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Buchanan, C., T. Manion, and R. Jayasinghe. "Heart Health Screening Clinics." Heart, Lung and Circulation 18 (2009): S195. http://dx.doi.org/10.1016/j.hlc.2009.05.442.
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Lock, Loren J., Roomasa Channa, Meghan B. Brennan, Ying Cao, and Yao Liu. "Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening." BMJ Open Diabetes Research & Care 10, no. 6 (2022): e003174. http://dx.doi.org/10.1136/bmjdrc-2022-003174.
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IntroductionRural versus urban disparities have been observed in diabetic eye screening, but whether the level of disadvantage in rural versus urban areas is related to these disparities is unclear. Our goal was to determine the role of level of disadvantage in explaining the effect of health systems on rural and urban disparities in diabetic eye screening.Research design and methodsThis is a retrospective cohort study using an all-payer, state-wide claims database covering over 75% of Wisconsin residents. We included adults with diabetes (18–75 years old) who had claims billed throughout the baseline (2012–2013) and measurement (2013–2014) years. We performed multivariable regressions to assess factors associated with receipt of diabetic eye screening. The primary exposure was the primary care clinic’s combined level of rurality and disadvantage. We adjusted for the health system as well as patient-level variables related to demographics and comorbidities. Health system was defined as an associated group of physicians and/or clinics.ResultsA total of 118 707 adults with diabetes from 698 primary care clinics in 143 health systems met the inclusion criteria. Patients from urban underserved clinics were less likely to receive screening than those from rural underserved clinics before adjusting for health system in the model. After adjusting for health system fixed effects, however, the directionality of the relationship between clinic rurality and screening reversed: patients from urban underserved clinics were more likely to receive screening than those from rural underserved clinics. Similar findings were observed for both Medicare and non-Medicare subgroups.ConclusionsThe effect of health system on receipt of diabetic eye screening in rural versus urban areas is most pronounced in underserved areas. Health systems, particularly those providing care to urban underserved populations, have an opportunity to increase screening rates by leveraging health system-level interventions to support patients in overcoming barriers from social determinants of health.
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Bloom, Joan R., Susan L. Stewart, Jocelyn Koo, and Robert A. Hiatt. "Cancer Screening in Public Health Clinics." Medical Care 39, no. 12 (2001): 1345–51. http://dx.doi.org/10.1097/00005650-200112000-00010.
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Buchanan, Christine. "Indigenous Heart Health Outreach Screening Clinics." Heart, Lung and Circulation 20 (January 2011): S4. http://dx.doi.org/10.1016/j.hlc.2011.04.016.
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Buchanan, Christine. "Indigenous Heart Health Outreach Screening Clinics." Heart, Lung and Circulation 21, no. 10 (2012): 651. http://dx.doi.org/10.1016/j.hlc.2012.07.029.
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de Vos, L., E. Mazinyo, D. Bezuidenhout, et al. "Reasons for missed opportunities to screen and test for TB in healthcare facilities." Public Health Action 12, no. 4 (2022): 171–73. http://dx.doi.org/10.5588/pha.22.0042.
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Missed opportunities for TB screening and/or passive testing in clinics continues to contribute to the number of missed cases. To understand reasons for these missed opportunities, we conducted focus group discussions with clinic-based nurses. Nurses described low indices of suspicion, prioritization of seemingly more urgent ailments and clinic operational challenges as barriers to TB screening and testing. To improve TB screening and testing in clinics, standard patients should be used to identify real-time factors that impact nurses’ clinical decision-making and engage in real-time feedback and discussion with nurses to help optimize opportunities for TB screening and testing.
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Stepien, Cathie J., Marilyn A. Bowbeer, and Roland G. Hiss. "Screening for Diabetic Retinopathy in Communities." Diabetes Educator 18, no. 2 (1992): 115–20. http://dx.doi.org/10.1177/014572179201800205.
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Twelve retinopathy screening clinics serving 489 diabetic patients were conducted in three Michigan communities as part of the outreach effort of the Michigan Diabetes Research and Training Center. Screening activities were initiated by local diabetes educators who conducted a program designed to promote detection of diabetic eye disease and increase patient and health care provider awareness of accepted ophthalmic evaluation guidelines. This experience suggests that retinopathy screening clinics can be successfully conducted if health care professionals in the community consider diabetic retinopathy to be a serious problem, one individual is willing to oversee the organizational aspects of the clinic, and an ophthalmologist with laser treatment capability is present or nearby. These clinics are effective in detecting diabetic eye disease and facilitating subsequent patient visits to an ophthalmologist for evaluation in accordance with national recommendations.
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Edwards, Joellen Beckett, and Fred Tudiver. "Women's Preventive Screening in Rural Health Clinics." Women's Health Issues 18, no. 3 (2008): 155–66. http://dx.doi.org/10.1016/j.whi.2008.01.005.
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Walker, Timothy J., Betsy Risendal, Michelle C. Kegler, et al. "Assessing Levels and Correlates of Implementation of Evidence-Based Approaches for Colorectal Cancer Screening: A Cross-Sectional Study With Federally Qualified Health Centers." Health Education & Behavior 45, no. 6 (2018): 1008–15. http://dx.doi.org/10.1177/1090198118778333.
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Multiple evidence-based approaches (EBAs) exist to improve colorectal cancer screening in health clinics. The success of these approaches is tied to effective implementation. Therefore, the purpose of this study was to assess the implementation of EBAs for colorectal cancer screening and clinic-level correlates of implementation in federally qualified health centers (FQHCs). We conducted descriptive and cross-sectional analyses using data collected from FQHC clinics across seven states ( n = 51). A clinic representative completed electronic surveys about clinic characteristics (e.g., size, patient characteristics, and medical record system characteristics) and the implementation of Community Guide recommended EBAs (e.g., client reminders, small media, and provider assessment and feedback). We used bivariate Spearman correlations to assess clinic-level correlates with implementation outcomes. Most clinics were planning to implement, in the early implementation stages, or inconsistently implementing EBAs. No EBA was fully implemented by more than nine (17.6%) clinics. Clinic size variables were inversely related to implementation levels of one-on-one education; medical record variables were directly related to implementation levels of client and provider reminders as well as provider assessment and feedback; and rapid and timely feedback from clinic leaders was directly associated with implementation levels of four out of six EBAs. Given the varying levels of implementation, clinics need to assess current use of implementation strategies and improve effective program delivery to increase colorectal cancer screening among their patients. In addition, clinics should also consider how their characteristics may support or serve as a barrier to implementation in their respective settings.
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MacDonald, Madeline, Abu-Sayeef Mirza, Rahul Mhaskar, et al. "Preventative Cancer Screening Rates Among Uninsured Patients in Free Clinics: A Retrospective Cohort Study of Cancer Survivors and Non-cancer Survivors." Cancer Control 29 (January 2022): 107327482110729. http://dx.doi.org/10.1177/10732748211072983.
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Background There is limited research on screening rates among uninsured cancer survivors. Uninsured cancer survivors are at higher risk of poorer health outcomes than the insured due to limited access to preventative screening for secondary cancers. This study examines the rates of surveillance and screening of uninsured cancer survivors and compares to uninsured patients without a cancer history seen in free clinics. Methods Data were collected retrospectively from electronic medical records and paper charts of patients from 10 free clinics between January 2016 and December 2018 in the Tampa Bay area. The prevalence of socioeconomic characteristics, cancer diagnoses, and screening practices were compared for cancer survivors and free clinic patients without a history of cancer. Study participants were determined to be eligible for cancer screenings based on the United States Preventive Services Task Force guidelines. Results Out of 13 982 uninsured patients frequenting free clinics between 2016 and 2018, 402 (2.9%) had a documented history of cancer. Out of the 285 eligible cancer survivors, 44 (15.4%) had completed age-appropriate colon cancer screening. Among the 170 female cancer survivors, 75 (44.1%) had completed breast cancer screenings, and only 5.9% (59/246) had completed cervical cancer screenings. After adjusting for age, gender, race, salary, employment status, and household size, cancer survivors were more likely to undergo colorectal cancer screening (OR: 3.59, 95% CI: 2.10–6.15) and breast cancer screening (OR: 2.13, 95% CI: 1.30–3.84) than patients without a cancer history. This difference was not seen for cervical cancer screening (OR: 0.99, 95% CI: .62–1.58). Conclusions Uninsured cancer survivors frequenting free clinics represent a unique population that is underrepresented in the medical literature. Our results suggest that uninsured survivors use screening services at higher rates when compared to uninsured patients without a reported cancer diagnosis. However, these rates are suboptimal when compared to national screening rates of insured cancer survivors.
