Jacquelyn Favours conducted a capstone project assessing the primary care needs of women in Middle Tennessee and making recommendations for Planned Parenthood of Middle & East Tennessee (PPMET) to expand its services. She analyzed 450 patient records from PPMET clinics, finding high rates of chronic conditions. She recommended that PPMET expand primary care services, seek partnerships with medical schools, and launch a "Primary Care Safety Net" program to provide initial primary care to uninsured women. The project provided evidence of need to support PPMET expanding its role in improving women's healthcare access in the region.
1) The document discusses various sampling methods used in medical research including simple random sampling, stratified sampling, and cluster sampling.
2) It explains the need for sampling over a complete census due to advantages like lower cost, ability to estimate errors, and feasibility for large populations.
3) Key concepts discussed include sampling units, frames, parameters, statistics, and different types of errors associated with sampling.
1. Sample size calculation is an important part of ethical scientific research to avoid underpowered studies.
2. There are different approaches to sample size calculation depending on the study design and endpoints, such as comparing proportions, estimating confidence intervals, or analyzing time to event outcomes.
3. Key steps include defining the research hypothesis, primary and secondary endpoints, how and in whom the endpoints will be measured, and determining what difference is clinically meaningful to detect between study groups.
This document discusses sample size calculation and determination. It begins by defining a sample as a subset of a population used to make inferences about the whole population. Several factors affect sample size, including required accuracy, available resources, and desired level of precision. The document outlines different formulas and methods for calculating sample size based on study design and outcome measures. It provides examples of calculating sample size for estimating means, proportions, rates, odds ratios, and risk ratios. Computer software and readymade tables can also be used to determine optimal sample sizes.
The document discusses survival analysis and Cox regression for cancer clinical trials. It begins with an overview of clinical trials for cancer, noting their complexity, long duration, high costs, and ethical concerns. It then covers survival analysis, describing key concepts like survival curves, hazard functions, and the Kaplan-Meier method for estimating survival when there is censoring. The document provides an example of survival data from a cancer study and discusses assumptions and parameters used in survival analysis like median and mean survival times.
The PRISMA 2020 statement provides guidance for reporting systematic reviews. This article presents the explanation and elaboration document for PRISMA 2020, which explains the rationale for each reporting item. For each item, the authors explain why reporting is recommended, present recommendations in bullet points, and provide an example from a published review. The goal is to facilitate uptake of PRISMA 2020 and improve transparent and complete reporting of systematic reviews.
This document provides guidance on writing a health research proposal. It discusses key components such as the problem statement, objectives, methodology, variables, study design, data collection procedures, and ethics. A well-written proposal clearly explains the research question and plan to answer it. The methodology section should provide operational definitions of variables and detail how the study will be conducted and data analyzed. Considering ethics is important when researching human subjects. Overall, a strong proposal demonstrates the value and feasibility of the proposed research.
5. Calculate samplesize for case-control studiesAzmi Mohd Tamil
This document discusses sample size calculations for case-control studies. It provides an example comparing the rate of diabetes mellitus (DM) between patients with cataracts (cases) and those with normal vision (controls). Based on literature finding a 50% DM rate in cases and 8% in controls, the required sample size is 17 cases and 17 controls to detect this difference with 80% power and 5% type 1 error rate. Manual calculations and online calculators can both be used to determine sample size for case-control studies. Prior information is needed on exposure rates in cases and controls to perform these calculations.
The document discusses methods for calculating sample sizes for various study designs, including measuring prevalence, cross-sectional studies, case-control studies, and clinical trials. It provides formulas and examples for calculating sample sizes needed to measure a dichotomous outcome and a continuous outcome. For measuring prevalence, the sample size depends on the expected prevalence rate, desired precision level, and confidence interval. For studies comparing two groups, the sample size depends on the event rates in each group and the desired power and significance level to detect a difference between groups.
1) The document discusses various sampling methods used in medical research including simple random sampling, stratified sampling, and cluster sampling.
2) It explains the need for sampling over a complete census due to advantages like lower cost, ability to estimate errors, and feasibility for large populations.
3) Key concepts discussed include sampling units, frames, parameters, statistics, and different types of errors associated with sampling.
1. Sample size calculation is an important part of ethical scientific research to avoid underpowered studies.
2. There are different approaches to sample size calculation depending on the study design and endpoints, such as comparing proportions, estimating confidence intervals, or analyzing time to event outcomes.
3. Key steps include defining the research hypothesis, primary and secondary endpoints, how and in whom the endpoints will be measured, and determining what difference is clinically meaningful to detect between study groups.
