Health Behavior Counseling Research Articles

A Digital Health Behavior Intervention to Prevent Childhood Obesity

Infant growth predicts long-term obesity and cardiovascular disease. Previous interventions designed to prevent obesity in the first 2 years of life have been largely unsuccessful. Obesity prevalence is high among traditional racial and ethnic minority groups. To compare the effectiveness of adding a digital childhood obesity prevention intervention to health behavior counseling delivered by pediatric primary care clinicians. Individually randomized, parallel-group trial conducted at 6 US medical centers and enrolling patients shortly after birth. To be eligible, parents spoke English or Spanish, and children were born after 34 weeks' gestational age. Study enrollment occurred between October 2019 and January 2022, with follow-up through January 2024. In the clinic-based health behavior counseling (clinic-only) group, pediatric clinicians used health literacy-informed booklets at well-child visits to promote healthy behaviors (n = 451). In the clinic + digital intervention group, families also received health literacy-informed, individually tailored, responsive text messages to support health behavior goals and a web-based dashboard (n = 449). The primary outcome was child weight-for-length trajectory over 24 months. Secondary outcomes included weight-for-length z score, body mass index (BMI) z score, and the percentage of children with overweight or obesity. Of 900 randomized children, 86.3% had primary outcome data at the 24-month follow-up time point; 143 (15.9%) were Black, non-Hispanic; 405 (45.0%) were Hispanic; 185 (20.6%) were White, non-Hispanic; and 165 (18.3%) identified as other or multiple races and ethnicities. Children in the clinic + digital intervention group had a lower mean weight-for-length trajectory, with an estimated reduction of 0.33 kg/m (95% CI, 0.09 to 0.57) at 24 months. There was also an adjusted mean difference of -0.19 (95% CI, -0.37 to -0.02) for weight-for-length z score and -0.19 (95% CI, -0.36 to -0.01) for BMI z score. At age 24 months, 23.2% of the clinic + digital intervention group compared with 24.5% of the clinic-only group had overweight or obesity (adjusted risk ratio, 0.91 [95% CI, 0.70 to 1.17]) based on the Centers for Disease Control and Prevention criteria of BMI 85th percentile or greater. At that age, 7.4% of the clinic + digital intervention group compared with 12.7% of the clinic-only group had obesity (adjusted risk ratio, 0.56 [95% CI, 0.36 to 0.88]). A health literacy-informed digital intervention improved child weight-for-length trajectory across the first 24 months of life and reduced childhood obesity at 24 months. The intervention was effective in a racially and ethnically diverse population that included groups at elevated risk for childhood obesity. ClinicalTrials.gov Identifier: NCT04042467.

Composition of buprenorphine prescribing networks in Medicaid and association with quality of care

IntroductionDespite Medicaid's outsized role in delivering and financing medications for opioid use disorder (MOUD), little is known about the extent to which buprenorphine prescriber networks vary across Medicaid health plans, and whether network characteristics affect quality of treatment received. In this observational cross-sectional study, we used 2018–2019 Medicaid claims in Oregon to assess network variation in the numbers and types of buprenorphine prescribers, as well as the association of prescriber and network characteristics with quality of care. MethodsWe describe prescribers (MD/DOs and advanced practice providers) of OUD-approved buprenorphine formulations to patients with an OUD diagnosis, across networks. For each patient who initiated buprenorphine treatment during 2018, we assigned a “usual prescriber” and assessed four measures of quality in the 180d following initiation: 1) continuous receipt of buprenorphine; 2) receipt of any behavioral health counseling services; 3) receipt of any urine drug screen; and 4) receipt of any prescription for a benzodiazepine. We used multivariable linear regressions to examine the association of prescriber and network characteristics with quality of buprenorphine care following initiation. ResultsWe identified 645 providers who prescribed buprenorphine to 20,739 eligible Medicaid enrollees with an OUD diagnosis. The composition of buprenorphine prescriber networks varied in terms of licensing type, specialty, and panel size, with the majority of prescribers providing buprenorphine to small panels of patients. In the 180 days following initiation, a third of patients were maintained on buprenorphine; 69.9 % received behavioral health counseling; 88.4 % had a urine drug screen; and 11.3 % received a benzodiazepine prescription. In regression analyses, while no single network characteristic was associated with higher quality across all examined measures, each one unit increase in prescriber-to-enrollee ratio was associated with a 1.18 p.p. increase in the probability of continuous buprenorphine maintenance during the 180 days following initiation (95 % confidence interval = [0.21, 2.15], p = 0.017). ConclusionsMedicaid plans may be able to leverage their networks to provide higher quality care. Our findings, which should be interpreted as descriptive only, suggest that higher prescriber-to-enrollee ratio is associated with increased buprenorphine maintenance. Future research should focus on isolating the causal relationships between MOUD prescribing network design and patient outcomes.

