101
|
Tenpas AS, Vascimini A, Westwood G, Morris E, Dietrich E, DeRemer C. Improvement in Clinical Outcomes and Access to Care With Pharmacist-Led Chronic Care Management Services at a Rural Family Medicine Clinic. J Pharm Pract 2023; 36:1392-1396. [PMID: 35938485 DOI: 10.1177/08971900221118232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Background: Chronic care management (CCM) can significantly impact the management of chronic diseases in rural patient populations. To date, few practice models have addressed its impact on clinical outcomes and access to care in rural practice settings. Objective: Implement a sustainable pharmacist-led CCM practice model while tracking clinical outcomes and healthcare access at a rural, medically underserved family medicine clinic. Methods: This study retrospectively examined data from the clinic's CCM program from October 2020 through May 2021 and included total clinical encounters at three- and 6-months intervals, as well as changes in clinical outcomes like A1c and systolic blood pressure (SBP) at three- and 6-months intervals. Results: Over an 8-month period, 46 patients were enrolled in pharmacist-led CCM services. Those with a CCM encounter or office visit within 3 months of enrollment showed a mean A1c reduction of 1.07% after 3 months (95% CI -1.70 to -.44, P = .0016), while those with an encounter or office visit within 6 months of enrollment displayed a mean A1c reduction of 1.64% after 6 months (95% CI -2.35 to -.92, P < .001). There was a 73.8% increase in total clinical encounters in the 6 months after CCM enrollment compared to the 6 months preceding it, signifying increased access to care. Conclusion: Patients with CCM encounters or office visits within the first 3-6 months experienced statistically significant reductions in A1c. Moreover, total clinical encounters markedly increased in the 6 months after enrollment, allowing for more frequent engagement between ambulatory pharmacists and traditionally challenging rural patients.
Collapse
Affiliation(s)
- Andrew S Tenpas
- Department of Pharmacy Practice, Texas A&M Irma Lerma Rangel College of Pharmacy, Kingsville, TX, USA
| | - Angelina Vascimini
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida Taneja College of Pharmacy, Tampa, FL, USA
| | - Greg Westwood
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Earl Morris
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Eric Dietrich
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Christina DeRemer
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA
| |
Collapse
|
102
|
Jindal M, Chaiyachati KH, Fung V, Manson SM, Mortensen K. Eliminating health care inequities through strengthening access to care. Health Serv Res 2023; 58 Suppl 3:300-310. [PMID: 38015865 PMCID: PMC10684044 DOI: 10.1111/1475-6773.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To provide a research agenda and recommendations to address inequities in access to health care. DATA SOURCES AND STUDY SETTING The Agency for Healthcare Research and Quality (AHRQ) organized a Health Equity Summit in July 2022 to evaluate what equity in access to health care means in the context of AHRQ's mission and health care delivery implementation portfolio. The findings are a result of this Summit, and subsequent convenings of experts on access and equity from academia, industry, and the government. STUDY DESIGN Multi-stakeholder input from AHRQ's Health Equity Summit, author consensus on a framework and key knowledge gaps, and summary of evidence from the supporting literature in the context of the framework ensure comprehensive recommendations. DATA COLLECTION/EXTRACTION METHODS Through a stakeholder-engaged process, themes were developed to conceptualize access with a lens toward health equity. A working group researched the most appropriate framework for access to care to classify limitations identified during the Summit and develop recommendations supported by research in the context of the framework. This strategy was intentional, as the literature on inequities in access to care may itself be biased. PRINCIPAL FINDINGS The Levesque et al. framework, which incorporates multiple dimensions of access (approachability, acceptability, availability, accommodation, affordability, and appropriateness), is the backdrop for framing research priorities for AHRQ. However, addressing inequities in access cannot be done without considering the roles of racism and intersectionality. Recommendations include funding research that not only measures racism within health care but also tests burgeoning anti-racist practices (e.g., co-production, provider training, holistic review, discrimination reporting, etc.), acting as a convener and thought leader in synthesizing best practices to mitigate racism, and forging the path forward for research on equity and access. CONCLUSIONS AHRQ is well-positioned to develop an action plan, strategically fund it, and convene stakeholders across the health care spectrum to employ these recommendations.
