Primary Care Program Research Articles

Screening of Glaucoma: Consensus and Directions.

Glaucoma is a leading public health concern globally. This summary discusses barriers to glaucoma screening and novel strategies for a cost-effective glaucoma screening. We discuss barriers to glaucoma screening and recent advancements in glaucoma detection and care, including targeted screening approach as well as telemedicine, genetic testing, and artificial intelligence (AI). A major barrier to glaucoma screening is the cost-effectiveness of case finding resulting from the low prevalence of the disease and the complexity of the diagnosis. Targeted-screening, as well as multi-level screening, can reduce the false positive rate and increase the cost-effectiveness of the program. Telemedicine, availability of genetic testing and polygenic risk scores, and AI provide the opportunity for novel glaucoma screening programs in primary care, portable, and home-based settings and will be helpful for lowering the costs, identifying patients in need of urgent treatment and enabling timely diagnosis and early intervention. Screening of glaucoma is challenging and changing. Recent advancements in digital technology and genetics have led to the development of tools that are promising for novel screening methodologies. Clinical trials are needed to demonstrate the long-term effect of targeted screening on the burden of glaucoma worldwide.

Impact of Referring High-Risk Patients to Intensive Outpatient Primary Care Services: A Propensity Score-Matched Analysis.

Many healthcare systems have implemented intensive outpatient primary care programs with the hopes of reducing healthcare costs. The Veterans Health Administration (VHA) piloted primary care intensive management (PIM) for patients at high risk for hospitalization or death, or "high-risk." We evaluated whether a referral model would decrease high-risk patient costs. Retrospective cohort study using a quasi-experimental design comparing 456 high-risk patients referred to PIM from October 2017 to September 2018 to 415 high-risk patients matched on propensity score. Veterans in the top 10th percentile of risk for 90-day hospitalization or death and recent hospitalization or emergency department (ED) visit. PIM consisted of interdisciplinary teams that performed comprehensive assessments, intensive case management, and care coordination services. Change in VHA and non-VHA outpatient utilization, inpatient admissions, and costs 12months pre- and post-index date. Of the 456 patients referred to PIM, 301 (66%) enrolled. High-risk patients referred to PIM had a marginal reduction in ED visits (- 0.7; [95% CI - 1.50 to 0.08]; p = 0.08) compared to propensity-matched high-risk patients; overall outpatient costs were similar. High-risk patients referred to PIM had similar number of medical/surgical hospitalizations (- 0.2; [95% CI, - 0.6 to 0.16]; p = 0.2), significant increases in length of stay (6.36; [CI, - 0.01 to 12.72]; p = 0.05), and higher inpatient costs ($22,628, [CI, $3587 to $41,669]; p = 0.02) than those not referred to PIM. VHA intensive outpatient primary care was associated with higher costs. Referral to intensive case management programs targets the most complex patients and may lead to increased utilization and costs, particularly in an integrated healthcare setting with robust patient-centered medical homes. PIM 2.0: Patient Aligned Care Team (PACT) Intensive Management (PIM) Project (PIM2). NCT04521816. https://clinicaltrials.gov/study/NCT04521816.

Effects of an exercise intervention in primary care after robot-assisted radical cystectomy for urinary bladder cancer: a randomised controlled trial

IntroductionAfter radical cystectomy physical activity is important to reduce risk of complications, but patients with urinary bladder cancer have difficulties in achieving general recommendations on physical activity and exercise. The aim of this randomised controlled trial was therefore to evaluate the effects of a physical exercise programme in primary care, following discharge from hospital after robot-assisted radical cystectomy for urinary bladder cancer.Materials and MethodsPatients with urinary bladder cancer scheduled for robot-assisted radical cystectomy at Karolinska University Hospital, Sweden between September 2019 and October 2022 were invited to join the study. At discharge, they were randomised to intervention or active control group. The intervention group was planned to start exercise with physiotherapist in primary care during the third week; the programme included aerobic and strengthening exercises, twice a week for 12 weeks, and daily walks. The control group received unsupervised home-based exercise with daily walks and a sit-to-stand exercise. Assessments were conducted before surgery, at discharge and after four months regarding the primary outcome physical function (Six-minute walk test), and secondary outcomes physical activity, pain, health-related quality of life, fatigue, and psychological wellbeing.ResultsNinety patients were included, mean (sd) age 71.5 (8.5) years. An intention-to-treat analysis showed no intervention effect on the primary outcome physical function, or on pain or psychological wellbeing, but effect on physical activity with a difference from discharge to four months with a median (IQR) of 4790 (3000) and 2670 (4340) daily steps in the intervention and control group, respectively (p = 0.046), and for fatigue, and health-related quality of life, in favour of the intervention group.ConclusionBoth the intervention and control groups improved physical function, but the patients who exercised in primary care experienced additional positive effects on physical activity, fatigue, and health-related quality of life. Hence, exercise in primary care after discharge from hospital could be a promising method after radical cystectomy for urinary bladder cancer.Trial registrationThe study was registered in Clinical Trials with registration number NCT03998579, 20,190,607.