Clinician Needs for Electronic Health Record Pediatric and Adolescent Weight Management Tools: A Mixed-Methods Study.

Clinicians play an important role in addressing pediatric and adolescent obesity, but their effectiveness is restricted by time constraints, competing clinical demands, and the lack of effective electronic health record (EHR) tools. EHR tools are rarely developed with provider input. We conducted a mixed method study of clinicians who provide weight management care to children and adolescents to determine current barriers for effective care and explore the role of EHR weight management tools to overcome these barriers. In this mixed-methods study, we conducted three 1-hour long virtual focus groups at one medium-sized academic health center in Missouri and analyzed the focus group scripts using thematic analysis. We sequentially conducted a descriptive statistical analysis of a survey emailed to pediatric and family medicine primary care clinicians (n = 52) at two private and two academic health centers in Missouri. Surveyed clinicians reported that they effectively provided health behavior lifestyle counseling at well-child visits (mean of 60 on a scale of 1-100) and child obesity visits (63); however, most felt the current health care system (27) and EHR tools (41) do not adequately support pediatric weight management. Major themes from the clinician focus groups were that EHR weight management tools should display data in a way that (1) improves clinical efficiency, (2) supports patient-centered communication, (3) improves patient continuity between visits, and (4) reduces documentation burdens. An additional theme was (5) clinicians trust patient data entered in real time over patient recalled data. Study participants report that the health care system status quo and currently available EHR tools do not sufficiently support clinicians working to manage pediatric or adolescent obesity and provide health behavior counseling. Clinician input in the development and testing of EHR weight management tools provides opportunities to address barriers, inform content, and improve efficiencies of EHR use.

Satisfaction and effectiveness of a digital health tool to improve health behavior counseling among adolescent and young adult cancer survivors: a randomized controlled pilot trial

BackgroundThis pilot study examined the preliminary effectiveness of the PREVENT digital intervention that supports health care teams in delivering health behavior counseling on cancer survivors’ motivation to change behavior, their physical activity and food intake behaviors, and cardiovascular health (CVH).MethodsClinicians (physicians, nurse practitioners) at three urban cancer survivorship clinics were trained to use PREVENT. Patients were randomized to the PREVENT intervention or a wait-list routine care control group. Eligibility criteria for patients included: between ages 12–39, overweight or obese, were at least 6-months post-active cancer treatment, and had sufficient English proficiency.ResultsFifty-five participants were enrolled; 27 were randomized to the PREVENT intervention and 28 to wait-list routine care control. The majority of the participants (82%) identified as non-Hispanic white, with an average age of 19.8 (SD ± 5.2) years. Patients that received the PREVENT intervention had greater increases in their self-efficacy, vigorous activity and number of food recommendations met than those who received routine clinical care. Changes in willingness, knowledge, and CVH outcomes were not significant.ConclusionsThe PREVENT digital intervention may provide improvements in preventive behaviors among AYA cancer survivors by supporting care teams with delivering evidence-based, tailored behavior change recommendations and resources to support patient health.Trial registrationThis trial (NCT04623190) was registered on 11/02/2022.

Embedding Counselors in Student Health Centers: Exploring Challenges to Implementing the Primary Care Behavioral Health Model

ABSTRACT Embedding counselors in various campus locations has been one strategy to address the student mental health crisis. The aim of this study was to evaluate challenges to implementing the primary care behavioral health (PCBH) model, in which behavioral health counselors (BHCs) are embedded within the college health center, and to explore characteristics associated with differing levels of PCBH fidelity. Seventy-one BHCs working in college health centers completed the online fidelity survey. Most respondent scores denoted moderate or strong fidelity to the PCBH model. Psychologists showed better adherence to autonomous clinical aspects of PCBH while social workers/counselors showed better adherence to collaborative aspects of PCBH. Overall findings suggest fidelity to PCBH by BHCs in college health is driven by independent clinical activity more than interdisciplinary collaboration. Strategies for developing and evaluating a PCBH program that complements the specialty mental health services offered through counseling centers are discussed.

Primary Care Providers' Experiences Treating Opioid Use Disorder Using Telehealth in the Height of the COVID-19 Pandemic.