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Herbert, Linda, and Steven Hardy. "Implementation of a Mental Health Screening Program in a Pediatric Tertiary Care Setting." Clinical Pediatrics 58, no. 10 (2019): 1078–84. http://dx.doi.org/10.1177/0009922819862613.
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We evaluated the acceptability and usefulness of brief mental health screening during pediatric subspecialty clinic visits. Patients (8-17 years) and parents (of patients 5-17 years) in pediatric allergy, immunology, and hematology clinics completed the PROMIS (Patient-Reported Outcomes Measurement Information System) Pediatric Profile. Medical providers reviewed results and interpretations to guide discussion of mental health during visits. Almost all providers (96%) reported discussing mental health during visits but fewer parents (60%) said this discussion occurred. All parents who reported that mental health discussions occurred liked that this happened. Some parents (25%) who said no mental health discussion occurred wished it had. Most parents strongly agreed that screening completion was easy and appropriate. Most providers (79%) believed the screening was useful and 87% reported using screening results to guide discussion. Brief electronic mental health screening in pediatric subspecialty clinics is feasible, useful in guiding discussion, and viewed favorably by providers and parents of children with chronic illnesses.
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Hamm, Jennifer, Lee Hilliard, Thomas H. Howard, and Jeffrey D. Lebensburger. "Maintaining High Level Of Care At Outreach Sickle Cell Clinics." Blood 122, no. 21 (2013): 2976. http://dx.doi.org/10.1182/blood.v122.21.2976.2976.
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Introduction Parents of children with sickle cell disease often seek care at large, university based sickle cell clinics. A major health care barrier for children in Alabama involves the cost and time of travelling to and from university based clinics. To reduce this health care barrier, the University of Alabama at Birmingham (UAB) developed The Children and Youth Sickle Cell Network(®) (CYSN(®)). This network consists of the central sickle cell clinic located at UAB and four outreach sickle cell clinics located in Montgomery (100 miles south of UAB), Opelika (110 miles southeast of UAB), Huntsville (100 miles north of UAB), and Tuscaloosa (60 miles west of UAB). The goal for these clinics is to maintain a similar level of medical care while reducing the health care barrier of transportation. Objective To determine if the outreach clinics provide similar care to university based clinics, we evaluated three surrogate preventive care markers to compare access to care in central vs. outreach clinics: 1) attendance rates, 2) number of patients on hydroxyurea, and 3) percent of MRIs obtained for screening of silent infarct among eligible patients. Methods A retrospective review of all CYSN(r) clinic visits from June 2012 to June 2013 was performed to determine clinic attendance rates. All patients on hydroxyurea were categorized by clinic location. Every patient attending CYSN(r) clinic between ages of 6 and 15 years had their medical record reviewed for completion of a screening MRI/MRA. Results At the central Birmingham clinic, the appointment show rate was 59.8% as compared to the Montgomery, Opelika, Huntsville, and Tuscaloosa show rates which were 57.7%, 73.1%, 59.4%, and 70% respectively. At UAB, institutional guidelines were developed for offering hydroxyurea to patients based on clinical indications and applied to all clinics. The percentage of patients on hydroxyurea therapy in Birmingham is 22.2%, while the percentages in Montgomery, Opelika, Huntsville, and Tuscaloosa are 21.5%, 32%, 21.4% and 24.4%, respectively. Finally, screening MRI/MRA to evaluate for evidence of silent cerebral infarctions is performed in Birmingham but offered to children ages 6-15 years at all sickle cell clinics. In Birmingham, 63.6% of eligible patients completed MRI/MRA screening. This percentage is similar for patients in Montgomery, Opelika, and Tuscaloosa who were screened at 66.7%, 83.3%, and 67.7% respectively. Conclusions Our data suggests that outreach clinics can provide similar levels of medical care for children with sickle cell disease. Sickle cell centers treating patients that must travel long distances should consider developing outreach clinics to help reduce this major health care barrier. Disclosures: No relevant conflicts of interest to declare.
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Owen, Sue, Mark Newman, Bethan Moran, Linda Pilkington, and Colm O'Mahony. "Nurse-led asymptomatic screening clinics." International Journal of STD & AIDS 17, no. 5 (2006): 355–56. http://dx.doi.org/10.1258/095646206776790222.
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Coker, Ann L., Vicki C. Flerx, Paige H. Smith, Daniel J. Whitaker, Mary Kay Fadden, and Melinda Williams. "Partner Violence Screening in Rural Health Care Clinics." American Journal of Public Health 97, no. 7 (2007): 1319–25. http://dx.doi.org/10.2105/ajph.2005.085357.
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Radcliffe, Keith, and Nicola Thorley. "Screening for alcohol misuse in sexual health clinics." Sexually Transmitted Infections 91, no. 1 (2014): 4–5. http://dx.doi.org/10.1136/sextrans-2014-051881.
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Cuevas, Heather, Julie Zuñiga, and Stephanie Morgan. "Factors Affecting Cognitive Dysfunction Screening for Latinx Adults With Type 2 Diabetes." Innovation in Aging 5, Supplement_1 (2021): 264–65. http://dx.doi.org/10.1093/geroni/igab046.1021.
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Abstract Before development of overt type 2 diabetes (T2DM), changes in brain structure and activation patterns are found in insulin resistance, indicating many with T2DM may already have alterations in cognitive function. How best practices are met for screening for cognitive dysfunction, specifically Latinx adults with T2DM who are at higher risk, remains unclear. The purpose of this study was to examine aspects influencing screening Latinx adults with T2DM for cognitive problems by identifying patient-, clinician- and clinic- level factors. This was a mixed methods study which used semi-structured interviews with Latinx adults with T2DM (n=30; mean age: 68; 57% Mexican American); surveys and interviews with health care providers (n = 15); and inventories of four outpatient clinics to identify factors (e.g. time, clinic policies) influencing screening. Data were analyzed via thematic analysis (interviews) and descriptive statistics (surveys and inventories). For patients, screening was important, but inability to work related to a possible diagnosis of dementia was a concern. Providers and patients agreed other health issues (e.g. hyperglycemia) took precedence to screening. Providers (96.7%) were expected to screen but did not have support/time from clinics and relied on patients for initial prompts. Only one clinic reported staff education on cognitive screening with an emphasis on potential cultural differences in test results and adequate resources related to dementia for Latinx adults. Clinics serving Latinx adults have a responsibility to deliver appropriate care. Leadership should consider innovative practices such creation, with patients, of educational materials for screening -a need highlighted by most participants.
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McCord, Sarah A., Mary G. Lynch, and April Y. Maa. "Diagnosis of retinal detachments by a tele-ophthalmology screening program." Journal of Telemedicine and Telecare 25, no. 3 (2018): 190–92. http://dx.doi.org/10.1177/1357633x18760418.
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In 2015, a tele-ophthalmology program was undertaken at the Atlanta Veterans Affairs Medical Center to provide screening eye care for veterans in their primary care clinics. Though this program was developed as a screening tool, the availability of these services in primary care clinics has enabled triage of certain acute eye complaints. These case reports describe two patients who were diagnosed with retinal detachments through this program, although their primary care providers had triaged them as requiring non-urgent referrals to the eye clinic. Although many patients are seen for acute ocular complaints in primary care clinics and emergency departments, providers in such settings may lack the ability to adequately examine eyes and thus triage ocular complaints. These cases demonstrate the ability of tele-ophthalmology to assist in diagnosing urgent ocular conditions in primary care clinics. Though tele-ophthalmology has been accepted in some parts of the world, in the United States of America it remains widely underutilized. These cases highlight the ability of tele-ophthalmology to close the gap in acute eye care coverage that exists in the USA, most prominently in rural regions.
