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Katherine McDermott,1,2 Alexander Mattia Presciutti,1,2 Nadine Levey,1 Julie Brewer,1 Christina L Rush,1,2 Natalia Giraldo-Santiago,1,3 Tony V Pham,1,2 Roger Pasinski,4 Neda Yousif,4 Milton Gholston,4 Vidya Raju,4 Jonathan Greenberg,1,3 Christine S Ritchie,2,3 Ana-Maria Vranceanu1,2 1Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA; 4MGH Revere HealthCare Center, Revere, MA, USACorrespondence: Ana-Maria Vranceanu, Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, One Bowdoin Square, 1st Floor, Suite 100, Boston, MA, 02114, USA, Email avranceanu@mgh.harvard.eduPurpose: Chronic pain is highly prevalent and disabling for older adults, particularly those from underserved communities. However, there is an absence of research on how contextual (eg, community/societal) factors interact with pain for these patients. Informed by the socio-ecological model, this study aimed to elucidate the individual, interpersonal, community, and societal factors associated with chronic pain from the perceptions of older adult patients and medical staff in a community clinic.Patients and Methods: In this qualitative study, we conducted four focus groups and two interviews with medical staff (n=25) and three focus groups and seven individual interviews with older adult patients with chronic pain (n=18). Participants were recruited using purposive sampling from an ethnically and economically diverse primary care clinic in the greater Boston community. We transcribed assessments and thematically analyzed data using a hybrid deductive-inductive approach.Results: At the individual level, we identified three themes: (1) older adults with complex care needs, (2) impact of pain (including on physical, emotional, work, and identity functioning), and (3) coping with pain. At the interpersonal level, complex relationships with (1) social supports and (2) medical staff emerged as themes. The need for (1) resources and (2) culturally informed care was identified at the community level, and socioeconomic status impacting the availability of resources for managing chronic pain emerged for the societal domain.Conclusion: Findings underscore the intersection of factors contributing to the experience of pain among older adults from underserved communities. Our findings highlight the need to develop and implement treatments that fully address the experience of older adults with chronic pain at the individual, interpersonal, community, and societal levels.Keywords: community clinic, pain, health disparities

Among 98 participants with penile discharge symptoms of Chlamydia trachomatis or Neisseria gonorrhoeae at a walk-in sexual health clinic, 11 were diagnosed with Mycoplasma genitalium , 10 had antibiotic resistance, and 6 were incorrectly presumptively treated. Our findings highlight the importance of public health strategies and research to curb M genitalium. [ABSTRACT FROM AUTHOR]

Introduction: Western Sydney Diabetes (WSD) established an innovative diabetes service in May 2020, using virtual and in-person care, linking primary care with the diabetes specialist team. This study evaluated the service's feasibility using qualitative and quantitative methods. Method: Evaluation included: 1) thematic analysis of interviews and workshops with patients and health professionals (n = 28); 2) quantitative analysis of records of patients admitted July 2020-June 2021 (n = 110). Results: Key themes related to 1) benefits: convenient location, access to integrated care, advantages of virtual care; 2) challenges: hard for patients to ask questions, technology issues; 3) confidence: shared care decision making, multidisciplinary team; and 4) future directions: additional multidisciplinary services, expanded insulin stabilisation service, promotion. Improvements between baseline and 3 months included 1.3% reduction in HbA1c (p < 0.05). Sulfonylurea dropped by 25% between initial appointment and follow-up, and GLP1RA/SGLT2i use increasing by 30% (p < 0.05). The clinic covered costs using Medicare billings and Nationally Weighted Activity Units. Discussion: The findings suggest this integrated care model was feasible and perceived as beneficial by both patients and providers. The clinic offers a promising model of practice that could be developed further to roll out in other regions for rural delivery of care. [ABSTRACT FROM AUTHOR]

Background: Bangladesh has improved maternal and child health, but healthcare indicators and access still need enhancement. Factors that contribute to increased antenatal care (ANC) need to be explored to inform healthcare policies. The study examined whether community-level (supply-side) predictors outperform individual/family-level (demand-side) predictors for the desired number of ANC services. Methods: This cross-sectional study collected primary data from 630 pregnant and lactating women (PLW) in seven upazilas in Rangpur and Nilphamari districts of Bangladesh in 2022. The individual/family and community-level factors as predictors of desired antenatal care services were investigated using a semi-structured questionnaire. Various statistical techniques including the Student t-test, z-test, Chi-square test, and logistic regression model were employed in analyzing the data. Results: Out of the total 630 participants, the majority were literate women who belong to higher pregnancy order and received benefits from SSNPs. In addition to this, these women did not earn and neither were the empowered. The outcome variable was the receiving status of 4+ ANC services by PLWs, which varied by different covariates. The desired 4+ ANC service received by 73 % PLWs. The significant (p

Background: To improve preventative health screening in regional Victoria, Australia, a collaborative student-led health prevention strategy was initiated. The aim of this study is to evaluate the impact of four health check clinics using a free 'pop-up' format within community settings. Methods: A mixed methods, explanatory sequential design was used to explore community health data and participant experiences in utilising the free health check clinics. The clinics were delivered over 6 months and located in three different communities within the regional government area. Descriptive statistics were used to analyse participant health data and a thematic analysis was utilised to determine themes from participant feedback and health outcomes. Results: The clinics were attended by 188 community members, largely impacted by government lockdowns during the coronavirus disease 2019 (COVID-19) pandemic. Health check results indicate the population is overweight and at high risk of diabetes. Participants enjoyed the free and convenient nature of the health check program and the location of the venues. Feedback from participants indicate the health education provided was useful and advocated for changes in current behaviours. Many embraced the new information and community connections and made changes to improve their future health. Others claimed to enjoy the clinic experience but reported no action from the recommendations. Conclusions: Evaluation of the health check clinics indicate they had a minor, yet positive impact on the local community in increasing engagement with preventative screening strategies. COVID-19 restrictions impacted participant numbers and thus more research is needed in a time where community movement is not limited. Access to preventative health care and screening is often challenging in regional areas. Free student-led pop-up health check clinics provide improved access and convenience, offering health education and early intervention strategies that aim to reduce future chronic health within the local population. This study demonstrates how community collaboration is able to provide screening services, support healthy behaviour change and strengthen the development of future health practitioners. [ABSTRACT FROM AUTHOR]