The COVID-19 pandemic catalyzed a rapid shift in healthcare delivery towards telehealth services, impacting patient care, including opioid use disorder (OUD) treatment. Regulatory changes eliminated the in-person evaluation requirement for buprenorphine treatment, encouraging adoption of telehealth. This study focused on understanding experiences of primary care providers in predominantly rural areas who used telehealth for OUD treatment during the pandemic. Semi-structured interviews were conducted with 22 primary care providers. Participants practiced in 13 rural and 9 urban counties in Kentucky and Arkansas. Data were analyzed using conventional content analysis. The pandemic significantly impacted healthcare delivery. While telehealth was integrated for behavioral health counseling, in-person visits remained crucial, especially for urine drug screenings. Telehealth experiences varied, with some facing technology issues, while others found it efficient. Telehealth proved valuable for behavioral health counseling and sustaining relationships with established patients. Patients with OUD faced unique challenges, including housing, internet, transportation, and counseling needs. Stigma surrounding OUD affected clinical relationships. Building strong patient-provider relationships emerged as a central theme, emphasizing the value of face-to-face interactions. Regarding buprenorphine training, most found waiver training helpful but lacked formal education. This research offers vital guidance for improving OUD treatment services, especially in rural areas during crises like the COVID-19 pandemic. It highlights telehealth's value as a tool while acknowledging its limitations. The study underscores the significance of strong patient-provider relationships, the importance of reducing stigma, and the potential for training programs to elevate quality of care in OUD treatment.

Incidence, Prevalence, and Disease Management Impactability of High Utilization in an Adult Sickle Cell Medical Home

Background: Utilization in adults with sickle cell disease (SCD) is driven by a biopsychosocial mix of predictors. Disease management intervenes on the biopsychosocial determinants of health, partly to drive down avoidable ED visits and hospitalizations. We previously reported the effect of disease management interventions on SCD utilization among adults enrolled in an Adult Sickle Cell Medical Home (Blood)[i]. To further understand the impact of these interventions, we evaluated the incidence, prevalence, and impactability of case management within our Medical Home. Method: The sample includes distinct individuals enrolled in the Adult SCD Medical Home (N=537 in 2017, N=621 in 2018, N=558 in 2019, N=677 in 2020, N=577 in 2021, and N=604 in 2022). We analyzed the “CoVID Years” (2020-2022) separately from the “Pre-CoVID” years (2017-2019). Interventions in the Adult SCD Medical Home included: medical care by MDs, NPs, and nurses; behavioral health counseling by a licensed clinical social worker; case management by Community Health Workers (Patient Navigators), and prior authorization management by a reimbursement specialist, a licensed pharmacy tech. To perform the analysis, we defined High utilizers (vs moderate or low utilizers) as those with >$200,000 in annual medical charges each year between the years 2017-2021. We used the definition threshold to calculate the annual incidence of high utilization: the percentage of moderate or low utilizers in an index year who became high utilizers in the subsequent year. Similarly, the annual prevalence of high utilization was the percentage of all patients who were high utilizers in an index year. And the impactability of high utilization was the percentage of high utilizers in an index year who became moderate or low utilizers in the subsequent year. We calculated the annual high-utilization incidence, prevalence, and impactability for 2018-2022. Results: The annual program high-utilizer incidence, prevalence, and impactability are shown in Table 1. Utilization was stable from year to year, except at the intersection of pre-COVID and COVID years. The impactability score was 0-3.5%. We could not find good literature showing comparative annual changes in rates of impactability in diabetes, congestive heart failure, or vulnerable Medicaid populations. The graphs show individual patients' index and multiple subsequent utilization costs for those remaining in the cohorts (Classes) starting from 2017-2022 (Class of 2018), 2018-2022 (Class of 2019), 2019-2022 (Class of 2020), and 2020-2022 (Class of 2021). No statistical analyses were performed, but the trends were numerically down for all periods. Conclusion: An intense disease management program, as part of an Adult Sickle Cell Medical Home was associated with stable year-over-year high-utilizer percentage. It was also associated with a stable, low annual incidence of ‘new’ high utilizers, and a stable, low impactability among current high utilizers. We could not determine how these program rates compare with analogous rates in other chronic diseases. [i] Intensive Case Management in an Adult Sickle Cell Medical Home: Annual Effects on Utilization Efficiency Using Community Health Workers; Shirley Johnson, BA, LSW1*, Daniel M Sop, BS, MS2, Yue May Zhang, MS3*,Benjamin Jaworowski, BS 1*and Wally R Smith, MD4

Component-Specific Effects of Team Case Management on Adult Sickle Cell Utilization in Moderate to Low Utilizers

