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PubMed1992

Drug prevention in a community setting: a longitudinal study of the relative effectiveness of a three-year primary prevention program in boys & girls clubs across the nation.

Tested the effectiveness of a youth drug prevention program in a community setting. Boys & Girls Clubs of America's Stay SMART program, adapted from a school-based personal and social competence drug prevention program, was offered, with and without a 2-year booster program, to 13-year-old members of Boys & Girls Clubs. Over 27 months, (a) 5 Boys & Girls Clubs offered the Stay SMART program, (b) 5 Boys & Girls Clubs offered the Stay SMART program with the booster programs, and (c) 4 Boys & Girls Clubs served as a control group. The Stay SMART program alone and the Stay SMART program with the booster programs showed effects for marijuana-related behavior, cigarette-related behavior, alcohol-related behavior, overall drug-related behavior, and knowledge concerning drug use. The Stay SMART program with the booster programs produced additional effects for alcohol attitudes and marijuana attitudes after each year of booster programs. Results suggest that a school-based personal and social competence program can be adapted effectively to a community setting and that booster programs might enhance program effects. Implications for alternative community models of prevention are discussed.

Adolescent↗

PubMed2002

[Interventions to improve the management of diabetes mellitus in primary health care and outpatient community settings].

UNLABELLED: This review should be cited as: Renders CM, Valk GD, Griffin S. Wagner EH, Eijk JThM van, Assendelft WJJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings (Cochrane Review). In: The Cochrane Library, Issue 2, 2001. Oxford: Update Software. A substantive amendment to this systematic review was last made on 29 June 2000. Cochrane reviews are regularly checked and updated if necessary. BACKGROUND: Diabetes is a common chronic disease that is increasingly managed in primary care. Different systems have been proposed to manage diabetes care. OBJECTIVES: To assess the effects of different interventions, targeted at health professionals or the structure in which they deliver care, on the management of patients with diabetes in primary care, outpatient and community settings. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, the Cochrane Controlled Trials Register (Issue 4 1999), MEDLINE (1966-1999), EMBASE (1980-1999), Cinahl (1982-1999), and reference lists of articles. SELECTION CRITERIA: Randomised trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) analyses of professional, financial and organisational strategies aimed at improving care for people with Type 1 or Type 2 diabetes. The participants were health care professionals, including physicians, nurses and pharmacists. The outcomes included objectively measured health professional performance or patient outcomes, and self-report measures with known validity and reliability. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Forty-one studies were included involving more than 200 practices and 48,000 patients. Twenty-seven studies were RCTs, 12 were CBAs, and two were ITS. The studies were heterogeneous in terms of interventions, participants, settings and outcomes. The methodological quality of the studies was often poor. In all studies the intervention strategy was multifaceted. In 12 studies the interventions were targeted at health professionals, in nine they were targeted at the organization of care, and 20 studies targeted both. In 15 studies patient education was added to the professional and organisational interventions. A combination of professional interventions improved process outcomes. The effect on patient outcomes remained less clear as these were rarely assessed. Arrangements for follow-up (organisational intervention) also showed a favourable effect on process outcomes. Multiple interventions in which patient education was added or in which the role of the nurse was enhanced also reported favourable effects on patients' health outcomes. REVIEWERS' CONCLUSION: Multifaceted professional interventions can enhance the performance of health professionals in managing patients with diabetes. Organisational interventions that improve regular prompted recall and review of patients (central computerised tracking systems or nurses who regularly contact the patient) can also improve diabetes management. The addition of patient-oriented interventions can lead to improved patient health outcomes. Nurses can play an important role in patient-oriented interventions, through patient education or facilitating adherence to treatment.

Community Health Centers↗

PubMed2006

Vulvovaginal-swab or first-catch urine specimen to detect Chlamydia trachomatis in women in a community setting?

