Primary Care Professionals Research Articles

Patient experiences of information-sharing and patient-centred care across the broad landscape of primary care practice and provision: a nationally representative survey of Australian adults

BackgroundAustralian government strategies and frameworks have been developed in recent years to encourage the integration and coordination of primary care delivery; including patient-centred approaches to clinical and preventative care, and health promotion. This study aims to explore patient experiences of information-sharing and patient-centred care across various primary care clinical settings, with a particular focus on clinical encounters with GPs, naturopaths, osteopaths and acupuncturists.MethodsData about healthcare utilisation and experiences from a 63-item cross-sectional survey obtained from a nationally representative sample of Australian adults aged ≥ 18 years were analysed. Chi-square and Kruskal-Wallis H tests were used to explore differences in the experiences of knowledge and information sharing during GP consultations among those who also consulted with a naturopath, osteopath or acupuncturist, compared those who had not. Logistic regression was used to investigate correlations between participants perceptions about GP consultation outcomes, and the GP’s information-sharing behaviour or perceived experience of patient-centredness.ResultsAcross 2354 participants, verbal explanation (76.3%) and/or individualised handouts (16.8%) were the most common type of information shared in GP consultations. Individuals who consulted with a GP and a naturopath, an osteopath, or an acupuncturist reported a lower rate of receiving a verbal explanation from their GP but higher rate of receiving other types of information sources including handouts. Over one quarter of study participants who visited a GP did not discuss any of their health information with their GP. Information sharing was lower for individuals who also visited a naturopath, osteopath or acupuncturist. Participants scored their consultations with a GP as patient-centred, but these scores were lower among participants who also consulted with at least one other primary care practitioner type included in the study.ConclusionsPublic health and health services researchers, policymakers and leaders of primary care professions have a role and responsibility to ensure practitioners are confident and competent in sharing health information with their patients that considers their health literacy needs, and the importance of patient-centred care. Research focussed on a more in-depth understanding of the differences and relationships observed across the primary care landscape in this study is recommended.

Social prescribing: how it can help people with long-term health conditions

Chia Swee Hong discusses social prescribing and how allied health professionals can help primary care professionals.

Strategies that facilitate the delivery of exceptionally good patient care in general practice: a qualitative study with patients and primary care professionals

BackgroundIn recent years, proactive strengths-based approaches to improving quality of care have been advocated. The positive deviance approach seeks to identify and learn from those who perform exceptionally well. Central to this approach is the identification of the specific strategies, behaviours, tools and contextual strategies used by those positive deviants to perform exceptionally well. This study aimed to: identify and collate the specific strategies, behaviours, processes and tools used to support the delivery of exceptionally good care in general practice; and to abstract the identified strategies into an existing framework pertaining to excellence in general practice; the Identifying and Disseminating the Exceptional to Achieve Learning (IDEAL) framework.MethodsThis study comprised a secondary analysis of data collected during semi-structured interviews with 33 purposively sampled patients, general practitioners, practice nurses, and practice managers. Discussions explored the key factors and strategies that support the delivery of exceptional care across five levels of the primary care system; the patient, provider, team, practice, and external environment. For analysis, a summative content analysis approach was undertaken whereby data were inductively analysed and summated to identify the key strategies used to achieve the delivery of exceptionally good general practice care, which were subsequently abstracted as a new level of the IDEAL framework.ResultsIn total, 222 individual factors contributing to exceptional care delivery were collated and abstracted into the framework. These included specific behaviours (e.g., patients providing useful feedback and personal history to the provider), structures (e.g., using technology effectively to support care delivery (e.g., electronic referrals & prescriptions)), processes (e.g., being proactive in managing patient flow and investigating consistently delayed wait times), and contextual factors (e.g., valuing and respecting contributions of every team member).ConclusionThe addition of concrete and contextual strategies to the IDEAL framework has enhanced its practicality and usefulness for supporting improvement in general practices. Now, a multi-level systems approach is needed to embed these strategies and create an environment where excellence is supported. The refined framework should be developed into a learning tool to support teams in general practice to measure, reflect and improve care within their practice.

