Recent Submissions

  • Implementation of the SafeCare model in Georgia for preventing child maltreatment

    Whitaker, Daniel; Glasheen, Theresa; Georgia State University (Georgia Public Health Association, 2017)
    Background: The SafeCare model is a behaviorally-based parenting model used in the prevention of child maltreatment. SafeCare targets three proximal risk factors for child neglect and abuse: parent-child interactions, home safety, and child health. SafeCare is one of only a few evidence-based practices for preventing child neglect, the dominant problem in child welfare, accounting for over 75% of child maltreatment cases. SafeCare has been broadly implemented in several states in the US, including Georgia, and is disseminated by the National SafeCare Training and Research Center (NSTRC) at Georgia State University. The presentation will (1) describe SafeCare and associated data, (2) describe the SafeCare implementation. Methods: SafeCare has been implemented in Georgia since 2008 using a rigorous implementation model, which includes on-going quality assurance of SafeCare providers and skill acquisition evaluation in families. Providers of child welfare services have been trained to deliver SafeCare and have been coached by trainers from NSTRC. Evaluation data are regularly collected which include provider fidelity via observed sessions, family outcomes relating to completion of SafeCare, and skill acquisitions (i.e., changes in parenting behaviors, reductions in home hazards, and increases in knowledge and behaviors regarding child health care). Results: Recent evaluation data (2013-2015) indicate 115 families have been referred to a SafeCare provider and 100 families completed at least one session. Thirty-eight (38%) have completed the program in its entirety. Provider fidelity data collected monthly indicate high program fidelity (mean of 91% of desired behaviors performed). Family behavior data indicate excellent skill acquisition among families completing each SafeCare model. Parenting skills increased by 104%; home hazards were reduced by 85%, and child health care skills increased by 34%. Conclusions: The SafeCare model is an effective parenting program for reducing child maltreatment, and has been implemented successfully in Georgia. Broader impact of SafeCare will require increased implementation of the model to increase reach.
  • Associations between multi-level contextual factors and mental health service utilization in adolescents with comorbid depression and substance-use: Moderating role of school connectedness on racial/ethnic disparities in service utilization

    Thornton, Kate; Georgia State University (Georgia Public Health Association, 2017)
    Background: Comorbid depression and substance use has been a prevalent issue in adolescent health. Although rates have remained relatively stable, their level is still alarming and efforts to see a decrease have led leaders and organizations to call for research to better understand factors related to both depression and substance use as well as how these factors may change when these disorders occur together. Methods: Data from the National Survey on Drug Use and Health (NSDUH) were utilized to pursue the research objectives for this study. The NSDUH is an ongoing cross-sectional survey of the civilian and non-institutionalized population of the United States. Multi-level logistic regression procedures were used to determine the relationship between mental health care utilization and research variables in adolescents with comorbid depression and substance-use. Results: Multi-level modeling showed that the model that controlled for individual-level and family-level factors was able to best predict mental health care use (model 4, -2LL=945,303, p << 0.001). In addition, school attachment was shown to be positively associated with mental health care use in all models tested, including the best-fit model selected (OR=2.18;(95% CI 2.13, 2.22). Other contextual factors that were significantly associated with mental health care use were gender (OR=1.92;95% CI 1.88, 1.94), parental attachment (OR=1.72; 95% CI 1.70, 1.74), and poverty (OR=1.59; 95% CI 1.58, 1.62). In addition, the school attachment and race/ethnicity interaction term was found to be significant with an odds ratio of 3.02 (95% CI 2.96, 3.22). Conclusions: This research has shown the importance of contextual factors, specifically the school environment, on the service use of comorbid adolescents. Particularly interesting in the world of mental health promotion is the use of schools as key coordinators in providing specialty mental health services to adolescents, especially for those who suffer from service use disparities.
  • Characteristics of reported symptoms among confirmed and suspect cases of Zika virus in Georgia, 2016

