Health Referrals Research Articles

Patient and Staff Experiences of Embedding Electronic Patient Reported Outcome Measures for Distress Screening and Quality of Life Assessment, Into Routine Melanoma Care: A Mixed-Methods Study.

Patient reported outcome measures (PROMs) are commonly collected in melanoma research. However, they are not used to guide immediate clinical care in Australia. This study explored the views and experiences of patients with Stage III melanoma and clinic staff during implementation of an electronic Patient-Reported Outcome Measures in melanoma (ePROMs-MEL) pilot to assess distress and quality of life. A prospective mixed-methods study in specialist melanoma clinics in Sydney, Australia between May 2021 and February 2023. Forty-two post-ePROMs implementation surveys and 17 semi-structured interviews were undertaken among patients and staff (including oncologists, melanoma nurses and clinic managers). Survey responses were tabulated using Likert scales and interview transcripts analysed thematically. Of the 31 patient survey responses, over 90% reported ePROMs were easy to complete and measured important components of their health and wellbeing. Of the 11 staff surveys, over 50% reported ePROMs to be useful when allied health referrals were accessible but found implementation disruptive to clinic workflows. Six themes about ePROMs in clinical care emerged during data analysis: (1) promoting self-reflection; (2) conversation-starters; (3) timing and setting; (4) fit for purpose questionnaires; (5) resource issues; (6) value and limitations of ePROMs. Patients overwhelmingly supported the real-time collection of ePROMs for their immediate care. In contrast, staff support was conditional on resources to maximise clinical care efficiency and minimise administrative burden. Australia and New Zealand Clinical Trials Registry: anzctr.org.au/ACTRN12620001149954.aspx.

Psychosocial predictors of adolescent depression and mental health referral in an urban mobile medical unit programme

Introduction: Given worsening youth mental health over the past years, mobile medical units are a potential avenue to increase access to mental healthcare services. Methods: This 1-year retrospective study examined a self-administered psychosocial assessment, and referrals made to mental health services for adolescent patients served by a mobile medical unit. We extracted psychosocial assessment responses, Patient Health Questionnaire (PHQ-9) scores, and mental health referral information for patients seen by the mobile medical unit in 2022 and examined rates and predictors of depression and referral to mental health services. Results: Of the 326 patients who completed the psychosocial assessment, one in five had moderate to severe depression symptoms based on PHQ-9 scores. Factors associated with referral to mental healthcare included female gender identity, LGBTQ+ identity, and several factors from the psychosocial assessment. Additionally, 13.8% wanted a mental health referral, and 16.6% were referred to mental healthcare. Patients who desired to see a mental health provider had higher odds of being referred (p < 0.0001). All patients with moderate to severe depression who were not already connected to mental healthcare and wanted a referral were referred. Conclusion: This study documents the impact of a mobile medical unit programme in identifying adolescent patients with mental health needs and referring them to mental healthcare.

Enhancing mental health referrals through AI-enabled chatbots

The increasing prevalence of mental health issues calls for innovative approaches to ensure timely and effective access to mental health services. AI-enabled chatbots offer a promising solution by providing immediate, anonymous, and accessible support. This concept note explores the potential of AI-enabled chatbots to enhance mental health outcomes by increasing referrals to mental health services. Key objectives include improving access, reducing stigma, facilitating early intervention, guiding individuals through available resources, and enhancing follow-up care. The document outlines chatbot features, implementation strategies, expected outcomes, and the methodology for assessing their impact, illustrating their potential to revolutionize mental health care delivery.

Improving psychological and social support needs after traumatic birth: A qualitative study

