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1.
J Ambul Care Manage ; 44(1): 2-6, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33196500

RESUMO

Federally qualified health centers (FQHCs) are on the front lines of the COVID-19 pandemic. Their mission of providing essential medical care to underserved populations is now even more vital. CrescentCare, an FQHC in New Orleans, evaluated and tested 3366 patients between March 16 and July 2, with an overall rate of 12% SARS-CoV-2 positivity. The clinic's experience demonstrates how to effectively and rapidly integrate COVID-19 programing, while preserving essential health services. Strategies include developing a walk-in COVID-19 testing site, ensuring appropriate clinical evaluation, providing accurate public health information, and advocating for job safety on behalf of our patients.


Assuntos
/diagnóstico , Centros Comunitários de Saúde/organização & administração , Área Carente de Assistência Médica , Acesso aos Serviços de Saúde , Humanos , Nova Orleans/epidemiologia , Pandemias
3.
Recurso educacional aberto em Português | CVSP - Regional | ID: oer-3925

RESUMO

O Conteúdo da Aula aborda: -Estratégias -Centros Comunitários (Objetivos, Cuidados, Tipos, Considerações Gerais)


Assuntos
Atenção Primária à Saúde , Coronavirus , Centros Comunitários de Saúde , Gestão em Saúde
4.
Am J Manag Care ; 26(11): 462-463, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33196278

RESUMO

One in 5 Americans utilizes federally qualified health center (FQHC) services for their primary care, preventive, and community health needs. Medicaid and FQHC programs have been partners at the forefront of addressing population health needs for more than 50 years. Although testing and contact tracing during the coronavirus disease 2019 (COVID-19) crisis are helping rural FQHC patients, there are other vital Medicaid services that are both available right now and ripe for enhancement to ensure the accessibility of services during and after the COVID-19 emergency. A primary example is nonemergency medical transportation (NEMT). Community health centers must focus on NEMT use to ensure access to care for rural patients as states reopen. This commentary defines NEMT and ways that FQHCs can enhance it as a Medicaid benefit as states reopen amid COVID-19.


Assuntos
Betacoronavirus , Centers for Medicare and Medicaid Services, U.S./organização & administração , Centros Comunitários de Saúde/organização & administração , Infecções por Coronavirus/terapia , Acesso aos Serviços de Saúde/organização & administração , Pneumonia Viral/terapia , Atenção Primária à Saúde/organização & administração , Humanos , Pandemias , Estados Unidos
5.
N C Med J ; 81(6): 394-397, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139474

RESUMO

The Affordable Care Act made direct and indirect investments in community health centers. Ten years later, more North Carolinians benefit from a stronger primary care safety net that provides a broader scope of comprehensive services, but missed policymaking opportunities leave work to be done to achieve a healthier, more equitable state.


Assuntos
Centros Comunitários de Saúde , Patient Protection and Affordable Care Act , Aniversários e Eventos Especiais , Humanos , North Carolina , Formulação de Políticas , Atenção Primária à Saúde , Estados Unidos
6.
Harm Reduct J ; 17(1): 87, 2020 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-33143699

RESUMO

BACKGROUND: Containment policies and other restrictions introduced by the Spanish government in response to the COVID-19 pandemic present challenges for marginalised populations, such as people who use drugs. Harm reduction centres are often linked to social services, mental health services, and infectious disease testing, in addition to tools and services that help to reduce the harms associated with injecting drugs. This study aimed to explore the impact of the pandemic on these services in four autonomous communities in Spain. METHODS: This is a cross-sectional study that employed a seven-section structured survey administered electronically to 20 centres in July 2020. Data from the most heavily affected months (March-June) in 2020 were compared to data from the same period in 2019. Averages were calculated with their ranges, rates, and absolute numbers. RESULTS: All 11 responding centres reported having had to adapt or modify their services during the Spanish state of alarm (14 March-21 June 2020). One centre reported complete closure for 2 months and four reported increases in their operating hours. The average number of service users across all centres decreased by 22% in comparison to the same period in the previous year and the average needle distribution decreased by 40% in comparison to 2019. Most centres reported a decrease in infectious disease testing rates (hepatitis B and C viruses, human immunodeficiency virus, and tuberculosis) for March, April, and May in 2020 compared to the previous year. Reported deaths as a result of overdose did not increase during the state of alarm, but 2/11 (18%) centres reported an increase in overdose deaths immediately after finalisation of the state of alarm. CONCLUSION: Overall, Spanish harm reduction centres were able to continue operating and offering services by adjusting operating hours. The number of overall service users and needles distributed fell during the Spanish state of alarm lockdown period, suggesting that fewer clients accessed harm reduction services during this time, putting them at greater risk of reusing or sharing injecting equipment, overdosing, acquiring infectious diseases with decreased access to testing or discontinuing ongoing treatment such as methadone maintenance therapy, hepatitis C treatment, or antiretroviral therapy.