    Thompson, Ashton; Georgia Department of Public Health (Georgia Public Health Association, 2017)
    Background: In May 2015, Zika virus was detected in Brazil. The virus has since spread through several countries in the Americas. Knowledge of the major symptoms of Zika virus infection was based on historic data from two previous outbreaks in the Pacific Islands. Currently-known Zika-specific symptoms include rash, conjunctivitis, arthralgia, and fever. Epidemiologists at the Georgia Department of Public Health (GDPH) began surveillance for travel-related Zika virus infections in January 2016. Surveillance data from GDPH contributes to better characterization of the current Zika clinical picture and more efficient triage of suspect cases for laboratory testing and prevention measures. Methods: For each patient approved for Zika testing, GDPH epidemiologists created an entry in the Zika Active Monitoring System (ZAMS) within the State Electronic Notifiable Disease Surveillance System (SendSS). Patients are categorized as “asymptomatic” or “symptomatic” and reported symptoms are noted. For symptomatic patients, clinical data are compared to determine differences in the distribution of symptoms in Zika negative and positive patients. Results: GDPH has approved testing for 383 symptomatic suspect Zika patients as of October 19, 2016; 88 (23%) were confirmed Zika infections. Among symptomatic positive patients, the most common Zika-specific symptom was maculopapular rash (95%); other common symptoms were headache and myalgia (27%). Among symptomatic Zika-negative patients, the most common Zika specific symptom was fever (62%), and the most common non-Zika specific symptom was headache (19%). Conclusions: Maculopapular rash is the most suggestive symptom of a true Zika virus infection, with 95% of symptomatic Zika positive patients in Georgia exhibiting the symptom. These data can be taken into consideration when updating the testing criteria for Zika virus. GDPH currently does not approve a patient for testing based on fever or non-Zika specific symptoms alone, and that guideline is reaffirmed by these results.
  • Development/enhancement of the assessment (monitoring and evaluation) knowledge and skills of workers in public health and related settings

    Telfair, Joseph; Georgia Southern University (Georgia Public Health Association, 2017)
    Background: A critical task of public health is the development and assessment of programs to address needs, concerns and issues of populations. The overall purpose of this workshop is to enhance the core public health workforce functional knowledge and skills (competencies) in the areas of program development and evaluation leading to improvements in population health and reducing health disparities. Methods: The hour long workshop will serve as an introduction and review of methods of program monitoring and assessment (M & A). The training approach will be an oral presentation with PowerPoint slides and hands -on practice that will include review of M & A terminology and review of M & A basic methodologies. Results: (Outcomes) Participants will become familiar with the basic terms and methods of program monitoring and assessment (M & A). Conclusions: The topics of this workshop will primarily benefit state and local health departments and public health districts that share services and face challenges in building or enhancing their functional public health knowledge and skills, improvement efforts and the documentation of those efforts.
  • Injection drug use and hepatitis C: Interventions in behavioral health settings

    Sutton, Marie; Imagine Hope INC (Georgia Public Health Association, 2017)
    Background: Georgia is experiencing a crisis of injection drug use and hepatitis C virus (HCV) infection. From 2002 to 2014, the statewide drug overdose mortality rate increased, with nearly every county experiencing a significant increase in drug overdose mortality. Especially concerning is the rising HCV infection rate in people younger than 30, many of whom inject drugs. HCV incidence in young people increased over 200% in Georgia from 2006 to 2012. CDC officials have suggested “…Georgia is experiencing an expanding epidemic of heroin use that is driving an increase in injection drug use, putting many more at risk for the spread of HIV and HCV infection.” Methods: Now in its second year, Imagine Hope is a Georgia-wide project that includes 20 agencies (8 methadone clinics, 12 abstinence based agencies) serving substance-using populations. It offers free routine HCV testing and linkage to care. Nearly all individuals served inject drugs. The agencies have implemented a novel combination of embedding routine HCV testing into services; tandem testing for HCV and HIV; linking individuals to HCV care and treatment; and providing access to two support groups. Results: Over 18 months, 6,136 consumers received HCV antibody testing. Of those, 677 (11%) were HCV antibody positive (Ab+), with 83% of them born outside the baby-boomer cohort. To confirm HCV status, clinics conducted RNA tests, completing 464 such tests that yielded 381 (82.1%) confirmed cases of HCV. Currently, the project has linked 102 (36.8%) confirmed HCV+ clients to care and treatment services, with 12 (11.8%) clients experiencing total remission. Conclusions: Among intravenous drug users, HCV prevalence is high, while infection awareness is low. Navigators and support groups enhance linkage. Connecting a population of mostly uninsured behavioral health clients to care is feasible. Providing HCV RNA confirmatory testing in the behavioral health setting greatly enhances the linkage to care process.
  • Probiotics as a novel treatment of mastitis in dairy goats to combat a nutritional concern

