Browsing by Subject "Federally qualified health center"

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    Clinic Factors Associated With Mailed Fecal Immunochemical Test (FIT) Completion: The Difference-Making Role of Support Staff
    (Annals of Family Medicine, 2022) Davis, Melinda M.; Schneider, Jennifer L.; Petrik, Amanda F.; Miech, Edward J.; Younger, Brittany; Escaron, Anne L.; Rivelli, Jennifer S.; Thompson, Jamie H.; Nyongesa, Denis; Coronado, Gloria D.; Emergency Medicine, School of Medicine
    Purpose: Mailed fecal immunochemical test (FIT) programs can facilitate colorectal cancer (CRC) screening. We sought to identify modifiable, clinic-level factors that distinguish primary care clinics with higher vs lower FIT completion rates in response to a centralized mailed FIT program. Methods: We used baseline observational data from 15 clinics within a single urban federally qualified health center participating in a pragmatic trial to optimize a mailed FIT program. Clinic-level data included interviews with leadership using a guide informed by the Consolidated Framework for Implementation Research (CFIR) and FIT completion rates. We used template analysis to identify explanatory factors and configurational comparative methods to identify specific combinations of clinic-level conditions that uniquely distinguished clinics with higher and lower FIT completion rates. Results: We interviewed 39 clinic leaders and identified 58 potential explanatory factors representing clinic workflows and the CFIR inner setting domain. Clinic-level FIT completion rates ranged from 30% to 56%. The configurational model for clinics with higher rates (≥37%) featured any 1 of the following 3 factors related to support staff: (1) adding back- or front-office staff in past 12 months, (2) having staff help patients resolve barriers to CRC screening, and (3) having staff hand out FITs/educate patients. The model for clinics with lower rates involved the combined absence of these same 3 factors. Conclusions: Three factors related to support staff differentiated clinics with higher and lower FIT completion rates. Adding nonphysician support staff and having those staff provide enabling services might help clinics optimize mailed FIT screening programs.
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    Outcomes of a Two-Visit Protocol for Long Acting Reversible Contraception for Adolescents and Young Adults
    (Elsevier, 2022) Wilkinson, Tracey A.; Edmonds, Brownsyne Tucker; Cheng, Erika R.; Pediatrics, School of Medicine
    Objectives: To examine outcomes of a 2-visit protocol for placement of intrauterine or subdermal contraception. Study design: We identified all women ages 15 to 27 who received an order for an intrauterine or subdermal contraceptive between January 2014-December 2016. We examined time from order to contraceptive placement and reasons for incomplete orders. Results: We identified 1,192 unique patients who received 1,323 orders for intrauterine or subdermal contraceptives; 68% were completed at a second visit. The median time from order to placement was 22 days (interquartile range = 15-35). Of incomplete orders, 41% were related to logistics of a subsequent visit. Twenty-eight percent of patients had a subsequent pregnancy within the study period. Conclusions: Efforts to provide same-day access for all contraceptive methods are needed.