Supporting patients with venous leg ulcers in self-care monitoring: an interview study with primary health care professionals

Objective This study described the experiences and perceptions of how primary health care professionals (PHCPs) support patients with venous leg ulcers (VLUs) in self-care monitoring. Design A qualitative approach with reflexive thematic analysis was used, with 24 individual qualitative open interviews. Setting Primary health care clinics and community health care in four southern regions in Sweden. Subjects Registered nurses, district nurses and nurse assistants who had experience of caring for patients with VLUs. In total, 24 interviews were conducted with PHCPs in Sweden. Results PHCPs have a vital role in promoting patient independence and responsibility, identifying needs and adapting care strategies, while also recognising unmet needs in patients with VLUs. Conclusion PHCPs actively monitor patients’ self-care and establish caring relationships. They see a need for a structured primary health care work routine for ulcer management.

P102 Should Fibromyalgia be Diagnosed in Primary or Secondary Care?

Abstract Background/Aims Both the Rheumatology Getting It Right First Time (GIRFT) report, published in February 2021, and the British Society for Rheumatology (BSR) referral guidelines from October 2021 recommend not referring patients with suspected Fibromyalgia to Rheumatology services. In contrast the Royal College of Physicians (RCP) guidelines on Fibromyalgia from 2022 recommend that for unequivocal cases, referral is not necessary, but that referral is appropriate if there is diagnostic uncertainty. We undertook an evaluation of our Rheumatology service to assess whether following either of these guidelines would be appropriate. Methods A prospective analysis of all patients referred to one general Rheumatologist over 18 months to assess the accuracy of suspected fibromyalgia diagnoses from primary care. The included cases were all patients referred with possible fibromyalgia on the referral letter, along with patients with an end diagnosis of fibromyalgia. Results Seventy-two patients were referred to one consultant with possible fibromyalgia on the referral letter. Of these, only 44 (61%) were confirmed as having fibromyalgia. Common other problems felt by the GP to be fibromyalgia included 2+ areas of localised soft tissue rheumatism (seven patients), localised chronic back pain (six patients) and biomechanical lower limb pains due to flat feet (three patients). Another 39 patients were diagnosed as fibromyalgia when not considered by primary care; nine of these patients were referred on the early arthritis pathway and two patients to the axial spondyloarthritis clinic. Overall this workload only constituted approximately 9% of new patients to the service, with patients with an end diagnosis of fibromyalgia making up approximately 7% of the overall new referrals. Conclusion The problems with diagnosing fibromyalgia in primary care are likely multifactorial - general practitioners (GP’s) are very busy and there is an increasing use of allied health professionals (AHP) in primary care, who do not always have the experience or training to diagnose fibromyalgia or other common musculoskeletal conditions. Some GP’s do not feel comfortable diagnosing fibromyalgia and some patients are just not happy with a primary care opinion. Overall, we do not feel that the diagnosis of fibromyalgia can be left solely in the hands of primary care; if the patients in this review had not been referred, then a significant number would have been incorrectly labelled as fibromyalgia, with all the problems that may bring. In view of this, the RCP guidelines would appear more appropriate than the BSR referral guidelines, but even then some of the patients in this review may still have ended up with an incorrect diagnosis, so overall Rheumatology departments should be very cautious about declining referrals for possible fibromyalgia and we continue to see these referrals in our department. Disclosure M.P. Sykes: None.