Collapse
Affiliation(s)
- Monique Jindal
- Department of Academic Internal MedicineUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Krisda H. Chaiyachati
- Verily, Inc.South San FranciscoCaliforniaUSA
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Vicki Fung
- Department of Medicine, Harvard Medical School, Mongan InstituteMassachusetts General HospitalBostonMassachusettsUSA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Karoline Mortensen
- Department of Health Management and PolicyMiami Herbert Business SchoolCoral GablesFloridaUSA
| |
Collapse
|
103
|
Stovall SL, Johnson MP, Evans ET, Kaplan JA, Law JK, Moonka R, Bahnson HT, Simianu VV. Understanding the Geographic Distribution of Diverticulitis Hospitalizations in Washington State. Am Surg 2023; 89:5720-5728. [PMID: 37144833 DOI: 10.1177/00031348231174002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND The incidence of diverticulitis in the United States is increasing, and hospitalization remains a surrogate for disease severity. State-level characterization of diverticulitis hospitalization is necessary to better understand the distribution of disease burden and target interventions. METHODS A retrospective cohort of diverticulitis hospitalizations from 2008 through 2019 was created using Washington State's Comprehensive Hospital Abstract Reporting System. Hospitalizations were stratified by acuity, presence of complicated diverticulitis, and surgical intervention using ICD diagnosis and procedure codes. Patterns of regionalization were characterized by hospital case burden and distance travelled by patients. RESULTS During the study period, 56,508 diverticulitis hospitalizations occurred across 100 hospitals. Most hospitalizations were emergent (77.2%). Of these, 17.5% were for complicated diverticulitis, and 6.6% required surgery. No single hospital received more than 5% (n = 235) of average annual hospitalizations. Surgeons operated in 26.5% of total hospitalizations (13.9% of emergent hospitalizations, and 69.2% of elective hospitalizations). Operations for complicated disease made up 40% of emergent surgery and 28.7% of elective surgery. Most patients traveled fewer than 20 miles for hospitalization, regardless of acuity (84% for emergent hospitalization and 77.5% for elective hospitalization). DISCUSSION Hospitalizations for diverticulitis are primarily emergent, nonoperative, and broadly distributed across Washington State. Hospitalization and surgery occur close to patients' homes, regardless of acuity. This decentralization needs to be considered if improvement initiatives and research in diverticulitis are to have meaningful, population-level impact.
Collapse
Affiliation(s)
- Stephanie L Stovall
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Meredith P Johnson
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Ethan T Evans
- Diabetes Clinical Research Program, Benaroya Research Institute, Seattle, WA, USA
| | - Jennifer A Kaplan
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Joanna K Law
- Department of Gastroenterology, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Ravi Moonka
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| | - Henry T Bahnson
- Clinical Research Program, Benaroya Research Institute, Seattle, WA, USA
| | - Vlad V Simianu
- Department of General, Thoracic, and Vascular Surgery, Virginia Mason Franciscan Health, Seattle, WA, USA
| |
Collapse
|
104
|
Wilkerson K, De Marchis E, Rudd N, Williams JC, Pantell M, Ackerman SL, Amerson EH, Chang AY. Patient Perspectives on Social Risk Screening and Documentation in a Dermatology Clinic. JAMA Dermatol 2023; 159:1346-1358. [PMID: 37878278 PMCID: PMC10600715 DOI: 10.1001/jamadermatol.2023.3887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/20/2023] [Indexed: 10/26/2023]
Abstract
Importance Providing person-centered dermatologic care includes consideration of social risk factors, such as housing instability and unreliable transportation, that may affect clinical management. Patients' perspectives on social risk screening and documentation in dermatology clinics have not yet been evaluated. Objective To understand patients' perspectives on social risk screening and documentation in a dermatology clinic. Design, Setting, and Participants This mixed-methods study used a survey and semistructured interviews and was conducted in a general dermatology clinic at a large urban public hospital. Patients at the clinic were eligible to complete the survey if they were 18 years or older; able to speak and read English, Spanish, or Cantonese; and comfortable using a computer tablet. Survey participants who preferred to use English were eligible for interviews. The survey included social risk screening questions, measures of acceptability, and questions on social risk factors associated with patient acceptability. Semistructured interviews were conducted to explore attitudes and beliefs about social risk screening and documentation. Survey and interview findings were integrated during data analysis through development of themes and joint display. Data were analyzed from December 2021 to April 2023. Main Outcomes and Measures There were 2 outcome measures of acceptability: appropriateness of screening in a dermatology clinic and comfort with documentation of social risk in the electronic health record (EHR). Results A total of 135 participants (including 73 males [54.1%]) answered both measures of acceptability in the survey. Of these participants, 116 (85.9%) reported that social risk screening in their dermatology clinic was very or somewhat appropriate and 85 (63.0%) reported being completely or somewhat comfortable with having their social risks documented in the EHR. Themes that were developed from surveys and interviews were the (1) role of interpersonal factors in willingness to disclose social risks, (2) implications of institutional trust for willingness to disclose and comfort with documentation, and (3) relevance of screening in a dermatology clinic. Conclusions and Relevance Results of this study showed that most participants found social risk screening to be appropriate in a dermatology clinic, although a smaller proportion of participants were comfortable with EHR documentation of their social risks. Optimizing patients' trust in their physicians and the medical system, while addressing privacy and discrimination concerns, may help facilitate disclosure of social risks.
