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Journal of Primary Care & Community Health

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https://www.readbyqxmd.com/read/28745137/exploring-the-value-proposition-of-primary-care-for-safety-net-patients-who-utilize-emergency-departments-to-address-unmet-needs
#1
Kimberly R Enard, Deborah M Ganelin
BACKGROUND: An underlying assumption of strategies intended to promote appropriate primary care over emergency department (ED) use for ongoing health care needs is that patients will understand the "value proposition" of primary care: that they will receive specific benefits from primary care providers over and above what they receive from EDs. However, there is evidence that this value proposition may be unclear to safety-net patients. The goals of this study are to describe factors motivating ED use for low-acuity conditions; describe similarities and differences in usual source of care (USOC) experiences, by ED versus non-ED setting; and assess awareness and perceptions of the patient-centered medical home (PCMH) concept among safety-net patients...
July 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28707507/marketplace-clinics-complementing-diabetes-care-for-urban-residing-american-indians
#2
Robert Rick, Robert E Hoye, Raymond W Thron, Vibha Kumar
INTRODUCTION: For several decades, the Minneapolis American Indian population has experienced limited health care access and threefold diabetes health disparity. As part of an urban health initiative, the marketplace clinics located in nearby CVS, Target, and Supervalu stores committed financial support, providers, certified educators, and pharmacy staff for a community-based diabetes support group. OBJECTIVES: To measure the extent to which collaborating marketplace clinics and the community-based support group expanded diabetes care and provided self-management education for this largely urban Indian neighborhood...
July 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28645236/a-quantitative-study-of-empathy-in-pakistani-medical-students-a-multicentered-approach
#3
Nabia Tariq, Tariq Rasheed, Mohsen Tavakol
OBJECTIVE: To examine the empathy level of undergraduate medical students in Pakistan. Three hypotheses are developed based on the literature review. (1) Female medical students have a higher level of empathy than do male students. (2) Empathy scores vary during the medical school years in Pakistani students. (3) Medical students interested in people-oriented specialties would score higher than the students interested in technology-oriented specialties. METHODS: This is a quantitative inquiry approach using a cross-sectional design of 1453 students from 8 Pakistani medical schools, both private and state...
June 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28645227/diabetic-and-obese-patient-clinical-outcomes-improve-during-a-care-management-implementation-in-primary-care
#4
Jodi Summers Holtrop, Zhehui Luo, Gretchen Piatt, Lee A Green, Qiaoling Chen, John Piette
BACKGROUND: To address the increasing burden of chronic disease, many primary care practices are turning to care management and the hiring of care managers to help patients coordinate their care and self-manage their conditions. Care management is often, but not always, proving effective at improving patient outcomes, but more evidence is needed. METHODS: In this pair-matched cluster randomized trial, 5 practices implemented care management and were compared with 5 comparison practices within the same practice organization...
June 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28643551/provider-advice-about-weight-loss-in-a-primary-care-sample-of-obese-and-overweight-patients
#5
Chanita Hughes Halbert, Melanie Jefferson, Cathy L Melvin, LaShanta Rice, Kemi M Chukwuka
OBJECTIVE: Primary care providers play an important role in obesity prevention and reduction by advising patients about weight loss strategies. This study examined receipt of provider advice to lose weight among primary care patients who were overweight and obese. METHODS: Observational study conducted among primary care patients (n = 282) who completed a survey that measured receipt of provider advice about weight loss/management, chronic health conditions, perceived weight status, and perceptions about shared decision making about weight loss/management...
June 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28613090/personality-disorders-in-primary-care-impact-on-depression-outcomes-within-collaborative-care
#6
Kurt B Angstman, Ashok Seshadri, Alberto Marcelin, Cesar A Gonzalez, Gregory M Garrison, Jay-Sheree Allen
BACKGROUND: Individuals with personality disorders (PDs) are high utilizers of primary care and mental health services; however, they struggle to utilize the care effectively and studies have shown a strong association between having a PD and higher impairment in social role functioning. This is especially important because PDs are highly comorbid with a wide range of other mental health disorders. The collaborative care model (CCM) for depression was developed with an emphasis on patient engagement and aimed to reduce health care utilization, while improving treatment outcomes in primary care...
June 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28606031/how-socioeconomic-status-affects-patient-perceptions-of-health-care-a-qualitative-study
#7
Nicholas C Arpey, Anne H Gaglioti, Marcy E Rosenbaum
INTRODUCTION: Clinician perceptions of patients with low socioeconomic status (SES) have been shown to affect clinical decision making and health care delivery in this group. However, it is unknown how and if low SES patients perceive clinician bias might affect their health care. METHODS: In-depth interviews with 80 enrollees in a state Medicaid program were analyzed to identify recurrent themes in their perceptions of care. RESULTS: Most subjects perceived that their SES affected their health care...