This document discusses sample size calculation and determination. It begins by defining a sample as a subset of a population used to make inferences about the whole population. Several factors affect sample size, including required accuracy, available resources, and desired level of precision. The document outlines different formulas and methods for calculating sample size based on study design and outcome measures. It provides examples of calculating sample size for estimating means, proportions, rates, odds ratios, and risk ratios. Computer software and readymade tables can also be used to determine optimal sample sizes.
The document discusses survival analysis and Cox regression for cancer clinical trials. It begins with an overview of clinical trials for cancer, noting their complexity, long duration, high costs, and ethical concerns. It then covers survival analysis, describing key concepts like survival curves, hazard functions, and the Kaplan-Meier method for estimating survival when there is censoring. The document provides an example of survival data from a cancer study and discusses assumptions and parameters used in survival analysis like median and mean survival times.
The PRISMA 2020 statement provides guidance for reporting systematic reviews. This article presents the explanation and elaboration document for PRISMA 2020, which explains the rationale for each reporting item. For each item, the authors explain why reporting is recommended, present recommendations in bullet points, and provide an example from a published review. The goal is to facilitate uptake of PRISMA 2020 and improve transparent and complete reporting of systematic reviews.
This document provides guidance on writing a health research proposal. It discusses key components such as the problem statement, objectives, methodology, variables, study design, data collection procedures, and ethics. A well-written proposal clearly explains the research question and plan to answer it. The methodology section should provide operational definitions of variables and detail how the study will be conducted and data analyzed. Considering ethics is important when researching human subjects. Overall, a strong proposal demonstrates the value and feasibility of the proposed research.
5. Calculate samplesize for case-control studiesAzmi Mohd Tamil
This document discusses sample size calculations for case-control studies. It provides an example comparing the rate of diabetes mellitus (DM) between patients with cataracts (cases) and those with normal vision (controls). Based on literature finding a 50% DM rate in cases and 8% in controls, the required sample size is 17 cases and 17 controls to detect this difference with 80% power and 5% type 1 error rate. Manual calculations and online calculators can both be used to determine sample size for case-control studies. Prior information is needed on exposure rates in cases and controls to perform these calculations.
The document discusses methods for calculating sample sizes for various study designs, including measuring prevalence, cross-sectional studies, case-control studies, and clinical trials. It provides formulas and examples for calculating sample sizes needed to measure a dichotomous outcome and a continuous outcome. For measuring prevalence, the sample size depends on the expected prevalence rate, desired precision level, and confidence interval. For studies comparing two groups, the sample size depends on the event rates in each group and the desired power and significance level to detect a difference between groups.
The document provides guidance on developing and presenting a research proposal. It discusses that a research proposal communicates a research idea to obtain approval and funding to conduct the study. It should convince readers that the research is significant and address key elements like the title, objectives, methodology, budget, and dissemination plan. Developing a clear proposal helps facilitate smooth conduct of the research project.
This document discusses different methods for disseminating research findings, including oral presentations, written papers, and posters. Oral presentations allow for clarification and persuasion but information may be omitted. Written papers are a permanent record but are time-consuming. Posters visually attract audiences but have limited space. The document suggests using multiple dissemination methods together for maximum impact of research findings.
RESEARCH DESIGN AND METHODOLOGY - MAZPA EJIKEM NIMSA.pptxTORASIF
Research Design:
the overall structure or plan of the research project
your plan to answer the research question.
Research Methodology:
The study of the scientific steps adopted by a researcher in conducting a research.
Largely theoretical.
Research Methods:
The steps and techniques used for conduction of research, especially data collection and analysis.
It has a narrower scope than methodology.
This document discusses survival analysis and Cox regression for cancer clinical trials. It begins with an introduction to Cox regression analysis and how it can be used to analyze the effects of covariates on survival rates in cancer trials. The document then provides examples of Cox regression outputs and how to interpret the results, including checking the proportional hazards assumption. It cautions against some invalid methods of survival analysis that do not properly account for censored or time-dependent data.
The document provides an overview of survival analysis. It defines survival analysis as a branch of statistics that focuses on time-to-event data and their analysis. It discusses censored and truncated data, the life table method, the Kaplan-Meier estimator for estimating survival functions when there is censoring, and the Cox regression model for assessing relationships between covariates and survival times. The key aspects of survival analysis are estimating the probability of surviving past a certain time point and comparing survival distributions between groups while accounting for censored observations.
The document discusses survival analysis techniques using SPSS. It defines key survival analysis terms and covers non-parametric and semi-parametric survival analysis methods like Kaplan-Meier analysis and Cox regression. For Kaplan-Meier analysis, it provides an example to compare the effect of two drugs on time to effect. For Cox regression, it demonstrates how to identify attributes associated with customer churn. The document also discusses how to address time-dependent covariates in Cox regression models.