IntroductionEmergency deliveries increase maternal risk for postpartum depression (PPD) and post-traumatic stress disorder (PTSD). One in three women describe their birth experience as traumatic, but patient-centered support needs are unclear. We conducted a qualitative study of women with traumatic birth to identify patient-centered priorities to optimize mental health support. MethodsSemi-structured interviews were conducted with women who experienced an emergency during birth, and who self-identified as experiencing traumatic birth. The Stanford Acute Stress Reaction Questionnaire and PTSD Checklist were completed. Interviews included open-ended questions about birth events that improved or worsened their delivery experience, perceptions of mental, physical, and emotional support provided by staff, and patient perspectives about psychological and social support referrals after emergent deliveries. ResultsA majority of participants met positive screening criteria for PTSD at the time of interviews. Birth experiences were affected by prenatal expectations, as well as the style and quality of clinical staff communication during and after delivery. There were four key themes central to their experiences and perceptions: (1) Emotional Impact and Intensity, (2) Factors Influencing Birth Experience, (3) Perceived Lack of Emotional Support, and (4) Desire for Post-Birth Follow-Up and Support. Participants almost unanimously desired to be offered psychosocial services after birth trauma. ConclusionThere are significant gaps in emotional support and communication for patients experiencing traumatic births. Offering structured, in-hospital mental health referrals may address immediate psychological needs, aid in trauma recovery, and potentially mitigate long-term mental health consequences. These findings advocate for a more holistic approach to postpartum care that prioritizes both physical and emotional well-being.

Athletic Trainers' Perceptions of Implementing Psychological Strategies for Patient Management: A Systematic Review.

To synthesize the best available evidence regarding the perceptions and current clinical practices of athletic trainers (ATs) in integrating psychological skills into patient management. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL; via EBSCOhost), PsycInfo (via EBSCOhost), SPORTDiscus (via EBSCOhost), and Scopus (via Elsevier). Studies had to investigate the current clinical practices and perceptions of certified ATs in integrating psychologically informed practice for patient management. Studies that had level 4 evidence or higher were included. Studies were excluded if they were published before 1999, the primary language was not English, they involved athletic training students or other rehabilitation specialists, or they explored the athlete's and/or patient's perception of psychosocial techniques or strategies. This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement in Exercise, Rehabilitation, Sport Medicine and Sports Science guidance. A total of 1857 articles were reviewed, and 8 met inclusion criteria. Two studies had level 2a evidence, 4 studies had level 4a evidence, and 2 studies had level 4b evidence. Six studies were rated as good quality, and 2 studies were rated as lesser quality. The included studies demonstrated a high-quality body of evidence with consistent results, which strengthens the review findings. Athletic trainers have the knowledge to identify when athletes are psychologically affected by injury and can identify common psychological responses. Although ATs acknowledge the value of implementing psychosocial strategies, a lack of confidence in implementing basic or advanced techniques, feeling underprepared by their educational program, and a lack of clinical training appear to affect the use of psychosocial techniques in clinical practice and the rate of mental health recognition and referral among ATs.

Potential benefits of incorporating social determinants of health screening on comprehensive medication management effectiveness.

Increasingly, pharmacists are asked to incorporate social determinants of health (SDoH) identification and referral into clinical practice. However, to date, no studies have evaluated clinical changes from embedding SDoH screening into the delivery of comprehensive medication management (CMM) in patients with chronic conditions. To examine the clinical effectiveness of implementing a clinical pharmacist-led SDoH screening and referral process as part of CMM encounters across a network of 7 Federally Qualified Health Centers (FQHCs). We used a retrospective cohort design to evaluate the effectiveness of integrating SDoH screening into CMM across a network of 7 FQHCs. A difference-in-difference approach was used to compare the effectiveness of CMM between patients with and without SDoH needs on the probability of achieving clinical control for blood pressure (<140 systolic/90 diastolic mm Hg) and diabetes (<9% hemoglobin A1c). Among 807 patients receiving CMM in 2023, 595 (74%) were screened for SDoH. 55.1% of patients screened had 1 or more SDoH, most commonly facing barriers related to insurance (22.0%), language (11.3%), transportation (9.1%), health behaviors (7.1%), income/employment (5.9%), and food insecurity (5.6%). Comparing patients with SDoH needs with those without, the proportion of patients controlled at baseline was 66.3% vs 72.3% for hypertension and 39.0% vs 75.4% for diabetes, respectively. Following a CMM encounter, the proportion of patients who achieved blood pressure control increased 7.6% more (P = 0.225) among patients with SDoH needs than in those without SDoH, whereas diabetes control rates increased 13.3% more (P = 0.143). Although not statistically significant, the results of this pilot evaluation suggest the potential for meaningful clinical improvements from screening and referral of SDoH needs as a part of CMM encounters. These results should be corroborated using a larger, more robust study design.