July 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28606030/assessing-breast-cancer-risk-estimates-based-on-the-gail-model-and-its-predictors-in-qatari-women
#8
Abdulbari Bener, Funda Çatan, Hanadi R El Ayoubi, Ahmet Acar, Wanis H Ibrahim
BACKGROUND: The Gail model is the most widely used breast cancer risk assessment tool. An accurate assessment of individual's breast cancer risk is very important for prevention of the disease and for the health care providers to make decision on taking chemoprevention for high-risk women in clinical practice in Qatar. AIM: To assess the breast cancer risk among Arab women population in Qatar using the Gail model and provide a global comparison of risk assessment...
July 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28606029/the-role-of-community-health-centers-in-reducing-racial-disparities-in-spatial-access-to-primary-care
#9
Jane W Seymour, Daniel E Polsky, Elizabeth J Brown, Corentin M Barbu, David Grande
INTRODUCTION: Racial minorities are more likely to live in primary care shortage areas. We sought to understand community health centers' (CHCs) role in reducing disparities. METHODS: We surveyed all primary care practices in an urban area, identified low access areas, and examined how CHCs influence spatial accessibility. RESULTS: Census tracts with higher rates of public insurance (≥40% vs <10%, odds ratio [OR] = 31.06, P < .001; 30-39% vs 10%, OR = 7...
July 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28606028/an-investigation-of-perspectives-of-respite-admission-among-people-living-with-amyotrophic-lateral-sclerosis-and-the-hospitals-that-support-them
#10
Michiko Nakai, Yugo Narita, Hidekazu Tomimoto
BACKGROUND: Amyotrophic lateral sclerosis is a progressive disease with rapid degeneration. Respite care is an essential service for improving the well-being of both patients with this disease and their family caregivers, but accessibility of respite services is limited. This study investigates perspectives on respite admission among people living with amyotrophic lateral sclerosis and the hospitals supporting them. METHOD: We conducted semistructured interviews among 3 patients with amyotrophic lateral sclerosis and 12 family members, exploring demographic information and their awareness and experience of respite admission...
July 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28142316/what-factors-are-associated-with-medicaid-patients-use-of-health-centers
#11
Yihe N Gao, Robert S Nocon, Ravi Sharma, Elbert S Huang
OBJECTIVE: To identify patient and neighborhood factors associated with health center (HC) use. METHODS: A cross-sectional study of Medicaid fee-for-service claims in 2009 comparing HC users and nonusers. RESULTS: Dually eligible patients (odds ratio [OR] 95% CI = [0.60, 0.61]) and those with high chronic disease burden (OR 95% CI = [0.73, 0.74]) had lower odds of HC use. Temporary Assistance for Needy Families participants (OR 95% CI = [1...
July 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28068854/breast-cancer-care-in-california-and-ontario-primary-care-protections-greatest-among-the-most-socioeconomically-vulnerable-women-living-in-the-most-underserved-places
#12
Kevin M Gorey, Caroline Hamm, Isaac N Luginaah, Guangyong Zou, Eric J Holowaty
BACKGROUND: Better health care among Canada's socioeconomically vulnerable versus America's has not been fully explained. We examined the effects of poverty, health insurance and the supply of primary care physicians on breast cancer care. METHODS: We analyzed breast cancer data in Ontario (n = 950) and California (n = 6300) between 1996 and 2000 and followed until 2014. We obtained socioeconomic data from censuses, oversampling the poor. We obtained data on the supply of physicians, primary care and specialists...
July 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28553751/patient-centered-care-in-small-primary-care-practices-in-new-york-city-recognition-versus-reality
#13
Margaret M Paul, Stephanie L Albert, Tod Mijanovich, Sarah C Shih, Carolyn A Berry
BACKGROUND: The Primary Care Information Project (PCIP) is a program administered by the New York City Department of Health and Mental Hygiene to help primary care providers adopt a fully functional electronic health record (EHR) and focus on population health. PCIP also offers practices assistance with the National Committee for Quality Assurance (NCQA) patient-centered medical home (PCMH) recognition application. The objectives of this study were to assess the presence of key dimensions of PCMH among PCIP practices with 5 or fewer providers and to determine whether and to what extent NCQA recognition was related to the presence of these dimensions...
May 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28513249/medicaid-expansion-produces-long-term-impact-on-insurance-coverage-rates-in-community-health-centers
#14
Nathalie Huguet, Megan J Hoopes, Heather Angier, Miguel Marino, Heather Holderness, Jennifer E DeVoe
BACKGROUND: It is crucial to understand the impact of the Affordable Care Act (ACA). This study assesses changes in insurance status of patients visiting community health centers (CHCs) comparing states that expanded Medicaid to those that did not. METHODS: Electronic health record data on 875,571 patients aged 19 to 64 years with ≥ 1 visit between 2012 and 2015 in 412 primary care CHCs in 9 expansion and 4 nonexpansion states. We assessed changes in rates of total, uninsured, Medicaid-insured, and privately insured primary care and preventive care visits; immunizations administered, and medications ordered...
