Genetic Counseling and Testing in a Community Setting: Quality, Access, and Efficiency

2019 ◽  
pp. e34-e44 ◽  
Author(s):  
Stephanie A. Cohen ◽  
Angela Bradbury ◽  
Vida Henderson ◽  
Kent Hoskins ◽  
Erica Bednar ◽  
...  
Keyword(s):  
Genetic Counseling ◽  
Health Care Providers ◽  
Community Setting ◽  
Care Providers ◽  
Counseling And Testing ◽  
Risk Patients ◽  
Diagnosis Of Cancer ◽  
Prevention Of Cancer ◽  
Improve Access ◽  
Early Detection And Prevention

There is an increasing need for genetic counseling and testing for individuals diagnosed with cancer, as treatment may be affected by the results. In addition, the identification of individuals before a diagnosis of cancer allows for optimal surveillance and early detection and prevention of cancer. With the recognition that as much as 10% of all cancers are hereditary, there is a growing need to improve access to genetic counseling and genetic testing, both before and at the time of diagnosis. This article focuses on models of identifying at-risk patients, including underserved communities; providing genetic counseling and testing in community practices; using telehealth; and collaborating with nongenetics health care providers and technological solutions to maximize efficiency and access.

Using Technology to Improve Access to Health Care for Culturally and Linguistically Diverse Populations

2012 ◽  
Vol 19 (3) ◽  
pp. 71-76 ◽  
Author(s):  
Pauline A. Mashima
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Access To Health Care ◽  
Underserved Populations ◽  
Linguistically Diverse ◽  
Care Providers ◽  
Department Of Health ◽  
Use Of Technology ◽  
Access To Health ◽  
Improve Access

Important initiatives in health care include (a) improving access to services for disadvantaged populations, (b) providing equal access for individuals with limited or non-English proficiency, and (c) ensuring cultural competence of health-care providers to facilitate effective services for individuals from diverse racial and ethnic backgrounds (U.S. Department of Health and Human Services, Office of Minority Health, 2001). This article provides a brief overview of the use of technology by speech-language pathologists and audiologists to extend their services to underserved populations who live in remote geographic areas, or when cultural and linguistic differences impact service delivery.

scholarly journals Computational Audiology: New Approaches to Advance Hearing Health Care in the Digital Age

2020 ◽  
Author(s):  
Jan-Willem Wasmann ◽  
Cris Lanting ◽  
Wendy Huinck ◽  
Emmanuel Mylanus ◽  
Jeroen van der Laak ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Services ◽  
Digital Transformation ◽  
Care Providers ◽  
Shared Data ◽  
Care Services ◽  
Source Models ◽  
Hearing Health ◽  
Improve Access

The global digital transformation enables computational audiology for advanced clinical applications that have the potential to impact the global burden of hearing loss. In this paper we describe emerging hearing-related artificial intelligence applications and argue for their potential to improve access, precision and efficiency of hearing health care services. In addition, we raise awareness of risks that must be addressed to enable a safe digital transformation in audiology. We envision a future where computational audiology is implemented via open-source models using interoperable shared data and where health care providers adopt new roles within a network of distributed expertise. All of this should take place in a health care system where privacy, the responsibility of each stakeholder and, most importantly, the safety and autonomy of patients are all guarded by design.

Increase in Genetic Counseling and Testing Referrals After Breast Cancer Pathway Implementation

2020 ◽  
Vol 16 (12) ◽  
pp. e1481-e1488
Author(s):  
Stephanie L. Graff ◽  
Jared M. Holder ◽  
Lindsay E. Sears ◽  
Dax Kurbegov
Keyword(s):  
Breast Cancer ◽  
Genetic Counseling ◽  
Observational Study ◽  
Care Coordination ◽  
Genetic Mutations ◽  
Software System ◽  
Potential Solution ◽  
Newly Diagnosed ◽  
Counseling And Testing ◽  
Improve Access

