From active treatment to surveillance: how the barriers and facilitators of implementing survivorship care planning could be an opportunity for telehealth in oncology care for rural patients.

Purpose: Cancer survivorship care planning is a recognized yet underutilized aspect of care delivery, and the opportunity for telehealth in cancer survivorship is examined.

Methods: We conducted a mixed-methods study in Vermont and New Hampshire to characterize perceptions of rural cancer providers and survivors regarding survivorship transitions in care, consisting of (a) key informant interviews with primary care and oncology clinicians, (b) a broader survey of clinicians, and (c) surveys and focus group discussions with cancer survivors. In these interactions, we also explored the use of a shared telehealth survivorship care planning appointment between oncology clinicians, primary care clinicians, and survivors.

From active treatment to surveillance: How the barriers and facilitators of implementing survivorship care planning could be an opportunity for telehealth in oncology care for rural patients.

Purpose: Cancer survivorship care planning is a recognized yet underutilized aspect of care delivery and the opportunity for telehealth in cancer survivorship is examined.

Methods: We conducted a mixed-methods study in Vermont and New Hampshire to characterize perceptions of rural cancer providers and survivors regarding survivorship transitions in care, consisting of: a) key informant interviews with primary care and oncology clinicians, b) a broader survey of clinicians, and c) surveys and focus group discussions with cancer survivors. In these interactions, we also explored the use of a shared telehealth survivorship care planning appointment between oncology clinicians, primary care clinicians, and survivors.

A Family-Based Collaborative Care Model for Treatment of Depressive and Anxiety Symptoms in Perinatal Women: Results From a Pilot Study.

Background: Untreated perinatal depression and anxiety can have detrimental consequences on family function. Logistical barriers prevent many perinatal women from accessing treatment, and these barriers are compounded for women residing in rural areas. This paper describes a Family-Based Collaborative Care Model (FBCCM) that is designed to bypass barriers to increase access to care for depressed and anxious perinatal women in rural regions of the United States.

Countering Antivax Misinformation via Social Media: Message-Testing Randomized Experiment for Human Papillomavirus Vaccination Uptake.

Background: Suboptimal adolescent human papillomavirus (HPV) vaccination rates have been attributed to parental perceptions of the HPV vaccine. The internet has been cited as a setting where misinformation and controversy about HPV vaccination have been amplified.

Objective: We aimed to test message effectiveness in changing parents' attitudes and behavioral intentions toward HPV vaccination.

Workshop on Implementation Science and Digital Therapeutics for Behavioral Health.

Digital therapeutics can overcome many of the barriers to translation of evidence-based treatment for substance use, mental health, and other behavioral health conditions. Delivered via nearly ubiquitous platforms such as the web, smartphone applications, text messaging, and videoconferencing, digital therapeutics can transcend the time and geographic boundaries of traditional clinical settings so that individuals can access care when and where they need it. There is strong empirical support for digital therapeutic approaches for behavioral health, yet implementation science with regard to scaling use of digital therapeutics for behavioral health is still in its early stages.

Private well water testing promotion in pediatric preventive care: A randomized intervention study.

Over 43 million U.S. residents rely on private unregulated wells for their drinking water, raising public health concerns, particularly in regions like northern New England where widespread groundwater arsenic contamination is now recognized.

Increasing collaboration on substance use disorder research with primary care practices through the National Drug Abuse Treatment Clinical Trials Network.

Background: The National Drug Abuse Treatment Clinical Trials Network (CTN) called for its national nodes to promote the translation of evidence-based interventions from substance use disorder (SUD) research into clinical practices. This collaborative demonstration project engaged CTN-affiliated practice-based research networks (PBRNs) in research that describes aspects of opioid prescribing in primary care.

Methods: Six PBRNs queried electronic health records from a convenience sample of 134 practices (84 participants) to identify the percent of adult patients with an office visit who were prescribed an opioid medication from October 1, 2015, to September 30, 2016, and, of those, the percent also prescribed a sedative in that year.

