Dental Care During the COVID-19 Pandemic: Patient Perceptions of Barriers to Dental Care, COVID-19 Safety Precautions, and Administration of the COVID-19 Vaccine at the Dental Office.

Background: The Mountain Area Health Education Center (MAHEC) Dental Health Center sought to learn how COVID-19 affected dental care attainment and patient perceptions of appropriate safety measures, as well as their acceptance of the dental office as a site for COVID-19 vaccinations. Methods: A cross-sectional online survey of dental patients was performed to inquire about barriers to care, safety precautions, including COVID-19 testing, and the acceptability of vaccination for COVID-19 in the dental office. All adult patients of the MAHEC Dental Health Center with an email address on file and a clinic visit in the past year were randomized for inclusion. Results: We sampled 261 adult patients; the majority were White (83.1%), female (70.1%), and over 60 years of age (60.1%). Patients who were included had visited the clinic for routine cleanings (67.2%) and dental emergency care (77.4%) in the past year. Respondents supported safety precautions at the clinic; however, there was little support for mandatory COVID-19 testing prior to a visit (14.7%). Just under half (47.3%) of respondents believed it would be appropriate for a dental office to give COVID-19 vaccinations. Conclusions: Overall, patients experienced concerns during the pandemic but still sought dental care for routine treatments and emergencies. Patients supported the use of precautionary COVID-19 safety measures at the clinic, though they did not support mandatory COVID-19 testing prior to a visit. Respondents were split on the acceptability of COVID-19 vaccination in the dental clinic.

Hepatitis C and HIV Screening, Testing, and Risk Perceptions among South-Central Appalachian County Health Department Staff.

OBJECTIVES: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are significant public health concerns, especially given the risks for disease interactions. Rates of HCV and HIV are increasing, especially in rural areas. Local health departments (LHDs) play an important role in rural health care, offering screening, testing, and treatment for HCV and HIV. Gaps persist in LHD resources for meeting these demands, especially in Appalachia and the US South. METHODS: To explore HCV/HIV screening, testing, and treatment approaches and perspectives in south-central Appalachian North Carolina, structured telephone questionnaires were administered to communicable disease nurses and other health department staff directly involved in screening and testing. Mixed-methods data analyses were conducted and triangulated with stakeholders. RESULTS: Eighteen participants representing 19 counties completed the questionnaire, achieving a saturation sample. Participants reported barriers to screening and testing, including housing insecurity, lack of transportation and insurance, unemployment, and the isolation of living in a rural area. Divergence in perceptions of barriers between public health regions emerged, as did perceptions of who is at risk and use of stigmatizing language about people at risk for HCV/HIV. CONCLUSIONS: This study highlights the impact of LHD behaviors and perceptions on screening and testing, and offers recommendations to improve HCV/HIV screening and testing accessibility in south-central Appalachia, a high-risk region.

Interconception Care for Mothers at Well Child Visits After Implementation of the IMPLICIT Model.

INTRODUCTION: Interconception care (ICC) is recommended to reduce maternal risk factors for poor birth outcomes between pregnancies. The IMPLICIT ICC model includes screening and brief intervention for mothers at well child visits (WCVs) for smoking, depression, multivitamin use, and family planning. Prior studies demonstrate feasibility and acceptability among providers and mothers, but not whether mothers recall receipt of targeted messages. METHODS: Mothers accompanying their child at 12- and 24-month WCVs at four sites of a family medicine academic practice were surveyed pre (2012) and post (2018) ICC model implementation. Survey items assessed health history, behaviors, and report of whether their child's physician addressed maternal depression, tobacco use, family planning, and folic acid supplementation during WCVs. Pre and post results are compared using logistic regression adjusting for demographics and insurance. RESULTS: Our sample included 307 distinct mothers with 108 and 199 respondents in the pre and post periods, respectively. Mothers were more likely to report discussions with their child's doctor post-intervention for family planning (31% pre to 86% post; aOR 18.65), depression screening (63-85%; aOR 5.22), and taking a folic acid supplement (53-68%; aOR 2.54). Among mothers who smoked, the percentage that reported their child's doctor recommended cessation increased from 56 to 75% (aOR = 3.66). DISCUSSION: The IMPLICIT ICC model resulted in increased reported health care provider discussions of four key areas of interconception health by mothers attending WCVs. This model holds promise as a primary care strategy to systematically address maternal risks associated with poor pregnancy outcomes.

Access to clinical pharmacy services in a pharmacist-physician covisit model.

BACKGROUND: A pharmacist-physician covisit model in which patients see both a pharmacist and physician on the same day was established in a primary care practice. Previously, patients were seen in a referrals-based model in which providers referred patients for clinical pharmacy services on a different day. OBJECTIVE: To assess access to clinical pharmacy services in a pharmacist-physician covisit model compared to a referrals-based model. METHODS: A retrospective chart review was completed for patients who were seen by physicians on pre-specified half-days of clinic before and after implementation of the covisit model. Covisit model half-days between June 29, 2018 and September 30, 2018 and matched half-days from 2015 were included. Charts were reviewed to determine if patients scheduled to see the physician would benefit from clinical pharmacy services, including being seen for chronic disease management, eligible for a Medicare Annual Wellness Visit (AWV), prescribed medications that required counseling, had an adverse medication-related event, or had adherence concerns. Those eligible for clinical pharmacy services were further reviewed to determine if the patient interacted with a pharmacist within three months of their visit. RESULTS: Prior to implementation of the covisit model, 123 patient visits were completed on the pre-specified half-days. Of these, 61 patients (49.6%) were deemed eligible for clinical pharmacy services. In the covisit model, 149 patients were seen by the physician, of which 69 patients (46%) were eligible for clinical pharmacy services. More patients in the covisit cohort went on to interact with a pharmacist (56 patients, 81% vs. 10 patients, 16%, adjusted OR = 32.98, 95% CI [8.89-122.39]). The most common reasons patients were identified for clinical pharmacy services were eligibility for AWV, hypertension, and diabetes. CONCLUSIONS: A pharmacist-physician covisit model significantly increased accessibility to clinical pharmacy services compared to a referrals-based model.