Prescribing patterns of long-acting injectable antipsychotics in a community setting in South Africa.

Background: Long-acting injectable antipsychotics (LAI - APs) improve adherence to antipsychotics and decrease functional decline in schizophrenia. Yet they are prescribed late, in patients with established functional decline. Although LAI - APs are widely prescribed in South Africa, there is a paucity of research regarding the prescription profile for LAI - APs. Aim: This study aimed to describe prescribing practices for LAI - APs at psychiatric clinics. Setting: Community psychiatric clinics in South Africa. Methods: A retrospective review of the psychiatric files of all patients on LAI - APs attending the clinics over the study period was conducted. Sociodemographic, clinical and pharmacological information regarding the LAI - AP prescribed was extracted from the files. Results: A total of 206 charts were examined. The mean age of the study population was 46 (SD ± 12) years. Significantly more patients were male (n = 154; 74.8%), single (n = 184, 89.3%) and unemployed (n = 115; 55.8%) (p < 0.001). Approximately half had a comorbid substance use disorder (47.6%). The most common indication for the prescription of a LAI - AP was non-adherence (66%). Only 9.7% of the patients were prescribed a LAI - AP alone. No significant socio-demographic or clinical characteristic was associated with this prescribing habit. A LAI - AP was prescribed in combination with an oral antipsychotic, mood stabiliser or antidepressant in 53.9%, 44.7% and 7.8% of patients, respectively. Conclusion: Long-acting injectable antipsychotics were prescribed mainly following noncompliance with oral antipsychotics and may represent a missed opportunity to prevent functional decline. The high prevalence of LAI - AP polypharmacy has been highlighted.

Cancer related knowledge, attitude, and practice among community health care providers and health assistants in rural Bangladesh.

BACKGROUND: Cancer remains one of the primary causes of death in Bangladesh. The success of cancer control in rural areas depends on the ability of the health care system and workforce to identify and manage cases properly at early stages. Community Health Workers (CHW) can play a vital role in this process. The present study aims to assess cancer related Knowledge, Attitude, and Practice (KAP) among 2 categories of CHWs - Community Health Care Providers (CHCP) and Health Assistants (HA) in rural Bangladesh. METHODS: A descriptive cross-sectional study was conducted using a self-administered questionnaire from July 2019 to June 2020. Multi-stage sampling technique was used to determine the sample. One Upazilla Health Complex (UHC) from each of the eight administrative divisions of Bangladesh were randomly chosen as study sites, from which 325 CHCPs and HAs were in the final sample. Multivariate logistic regression models were developed to determine the association between KAP scores and demographic variables. RESULTS: Our study shows that a modest number of respondents scored above average in the knowledge (54.15%), attitude (58.15%), and practice (65.54%) sections. Majority CHCPs (90.91%) and HAs (96.06%) did not receive govt. training on cancer. Only 20.71% HAs and 25.2% CHCPs knew about the availability of cancer treatment options in Bangladesh. Uncertainty about the availability of relevant treatments or vaccinations at public facilities was also high. Having cancer in the family, income, duration of employment and workplace locations were important predictors of cancer related KAP scores. CONCLUSION: Healthcare workforce's knowledge gap and unfavorable attitude towards cancer may result in poor delivery of care at the rural level. For many people in rural areas, CHCPs and HAs are the first point of contact with the healthcare system and thus effective cancer control strategies must consider them as key stakeholders. Targeted training programs must be adopted to address the cancer related KAP gaps among CHCPs and HAs.

Primary health care clinics as catalyst to community building and health among residents in low income housing units.

BACKGROUND: This paper focuses on the identified value of a community-based project (CBP), including residents' living within low income housing units and their reported experiences of receiving health and social services within two communities by nurse practitioners (NPs) and its impact on their communities. OBJECTIVE: To gain insight into the lived experience of residents in the housing units from a collaborative interprofessional care approach provided in a clinic situated within each housing unit, in integrating health and social services within the residents' own 'community' and its outcomes. DESIGN: A qualitative descriptive study to gain insight into the shared views of care informants. SETTINGS: Two low income housing units in xxxxxxxxxxxxxxxxxxxx. PARTICIPANTS: Twenty-two residents representing all genders who lived in the housing units. METHODS: A purposive sampling of willing residents participated in a focus group interview. Each group comprised from 4 to 6 persons. Two focus group interviews occurred in each of the two housing units. RESULTS: Their voices resulted in identification of two themes - clinic as a catalyst to creating a sense of community and clinic as assisting them in managing their overall health. Two subthemes were also identified within each theme. CONCLUSION: Findings provide insight into the value of CBP, that a strengths-based and interprofessional care approach can serve as a catalyst for an evolving community.