Assuntos
Betacoronavirus , Centros Comunitários de Saúde/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Redução do Dano , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Estudos Transversais , Humanos , Espanha
7.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33181875

RESUMO

The health-service redesign that came with the preparation for the surge of COVID-19 had a potential of disrupting the Family Medicine internship programme like it did to many other health and academic programmes. A team of Cape-Town based Community Health Centre (CHC) doctors mitigated this challenge by designing an innovative tool that facilitated ongoing supervision of the interns in order to achieve the outcomes of the Health Professions Council of South Africa (HPCSA).


Assuntos
Centros Comunitários de Saúde , Infecções por Coronavirus , Aconselhamento , Medicina de Família e Comunidade/educação , Internato e Residência , Pandemias , Pneumonia Viral , Preceptoria , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Pessoal de Saúde , Humanos , Médicos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , África do Sul
9.
J Prim Care Community Health ; 11: 2150132720953680, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32909504

RESUMO

BACKGROUND: Chronic spinal pain is one of the most common diseases in the United States. Underserved patients are most affected, and disproportionately may use opioid medications as they lack access to other therapies. It is therefore important to develop systems to treat spinal pain within the primary medical home. METHODS: We designed a prospective observational pilot study at a community health center to measure the effectiveness of two interventions among an underserved population: a multidisciplinary pain team and chiropractic care. Study outcomes were pain and functional disability measured by the Pain Disability Questionnaire (PDQ), and reduction of opioid dose at baseline and 6-12 months. Multivariate linear regression was used to determine associating factors for change in PDQ scores. RESULTS: Thirty-five individuals completed baseline and follow-up PDQs from August 2018 to May 2020. Overall, the mean baseline PDQ was 92.4 +/- 6.1 and the mean follow-up PDQ was 81.9 +/- 7.7, resulting in a mean improvement of -10.6 (95% CI 1.2 - -22.3, P = .08). Participants in the chiropractic team (mean change -25.0, P = .01) and those completing the study before COVID-19 (mean change = -22.6, P < .01) were found to have significantly greater improvement at follow-up. CONCLUSION: This observational study within a community health center resulted in improvement in spinal pain and disability with chiropractic care versus a multidisciplinary pain team. Offering similar services in primary care may help to address pain and disability, and hopefully limit external referrals, advanced imaging, and opioid prescriptions.


Assuntos
Dor Crônica/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Manipulação Quiroprática , Equipe de Assistência ao Paciente/organização & administração , Doenças da Coluna Vertebral/terapia , Adolescente , Adulto , Canadá , Centros Comunitários de Saúde , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
10.
J Am Board Fam Med ; 33(5): 774-778, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32989072

RESUMO

BACKGROUND: Primary care practice-based research networks (PBRNs) are critical laboratories for generating evidence from real-world settings, including studying natural experiments. Primary care's response to the novel coronavirus-19 (COVID-19) pandemic is arguably the most impactful natural experiment in our lifetime. EVALUATING THE IMPACT OF COVID-19: We briefly describe the OCHIN PBRN of community health centers (CHCs), its partnership with implementation scientists, and how we are leveraging this infrastructure and expertise to create a rapid research response evaluating how CHCs across the country responded to the COVID-19 pandemic. COVID-19 RESEARCH ROADMAP: Our research agenda focuses on asking: How has care delivery in CHCs changed due to COVID-19? What impact has COVID-19 had on the delivery of preventive services in CHCs? Which PBRN services (e.g., data surveillance, training, evidence synthesis) are most impactful to real-world practices? What decision-making strategies were used in the PBRN and its practices to make real-time changes in response to the pandemic? What critical factors in successfully and sustainably transforming primary care are illuminated by pandemic-driven changes? DISCUSSION AND CONCLUSIONS: PBRNs enable real-world evaluation of practice change and natural experiments, and thus are ideal laboratories for implementation science research. We present a real-time example of how a PBRN Implementation Laboratory activated a response to study a historic natural experiment, to help other PBRNs charting a course through this pandemic.


