Abstract Injection drug users (IDUs) have the highest rate of HCV infection. Although IDUs need support to access and use HCV services, they often lack this support. Many IDUs, however, have contact with a methadone maintenance treatment program (MMTP) where they can gain access to HCV services and obtain support in using them. Unfortunately, however, IDUs often underutilize the MMTP services that are available to them. Using qualitative data collected in 4 MMTPs, we identify some reasons for clients' lack of HCV service utilization and staff strategies that influence clients' perceptions of support in using these services.
Health care workers promote COVID-19 vaccination for adolescent patients, and as parents, may influence their own children to get vaccinated. We conducted virtual, semi-structured qualitative interviews with vaccinated health care workers and their adolescent children to explore their decision-making process for COVID-19 vaccination. In total, 21 health care workers (physicians, nurses, and medical staff) and their adolescent children ( N = 17) participated in interviews. The following three themes described parent-adolescent decision-making for COVID-19 vaccination: (1) family anticipation and hesitation about COVID-19 vaccine approval; (2) parents’ or adolescents’ choice: the decision maker for adolescent COVID-19 vaccination; and (3) leveraging one’s vaccination status to encourage others to get vaccinated. Nurses encouraged adolescent autonomy in decisions for COVID-19 vaccination while physicians viewed vaccination as the parent’s decision. Health care workers and their adolescent children used role-modeling to motivate unvaccinated peers and may model their decision-making process for adolescent COVID-19 vaccination with their own children to support their patients’ and parents’ vaccine decisions.
Background: Patients with colorectal cancer (CRC) commonly present at an older age with multiple comorbid conditions and complex care needs at the time of diagnosis. Clusters of comorbid conditions, or profiles, have not been systematically identified in this patient population. This study aimed to identify clinically distinct comorbidity profiles in a large sample of patients with CRC from an integrated healthcare system, and to examine the effect of comorbidity profiles on treatment and survival. Methods: In this retrospective cohort study, we used latent class analysis (LCA) to identify comorbidity profiles in a sample of 7,803 patients with CRC diagnosed between 2008 and 2013. We identified treatment received from electronic health records and used Cox proportional hazards analysis to examine the effect of comorbidity class on survival. We also examined the effect of comorbidity profile on receipt of guideline-recommended treatment. Results: Median age at diagnosis was 66 years, 52% of patients were male, and 48% were nonwhite. A plurality had stage 0-I disease (42%), with 22% stage II, 22% stage III, and 14% stage IV. More than half (59%) had ≤1 comorbid condition, whereas 19% had ≥4 comorbidities. LCA identified 4 distinct comorbidity classes. Classes were distinguished by the presence or absence of vascular and/or respiratory disease and diabetes with complications, as well as progressively greater Charlson comorbidity index scores. Comorbidity class was independently associated with treatment selection (P<.001) and survival (P<.001). Conclusions: Patients with CRC can be described by 4 distinct comorbidity profiles that are independent predictors of treatment and survival. These results provide insight into how comorbidities cluster within patients with CRC. This work represents a shift away from simple counting of comorbid conditions and toward a more nuanced understanding of how comorbidities cluster within groups of patients with CRC.
Staff in drug treatment programs are in an optimal position to support the hepatitis C related needs of their patients. To do so effectively, however, staff need to have accurate information about the hepatitis C virus (HCV). This article examines the HCV knowledge of staff (N= 104) in two drug-free and two methadone maintenance treatment programs (MMTPs) in the New York metropolitan area. Five of 20 items on an HCV Knowledge Assessment were not answered correctly by the majority of the participating staff, and total scores on the Assessment averaged 70%, 71%, and 45% among the medically credentialed staff, non-medically credentialed staff in the MMTPs, and non-medically credentialed staff in the drug-free programs, respectively. The majority of those in the latter group had never participated in a training specifically devoted to HCV. Results suggest the need for effective HCV-related training for all staff in drug treatment programs.