Factors Influencing the Incident of Acute Respiratory Tract Infections in Children Aged 12-59 Months in Wallandimu East Nusa Tenggara

Background: Acute Respiratory Infection Disease is one of the highest causes of morbidity and mortality in children under five in Indonesia, especially in East Nusa Tenggara. The implementation of the ISPA disease control program focuses on finding and treating sufferers as early as possible by involving the active role of cadres, integrated health service support and referrals to related health facilities, however, these control efforts have not shown significant results. Purpose: The aim of this study was to determine the factors that influence the incidence of Acute Respiratory Infection Disease in children aged 12-59 months in the Wallandimu Community Health Center working area. Method: This research uses an analytical research design with a cross sectional approach. The population in this study were toddlers aged 12-59 months in the Wallandimu health center working area and the sample in this study was 30 toddlers. The sampling technique in this research was simple random sampling. The Chi-Square statistical test was used to determine the relationship between variables. Results: The results of the research from 18 respondents showed complete immunization status (76.7%), poor nutritional status (60.0%), and insufficient knowledge (56,7%) regarding the incidence of ISPA in the Wallandimu Health Center working area. The results of bivariate analysis showed no influence between immunization status and the incidence of ISPA (p= 0.896 &gt; 0.05), there was an influence between nutritional status and the incidence of ISPA (p= 0.007 &lt; 0.05), there was an influence between maternal knowledge and the incidence of ISPA (p = 0.010 &lt; 0.05). Conclusion: It is hoped that the Wallandimu Community Health Center will further improve its health programs, especially the Acute Respiratory Infection Disease control program for toddlers and provide education regarding maternal knowledge and the dangers of malnutrition for toddlers, so that the incidence of Acute Respiratory Infection Disease in children aged 12-59 months will decrease.

Community Paramedicine Program in Social Housing and Health Service Utilization

Community Paramedicine at Clinic (CP@clinic) is a chronic disease prevention program that decreases 911 calls for emergency medical services, but its wider system effects are unknown. To evaluate the effects of CP@clinic vs usual care on individual-level health service utilization outcomes. This open-label, pragmatic cluster randomized clinical trial evaluated all residents 55 years or older in 30 social housing buildings in Ontario, Canada, that had (1) a unique postal code, (2) at least 50 apartments, (3) 60% or more residents 55 years or older, and (4) a similar building for pairing (15 intervention and 15 control buildings, pair-matched randomization). The 12-month intervention had a staggered start date from January 1, 2015, to December 1, 2015, and ended between December 31, 2015, and November 30, 2016. Administrative health data analysis was conducted in May 2022. CP@clinic was a health promotion and disease prevention program led by specially trained community paramedics who held weekly drop-in sessions in social housing buildings. These paramedics conducted 1-on-1 risk assessments, provided health education and referrals to relevant community resources, and, with consent, sent assessments to family physicians. Control buildings received usual care (universal health care, including free primary and specialty medical care). Individual-level health service utilization was measured from administrative health data, with ED visits via ambulance as the primary outcome; secondary outcomes included ED visits for any reason, primary care visits, hospitalizations, length of hospital stay, laboratory tests, receipt of home care, transfer to long-term care, and medication initiation. Generalized estimating equations were used to estimate intervention effects on individual-level health service utilization, accounting for trial design and individual-level baselines. The 30 social housing buildings had 3695 residents (1846 control and 1849 intervention participants; mean [SD] age, 72.8 [9.1] years; 2400 [65.0%] female). Intention-to-treat analysis found no significant difference in ED visits by ambulance (445 of 1849 [24.1%] vs 463 of 1846 [25.1%]; adjusted odds ratio [AOR], 0.97; 95% CI, 0.89-1.05) but found higher antihypertensive medication initiation (74 of 500 [14.8%] vs 47 of 552 [8.5%]; AOR, 1.74; 95% CI, 1.19-2.53) and lower anticoagulant initiation (48 of 1481 [3.2%] vs 69 of 1442 [4.8%]; AOR, 0.68; 95% CI, 0.53-0.86) in the intervention arm vs the control arm. CP@clinic attendance was associated with higher incidence of primary care visits (adjusted incidence rate ratio, 1.10; 95% CI, 1.03-1.17), higher odds of receiving home care (AOR, 1.07; 95% CI, 1.01-1.13), and lower odds of long-term care transfers (AOR, 0.32; 95% CI, 0.13-0.81). In this cluster randomized clinical trial of CP@clinic, the intervention did not affect the rate of ED visits by ambulance; however, there were increased primary care visits and connections to home care services, which may have increased antihypertensive medication initiation and reduced long-term care transfers from social housing. Health policymakers should consider CP@clinic's impact as an upstream approach to improve care for older adults with low income. ClinicalTrials.gov Identifier: NCT02152891.