Assuntos
Betacoronavirus , Centros Comunitários de Saúde/tendências , Redes Comunitárias/tendências , Infecções por Coronavirus , Assistência à Saúde/tendências , Pesquisa sobre Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Atenção Primária à Saúde/tendências , Centros Comunitários de Saúde/organização & administração , Redes Comunitárias/organização & administração , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Prática Clínica Baseada em Evidências , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Ciência da Implementação , Disseminação de Informação , Inovação Organizacional , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , Participação dos Interessados , Estados Unidos
11.
BMC Public Health ; 20(1): 1289, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32843002

RESUMO

BACKGROUND: Limited health literacy is linked with poor health behaviors, limited health care access, and poor health outcomes. Improving individual and population health outcomes requires understanding and addressing barriers to promoting health literacy. METHODS: Using the socio-ecological model as a guiding framework, this qualitative study (Phase 1 of a larger ongoing project) explored the interpersonal and organizational levels that may impact the health literacy levels of patients seeking care at federally qualified community health centers (FQCHCs) in Rhode Island. Focus groups were conducted with FQCHC employees (n = 37) to explore their perceptions of the health literacy skills of their patients, health literacy barriers patients encounter, and possible strategies to increase health literacy. The focus groups were audio-recorded and transcribed, and transcripts were coded using a process of open, axial, and selective coding. Codes were grouped into categories, and the constant comparative approach was used to identify themes. RESULTS: Eight unique themes centered on health literacy, sources of health information, organizational culture's impact, challenges from limited health literacy, and suggestions to ameliorate the impact of limited health literacy. All focus group participants were versed in health literacy and viewed health literacy as impacting patients' health status. Participants perceived that some patients at their FQCHC have limited health literacy. Participants spoke of themselves and of their FQCHC addressing health literacy through organizational- and provider-level strategies. They also identified additional strategies (e.g., training staff and providers on health literacy, providing patients with information that includes graphics) that could be adopted or expanded upon to address and promote health literacy. CONCLUSIONS: Study findings suggest that strategies may need to be implemented at the organizational-, provider-, and patient- level to advance health literacy. The intervention phase of this project will explore intervention strategies informed by study results, and could include offering health literacy training to providers and staff to increase their understanding of health literacy to include motivation to make and act on healthy decisions and strategies to address health literacy, including the use of visual aids.


Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde/estatística & dados numéricos , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Educação de Pacientes como Assunto/métodos , Saúde Pública/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Rhode Island
13.
JCO Glob Oncol ; 6: 1298-1305, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32795196

RESUMO

PURPOSE: As a result of their immunocompromised status associated with disease and treatment, patients with cancer face a profound threat for higher rates of complications and mortality if they contract the coronavirus disease 2019 infection. Medical oncology communities have developed treatment modifications to balance the risk of contracting the virus with the benefit of improving cancer-related outcomes. METHODS: We systemically examined our community cancer center database to display patterns of change and to unveil factors that have been considered with each decision. We studied a cohort of 282 patients receiving treatment and found that 159 patients (56.4%) had treatment modifications. RESULTS: The incidence of treatment modification was observed in patients undergoing adjuvant and neoadjuvant (41.4%), palliative (62.9%), or injectable endocrine or bone-modulating only (76.0%) treatments. Modifications were applied to regimens with myelosuppressive (56.5%), immunosuppressive (69.2%), and immunomodulating (61.5%) potentials. These modifications also affected intravenous (54.9%) and subcutaneous injectable treatments (62.5%) more than oral treatments (15.8%). Treatment modifications in 112 patients (70.4%) were recommended by providers, and 47 (29.6%) were initiated by patients. The most common strategy of modification was to skip or postpone a scheduled treatment (49%). Among treatment with no modifications, treatment regimens were maintained in patients who tolerated treatment well (37.0%), in treatments with curative intent (22%), and in symptomatic patients who required treatment (14%). CONCLUSION: Our observation and analysis suggested that the primary goal of treatment modification was to decrease potential exposure. The pattern also reflected the negative impact of the pandemic on health care providers who initiated these changes. Providers have to consider individualized recommendations incorporating multiple factors, such as tolerance, potential toxicity, treatment nature and route, and disease severity.


