Care Clinics (care + clinic)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Care Clinics

  • health care clinic
  • primary care clinic


  • Selected Abstracts


    Risk factors for periodontitis in HIV+ patients

    JOURNAL OF PERIODONTAL RESEARCH, Issue 3 2004
    Tamer Alpagot
    Objective:, The purpose of this study was to identify risk factors for periodontitis associated with human immunodeficiency virus (HIV) infection. Methods:, A total of 152 HIV+ patients were recruited from the CARE clinic at the University of the Pacific School of Dentistry. Clinical measurements (gingival index, plaque index, bleeding index, probing depth, and attachment loss), gingival crevicular fluid (GCF) and subgingival plaque samples were taken from eight sites of each patient at baseline and 6-month visits. GCF neutrophil elastase was determined by measurement of p -nitroanalide resulting from hydrolysis of an elastase-specific peptide. GCF ,-glucuronidase was determined by release of 4-methylumbelliferone from hydrolysis of a specific substrate. A bacterial concentration fluorescence immunoassay was used to detect periodontopathic bacteria in subgingival plaque samples. Results:, Viral load, age, smoking pack-years, Fusobacterium nucleatum, Prevotella intermedia, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, neutrophil elastase, and ,-glucuronidase were significantly correlated with clinical measurements (0.0001 < p < 0.05). Significantly higher levels of elastase, ,-glucuronidase, F. nucleatum, P. intermedia, and A. actinomycetemcomitans were found at progressing sites than in non-progressing sites (0.001 < p < 0.05). Conclusions:, These data indicate that age, smoking pack-years, viral load, F. nucleatum, P. intermedia, A. actinomycetemcomitans, elastase, and ,-glucuronidase are risk factors for periodontitis in HIV+ patients. [source]


    The Breathmobile‘: A Novel Comprehensive School-Based Mobile Asthma Care Clinic for Urban Underprivileged Children

    JOURNAL OF SCHOOL HEALTH, Issue 6 2006
    Otto Liao
    Many school-based programs have been funded to improve asthma management, especially for these "high-risk" inner-city children with asthma. Here we report the outcomes of the Children's Hospital of Orange County Breathmobile program, which is a school-based asthma program that combines the use of a mobile clinic and a pediatric asthma specialist. Baseline evaluations included a detailed history and physical, skin prick test to common allergens, spirometry measurements, and asthma severity classification based on the current National Asthma Education and Prevention Program guidelines. From April 2002 to September 2005, a total of 1321 children were evaluated for asthma. Analysis of the 1112 (84%) children diagnosed with asthma showed a population mean age of 7.8 years, 81% Latino ethnicity, and 73% with persistent disease. At baseline, only 24% of children with persistent asthma were on daily anti-inflammatory medications, which increased to 78% by the first follow-up visit. In the year prior to entry into the program, 64% had school absenteeism related to asthma (38% >10 days), 45% had emergency room (ER) visits (28% >1), and 19% had hospitalizations (9% >1). There was a significant reduction (p < .001) in the annual rates of ER visits, hospitalizations, and school absenteeism when comparing pre- and postentry into the program. These data suggest that a mobile asthma van clinic at the school site with an asthma specialist could be an effective model in reducing morbidity in the underserved child with asthma. Further studies are necessary to determine whether this model is applicable to other inner-city settings. (J Sch Health. 2006;76(6):313-319) [source]


    Multilevel Analysis of the Chronic Care Model and 5A Services for Treating Tobacco Use in Urban Primary Care Clinics

    HEALTH SERVICES RESEARCH, Issue 1 2009
    Dorothy Y. Hung
    Objective. To examine the chronic care model (CCM) as a framework for improving provider delivery of 5A tobacco cessation services. Methods. Cross-sectional surveys were used to obtain data from 497 health care providers in 60 primary care clinics serving low-income patients in New York City. A hierarchical generalized linear modeling approach to ordinal regression was used to estimate the probability of full 5A service delivery, adjusting for provider covariates and clustering effects. We examined associations between provider delivery of 5A services, clinic implementation of CCM elements tailored for treating tobacco use, and the degree of CCM integration in clinics. Principal Findings. Providers practicing in clinics with enhanced delivery system design, clinical information systems, and self-management support for cessation were 2.04,5.62 times more likely to perform all 5A services ( p<.05). CCM integration in clinics was also positively associated with 5As delivery. Compared with none, implementation of one to six CCM elements corresponded with a 3.69,30.9 increased odds of providers delivering the full spectrum of 5As ( p<.01). Conclusions. Findings suggest that the CCM facilitates provider adherence to the Public Health Service 5A clinical guideline. Achieving the full benefits of systems change may require synergistic adoption of all model components. [source]


    Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care Clinics

    HEALTH SERVICES RESEARCH, Issue 1p1 2007
    Sylvia J. Hysong
    Background. The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. Objective. This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Research Design. Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. Subjects. One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. Measures. Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. Findings. High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. Conclusion. A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels. [source]


    Cooperative Dementia Care Clinics: A New Model for Managing Cognitively Impaired Patients

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006
    Mary Lessig BS
    Cooperative health care clinics (CHCCs), or shared medical appointments, are a healthcare innovation that can improve access and expand physicians' capacity to manage common geriatric conditions. This report describes a pilot program and working model for extending CHCCs to patients with dementia. Three cooperative dementia care clinics (CDCCs) met monthly for up to 1 year, drawing participants from a dementia clinic roster of patients and caregivers who had required continued specialty care for at least 3 months. Twenty-six of 33 eligible patient,caregiver dyads expressed interest, and 21 enrolled; five whose clinical status changed during the year withdrew and were replaced with new members. Brief introductory socialization, individualized clinical management, and an educational focus selected from problems of patients and caregivers were common to all sessions. Most participants required several types of clinical intervention and educational support. One group ended after reaching a natural termination point, and two others are ongoing at the request of participants. CDCCs can be a viable approach to increasing dementia care capacity in health systems. Formal service intervention trials to evaluate the generalizability and comparative effectiveness and economic viability of this model versus usual care are an appropriate next step. [source]


    Fasting capillary glucose as a screening test for gestational diabetes mellitus

    BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2006
    H Fadl
    Objective, To evaluate fasting capillary glucose as a screening test for gestational diabetes mellitus (GDM) compared with traditional risk factors and repeated random capillary glucose measurements. Design, Cross-sectional, population-based study. Setting, Maternal Health Care Clinics in ÷rebro County, Sweden. Population, An unselected population of women without diabetes. Methods, Fasting capillary glucose levels were measured at gestational weeks 28,32. Random capillary glucose levels were measured four to six times during pregnancy. Traditional risk factors for GDM were registered. GDM was diagnosed using a 75-g oral glucose tolerance test. Main outcome measures, Sensitivity, specificity, likelihood ratios. Results, In 55 of 3616 women participating in the study, GDM was diagnosed before 34 weeks of gestation. For fasting capillary glucose cutoff values between 4.0 and 5.0 mmol/l, sensitivity was in the range between 87 and 47% and specificity between 51 and 96%. Using a combined screening model of traditional risk factors with fasting capillary glucose at various cutoff values increased the sensitivity only slightly compared with using fasting capillary glucose alone. Conclusion, In this Swedish, unselected, low-risk population, fasting capillary glucose measurements were found to be an acceptable and useful screening test for GDM. [source]


    Panic disorder and suicidal ideation in primary care

    DEPRESSION AND ANXIETY, Issue 1 2006
    Daniel J. Pilowsky M.D., M.P.H.
    Abstract The purpose of this study was to ascertain whether panic disorder (PD) and suicidal ideation are associated in an inner-city primary care clinic and whether this association remains significant after controlling for commonly co-occurring psychiatric disorders. We surveyed 2,043 patients attending a primary care clinic using the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire, a screening instrument that yields provisional diagnoses of selected psychiatric disorders. We estimated the prevalence of current suicidal ideation and of common psychiatric disorders including panic disorder and major depression. A provisional diagnosis of current PD was received by 127 patients (6.2%). After adjusting for potential confounders (age, gender, major depressive disorder [MDD], generalized anxiety disorder, and substance use disorders), patients with PD were about twice as likely to present with current suicidal ideation, as compared to those without PD (adjusted odds ratio [AOR]=1.84; 95% confidence interval [CI]: 1.06,3.18; P=.03). After adjusting for PD and the above-mentioned potential confounders, patients with MDD had a sevenfold increase in the odds of suicidal ideation, as compared to those without MDD (AOR=7.00; 95% CI: 4.42,11.08; P<.0001). Primary care patients with PD are at high risk for suicidal ideation, and patients with PD and co-occurring MDD are at especially high risk. PD patients in primary care thus should be assessed routinely for suicidal ideation and depression. Depression and Anxiety 23:11,16, 2006. © 2005 Wiley-Liss, Inc. [source]


    Affective and anxiety disorders in a German sample of diabetic patients: prevalence, comorbidity and risk factors