The healthcare industry is well aware of the issue of limited resources. By properly managing available resources, waste may be minimized. Bangladesh is a developing nation with limited resources, hence it is essential to estimate technical efficiency in this circumstance. Health care efficiency in the developed world has long been examined using Data Envelopment Analysis (DEA). However, few studies have used DEA to evaluate the effectiveness of healthcare delivery in emerging economies, especially in Bangladesh. A total of 24 community clinics in Kushtia were chosen at random for this study, and their technical efficiency was determined using the DEA method. The goal was to assess health centers’ levels of efficiency and provide recommendations for improving less effective centers’ performance. Input-based Data Envelopment Analysis was utilized to evaluate technical efficiency. The first category comprised of twelve prominent public hospitals. In this study, the number of outpatient visits was both an input and an outcome variable, whereas physicians, nurses, drugs, and other medical supplies were input variables. The Malmquist index was also utilized to assess efficiency gains and losses over time in community clinics. The eleven surviving community health clinics ended just inside the border. Based on their average efficiency rating, the facilities could accomplish the same goals while consuming 42% less inputs. On average, each CC created garbage worth TK. 0.14 crore. Across the board, production grew during the study periods. Overall, the findings suggest that public health centres are extremely inefficient in their delivery of health care and that substantial savings may be achieved by implementing steps to reduce waste.

The healthcare industry is well aware of the issue of limited resources. By properly managing available resources, waste may be minimized. Bangladesh is a developing nation with limited resources, hence it is essential to estimate technical efficiency in this circumstance. Health care efficiency in the developed world has long been examined using Data Envelopment Analysis (DEA). However, few studies have used DEA to evaluate the effectiveness of healthcare delivery in emerging economies, especially in Bangladesh. A total of 24 community clinics in Kushtia were chosen at random for this study, and their technical efficiency was determined using the DEA method. The goal was to assess health centers' levels of efficiency and provide recommendations for improving less effective centers' performance. Input-based Data Envelopment Analysis was utilized to evaluate technical efficiency. The first category comprised of twelve prominent public hospitals. In this study, the number of outpatient visits was both an input and an outcome variable, whereas physicians, nurses, drugs, and other medical supplies were input variables. The Malmquist index was also utilized to assess efficiency gains and losses over time in community clinics. The eleven surviving community health clinics ended just inside the border. Based on their average efficiency rating, the facilities could accomplish the same goals while consuming 42% less inputs. On average, each CC created garbage worth TK. 0.14 crore. Across the board, production grew during the study periods. Overall, the findings suggest that public health centres are extremely inefficient in their delivery of health care and that substantial savings may be achieved by implementing steps to reduce waste. [ABSTRACT FROM AUTHOR]

Introduction: Western Sydney Diabetes (WSD) established an innovative diabetes service in May 2020, using virtual and in-person care, linking primary care with the diabetes specialist team. This study evaluated the service’s feasibility using qualitative and quantitative methods. Method: Evaluation included: 1) thematic analysis of interviews and workshops with patients and health professionals (n = 28); 2) quantitative analysis of records of patients admitted July 2020–June 2021 (n = 110). Results: Key themes related to 1) benefits: convenient location, access to integrated care, advantages of virtual care; 2) challenges: hard for patients to ask questions, technology issues; 3) confidence: shared care decision making, multidisciplinary team; and 4) future directions: additional multidisciplinary services, expanded insulin stabilisation service, promotion. Improvements between baseline and 3 months included 1.3% reduction in HbA1c (p < 0.05). Sulfonylurea dropped by 25% between initial appointment and follow-up, and GLP1RA/SGLT2i use increasing by 30% (p < 0.05). The clinic covered costs using Medicare billings and Nationally Weighted Activity Units. Discussion: The findings suggest this integrated care model was feasible and perceived as beneficial by both patients and providers. The clinic offers a promising model of practice that could be developed further to roll out in other regions for rural delivery of care.

Objectives: This article argues that community healthcare clinics managed by dedicated medical professionals who are familiar with the special needs of the local community may serve as effective alternatives to centralized hospitals and medical facilities, which may be disconnected from these local communities. Background: The literature indicates that socioeconomic factors that affect an individual's ability to seek medical help when needed can cause vulnerability to public health emergencies. These factors include belonging to lower income populations, being African American, being dependent due to age (below 18 or above 65) or disability, being an immigrant, English-language ability, access to transportation means, and the strength of an individual's social network. Method: This study aims at developing a multifaceted methodology to identify optimal locations for deployment of temporary healthcare clinics to address health disparity issues among socially vulnerable populations, especially during pandemics and public health crises. This case study looks at the Health Enterprise Zone (HEZ) in Baltimore and ranks Census tracts based on their vulnerability, using two novel health vulnerability indices and considering their locations. Results: Using the proposed methodology, the optimal tracts within the HEZ are identified as potential locations for deploying temporary healthcare clinics. Conclusion: The analysis of vulnerabilities to public health emergencies based on socioeconomic factors can assist in identifying potential locations for setting up temporary healthcare clinics with the goal of assisting socially vulnerable populations during outbreaks and pandemics. [ABSTRACT FROM AUTHOR]

Abstract Background Although falls are common and can cause serious injury to older adults, many health care facilities do not have falls prevention resources available. Falls prevention resources can reduce injury and mortality rates. Using the Centers for Disease Control and Prevention’s (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI) model, a falls risk clinic was implemented in a rural Indian Health Service (IHS) facility. Methods A Fall Risk Questionnaire was created and implemented into the Provider’s Electronic Health Records system interface to streamline provider screening and referral of patients who may be at risk for falls to a group falls risk reduction class. Results Participants exhibited average improvements in the Timed Up and Go (6.8 s) (P = 0.0001), Five-Time Sit-to-Stand (5.1 s) (P = 0.0002), and Functional Reach (3.6 inches) (P = 1.0) tests as compared to their own baseline. Results were analyzed via paired t test. 71% of participants advanced out of an “increased risk for falls” category in at least one outcome measure. Of the participants to complete the clinic, all were successfully contacted and three (18%) reported one or more falls at the 90-day mark, of which one (6%) required a visit to the Emergency Department but did not require hospital admission. Conclusions In regards to reducing falls in the community, per the CDC STEADI model, an integrated approach is best. All clinicians can play a part in reducing elder falls.