Mental Health Collaborative Care in Brazil and the Economy of Attention: Disclosing Barriers and Therapeutic Negotiations

The introduction of mental health collaborative care (MHCC) is one of the strategies to scale up access to mental health care in primary health care in Brazil. This article investigates an experience of mental health collaborative care in the city of Rio de Janeiro, Brazil. It is a qualitative study involving interviews with physicians and mental health professionals working in primary health care units located in the northern part of the city of Rio de Janeiro, Brazil. The aim is to examine the various strategies and negotiations that primary health care professionals deploy to identify mental distress and plan health care interventions. We discuss the results within the economy of attention framework. We argue that divergences in diagnostic design and therapeutic planning carried out by professionals and users or observed in MHCC meetings illustrate the health-disease-care seeking phenomenon as a negotiated process, entangled in complex interactions. Our results evince that those interactions are not always evident and configure 'what is at stake' in mental suffering. The incorporation of cultural and structural determinants in collaborative care may enable the expansion of mental health initiatives sensitive to local needs and realities.

Developing an interprofessional decision support tool for diabetic foot ulcers management in primary care within the family medicine group model: a Delphi study in Canada

BackgroundPrimary care professionals encounter difficulties coordinating the continuum of care between primary care providers and second-line specialists and adhere to practice guidelines pertaining to diabetic foot ulcers management. Family medicine groups are providing primary care services aimed to improve access, interdisciplinary care, coordination and quality of health services, and reduce emergency department visits. Most professionals working in family medicine groups are primary care physicians and registered nurses. The aim of this study was to develop and validate an interprofessional decision support tool to guide the management of diabetic foot ulcers for primary care professionals working within the family medicine group model.MethodsA one-page decision tool developed by the research team was validated by an expert panel using a three-round Delphi protocol held between December 2019 and August 2021. The tool includes 43 individual actions and a care pathway from initial presentation to secondary prevention. Data collection was realized with both paper and electronic questionnaires, and answers were compiled in an electronic spreadsheet. Data was analyzed with use of descriptive statistics, and consensus for each item was defined as ≥ 80% agreement.ResultsExperts from 12 pre-identified professions of the diabetic foot ulcer interdisciplinary care team were included, 39 participants out of the 59 invited to first round (66.1%), 34 out of 39 for second (87.2%) and 22 out of 34 for third (64.7%) rounds. All items included in the final version of the decision support tool reached consensus and were deemed clear, relevant and feasible. One or more professionals were identified to be responsible for every action to be taken.ConclusionsThis study provided a comprehensive decision support tool to guide primary care professionals in the management of diabetic foot ulcers. Implementation and evaluation in the clinical setting will need to be undertaken in the future.

Occupational burnout and job satisfaction among community pharmacists

IntroductionCommunity pharmacists (CPs) are the most accessible healthcare professionals in primary care due to pharmacies' open-door policy and convenience, resulting in high patient and prescription volumes, and numerous free-of-charge consultations. Therefore, they are at high risk for burnout. ObjectivesThe primary objective of this study was to assess the levels of burnout among community pharmacists in Greece, marking the first investigation of its kind within the country. Additionally, this study aimed to explore potential correlations between demographic variables and other health-related factors with burnout scores. MethodsThis study used a quantitative cross-sectional design involving two validated questionnaires(the Greek version of Maslach (MBI) questionnaire and the SF-36 questionnaire). Prior to data collection, all the relevant documentation was approved by the Metropolitan College Research Ethics Committee and was adopted under the auspices of the Panhellenic Pharmaceutical Association. Random sampling was used. Data collection period was July to August 2022. ResultsA total of 368 responses were included in the analysis, with the majority being pharmacy-owners (n = 292, 79.3%). Notably, a significant proportion of respondents were female practitioners working within community pharmacy settings (n = 230, 62.5%). Analysis revealed that the sample exhibited low levels of personal achievement (M = 30.99, SD = 6.41), high levels of emotional exhaustion (M = 41.73, SD = 6.94), and moderate levels of depersonalization (M = 23.38, SD = 3.78), indicative of substantial occupational burnout. Furthermore, gender had a discernible impact on depersonalization, with women scoring higher than men (t = −3.29, p < 0.01). Pharmacists who identified medicine shortages as their primary challenge in daily practice reported lower emotional burnout and depersonalization, albeit with a diminished sense of accomplishment (t = −2.62, p < 0.01). ConclusionsThis study sheds light on burnout levels and health-related quality of life among community pharmacists in Greece.

