Primary Care Partnership Research Articles

Identifying implementation barriers and facilitators in an integrated behavioral health training program to improve workforce development.

Integrated behavioral health (IBH) in pediatric primary care settings can improve access to needed care and outcomes. Behavioral Health Workforce Education and Training (BHWET) programs can better prepare the workforce and support improved care access. This case study identified factors that impede and facilitate the implementation of practice-based training in a BHWET program using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Surveys were administered to BHWET trainees and primary care partners to assess stakeholder perspectives on field-based training processes. Qualitative data were extracted from surveys and trainee clinical logs. Providers reported high levels of satisfaction with IBH care training experiences. Data analysis identified several implementation facilitators and barriers. Implementation facilitators were associated with two EPIS outer context factors (leadership and collaboration) and one inner context factor (partner staffing). Identified barriers were associated with two inner context factors (organizational characteristics and data collection). Although the facilitators and barriers identified in this study were program specific, they have relevance for similar programs. Barriers identified at the organizational level reflect those identified in the research literature and provide insights for university programs regarding factors that must be considered when integrating IBH training components in primary care settings.

Implementing Dementia Care Management into routine care: protocol for a cohort study in Siegen-Wittgenstein, Germany (RoutineDeCM)

IntroductionDementia Care Management is an evidence-based model of care. It has proven its efficacy and cost-effectiveness and has been applied to different settings and different target groups. However, it is...

Primary care and community partnerships to promote age-friendly care for Hispanic older adults.

Healthcare and community collaborations have the potential to address health-related social needs. We examined the implementation of an educational initiative and collaborative intervention between a geriatric clinic and Area Agency on Aging (AAA) to enhance age-friendly care for a Hispanic patient population. As part of a Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Program, a geriatric clinic partnered with AAA to embed an English- and Spanish-speaking Social Service Coordinator (SSC). The SSC met with patients during new and annual visits or by referral to address What Matters and Mentation in the patient's primary language, provide education, and make social service referrals. Patients aged 60 and older, who received SSC services during a 12-month period, were defined as the intervention group (n = 112). Using a retrospective chart review, we compared them to a non-intervention group (n = 228) that received primary care. We examined available demographic and clinical data within the age-friendly areas of What Matters and Mentation. Measures included cognitive health screenings, advance care planning, patient education, and community referrals. Most of the intervention groups were eligible for AAA services and had the opportunity for service referrals to address identified needs. A higher proportion of patients within the intervention group completed screenings for cognitive health and advance care planning discussions. Interagency partnerships between ambulatory care settings and community-based organizations have the potential to expand access to linguistically and culturally competent age-friendly primary care for older adults.

Collaborative governance in a primary health care partnership in Papua New Guinea.

Collaboration in primary health care is recommended to achieve global health goals. Public-private partnerships (PPP) are one means of collaboration. Our study examined collaboration in a case study PPP for primary health care in Western Province, Papua New Guinea (PNG). Interviews with key informants involved in the PPP were conducted and key programme documents were reviewed. Data were coded and deductively analysed using the collaborative governance model developed by Emerson, Nabatchi and Balogh. The key features of the case study PPP that were highlighted by the collaborative governance model were: identification of partners, trust, procedural arrangements, and leadership. We identified four lessons of significance in the practical establishment and implementation of a partnership in a complex and challenging setting such as PNG: the need to (i) prioritise in-person collaboration and communication, (ii) engage dynamic individuals to lead the partnership, (iii) encourage relationships across all sectors and actors, and (iv) remain flexible and adapt to local cultural and context. Collaborative governance offers a practical framework to understand, assess and strengthen collaboration in multi-stakeholder partnerships in the health sector.