    Singh, Vishal; Fort Valley State University (Georgia Public Health Association, 2017)
    Background: The demand for goat dairy products has grown in the US and continues to increase. This is partially due to nutritional advantages that include higher protein, lower cholesterol, ease in digestibility and low fat content as compared to cows’ milk. Goat milk is also used in a variety of health and beauty products such as lotions, soaps and creams. Mastitis continues to have a negative impact on the supply of and demand for goat milk as well as contributing to lack of financial gains for farmers. Methods: Faculty and graduate students of Department of Veterinary Science and Public Health at Fort Valley State University are conducting research both in vitro and in vivo to determine if mastitis may be prevented and/or treated with probiotics. To demonstrate that probiotics will be an effective alternative to traditional antibiotic therapy in treatment of mastitis in dairy goats, antibiotic-resistant bacteria will be treated in vitro with Lactobacillis sp. probiotics to determine bacterial susceptibility. This study has two phases. In Phase I, bacteria isolated from milk from goats with mastitis is subjected to Kirby-Bauer testing to ascertain antibiotic resistance. Once resistance is observed, bacterial sub-colonies will then be subjected to treatment with probiotics (L. plantarum, B. subtilus, B. licheniformis, S. cerevisiae). Phase II involves treatment of antibiotic resistant mastitis in dairy goats to treat and prevent mastitis. Results: Results are pending completion of all testing, to be reported in 2017. Conclusions: Mastitis, an inflammatory process involving the mammary glands, has a negative effect on milk production which in turn influences the supply of and demand for goat milk products. Probiotics present the possibility of a novel treatment in the treatment of antibiotic resistant mastitis.
  • Characterizing discrepancies in school recovery after disasters

    Shah, Hazel; Georgia State University (Georgia Public Health Association, 2019-01-30)
    Background: Academic institutions provide consistency and routine to children. When disasters damage schools, students often suffer in a variety of ways, and racial minority students are often impacted disproportionately. However, minimal research exists exploring these discrepancies. This presentation examines racial disparities in school systems affected by Hurricane Ike (2008). Methods: This study, funded by the National Science Foundation, uses publicly available Texas Education Agency data from approximately 600 schools affected by Hurricane Ike. Schools were included in the study based on two criteria: if they were declared “disaster areas” by FEMA and if they were closed for at least 10 school days after Hurricane Ike. Results: Descriptive analyses were conducted comparing school characteristics and pass rates for all students in grades 3-11 on the Texas Assessment of Knowledge and Skills (TAKS) standardized test during pre- and post-hurricane school years (i.e., 2003 – 2011). Mean pass rates on the TAKS varied greatly by race/ethnicity and other factors. Of African American students, 60.7% (SD=17.4) passed the TAKS in 2004 compared to 69.9% in 2011 (SD=15.0); 68.0% (SD=15.7) of Hispanic students passed in 2004 as opposed to 76.23% (SD=12.2) in 2011; 78.8% (SD=14.8) of White students passed in 2004 versus 83.1% in 2011. Further analyses will explore various other determinants influencing academic performance. Conclusions: Preliminary findings show discrepancies at baseline in academic outcomes between racial/ethnic groups. These discrepancies persisted post-hurricane, though all groups saw an increase in pass-rates. Further research utilizing advanced statistical approaches and geographic information system (GIS) analysis could yield insights on variation of academic performance between schools and school districts, as well as physical exposure and risk factors. These insights can inform strategies for improving schools’ academic trajectories after disasters and optimizing community recovery as a whole.
  • Application of a faith-based integration tool to assess mental and physical health interventions

    Saunders, Donna; Leak, Jean; Carver, Monique; Smith, Selina; Refreshing Springs Outreach, Medical College of Georiga (Georgia Public Health Association, 2017)
    Background: To build on current research involving faith-based interventions (FBIs) for addressing mental and physical health, this study a) reviewed the extent to which relevant publications integrate faith concepts with health and b) initiated analysis of the degree of FBI integration with intervention outcomes. Methods: Derived from a systematic search of articles published between 2007 and 2017, 36 studies were assessed with a Faith-Based Integration Assessment Tool (FIAT) to quantify faith-health integration. Basic statistical procedures were employed to determine the association of faith-based integration with intervention outcomes. Results: The assessed studies possessed (on average) moderate, inconsistent integration because of poor use of faith measures, and moderate, inconsistent use of faith practices. Analysis procedures for determining the effect of FBI integration on intervention outcomes were inadequate for formulating practical conclusions. Conclusions: Regardless of integration, interventions were associated with beneficial outcomes. To determine the link between FBI integration and intervention outcomes, additional analyses are needed.
  • A preliminary examination of elevated blood lead levels in a rural Georgia county

