About

Kent D.W. Bream, MD, is an Associate Professor of Clinical Family Medicine and Community Health at the University of Pennsylvania. He serves as a Staff Physician at both Penn Presbyterian Medical Center and the Hospital of the University of Pennsylvania. Dr. Bream is the founding Program Director of the Guatemala Health Initiative and Field School in Community Health Research, reflecting his engagement in global health and community-based research. He holds faculty positions as a Senior Fellow in the MPH Program at the Center for Public Health Initiatives and as Faculty Director at the University of Pennsylvania Harnwell College House. His roles also include co-directing community engagement efforts and serving as the Senior Medical Director of the Community Partnership for Wellness, which encompasses programs such as Shelter Health Outreach, school-based clinics, and mobile vaccination initiatives. Dr. Bream's educational background includes a BA in Comparative Literature from the University of Pennsylvania and an MD from the University of Maryland at Baltimore School of Medicine. His work emphasizes community health, public health initiatives, and global health collaborations.

Research topics

• Medicine
• Demography
• Environmental health
• Gerontology
• Psychology

Selected publications

• Assessing Family Medicine Obstetrics Training Needs to Strengthen Maternal Health in Underserved and Rural US Communities

  Journal of Primary Care & Community Health · 2025-07-01 · 1 citations

  articleOpen access

  BACKGROUND: Family medicine obstetricians (FMOBs) are essential for providing maternity care in underserved communities, yet their numbers have sharply declined, contributing to maternity care deserts and persistent inequities. To address the FMOB workforce gap, a large urban residency implemented the PROMOTE OB track (PRimary care Obstetrics and Maternal Outcomes Training Enhancement). We explored FMOB residents' training needs, practice barriers, and perceived patient needs from the perspectives of faculty and graduates involved in obstetrics training. METHODS: We conducted 7 focus groups with university FMOB faculty, non-OB FM graduates, FMOB graduates, obstetrics and gynecology (OB/GYN) faculty and fellows, and maternal-fetal medicine (MFM) faculty and fellows. Discussions were guided by a semi-structured protocol exploring training gaps, collaborative care, structural and cultural barriers, and unmet patient needs. Focus groups were audio-recorded and transcribed verbatim, and transcripts were then analyzed thematically. RESULTS: During focus group discussions (n = 7), participants emphasized that FMOB training must go beyond procedural competencies to include cultural humility, structural competency, and interprofessional collaboration. Five thematic domains emerged: (1) FMOB training needs and curriculum gaps; (2) building collaborative care teams in residency; (3) preparing FMOBs to address structural barriers to care; (4) navigating cultural barriers to care; and (5) responding to unmet provider-perceived patient needs in underserved settings. CONCLUSIONS: FMOB training must prepare residents for the clinical and contextual realities of underserved maternity care. Programs should standardize competencies, expand mentorship, and ensure structured exposure to diverse care settings. Sustained policy-level investment is needed to strengthen training infrastructure and expand the FMOB workforce. Aligning curricula with community needs and national policy priorities may improve access to equitable, comprehensive maternity care.

  PublisherDOI

• Academic-Rural Partnerships Need Bidirectionality

  Academic Medicine · 2025-04-15

  articleSenior author
  PublisherDOI

• Perspectives and practices surrounding stroke and seizure in a rural Tz'utujil Maya community in Guatemala: A qualitative study

  Journal of the Neurological Sciences · 2025-12-01

  articleSenior author
  PublisherDOI

• Abstract P110: Analysis of Community-Level High Blood Pressure Awareness Efforts for Philadelphia's Unhoused Population

