American journal of preventive medicine
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The Choosing Wisely(®) initiative is a national campaign led by the American Board of Internal Medicine Foundation, focused on quality improvement and advancing a dialogue on avoiding wasteful or unnecessary medical tests, procedures, and treatments. The American College of Preventive Medicine (ACPM) Prevention Practice Committee is an active participant in the Choosing Wisely project. ⋯ These include: (1) don't take a multivitamin, vitamin E, or beta carotene to prevent cardiovascular disease or cancer; (2) don't routinely perform prostate-specific antigen-based screening for prostate cancer; (3) don't use whole-body scans for early tumor detection in asymptomatic patients; (4) don't use expensive medications when an equally effective and lower-cost medication is available; and (5) don't perform screening for cervical cancer in low-risk women aged 65 years or older and in women who have had a total hysterectomy for benign disease. The Task Force also reviewed some of the barriers to implementing these recommendations, taking into account the interplay between system and environmental characteristics, and identified specific strategies necessary for timely utilization of these recommendations.
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Patient-facing online tools for managing preventive and chronic care can be a resource-effective way to increase patient agency in health promotion. Recently, Kaiser Permanente Southern California added the Online Personal Action Plan (oPAP) to the member web portal to better enable members to access information about prevention, health promotion, and care gaps. This study described Kaiser Permanente Southern California members who use oPAP, as well as how members use oPAP to close five different care gaps: hemoglobin A1c testing, pneumonia vaccination, and three cancer screenings. ⋯ Although healthcare organizations have developed approaches to managing and closing preventive care gaps, these efforts are resource intensive. Users of oPAP are more likely than non-registered members to close gaps, especially cancer screening tests. The oPAP appears to be an effective tool at improving patient engagement in preventive health care.
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Asthma is a leading cause of chronic disease-related school absenteeism. Few data exist on how information on absenteeism might be used to identify children for interventions to improve asthma control. This study investigated how asthma-related absenteeism was associated with asthma control, exacerbations, and associated modifiable risk factors using a sample of children from 35 states and the District of Columbia. ⋯ Missing any school because of asthma is associated with suboptimal asthma control, urgent or emergent asthma-related healthcare utilization, mold in the home, and financial barriers to asthma-related health care. Further understanding of asthma-related absenteeism could establish how to most effectively use absenteeism information as a health status indicator.
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Despite many recommended strategies for obesity prevention during infancy, effectively delivering recommendations to parents in clinical settings is challenging, especially among high-risk populations. This study describes and compares mothers' and clinicians' priorities for obesity prevention during infancy, to facilitate more-effective obesity prevention messaging. ⋯ Low-income, obese, black mothers of infants highly prioritized learning about many effective obesity prevention strategies, including recognizing hunger and satiety cues, promoting infant activity, and maintaining regular routines. Clinicians may frame preventive guidance to be responsive to these priorities.
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Care coordination (CC), a core element of the medical home, has the potential to reduce fragmented care and improve patient experience for children with sickle cell disease (SCD). This study aimed to (1) assess CC for pediatric SCD and (2) determine its association with acute care utilization-emergency department encounters and hospitalizations. It was hypothesized that CC would reduce acute care utilization. ⋯ Although parents report multiple CC deficiencies, no associations were found between CC and acute care utilization. Population-based studies are warranted to more definitively determine the association between CC and acute care utilization for children with SCD.