    DIABETIC MEDICINE, Issue 3 2005
    N. Hermanns
    Abstract Aims The aims of this study were to examine (1) the prevalence of clinical and subclinical anxiety and affective disorders in a sample of diabetic patients attending a secondary care clinic in Germany and (2) risk factors associated with the occurrence of these disorders. Methods Four hundred and twenty diabetic patients (36.9% Type 1; 24.7% Type 2; 38.4% Type 2 with insulin) participated in a questionnaire-based screening survey. Those who screened positive received a diagnostic interview. Results Prevalence of clinical affective disorders was 12.6%, with an additional 18.8% of patients reporting depressive symptoms without fulfilling all criteria for a clinical affective disorder. The prevalence of anxiety disorders was 5.9%, with an additional 19.3% of patients reporting some anxiety symptoms. The comorbidity rate of affective and anxiety disorders was 1.8%, whereas 21.4% of the diabetic patients reported elevated affective as well as anxiety symptomatology. Logistic regression established demographic variables such as age, female gender and living alone as well as diabetes-specific parameters such as insulin treatment in Type 2 diabetes, hypoglycaemia problems and poor glycaemic control as risk factors for affective disorders. For anxiety symptoms female gender, younger age and Type 2 diabetes were significant independent variables. Conclusion The prevalence of affective disorders in diabetic patients was twofold higher than in the non-diabetic population, whereas prevalence for anxiety disorders was not increased. Analysis of risk factors can facilitate the identification of patients who are at a greater risk for these disorders. [source]


    Development of a Gerodontology course in Athens: a pilot study

    EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 3 2006
    A. E. Kossioni
    Aim:, To describe the development of an undergraduate Gerodontology course in Athens Dental School. Background:, Because of demographic changes, undergraduate dental curricula should place appropriate emphasis on the oral care of the elderly. Therefore, the Athens Dental School Curriculum Committee authorised the development of a new Gerodontology course. Methods:, The new course was introduced in the 10th (final) semester of undergraduate studies. Teaching responsibilities were shared amongst staff from various Dental School departments and the National Health System. The course was elective and mainly didactic, consisting of seminars within the Dental School, educational visits to hospitals and geriatric day centres and elective clinical work in the comprehensive care clinic. The students evaluated the course at the end of the semester and indicated its strengths and weaknesses from their perspective. Conclusion:, The new course was generally satisfying. Based on the experience and evaluation of the first pilot year and taking into consideration the existing barriers, we plan to improve and expand educational activities, mainly including improved methods of teaching and assessment, and more clinical assignments. [source]


    Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care Clinics

    HEALTH SERVICES RESEARCH, Issue 1p1 2007
    Sylvia J. Hysong
    Background. The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. Objective. This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Research Design. Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. Subjects. One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. Measures. Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. Findings. High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. Conclusion. A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels. [source]


    Integrated specialty mental health care among older minorities improves access but not outcomes: results of the PRISMe study

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2008
    Patricia A. AreŠn
    Abstract Objective In this secondary data analysis of Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRIMSe) study, we hypothesized that older minorities who receive mental health services integrated in primary care settings would have greater service use and better mental health outcomes than older minorities referred to community services. Method We identified 2,022 (48% minorities) primary care patients 65 years and older, who met study inclusion criteria and had either alcohol misuse, depression, and/or anxiety. They were randomized to receive treatment for these disorders in the primary care clinic or to a brokerage case management model that linked patients to community-based services. Service use and clinical outcomes were collected at baseline, three months and six months post randomization on all participants. Results Access to and participation in mental health /substance abuse services was greater in the integrated model than in referral; there were no treatment by ethnicity effects. There were no treatment effects for any of the clinical outcomes; Whites and older minorities in both integrated and referral groups failed to show clinically significant improvement in symptoms and physical functioning at 6 months. Conclusions While providing services in primary care results in better access to and use of these services, accessing these services is not enough for assuring adequate clinical outcomes. Copyright © 2008 John Wiley & Sons, Ltd. [source]


    Recognizing and engaging depressed Chinese Americans in treatment in a primary care setting

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2006
    Albert Yeung
    Abstract Objectives To examine the effectiveness of depression screening and the Engagement Interview Protocol (EIP) in identifying and engaging in treatment depressed Chinese Americans in a primary care setting. Methods Chinese American patients who attended a primary care clinic between 15 September, 2004 and 14 September, 2005 were screened for depression using the Chinese Bilingual version of the Patient Health Questionnaire (CB-PHQ-9). Patients who screened positive (CB-PHQ-9,,,15) were evaluated using the EIP to establish psychiatric diagnosis and to engage patients in treatment. Results Three thousand eight hundred and twelve patients completed the CB-PHQ-9, of which 113 (3.2%) screened positive for MDD. Among those screening positive, six (5.3%) had been receiving psychiatric treatment for depression, 57 (50%) declined to receive a psychiatric interview or were unable to be contacted, and 50 (44%) agreed to be interviewed with the EIP. Out of the 50 patients interviewed, 44 (88%) had their MDD diagnosis confirmed; among them, 41 (93%) agreed to receive treatment for depression and three (7%) declined intervention. Conclusions Under-recognition and under-treatment of depressed Chinese Americans in primary care settings continue to be prevalent. Recognition of depression can be enhanced by using the brief CB-PHQ-9 to screen for depression. Half of the Chinese Americans who screened positive for MDD declined evaluation by a mental health professional. Most of the depressed Chinese Americans who were evaluated agreed to receive treatment. Enhanced cultural sensitivity with the use of the EIP in psychiatric assessment may have contributed to the success in engaging depressed Chinese Americans in treatment. Copyright © 2006 John Wiley & Sons, Ltd. [source]


