Publications
The Center exists in part to create original evidence and information that support and advance conversations around professionalism, value, and other health care issues.
READ about scientific publications, briefs, and reports emerging from the Center and its collaborators below.
Comprehensiveness—the Need to Resurrect a Sagging Pillar of Primary Care
- Tracey L. Henry MD, MPH, MS
- Eugene C. Rich MD
- Andrew W. Bazemore, MD, MPH
Submitted on: August, 2021
The COVID-19 pandemic highlighted both the importance of primary care and the fragility of its current infrastructure in the United States (US). Within its first 2 months, stark reminders of racial injustice, unaddressed health disparities, and grossly inequitable access to healthcare further underscored the current lack and future importance of universal access to high-performing primary care. At the start of the pandemic, fewer than 1 in 5 Americans could identify a personal usual source of healthcare. In this time of uncertainty, many patients went without timely care due to a myriad of difficulties. Perhaps chief among these was the lack of an accessible, trusted personal clinician capable of and committed to delivering personalized advice and comprehensive care at a time of unprecedented medical and public health uncertainty. In response to this crisis, changes in actual and virtual visit accessibility to primary care were further complicated by the limited office hours or practice closures imposed by crises in provider organizational finances.
Follow-up survey on international COVID-19 primary care pandemic response study: report
- Felicity Goodyear-Smith
- Karen Kinder
- Andrew Bazemore
- Cristina Mannie
- Stefan Strydom
- Melina Taylor
- Aimee Eden
- Nam Bui
Submitted on: August, 2021
In our previous study, we revealed a disconnect in the early phases of the pandemic between primary care strength at a national level and early mortality rates from COVID-19, but also widespread and shared perceptions of limited investment in, coordination with, and engagement of primary care in pandemic response. This follow up one year into pandemic confirms nearly 80% of respondents felt that primary care providers are insufficiently remunerated to provide remote access services, with even higher proportions in the AMRO region.
In general, countries where primary care has been integrally involved in vaccine delivery appear to have better vaccination rates, but this is also influenced by the availability of vaccine. Having a coordinated response between public health and primary care also appears to be an effective strategy.
The vast majority of respondents affirmed the need for greater integration of and coordination between public health and primary care. And on a personal level, 85% reported experiencing some degree of personal mental health difficulty over the preceding year.
More positively, respondents felt that the primary care sector had learned from the pandemic, and would be in a better position to respond to the next one. Specifically, they noted that primary care providers have acquired an increased capacity for using technology in delivering primary care services as a result of COVID-19.
Role of social deprivation on asthma care quality among a cohort of children in US community health centres
- Jennifer A. Lucas
- Andrew W. Bazemore
- Miguel Marino
- Katie Fankhauser
- Sophia Giebultowicz
- Stuart Cowburn
- Jorge Kaufmann
- David Ezekiel-Herrera
- John Heintzman
Submitted on: July, 2021
Objective
Social deprivation is associated with worse asthma outcomes. The Social Deprivation Index is a composite measure of social determinants of health used to identify neighbourhood-level disadvantage in healthcare. Our objective was to determine if higher neighbourhood-level social deprivation is associated with documented asthma care quality measures among children treated at community health centres (CHCs).
Methods
(setting, participants, outcome measures) We used data from CHCs in 15 states in the Accelerating Data Value Across a National Community Health Center Network (ADVANCE). The sample included 34 266 children with asthma from 2008 to 2017, aged 3–17 living in neighbourhoods with differing levels of social deprivation measured using quartiles of the Social Deprivation Index score. We conducted logistic regression to examine the odds of problem list documentation of asthma and asthma severity, and negative binomial regression for rates of albuterol, inhaled steroid and oral steroid prescription adjusted for patient-level covariates.
Results
Children from the most deprived neighbourhoods had increased rates of albuterol (rate ratio (RR)=1.22, 95% CI 1.13 to 1.32) compared with those in the least deprived neighbourhoods, while the point estimate for inhaled steroids was higher, but fell just short of significance at the alpha=0.05 level (RR=1.16, 95% CI 0.99 to 1.34). We did not observe community-level differences in problem list documentation of asthma or asthma severity.
Conclusions
Higher neighbourhood-level social deprivation was associated with more albuterol and inhaled steroid prescriptions among children with asthma, while problem list documentation of asthma and asthma severity varied little across neighbourhoods with differing deprivation scores. While the homogeneity of the CHC safety net setting studied may mitigate variation in diagnosis and documentation of asthma, enhanced clinician awareness of differences in community risk could help target paediatric patients at risk of lower quality asthma care.