Assuntos
Antineoplásicos/administração & dosagem , Betacoronavirus , Infecções por Coronavirus , Neoplasias/terapia , Pandemias , Pneumonia Viral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Centros Comunitários de Saúde , Feminino , Humanos , Masculino , Oncologia/normas , Pessoa de Meia-Idade , Terapia Neoadjuvante , Neoplasias/patologia , Cidade de Nova Iorque , Cuidados Paliativos/métodos , Aceitação pelo Paciente de Cuidados de Saúde
14.
BMC Fam Pract ; 21(1): 147, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32698768

RESUMO

BACKGROUND: Epidemic chronic diseases pose significant challenges to the improvement of healthcare in China and worldwide. Despite increasing international calls for the inclusion of evidence-based decision-making (EBDM) processes in chronic disease prevention and control programming as well as policymaking, there is relatively little research that assesses the current capacity of physicians and the factors that influence that capacity in China. METHOD: This cross-sectional study was conducted in community health centres (CHCs) in Shanghai, China, using multistage cluster sampling. An evidence-based chronic disease prevention (EBCDP) evaluation tool was employed to assess physician EBCDP awareness, adoption, implementation and maintenance based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and using a 7-point Likert scale. Linear regression analysis was used to assess associations between each EBCDP aspect and overall EBCDP status with participant characteristics or organizational factors. RESULT: A total of 892 physicians from CHCs in Shanghai, China, were assessed. The physicians perceived their awareness (mean = 4.90, SD = 1.02) and maintenance (mean = 4.71, SD = 1.07) of EBCDP to be relatively low. Physicians with relatively lower job titles and monthly incomes (> 9000 RMB) tended to have relatively higher scores for the awareness, adoption, and implementation of EBCDP (P < 0.05). Those who had participated in one program for chronic disease prevention and control were less likely to adopt (b = - 0.284, P = 0.007), implement (b = - 0.292, P = 0.004), and maintain (b = - 0.225, P = 0.025) EBCDP than those who had participated in more programs. Physicians in general practice (Western medicine) had a lower level of awareness of EBCDP than those in other departments (P < 0.0001). Physician from CHCs located in suburban areas had lower scores for awareness (b = - 0.150, P = 0.047), implementation (b = - 0.171, P = 0.029), and maintenance (b = - 0.237, P = 0.002) that those from urban CHCs. Physicians in CHCs affiliated with universities had higher scores on all four EBCDP aspects that those in CHCs not affiliated with a university. CONCLUSIONS: This study provides quantitative evidence illustrating EBCDP practices among physicians in CHCs with various personal and organizational characteristics, respectively. More methods should be provided to increase the awareness of such physicians regarding EBCDP to stimulate the use of EBCDP for their patients and in connection with other public health priorities.


Assuntos
Atitude do Pessoal de Saúde , Doença Crônica/prevenção & controle , Tomada de Decisão Clínica , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Adulto , China , Centros Comunitários de Saúde , Estudos Transversais , Feminino , Humanos , Ciência da Implementação , Renda , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Percepção
16.
Artigo em Inglês | MEDLINE | ID: mdl-32646063

RESUMO

BACKGROUND: A series of reforms were implemented to improve the quality of primary care services in China. This study aims to assess patients' perceived quality of primary healthcare between rural and urban community health centers in Guangdong. METHODS: A cross-sectional survey was conducted from July to December 2015 in Guangdong. We surveyed 1010 respondents who visited either community health centers/stations (CHCs/CHSs) in urban areas or township health centers/rural health stations (THCs/RHSs) in rural areas. A validated Chinese version of the Primary Care Assessment Tool-Adult Short Version (PCAT-AS), representing ten primary care domains, was used to collect information on patients' primary care experiences. A t-test was used for comparison on domain scores and total scores between patients from CHCs/CHSs and THCs/RHSs. An analysis of covariance was employed to compare the adjusted PCAT domain scores and total scores. Multilevel models were used to explore factors associated with PCAT total scores. RESULTS: Overall, patients reported a lower level of experience of community orientation and family centeredness compared to other primary care domains. Patients from THCs/RHSs settings in the rural area reported better primary care experience in four domains, including first contact, accessibility, ongoing care, and community orientation. Higher education background and those with a chronic disease were associated with better primary care experience, after controlling for confounding factors. Patients who preferred primary care institutions when getting sick or used health services more frequently reported better primary care experiences. CONCLUSION: Continued efforts are needed to strengthen primary care performances, particularly in a community orientation and family centeredness. Primary care delivery in CHCs/CHSs settings should be improved in four domains, including first contact, accessibility, ongoing care, and community orientation.