A framework for more equitable, diverse, and inclusive Patient and Public Involvement for palliative care research

BackgroundThere are marked inequalities in palliative care provision. Research is needed to understand how such inequalities can be addressed, so that everyone living with advanced illness can receive the care they need, when they need it. Research into inequalities in palliative care should be guided by Patient and Public Involvement (PPI) that includes people from diverse backgrounds, who are less likely to receive specialist services. Multi-disciplinary research partnerships, bringing together primary care (the main providers of palliative care to diverse communities) and specialist palliative care, have the potential to work together in new ways to do research to address inequalities and improve palliative care in practice. This report describes a research partnership between primary care and palliative care that aimed to: (1) create opportunities for more inclusive PPI in palliative care research, (2) co-design new resources to support more equitable, diverse and inclusive PPI for palliative care, (3) propose a new framework for inclusive PPI in palliative care research.MethodsPPI members were recruited via primary care and palliative care research networks from three diverse areas of the UK. A pragmatic, collaborative approach was taken to achieve the partnership aims. Online workshops were carried out to understand barriers to inclusive PPI in palliative care and to co-design resources. Evaluation included a “you said, we did” impact log and a short survey. The approach was informed by good practice principles from previous PPI, and existing theory relating to equity, equality, diversity, and inclusion.ResultsIn total, 16 PPI members were recruited. Most were White British (n = 10), other ethnicities were Asian (n = 4), Black African (n = 1) and British mixed race (n = 1). The research team co-ordinated communication and activities, leading to honest conversations about barriers to inclusive PPI. Resources were co-designed, including a role description for an Equity, Equality, Diversity and Inclusion Champion, a “jargon buster”, an animation and an online recipe book (http://www.re-equipp.co.uk/) to inform future PPI. Learning from the partnership has been collated into a new framework to inform more inclusive PPI for future palliative care research.ConclusionCollaboration and reciprocal learning across a multi-disciplinary primary care and palliative care research partnership led to the development of new approaches and resources. Research team commitment, shared vision, adequate resource, careful planning, relationship building and evaluation should underpin approaches to increase equality, diversity and inclusivity in future PPI for palliative care research.

Advocating for Policy Change: Examples Emerging From a Medical-Legal Partnership in Primary Care.

Medical-legal partnerships bring legal services directly into clinical settings. Policy advocacy is often opportunistic and varies across partnerships. Our objective was to study policy advocacy that emerged from a medical-legal partnership in Toronto over a four-year period. This study consisted of a document review and thematic analysis, triangulated with data from interviews with legal team members and health providers. We defined policy advocacy as actions associated with attempts to change policy or legislation. The medical-legal partnership engaged in seven distinct cases of policy advocacy: disability support form requirements, changing workplace review, challenging barriers to citizenship, housing, publicly funded medication program (pharma care), safe injection sites, and the need for increased social assistance. Actions taken included presentations at conferences and submissions of briefs to government. We found that a medical-legal partnership resulted in policy advocacy with issues arising from both the health and the legal team with impacts likely greater than if each group had acted alone.

Primary Care and Community-Based Partnerships to Enhance HPV Vaccine Delivery.

With growing vaccination misinformation and mistrust, strategies to improve vaccination communication across community-based settings are needed. The Rural Adolescent Vaccine Enterprise (RAVE), a 5-year (2018-2022) stepped-wedge cluster randomized study, tested a clinic-based practice facilitation intervention designed to improve HPV vaccination. An exploratory aim sought to explore the use of partnerships between primary care clinics and a community partner of their choosing, to implement a social marketing campaign related to HPV immunization. We assessed perceptions about the value and success of the partnership, and barriers and facilitators to its implementation using a 29-item community partner survey, key informant interviews, and field notes from practice facilitators. Of the initial 45 clinics participating in RAVE, 9 were unable to either start or complete the study, and 36 participants (80.0%) were actively engaged. Of these, 16/36 clinics (44.4%) reported establishing successful partnerships, 10 reported attempting to develop partnerships (27.8%), and another 10 reported not developing a partnership (27.8%), which were often caused by the COVID-19 pandemic. The most common partnership was with public health departments at 27.3%. Other partnerships involved libraries, school districts, and local businesses. More than half (63.7%) reported that creating messages regarding getting HPV vaccination was moderately to very challenging. Just under half reported (45.5%) that messaging was hard because of a lack of understanding about the seriousness of diseases caused by HPV, parents being against vaccines because of safety concerns, and religious values that result in a lack of openness to HPV vaccines. Community partners' health priorities changed as a result of RAVE, with 80% prioritizing childhood immunizations as a result of the RAVE partnership. Community groups want to partner with primary care organizations to serve their patients and populations. More research is needed on how best to bring these groups together.