The document summarizes the results of a quantitative questionnaire given to 15 people about their viewing habits and preferences related to short films. Most respondents were female, white, and between ages 15-25 or 36-45. Respondents generally watch at least one film per week and prefer horror and drama genres. They have a difficult time accessing short films and do not go out of their way to watch them regularly. Themes around inaccurate adult perceptions and underrepresentation of parents in films could provide opportunities for new short films.
Risk of bias assessment and different tools used to assess systematic review ...Pubrica
The document discusses risk of bias assessment, which is used to evaluate systematic errors in studies. It describes different tools used to assess risk of bias based on study design, such as AMSTAR-2 for systematic reviews and Cochrane RoB for randomized trials. The document provides a table matching study types with the appropriate assessment tools. It explains that risk of bias assessment helps ensure findings are accurate and appropriate by identifying factors like selection bias or reporting bias. Selecting the correct risk of bias tool is important to properly evaluate studies and avoid systematic errors.
This document provides an overview of health technology assessment (HTA) through a presentation given at the 62nd Session of the WHO Regional Committee for the Eastern Mediterranean. It defines HTA and its goals of providing evidence-informed input to decision makers and ensuring value for money. The presentation outlines how HTA is a multidisciplinary activity that examines the effects of health technologies on resources, costs, technical aspects, and other issues. It provides examples of HTA implementation from Thailand, Iran, and other countries. The presentation calls for all countries to establish national HTA programs and capacities and emphasizes that HTA is especially important for resource-limited settings. It outlines future commitments and steps from member states and WHO to strengthen HTA in the
A cross-sectional study involves identifying a population at a single point in time and measuring variables like exposures and outcomes simultaneously. It can be descriptive by measuring single variables or analytical by examining associations between variables. While able to estimate disease prevalence and exposure proportions quickly, cross-sectional studies cannot determine causation due to issues like recall bias and inability to assess temporal sequence. Analysis uses contingency tables to calculate prevalence rates and measures of association like prevalence rate ratios.
Writing a research proposal is a very important step for research at any level. Good quality research is always based on a perfectly planned outline. The meaning & the procedure of writing a research proposal is described in the given presentation.
This document provides details on a case control study design. It discusses the history and definition of case control studies, noting they are observational and retrospective. The document outlines key aspects of case control study design including selecting cases and controls, matching subjects, measuring exposure, and analyzing the data. Examples are provided to illustrate selection of cases and controls as well as exposure rates and odds ratio calculations. Potential biases are also reviewed.
Critical appraisal of a journal articleDrSahilKumar
This document provides guidance on critically appraising journal articles. It defines critical appraisal as systematically identifying the strengths and weaknesses of research to assess validity and usefulness. Key aspects to evaluate include relevance of the research question, appropriateness of study design, addressing biases, adherence to original protocol, statistical analyses, and conflicts of interest. Checklists like CASP, CONSORT, and STROBE provide frameworks to appraise study methodologies like randomized trials, systematic reviews, and observational studies. The goal of critical appraisal is for clinicians to identify high-quality evidence to inform clinical practice.
This document discusses cohort studies, including:
1. A cohort study examines a group of individuals who share a common characteristic or experience to identify risk factors for outcomes like diseases.
2. Cohort studies can be prospective, following groups forward over time, or retrospective, looking back at medical records.
3. Key aspects of cohort studies include selecting study subjects, obtaining exposure and outcome data, choosing comparison groups, and following up with participants over time.
4. Cohort studies provide information on incidence rates and relative risks but can be resource-intensive and sensitive to losses during follow-up. The Framingham Heart Study is an ongoing prospective cohort study examining heart disease risk factors.
This document discusses key concepts related to determining sample size for surveys:
- Confidence interval and confidence level describe the level of certainty or precision in a sample - a 95% confidence level means the true population value would fall within the confidence interval 95% of the time.
- Sample size, population size, and response distribution (how answers are split) all impact the required sample size to achieve a given confidence level and interval. Higher confidence or lower intervals require larger samples.
- For a population of 20,000, with a 50-50 response split, and 95% confidence level, the required sample size is 377 people.
How to write the introduction section of a research paper, a Research paper, or Call for a Paper, Background of the Study, Purpose of the Study, Research Question and Hypothesis, Research Objectives.
This document discusses improving the patient experience in primary health care. It outlines issues with the current system such as fragmented care, access problems, and feelings of disempowerment among patients. Data shows many patients experience long wait times, lack of communication between providers, and doctors not spending enough time with them. The document calls for a more coordinated, comprehensive, and consumer-centered primary health care system to address these issues.