Dementia Rehabilitation Training for General Practitioners and Practice Nurses: Does It Make a Difference?

Rehabilitation helps reduce disability in dementia. The Australian National Dementia Action Plan identifies a gap in clear treatment pathways post-diagnosis, affecting the quality of life for those with dementia. This study assessed the impact of a one-day dementia training course and follow-up on GPs' and practice nurses' knowledge, attitudes, and confidence regarding dementia rehabilitation. The training, led by two experienced GPs and an academic physiotherapist, covered dementia diagnosis, allied health roles, care planning, and referrals. The follow-up involved applying the learnt material and completing a reflective task. Three longitudinal surveys (Dementia Knowledge Assessment Scale-DKAS, General Practitioners' Attitudes and Confidence towards Dementia Survey-GPACS-D, and Dementia Rehabilitation Scale) and Likert-scale statements were conducted pre-course, post-course, and at four-month follow-up, alongside a focus group. Descriptive and regression analyses were applied to survey data, and content analysis was used for focus group data. Seventeen participants (14 GPs, 3 nurses) completed the pre-post-course survey, with eight (6 GPs, 2 nurses) participating in follow-up and focus group discussions. Post-course, DKAS scores increased by 12.1%, GPACS-D by 10.1%, and the dementia rehabilitation scale by 9.4%. Likert-scale statements improved by 8-79%. At the four-month follow-up, there was a slight, non-significant decline in most measures. Focus groups highlighted the training's impacts, useful components, barriers, and suggestions for improvement. Training GPs and practice nurses in dementia rehabilitation enhances knowledge, awareness, and confidence. Ongoing efforts are needed to sustain benefits and address referral barriers for better access to dementia rehabilitation services.

Implementing an Adverse Childhood Experiences Screening Tool With Migrant Children: A Quality Improvement Project Using the PEARLS Screening Tool

BackgroundImmigrants, asylum seekers, and refugees live with extreme stress, consistent vulnerability, and life-long health consequences. Children in these populations face increased risk of poor mental health due to adverse childhood experiences (ACEs) and related healthcare barriers, such as lack of screening, that limit their ability to receive appropriate mental health care. AimTo implement an ACEs screening questionnaire for all migrant children 19 and under in a community shelter. MethodsThe Model for Improvement. InterventionThe Pediatric ACES and Related Life Events Screener (PEARLS) was implemented over a 10-week period in a community shelter. ResultsAll children screened had at least 1 ACE. Initiation of PEARLS screening led to recognition of adverse experiences thus allowing for mental health support and referrals to mental health specialists. ConclusionsThis QI project supports implementation of screening for adverse childhood experiences within populations of migrant children in order to uncover potential mental health concerns and provide targeted support, recognizing the long-term effects of trauma on their wellbeing.

Partnerships Between Faith Communities and the Mental Health Sector: A Scoping Review.

