Violent victimization among immigrants: Using the National Violent Death Reporting System to examine foreign-born homicide victimization in the United States.

Limited research attention has focused on homicides involving foreign-born victims. Using data from the National Violent Death Reporting System, we examined 9428 homicides that occurred in 2017 in the United States across 32 states and D.C. Approximately 8% of homicide victims were foreign-born. Homicide victimization rates were substantially lower for foreign-born persons, compared to U.S.-born persons. However, foreign-born persons from Honduras, El Salvador, and Jamaica had a substantially higher risk of homicide victimization. Notably, few homicides involving foreign-born victims were gang- or drug-trade-related. With the growing number of immigrants in the United States, policy and prevention efforts should be guided by research.

Coprescribing naloxone for patients on chronic opioid therapy: Les-sons learned from a patient-safety initiative in primary care training sites.

OBJECTIVE: To describe the development and implementation of a resident-led effort to increase coprescription of naloxone in a primary care setting. DESIGN: An exploratory, prospective pilot project to increase coprescription rates of naloxone. SETTING: Four primary care offices in western Connecticut serving as medical home training sites for primary care residents. PATIENTS, PARTICIPANTS: All patients on chronic opioid therapy. INTERVENTIONS: Over a 2-month period, eligible patients were identified and approached to receive a naloxone coprescription. MAIN OUTCOME MEASURE: Rate of coprescriptions written. RESULTS: Three out of four training sites were able to increase coprescription rates, and 26 percent of eligible patients were able to have a prescription written. CONCLUSIONS: Primary care practices, particularly primary care training sites, looking to implement a coprescription initiative should take several important factors into consideration during the planning stages, including naloxone availability and availability of the patient for naloxone education. More extensive research on best practices is needed.

What Peer Mentoring Adds to Already Good Patient Care: Implementing the Carpeta Roja Peer Mentoring Program in a Well-Resourced Health Care System.

PURPOSE: The purpose of this study was to evaluate the impact of a peer support program on the health outcomes of patients already receiving well-organized, comprehensive diabetes care. METHODS: We used a mixed-methods, nonrandomized, control-group design to evaluate the impact of a peer-mentoring program on the health outcomes and self-management behaviors of adults with type 2 diabetes in 15 primary care practices in San Antonio. Propensity score analysis, t-tests, and multivariable repeated analyses were used to evaluate impact. Qualitative interviews were conducted with 15 participants in the intervention group and analyzed using a grounded theory approach. RESULTS: Both intervention and control groups showed significant improvement on all health indicators from baseline to 6-month follow-up (P<.001). Hemoglobin A1c (HbA1c) decreased slightly faster for patients in the intervention group (P=.04). Self-management behaviors improved significantly from baseline to 6-month follow-up for the intervention group. Interviewed participants also reported reductions in social isolation and extension of impact of health behavior changes to multiple generations of family members. CONCLUSIONS: The addition of peer mentoring to already well-organized comprehensive diabetes care does not improve outcomes. However, findings suggest that the impact of the program extends to members of the participants' families, which is an intriguing finding that deserves further study.

Practice patterns, beliefs, and perceived barriers to care regarding dementia: a report from the American Academy of Family Physicians (AAFP) national research network.

PURPOSE: Given the increasing age of the US population, understanding how primary care is delivered surrounding dementia and physicians' perceived barriers and needs associated with this care is essential. METHODS: A 29-item questionnaire was developed by project investigators and family physician consultants and mailed to a random sample of 1500 US members of the American Academy of Family Physicians in 2008; 2 follow-up mailings were sent to nonrespondents. Physicians were queried about sociodemographic characteristics, practice patterns, and beliefs (including challenges, barriers, and needs) about care processes focusing on dementia among older patients. RESULTS: The response rate was 60%, with respondents statistically comparable (P > .05) to the American Academy of Family Physicians physician population. Among physicians, 93% screen and/or conduct diagnostic evaluations for dementia in older patients, whereas 91% provide ongoing primary care for patients with dementia whether or not they screen for or diagnose dementia. Forty percent of physicians refer some patients with suspected dementia to other providers (primarily neurologists) to verify diagnosis, for comanagement, or both. Factors affecting the diagnosis of dementia and the delivery of dementia care included patient behavior challenges (aggressiveness, restlessness, paranoia, wandering); comorbidities (falls, delirium, adverse medication reactions, urinary incontinence); caregiver challenges (fatigue, planning for patient's institutional placement, anger); and structural barriers (clinician time, time required for screening, limited treatment options). Tools needed to provide enhanced dementia care included better assessment tools, community resources, and diagnostic and screening tools. CONCLUSION: Family physicians are highly involved in the assessment and routine care of patients with suspected dementia or diagnosed with dementia, although a relative few are not. This is despite the recognized challenges physicians encounter in the assessment and care processes.

GAPS in implementing health assessments in primary care: a literature review.

Patient-reported health data are critical components of patient-centered health care. However, barriers related to acquisition, implementation, and data use have not been well characterized. We conducted a systematic review of literature about health assessments in ambulatory and primary care covering 2 domains: (1) best practices in health assessments in primary care and (2) integration of health assessments into electronic health records. Our review found that training and standardization of practice workflows improves implementation of health assessments; however, gaps remain on identification and selection of health assessments, integration with electronic health records, and optimal intervals of health assessments administration.

Improving use of narcotics for nonmalignant chronic pain: a lesson from Community Care of North Carolina.