Experience with setting up community intravenous therapy clinics.

The NHS Long Term Plan aims for patients to receive more options, better support and integrated care at the right time and in the optimal care setting. Community nursing teams at the Wirral Community Health and Care NHS Foundation Trust have experienced several challenges in delivering intravenous antibiotics (IV) to patients within their own homes, especially for non-housebound patients, due to the complexity of and demand on the service. Traditionally, intravenous antimicrobials are administered in the acute hospital or in-patient settings. However, there is now a growing trend to deliver intravenous antibiotic therapy within the community. Community nurses have a wealth of knowledge and skills that can support the delivery of the NHS Long Term Plan by developing new models of care in integrated care systems while supporting the implementation and delivery of the governments five-year action plan on antimicrobial resistance. This article describes how the community nursing service at Wirral Community Health and Care NHS Foundation Trust set up community IV clinics.

Follow-up approaches to a health literacy intervention to increase colorectal cancer screening in rural community clinics: A randomized controlled trial.

BACKGROUND: Significant disparities exist in colorectal cancer (CRC) screening rates among those of low socioeconomic status, with fewer years of education, lacking health insurance, or living in rural areas. METHODS: A randomized controlled trial was conducted to compare the effectiveness of 2 follow-up approaches to a health literacy intervention to improve CRC screening: automated telephone call or personal call. Patients aged 50 to 75 years residing in 4 rural community clinics in Louisiana were given a structured interview that assessed demographic, health literacy and CRC screening barriers, knowledge, and attitudes. All were given health literacy-informed CRC education, a patient-friendly CRC screening pamphlet, simplified fecal immunochemical test (FIT) instructions, and a FIT kit, and a "teach-back" method was used to confirm understanding. Patients were randomized to 1 of 2 telephone follow-up arms. If they did not mail their FIT kit within 4 weeks, they received a reminder call and were called again at 8 weeks if the test still was not received. RESULTS: A total of 620 patients were enrolled. Approximately 55% were female, 66% were African American, and 40% had limited literacy. The overall FIT completion rate was 68%: 69.2% in the automated telephone call arm and 67% in the personal call arm. Greater than one-half of the patients (range, 58%-60%) returned the FIT kit without receiving a telephone call. There was no difference noted with regard to the effectiveness of the follow-up calls; each increased the return rate by 9%. CONCLUSIONS: Providing FIT kits and literacy-appropriate education at regularly scheduled clinic visits with a follow-up telephone call when needed was found to increase CRC screening among low-income, rural patients. The lower cost automated call was just as effective as the personal call.

Is burnout associated with referral rates among primary care physicians in community clinics?

BACKGROUND: There is little empirical research examining the effects of burnout on objective measures of primary care physicians' behaviour in the medical encounter. OBJECTIVES: We studied possible associations between primary care physicians' burnout and the rates of referrals. We conceptualized referral rate as a negative outcome of burnout because high and unnecessary referral rates incur extra costs to health care systems. METHODS: In this cross-sectional study, 136 primary care physicians in one district of one Israeli health maintenance organization (HMO) completed the Maslach Burnout Inventory in the presence of an interviewer. Data on each physician's objective workload and number of referrals for high- and low-cost imaging tests, specialist clinics and treatments by nurses were collected from the HMO's databases. RESULTS: Due to high correlations between referral rate indicators, a Confirmatory Factor Analysis revealed one factor: 'referrals for diagnostic tests and specialist clinics'. Path Analysis using Structural Equation Modelling explained a total of 18.1% of referral rate variance, with board-certified specialist mostly associated (ß = 0.31, P < 0.01), followed by burnout (ß = 0.20, P < 0.05) and objective workload (ß = 0.18, P < 0.05). CONCLUSIONS: In this preliminary investigation, we found that referral rates for diagnostic tests and specialist clinics increased independently for board-certified specialists (compared with GPs), for those with higher burnout levels and when objective workload increases. These findings support the conceptualization of referrals rates as objectively measured negative outcomes of burnout. Further replications with other objective outcomes, additional HMOs and bigger samples are warranted.

