Primary Care Research Articles

The first trimester abortion journey Aotearoa: health practitioners’ perspectives

aim: To gain insight into health practitioners’ understanding of how people experience the first trimester abortion journey. methods: Qualitative interviews informed by phenomenology with health practitioners from a range of practice settings across Aotearoa New Zealand. Participants were recruited via a separate but related study. Inductive thematic analysis was used to develop themes. results: Interviews were undertaken with 18 health practitioners. Analysis revealed three main themes: 1) abortion is a stepwise process, 2) barriers to accessing abortion care, and 3) solutions to improve access to abortion care. There were a number of sub-themes. conclusion: While there remain multiple personal, institutional and societal barriers to abortion in Aotearoa, this study identifies potential solutions and that a desire for positive change among health practitioners exists. To achieve this, a strategy is required to ensure that the health consumer is placed at the centre of abortion services to provide accessible, equitable and culturally appropriate care. The primary care sector stands to play a significant role in future abortion provision but requires appropriate funding and support to do so.

Nutritional Behavior Change in Primary Care: What do you Know and What do you Need? A Qualitative Study

Nutritional Behavior Change in Primary Care: What do you Know and What do you Need? A Qualitative Study

Primary Care Referral Delays in Oral Cancer Diagnosis: A Meta-Analysis.

To measure the primary care interval (PCI) in the diagnostic delay of oral cancer and to assess the relation of the referring physician's specialty with disease stage at diagnosis. We meta-analyzed reports of oral/oropharyngeal carcinomas detailing PCI start- and endpoints, i.e., the time needed by a primary care physician to refer a suspected oral cancer patient to a specialist. 17 studies with a total of 2530 patients were eligible; nine provided data on the relative length of PCI, and 10 reported on the impact of the referring professional's specialty on oral cancer diagnostic delay. The average PCI length was slightly longer for general practitioners (GPs) (30.5 days) than for general dental practitioners (GDPs) (27.6 days), while that for the total group was 28.7 days. One-third of the total pre-hospital time spent on diagnosis elapses in GP practices (PCI%: 0.31 [95% CI: 0.23, 0.40]). GDPs refer their patients for treatment at earlier disease stages (TNM I-II) than GPs (Odds Ratio: 0.58; 95% CI: 0.34-0.98). Primary care accounts for a considerable pre-hospital amount of time of what is necessary for reaching a diagnosis of oral cancer patients. This calls for enhancing early oral cancer recognition in primary care settings.

Trends and associated factors of mental health diagnoses in Catalan Primary Care (2010-2019).

The prevalence of mental health disorders has significantly increased in recent years, posing substantial challenges to healthcare systems worldwide, particularly primary care (PC) settings. This study examines trends in mental health diagnoses in PC settings in Catalonia from 2010 to 2019 and identifies associated sociodemographic, clinical characteristics, psychopharmacological treatments, and resource utilization patterns. Data from 947,698 individuals without prior severe mental illness, derived from the Data Analytics Program for Health Research and Innovation (PADRIS), were analyzed for this study. Sociodemographic data, diagnoses, and resource utilization were extracted from electronic health records. Descriptive statistics, chi-square tests, Mann-Whitney tests, and a multivariate binary logistic regression were employed to analyze the data. Over the study period, 172,112 individuals (18.2%) received at least one mental health diagnosis in PC, with unspecified anxiety disorder (40.5%), insomnia (15.7%) and unspecified depressive disorder (10.2%) being the most prevalent. The prevalence of these diagnoses increased steadily until 2015 and stabilized thereafter. Significant associations were found between mental health diagnoses, female sex, lower socioeconomic status, higher BMI, and smoking status in a multivariate binary logistic regression. This study highlights a growing burden of stress-related mental health diagnoses in PC in Catalonia, driven by demographic and socioeconomic factors. These findings may be indicative of broader trends across Europe and globally. Addressing this rising prevalence requires innovative approaches and collaborative strategies that extend beyond traditional healthcare resources. Engaging stakeholders is essential for implementing effective, sustainable solutions that promote mental health in Catalonia and potentially inform similar initiatives worldwide.