Introduction Bangladesh provides free healthcare to its citizens through 10,723 community clinics which provide one-stop healthcare services that is vital in ensuring primary healthcare. Measuring beneficiary' contentment is crucial to improve the quality of care and the perceived service quality have a significant impact on how often people use those health services. This study focuses on perceived quality and satisfaction of beneficiaries about the primary health care services and benefits of community clinics in Bangladesh. Methods A quantitative descriptive survey was conducted from March 2019 to April 2019 in the catchment area of 80 community clinics located at 16 Upazila under eight districts of eight divisions in Bangladesh. The survey compiled local data on client's experience on health care service of community clinics. Besides, Sixteen Upazilas from eight districts were randomly selected for conducting interviews. Results Data was provided by a total of 760 female participants, among them majority (41%) belonged to the age group of 18-24 years old, and this very group showed more satisfaction than others (Odds Ratio 1.44). Besides, childless married women were also found to be content with the community clinic services compared to the remaining types of clients (Odds Ratio 1.64). However, gender, education, and economic perspective were positive aspects of getting service from community clinics. Conclusions Although there is a challenge balancing psychosocial and medical care, promoting client-oriented care with a focus on the cultural factors of the area is vital. This can be done through community-focused training together with explaining written prescriptions to the beneficiary, including the signs, symptoms, treatment, and referral points. The study findings will enable responsible authority to improve quality of primary health care services, realizing beneficiary' ideas of community clinic service quality. [ABSTRACT FROM AUTHOR]

Abstract Background Globally, naturopathic practitioners offer services in 98 countries, reaching every world region and providing care to diverse populations for a range of acute and chronic health conditions. Community clinics provide free or low-cost healthcare services and play a key role in providing necessary primary healthcare for underprivileged or marginalized populations. However, the reach and impact of naturopathic community clinics (NCCs) has not yet been examined. The aim of this study was to identify the characteristics of NCCs around the world, determine the types of services they offer and provide insight into the populations being served. Methods Two online cross-sectional surveys were administered using purposive and snowball sampling. A 6-item screening survey was administered first to identify clinics and institutions who fit the criteria for NCC services, followed by a 40-item follow-up survey. Descriptive analysis was conducted using frequencies and means. Results The screening survey returned a total of 37 responses from six world regions. Of those respondents who indicated involvement in NCCs, 74% went on to complete the follow-up survey. The majority of the responding NCCs were located in North America (50%), followed by Western Pacific (17%), Europe (10%), Asia (13%), Latin America (7%) and Africa (3%). The vast majority (71%) of the NCCs that have been in operation for more than 10 years are located in North America, while 43% of the NCCs that have been operational less than 5 years are in the Western Pacific Region. 80% of the responding NCCs were affiliated with a naturopathic school. The majority of respondents (76%) mentioned that they aim to serve underserved and/or marginalized populations, with 34% indicating that their target population is low-income families, 21% focusing on serving immigrants and refugees, 21% on serving people experiencing homelessness, 14% on serving Indigenous peoples, 14% on serving those with specific gender differences, 10% on serving seniors and 10% on serving drug users. Conclusion The naturopathic profession offers free or significantly low-cost naturopathic services through community clinics around the world. The findings of this survey provide insight into the important role of the naturopathic profession in primary health care and provide rationale for exploring this topic in greater detail.

Objectives: Emergency department (ED) hepatitis C virus (HCV) screening programs are proliferating, and it is unknown whether EDs are more effective than traditional community screening at promoting HCV follow-up care. The objective of this study was to investigate whether patients screened HCV seropositive (HCV+) in the ED are linked to care and retained in treatment more successfully than patients screened HCV+ in the community.Methods: A retrospective cohort study was performed including patients screened HCV+ at twelve screening facilities in New Orleans, LA from March 1, 2015 to July 31, 2017. Treatment outcomes, including retention and time to follow-up care, were assessed using the HCV continuum of care model.Results: ED patients (n = 3008) were significantly more likely to achieve RNA confirmation (aRR = 1.91, 95% CI = 1.54-2.37), initiate HCV therapy (aRR = 2.23 [1.76-2.83]), complete HCV therapy (aRR = 1.77 [1.40-2.24]), and achieve HCV functional cure (aRR = 2.80 [1.09-7.23]) compared to community-screened patients (n = 322). ED screening was associated with decreased likelihood of fibrosis staging (aRR = 0.65 [0.51-0.82]) and no difference in linkage to specialty care (aRR = 1.03 [0.69-1.53]). In time to follow up, RNA confirmation occurred at faster rates in the ED (aHR = 2.26 [1.86-2.72]), although these patients completed fibrosis staging at slower rates (aHR = 0.49 [0.38-0.63]) than community patients.Conclusions: Compared to community screening, HCV screening in the ED was associated with higher rates of disease confirmation, treatment initiation/completion, and cure. Our findings provide new evidence that EDs may be the most effective setting to screen patients for HCV to promote follow-up care. [ABSTRACT FROM AUTHOR]

Background: A key strategy to eliminate tuberculosis (TB) in the United States is to increase latent tuberculosis infection (LTBI) screening, testing, and treatment among non-US-born Asian populations. Purpose: The purpose was to increase LTBI screening, testing, and treatment at a community clinic. Methods: Retrospective baseline LTBI data were retrieved through electronic medical record review. Interventions included adoption of standardized TB risk assessment, training providers to use shorter LTBI treatment regimens, and use of a care coordinator. Chart abstraction to examine outcomes was conducted postintervention at 4 months. Results: In 2017, only 3 patients (7%) with LTBI were started on treatment. At 4 months postintervention, 28 (72%) patients with LTBI were started on treatment, of which 27 (96%) were placed on 3- to 4-month regimens. Conclusions: Training for providers and changes to clinic workflow, including use of a care coordinator, can help increase LTBI screening, testing, and treatment in community clinics. [ABSTRACT FROM AUTHOR]

Telemedicine services in India are underutilized. Otolaryngology provides a unique opportunity to adopt telemedicine services. Otolaryngology has seen a drastic surge in teleconsultation due to the COVID-19 pandemic. However, the challenge lies in sustaining the services and making them affordable and acceptable in the remote corners of the country. The concept of “Mohalla clinics” offers a scope to integrate and adopt telemedicine in otolaryngology and expand its outreach effectively and with minimal resources. It is high time we start training ourselves and investing in telemedicine and develop the modality across our specialties.