Assessing the effectiveness of “BETTER Women”, a community-based, primary care-linked peer health coaching programme for chronic disease prevention: protocol for a pragmatic, wait-list controlled, type 1 hybrid effectiveness-implementation trial

IntroductionThe Building on Existing Tools to Improve Cancer and Chronic Disease Prevention and Screening in Primary Care (BETTER) programme trains allied health professionals working in primary care settings to develop...

A Primary Health Care Program and COVID-19. Impact in Hospital Admissions and Mortality

BackgroundMost patients with mild or moderate COVID infection did not require hospital admission, but depending on their personal history, they needed medical supervision. In monitoring these patients in primary care, the design of specific surveillance programs was of great help. Between February 2021 and March 2022, EDCO program was designed in Tenerife, Spain, to telemonitor patients with COVID infection who had at least one vulnerability factor to reduce hospital admissions and mortality.ObjectiveThe aim of this study is to describe the clinical course of patients included in the EDCO program and to analyze which factors were associated with a higher probability of hospital admission and mortality.DesignRetrospective cohort study.PatientsWe included 3848 patients with a COVID-19 infection age over 60 years old or age over 18 years and at least one vulnerability factor previously reported in medical history.Main MeasuresPrimary outcome was to assess risk of admission or mortality.Key Results278 (7.2%) patients required hospital admission. Relative risks (RR) of hospital admission were oxygen saturation ≤ 92% (RR: 90.91 (58.82–142.86)), respiratory rate ≥ 22 breaths per minute (RR: 20.41 (1.19–34.48), obesity (RR: 1.53 (1.12–2.10), chronic kidney disease (RR:2.31 (1.23–4.35), ≥ 60 years of age (RR: 1.44 (1.04–1.99). Mortality rate was 0.7% (27 patients). Relative risks of mortality were respiratory rate ≥ 22 breaths per minute (RR: 24.85 (11.15–55.38), patients with three or more vulnerability factors (RR: 4.10 (1.62–10.38), oxygen saturation ≤ 92% (RR: 4.69 (1.70–15.15), chronic respiratory disease (RR: 3.32 (1.43–7.69) and active malignancy (RR: 4.00 (1.42–11.23).ConclusionsVulnerable patients followed by a primary care programme had admission rates of 7.2% and mortality rates of 0.7%. Supervision of vulnerable patients by a Primary Care team was effective in the follow-up of these patients with complete resolution of symptoms in 91.7% of the cases.

Characteristics Associated With Homebound Vaccination Against COVID-19

ObjectivesHomebound patients are older and suffer from multiple comorbidities, and many experienced difficulties getting vaccinated because of their inability to routinely leave the home due to health and function. Home-based primary care (HBPC) programs offer vaccination at home to reach this high-risk population. We evaluated an urban HBPC program's COVID-19 vaccination campaign to explore whether home-based vaccination can reduce inequity in vaccine administration or improve vaccine efforts. DesignWe conducted a cross-sectional study to examine characteristics of homebound patients who were vaccinated through an HBPC program or were vaccinated elsewhere. Setting and ParticipantsWe analyzed 795 patients enrolled in the HBPC program who were eligible for vaccination at home in 2021. MethodsWe collected vaccination data from patients, demographic data from the electronic medical record, and neighborhood-level characteristics for each patient based on census tract. ResultsHomebound patients vaccinated by HBPC were significantly more likely than homebound patients vaccinated outside of the program to have a history of dementia (P = .003), live in public housing (P < .001), have Medicaid (P = .005), be enrolled in HBPC for longer (P = .03), and live in neighborhoods with higher proportions of immigrants (P = .022), lower English proficiency (P = .007), lower computer usage (P = .001), and greater poverty (P < .001). Conclusion and ImplicationsHome-based vaccination campaigns may help lower-resourced patients get vaccinated by mitigating logistic barriers and using the influence of trusted patient-provider relationships established through HBPCs.