Background: Utilization in adult sickle cell disease (SCD) patients is driven by a large array of biopsychosocial predictors which are often dominated by social determinants of health. We have previously demonstrated that disease management in an Adult Sickle Cell Medical Home may curb avoidable ED visits and hospitalizations, particularly in high utilizers (Blood).[i] However, further analysis is needed to determine the relative “doses” of components, and component-specific effects, of such team interventions as medical care for biological determinants; behavioral health counseling for behavioral determinants; case management for social determinants, and; administrative/reimbursement management for administrative determinants. And further analysis is needed to determine how the latter three, non-biological, components affected total utilization and subtypes of care utilization among moderate to low utilizers within the Medical Home. We examined the latter question for this analysis. The analysis was correlational and non-causal since interventions and outcomes occurred in the same time period. Method: We excluded data available during the “Pre-CoVID” years (2017-2019), in order to isolate impact apart from the COVID phenomenon. We also excluded the 50 Highest utilizers, defined as those with >$200,000 in annual medical charges in a given year and high utilization of the hospital, because they were already assigned specific case managers. Thus, our sample, unlike high-utilization patients, was not assigned specific case managers. We counted and empirically weighted any contact with any member of the Medical Home during a particular year as an intervention. We stacked counts of interventions-multiple visits were weighed more heavily than a single visit. Interventions could have included behavioral health counseling by a licensed clinical social worker. The number of these visits was counted. Case management by Community Health Workers called Patient Navigators (PNs) could have included three types of visits: inpatient, outpatient, and telephone. PN visit weights were obtained by measuring the number of each type of visit, and the time of each visit. Last, prior authorization case management by a reimbursement specialist who was a licensed pharmacy tech each intervention was counted. Thus, the maximum intervention score for any patient in any year was not capped. We calculated charges due to all ambulatory, ED, and hospital utilization separately, and we also calculated combined charges for all utilization. Statistics include Spearman's Correlations, comparing the annual intervention score to charges for each utilization outcome, recognizing that charges would reflect charges for ambulatory medical and behavioral interventions. Results: The sample included N=466 distinct individuals in 2020, 499 in 2021, and 522 in 2022, the “CoVID Years.” Correlations between the annual intervention scores and ambulatory, ED, hospital, and total utilization charges during each corresponding year are shown in Table 1. High PN contact (doses) correlated with more ambulatory visits. More PN contact (dose) was correlated with more inpatient discharges and either more ED visits, or insignificant reductions in ED visits. Conclusion: The case management components of an ambulatory case management program, where patients were not assigned case managers, were inconsistently associated with annual utilization costs for ambulatory care. Because these data were measured essentially simultaneously, we cannot draw causal inferences between management dose and utilization. Perhaps the most significant finding was determining a system of empiric weights for different types of interventions, and summary scores of all interventions may represent a new method to measure team interventions for case management in SCD. [i] Intensive Case Management in an Adult Sickle Cell Medical Home: Annual Effects on Utilization Efficiency Using Community Health Workers; Shirley Johnson, BA, LSW1*, Daniel M Sop, BS, MS2, Yue May Zhang, MS3*,Benjamin Jaworowski, BS 1*and Wally R Smith, MD4

Association of health behaviour and clinical manifestation in early multiple sclerosis in Germany – Baseline characteristics of the POWER@MS1 randomised controlled trial

BackgroundReceiving a multiple sclerosis (MS) diagnosis is a significant stressor. Therefore, highly individualised counselling is needed, especially in early MS. Modifiable risk factors (e.g. smoking and obesity) are gaining relevance in MS. Despite evidence for worse MS-related health outcomes, prevalence of adverse health behaviours, such as smoking and physical inactivity, is high across all MS stages. However, knowledge regarding health behaviours as well as their association with MS-related health outcomes among newly diagnosed PwMS in Germany is scarce. Currently, the efficacy of an interactive digital lifestyle management application intended to be used as an add-on to standard care among newly diagnosed PwMS in Germany is evaluated in an ongoing multicentre randomised controlled trial (RCT) (‘POWER@MS1’). ObjectivesTo describe baseline disease characteristics and health behaviours of the POWER@MS1 cohort and investigate associations between MS characteristics, quality of life (QOL), health behaviours and intention to optimise health behaviour habits. MethodsThis study included 234 persons with early MS from 20 study centres located across Germany who participate in the POWER@MS1 RCT. Participants were recruited by treating neurologists from different regions and health-care settings in Germany. Baseline data was obtained using paper-based questionnaires and a web-based healthy diet screener between July 2019 and end of March 2022 and analysed descriptively. ResultsIn this early MS cohort (mean disease duration 4 months), a screening tool showed severe symptoms of anxiety in 15 % of the participants. Better means for stress management appeared to be particularly relevant for the whole cohort. Moreover, 19 % were current smokers, 15 % were obese and 36 % were insufficiently physically active. On average, participants only moderately adhered to dietary guidelines for recommended intake of key food groups (e.g. vegetables, fruits and fatty marine fish). Higher EDSS scores were associated with approximately 20 % higher T2-lesion burden (rate ratio RR=1.2, p<0.001) and 13 % higher relapse rate (RR=1.13,p=0.02) per EDSS disability level. Moreover, a higher T2-lesion burden was associated with current smoking (RR=0.76, p=0.033), resulting in approximately 24 % less T2-lesions at disease onset among non-smokers. In addition, smoking was associated with unhealthier dietary habits according to lower diet scores (linear regression coefficient β=−1.27, p<0.001). Higher EDSS scores (β=0.19,p<0.001) and higher BMI (β=0.013,p=0.03) were associated with higher HAQUAMS (lower QOL). Further, lower diet scores (β=−0.044,p=0.039) were associated with lower QOL. Moreover, higher HAQUAMS (lower QOL) indicated a higher intention to optimise stress management (β=0.98,p<0.001), physical activity (β=0.74,p=0.046) and sleep behaviour (β=1.82,p<0.001). Further, higher intention to optimise stress management was accounted for by higher EDSS scores (β=0.39,p=0.004) and a higher number of T2-lesions (β=0.029,p=0.015) in this newly diagnosed MS cohort. ConclusionResults indicate a clear need for modifications of health behaviours among newly diagnosed PwMS participating in POWER@MS1. Individualised psychological and health behaviour counselling appears to be an important factor in treatment, also for similar early MS cohorts and particularly in those who demonstrate a more severe disease in clinical and MRI metrics.