Background: Healthcare-associated infections caused by poor hand hygiene (HH) practices can affect both the care seekers and the health care providers (HCPs) while providing primary health care. No study has been conducted on the compliance of HH practices among the primary level HCPs in Bangladesh. Objective: The study aimed to assess the compliance rates of HH and its determinant factors among Community Health Care Providers (CHCPs) in Community Clinics (CC). Methods: A cross-sectional study was conducted from September 2019 to February 2020 among 150 randomly selected CHCPs with functional HH facilities in Patuakhali district, Bangladesh. Structured interviews and observation tools were used to collect data. Results: Good HH compliance among CHCPs was found to be 16.7% (95% CI: 11.3–21.3). Out of all 1218 possible HH opportunities, only 255 (20.9%) resulted in any HH action. Presence of 70% alcohol-based hand sanitiser at the point of care (aOR: 6.4, 95% CI: 1.1–38.3), HH training (aOR: 4.6, 95% CI: 1.1–18.9), displayed visual cues (aOR: 4.4, 95% CI: 1.1–17.7), knowledge about HH (aOR: 3.8, 95% CI: 1.1–13.6) and number of HH opportunities (aOR: 0.6, 95% CI: 0.4–0.8) were factors associated with HH compliance. Discussion: Overall HH compliance among CHCPs was relatively low. It was recommended to implement multimodal HH improvement strategies, including a continuous training program, supply of alcohol-based hand rub, reminder, provision of five moments of HH in the training modules and feedback on HH performance. [ABSTRACT FROM AUTHOR]

Background: Community-based dental education is increasingly integrated in dental school curricula to promote educational enrichment, to accommodate larger class sizes and to expose students to a broader patient demographic. This review examined community clinic rotations and their impact on dental students' level of competence in Australia and the United States. Methods: A systematic review identified pertinent literature between 2005 and 2021 from databases including PubMed, SCOPUS and the Cochrane Library. It was limited to studies involving dental student placement at community-based dental clinics and the impact of the community-based dental rotation on clinical competency. Two case studies present data from identical surveys addressing final-year dental students. Results: Nineteen articles met the inclusion criteria out of an initial 51 titles identified. Eleven articles addressed community-based dental education (CBDE) in the U.S and five related to Australia. Overall, there was a positive effect following students' rotation across all outcomes, including treatment planning, diagnosis, time management, clinical skills, productivity and communication/interpersonal skills. In addition, students were found to be more likely to consider employment in rural/underserved areas following these clinic outplacements. These findings were in line with feelings and observation by the selected cohorts of students in Australia and the U.S. Conclusion: Community clinic rotations resulted in evident gains in competency for students across multiple competencies. The current literature suggests that a longer outplacement program with more patient encounters offers increased benefits. Moreover, placement to clinics in underserved regions may encourage students to practice in these locations, mitigating the maldistribution of the dental workforce in rural areas. [ABSTRACT FROM AUTHOR]

Abstract Background The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh. Methods This study was conducted from December 2017 to November 2018. Three intervention and three control CCs were selected from Chakaria, a rural sub-district of Bangladesh. CSC was introduced with the Community Groups and Community Support Groups in intervention CCs between January to October 2018. Data were collected through observation of CCs during operational hours, key informant interviews, focus group discussions, and from DHIS2. Utilisation of CC services was compared between intervention and control areas, pre and post CSC intervention. Results Post CSC intervention, community awareness about CC services, utilisation of clinic operational hours, and accountability of healthcare providers have increased in the intervention CCs. Utilisation of primary healthcare services including family planning services, antenatal care, postnatal care and basic health services have significantly improved in intervention CCs. Conclusion CSC is an effective tool to increase the service utilization provided by CCs by ensuring community awareness and participation, and service providers’ accountability. Policy makers and concerned authorities may take necessary steps to integrate community scorecard in the health system by incorporating it in CCs.

Abstract Background Engaging communities in health facility management and monitoring is an effective strategy to increase health system responsiveness. Many developing countries have used community scorecard (CSC) to encourage community participation in health. However, the use of CSC in health in Bangladesh has been limited. In 2017, icddr,b initiated a CSC process to improve health service delivery at the community clinics (CC) providing primary healthcare in rural Bangladesh. The current study presents learnings around feasibility, acceptability, initial outcome and challenges of implementing CSC at community clinics. Methods A pilot study conducted between January’2018-December’2018 explored feasibility and acceptability of CSC using a thematic framework. The tool was implemented in purposively selected three CCs in Chakaria and one CC in Teknaf sub-district of Bangladesh. Qualitative data from 20 Key-Informant Interviews and four Focus Group Discussions with service users, healthcare providers, and government personnel, document reviews and meeting observations were used in analysis. Results The study showed that participants were enthusiastic and willing to take part in the CSC intervention. They perceived CSC to be useful in raising awareness about health in the community and facilitating structured monitoring of CC services. The process facilitated building stronger community ownership, enhancing accountability and stakeholder engagement. The participants identified issues around service provision, set SMART (specific, measurable, attainable, relevant and time-bound) targets and indicators on supplies, operations, logistics, environment, and patient satisfaction through CSC. However, some systematic and operational challenges of implementation were identified including time and resource constraint, understanding and facilitation of CSC, provider-user conflict, political influence, and lack of central level monitoring. Conclusion The findings suggest that CSC is a feasible and acceptable tool to engage community and healthcare providers in monitoring and managing health facilities. For countries with health systems faced with challenges around accountability, quality and coverage, CSC has the potential to improve community level health-service delivery. The findings are intended to inform program implementers, donors and other stakeholders about context, mechanisms, outcomes and challenges of CSC implementation in Bangladesh and other developing countries. However, proper contextualization, institutional capacity building and policy integration will be critical in establishing effectiveness of CSC at scale.

Background: Assessing patient satisfaction with community clinic (CC) services can contribute to promotion of quality of care. This study aimed to investigate the satisfaction level of patients with CC services and to identify the influential determinants of patient satisfaction in a rural area of Bangladesh. Methods: A cross-sectional study using simple random sampling without replacement was carried out in 2019 on 310 patients who have received services from CCs in Haripur upazila, Bangladesh. The patients completed a questionnaire consisting of 17 items on variables related to patient satisfaction. The items were scored using a 5-point Likert scale and patients socioeconomic and demographic characteristics were also recorded. To examine the association of patient satisfaction with other selected determinants, the Chi-square (χ2) test was performed. To assess the net effect of determinants on satisfaction level, multivariate binary logistic regression analysis was conducted. Results: Overall mean satisfaction level was 3.70±0.982. We found that 68.9% were satisfied and 31.1% were unsatisfied with the services. Moreover, 63.92% of females and 77.48% of males were satisfied. In addition, 70% of individuals aged 15-30 years, 69.28% of those aged 31-45 years and 57.89% of patients aged 46-65+ were satisfied with the services. According to the results of the Chi-square test, gender, occupation, receiving necessary medicine, receiving essential treatments, waiting time, behavior of the CC staffs, hygienic atmosphere, internal environment, female health worker visits, and difficulties faced when taking service from CC were significantly associated with patient satisfaction. Conclusion: Given the important role of patient satisfaction for improving quality of care, it is recommended to cogitate the influential factors when planning for public health promotion.