A multifaceted risk management program to improve the reporting rate of patient safety incidents in primary care: a cluster-randomised controlled trial

BackgroundWhile patient safety incident reporting is of key importance for patient safety in primary care, the reporting rate by healthcare professionals remains low. This study aimed to assess the effectiveness of a risk management program in increasing the reporting rate within multiprofessional primary care facilities.MethodsA nation-wide cluster-randomised controlled trial was performed in France, with each cluster defined as a primary care facility. The intervention included professional e-learning training, identification of a risk management advisor, and multidisciplinary meetings to address incident analysis. In the first observational period, a patient safety incident reporting system for professionals was implemented in all facilities. Then, facilities were randomised, and the program was implemented. Incidents were reported over the 15-month study period. Quasi-Poisson models were used to compare reporting rates.ResultsThirty-five facilities (intervention, n = 17; control, n = 18) were included, with 169 and 232 healthcare professionals, respectively, involved. Overall, 7 out of 17 facilities carried out the entire program (41.2%), while 6 did not hold meetings (35.3%); 48.5% of professionals logged on to the e-learning website. The relative rate of incidents reported was 2.7 (95% CI = [0.84–11.0]; p = 0.12). However, a statistically significant decrease in the incident rate between the pre-intervention and post-intervention periods was observed for the control arm (HR = 0.2; 95% CI = [0.05–0.54]; p = 0.02), but not for the intervention arm (HR = 0.54; 95% CI = [0.2–1.54]; p = 0.23).ConclusionThis program didn’t lead to a significant improvement in the patient safety incident reporting rate by professionals but seemed to sustain reporting over time. Considering that the program was fully implemented in only 41% of facilities, this highlights the difficulty of implementing such multidisciplinary programs in primary care despite its adaptation to the setting. A better understanding of how risk management is currently organized in these multiprofessional facilities is of key importance to improve patient safety in primary care.Trial registrationsThe study has been registered at clinicaltrials.gov (NCT02403388) on 30 March 2015.

Outcomes and Hospital Service Use Among Patients With COPD in a Nurse- and Allied Health–Led Clinic

Multidisciplinary disease management efforts enable the improvement in lung function among patients with chronic obstructive pulmonary disease (COPD), but there is little evidence of its association with risks of adverse health outcomes and health care service use. To examine the association between the use of a nurse- and allied health-led primary care clinic for respiratory patients, namely the Nurse and Allied Health Clinic-Respiratory Care (NAHC-Respiratory), and their risks of mortality and morbidity and health care service use. This territory-wide, population-based, propensity-matched, retrospective cohort study used data from the electronic health records of all patients who used public health care services in Hong Kong, China, from January 1, 2010, to December 31, 2019. All patients with COPD treated in public outpatient clinics between January 1, 2010, and December 31, 2014, were included. Patients who attended NAHC-Respiratory and usual care only were propensity score-matched at a 1:2 ratio. Data analyses were conducted between August 2023 and April 2024. Attendance at NAHC-Respiratory. All-cause and cause-specific mortality, incidence of COPD complications, and use of emergency department and inpatient services until the end of 2019 were compared between the NAHC-Respiratory and usual care participants using Cox proportional hazard regression, Poisson regression, and log-link gamma regression models after matching. This study included 9048 eligible patients after matching, including 3093 in the exposure group (2814 [91.0%] men; mean [SD] age, 69.8 [9.5] years) and 5955 in the reference group (5431 [91.2%] men; mean [SD] age, 69.5 [11.7] years). Compared with patients in the usual care-only group (reference), patients in the exposure group had lower risks of all-cause mortality (hazard ratio [HR], 0.84; 95% CI, 0.78-0.90) as well as pneumonia-caused (HR, 0.85; 95% CI, 0.74-0.97), respiratory-caused (HR, 0.86; 95% CI, 0.77-0.96), and cardiovascular-caused (HR, 0.74; 95% CI, 0.59-0.93) mortality. Exposure was associated with reduced rates of emergency department visits (incidence rate ratio [IRR], 0.92; 95% CI, 0.86-0.98) and hospitalization through emergency department (IRR, 0.89; 95% CI, 0.83-0.95). In this cohort study, the use of a nurse- and allied health-led clinic in primary care settings was associated with reduced risks of mortality and use of hospital services among patients with COPD. These findings emphasize the important role of health care workers other than physicians in disease management in the primary care setting. The NAHC-Respiratory model and service components can be used to help improve primary care programs to benefit more patients with COPD.

