Community Medicine

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    Patient Perspectives Unveiled: An Analysis of Common Questions and Concerns to Empower Informed Healthcare Dialogues with Elderly Patients Taking Multiple Medications
    (2024-03-21) Schneider, Clara; Lal, Kevin; Espinoza, Anna; Xiao, Yan; Hendrix, Noah; Young, Richard; Fulda, Kimberly
    Purpose: Health literacy is often a barrier to patient understanding and effective communication with healthcare providers. Patients are often unaware of what questions to ask during their visits and leave their provider offices without fully understanding their conditions or medication regimens. Past studies have shown that facilitating patient dialogue through structured questions during the encounter results in fewer patient callbacks and improved comprehension. The goal of this study was to identify the most common questions and concerns that patients 50 years and older who are on five or more medications would like to discuss with their physicians about their medications. Such data could help physicians anticipate and educate patients with information most valuable to them during office visits. Methods: We designed a 20-question survey to better understand what patients desired from their primary care visit including questions to ask, concerns to tell, and positive behaviors to report to their provider. We focused on the ask and tell sections which involved presenting questions or concerns that were pertinent to the patient's conditions or medications. Participants included patients at family medicine clinics from a county hospital system (240) and a private practice (211) in Fort Worth who were 50 years of age or older and taking five or more medications. Surveys were administered at a clinical visit by the medical assistant before the physician/patient encounter. Descriptive statistics are provided. Results: Out of 451 surveys completed, the questions that patients were most interested in talking with their physician included: 1) What should I eat, and what should I not eat for my condition? (20.4%) 2) Can I take fewer medicines than I am taking? (15.3%) 3)How do I learn more about my condition? (14.6%) The least common questions were 1) Why do I need several medications for my condition? (8.2%) 2) Other questions: (8.6%) 3) How can I stop my blood sugar, heart rate, or blood pressure from getting too low? (9.1%) The most common concerns about their medications were: 1) I stopped or skipped these medicines, due to: cost, side effects, or other reasons (11.1%) 2) I have new medicines from other doctors (offices, hospitals or emergency rooms) (8%) 3) I have concerns with my medicines (examples: cost, hard to read, not helping much) (5.7%) Conclusions: It is evident that patients are interested in learning about their conditions and making appropriate lifestyle changes. The most commonly raised concerns were related to medication access, polypharmacy, and efficacy. These data show some of the potential topics patients want to discuss with their providers. The most common topics from this study can be implemented into a question prompt lists (QPL []) specific to medications and chronic disease management. Providers could give lists to patients to review while waiting for care. Having these topics beforehand would help the patients be prepared when presented with “what questions do you have?”; thus, revealing the patient's perspective and helping to increase their health literacy.
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    An Evaluation of School-Based Health Centers' Program Elements
    (2024-03-21) Seiffert, Amanda; Nguyen, Sharon
    Purpose: School-Based Health Centers (SBHCs) are being evaluated for their effectiveness worldwide. They consist of facilities providing health care services to children located on or near a school campus. SBHCs have a goal of advancing equity at the intersection of health and education, especially for students facing barriers to needed services. SBHCs use differing strategies that need to be assessed to identify which are most effective in implementing positive change for students. The purpose of this study is to analyze which aspects of SBHC mental and behavioral health services have been demonstrated to be successful in providing the best possible care to students. Three specific research questions were addressed: 1) what SBHC outcomes have been evaluated in the literature 2) what barriers to implementation are identified, 3) are there models that integrate on-site and telehealth service delivery. Methods: This study was conducted in accordance with PRISMA guidelines for rapid systematic reviews using Covidence software. Key words were searched in PubMed, Scopus, Cinahl, and PsycINFO databases, and resulted in 436 articles being identified. After duplicates were removed, 230 studies remained. Titles and abstracts of these studies were screened using defined inclusion and exclusion criteria screen. Following the screening, 13 studies were included for complete review. Data extraction was performed addressing the three research questions above and included use of school-based health centers before and after the 2020 pandemic. Results: 1) SBHC outcomes identified in the 13 studies included academic performance, tardiness, attendance, discipline, school connectedness, and commitment to educational future. 2) Two studies examined barriers to implementation and identified high turnover among staff and patients, insufficient buy-in, and insufficient time for training and planning. 3) Two studies were identified that examined hybrid models combining telehealth and on-site care Conclusions: SBHC use is significantly associated with increases in GPA over time and these effects are moderated by the types of services used. SBHC use indirectly impacts academic performance by improving health and emotional well-being, but the association with attendance was variable. Tardiness was increased in SBHC users, but SBHC users reported higher scores relating to school bonding. This implied that the users reported happiness at school and looked forward to going to school. While these outcomes are of importance to school stakeholders, students, and families, the measurement of mental health outcomes in existing studies is limited. Implementation of school-based health centers had its challenges, including high turnover among staff, lack of buy-in and leadership among staff, and insufficient time for planning and training. Integrating educators and school-based health clinics could create more buy-in as staff would be more aware and potentially more supportive of school-based mental health clinics overall. There was limited evidence that met inclusion criteria regarding the hybrid model, however, the evidence showed that the hybrid model increased access to care. Studies also found that SBHC use increased significantly following the pandemic of 2020, due to increased health awareness and mental health struggles that occurred during this time.