Faith communities are increasingly providing services to address the mental health needs of their congregations and communities. However, many feel limited in their capacity to address serious illness and experience challenges to collaborating with the mental health sector. To inform the development of faith community-mental health sector partnerships, the authors conducted a scoping review to assess the characteristics and evidence base of partnership approaches to addressing mental health needs. A search of four databases identified peer-reviewed articles published between 2010 and 2023 on faith community-mental health sector partnerships in the United States. In total, 37 articles representing 32 unique partnerships were reviewed. Most partnerships (N=19) used multicomponent approaches, particularly involving training the faith community (N=18), mental health education for the broader community (N=14), and direct counseling (N=11). Many partnerships (N=14) focused on African American communities. Partnerships that included an evaluation component (N=20) showed promising findings for improving mental health symptoms, mental health literacy, stigma, and referrals, among other outcomes. Several articles reported facilitators (e.g., support from faith leaders and reciprocal relationships and equal power) and barriers (e.g., limited time and funding and differing interests and attitudes) to developing partnerships. The findings highlight how faith communities can be a critical partner in providing services across the continuum of mental health care and reveal the need for more rigorous evaluations of the effectiveness, feasibility, and sustainability of these partnerships. The results also identify strategies that may facilitate the development and strengthening of future faith community-mental health partnerships.

System-Based Intervention for Medical Providers to Improve Dental Attendance in Adult Primary Care.

There are minimal evidence-based outcomes from clinical trials for medical-dental integration. This formative work and pilot study is a precursor to a larger cluster-randomized clinical trial in adult primary care practices to test an electronic health record (EHR) structured workflow for primary care providers (physicians/nurse practitioners [NPs]) and medical staff (medical assistants [MAs] and nurses) with oral health (OH) screening and referral for Medicaid-enrolled adults ≥55 years. This study was conducted in 2 practices with providers, medical staff, and older adults. Focus groups preceded the pilot study to gain stakeholder insights prior to the multilevel interventions of systems changes and provider education. The system-level EHR changes for medical staff included ask (OH screening), advise (visit dentist soon/annually), assess (need for referral: eReferral to co-located dentists or structured referral to community dentists), and connect (referral; resources). Provider education (didactic and skills) was based on the Common-Sense Model of Self-Regulation (CSM) to deliver OH facts to older adults at primary care visits. Descriptive analysis was used to report on process outcomes of reach, adoption, and implementation/fidelity. After stakeholder input, the CSM-based didactic and skills curriculum was developed, and 4 physicians were trained. Changes in the Epic EHR were implemented, and 19 medical staff were trained in this new structured workflow together with physicians. In terms of reach, 83% (N = 80) of older adults were enrolled out of 96 approached (female: 66%; non-Hispanic: 83%; Caucasian: 43%). Workflow adoption was 100% of MAs completing the EHR questions and 89% of providers documenting giving OH facts. About 94% of older adults reported their physician giving them OH facts indicating implementation/fidelity of the intervention. About 60% of older adults reported no dental visits in the past year, and 66% requested eReferrals. This study presents an innovative systems-based multilevel intervention for medical-dental integration. The results of this study can be used by practice leadership and clinicians when incorporating oral health into primary care for older adults. Considering adoption and implementation costs, this information could lead to a more complete approach to address oral health with patients.

Evaluation of a student pharmacist-led depression screening program in a community pharmacy.

One in 5 adults in the United States have depression and are at risk for suicide, the 11th leading cause of death in the United States. Community pharmacy settings are ideal for increasing access to mental health services. Our objectives were to assess PHQ-9 scores and evaluate participant satisfaction in a student pharmacist-led depression screening program in a community pharmacy. Student pharmacists trained in mental health first aid recruited participants 18 to 90 years old in a community pharmacy to complete the PHQ-9 and provided mental health education, referrals, and resources. A 2-week follow-up was completed, and participants reported on actions taken since the initial visit. Descriptive statistics, independent t tests, and χ 2 tests were used in data analysis. Twelve depression screening events were held, and 70 participants completed the screenings. The mean age was 52 years, and 75.7% were female. PHQ-9 scores ranged from 0 to 24 with an average of 3.96. Most participants (92.9%) reported the depression screening program was helpful. More than 90% of participants completed the 2-week follow-up, and 92.3% reported being comfortable seeking mental health services from a pharmacist. About half (53.8%) reported reading the educational materials, 24.6% helped a friend or family member, and 16.9% made an appointment with their health care provider. Student pharmacists successfully provided depression screenings and mental health education in a community pharmacy. Most participants had low PHQ-9 scores, found the program helpful, and are willing to utilize mental health services in a community pharmacy.