Pharmacist-led new medicine service: a real-world cohort study in the Netherlands on drug-related problems, satisfaction, and self-efficacy in cardiovascular patients transitioning to primary care.

Patients transitioning from hospital to home while starting long-term cardiovascular medicines are likely to experience drug-related problems(DRPs). The New Medicine Service (NMS) may support readmission to primary care. To evaluate NMS in a real world setting, for patients transitioning from hospital to primary care with newly prescribed cardiovascular medicines on identifying DRPs, patient satisfaction with medication information and patient self-efficacy. Secondary objectives were identifying risk factors for DRPs and assessing first-fill discontinuation. A cohort study in an outpatient pharmacy and 14 community pharmacies in Almere, the Netherlands, involved patients ≥ 18years receiving new cardiovascular prescriptions. Usual pharmacy care was complemented with a telephone counselling two weeks post-dispensing to identify and address DRPs. Patient satisfaction and self-efficacy were assessed during a follow-up call. First-fill discontinuation was measured using dispensing data, and logistic regression identified risk factors for DRPs. Of 1647 eligible patients, 743 received NMS; 72.5% experienced ≥ 1 DRP. NMS improved patients' satisfaction with information and self-efficacy (p < 0.001). Outpatient visits (adj. OR 0.64), cardiovascular medicine use (adj. OR 0.65), and use of chronic medicines (adj. OR 1.71) influenced DRPs. First-fill discontinuation remained unchanged post-NMS, but patients with DRPs discontinued more often (14.8% vs. 8.6%, p = 0.030). Implementing the NMS in a real-world transitional care setting allowed pharmacists to identify DRPs and provide counselling tailored to patient needs. Patients reported higher satisfaction with information and increased self-efficacy. Priority should be given to at-risk patients for DRPs, and deploy other pharmacy staff to perform the NMS.

Brick Walls and Broken Hearts: Physicians Draw how they Feel About Treating Pain and Addiction.

As part of a continuing medical education activity, primary care physicians in Arizona were asked to draw how they feel about treating patients with chronic pain and addiction. Their drawings, complete with cliffs, walls, torn-out hair, and connected hearts, make for a harrowing look at burnout, angst, and empathy among physicians who treat this subset of patients. Public health and exercise facilitators were troubled, leading them to publish this essay along with a selection of the drawings that depict the feelings of the physicians who feel ill-prepared to treat this patient population, which is only growing in number and needs.

Methodological approaches to the detection of occupational cancer on the example of the Center for Occupational Pathology of the Trans-Baikal Territory

Introduction. Occupational malignant neoplasms (OMN) in the structure of occupational pathology in our country for a long time occupy the last rank place, amounting to no more than 0.5%. In fact, in the Russian Federation, doctors detect from 20 to 40 cases of occupational cancer every year. The share of OMN in the structure of occupational diseases detected in the EEC countries is about 5% (up to 3,700 cases per year). The actual number of detected cases of occupational cancer in our country is several orders of magnitude lower than forecast estimates. The problem of incomplete detection of occupational cancer is quite multifaceted, largely due to the lack of vigilance of primary care doctors, the high probability of a long latent period of the disease, etc. The study aims to find possible causes of occupational cancer based on data on newly identified cases of OMN entered into the regional cancer registry. Materials and methods. The objects of the study were 1,359 primary cases of OMN, entered into the regional cancer registry on the basis of the Zabaikalsky regional oncological dispensary. Scientists have developed an algorithm of actions, on the basis of which they carried out the selection of cases, taking into account the localization of the disease, anamnestic information, age parameters. The authors identified cases with suspicion of the occupational nature of the disease, followed by a request for documents necessary to conduct an examination of the connection of the disease with working conditions. On the basis of the Center for Occupational Pathology of the Trans-Baikal Territory, specialists conducted a direct examination and summed up the final results. Results. The authors selected 49 patients from 1359 cases and, after an additional request for information on the professional path, work experience in comparison with the nosological form of OMN, identified 16 cases with suspected occupational disease, of which a causal relationship between the development of the disease and working conditions was established in 12 cases, including 4 cases in patients in the post-contact period. Limitations. The study is limited by the number of cancer cases provided for analysis. Conclusion. The data obtained indicate that, using the example of one subject of the federation, over 10 months of work on the targeted analysis of cancer registry data, the number of cases of occupational cancer was revealed, almost comparable to the number of similar diseases detected in a year in the whole country. Ethics. The conduct of the study did not require the conclusion of the Ethics committee.