Background: Although falls are common and can cause serious injury to older adults, many health care facilities do not have falls prevention resources available. Falls prevention resources can reduce injury and mortality rates. Using the Centers for Disease Control and Prevention's (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI) model, a falls risk clinic was implemented in a rural Indian Health Service (IHS) facility. Methods: A Fall Risk Questionnaire was created and implemented into the Provider's Electronic Health Records system interface to streamline provider screening and referral of patients who may be at risk for falls to a group falls risk reduction class. Results: Participants exhibited average improvements in the Timed Up and Go (6.8 s) (P = 0.0001), Five-Time Sit-to-Stand (5.1 s) (P = 0.0002), and Functional Reach (3.6 inches) (P = 1.0) tests as compared to their own baseline. Results were analyzed via paired t test. 71% of participants advanced out of an "increased risk for falls" category in at least one outcome measure. Of the participants to complete the clinic, all were successfully contacted and three (18%) reported one or more falls at the 90-day mark, of which one (6%) required a visit to the Emergency Department but did not require hospital admission. Conclusions: In regards to reducing falls in the community, per the CDC STEADI model, an integrated approach is best. All clinicians can play a part in reducing elder falls. [ABSTRACT FROM AUTHOR]

Measurement-based care (MBC), an evidence-based approach that has demonstrated efficacy for improving treatment outcomes, has yet to be investigated in clients with Autism Spectrum Disorder. The current paper investigates the use of MBC in autistic (n = 20) and non-autistic (n = 20) clients matched on age, sex, and presenting problem. Results of change score analysis indicated that utilizing routine symptom monitoring can enhance treatment evaluation. Autistic clients participated in significantly more sessions, made significantly less progress, and were less compliant with MBC than non-autistic clients. Though hierarchical linear modeling demonstrated no significant differences in treatment slope, results indicated moderate effect size. These results inform the use of MBC in community clinics, highlighting policy implications and need for targeted measurement. [ABSTRACT FROM AUTHOR]

Using data from an outcome study of adult individual psychoanalytic psychotherapy, conducted in a low‐cost Australian clinic, a mixed‐methods approach was employed to investigate patient discontinuation. This paper addresses the qualitative component of the discontinuation study, which explored patients' reasons for leaving the clinic service upon assessment or in treatment proper. Of 205 patients commencing clinic contact, 41% discontinued during or shortly after the four‐week assessment period, while 40.5% of patients beginning psychotherapy withdrew before reaching the two‐year treatment limit. Across these two groups, former patients were interviewed about their therapy experience and decision to discontinue. Thematic analysis of 20 interview transcripts generated five descriptive categories of discomfort or dissatisfaction prompting discontinuation: clinic factors, therapist factors, patient factors, therapist–patient relationship factors and therapy factors. Findings suggest that experience of the clinic setting itself, together with negative patient perceptions of therapists and therapist interactional style, weres significant influences and that dissatisfaction with the psychotherapy process and outcome was more relevant than problematic patient factors in treatment withdrawal. A number of patients, mainly late discontinuers, reported positive experiences of psychotherapy and significant treatment gains. Implications of the findings, with specific emphasis on psychoanalytic treatment settings, are discussed. [ABSTRACT FROM AUTHOR]

Background: Globally, naturopathic practitioners offer services in 98 countries, reaching every world region and providing care to diverse populations for a range of acute and chronic health conditions. Community clinics provide free or low-cost healthcare services and play a key role in providing necessary primary healthcare for underprivileged or marginalized populations. However, the reach and impact of naturopathic community clinics (NCCs) has not yet been examined. The aim of this study was to identify the characteristics of NCCs around the world, determine the types of services they offer and provide insight into the populations being served.Methods: Two online cross-sectional surveys were administered using purposive and snowball sampling. A 6-item screening survey was administered first to identify clinics and institutions who fit the criteria for NCC services, followed by a 40-item follow-up survey. Descriptive analysis was conducted using frequencies and means.Results: The screening survey returned a total of 37 responses from six world regions. Of those respondents who indicated involvement in NCCs, 74% went on to complete the follow-up survey. The majority of the responding NCCs were located in North America (50%), followed by Western Pacific (17%), Europe (10%), Asia (13%), Latin America (7%) and Africa (3%). The vast majority (71%) of the NCCs that have been in operation for more than 10 years are located in North America, while 43% of the NCCs that have been operational less than 5 years are in the Western Pacific Region. 80% of the responding NCCs were affiliated with a naturopathic school. The majority of respondents (76%) mentioned that they aim to serve underserved and/or marginalized populations, with 34% indicating that their target population is low-income families, 21% focusing on serving immigrants and refugees, 21% on serving people experiencing homelessness, 14% on serving Indigenous peoples, 14% on serving those with specific gender differences, 10% on serving seniors and 10% on serving drug users.Conclusion: The naturopathic profession offers free or significantly low-cost naturopathic services through community clinics around the world. The findings of this survey provide insight into the important role of the naturopathic profession in primary health care and provide rationale for exploring this topic in greater detail. [ABSTRACT FROM AUTHOR]

BACKGROUND Community Clinics (CC) has been established to provide basic healthcare services at the doorstep of the community people in Bangladesh. Besides health care, government has taken a development program through CC to improve maternal health care with an aim to reduce the maternal mortality. This study was an attempt to find out the role of community women in the utilization and participation of CC management. METHODS This cross-sectional study was carried out in 32 randomly selected CCs from 16 randomly selected districts. A total of 63 service providers, 2238 service users (patients) and 3285 community members were included as the respondents of this study. For data collection respondents were interviewed face to face by using a pretested questionnaire. RESULTS The majority of the service providers of the CC were from the local community, and a higher proportion of them were female (52.4%). The providers provided healthcare services both in CC and at community level. A total of 2238 patients visited the 32 studied CCs per day for getting treatment and significantly a higher proportion of them were female (71.2%). Most of the patients (83.0%) expressed satisfaction with the services provided in the CCs and most of them were female (83.8%). Of the total 3285 respondents, 60.3% were the women from the catchment communities. The activities of the CC were known by all of them (98.3%) and they participated in the management of CC. CONCLUSIONS The study revealed that because of utilization and participation in the management of CC, the women became an imperative person in the community, thus empowering them in healthcare development. [ABSTRACT FROM AUTHOR]