Brief Cognitive-Behavioral Therapy for Depression in Community Clinics: A Hybrid Effectiveness-Implementation Trial.

OBJECTIVE: The authors examined whether brief cognitive-behavioral therapy (bCBT) for depression, delivered by mental health providers in community-based outpatient clinics (CBOCs) of the Veterans Health Administration, improved depression outcomes and was feasible and acceptable in clinical settings. METHODS: The authors used a type-2 hybrid effectiveness-implementation, patient-randomized trial to compare bCBT with enhanced usual care. Participants (N=189) with moderate symptoms of depression (Patient Health Questionnaire-9 [PHQ-9] score ≥10) were enrolled from CBOCs in the southern United States. bCBT (N=109) consisted of three to six sessions, delivered by mental health providers (N=17) as part of routine clinic practices. Providers received comprehensive training and support to facilitate bCBT delivery. Recipients of enhanced usual care (N=80) were given educational materials and encouraged to discuss treatment options with their primary care provider. The primary effectiveness outcome was PHQ-9-assessed depression symptoms posttreatment (4 months after baseline) and at 8- and 12-month follow-ups. Implementation outcomes focused on bCBT dose received, provider fidelity, and satisfaction with bCBT training and support. RESULTS: bCBT improved depression symptoms (Cohen's d=0.55, p<0.01) relative to enhanced usual care posttreatment, and the improvement was maintained at 8- and 12-month follow-ups (p=0.004). bCBT participants received a mean±SD of 3.7±2.7 sessions (range 0-9), and 64% completed treatment (≥3 sessions). Providers delivered bCBT with fidelity and reported that bCBT training and support were feasible and effective. CONCLUSIONS: bCBT had a modest treatment footprint of approximately four sessions, was acceptable to participants and providers, was feasible for delivery in CBOCs, and produced meaningful sustained improvements in depression.

Taking a Pulse on Community Participation in Maternal Health through Community Clinics in Bangladesh.

Bangladesh started institutionalising community participation by setting-up community clinics (CCs) during the mid-90 s. This paper presents the genealogy of CCs, the community participation mechanism embedded within CCs, and the case of 54 CCs in Brahmanbaria, through the lens of maternal health. We undertook a desk review to understand the journey of CCs. In 2018, we assessed the accessibility, readiness and functionality of CCs, and a household survey to know recently delivered women's perceptions of CC's community groups (CGs) and community support groups (CSGs). We performed multiple logistic regression to determine the association between the functionality of these groups and women's perception regarding these groups' activities on maternal health. The integration of community participation involving CCs started to roll out through the operationalisation of the Health and Population Sector Programme 1998-2003. In 2019, 13,907 CCs were operational. However, per our CC assessment, their accessibility and readiness were moderate but there were gaps in the functionality of the CCs. The perception of women regarding these groups' functionality was significantly better when the group members met regularly. The gaps in CCs are primarily induced by the shortcomings of its community participation model. Proper understanding is needed to address this problem which has many facets and layers, including political priorities, expectations, and provisions at a local level.

Patients Response to Interventional Care for Chronic Pain Study (PRICS): A Cross-Sectional Survey of Community-Based Pain Clinics in Ontario, Canada.