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    Risk of Overuse Injury and Burnout as Consequences of Early Specialization in Youth Sports
    (2024-03-21) Rice, Ellina
    Purpose: In the US, 60 million children participate in organized youth sports yearly and there is a growing emphasis on athletes specializing in a particular sport and developing their skill. Sports Specialization has been defined as participation in a single sport, which entails quitting all other sports, while also participating in year-round training (>8 months per year). The consequences of specializing in one sport at an early age including risks of overuse injuries, greater susceptibility to early burnout, and lack of social development. The purpose of the present study is to explore the literature related to youth sports specialization and its relationship to burnout and overuse injuries. Methods: A literature review was conducted using electronic databases, and the reference list of the relevant articles was screened for titles and abstracts containing the keywords. The keywords used included specialization, youth athletics, burnout, adolescence, children, organized sport, overtraining syndrome, awareness, prevention. The retrospective search was limited to: articles in English; studies in the US; articles including athletes in high school or younger; articles including overuse injury, burnout, specialization in the title or abstract. Based on above criteria, the search yielded 28 articles that included case studies, qualitative and quantitative studies, and systematic reviews. Results: Specializing in a single sport as well as participating in many hours per week training can lead to overuse injuries. Youth athletes who participated in more hours of training or specialized early were more likely to report history of injuries, particularly in lower extremities. Early sports specialization was associated with an increased risk of developing anterior knee-pain pathologies compared to their multi-sport counterparts. Compared to healthy athletes, injured athletes spent more hours per week in sports and there was an independent risk of injury and overuse injury in athletes specializing in a single sport. Burnout and dropout are positively correlated in youth athletes. Main factors contributing to sports dropout were lack of support from school friends, lack of support from teammates, and pressure from parents. Additionally, players that dropped out began their training at a younger age and participated in more hours per year training between ages 12-13. One study used an athlete burnout questionnaire and found that, compared to multi-sport athletes, specialized athletes reported higher levels of burnout, a reduced sense of accomplishment, sport devaluation, and exhaustion. Conclusion: These findings indicate that levels of specialization are related to psychological burnout and increased rate of overuse injuries in youth athletes, primarily through time spent in sports. Yet there is a further need for more research into whether multisport athletes are at a decreased risk of injury due to engagement in a broader set of movements and thus overall muscle strength and stability, or whether it is due to less hours spent overtraining one muscle group. Overall, educational programs should be developed to educate parents and coaches about risks of overtraining, early signs of overuse injuries, and positive ways to build a youth athlete’s confidence in their ability to play sports to avoid injury and burnout.
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    Addressing risk through Community Treatment for Infectious disease and Opioid use disorder Now (ACTION) among Justice-involved Populations
    (2024-03-21) Dhother, Bani; Caliman, Celeste; Bell, April; Bennett, Ahrein; Pankow, Jen; Lehman, Wayne; Proffitt, Randi; Knight, Kevin
    Purpose: ACTION is a 5-year randomized controlled trial comparing the effectiveness of a patient navigation model versus a mobile health unit (MHU) model to link individuals during re-entry from incarceration to healthcare services, with emphasis on prevention and treatment for HIV, hepatitis C, opioid use disorder. The current study examined secondary outcomes, comparing the type of referrals made (treatment vs ancillary services) at the initial MHU visit and the correlation between the number of MHU visits during the first six weeks of the intervention and having a primary care physician (PCP) prior to incarceration (before joining ACTION). Methods: Participants (N=34) who attended at least one in-person MHU visit within the first six weeks of the intervention were included in the analysis. Demographics, PCP status, and referral type were collected from RealTime, an electronic health records system used on the TCU MHU and confirmed in the main study database. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) and Microsoft Excel. Results: At the initial MHU visit, 97% of participants were given referrals for medical/health needs, 94% were given referrals for socio-economic needs, and 91% received referrals for both medical/health and socio-economic needs. Top medical/health referrals made were dental (71%), general medical care (53%), vision (41%), mental health (35%), and specialty care (26%). Participants with a PCP prior to joining ACTION attended a mean of 0.97 MHU visits, while those who did not have a PCP attended an average 1.32 visits. Having a PCP prior to joining the study was negatively correlated to MHU visits (r = - 0.24). 46.2% of females (n=13) reported having a PCP, compared to 19% of males (n=21). Females averaged fewer MHU visits than males during the first six weeks of the intervention. Conclusions: More participants received referrals at the initial MHU visit for health-related needs compared to socio-economic needs such as housing, transportation, and identification documents. The negative correlation between having a PCP prior to incarceration and frequency of MHU visits suggests that participants without a PCP are likely to attend more MHU visits. Future research should examine if individuals with a PCP experience trust issues with the healthcare system (compared to those without a PCP), experiences that could impact healthcare-seeking behavior. Females averaged fewer visits to the MHU than did males, and females were more likely than males to have previously had a PCP. These findings are preliminary and based on a small sample size but suggest interesting directions for future analysis on women’s health issues.