Optimizing asthma care in low-to-middle income countries through multisectoral collaboration: recommendation report of the first Philippine asthma assembly.

Asthma is one of the most common noncommunicable diseases, raising serious concerns about asthma-related deaths globally. Studies have reported safety concerns with shortacting beta-agonists (SABAs) monotherapy. SABA overuse contributes significantly to the healthcare burden in the Philippines. Despite Global Asthma Network's years-long advocacy for equal access to good quality essential medicines at an affordable cost, the uptake of international healthcare policies is limited in most low- and middle-income countries, including the Philippines. We reviewed a synthesis of targeted nonsystematic literature searches on the prevalence of asthma and asthma-related mortality, SABA overreliance and its adverse events, alternatives to SABA, patient referral, and the MDT approach for asthma management. Here, we describe regional challenges and recommendations for improving asthma care through continued multisectoral collaboration. The use of medications like inhaled corticosteroidformoterol combinations may aid in reducing adverse events including severe exacerbations, hospitalizations, complications resulting from oral corticosteroid use, and longterm treatment costs. Raising patient awareness about preventive measures, proper inhaler technique, and medication adherence can mitigate the burden of uncontrolled asthma. In addition, improving access to asthma medications, developing treatment algorithms and referral pathways including a multidisciplinary team for primary care physicians will pave the way for optimal asthma care in LMICs including the Philippines.

How Would You Manage This Patient With Gastroesophageal Reflux Symptoms? Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Gastroesophageal reflux disease (GERD) is a common medical condition presenting with heartburn, regurgitation, cough, hoarseness, and/or wheezing. Patients with classic GERD symptoms often do not require diagnostic studies before empirical treatment is initiated. However, if atypical features are present, including alarm symptoms for malignancy, or if symptoms do not respond to conventional treatment, upper endoscopy may be necessary. The optimal management of GERD, which is the subject of debate, depends on the frequency and severity of symptoms. In 2021, the American College of Gastroenterology published updated recommendations for diagnosis and management of GERD. In addition to histamine-2 receptor antagonist or proton-pump inhibitor therapy, which may be prescribed as needed or continuously, lifestyle and dietary modification are often advised. Here, 2 physicians, a primary care practitioner and a gastroenterologist, debate how to manage a patient with GERD symptoms. They discuss the diagnosis of this condition, its initial management, indications for upper endoscopy, and how to care for the patient whose condition does not respond to empirical therapy.

Age-stratified comparison of heart age and predicted cardiovascular risk in 370 000 primary care patients

BackgroundCardiovascular disease (CVD) preventive medications are recommended for patients at high short-term CVD risk. As most younger people with multiple raised CVD risk factors levels have low short-term risk, they...

A model of co-creation: strengthening primary health care (PHC) in Ghana through an innovative “Nyansapo” partnership

The Africa Health Collaborative (AHC) initiative embarked on a transformative ten-year collaboration with Kwame Nkrumah University of Science and Technology (KNUST) and the University of Toronto (U of T) to co-create continuing education programs geared toward augmenting the proficiency of primary care practitioners in Ghana. While upholding core principles within the AHC framework, emphasizing respect, inclusivity, equity, reciprocity, ethics, dynamism, and stewardship, seven teams of U of T and KNUST faculty engaged in collaborative efforts to design, administer, and evaluate five in-person “short courses” in Ghana on Palliative Care, Quality Improvement for Health Professionals, Prehospital Emergency Care, Community Emergency Care, and Emergency Preparedness and Response to Epidemic-Prone Diseases to approximately 100 Ghanaian primary care professionals. This paper describes a model of co-creation, highlights lessons learned from a robust evaluation process, and proposes that this co-creation model can strengthen primary health care in Ghana and ultimately transform health systems in Africa.