    Recommendations for Sexuality Education for Early Adolescents

    JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2006
    Kristin Haglund
    Objective:, To determine community support and identify appropriate learning methodologies, parameters of delivery, and intervention content. Design:, Qualitative descriptive study in which participants were interviewed in a semistructured format. Data were analyzed thematically. Setting:, An urban pediatric primary care clinic from which youths and parents were recruited. Participants:, Ten youths, 10 parents, and 10 community members. Community members included professional and laypersons who had experience in working with early adolescents or in working with children of any age on sexuality issues. Overall, most participants were female (67%) and African American (67%). Results:, Descriptions of early adolescents' knowledge of sexuality, participants' support for sexuality education for early adolescents, recommendations for education content, and preferred methods for education delivery. Conclusion:, The participants supported comprehensive sexuality education for early adolescents. They believed that it would help youths to be abstinent, would provide some protection from sexual abuse, and would prepare them to practice safer sex in the future. JOGNN, 35, 369-375; 2006. DOI: 10.1111/J.1552-6909.2006.00048.x [source]


    A Comparison of Perspectives on Breastfeeding Between Two Generations of Black American Women

    JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 1 2001
    Marjaneh M. Fooladi MSN, PhDArticle first published online: 24 MAY 200
    PURPOSE To determine differences in breastfeeding perspectives between two generations of black American women with and without access to governmental food assistance programs (i.e., WIC). DATA SOURCES Descriptive, comparative study of a convenience sample of 118 black American women in their childbearing years and beyond conducted in a primary rural health care clinic serving an indigent population. CONCLUSIONS A significant difference was found between breastfeeding perceptions and rate among younger black American women on WIC program and their mothers without access to these programs. The availability of free formula through WIC programs has partially influ-enced the rate of breastfeeding among the young black American women. The other sig-nificant influencing factor was public embarrassment at breastfeeding. IMPLICATIONS FOR PRACTICE An extensive educational campaign is needed in order to influence the public's perceptions of breastfeeding as an embarrassment. The success of programs such as WIC must be measured beyond the first six months of an infant's life. [source]


    Learning medical ethics in a primary care clinic

    MEDICAL EDUCATION, Issue 11 2008
    Keng Yin Loh
    No abstract is available for this article. [source]


    Vitamin supplement use among children with Down's syndrome and risk of leukaemia: a Children's Oncology Group (COG) study

    PAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 3 2008
    Cindy K. Blair
    Summary Vitamin supplements have been proposed for children with Down's syndrome (DS) with claims of improving cognitive abilities, or immune or thyroid function. Several studies have shown decreased levels of zinc in this population. Because children with DS have a 50-fold increased risk of developing acute leukaemia during the first 5 years of life, we explored the relation between child vitamin and herbal supplement use and the risk of leukaemia in a case-control study. During the period 1997,2002, we enrolled 158 children with DS aged 0,18 years that were diagnosed with acute lymphoblastic leukaemia (ALL) (n = 97) or acute myeloid leukaemia (AML) (n = 61) at participating Children's Oncology Group institutions. We enrolled 173 DS children without leukaemia (controls), selected from the cases' primary care clinic and frequency-matched on age. Data were collected via telephone interviews with mothers of the index child regarding use of multivitamins, zinc, vitamin C, iron and herbal supplements, including age at first use, frequency and duration. Among controls, 57% reported regular multivitamin use (,3 times/week for ,3 months) compared with 48% of ALL cases and 61% of AML cases. We found no evidence of an association between children's regular multivitamin use and ALL or AML (adjusted odds ratios [OR] = 0.94 [95% CI 0.52, 1.70] and 1.90 [0.73, 4.91] respectively). There was a suggestion of an increased risk for AML associated with regular multivitamin use during the first year of life or for an extended duration (ORs = 2.38 [0.94, 5.76] and 2.59 [1.02, 6.59] respectively). Despite being the largest study of DS-leukaemia, our sample size was small, resulting in imprecise effect estimates. Future research should include larger sample sizes as well as a full assessment of diet including vitamin supplementation to adequately examine the relation between nutritional status and childhood leukaemia. [source]