The document provides guidance on developing and presenting a research proposal. It discusses that a research proposal communicates a research idea to obtain approval and funding to conduct the study. It should convince readers that the research is significant and address key elements like the title, objectives, methodology, budget, and dissemination plan. Developing a clear proposal helps facilitate smooth conduct of the research project.
This document discusses different methods for disseminating research findings, including oral presentations, written papers, and posters. Oral presentations allow for clarification and persuasion but information may be omitted. Written papers are a permanent record but are time-consuming. Posters visually attract audiences but have limited space. The document suggests using multiple dissemination methods together for maximum impact of research findings.
RESEARCH DESIGN AND METHODOLOGY - MAZPA EJIKEM NIMSA.pptxTORASIF
Research Design:
the overall structure or plan of the research project
your plan to answer the research question.
Research Methodology:
The study of the scientific steps adopted by a researcher in conducting a research.
Largely theoretical.
Research Methods:
The steps and techniques used for conduction of research, especially data collection and analysis.
It has a narrower scope than methodology.
This document discusses survival analysis and Cox regression for cancer clinical trials. It begins with an introduction to Cox regression analysis and how it can be used to analyze the effects of covariates on survival rates in cancer trials. The document then provides examples of Cox regression outputs and how to interpret the results, including checking the proportional hazards assumption. It cautions against some invalid methods of survival analysis that do not properly account for censored or time-dependent data.
The document provides an overview of survival analysis. It defines survival analysis as a branch of statistics that focuses on time-to-event data and their analysis. It discusses censored and truncated data, the life table method, the Kaplan-Meier estimator for estimating survival functions when there is censoring, and the Cox regression model for assessing relationships between covariates and survival times. The key aspects of survival analysis are estimating the probability of surviving past a certain time point and comparing survival distributions between groups while accounting for censored observations.
The document discusses survival analysis techniques using SPSS. It defines key survival analysis terms and covers non-parametric and semi-parametric survival analysis methods like Kaplan-Meier analysis and Cox regression. For Kaplan-Meier analysis, it provides an example to compare the effect of two drugs on time to effect. For Cox regression, it demonstrates how to identify attributes associated with customer churn. The document also discusses how to address time-dependent covariates in Cox regression models.
The document summarizes the results of a quantitative questionnaire given to 15 people about their viewing habits and preferences related to short films. Most respondents were female, white, and between ages 15-25 or 36-45. Respondents generally watch at least one film per week and prefer horror and drama genres. They have a difficult time accessing short films and do not go out of their way to watch them regularly. Themes around inaccurate adult perceptions and underrepresentation of parents in films could provide opportunities for new short films.
Risk of bias assessment and different tools used to assess systematic review ...Pubrica
The document discusses risk of bias assessment, which is used to evaluate systematic errors in studies. It describes different tools used to assess risk of bias based on study design, such as AMSTAR-2 for systematic reviews and Cochrane RoB for randomized trials. The document provides a table matching study types with the appropriate assessment tools. It explains that risk of bias assessment helps ensure findings are accurate and appropriate by identifying factors like selection bias or reporting bias. Selecting the correct risk of bias tool is important to properly evaluate studies and avoid systematic errors.
This document provides an overview of health technology assessment (HTA) through a presentation given at the 62nd Session of the WHO Regional Committee for the Eastern Mediterranean. It defines HTA and its goals of providing evidence-informed input to decision makers and ensuring value for money. The presentation outlines how HTA is a multidisciplinary activity that examines the effects of health technologies on resources, costs, technical aspects, and other issues. It provides examples of HTA implementation from Thailand, Iran, and other countries. The presentation calls for all countries to establish national HTA programs and capacities and emphasizes that HTA is especially important for resource-limited settings. It outlines future commitments and steps from member states and WHO to strengthen HTA in the
A cross-sectional study involves identifying a population at a single point in time and measuring variables like exposures and outcomes simultaneously. It can be descriptive by measuring single variables or analytical by examining associations between variables. While able to estimate disease prevalence and exposure proportions quickly, cross-sectional studies cannot determine causation due to issues like recall bias and inability to assess temporal sequence. Analysis uses contingency tables to calculate prevalence rates and measures of association like prevalence rate ratios.
Writing a research proposal is a very important step for research at any level. Good quality research is always based on a perfectly planned outline. The meaning & the procedure of writing a research proposal is described in the given presentation.