Introduction: Mental illness is a global health challenge and continues to rise among minors. Community clinics are well positioned to provide mental health services to young people. Objective: To assess community clinic front staff awareness of recent legislation mandating access by minors to mental health services and the actual services delivered by these clinics. Methods: We conducted a face-to-face survey with front office staff at community clinics in service planning areas (SPA) 6, 7, and 8 in Los Angeles County (LAC) to understand the staff awareness of the services provided to the minor by the clinic. These SPAs have been previously identified as serving a low socioeconomic population. Fisher's exact test and the chi-square test were conducted to understand the factors influencing the front desk personnel awareness. Results: Data were collected from 17 clinics in SPA6, 15 clinics in SPA7, and 4 clinics in SPA8. All of the clinics provided Family-PACT insurance, resources for domestic abuse, intimate partner violence, mental health (such as anxiety and depression) and alcohol/drug abuse; however responding front desk staff in twenty-five out of 36 (69.4%) clinics was aware of the availability of Family-PACT insurance to minor patients; 21 (58.3%) was aware that the clinic provided resources for domestic abuse or intimate partner violence, and 20 (55.5%) was aware that the clinic offered resources for mental health (such as anxiety or depression) or alcohol/drug abuse to minor patients. Discussion: In this pilot study, about half of the front desk staff at the surveyed clinics in LA County did not know that the clinic is fully authorized and equipped to provide mental health services to the minors (patients under 18 years of age). These are missed opportunities. There is a need for better education of the front-desk personnel. [ABSTRACT FROM AUTHOR]

The novel coronavirus has added new anxieties and forms of grieving to the myriad practical and emotional burdens already present in the lives of underserved and uninsured immigrant families and communities. In this article, we relate our experiences since the COVID‐19 crisis to the lessons we have learned over time as mental health professionals working with families in no‐cost, student‐managed community comprehensive health clinics in academic‐community partnerships. We compare and contrast the learnings of flexibility of time, space, procedures, or attendance we acquired in this clinical community setting during regular times, with the new challenges families and therapists face, and the adaptations needed to continue to work with our clients in culturally responsive and empowering ways during the COVID‐19 pandemic. We describe families, students, professionals, promotoras (community links), and IT support staff joining together in solidarity as the creative problem solvers of new possibilities when families do not have access to Wi‐Fi, smartphones, or computers, or suffer overcrowding and lack of privacy. We describe many anxieties related to economic insecurity or fear of facing death alone, but also how to visualize expanding possibilities in styles of parenting or types of emotional support among family members as elements of hope that may endure beyond these unprecedented tragic times of loss and uncertainty. [ABSTRACT FROM AUTHOR]

Abstract Introduction Robust evaluation of service models can improve the quality and efficiency of care while articulating the models for potential replication. Even though it is an essential part of learning health systems, evaluations that benchmark and sustain models serving adults with developmental disabilities are lacking, impeding pilot programs from becoming official care pathways. Here, we describe the development of a program evaluation for a specialized medical‐dental community clinic serving adults with autism and intellectual disabilities in Montreal, Canada. Method Using a Participatory Action‐oriented approach, researchers and staff co‐designed an evaluation for a primary care service for this population. We performed an evaluability assessment to identify the processes and outcomes that were feasible to capture and elicited perspectives at both clinical and health system levels. The RE‐AIM framework was used to categorize and select tools to capture data elements that would inform practice at the clinic. Results We detail the process of conceptualizing the evaluation framework and operationalizing the domains using a mixed‐methods approach. Our experience demonstrated (1) the utility of a comprehensive framework that captures contextual factors in addition to clinical outcomes, (2) the need for validated measures that are not cumbersome for everyday practice, (3) the importance of understanding the functional needs of the organization and building a sustainable data infrastructure that addresses those needs, and (4) the need to commit to an evolving, “living” evaluation in a dynamic health system. Conclusions Evaluation employing rigorous patient‐centered and systems‐relevant metrics can help organizations effectively implement and continuously improve service models. Using an established framework and a collaborative approach provides an important blueprint for a program evaluation in a learning health system. This work provides insight into the process of integrating care for vulnerable populations with chronic conditions in health care systems and integrated knowledge generation processes between research and health systems.

Background: Bangladesh has improved maternal and child health, but healthcare indicators and access still need enhancement. Factors that contribute to increased antenatal care (ANC) need to be explored to inform healthcare policies. The study examined whether community-level (supply-side) predictors outperform individual/family-level (demand-side) predictors for the desired number of ANC services., Methods: This cross-sectional study collected primary data from 630 pregnant and lactating women (PLW) in seven upazilas in Rangpur and Nilphamari districts of Bangladesh in 2022. The individual/family and community-level factors as predictors of desired antenatal care services were investigated using a semi-structured questionnaire. Various statistical techniques including the Student t-test, z-test, Chi-square test, and logistic regression model were employed in analyzing the data., Results: Out of the total 630 participants, the majority were literate women who belong to higher pregnancy order and received benefits from SSNPs. In addition to this, these women did not earn and neither were the empowered. The outcome variable was the receiving status of 4+ ANC services by PLWs, which varied by different covariates. The desired 4+ ANC service received by 73 % PLWs. The significant (p < 0.05) predictors of receiving 4+ ANC services were secondary-level education (95 % CI:0.97-7.55), knowledge on danger signs (95 % CI:1.02-1.48), empowered women (95 % CI:0.99-2.69), community clinics as place of services (95 % CI:1.52-3.49), sources of information through SMS (95 % CI:2.63-7.04) and fully functional community clinic (95 % CI:1.0-2.347). The statistical evidence through the values of pseudo R 2 of the reduced models of community level (0.09), individual level (0.03) and family level (0.01) revealed that the community level predictors are more influential than individual/family level predictors., Conclusion: The findings indicate that community level predictors played a dominant role in receiving the 4+ ANC services in Bangladesh. In short, the well-functioning of community clinics in tandem with government forums/bodies and awareness raising through SMS messages, are sufficient for ensuring the desired number of ANC services in rural areas of Bangladesh., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Deficits in metacognition have often been identified as a central feature in various forms of psychopathology. The current study explores changes in metacognition and symptoms during the process of psychodynamic-oriented psychotherapy conducted in a community setting among people with diverse psychological challenges. We examined the associations between metacognition and symptoms at both the within-client and the between-clients level. Nine good-outcome and nine poor-outcome cases of psychodynamic treatment were analyzed. In terms of metacognitive abilities, results showed that clients who were part of the good-outcome group had higher levels of decentration than did clients who were part of the poor-outcome group. In addition, clients' ability to understand the other's mind improved significantly only for clients in the good-outcome group. Furthermore, sessions in which clients' self-reflectivity was higher were followed by increased symptom levels (in the next session) beyond group (poor or good outcome group). Clinical implications regarding the improvement of metacognitive abilities and their associations with outcome measures are discussed. [ABSTRACT FROM AUTHOR]

