Browsing by Author "Matches, Sarah"
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Item Effectiveness of provider communication training for increasing human papillomavirus vaccine initiation at a safety-net health system(Elsevier Inc., 2024-03-01) Meadows, Rachel J.; Gehr, Aaron W.; Lu, Yan; Maynard, Grace; Akpan, Idara N.; Taskin, Tanjila; Fulda, Kimberly G.; Patel, Divya; Matches, Sarah; Ojha, Rohit P.; Thompson, Erika L.BACKGROUND: Strong provider recommendation can increase uptake of human papillomavirus (HPV) vaccination. Therefore, we developed and implemented a provider education intervention on communication strategies for recommending HPV vaccination with clinic-level audit and feedback (HPV: Communicating about HPV to Adults and Teens [HPV CHAT]). We aimed to evaluate the effect of HPV CHAT on HPV vaccine uptake in seven family medicine and pediatric clinics in a large urban health system (USA). METHODS: We used a quasi-experimental design, where the eligible population included people aged 9-26 years with at least one encounter in June 2020-February 2023 at one of the participating community health clinics. We used interrupted time-series analysis to assess changes in the prevalence of HPV vaccine uptake. We used segmented Poisson regression with a log link function to estimate prevalence ratios (PR) and 95% confidence limits (CL) for level (immediate) and slope (over time) changes with adjustment for seasonality using Fourier transformation. RESULTS: Our study population comprised 60,328 observations in which the median age was 17 years (interquartile range: 13-21). A majority (58%) were female and 87% were racial/ethnic minorities. Overall, we observed no sizeable effect of the intervention on HPV vaccination uptake. Nonetheless, heterogeneity was observed by age group with modest increases in individuals aged 9-12 and 13-17 years. CONCLUSION: Our provider feedback intervention had minimal effect on increasing prevalence of HPV vaccination in seven family medicine and pediatric clinics. Novel strategies are needed to address provider barriers related to HPV vaccination.Item Increases in Adolescent Mental Health Disorders and Antidepressant Prescriptions following the COVID-19 pandemic at HSC Clinics in Fort Worth, Texas(2024-03-21) Morse, Elizabeth; Matches, SarahPurpose: The COVID-19 pandemic exposed adolescents to unpredictable events including quarantines, school closures, and loss of loved ones, bringing a sense of fear, anxiety, and social isolation. This led to short-term and long-term mental health effects for adolescents. Most literature conducted throughout the pandemic showed an increase in depressive and anxiety symptoms in the adolescent population world-wide. This research aims to determine if these trends are seen in the specific population in Fort Worth, Texas at HSC clinics. Methods: Patient data from HSC Pediatrics and HSC Pediatric Mobile Clinic from 2019-2022 for ages 12-18 years old was pulled from EMR, NextGen, into Excel (n=18,359). Only the patient’s first visit each year was included (n=6,285). The data set was filtered into 3 categories: Depression, Anxiety, and Depression and Anxiety. The first visit each year for every patient who completed the PHQ-9 was included using the qualitative “Detail” data (n=3,479). A separate data set for the same patients on Antidepressant medications was used. Using Excel’s tools, totals and percentages were calculated for number of patients seen, ages, gender, race, ethnicity, PHQ-9, and medications. Results: Overall, the percentage of patient’s seen for all 3 categories increased from 2019 to 2022 despite less patients being seen since 2019. The greatest increase was seen in Depression from 2020 (10.71%) to 2021 (17.71%) from 2019 (4.93%). Patients with anxiety increased each year from 2019 (3.10%) to 2022 (11.98%). Over less than a half of patients completed the PHQ-9 from 2019 (990) to 2020 (455), however the percentage of patients who scored “Moderately Severe Depression” and “Severe Depression” increased from 2019-2020. The greatest increase was seen in “Mild Depression” from 2020 (24.84%) to 2021 (30.68%). Those who scored “None” decreased each year with 10.46% decrease from 2019 to 2022. Only “Moderately Severe Depression” increased each year. The number of patients prescribed antidepressant medications increased each year from 2019 to 2022 with the largest increase seen in those prescribed Escitalopram/Lexapro. Conclusion: The increase in Depression and Anxiety and antidepressant prescriptions in the adolescent population poses new challenges for providers, clinics, in-patient psych facilities, and families. To increase access to care and prevent no-show visits, telehealth visits can be implemented. Given the rise in mental health disorders in the adolescent population, training in Pediatric mental health and resources like Child Psychiatry Access Network (CPAN) should be more readily available. For each category, fewer patients were seen in 2020, possibly due to social distancing, fear of contracting COVID-19, and/or decreased clinic availability. Another limitation could be a lack of reporting due to parent vs. child reporting, lack of awareness, family values, and/or societal pressures. To