This document provides details on a case control study design. It discusses the history and definition of case control studies, noting they are observational and retrospective. The document outlines key aspects of case control study design including selecting cases and controls, matching subjects, measuring exposure, and analyzing the data. Examples are provided to illustrate selection of cases and controls as well as exposure rates and odds ratio calculations. Potential biases are also reviewed.
Critical appraisal of a journal articleDrSahilKumar
This document provides guidance on critically appraising journal articles. It defines critical appraisal as systematically identifying the strengths and weaknesses of research to assess validity and usefulness. Key aspects to evaluate include relevance of the research question, appropriateness of study design, addressing biases, adherence to original protocol, statistical analyses, and conflicts of interest. Checklists like CASP, CONSORT, and STROBE provide frameworks to appraise study methodologies like randomized trials, systematic reviews, and observational studies. The goal of critical appraisal is for clinicians to identify high-quality evidence to inform clinical practice.
This document discusses cohort studies, including:
1. A cohort study examines a group of individuals who share a common characteristic or experience to identify risk factors for outcomes like diseases.
2. Cohort studies can be prospective, following groups forward over time, or retrospective, looking back at medical records.
3. Key aspects of cohort studies include selecting study subjects, obtaining exposure and outcome data, choosing comparison groups, and following up with participants over time.
4. Cohort studies provide information on incidence rates and relative risks but can be resource-intensive and sensitive to losses during follow-up. The Framingham Heart Study is an ongoing prospective cohort study examining heart disease risk factors.
This document discusses key concepts related to determining sample size for surveys:
- Confidence interval and confidence level describe the level of certainty or precision in a sample - a 95% confidence level means the true population value would fall within the confidence interval 95% of the time.
- Sample size, population size, and response distribution (how answers are split) all impact the required sample size to achieve a given confidence level and interval. Higher confidence or lower intervals require larger samples.
- For a population of 20,000, with a 50-50 response split, and 95% confidence level, the required sample size is 377 people.
How to write the introduction section of a research paper, a Research paper, or Call for a Paper, Background of the Study, Purpose of the Study, Research Question and Hypothesis, Research Objectives.
This document discusses improving the patient experience in primary health care. It outlines issues with the current system such as fragmented care, access problems, and feelings of disempowerment among patients. Data shows many patients experience long wait times, lack of communication between providers, and doctors not spending enough time with them. The document calls for a more coordinated, comprehensive, and consumer-centered primary health care system to address these issues.
The document provides an overview of nurse practitioners (NPs) in Ontario, Canada. It discusses the history and evolution of the NP role, including the establishment of NP education programs in the 1960s-1970s and the re-establishment of programs in the 1990s. It outlines the scope of practice of NPs, which includes diagnosing and treating illnesses, prescribing medications, and providing primary health care services. It also discusses challenges faced by NPs, such as issues around funding, and recommendations to better integrate and support the NP role in Ontario's healthcare system.
Advancing Team-Based Care: Complex Care Management in Primary CareCHC Connecticut
This webinar investigated the ways that team members can contribute to the care of patients with complex medical and/or social needs. The focus was on developing the expanded care team and ensuring ready communication between the core and expanded care teams. Models for effective care management were presented.
This webinar was presented May 5, 2016 3:00 p.m. Eastern Time
Community Wellness Through Improved Maternity Practices By Drs Jose Gorrin and Ana Parilla. Given at the Puerto Rican Cultural Center in September of 2003
The document summarizes a team's proposal on universal access to primary health care. The team details their coordinator, members, and contact information. It then discusses definitions of primary health care, principles of PHC, services offered at health centers, strategies to improve quality PHC according to WHO, requirements for universal access, and proposed solutions focusing on patient-provider relationships and comprehensive, equitable care.
This document summarizes Phase 1 of the Pioneer Baby quality improvement initiative which aims to improve pregnancy and birth outcomes in rural western Kansas. Phase 1 involved a health assessment of 185 rural women through surveys to obtain information on risk factors like weight, diet, exercise and family history. Key findings included that over half the women were overweight or obese prior to pregnancy, most did little to no moderate physical activity daily, and nearly a third had a family member with diabetes. Future phases will include an on-site prenatal clinic, focus groups to inform a health promotion program, and implementing an intervention to lower risks and improve outcomes.
Emerging Models- Reaching the Hard to Reach and UnderservedLaShannon Spencer
This panel discussion explored emerging models for reaching underserved populations in healthcare. Panelists presented on models for African American males, immigrants, rural residents, and the elderly. Community health centers were shown to effectively serve populations with high rates of poverty. A community health worker model improved access and outcomes. A home-based program reduced hospitalizations and improved management of diabetes and heart failure in rural areas. The transition to value-based care emphasizes primary care and care coordination through models like integrated behavioral health teams.