Assuntos
Centros Comunitários de Saúde/normas , Satisfação do Paciente , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Adulto , China , Estudos Transversais , Feminino , Humanos , Masculino , Garantia da Qualidade dos Cuidados de Saúde , População Rural , Inquéritos e Questionários , População Urbana
17.
PLoS Med ; 17(7): e1003146, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32673305

RESUMO

BACKGROUND: Atrial fibrillation (AF) is underdiagnosed and especially undertreated in China. We aimed to investigate the prevalence of unknown and untreated AF in community residents (≥65 years old) and to determine whether an education intervention could improve oral anticoagulant (OAC) prescription. METHODS AND FINDINGS: We performed a single-time point screening for AF with a handheld single-lead electrocardiography (ECG) in Chinese residents (≥65 years old) in 5 community health centers in Shanghai from April to September 2017. Disease education and advice on referral to specialist clinics for OAC treatment were provided to all patients with actionable AF (newly detected or undertreated known AF) at the time of screening, and education was reinforced at 1 month. Follow-up occurred at 12 months. In total, 4,531 participants were screened (response rate 94.7%, mean age 71.6 ± 6.3 years, 44% male). Overall AF prevalence was 4.0% (known AF 3.5% [n = 161], new AF 0.5% [n = 22]). The 183 patients with AF were older (p < 0.001), taller (p = 0.02), and more likely to be male (p = 0.01), and they had a higher prevalence of cardiovascular disease than those without AF (p < 0.001). In total, 85% (155/183) of patients were recommended for OAC treatment by the established guidelines (CHA2DS2-VASc ≥ 2 for men; ≥ 3 for women). OAC prescription rate for known AF was 20% (28/138), and actionable AF constituted 2.8% of all those screened. At the 12-month follow-up in 103 patients (81% complete), despite disease education and advice on specialist referral, only 17 attended specialist clinics, and 4 were prescribed OAC. Of those not attending specialist clinics, 71 chose instead to attend community health centers or secondary hospital clinics, with none prescribed OAC, and 15 had no review. Of the 17 patients with new AF and a class 1 recommendation for OAC, only 3 attended a specialist clinic, and none were prescribed OAC. Of the 28 AF patients taking OAC at baseline, OAC was no longer taken in 4. Ischemic stroke (n = 2) or death (n = 3) occurred in 5/126 (4%), with none receiving OAC. As screening was performed at a single time point, some paroxysmal AF cases may have been missed; thus, the rate of new AF may be underestimated. CONCLUSIONS: We demonstrated a noticeable gap in AF detection and treatment in community-based elderly Chinese: actionable AF constituted a high proportion of those screened. Disease education and advice on specialist referral are insufficient to close the gap. Before more frequent or intensive screening for unknown AF could be recommended in China, greater efforts must be made to increase appropriate OAC therapy in known AF to prevent AF-related stroke.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Administração Oral , Idoso , Anticoagulantes/administração & dosagem , Fibrilação Atrial/epidemiologia , China/epidemiologia , Centros Comunitários de Saúde , Estudos Transversais , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Programas de Rastreamento , Prevalência , Estudos Prospectivos , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Varfarina/administração & dosagem , Varfarina/uso terapêutico
19.
JAMA Netw Open ; 3(6): e206874, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32496568