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Grunauer, Michelle, David Schrock, Eric Fabara, et al. "Tablet-Based Screening of Depressive Symptoms in Quito, Ecuador: Efficiency in Primary Care." International Journal of Family Medicine 2014 (February 17, 2014): 1–7. http://dx.doi.org/10.1155/2014/845397.
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Depression is a frequent yet overlooked occurrence in primary health care clinics worldwide. Depression and related health screening instruments are available but are rarely used consistently. The availability of technologically based instruments in the assessments offers novel approaches for gathering, storing, and assessing data that includes self-reported symptom severity from the patients themselves as well as clinician recorded information. In a suburban primary health care clinic in Quito, Ecuador, we tested the feasibility and utility of computer tablet-based assessments to evaluate clinic attendees for depression symptoms with the goal of developing effective screening and monitoring tools in the primary care clinics. We assessed individuals using the 9-item Patient Health Questionnaire, the Quick Inventory of Depressive Symptoms-Self-Report, the 12-item General Health Questionnaire, the Clinical Global Impression Severity, and a DSM-IV checklist of symptoms. We found that 20% of individuals had a PHQ9 of 8 or greater. There was good correlation between the symptom severity assessments. We conclude that the tablet-based PHQ9 is an excellent and efficient method of screening for depression in attendees at primary health care clinics and that one in five people should be assessed further for depressive illness and possible intervention.
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Camino, Andres, Meghan Whitfield, and Nicholas Van Wagoner. "10543 Assessing Sexual Health Services at a public university in the Deep South." Journal of Clinical and Translational Science 5, s1 (2021): 26. http://dx.doi.org/10.1017/cts.2021.472.
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ABSTRACT IMPACT: Our work helps show universities that embedding dedicated sexual health clinics within university health and wellness clinics may expand the amount of students they see for sexual health screenings during a time of increased sexual behavior and exploration. OBJECTIVES/GOALS: The National College Health Association reports that college students have frequent, condomless sex. Student health and wellness clinics (SHWC) offer sexual health services, but few have dedicated sexual health clinics (SHC). We evaluated sexual health service use at a university SHWC after implementation of a dedicated SHC two half-days per week. METHODS/STUDY POPULATION: This was a retrospective analysis of data collected from patients receiving sexual health screening at the University of Alabama at Birmingham (UAB) SHWC between January 2015 and June 2019. Demographic variables, sexual behaviors, reason for testing, and rates of STIs were extracted from the electronic medical record and were compared by clinic (SHC vs. SHWC). Data on screening visits of patients over 18 were included in the final analysis. Variables were summarized with frequencies and percentages. Univariate models were fit, and multi-variable models will be fit, selecting variables with p values of 0.1 or less. Odds ratios with corresponding 95% confidence intervals for univariate analysis are presented. The study was approved by the UAB Institutional Review Board. RESULTS/ANTICIPATED RESULTS: A total of 5025 STI screenings were performed. Males (OR 4.13; 3.61-4.72), undergraduates (OR 1.33; 1.15-1.54), and persons reporting sex with the same sex (OR 1.88; 1.56-2.28), were significantly more likely to seek care at the SHC. Students with symptoms were more likely to seek care at the SHWC (OR 0.53; 0.47-0.61), while persons who reported contact with STIs were more likely to seek care at the SHC (OR 2.88; 2.22-3.74). The overall percentage of positive screenings was 9.3% for chlamydia (CT), 3.0% for gonorrhea (GC), 0.8% for trichomoniasis (TV), 0.7% for syphilis, and 0.3% for HIV with higher percentages of positive for CT (OR 1.60; 1.30-1.96) and GC (OR 2.02; 1.44-2.85) in the SHC. A greater percentage of positives for TV (OR 0.37; 0.14-0.96) was found in the SHWC. DISCUSSION/SIGNIFICANCE OF FINDINGS: Based on demographics of persons utilizing services, embedding a dedicated SHC within a university SHWC may expand populations reached for STI screening. With higher percentages of patients testing positive for CT and GC, a SHC may allow for greater diagnosis and treatment of STIs in general screening and persons presenting as contacts.
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Ketema, L., Z. G. Dememew, D. Assefa, et al. "Evaluating the integration of tuberculosis screening and contact investigation in tuberculosis clinics in Ethiopia: A mixed method study." PLOS ONE 15, no. 11 (2020): e0241977. http://dx.doi.org/10.1371/journal.pone.0241977.
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Background Aligned with global childhood tuberculosis (TB) road map, Ethiopia developed its own in 2015. The key strategies outlined in the Ethiopian roadmap are incorporating TB screening in Integrated Maternal, Neonatal and Child Illnesses (IMNCI) clinic for children under five years (U5) and intensifying contact investigations at TB clinic. However, these strategies have never been evaluated. Objective To evaluate the integration of tuberculosis (TB) screening and contact investigation into Integrated Maternal, Neonatal and Child Illnesses (IMNCI) and TB clinics in Addis Ababa, Ethiopia. Methods The study used mixed methods with stepped-wedge design where 30 randomly selected health care facilities were randomized into three groups of 10 during August 2016-November 2017. The integration of TB screening into IMNCI clinic and contact investigation in TB clinic were introduced by a three-day childhood TB training for health providers. An in-depth interview was used to explore the challenges of the interventions and supplemented data on TB screening and contact investigation. Results Overall, 180896 children attended 30 IMNCI clinics and145444 (80.4%) were screened for TB. A total of 688 (0.4%) children had presumptive TB and 47(0.03%) had TB. During the pre-intervention period, 51873 of the 85278 children (60.8%) were screened for TB as compared to 93570 of the 95618 children (97.9%) in the intervention (p<0.001). This had resulted in 149 (0.30%) and 539 (0.6%) presumptive TB cases in pre-intervention and intervention periods (p<0.001), respectively. Also, nine TB cases (6.0%) in pre-intervention and 38 (7.1%) after intervention were identified (p = 0.72). In TB clinics, 559 under-five (U5) contacts were identified and 419 (80.1%) were screened. In all, 51(9.1%) presumed TB cases and 12 (2.1%) active TB cases were identified from the traced contacts. TB screening was done for 182 of the 275 traced contacts (66.2%) before intervention and for 237 of the 284 of the traced (83.5%) under intervention (p<0.001). Isoniazid prevention therapy (IPT) was initiated for 69 of 163 eligible contacts (42.3%) before intervention and for 159 of 194 eligible children (82.0%) under intervention (p<0.001). Over 95% of health providers indicated that the integration of TB screening into IMNCI and contact investigation in TB clinic is acceptable and practical. Gastric aspiration to collect sputum using nasogastric tube was reported to be difficult. Conclusions Integrating TB screening into IMNCI clinics and intensifying contact investigation in TB clinics is feasible improving TB screening, presumed TB cases, TB cases, contact screening and IPT coverage during the intervention period. Stool specimen could be non-invasive to address the challenge of sputum collection.
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Louw, Christine, De Wet Swanepoel, Robert H. Eikelboom, and Hermanus C. Myburgh. "Smartphone-Based Hearing Screening at Primary Health Care Clinics." Ear and Hearing 38, no. 2 (2017): e93-e100. http://dx.doi.org/10.1097/aud.0000000000000378.
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Tudiver, Fred, Joellen Beckett Edwards, and Deborah T. Pfortmiller. "Depression Screening Patterns for Women in Rural Health Clinics." Journal of Rural Health 26, no. 1 (2010): 44–50. http://dx.doi.org/10.1111/j.1748-0361.2009.00264.x.
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Tantipoj, Chanita, Narin Hiransuthikul, Sirirak Supa-amornkul, Vitool Lohsoonthorn, and Siribang-on Piboonniyom Khovidhunkit. "Patients’ attitude toward diabetes mellitus screening in Thai dental clinics." Journal of Health Research 32, no. 1 (2018): 2–11. http://dx.doi.org/10.1108/jhr-11-2017-001.