    The Art of Prescribing

    PERSPECTIVES IN PSYCHIATRIC CARE, Issue 2 2006
    Antidepressants in Late-Life Depression: Prescribing Principles
    QUESTION. , Ms. Antai-Otong, I am a psychiatric nurse practitioner currently employed in a large primary care clinic. My greatest challenge with older adults suspected of being depressed is their hesitancy to admit they are depressed or unwillingness to take antidepressants. I have started some of these patients on antidepressants and had mixed results. Please provide some guidelines for treating depression in older adults with coexisting medical conditions. ANSWER., Depression is a common companion of chronic medical illnesses and frequently goes unrecognized and untreated, resulting in high morbidity and mortality. Depression is unrecognized and underdiagnosed in approximately 16% of older patients seen in primary care settings (Unutzer, 2002). Typically, older adults deny being depressed, minimize symptom severity, fail to recognize common subjective experiences, such as anhedonia, fatigue, and concentration difficulties associated with this disorder, and hesitate to accept their illness due to social stigma and effects of stoicism. Cultural and generational influences also impact how older adults perceive mental health services. Due to the growing number of individuals 65 and older with coexisting medical and psychiatric conditions, particularly depression, seeking health care in vast practice settings, advanced practice psychiatric nurses must collaborate with primary care providers and develop holistic care that addresses coexisting chronic medical and psychiatric conditions. [source]


    Reliability and validity of the Thai version of the WHO-Five Well-Being Index in primary care patients

    PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2009
    Ratana Saipanish md
    Aims:, Because of the high patient load in Thailand, we need a practical measurement to help primary physicians detect depression. This study aimed to examine the reliability and validity of the Thai version of the World Health Organization-Five Well-Being Index (WHO-5-T), which is short and easy to use as a screening tool for major depression in primary care patients. Methods:, The English version of the WHO-Five Well-Being Index was translated into Thai. Back-translations, cross-cultural adaptation and field testing of the pre-final version with final adjustments were performed accordingly. The WHO-5-T was administered randomly to 300 patients in our primary care clinic. Then the patients were further assessed using the Mini International Neuropsychiatric Interview and the Hamilton Rating Scale for Depression as the gold standard of diagnosis and symptom severity, respectively. Results:, Completed data were obtained from 274 respondents. Their mean age was 44.6 years [standard deviation (SD) = 14.7] and 73.7% of them were female. The mean WHO-5-T score was 14.32 (SD = 5.26). The WHO-5-T had a satisfactory internal consistency (Cronbach's alpha = 0.87) and showed moderate convergent validity with the Hamilton Rating Scale for Depression (r = ,0.54; P < 0.001). The optimal cut-off score of the WHO-5-T <12 revealed a sensitivity of 0.89 and a specificity of 0.71 in detecting depression. The area under the curve in this study was 0.86 (SD = 0.03, 95% confidence interval 0.81 to 0.89). Conclusions:, The Thai version of the WHO-Five Well-Being Index was found to be a reliable and valid self-assessment to screen for major depression in primary care setting at a cut-off point of <12. [source]


    Clinical score for nonbacterial osteitis in children and adults

    ARTHRITIS & RHEUMATISM, Issue 4 2009
    Annette F. Jansson
    Objective To accurately differentiate nonbacterial osteitis (NBO) from other bone lesions by applying a clinical score through the use of validated diagnostic criteria. Methods A retrospective study was conducted to assess data on patients from a pediatric clinic and an orthopedic tertiary care clinic, using administrative International Classification of Diseases codes as well as laboratory and department records from 1996 to 2006. Two hundred twenty-four patients older than age 3 years who had either NBO (n = 102), proven bacterial osteomyelitis (n = 22), malignant bone tumors (n = 48), or benign bone tumors (n = 52) were identified by chart review. Univariate logistic regression was used to determine associations of single risk factors with a diagnosis of NBO, and multivariable logistic regression was used to assess simultaneous risk factor associations with NBO. Results NBO was best predicted by a normal blood cell count (odds ratio [OR] 81.5), symmetric bone lesions (OR 30.0), lesions with marginal sclerosis (OR 26.8), normal body temperature (OR 20.3) a vertebral, clavicular, or sternal location of lesions (OR 13.9), presence of >1 radiologically proven lesion (OR 10.9), and C-reactive protein level ,1 mg/dl (OR 6.9). The clinical score for a diagnosis of NBO based on these predictors ranged from 0 to 63. A score for NBO of ,39 had a positive predictive value of 97% and a sensitivity of 68%. Conclusion The proposed scoring system helps to facilitate the diagnostic process in patients with suspected NBO. Use of this system might spare unnecessary invasive diagnostic and therapeutic procedures. [source]