Implementation science for cancer control: One center's experience addressing context, adaptation, equity, and sustainment.

Implementation science (IS) has great potential to enhance the frequency, speed, and quality of the translation of evidence-based programs, policies, products, and guidelines into practice. Progress has been made, but with some notable exceptions, this promise has not been achieved for cancer prevention and control. We discuss five interrelated but conceptually distinct, crosscutting issues important to accelerate IS for cancer prevention and control and how our Colorado Implementation Science Center in Cancer Control (COISC3) addressed these issues. These needs and opportunities include more fully addressing changing, multi-level context; guiding rapid, iterative adaptations; evaluating innovative approaches to engagement and health equity; greater attention to costs and economic issues; and sustainability. We summarize conceptual issues; evaluation needs and capacity building activities and then provide examples of how our IS center addressed these five needs for cancer prevention and control. We discuss changes made to address priorities of (i) guiding adaptations of implementation strategies to address changing context and (ii) working on issues identified and prioritized by our primary care partners rather than the research team. We conclude with discussion of lessons learned, limitations, and directions for future research and practice in IS to enhance cancer prevention and control as well as translational behavioral medicine more generally.

Integrated transmural care pathway for stroke patients after discharge from the hospital: the growth towards a total concept in cooperation with primary care partners in southwest-Flanders

Every year, nearly 27,000 Belgians suffer a stroke. After discharge from the hospital there is follow-up. In this best practice, we want to discuss the initiatives that AZ Groeninge has taken over the years to achieve an integrated transmural care pathway for stroke patients after discharge from the hospital in collaboration with primary care, regional GP-associations and home care organizations. 
 Transmural care pathway for stroke care: Prof. Dr. Peter Vanacker, neurologist AZ Groeninge, took the initiative in 2017 to roll out the transmural clinical care pathway for stroke in the south West-Flanders region together with GP-associations and neurologists from various hospitals. Other primary care partners were also involved such as the Pharmacists Association and home care organizations. 
 Through uniform cooperation of health care providers and coordinated follow-up to support stroke patients, they succeeded in offering better care to stroke patients after discharge.
 Guidelines were developed for GP's, home care nurses and pharmacists. To ensure continuity of care and enhance patient empowerment, a diary was also given to the patient to record key parameters and issues.
 In 2020, the care pathway was expanded with the Chronic Care Project "De Brug". 
 The following additional items were added:
 - commitment to communication between the care providers of the stroke team
 - commitment to the conversation ""good use of medicines"" after stroke
 - focus on clarifying questions
 - commitment to lifestyle through health vouchers that encouraged stroke patients to make lifestyle changes.
 Strokecoach: In AZ Groeninge, the transmural care pathway was supplemented with a specific coaching program for stroke patients.
 The strokecoach is responsible for a personal follow-up of stroke patients to promote therapy compliance, disease insight, reduction of their cardiovascular risk profile. The coaching process runs between 6 and 24 months depending on patient preference.
 Jobcontent of our strokecoach is to:
 - play an intermediary role between GP's, home care services and the hospital.
 - be point of contact for stroke care in the region.
 - do more intensive screening for early and late complications and compliance. Thus, complications are captured more quickly. Together with the primary care team, the strokecoach will motivate the patient to achieve health goals and prevent for stroke recurrence.
 Stroke2Gether: Electronic stroke recovery pathway.AZ Groeninge is also participating in the EFRO project "Stroke2Gether". This is a digital recovery pathway for stroke patients after discharge by a smartphoneapp. Medical en therapy follow-up and health prevention are built in, through monitoring, education and coaching, live and remote. In addition, there is also a rights recognition module so that patients are also guided more proactively in the administrative and financial aspects and care support in collaboration with the social services of the insurance companies.
 Decision: AZ Groeninge has already completed a long journey in cooperation with its primary care partners to arrive at an integrated care pathway for stroke patients.
 In the following years, the main focus will be on the evaluation and adjustment of the developed instruments and the cooperation to further optimize the aftercare for this patient group.