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Purpose Diabetes mellitus (DM) is an important health problem throughout the world. Association between DM and oral diseases has been reported and dental clinic is indicated to be one of the suitable venues for the screening of DM. The purpose of this paper is to determine patients’ attitude toward DM screening in dental clinics. Design/methodology/approach The anonymous, self-administered questionnaires of five-point response scale questions were distributed to convenience samples of adult patients (⩾25 years) attending one of the dental settings. These dental settings were divided into the university/hospital-based dental clinics (encompassing two university-based and five hospital-based dental clinics) or the private dental clinics (encompassing two private, and one special (after office hour) clinic of a faculty of dentistry). The questions could be categorized into three groups regarding importance, willingness, and agreement of DM screening in dental settings. Results are presented as percentage by respondents based upon the number of responses for each question. The favorable outcomes which were defined as responses of either scale of 4 or 5 were also summarized according to dental settings. The χ2 test for comparison was used to compare the favorable outcomes between the two settings. Findings A total of 601 completed questionnaires were collected; 394 from university/hospital-based dental clinics and 207 from two private clinics and a special (after office hour) clinic of a faculty of dentistry. Overall, the majority of respondents in both university/hospital-based and private practice settings felt that it is important to have a dentist conduct a screening (84.8 vs 79.5 percent). The majority of patients in both groups were willing to receive blood pressure examination (95.0 vs 92.0 percent), weight and height measurements (94.7 vs 94.0 percent), saliva/oral fluid investigation (86.4 and 86.9 percent) and finger-stick blood test (83.8 vs 83.9 percent). More than 75 percent of all respondents agreed with diabetes screening in dental clinics. Originality/value The majority of respondents supported the screening of DM in dental settings and they were willing to have a screening test by the dentist. Patient acceptance is an important key to be successful in the screening of DM in dental settings.
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Menon, Usha, Laura A. Szalacha, Jennifer Kue, et al. "Effects of a Community-to-Clinic Navigation Intervention on Colorectal Cancer Screening Among Underserved People." Annals of Behavioral Medicine 54, no. 5 (2019): 308–19. http://dx.doi.org/10.1093/abm/kaz049.
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Abstract Background Colorectal cancer screening remains suboptimal among poor and underserved people. Purpose We tested the effectiveness of a community-to-clinic navigator intervention to guide multicultural, underinsured individuals into primary care clinics to complete colorectal cancer screening. Methods This two-phase behavioral intervention study was conducted in Phoenix, Arizona (2012–2018). Community sites were randomized to group education or group education plus tailored navigation to increase attendance at primary care clinics (Phase I). Individuals who completed a clinic appointment received the tailored navigation in person or via phone (Phase II). Results In Phase I (N = 345), 37.9% of the intervention group scheduled a clinic appointment versus 19.4% of the comparison group. In Phase II, 26.5% of the original intervention group were screened versus only 10.4% of the original comparison group. Those in the intervention group were 3.84 times more likely to be screened than were those in the comparison group (odds ratio = 3.84; 95% confidence interval = 1.81–6.92). Conclusions Translation of an efficacious tailored navigation intervention for colorectal cancer screening to a community-to-clinic context is associated with significantly increased rates of colorectal cancer screening. Navigation assistance to address barriers to screening may serve as the most important component of any educational program to increase individual adherence to colorectal cancer screening.
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Woo, Y. L., N. H. Nasir, J. Kanapathy, and Z. Mohd Said. "A Study Utilizing Mobile E-Health and Self-Acquired Cervical Screening in Health Clinics." Journal of Global Oncology 4, Supplement 2 (2018): 213s. http://dx.doi.org/10.1200/jgo.18.85700.
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Background: Malaysia continues to have a high incidence of cervical cancer with a relatively high mortality rate due to late presentation. Pilot Project R.O.S.E was a cross-sectional study to assess acceptability, feasibility and reach of a cervical screening strategy that utilizes self-collected, point-of-care HPV testing in primary care settings. Within this study, mobile SMS technology was used to register patients into a cervical screening registry and to deliver the HPV test results. Aim: To assess the feasibility, acceptability, advantages and limitations of the use of mobile SMS technology to deliver HPV screening test results. Methods: Invitation for cervical screening was offered to women aged 30 to 65 years who are presenting to these clinics for care, or accompanying another individual. Upon agreeing to do the test, the nurse registered the woman's details and mobile number. A mobile phone verification SMS is triggered at this point. HPV results were delivered to women via mobile SMS within 3 working days. Phone-based surveys were conducted on randomly selected screened positives and screened negative women to ascertain acceptability of the screening and the usage of mobile technology. Results: Ninety percent of participants received their SMS results without any hitches. Ten percent of participants experienced problems with receiving their results SMS. Further investigations revealed that there were various reasons for message delivery failure. Posttest surveys revealed that majority of participants were satisfied with the use of mobile technology to receive HPV screening test results. Conclusion: This study suggests that the use of mobile SMS technology for delivery of HPV screening test results is feasible and acceptable. However, measures should be taken to overcome technology related failures. The findings of this implementation research may help to inform the design of future mobile SMS technology usage within health settings in Malaysia.
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Bennett, Sophie D., Isobel Heyman, Anna E. Coughtrey, et al. "Assessing feasibility of routine identification tools for mental health disorder in neurology clinics." Archives of Disease in Childhood 104, no. 12 (2019): 1161–66. http://dx.doi.org/10.1136/archdischild-2018-316595.
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ObjectiveWe aimed to test the feasibility of using an online parent-completed diagnostic assessment for detecting common mental health disorders in children attending neurology clinics. The assessment does not require intervention by a mental health professional or additional time in the clinic appointment.SettingTwo parallel and related screening studies were undertaken: Study 1: Tertiary paediatric neurology clinics. Study 2: Secondary and tertiary paediatric neurology clinics.PatientsStudy 1: 406 Young people aged 7–18 attending paediatric neurology clinics. Study 2: 225 Young people aged 3–18 attending paediatric epilepsy clinics.InterventionsParents completed online versions of the Strengths and Difficulties Questionnaire (SDQ) and Development and Well-being Assessment (DAWBA).Main outcome measuresWe investigated: the willingness of families to complete the measures, proportion identified as having mental health disorders, time taken to complete the measures and acceptability to families and clinicians.ResultsThe mean total difficulties score of those that had completed the SDQ fell in the ‘high’ and ‘very high’ ranges. 60% and 70% of the DAWBAS completed met criteria for at least one DSM-IV disorder in study 1 and 2 respectively. 98% of the parents reported that the screening methods used were acceptable.
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Rangolo, Nthanyiseni, Takalani Grace Tshitangano, and Foluke Comfort Olaniyi. "Compliance of Professional Nurses at Primary Health Care Facilities to the South African Cervical Cancer Screening Guidelines." Nursing Reports 11, no. 4 (2021): 741–49. http://dx.doi.org/10.3390/nursrep11040069.
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Despite the availability of the South African cervical cancer screening guidelines at clinics, women still present in district hospitals of Thulamela Municipality with no cervical cancer screening results. Thus, many cervical cancer screenings done at the hospitals often come back positive for cervical cancer at advanced stages. This study was conducted to investigate the compliance of professional nurses at primary health care facilities (PHCs) in Thulamela Municipality to the South African cervical cancer screening guidelines. The study adopted a qualitative approach. Purposive, non-probability sampling method was used to select PHCs and recruit eligible participants. Sample size was determined by data saturation. A digital recorder was used to log individual responses during interview sessions. Data from the digital recordings were transcribed verbatim. Results were analysed and interpreted in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist. This study established that clinic professional nurses are non-compliant to the South African cervical cancer screening guidelines owing to several challenges they face, such as inadequate knowledge of the cervical cancer screening guidelines, shortage of resources, shortage of staff and patients’ factors. We recommend a strengthening of the South African cervical cancer screening guideline, in-service trainings and workshops on cervical cancer and cervical cancer screening guideline as well as improvement on patients’ education.