BACKGROUND: Non-image guided injection treatments ("nerve blocks") are commonly provided in community pain clinics in Ontario for chronic non-cancer pain (CNCP) but remain controversial. AIM: We explored patients' perspectives of nerve blocks for CNCP. METHODS: We administered a 33-item cross-sectional survey to patients living with CNCP pain attending four community-based pain clinics in Ontario, Canada. The survey captured demographic information and asked about patient experiences with nerve blocks. RESULTS: Among 616 patients that were approached, 562 (91%) provided a completed survey. The mean age of respondents was 53 (SD 12), 71% were female, and the majority (57%) reported living with CNCP for more than a decade. Fifty-eight percent had been receiving nerve blocks for their pain for >3 years, 51% on a weekly frequency. Since receiving nerve blocks, patients self-reported a median improvement in pain intensity of 2.5 points (95% CI -2.5 to -3.0) on an 11-point numeric rating scale and 66% reported stopping or reducing prescription medications, including opioids. The majority who were not retired (62%) were receiving disability benefits and were unable to work in any capacity. When asked what impact cessation of nerve blocks would have, most employed patients (52%) reported they would be unable to work, and the majority indicated their ability to function across multiple domains would decrease. CONCLUSION: Our respondents who received nerve blocks for CNCP attribute important pain relief and functional improvement to this intervention. Randomized trials and clinical practice guidelines are urgently needed to optimize the evidence-based use of nerve blocks for CNCP.

A Novel Approach to Locating Community Clinics to Promote Health Care Accessibility and Reduce Health Disparities in Baltimore, Maryland.

Baltimore, Maryland's entrenched racial residential segregation renders the city's world-class medical facilities and services inaccessible to many Black residents living in its most divested neighborhoods. Arguing the need for post-pandemic health care facilities to address health inequities as a practice of care-giving, this article describes a project funded by the National Institutes of Health (NIH) to define a novel, transdisciplinary methodology for identifying ideal vacant sites for conversion into community clinics in Baltimore's most vulnerable neighborhoods. Positioning architecture as a social determinant of health, this paper suggests ethical and methodological reorientations toward a compassionate approach to clinic design and placement.

Embedding comprehensive smoking cessation programs into community clinics: study protocol for a cluster-randomized controlled trial.

BACKGROUND: Cigarette smoking among adults in the USA is a leading cause of preventable death worldwide, even though there has been a decline in prevalence since 2005. The addictive nature of nicotine is the chief reason smokers continue to use tobacco. Although the majority of smokers report a desire to quit smoking, a small minority who attempt to quit achieve long-term cessation. Combined, smoking cessation best practices include coordinated medication and behavioral treatments. However, these treatments are not currently adequately delivered to Medi-Cal beneficiaries in the publicly funded patient-centered medical homes (PCMHs) and community mental health clinics operated by Los Angeles County (LAC)-Department of Health Services (LACDHS) and LAC-Department of Mental Health (LACDMH). METHODS: This is a 5-year implementation, cluster-randomized comparative effectiveness trial that will support the implementation of smoking cessation services delivered in LAC-LACDHS-operated outpatient primary care clinics and in LAC-LACDMH-operated community mental health clinics. We will enroll 1000 participants from clinics that will offer smoking cessation services and 200 from clinics that will offer treatment as usual. Participants will be asked to complete assessments at baseline, 3 months, 6 months, and 12 months. The assessments will include self-reports on smoking history, anxiety, stress, quality of life, and participant satisfaction. Participants who are assigned to clinics that provide smoking cessation services will also be asked about the frequency of their participation in the smoking cessation services during the 12-month period. DISCUSSION: This study will evaluate the effectiveness and feasibility of implementing smoking cessation services in outpatient primary care and community mental health clinics. It will also determine if there will be higher rates of smoking cessation in the implementation sites as compared to the sites with treatment as usual. If the implementation proves to be effective, the plan is to sustain these services using a workflow we will develop in the LAC-operated sites. This would lead to ameliorating the significant smoking cessation treatment gaps among those served within the LAC Health Agency departments. TRIAL REGISTRATION: ClinicalTrials.gov NCT04717544 "Embedding comprehensive smoking cessation programs into community clinics." Registered on January 22, 2021.

Design of a randomized controlled trial to assess the comparative effectiveness of a multifaceted intervention to improve three-year adherence to colorectal cancer screening among patients cared for in rural community health centers.