FRI060 Real World Experience Of Weight Management In Low Socioeconomic Community Clinic

Abstract Disclosure: B.A. West: None. S. Mon: None. Pilot Study: Real-world experience of weight management in low socioeconomic community clinic Introduction: Management of obesity and unhealthy behaviors is an essential step in patients with Prediabetes and T2DM, particularly those with socioeconomic status (SES) in whom obesity is more prevalent. While several behavior interventions targeting obesity exist, a successful adaptation of interventions in routine care is challenging especially in those with low SES. We examined the real word experience of weight loss management in our community clinic. Method: Retrospective chart review of consecutive patients seen in an endocrinology clinic at a hospital-based community clinic. Result: A total of 23 female patients, average age 48.4 ± 10.8 years, with average BMI 37.4 ± 6.9 kg/m2, were provided comprehensive lifestyle counseling focusing on nutrition, exercise, sleep health at each visits along with semaglutide at the highest tolerable dose of 2.4 mg/dl weekly. Within 6 months from the initiation of semaglutide and the weight loss intervention, 11/23 (48%) patients lost weight by &amp;gt;5% from their baseline visit, and 17/20 (85%) patients at the end of 1 year. 12/20 (60%) and 6/20 (30%) lost weight at least by 10% and 15% respectively at the end of 1 year. Compared to the baseline data, weight ( 101.2±18.4) kg, SBP 127.6 ± 13.4 mmHg, HbA1C 6.0 ± 1.1 mg/dL, Total Cholesterol 182.1 ± 40.4 mg/dL, LDL 102.4 ± 35.8 mg/dL, most parameters were improved at the end of 6 and 12 months respectively: weight 91.0± 18.6 vs 88.4± 16.2 kg, SBP 125.2± 16.8 vs. 126.9± 15.6 mmHg, HbA1C 5.8 ± 1.2 vs 6.3 ± 1.4 mg/dl, Total cholesterol 178.9± 33.1 vs 175.0 ± 50.7mg/dl, LDL 100.4± 27.7 vs 101.8± 47.7 mg/dL. Conclusion: This real-world implementation study reported the benefits of weight loss and other clinical parameters after the intervention consisting of a combined health behavior counseling and use of semaglutide at the low-SES community clinic. Presentation: Friday, June 16, 2023

Multiple Substance Use Patterns and Its Relationship with Imprisonment in a High-Risk Group of Iranian Adults.

Substance use is recognized as an important factor associated with many diseases and premature deaths and the main risk factor for disability worldwide. This study aims to identify subgroups of substance use in adults and detect the effect of imprisonment on the membership of participants in latent classes of substance use. Study Design: A cross-sectional study. This study was performed on 930 adult people who were referred to behavioral health counseling centers in Tehran province. All participants completed some checklists and questionnaires. Data analysis was performed using chi-square, Fisher's exact test, and latent class analysis (LCA). Four latent classes were identified, including non-users (58%), cigarette smokers (11.6%), users of low stigma substances (27.4%), and drug users (3.1%). After adjusting for other studied variables, having a history of imprisonment increased the odds of membership in the cigarette smoker class (Odds ratio [OR]=5.82, 95%, confidence interval [CI]: 3.19-10.63) and drug user class (OR=53.59, 95% CI: 18.00- 159.52) compared to non-user class. Among all participants, 84 (9.0%) had a history of imprisonment. Results from the present study indicate that 30.5% of the participants fell under the user of the low-stigma substance or drug user group. Focusing on increasing prisoner's knowledge of the dangers of using different substances and considering various programs for prisoners' leisure time may help reduce substance use prevalence.