Development and launch of a regional learning network to improve physical and mental health outcomes

AbstractBackgroundCare gaps in routine and preventive care are common among youth. To close care gaps, health systems should take a population health approach and create opportunities for partnership, collaboration, shared learning, and scale via learning networks (LNs).MethodsWe describe the Pediatric Improvement Network for Quality (PINQ), a regional population health LN with the aim of closing well‐child and mental and behavioral health (MBH) care gaps. We initially launched PINQ with 2 primary care domains: well‐child care (WCC) and MBH and later added the third domain of PINQ focused on community MBH organizations. We defined measures for the primary care WCC (well‐child visits for infants 0–15 months; lead screening by 2 years of age, childhood immunization status 3 completion) and MBH domains (depression screening in youth 12–17 years, 30‐day follow‐up for positive depression screen, mental health emergency department utilization) and established system‐level key drivers.ResultsPINQ launched in September 2022 with 7 teams (5 in primary care WCC and 2 in primary care MBH domains, respectively). All teams participate in a monthly meeting that alternates between the Action Period call and Solutions Labs. We highlight two case studies that illustrate the impact of shared learning and quality improvement support on Improvement Team efforts.ConclusionWe foresee PINQ as a means of moving the needle toward high quality, comprehensive health care for Greater Cincinnati youth. The next steps include growing PINQ by adding Improvement Teams and expanding the network focus to include other primary care‐centric metrics and conditions.

Depression Treatment After a Positive Depression Screen Result.

As primary care practices increase depression screening, it is unknown whether screening is associated with appropriate and equitable treatment. To investigate factors associated with initial treatment among patients who screen positive for depression and/or suicidal ideation (SI). Cohort study using electronic health record data from September 2017 to September 2021, from a large US academic health system. Participants were adult primary care patients with elevated depressive symptoms (Patient Health Questionnaire-9 score ≥10) and/or SI, excluding patients with baseline depression, bipolar disorder, schizophrenia, schizoaffective disorder, or dementia. Data were analyzed from December 30, 2022, to February 17, 2024. Patient characteristics including gender, age, preferred language, and race and ethnicity. Primary outcome was antidepressant or mental health referral ordered at screening. Secondary outcomes were antidepressant/referral and antidepressant/referral or follow-up visit within 8 weeks. Of 60 062 patients screened, 3980 (7%) reported elevated depressive symptoms or SI. The cohort was 68.1% women (2711), and the mean (SD) age was 46.5 (17.6) years; 0.8% were 12.4% African American or Black (493), American Indian or Alaska Native (30), 24.8% Asian (988), 14.6% Latino/Latina/Latinx (582), 1.5% Pacific Islander (58), and 36.9% White (1470), and 9.0% other/unknown (359); 5.6% preferred a non-English language (223). Approximately 38% (1518) received antidepressants/referrals when screened (including 44% of 461 patients [203] with SI). By 8 weeks, 2785 patients (70%) received antidepressant/referral and/or follow-up (including 75% of 783 patients with SI). In multivariable logistic regression models adjusting for site and clustered on primary care physician, there were no statistically significant differences in the primary outcome by gender, preferred language, or health insurance. African American or Black and Asian patients had lower estimated probabilities of treatment ordered when screened (34.0% [95% CI, 28.4%-39.6%] for Black patients and 35.4% [95% CI, 31.5%-39.4%] for Asian patients) than White patients (40.5% [95% CI 37.4%-43.5%]). Estimated treatment decreased with increasing age (46.4% [95% CI, 41.2%-51.5%] for patients aged 18-30 years and 17.5% [95% CI, 12.1%-22.9%] for patients aged ≥75 years). Patients with SI had greater estimated treatment than those without SI (43.5% [95% CI, 39.9%-47.1%] vs 35.2% [95% CI, 33.0%-37.5%]), although treatment was overall low for this high-risk group. Secondary outcomes were consistent, although there were no statistically significant differences in follow-up visits for African American or Black and Asian patients compared with White patients. In this cohort study, moderate rates of initial treatment among patients with elevated depressive symptoms and/or SI were found. Targeted interventions are needed for patients at risk of undertreatment, including patients with SI, African American or Black and Asian patients, and older adults.