Collapse
Affiliation(s)
- Kamina Wilkerson
- University of California, San Francisco School of Medicine, San Francisco
| | - Emilia De Marchis
- Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco
| | - Nora Rudd
- University of California, San Francisco School of Medicine, San Francisco
| | | | - Matt Pantell
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco
| | - Sara L. Ackerman
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco
| | - Erin H. Amerson
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco
- Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Aileen Y. Chang
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco
- Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| |
Collapse
|
105
|
Copeland J, Neal E, Phillips W, Hofferberth S, Lathan C, Donington J, Colson Y. Restructuring lung cancer care to accelerate diagnosis and treatment in patients vulnerable to healthcare disparities using an innovative care model. MethodsX 2023; 11:102338. [PMID: 37701734 PMCID: PMC10494257 DOI: 10.1016/j.mex.2023.102338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/19/2023] [Indexed: 09/14/2023] Open
Abstract
The diagnosis and treatment of lung cancer is challenged by complex diagnostic pathways and fragmented care that can lead to disparities for vulnerable patients. Our model involved a multi-institutional, multidisciplinary conference to address the complexity of lung cancer care in vulnerable patient populations. The conference was conducted using a process adapted from the problem-solving method entitled FastTrack, pioneered by General Electric. Conference attendees established critical social determinants of health specific to lung cancer and designed a practical care model to accelerate diagnosis and treatment in this population. The resulting care delivery model, the Lung Cancer Strategist Program (LCSP), was led by a lung cancer trained advanced practice provider (APP) to expedite diagnosis, surgical and oncologic consultation, and treatment of a suspicious lung nodule. We compared the timeliness of care, care efficiency, and oncologic outcomes in 100 LCSP patients and 100 routine referral patients at the same thoracic surgery clinic. Patient triage through our integrated care model transitioned initial referral evaluation to a lung cancer trained APP to coordinate multidisciplinary patient-centered care that was highly individualized and significantly reduced the time to diagnosis and treatment among vulnerable patients at high-risk for treatment delay due to healthcare disparities.•To develop the Lung Cancer Strategist Program care model, we used a three-step (Design, Meeting, and Culmination), team-based, problem-solving process entitled FastTrack.•An advantage of FastTrack is its ability to overcome barriers embedded within hierarchal and institutional social systems, empowering those closest to the relevant issue to propose and enact meaningful change.•Under this framework, we engaged a diverse field of experts to assess systemic barriers in lung cancer care and design an innovative care pathway to improve the timeliness and efficiency of lung cancer care in patients at risk for healthcare disparities.
Collapse
Affiliation(s)
- Jessica Copeland
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Eliza Neal
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Will Phillips
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sophie Hofferberth
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Christopher Lathan
- Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Jessica Donington
- Division of Thoracic Surgery, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Yolonda Colson
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
106
|
Lu Y, Liu Y, Dhingra LS, Caraballo C, Mahajan S, Massey D, Spatz ES, Sharma R, Rodriguez F, Watson KE, Masoudi FA, Krumholz HM. National Trends in Racial and Ethnic Disparities in Use of Recommended Therapies in Adults with Atherosclerotic Cardiovascular Disease, 1999-2020. JAMA Netw Open 2023; 6:e2345964. [PMID: 38039001 PMCID: PMC10692850 DOI: 10.1001/jamanetworkopen.2023.45964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023] Open
Abstract
Importance Despite efforts to improve the quality of care for patients with atherosclerotic cardiovascular disease (ASCVD), it is unclear whether the US has made progress in reducing racial and ethnic differences in utilization of guideline-recommended therapies for secondary prevention. Objective To evaluate 21-year trends in racial and ethnic differences in utilization of guideline-recommended pharmacological medications and lifestyle modifications among US adults with ASCVD. Design, Setting, and Participants This cross-sectional study includes data from the National Health and Nutrition Examination Survey between 1999 and 2020. Eligible participants were adults aged 18 years or older with a history of ASCVD. Data were analyzed between March 2022 and May 2023. Exposure Self-reported race and ethnicity. Main