Implementing the DSM-5 parent/guardian-rated level 1 cross-cutting symptom measure child 6-17 in a community mental health clinic.

Despite their relevance to assessment and clinical decision-making in behavioral health, measurement tools are still rarely used in clinical settings. With an increase in undiagnosed and untreated mental health problems in children and adolescents, a southeastern US Community Health System was the ideal setting for the implementation of a behavioral health assessment tool. This quality improvement project was conducted to address the question: "Among mental health clinicians at the Community Health System, will the use of the DSM-5 parent/guardian-rated level 1 cross-cutting symptom measure 6-17 (CCSM) improve diagnosis and treatment choices of children with mental health conditions, over a 4-week period?" A convenience sample was recruited from among behavioral health counselors working at various out-patient clinics and school-based counseling sites in the Community Health System. After nurse-led training on use of the CCSM, including a PowerPoint intervention and individual coaching sessions, the five clinical participants were encouraged to use the CCSM screening tool on their patients presenting for mental health assessment. Knowledge of the tool was assessed using a pre- and post-training survey. Completed screening tools were collected from participants over the 4-week duration of the project. A chart audit comparing the project period with the previous year showed an increase in diagnosis and treatment in 6-17 year-old patients at the outpatient clinic. This project demonstrated the usefulness of the CCSM for behavioral health assessment in the child/adolescent population at the Community Health System and supported use of the intervention in other clinics.

An application of social marketing for promoting HIV testing in Iran

BackgroundIt has been estimated that 60,000 Iranians have been infected with HIV/AIDS and only 36% of them are aware of their status. This study aimed to design, implement and evaluate a social marketing campaign to promote HIV testing in Boyer-Ahmad County, Kohgiluyeh, and Boyer-Ahmad Province, southwest of Iran.Materials and methodsThis study was a quasi-experimental pretest-posttest without a control group, developed based on a social marketing assessment and response tool. To design the intervention formative research was conducted, comprised of four focus group discussion sessions with 42 participants of the target community along with seven in-depth semi-structured personal interviews with health care providers involved in the HIV/AIDS Program. Data analysis was done manually using content analysis and the main content was formulated for the campaign. Afterward, the slogan and messages of the campaign were developed. The campaign’s materials including banners, posters, pamphlets, referral forms, and short messages were designed, pretested, and revised. Ultimately, the campaign was conducted for one month in October 2019. To determine the effectiveness of the campaign, the rate of referrals to the Center for Behavioral Health Counseling Services (CBHCS), for three months before and after the campaign, was compared.ResultsQualitative findings identified that the majority of the interviewees mentioned that the main reasons for the low rate of referrals to get tested for HIV were lack of awareness and information about HIV/AIDS and its diagnosis as well as the free and confidential tests available from the CBHCS. Moreover, the stigma associated with HIV/AIDS was another important reason for low referrals for testing. The rate of referrals for HIV testing in the three months leading up to the campaign was 18, 32, and 23 people, and three months after the campaign was 64, 81, and 44 individuals; respectively. The results of the multivariate analysis demonstrated that the campaign had increased the rates of referrals for HIV testing through its significant influence on females, and individuals with academic degrees.ConclusionIt can be concluded that the social marketing campaign was successful in persuading people to get tested for HIV.

Patient Perspective on the Efficacy of Health Behaviour Counselling After a Hypertensive Disorder of Pregnancy: A Mixed-Methods Study

Patient Perspective on the Efficacy of Health Behaviour Counselling After a Hypertensive Disorder of Pregnancy: A Mixed-Methods Study

Prehabilitation for spine surgery: A scoping review.

We aimed to identify and describe the current interventions used in preoperative programs ("prehabilitation") for spine surgery. Knowledge gaps in approaches, feasibility, timing, patient experience, clinical outcomes, and health care costs were explored while describing their potential benefits on physical and psychological outcomes. An electronic search was conducted from January 2004 to February 2022 in Ovid Medline, Embase, EBSCO CINAHL, the Cochrane Database of Systematic Reviews, and PEDro to identify studies in English evaluating adults enrolled in prehabilitation before undergoing elective spine surgeries. Studies were uploaded into DistillerSR for systematic screening after removing duplicates. Four reviewers screened nested references for inclusion based on titles and abstracts, followed by their full-text review. Two reviewers subsequently extracted data and summarized the results. The results were reported using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Studies were rated for quality using National Health and Medical Research Council criteria. Out of 18,879 potential studies, a total of 23 studies (0.12%) met the eligibility criteria and were included in this scoping review. The prehabilitation programs included general education (n=6, 26%), exercise (n=6, 26%), cognitive behavioral therapy (n=3, 13%), pain neuroscience education (n=3, 13%), health behavior counseling (n=3, 13%), and mindfulness (n=2, 9%). Additional studies are needed to identify optimal patient characteristics, intervention dosage, and whether multimodal approaches using a combination of physical and psychological strategies lead to more favorable outcomes. Although studies on prehabilitation for spine surgery are limited, they seem to demonstrate that prehabilitation programs are feasible, reduce medical expenditures, and improve patients' postoperative pain, disability, self-efficacy, psychological behaviors, and satisfaction with surgical outcomes. The available literature suggests there is an opportunity to improve patient experience, clinical outcomes and reduce medical costs with the use of prehabilitation in spine surgery.