    Rustin, Christopher; Sun, Yu; Calhoun, Chris; Kuriatnyk, Christy; Georgia Southern University, Georgia Department of Health (Georgia Public Health Association, 2017)
    Background: Children in Flint, Michigan were exposed to lead at unsafe levels in drinking water bringing renewed interest and national attention to an old public health problem. In Georgia, thousands of children are exposed annually to lead at unsafe levels primarily from paint in homes built before 1978. With lead poisoning typically viewed as an urban problem, rural areas are often considered lower-risk in light of similar lead poisoning risk factors, albeit on a smaller scale. The purpose of this preliminary study was to examine the prevalence of elevated blood lead levels in children <6 years of age tested in rural Ben Hill County, Georgia, a county designated as lower risk. Methods: Lead surveillance data from the Georgia Department of Public Health (DPH) were analyzed using SAS®v-9.3 to calculate the prevalence of elevated blood lead levels (≥5ug/dL) among those children in Ben Hill County who had been tested for lead; the results were compared to state and national data. Results: A preliminary analysis of 2010-2015 screening data for Ben Hill County indicates that 8.73% (95%- CI: 7.4%-10.1%) of children who were tested for lead exceeded the Centers for Disease Control reference level (≥5ug/dL). This is approximately 3.5 and 2.4 times higher, respectively, when compared to national (2.5%) and state (3.64%) percentages of children exposed to lead ≥5ug/dL. Analysis also indicated low screening rates, which limits interpretation of population prevalence. Conclusions: Lead poisoning is often viewed as an urban, inner-city problem due to a higher percentage of older homes clustered together, exposing more children, compared to rural areas with homes geographically dispersed. While these data are preliminary and more analysis is planned to understand the problem, it highlights lead poisoning risks rural communities face that are often overlooked in population-based risk analysis and research on lead exposure in children.
  • Recruitment, retention, and succession planning for district health directors

    Rudd, Lee; Georgia Department of Health (Georgia Public Health Association, 2017)
    Background: Since the District Health Director (DHD) leads the district health organization, plans must be put in place to ensure that we retain current directors and anticipate the future when the DHD retires from the position. Methods: Best practices in the areas of recruiting, retention, and succession planning are used to present resolutions to the problems. Results: By following the steps identified in the best practices, there is a reasonable chance that the district will be prepared for any change in leadership. Conclusions: Using the best practices identified by human resources professionals combined with the unique characteristics of public health districts will ensure success.
  • After initial accreditation - The PHAB Annual Report

    Roberts, Gurleen; Frantz, Emily; Kennedy, Jack; Cobb & Douglas Public Health (Georgia Public Health Association, 2017)
    Background: Cobb & Douglas Public Health (CDPH) was the first health district in Georgia to achieve accreditation by the Public Health Accreditation Board (PHAB) (accredited on May 12, 2015). Since then, two additional health districts, DeKalb (3-5) and Gwinnett, Newton, and Rockdale County Health Departments (3-4), have achieved accreditation. Efforts are underway among health districts statewide to become accredited, yet, little is known about life after accreditation. This presentation will highlight CDPH’s approach to submitting the PHAB Annual Report, which is required of health departments in order to maintain their accreditation status. Methods: CDPH will provide an overview of the PHAB Annual Report process and requirements. We will also share the process we used to construct a one-year timeline to prepare for the submission of the Annual Report and organize the Accreditation Team. CDPH will also provide a preview of the electronic submission process using ePHAB. Finally, CDPH will share tips, including lessons learned while preparing and submitting the Annual Report during July-August 2016. We will also discuss our experiences since submission and feedback received from PHAB’s Evaluation and Quality Improvement Committee. Results: CDPH will share knowledge and experiences related to the submission and feedback received of its first PHAB Annual Report, which was submitted August 2016. Conclusions: Health departments devote a tremendous amount of time, money, and energy to become accredited; however, the journey continues through the submission of PHAB Annual Progress Reports and reaccreditation planning.
  • Kaizen: Improving patient flow

