Increasing Colorectal Cancer Screening Among Hispanic Primary Care Patients: RE-AIM Analysis.

Context: Hispanic adults experience disparities in rates of colorectal cancer (CRC) screening. This RE-AIM analysis encompassed a multilevel decision support and navigation intervention (DSNI) for CRC screening. Interim findings were previously presented; we now aim to share the final analysis, particularly for effectiveness and implementation. Objective: Apply RE-AIM framework to a completed randomized controlled trial of a CRC screening intervention for Hispanic adults Setting: Five primary care practices Patients or Other Participants: Potential participants included a sampling frame of 2,720 screening-eligible patients, ages 50-75, Hispanic ethnicity, without history of CRC and polyps. 400 participants were enrolled. Intervention/Instrument: Decision support and navigation by a bilingual Patient Assistant (PA) as compared to a standard mailed intervention (SI) Main and Secondary Outcome Measures: 1) Reach- Study participants as compared to sampling frame 2) Effectiveness- Screening adherence 3) Adoption- Number of practice participants to complete intervention, engagement of patient and stakeholder advisory committee (PASAC) 4) Implementation- Quantitative data pertaining to patient contacts and communication of screening plan to primary care practices, Qualitative data on PA and Telephone Interviewer (TI) experiences 5) Maintenance- Health system dissemination (Pending). Results: 1) Reach- Study participants differed from the sampling frame in that ages 50-59 were overrepresented. There were no differences in race, gender, or language. 2) Effectiveness- Screening adherence was significantly increased in the DSNI group (73%) as compared to the SI group (44%) (OR=3.48, CI: 2.29-4.29,

Survey of the Health of Urban Residents: a Community-Driven Assessment of Conditions Salient to the Health of Historically Excluded Populations in the USA.

BACKGROUND: Data from the Survey of the Health of Urban Residents (SHUR) identified connections between police brutality and medical mistrust, generating significant media, policy, and research attention. Amidst intersecting crises of COVID-19, racism, and police brutality, this report describes survey development and data collection procedures for the SHUR. BASIC PROCEDURES: We conducted focus groups with Black men, Latinxs, and immigrants in Allentown, Pennsylvania. Findings were used to develop and refine measures of conditions salient to the health of urban residents across the country. Quota sampling was employed; oversampling people of color and persons whose usual source of care was not a doctor\u27s office. MAIN FINDINGS: Non-Hispanic Whites made up just under two thirds of the sample (63.65%, n = 2793). Black/African American respondents accounted for 14.2% of the sample (n = 623), while 11.62% (n = 510) were Latinx. Only 43.46% of respondents reported a doctor\u27s office as their usual source of care. Novel measures of population-specific stressors include a range of negative encounters with the police, frequency of these encounters, and respondents\u27 assessments of whether the encounters were necessary. SHUR assessed the likelihood of calling the police if there is a problem, worries about incarceration, and cause-specific stressors such as race-related impression management. PRINCIPAL CONCLUSIONS: SHUR (n = 4389) is a useful resource for researchers seeking to address the health implications of experiences not frequently measured by national health surveillance surveys. It includes respondents\u27 zip codes, presenting the opportunity to connect these data with zip code-level health system, social and economic characteristics that shape health beyond individual factors

Promoting family medicine

The year 2002 saw the publication of a landmark white paper in the United Kingdom entitled "Shifting the balance." It proposed redistribution of funds with the lion's share of the NHS budget going towards Primary Care services. Soon after, the white paper was approved, and at present 75% of the NHS budget is directed towards primary care.1 This underpins the importance and priority which the government in the United Kingdom gives to primary care in order to have an effective health system.peer-reviewe

Family medicine in Malta

Whereas education in family medicine has made great advances in Europe in the last 30 years, it is still developing in Malta. The setting up of a Department of Family Medicine within the Faculty of Medicine and Surgery has brought our country in line with the rest of the European countries. The Malta College of Family Doctors, founded in 1989 filled the great void in the academic field of Family Medicine. Much was accomplished in the last 14 years, though much remains to be done.peer-reviewe

Family medicine training in Sub-Saharan Africa : South-South cooperation in the Primafamed project as strategy for development

BACKGROUND. Health-care systems based on primary health care (PHC) are more equitable and cost effective. Family medicine trains medical doctors in comprehensive PHC with knowledge and skills that are needed to increase quality of care. Family medicine is a relatively new specialty in sub-Saharan Africa. OBJECTIVE. To explore the extent to which the Primafamed South–South cooperative project contributed to the development of family medicine in sub-Saharan Africa. METHODS. The Primafamed (Primary Health Care and Family Medicine Education) project worked together with 10 partner universities in sub-Saharan Africa to develop family medicine training programmes over a period of 2.5 years. A SWOT (strengths, weaknesses, opportunities and threats) analysis was done and the training development from 2008 to 2010 in the different partner universities was analysed. RESULTS. During the 2.5 years of the Primafamed project, all partner universities made progress in the development of their family medicine training programmes. The SWOT analysis showed that at both national and international levels, the time is ripe to train medical doctors in family medicine and to integrate the specialty into health-care systems, although many barriers, including little awareness, lack of funding, low support from other specialists and reserved support from policymakers, are still present. CONCLUSIONS. Family medicine can play an important role in health-care systems in sub-Saharan Africa; however, developing a new discipline is challenging. Advocacy, local ownership, action research and support from governments are necessary to develop family medicine and increase its impact. The Primafamed project showed that development of sustainable family medicine training programmes is a feasible but slow process. The South–South cooperation between the ten partners and the South African departments of family medicine strengthened confidence at both national and international levels