Private Outpatient Settings Research Articles

Sexually Transmitted Infection/Human Immunodeficiency Virus (STI/HIV) Testing, STIs, and HIV Pre-exposure Prophylaxis Use Among Men Who Have Sex With Men and Men Who Have Sex With Men and Women in the United States, 2019–2022

Abstract Background Routine sexually transmitted infection and human immunodeficiency virus (STI/HIV) testing and HIV pre-exposure prophylaxis (PrEP) use are recommended for men who have sex with men (MSM) at increased risk of HIV. Methods Using HealthVerity, a large administrative dataset in the United States, we assessed STI/HIV testing, chlamydia and gonorrhea positivity by specimen type, and HIV PrEP use among MSM and men who have sex with men and women (MSMW) at their first visits (index date) for those at increased risk of HIV and STIs from 2019 through 2022. Results Among 81 716 MSM and MSMW aged 15–64 years at their index date visit, STI testing rates were 57.9% for chlamydia, 58.1% for gonorrhea, and 52.2% for syphilis testing, respectively; 55.5%, 30.9%, and 18.1% had HIV testing, HIV PrEP use, and PrEP initiation, respectively, among the patients who did not have HIV. Of patients with chlamydia and gonorrhea testing, 48% were tested from the genital site only and 25% from 3 anatomic sites (rectal, pharyngeal, and urogenital). Chlamydia and gonorrhea positivity was 9.8% for chlamydia rectal infection, 7.3% for gonorrhea rectal infection, and 5.3% for gonorrhea pharyngeal infection. Conclusions Our results present current medical services provided during initial clinic visits for MSM and MSMW in private outpatient settings. Our study suggests that the assessment of STI/HIV testing is periodically needed due to the high prevalence of infection, and efforts to promote HIV PrEP for MSM and MSMW in private settings are urgently needed.

REBT Integration in Public and Private Outpatient Settings during COVID-19 Pandemic: Perspectives from Indonesia

This quasi-experimental study aimed to investigate how rational emotive behavior therapy (REBT) works in Indonesian outpatient settings, especially in the context of the COVID-19 pandemic. This study evaluated depression, anxiety, and sleep among 60 Atma Jaya Hospital patients (public and private) using several assessment tools (PHQ-9, GAD-7, and PSQI). The majority of participants were under 40 (53.3%), female (58.3%), married (56.6%), and working formally (65%), with either high school or diploma/bachelor’s level education (86.6%). After six REBT therapy sessions, significant improvements were evident in anxiety, depression, and sleep quality scores (p < 0.001). Participants showed improvements in anxiety and depression during the third and sixth sessions; and in sleep quality during the sixth session. These findings suggest that REBT-based interventions are effective in public and private outpatient settings, highlighting the importance of psychotherapy and cross-division collaboration in the Indonesian healthcare system.

Maintained activity in ankylosing spondylitis patients treated with TNFi and/or NSAID for at least 12 weeks: a cross-sectional study in Brazil

BackgroundThe aim of this study was to evaluate disease activity among patients with axial spondyloarthritis (AS) treated with tumor necrosis factor inhibitors (TNFi) and/or nonsteroidal anti-inflammatory drugs (NSAIDs) for at least 12 weeks in private outpatient settings in Brazil.MethodsThis was a cross-sectional, real-world study conducted in 17 Brazilian private health care institutes. Patients were selected if diagnosed with AS or axial radiographic spondyloarthritis (AxSpA) and treated with NSAIDs or TNFi for at least 12 weeks within the last 26 weeks prior to enrollment. The data were collected from interviewed-based and self-administered questionnaires from patients and physicians. Disease activity was defined as active (≥ 4), low /suboptimal (≥ 2 and < 4) and inactive (< 4) by Bath AS Disease Activity Index (BASDAI) and/or very high (≥ 3.5), high (≥ 2.1 to < 3.5), low (≥ 1.3 to < 2.1), and inactive (< 1.3) by AS Disease Activity Score (ASDAS-CRP). Both patients and physicians’ perceptions of disease control were assessed using a numeric rating scale (NRS; 0—inactive to 10—very active disease).ResultsThe cohort included 378 patients with a mean age of 46 years, and the median time since diagnosis until enrollment was 5.4 years (interquartile range 2.7–10.5). Most patients were treated with TNFi alone (74%), followed by TNFi in combination with NSAID (15%), and NSAID alone (11%). About half AS patients showed active disease and 24% of patients showed low activity/suboptimal disease control despite having been treated for at least 12 weeks. Although TNFi showed better disease control than NSAID, inactive disease was experienced by few patients. The NRS (mean [standard deviation]) score for disease perception was 4.24 (3.3) and 2.85 (2.6) for patients and physicians, respectively.ConclusionThis real-world study showed that most AS patients on TNFi and/or NSAID had not achieved an adequate disease control, as almost 75% of them exhibited active disease or low activity/suboptimal disease control. There remains a need for improved disease management among patients with AS.

Assessment of Professional Quality of Life in the Alabama Physical Therapy Workforce.

