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Estimates of high-risk human papillomavirus (HPV) infection and susceptibility to HPV-related cancer in transgender men (TM) are comparable to prevalence rates found in cisgender women. Regular and thorough screening for cervical cancer is equally as crucial for TM as for cisgender women; however, despite continued risk for cervical cancer in TM and associated recommendations for screening, studies indicate disparities in rates of cervical cancer screening (CCS) in TM compared to cisgender women. The current scoping review explores TM’s knowledge and experiences of CCS and barriers to screening uptake in this population. A range of barriers were identified including the need for health-care services to provide care for TM within the context of a nonbinary approach to gender identity and health. Findings synthesized from relevant research studies (n = 15; published 2008–2019) are presented, and recommendations are drawn from these findings to inform primary health-care providers’ clinical practice and care of TM.

The human papillomavirus (HPV) potentially affects every sexually active man in the United States and Canada. In 2017, the vaccine became publicly funded in Canada for males ages 9–26, and was integrated into school vaccination programs. In 2019, HPV vaccination was recommended as routine for all U.S.-based males and females ages 9 through 26, and a shared decision for adults >26 years; however, since the approval of the vaccine in 2006 for females only, the age and dosing recommendations for males have followed a complicated and changing trajectory. Current adherence rates are low among college and university age males (18–26 years); therefore, understanding and addressing the barriers and facilitators for men’s HPV vaccination is critically important. The purpose of the current scoping review is to provide a synthesis of recent literature pertaining to HPV in college and university age men, as a means to guiding health-care providers (HCPs). Drawing from 15 published articles, three thematic findings were inductively derived. Theme one, lack of awareness, was underpinned by men’s knowledge deficits about their eligibility for, and the availability of HPV vaccines. Theme two, underestimating and embodying risk, included men’s engagement in sexual activities while misinformed or denying the risk for contracting HPV. The third theme, strategies for increasing men’s awareness, summarizes messaging strategies used to lobby young men to vaccinate. The review findings indicate gender-sensitive interventions targeting college-age men, including early, frequent, and consistent messaging on HPV are key.

Preeclampsia (PE) is a complex and severe hypertensive disorder of pregnancy, contributing to a leading cause of maternal and fetal mortality worldwide. Currently, there is no recognized, evidence-based testing to effectively screen for PE in a nulliparous woman. Early recognition, intervention, and surveillance remains critical in preventing eclampsia, multi-organ failure, and stroke. This quality improvement DPI project aimed to translate existing evidence of PE risk factor screening and electronic health record (EHR) reminder systems tools into a community maternity clinic, to encourage clinician screening adherence, accurate identification of at-risk PE patients, and early provision of disease education through delivery of a one-page visual handout. Applying concepts of the health belief model, this project utilized quantitative methodology, with quasi-experimental pretest-posttest design to implement a PE Risk Factor Screening Tool within an EHR reminder system for community maternity care providers (MCP). The project evaluated retrospective and prospective data comparing 36 pre-and 36 post-intervention patient charts from six MCPs (n = 72). Post-intervention data demonstrated a 66.7% increase in identifying at-risk for PE patients (p < .001); and, a 72% increase in PE education using a one-page, visual handout to those identified at risk, determining a statistically significant relationship between the studied categorical variables (p < .001). Recommendations from findings include broad implementation of PE risk factor screening tools into multidisciplinary maternity care settings.

Background Pediatric emergency department (ED) visits for mental health are costly and often preventable. Access to primary care and behavioral health providers can improve mental health and reduce unnecessary ED visits. Methods Quantitative analysis of the Virginia All-Payers Claims Database to assess mental health ED and outpatient care for children and adolescents up to age 21 years between 2016 and 2021. We determined the proportion of children and adolescents seen by primary care or behavioral health one week and one year before an ED visit, and how many had follow-up care within one and two months after. Results: From 2016 to 2021, pediatric ED visits dropped 14%, but mental health visits rose 10.6%, and suicidality visits tripled (301 to 929, p  < 0.001). Only 5% of youth with suicidality ED visits had a primary care visit within 7 days prior, and 18% saw a mental health provider. During the pandemic, prior-year primary care visits for mental health ED cases declined (68.1–61.8%, p  < 0.0001). Follow-ups within 60 days dropped for primary care (mental health: 40.0–34.2%; suicidality: 37.5–33.5%), slightly improved for behavioral health (32.2–37.1%), and stayed stable for suicidality (64.1–63.0%). Conclusions The pediatric mental health crisis has worsened since the pandemic. There were substantial missed opportunities for prevention and intervention for children and adolescents prior to and following an ED visit for mental health or suicidality.

Introduction It is not realistic for most clinicians to perform the multitude of recommended preventive primary care services. This is especially true in low resource and rural settings, creating challenges to delivering high-quality care. This study collected stakeholder input from clinicians on which services they most need to improve. Methods The authors conducted a survey of primary care physicians 9–12/2021, with an emphasis on rural practices, to assess areas in which clinicians felt the greatest needs for improvement. The survey focused on primary prevention (behavior change counseling) and cancer screening, and contrasted needs for improvement for these services vs. other types of screening, and between clinicians in rural vs. non-rural practices. Results There were 326 respondents from 4 different practice-based research networks, a wide range of practice types, 49 states and included 177 clinicians in rural settings. Respondents rated the need to improve delivery of primary prevention counseling services highest, with needs for nutrition and dietary assessment and counseling rated highest followed by physical activity and with almost no differences between rural and nonrural. Needs for improvement in cancer screenings were rated higher than non-cancer screenings, except for blood pressure screening. Conclusions Both rural and nonrural primary care clinicians feel a need for improvement, especially with primary prevention activities. Although future research is needed to replicate these findings with different populations and other types of preventive service activities, greater priority should be given to development of practical, stakeholder informed assistance and resources for primary care to conduct primary prevention.