    Retinal photography for diabetic retinopathy screening in Indigenous primary health care: the Inala experience

    AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2010
    Geoffrey K. P. Spurling
    Abstract Objective: We aimed to determine the impact of clinic based retinal photography on access to appropriate screening for diabetic retinopathy (DR). Design, setting and participants: We opportunistically recruited patients undergoing their annual diabetic cycle of care over a two year period in the urban Indigenous primary health care clinic. Data were collected on retinal outcomes, health variables and referral patterns. Main outcome measures: Access to appropriate screening and ophthalmic follow up, prevalence of DR, acceptability and feasibility of clinic-based retinal photography were the main outcome measures of this study. Results: One hundred and thirty-two of a possible 147 patients consented to participate. 30% of participants had DR. Appropriate screening and ophthalmic follow up increased six fold, from 20 to 124 participants, following the introduction of the retinal camera. Most participants felt very positive about DR screening. Conclusions: Primary care DR screening using retinal photography can improve access to DR screening for indigenous patients, reduce the burden on busy outpatient departments and should reduce visual loss. Policy-makers could contribute to screening sustainability by funding a medicare item-number for primary care based DR screening associated with the annual diabetic cycle of care. An upfront Practice Incentive Program (PIP) payment could offset set up costs. [source]


    What Factors in Early Pregnancy Indicate that the Mother Will Be Hit by Her Partner during the Year after Childbirth?

    BIRTH, Issue 2 2004
    A Nationwide Swedish Survey
    The purpose of this study was to document the prevalence and indicators in early pregnancy of a woman being hit by her partner during the year after childbirth. Method: Information was collected by a postal questionnaire in early pregnancy and 12 months after childbirth from the approximately 5,550 women in Sweden who visited an antenatal care clinic for the first time during one of three chosen weeks in 1999 and 2000. Results: Of the 3,266 recruited women, 2,563 returned the follow-up questionnaire. Being hit during the first year after childbirth was reported by 52 of the 2,563 (2%) women: 32 (61%) had been hit by their partner once, 12 (23%) twice, and 8 (15%) three or more times. Risk increased in women who were age 24 years or younger (3.9% had been hit), unmarried (7.1%), born in countries outside Europe (6.8%), with a partner born outside Europe (5.4%), had a low level of education (8.9%), and were unemployed (5.0%). In early pregnancy, women with back pain (4.0%), a chronic illness (4.1%), coital pain (6.1%), frequent depression-related symptoms (8.1%), stomach pain (3.8%), or a urinary tract problem (6.3%) were hit more often than others after childbirth. Conclusions: At least 2 percent of Swedish women giving birth in 2000 were hit by their partner during the year after childbirth. Using identified predictors during antenatal care may increase the likelihood of finding women at risk, thereby enhancing the possibility of interventions to prevent this crime and health hazard. [source]


    The characteristics of complementary and alternative medicine use by parents of asthmatic children in Southern Israel

    ACTA PAEDIATRICA, Issue 11 2007
    Lilach Singer
    Abstract Aim: The aim of this study was to estimate the rate and describe the characteristics of complementary and alternative medicine (CAM) use by children with asthma in a paediatric primary care clinic in southern Israel. Method: A cross-sectional study including 252 asthmatic children aged 2,12-years was conducted. Socio-demographic data and asthma history were collected using a telephone questionnaire. Computerized medical records were used to complete the data. Results: Sixteen percent (95% CI 11.5,20.5) of the asthmatic children participating in this study used CAM; most popular were homeopathy (36.6%) and reflexology (14.6%). According to multivariate model, CAM use was more prevalent in families in which fathers had professional training (OR = 4.9, 95% CI 1.82,13.02, p = 0.002), mothers were employed (OR = 4.1, 95% CI 1.018,16.1, p = 0.047), and origin of maternal grandfathers was European (OR = 4.7, 95% CI 1.86,11.8, p = 0.001). Families who used CAM, also more frequently sought rabbinical advice (OR = 11.9, 95% CI 2.94,47.7, p = 0.001). Conclusions: The prevalence of CAM use found in this study is lower than seen in other Western countries. The ,average family' using CAM to treat its asthmatic child includes an educated father, an employed mother and maternal grandfather from Europe, and would more often seek rabbi's advice. [source]


    Suicide in people with epilepsy: How great is the risk?