The purposes of this study were to 1) determine the level of professional quality of life among physical therapists and physical therapist assistants in Alabama and 2) to identify personal or professional factors that may contribute to compassion satisfaction (CS), burnout, and secondary traumatic stress (STS). This study used a cross-sectional design and mixed-methods survey methodology to calculate odds ratios for factors affecting professional quality of life. Respondents completed a survey that included the Professional Quality of Life (ProQOL) scale, an open-ended question regarding their experience with professional burnout, and personal and professional demographics. Of the 742 physical therapists and physical therapist assistants in Alabama who completed the survey, the majority experienced moderate-high levels of CS and moderate-low levels of burnout and STS. Regression analyses indicated clinicians working 40 or more hours per week in patient care had greater odds for low-moderate CS and moderate-high burnout and STS subscale scores. Clinicians in our sample licensed between 6 to 15 or more than 30years and those working in private outpatient settings had reduced odds of having moderate-high burnout, whereas those working 16 or more years had significantly increased odds for high CS scores. Responses to the open-ended question indicated workload demands and documentation as the top factors contributing to clinician burnout, while the connections with patients and coworkers help minimize such feelings. Individuals later in their career may develop protective factors to mitigate feelings of burnout compared to those early in their career. Also, clinicians working 40 or more hours per week may be more vulnerable to experiencing low-moderate CS and moderate-high burnout. Thus, individual clinicians and employers must evaluate personal, occupational, and systemic factors that contribute to reduced professional quality of life to inform preventive strategies for mitigating burnout.

Abstract TP411: Improving Pediatric Stroke Recognition Among Pediatric Health Care Providers

Introduction: Pediatric acute ischemic stroke (P-AIS) is an under-recognized disease by pediatric healthcare providers, resulting in delay of its diagnosis. In spite of diagnostic tools such as the FAST and BE FAST mnemonics, lack of awareness leads to increased morbidity and mortality. This study aims to elucidate whether a brief educational activity would modify the identification and perception of P-AIS. Methods: Forty-nine pediatric healthcare providers were surveyed to assess their baseline skills in recognizing P-AIS. Providers attended a 30-minute activity outlining incidence, natural history, diagnosis, and examples of P-AIS treatment. The mnemonics “FAST” and “BE FAST” as applicable to children were futher expounded. Pre and post-surveys assessed providers’ profession, type of practice, ED service involvement, familiarity with the mnemonics, and P-AIS recognition performance for infants and children. Results: The forty-nine pediatric healthcare providers surveyed had the following degrees: 61% MD, 20% NP, 6% RN, 6% student, 4% PA, 2% DO. Futhermore, 78% work in private outpatient enviroments, 17% in academic outpatient institutions, 4% in private outpatient settings, and only 10% had emergency department involvement. Pre-Activity: 53% had heard of “FAST,” and 8% had heard of “BE FAST.” Correct knowledge of individual letters ranged between 12-39%, with the lowest recognition rates for “B” and “E.” At baseline, 65% of providers correctly recognized pediatric and specifically infant stroke cases. Post-Activity: 97% felt familiar with “BE FAST.”. Correct knowledge of individual letters following the educational activity improved to 100%. 95% of providers correctly recognized P-AIS, and 95% correctly identified infant stroke. Univariate logistic analysis showed that completing the training activity was the only significant factor improving the ability to identify P-AIS (OR: 10.35, CI: 2.2 to 48.2). Profession and type of practice were not significant. Conclusion: A 30-minute focused educational activity was sufficient to improve the perception and ability to recognize P-AIS among different levels of healthcare providers. The long-term effects of these interventions should be examined.

Health Care Utilization Inequality in a Mixed Public-Private Health Care System: An Insight from the National Survey in Iran

Background: Equitable health care utilization is a pillar of the Universal Health Coverage (UHC) and is also a concern to policymakers. Measuring and quantifying the inequalities are essential in assessing the progress toward achieving the UHC goals. Several studies have focused on overall measures of unfair inequality in health care utilization. The overall approaches to outpatient and inpatient services are not representative of the differences in health care usage in public and private sectors in a mixed healthcare system, like Iran. A few studies have assessed inequality measures for general practitioners (GPs), specialists (SPs), and hospital admission services in different sectors, separately. Objectives: This study aimed at measuring health care utilization inequalities in outpatient and inpatient health services in public and private sectors in Iran. Methods: In this study, national representative data derived from the utilization of health services survey (UHSS) in 2014 was used. The concentration curve (CC) and concentration index (CI) were applied to assess inequalities in health care utilization services, including the number of GP visits, SP visits, and admission in hospitals. We used ADePT software to produce a nonlinear estimation of CI for these count variables. The indirect standardization method was used to standardize the services for differences in needs by age and gender. The inequality in health care utilization was examined in both public and private sectors, separately. Results: Based on the results, public and private outpatient settings, except for the private GP visits, followed a pro-poor pattern. Inpatient admission in the public sector had a pro-poor model, but it showed a pro-rich pattern in the private sector. GP visits in the private sector changed in favor of the poorer people and SP visits in the public sector changed toward a pro-rich pattern after standardization for differences in needs. CI for family physician (FP) and GP visits in public and private sectors, and also SP visits in public and private sectors was -0.089, -0.086, -0.010, 0.025, and -0.018, respectively. CI for the inpatient admission in public and private sectors was -0.126 and 0.157, respectively. GP, SP and hospital services utilization showed a pro-poor pattern. Conclusions: The results of this study showed that most of the health care utilization followed a pro-poor model in the mixed health care system in Iran. SP visits in the public sector changed toward a pro-rich pattern after standardization for differences in needs. Although public outpatient services need more attention to maintain their pro-poor distribution, SP visits in the public sector should be more considered to follow a pro-poor pattern. Health policymakers are recommended to take measures to eliminate barriers to access this service. This may lead to reduce a gap between the poor and rich people in the utilization of the health care and moving toward the UHC.