Evaluation of Stages, Treatment Protocols, and Outcomes of Colorectal Cancer among West Bank Patients.

Background: Colorectal cancer (CRC) is the second most widespread cancer among Palestinian patients. As cancer care improves in hospitals across the West Bank, services like palliative care, targeted therapy, bone marrow transplantation, and individualized therapy are still limited. This study aimed to assess the CRC stages, treatment protocols, and survival rates of patients in the West Bank. Methodology: This retrospective study collected data from the medical records of Al-Najah University Hospital (NUH), which specializes in the care of cancer patients. Patients with confirmed CRC (stages I-IV) undergoing surgical or medical treatment were included in the study. Data collection was standardized by using a data collection form to gather information from the medical records included in the study. All statistical analyses were performed using SPSS (version v27), and survival was assessed using a regression analysis of the number of days from the time of diagnosis to the most recent visit against the type of treatment (e.g., surgery, chemotherapy, radiotherapy). Results: A sample of 252 patients with CRC from NUH was collected, including 143 males and 109 females aged between 27 and 86 years, with the average age being 60.6 ± 11.4 years. The sample included 183 patients (72.6%) diagnosed with colon cancer only, 29 patients (11.5%) diagnosed with rectal cancer only, and 40 patients (15.9%) diagnosed with both. Diagnosis took place at CRC stage I for 3 patients (1.2%), stage II for 33 patients (13.1%), stage III for 57 patients (22.6%), and stage IV for 159 patients (63.1%). Surgery was the most prevailing mode of treatment for 230 patients (91.3%), while 227 patients (90.1%) received chemotherapy treatment, and 38 patients (15.1%) received radiotherapy. Of the 252 patients, 40 patients (15.8%) received FOLFOX (i.e., folinic acid, fluorouracil, oxaliplatin), and 25 patients (9.9%) received FOLFIRI (i.e., folinic acid, fluorouracil, irinotecan), while the 187 remaining patients (74.2%) were treated with capecitabine, oxaliplatin, bevacizumab, cetuximab, regorafenib, cisplatin, etoposide, gemcitabine, or a combination thereof. The sample was categorized into six outcomes: (1) death, (2) cure, (3) disease progression, (4) disease recurrence, (5) under-treatment, and (6) unknown. Mortality was high, with 104 patients (41.3%) dying within a short time after diagnosis, and may have been attributable to delayed diagnosis. Surgical treatment had a positive impact on increasing the survival years, and it was significant (p = 0.033). Conclusions: A high percentage of patients were diagnosed in advanced CRC stages. The treatment modes were adopted from general international guidelines; however, the cure rates were low, and mortality was high. More studies need to be undertaken to investigate the actual application of chemotherapy protocols, and survival would benefit from the involvement of clinical pharmacists in the chemotherapy protocol selection, dosing, frequency, and follow-up. The present study advocates for greater public awareness of CRC and attests to the merits of screening by primary care professionals, which can help to avoid this serious illness and to promote a better prognosis.

Application of machine learning methods for predicting childhood anaemia: Analysis of Ethiopian Demographic Health Survey of 2016.