    Roberts, Gurleen; Kennedy, Jack; Smythe, Catharine; Krahwinkel, Dawn; Green, Melissa; Georgia Southern University (Georgia Public Health Association, 2017)
    Background: Since Cobb & Douglas Public Health (CDPH) achieved accreditation in May 2015, efforts to mature a culture of quality have been emphasized. In addition, the Adult Health Clinic moved to a new facility in Spring 2016. This move has improved many patient flow issues, but also has had unexpected consequences that spurred interest in doing several quality improvement (QI) projects. Methods: Rather than doing one QI project at a time, a kaizen event was held. Kaizen is a Japanese term for continuous improvement. This workshop allowed the Adult Health Team to plan seven QI projects and implement them simultaneously over the next several weeks. After the first six weeks of implementation, nearly 14 different projects were in various stages of the Plan-Do-Study-Act (PDSA) cycle. Baseline average patient flow for 1880 patient encounters was 75.11 minutes. Results: Results are still pending. Preliminary results reflect increased collaboration among clinic staff and an increase in staff members taking the initiative to make improvements. Employee morale has improved, and employee and customer satisfaction seems to be improved. Conclusions: The Adult Health Clinic used the LEAN methodology to reduce waste in the patient flow process and used the PDSA framework to structure their 14 QI projects. A kaizen event allows rapid improvements to be planned and implemented in a short period of time.
  • Hepatitis C and HIV screening

    Perry, Merry (Georgia Public Health Association, 2017)
    Background: Chronic hepatitis C virus (HCV) affects more than 3 million people in the United States. Current HCV treatment offers a shorter treatment interval with fewer adverse reactions as well as improved cure rates of 96%. The increasing rates of hepatitis C infections in adults have been accompanied by multifaceted adverse health outcomes. The purpose of this screening program is to identify HCV-infected individuals, which will lead to clinical interventions and treatment that will improve health outcomes compared to no screening. Methods: The Centers for Disease Control and Prevention guidelines recommend that anyone with risk factors should be screened for HCV infection. In addition, all persons born between 1945 and 1965 should be screened once in their lifetime. Screening at Curtis V. Cooper Primary HealthCare Inc. (CVCPHC) includes individuals 18 and over for HCV and HIV. Results: CVCPHC’s screening program was implemented in January 2016. As of October 1, 2016, 4054 individuals had been screened for HCV with 187 antibody-positive. Of the individuals with positive antibody tests, 179 were RNA tested, and of these, 122 tested positive. Seventy four percent of those with a positive RNA test were linked to care. Eighty five percent of individuals with a positive RNA test were born between 1945 and 1965. The current case reports consist of 57 active HCV patients on medication and/or have completed therapy; 10 have a viral load not detected (ND) > 4-6 weeks after starting medication; 15 completed therapy with a ND viral load resulting in a 100% cure rate; 12 are currently on medication < 4 weeks; 15 were referred to GI; and five deferred treatment. Conclusions: Screening for HCV and HIV lead to the appropriate interventions and treatments for persons infected, preventing the progression of liver disease and reducing morbidity and possibly mortality.
  • EMS 2020: A multi-year SWOT and financial analysis of Georgia’s emergency medical services system

    Owens, Charles; Georgia Southern University (Georgia Public Health Association, 2017)
    Background: As Georgia’s Emergency Medical Services (EMS) system approaches 50 years in operation, the Georgia EMS Association and Georgia Southern University’s Center for Public Health Practice and Research began an evaluation of the strengths, weaknesses, opportunities, and threats facing Georgia’s EMS system. Methods: During the first year of the study, eight meetings were held across Georgia involving EMTs, physicians, hospital administrators, emergency planners, and state policy makers to identify strengths, weaknesses, opportunities, and threats facing the system. Results: Results obtained during the first year of this study offered valuable insight into current and future factors affecting the ability of Georgia’s EMS system to provide effective care to an expanding population. Conclusions: Quality of care, financial solvency, community paramedicine models, and reimbursement strategies were discussed and numerous strategies were evaluated to improve EMS operations in both urban and rural populations.
  • Breaking the chains: A public health approach to modern day slavery