RESUMO

Importance: Use of effective contraception decreases unintended pregnancy. It is not known whether Medicaid expansion under the Affordable Care Act increased use of contraception for women who are underserved in the US health care safety net. Objective: To evaluate the association of Medicaid expansion under the Affordable Care Act with changes in use of contraception among patients at risk of pregnancy at US community health centers, with the hypothesis that Medicaid expansion would be associated with increases in use of the most effective contraceptive methods (long-acting reversible contraception). Design, Setting, and Participants: This was a participant-level retrospective cross-sectional study comparing receipt of contraception before (2013) vs immediately after (2014) and a longer time after (2016) Medicaid expansion. Electronic health record data from a clinical research network of community health centers across 24 states were included. The sample included all female patients ages 15 to 44 years at risk for pregnancy, with an ambulatory care visit at a participating community health center during the study period (315 clinics in expansion states and 165 clinics in nonexpansion states). Exposures: Medicaid expansion status (by state). Main Outcomes and Measures: Two National Quality Forum-endorsed contraception quality metrics, calculated annually: the proportion of women at risk of pregnancy who received (1) either a moderately effective or most effective method (hormonal and long-acting reversible contraception) methods and (2) the most effective method (long-acting reversible contraception). Results: The sample included 310 132 women from expansion states and 235 408 women from nonexpansion states. The absolute adjusted increase in use of long-acting reversible contraceptive methods was 0.58 (95% CI, 0.13-1.05) percentage points greater among women in expansion states compared with nonexpansion states in 2014 and 1.19 (95% CI, 0.41-1.96) percentage points larger in 2016. Among adolescents, the association was larger, particularly in the longer term (2014 vs 2013: absolute difference-in-difference, 0.80 [95% CI, 0.30-1.30] percentage points; 2016 vs 2013: absolute difference, 1.79 [95% CI, 0.88-2.70] percentage points). Women from expansion states who received care at a Title X clinic had the highest percentage of women receiving most effective contraceptive methods compared with non-Title X clinics and nonexpansion states. Conclusions and Relevance: In this study, Medicaid expansion was associated with an increase in use of long-acting reversible contraceptive methods among women at risk of pregnancy seeking care in the US safety net system, and gains were greatest among adolescents.


Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Medicaid/organização & administração , Patient Protection and Affordable Care Act , Adolescente , Adulto , Estudos Transversais , Registros Eletrônicos de Saúde , Serviços de Planejamento Familiar/estatística & dados numéricos , Serviços de Planejamento Familiar/provisão & distribução , Feminino , Humanos , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
20.
Int J Behav Med ; 27(5): 565-575, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32542474

RESUMO

BACKGROUND: Given the psychological stress associated with managing type 2 diabetes (T2D), resilience-promoting interventions may particularly benefit populations experiencing high levels of stress (e.g., racial/ethnic minority and lower-income individuals). Federally qualified Community Health Centers (CHCs) primarily serve these patients and are therefore ideal settings for resilience-promoting T2D programs. This proof-of-concept study tested the Resilience-Based Diabetes Self-Management Education (RB-DSME) intervention within a CHC. METHOD: Thirty-five patients with T2D (M age = 51 years, 71% female, 60% Hispanic, 69% annual household income < $20,000) at two clinics within the CHC completed the RB-DSME, consisting of eight bi-weekly classes and two monthly support groups. In this treatment-only design, resilience resources, self-management behaviors, and physical and mental health outcomes were measured at baseline and 6 months. RESULTS: Attendance (M = 7.66/10) and program satisfaction (M = 6.79/7) were high. Participants improved adaption to stress (d = .67), adaptive coping (d = .60), diabetes empowerment (d = .57), and finding positive meaning (d = .85). Large increases in self-management behaviors (d = 1.38) and number of steps (d = 1.11) were also observed. Participants lowered A1C from baseline (M = 8.79%) to 6 months (M = 8.11%; d = .50), along with diabetes distress (d = 1.31), depressive symptoms (d = .80), and general perceived stress (d = .55). CONCLUSION: This study demonstrated the ability of the RB-DSME to improve resilience resources, self-management behaviors, and health outcomes among racial/ethnic minority and lower-income patients with T2D at clinics within a CHC. A larger, randomized trial should more rigorously test the RB-DSME in this clinical setting.


Assuntos
Diabetes Mellitus Tipo 2 , Autogestão , Adulto , Centros Comunitários de Saúde , Diabetes Mellitus Tipo 2/terapia , Grupos Étnicos , Feminino , Humanos , Masculino , Grupos Minoritários , Autocuidado
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