This organization provides comprehensive healthcare services through 25 health centers across Manhattan, the Bronx, and the Mid-Hudson Valley in New York. It trains health professionals and students while promoting diversity. It has over 600 staff members and a $45 million budget. Services include primary care, dental, mental health care, and programs for homeless individuals, those with HIV/AIDS, and new mothers and families with young children.
as part of the IFPRI-Egypt Seminar Series- funded by the United States Agency for International Development (USAID) project called “Evaluating Impact and Building Capacity” (EIBC) that is implemented by IFPRI.
This document provides an overview of maternal health services including family planning, antenatal care, delivery services, and postnatal care. It describes the objectives and components of each service, including identifying and managing risk factors during pregnancy to help prevent maternal and infant mortality. Key points covered include the importance of antenatal care in screening and treating conditions like anemia, providing tetanus immunizations, educating mothers on nutrition and birth preparedness, and using a risk scoring system to properly refer high-risk mothers for specialized care.
Harvesting Health: Growing Our Own Health Care ProfessionalsGreat Valley Center
Presentation given by Dr. Don Hilty and Michelle Villegas-Frazier from the UC Davis Medical School on the Panel: "Harvesting Health: Growing our own Health Care Professionals" at the Great Valley Center's Sacramento Valley Forum on October 27, 2010 in Chico, CA.
This document profiles 7 exemplary interprofessional primary care training programs across the United States that focus on developing competencies for team-based primary care. The programs highlighted train professionals such as family physicians, nurses, pharmacists, psychologists, social workers and more. They share common elements like a focus on patient-centered care, cultural sensitivity, quality improvement, effective team practice, dispersed leadership and integrating behavioral health. The profiles describe the programs' educational levels, elements, organization types, professions trained and competencies developed for team-based primary care. Interprofessional education is seen as key to achieving the goals of better health, better care and lower costs through the patient-centered medical home model.
The document summarizes the development and services of the Integrative Medicine and Palliative Care Team (IMPACT) at Children's Hospital at Montefiore. It describes how IMPACT began with a few clinicians in 2005 and has expanded to include various complementary and alternative medicine services. IMPACT assesses patients' physical, psychosocial and spiritual needs. It also provides education to medical staff and students on palliative care and integrative medicine. IMPACT is researching the effectiveness of interventions like aromatherapy, yoga and alternative diets.
The document summarizes the development and services of the Integrative Medicine and Palliative Care Team (IMPACT) at Children's Hospital at Montefiore. It describes how IMPACT evolved from initial assessments of patient needs to a multidisciplinary team providing services like herbal medicine, yoga, massage, and spiritual support. It also discusses IMPACT's education initiatives and current research studies exploring topics like the effectiveness of different diets for cancer patients and the impact of therapies like aromatherapy and yoga on symptoms.
The document summarizes the development and services of the Integrative Medicine and Palliative Care Team (IMPACT) at Children's Hospital at Montefiore. It discusses how IMPACT evolved from an initial focus on palliative care to offering additional complementary and alternative medicine services. IMPACT now includes practitioners of herbal medicine, yoga, massage, acupuncture, nutrition counseling, and other therapies. It also provides education to medical students and conducts research on topics like the effectiveness of different diets for pediatric oncology patients.
The document summarizes the development and services of the Integrative Medicine and Palliative Care Team (IMPACT) at Children's Hospital at Montefiore. It discusses how IMPACT evolved from an initial focus on palliative care to incorporate complementary and alternative medicine (CAM) approaches. IMPACT now provides a range of CAM services like yoga, massage, acupuncture, and herbal medicine to improve patients' quality of life. It also conducts education and research on palliative care and CAM for pediatric cancer patients.
The document summarizes the charge given by the Institute of Medicine to convene a committee of experts to review women's preventive health services and identify gaps. The committee was tasked with recommending services to be included in comprehensive national guidelines. After reviewing evidence, the committee made 8 recommendations, including screening for gestational diabetes, HPV testing, counseling on STIs and HIV, contraception services, lactation support, interpersonal violence screening, and annual well-woman visits.
This document discusses women's health residencies and fellowships at the University of Pittsburgh and VA Pittsburgh Health Care System. It outlines the goals of educational experiences in women's health, including early and frequent exposure through both integrated and focused learning. It describes the Women's Health Track program, which designates residency spots for focused training, and the Women's Health Fellowship program. Benefits of these programs include developing expertise in women's health research and recruiting residents interested in this specialty area.