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Hunter, Tara, Jessica R. Botfield, Jane Estoesta, Pippa Markham, Sarah Robertson, and Kevin McGeechan. "Experience of domestic violence routine screening in Family Planning NSW clinics." Sexual Health 14, no. 2 (2017): 155. http://dx.doi.org/10.1071/sh16143.
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Background: This study reviewed implementation of the Domestic Violence Routine Screening (DVRS) program at Family Planning NSW and outcomes of screening to determine the feasibility of routine screening in a family planning setting and the suitability of this program in the context of women’s reproductive and sexual health. Methods: A retrospective review of medical records was undertaken of eligible women attending Family Planning NSW clinics between 1 January and 31 December 2015. Modified Poisson regression was used to estimate prevalence ratios and assess association between binary outcomes and client characteristics. Results: Of 13 440 eligible women, 5491 were screened (41%). Number of visits, clinic attended, age, employment status and disability were associated with completion of screening. In all, 220 women (4.0%) disclosed domestic violence. Factors associated with disclosure were clinic attended, age group, region of birth, employment status, education and disability. Women who disclosed domestic violence were more likely to have discussed issues related to sexually transmissible infections in their consultation. All women who disclosed were assessed for any safety concerns and offered a range of suitable referral options. Conclusion: Although routine screening may not be appropriate in all health settings, given associations between domestic violence and sexual and reproductive health, a DVRS program is considered appropriate in sexual and reproductive health clinics and appears to be feasible in a service such as Family Planning NSW. Consistent implementation of the program should continue at Family Planning NSW and be expanded to other family planning services in Australia to support identification and early intervention for women affected by domestic violence.
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CALSYN, DONALD A., ANDREW J. SAXON, and D. CHRISTOPHER BARNDT. "Urine Screening Practices in Methadone Maintenance Clinics." Journal of Nervous and Mental Disease 179, no. 4 (1991): 222–27. http://dx.doi.org/10.1097/00005053-199104000-00008.
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Stipelman, Carole H., Gregory J. Stoddard, Elizabeth R. Smith, et al. "Quality Improvement Intervention for Universal Lipid Screening in Children Aged 9 to 11 Years." Clinical Pediatrics 58, no. 14 (2019): 1528–33. http://dx.doi.org/10.1177/0009922819884403.
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We performed a quality improvement intervention to increase universal lipid screening in well-child visits (age 9 to 11 years): 12-month preintervention; phase 1 (8 months) with provider education, group monthly chart review with feedback, and electronic health record cues to order lipids; and phase 2 (16 months) with electronic health record cues and examination room phlebotomy. Outcomes were compared with clinics having no intervention. In phase 1, immediate treatment effect on the regression line for provider behavior (proportion of visits with lipids ordered) showed 34% increase in intervention and 7% decrease in comparison clinics; patient behavior (phlebotomy completed) showed 19% increase in intervention and 5% decrease in comparison clinics. At the beginning of phase 2, the intervention clinic had average 44% orders entered and 33% phlebotomy completed per well-child visit, and these proportions were maintained. Provider education and chart review with feedback were associated with the greatest gains in outcomes.
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Macnee, Carol L., Jean C. Hemphill, and Jacqueline Letran. "Screening Clinics for the Homeless: Evaluating Outcomes." Journal of Community Health Nursing 13, no. 3 (1996): 167–77. http://dx.doi.org/10.1207/s15327655jchn1303_4.
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Sinclair, Julia, Mark McCann, Ellena Sheldon, Isabel Gordon, Lyn Brierley-Jones, and Ellen Copson. "The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics." BMJ Open 9, no. 6 (2019): e027371. http://dx.doi.org/10.1136/bmjopen-2018-027371.
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ObjectivesPotentially modifiable risk factors account for approximately 23% of breast cancers, with obesity and alcohol being the two greatest. Breast screening and symptomatic clinical attendances provide opportunities (‘teachable moments’) to link health promotion and breast cancer-prevention advice within established clinical pathways. This study explored knowledge and attitudes towards alcohol as a risk factor for breast cancer, and potential challenges inherent in incorporating advice about alcohol health risks into breast clinics and screening appointments.DesignA mixed-method study including a survey on risk factors for breast cancer and understanding of alcohol content. Survey results were explored in a series of five focus groups with women and eight semi-structured interviews with health professionals.SettingWomen attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in those settings.Participants205 women were recruited (102 NHSBSP attenders and 103 symptomatic breast clinic attenders) and 33 NHS Staff.ResultsAlcohol was identified as a breast cancer risk factor by 40/205 (19.5%) of attenders and 16/33 (48.5%) of staff. Overall 66.5% of attenders drank alcohol, and 56.6% could not estimate correctly the alcohol content of any of four commonly consumed alcoholic drinks. All women agreed that including a prevention-focussed intervention would not reduce the likelihood of their attendance at screening mammograms or breast clinics. Qualitative data highlighted concerns in both women and staff of how to talk about alcohol and risk factors for breast cancer in a non-stigmatising way, as well as ambivalence from specialist staff as to their role in health promotion.ConclusionsLevels of alcohol health literacy and numeracy were low. Adding prevention interventions to screening and/or symptomatic clinics appears acceptable to attendees, highlighting the potential for using these opportunities as ‘teachable moments’. However, there are substantial cultural and systemic challenges to overcome if this is to be implemented successfully.
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Magon, Rakesh, and Ruth White. "Specialist community perinatal screening clinic: service evaluation." Psychiatrist 34, no. 11 (2010): 492–95. http://dx.doi.org/10.1192/pb.bp.109.026625.
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Aims and methodTo identify the outcomes of patients in the obstetric screening clinic. In 2 years, 180 women were referred by midwives to a clinic run by specialist community perinatal team. ‘Ultra-high risk’ patients were identified. There were four outcome measures predicated on level of care.ResultsOf those referred, 69 women were managed in primary care/generic community mental health teams, 90 by specialist perinatal team and 21 did not attend; 23 women were ultra-high risk. The majority of the ultra-high risk patients required treatment with specialist teams.Clinical implicationsSpecialist community perinatal screening clinics are successful at identifying those at high risk of developing mental health problems. Ultra-high risk women needed a higher level of service. High morbidity in women who fail to attend the services demands more assertive follow-up. Cumulative personal and family history is an important risk factor.
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Lyketsos, Constantine G., Anne Hanson, Marc Fishman, Paul R. McHugh, and Glenn J. Treisman. "Screening for Psychiatric Morbidity in a Medical Outpatient Clinic for HIV Infection: The Need for a Psychiatric Presence." International Journal of Psychiatry in Medicine 24, no. 2 (1994): 103–13. http://dx.doi.org/10.2190/urtc-aqvj-n9kg-0rl4.
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Objective: To ascertain the prevalence and type of psychiatric morbidity present in HIV infected patients presenting for the first time to a specialty HIV medical clinic. Also, to develop a way of screening for psychiatric cases in this setting using established self-report questionnaires. Method: Fifty patients who presented consecutively for medical care at the Johns Hopkins Hospital General HIV Clinic participated in this study. These patients were first screened using the General Health Questionnaire and the Beck Depression Inventory and subsequently underwent a comprehensive neuropsychiatric evaluation. Results: Fifty-four percent were found to suffer from a psychiatric disorder with an additional 22 percent from an active substance use disorder. These rates are one-and-one-half to two times higher than those reported from other medical clinics. The GHQ and BDI used together as screens could identify psychiatric “cases” with a sensitivity of 81 percent and a specificity of 61 percent, an efficacy similar to that found in other clinics. Conclusions: Given the high prevalence of psychiatric disorders in HIV infected patients presenting for medical care, screening, evaluating, and treating for these disorders is crucial and should be pursued systematically. This is best done through the presence of a psychiatric team within HIV medical clinics rather than in affiliation with such clinics.
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Byrom, J., P. D. J. Dunn, G. M. Hughes, et al. "Colposcopy Information Leaflets: What Women Want to Know and When They Want to Receive This Information." Journal of Medical Screening 10, no. 3 (2003): 143–47. http://dx.doi.org/10.1177/096914130301000309.