VA-Community Dual Care: Veteran and Clinician Perspectives.

Many veterans receive care in both community settings and the VA. Recent legislation has increased veteran access to community providers, raising concerns about safety and coordination. This project aimed to understand the benefits and challenges of dual care from the perceptions of both the Veterans their clinicians.

Part II: A Qualitative Study of Social Risk Screening Acceptability in Patients and Caregivers.

Introduction: This study aimed to better understand patient and caregiver perspectives on social risk screening across different healthcare settings.

Methods: As part of a mixed-methods multisite study, the authors conducted semistructured interviews with a subset of adult patients and adult caregivers of pediatric patients who had completed the Center for Medicare and Medicaid Innovation Accountable Health Communities social risk screening tool between July 2018 and February 2019. Interviews, conducted in English or Spanish, asked about reactions to screening, screening acceptability, preferences for administration, prior screening experiences that informed perspectives, and expectations for social assistance.

Part I: A Quantitative Study of Social Risk Screening Acceptability in Patients and Caregivers.

Introduction: Despite recent growth in healthcare delivery-based social risk screening, little is known about patient perspectives on these activities. This study evaluates patient and caregiver acceptability of social risk screening.

Methods: This was a cross-sectional survey of 969 adult patients and adult caregivers of pediatric patients recruited from 6 primary care clinics and 4 emergency departments across 9 states.

Assessing Mental Health Concerns of Spanish-Speaking Dairy Farm Workers.

: Hispanic dairy farm workers have risk factors for mental health concerns. There is insufficient study of their mental health needs.: We conducted focus groups at five farms.

Smoke-Free Moms: Financial Rewards for Smoking Cessation by Low-Income Rural Pregnant Women.

Introduction: Maternal smoking places the child at risk during pregnancy and postpartum. Most women who quit smoking do so early when they first learn of pregnancy. Few low-income women quit once they enter prenatal care.

Right For Me: protocol for a cluster randomised trial of two interventions for facilitating shared decision-making about contraceptive methods.

Introduction: Despite the observed and theoretical advantages of shared decision-making in a range of clinical contexts, including contraceptive care, there remains a paucity of evidence on how to facilitate its adoption. This paper describes the protocol for a study to assess the comparative effectiveness of patient-targeted and provider-targeted interventions for facilitating shared decision-making about contraceptive methods.

Methods And Analysis: We will conduct a 2×2 factorial cluster randomised controlled trial with four arms: (1) video+prompt card, (2) decision aids+training, (3) video+prompt card decision aids+training and (4) usual care.

Choctaw Nation Youth Sun Exposure Survey.

The incidence of skin cancer is rising among American Indians (AI) but the prevalence of harmful ultraviolet light (UVL) exposures among AI youth is unknown. In 2013, UVL exposures, protective behaviors, and attitudes toward tanning were assessed among 129 AI and Non-Hispanic (NHW) students in grades 8-12 in Southeastern Oklahoma. Sunburn was reported by more than half the AI students and most of the NHW students.

Improving Health Care for Spanish-Speaking Rural Dairy Farm Workers.

Background: Dartmouth Geisel Migrant Health (DGMH) is a medical student group that provides on-site health services for Spanish-speaking dairy workers in rural Vermont and New Hampshire in conjunction with a federally qualified health center (FQHC).

Study Objective: This project was undertaken to evaluate and improve the services provided by DGMH and the FQHC and to refine understanding of the target population.

Methods: We surveyed 25 workers at 6 collaborating dairy farms to identify health priorities and concerns and perceived barriers and facilitators to health care for these workers.

Screening for Adverse Childhood Experiences in a Family Medicine Setting: A Feasibility Study.

Introduction: The role of adverse childhood experiences (ACEs) in predicting later adverse adult health outcomes is being widely recognized by makers of public policy. ACE questionnaires have the potential to identify in clinical practice unaddressed key social issues that can influence current health risks, morbidity, and early mortality. This study seeks to explore the feasibility of implementing the ACE screening of adults during routine family medicine office visits.