1. Assessing the Primary
Care Needs of Women
in Middle Tennessee
Jacquelyn Favours, MPHc
TSU – MPH Program Capstone Presentation
May 7th, 2015
2. Overview
Health Care Access for Women in the U.S.
Planned Parenthood of Middle & East Tennessee – Internship Site
Current Planned Parenthood healthcare services
Capstone Project – Goals & Objectives
Capstone Project – Results
Project Recommendations – Site, Students, & Future Studies
Lessons Learned
Acknowledgements
3. Health Care Access Definitions
Primary (Preventive) Care11,12
• Concept used to describe
nature of services &
provider type
• Integrated/coordinated,
affordable & accessible, first-
contact, long-term
• HHS – “Services which help
you avoid illness & improve
health”
Comprehensive
care for patient
needs
Integration;
Coordination of
care
1st contact access
for each new
need
Long-term
focused care
Primary
Care
4. Health Care Access Definitions
Health Care Safety Net
• Public or private health care
providers that deliver care in a
variety of settings to a diverse
patient population, who are
other wise unable to afford or
access care
Health Care Safety Net4
5. What are the issues with
women’s preventive care in
the U.S.?
6. Issues in Women’s Preventive Health in U.S.
Primary Care Physicians (PCPs)
• Shortage in U.S. – 1: 88315,16
• Low % of uninsured & underinsured
patients
• No clear cut definition for primary care vs.
reproductive care - misdiagnosis &
underdiagnoses1
Inconvenient Healthcare Expectations10
• PCP & OBGYN – fragmentation
• Belief that annuals consist of all preventive
health care services
Uninsured, Underinsured, &
Low-Income
• Most likely to not identify a PCP
• Rely solely on family planning
clinics1
7. Coverage Gap
Garfield, R., Damico, A., Stephens, J., & Rouhani, S. (2015). The coverage gap: uninsured poor adults in states that do not expand Medicaid
– an update. The Henry J. Kaiser Family Foundation. Retrieved from http://kff.org/health-reform/issue-brief/the-coverage-gap-
uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/
9. The Coverage Gaps in Tennessee17
Approx. 284,000 uninsured in TN – 44% women
66% of uninsured women see cost as a barrier vs. 24%
insured
- Not qualified for Medicaid in TN
- Not qualified for tax credits
10. Women who need preventive care the most continue to
fall through the gaps of the fragmented U.S. health
care system1.
Don’t receive
full extent of
recommended
primary care.
At higher risk for
chronic diseases.
Continue to
face barriers
to health
care.
Miss opportunity
to prevent/treat
disease and illness
at the initial
stages.
The Big Picture
11. U.S. Health Reform Passed
Additional & “Free”
Preventive Services
for Women1
Women are now
accessing “affordable”
health care insurance
Health Care Status for Women in
the U.S.
12. Preventive Health
Services for Women
under
Health Care Reform
http://www.ghcbettertogether.com/basics/womens-health-care/
14. Planned Parenthood of Middle &
East Tennessee (PPMET)– Nashville
Health Center
Internship Site – June 2014 to August 2014
15. 1 Central Office (London)
6 Regional Offices:
- New York, Western
Hemisphere
- Nairobi, Africa
- Tunis, Arab World
- New Delhi, South Asia
- Kuala Lumpur,
East/South East Asia &
Oceania
- Brussels, European
Network
16. Located in all 50 states & D.C. – 65 affiliates nationally
17. 3 clinics: Nashville, Knoxville, & Johnson City
Covers 76 of 95 counties in TN & 39
Southeastern counties in KY.
Serving nearly 20,000 women a year
Mission – “…provide access to reproductive, sexual, an
complimentary healthcare and complimentary sexuality
services and education…protect the right to privacy … for
men, women, and teens. On the belief that … an
individuals' pursuit of sexual health is essential to one’s
well-being regardless of race, age, income status, religion,
or sexual orientation.9”
Health Services Offered:
- Sexual Health Education
- Contraception
- Gynecological care
- Family planning counseling
- HIV testing/counseling
- STI screening & treatment
- Prenatal care
- Primary care
- General health care
- Specialized care referrals
18. PPMET & Primary Care Expansion
- By expanding primary care services to serve as a safety net
for low-income, underserved, & uninsured patient population.
Potential Services:
• Check-ups
• School physicals
• Immunizations (influenza, pertussis,
hepatitis)
• Minor health problems (strep throat,
bladder infections)
• Chronic disease management
(hypertension, asthma, diabetes,
smoking cessation, weight
management)
19. Capstone Project – Goals & Objectives
Determine PPMET’s potential
for expanding to full extent of
primary care services for
women 18 – 49.