Outpatient follow-up and use of medications for opioid use disorder after residential treatment among Medicaid enrollees in 10 states

BackgroundFollow-up after residential treatment is considered best practice in supporting patients with opioid use disorder (OUD) in their recovery. Yet, little is known about rates of follow-up after discharge. The objective of this analysis was to measure rates of follow-up and use of medications for OUD (MOUD) after residential treatment among Medicaid enrollees in 10 states, and to understand the enrollee and episode characteristics that are associated with both outcomes. MethodsUsing a distributed research network to analyze Medicaid claims data, we estimated the likelihood of 4 outcomes occurring within 7 and 30 days post-discharge from residential treatment for OUD using multinomial logit regression: no follow-up or MOUD, follow-up visit only, MOUD only, or both follow-up and MOUD. We used meta-analysis techniques to pool state-specific estimates into global estimates. ResultsWe identified 90,639 episodes of residential treatment for OUD for 69,017 enrollees from 2018 to 2019. We found that 62.5% and 46.9% of episodes did not receive any follow-up or MOUD at 7 days and 30 days, respectively. In adjusted analyses, co-occurring mental health conditions, longer lengths of stay, prior receipt of MOUD or behavioral health counseling, and a recent ED visit for OUD were associated with a greater likelihood of receiving follow-up treatment including MOUD after discharge. ConclusionsForty-seven percent of residential treatment episodes for Medicaid enrollees are not followed by an outpatient visit or MOUD, and thus are not following best practices.

Integrated care for HIV/AIDS infected patients. The Romanian experience

The human immunodeficiency virus (HIV) targets the body’s immune system and, if left untreated, may result in acquired immunodeficiency syndrome. (AIDS). HIV’s pathogenesis entails the gradual destruction of CD4+ T cells, which lowers the immune system and leaves the body more susceptible to co-infections and other diseases. HIV has been highlighted as a global public health concern, and since the first instances were recorded in the early 1980s, it has caused extensive morbidity and mortality. The HIV epidemic is still impacting millions of individuals throughout the entire globe, even though available antiretroviral therapy (ART) has transformed HIV infection from an almost universally fatal disease into a controllable chronic medical condition. The magnitude of the HIV epidemic varies between areas and countries. In 2021, the Joint United Nations Program on HIV/AIDS (UNAIDS) projected that 38.4 million individuals worldwide were living with HIV. The HIV integrated care approach highlights the significance of early diagnosis, care coordination, and medication adherence. This strategy incorporates a multidisciplinary team of medical specialists, including physicians, pharmacists, social workers, nurses, and mental health professionals. In addition to medication management, mental health counseling, drug addiction treatment, and peer support, HIV-integrated care includes additional therapies such as behavioral health counseling. HIV integrative care is a holistic approach to HIV infection management that addresses patients’ medical, interpersonal, and emotional requirements. It has been demonstrated that this form of treatment improves health outcomes, reduces stigma, and increases community involvement in combating HIV infections.

Clinic Based, Patient Choice Driven Lifestyle Intervention Lowers HbA1c In Type 2 Diabetes

