Ultrasonic partial glossectomy

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Promotoras as Mental Health Practitioners in Primary Care: A Multi-Method Study of an Intervention to Address Contextual Sources of Depression

We assessed the role of promotoras—briefly trained community health workers—in depression care at community health centers. The intervention focused on four contextual sources of depression in underserved, low-income communities: underemployment, inadequate housing, food insecurity, and violence. A multi-method design included quantitative and ethnographic techniques to study predictors of depression and the intervention’s impact. After a structured training program, primary care practitioners (PCPs) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and/or arranged consultations by mental health professionals and promotoras addressed the contextual sources of depression. Based on an intake interview with 464 randomly recruited patients, 120 patients with depression were randomized to enhanced care plus the promotora contextual intervention, or to enhanced care alone. All four contextual problems emerged as strong predictors of depression (chi square, p < .05); logistic regression revealed housing and food insecurity as the most important predictors (odds ratios both 2.40, p < .05). Unexpected challenges arose in the intervention’s implementation, involving infrastructure at the health centers, boundaries of the promotoras’ roles, and “turf” issues with medical assistants. In the quantitative assessment, the intervention did not lead to statistically significant improvements in depression (odds ratio 4.33, confidence interval overlapping 1). Ethnographic research demonstrated a predominantly positive response to the intervention among stakeholders, including patients, promotoras, PCPs, non-professional staff workers, administrators, and community advisory board members. Due to continuing unmet mental health needs, we favor further assessment of innovative roles for community health workers

Improving Craniofacial Team Collaboration: A Multicenter Interview Study of Effective Team Meetings

Elexis Hollingsworth,1,2 Benjamin H Shields,2,&ast; Christopher Rutter,2,3,&ast; Lynn Fox,4 Kelly N Evans,5 Jay Paul Willging,6 Amelia F Drake2 1School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2Department of Otolaryngology/Head and Neck Surgery, UNC Hospitals, Craniofacial Center, University of North Carolina, Chapel Hill, NC, USA; 3University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA; 4Adams School of Dentistry, UNC Craniofacial Center, University of North Carolina, Chapel Hill, NC, USA; 5Division of Craniofacial Medicine, Seattle Children’s Hospital, Seattle, WA, USA; 6Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA&ast;These authors contributed equally to this workCorrespondence: Elexis Hollingsworth, UVA Health, Department of Anesthesiology, 1215 Lee St. Box 800710, Charlottesville, VA, 22908‐0816, USA, Fax +1 434‐982‐0019, Email [email protected]: In the USA, the American Cleft Palate Association-Craniofacial Association (ACPA-CPF) specifies guidelines to ensure craniofacial teams function in a multidisciplinary fashion to provide care in a sequence that mirrors the patient’s needs. Among these guidelines is the expectation that teams hold regular multidisciplinary team meetings to discuss patient care. The purpose of this study was to identify factors that contribute to optimal team functioning during these meetings. The impact of the virtual format on meetings was also evaluated.Design: One-hour semi-structured interviews of craniofacial team members, queried on current and ideal team meetings, were conducted from December 2020 – January 2021. Interviews were recorded, transcribed, and coded to identify common themes until thematic saturation was achieved.Setting/Participants: Sixteen team members from three major American craniofacial centers were interviewed virtually.Results: Three major categories were identified as integral to successful meetings: (1) meeting content, (2) meeting processes, and (3) team dynamics. Within these categories are several factors that participants reported as important to optimize their multidisciplinary meetings: key content for discussions, integration of patient perspective, recognition of collaboration in determining proper sequence of treatments, an attentive discussion leader promoting equitable discussions, managing absences, and team diversity. Participants also identified benefits and pitfalls of hosting meetings in the virtual setting, including lack of engagement and awkward communication.Conclusion: Diverse groups of disciplines are expected to come together during craniofacial multidisciplinary meetings to formulate intricate care plans for complex patients. In this study, craniofacial team members have identified several key factors to optimize these meetings. The research group used these factors to propose a self-evaluation instrument for meeting quality improvement, provided in printable format. Further studies should evaluate how implementation of these factors affects meetings and ultimately guides patient care.Keywords: cleft lip-palate, multidisciplinary, interdisciplinary, teamwork, self-evaluation, virtua