OBJECTIVE: To describe the development, implementation, and effects of collaborative effort to reduce diversion of prescription drugs in Caldwell County, NC. DESIGN: Development and implementation of practice guideline, statewide opioid registry, and survey of all primary care providers. SETTING: Rural Caldwell County, NC, has a population of 83,029, of which 89 percent are non-Hispanic White; 2009 median household income of $35,489. PATIENTS, PARTICIPANTS: All primary care clinicians in the county (N = 35). INTERVENTIONS: A task force developed and implemented a practice guideline that encouraged the following: 1) signing of pain contracts; 2) requiring patients to undergo random urine drug testing; and 3) requiring random pill counts. North Carolina implemented a statewide registry in 2007 that contained information on virtually all opioid prescriptions filled by pharmacies. MAIN OUTCOME MEASURE(S): Opioid pill confiscations by the Caldwell County Narcotics Division 24 months prior to implementation of the guidelines, the first 12 months during guideline implementation, and 12 months after the guideline was fully implemented. RESULTS: From 2005 to 2007, opioid pill confiscations decreased by 300 percent. Of the 35 physicians who were sent surveys, 27 responded (77 percent response rate). Ninety percent of respondents who prescribe opioids use the chronic pain guidelines. Sixty percent report an improvement in the overall management of patients with chronic pain; 65 percent reported having more confidence in treating patients with chronic pain; and 60 percent reported using the opioid registry. CONCLUSIONS: This county wide medical initiative appears to have resulted in a significant improvement in the abuse and diversion of medically derived opioids.

TRIPPD: a practice-based network effectiveness study of postpartum depression screening and management.

PURPOSE: Postpartum depression is common but inadequately recognized and undertreated. Continuing depressive symptoms are associated with adverse outcomes for the woman, her infant, and family. We wanted to determine the effect of a practice-based training program for screening, diagnosis, and management of depression in postpartum mothers. METHODS: In this practice-based effectiveness study, 28 practices were randomized to usual care (n = 14) or intervention (n = 14), and 2,343 women were enrolled between 5 and 12 weeks' postpartum. The intervention sites received education and tools for postpartum depression screening, diagnosis, initiation of therapy, and follow-up within their practices. Usual-care practices received a 30-minute presentation about postpartum depression. Screening information for the usual care was obtained from baseline surveys sent directly to the central site but was not available for patient care. Outcomes were based on patient-reported outcomes (level of depressive symptoms) from surveys at 6 and 12 months, plus medical record review (diagnosis and therapy initiation). RESULTS: Among the 2,343 women enrolled, 1,897 (80.1%) provided outcome information, and were included in the analysis. Overall, 654 (34.5% of 1,897) women had elevated screening scores indicative of depression, with comparable rates in the intervention and usual-care groups. Among the 654 women with elevated postpartum depression screening scores, those in the intervention practices were more likely to receive a diagnosis (P = .0006) and therapy for postpartum depression (P = .002). They also had lower depressive symptom levels at 6 (P = .07) and 12 months' (P=.001) postpartum. CONCLUSIONS: Primary care-based screening, diagnosis, and management improved mother's depression outcomes at 12 months. This practical approach could be implemented widely with modest resources.

Practice benefit from participating in a practice-based research network study of postpartum depression: a national research network (NRN) report.

BACKGROUND: At the midpoint of a large clinical trial taking place in a practice-based research network (PBRN), we asked leaders of the enrolled practices about the impact of participating in a PBRN study. METHODS: Using semistructured interviews, the lead study nurse and physician from each site were queried about the impact of study participation on issues related to the study topic of postpartum depression (PPD) as well as any other impacts on the practice not directly related to PPD. From the results, initial themes were identified by 3 of the investigators (BPY, SB, MK) and confirmed by all the authors. Interviewee responses were grouped by theme. RESULTS: Forty-eight study leaders from 28 solo, moderately sized group and residency practices were interviewed during a period of 60 days. Practices were located in 20 different states, and 54% were in rural communities. Six major themes emerged. Study participation led to: ((1)) the recognition of the need for systematic approaches; ((2)) more effective teamwork and communication within the practice; ((3)) adaptation and extension of the PPD study tools and a systematic approach to the care of other chronic conditions; ((4)) increased professional self-worth and community recognition; ((5)) opportunity and support for staff members to "stretch" into new roles; and ((6)) increased research literacy within the practice. CONCLUSIONS: Participating in a PBRN research study can provide advantages to practices that extend beyond the study's specific purpose and content. These results provide further support for the value of PBRN research funding.

Practice-based research network studies and institutional review boards: two new issues.

BACKGROUND: Practice-based research network (PBRN) study investigators must interface with multiple Institutional Review Boards (IRBs), many of which are unfamiliar with PBRN research. OBJECTIVE: To present 2 IRB-related issues that have not appeared in the literature but occurred during the course of a large 5-year PBRN study involving 32 sites dispersed around the United States. RESULTS: Our study required IRB approval from a total of 19 local, hospital, academic center, and professional organization-based IRBs that reviewed a protocol of postpartum depression screening and follow-up completed in English or Spanish. Initial approval of the protocol and consent forms proceeded with only the usual barriers of submitting 19 different forms, and no protocol amendments were required. However, 2 unanticipated IRB issues provided significant additional work for the study team and the local practice sites. First, several IRBs required staff to repeat human subjects training every 1 to 2 years, resulting in 92 practicing physicians, residents, and members of the nursing staff spending time completing the exact same human subjects' training at least twice during the course of this study. Second, 17 of the 19 IRBs required that the patient be given consent forms that were newly stamped and dated each year, requiring the central site to reprint and replace consent forms yearly. Because not all IRBs returned the newly stamped and dated forms in a timely fashion, study enrollment with valid consent forms was interrupted in 4 sites for periods of 2 to 13 weeks. CONCLUSIONS: IRB requirements not directly responsive to federal regulations can add significant costs, frustrations, and burdens to PBRN studies. Non-federally mandated IRB requirements should be based on an identified need with evidence to support the solution.