Colorectal cancer (CRC) screening has been shown to decrease CRC mortality, yet significant disparities persist among those living in rural areas, from minority backgrounds, and those having low income. The purpose of this two-arm randomized controlled trial is to test the effectiveness and fidelity of a stepped care (increasing intensity as needed) approach to promoting 3-year adherence to CRC screening via fecal immunochemical testing (FIT) or colonoscopy in rural community clinics serving high rates of low-income and minority patients. We hypothesize that, compared to enhanced usual care (EUC), patients receiving the multifaceted CRC screening intervention will demonstrate higher rates of CRC screening completion over 3 years. Participants from six federally qualified health centers (FQHCs; N = 1200 patients) serving predominately low-income populations in rural Louisiana will be randomized to the intervention or EUC arm. All participants will receive health literacy-directed CRC counseling, simplified materials about both the FIT and colonoscopy procedures, and motivational interviewing to aid in the determination of test preference. Participants in the intervention arm will also receive motivational reminder messages from their primary care provider (via audio recording or tailored text) for either a scheduled colonoscopy or return of a completed FIT. Participants in the EUC arm will receive the standard follow-up provided by their clinic or colonoscopy facility. The primary outcome will be completion of either colonoscopy or annual FIT over 3 years. Results will provide evidence on the effectiveness of the intervention to decrease disparities in CRC screening completion related to health literacy, race, and gender. Trial registration:Clinicaltrials.gov Identifier NCT04313114.

Evaluation of alcohol use pattern among OST patients using alcohol biomarkers: Report from community clinics in India.

Background: Opioid-dependent patients undergoing opioid substitution therapy (OST) consume alcohol in a hazardous pattern which adversely affects their treatment outcome. This study aims to measure alcohol biomarkers to screen for secondary alcohol use in OST patients. Methods: A pilot study was planned to measure alcohol biomarkers (AST, ALT, GGT, and CDT) to assess alcohol use in OST patients from three community clinics. The biomarkers were categorized based on the reported frequency of alcohol use. The association of the biomarkers with the frequency of alcohol consumption was determined using the post hoc (Mann-Whitney) test. Results: Forty-five patients with a mean (SD) age of 37.04 (10.7) years were included in the study. Alcohol intake was reported in daily, weekly, and monthly patterns by 22, 63, and 16% of the patients, respectively. High levels of ALT, GGT, and CDT were measured in patients with daily use of alcohol. Serum CDT levels significantly differentiate daily and weekly use from monthly consumption of alcohol. Conclusions: Alcohol biomarkers significantly predict the pattern of alcohol use among OST patients. These results can be prudent in low-resource community clinics to improve the overall outcomes of OST in India.

The effect of the COVID-19 pandemic on primary care physicians in Israel, with comparison to an international cohort: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic had a major impact on primary care and primary care physicians (PCPs) in Israel and around the world. There is paucity of information regarding treatment of patients with COVID-19 in the community, since most research was performed in hospitals. The aim of this study was to describe the Israeli PCPs' experience. METHODS: This study is a part of an international cross-sectional study, the PRICOV-19. A translated version of the questionnaire was distributed among Israeli PCPs from December 2020 to July 2021. In this study, we describe the Israeli results and compare them to the international results. RESULTS: 5,961 respondents from 29 countries answered the questionnaire, 94 from Israel, with an Israeli response rate of 16%. Israeli PCPs reported an increase in use of telemedicine from 11 to 49% during the COVID epidemic. PCPs also reported a decline in their wellbeing; absence of secured time slots for keeping updated; perception that the Ministry of Health guidelines were a threat to the staff wellbeing and organization of practice and delays in the examination of non-COVID urgent cases. CONCLUSIONS: The findings of this study raise concerns regarding the PCPs experience and may form the basis for an improved process of care. Guidelines for proper usage of telemedicine, substitutes for the physical examination and procedures for minimizing delayed patient examination for urgent conditions should be developed. Government directives and clinical guidelines should be communicated in a timely manner, with secured timeslots for physicians' self-learning or updating. Ensuring physicians' well-being in general should be an organization priority.

The Value and Impact of a Health Café Organized by Primary Care Physician, On Visitors, Clinics, and the Community: A Qualitative Study.