Home Care Services and Early Detection & (Risk)Signaling: An Indispensable Link in Integrated Primary Care

Summary: Funded by the city of Antwerp, this project wants to optimize the preventive role and position of Home Care Services (HCS) in primary care by (1) improving the early detection en (risk)signaling of the home care professionals, (2) and elaborating the bridging function between HCS and the different primary care disciplines and sectors through shared vision and goals, suitable tools, communication systems and clear procedures in information sharing.
 Short description: HCS provide essential (non-medical) support that a person or a family in need of care requires in order to continue to live independently at home. Typical for Home Care Services is that employees spend many hours in close contact to the person or family in need of care. As a confidant to the client they quickly pick up on behavior changes, evolution in illness or condition. They are often the “eyes and ears” to a multidisciplinary team of care providers surrounding a client or patient. Or at least: they could be. All too often this indispensable role of HCS is insufficiently recognized by welfare organizations and medical care providers.
 The confidant position and early detection role of HCS professionals can bridge gaps between other professional care givers and a (psychologically or mentally vulnerable) client/patient, via signalization and referral to best placed (mental) health care or welfare actors.
 Several conditions need to be fulfilled for HCS to being able to effectively play this part in an integrated care system, like shared vision and goals, suitable tools, clear procedures in information sharing, recognition of HCS professionals as equal partners in primary care. All these conditions are being addressed in this project.
 Target group: All independent living persons in need of care and their care givers. In the first phase the project focusses on people with a psychological or mental vulnerability. 
 Project design
 * Involved actors:
 All HCS active in the City of Antwerp, in intense collaboration with a network of mental health care organizations, the social health services of the City of Antwerp. A sounding board is established to ensure the involvement of all relevant parties (project intervision, monitoring, adjustment).
 
 * Co –design approach: the target groups are therefore being involved via focus groups and quality surveys, throughout the project.
 * Possible restrictions:
 
 Legal restrictions on information sharing (e.g. GDPR, professional secrecy)
 Diversity in ways of financing of organizations.
 A broad and diverse set of (online) communication tools and ways of information sharing between health care sectors
 
 Next steps:
 
 Roll out of training programs to add to the competences of HCS professionals.
 Adjustment of internal and external communication protocols.
 Development and testing of uniform and shared (digital) communication tools.
 Application of uniformized methods concerning early detection, signalization and guidance in all vulnerable client situations.
 
 Learning for the international audience:
 
 Insights regarding the project's approach
 Importance of the role and contribution of a home care service (with lower-skilled staff) compared to the (highly-skilled) GP or home care nurse.
 
 
 

Code accommodation as a measure of inclusion for bilingual people living with dementia of the Alzheimer’s type

Abstract This case study explores the dynamics of code choices in interactions involving bilingual people living with dementia of the Alzheimer’s Type (DAT) and their primary care partners, focusing on two narrative interviews held in private settings. Drawing on a combination of Communication Accommodation Theory and Conversation Analysis, it takes account of the patterns, communicative functions and effects of code choices and code switching as practices of interactional adjustment. The qualitative analysis sheds light on inclusive and non-inclusive interactional adjustments expressed through code choices by individual speakers, especially focusing on code accommodation at turn boundaries. Results indicate a high language awareness in the two speakers living with DAT and positive communicational outcomes when code accommodation is performed by the conversational partner.