Prevalence and type distribution of human papillomavirus infection in women from North Sardinia, Italy

BackgroundHuman papillomavirus (HPV) has been associated with several disorders of the genital tract, skin and oropharynx. The aims of our study were to evaluate the prevalence of HPV infection in women between 15 and 54 years of age in North Sardinia, Italy, to identify the prevalence of High Risk - Human papillomaviruses (HR-HPV) genotypes and to establish a correlation between molecular and cytological results.MethodsFrom 2007 to 2009 we consecutively enrolled women aged 15-54 years admitted to public and private outpatient settings. All the participants filled in a questionnaire about the socio-cultural state, sexual activity and awareness about HPV. 323 cervical specimens were tested for HPV-DNA and HPV genotypes with INNO-LiPA HPV Genotyping CE Amp kit. Samples showing positivity to some HPV genotypes were re-tested using "in house" quantitative Real-Time PCR assays.ResultsOverall HPV-DNA positivity was detected in 35.9% of the women. The prevalence of HR-HPV infection among HPV positive samples was 93.1% with a specific prevalence of HPV 16, 51, 31, 53 and 18 of 54.3%, 37.9%, 10.3%, 6.9% and 5.2%, respectively. Co-infection with any HPV, HR-HPV, LR-HPV and HR/LR-HPV type was 18.3%, 14.9%, 0.9% and 2.5%, respectively; HPV 16/51 co-infection was detected in 64.6% of the HR-HPV co-infection group. The most frequent HPV-genotypes detected were 16 (32.5%) and 51 (22.7%). Among the 57 patients harboring mono-infection the most prevalent HPV genotypes were 16 (38.6%) and 31(10.5%). A multivariate analysis identified a statistical significant association between HPV infection and age and between HPV infection and previous sexual transmitted diseases. A statistically significant association between cytological cervical lesions and generic HPV exposure was identified.ConclusionsTo our knowledge, this is the first survey evaluating the prevalence of HPV infection in Northern Sardinia and drawing attention to the unusual high proportion of genotype HPV 51. Given the recent implementation of a widespread immunization program with vaccines not containing HPV 51, it has been relevant to prove the high prevalence of this HPV genotype from the start of the vaccination campaign, in order to avoid in the future attributing to the vaccination program a possible selection effect (HPV replacement).

Quality Assurance by Practice Visit

Should the Royal Australian and New Zealand College of Psychiatrists attempt to assess the office practice of psychiatrists and, if so, how should it be done ? This is one of the matters under consideration by the RANZCP Quality Assurance Committee, and a matter about which the College will be required to make a decision. Assessment may be undertaken with a view to maintaining high standards of practice, for quality assurance, or with a view to weeding out obviously substandard practice. The intention will effect the approach taken, as relatively brief examination may detect grossly deficient practice whereas detecting relatively weak areas in a generally good standard practice will require more careful assessment. Detection of deliberate bad practice may require intense scrutiny and is outside the scope of this paper. Hospital practice is already subject to hospital accreditation inspections. Inspection and examination of records and physical facilities and interviews of personnel are standard methods of assessment for institutions, but have less commonly been applied to office practice, yet substandard performance is significantly more frequent in office cases than in hospital cases, 13.3% versus 3.9% in the study of Sanazaro and Worth 1’1. Assessment of psychiatric office practice is particularly important as a high proportion of psychiatrists’ work, in some cases all of it, is carried out in this setting. Burvill [‘I found 52.2% of Australian psychiatrists’ time was spent with private patients, and Olfson and associates l31 reported 54.6% of psychiatrists worked in private office practice or private outpatient settings. Presumably, most of the private practice time of the Australian psychiatrists is private office practice, so assessment of office practice is important in the overall assessment of psychiatrists’ practice.

Marketing Strategies of Nurse Practitioners in New York State

As competition within the health care field increases, marketing strategies are becoming more important for all members of the health care team, including nurse practitioners. The purpose of this research was to identify marketing strategies being used by nurse practitioners in New York state. A total of 285 practitioners responded to a survey containing questions related to marketing techniques traditionally used in the business world: service differentiation, market segmentation and practice promotion. A majority of respondents did not report using many of the marketing strategies contained in the survey, although most nurse practitioners did report identifying themselves as primary care providers in one-on-one interactions with clients. Significantly higher marketing scores were found for nurse practitioners who attended a workshop or seminar on marketing strategies, had three or more years of experience, or who practiced in private outpatient settings.