Cost-effectiveness analysis of health tapestry, a complex primary care program for older adults: a post-hoc analysis

BackgroundWe initially reported on the cost-effectiveness of a 6-month randomized controlled implementation trial which evaluated Health TAPESTRY, a primary care program for older adults, at the McMaster Family Health Team (FHT) site and 5 other FHT sites in Ontario, Canada. While there were no statistically significant between-group differences in outcomes at month 6 post randomization, positive outcomes were observed at the McMaster FHT site, which recruited 40% (204/512) of the participants. The objective of this post-hoc study was to determine the cost-effectiveness of Health TAPESTRY based on data from the McMaster FHT site.MethodsCosts included the cost to implement Health TAPESTRY at McMaster as well as healthcare resource consumed, which were costed using publicly available sources. Health-related-quality-of-life was evaluated with the EQ-5L-5L at baseline and at month 6 post randomization. Quality-adjusted-life-years (QALYs) were calculated under an-area-under the curve approach. Unadjusted and adjusted regression analyses (two independent regression analyses on costs and QALYs, seemingly unrelated regression [SUR], net benefit regression) as well as difference-in-difference and propensity score matching (PSM) methods, were used to deal with the non-randomized nature of the trial. Sampling uncertainty inherent to the trial data was estimated using non-parametric bootstrapping. The return on investment (ROI) associated with Health TAPESTRY was calculated. All costs were reported in 2021 Canadian dollars.ResultsWith an intervention cost of $293/patient, Health TAPESTRY was the preferred strategy in the unadjusted and adjusted analyses. The results of our bootstrap analyses indicated that Health TAPESTRY was cost-effective compared to usual care at commonly accepted WTP thresholds. For example, if decision makers were willing to pay $50,000 per QALY gained, the probability of Health TAPESTRY to be cost effective compared to usual care varied from 0.72 (unadjusted analysis) to 0.96 (SUR) when using a WTP of $50,000/QALY gained. The DID and ROI analyses indicated that Health Tapestry generated a positive ROI.ConclusionHealth TAPESTRY was the preferred strategy when implemented at the McMaster FHT. We caution care in interpreting the results because of the post-hoc nature of the analyses and limited sample size based on one site.

Clinical officers in Uganda: Training and workforce role.

The clinical role of a clinical officer in Uganda is very similar to that of a physician associate/assistant in the United States. This article describes the qualifications and workforce role of clinical officers in Uganda, as well as their use in two primary care programs that provide effective, low-cost medical care to a growing population with an increasing burden of chronic disease.

Short report: Integrated evaluations for autism spectrum disorder in pediatric primary care clinics.

Primary care providers often screen for autism during well child visits in the first few years of life and refer children for diagnostic evaluations when needed. However, most children do not receive a diagnosis until years later which delays access to services. Racism, socioeconomic status, and other systemic inequalities that limit access to health care further delay diagnostic evaluations. Mental health clinicians who work in primary care clinics can help address barriers to accessing diagnostic evaluation services once they are recommended by their primary care provider. However, mental health clinicians who work in primary care typically do not have training in diagnosing autism. The goal of this study was to evaluate a program training mental health professionals working in an urban primary care setting, primarily serving Black and Latinx families insured by Medicaid, to provide autism diagnostic evaluations. Two hundred and fifty children completed evaluations through the Autism in Primary Care (APC) program. The wait time to access an evaluation through APC was significantly shorter than through standard avenues of care (e.g. referring to a separate autism clinic). Referring primary care providers and caregivers endorsed high levels of satisfaction with the program. Conducting autism evaluations in primary care settings offers a promising opportunity to improve earlier diagnosis and treatment access for families, reduce inequities in care, and increase caregiver and child well-being.

