RESUMO
During the COVID-19 pandemic, medical students were removed from clinical clerkships. During this time of uncertainty, 4 clinical medical students at the University of Michigan returned to the community to support their neighbors experiencing homelessness. They did so by making brown bag lunches for people sleeping on the streets and acting as community volunteers in temporary shelters. Though formal education was stalled, they reconnected with the initial desire that led them to pursue medical education in the first place and developed key skills in communication, relating to others, and compassion that they believe will enable them to become better physicians in the future.
Assuntos
COVID-19/prevenção & controle , Pessoas Mal Alojadas , Estudantes de Medicina , Voluntários , Comunicação , Empatia , Humanos , Relações Interpessoais , Almoço , SARS-CoV-2RESUMO
Substance use and mental health (SU/MH) disorders are insufficiently recognized in HIV care. We examined whether conveying SU/MH screening results to patients and providers increased SU/MH discussions and action plans. Intervention participants completed a computerized patient-reported questionnaire before their HIV visit; screened positive on ≥ 1 measure: depression, anxiety, PTSD symptoms, at-risk alcohol use, or drug use; and reviewed screening results to decide which to prioritize with their provider. Screening results and clinical recommendations were conveyed to providers via medical record. A historic control included patients with positive screens but no conveyance to patient or provider. The patient-provider encounter was audio-recorded, transcribed, and coded. For the overall sample (n = 70; 38 control, 32 intervention), mean age (SD) was 51.8 (10.3), 61.4% were male, and 82.9% were Black. Overall, 93.8% raised SU/MH in the intervention compared to 50.0% in the control (p < 0.001). Action plans were made for 40.0% of intervention and 10.5% of control encounters (p = 0.049). Conveying screening results with clinical recommendations increased SU/MH action plans, warranting further research on this intervention to address SU/MH needs.
Assuntos
Infecções por HIV , Transtornos Relacionados ao Uso de Substâncias , Infecções por HIV/diagnóstico , Infecções por HIV/terapia , Humanos , Masculino , Saúde Mental , Medidas de Resultados Relatados pelo Paciente , Projetos Piloto , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
BACKGROUND: Inadequate identification and treatment of substance use (SU) and mental health (MH) disorders hinders retention in HIV care. The objective of this study was to elicit stakeholder input on integration of SU/MH screening using computer-assisted patient-reported outcomes (PROs) into clinical practice. METHODS: We conducted semi-structured interviews with HIV-positive patients who self-reported SU/MH symptoms on a computer-assisted PROs (n = 19) and HIV primary care providers (n = 11) recruited from an urban academic HIV clinic. Interviews were audio-recorded and transcribed. We iteratively developed codes and organized key themes using editing style analysis. RESULTS: Two themes emerged: (1) Honest Disclosure: Some providers felt PROs might improve SU/MH disclosure; more were concerned that patients would not respond honestly if their provider saw the results. Patients were also divided, stating PROs could help overcome stigma but that it could be harder to disclose SU/MH to a computer versus a live person. (2) Added Value in the Clinical Encounter: Most providers felt PROs would fill a practice gap. Patients had concerns regarding confidentiality but indicated PROs would help providers take better care of them. CONCLUSIONS: Both patients and providers indicated that PROs are potentially useful clinical tools to improve detection of SU/MH. However, patients and providers expressed conflicting viewpoints about disclosure of SU/MH using computerized PROs. Future studies implementing PROs screening interventions must assess concerns over confidentiality and honest disclosure of SU/MH to understand the effectiveness of PROs as a clinical tool. More research is also needed on patient-centered integration of the results of PROs in HIV care.