  Hypertension · 2024-09-01

  article

  Introduction: The University of Pennsylvania Shelter Health Outreach Program (SHOP) is a student-led community health initiative where volunteers go weekly to various sites around Philadelphia and take blood pressure (BP) for unhoused guests at no cost. The objective of the study is to estimate the prevalence of high BP among the unhoused population in Philadelphia and its association with various factors relating to health access. Methods: SHOP BP screening tables were set up at six food and housing sites once a week from September 2022 to December 2023. The study cohort included guests who voluntarily came to the tables for BP measurement. High BP was defined as having a single measurement systolic BP over 130 mmHg and/or having a diastolic blood pressure over 80 mmHg. BP results and responses to survey questions about health status and momentary social situation were stored in a secure cloud server. The data were analyzed using the R statistical software. Results: We surveyed 2,138 guests across the 6 sites. Among the guests who were surveyed, 73.6% had high BP and of these 65% of guests had at least stage 2 hypertension as defined by the American Heart Association Guidelines. In addition, a higher proportion of high BP was observed among guests who were returning to a SHOP table for a repeat screening after one or more weeks. A higher proportion of high BP was also observed for guests who reported having had a physical exam in the past year. At least one-third of the guests reported as returning to the screening site after having received a prior BP screening from a SHOP table. Conclusions: Our results show a high burden of hypertension, especially severe hypertension, in the unhoused population in Philadelphia. Although significant challenges exist to ascertain accurate BP readings at the community level, SHOP demonstrated relatively high retention. This model of BP screening represents a distinct opportunity to introduce community-based interventions to manage hypertension in such a highly disadvantaged population.

  PublisherDOI

• Community-Based COVID-19 Vaccine Clinics in Medically Underserved Neighborhoods to Improve Access and Equity, Philadelphia, 2021–2022

  American Journal of Public Health · 2022-10-27 · 4 citations

  articleOpen access

  Vaccination remains key to reducing the risk of COVID-19–related severe illness and death. Because of historic medical exclusion and barriers to access, Black communities have had lower rates of COVID-19 vaccination than White communities. We describe the efforts of an academic medical institution to implement community-based COVID-19 vaccine clinics in medically underserved neighborhoods in Philadelphia, Pennsylvania. Over a 13-month period (April 2021–April 2022), the initiative delivered 9038 vaccine doses to community members, a majority of whom (57%) identified as Black. (Am J Public Health. 2022;112(12):1721–1725. https://doi.org/10.2105/AJPH.2022.307030 )

  PublisherOA PDFDOI

• Who, What, and Where: Transforming Primary Care Education to Advance Health Equity

  Journal of Health Care for the Poor and Underserved · 2020-01-01 · 2 citations

  article

  To transform primary care with the goal of achieving health equity, changes in the way the health care workforce is selected, trained, and ultimately delivers care should be expedited. Research has repeatedly shown the immense impact of the social determinants of health and the gaps related to health equity in the United States. Despite this knowledge, health care education and delivery systems have been slow to evolve. The Health Resources and Services Administration established the Academic Units for Primary Care Training and Enhancement to work towards strengthening the primary care workforce. Through their research, the six individual Academic Units (AU) have identified gaps related to health equity in their areas of focus. This article provides recommendations from the AUs on ways primary care health professions education can be transformed to advance health equity and serves as background for the articles to follow in the remainder of the supplement.

  PublisherDOI

• Ongoing challenges in access to diabetes care among the indigenous population: perspectives of individuals living in rural Guatemala

  International Journal for Equity in Health · 2019-11-21 · 17 citations

  articleOpen access

  BACKGROUND: Indigenous persons living in Latin America suffer from a higher prevalence of type 2 diabetes compared to their non-indigenous counterparts. This difference has been attributed to a wide range of factors. Future interventions could be influenced by a deeper understanding of the challenges that impact care in rural regions and in other low-income settings. METHODS: This study was conducted using a modified grounded theory approach. Extended observations and fifteen interviews were performed with adult male and female residents of three rural Mayan towns in Sololá Department, Guatemala using purposive sampling. Questions focused on the perceptions of individuals living with type 2 diabetes and their caregivers regarding disease and treatment. RESULTS: Across interviews the most common themes that emerged included mistreatment by healthcare providers, mental health comorbidity, and medication affordability. These perceptions were in part influenced by indigeneity, poverty, and/or gender. CONCLUSIONS: Both structural and cultural barriers continue to impact diabetes care for indigenous communities in rural Guatemala. The interviews in this study suggest that indigenous people experience mistrust in the health care system, unreliable access to care, and mental health comorbidity in the context of type 2 diabetes care. These experiences are shaped by the complex relationship among poverty, gender, and indigeneity in this region. Targeted interventions that are conscious of these factors may increase their chances of success when attempting to address similar health disparities in comparable populations.

