Purpose: Examine a clinic-based approach to improve food security and glycemic control among patients with diabetes. Design: One-group repeated-measures design. Setting: Federally Qualified Health Centers in a large Midwest city. Sample: Of the 933 patients with diabetes who consented at baseline, 398 (42.66%) returned during the follow-up period for a visit that included Hemoglobin A1c (HbA1c) results. Intervention: Integrated social medicine approach that includes food insecurity screening, nutrition education, and assistance accessing food resources as a standard-of-care practice designed to minimize disruptions in how patients and providers experience medical care. Measures: HbA1c collected as part of a standard blood panel. Analysis: Repeated-measure, mixed-effect linear regression models. Results: There was a decrease in mean HbA1c (Δ = −0.22, P = 0.01) over the study period. The model examining change over time, glycemic control (GC), and food security status (F1, 352 = 5.80, P = 0.02) indicated that among participants with poor GC (33.12%), food secure (FS) participants exhibited significantly greater levels of improvement than food insecure (FI) participants (Δ = −0.55, P = 0.04). Among participants with good GC, changes in HbA1c were not significantly different between FS and FI participants (Δ = 0.23, P = 0.21). Conclusion: Providing nutrition education and food assistance improved HbA1c profiles among FS and FI participants, but FI participants may face social and structural challenges that require additional support from health care teams.
In 2012, Access Community Health Network, a Federally Qualified Health Center (FQHC) network with 36 health centers serving the greater Chicago area, embarked on a 3-year initiative to improve patient access. “Dramatic Performance Improvement” (DPITM) included the adoption of modified open access scheduling and practice changes designed to improve capacity and the ability to balance supply and demand. This article describes DPITM implementation, strategies, and associated outcomes, including a 20% decrease in no-show rate, a 33% drop in time to the third next available appointment (TNAA), a 37% decrease in cycle time, and a 13% increase in patient satisfaction.
Para dar consejo, distribuir métodos, y hacer referencias clínicas competentemente, las promotoras comunitarias de anticonceptivos de INPPARES deben conocer la tecnología de planificación familiar. Se describe la construcción del Test de Conocimientos de Planificación Familiar para Promotoras mediante un proceso que aseguró la validez de los contenidos, la consistencia interna de los pontajes, y la confiabilidad de pruebas paralelas del test. El test viene en dos versiones equivalentes, A y B, de 80 items de elección múltiple cada una. Produce pontajes separados para cuatro áreas temáticas: Anticonceptivos Orales, Métodos de Barrera, Sistema Reproductivo, y Política Institucional/Dispositivos Intrauterinos; además genera varios puntajes compuestos y un pontaje total. Se evalúa las propiedades psicométricas del test, sus aplicaciones en investigación, y sus usos prácticos
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