A system-wide approach to digital equity: the Digital Access Coordinator program in primary care.

The transition to digital tools prompted by the pandemic made evident digital disparities. To address digital literacy gaps, we implemented a system-wide digital navigation program. The Digital Access Coordinator (DAC) program consists of 12 multilingual navigators who support patients in enrolling and using the patient portal and digital tools. We implemented the program in our primary care network which consists of 1.25 million patients across 1211 clinicians. From May 2021 to November 2022, the DACs completed outreach to 16045 patients. Of the 13413 patients they reached, they successfully enrolled 8193 (61%) patients in the patient portal. Of those patients they enrolled, most patients were of Other race, Hispanic ethnicity, and were English-speaking (44%) and Spanish-speaking patients (44%). Using our embedded model, we increased enrollment across 7 clinics (mean increase: 21.3%, standard deviation: 9.2%). Additionally, we identified key approaches for implementing a digital navigation program. Organizations can support patient portal enrollment, a key part of digital health equity, by creating and prioritizing digital navigation programs.

Evaluation of the First Approach Skills Training (FAST) Integrated Pediatric Primary Care Program: Implementation and Clinical Effectiveness

ABSTRACT The current study evaluated the clinical effectiveness and implementation of a brief integrated pediatric primary care program, First Approach Skills Training (FAST). We analyzed clinical retrospective data during the first year of implementation of FAST. Patients and parents completed symptom measures as part of standard clinical care. Integrated behavioral health providers completed measures regarding the FAST program's usability, feasibility, effectiveness, and cultural responsiveness. Patients and parents reported significant improvement in anxiety symptoms, depression symptoms, and disruptive behaviors. Clinicians rated FAST as highly usable, feasible, effective, and culturally responsive. The FAST program demonstrates preliminary clinical effectiveness for common youth mental health problems in pediatric primary care.

Evaluation of the Nurses' Understanding of Disease Prevention and Health Promotion in Primary Health Care Centres in Al-Diwaniyah

A descriptive study was undertaken from January 15, 2023 to May 26, 2023 in order to measure the level of knowledge among nurses This text pertains to the improvement of health and the avoidance of illnesses at primary healthcare clinics located in the municipality of Al-Diwaniyah. A precise random population of 150 individuals, evenly distributed among There are eleven primary health care institutions located in the city of Al Diwaniyah. The numbers were obtained from the health promotion and disease prevention tool that has been authorized by the Iraqi Ministry of Health. Data was gathered by conducting a questionnaire for each variable, employing a research instrument and the personal interview method. Each survey necessitated roughly 10 minutes to complete. The questionnaire comprised four axes, with the initial axis explicitly focusing on community partnership and mobilization. The second axis relates to the local council of the primary health care centre. The third level of communication focuses on modifying behaviour, while the fourth dimension revolves around promoting health and preventing sickness. The data was evaluated using the weighted average method, renowned for its ability to generate accurate outcomes by using the principle of weight ratios. The study found that the research sample had outstanding expertise in the field of health promotion and illness prevention. The study proposes improving training programs in primary health care, with a specific emphasis on boosting communication skills and promoting changes in health behaviours. Additionally, it suggests prioritizing community involvement and activation, while also strengthening the local governing bodies of basic healthcare facilities. In addition, the study cautions against indiscriminately replacing experienced nurses with new workers.

Prevalence of dental carries and its association with breastfeeding duration among young children in Addis Ababa, Ethiopia

BackgroundBreastfeeding is a crucial feeding practices that significantly contributes to the healthy development of children. However, the effect of breastfeeding duration on caries risk is unclear, as different studies have found different results. This study aims to assess the prevalence of dental caries and its association with breastfeeding duration among young children aged 12–36 months in selected health facilities of Addis Ababa, Ethiopia.MethodsA cross-sectional study among 380 children aged 12–36 months from 11 health centers in Addis Ababa was conducted. Questionnaires and dental examinations were used to collect data. Dental caries was measured by the deft (decayed–extracted–filled teeth) index. Binary logistic regression was used to assess the association between dental caries and duration of breastfeeding, after adjusting for the confounders.ResultsThe prevalence of dental caries was 53.4% (95% CI: 48.3, 58.5%), with 13.7% having high caries and 39.7% having low caries. Breastfeeding duration was not significantly associated with dental carries, after adjusting for confounders. However, sugar intake, older age, mothers’ unemployment, and not being in marital union are risk factors for dental caries development.ConclusionsPromotion of healthy diet, especially limiting intake of sugar and sweets, and integration of oral health into primary health care programs are recommended. Further research using longitudinal design or meta-analysis is recommended to establish more concise evidence on the association between breastfeeding duration and dental caries.