Objectives: Guidelines recommend addressing health behaviors, mental health, and social needs in primary care. However, it is unclear how often patients want support to address these risks. As part of a randomized trial comparing enhanced care planning versus usual care, we evaluated what risks patients wanted to address. Methods: All patients with multiple chronic conditions, 1 or more of which was uncontrolled, from 81 clinicians in 30 primary care practices. Using My Own Health Report (MOHR), patients identified and prioritized their health risks to create a care plan. Results: All patients had at least 1 unhealthy behavior (100%) and most had a mental health risk (66.8%) and a social need (51.3%). Participants more often chose to create care plans addressing unhealthy behaviors (92.5%) rather than mental health (23.2%), or social needs (12.5%). The most frequently created care plans were for exercise (65.1%), weight loss (37.2%), and nutrition (36.2%). Conclusion: All patients had 1 or more unhealthy behaviors, mental health risks, or social needs, and were more likely to address health behaviors. We need to better understand these patient choices, and change the culture to normalize the integration of mental health and social care into primary care.

Background Many patients with poorly controlled multiple chronic conditions (MCC) also have unhealthy behaviors, mental health challenges, and unmet social needs. Medical management of MCC may have limited benefit if patients are struggling to address their basic life needs. Health systems and communities increasingly recognize the need to address these issues and are experimenting with and investing in new models for connecting patients with needed services. Yet primary care clinicians, whose regular contact with patients makes them more familiar with patients’ needs, are often not included in these systems. Methods We are starting a clinician-level cluster-randomized controlled trial to evaluate how primary care clinicians can participate in these community and hospital solutions and whether doing so is effective in controlling MCC. Sixty clinicians in the Virginia Ambulatory Care Outcomes Research Network will be matched by age and sex and randomized to usual care (control condition) or enhanced care planning with clinical-community linkage support (intervention). From the electronic health record we will identify all patients with MCC, including cardiovascular disease or risks, diabetes, obesity, or depression. A baseline assessment will be mailed to up to 50 randomly selected patients for each clinician (3000 total). Ten respondents per clinician (600 patients total) with uncontrolled MCC will be randomly selected for study inclusion, with oversampling of minorities. The intervention includes two components. First, we will use an enhanced care planning tool, My Own Health Report (MOHR) , to screen patients for health behavior, mental health, and social needs. Patients will be supported by a patient navigator, who will help patients prioritize needs, create care plans, and write a personal narrative to guide the care team. Patients will update care plans every 1 to 2 weeks. Second, we will create community-clinical linkage to help address patients’ needs. The linkage will include community resource registries, personnel to span settings (patient navigators and a community health worker), and care team coordination across team members through MOHR. Discussion This study will help inform efforts by primary care clinicians to help address unhealthy behaviors, mental health needs, and social risks as a strategy to better control MCC. Trial registration ClinicalTrials.gov: NCT03885401 . Registered on 19 September 2019.

Background: In 2019, the Agency for Healthcare Research and Quality (AHRQ) funded 6 grantee teams to evaluate the effectiveness of practice facilitation (PF) as an implementation approach for improving the delivery of U.S. Preventive Services Task Force-recommended unhealthy alcohol use (UAU) services in primary care. This report characterizes practice facilitators’ first-hand experiences with implementation. Methods: We invited practice facilitators from each grantee team to participate in group interviews focused on facilitation strategies employed, facilitators and barriers encountered, adaptations made, and practice transformation observed. Interview transcripts were thematically coded using inductive and deductive methods and analyzed using immersion-crystallization. Results: Seventeen practice facilitators who worked with ~300 practices participated. PF was perceived as effective in overcoming barriers to improve screening and counseling for UAU in varied settings and contexts. Practice-centered strategies that personalized practice engagement, met practices “where they are at,” tailored to local context, and fostered deep cultural change were highlighted as instrumental to the multilevel changes needed to transform practice workflow around management of UAU. Facilitator quotes, strategies, and multiple facilitation resources are provided. Conclusions: Practice facilitators’ collective perspectives paint a more complete picture of the processes, adaptations, and outcomes associated with this substantial practice-based research effort. PF is a versatile, flexible, and adaptable implementation approach to improve management of UAU in primary care that provides pragmatic strategies for care teams, practice leaders, researchers, and funders. Practice facilitators’ collective perspectives paint a more complete picture of the processes, adaptations, and outcomes associated with this substantial practice-based research effort.

Objectives: To help better control chronic conditions we need to address root causes of poor health like unhealthy behaviors, mental health, and social needs. However, addressing these needs in primary care is difficult. One solution may be connecting patients with a navigator for support creating a personal care goal. Methods: As part of an RCT to evaluate a feasible approach to care planning, 24 clinicians from 12 practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) and 87 intervention patients with uncontrolled chronic conditions participated in a care planning intervention. We had a structured process to guide patients, train navigators, and adapt the navigation process to meet the needs of each practice. Results: Only 1 practice had bandwidth for staff to serve as a patient navigator, even for extra pay. For the other 11 practices, a research team member needed to provide navigation services. On average, patients wanted 25 weeks of support to complete care plans. The average time patients needed to speak with navigators on the phone was 7 min and 3 s. In exit interviews, patients consistently shared how motivational it was to have a caring person check in on them, offer help, and hold them accountable. Conclusion: Patient navigation to address care plans should be feasible. The time commitment is minimal. It does not require intensive training, and primary care is already doing much of this work. Yet, given the burden and competing demands in primary care, this help cannot be offered without additional resources.