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Objectives: To evoluate whether the information leoflets produced by UK colposcopy clinics provide women with the information they desire and to determine when they would like to receive this information. Design: Questionnaire study and structured evaluation. Setting: The colposcopy clinic of a UK cancer centre. Participants: Forty-two women attending a pre-colposcopy counselling session and 100 consecutive women attending the colposcopy clinic. Methods: Thirty-eight standards derived from the concerns/questions asked by women attending a pre-colposcopy counselling session were used to assess locally produced colposcopy clinic leaflets from UK colposcopy clinics, the leaflets produced by the Royal College of Obstetricians and Gynaecologists and the National Health Service Cervical Screening Programme (NHSCSP), and two “leaflets” obtained from internet sites. The Gunning fog test was used to assess the leaflets' readability. A questionnaire survey of 100 women attending the colposcopy clinic was used to determine when women wanted to receive information about colposcopy. Main outcome measures: Percentage of questions answered by a given leaflet and Gunning fog scores for readability. Results: The information leaflets of 128 colposcopy clinics were received and assessed. Thirty-two clinics only sent women the NHSCSP leaflet. No leaflet answered all 38 questions. Less than half (36/100) of the leaflets answered more than 50% of the questions. In addition to the lack of advice given, different leaflets frequently gave conflicting advice. The average Gunning fog score was 9.7 (range 5.5–15.5). The majority of women (70%) wanted to receive information about colposcopy at or prior to the time of receiving their abnormal smear test result, although only 42% of women actually received information at this time. Conclusions: Many UK colposcopy clinics do not appear to be providing women with the information they require to understand their condition and the procedure that they are about to undergo. Furthermore, this information is often not provided at the appropriate time in the screening process.
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Skaer, Tracy L., Linda M. Robison, David A. Sclar, and Gary H. Harding. "Cancer-Screening Determinants Among Hispanic Women Using Migrant Health Clinics." Journal of Health Care for the Poor and Underserved 7, no. 4 (1996): 338–54. http://dx.doi.org/10.1353/hpu.2010.0465.
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Pittrof, Rudiger, and Elizabeth Goodburn. "Should we change the focus of health promotion in sexual health clinics?" Sexual Health 7, no. 4 (2010): 407. http://dx.doi.org/10.1071/sh09107.
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The effectiveness of sexual behaviour change interventions in sexual health clinics is unknown. Risk factors for poor sexual and reproductive health such as depression, violence, alcohol and smoking in sexual health clinics are all common and can be identified easily in sexual health services. Targeting these risk factors could be as effective as traditional sexual health promotion and could have additional benefits. The authors propose a pilot to assess the cost-effectiveness and acceptability of incorporating screening and interventions for these risk factors.
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Roche, Laura, Saul Zepeda, Blair Harvey, Karen A. Reitan, and Raekiela D. Taylor. "Routine HIV Screening as a Standard of Care: Implementing HIV Screening in General Medical Settings, 2013-2015." Public Health Reports 133, no. 2_suppl (2018): 52S—59S. http://dx.doi.org/10.1177/0033354918801833.
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Objective: We implemented routine HIV screening as part of the 4-year Care and Prevention in the United States Demonstration Project, whose aim was to reduce HIV/AIDS–related morbidity and mortality among racial/ethnic minority groups in the United States. We describe the capacity-building efforts to implement routine HIV screening and provide lessons learned and implications for practice. Methods: From January 2013 through September 2015, the Public Health Institute of Metropolitan Chicago (PHIMC) implemented routine HIV screening in 7 health care systems in Illinois by providing capacity-building assistance focused on systems and operational infrastructure, staff member skills and organizational structure, and clinic culture. Each site received funding to integrate routine HIV screening into the existing clinic flow, engage the entire health care team in the process, and transform the system and shift clinic culture to sustain HIV screening. Results: All 7 systems established policies and procedures to implement routine screening, 5 systems integrated HIV test ordering and documentation into their electronic health records, and 4 systems established a third-party billing and reimbursement process for testing. The 7 systems conducted a total of 49 285 tests and identified 160 people living with HIV. The number of tests increased by more than 40% each year. Conclusions: PHIMC identified the following practices for consideration when implementing routine HIV screening in general medical settings: create a culture that supports HIV screening, use champions in clinics, integrate HIV screening into clinic flow and electronic health records, and train clinic staff members on HIV messaging. Incorporating these practices can help other clinical settings build capacity to make routine HIV screening a standard of care.
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Latif, Finza, Shilpa Patel, Gia Badolato, et al. "Improving Youth Suicide Risk Screening and Assessment in a Pediatric Hospital Setting by Using The Joint Commission Guidelines." Hospital Pediatrics 10, no. 10 (2020): 884–92. http://dx.doi.org/10.1542/hpeds.2020-0039.
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OBJECTIVES: Hospitals accredited by The Joint Commission (TJC) are now required to use a validated screening tool and a standardized method for assessment of suicide risk in all behavioral health patients. Our aims for this study were (1) to implement a TJC-compliant process of suicide risk screening and assessment in the pediatric emergency department (ED) and outpatient behavioral health clinic in a large tertiary care children’s hospital, (2) to describe characteristics of this population related to suicide risk, and (3) to report the impact of this new process on ED length of stay (LOS). METHODS: A workflow using the Columbia Suicide Severity Rating Scale was developed and implemented. Monthly reviews of compliance with screening and assessment were conducted. Descriptive statistics were used to define the study population, and multivariable regression was used to model factors associated with high suicide risk and discharge from the ED. ED LOS of behavioral health patients was compared before and after implementation. RESULTS: Average compliance rates for screening was 83% in the ED and 65% in the outpatient clinics. Compliance with standardized assessments in the ED went from 0% before implementation to 88% after implementation. The analysis revealed that 72% of behavioral health patients in the ED and 18% of patients in behavioral health outpatient clinics had a positive suicide risk. ED LOS did not increase. The majority of patients screening at risk was discharged from the hospital after assessment. CONCLUSIONS: A TJC-compliant process for suicide risk screening and assessment was implemented in the ED and outpatient behavioral health clinic for behavioral health patients without increasing ED LOS.
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Beruchashwili, Tina, Rema Gvamichava, and Stephen W. Duffy. "Screening organization and recall rate in a regional breast screening programme." Journal of Medical Screening 25, no. 1 (2017): 55–56. http://dx.doi.org/10.1177/0969141317704680.
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Objective To use results on recall rates from a regional non-population-based breast screening programme to inform practice in a planned national population-based programme. Methods We analysed data on rates of recall for further assessment in 27,327 mammographic screening episodes in 2015–2016 in the breast screening programme in the city of Tbilisi, Georgia. Screening was done by two-view digital mammography with double reading in women aged 40–70, and further assessment took place at the same clinic and during the same visit as the initial screening mammogram. Results The recall rates were 46% (3573/7824) in 2015 and 27% (5276/19,503) in 2016. Cancer detection rates were 8 per 1000 in 2015 and 3 per 1000 in 2016. Rates of recall were higher in younger women than in older, whereas the rates of cancer detection were higher in older women. Conclusions The recall rates, while lower in 2016 than in 2015, are still too high to manage in a nationwide population programme. The use of same-visit assessment is likely to be contributing to this. The national programme should consider separate assessment clinics and carry out audit of recalls to date.
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Kagawa-Singer, Marjorie, Liane Wong, Sara Shostak, Chantal Raymer Walsh, and Rod Lew. "Breast and Cervical Cancer Screening Practices for Low-Income Asian American Women in Ethnic-Specific Clinics." Californian Journal of Health Promotion 3, no. 3 (2005): 180–92. http://dx.doi.org/10.32398/cjhp.v3i3.659.