Objective · To understand the status of self-rated health of elderly hypertensive patients in some commimity clinics in Slianghai, and analyze the influence factors. Methods - The elderly patients with hypertension in three community clinics in Shanghai were investigated with the basic information questionnaire and the Self-rated Health Rating Scale (SRHMS). The influence factors of self-rated health of these people were analyzed by multiple linear stepwise regression. Results · A total of 458 elderly patients with hypertension were enrolled. The total score of SRHMS and the scores of its 3 subscales，f.e.，physiological health, mental health, and social health, were 347.91±32.97, 142.29±13.03, 116.95±12.65, and 88.66±11.83, respectively. Totally, 88.4% of the patients were at good level of self-rated health. The results of multiple linear stepwise regression showed that agc> primary occupation, daily times of taking antihypertensive drugs，marital status and life satisfaction were independent influence factors of the total score of SRHMS in the elderly patients with hypertensioiL Conclusion · The self-rated health level of elderly hypertension patients in the community clinics in Shanghai is good, and age, original occupation, daily times of taking antihypertensive drugs，marital status and life satisfaction axe the influence factors. [ABSTRACT FROM AUTHOR]

This study describes clinical characteristics of poor and uninsured patients living with hepatitis C virus (HCV) who received care from a multidisciplinary HCV clinic, reports treatment completion and cure rates, and estimates the cost of HCV medications provided at no cost to uninsured patients. A retrospective chart review was performed and identified 69 uninsured HCV patients who received medical care at Mercy Health Center, a small non-profit community clinic, between January 2008 and March 2015. Three-fourths of the patients were unemployed, a third had multiple HCV exposures, nearly half acquired HCV due to illicit drug use, and more than half had active psychiatric disorders. Of those who received HCV treatment, 81% completed treatment and 85% were achieved virological cure. The multidisciplinary community clinic provided > $1.4 million of HCV antivirals at no cost to uninsured patients. Findings suggest a multidisciplinary community clinic comprised of a social worker, pharmacist, gastroenterologist, nurse, nurse practitioner, psychologist, and dietitian can help patients achieve HCV treatment completion and cure rates comparable to traditional physician-led clinics, and successfully manage uninsured and underserved HCV patients—who are often regarded as “difficult-to-treat” patients. Public health social workers and other health professionals are encouraged to advocate for treatment and care of poor and uninsured patients living with HCV in health agencies and health systems, otherwise population-wide reductions in HCV morbidity and mortality will not be realized. [ABSTRACT FROM AUTHOR]

Abstract Pneumonia is a major cause of child mortality among children under five years, worldwide. Pneumonia infection may be caused by bacteria, viruses, or fungi in single or in both lungs. According to recent criteria developed by World Health Organization (WHO) in September (2013), pneumonia can be classified into severe pneumonia, pneumonia and no pneumonia. Most of the deaths occur from severe pneumonia and management of severe childhood pneumonia requires early identification, prompt referral and the availability of intensive quality of care. This case study aimed to represent the actual scenario of severe childhood pneumonia case management at community clinic. Considering that circumstances, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) developed an innovative day care management approach as safe, effective and less expensive alternative to hospital management of severe childhood pneumonia. A twenty-seven months old boy came to the Health & Family Welfare Centre (HFWC) with severe breathing difficulty, cough, history of fever. The management described below was continued daily until there was clinical improvement; no fever, no fast breathing, no lower chest wall indrawing, no danger signs, no rales on auscultation and no hypoxemia. Considering the WHO case management protocol for severe pneumonia, day care management approach on community clinic recommends that diagnosis of severe pneumonia should be based primarily on visible clinical parameters. On that basis, severe childhood pneumonia can be successfully managed at community clinics including for children with hypoxemia who is required prolong (4–6 hours) oxygen therapy. [ABSTRACT FROM AUTHOR]

Background: Mental illness is often stigmatised in Ghana. The World Health Organization has estimated that as few as 2% of Ghanaians with mental health needs are able to access treatment. To approach this shortfall, the charity Ghana Homeopathy Project (GHP) supports the use of homeopathy in community clinics to improve Ghanaians' psychological health and well-being. Objectives: To perform an audit of GHP-partnered clinic service users and assess the impact of homeopathy in the Mafi Seva Community Clinic (MSCC) on service users' self-reported levels of emotional distress. Methods: The audit was performed in two GHP-partnered clinics; one in the rural setting of MSCC in the Volta region and one in the urban setting of Accra (participants N = 326). The service evaluation was performed solely in MSCC (N = 65). Socio-demographic and clinical data were collected using standardised forms; emotional distress was assessed using the validated Schwartz Outcome Scale (SOS-10). Results: Over 90% of participants in both the audit and service evaluation presented with predominantly physical chronic (>1 year) complaints. Despite the low prevalence of mental/emotional presenting complaints, assessment of SOS-10 scores and changes in emotional distress across three consecutive homeopathic appointments showed a clear and statistically significant improvement (Friedman's test, p < 0.001; median score change of 8). Prevalence of "severe" distress (SOS-10 score 1-22) was reduced from 66.2% at baseline to 13.8% after three appointments. Conclusion: GHP-partnered community clinics provide a valuable service to Ghanaians, satisfying an unmet need for support and treatment of a range of health problems including psychological well-being. Such clinics could contribute to delivering community-based mental health services as outlined in the Mental Health Act (2012), through providing a service that is clearly of benefit to its users. [ABSTRACT FROM AUTHOR]