Perception of antimicrobial stewardship interventions in swiss primary care: a mixed-methods survey.

With most of the antibiotic prescriptions occurring in primary care, antimicrobial stewardship (AMS) interventions must be known, welcomed, and used by primary care physicians (PCPs). The main objective of this study was to evaluate the present awareness about, use of, and perceived acceptability, appropriateness, and feasibility of a broad range of interventions. A cross-sectional survey was distributed to Swiss PCPs from December 2023 to February 2024. The survey focused on eight AMS interventions: shared decision-making tools, factsheets for physicians, Swiss Federal Office of Public Health (FOPH) information material, national antibiotic guidelines website, audit and feedback, communication skills training, as well as the use of point-of-care C-reactive protein (POC-CRP) and procalcitonin (POC-PCT) to guide prescription. PCPs' perceived acceptability, appropriateness, and feasibility were assessed using five-point Likert scales. General expectations regarding AMS were evaluated via qualitative analysis of free-text answers. Out of 7456 potentially eligible primary care physicians, 355 PCPs answered at least one question (response rate 4.7%). PCPs were most aware of biomarkers to guide antibiotic prescription in RTIs, such as POC-PCT (67.6%) and POC-CRP (61.1%), the FOPH awareness campaign (57.3%) and the national guidelines website (52.7%). All interventions were rated as acceptable, appropriate, and feasible, with respective mean scores out of five of 3.89, 3.91, and 3.81. Despite the high perceived acceptability, appropriateness, and feasibility of AMS interventions available for RTIs, their real-life impact may be hindered by insufficient awareness. Additional promotion of those tools could increase their uptake by physicians.

Using Learning Health System Principles to Embed Patient Experience Data in Primary Care: A Qualitative Investigation.

Though an important component of high-quality healthcare, the routine collection of patient experience data is limited in primary care, as is the evidence for how this data is being used for quality improvement. This study used a learning health system (LHS) framework to describe how a university-affiliated community general practice is integrating patient experience data into service and quality improvement efforts, and to identify barriers and facilitators. A co-designed qualitative case study was conducted with academic researchers and staff from a university-affiliated general practice in Australia. Semi-structured interviews were conducted in April 2024 with practice staff, and transcripts were deductively coded according to a five-domain learning health systems framework, and with additional codes capturing barriers and facilitators. Eighteen (53%) practice staff were interviewed, including general practitioners (n=11), a practice nurse (n=1), and administrative staff (n=6). Participants identified multiple methods through which the practice captured the patient experience that spanned all domains of the LHS framework. However, there was less evidence of a coherent quality improvement strategy being employed, with associated barriers identified around staff workloads, training, and existing government funding policies. Key facilitators to the use of patient experience data included: membership of a larger health organisation and university; key dedicated administrative and clinical roles; and effective leadership, governance structures and policies to support continuous learning and drive service improvement. This study presents a case example of how patient experience data is being integrated into general practice and identifies key barriers and facilitators to initiating and translating this data for continuous healthcare improvement. By mapping the use of patient experience data to a LHS framework, this study shows how LHS principles can be applied to primary care to facilitate the capture and use of patient experience data on an ongoing basis.

Advanced Practice Nurses in Primary Care and Their Impact on Health Service Utilisation, Costs and Access Globally: A Scoping Review.

