Depression, Anxiety, Post-traumatic Stress Disorder and a History of Pervasive Gender-Based Violence Among Women Asylum Seekers Who Have Undergone Female Genital Mutilation/Cutting: A Retrospective Case Review

We sought to evaluate the frequency of anxiety, depression, PTSD, and any experiences of violence in women who had undergone Female Genital Mutilation/Cutting (FGM/C) and were seeking asylum in the United States. We undertook a retrospective qualitative descriptive study of FGM/C cases seen in an asylum clinic over a 2-year period. Standardized questionnaires provided quantitative scores for anxiety, depression and PTSD. Clients’ personal and physician medical affidavits were analyzed for experiences of violence. Of the 13 cases, anxiety and depression were exhibited by 92 and 100% of women, while all seven women screened for PTSD had symptoms. Qualitative analysis revealed extensive violence perpetrated against these women, demonstrating that FGM/C is only part of the trauma experienced. The high level of mental health disorders and endured violence has implications for providers working with FGM/C survivors and indicates the need for accessible mental health services and trauma-informed care

Building patient participation in quality of care through the healthcare stories project: A demonstration program in New York State HIV clinics

There is growing recognition that patients should play a central role in defining, assessing, and improving the quality of healthcare, thereby enhancing patient experiences. Healthcare organizations struggle to meet these goals, which require becoming more patient-centered and patient-involved. The Healthcare Stories Project (HCSP), a demonstration program of the NYS Department of Health AIDS Institute, aimed to address this. HCSP comprises three, stepwise activities to: 1) Capture how patients define and experience ‘quality of care’ in the clinic; 2) Engage patients and providers as equal partners in understanding and improving the quality of care; and through partnerships, 3) Support the building of a coproduced healthcare system. After reviewing HCSP and its rollout in New York HIV outpatient settings, we describe a qualitative process evaluation, consisting of interviews at two time points with implementing organizations (N=12, 11). Each activity offered an opportunity to share ideas and experiences of quality of care, generating concrete improvement project ideas. Activities strengthened patient involvement by engaging consumer advisory boards, and staff not traditionally involved in quality. While designed to be implemented with HIV patients, organizations implemented Activity Two and Three with broader populations. Organizations had the hardest time implementing Activity Three that focused on the coproduction concept, but they none the less applied and strengthened coproduced healthcare during Activities One and Two. Overall, HCSP is a promising model to advance patient-centered and patient-partnered quality of care, better understanding patient experiences and acting with patients to develop practical improvements and a more coproduced healthcare system. Experience Framework This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Morbidity and Mortality Conference, 2023-03-14

Morbidity and Mortality Conference, Hazel Lever, MD, MPH, Primary Care Physician at the Center for Refugee Health, Teaching Faculty, Unity Faculty Partner

Why VIP Services Are Ethically Indefensible in Health Care

Many health care centers make so-called VIP services available to very important persons who have the ability to pay. This article discusses common services (eg, concierge primary care, boutique hotel-style hospital stays) offered to VIPs in health care centers and interrogates trickle down economic effects, including the exacerbation of inequity in access to health services and the maldistribution of resources in vulnerable communities. This article also illuminates how VIP care contributes to multitiered health service delivery streams that constitute de facto racial segregation and influence clinicians\u27 conceptions of what patients deserve from them in health care settings