Articles: community-health-services.
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Preventive medicine · Jun 2019
Multicenter StudyThe association between the receipt of primary care clinician provision of preventive care and short term health behaviour change.
Primary healthcare services are recommended to provide preventive care to address chronic disease risk behaviours. However, all care elements are infrequently provided, and there is a need to understand the impact of partial care provision on behaviour change. This study examined the association between variable levels of preventive care receipt from primary care clinicians on short-term behaviour change for four risk behaviours. ⋯ Receipt of both assessment and advice increased the odds of behaviour change, compared to no care, for all behaviours except smoking, ranging from 2.32 (physical inactivity, 95% CI 1.60-3.35) to 2.83 (alcohol consumption, 95% CI 1.84-4.33). Receipt of 'assessment only' increased the odds of behaviour change, compared to no care, for inadequate fruit and/or vegetable consumption (OR = 2.40, 95% CI 1.60-3.59) and physical inactivity (OR = 2.81, 95% CI 1.89-4.17). Results highlight the importance of primary care clinicians providing best practice preventive care to maximise client behaviour change.
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Multicenter Study
Community-Designed Messaging Interventions to Improve Cost-of-Care Conversations in Settings Serving Low-Income, Latino Populations.
Little is known about how to promote cost-of-care conversations in health care settings. ⋯ Robert Wood Johnson Foundation.
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Randomized Controlled Trial Multicenter Study
Cultural respect in general practice: a cluster randomised controlled trial.
To examine whether the Ways of Thinking and Ways of Doing (WoTWoD) cultural respect framework improves clinically appropriate anticipatory care in general practice and the cultural respect levels of medical practice staff. ⋯ The WoTWoD program did not increase the rate of Indigenous health checks or improve cultural respect scores in general practice. Conceptual, methodologic, and contextual factors that influence cultural mentorship, culturally respectful clinical practice, and Indigenous health care require further investigation.
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Multicenter Study
Enhancing guideline-based asthma care processes through a multi-state, multi-center quality improvement program.
This study investigated the effectiveness of Enhancing Care for Patients with Asthma (ECPA)-a collaborative quality improvement program implemented in 65 community health centers that serve asthma patients in four states-on clinic-based asthma performance measures consistent with national guidelines. ⋯ This study demonstrated the favorable effect of the ECPA program on evidence-based asthma quality measures. This program could be considered a model worth replication on a broader scale.
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Preventive medicine · Mar 2019
Review Multicenter StudySimulated impacts and potential cost effectiveness of Communities Putting Prevention to Work: Tobacco control interventions in 21 U.S. communities, 2010-2020.
In 2010, the Centers for Disease Control and Prevention (CDC) funded communities to implement policy, systems, and environmental (PSE) changes under the Communities Putting Prevention to Work (CPPW) program to make it easier for people to make healthier choices to prevent chronic disease. Twenty-one of 50 funded communities implemented interventions intended to reduce tobacco use. To examine the potential cost-effectiveness of tobacco control changes implemented under CPPW from a healthcare system perspective, we compared program cost estimates with estimates of potential impacts. ⋯ We found $735 million in potentially averted medical costs cumulatively from 2010 through 2020 because of the CPPW-supported interventions. If the CPPW tobacco control PSE changes are sustained through 2020 without additional funding after 2013, we find that medical costs averted will likely exceed program costs by $604 million. Our results suggest that the medical costs averted through 2020 may more than offset the initial investment in CPPW tobacco control interventions, implying that such interventions may be cost saving, especially over the long term.