Synthesise evidence on advanced practice nurses' impact on health services utilisation, healthcare costs, access and quality of care globally. Scoping review. A scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis and the PRISMA-ScR checklist. PubMed, CINHAL and Embase for articles between 2016 and 2023. Eighteen studies were included (14 from the United States, two from the Netherlands and one from Australia and New Zealand each). Outcomes included health services utilisation, healthcare costs, access, and quality of care. Most studies reported advanced practice nursing patients had fewer emergency department (9 of 11 studies), fewer hospital (re-)admissions (9 of 10 studies) and primary care visits (3 of 3 studies). Seven (of eight) studies found advanced practice nursing care was associated with significantly lower healthcare costs. For access and quality of care, advanced practice nursing care was associated with lower consultation rates, similar mean number of patients seen, higher protocol adherence, more rural patient care and lower-to-similar quality delivery of chronic disease management. Majority of the studies reported that advanced practice nursing care was associated with lower emergency department visits, hospital readmissions and costs. Access to care outcomes varied under advanced practice nursing care. Advanced practice nursing care can improve patient outcomes, reduce costs and impact access and quality of care. Practices need supportive work environments for advanced practice nurses to deliver high-quality, effective care. Addressing the need for a synthesis of up-to-date evidence, this review highlights the importance of advanced practice nurses in primary care. Findings can inform global workforce development strategies to address health inequalities through effective advanced practice nursing integration. No patient or public contribution is required for this study.

Polygenic Risk Score Implementation into Clinical Practice for Primary Prevention of Cardiometabolic Disease

Background: Cardiovascular disease is a leading cause of mortality globally and a major contributor to disability. Traditional risk factors, as initially established in the FRAMINGHAM study, have helped to stratify populations and identify patients for early intervention. Incorporating genetic factors enhances risk stratification tools, enabling the earlier identification of individuals at increased risk and facilitating more targeted and effective risk factor modifications. While monogenic risk variants are present in a minority of the population, polygenic risk scores (PRS) are collections of multiple single-nucleotide variants that collectively provide summative risk and capture a more accurate risk score for a greater number of people. PRS have demonstrated clear utility in cardiometabolic diseases by predicting onset, progression, and therapeutic response. Methods: A structured and exploratory hybrid search strategy was employed, combining keyword-based database searches and supplementary techniques to comprehensively synthesize the literature on PRS implementation in clinical practice. Discussion: A comprehensive overview of PRS in cardiometabolic diseases and their potential avenues for integration into primary care is discussed. First, we examine the implementation of genetic screening, risk communication, and intervention strategies through the lens of the American Heart Association’s implementation criteria, focusing on their efficacy, minimization of harm, and logistical considerations. Then, we explores how the varied perceptions of patients and practitioners towards PRS can influence both adoption and utilization. Lastly, we addresses the need for the development of clear guidelines and regulations to support this process, ensuring PRS integration is both scientifically sound and ethically responsible. Future directions: Initiatives aimed at advancing personalized approaches to disease prevention will enhance health outcomes. Developing guidelines for the responsible use of PRS by establishing benefits, while mitigating risk, will a key factor in implementation for clinical utility. Conclusions: For integration into clinical practice, we must address both patient and provider concerns and experience. Standardized guidelines and training will help to effectively implement PRS into clinical practice. Developing these resources will be essential for PRS to fulfill its potential in personalized, patient-centered care.

Post-discharge telephone follow-up calls to patients with chronic obstructive pulmonary disease by primary care nurses: a best practice implementation project.

