Purpose To describe the impact of a community gardening project on vegetable intake, food security and family relationships. Methods This community-based participatory research project used popular education techniques to support and educate Hispanic farm worker families in planting and maintaining organic gardens. Measures included a pre- post gardening survey, key informant interviews and observations made at community-based gardening meetings to assess food security, safety and family relationships. Results Thirty-eight families enrolled in the study during the pre-garden time period, and four more families enrolled in the study during the post-garden period, for a total of 42 families enrolled in the 2009 gardening season. Of the families enrolled during the pre-gardening time period there were 163 household members. The mean age of the interviewee was 44.0, ranging from 21 to 78 years of age. The median number of occupants in a household was 4.0 (range: 2 to 8), Frequency of adult vegetable intake of “Several time a day” increased from 18.2% to 84.8%, (p < 0.001) and frequency of children’s vegetable intake of “Several time a day” increased from 24.0% to 64.0%, (p = 0.003). Before the gardening season, the sum of the frequencies of “Sometimes” and “Frequently” worrying in the past month that food would run out before money was available to buy more was 31.2% and the sum of these frequencies dropped to 3.1% during the post garden period, (p = 0.006). The frequency of skipping meals due to lack of money was not statistically significantly different before and after the gardening season for either adults or children. Analysis of text responses and key informant interviews revealed that physical and mental health benefits were reported as well as economic and family health benefits from the gardening study, primarily because the families often worked in their gardens together. Conclusions A community gardening program can reduce food insecurity, improve dietary intake and strengthen family relationships.

Electronic health records (EHRs) can improve many aspects of patient care, yet few formal EHR curricula exist to teach optimal use to students and other trainees. The Simulated EHR (Sim-EHR) curriculum was introduced in January 2011 at Oregon Health & Science University (OHSU) to provide learners with a safe hands-on environment in which to apply evidence-based guidelines while learning EHR skills. Using an EHR training platform identical to the OHSU EHR system, learners review and correct a simulated medical chart for a complex virtual patient with chronic diseases and years of fragmented care. They write orders and prescriptions, create an evidence-based plan of care for indicated disease prevention and management, and review their work in a small-group setting. Third-year students complete the Sim-EHR curriculum as part of the required family medicine clerkship; their chart work is assessed using a rubric tied to the curriculum’s general and specific objectives. As of January 2014, 406 third-year OHSU medical students, on campus or at remote clerkship sites, and 21 OHSU internal medicine interns had completed simulated charts. In this article, the authors describe the development and implementation of the Sim-EHR curriculum, with a focus on use of the curriculum in the family medicine clerkship. They also share preliminary findings and lessons learned. They suggest that the Sim-EHR curriculum is an effective, interactive method for providing learners with EHR skills education while demonstrating how a well-organized chart helps ensure safe, efficient, and quality patient care.

Background Studies of the virtual interview format are needed to inform medical residency program leaders as they plan for future virtual interview seasons. Objective In the current study, completed in 2021, we sought to assess applicant perspectives of virtual interview effectiveness, advantages, and barriers, including factors that might impact equity and inclusion. Methods Interviewees applying to 7 residency programs and 2 clinical psychology programs at an academic medical center in the Pacific Northwest completed a post-interview survey. Results A total of 565 of 1429 interviewees (40%) completed the survey. A vast majority (83%–96%) agreed virtual interviews were effective in each measured domain, except for learning institutional culture (352 of 565, 62%). Many also found information regarding social/living environments inadequate. Participants selected advantages to virtual interviews more frequently than disadvantages. Commonly selected advantages included cost savings, time efficiency, reduced burden of travel, and reduced carbon footprint. Disadvantages included time zone differences, access to an appropriate interview setting, and reliable access to internet. The majority of interviewees (84%, 456 of 542) desired to keep a component of virtual interviews in the future. There were no significant disparities in results based on gender, rural/suburban/urban location, race, or underrepresented minority status. Conclusions Virtual interviews were perceived as effective, more advantageous than burdensome, and widely acceptable, with no disparities in these findings by included demographic characteristics.

Community health centers (CHCs), which serve socioeconomically disadvantaged patients, experienced an increase in insured visits after the 2014 Affordable Care Act (ACA) coverage options began. Yet, little is known about how cancer screening rates changed post-ACA. Therefore, this study assessed changes in the prevalence of cervical and colorectal cancer screening from pre- to post-ACA in expansion and non-expansion states among patients seen in CHCs. Electronic health record data on 624,601 non-pregnant patients aged 21–64 eligible for cervical or colorectal cancer screening between 1/1/2012 and 12/31/2015 from 203 CHCs were analyzed. We assessed changes in prevalence and screening likelihood among patients, by insurance type and race/ethnicity and compared Medicaid expansion and non-expansion states using difference-in-difference methodology. Female patients had 19% increased odds of receiving cervical cancer screening post-relative to pre-ACA in expansion states [adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.09–1.31] and 23% increased odds in non-expansion states (aOR = 1.23, 95% CI = 1.05–1.46): the greatest increase was among uninsured patients in expansion states (aOR = 1.36, 95% CI = 1.16–1.59) and privately-insured patients in non-expansion states (aOR = 1.43, 95% CI = 1.11–1.84). Colorectal cancer screening prevalence increased from 11% to 18% pre- to post-ACA in expansion states and from 13% to 21% in non-expansion states. For most outcomes, the observed changes were not significantly different between expansion and non-expansion states. Despite increased prevalences of cervical and colorectal cancer screening in both expansion and non-expansion states across all race/ethnicity groups, rates remained suboptimal for this population of socioeconomically disadvantaged patients.