Assuntos
Continuidade da Assistência ao Paciente , Infecções por HIV/epidemiologia , Melhoria de Qualidade/normas , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Continuidade da Assistência ao Paciente/normas , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Pesquisa Qualitativa , Estigma Social , Transtornos Relacionados ao Uso de Substâncias/psicologia , Revelação da Verdade , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Information and communication technologies (ICT) offer the potential for delivering health care interventions to low socioeconomic populations who often face barriers in accessing health care. However, most studies on ICT for health education and interventions have been conducted in clinical settings. OBJECTIVE: The aim of this study was to examine access to and use of mobile phones and computers, as well as interest in, using ICT for receipt of behavioral health information among a community sample of urban, predominately black, women with low socioeconomic status. METHODS: Participants (N=220) were recruited from hair salons and social service centers and completed audio-computer assisted self-interviews. RESULTS: The majority of the participants (212/220, 96.3%) reported use of a cell phone at least weekly, of which 89.1% (189/212) used smartphones and 62.3% (137/220) reported computer use at least weekly. Of the women included in the study, 51.9% (107/206) reported using a cell phone and 39.4% (74/188) reported using a computer to access health and/or safety information at least weekly. Approximately half of the women expressed an interest in receiving information about stress management (51%-56%) or alcohol and health (45%-46%) via ICT. Smartphone ownership was associated with younger age (odds ratio [OR] 0.92, 95% CI 0.87-0.97) and employment (OR 5.12, 95% CI 1.05-24.95). Accessing health and safety information weekly by phone was associated with younger age (OR 0.96, 95% CI 0.94-0.99) and inversely associated with higher income (OR 0.42, 95% CI 0.20-0.92). CONCLUSIONS: Our findings suggest that ICT use, particularly smartphone use, is pervasive among predominantly black women with low socioeconomic status in urban, nonclinical settings. These results show that ICT is a promising modality for delivering health information to this population. Further exploration of the acceptability, feasibility, and effectiveness of using ICT to disseminate behavioral health education and intervention is warranted.
Assuntos
Tecnologia da Informação/tendências , Adulto , Negro ou Afro-Americano , Idoso , Comunicação , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos e Questionários , População Urbana , Adulto JovemRESUMO
OBJECTIVE: This qualitative study analyzed the perspective of patients living with sickle cell disease (SCD) on their process of deciding whether to take hydroxyurea (HU), and the role of physician communication in patients' decision-making process. METHODS: From October 2015 to July 2016, we conducted semi-structured interviews among patients with SCD (N = 20) that were audio-recorded and transcribed. Participants were ≥ 18 years old, a patient of an urban adult sickle cell center, able to provide informed consent, and English-speaking. We iteratively developed codes and used thematic analysis to organize the key themes. RESULTS: Most participants were female (65%), middle aged (M = 44, SD = 12.2), and 55% were prescribed HU for an average of 10.4 (SD = 4.7) years. Participants described 3 key factors that influenced their decision regarding HU treatment: (1) lifestyle, (2) health status, and (3) HU characteristics. Four themes emerged about provider communication and HU treatment decisions: (1) provider's advisement, (2) shared decision-making, (3) "wrestled," and (4) not feeling heard. CONCLUSION: Providers who engaged in shared decision-making empowered participants to decide whether to start HU treatment. Participants who felt their providers were not listening to their concerns expressed disengaging from HU treatment. During discussions about HU with patients living with SCD, providers must understand the multi-faceted aspects that impact patients' decision and empower patients to engage in such discussions. Further research is needed to understand the role of shared decision-making among patients with SCD to improve management of SCD.
Assuntos
Anemia Falciforme/tratamento farmacológico , Antidrepanocíticos/uso terapêutico , Comunicação , Tomada de Decisão Compartilhada , Hidroxiureia/uso terapêutico , Relações Médico-Paciente , Adulto , Tomada de Decisões , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa QualitativaRESUMO
This study aims to describe patients' and families' perspectives regarding the ideal role and responsibilities of a health coach to facilitate pediatric weight management in the primary care setting. Systematic thematic analysis of semistructured interviews with overweight children and their parents was performed. The majority of participants self-identified as racial/ethnic minorities and were Medicaid eligible. Desired health coaching elements included ( a) customized support and encouragement, including goal setting and maintenance, cultural sensitivity, and consideration of budget and lifestyle; ( b) nutritional guidance, including meal planning, assistance obtaining healthy food, and education and counseling; and ( c) linkage to resources, including social services, physical activity support, and programs for children with special health care needs. We conclude that families' specific needs should be holistically considered in the design of health coaching programs targeting pediatric obesity. Such support may help overcome social and financial barriers to changing health behaviors related to weight management.