INTRODUCTION: Reflecting the rapidly aging society, there has been a worldwide increase in the number of health cafés and dementia cafés which can provide a variety of support to people with illnesses and their families in the community. Nevertheless, health cafés organized by primary care physicians are rarely reported, and the social value of these activities has not yet been fully elucidated. OBJECTIVES: This study was aimed to investigate the value and impact that the health café organized by the primary care physician, brings to the visitors, the clinic, and the community. METHODS: Conversations between the author (YO), who belongs to a medical clinic that has been operating for many years in Shizuoka City, and visitors of the health café were qualitatively analyzed using Steps for Coding and Theorization (SCAT), which is a sequential and thematic qualitative analysis technique consisting of 4 steps. RESULTS: Sixteen people participated in the study. The values and impacts of holding a health café were social support, opportunities for cognitive and behavioral changes, complementary functions to outpatient care, advantages for medical care, the creation of encounters with diverse individuals, connections with local community organizations, and motivating visitors to become proactive actors. CONCLUSION: It was considered valuable for physicians in community-based medical clinics to have opportunities to interact with patients and local residents outside the clinical settings. Because they can potentially enhance their role as primary care physicians in the community. In addition, the impact on the community is that local residents can receive social support, increase community ties, and make people more proactive about their health.

Compliance on existing WASH facilities in community clinics of Bangladesh: A comparative study.

Provisions of water sanitation and hygiene (WASH) facilities are essential to make accessible and sustainable through Community Clinics (CCs) to control infection in primary health care service. However, there is scarcity of literature to observe the scenario. This cross-sectional study with mix-method approach conducted a comparative analysis with a focus on compliance with WASH facilities between two categories of CCs in Meherpur and Kustia District in Bangladesh. There were total 420 respondents out of which 400 were selected purposively from the 20 renovated and non-renovated CCs for quantitative approach and 20 respondents for qualitative approach. Data were collected using face-to-face interview method. The study revealed that all of the renovated CCs had safe drinking water source, functioning toilet, hand washing and dust bin facilities except for a few cases with technical problem in water supply. But the reverse scenario was observed in non-renovated CCs. Compliance on WASH facilities in renovated CCs was two times higher than the non-renovated CCs. Clients aged ≤40 years (AOR = 0.41, renovated CCs), and married (AOR = 4.03, non-renovated CCs) did not comply the use of safe drinking water in CCs. Noncompliance of toilet use (AOR = 12.15, renovated CCs and AOR = 8.96, non-renovated CCs) and hand washing facility use (AOR = 8.46, renovated CCs and AOR = 16.8, non-renovated CCs) significantly found higher among respondents who had no formal education. Non-renovated CCs need to develop their WASH facilities as well as ensure maintenance whereas the renovated CCs need dedicated human resource as well as effective policies to maintain the sustainability.

Translating Psychedelic Therapies From Clinical Trials to Community Clinics: Building Bridges and Addressing Potential Challenges Ahead.

Research exploring the potential of psychedelic-assisted therapies to treat a range of mental illnesses is flourishing, after the problematic sociopolitical history of psychedelics led to the shutdown of clinical research for almost 40 years. Encouraged by positive results, clinicians and patients are now hopeful that further interruptions to research will be avoided, so that the early promise of these therapies might be fulfilled. At this early stage of renewed interest, researchers are understandably focusing more on clinical trials to investigate safety and efficacy, than on longer-term goals such as progression to community practice. Looking to identify and avoid potential pitfalls on the path to community clinics, the authors, a group of Australian clinicians and researchers, met to discuss possible obstacles. Five broad categories of challenge were identified: 1) inherent risks; 2) poor clinical practice; 3) inadequate infrastructure; 4) problematic perceptions; and 5) divisive relationships and fractionation of the field. Our analysis led us to propose some strategies, including public sector support of research and training to establish best practice and optimize translation, and funding to address issues of equitable access to treatment. Above all, we believe that strategic planning and professional cohesion will be crucial for success. Accordingly, our key recommendation is the establishment of a multidisciplinary advisory body, broadly endorsed and representing all major stakeholders, to guide policy and implementation of psychedelic-assisted therapies in Australia. Although these challenges and strategies are framed within the Australian context, we sense that they may generalize to other parts of the world. Wherever they apply, we believe that anticipation of potential difficulties, and creative responses to address them, will be important to avoid roadblocks in the future and keep the "psychedelic renaissance" on track.