Two hundred and forty five women were identified in recruiting and enrolling 103 study participants involving 1,232 contact-attempts. Self-referral had the highest ratio of referrals to enrollees (55.6%), while this ratio was the lowest for community outreach (33.3%). Retention activities succeeded in maintaining over 90% of the sample. Ninety-two percent of English-speaking participants completed the study versus 79% of Spanish-speaking participants. The time expenditure per enrollee was 10.4 hours for recruitment and 1.2 hours for retention, with an estimated cost per enrollee of $324.03 for recruitment and $39.14 for retention. More retention activities were required to maintain women in the comparison group than in the intervention group.

Purpose: Internet-based patient portals are increasingly being implemented throughout health care organizations to enhance health and optimize communication between patients and health professionals. The decision to adopt a patient portal requires careful examination of the advantages and disadvantages of implementation. This study aims to investigate 1 proposed advantage of implementation: alleviating some of the clinical workload faced by employees.Methods: A retrospective time-series analysis of the correlation between the rate of electronic patient-to-provider messages-a common attribute of Internet-based patient portals-and incoming telephone calls. The rate of electronic messages and incoming telephone calls were monitored from February 2009 to June 2014 at 4 economically diverse clinics (a federally qualified health center, a rural health clinic, a community-based clinic, and a university-based clinic) related to 1 university hospital.Results: All 4 clinics showed an increase in the rate of portal use as measured by electronic patientto-provider messaging during the study period. Electronic patient-to-provider messaging was significantly positively correlated with incoming telephone calls at 2 of the clinics (r ‫؍‬ 0.546, P < .001 and r ‫؍‬ 0.543, P < .001). The remaining clinics were not significantly correlated but demonstrated a weak positive correlation (r ‫؍‬ 0.098, P ‫؍‬ .560 and r ‫؍‬ 0.069, P ‫؍‬ .671).Conclusions: Implementation and increased use of electronic patient-to-provider messaging was associated with increased use of telephone calls in 2 of the study clinics. While practices are increasingly making the decision of whether to implement a patient portal as part of their system of care, it is important that the motivation behind such a change not be based on the idea that it will alleviate clinical workload. (J Am Board Fam Med 2016;29:613-619.)

IntroductionAlthough safe and effective contraceptive methods are readily available, unintended pregnancy remains a serious public health problem, causing adverse health effects for thousands of women, children and families across the United States (Sheeder, Scott and Stevens-Simon, 2004, Stevens-Simon, Beach andKlerman, 2001). Unintended pregnancies account for about half of all births to U.S. women. An estimated 48% of women age 15-44 have at least one unplanned pregnancy sometime in their lives (Henshaw, 1998, Brown andEisenberg, 1995). Women who are younger, not married, poor and non-white have higher rates of unintended pregnancy (Henshaw, 1998).For sexually active individuals, unintended pregnancy is inextricably linked with contraceptive use and can be attributed to failure to use any contraceptive method, ineffective use of a method or method failure. The results of a recently conducted national survey revealed that over a year, approximately 40% of reproductive-aged women used no contraceptive method for at least one month and an average of 6 to 12 months. Less than 10% of the participants were pregnant or seeking pregnancy. Therefore, 30% of the participants were at risk for unintended conception during these hiatuses in contraceptive use . Three factors, difficulty obtaining contraceptive supplies and care, infrequent sexual intercourse and periodic abstinence, and ambivalence about the desirability of remaining non-pregnant accounted for 80% of the gaps in contraceptive use observed in the study . In addition, women at risk for unintended pregnancy who had less than a college education or were on Medicaid had higher likelihoods of experiencing gaps of at least one month in contraceptive use ).Correspondence to: Alan L. Melnick, MD, MPH, Dept. of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Mail Code: FM, Portland, OR 97239, Telephone: 503-494-0756, Fax: 503-494-2746, e-mail: melnicka@ohsu.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptIncreasing effective contraceptive use could reduce the incidence of unintended pregnancies, and if provided after delivery, could reduce short-interval unintended pregnancy (Sable, Libbus and Chiu, 2000). Unfortunately, many women who are at high risk for unintended pregnancy and could receive services from publicly funded family planning programs may not be able to use them for several reasons. These include the cost of services, structural barriers such as childcare and transportation probl...

Problem Because many medical students do not have access to electronic health records (EHRs) in the clinical environment, simulated EHR training is necessary. Explicitly training medical students to use EHRs appropriately during patient encounters equips them to engage patients while also attending to the accuracy of the record and contributing to a culture of information safety. Approach Faculty developed and successfully implemented an EHR objective structured clinical examination (EHR-OSCE) for clerkship students at two institutions. The EHR-OSCE objectives include assessing EHR-related communication and data management skills. Outcomes The authors collected performance data for students (n = 71) at the first institution during academic years 2011–2013 and for students (n = 211) at the second institution during academic year 2013–2014. EHR-OSCE assessment checklist scores showed that students performed well in EHR-related communication tasks, such as maintaining eye contact and stopping all computer work when the patient expresses worry. Findings indicated student EHR skill deficiencies in the areas of EHR data management including medical history review, medication reconciliation, and allergy reconciliation. Most students’ EHR skills failed to improve as the year progressed, suggesting that they did not gain the EHR training and experience they need in clinics and hospitals. Next Steps Cross-institutional data comparisons will help determine whether differences in curricula affect students’ EHR skills. National and institutional policies and faculty development are needed to ensure that students receive adequate EHR education, including hands-on experience in the clinic as well as simulated EHR practice.