  PublisherOA PDFDOI

• Medical Student Exposure to Integrated Behavioral Health

  Academic Psychiatry · 2018-05-22 · 7 citations

  articleSenior author
  PublisherDOI

• Diabetes prevalence in rural Indigenous Guatemala: A geographic-randomized cross-sectional analysis of risk

  PLoS ONE · 2018-08-09 · 27 citations

  articleOpen access1st authorCorresponding

  BACKGROUND: Developing countries and Indigenous populations are disproportionately affected by global trends in diabetes (T2DM), but inconsistent data are available to corroborate this pattern in Guatemala and indigenous communities in Central America. Historic estimates of T2DM, using a variety of sampling techniques and diagnostic methods, in Guatemala include a T2DM prevalence of: 4·2% (1970) and 8·4% (2003). Objectives of this geographically randomized, cross-sectional analysis of risk include: (1) use HbA1c to determine prevalence of T2DM and prediabetes in rural Indigenous community of Atitlán (2) identify risk factors for T2DM including age, BMI and gender. METHODS: A spatially random sampling method was used to identify 400 subjects. Prevalence was compared using the confidence interval method, and logistic regression and linear regression were used to assess association between diabetes and risk factors. FINDINGS: The overall prevalence of T2DM using HbA1c was 13·81% and prediabetes was also 13·81% in Atitlán, representing a tripling in diabetes from historic estimates and a large population with pre-diabetes. The probability of diabetes increased dramatically with increasing age, however no significant overall relationship existed with gender or BMI. CONCLUSIONS: Diabetes is a larger epidemic than previously expected and appears to be related to ageing rather than BMI. Our proposed explanations for these findings include: possible Indigenous unique genetic susceptibility to T2DM, shortcomings in BMI as a metric for adiposity in assessing risk, changes in lifestyle and diet, and an overall aging population. The conclusion of this study suggest that (1) T2DM in rural regions of Guatemala may be of epidemic proportion. With pre-diabetes, more than 25% of the population will be diabetic in the very near future; (2) Age is a significant risk factor in the Indigenous population but BMI is not. This suggests that in some populations diabetes may be a disease of ageing.

  PublisherOA PDFDOI

• Identifying Prevalence and Characteristics of Behavioral Health Education in Family Medicine Clerkships:

  Family Medicine · 2018-01-08 · 2 citations

  articleOpen accessSenior author

  BACKGROUND AND OBJECTIVES: Many patients with behavioral health disorders do not seek or receive adequate care for their conditions. Among those that do, most will receive care in a primary care setting. To best meet this need, clinicians will need to demonstrate proficiency of behavioral health skills and evidence-based practices. We sought to explore the degree to which these skills are being taught in family medicine clerkships. METHODS: The Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) 2016 survey of clerkship directors (CDs) was sent to 141 CDs at US and Canadian medical schools with a required family medicine run course. CDs were asked about the inclusion of behavioral health topics, tools, and techniques in the clerkship, as well as rating the importance of these items. RESULTS: Eighty-six percent of CDs completed the survey. Mood disorders (81.4%) were most frequently taught, followed by anxiety disorders (77.8%), substance use disorders (74.4%), and impulse control disorders (39.1%). Screening tools and behavioral health counseling skills were less commonly taught. CONCLUSIONS: Many behavioral health topics are not taught universally to all family medicine clerkship students. Gaps exist between what is included in current curriculum and what is recommended by the National Clerkship Curriculum for family medicine. These gaps may represent challenges for improving the care for patients with behavioral health disorders.

  PublisherOA PDFDOI

Frequent coauthors

• Frances K. Barg

  University of Pennsylvania

  17 shared

• Erwin Calgua

  University of San Carlos of Guatemala

  10 shared

• Roger A. Band

  Thomas Jefferson University

  9 shared

• Sourav K. Bose

  Children's Hospital of Philadelphia

  9 shared

• Amelia Breyre

  Yale University

  8 shared

• Lynne Taylor

  University of Pennsylvania

  8 shared

• Claudia Valeggia

  4 shared

• Caroline A. Nelson

  Yale University

  4 shared