Childhood anaemia is a public health problem in Ethiopia. Machine learning (ML) is a growing in medicine field to predict diseases. Diagnosis of childhood anaemia is resource intensive. The aim of this study is to apply machine learning (ML) algorithm to predict childhood anaemia using socio-demographic, economic, and maternal and child related variables. The study used data from 2016 Ethiopian demographic health survey (EDHS). We used Python software version 3.11 to apply and test ML algorithms through logistic regression, Random Forest (RF), Decision Tree, and K-Nearest Neighbours (KNN). We evaluated the performance of each of the ML algorithms using discrimination and calibration parameters. The predictive performance of the algorithms was between 60% and 66%. The logistic regression model was the best predictive model of ML with accuracy (66%), sensitivity (82%), specificity (42%), and AUC (69%), followed by RF with accuracy (64%), sensitivity (79%), specificity (42%), and AUC (63%). The logistic regression and the RF models of ML showed poorest family, child age category between 6 and 23 months, uneducated mother, unemployed mother, and stunting as high importance predictors of childhood anaemia. Applying logistic regression and RF models of ML can detect combinations of predictors of childhood anaemia that can be used in primary health care professionals.

Clinical and genetic characterization of Duchenne Muscular Dystrophy

Introduction: people with disabilities represent around 10% of the population. The most common of the muscular dystrophies is Duchenne, a recessive X-linked disorder that affects 1 in 3,500 males. Objectives: characterize the clinical and genetic findings of Duchenne muscular dystrophy. Methods: an observational and descriptive study was carried out in a series of 9 patients evaluated at the Department of Medical Genetics of Pinar del Río, Cuba in the period from January 2014 to December 2023. Results: 78% of the total cases were diagnosed between 5 and 8 years of age, in 66.6% of the patients a family history of the disease was reported. Delayed psychomotor development and gastrocnemius pseudohypertrophy were highlighted in 100% of cases followed by gait disturbance, Gowers sign and hyporeflexia in 88.8% of patients. In 77.7% of the patients, deletion-type mutations were identified in some of the exons analyzed. Conclusions: The clinical and molecular characterization of the disease allows the diagnosis to be made and subsequently provides tools to primary care professionals to provide assistance, coordinate care with appropriate specialists, provide genetic counseling not only to the index case but also to the families to screen for female carriers..

143 Training &amp; Sustaining: Training and learning collaborative outcomes across a statewide network for early diagnosis of children with autism

OBJECTIVES/GOALS: Community-based primary care autism diagnostic models are one promising solution to delays in autism diagnosis. Our objective is to describe the development and report on outcomes related to primary care professional (PCP) training and sustained engagement in a longitudinal learning collaborative across a statewide network for autism diagnosis. METHODS/STUDY POPULATION: We developed ADAPT (i.e., Accelerating the Diagnosis of Autism with Primary care Training), a training program to prepare PCPs to develop independent competency in evaluation of autism in children ages 14-48 months. ADAPT includes didactic and case-based modules and expert practice-based coaching delivered by a diagnostic specialist; following training PCPs participate in a longitudinal learning collaborative. Aligned with competency-based medical education standards, measures of autism evaluation knowledge and diagnostic competency are collected. RESULTS/ANTICIPATED RESULTS: To date, 13 PCPs have completed ADAPT didactic and practicum training reaching competency in independent autism evaluation. Clinicians demonstrated significant improvement in total autism knowledge following didactic training (p=.02). There was an overall trend toward increased scoring agreement on an autism observational assessment over case observations and practicum evaluations. Similarly, PCPs demonstrated improved evaluation competence, moving on average from Advanced Beginner to Competent Performer as rated by expert trainers. Following training, PCPs attended 57% of monthly learning collaborative sessions. DISCUSSION/SIGNIFICANCE: Training PCPs to deliver autism evaluations as part of community-based models of care is a promising solution to address access and waitlist challenges. ADAPT is an intensive, standard PCP training model which results in achievement of independent competency and sustained engagement in in autism evaluation.

Introduction: Standards of Care in Diabetes-2024 Abridged for Primary Care Professionals.

Introduction: Standards of Care in Diabetes-2024 Abridged for Primary Care Professionals.

Assessment of Standardized Care Plans for People with Chronic Diseases in Primary Care Settings.