Surgical pathology reports (SPR) contain rich clinical diagnosis information. The text information extraction system (TIES) is an end-to-end application leveraging natural language processing technologies and focused on the processing of pathology and/or radiology reports.We deployed the TIES system and integrated SPRs into the TIES system on a daily basis at Kaiser Permanente Southern California. The breast cancer cases diagnosed in December 2013 from the Cancer Registry (CANREG) were used to validate the performance of the TIES system. The National Cancer Institute Metathesaurus (NCIM) concept terms and codes to describe breast cancer were identified through the Unified Medical Language System Terminology Service (UTS) application. The identified NCIM codes were used to search for the coded SPRs in the back-end datastore directly. The identified cases were then compared with the breast cancer patients pulled from CANREG.A total of 437 breast cancer concept terms and 14 combinations of "breast"and "cancer" terms were identified from the UTS application. A total of 249 breast cancer cases diagnosed in December 2013 was pulled from CANREG. Out of these 249 cases, 241 were successfully identified by the TIES system from a total of 457 reports. The TIES system also identified an additional 277 cases that were not part of the validation sample. Out of the 277 cases, 11% were determined as highly likely to be cases after manual examinations, and 86% were in CANREG but were diagnosed in months other than December of 2013.The study demonstrated that the TIES system can effectively identify potential breast cancer cases in our care setting. Identified potential cases can be easily confirmed by reviewing the corresponding annotated reports through the front-end visualization interface. The TIES system is a great tool for identifying potential various cancer cases in a timely manner and on a regular basis in support of clinical research studies.
35 Background: There is limited understanding of factors that affect uptake of different models of survivorship care. Few systems have incorporated implementation science into program planning and implementation. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted an evaluation of stakeholder-perceived acceptability and feasibility of an embedded primary care provider (PCP) survivorship care model as the initial step of an implementation project within an integrated healthcare system. Methods: We identified clinical, operational, and patient stakeholders and conducted semi-structured qualitative interviews. Interviews were recorded, transcribed, coded, and analyzed. Deductive thematic categories were derived a priori from CFIR domains (e.g., acceptability, culture); thematic sub-categories were developed inductively. Results: We interviewed 12 stakeholders; a diverse array of themes was identified. Acceptability: Oncologists and operational leaders perceived the model to be an acceptable solution to issues of capacity and efficiency with the potential to improve quality; however, several oncologists perceived negative consequences including “[loss of] the joy of medicine”. PCPs perceived difficulty in co-managing existing patient panels and new survivors. Patients were less enthusiastic, fearing the loss of a trusted clinician and wary about the introduction of “[someone] who doesn’t know me.” Feasibility: Organizational confidence was high that this model can succeed, although there was concern about finding the right PCP and investment in training and staff support. Culture: Numerous system-level facilitators were identified, including the integrated structure: “We don’t have a fee for service mentality so nobody’s giving up revenue.” Conclusions: Acceptability and feasibility for this model were high among oncologists and operational leaders but patients were ambivalent. Successful implementation requires training and support of engaged PCPs and staff, and a formalized patient transition introduced early in the care trajectory. Operationalization of survivorship models may be improved with integration of implementation science methods.
To assess acute sinusitis (AS) encounters in primary care (PC), urgent care (UC), and emergency department (ED) settings for adherence to recommendations to avoid low-value care.A retrospective, observational study of adult AS encounters (2010-2012) within a large integrated healthcare system.We compared ED and UC encounters with PC visits, adjusting for differences in patient characteristics.adherence to recommendations to avoid antibiotics and a computed tomography (CT) scan of the face, head, or sinuses.length of symptoms and adherence with AS recommendations.Of 152,774 AS encounters, 89.2% resulted in antibiotics and 1.1% resulted in a CT scan. Compared with PC encounters, ED encounters were less likely to result in antibiotics (adjusted odds ratio [AOR], 0.57; 95% CI, 0.50-0.65) but more likely to result in a CT scan (AOR, 59.4; 95% CI, 51.3-68.7), while UC encounters were more likely to result in both antibiotics (AOR, 1.12; 95% CI, 1.08-1.17) and CT imaging (AOR, 2.4; 95% CI, 2.1-2.7). Chart review of encounters resulting in antibiotics found that 50% were inappropriately prescribed for symptoms of ≤7 days' duration (95% CI, 41%-58%), while 35% were appropriately prescribed for symptoms of ≥14 days' duration (95% CI, 27%-44%). Only 29% (95% CI, 22%-36%) of encounters were consistent with guideline-adherent care.AS encounters in an integrated health system infrequently result in CT imaging, but antibiotic treatment is common. Differences exist across acute care settings, but improved antibiotic stewardship is needed in all settings.