    EPILEPSIA, Issue 8 2009
    Gail S Bell
    Summary Purpose:, Suicide is more common in populations with epilepsy, but estimates vary concerning the magnitude of the risk. We aimed to estimate the risk using meta-analysis. Methods:, A literature search identified 74 articles (76 cohorts of people with epilepsy) in whom the number of deaths by suicide in people with epilepsy and the number of person,years at risk could be estimated. Standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated for each cohort, for groups of cohorts, and for the total population. Results:, The overall SMR was 3.3 (95% CI 2.8,3.7) based on 190 observed deaths by suicide compared with 58.4 expected. The SMR was significantly increased in people with incident or newly diagnosed epilepsy in the community (SMR 2.1), in populations with mixed prevalence and incidence cases (SMR 3.6), in those with prevalent epilepsy (SMR 4.8), in people in institutions (SMR 4.6), in people seen in tertiary care clinics (SMR 2.28), in people with temporal lobe epilepsy (SMR 6.6), in those following temporal lobe excision (SMR 13.9), and following other forms of epilepsy surgery (SMR 6.4). The SMR was significantly low overall in two community-based studies of people with epilepsy and developmental disability. Discussion:, We confirm that the risk of suicide is increased in most populations of people with epilepsy. Psychiatric comorbidity has been demonstrated to be a risk factor for suicide in the general population and in people with epilepsy, and such comorbidity should thus be identified and treated. [source]


    Patient, consumer, client, or customer: what do people want to be called?

    HEALTH EXPECTATIONS, Issue 4 2005
    Raisa B. Deber PhD
    Abstract Objective, To clarify preferred labels for people receiving health care. Background, The proper label to describe people receiving care has evoked considerable debate among providers and bio-ethicists, but there is little evidence as to the preferences of the people involved. Design, We analysed dictionary definitions as to the derivation and connotations of such potential labels as: patient, client, customer, consumer, partner and survivor. We then surveyed outpatients from four clinical populations in Ontario, Canada about their feelings about these labels. Setting and participants, People from breast cancer (n = 202), prostate disease (n = 202) and fracture (n = 202) clinics in an urban Canadian teaching hospital (Sharpe study), and people with HIV/AIDS at 10 specialty care clinics and three primary care practices affiliated with the HIV Ontario Observational Database (n = 431). Variables and outcome measures, The survey instruments included questions about opinion of label, role in treatment decision-making (the Problem Solving Decision Making scale), trust, use of information and health status. Results, Our respondents moderately liked the label ,patient'. The other alternatives evoked moderate to strong dislike. Conclusions, Many alternatives to ,patient' incorporate assumptions (e.g. a market relationship) which care recipients may also find objectionable. People who are receiving care find the label ,patient' much less objectionable than the alternatives that have been suggested. [source]


    Multilevel Analysis of the Chronic Care Model and 5A Services for Treating Tobacco Use in Urban Primary Care Clinics

    HEALTH SERVICES RESEARCH, Issue 1 2009
    Dorothy Y. Hung
    Objective. To examine the chronic care model (CCM) as a framework for improving provider delivery of 5A tobacco cessation services. Methods. Cross-sectional surveys were used to obtain data from 497 health care providers in 60 primary care clinics serving low-income patients in New York City. A hierarchical generalized linear modeling approach to ordinal regression was used to estimate the probability of full 5A service delivery, adjusting for provider covariates and clustering effects. We examined associations between provider delivery of 5A services, clinic implementation of CCM elements tailored for treating tobacco use, and the degree of CCM integration in clinics. Principal Findings. Providers practicing in clinics with enhanced delivery system design, clinical information systems, and self-management support for cessation were 2.04,5.62 times more likely to perform all 5A services ( p<.05). CCM integration in clinics was also positively associated with 5As delivery. Compared with none, implementation of one to six CCM elements corresponded with a 3.69,30.9 increased odds of providers delivering the full spectrum of 5As ( p<.01). Conclusions. Findings suggest that the CCM facilitates provider adherence to the Public Health Service 5A clinical guideline. Achieving the full benefits of systems change may require synergistic adoption of all model components. [source]


    Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care Clinics

    HEALTH SERVICES RESEARCH, Issue 1p1 2007
    Sylvia J. Hysong
    Background. The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. Objective. This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Research Design. Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. Subjects. One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. Measures. Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. Findings. High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. Conclusion. A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels. [source]


    Alcohol Drinking Patterns and Health Care Utilization in a Managed Care Organization

