Urban Federally Qualified Health Centers Research Articles

Enhancing Adolescent and Young Adult Health Services! A Review of the Community Needs Assessment Process in an Urban Federally Qualified Health Center.

Background: Urban African American adolescents and young adults (AYAs) face multiple barriers to effective engagement in health care, including access to primary and specialty care services resulting in significant disparities in care.Purpose: To conduct a needs assessment to enhance service delivery of AYAs at an urban federally qualified health center (FQHC) organization in Detroit.Methods: Semistructured interviews were conducted among pediatric staff members (N=11) using the community needs assessment approach specified for FQHCs.Results: The needs assessment determined the following priorities for AYAs seeking care at this FQHC organization: (1) mental health (e.g., depression and anxiety), (2) obesity, and (3) sexual health (e.g., sexually transmitted infection testing).Conclusion: When analyzing a population to learn about community-based issues, a needs assessment is a valuable tool. The information here has been used as supplemental information to address the health inequities that African American youth face within Detroit.

Attitudes Surrounding a Community-Based Fitness Intervention at an Urban FQHC.

The population surrounding an urban federally qualified health center (FQHC) in Philadelphia has poorer health than Philadelphia overall. Community residents identified aerobics and dance classes as very important services or programs that an FQHC might provide. We sought to measure the impact of participation in a resident physician-led, patient-centered fitness and nutrition class on participants' attitudes, knowledge, and self-efficacy regarding their health. An urban line dancing class and brief healthy eating intervention for adults was held at a YMCA adjacent to a residency-affiliated FQHC weekly for 8 weeks. Pre/postsurveys were administered to assess attitudes and confidence toward physical activity and healthy lifestyles. Participants' self-assessment of health and levels of physical activity improved. Confidence in performing everyday activities, doing regular exercise and exercising without making symptoms worse increased. A significant decrease in participants' physical activity gratification was observed. Participants' confidence improved in reading food labels for health, but confidence in eating a balanced diet did not improve. A resident-led fitness and nutrition class, tailored to perceived community needs, generated significant interest and sustained participation. This pilot study furthered development of community infrastructure addressing health, nutrition, and overall fitness, and the results reflect opportunities and challenges of engaging communities in physical fitness.

Su1744 - Predictors of Colon Cancer Screening Among Individuals in a Network of Urban Federally Qualified Health Centers

Su1744 - Predictors of Colon Cancer Screening Among Individuals in a Network of Urban Federally Qualified Health Centers

Prevalence of Sexual Violence and its Association with Depression among Male and Female Patients with Risky Drug Use in Urban Federally Qualified Health Centers.

Sexual violence (SV) is common; however, the prevalence of SV and its long term sequela vary geographically and among subpopulations within the USA. As such, the aims of this study are the following: (1) to determine the prevalence of SV, (2) to identify correlates of SV, and (3) to determine if SV is associated with depression among male and female risky drug users in urban Federally Qualified Health Centers (FQHCs) in Los Angeles. This study includes adult patients of five urban FQHCs who self-reported risky drug use. We identified survivors of SV and those experiencing depression through survey questions that queried, before or after age 18, "Were you ever sexually assaulted, molested or raped?" and with the RAND Mental Health Index (MHI-5). We utilized Pearson's chi-square tests to assess predictors of SV and logistic regression to assess for an association between SV and depression. Data collection took place from February 2011 to November 2012. Of the 334 study patients, 49% of females and 25% of males reported surviving SV. Exposure to SV, (both before 18years of age and after 18years of age) was the strongest predictor of depression among men and women in this study (OR 4.7, p<0.05). These data demonstrate that sexual violence is prevalent in this urban FQHC population and is strongly associated with depression. Providers should consider screening both men and women with risky drug use for SV while health systems should continue to align mental health and primary care services to appropriately care for these extremely vulnerable patients. Trial Registration Clinical Trials. gov ID NCT01942876, Protocol ID DESPR DA022445, http://www.clinicaltrials.gov.

Increasing Colorectal Cancer Screening at an Urban FQHC Using iFOBT and Patient Navigation.

Colorectal cancer is the second leading cause of cancer death in the United States. Black Americans suffer even higher incidence and death rates than the general population. Genetics and patient perceptions explain some of this difference, however, modifiable health care system factors such as lack of access to colon cancer screening also contribute. Partnering an academic health center with local community groups, we piloted a colorectal cancer screening program at a Federally Qualified Health Center (FQHC) serving predominately low socioeconomic status Black Americans. The program was designed to identify and remove barriers to screening and improve screening rates. At a single center FQHC, we developed an outreach program centered around (1) patient and provider education, (2) immunochemical fecal occult blood test (iFOBT) distribution, and (3) patient navigation. We identified 402 eligible patients, of which 228 (56.7%) completed screening. Our 56.7% screening rate represented a twofold increase above prepilot levels at the clinic. Nine (4%) iFOBT returned positive. Three of these nine patients completed colonoscopy. Screening rates and follow through were higher under a single navigator model. Our academic-community partnership provided an effective, evidence based, and sustainable model for increasing colorectal cancer screening in a high risk, low resource community.