Cognitive behavioral therapy (CBT) has demonstrated favorable long-term outcomes in youth with anxiety disorders in efficacy trials. However, long-term outcomes of CBT delivered in a community setting are uncertain. This study examined the long-term outcomes of individual (ICBT) and group CBT (GCBT) in youth with anxiety disorders treated in community mental health clinics. A total of 139 youth (mean age at assessment 15.5 years, range 11–21 years) with a principal diagnosis of separation anxiety disorder (SAD), social anxiety disorder (SOP), and/or generalized anxiety disorder (GAD) were evaluated, on average, 3.9 years post-treatment (range 2.2–5.9 years). Outcomes included loss of all inclusion anxiety diagnoses, loss of the principal anxiety diagnosis and changes in youth- and parent-rated youth anxiety symptoms. At long-term follow-up, there was loss of all inclusion anxiety diagnoses in 53%, loss of the principal anxiety diagnosis in 63% of participants as well as significant reductions in all anxiety symptom measures. No statistical significant differences in outcome were obtained between ICBT and GCBT. Participants with a principal diagnosis of SOP had lower odds for recovery, compared to those with a principal diagnosis of SAD or GAD. In conclusion, outcomes of CBT for youth anxiety disorders delivered in community mental health clinics were improved at nearly 4 years post-treatment, and recovery rates at long-term follow-up were similar to efficacy trials. [ABSTRACT FROM AUTHOR]

ABSTRACT Reflective practice forms a pivotal part of mental health intervention in a setting where language and cultural differences require working together with a community counselor for language interpretation. Reflective practice in infant mental health began with Esther Bick's () infant observations and continued with Selma Fraiberg's () parent-infant psychotherapy. These two models formed the basis of the practice of infant mental health in a community in South Africa. A clinical example will highlight the importance of culturally informed observation that is then reflected upon. A qualitative study that examined the interaction among the participants in three clinical settings shows that a sustained partnership and tolerance for flexibility lie at the heart of good practice in intercultural settings. Object-relations theory offers an additional, in-depth understanding of the underlying psychic processes in reflective practice. [ABSTRACT FROM AUTHOR]

Background: Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic services.Methods: This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 community clinics. Since most of the outcome indicators focus mainly on women and children, women having children less than 2 years of age were randomly assigned and interviewed for the study purpose. Data were collected through FGD, Key informants interview and a pretested semi- structured questionnaire.Results: About 95 % of the respondents were Muslims and 5 % were Hindus. The average age of the respondents was 23.38 (SD 4.15) and almost all of them are home makers. The average monthly expenditure of their family was 95US $ (SD 32US$). At the beginning of the study, two psychometric research instruments; 24 items perceived quality of primary care services PQPCS scale (chronbach's α = .89) and 22 items community clinic service satisfaction CCSS scale (chronbach's α = .97), were constructed and validated. This study showed less educated, poor, landless mothers utilized the community clinic services more than their educated and wealthier counterpart. Women who lived in their own residence used the community clinic services more frequently than those who lived in a rental house. Perceptions concerning skill and competence of the health care provider and satisfaction indicating interpersonal communication and attitude of the care provider were important predictors for community clinic service utilization. Perception related to the quality of management, administration, physical environment of the service point and satisfaction addressing health promotion and women health issues played significant role on community clinic's services utilization.Conclusions: Besides parental education and income, client's perception and satisfaction played significant role in community clinic service utilization. Provider's perception of service quality should be studied. The study findings will enable policy-makers to improve quality of primary health care services, realizing providers' and patients' ideas of community clinic service quality. [ABSTRACT FROM AUTHOR]

The current hepatitis A outbreak in San Diego County, largely among homeless individuals and illicit drug users, prompted a community clinic to vaccinate at-risk patients. The clinic marshaled the efforts of multiple departments to educate and vaccinate 7,521 adults in 7 months. Strong support from executive leaders, coordinated efforts from various departments, and leveraged relationships with other community organizations and public health officials are key factors of a strong response to a public health concern. [ABSTRACT FROM AUTHOR]

Background: Although Bangladesh has achieved tremendous success in health care over the last four decades, it still lagged behind in the areas of maternal and child malnutrition and primary health care (PHC). To increase access to PHC, the Bangladesh government established approximately 18,000 community clinics (CCs). The purpose of this study was to examine the associations of socioeconomic determinants of women aged 12-49 years with the CCs awareness and visitation. Methods: We analyzed secondary data provided by Bangladesh Demographic and Health Survey-2011. A two-stage cluster sampling was used to collect the data. A total of 18,222 ever married women aged 12-49 years were identified from selected households and 17,842 were interviewed. The main outcome measures of our study were awareness and visitation of CCs. Bivariate logistic regression was used to calculate odds ratio (OR) and 95 % confidence interval (CI) to examine the associations between the awareness and visiting CCs with socioeconomic determinants. Results: Low prevalence of awareness about CC (18 %) was observed among studied women and only 17 % of them visited CCs. Significant associations (P < 0.05) with CCs awareness and visitation were observed among aged 20-29 years (adjusted OR = 1.18; 95 % CI = 1.03-1.35 and adjusted OR = 1.49; 95 % CI = 1.05-2.11), primary education (adjusted OR = 1.20; 95 % CI = 1.08-1.34 and adjusted OR = 1.37; 95 % CI = 1.05-1.78), and poorest family (adjusted OR = 1.21; 95 % CI = 1.03-1.42 and adjusted OR = 2.36; 95 % CI = 1.56-3.55, respectively), after controlling potential confounders. Conclusions: Awareness and visitation of CCs were found to be positively associated with lower economic conditions, young age, and primary education. Awareness and access to CCs might be increased through community activities that involve health care workers. The government should also lower barriers to PHC access through CCs by providing adequate logistics, such as human resources and equipment. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is under-diagnosed due to time constraints in community-based clinics and costs related to diagnostic spirometry. Early diagnosis results in improved quality of life if COPD is managed well. This literature review aims to determine the accuracy and helpfulness of the mini-spirometer as a screening tool for COPD, to improve health outcomes for patients with COPD. It was carried out in New Zealand, where 15% of people over the age of 40 years have COPD and where prevalence in Maori is more than double that of non-Maori populations, and community screening initiatives are required to ensure early intervention and disease prevention. [ABSTRACT FROM AUTHOR]