PURPOSE: Genetic counseling and testing (GC/T) for breast cancer–associated genetic mutations are important components in the appropriate management of newly diagnosed breast cancer. We initiated pathways to help appropriately select patients who meet criteria for GC/T referral (GC/T-R) across the Sarah Cannon Cancer Institute Network. This study evaluated physician pathway training as a means to improve access to GC/T-R. METHODS: In this retrospective, observational study, we collected data from 7 regions across 6 states, identifying 3,113 patients eligible for GC/T. Patients were divided into 3 defined cohorts: patients treated before implementation of pathways (n = 988), patients treated by non-pathway physicians after pathways were established (n = 1,094), and patients treated by pathway-trained physicians (n = 1,031). Pathways were established in March 2016. Nurse navigators documented eligible patients who were referred for GC/T within a care coordination software system. RESULTS: Eligible patients were referred for GC/T 71.77% of the time if treated on pathways and only 36.47% of the time if treated off pathways. On-pathway patients eligible for GC/T also received testing referral at a higher rate than pre-pathway patients (21.36%). CONCLUSION: After implementation of pathways and appropriate training of physicians on those pathways, GC/T-R among appropriate patients significantly improved. Pathway training represents a potential solution to improve GC/T-R among patients with breast cancer.

scholarly journals Thai Adolescent Depression: Recurrence Prevention in Practice

2018 ◽  
Vol 36 (2) ◽  
pp. 147 ◽  
Author(s):  
Chonnakarn Jatchavala ◽  
Stella W. Y. Chan
Keyword(s):  
Depressive Disorder ◽  
Health Care Providers ◽  
Hospital Setting ◽  
Community Setting ◽  
Main Tool ◽  
Child And Adolescent Psychiatry ◽  
Care Providers ◽  
Nice Guideline ◽  
Recurrence Prevention ◽  
Practice Parameters

This article aims to review the current practice of recurrence prevention and intervention of adolescent depressive disorder in Thailand. In particular, we assess the Clinical Practice Guideline of Major Depressive Disorder for General Practitioners (CPG-MDD-GP) for Thailand, which is now the official guideline for all depressive patients who are children, adolescents, and adults in Thailand. Although this current Thai clinical guideline was developed and derived from the National Institute for Health and Care Excellence (NICE) of the United Kingdom and the recommendations and the practice parameters of the American Academy of Child and Adolescent Psychiatry (AACAP), it differs from these guidelines in a number of ways. Specifically, the main tool for the primary assessment of the Thai CPG-MDD-GP is called 9Q which categorizes the severity and follow-up of depressive symptoms by health care providers in a hospital setting, whereas the NICE guideline for depression in children and adolescents is based mainly on the community setting, and the AACAP parameter assesses patients by a direct interview method. Additionally, the Thai CPG-MDD-GP has no premise intervention for recurrence prevention of depression and lacks details regarding the importance of treatment engagement by family and community.

scholarly journals Impacting Quadruple Aim Through Sustainable Clinical-Community Partnerships: Best Practices From a Community-Based Organization Perspective

2020 ◽  
Vol 14 (5) ◽  
pp. 524-531
Author(s):  
Marc Rosen
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Financial Risk ◽  
Community Setting ◽  
Community Partnerships ◽  
Social Needs ◽  
Care Providers ◽  
Community Based ◽  
Community Based Organizations ◽  
Payment Models

Health reform initiatives have caused disruptive change throughout the US health care system. A key driver of change is the adoption of alternative payment models that apply financial risk on physicians and hospital systems. Success in these value-based payment models requires health care provider and payor organizations to continue developing population-based approaches, including partnerships with community-based organizations that provide services within a community setting. Community-based organizations are positioned to serve as an extension of the care continuum because they provide desired access points to upstream services that address nonclinical factors. Yet many health care providers fail to enter into sustainable contracts with community organizations. This limits their ability to treat patients’ social needs and widens the clinic-to-community gap, both of which must be addressed for success in value-based contracts. Future cross-sector collaboration will require stakeholders to abandon transactional partnership arrangements primarily concerned with referral systems in favor of transformational arrangements that better align partnership aims and more equally distribute ownership in solving for capacity building, evaluation, and sustainability. The following practices are based on the experience of local YMCAs and YMCA of the USA in establishing clinic-to-community partnerships throughout the country that can influence clinical cost and quality measures.