Outcome and Measures Rates and racial and ethnic differences in the use of guideline-recommended pharmacological medications and lifestyle modifications. Results The study included 5218 adults with a history of ASCVD (mean [SD] age, 65.5 [13.2] years, 2148 women [weighted average, 44.2%]), among whom 1170 (11.6%) were Black, 930 (7.7%) were Hispanic or Latino, and 3118 (80.7%) were White in the weighted sample. Between 1999 and 2020, there was a significant increase in total cholesterol control and statin use in all racial and ethnic subgroups, and in angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) utilization in non-Hispanic White individuals and Hispanic and Latino individuals (Hispanic and Latino individuals: 17.12 percentage points; 95% CI, 0.37-37.88 percentage points; P = .046; non-Hispanic White individuals: 12.14 percentage points; 95% CI, 6.08-18.20 percentage points; P < .001), as well as smoking cessation within the Hispanic and Latino population (-27.13 percentage points; 95% CI, -43.14 to -11.12 percentage points; P = .002). During the same period, the difference in smoking cessation between Hispanic and Latino individuals and White individuals was reduced (-24.85 percentage points; 95% CI, -38.19 to -11.51 percentage points; P < .001), but racial and ethnic differences for other metrics did not change significantly. Notably, substantial gaps persisted between current care and optimal care throughout the 2 decades of data analyzed. In the period of 2017 to 2020, optimal regimens were observed in 47.4% (95% CI, 39.3%-55.4%), 48.7% (95% CI, 36.7%-60.6%), and 53.0% (95% CI, 45.6%-60.4%) of Black, Hispanic and Latino, and White individuals, respectively. Conclusions and Relevance In this cross-sectional study of US adults with ASCVD, significant disparities persisted between current care and optimal care, surpassing any differences observed among demographic groups. These findings highlight the critical need for sustained efforts to bridge these gaps and achieve better outcomes for all patients, regardless of their racial and ethnic backgrounds.
Collapse
Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yuntian Liu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Lovedeep Singh Dhingra
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Richa Sharma
- Department of Neurology, Yale School of Public Health, New Haven, Connecticut
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, School of Medicine, Stanford University, Stanford, California
| | - Karol E Watson
- David Geffen School of Medicine, University of California, Los Angeles
| | | | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| |
Collapse
|
107
|
Dumedah G, Iddrisu S, Asare C, Adu-Prah S, English S. Inequities in spatial access to health services in Ghanaian cities. Health Policy Plan 2023; 38:1166-1180. [PMID: 37728231 DOI: 10.1093/heapol/czad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/12/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023] Open
Abstract
Consideration of health equity is fundamental to enhancing the health of those who are economically/socially disadvantaged. A vital characteristic of health equity and therefore health disparity is the level of spatial access to health services and its distribution among populations. Adequate knowledge of health disparity is critical to enhancing the optimal allocation of resources, identification of underserved populations and improving the efficiency and performance of the health system. The provision of such insight for sub-Saharan African (SSA) cities is a challenge and is severely limited in the literature. Accordingly, this study examined the disparities in potential spatial access to health services for four selected urban areas in Ghana based on: (1) the number of physicians per population; (2) access score based on a weighted sum of access components; (3) travel time to health services and (4) the combined evaluation of linkages between travel distance, settlement area, population and economic status. The overall spatial access to health services is low across all selected cities varying between 3.02 and 1.78 physicians per 10 000 persons, whereas the access score is between 1.70 and 2.54. The current number of physicians needs to be increased by about five times to satisfy the World Health Organization's standard. The low spatial access is not equitable across and within the selected cities, where the economically disadvantaged populations were found to endure longer travel distances to access health services. Inequities were found to be embedded within the selected cities where economically poor populations are also disadvantaged in their physical access to healthcare. The health facilities in all cities have reasonable travel distances separating them but are inadequately resourced with physicians. Thus, increasing the physician numbers and related resources at spatially targeted existing facilities would considerably enhance spatial access to health services.