A Mixed-Methods Approach to Evaluate the Needs, Support, and Services for Common Mental Disorders: A Protocol Examining Two Community Extension Clinics.

BACKGROUND: The social, economic, and physical environments are widely recognized as important determinants of health and affect the outcome of service delivery. The differences in the patient outcomes can be inferred upon by looking into the process and content of service delivery. METHODS: This study is a mixed-methods, prospective cohort study to be conducted at two community extension clinics run by the Central Institute of Psychiatry, Ranchi, Jharkhand. Service users diagnosed with a common mental disorder (CMDs) will be recruited during the study period of three years. The main objective is to ascertain the unmet needs of patients with CMDs. The secondary goals involve measuring the clinical outcome through the lens of process-oriented recovery, service satisfaction, and accessibility, and analyzing the barriers to access healthcare services along with the impact on the carers. Focus group discussions with participants will help understand the reasons behind their unmet needs and factors essential in service delivery. DISCUSSION: Healthcare, as well as social care, aims to deliver services according to need. In a country with 15 million people with CMDs, evaluation of needs could create a platform for the rational distribution of services.

Academic Nurse-Managed Community Clinics Transitioning to Telehealth: Case Report on the Rapid Response to COVID-19.

BACKGROUND: In response to the COVID-19 pandemic, many health care organizations have adopted telehealth. The current literature on transitioning to telehealth has mostly been from large health care or specialty care organizations, with limited data from safety net or community clinics. OBJECTIVE: This is a case report on the rapid implementation of a telehealth hub at an academic nurse-managed community clinic in response to the national COVID-19 emergency. We also identify factors of success and challenges associated with the transition to telehealth. METHODS: This study was conducted at the George Mason University Mason and Partners clinic, which serves the dual mission of caring for community clinic patients and providing health professional education. We interviewed the leadership team of Mason and Partners clinics and summarized our findings. RESULTS: Mason and Partners clinics reacted quickly to the COVID-19 crisis and transitioned to telehealth within 2 weeks of the statewide lockdown. Protocols were developed for a coordination hub, a main patient triage and appointment telephone line, a step-by-step flowchart of clinical procedure, and a team structure with clearly defined work roles and backups. The clinics were able to maintain most of its clinical service and health education functions while adapting to new clinic duties that arose during the pandemic. CONCLUSIONS: The experiences learned from the Mason and Partners clinics are transferable to other safety net clinics and academic nurse-led community clinics. The changes arising from the pandemic have resulted in sustainable procedures, and these changes will have a long-term impact on health care delivery and training.

Pattern of Use and Determinants of Return Visits at Community or Mohalla Clinics of Delhi, India.

BACKGROUND: Mohalla or Community Clinics of Delhi, India, have made primary care accessible, equitable, and affordable for women, elderly, and children in the underserved areas. OBJECTIVES: To understand the population subgroups which use these clinics and to analyze why people use these facilities and the determinants of the return visits for health seeking. MATERIALS AND METHODS: This was a community-based cross-sectional study, with primary data collection from 25 localities across Delhi. A pretested semi-structured interview schedule was used for data collection. Two regression models were used for data analysis: a linear probability model to understand the factors contributing to the use of these clinics and a probit regression model to understand the determinants of return visits to these facilities. RESULTS: Four hundred ninety-three ever-married women residing in study settings were included. The age of beneficiaries, marital status, distance from the clinics, and awareness about the services were found to be positively associated with the use of Mohalla Clinics. The proximity to households, waiting time at clinics, interaction time with the doctor, perceived performance of doctor, and effectiveness of treatment influenced the decision on a return visit for care seeking. CONCLUSIONS: Improved information on service provision, proximity to the facility, assured provision of doctors and laboratory services, and increased patient-doctor interaction time have the potential to increase the use and return visits to these Community or Mohalla Clinics. The lessons from this study can be used to design government primary health-care facilities in urban settings, for increased use by the target populations.