The Role of Pharmacists in Safe Opioid Dispensing

2019 ◽  
Vol 33 (6) ◽  
pp. 856-862 ◽  
Author(s):  
Thomas Gregory ◽  
Leah Gregory
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Community Setting ◽  
Opioid Abuse ◽  
Public Health Issue ◽  
Opioid Overdose ◽  
Care Providers ◽  
Opioid Misuse ◽  
Prescription Drug Monitoring Programs

Opioid misuse, abuse, and diversion continues to be a public health issue. Pharmacists (particularly those who work in the community setting) form the vanguard of health-care providers facing the opioid crisis because they have the opportunity to interact with patients more frequently than primary care or specialty medical providers. These frequent interactions give pharmacists more opportunities to properly counsel patients on prevention and to reinforce appropriate use of opioid medications. Pharmacists should be aware of the strategies for reducing opioid misuse, abuse, and diversion, including understanding mandates on prescription limitations; knowing how to use prescription drug monitoring programs; knowing when drug take-back programs are occurring; educating patients on the risks of opioid abuse, safe storage, and proper disposal of unused medications; identifying “red flag” behavior that may indicate opioid misuse; using assessments that help identify a patient’s risk for opioid abuse; interacting with other health-care professionals to discuss a patient’s care; understanding how abuse-deterrent opioids work and their limitations; preparing for opioid overdose management and understanding the local regulations on naloxone availability; and knowing when to refer patients to addiction services. Using these strategies, pharmacists have an opportunity to potentially reduce opioid abuse and improve patient outcomes.

Screening and genetic counseling practices for hereditary non-polyposis colorectal cancer (HNPCC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6564-6564
Author(s):  
S. Karri ◽  
S. R. Govindarajan ◽  
W. B. Bendure ◽  
S. A. Jackson ◽  
K. D. McKelvey ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Genetic Counseling ◽  
Health Care Providers ◽  
Medical Center ◽  
University Of Arkansas ◽  
Care Providers ◽  
Medical Sciences ◽  
Bethesda Criteria ◽  
Autosomal Dominant Fashion ◽  
The University

6564 Background: HNPCC, the most common cause of hereditary colorectal cancer (CRC), is inherited in an autosomal dominant fashion and caused by micro satellite instability and mutations in mismatch repair genes. Affected patients (pts) and first degree relatives tend to develop colonic and extra colonic tumors that need to be tested for the mutations. Genetic consultation (GC) should be routinely offered to the affected pts and relatives. To assess the utilization of GC, we assessed the frequency of referral for GC for the presence of HNPCC syndrome at our medical center. Methods: Patients with CRC were identified from the tumor registry at the University of Arkansas for Medical Sciences (UAMS) and the Central Arkansas Veterans Healthcare System (CAVHS) from January 1st 2000 to September, 2006. Pts’ charts were reviewed for synchronous or metachronous HNPCC tumors and family history (FH). FH was categorized as positive according to the Bethesda criteria (BC, 2000–2002), revised Bethesda criteria (RBC, 2003–2006), negative (documented FH but no h/o cancer) or inadequate documentation. Percentage of pts with positive FH for HNPCC syndrome and those with CRC less than 50 years of age (for pts diagnosed 2003–2006) who were referred for GC was calculated. The list of these pts was cross referenced to the list in genetics clinic at UAMS and CAVHS. Results: 858 patient charts were reviewed. Table 1 shows the number of pts meeting criteria for genetic counseling. 138 (16%) pts had inadequate /no documented FH. Of the 720 pts with documented FH, 67 (9.3%) had positive FH and 126(17%) met BC / RBC. Only 13 (10.3%) of 126 pts were referred for genetic counseling. The number of pts eligible for GC increased with inclusion of RBC. However, the percentage of eligible pts referred for GC was extremely low. Conclusions: FH is not adequately documented in many pts presenting with CRC. Only a small percentage of pts who qualify for GC are referred. Education of health care providers for referral to genetics counseling is warranted. No significant financial relationships to disclose. [Table: see text]

Perseverance Pays Off: Health Care Providers' Impact on HIV Testing Decisions by Adolescent Females

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 878-882 ◽  
Author(s):  
Elizabeth Goodman ◽  
Ann C. Tipton ◽  
Liza Hecht ◽  
Margaret A. Chesney
Keyword(s):  
Health Care ◽  
Hiv Testing ◽  
Adolescent Girls ◽  
Health Care Providers ◽  
Care Providers ◽  
Hiv Counseling And Testing ◽  
Hiv Counseling ◽  
Counseling And Testing ◽  
Hiv Test ◽  
Hiv Testing Services