Successful Recruitment of Low‐income and Minority Patients in the Southern United States: Implementation of Intensive Blood Pressure Control to Slow Cognitive Decline (IMPACTS‐MIND) Trial

AbstractBackgroundBlack communities, low‐income populations, and those living in the stroke belt bear a disproportionate burden of dementia and are underrepresented in previous trials on preventing cognitive decline and dementia. Improved methods to implement interventions to slow cognitive decline and reduce health disparities are needed. The Implementation of Multifaceted Patient‐Centered Treatment Strategies for Intensive Blood Pressure Control to Minimize Cognitive Decline (IMPACTS‐MIND) trial is testing a multifaceted strategy for implementing an intensive blood pressure (BP) intervention protocol on cognitive decline in racial minority and low‐income hypertensive patients in primary care.MethodThe IMPACTS‐MIND study is a cluster‐randomized trial in 10 primary care organizations with 40 clinics in Louisiana and Mississippi. The included organizations predominantly treat low‐income and minority patients, and 9 of the organizations (with 36 included clinics) are federally‐qualified health centers (FQHCs). We are recruiting a goal of 1,260 patients who are at least 40 years of age (2/3s over age 60 years) with have uncontrolled systolic BP. Recruitment has been conducted in partnership with primary care organizations. Using electronic health record systems, potentially eligible patients based on BP are contacted via a letter and phone call to assess willingness and preliminary eligibility. Provider and staff referrals are also encouraged and incentivized.ResultWe have enrolled 581 participants in the study to date. Participants are an average of 63.0 years of age, 68% are Black, and 59% are female. More than 60% have a high school education or less, and 72.8% have an annual household income <$25,000. Over 44% have diabetes, 28.9% depression, and mean body mass index of 33.6 kg/m2. Mean baseline Montreal Cognitive Assessment (MoCA) score is 19.7. Successful recruitment of low‐income and minority participants has hinged on strong relationships with primary care partners through study steering committee membership for each organization and state FQHC organizations, manuscript co‐authorship for all members, monthly meetings to support study conduct, and building research capacity and opportunities for partnering organizations.ConclusionEffectively recruiting low‐income and minority patients is possible through partnership with primary care providers who treat these patients. Building relationships with these organizations around common interests and priorities is critical to effective recruitment.

Multiple Myeloma Treatment-Related Decision-Making and Preferences of Patients and Care Partners in the United States

BACKGROUND Multiple myeloma is a largely incurable disease characterized by periods of response followed by relapse and/or refractoriness to therapy. With many new treatments available, patients now have more flexibility to assess treatment benefits and risks and what aspects of a treatment are most important to them. The purpose of this non-interventional qualitative study was to examine treatment-related decision-making in patients with MM and care partners with varying experience with refractoriness. METHODS Patients with MM and care partners were recruited through the Gryt Health Cancer Community, social media, and participant referrals to join a qualitative study centered around a semi-structured interview. Adult patients with MM who self-reported treatment for MM in the United States were eligible; adults who self-reported being the primary care partner to an adult with a MM diagnosis who had received treatment in the United States were also eligible. Participants were stratified based on refractoriness to at least one proteasome inhibitor, immunomodulatory drug, and/or anti-CD38 monoclonal antibody (non-refractory; single or double refractory; triple refractory). An Institutional Review Board approved this study. RESULTS The study was completed by 42 participants, of which 32 were patients with MM (12 non-refractory; 10 single or double refractory; 10 triple refractory) and 10 were MM care partners (3 non-refractory; 3 single or double refractory; 4 triple refractory) (Table). Each care partner was paired to a patient participant, and 80% lived in the same household as the patient. All care partners had provided support since the MM diagnosis, if not before, and at minimum had been providing support for at least 2 years. More than half (60%) of care partners were currently working full-time, relative to only 20% of the paired patients. Patients and care partners made comments supportive of MM being approached as a chronic disease, which suggests an abrupt shift in perspective compared to historical sentiment. Participants wanted to retain or improve their quality of life (QoL) and focus less on the disease itself. Reasons for this shift in perspective include an increased sense of hope brought about by new treatments and community support, documented improvements in long-term survival, and better techniques for monitoring disease relapse, particularly minimal residual disease (MRD) status. More than 70% of participants expressed that treatment-related decision-making was shared, particularly as they were further from diagnosis, and felt comfortable asking their doctor(s) questions related to treatment options, even if treatment options were only discussed on an as-needed basis. Care partners were more actively involved in decision-making around significant events, such as diagnosis, stem cell transplant, and relapses. When making treatment decisions, participants were most concerned about extending remission and overall survival (OS), improving QoL, and minimizing MM symptoms and treatment-related side effects (Figure). Extending remission and OS and improving QoL were rated very important underscoring the value of shared decision-making as patient engagement is key in monitoring and enhancing QoL. Location of care and/or treatment, financial burden, possibility of hospitalization, potential impact on other medical conditions, and frequency and duration of treatment were of lesser concern. Participants were least concerned about the mode of administration of the treatment; none of the patients with double or triple refractory disease considered mode of administration to be fairly or very important. Those with triple refractory disease were more likely to be concerned about frequency and duration of treatment compared with other patients. Patient and care partner participants were generally aligned on priorities when making treatment decisions but had the least alignment on financial burdens with patients expressing more concern. CONCLUSIONS With the availability of new treatment options, patients are seeking therapies that both extend remission and OS and improve QoL, placing more importance on the need for patient engagement in the decision-making process. Treatment of MM is now often being approached from a chronic care perspective, perhaps reflective of changing attitudes about MM as a more treatable disease today.