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Introduction: Early detection and screening are the most effective means to reduce cancer mortality in all populations. Asian American (AA) women have among the lowest rates in aggregate for use of early detection, and screening practices of all ethnic populations. The only nationally disaggregated populationbased data on these ethnic groups at the time of the study was the 1993-1994 National Health Interview Survey (NHIS) of English speaking AA, but 70% of the AA population is non-English speaking. Our study presents heretofore unavailable data for cancer screening for monolingual AA women for a comparable time period in California between 1992 and 1994, prior to initiation of the state and Federal programs targeting this group of women. Methods: Retrospective chart reviews of randomly selected medical records were conducted for the breast and cervical cancer screening practices of low-income, non-English speaking Chinese, Korean, and Thai women attending ethnic specific community-based health clinics. All women seen in the clinics between 1992-1994 who were within the appropriate screening age categories were eligible. Results: Asian American women utilizing ethnic specific clinics had equal to or better screening rates for mammography and Pap tests than mainstream services for English-speaking AA women in a national survey. These screening rates, however, were still well below nationally recommended screening rates for breast and cervical cancer according to Healthy People 2000 or 2010 goals. Conclusion: These data support the effectiveness of Community Based Clinics (CBOs) to reach these hard to reach women and address the call for the elimination of health disparities. In addition, we compare our findings with national data to highlight within group variations.
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Carne, C. A., H. McClean, A. K. Sullivan, et al. "National audit of asymptomatic screening in UK genitourinary medicine clinics: clinic policies audit." International Journal of STD & AIDS 21, no. 7 (2010): 512–15. http://dx.doi.org/10.1258/ijsa.2010.009573.
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Aftab, Rabia. "Chlamydia screening." InnovAiT: Education and inspiration for general practice 11, no. 7 (2018): 366–70. http://dx.doi.org/10.1177/1755738018769688.
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Sexually transmitted infections (STIs) are a major public health problem worldwide, affecting quality of life, adding economic burden and causing serious morbidity. Chlamydia infection is the most common bacterial STI, making up a large proportion of the over 1 000 000 STIs acquired every day. Although easily cured with antibiotics, untreated chlamydial infection can have serious consequences affecting reproductive health and the unborn child. Since chlamydia infection is typically asymptomatic, screening provides an opportunity to prevent complications and reduce transmission. With long waits for genitourinary medicine appointments and busy sexual health clinics, screening in primary care can help to improve chlamydia detection and treatment rates.
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Perialathan, Komathi, Mohammad Zabri Johari, Norrafizah Jaafar, et al. "Enhanced Primary Health Care Intervention: Perceived Sustainability and Challenges Among Implementers." Journal of Primary Care & Community Health 12 (January 2021): 215013272110140. http://dx.doi.org/10.1177/21501327211014096.
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Purpose: This study aimed to assess and explore perceived sustainability and challenges of the intervention among Health Care Providers (HCPs) who were involved. Methods: The study applied mixed-method embedded design to analyze both quantitative and qualitative data. Quantitative approach was used to evaluate sustainability perception from 20 intervention clinics via self-reported assessment form whereas qualitative data were obtained through in-depth interview (IDI) and focus group discussions (FGDs) 14 health care professionals participated in IDI session and were either care coordinators, liaison officers (LOs)/clinic managers, or medical officers-in-charge for the clinic’s intervention. Nine FGDs conducted comprised 58 HCPs from various categories. Results: HCPs from all the 20 clinics involved responded to each listed Enhanced Primary Healthcare (EnPHC) intervention components as being implemented but the perceived sustainability of these implementation varies between them. Quantitative feedback showed sustainable interventions included risk stratification, non-communicable disease (NCD) screening form, referral within clinics and hospitals, family health team (FHT), MTAC services and mechanisms and medical adherence status. Qualitative feedback highlighted implementation of each intervention components comes with its challenges, and most of it are related to inadequate resources and facilities in clinic. HCPs made initiatives to adapt based on clinical setting to implement the interventions at best level possible, whereby this seems to be one of the core values for sustainability. Conclusion: Overall perceptions among HCPs on sustainability of EnPHC interventions are highly influenced by current experiences with existing resources. Components perceived to have inadequate resources are seen as a challenge to sustain. It’s crucial for stakeholders to understand implications affecting implementation process if concerns raised are not addressed and allocation of needed resources to ensure overall successfulness and long term sustainability.
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Devereux, Paul G., John Gray, Susan Robinson, Janie Galvin, and Jesse Gutierrez. "Using Community Engagement and Navigators to Increase Colon Cancer Screening and Patient Outcomes." Health Promotion Practice 20, no. 1 (2018): 85–93. http://dx.doi.org/10.1177/1524839918757485.
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A theory-driven tailored intervention developed in partnership with the community used evidence-based practices to (a) increase knowledge about colon cancer and screening and (b) assist patients in completing screenings. During the 16 months of delivery screening, patient navigators integrated into gastroenterology clinics met all goals, which included (a) enrolling an ethnically diverse group of participants ( N = 415) through inreach (clinic-referred patients who did not schedule appointments) and community outreach, (b) facilitating screening completions for 217 of the 358 (61%) patients identified as needing screening, and (c) obtaining satisfaction ratings from 89% of participants. A random sample ( N = 214) of nonnavigated patients matched on gender and age revealed no differences between navigated and nonnavigated patients on polyps detected. Navigated males (but not females) were significantly less likely than nonnavigated males to have either poor or only fair bowel preparation quality (odds ratio = .418, p = .020, 95% confidence interval [.197, .885]). Low-quality bowel preparation can lead to incomplete readings of the colon or cancelling a colonoscopy. This intervention demonstrates that evidence-based patient navigator programs are effective in increasing screening among a hard-to-reach population and improving bowel preparation quality for males.
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Louw, Christine, De Wet Swanepoel, and Robert H. Eikelboom. "Self-Reported Hearing Loss and Pure Tone Audiometry for Screening in Primary Health Care Clinics." Journal of Primary Care & Community Health 9 (January 2018): 215013271880315. http://dx.doi.org/10.1177/2150132718803156.
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Objective: To evaluate the performance of self-reported hearing loss alone and in combination with pure tone audiometry screening in primary health care clinics in South Africa. Design: Nonprobability purposive sampling was used at 2 primary health care clinics. A total of 1084 participants (mean age 41.2 years; SD 15.5 years; range 16-97 years, 74.0% female) were screened using self-report and audiometry screening. Those failing audiometric screening and a sample of those who passed audiometric screening were also assessed by diagnostic pure time audiometry, to confirm or negate the finding of a hearing loss. Results: Four hundred and thirty-six participants (40.2%) self-reported a hearing loss with no significant association with gender or race. One hundred and thirty-six participant (12.5%) self-reported hearing loss and failed audiometry screening (35 dB HL at 1, 2, and 4 kHz). Combining self-report with a second stage audiometry screening revealed a high test accuracy (81.0%) for hearing loss, being most accurate (86.1%) to identify high-frequency hearing loss. Conclusion: While self-report of hearing loss is an easy and time-efficient screening method to use at primary health care clinics, its accuracy may be limited when used in isolation and it may not be sufficiently sensitive to detect hearing loss. Combining a simple audiometry screening as a second-stage screen can significantly improve overall performance and efficiency of the screening protocol.
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Amin, Robby, Lorriane Achieng Odhiambo, Sayeda Ali, et al. "Alleviating the click fatigue on clinicians to improve referrals for colorectal cancer screening." Journal of Clinical Oncology 40, no. 16_suppl (2022): 11021. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.11021.
