative therapy for the management of hypertension. In order for the hypertension management program in families to have maximum impact, it is very necessary to increase family empowerment through health workers in community health centers who are monitored periodically.

The Rural Youth Public Health Summit: A Pilot Pathway Program for Rural Adolescents.

There is a pressing need to increase the health care and public health workforce in rural communities across the United States. In Colorado, many of the rural communities are medically underserved, lacking resources and employment prospects to appropriately address the health needs of its communities. A potential strategy to address these medically underserved areas and the public health workforce shortage is to develop pathway programs for rural adolescents into health-related careers. The Rural Youth Public Health Summit (Summit) was a pilot pathway program for rural secondary school students hosted at a 4-year public university. The planning and formation of the Summit were done through the collaboration of school administration and teachers, university faculty and staff, educational non-profits, and health care and public health professionals. The Summit's goals were to increase awareness and interest in public health careers and to further partnerships between a university and rural secondary schools. Participants included 22 secondary school students and 10 chaperones from rural schools. Throughout the 2-day Summit, participants engaged in campus tours, a keynote speaker, workshops facilitated by faculty and public health professionals, and an overnight stay in the dorms. Despite some limitations, the Summit showed promising results as a pilot program in its ability to conduct planning, outreach, recruitment, and facilitation of a pathway program to connect rural adolescents to college education and career opportunities in public health.

"Like an umbrella, protecting me from the rain until I get to my destination": Evaluating the implementation of a tailored primary care model for urban marginalized populations.

Improving health equity and access to the highest possible standard of health care is a key issue of social accountability. Centretown Community Health Centre in Ottawa, Canada has iteratively developed a program to target and serve marginalized and complex populations since 1999. The program implementation was evaluated using a validated implementation framework. Quantitative and qualitative data were collected through a health records extraction (n = 570), a client complexity assessment tool (n = 74), semi-structured interviews with clients and key stakeholders (n = 41), and a structured client satisfaction survey (n = 30). Data were analyzed using descriptive statistics and inductive thematic analysis. Five hundred and seventy unique clients were seen between November 1-30, 2021. A third of clients (34%) did not have a provincial health card for access to universal health care services, and most (68%) were homeless or a resident of rooming houses. Most clients who reported their income (92%) were at or below Canada's official poverty line. The total mean complexity score for clients seen over a one-month period (n = 74) was 16.68 (SD 6.75) where a total score of at least 13 of 33 is perceived to be a threshold for client biopsychosocial complexity. Clients gained the majority of their total score from the Social support assessment component of the tool. Clients (n = 31) and key informants (n = 10) highlighted the importance of building relationships with this population, providing wrap-around care, and providing low-barrier care as major strength to the Urban Health program (UH). Key areas for improvement included the need to: i) increase staff diversity, ii) expand program hours and availability, and iii) improve access to harm reduction services. Clients appeared to be highly satisfied with the program, rating the program an average total score of 18.50 out of 20. The program appears to serve marginalized and complex clients and seems well-received by the community. Our findings have relevance for other health care organizations seeking to better serve marginalized and medically and socially complex individuals and families in their communities.

Overview of Medication Administration to Hypertension Patients at Harapan Raya Community Health Center

Hypertension or high blood pressure is an increase in systolic blood pressure of more than 140 mmHg and diastolic blood pressure of more than 90 mmHg in two measurements with an interval of five minutes in a state of sufficient rest/calm. This research is a descriptive observational study. The research was conducted at Harapan Raya Community Health Center in April 2024. The sample in this study was hypertension patients who received treatment at Harapan Raya Community Health Center in March 2024. The instrument used in this research was secondary data from the monthly report of Harapan Raya Community Health Center in March 2024. The data used obtained and then analyzed by calculating the percentage of drug use. Based on the results at the Harapan Raya Community Health Center, it can be concluded that: Patients who consume a lot of hypertension medication are female with 75 respondents and 39 male respondents. The highest number of patients who took hypertension medication were in the elderly age range, with 68 respondents, 44 respondents for middle adults, and 2 respondents for early adults. The drug that is often used in community health centers is amlodipine 10 mg.

"You Can't Let Go" - A Black Community Leader's Perspective on Engagement and Advocacy.

Lanre Tunji-Ajayi is president and CEO of the Sickle Cell Awareness Group of Ontario (SCAGO). This charitable organization focuses on ameliorating the lives of those living with sickle cell disease by providing evidence-based support to patients and supporting clinical and psychosocial research, health promotion and the development of best practice guidelines. Lanre's passion for this work is personal. Following the death of her brother Sunday Afolabi from preventable and treatable complications of sickle cell disease, Lanre immersed herself in advocacy for community health and quality patient care. In this oral history narrative, Lanre reflects on her decades-long journey advocating for those living with sickle cell disease - a disease which disproportionately affects Black people. Her reflections focus acutely on the challenges she has faced in raising awareness and visibility, including through formal public engagement policy processes. Lanre also speaks to the personal costs she has encountered engaging in this advocacy work and the subtle and institutionalized forms of anti-Black racism that have punctuated this already difficult effort to bring about change.

The impact of a nurse's dual role on implementing an effectiveness study.

Reorganizing the Approach to Diabetes through the Application of Registries (RADAR) improved diabetes care and outcomes for First Nations people in Alberta, Canada. The nurse involved in the implementation of RADAR performed two roles in this model of care: research nurse and care coordinator. To describe the research nurse's dual role in the implementation and evaluation of RADAR. The research nurse not only documented and collected data in hard-to-reach communities as part of effective research, she also provided remote care coordination to support community healthcare providers using a culturally tailored registry to facilitate population-level care. This dual role required many qualities of nursing leadership and transformation. The research nurse's two roles contributed to the success of the intervention and were critical to the successful implementation of the model, creating valuable real-world evidence across diverse populations and settings. for practice Nurses are well placed to perform research duties alongside engagement and implementation activities. This can enhance the effectiveness and evaluation of healthcare interventions, particularly in community-based interventions within First Nations communities.