Abstract C51: Integrating a Health Risk Assessment Mobile App into Diverse Primary Care Settings - a Pilot Project

Abstract Purpose: We designed an intervention combining the Zuum health risk assessment tool, healthcare provider, and text messaging (SMS) to deliver critical health messages to diverse populations. Zuum is a mobile version of the evidence-based and scientifically-validated Your Disease Risk suite of health risk assessment tools. Our aim was to assess feasibility and acceptance of integrating the intervention into the primary care setting of Federally-Qualified Health Centers (FQHC). Background: Chronic diseases caused largely by modifiable risk factors are the leading causes of death in the United States. Rates of these diseases and their risk factors are higher among many minorities and the poor. As most adults from all backgrounds have a primary care source, this can be an effective intervention setting. However, provider time remains a major barrier to prevention counseling. Health risk assessment tools can help facilitate counseling, as they have demonstrated improvements in patient risk knowledge and accuracy, integration into primary care and promotion of patient-provider risk discussions. Yet, its influence on health behavior and intentions is not well supported. Supplementing these with interventions shown to directly influence behavior change might improve their efficacy. SMS has shown promising ability to improve health behavior and intentions and may enhance the impact of the risk assessment tool. Procedures: The intervention was conducted in urban FQHCs in St. Louis, Missouri. Eligible patients were adults in the waiting room for a scheduled primary care visit. Participants completed the mobile Zuum assessment and received a summary of their risks for 6 chronic diseases with recommendations to lower those risks. Their physician was given an abridged version to help guide preventative counseling during their appointment. For three months, participants received weekly text messages on lifestyle modification tailored to their risk results and behaviors. Results: We enrolled 107 patients, 85% African-American and ages 20 to 70. Most were high risk for at least one chronic disease (82%), and nearly half for two or more (47%). Most patients screened were interested in participating (69%) and had compatible phones (89%). The majority (95%) had time to complete the Zuum assessment before their appointment. We delivered 5,750 (89%) of generated messages, averaging 4-5 messages weekly. Most participants strongly agreed that answering Zuum questions was easy (95%), the texts were clear (90%) and texting is good method to improve health (84%). Most would recommend health text messages (90%) and the Zuum assessment (73%) to friends and family. The patient level of agreement with the Zuum risk labels was high across all diseases (80-92%). Conclusions: The Zuum intervention integrated well into the FQHC clinic setting and was highly accepted by the FQHC patients. This study advances the knowledge base on the feasibility of harnessing the power of mobile health to deliver effective, efficient, and personalized prevention messages to diverse and underserved patient populations. Findings suggest that the Zuum app, and other interventions like it, are tools that may help meet that need in settings where time and resources are limited. Citation Format: Graham Colditz, Sonya Izadi, Hank Dart, Erika Waters, Aimee James. Integrating a Health Risk Assessment Mobile App into Diverse Primary Care Settings - a Pilot Project. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C51.

Factors influencing adults' immunization practices: a pilot survey study of a diverse, urban community in central Ohio.

BackgroundAdult vaccination rates in the United States are well below recommendations with disparities in race, ethnicity, and education level resulting in even lower rates for these populations. This study aimed to identify the barriers to and perceptions of immunizations in adults in an urban, underserved, multicultural community. Understanding the factors that influence adults’ decisions to receive routinely recommended vaccines will aid health care providers and public health officials to design programs to improve vaccination rates.MethodsThis cross-sectional, survey-based study was conducted in January 2014 in Columbus, Ohio. Participants were recruited from four urban federally-qualified health centers and four grocery stores affiliated with those clinics. The survey gathered self-reported receipt of immunizations, knowledge about indications for immunizations, and factors influencing decisions to receive an immunization. Data was analyzed in 2014. Descriptive statistics were generated for all survey items and Chi-Square or Fisher’s Exact tests were used as appropriate to test for associations between demographic characteristics and factors influencing immunization decisions.ResultsThe top five factors likely to affect the decision to receive an immunization among the 304 respondents were: “doctor’s recommendation” (80.6 %), “knowing why I should get a vaccine” (78.2 %), “knowing which vaccines I need” (75.5 %), cost (54.2 %), and “concern about getting sick if I get a vaccine” (54.0 %). Significant differences in factors influencing the immunization decision exist among respondents based on ethnicity and education level. For those participants with self-identified diabetes, heart disease, or asthma, less than half were aware that certain immunizations could reduce the risk of complications associated with their disease(s).ConclusionsData from this study may inform and shape patient education programs conducted in clinics, retailers, and communities, as well as advocacy efforts for adult immunizations. Results from this study suggest that patients would respond to programs for promoting vaccine uptake if they focused on benefits and indications for vaccines. The results also highlighted the need for education regarding immunizations for patients with chronic diseases and special indications. The differences in perceptions found between groups can be used to create targeted interventions based on the needs of those patient populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3107-9) contains supplementary material, which is available to authorized users.