Factors affecting the delivery of community-based salon interventions to prevent cardiovascular disease and breast cancer among ethnically diverse women in South London: a concept-mapping approach

BackgroundIn the UK, women from ethnically diverse and socioeconomically deprived communities are at increased risk of underdiagnosis of cardiovascular disease (CVD) and breast cancer. Promoting CVD prevention and awareness of breast cancer screening via community salons and primary health care partnerships can improve uptake of screening services and early detection. MethodsConcept mapping is a multistage mixed methods participatory approach comprised of six stages: preparation, brainstorming, structuring of statements, representing statements, interpretation and utilisation of maps using Group wisdom software. A target of 20 salons, excluding male-only salons were approached. Salons included Salons included hairdressing or hairdressing and beauty salons. Purposeful and convenience sampling (online and face to face) among UK salons (hair and beauty) was conducted. Participants were given a focus prompt “What would be some factors that can influence the ability of salons to deliver this service?” and required to generate statements, which were sorted into categories based on similarity and rated for importance and feasibility. Concept maps using multidimensional scaling and hierarchical cluster analyses were produced. FindingsOf 35 participants invited, 25 (71%) consented and agreed to take part in concept mapping. Reported ages were 26–35 years (n=5, 20%), 36–45 years (n=12, 48%), 46–55 years (n=3, 12%), 56–65 years (n=5, 20%), and no age reported (n=10, 40%). Around 36% (n=9) of participants were from non-White ethnic groups, with 12% (n=3) being male and 88% (n=22) female. Seven clusters emerged. Salon staff capabilities and capacities and engaging in health conversations in community salons scored average bridging values of 0·09 and 0·2 respectively, indicating good cluster homogeneity (similar meaning statements were closely sorted). Facilitating health-care access with GP practices was rated highly important to effectively promote the intervention. Engaging in health conversations in community salons and salon incentives for participation were examples of factors that were highly feasible to address. The r correlation coefficient was 0·68 between importance and feasibility to address factors affecting community health interventions. InterpretationSalons are well positioned to support health promotion interventions. Actionable priorities were identified for a salon–GP surgery partnership to promote CVD prevention through lifestyle changes and health check uptake, raising breast cancer screening awareness and address issue of equity. FundingNational Institute of Health and Care Research (NIHR), Research for Patient Benefit (RfPB) Programme NIHR202769.

