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Prevalence of SARS-CoV-2 in newborns born to SARS-CoV-2-positive mothers at 2 weeks of life
No full textIntroduction: Limited evidence exists on management recommendations for neonates born to SARS-CoV-2-positive mothers. This study looked at transmission risk of neonates presenting for primary care in a large regional health system within New York during the early months of the COVID-19 pandemic.
Methods: This was a prospective, observational study of newborns born to SARS-CoV-2-positive mothers presenting at any of the 19 Northwell Health-Cohen Children\u27s Medical Center primary care practices who underwent another oropharyngeal/nasopharyngeal swab for detection of SARS-CoV-2 by day of life (DOL) 14.
Results: Among 293 newborns born to SARS-CoV-2-positive mothers who were negative at birth, 222 were retested at DOL 14, corresponding to times with different predominant strains. Of these, seven tested positive but had no symptoms.
Conclusion: The overall low transmission rates and absence of symptomatic infection support the safety of direct breastfeeding after hospital discharge with appropriate hand and breast hygiene.
Keywords: COVID-19; SARS-CoV-2; newborns; pediatric medicine; transmission risk
Advancing Primary Care Access: Exploring the Impact of the Virtual Waiting Room on the Quadruple Aim
No full textBackground: Community health centers grapple with high no-show rates, posing challenges to patient access and primary care provider (PCP) utilization.
Aim: To address these challenges, we implemented a virtual waiting room (VWR) program in April 2023 to enhance patient access and boost PCP utilization.
Setting: Academic community health center in a small urban city in Massachusetts.
Participants: Community health patients (n = 8706) and PCP (n = 14).
Program description: The VWR program, initiated in April 2023, involved nurse triage of same-day visit requests for telehealth appropriateness, then placing patients in a standby pool to fill in as a telehealth visit for no-shows or last-minute cancellations in PCP schedules.
Program evaluation: Post-implementation, clinic utilization rates between July and September improved from 75.2% in 2022 to 81.2% in 2023 (p \u3c 0.01). PCP feedback was universally positive. Patients experienced a mean wait time of 1.9 h, offering a timely and convenient alternative to urgent care or the ER.
Discussion: The VWR is aligned with the quadruple aim of improving patient experience, population health, cost-effectiveness, and PCP satisfaction through improving same-day access and improving PCP schedule utilization. This innovative and reproducible approach in outpatient offices utilizing telehealth holds the potential for enhancing timely access across various medical disciplines.
Keywords: academic community health center; patient access; primary care provider utilization; quadruple aim; virtual waiting room
Nursing News & Views - June 2024
Get PDFNursing News & Views Newsletter - June 2024https://scholarlycommons.libraryinfo.bhs.org/nursing_newsletters/1034/thumbnail.jp
Using community-based participatory research methods to build the foundation for an equitable integrated health data system within a Canadian urban context
No full textHealth inequalities amplified by the COVID-19 pandemic have disproportionately affected racialized and equity-deserving communities across Canada. In the Municipality of Peel, existing data, while limited, illustrates that individuals from racialized and equity-deserving communities continue to suffer, receive delayed care, and die prematurely. In response to these troubling statistics, grassroots community advocacy has called on health systems leaders in Peel to work with community and non-profit organizations to address the critical data and infrastructure gaps that hinder addressing the social determinants of health in the region. To support these advocacy efforts, we used a community-based participatory research approach to understand how we might build a data collection ecosystem across sectors, alongside community residents and service providers, to accurately capture the data about the social determinants of health. This approach involved developing a community engagement council, defining the problem with the community, mapping what data is actively collected and what is excluded, and understanding experiences of sociodemographic data collection from community members and service providers. Guided by community voices, our study focused on sociodemographic data collection in the primary care context and identified which service providers use and collect these data, how data are used in their work, the facilitators and barriers to data use and collection. Additionally, we gained insight into how sociodemographic data collection could be respectful, safe, and properly governed from the perspectives of community members. From this study, we identify a set of eight recommendations for sociodemographic data collection and highlight limitations. This foundational community-based work will inform future research in establishing data governance in partnership with diverse and equity-deserving communities.
Keywords: Community-based Participatory Research; Data; Data Justice; Equity-Deserving communities; Health Equity; Racialized populations or communities
A 12-year Retrospective Cohort Study of Point-of-care Ultrasound and Aortic Dissection Risk Score in Type A Aortic Dissection
No full textBackground: Aortic dissection (AD) is a vascular emergency with time-dependent mortality. Point-of-care ultrasound (POCUS) and AD risk score (ADRS) have been proposed as diagnostic tools to risk stratify patients and reduce time to diagnosis.