Aging populations are driving a shift in emphasis toward enhancing chronic disease care, reflected in Catalonia's regional plan which prioritizes standardized nursing care plans in primary care settings. To achieve this, the ARES-AP program was established with a focus on harmonizing standards and supporting routine nursing clinical decision-making. This study evaluates nurses' perceptions of ARES-AP's standardized care plans for chronic diseases. A mixed-methods approach based on an ad hoc questionnaire (n = 141) and a focus group (n = 14) was used. Quantitative data were statistically analysed, setting significance at p < 0.05. Qualitative data were explored via content analysis. ARES-AP training was assessed positively. The resources for motivational interviewing and care plans for the most prevalent chronic diseases were rated very positively. This study identified key factors influencing program implementation, including facilitators such as structured information and nursing autonomy, barriers such as resistance to change, motivators such as managerial support, and suggested improvements such as technological improvements and time management strategies. This study identifies areas for improvement in implementing standardized nursing care plans, including additional time, motivation, enhanced IT infrastructure, and collaboration among primary care professionals. It enhances understanding of these plans in primary care, especially in managing chronic diseases in aging populations. Further research should assess the program's long-term impact on chronic patients. This study was not registered.

The COVID-19 pandemic and cases of domestic violence: perceptions of primary healthcare professionals in the context of social isolation

Objective: to analyze the perceptions of primary health care professionals in Paranaguá/PR about the relationship between the COVID-19 pandemic and cases of domestic violence in their assigned territories, identifying challenges in the approach, impacts on families and case management. Methodology: qualitative research was conducted using semi-structured interviews and focus groups with 36 professionals from two primary health care units in Paranaguá, on the Paraná coast. Results: Primary health care professionals unanimously reported an increase in the number of domestic violence cases in those communities, affecting women, children, and adolescents, with the closure of schools identified as an aggravating factor. The main challenges highlighted were the disruption of primary health care services during the peak of the pandemic due to the reallocation of professionals and resources; misinformation about referral processes for domestic violence cases within the intersectoral network; fear among professionals regarding the pandemic and reporting domestic violence cases; and high staff turnover. Conclusion: The period of social isolation caused by the pandemic intensified domestic violence cases, according to the perceptions of primary health care professionals in Paranaguá. The dismantling of the intersectoral network further compromised the care of individuals in situations of vulnerability and/or violence. The absence of national guidelines from the federal government left municipalities and primary health care professionals on their own to deal with the issue. Submission: 03/30/23| Review: 06/14/23| Approval: 10/04/23

Who are vaccine champions and what implementation strategies do they use to improve adolescent HPV vaccination? Findings from a national survey of primary care professionals

BackgroundImplementation science researchers often cite clinical champions as critical to overcoming organizational resistance and other barriers to the implementation of evidence-based health services, yet relatively little is known about who champions are or how they effect change. To inform future efforts to identify and engage champions to support HPV vaccination, we sought to describe the key characteristics and strategies of vaccine champions working in adolescent primary care.MethodsIn 2022, we conducted a national survey with a web-based panel of 2527 primary care professionals (PCPs) with a role in adolescent HPV vaccination (57% response rate). Our sample consisted of pediatricians (26%), family medicine physicians (22%), advanced practice providers (24%), and nursing staff (28%). Our survey assessed PCPs’ experience with vaccine champions, defined as health care professionals “known for helping their colleagues improve vaccination rates.”ResultsOverall, 85% of PCPs reported currently working with one or more vaccine champions. Among these 2144 PCPs, most identified the champion with whom they worked most closely as being a physician (40%) or nurse (40%). Almost all identified champions worked to improve vaccination rates for vaccines in general (45%) or HPV vaccine specifically (49%). PCPs commonly reported that champion implementation strategies included sharing information (79%), encouragement (62%), and vaccination data (59%) with colleagues, but less than half reported that champions led quality improvement projects (39%). Most PCPs perceived their closest champion as being moderately to extremely effective at improving vaccination rates (91%). PCPs who did versus did not work with champions more often recommended HPV vaccination at the earliest opportunity of ages 9–10 rather than later ages (44% vs. 33%, p < 0.001).ConclusionsFindings of our national study suggest that vaccine champions are common in adolescent primary care, but only a minority lead quality improvement projects. Interventionists seeking to identify champions to improve HPV vaccination rates can expect to find them among both physicians and nurses, but should be prepared to offer support to more fully engage them in implementing interventions.