May 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28447914/diagnosis-of-life-threatening-alpha-gal-food-allergy-appears-to-be-patient-driven
#15
Mary Grace Flaherty, Samantha Jan Kaplan, Maya R Jerath
OBJECTIVE: Patients exhibiting life-threatening symptoms associated with the alpha-gal food allergy (delayed urticaria or anaphylaxis due to mammalian meat) are frequently undiagnosed, causing unnecessary emergency department (ED) and health care visits, and extensive pain and suffering. This study aimed to determine the path to diagnosis experienced by alpha-gal patients. METHODS: Semistructured interviews were conducted from March to June 2016 with a chronological systematic sample of approximately 10% of patients diagnosed with alpha-gal and treated by the University of North Carolina Allergy and Immunology Clinic (n = 28)...
April 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28447866/which-fecal-immunochemical-test-should-i-choose
#16
Jeanette M Daly, Yinghui Xu, Barcey T Levy
OBJECTIVES: To summarize the fecal immunochemical tests (FITs) available in the United States, the 2014 pathology proficiency testing (PT) program FIT results, and the literature related to the test characteristics of FITs available in the United States to detect advanced adenomatous polyps (AAP) and/or colorectal cancer (CRC). METHODS: Detailed review of the Food and Drug Administration's Clinical Laboratory Improvement Amendments (CLIA) database of fecal occult blood tests, the 2014 FIT PT program results, and the literature related to FIT accuracy...
April 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28434390/how-preferences-for-continuity-and-access-differ-between-multimorbidity-and-healthy-patients-in-a-team-care-setting
#17
Katherine M Ehman, Mark Deyo-Svendsen, Zachary Merten, Anne Marie Kramlinger, Gregory M Garrison
INTRODUCTION: Team-based care has become an essential part of modern medical practice. Patient-centered medical homes often struggle to balance the dual competing goals of acute access and continuity of care. Multimorbidity patients may value continuity more than healthy patients, and thus may prefer to wait to see their primary care physician (PCP). METHODS: A total of 1700 randomly selected healthy adults and multimorbidity patients were asked to rate satisfaction with care and presented with 4 acute and 4 chronic scenarios to choose an access and continuity preference in an anonymous mailed survey...
April 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28434273/development-of-distinct-body-mass-index-trajectories-among-children-before-age-5-years-a-population-based-study
#18
Brian A Lynch, Lila J Finney Rutten, Jon O Ebbert, Seema Kumar, Barbara P Yawn, Debra Jacobson, Jennifer St Sauver
The prevalence of childhood obesity has increased over the past 3 decades. This study was designed to understand how childhood body mass index (BMI) influences later risk of obesity. We calculated BMIs for children residing in Olmsted County, Minnesota, between January 1, 2005 and December 31, 2012 using medical records data. We defined homogenous BMI trajectory clusters using a nonparametric hill-climbing algorithm. Overall, 16,538 (47%) children had >3 weight assessments at least 1 year apart and were included in the analyses...
April 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28381095/improving-chronic-disease-outcomes-through-medication-therapy-management-in-federally-qualified-health-centers
#19
Jennifer L Rodis, Alexa Sevin, Magdi H Awad, Brianne Porter, Kyle Glasgow, Carrie Hornbeck Fox, Barbara Pryor
INTRODUCTION: Appropriate management of chronic diseases, including proper use of medications, can lead to better disease control, decrease disease-related complications, and improve overall health. Pharmacists have been shown to positively affect chronic disease outcomes through medication therapy management (MTM). The primary objectives of this project are to increase the number of patients with (1) A1c in control and (2) blood pressure in control; secondary objectives are to (3) describe number and type of medication-related problems identified and resolved by pharmacists providing MTM in Federally Qualified Health Centers (FQHCs), (4) identify potential (pADEs) and actual adverse drug events (ADEs), and refer patients to diabetes self-management education classes, as needed...
April 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/27879455/diagnostic-care-pathways-in-dementia
#20
Christine E Wells, Sarah J Smith
OBJECTIVES: Increasing diagnostic rates of dementia is a national health priority; to meet this priority, improvement needs to be made to diagnostic services. It has been increasingly recognized that primary can play a significant role in the diagnostic journey for people with dementia, with some diagnostic services entirely located in primary care. This article reviews the extent of the involvement of primary care in diagnostic care pathways for people presenting with memory complaints within England, and presents examples of innovative approaches, which may be of interest to practitioners...
April 2017: Journal of Primary Care & Community Health
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