A time series analysis of disruptions to maternal and child health care in northern Togo during the COVID-19 pandemic in the context of an integrated primary care program

There are significant concerns that COVID-19-related disruptions in routine health care will reverse the gains made over the past 2 decades in reducing maternal and under-5 mortality in low- and middle-income countries. The objective of this study was to examine the extent of disruptions in community-based maternal and child health services and explore community perceptions and experiences with health care use in the year following the start of the COVID-19 pandemic in one district in northern Togo, West Africa. This study included analysis of multiple types of data including: (1) routine health management information system data from 18 public sector health centers, (2) programmatic data collected through an integrated health center- and community-based primary care program at 5 health centers, and (3) semi-structured interviews with health center managers, community health workers (CHWs), and community members at those 5 health centers. We found only short-term declines in service utilization coinciding with the COVID-19 pandemic and no decline in the delivery of community-based care by CHWs. Qualitative data were consistent with the quantitative results, reporting sustained use of health-care services. Multilevel factors related to the continued provision of care during the COVID-19 pandemic included regular and clear communication from CHWs as trusted community sources, risk minimization at the health-center level, continued provision of community-based care by CHWs, and collaboration between community leaders and health-care workers to limit COVID-19 transmission. Findings demonstrate resiliency of an integrated primary care system when equipped with an adequately trained, supervised, and supplied health workforce, implementation of infection prevention and control measures, communication by trusted community sources, and adaptations to health-care delivery that enable the continued provision of care.

A review of skin cancer primary prevention activities in primary care settings.

Skin cancer is highly preventable through primary prevention activities such as avoiding ultraviolet radiation exposure during peak times and regular use of sun protection. General practitioners (GPs) and primary care nurses have key responsibilities in promoting sustained primary prevention behaviour. We aimed to review the evidence on skin cancer primary prevention activities in primary care settings, including evidence on feasibility, effectiveness, barriers and enablers. Rapid review and narrative synthesis. We searched published literature from January 2011 to October 2022 in Embase, Medline, PsychInfo, Scopus, Cochrane Central and CINAHL. The search was limited to skin cancer primary prevention activities within primary care settings, for studies or programs conducted in Australia or countries with comparable health systems. Analysis of barriers and enablers was informed by an implementation science framework. A total of 31 peer-reviewed journal articles were included in the review. We identified four main primary prevention activities: education and training programs for GPs; behavioural counselling on prevention; the use of novel risk assessment tools and provision of risk-tailored prevention strategies; and new technologies to support early detection that have accompanying primary prevention advice. Enablers to delivering skin cancer primary prevention in primary care included pairing preventive activities with early detection activities, and access to patient resources and programs that fit with existing workflows and systems. Barriers included unclear requirements for skin cancer prevention counselling, competing demands within the consultation and limited access to primary care services, especially in regional and remote areas. These findings highlight potential opportunities for improving skin cancer prevention activities in primary care. Ensuring ease of program delivery, integration with early detection and availability of resources such as risk assessment tools are enablers to encourage and increase uptake of primary prevention behaviours in primary care, for both practitioners and patients.

Repercussions of the COVID-19 pandemic on breast cancer actions in a Brazilian state.