689 Development and implementation of an adult cystic fibrosis team and primary care partnership

689 Development and implementation of an adult cystic fibrosis team and primary care partnership

SP10.15 Review of the Two-Week-Wait Suspected Lower GI Cancer Referral Process: Incomplete Information Delays Investigation

Abstract Aims With a rise in lower-GI2ww referrals compared to pre-pandemic levels, straight-to-test (STT)pathways in secondary-care are increasingly relied on to achieve the 28day faster diagnosis standard. Incomplete referral forms can delay the diagnosis. This study analyses lower-GI2ww referrals to a DGH to assess the impact on the straight to test pathway. Methods A prospectively maintained database of 2ww lower-GI cancer referrals between January2021to June2022, was analysed. Key referral criteria were identified as essential to make a STT decision (haemoglobin, renal function, ferritin, performance status/frailty index, FIT). With prior agreement with primary care partners, incomplete referrals were returned to GPs with request for further information, with patient remaining on the pathway. Results In an 18month period, 4740 2ww referrals were received. The cancer diagnosis rate was 3.1%. Assessing NG12 symptoms, 64.1%of patients were triaged STT. Incomplete referrals formed 22.6% of referrals. Upon requesting more information 4.1%of incomplete referrals were withdrawn from the 2ww pathway by GP. 10.4% of incomplete referrals were downgraded to routine pathways once more information was provided. 7.9% had no symptoms noted, 21.8% did not have blood tests and 73.7% lacked frailty score/performance-status. The median time to receive requested information was 7days. The median number of reminders required was 2. In those diagnosed with cancer, there was an average delay of 5 days in diagnosis when inadequate information provided. The proportion of patients requiring more information reduced over the 18month period from 25.7% in first 6months to 19.4% in final 6months. Conclusion Submission of complete referral forms facilitates faster diagnosis, enabling secondary care clinicians to make timely informed decisions about STT investigations for suspected cancer in accordance with BPTPs (BestPracticeTimedPathways) to achieve the Faster Diagnosis standard.

“¿Cómo te sientes? – With my butt!”: code-choice-related humor in bilingual speakers living with dementia of the Alzheimer’s type

This study investigates data from three narrative interviews held with people living with early- and mid-stage dementia of the Alzheimer’s type (DAT) and their primary care partners speaking English and Spanish in informal settings; the analysis focuses on the humorous moves which are employed by the participants living with dementia in both languages. Drawing on the General Theory of Verbal Humor and the Cooperative Principle, this study sheds light on the conversational humor on a semantic (i.e. language-dependent) as well as pragmatic level (i.e. contextually situated) initiated by the people living with dementia in this dataset while investigating the interpersonal goals behind such moves. By analyzing the (intentional) humorous practices and their respective code choices, our aim is to gain a better understanding of the pragmatic abilities of speakers which are retained while experiencing communication challenges in the face of DAT. This study thus contributes with increased knowledge about people living with dementia as active conversational partners.

Perceived impacts of COVID-19 and bushfires on the implementation of an obesity prevention trial in Northeast Victoria, Australia.

Calls for the adoption of a systems approach to chronic disease prevention date back at least ten years because of the potential to empower communities to identify and address the complex causes of overnutrition, undernutrition and climate change. Australia, like many countries, has high levels of obesity and extreme climate events. The Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND) trial aims to prevent unhealthy weight gain in children in 10 intervention and two pilot communities in north-east Victoria, Australia using community-based participatory approaches informed by systems science. Intervention activities co-designed in 2019 were disrupted by COVID-19 and bushfires. This paper explores the impacts of these 'shocks' on the local prevention workforce to implement actions within communities. A case study design involving one-hour online focus groups and an on-line survey (November 2021-February 2022). Purposive sampling was used to achieve diverse representation from RESPOND stakeholders including local council, health services, primary care partnerships and department of health. The focus group interview schedule and survey questions were based on Durlak and DuPre's implementation factors. Twenty-nine participants from seven different communities participated in at least one of nine focus groups to discuss the impacts of COVID-19 and bushfires on localised implementation. Twenty-eight participants (97% of focus group sample) also completed the on-line survey. Implementation of RESPOND stalled or stopped in most communities due to bushfires and/or COVID-19. These shocks resulted in organisational priorities changing, loss of momentum for implementation, redeployment of human resources, culminating in fatigue and exhaustion. Participants reported adaptation of RESPOND, but implementation was slowed due to limited resources. Further research is needed to advance risk management strategies and protect resources within health promotion. System shocks such as bushfires and COVID-19 are inevitable, and despite multiple adaptation opportunities, this intervention approach was not 'shock proof'.