Abstract 998: Pursuing leadership in literacy to ameliorate head and neck cancer disparities

Abstract Overview of Proposed Research. Head and neck cancers are a deadly cancer that ranks among the six most common cancers worldwide. (American Cancer Society, 2021). Studies have shown greater disease burden among minority populations for head and neck cancer, higher mortality rates and lower oral cancer knowledge, but limited evidence has defined the underlying causes of late stage diagnoses and access to the healthcare system (Suzuki et al, 2019). More specifically, in comparison to the national rates, South Carolina is among the top ten for head and neck cancers (Community Outreach, Hollings Cancer Center, MUSC, 2019). Dental and primary care play a critical role delivering quality patient education, prevention, risk reduction and treatment regimes. However, there is a paucity of information published on the value of designing and implementing a health literacy program to prioritize head and neck cancer screening and prevention. Rural communities face unique challenges to achieving optimal oral health, impacted mainly by geographic location and socioeconomic status (IOM&amp;NRC, 2011). More specifically, rural southern states such as SC continues to have a tremendous shortage of primary care providers. SC currently has 44 of 46 counties designated as geographic Primary Care and Dental Health Professional Shortage Areas and approximately 25% of SC citizenry are living in rural areas (HRSA, 2018). Because the vast majority of the state has challenges with availability of primary care and dental providers, this potentially exacerbates access to care inequities for rural and underserved minority populations. To enhance the quality and equity of oral cancer prevention in rural SC, it is critical that we prioritize strategies to elevate the significance of head and neck cancer risks. Therefore, the need to design and deliver innovative strategies to increase opportunities that intersect the healthcare system and community is inevitable. In this regard, we propose PULL A-HEAD, Pursuing Leadership in Literacy to Ameliorate HEAd and neck cancer Disparities. PULL A-HEAD is aimed to develop and implement a community-centered approach design for increasing the health literacy and efficacy of navigating the healthcare system for early detection of head and neck cancers. In this presentation we will share outcome and impact results of a community-centered, health literacy program in collaboration with our Regional Medical Library - Region 2 (RML2), National Library of Medicine partners at the Medical University of South Carolina. The program (i.e. PULL A-HEAD) will emphasize the delivery of health literacy education and health systems navigation tools to improve the early detection of head and neck cancers. Citation Format: Joni D. Nelson, Irene M. Lubker. Pursuing leadership in literacy to ameliorate head and neck cancer disparities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 998.

Metabolic Dysfunction–Associated Fibrosis 5 (MAF-5) Score Predicts Liver Fibrosis Risk and Outcome in the General Population With Metabolic Dysfunction