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11021 Background: The impact of clinician burnout on patient care is pervasive across medical delivery systems. The effects are also felt in preventive care where cancer screening efforts rely on clinician referrals through the electronic medical records (EMRs). Though designed to support healthcare, EMRs are a significant source of clinician burnout given the number of clicks or navigation time needed to refer a patient. This is a barrier to Patient Navigation (PN) when ordered tests do not materialize into screenings or when clinicians order labs/imaging and the pending orders are not created. This causes frustration for all clinical staff involved, delays the workflow processes, and leads to missed opportunities for PN. We implemented an ‘order set’ intervention to reduce the click burden linked to colorectal cancer (CRC) screening referral among clinicians in South Georgia. Methods: The ‘order set’ intervention was developed to facilitate PN for a Colorectal Cancer Control Program (CRCCP) aimed at implementing Evidence-Based Interventions to increase CRC screening rates in Georgia. The ‘order set’ was designed to address workflow issues by consolidating steps associated with CRC screening. This reduced typing input and the need to click between multiple windows within the EMR while making a referral to PN. The intervention was piloted in the Albany Area Primary Health Care (AAPHC) system after modifications were made to the EMR and clinician workflows. The monthly CRC screening rates continue to be generated and tracked post-implementation. Results: The use of the ‘order set’ reduced the click burden from 78 to 7 inputs and clinician EMR interaction time from 110 seconds to 29 seconds. Providers from 4/7 clinics have adopted the ‘order sets’ when making referrals for CRC screening. Two clinics provided post-implementation screening data. The pre-implementation screening rates for one clinic were comparable (August = 59.3%, September = 57.6%) to post-implementation (October = 56.3%, November = 56.6%, December = 57.2%), while the second clinic showed some increase (August = 58.6%, September = 60%) vs. (October = 61%, November = 62.1%, December = 62.8%). Conclusions: The ‘order sets’ intervention reduced the time clinicians spent creating referrals for CRC screening, including fecal immunochemical tests (FIT) and colonoscopies. Additional follow-up and rollout to clinics participating in the program is underway to evaluate further the impact of the order sets on CRC screening outcome and process measures, including qualitative interviews with clinicians. There is significant potential in the application of order sets to various workflow processes to aid in preventative health efforts. Challenges linked to the COVID-19 pandemic and staff turnover affected acquisition of patient referral data.
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Amin, Robby, Lorriane Achieng Odhiambo, Sayeda Ali, et al. "Alleviating the click fatigue on clinicians to improve referrals for colorectal cancer screening." Journal of Clinical Oncology 40, no. 16_suppl (2022): 11021. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.11021.
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11021 Background: The impact of clinician burnout on patient care is pervasive across medical delivery systems. The effects are also felt in preventive care where cancer screening efforts rely on clinician referrals through the electronic medical records (EMRs). Though designed to support healthcare, EMRs are a significant source of clinician burnout given the number of clicks or navigation time needed to refer a patient. This is a barrier to Patient Navigation (PN) when ordered tests do not materialize into screenings or when clinicians order labs/imaging and the pending orders are not created. This causes frustration for all clinical staff involved, delays the workflow processes, and leads to missed opportunities for PN. We implemented an ‘order set’ intervention to reduce the click burden linked to colorectal cancer (CRC) screening referral among clinicians in South Georgia. Methods: The ‘order set’ intervention was developed to facilitate PN for a Colorectal Cancer Control Program (CRCCP) aimed at implementing Evidence-Based Interventions to increase CRC screening rates in Georgia. The ‘order set’ was designed to address workflow issues by consolidating steps associated with CRC screening. This reduced typing input and the need to click between multiple windows within the EMR while making a referral to PN. The intervention was piloted in the Albany Area Primary Health Care (AAPHC) system after modifications were made to the EMR and clinician workflows. The monthly CRC screening rates continue to be generated and tracked post-implementation. Results: The use of the ‘order set’ reduced the click burden from 78 to 7 inputs and clinician EMR interaction time from 110 seconds to 29 seconds. Providers from 4/7 clinics have adopted the ‘order sets’ when making referrals for CRC screening. Two clinics provided post-implementation screening data. The pre-implementation screening rates for one clinic were comparable (August = 59.3%, September = 57.6%) to post-implementation (October = 56.3%, November = 56.6%, December = 57.2%), while the second clinic showed some increase (August = 58.6%, September = 60%) vs. (October = 61%, November = 62.1%, December = 62.8%). Conclusions: The ‘order sets’ intervention reduced the time clinicians spent creating referrals for CRC screening, including fecal immunochemical tests (FIT) and colonoscopies. Additional follow-up and rollout to clinics participating in the program is underway to evaluate further the impact of the order sets on CRC screening outcome and process measures, including qualitative interviews with clinicians. There is significant potential in the application of order sets to various workflow processes to aid in preventative health efforts. Challenges linked to the COVID-19 pandemic and staff turnover affected acquisition of patient referral data.
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Atkinson, Josie R., Andrea I. Boudville, Emma E. Stanford, Fiona D. Lange, and Mitchell D. Anjou. "Australian Football League clinics promoting health, hygiene and trachoma elimination: the Northern Territory experience." Australian Journal of Primary Health 20, no. 4 (2014): 334. http://dx.doi.org/10.1071/py14050.
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Australia is the only developed country to suffer trachoma and it is only found in remote Indigenous communities. In 2009, trachoma prevalence was 14%, but through screening, treatment and health promotion, rates had fallen to 4% in 2012. More work needs to be done to sustain these declining rates. In 2012, 25% of screened communities still had endemic trachoma and 8% had hyperendemic trachoma. In addition, only 58% of communities had reached clean face targets in children aged 5–9 years. Australian Football League (AFL) players are highly influential role models and the community love of football provides a platform to engage and strengthen community participation in health promotion. The University of Melbourne has partnered with Melbourne Football Club since 2010 to run trachoma football hygiene clinics in the Northern Territory (NT) to raise awareness of the importance of clean faces in order to reduce the spread of trachoma. This activity supports Federal and state government trachoma screening and treatment programs. Between 2010 and 2013, 12 football clinics were held in major towns and remote communities in the NT. Almost 2000 children and adults attended football clinics run by 16 partner organisations. Awareness of the football clinics has grown and has become a media feature in the NT trachoma elimination campaign. The hygiene station featured within the football clinic could be adapted for other events hosted in remote NT community events to add value to the experience and reinforce good holistic health and hygiene messages, as well as encourage interagency collaboration.
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Nguyen, Anne Xuan-Lan, Alexander Kevorkov, Patricia Li, and Rislaine Benkelfat. "93 Mapping Mobile Health Clinics in Canada: Delivering Equitable Primary Care to Children and Vulnerable Populations." Paediatrics & Child Health 27, Supplement_3 (2022): e43-e44. http://dx.doi.org/10.1093/pch/pxac100.092.
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Abstract Background Low-income and racially diverse populations often have multiple barriers in accessing healthcare and are at increased risk of poor health outcomes. COVID-19 exacerbated these health inequities: decreased in-person appointments, difficult access to virtual care and deprioritization of elective clinical activity led to delays in well-child visits and vaccination. This public health emergency highlighted a need to develop alternative models to enable access to primary care for vulnerable children. While mobile clinics are well-established in the United States, little is known about them in Canada. Objectives This study aims to characterize Canadian mobile clinics providing primary care health services to vulnerable populations, including children, and seeks to inform the implementation of a pediatric mobile clinic under development. Design/Methods This environmental scan screened scientific databases and the grey literature using a combination of terms designating mobile health clinics and Canadian locations. Relevant Canadian primary care mobile clinic initiatives were subsequently included. We defined primary care mobile clinics as movable health care units providing primary healthcare services delivered by general medical practitioners (pediatricians and family physicians). Examples of excluded initiatives were mobile clinics focused on education/literacy, dental care, vision care, endocrinology, cancer screening, safe injection sites, vaccination, physical rehabilitation and urgent care. Descriptive statistics and qualitative analysis were performed. Results 29 clinics were identified, of which 26 are still active. Most clinics were located in Ontario (n=11), followed by British Columbia (n=8), Alberta (n=5), Quebec (n=2) and the Maritimes (n=2). The first mobile clinic in Canada was launched in 1996, with an increasing number of new clinics in 2021. While all clinics served vulnerable populations, some targeted specific groups, such as children, people experiencing homelessness, immigrants, LGBTQ+ individuals and Indigenous peoples. We identified three pediatric mobile clinics, two of which targeted teenagers. Onboard the clinics, physicians often worked with nurses, outreach workers and social workers. These professionals provided primary care services, as well as healthcare navigation, sexual education, mental health care, harm reduction supplies, vaccination and emergency care. All mobile clinics partnered with their local government, charities or businesses to fund their initiative. Conclusion Mobile health clinics are a growing model of primary care in Canada. They are the result of a multidisciplinary collaboration between healthcare providers, social workers and outreach workers. To this date, Canadian pediatric mobile clinics remain a handful and represent an interesting avenue to address health inequities in children, during the pandemic and beyond.