To analyze whether the COVID-19 pandemic had an impact on the screening, diagnosis and treatment of breast cancer in women up to 50 years of age in the state of Pará. Retrospective, cross-sectional study with a quantitative approach, using data from the Information Technology Department of the Brazilian Unified Health System. (DATASUS). The number of exams carried out in the pre-pandemic (2018-2019) and pandemic (2020-2021) period was analyzed based on the percentage variation, application of the chi-square test and G test for the time of exams and start time of treatment. During the pandemic period, there was a greater number of screening mammograms (+3.68%), cytological (+23.68%), histological (+10.7%) and a lower number of diagnostic mammograms (-38.7%). The time interval for carrying out the exams was up to 30 days for screening and diagnostic exams and more than 60 days to start treatment during the pandemic period. Although the results indicate an increase in the number of screening and diagnostic procedures for breast cancer during the pandemic period, with the exception of diagnostic mammography, when considering probability values, the study points out that statistically the COVID-19 pandemic did not interfere with actions of breast cancer, in women over 50 years of age, in the state of Pará. Considering the autonomy of nursing and its role in public health, it is up to the professionals who are in charge of primary care programs to implement contingency plans in periods of crisis so that the population is not left unassisted.

Building a National Standard for Outreach and Assistance to At-Risk Patients During Large-Scale Disasters

Health care institutions play an essential role in community resilience. As one of the largest health care systems in the United States, the Veterans Health Administration (VHA) plays a critical role in supporting medically vulnerable Veterans during disasters. Disasters require large-scale outreach to individuals in affected areas, including the capability to identify patients, establish contact, determine needs, and deliver required services. Here we describe the development and implementation of VHA's Vulnerable Patient Care, Access, and Response in Emergencies (VP CARE) program, a data-driven system of outreach to preidentified medically vulnerable patients, which seeks to streamline this process. VP CARE was inspired by the VHA's Home-Based Primary Care (HBPC) program and the US Department of Health and Human Services’ emPOWER program. It seeks to enhance Veteran patients' well-being and continuity of care during disasters using 3 components: (1) improving the readiness and resilience of vulnerable patients and their caregivers; (2) establishing an organization, policies, procedures, and competency-based training exercises to guide outreach and assistance; and (3) creating and implementing standardized 1- and 2-way outreach technology and reporting. Using Geographic Information Systems embedded in VP CARE, VHA can generate a list of high-risk patients and deploy a 2-way texting capability to contact and receive responses from them. VP CARE automatically tracks patient contact and responses, reducing duplication of effort and freeing up VA staff to focus on patients with immediate needs. Patients and their caregivers benefit from the reassurance of knowing that VHA is focused on their well-being and available to support them. The technologies deployed in VP CARE improve the efficiency of outreach efforts and reduce the risk of life-threatening harm, while reducing the cost and demands on VA staff. This article concludes with lessons learned that may be instructive for other health care systems seeking to establish similar outreach capabilities.

Implementation and adaptation of a hub-based psychiatric and primary care program: A qualitative descriptive analysis of The Seamless Care Optimizing the Patient Experience (SCOPE) Mental Health program.

The Seamless Care Optimizing the Patient Experience (SCOPE)-Mental Health program is a comprehensive case management and psychiatric care initiative that supports primary care physicians in independent medical practices. This program offers a range of services that aims to enhance primary care capacity for mental health and provide accessible clinical care for patients. With its flexible hub-based approach, this program allows participating sites to tailor their implementation based on their available resources and specific needs within their community. The aim of this quality improvement initiative was to investigate the evolution of this collaborative mental health model, focusing on specific site adaptations, local implementation challenges, and opportunities for ongoing development and sustainability across SCOPE sites in the Greater Toronto Area. This evaluation employed a qualitative descriptive design where semi-structured interviews, guided by the Reach Effectiveness Adoption, Implementation, and Maintenance framework were conducted with staff from all 8 SCOPE-Mental Health sites. Site representatives were interviewed virtually between March and July 2023 and data were analyzed using qualitative content analysis. The SCOPE-Mental Health model permits flexibility through specific local adaptations led by community need that leverage existing assets either at the site or within the individual community. Adoption by primary care physicians was crucial to program success and facilitated efficiency and interprofessional collaboration. Maintenance efforts included pathway refinement, and marketing and funding considerations. Challenges to program development included continuity of staff, physician compensation issues, and electronic health record interoperability. The SCOPE-Mental Health program fosters linkages among unaffiliated primary care offices, hospitals, and community-based resources to improve mental health care. Key recommendations include advocating for sustainable funding and facilitated mechanisms for psychiatric consultations. This initiative offers valuable insights for healthcare organizations seeking to develop similar programs, emphasizing the need for tailored approaches and ongoing evaluation to ensure a lasting impact in underserved communities.