There is an unmet need for noninvasive tests to improve case-finding and aid primary care professionals in referring patients at high risk of liver disease. A metabolic dysfunction-associated fibrosis (MAF-5) score was developed and externally validated in a total of 21,797 individuals with metabolic dysfunction in population-based (National Health and Nutrition Examination Survey 2017-2020, National Health and Nutrition Examination Survey III, and Rotterdam Study) and hospital-based (from Antwerp and Bogota) cohorts. Fibrosis was defined as liver stiffness ≥8.0 kPa. Diagnostic accuracy was compared with FIB-4, nonalcoholic fatty liver disease fibrosis score (NFS), LiverRisk score and steatosis-associated fibrosis estimator (SAFE). MAF-5 was externally validated with liver stiffness measurement ≥8.0 kPa, with shear-wave elastography ≥7.5 kPa, and biopsy-proven steatotic liver disease according to Metavir and Nonalcoholic Steatohepatitis Clinical Research Network scores, and was tested for prognostic performance (all-cause mortality). The MAF-5 score comprised waist circumference, body mass index (calculated as kg / m2), diabetes, aspartate aminotransferase, and platelets. With this score, 60.9% was predicted at low, 14.1% at intermediate, and 24.9% at high risk of fibrosis. The observed prevalence was 3.3%, 7.9%, and 28.1%, respectively. The area under the receiver operator curve of MAF-5 (0.81) was significantly higher than FIB-4 (0.61), and outperformed the FIB-4 among young people (negative predictive value [NPV], 99%; area under the curve [AUC], 0.86 vs NPV, 94%; AUC, 0.51) and older adults (NPV, 94%; AUC, 0.75 vs NPV, 88%; AUC, 0.55). MAF-5 showed excellent performance to detect liver stiffness measurement ≥12 kPa (AUC, 0.86 training; AUC, 0.85 validation) and good performance in detecting liver stiffness and biopsy-proven liver fibrosis among the external validation cohorts. MAF-5 score >1 was associated with increased risk of all-cause mortality in (un)adjusted models (adjusted hazard ratio, 1.59; 95% CI, 1.47-1.73). The MAF-5 score is a validated, age-independent, inexpensive referral tool to identify individuals at high risk of liver fibrosis and all-cause mortality in primary care populations, using simple variables.

Primary care professionals' perspectives on tailoring buprenorphine training for rural practice.

Buprenorphine is a highly effective medication for opioid use disorder (OUD) that remains substantially underutilized by primary care professionals (PCPs). This is particularly true in rural communities, which have fewer prescribers and significant access disparities. The Drug Enforcement Administration removed the X-waiver requirement in December 2022, yet many rural clinicians still report barriers to prescribing buprenorphine. In this study, we examined rural PCPs' experiences with buprenorphine to identify tailored training strategies for rural practice. Physicians, nurse practitioners, and physician associates practicing in rural Ohio counties were recruited through contacts at statewide health associations and health professions training programs. Twenty-three PCPs were interviewed about their perspectives on prescribing buprenorphine, including their training history. PCPs self-reported being motivated to respond to OUD. However, they also reported that current training efforts failed to equip them with the knowledge and resources needed to prescribe effectively, and that urban-focused training often alienated rural clinicians. Participants suggested tailoring training content to rural settings, using rural trainers, and bolstering confidence in navigating rural-specific barriers, such as resource deficits and acute opioid fatigue. Our study found that current training on buprenorphine prescribing is inadequate for meeting the needs of rural PCPs. Tailored buprenorphine training is needed to improve accessibility and acceptability, and to better support the clinical workforce in communities disproportionately impacted by the opioid epidemic.

Use of Practice-Based Research Networks in Massage Therapy Research.

Massage therapy is a profession, not simply an intervention, and pathways are needed to connect all key massage therapy profession components-clinicians, patient/clients, and the work-to the scholarship and research that describes, investigates, and shapes practice. While the volume of massage-related research has grown over the past few decades, much of the growing massage evidence base is not reflective of real-world massage therapy, nor is research typically conducted through the clinical lens of the massage therapy discipline. This situation reflects the unfortunate disconnect between massage therapy research and massage therapy practice, while magnifying a key research infrastructure deficiency within the massage therapy discipline: the who and where research is conducted is disconnected from the who and where massage therapy is practiced. Practice-based research networks (PBRNs) are a staple of primary care and other health professions research reflecting real life, discipline-focused practice that seeks to address the needs of the discipline's practitioners and patients. The PBRN model fits well with the directional need of massage therapy research. This paper presents a commentary on the use of PBRNs in massage therapy research, and the current state of PBRN research within the field of massage therapy, namely the recently launched MassageNet PBRN.