Mindfulness-Based Group Medical Visits in Primary Care for Stress and Anxiety: An Observational Study.

Background: The prevalence of anxiety disorders in primary care is 20%, with 41% of these patients reporting no current treatment. Patients with anxiety are also more likely to have comorbidities with other medical and/or psychiatric conditions, increasing medical costs. Integrating mindfulness-based interventions (MBIs) into a group medical visit (GMV) format has been successfully used to manage pain, but limited literature is available on the effectiveness of these visit formats for patients with stress and anxiety. Methods: Ninety-two adult patients with self-reported stress and/or anxiety were recruited from three university outpatient primary care clinics between 2016 and 2019. Participants attended at least 4 of 6 weekly GMVs focused on MBIs. Change in heart rate, blood pressure, Generalized Anxiety Disorder-7 (GAD-7) score, and 9 item Patient Health Questionnaire (PHQ-9) score from the first to last visit were evaluated using mixed effect linear regression models. Results: Both GAD-7 (estimated change: -5.1; 95% confidence interval [CI]: -6.4 to -3.7) and PHQ-9 (estimated change: -3.3; 95% CI: -4.3 to -2.2) scores significantly decreased from the first to last visit. These reductions were independent of age, sex, and number of visits attended. No significant changes in heart rate or blood pressure were found. Conclusions: Significant reductions in anxiety and depression in primary care patients were observed after a 6-week standardized mindfulness based GMV. Intergroup variability was not significant indicating that the intervention is reproducible over time and across providers. Future randomized controlled trials with appropriate controls will better evaluate which components of the intervention account for findings.

Accessing behavioral health care during COVID: rapid transition from in-person to teleconferencing medical group visits.

BACKGROUND AND AIM: Effective and safe behavioral health interventions in primary care are critical during pandemic and other disaster situations. California shelter-in-place orders necessitated rapid transition of an effective mindfulness-based medical group visit (MGV) program from in-person to videoconferenced sessions (VCSs). Aim: to Describe procedures, acceptability, and feasibility of converting from in-person to VCS. PATIENTS AND METHODS: Methods: qualitative. Dataset: primary care. Intervention: a six-session 2-h MGV program with educational and mindfulness components was converted. Four in-person sessions and two VCSs were held. General Anxiety Disorder and Patient Health Questionnaire-9 were administered at first and last sessions. A semi-structured focus group was conducted after session six. Population studied: six primary care patients (42 ± 11 years) with stress, anxiety, or depression participated. RESULTS: Procedural changes included remote material distribution, scheduling, hosting, and facilitation functions using the Zoom platform. The focus group revealed that patients preferred in-person sessions during initial visits, but appreciated transitioning to VCS, which provided continued support during a challenging time. Instruction on technical (e.g. logging on) and social (e.g. signaling next speaker) aspects of VCS was suggested. Building relationships through conversations was an important part before and after in-person sessions missing from VCS. Patients suggested combining in-person and VCS to allow relationship building while also improving access. CONCLUSION: While many procedural changes were needed to facilitate conversion to VCS, primary care patients seeking stress, anxiety, and depression interventions found VCS acceptable during COVID-19. Future iterations of this program are proposed which incorporate procedural changes and facilitate relationship building between patients in VCS.

Completion Rate and Side-Effect Profile of Three-Month Isoniazid and Rifapentine Treatment for Latent Tuberculosis Infection in an Urban County Jail.

In an urban jail population, 3 months of isoniazid and rifapentine (3HP) was associated with an 85% latent tuberculosis infection treatment completion rate compared with 18% in a standard 9-month isoniazid treatment group. Among the 91 patients who started 3HP therapy, there were 2 treatment discontinuations from adverse drug reactions.

Smoking cessation counseling with young patients: the practices of family physicians and pediatricians.

OBJECTIVE: To investigate family physicians' and pediatricians' practice of and perceived barriers to smoking cessation counseling among patients 18 years and younger. DESIGN: Cross-sectional mail survey conducted between November 1, 1997, and January 31, 1998. PARTICIPANTS: A stratified random sample selected from the 1997 American Medical Association Physician Masterfile of 1000 family physicians and pediatricians who practice in urban California, work at least 10% of the time in ambulatory care, and have at least 10% of patients 18 years and younger. MAIN OUTCOME MEASURES: Physicians' adherence to 5 components of the National Cancer Institute's smoking cessation counseling recommendations (anticipate, ask, advise, assist, and arrange) and their perceived barriers to smoking cessation counseling. RESULTS: A total of 429 physicians participated in the study. Physicians of both specialties were more likely to anticipate, ask, and advise patients about smoking than to assist with and arrange cessation activities. Family physicians were more likely than pediatricians to assist and arrange, including scheduling follow-up visits to discuss quitting (25.1% vs 11.7%; odds ratio [OR], 3.07; 95% confidence interval [CI], 1.22-7.73) and directing nursing staff to counsel patients (17.1% vs 10.9%; OR, 3.70; 95% CI, 1.30-10.60). The most common perceived barrier to counseling was the belief that children would provide inaccurate responses due to either the presence of parents (86.4%) or the fear that parents would be notified of their answers (74.0%). Pediatricians reported lack of counseling skills as a barrier to providing smoking interventions in greater proportion than did family physicians (24.9% vs 54.8%; OR, 0.29; 95% CI, 0.14-0.63; P<.001). CONCLUSION: Improvement in smoking cessation counseling skills and practices is needed among physicians treating children and adolescents.

Factors affecting follow-up among low-income women with breast abnormalities.

PURPOSE: To assess factors affecting follow-up care among low-income women after identification of a breast abnormality. METHODS: Women with a newly discovered breast abnormality were selected from one public hospital and two comprehensive health centers (CHCs) in Los Angeles county. Twelve months later, a telephone survey and medical chart review were conducted. RESULTS: Of the 535 respondents, 8.6% received no follow-up care. Among those with follow-up care, 29.4% received inadequate care (did not initiate follow-up in a timely manner or did not complete all recommended procedures). Factors affecting receipt of any follow-up care included having the index visit at a CHC vs. a hospital (OR 2.79, CI 1.20-6.50), patient uncertainty about where to receive care (OR 0.24, CI 0.07-0.77), and recommendation of a clinical breast examination (CBE) (OR 0.12, CI 0.04-0.40) or 6-month mammogram (OR 0.11, CI 0.04-0.31) vs. a diagnostic mammogram as a first follow-up procedure. Factors affecting receipt of adequate follow-up care included index visit at a CHC vs. a hospital (OR 1.90, CI 1.13-3.20), being white/Asian Pacific Islander/other vs. Latina (OR 5.33, CI 1.71-16.68), recommendation of a 6-month mammogram vs. a diagnostic mammogram (OR 0.06, CI 0.02-0.14), and a family history of breast cancer (OR 0.44, CI 0.22-0.89). CONCLUSIONS: To maximize return for follow-up among low-income women with a breast abnormality, clear information should be provided about where to obtain care, particularly to patients in hospital settings. The importance of complete and timely follow-up care should be emphasized, especially with referrals for clinical breast examinations or 6-month mammograms.