    Nosin, Rachael; Deloitte Consulting (Georgia Public Health Association, 2017)
    Background: Modern day slavery is a $150 billion industry and the second largest criminal enterprise, behind drug trafficking.1 Approximately 21-30 million men, women, and children are modern day slaves worldwide, and over 200 cases of human trafficking were confirmed in GA in 2016 alone.2, 3 In 2006 Georgia incorporated a statute against trafficking of persons for labor or sexual servitude into its criminal code (see O.C.G.A. § 16-5-46). The penalties for this crime are stiff, and those convicted face a minimum of 10 years in state prison and up to a $100,000 fine. This is not enough, however. There is a need to identify this as a public health issue and work to create Georgia’s “Freedom Ecosystem,” a network of key players, including state government, businesses, consumers, and non-profit organizations. Together, these players can make strides in ending and preventing modern day slavery. Methods: Human trafficking is prevalent across our state, partly due to factors related to supply, demand, and facilitation. By applying a public health lens to human trafficking, we may deconstruct the issue across the socio-ecological model to identify the root causes and the most strategic approaches to overcoming systemic barriers, identifying and aiding victims, and empowering survivors. To do so, the Freedom Ecosystem can be used as a framework for harnessing change. Results: Through external interviews and research, we identified nine ways that organizations play a role in the Freedom Ecosystem. Conclusions: Members of Georgia’s private sector, civil society, government, funding communities, academia, and the broader public can use a collective-action framework with a public health lens to promote prevention and advance freedom from modern-day slavery.
  • The association between nutrition, physical activity, and weight status among adults in Georgia

    Nguyen, Trang; Thapa, Janani; Zhang, Donglan; Pullekines, Elizabeth; University of Georgia (Georgia Public Health Association, 2017)
    Background: Obesity is classified as having a body mass index (BMI) greater than 30 and is associated with higher risks of type 2 diabetes, coronary heart diseases, hypertension, and other adverse health outcomes. In 2015, the prevalence of self-reported obesity among adults in Georgia was 30.7. The present study focused on how, in 2015, lifestyle factors, specifically nutrition and physical activity levels, related with weight status in Georgia. Methods: The dataset used for this analysis was from the 2015 Behavioral Risk Factor Surveillance System. The association between weight status (as measured by BMI) and nutrition and physical activity levels was examined by use of linear regressions, controlling for socio-demographic variables. Results: The sample consisted of 3,543 adult respondents in Georgia, of whom 2,285 (64.5%) were overweight or obese. Regarding the variables assessing nutrition, vegetable consumption had a significant association with weight status: one unit increase in consumption of vegetables decreased BMI by 0.009 (p=0.039). Conclusions: Vegetable consumption was negatively associated with BMI. Future research should examine, with more robust measures, the relationship between physical activity levels and weight status and determine how other lifestyle factors relate to weight status. This will become increasingly relevant, as the rates for obesity in Georgia and the United States continue to trend upward.
  • Discussion of public health education and training, and the needs of the future public health workforce.

    Nelson, Gary; Healthcare Georgia Foundation (Georgia Public Health Association, 2017)
    Georgia enjoys a wealth of public health capacity ranging from governmental public health to academic programs as well as local, state, and internationally acclaimed organizations. Leadership is evident across public health policy, practice and research. In the closing plenary of the 2017 Annual Meeting-Faces of Public Health, GPHA engages leaders in our field in a spirited conversation on the public health workforce. The esteemed panel representing state, national, and international public health organizations will reflect on the needs of a 21st Century workforce: prepared to respond beyond emergencies and identified threats; able to adapt to an increasing complex technological, political and economic environment; committed to affecting the economic and social determinants of health inequities; and collaborating to advance the knowledge base aligned with core public health functions and essential services. Are professional standards, qualifications and credentials appropriately calibrated for the needs and opportunities ahead? How has the underlying science base for public health practice, leadership and research changed? As stewards of population health, is the workforce equipped to provide thought leadership on health policy and legislation? What’s working and what’s not working in the recruitment, preparation, and retention of Georgia’s large and diverse public health workforce? The audience will be invited to join the panel in this engaging dialogue.
  • Solo practice physicians in Georgia