Application of Community Detection Methods to Identify Emergency General Surgery–Specific Regional Networks

There is growing interest in developing coordinated regional systems for nontraumatic surgical emergencies; however, our understanding of existing emergency general surgery (EGS) care communities is limited. To apply network analysis methods to delineate EGS care regions and compare the performance of this method with the Dartmouth Health Referral Regions (HRRs). This cross-sectional study was conducted using the 2019 California and New York state emergency department and inpatient databases. Eligible participants included all adult patients with a nonelective admission for common EGS conditions. Interhospital transfers (IHTs) were identified by transfer indicators or temporally adjacent hospitalizations at 2 different facilities. Data analysis was conducted from January to May 2024. Admission for primary EGS diagnosis. Regional EGS networks (RENs) were delineated by modularity optimization (MO), a community detection method, and compared with the plurality-based Dartmouth HRRs. Geographic boundaries were compared through visualization of patient flows and associated health care regions. Spatial accuracy of the 2 methods was compared using 6 common network analysis measures: localization index (LI), market share index (MSI), net patient flow, connectivity, compactness, and modularity. A total of 1 244 868 participants (median [IQR] age, 55 [37-70 years]; 776 725 male [62.40%]) were admitted with a primary EGS diagnosis. In New York, there were 405 493 EGS encounters with 3212 IHTs (0.79%), and 9 RENs were detected using MO compared with 10 Dartmouth HRRs. In California, there were 839 375 encounters with 10 037 IHTs (1.20%), and 14 RENs were detected compared with 24 HRRs. The greatest discrepancy between REN and HRR boundaries was in rural regions where one REN often encompassed multiple HRRs. The MO method was significantly better than HRRs in identifying care networks that accurately captured patients living within the geographic region as indicated by the LI and MSI for New York (mean [SD] LI, 0.86 [1.00] for REN vs 0.74 [1.00] for HRR; mean [SD] MSI, 0.16 [0.13] for REN vs 0.32 [0.21] for HRR) and California (mean [SD] LI, 0.83 [1.00] for REN vs 0.74 [1.00] for HRR; mean [SD] MSI, 0.19 [0.14] for REN vs 0.39 [0.43] for HRR). Nearly 27% of New York hospitals (37 of 139 hospitals [26.62%]) and 15% of California hospitals (48 of 336 hospitals [14.29%]) were reclassified into a different community with the MO method. Development of optimal health delivery systems for EGS patients will require knowledge of care patterns specific to this population. The findings of this cross-sectional study suggest that network science methods, such as MO, offer opportunities to identify empirical EGS care regions that outperform HRRs and can be applied in the development of coordinated regional systems of care.

Gerotranscendence, Hope, and Coherence in the Face of Life Adversity.

Background and Purpose: Older adults are living longer and becoming more diverse. The current study examined the relationship between traumatic life events, hope, coherence, and successful aging in Black and White older adults with at least one chronic health condition, and the influence of life events on gerotranscendence. Methods: Fifty older adults from two senior centers participated. Participants completed the Successful Aging Inventory, Life Events Checklist, Herth Hope Index, and Sense of Coherence Scale. Results: Significant correlations were found between successful aging and gerotranscendence (r = .290; p = .048) and hope (r = .585; p = <.001). Simple linear regression found that Successful Aging Index (SAI) scores significantly predicted gerotranscendence (R2 = .10, F(1, 46) = 5.157, p = .028) and Herth Hope Index scores (R2 = .36, F(1, 46) = 25.850, p <.001). Higher Sense of Coherence (SoC) and Gerotranscendence Scale scores among those with no firsthand trauma experience suggest that experiencing traumatic events firsthand may adversely affect the aging process. Implications: Therefore, exploration of trauma experiences, with mental health referrals as appropriate are clinical implications to consider.

