Bilingual patient portal implementation has considerable potential to promote health care engagement within Spanish-speaking safety-net populations; however, lack of provider engagement in the process could undermine the effort.
BackgroundThe United States health care system remains far from implementing the Centers for Disease Control and Prevention's recommendation of routine human immunodeficiency virus (HIV) screening as part of health care for adults. Although consensus for the importance of screening has grown, innovations in implementing routine screening are still lacking. HIV on the Frontlines of Communities in the United States (FOCUS) was launched in 2010 to provide an environment for testing innovative approaches to routine HIV screening and linkage to care.ObjectiveThe strategy of the FOCUS program was to develop models that maximize the use of information systems, fully integrate HIV screening into clinical practice, transform basic perceptions about routine HIV screening, and capitalize on emerging technologies in health care settings and laboratories.MethodsIn 10 of the most highly impacted cities, the FOCUS program supports 153 partnerships to increase routine HIV screening in clinical and community settings.ResultsFrom program launch in 2010 through October 2013, the partnerships have resulted in a total of 799,573 HIV tests and 0.68% (5425/799,573) tested positive.ConclusionsThe FOCUS program is a unique model that will identify best practices for HIV screening and linkage to care.
Background
QUIT is the only primary care-based brief intervention that has previously shown efficacy for reducing risky drug use in the US (Gelberg et al., 2015). This pilot study replicated the QUIT protocol in one of the five original QUIT clinics primarily serving Latinos.
Design
Single-blind, two-arm, randomized controlled trial of patients enrolled from March–October 2013 with 3-month follow-up.
Setting
Primary care waiting room of a federally qualified health center (FQHC) in East Los Angeles.
Participants
Adult patients with risky drug use (4–26 on the computerized WHO ASSIST): 65 patients (32 intervention, 33 control); 51 (78%) completed follow-up; mean age 30.8 years; 59% male; 94% Latino.
Interventions and measures
Intervention patients received: 1) brief (typically 3–4 minutes) clinician advice to quit/reduce their risky drug use, 2) video doctor message reinforcing the clinician’s advice, 3) health education booklet, and 4) up to two 20–30 minute follow-up telephone drug use reduction coaching sessions. Control patients received usual care and cancer screening information. Primary outcome was reduction in number of days of drug use in past 30 days of the highest scoring drug (HSD) on the baseline ASSIST, from baseline to 3-month follow-up.
Results
Intervention patients reduced past month HSD use by 4.5 more days than controls (p<.042, 95% CI: 0.2, 8.7) by 3-month follow-up in intent-to-treat linear regression analysis. Similar significant results were found using a complete sample regression analysis: 5.2 days (p<.03, 95% CI: 0.5, 9.9). Additionally, on logistic regression analysis of test results from 47 urine samples at follow-up, intervention patients were less likely than controls to test HSD positive (p < .05; OR:0.10, 95% CI: 0.01, 0.99).
Conclusions
Findings support the efficacy of QUIT for reducing risky drug use.
BackgroundThe Affordable Care Act (ACA) has improved healthcare access in the community health centers that have played a critical role in enrolling low income and minority patients. This study examined the ACA enrollment for one of the largest federally qualified community health centers in the country.MethodsAn exploratory sequential mixed method study was used as the main qualitative and quantitative approach for this study. Key stakeholders (n = 6) were interviewed as part of the qualitative component, and information about barriers and best practices were acquired. As part of the quantitative analysis, we examined cross-sectional data among 59,272 AltaMed enrollees in 2013–2015. We analyzed data on age, gender, language, ethnicity, and enrollment periods. The interviews were conducted first and followed by the data analysis.ResultsAltaMed was the top enroller of patients in ACA insurance plans in California (2013–14 and 2014–15) through the state exchange and Medicaid expansion. Using key stakeholder interviews, 5 main barriers were identified and 5 innovative solutions that allowed AltaMed to enroll people into the state exchange and Medicaid expansion. Barriers to enrollment included training, new workflows, and enrollment of Young Invincibles, and these enrollment barriers were overcome with community health workers.ConclusionEnrollment barriers were overcome through AltaMed’s community-based approach and long term community partnerships.
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