    Mutiso, Fedelis; Akowuah, Emmanuel; Opoku, Samuel; Apenteng, Bettye; Georgia Southern University (Georgia Public Health Association, 2017)
    Background: Office-based physicians can practice in a solo or group setting. Solo physician practices are staffed by a single physician who is responsible for all the care of the patients. Physicians in solo practices are also responsible for the infrastructure, personnel and investment cost of their practices. Further, evidence suggests that physicians in solo practices are more likely to be dissatisfied with their medical career compared to those in group practices. Given these challenges, current trend suggests a shift away from solo physician practices. However, there are still physicians in solo practices in Georgia but little is known about them. This study attempts to characterize the physicians working in solo practices and in so doing, add to the growing knowledge of the healthcare workforce in Georgia. Methods: The 2014 Physician Compare data were used for this study. This database contains information on individual physician level characteristics including gender, credential, primary specialty and practice type. The data were linked to the 2014 Area Resource File to provide information on the rural/urban location of physician practices. Physician practices were classified as rural or urban based on the Economic Research Service classification. Chi square and t-tests were carried out to examine the characteristics of physicians practicing in solo practices. Statistical analyses were conducted in StataMP 14. Results: Of the 13,499 Georgia physicians studied, 1448 physicians were in solo practices. The majority of these physicians were in urban areas (78.30%; p<0.001), male (72.18% p<0.001), had primary care specialties (46.31% p<0.001) and more experience in practice (27.6 years; p<0.001). In addition, almost three quarters did not use electronic health records (71.97% p<0.001) and the majority did not report on quality measures to the Centers for Medicare and Medicaid Services (66.7%; p<0.001). Conclusions: There are a large number of physicians in solo practices in Georgia. Given the challenges facing these physicians, it is important for Georgia to consider approaches to decrease the burden on physicians working in solo practices.
  • C the light! Exploring dynamic changes in hepatitis C epidemiology, screening, and treatment

    Miller, Lesley; Travis, Natasha; Lom, Jennifer; Fluker, Shelly-Ann; Emory University, Grady Memorial Hospital (Georgia Public Health Association, 2017)
    Background: Hepatitis C is common, deadly and curable. A major public health epidemic, it affects close to 4 million Americans, and kills more Americans than HIV, hepatitis B and tuberculosis combined. New all-oral therapies for hepatitis C can cure over 90% of those treated with few side effects and with a short 12-week course. However, many people with hepatitis C are unaware of their infection and access to curative therapy remains limited, especially for underserved populations. Methods: Our workshop will focus on areas of dynamic change in hepatitis C. We will discuss the changing epidemiology, focusing on the epidemic of new infections among young injection drug users. We will discuss hepatitis C screening recommendations and how these are applied in medical and public health settings, including barriers and facilitators to screening and linkage to care. We will describe current available therapies for hepatitis C and challenges to accessing these medications. Results: We will present results of our screening and linkage to care cascade, as well as the impact of our primary care-based hepatitis C clinic on antiviral treatment outcomes. We will focus on ways that workshop attendees can apply these principles to hepatitis C screening in their individual settings throughout the state of Georgia. Conclusions: We will conclude by making the compelling argument that combining public awareness of the disease, screening, linkage to care and treatment can lead to hepatitis C elimination in an unexpectedly short time frame.
  • Georgia’s critical access hospitals: Financial performance and process improvement

    Mase, William; Apenteng, Bettye; Carhuff, Lisa; Hanna, Mark; Boakye, Kwabena; Kimsey, Linda; Opoku, Samuel; Owens, Charles; Tedders, Stuart; Whaley, Patricia; Georgia Southern University, Georgia Department of Health (2017)
    Background: Georgia’s Critical Access Hospitals (CAH) are in crisis. Within the last 2 years, four CAHs have closed their doors due to failed financial and operational performance. Evidence points to the risk that several more are on the brink of closure. CAH closures have far-reaching impact on residents. Negative impacts include the extra distance that patients must travel to seek care, the displacement of health professionals and the unravelling of the entire fabric of the communities these hospitals serve. We hope to help participants understand the financial and operational challenges of CAHs, and to identify realistic strategies to enhance the resilience of these hospitals. Methods: The Georgia Southern team worked with a cohort of CAHs across the state of Georgia to identify financial and operational best practices. Year 1 of this project focused on data collection, analysis and benchmarking. Year 2 is currently focused on performance improvement through Lean Six Sigma. Results: CAHs face financial constraints due to factors such as low volume, declining market share, unfavorable payer mix, challenges relating to collections, and difficulties in recruiting providers. CAHs in Georgia performed more poorly on the financial indicators assessed, in comparison to respective national medians. Many CAHs in our cohort are better organized to deal with crises – utilizing strong executive and bureaucratic structures – than to pursue ongoing improvement through employee empowerment and a process focus. Conclusions: Improvements in the operational and financial management practices of Georgia’s CAHs may significantly improve performance. Evidence-based strategies for operational and financial improvement are vital to sustainability. Opportunities exist for collaboration between public health systems and rural hospitals, including CAHs in assuring healthcare access for rural populations.

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