ABSTRACT Existing research emphasizes individual characteristics, such as psychosocial barriers and preferences, as the main barrier that low-income groups face when attempting to maintain a healthy diet. This study is one component of a partnership between a community and academics who are addressing limited food access in East New York, Brooklyn, by establishing a community-owned food store that provides affordable, nutritious groceries. Prior to the store's opening, focus groups were held with residents in order to understand their experiences related to obtaining food in East New York. These residents identified factors within the built environment that limit their ability to obtain healthy food options, including (1) poor quality of food, (2) higher cost of food, (3) few store options, (4) limited transportation, and (5) concerns about food marketing practices.
Drug users are at risk of acquiring the hepatitis C virus (HCV). Although ancillary services available to clients at drug treatment programs are often limited, some of these programs are providing HCV services. Presenting qualitative data, the authors describe the HCV education and/or support services available at four drug treatment programs and examine staff and client perspectives on factors that facilitated the implementation of these services. Major findings include participants' perceptions that their programs had: (1) at least one change agent on staff who promoted the innovation and delivery of HCV services; (2) at least one administrator or director who encouraged and supported the adoption of these services; and (3) a treatment team that tended to collectively "buy into" and value the HCV service. Ultimately, we found that some drug treatment programs are finding creative and nonresource-intensive ways of delivering HCV services despite the existence of significant barriers. While programs need more funding and resources to overcome these barriers, these findings may prove helpful to other drug treatment programs that would like to offer HCV services to at least some of their clients.
Information and opinions shared by health care providers can affect patient vaccination decisions, but little is known about who health care providers themselves trust for information in the context of new COVID-19 vaccines.The purpose of this study is to investigate which sources of information about COVID-19 vaccines are trusted by health care providers and how they communicate this information to patients.This mixed methods study involved a one-time, web-based survey of health care providers and qualitative interviews with a subset of survey respondents. Health care providers (physicians, advanced practice providers, pharmacists, nurses) were recruited from an integrated health system in Southern California using voluntary response sampling, with follow-up interviews with providers who either accepted or declined a COVID-19 vaccine. The outcome was the type of information sources that respondents reported trusting for information about COVID-19 vaccines. Bivariate tests were used to compare trusted information sources by provider type; thematic analysis was used to explore perspectives about vaccine information and communicating with patients about vaccines.The survey was completed by 2948 providers, of whom 91% (n=2683) responded that they had received ≥1 dose of a COVID-19 vaccine. The most frequently trusted source of COVID-19 vaccine information was government agencies (n=2513, 84.2%); the least frequently trusted source was social media (n=691, 9.5%). More physicians trusted government agencies (n=1226, 93%) than nurses (n=927, 78%) or pharmacists (n=203, 78%; P<.001), and more physicians trusted their employer (n=1115, 84%) than advanced practice providers (n=95, 67%) and nurses (n=759, 64%; P=.002). Qualitative themes (n=32 participants) about trusted sources of COVID-19 vaccine information were identified: processing new COVID-19 information in a health care work context likened to a "war zone" during the pandemic and communicating information to patients. Some providers were hesitant to recommend vaccines to pregnant people and groups they perceived to be at low risk for COVID-19.Physicians have stronger trust in government sources and their employers for information about COVID-19 vaccines compared with nurses, pharmacists, and advanced practice providers. Strategies such as role modeling, tailored messaging, or talking points with standard language may help providers to communicate accurate COVID-19 vaccine information to patients, and these strategies may also be used with providers with lower levels of trust in reputable information sources.
