Intensive handwashing promotion can reduce diarrheal and respiratory disease incidence. To determine whether less intensive, more scalable interventions can improve health, we evaluated a school-based handwashing program. We randomized 87 Chinese schools to usual practices: standard intervention (handwashing program) or expanded intervention (handwashing program, soap for school sinks, and peer hygiene monitors). We compared student absence rates, adjusting for cluster design. In control schools, children experienced a median 2.0 episodes (median 2.6 days) of absence per 100 student-weeks. In standard intervention schools, there were a median 1.2 episodes (P = 0.08) and 1.9 days (P = 0.14) of absence per 100 student-weeks. Children in expanded intervention schools experienced a median 1.2 episodes (P = 0.03) and 1.2 days (P = 0.03) of absence per 100 student-weeks. Provision of a large-scale handwashing promotion program and soap was associated with significantly reduced absenteeism. Similar programs could improve the health of children worldwide.
This study reports on implementation of the CommunityRx system, a population health innovation that promoted clinic-community linkages via: a youth workforce (MAPSCorps) that conducted an annual community resource census; Community Health Information Specialists (CHIS) who supported cross-sector resource navigation; and a health information technology (HIT) for prescribing community resources. Between 2012–14, MAPSCorps identified 19,589 public-serving places in the 106mi2 implementation region. CHIS used these data to generate an inventory of nearly 15,000 health-promoting resources. The HIT platform was integrated with 3 electronic health record (EHR) systems at 33 clinical sites to map 37 prevalent health and wellness conditions to community resources; 253,479 personalized HealtheRx “prescriptions” were generated for approximately 113,000 participants. Participants found the HealtheRx very useful (83%); 19% went to a place they learned about from the HealtheRx. This study demonstrates the feasibility of using HIT and workforce innovation to bridge the gap between clinical and other health-promoting sectors.
T he risk of developing cardiovascular disease (CVD) can be greatly reduced through lifestyle and medical therapies that address diet, overweight and obesity, smoking, dysplipidemia, hypertension, and diabetes mellitus. Irrespective of which factors are contributing on an individual's risk for the development of CVD, treatment with statins safely and effectively reduces morbidity and mortality from CVD. 1,2The recent American College of Cardiology/American Heart Association cholesterol treatment guideline emphasizes identifying and treating individuals at risk for developing CVD. 3 However, fewer than half of high-risk individuals are treated with statins. 4,5 Statin use is lower among blacks, 4,6 Hispanics, 5,6 the uninsured, 7 and poorer individuals. 8,9 Reducing the population burden of CVD and decreasing disparities will require maximizing the use of preventive strategies among all individuals likely to benefit from them.Statins may be underused for primary prevention for several reasons. Clinicians and patients may not readily appreciate increased CVD risk, particularly when risk comes from factors other than elevated cholesterol. 10,11 Patients may also Background-Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. Methods and Results-We performed a pragmatic randomized controlled trial at community health centers in 2 states.Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, [12][13][14] Outreach interventions focused on addressing this risk could increase the number of high-risk patients who seek out treatment. 15Implementing population health management strategies in settings that serve large numbers of patients from low income and minority populations may be an effective way to reduce disparities. 16,17 In addition, testing strategies in safety net settings will help ensure that the study findings are applicable to low income and minority populations.We hypothesized that m...
Purpose The cancer survivor population is projected to increase to 22.2 million by 2030, requiring improved collaboration between oncology and primary care practices (PCP). PCPs may feel ill-equipped to provide cancer survivorship care to patients without input from cancer specialists. Compared with nonrural cancer survivors, rural cancer survivors report experiencing worse treatment-related symptoms. The goal of this study was to gain a better understanding of the perspectives of PCP teams towards survivorship care and to develop and test an interdisciplinary training program to improve cancer survivorship care in rural practice. Methods This study was conducted in two phases. First, focus groups were conducted with rural PCP teams to gather information regarding beliefs, practices, and barriers related to cancer survivorship care delivery. A thematic analysis was completed using an iterative process of reviewing transcripts. Results from phase 1 were used to inform the development of a pilot intervention tested within seven rural PCPs (phase 2). Pre- and post-intervention knowledge changes were compared, and post-session interviews assessed planned or sustained practice changes. Results Seven PCPs participated in focus groups (phase 1). Cross-cutting themes identified included (1) organizational barriers affecting the delivery of cancer survivorship care, (2) challenges of role delineation with specialists and patients, (3) difficulty accessing survivorship care and resources, and (4) providers’ lack of knowledge of cancer survivorship care. For phase 2, seven practices participated in four case-based educational sessions. Within and between practice changes were identified. Conclusion This project explored cancer survivorship perspectives among PCP teams. Lack of familiarity with evidence-based guidelines and the inability to identify cancer survivors was apparent during discussions and led to the implementation of the phase 2 intervention, iSurvive. As a result, PCPs either changed or planned changes to improve the identification and evidence-based care of cancer survivors. Implications for Cancer Survivors Address barriers to access cancer survivorship care in rural primary care practices.
Background Underserved ethnic minority populations experience significant disparities in HIV, hepatitis C virus (HCV), colorectal cancer (CRC), and cervical cancer incidence and mortality. Much of the excess burden of these diseases among underserved communities is due to lack of preventive care, including screening. Barriers to disease screening include low awareness, lack of access to care and health insurance, and cultural beliefs regarding disease prevention. Our current trial aims to examine community health worker (CHW)-delivered, home-based multi-modality screening for HIV, HCV, CRC, and cervical cancer simultaneously. Design We are conducting a randomized pragmatic trial among 900 Haitian, Hispanic, and African-American participants from diverse underserved communities in South Florida. People between the ages of 50 and 65 who have not had appropriate HIV, HCV, CRC, and cervical cancer screening per United States Preventive Services Task Force (USPSTF) recommendations are eligible for the study. Participants are recruited by CHWs and complete a structured interview to assess multilevel determinants of disease risk. Participants are then randomized to receive HIV, HCV, CRC, and cervical cancer screening via navigation to care by a CHW (Group 1) or via CHW-delivered home-based screening (Group 2). The primary outcome is completion of screening for each of these diseases within 6 months post-enrollment. Discussion Our trial is among the first to examine the effectiveness of a CHW-delivered, multimodality, home-based disease-screening approach. If found to be effective, this approach may represent a cost-effective strategy for disease screening within underserved and underscreened minority groups. Trial registration Clinical Trials.gov # NCT02970136, registered November 21, 2016.
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