Implementation and evaluation of a proactive consultation-liaison model on an inpatient obstetric unit

ObjectivePerinatal mental and anxiety disorders (PMADs) contribute to adverse health outcomes, though they are underrecognized and undertreated. Inpatient obstetric settings represent a unique opportunity for behavioral health engagement, including screening, brief treatment, and referrals for outpatient care. The proactive consultation-liaison (CL) model has proven effective in general hospital settings but is not well-studied in obstetric settings. This article describes the implementation and evaluation of a proactive CL model in an inpatient obstetric unit within a tertiary medical center. MethodsWe implemented a multidisciplinary, proactive CL model in an inpatient obstetric unit with the purpose of identifying patients at risk for or experiencing PMADs and providing intervention and/or referral to treatment. Systematic screening of 7322 admitted patients was performed over a 17-month period to identify eligible patients for behavioral health consultation. Consultation data was retrospectively extracted from the electronic medical record. Key implementation outcomes were assessed using a RE-AIM measures (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Results1589 initial consults were conducted by the multidisciplinary team, yielding a consult rate of 21.7 %. The majority of consults (94 %) were completed by a social worker or psychologist, with most patients identified for consultation at multidisciplinary rounds (60.7 %). The most common indications for consultation with a psychiatrist included medication management, history of bipolar disorder, and history of anxiety. All invited staff and providers participated in the model. Alternative funding sources agreed to cover the salaries of the multidisciplinary team following conclusion of pilot grant funding. ConclusionsA proactive CL model implemented in an inpatient obstetric unit led to a higher consult rate (21.7 %) than is observed with traditional CL services. A multidisciplinary proactive CL model shows promise in identifying people at-risk for PMADs and providing targeted interventions to prevent PMADs and treat those with active symptoms.

Factors associated with human papillomavirus infections among women living with HIV in public health facilities in Western Oromia, Ethiopia

BackgroundHuman Papillomavirus infection (HPV) is among the most common sexually transmitted infections with the highest incidence and prevalence worldwide. HPV has been established as the main cause of cervical cancer and remains a public health problem globally. In Western Oromia, Ethiopia cervical screening remains a major issue because of limited resources, and shortage of HPV testing technology. As a result, the prevalence of HPV and associated factors remain unknown among HIV-positive women. This study aimed to assess the prevalence of HPV and associated factors among women living with HIV attending Antiretroviral Therapy (ART) services in public health facilities of East Wollega and West Showa Zones, Ethiopia, 2022.MethodUsing a cross-sectional study design, a total of 415 women ≥ 18 years old were enrolled using systematic random sampling from five public health facilities. Cervical specimens were collected by a trained nurse from April 01 2022, to May 30, 2022, and tested at Nekemte Public Health Research and Referral Molecular Biology, a certified/accredited laboratory for HPV-DNA Polymerase Chain Reaction by expertise using Abbott m2000rt-PCR assays. Finally, Epi data version 4.6 was used for data entry and SPSS version 24.0 were used for data cleaning and analysis, and frequencies and prevalence of HPV were computed. Variables were identified using the multivariable model and statistically significant associations of variables were determined based on the adjusted odds ratio (AOR) with its 95% CI and P-value < 0.05 to determine the strength of association.ResultThe prevalence of HPV was 30.4% [95% CI: 26.0, 34.9]. Of HPV-infected women, 11.9% were positive for HPV-16, 9.5% for HPV-18, and 65.9% were positive for other hr-HPV . The odds of HPV infection among women aged beyond 48 years are 2.85 times the odds of HPV among people who were aged 18–27(AOR = 2.85, 95% CI: 1.16, 5.58). The odds of HPV infection among women who had three or more sexual partners is 4.12 times the odds of HPV infection among women with a single sexual partner(AOR = 4.12, 95% CI: 2.34–8.62). The odds of HPV infection among women who didn’t use condom during sexual intercourse are 4.73 times the odds of HPV among women who used condom during sexual intercourse. (AOR = 4.73, 95% CI: 1.98–9.33). The odds of HPV infection among women who had history of is 4.52 times the odds of HPV infection among women with no history of abortion. [AOR = 4.52, 95% CI: 2.04, 6.89] The odds of HPV infection among women with history of Sexually Transmitted Infection (STI) 3.62 times the odds of HPV among women with no history of STI (AOR = 3.62, 95%CI: 1.75, 5.83). The odd of HPV among women with abnormal vaginal discharge is 3.31 times the odds of the disease among women with normal vaginal discharge [AOR = 3.31, 95% CI: 2.87,7.35).Conclusion and recommendationThe prevalence of HPV infection among HIV-infected women was high in the study area. Given the above-associated factors, we recommend that the stakeholders integrate HPV prevention strategies into HIV /AIDS services. Furthermore, the study has provided essential information about the HIV link with hr-HPV infections, which may explain the high prevalence among HIV-infected women. This can contribute to policy development and planning of prevention strategies incorporating HPV infection prevention especially among youth and HIV-infected people.