1081-P: Redesigning Diabetes Care for Treatment Inertia

Background: As 90% of those with diabetes see primary care, there is opportunity for collaborations to address clinician-level therapeutic inertia. The Diabetes Inertia Collaborative (DIC) is a primary and diabetes specialty care partnership to address lack of time, availability, and increase confidence in clinical recommendations. A diabetes specialty team (endocrinologists, CDCES, RN, RD, NPs) roundtable group reviewed and referred patients to Team-Based Care Pathways (Table 1). Methods: A prospective pilot QI was conducted at an academic center with a Population Health Accountable Care Organization. Those with A1c >7.0% on the employee health plan were identified through an enterprise data warehouse population health dashboard. Preliminary pre-post evaluation of clinical outcomes (A1c) over six months was conducted for the first 494 participants (N=1065 total) enrolled. Results: N=494 were mean 54.38 (SD 10.85) years with A1c of 9.4% (1.74) at baseline. Most were White (n=307, 62.1%), non-Hispanic (n=445, 90.1%), and male sex (n=260, 52.6%). Overall, A1c decreased pre-post-intervention (-0.77%, 95% CI [-0.60,-.94]). Multiprogram (-0.55%, CI [-0.11, -0.99]), Pharmacy (-1.01%, CI [-0.61, -1.42]), Milestones (-1.52%, CI [-0.89, -2.14]) and PCP (-0.85%, CI [-0.53, -1.18]) had a significant A1c decrease. Conclusion: The DIC was well received and adopted by primary care, resulting in program referrals as needed and improved A1c from baseline. Disclosure B.Hatipoglu: None. J.E.Blanchette: Advisory Panel; LifeScan Diabetes Institute, Cardinal Health/Edgepark, Provention Bio, Inc., Board Member; JDRF, Consultant; WellDoc, Other Relationship; Tandem Diabetes Care, Inc., Research Support; Association of Diabetes Care & Education Specialists, Speaker's Bureau; Insulet Corporation. R.Ozturk: None. J.Fetzner: None. P.Pronovost: None.

Perceived usefulness of a shared journal feature to support coordination and communication across dementia care networks

AbstractBackgroundCare partners (family and friends) for people living with Alzheimer’s Disease and related dementias (ADRD) often provide care within a care network of both informal (e.g. family, friends) and formal (e.g. home aides, respite care) supports. Care networks can improve care but are often associated with increased communication and coordination demands. Technology interventions have potential to support care networks, but evidence is limited. This study explored care network use of a shared communication platform to identify care partner’s perceptions of the platform’s usefulness.MethodThis study used data from a feasibility trial for CareVirtue, a web application designed to support care partners in storing and sharing information with members of their network. Fifty‐one care networks comprised of a primary care partner and other network members (N = 61) in California and Wisconsin used CareVirtue for 60 days and completed a post‐trial semi‐structured interview. This analysis focused on CareVirtue’s journal feature, which allows users to share daily experiences through written posts published to a newsfeed that care network members can view and comment on. We exported the text of these journal entries and conducted team‐based content analysis. We performed a thematic analysis on interview transcripts to identify themes related to the journal’s usefulness.ResultIn total 2,535 journal entries from 51 primary care partners (75% female, mean age = 60 years old, 55% children of care recipient, 40% spouses) and their care network were analyzed.Journal entries: We identified four categories of communication and coordination activities: 1) information acquisition in which care network members sought updates; 2) information sharing including tracking behaviors, symptoms, and daily activities; 3) strategy development in which care network members used two‐way communication to co‐create care solutions; and 4) feedback including affirmation, empathy, gratitude, confirmation, and information exchange.Interviews: We identified three journal usefulness themes: individual level usefulness including tracking information and therapeutic benefits; network level usefulness including facilitating collaboration; and relational usefulness including increased situational awareness and feeling seen as a care partner.ConclusionThe CareVirtue journal facilitated communication across the care network and also enabled self‐exploration, heightened awareness, and collaborative strategy development among the care network.