Publications

INTRODUCTION

Emerging policy consensus advocates that patient-centered care should include an active, practice-level patient role, but it is unknown how commonly these roles are implemented. We sought to understand current prevalence and predictors of practice-level patient engagement in US primary care settings.

METHODS

We assessed practice-level patient engagement by using 2016 American Board of Family Medicine Certification Examination registration data, restricted to ambulatory primary care site respondents randomly selected for a patient-centered medical home (PCMH) question module. Multivariate logistic regression models identified predictors of high-intensity patient engagement, defined as a patient advisory council or patient volunteers in quality improvement activities.

RESULTS

A total of 6900 examinees reported practicing in primary care sites; 1368 randomly received PCMH questions. Practice-level patient engagement included patient surveys (76.5%; 95% CI, 74.3-78.8%), patient suggestion boxes (52.9%; 95% CI, 50.2-55.5%), patient board of director memberships (18.8%; 95% CI, 16.7-20.9%), patient advisory councils (23.8%; 95% CI, 21.5-26.0%), and patient participation in quality improvement (20.5%; 95% CI, 18.3-22.6%). High-intensity patient engagement was reported by 31.1% (95% CI, 28.7-33.6%); predictors included large practice size (OR, 3.30; 95% CI, 1.96-5.57), serving more vulnerable patient populations, (OR, 1.83; 95% CI, 1.18-2.84) and PCMH certification (OR, 2.19; 95% CI, 1.62-2.97).

CONCLUSIONS

Nearly one-third of physicians reported working in settings with high-intensity practice-level patient engagement. An implementation science approach should examine why high-intensity activities are more common in some practice settings and whether these activities add value through improved patient experience and health outcomes.

Background HIV-positive women in the United States can have healthy pregnancies and avoid transmitting HIV to their children. Yet, little is known about the extent to which HIV care providers' reproductive health practices match women's pregnancy desires. Accordingly, we explored young HIV-positive women's pregnancy desires and reproductive health behaviors and examined reproductive health information offered by HIV care clinics. Methods A mixed-method analysis was conducted using data from a 14-site Adolescent Medicine Trials Network (ATN) study. We conducted descriptive statistics on data from 25 HIV-positive women (e.g., demographics, pregnancy desires, and sexual- and health-related behaviors). Qualitative interviews with 58 adolescent and adult clinic providers were analyzed using the constant comparative method. Results About half of the women reported using reproductive health care services (i.e., contraception and pregnancy tests) (n = 12) and wanted a future pregnancy (n = 13). Among women who did not desire a future pregnancy (n = 5), three used dual methods and two used condoms at last sexual encounter. Qualitative themes related to clinics' approaches to reproductive health (e.g., "the emphasis…is to encourage use of contraceptives") and the complexity of merging HIV and reproductive care (e.g., "We [adolescent clinic] transition pregnant moms from our care back and forth to adult care"). Discussion Despite regular HIV-related medical appointments, HIV-positive women may have unaddressed reproductive health needs (e.g., pregnancy desire with providers focused on contraceptive use). Findings from this study suggest that increased support for young HIV-positive women's reproductive health is needed, including supporting pregnancy desires (to choose when, how, and if, to have children).

Routine, comprehensive molecular characterization of patient tumours has the potential to accelerate therapeutic advances and inform cancer biology. Here, we describe insights from the implementation of an enterprise-wide, prospective clinical sequencing strategy at an academic cancer centre.