Chronic obstructive pulmonary disease (COPD) is a complex health problem, with important repercussions for patients and their families. Interventions need to be improved to prevent exacerbations and reduce high readmission and mortality rates. Evidence suggests that including a telephone follow-up (TFU) call in discharge plans could improve outcomes in patients with a chronic disease. This project aimed to improve how primary care nurses in Gran Canaria, Spain, followed up COPD patients after hospital discharge. This project was guided by the JBI Evidence Implementation Framework, which includes the JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) method. The JBI approach uses audit, feedback, and re-audit to promote evidence-based health care. A baseline audit was conducted to compare current practices against best practices. Five barriers to best practices were identified and improvement strategies were developed. The follow-up audit revealed 100% compliance for Criteria 1 and 2, which related to COPD patients having a discharge plan and that plan including TFU. There was a 4.88% improvement for both Criteria 3 and 4, which involved the TFU being prompt and using a validated clinical questionnaire. Following project implementation, the 30-day readmission rate increased from 2.78% to 4.88% but the 30-day emergency room presentation rate decreased from 25% to 9.76%. The practice changes were partly achieved, but further strategies are needed to achieve full compliance. Educational programs are necessary when conducting improvement projects. Chances of success increase when decisions about hospital discharge involve both the hospital and the primary care service. http://links.lww.com/IJEBH/A296.

Leadership, cohesion, and stress in primary care facilities and retention in chronic care in rural northeast South Africa before and during the COVID-19 pandemic: A longitudinal study.

Human immunodeficiency virus (HIV) and hypertension are major contributors to morbidity and mortality in South Africa. Effective management of these conditions is critical to population health, yet patient management and retention varies by facility for reasons that are not fully understood. We assessed whether measures of clinic leadership, cohesion, and stress were associated with retention for HIV and hypertension in a cohort of patients in northeast South Africa before and during the Coronavirus disease 2019 pandemic. We quantified nursing capacity and service readiness within primary health care facilities in the Bushbuckridge sub-district in Mpumalanga province South Africa. We administered brief scales on facility leadership, cohesion, and stress from January to March 2019, and tested scales for individual and facility-level agreement. We extracted clinical records for patients with HIV and/or hypertension from 2019 to 2021 and quantified treatment retention by quarter. We used generalised estimating equations to assess individual and clinic factors associated with retention in each treatment programme prior to (2019-first quarter 2020) and during (second quarter 2020-2021) the pandemic. The nine facilities had a median of 12 nurses on staff and scored 0.83 out of 1.0 on basic service readiness. We collected responses to leadership, cohesion, and stress scales from 54 nurses and counsellors. Scales showed high inter-item agreement and moderate within-facility agreement. From 2019 to 2021, 19 445 individuals were treated for HIV and/or hypertension across seven participating facilities. Two-year retention was 91% for those with both conditions, 82% for those in treatment for HIV alone and 77% for those in treatment for hypertension alone, with 10-15% differences between facilities and high retention during the pandemic period. In addition to those with both conditions, women and adults aged 60-69 were more likely to be retained. Clinic factors were inconsistently associated with patient retention. While measures of clinic leadership, cohesion, and stress were generally reliable at individual and facility levels, we found limited evidence supporting a link between these factors and better retention in care. Retention was stable during the Coronavirus disease 2019 pandemic. Men, the youngest and oldest adults, and those without known multimorbidity should be prioritised for retention interventions.

Utilizing Quality Improvement Methodology to Address Disparities in Colorectal Cancer Screening Between Faculty and Resident Physicians.

Health system data from a large academic medical center revealed a 14% lower rate of colorectal cancer (CRC) screening in resident patient panels compared to faculty patient panels. This resident-led quality improvement (QI) work identified causes for disparities in CRC screening and implemented an innovative panel management intervention to reduce CRC screening disparities. Analysis was conducted across two academic primary care clinics at a single institution. Residents engaged key stakeholders in the CRC screening process to identify causes for disparities and potential solutions in the CRC screening process. A novel interprofessional panel management protocol was implemented to guide residents on how to perform population health strategies to increase CRC screening and to streamline the navigation process. The effectiveness of each intervention in improving CRC screening was analyzed. After four months of protocol implementation, CRC screening for resident patient panels improved from 62 to 68% based on analysis done on a run chart. The difference in CRC screening between faculty and resident patient panels decreased from 14 to 10%, reducing the disparity by 29%. This interprofessional panel management protocol significantly increased the CRC screening rates among patients receiving primary care from resident physicians. This further highlights the importance of multipronged interventions to improve disparities in CRC screening and to improve overall screening rates.