    HEALTH SERVICES RESEARCH, Issue 3 2004
    Gary A. Zarkin
    Objective. To estimate the relationship between current drinking patterns and health care utilization over the previous two years in a managed care organization (MCO) among individuals who were screened for their alcohol use. Study Design. Three primary care clinics at a large western MCO administered a short health and lifestyle questionnaire to all adult patients on their first visit to the clinic from March 1998 through December 1998. Patients who exceeded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for moderate drinking were given a more comprehensive alcohol screening using a modified version of the Alcohol Use Disorders Identification Test (AUDIT). Health care encounter data for two years preceding the screening visit were linked to the remaining individuals who responded to one or both instruments. Using both quantity,frequency and AUDIT-based drinking pattern variables, we estimated negative binomial models of the relationship between drinking patterns and days of health care use, controlling for demographic characteristics and other variables. Principal Findings. For both the quantity,frequency and AUDIT-based drinking pattern variables, current alcohol use is generally associated with less health care utilization relative to abstainers. This relationship holds even for heavier drinkers, although the differences are not always statistically significant. With some exceptions, the overall trend is that more extensive drinking patterns are associated with lower health care use. Conclusions. Based on our sample, we find little evidence that alcohol use is associated with increased health care utilization. On the contrary, we find that alcohol use is generally associated with decreased health care utilization regardless of drinking pattern. [source]


    A simple primary care information system featuring feedback to clinicians

    INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 3 2008
    Gary Gaumer
    Abstract A simple information system for primary care clinics was designed to support the USAID funded health system strengthening project in the Suez Governorate in Egypt. This system (FACT,Feedback and Analytic Comparison Tool) was implemented in December 2003 in 14 primary care clinics. The MS Access-based system was designed and prototyped in several months, and was easily and cheaply modified several times after implementation. A total of 128,562 persons have been registered in the system (as of June 2005) and 36,083 visits have been documented. A key feature of FACT is the ease with which clinicians can conduct exploratory research about practice patterns, and variations in them across doctors and the other clinics. This analytic feature enables the clinicians to self-diagnose quality problems and take action accordingly. Several of the clinics have used this feature of FACT to identify important gaps in service use among patients, and have taken steps to remove barriers to promote more appropriate patterns of utilization. The paper reviews the design and implementation issues and early evidence of the system's utility in helping support quality improvement (QI) work in the clinics. Copyright © 2007 John Wiley & Sons, Ltd. [source]


    The influence of education on the interpretation of pharmaceutical pictograms for communicating medicine instructions

    INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 1 2003
    Ros Dowse senior lecturer
    Objective To assess the influence of formal education on the interpretation of pharmaceutical pictograms. Method A total of 46 pictograms were used: 23 were extracted directly from the USP-DI, and 23 with corresponding meanings were designed in accordance with the local culture (local pictograms). One hundred and thirty Xhosa respondents, who ranged from having no formal education to tertiary level education, were interviewed with the aid of an interpreter. Demographic data were collected, a literacy test was conducted and respondents were tested for their interpretation of all 46 pictograms. Preference for either the USP-DI or the local pictogram was determined. Setting Respondents were interviewed in primary health care clinics, a variety of work settings or in their homes in Grahamstown, South Africa. Key findings Standard of education had a significant influence on the interpretation of 24 of the 46 pictograms. Generally, significant differences in interpretation were apparent between those with only primary school education and those who had completed at least some senior school education (P < 0.05). The group with tertiary education was significantly better than the other groups (P < 0.05). Only 15 of the 46 pictograms met the American National Standards Institute (ANSI) 85% correct criterion. Conclusion Interpretation was dependent on education and the development of visual literacy skills, but potential for misinterpretation in all educational groups was noted. These results suggest that pictograms should only be used as a communication aid in combination with text or verbal information from the health care provider. [source]


    Cooperative Dementia Care Clinics: A New Model for Managing Cognitively Impaired Patients

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006
    Mary Lessig BS
    Cooperative health care clinics (CHCCs), or shared medical appointments, are a healthcare innovation that can improve access and expand physicians' capacity to manage common geriatric conditions. This report describes a pilot program and working model for extending CHCCs to patients with dementia. Three cooperative dementia care clinics (CDCCs) met monthly for up to 1 year, drawing participants from a dementia clinic roster of patients and caregivers who had required continued specialty care for at least 3 months. Twenty-six of 33 eligible patient,caregiver dyads expressed interest, and 21 enrolled; five whose clinical status changed during the year withdrew and were replaced with new members. Brief introductory socialization, individualized clinical management, and an educational focus selected from problems of patients and caregivers were common to all sessions. Most participants required several types of clinical intervention and educational support. One group ended after reaching a natural termination point, and two others are ongoing at the request of participants. CDCCs can be a viable approach to increasing dementia care capacity in health systems. Formal service intervention trials to evaluate the generalizability and comparative effectiveness and economic viability of this model versus usual care are an appropriate next step. [source]