• Identified primary care service
parameters for needs assessment form
patient charts
• Analyzed data from primary data
collection
• Interpreted findings to indicate if need
for expanded primary care exist
• Drafted final report
Facilitate PPMET’s primary
service delivery to target
population through
recommendations.
• Assessed patient & public opinions on
use of primary care from PPMET
• Determined conduciveness of political
environment and funding opportunities
• Identified strategy for expansion of
primary care
20. Project Activities
- Primary Care Needs Assessment for Existing Patient
Population.
Data Collection
Created instrument in REDCap
Collected data on demographics,
social risk factors, vitals, medical
history, & medications
450 patient records surveyed
Data Analysis Results
Exported data from REDCap to Excel
Case Summaries
Presented to Ad Hoc Primary Care
Committee
21. Results – The Breakdown
292 women of reproductive age
(18-49) 65% overall
- Presence of chronic disease
contributors
- Only small % of chronic disease
detected
Surveyed Responses
- 120 TSU students
- 61% would consider using primary
care services
Table1.2–NeedsAssessmentHealthIndicatorsofFemales18-49
Frequency Percentage(%)
Vitals
Overweight/Obesity 115 40%
HighSystolic
BloodPressure
99 34%
BehavioralRisk
CigaretteSmokers 66 23%
AlcoholConsumption 116 40%
HealthHistory
Migraines 84 29%
ThyroidProblems 13 4%
Asthma 32 11%
HighCholesterol 13 4%
Anemia 49 17%
22. Results – Demographic Breakdown
White
60%
Black
25%
Hispanic
9%
Asian
3%
Females Patients Age 18 – 49 by Ethnicity
White
Black
Hispanic
Asian
Amer. Indian/Pacific Islander
Other
23. Results – A Closer Look: Overweight & Obesity
0
10
20
30
40
50
60
Asian Black Hispanic Indian/Pacific
Islander
Other White
Percentage
Ethinicity
Overweight/Obese Female
Patients 18 - 46
by Ethnicity
Obese
Overweight
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
18 - 23 24 - 29 30 - 34 35 - 39 40 - 46
Percentage
Age Group
OVERWEIGHT/OBESE FEMALE
PATIENTS 18 - 46
BY AGE AND ETHNICITY
Other
Amer.Indian/Pacific Islander
Asian
Black
White
24. Recommendations for PPMET
Expand primary care services? – YES.
To extent of recommended preventive services for women
Seek use of resident/students from partnering nursing
and medical schools to provide primary care.
Launch campaign for service expansion
Ex. “More Than What You Think” Campaign – used by Planned
Parenthood Action Fund (PPAF)
Set up program for patient centered medical home for
women 18 – 49 – “Primary Care Safety Net”
25. Recommendations for PPMET (cont.)
Primary Care Safety Net Program
1. Screen patients for insurance & PCP
2. Target uninsured and/or unable to identify
PCP
3. Provide initial primary care; schedule next
annual appt.
4. Monitor/survey use of healthcare services
5. Provide reminders & follow ups for
program
6. Maintain well-documented program for
prospective funding purposes and program
retention
26. Recommendations
Future Studies & Students
Explore preferences for family planning clinics vs. private practice
Assess use of services by PPMET vs. Federally Qualified Health
Centers (FQHCs).
Consider public perceptions of Planned Parenthood clinics.
Explore strategies to fill gaps or create coordinated
women’s health care.
Evaluate primary care services, if expanded by PPMET.
Maintain communication with preceptor(s).
Be innovative!
27. Lessons Learned
• Healthcare gaps remain despite efforts to break barriers.
• Most women of reproductive age prefer women’s health clinics
due to cost & confidentiality.
• Funding is essential to primary care expansion, but
controversial for the context of PPMET.
• Do not underestimate data collection!
• Focused scope of Public Health Interests.
28. Acknowledgements
Planned Parenthood of Middle & East
Tennessee
Ad Hoc Primary Care Committee
Dr. Ellen Clayton, Committee Chair
Mr. Steven Emmert, PPMET COO & Preceptor
Dr. Maureen Sanderson, P.I. & PPMET Board
Ms. Denis Bentley
Ms. Tracey George, PPMET Board
Ms. Dakasha Winton, PPMET Board
Ms. Mary Kay Fadden, MMC Supervisor
TSU – Master of Public Health Program
Dr. Mohamed Kanu, Program Director &
Field Placement Coordinator
Dr. Elizabeth Brown, Faculty Advisor
Dr. Elizabeth Williams, Capstone Advisor
Ms. Jessica Powell, MPH Program
Manager
The TSU MPH Graduating Cohort of
Spring 2015!
29. References
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