Screening for chlamydia in women is widely recommended. We evaluated the performance of two nucleic acid amplification tests for detecting Chlamydia trachomatis in self-collected vulvovaginal-swab and first-catch urine specimens from women in a community setting and a strategy for optimizing the sensitivity of an amplified enzyme immunoassay on vulvovaginal-swab specimens. We tested 2,745 paired vulvovaginal-swab and urine specimens by PCR (Roche Cobas) or strand displacement amplification (SDA; Becton Dickinson). There were 146 women infected with chlamydia. The assays detected 97.3% (95% confidence interval [CI], 93.1 to 99.2%) of infected patients with vulvovaginal-swab specimens and 91.8% (86.1 to 95.7%) with urine specimens. We tested 2,749 vulvovaginal-swab specimens with both a nucleic acid amplification test and a polymer conjugate-enhanced enzyme immunoassay with negative-gray-zone testing. The relative sensitivities obtained after retesting specimens in the negative gray zone were 74.3% (95% CI, 62.8 to 83.8%) with PCR and 58.3% (95% CI, 46.1 to 69.8%) with SDA. In community settings, both vulvovaginal-swab and first-catch urine specimens from women are suitable substrates for nucleic acid amplification tests, but enzyme immunoassays, even after negative-gray-zone testing, should not be used in screening programs.

Adolescent↗

PubMed1999

Pharmaceutical care and health outcomes in community settings: a matched pair analysis of perceptions of hypertensive patients versus pharmacists.

UNLABELLED: This study aimed to: (1) assess the level of pharmaceutical care delivered by pharmacists, and (2) compare patients' and pharmacists' health related quality of life (HRQOL) assessments for patients receiving antihypertensive therapy as an indicator of the delivery of pharmaceutical care. DESIGN: An exploratory, cross-sectional study using matched pair survey instruments. SETTING: Columbus, Ohio. PARTICIPANTS: Patients in a community setting prescribed antihypertensive medication and their pharmacists were selected for study participation. INTERVENTIONS: Parallel surveys distributed to patients and their pharmacists. MAIN OUTCOME MEASURES: Level of pharmaceutical care delivered by pharmacists, and perceived patient viewpoints on: clinical outcomes (blood pressure control, and side effects due to antihypertensive medication) and humanistic outcomes (overall, emotional and physical HRQOL) by patients and pharmacists. RESULTS: Analysis of 52 useable matching surveys of pharmacists and patients indicated that nearly all pharmacists counsel patients and two thirds of pharmacists counsel and monitor drug therapy. This is consistent with providing the minimal OBRA 90 requirements. When comparing patient and pharmacist perceived patient clinical as well as humanistic outcomes, a high level of association was reported between the two groups. CONCLUSIONS: The results of this study suggest that pharmacists are cognizant of patient clinical and humanistic outcomes and hence, they are in an excellent position to improve patient outcomes by making appropriate drug therapy changes.

Antihypertensive Agents↗

PubMedDate not supplied

Respiratory care in community settings.

BACKGROUND: This article reviews the nurse's role in respiratory care in community settings. It aims to identify successful models of community-based respiratory care so that future models and programmes can benefit. CONCLUSION: From the literature it is evident that the nurse's role could be strengthened by the national standardisation of education and the development of models of care and relevant career paths. Improvements to patient care could include the addition of palliative counselling services, general psychosocial support care, auditing patient satisfaction and implementing individualised care plans.

Attitude of Health Personnel↗

PubMed2001

Educating health professionals in a community setting: what students value.

CONTEXT: Health care and health professions education has been shifting into community settings. Hawai'i participated in the Community Partnerships for Health Professions Education program, an initiative funded by the W.K. Kellogg Foundation that aimed to develop educational collaboration between community health centers, their respective communities and health professions schools. OBJECTIVE: In 1998, after completing 5 academic years in this program, former students from one community health center site were polled to begin exploring those components of their experience that were most valuable to their subsequent health care practice. METHOD: A survey was mailed to 65 former students, asking three questions: (1) what three components of your Ke Ola O Hawai'i experience (Wai'anae site) had the most impact on your practice;(2) is there anything else you would like us to know; and (3) where do you see yourself in 5 years? FINDINGS: Thirty responses were received for a 46% response rate. Students identified three components as having the greatest impact: (1) the multiprofessional approach to health care and learning, (2) the community setting/contact, and (3) understanding the culture of the community. A fourth component that was also revealed was the impact this experience had on their personal and professional growth. Most students reported employment or plans to practice in a community-based, rural, or underserved area. CONCLUSION: These responses introduce ideas for sustaining a community-based multi-professional curriculum that is relevant to current health care practice.

Journal Article↗

PubMedDate not supplied

Safe laparoscopic cholecystectomy in a community setting, N = 762.