The hyperglycemia associated with type 2 diabetes (T2D) results in substantially increased morbidity and mortality risk. Though efficacious pharmacotherapies exist, glycemic control remains poor with 33-49% of patients not meeting targets for glycemic control as quantified by HbA1c. While traditional lifestyle interventions have been shown to improve health outcomes, adherence is low. PURPOSE: This study sought to determine the efficacy of a clinic-based, menu-driven intervention on measures of glycemia and cardiovascular health. METHODS: Patients with T2D (n = 20; 56.7 ± 12y; 33.7 ± 7.2 BMI) with an HbA1c of 7.5-10% not requiring injectable insulin were recruited from an outpatient, family medicine clinic in Phoenix, AZ and underwent a quasi-experimental 3-month lifestyle intervention. In addition to behavioral counseling, subjects were given a daily menu of exercise and nutritional options and had to choose one option from each category. Exercise options: Moderate intensity (MOD) 3 x 10-minute bouts, MOD 1 x 30-minute bout, 2 minutes every hour at a high or MOD, and 10 x 1-minute bouts of high intensity (RPE 17-19). The dietary choices included: apple cider vinegar, psyllium husk powder, unsalted tree nuts, avocados, or extra virgin olive oil. Behavioral health counseling utilized motivational interviewing, acceptance and commitment therapy, and problem-solving therapy to promote behavior change. The intervention was administered to patients by medical assistants in a family medicine clinic and overseen by exercise physiologists and physicians. Wilcoxon Signed Rank tests were used to analyze pre- and post-intervention differences. RESULTS: A reduction in HbA1c of 0.5% was observed after the intervention (8.6 ± 0.9 vs. 8.1 ± 1.2% respectively; p = 0.05). Additionally, there was a reduction in waist circumference (115.5 ± 12.6 vs. 112.5 ± 15.2 cm; p = 0.014), body weight (97.7 ± 21.9 vs. 95.6 ± 23.9 kg; p = 0.016), and BMI (33.7 ± 7.2 vs 32.8 ± 7.5 kg/m2; p = 0.028). CONCLUSIONS: Our pilot data suggest that a lifestyle intervention administered by medical assistants in a family medicine clinic demonstrates improvements in glycemic control, waist circumference, and BMI in T2D. These results remain to be verified in a randomized controlled trial setting. Funding: Dignity Health/ASU Strategic Initiatives Program

Nutrition Assessment in Student-Run Clinics Serving Hispanic/Latinx Patients

Background: The patients of student-run clinics, especially Hispanic/Latinx patients, are at a disproportionately high risk for chronic disease due to the negative impacts of the social determinants of health, including barriers to obtaining healthcare, ranging from lack of financial resources to fear of deportation. Nutrition services are pivotal in providing effective, holistic healthcare for this patient population seeking care at student-run clinics. The purpose of this review is to examine how nutrition assessment is conducted at student-run clinics and to determine if the nutrition assessments are culturally tailored.&#x0D; Methods: Three scientific databases were searched using keywords focused on the concept of nutrition assessment in student-run clinics serving the Hispanic/Latinx population. The articles generated were reviewed by 4 independent reviewers to determine key elements related to nutrition assessment and/or nutrition services provided in student-run, free, or community clinics, with attention to addressing social and cultural barriers addressed by the clinic.&#x0D; Results: A search of the literature related to nutrition services at student-run clinics yielded 3 results for nutrition assessment of the Hispanic/Latinx population in student-run, free, or community clinics. Several articles presented research on health behavioral counseling and food insecurity screening, but few studies were conducted specifically on nutrition assessment, especially for the Hispanic/Latinx population.&#x0D; Conclusions: The current assessment tools have widespread use in nutrition assessment; however, they are insufficient for the distinctive characteristics of the Hispanic or Latinx population being served in a student-run clinic. Including dietetics students into a student-run clinic, if plausible, and/or a culturally sensitive guided nutrition assessment tool for students would be of benefit to adequately address the relevant social determinants of health in the nutrition assessment of patients at student-run clinics.

Adolescent suicide assessment and management in primary care

BackgroundTo understand how suicide management occurs within the primary care setting in terms of follow-up assessments and referral practices.MethodsAt an initial primary care visit, adolescents (aged 12–20 years old) completed electronic screening. Data were focused on youth who endorsed a suicidal risk item while completing screening at two Midwestern primary care clinics. Data were collected through retrospective chart reviews to analyze actions taken by the primary care physician at the youth’s initial visit and follow-up visit within the next 12 months.ResultsAt initial visits 200 adolescents endorsed a suicidal risk item and 39 (19.5%) were considered to be concerning by their primary care physician. The average age was 14.7 years old (SD ± 2.0). Seventy-two percent (n = 144) were female, and 65% (n = 129) identified as Black. At initial visits, significant differences between suicidal concern groups were found in reporting active suicidal ideation, past suicide attempts, those who were referred to behavioral health counseling, and those who had a diagnosis of depression. Interestingly, only 13% (n = 25) of all patients who endorsed the suicide item were asked whether or not there were weapons in their home and primary care providers asked only 7% (n = 13) of all patients whether they had a safety plan.ConclusionsThere was inconsistent follow-up for adolescents with a history of suicide concerns. At this time, national guidelines do not exist regarding primary care follow-up of youth with suicide concerns. Guidelines are a necessary precursor for practice improvement.Trial RegistrationClinical Trials Registry: NCT02244138. Registration date, September 1, 2014.