Pet Dogs and Children's Health: Opportunities for Chronic Disease Prevention?

Introduction: Positive associations between having a pet dog and adult health outcomes have been documented; however, little evidence exists regarding the benefits of pet dogs for young children. This study investigates the hypothesis that pet dogs are positively associated with healthy weight and mental health among children.

Methods: This cross-sectional study accrued a consecutive sample of children over 18 months in a pediatric primary care setting.

Integrating mental health into adolescent annual visits: impact of previsit comprehensive screening on within-visit processes.

Purpose: To evaluate how a comprehensive, computerized, self-administered adolescent screener, the DartScreen, affects within-visit patient-doctor interactions such as data gathering, advice giving, counseling, and discussion of mental health issues.

Methods: Patient-doctor interaction was compared between visits without screening and those with the DartScreen completed before the visit. Teens, aged 15-19 years scheduled for an annual visit, were recruited at one urban and one rural pediatric primary care clinic.

TXT me I'm only sleeping: adolescents with mobile phones in their bedroom.

The purpose of this study was to determine if mobile phones interfere with adolescent sleep. We conducted a pilot test in a pediatric primary care practice of 454 patients, half female (51.2%), 12 to 20 years old (mean = 15) attending a well-child visit.

A comparison of cesarean delivery outcomes for rural family physicians and obstetricians.

Purpose: Despite declining access to obstetrical care in many regions, family physicians often have difficulty obtaining Cesarean delivery privileges. We compared outcomes of Cesarean deliveries performed by family physicians (FPs) and obstetricians (OBs). The last such study done was more than 15 years ago.

Assessing the impact of a web-based comprehensive somatic and mental health screening tool in pediatric primary care.

Objective: To evaluate how parents and physicians perceive the utility of a comprehensive, electronic previsit screener, and to assess its impact on the visit.

Methods: A mixed methods design was used. English-speaking parents were recruited from 3 primary care systems (urban MD and rural NY and VT) when they presented for a well-child visit with a child 4 to 10 years of age.

Community variation in adolescent access to indoor tanning facilities.

Melanoma rates among younger women in New Hampshire (NH) are rising. In urban studies, youth proximity to tanning facilities has been linked to indoor tanning, a proven cause of melanoma. Youth access has not been examined in rural settings.

Postpartum Depression: Screening, Diagnosis, and Management Programs 2000 through 2010.

The value and appropriateness of universal postpartum depression (PPD) screening remains controversial in the United States. To date, several PPD screening programs have been introduced and a few have been evaluated. Among those programs that have been evaluated, most report screening rates, diagnosis rates, or treatment initiation rates.

Primary care, depression, and anxiety: exploring somatic and emotional predictors of mental health status in adolescents.

Introduction: A growing body of research points to regular, comprehensive mental health screening in primary care practices as an effective tool, but a thorough and efficient approach is not yet widely used. The purpose of this report is to describe the pattern of mental health-related concerns, protective and social risk factors reported by adolescents during routine well-child visits in primary care settings, and their occurrence among teens that screen positive for either depression or anxiety with brief validated measures.

Methods: A personal digital assistant-based questionnaire was administered as part of clinical care to adolescents 11 to 18 years old (N = 2184) attending preventive well-child visits in 13 pediatric and family medicine primary care practices in a northern New England practice-based research network over 18 months (2008 to 2009).

Use of inexpensive technology to enhance adolescent health screening and counseling.

Objectives: To describe the health issues reported using a personal digital assistant (PDA) to conduct screening at adolescent well visits, and to determine the effect of a PDA screening tool on the content and quality of the clinical interaction.

Design: The PDA screening tool was used to record adolescent health risk behaviors, and cross-sectional exit surveys were administered before and after PDA introduction.

Setting: Five primary care practices in New England.