Retrospective study on the dengue fever outbreak in Puntland State, Somalia

BackgroundDengue infection is a mosquito-borne, endemic viral disease, particularly in developing countries. Here, we report the results of the clinicodemographic, serologic profile and the monthly occurrence of a recent dengue fever outbreak in Puntland State (Somalia).MethodologyWe analyzed the data of 956 dengue-suspected patients who were investigated using the rapid diagnostic testing (RDT) method for detecting NS1 (dengue virus non-structural protein) and IgM antibodies employing the SD Biosensor Dengue Dou NS Ag and IgM test kit (Germany) at the Puntland Public Health Referral Laboratory from November 21, 2022, to May 27, 2023.ResultsWe found that 118 cases were positive for dengue among the suspected patients enrolled in the present study. Of these cases, 76.2% were dengue NSI positive, 13.6% were dengue IgM positive, and 10.2% were both NSI and IgM positive. The number of females and males in the confirmed cases was equal, and most (48.3%) were aged 20 years or less. 43.1% of them lived in the Nugal region, particularly in Garowe. Clinically, fever was the most frequent symptom (88.9%). The cases peaked in December 2022 but dropped from January to March, with a slight rise in February, and then increased in April and May 2023.ConclusionThis study highlights the clinicodemographic characteristics, seroprevalence, and monthly occurrence of dengue in Puntland. We recommend improving vector control measures, enhancing case management, strengthening dengue surveillance, developing an early warning system, and conducting future studies to characterize the circulating strains.

Social Determinants of Health Screening, Referral, and Outcomes: Toward an Evidence-Based Simulation Model.

A more complete conceptual model of the social determinants of health (SDOH) screening and referral process is needed to identify effective interventions to address unmet social needs that impact health outcomes. The objective was to develop an evidence-based, complex, multi-factorial model that makes explicit the behaviors and experiences of both patients and the care team (factors) who use an SDOH platform to facilitate patient connections to community resources. The resulting model organized 88 factors among five main stages in the process and among health outcomes. Factors were grouped into eight categories among person, system, and organization levels. Most factors were related to the screening process, with sparse factors related to referral completion. The resulting model is offered as an initial step toward the development of a simulation model to assess interventions before implementation in real-world settings.

Mind the Gap: Understanding Palliative Care Clinician Attitudes Toward Mental Health Training.

Background: Palliative care (PC) clinicians provide mental healthcare to individuals with serious illnesses. Despite this, there is limited knowledge regarding their mental health training opportunities. Methods: To identify predictors of satisfaction with mental health training opportunities and assess the relationship between training opportunities and clinician comfort in managing mental health comorbidities, we conducted a secondary analysis of a nationwide survey involving 708 PC clinicians. Results: Satisfaction with mental health training was moderate (M = 2.75/5, SD = .915). Access to lectures/webinars was the most common training opportunity (54%). Significant predictors of satisfaction with training included access to lectures/webinars (β = .328, P <.001) and case discussions (β = .231, P = .007). Academic practice settings and satisfactory mental health referrals were associated with a greater number of different training opportunities. Clinicians in academic settings had higher odds of accessing various training opportunities, such as lectures/webinars (OR = 2.58, P <.001) and longitudinal training pathways (OR = 4.51, P <.001). A moderate, positive correlation was found between training satisfaction and comfort in managing mental health comorbidities (r = .30, P <.001). Discussion: This study is among the first to elucidate factors influencing PC clinicians' satisfaction with mental health training. Low-resource training opportunities, such as webinars and lectures, significantly predict satisfaction, suggesting the potential of these scalable solutions to enhance training. The findings underscore the importance of expanding evidence-based mental health training for PC clinicians to improve patient care.