prevent missed diagnoses or symptoms, more proactive screening is necessary. Additionally, approximately 1,000 fewer patients were seen in 2022 than 2019. Continued research into the long-term mental health effects from the pandemic is necessary to determine how to treat this generation now and in the future, as well as what certain subpopulations are more susceptible to not seek care or follow-up.Item Pediatric Weight Gain Rates in Fort Worth, TX Due to the COVID-19 Pandemic(2023) Elashyi, Tamer; Fernando, Shane; Matches, SarahBackground: Childhood obesity is already a problem in the United States, with one out of three children being overweight or obese and one out of six being obese. The consequences from the COVID-19 lockdown seemed to have progressed into something bigger. During the pandemic, added stress amongst the pediatric population dramatically increased causing this population to snack more and exercise less. This change in eating habits and behaviors can have long term implications on their health currently and in the future. Methods: Data from the outpatient Pediatric and Health Clinic at UNTHSC in Fort Worth, TX from January 2018 to May 2022 was used to assess this effect. Average weight gain year to year was computed and compiled for several zip codes in the North Texas area. The average weight gain was calculated based on the children’s age, sex, zip code and their ethnicity and race. Results : Within each variable the average weight gain had increased year to year. The average weight gain amongst the pediatric population in this study increased to 16.13% compared to 13.92% pre-pandemic. The increased weight gains are cumulative with each year, as with each year they are adding more weight on top of the weight they had gained the previous year. When we calculate the percent weight gain in specific age groups and genders, we see a higher increase in weight gain, with male children gaining more weight on average compared to females. When looking at different zip codes, we see greater increases in weight gain related to lower household incomes. Boyd had an average of 34.87% increase in weight post pandemic compared to 13.91% pre-pandemic. Conclusion: The increased weight gain leads to an increase in obesity rates among the pediatric population and the future adult population. This will burden our healthcare system now and more so in the future. Further research needs to be conducted on the health disparities between different ethnicities and races and average household incomes.Item Universal Cholesterol Screening of all 9 - 11 year old Children in Community Based Ambulatory Pediatric Clinics(2015-03) Mou, Margaret; Wilson, Don P.; Davis, Sharon; Matches, Sarah; Shah, Deep; Leung-Pineda, Van; Suzuki, Sumihiro; McNeal, Catherine; Bowman, W. PaulIntroduction: In the U.S. and in most Western countries, coronary artery disease (CAD) is theleading cause of death, linked to hypercholesterolemia, especially in familial hypercholesterolemia (FH). Early identification and treatment of children with hypercholesterolemia has been shown to be effective and safe in reducing morbidity and mortality, especially in those with FH. However, few children with FH are currently being identified. Thus, the National Heart, Blood and Lung Institute (NHLBI) issued a guideline recommending universal cholesterol screening (UCS) of all 9 – 11 year old children in November 2011. We report a comparison of the number of 9 - 11 year old children screened for hypercholesterolemia 1 year prior to and 1 year following publication of the NHLBI’s screening guidelines in 5 community-based ambulatory pediatric clinics. Methods: Five (5) community-based ambulatory pediatric clinics (4 hospital affiliated and 1 university affiliated) were recruited for this study, with retrospectively obtained data that was de-identified. Cholesterol screening results 1 year prior to publication of the NHLBI’s screening guidelines acted as the baseline for each clinic. Rates and results of lipid screening performed by each clinic in all 9-11 year old children at the time of scheduled or un-scheduled clinic visits was measured. Results: Of all eligible 9–11 year-old children, 489 (17.1%) were screened 1 year prior to publication of recommendations, and 686 (20.1%) were screened 1 year following publication of recommendations for universal cholesterol screening. Specifically, Clinic 1 increased screening from 24.2% to 32.3%, Clinic 2 decreased screening from 19% to 16.1%, Clinic 3 decreased screening from 14.7% to 11.9%, Clinic 4 increased screening from 23.1% to 28.5%, and Clinic 5 increased screening from 8.8% to 14.3% of target population. Conclusion: There was a significant increase in the rates of lipid screening for the five clinics in our study following publication of the NHLBI’s recommendations for universal cholesterol screening compared to the year previous to recommendations. Given the high prevalence of premature CVD associated with familial hypercholesterolemia, additional strategies are needed to improve screening rates. The ability to identify this vulnerable population creates the opportunity for prevention of future cardiovascular disease by encouraging healthy lifestyles and the use of lipid lowering medication.