Laparoscopic cholecystectomy (LC) can be introduced into a community with morbidity and mortality rates equal to that of open cholecystectomy. The entire general surgical community of Greensboro, NC, learned the technique of LC on animal models prior to offering this innovation to the community. Over the ensuing 12 months, they served as surgeons or assistant surgeons to each other on 762 LCs with morbidity and mortality rates comparable to open cholecystectomy. This retrospective study examined the first 1 year of experience beginning 8/13/90. This work represents all of the LCs performed in Greensboro, and all of the surgeons participated in this review. All of the surgeries were done with an electrocautery and utilized a 0 degree forward-viewing scope. Cases were performed at two hospitals with a surgeon as both operator and assistant, and no effort was made to exclude high-risk or elderly patients from this procedure. Patients averaged 50 years of age and ranged from 14 to 96 years. Static cholangiograms were performed in 27% of patients. Conversion to open cholecystectomy was seen in 4.8%. There were two cardiac deaths (0.26%) and significant complications were seen in 3.4%. Seven patients required reoperations. There were no major common bile duct injuries. This retrospective review indicates that this new procedure can be introduced into a community setting by novice laparoscopic surgeons acting both as operators and assistant with a morbidity and mortality rate comparable to that reported for open cholecystectomy.

Cholangiography↗

PubMedDate not supplied

Said another way. Is the ADN graduate prepared to practice in community settings?

The downsizing and closing of acute care facilities and the movement to community-based healthcare services are decreasing the need for RNs in acute care facilities. In the past, the associate-degree nurse (ADN) has filled the majority of positions in acute care. With the trend to provide health services in community setting, will the ADN be prepared for positions in community facilities? ADN educators must reevaluate how they are educating students for practice. The author reviews the 1995 recommendations from the Pew Health Professions Commission and relevant current directives from the National League for Nursing.

Clinical Competence↗

PubMed2004

Priorities in nursing management of fistulas in a community setting.

The aim of this article is to discuss care in the community of patients with a fistula. Areas considered include definition and classification of fistulae, potential causal factors and associated diseases. The article concentrates on enterocutaneous fistulation and the care of patients, but also includes a summary about caring for a patient with an anal fistula. The essential elements of nursing in a community setting are described, and information given on skin care, nutrition, fluids and appliances.

Bandages↗

PubMed2004

Behavior change intervention research in community settings: how generalizable are the results?

This review examines the extent to which recent behavioral intervention studies conducted in community settings reported on elements of internal and external validity, with an emphasis on whether research has been conducted in representative settings with representative populations. A targeted review was conducted on community-based intervention studies that promoted good nutrition, physical activity or smoking cessation/prevention, and were published in 11 leading health behavior journals between 1996 and 2000. The RE-AIM framework (reach, efficacy, adoption, implementation and maintenance) was used to evaluate the extent to which each paper reported on elements of reach, efficacy/effectiveness, adoption, implementation and maintenance. A total of 27 publications were reviewed. Although most studies (88%) reported participation rates among eligible members of the target audience ('reach'), only 11% of studies reported the participation rate ('adoption') among eligible community-based organizations or settings. Few studies reported if participating individuals or settings were representative of those found in the broader population. Although a majority of studies (59%) reported whether the intervention was delivered ('implementation'), few reported whether individuals maintained behavior change (30%) or whether organizations maintained or institutionalized interventions (0%). To increase the potential to translate community research findings to practice, studies should place a greater emphasis on obtaining and reporting external validity information, such as representativeness. The lack of external validity information limits researchers' and practitioners' ability to judge the generalizability of effects and the comparative utility of interventions. Improved reporting will facilitate implementation of proven and broadly applicable intervention strategies in communities. To make significant progress, all parties, including researchers, reviewers, editors and funders, need to take responsibility for increased emphasis on external validity information and ask what role they can best play to facilitate this process.

Adolescent↗

PubMed1994

Obstacles to the accrual of patients to clinical trials in the community setting.

Data indicate that substantial pool of candidates exists, especially in the community setting, for enrollment in clinical oncologic trials. However, only a small proportion of cancer patients are actually enrolled. Obstacles to accrual include physician determinants, patient determinants, organizational issues, and health care system factors. Physicians can influence patient enlistment in their capacity as either referring physician or study investigator. A practitioner's medical orientation may impact the likelihood of referral. Physicians reluctant to enroll patients cite logistic and practical problems and the potential for disrupting patient relationships; a trial's protocol also may be questioned. Patient refusals to participate in clinical trials may stem from practical concerns, psychosocial issues, or a wariness of toxic treatment effects. Organizational issues affecting patient accrual have not been extensively studied; an institutional review board's view of research may be a major factor. Health care system factors such as escalating costs and prohibitive reimbursement policies of third-party payers also adversely affect accrual, and will require a new commitment to minimizing protocol costs. Continued evaluation of physician and patient barriers to accrual is warranted. Once these barriers are recognized, randomized intervention trials will be required to identify ways to overcome them.