Study objective: We evaluate POCUS findings and ADRS in a retrospective cohort of patients with known type A AD. The objective of this study is to describe the prevalence of POCUS findings and ADRS in this population.
Methods: This is a retrospective cohort study of patients with acute type A AD as confirmed on computed tomography scan over a 12-year period from 2008 to 2020, with a subgroup analysis of patients who received POCUS in the emergency department. ADRS was calculated and POCUS findings were reviewed. Descriptive statistics were used to describe the distribution of POCUS findings.
Results: Ninety-one patients met inclusion criteria. POCUS was performed in 41 but only 35 had images of adequate quality for inclusion. Of the POCUS images available, 30/35 (86%) patients had a POCUS finding consistent with dissection and 5/35 (14%) had no findings on POCUS. Twelve percent (11/91) of patients had ADRS = 0. Two patients with ADRS = 0 received POCUS, and one patient had no findings on POCUS.
Conclusion: Although POCUS provides rapid information in the diagnosis of type A AD, 14% of patients with images available for review had no findings on POCUS. Of the whole cohort, 12% had an ADRS = 0. Further studies are needed to identify an optimal diagnostic pathway for this catastrophic disease.
Keywords: POCUS; aortic dissection; aortic dissection risk score; pericardial effusion; ultrasound
Preventive Primary Care in the Postpartum Year: The Role of Medicaid Delivery System Reform
No full textIntroduction: Preventive and primary care in the postpartum year is critical for future health and may be increased by primary care focused delivery system reform including implementation of Medicaid Accountable Care Organizations (ACO). This study examined associations of Massachusetts Medicaid ACO implementation with preventive visits in the postpartum year.
Methods: The Massachusetts All-Payer Claims Database was used to identify births to privately-insured or Medicaid ACO-eligible individuals from January 1, 2016 to February 28, 2019. Comparing these groups before and after implementation, a propensity score weighted difference-in-difference design was used to analyze associations of Medicaid ACO implementation with any preventive care visit and any primary care physician (PCP) preventive visit within one year postpartum, controlling for other characteristics. Analyses were performed in 2023 and 2024.
Results: Of the 110,601 births in the study population, 35.5% had any preventive care visit and 23.0% had any preventive PCP visit in the year postpartum, with higher rates of preventive visits among privately-insured individuals. In adjusted difference-in-difference analyses, relative to the pre-period, there was a 2.7 percentage point (pp) decrease (95% confidence interval [CI]: -4.3pp, -1.2pp) and 3.5 pp decrease (95% CI: -4.9pp, -2.0pp) in use of any preventive visits and any PCP preventive visits, respectively, for Medicaid-insured versus privately-insured individuals after ACO implementation.
Conclusions: Implementation of Massachusetts Medicaid ACOs was associated with decreases in receipt of preventive visits and preventive PCP visits for Medicaid-insured individuals relative to privately-insured individuals. Medicaid ACOs should consider potential implications of primary care access in the postpartum year for health across the lifecourse
Effect of Pharmacist-Led Interventions on Diabetes Distress Among People With Type 2 Diabetes
No full textPurpose: The purpose of this study was to determine the effectiveness of pharmacist-led interventions on diabetes distress and glucose management among people with type 2 diabetes (T2DM) in a community care clinic.
Methods: Adults with T2DM were recruited during routine visits at the pharmacist-run clinic. Participants completed a baseline A1C, demographic survey, Diabetes Distress Scale (DDS), and Patient Health Questionnaire-2 (PHQ-2). Depending on DDS subscale-specific responses, participants qualified for pharmacist-led educational interventions based on the ADCES7 Self-Care Behaviors™. After 6 months, participants completed another A1C, satisfaction survey, DDS, and PHQ-2. Data analysis included descriptive statistics and paired t tests.
Results: Among 53 participants at baseline, diabetes distress was present in 77.4%; emotional burden was most common in 64.2%, followed by regimen distress in 45.3%, interpersonal distress in 34.0%, and physician distress in 20.8%. After the intervention, significant reductions occurred in mean overall DDS score (2.0 to 1.7), emotional burden (2.4 to 1.8), regimen distress (2.3 to 1.7), A1C (7.0% to 6.5%; 53.0 to 47.5 mmol/mol), and PHQ-2 score (1.6 to 1.0). Participants were highly satisfied with the service, their knowledge, and self-management skills following completion of the study.
Conclusions: Diabetes distress was present in most participants despite glucose management that was largely achieving treatment goals. Pharmacist-led educational interventions significantly reduced overall DDS score, emotional burden, regimen distress, A1C, and PHQ-2 score. The results of this study suggest that people with T2DM should receive routine screening for diabetes distress and that pharmacists can positively affect diabetes management and emotional well-being through tailored education