SBIRT Implementation for Adolescents in Urban Federally Qualified Health Centers

BackgroundAlcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Evidence from clinical trials and meta-analyses supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse but primary care providers have been slow to adopt this evidence-based approach. The purpose of this paper is to describe the theoretically informed methodology of an on-going implementation study. MethodsThis study protocol is a multi-site, cluster randomized trial (N=7) guided by Proctor’s conceptual model of implementation research and comparing two principal approaches to SBIRT delivery within adolescent medicine: Generalist vs. Specialist. In the Generalist Approach, the primary care provider delivers brief intervention (BI) for substance misuse. In the Specialist Approach, BIs are delivered by behavioral health counselors. The study will also examine the effectiveness of integrating HIV risk screening within an SBIRT model. Implementation Strategies employed include: integrated team development of the service delivery model, modifications to the electronic medical record, regular performance feedback and supervision. Implementation outcomes, include: Acceptability, Appropriateness, Adoption, Feasibility, Fidelity, Costs/Cost-Effectiveness, Penetration, and Sustainability. DiscussionThe study will fill a major gap in scientific knowledge regarding the best SBIRT implementation strategy at a time when SBIRT is poised to be brought to scale under health care reform. It will also provide novel data to inform the expansion of the SBIRT model to address HIV risk behaviors among adolescents. Finally, the study will generate important cost data that offer guidance to policymakers and clinic directors about the adoption of SBIRT in adolescent health care.

Buprenorphine Maintenance Treatment Retention Improves Nationally Recommended Preventive Primary Care Screenings when Integrated into Urban Federally Qualified Health Centers

Buprenorphine maintenance therapy (BMT) expands treatment access for opioid dependence and can be integrated into primary health-care settings. Treating opioid dependence, however, should ideally improve other aspects of overall health, including preventive services. Therefore, we examined how BMT affects preventive health-care outcomes, specifically nine nationally recommended primary care quality health-care indicators (QHIs), within federally qualified health centers (FQHCs) from an observational cohort study of 266 opioid-dependent patients initiating BMT between 07/01/07 and 11/30/08 within Connecticut's largest FQHC network. Nine nationally recommended preventive QHIs were collected longitudinally from electronic health records, including screening for chronic infections, metabolic conditions, and cancer. A composite QHI score (QHI-S), based on the percentage of eligible QHIs achieved, was categorized as QHI-S ≥80% (recommended) and ≥90% (optimal). The proportion of subjects achieving a composite QHI-S ≥80 and ≥90 % was 57.1 and 28.6%, respectively. Screening was highest for hypertension (91.0%), hepatitis C (80.1%), hepatitis B (76.3%), human immunodeficiency virus (71.4%), and hyperlipidemia (72.9%) and lower for syphilis (49.3%) and cervical (58.5%), breast (44.4%), and colorectal (48.7%) cancer. Achieving QHI-S ≥80% was positively and independently associated with ≥3-month BMT retention (adjusted odds ratio (AOR) = 2.19; 95% confidence interval (CI) = 1.18-4.04) and BMT prescription by primary care providers (PCPs) rather than addiction psychiatric specialists (AOR = 3.38; 95% CI = 1.78-6.37), and negatively with being female (AOR = 0.30; 95% CI = 0.16-0.55). Within primary health-care settings, achieving greater nationally recommended health-care screenings or QHIs was associated with being able to successfully retain patients on buprenorphine longer (3 months or more) and when buprenorphine was prescribed simultaneously by PCPs rather than psychiatric specialists. Decreased preventive screening for opioid-dependent women, however, may require gender-based strategies for achieving health-care parity. When patients can be retained, integrating BMT into urban FQHCs is associated with improved health outcomes including increased multiple preventive health-care screenings.

1342Optimization of the HCV Testing and Care Continuum in an Urban Federally Qualified Health Center

1342Optimization of the HCV Testing and Care Continuum in an Urban Federally Qualified Health Center

Using an Established Telehealth Model to Train Urban Primary Care Providers on Hypertension Management

The objective of this study was to determine whether a videoconference-based telehealth network can increase hypertension management knowledge and self-assessed competency among primary care providers (PCPs) working in urban Federally Qualified Health Centers (FQHCs). We created a telehealth network among 6 urban FQHCs and our institution to support a 12-session educational program designed to teach state-of-the-art hypertension management. Each 1-hour session included a brief lecture by a university-based hypertension specialist, case presentations by PCPs, and interactive discussions among the specialist and PCPs. Twelve PCPs (9 intervention and 3 controls) were surveyed at baseline and immediately following the curriculum. The mean number of correct answers on the 26-item hypertension knowledge questionnaire increased in the intervention group (13.11 [standard deviation (SD)]=3.06) to 17.44 [SD=1.59], P<.01) but not among controls (14.33 [SD=3.21] to 13.00 [SD=3.46], P=.06). Similarly, the mean score on a 7-item hypertension management self-assessed competency scale increased in the intervention group (4.68 [SD=0.94] to 5.41 [SD=0.89], P<.01) but not among controls (5.28 [SD=0.43] to 5.62 [SD=0.67], P=.64). This model holds promise for enhancing hypertension care provided by urban FQHC providers.