Assessing Primary Care Providers’ Awareness of ACE · PDF fileAssessing Primary Care...
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Assessing Primary Care Providers Awareness of ACE
Scores
Joshua Strait, Kevin Gandhi, Brett Ostrander, Ginger Cupit, Elisabeth Guenther, MD, MPH WesternU/COMP-Northwest
What are Adverse Childhood Experiences (ACEs)?
Adverse Childhood Experiences (ACEs): a term used to describe abuse, neglect, and/or
dysfunctional household environments that are experienced by children under the age of 18.
-Partnered study between CDC and Kaiser Permanente (San Diego) from 1995-1997. -17,000 participants. -Examined the lifespan medical, social, and economic consequences in adults of adverse childhood experiences.
The Adverse Childhood Experiences (ACE) Study
Vincent J. Felitti, M.D.
Prevalence of Adverse Childhood Experiences
Abuse, by Category Psychological (by parents) Physical (by parents) Sexual (anyone) Neglect, by Category Emotional Physical Household Dysfunction, by Category Alcoholism or drug use in home Loss of biological parent < age 18 Depression or mental illness in home Mother treated violently Imprisoned household member
Vincent J. Felitti, M.D.
The ACE Study: Summary of Findings
Figure from Addressing ACEs at Local Health Jurisdictions Webinar
Figure from Addressing ACEs at Local Health Jurisdictions Webinar
Objectives Determine whether primary care providers in Linn
County, OR are aware of ACE Scores. If they are aware of ACE scores, are they
assessing the ACE Score of patients in their practices?
If they are not assessing ACE Scores, what are the
barriers toward implementing them in their practices?
Methods
Anonymous Electronic Survey Multiple choice/ short response
Contacted via phone/email/in-person: 17 offices in Linn County Primary Care Providers
Tracked estimated number of recipients Incentive: $50 Amazon gift card
Methods
Assessed: Demographic data, health profession, knowledge &
implementation of ACE Scores Timeline: 2 months to complete
One month extension One follow-up reminder
Statistical Analysis Qualtrics & Microsoft Excel
Health Care Setting of Respondents
N=82 Estimated
response rate > 24%
Mental Health 23%
Family Practice
20%
Pediatrics 12%
Emergency Medicine
12%
Internal Medicine
1%
Other 32%
Distribution of Respondents
MD 22%
DO 11%
PA 1% RN
29% LPN 3%
Other, please specify:
34%
Considering the population of patients you work with, what are the top three health risk factors you have noted?
Drugs/ETOH use/abuse
23%
Abusive Relationships
3%
Low Education 11%
Poverty/ Unemployment
[PERCENTAGE] [CATEGORY NAME]
Low self-esteem 4%
[CATEGORY NAME]
[PERCENTAGE]
Abused as a child 4%
[CATEGORY NAME]
[PERCENTAGE] Other:
7%
Do you record your patients past history regarding any maltreatment that occurred in their family of origin?
(physical, sexual, emotional, neglect)
Yes 65%
No 35%
How familiar are you with the Adverse Childhood Experience (ACE) Study? (Vincent J. Felitti, MD, FACP,
Robert F. Anda, MD, MS)
Not at all 79%
Very familiar 7%
Somewhat familiar
14%
Do you currently implement ACE Scores in your practice? If no, then why?
Lack of time 21%
Feel uncomfortable
talking to patient about
childhood trauma
0%
Extra paperwork
17%
Costs too much money
0%
Not required/mandated for practice
33%
Not necessary/ sufficient for patient care
[PERCENTAGE]
ACE questions are redundant
to those gathered from patient history
8%
Other: 21%
Limitations
Non-applicable professions: i.e. Communicable Disease, Front Desk.
Unknown exact number of recipients. Unable to confirm respondents. Sample size and population. Inefficient communication channels for health
providers in Linn County.
Addressing ACEs
Implement ACE Score in Practice. Tell me how that has affected you later in your
life How would you feel if you learned that a child you
care about was growing up exactly as you did? Team-Based Approach
Form list of referrals & other health professionals
Future Directions
Medical School Curriculum Samaritan Health Services
Chief Medical Officer & Director of Population Health
Publication Study/ Increase Knowledge of Trauma Informed
Care Get Connected Self Awareness/ Provider Assessment
How do our ACEs affect our profession?
Too much on your plate?
Image from Google
Questions?
Resources
CDC: http://www.cdc.gov/violenceprevention/acestudy/ ACE Score Questionnaire: http://acestudy.org/ace_score Academy on Violence & Abuse: http://www.avahealth.org ACEs Connection: http://www.acesconnection.com ACEs Too High: http://acestoohigh.com Addressing ACEs at Local Health Jurisdictions:
http://www.nwcphp.org/docs/ht2014/20140527/htip20140527.html