Background and objective. Although HIV counseling and testing of adolescents has increased rapidly in recent years due to increasing HIV seroprevalence rates, little is known about adolescents' use of HIV testing services. The aims of this study were to determine what proportion of high risk adolescent girls would use confidential HIV testing services linked to primary care and to explore the characteristics, beliefs, and experiences that distinguish those teenage girls who obtain HIV testing in this setting from those who do not. Design. Prospective cohort study. Setting. General pediatrics clinic with adolescent-specific appointments at a large urban HMO. Participants. Convenience sample of 124 adolescent girls engaging in risky behaviors identified by chart review before regularly scheduled clinic appointments. Intervention. Subjects completed a self-report questionnaire assessing HIV-related knowledge, attitudes, beliefs, and behaviors before the medical visit. During their provider visit, teens were counseled about their risk behaviors and the availability of HIV testing services at the clinic. Subjects were also given the opportunity to view an educational video about HIV testing designed for adolescents. Main outcome measures. Use of HIV counseling and testing services at the clinic and HIV test results. Results. Forty-one percent of these adolescent girls obtained HIV testing at the clinic on the day of their scheduled appointment. Univariate analysis revealed that adolescents who obtained testing had initiated sexual intercourse at a younger age (mean age 13.8 vs 14.4 years, P = .02) and were more likely to have had a prior discussion about HIV testing with a health care provider [RR = 2.02, 95% CIs (1.22, 3.36)]. Those who did not view the video were less likely to test [RR = 0.20, 95% CIs (0.07, 0.58)]. Multiple logistic regression modeling revealed that a prior discussion with a health care provider was the only independent predictor of obtaining an HIV test [OR = 3.47 95% CIs (1.26, 9.52)]. Conclusions. A significant proportion of adolescent girls engaging in risky behaviors will use confidential HIV counseling and testing services that are linked to primary care. Health care providers play an important role in helping teens address their risk for and concerns about HIV infection by engaging adolescents in repeated discussions about HIV testing.

Development of health literacy in persons and caregivers living with dementia: A qualitative directed content analysis

Dementia ◽  
2021 ◽  
pp. 147130122110496
Author(s):  
Michelle Kimzey ◽  
Carol J. Howe ◽  
Chelsea Martin ◽  
Jim McLarty ◽  
Ramona Baucham
Keyword(s):  
Health Care ◽  
Content Analysis ◽  
Health Literacy ◽  
Health Information ◽  
Health Care Providers ◽  
Daily Life ◽  
Medication Management ◽  
Community Setting ◽  
Care Providers ◽  
Directed Content Analysis

Background Persons living with dementia and their caregivers need health information to understand and manage daily life. Previous studies focused on the associations of health literacy and cognitive impairment with less exploring if and how individuals develop health literacy during the course of the disease. Purpose This descriptive qualitative study aimed to explore the development of health literacy competencies among persons living with dementia and their caregivers. Methods Directed content analysis of six focus groups conducted in the community setting (15 persons living with dementia and 28 caregivers) was completed, using predetermined categories from the Integrated Model of Health Literacy: access, understand, appraise, and apply health information. Findings Participants described developing health literacy competencies over time, moving from a dependence on health care providers to becoming their own experts. Although health care providers were involved in the diagnosis and medication management, most participants admitted that they provided very little information on how to manage their daily life with dementia and often failed to inform them of community resources. Conclusion Participants seemed to find dementia resources on their own for both education and support, often stumbling upon them by accident. Health care providers should promote the health literacy competencies of their patients and caregivers by more intentionally providing dementia health and community resource information.

Application of business case analysis in planning a province-wide telehealth network in Alberta

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 87-89 ◽  
Author(s):  
Linda Weaver ◽  
Dorothy Spence
Keyword(s):  
Health Care Providers ◽  
Success Factors ◽  
Emergency Services ◽  
Comprehensive Evaluation ◽  
Business Case ◽  
Care Providers ◽  
Access To Health Services ◽  
Technical Standards ◽  
Access To Health ◽  
Improve Access

A strategy for implementing telemedicine throughout Alberta was developed. The model was based on a comprehensive evaluation of the four clinical specialties chosen as representative telemedicine services – radiology, psychiatry, emergency services and continuing education. The goals of the telemedicine network were to improve access to health services, provide support for rural health-care providers and increase the efficiency of specialized services. The findings showed that the success factors in a national telemedicine programme depend on a clear organizational structure, with appropriate technical standards and support.

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