Clinical Trials as Topic↗

PubMedDate not supplied

Diagnostic accuracy for lupus and other systemic autoimmune diseases in the community setting.

BACKGROUND: Most individuals with autoimmune and other immune disorders undergo initial evaluation in the community setting. Since misdiagnosis of systemic autoimmune diseases can have serious consequences, we evaluated community physicians' accuracy in diagnosing autoimmune diseases and the consequences of misdiagnosis. METHODS: We studied the patients referred to our Autoimmune Disease Center for 13 months (n = 476). We estimated the degree of agreement with the final diagnosis (kappa statistic) and the accuracy indexes (sensitivity, specificity, and predictive values) of the referring physicians' diagnoses. RESULTS: We found a 49% agreement between the referring and final diagnoses (kappa = 0.36). Of 263 patients referred with a presumptive diagnosis of systemic lupus erythematosus (SLE), 125 received a diagnosis of other conditions (kappa = 0.34). Of those referred with SLE, 76 (29%) were seropositive for antinuclear antibodies but did not have autoimmune disease. The degree of agreement for referring rheumatologists (kappa = 0.55) was better than that for nonrheumatologists (kappa = 0.32). Stepwise logistic regression indicated that rheumatologists were 4 times more likely to make an accurate diagnosis of SLE than were nonrheumatologists (P<.003). Thirty-nine patients who were seropositive for antinuclear antibodies but had no autoimmune disease had been treated with corticosteroids at dosages as high as 60 mg/d. CONCLUSIONS: Many patients with a positive antinuclear antibody test are incorrectly given a diagnosis of SLE and sometimes treated with toxic medications. The data support the importance of continuing medical education for community physicians in screening for autoimmune diseases and identifying patients who may benefit from early referral to a specialist.

Adrenal Cortex Hormones↗

PubMed2002

The management of surgical wounds in a community setting.

Many patients are now having minor surgical procedures carried out in the community and those patients who undergo surgery in hospital are likely to be discharged earlier due to increasing pressure on hospital beds. This article discusses the management of surgical wounds healing by both primary and secondary closure, in the community setting. Understanding the complex process of wound healing is essential if nurses are to recognize abnormalities and select appropriate treatments for patients. The stages of wound healing will be discussed in detail, including the patient's presentation. Factors that influence this process within the patient (e.g. age, nutrition, medication and pain) and those at the wound bed (e.g. exudate, tissue type and infection) will be highlighted. Choosing the correct type of surgical wound dressing for the type of wound can contribute to wound healing, patient comfort and the cost-effectiveness of treatment. Factors that need to be taken into consideration when choosing a dressing will be outlined and suggestions made for the type of dressings that would be most appropriate. The importance of accurate and detailed documentation will be highlighted as part of this process.

Bandages↗

PubMed1995

Threshold parameters for epidemics in different community settings.

Threshold parameters of epidemic models play a central role in the assessment of proposed control strategies for infectious diseases. They have been determined for numerous standard epidemic models. This paper points out, with several examples, that threshold parameters depend on the social setting of the community and the variations in the behavior of the members of the community. Specifically, communities are considered in which individuals have fixed patterns of behavior or random patterns of behavior as well as communities of households with fixed or random patterns of behavior. A threshold parameter is computed for each of the different settings. Some comparisons are made to provide insights into the effects that social settings and behavior changes have on the threshold parameters.

Communicable Diseases↗

PubMed1996

Efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting.

OBJECTIVES: To determine the efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting. METHODS: In this double-blind field trial, 156 children aged 4-36 months with persistent diarrhoea not associated with Giardia lamblia infestation seeking treatment in a community outpatient clinic, were randomized to receive a combination of nalidixic acid and metronidazole, metronidazole alone, or placebo for 7 days. RESULTS: In comparison with placebo, metronidazole treatment did not result in a significant reduction in the mean post-enrollment diarrhoeal duration and stool frequency, increase in the proportion of patients recovered by days 3, 5 and 7 of treatment, and increase in weight gain at days 7 and 14. Comparing the combination of nalidixic acid and metronidazole with metronidazole alone, 17.5% more children treated with the combination recovered by day 3 of treatment (p = 0.08) and the mean stool frequency ascertained on day 7 for the previous 24 h was 26.8% less in them (p = 0.05). The weight gains at days 7 and 14 were similar in the two groups. CONCLUSIONS: These findings indicate that metronidazole offers no therapeutic benefit in persistent diarrhoea not associated with Giardia lamblia and nalidixic acid has only a modest clinical benefit, which is not substantial enough to warrant its routine use.

Anti-Infective Agents↗

PubMed2026

The influence of organizational culture on medication safety practices and associated risk factors in the community setting: A systematic review.

BACKGROUND: Increasing attention has been given to the role of organizational culture in influencing medication safety practices across healthcare settings. The lack of widely accepted standardized instrumentation makes operational measurement of organizational culture and medication safety challenging. The purpose of this systematic review was to examine the impact of organizational culture on medication safety within community healthcare settings. METHODS: MEDLINE, CINAHL, Scopus, and Nursing & Allied Health were searched in August 2025 using keywords, subject terms, field codes, and Boolean operators to identify papers relevant to the review question; bibliographies of included studies were also reviewed. Screening and full-text review were completed independently by two reviewers with a third to adjudicate conflicts. The Critical Appraisal Skills Programme was used for quality assessment. The PRISMA statement guided the development and implementation of the review. RESULTS: Thirteen articles were included representing various community settings. Most studies reported on untoward medication events, but few measured systematically collected safety data before and after an intervention. Organizational culture was seldom defined or operationalized. Most studies were methodologically sound, but the overall level of evidence was weak to moderate. CONCLUSION: Organizational culture influences medication safety through aspects such as communication channels, teamwork, training, and an environment that allows error and near-miss reporting. Few studies explicitly evaluate the causal impact of culture interventions on measurable medication safety outcomes in community healthcare settings. Further research should incorporate standardized measurement tools and intervention-based, pre-post designs to better understand how organizational culture influences medication safety in community healthcare settings.

Organizational Culture↗

PubMed1999

Management of patients with venous ulcers in the community setting.

Venous ulcers, a chronic disabling condition, present a complex management challenge to the interdisciplinary team in the community setting. The incidence of venous ulcers is increasing as the population ages with such comorbidities as congestive heart failure (CHF), deep vein thrombosis (DVT), obesity, and others. Disability associated with venous ulcers may increase caregiver burden in accomplishing the patient's activities of daily living (ADL), and handicap may exist from difficulty in community participation because of impaired mobility. Venous hypertension, the primary culprit in venous ulcerations, must be managed with an arsenal of strategies to control the underlying condition, heal the wound, and prevent recurrence.

Activities of Daily Living↗

PubMed2000

Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting.

OBJECTIVE: Percutaneous endoscopic gastrostomy (PEG) has become the preferred method to provide enteral tube feeding to older adults who have difficulty eating, but the impact of PEG on patient outcomes is poorly understood. The objective of this study was to describe changes in nutrition, functional status, and health-related quality of life among older adults receiving PEG. DESIGN: A prospective cohort study. SETTING: A small community of approximately 60,000 residents served by two hospital systems. PARTICIPANTS: One hundred fifty patients aged 60 and older receiving PEG from one of the four gastroenterologists practicing in the targeted community. MEASUREMENTS: Patients were assessed at baseline and every 2 months for 1 year to obtain clinical characteristics, process of care data, physical and cognitive function, subjective health status, nutritional status, complications, and mortality. RESULTS: Over a 14-month period, 150 patients received PEG tubes in the targeted community; the mean age was 78.9. The most frequent indications for the PEG were stroke (40.7%), neurodegenerative disorders (34.7%), and cancer (13.3%). All measures of functional status, cognitive status, severity of illness, comorbidity, and quality of life demonstrated profound and life-threatening impairment; 30-day mortality was 22% and 1-year mortality was 50%. Among patients surviving 60 days or more, at least 70% had no significant improvement in functional, nutritional, or subjective health status. Serious complications were rare, but most patients experienced symptomatic problems that they attributed to the enteral tube feeding. CONCLUSIONS: PEG tube feeding in severely and chronically ill older adults can be accomplished safely. However, there are important patient burdens associated with the PEG and there was limited evidence that the procedure improves functional, nutritional, or subjective health status in this cohort of older adults. The issues raised in this descriptive study provide impetus for a randomized trial of PEG tube feeding compared with alternative methods of patient care for older adults with difficulty eating.

Activities of Daily Living↗