Collapse
Affiliation(s)
- Gift Dumedah
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ashanti Region 0000, Ghana
| | - Seidu Iddrisu
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ashanti Region 0000, Ghana
| | - Christabel Asare
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ashanti Region 0000, Ghana
| | - Samuel Adu-Prah
- Department of Environmental and Geosciences, Sam Houston State University, Huntsville, TX 77341, USA
| | - Sinead English
- School of Biological Sciences, University of Bristol, Bristol BS8 1QU, UK
| |
Collapse
|
108
|
Slutske WS, Conner KL, Kirsch JA, Smith SS, Piasecki TM, Johnson AL, McCarthy DE, Nez Henderson P, Fiore MC. Explaining COVID-19 related mortality disparities in American Indians and Alaska Natives. Sci Rep 2023; 13:20974. [PMID: 38017023 PMCID: PMC10684501 DOI: 10.1038/s41598-023-48260-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/24/2023] [Indexed: 11/30/2023] Open
Abstract
American Indian and Alaska Native (AI/AN) individuals are more likely to die with COVID-19 than other groups, but there is limited empirical evidence to explain the cause of this inequity. The objective of this study was to determine whether medical comorbidities, area socioeconomic deprivation, or access to treatment can explain the greater COVID-19 related mortality among AI/AN individuals. The design was a retrospective cohort study of harmonized electronic health record data of all inpatients with COVID-19 from 21 United States health systems from February 2020 through January 2022. The mortality of AI/AN inpatients was compared to all Non-Hispanic White (NHW) inpatients and to a matched subsample of NHW inpatients. AI/AN inpatients were more likely to die during their hospitalization (13.2% versus 7.1%; odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.48, 2.65) than their matched NHW counterparts. After adjusting for comorbidities, area social deprivation, and access to treatment, the association between ethnicity and mortality was substantially reduced (OR 1.59, 95% CI 1.15, 2.22). The significant residual relation between AI/AN versus NHW status and mortality indicate that there are other important unmeasured factors that contribute to this inequity. This will be an important direction for future research.
Collapse
Affiliation(s)
- Wendy S Slutske
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Conner
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
| | - Julie A Kirsch
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Stevens S Smith
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Thomas M Piasecki
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Adrienne L Johnson
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Danielle E McCarthy
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Michael C Fiore
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
109
|
Krekelberg MO, Ruckart JD, Morton-Jones ME, Lacy AL, Madden LL, Ruckart KW. Evaluating Geographic Access to Interdisciplinary Laryngology and Speech-Language Pathology Clinic Models in the Southeast Region of the United States. J Voice 2023:S0892-1997(23)00327-2. [PMID: 37932131 DOI: 10.1016/j.jvoice.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE An interdisciplinary model of care for the evaluation and treatment of voice, swallowing, and upper airway disorders with laryngologists and specialized speech-language pathologists is known to increase revenue, attendance to visits, patient adherence, and most importantly, improve patient outcomes. Individuals who live outside of areas with high population density often have reduced geographic access to this specialized care. The primary aim of this study is to identify the percentage of the population that has an "extended drive time" to access an interdisciplinary clinic in the Southeast region of the United States. STUDY DESIGN NA. METHODS Interdisciplinary laryngology and speech-language pathology clinics were identified via publicly accessible information including an internet search and state department of public health databases. Included clinics had at least one full-time fellowship-trained laryngologist and at least one full-time speech-language pathologist on staff. Descriptive statistics and visual representation of the results were achieved with the use of Smappen, a location intelligence online platform, to identify the percent of the population with a drive time greater than 1 hour. RESULTS 47.24% of the Southeast population of the United States must drive over 1 hour to access an interdisciplinary clinic. Visual representations of these data are included and generated by Smappen. CONCLUSIONS While close geographic proximity does not ensure access to care, it can increase the likelihood that healthcare services will be used. This study identified the population in the Southeast region of the United States with extended drive time to interdisciplinary voice and swallowing centers due to their geographic distance from these centers. The results from this study support the need for increased geographic access to specialty care clinics, specifically voice, swallowing, and upper airway care, and provide insight into potential sites for interdisciplinary centers based on population density in areas that are underserved.
Collapse
Affiliation(s)
- Maris O Krekelberg
- Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist/Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - James D Ruckart
- Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist/Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mariah E Morton-Jones
- Department of Otolaryngology, School of Kinesiology, Auburn University, Auburn, Alabama
| | - Alexa L Lacy
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist/Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kathryn W Ruckart
- Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist/Wake Forest University School of Medicine, Winston-Salem, North Carolina.
| |
Collapse
|
110
|
Adams OR, Holder-Dixon AR, Campbell JT, Bennett-Brown M, Moscovici Z, Gesselman AN. Medical Mistrust and Healthcare Seeking Among Women of Color with Chronic Vulvovaginal Pain. Int J Behav Med 2023:10.1007/s12529-023-10236-4. [PMID: 37923884 DOI: 10.1007/s12529-023-10236-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Chronic vulvovaginal pain (CVVP), an umbrella term encompassing several gynecological pain conditions (e.g., vulvodynia, vaginismus), has a prevalence rate of 7-8% in the USA and is characterized by considerable diagnostic delay in patient experience research. Furthermore, current research in this area focuses largely on the experiences of white women, while the experiences of women of color are underrepresented. METHOD In the present cross-sectional study (N = 488), we surveyed women of color (i.e., Asian, Black, and/or Hispanic/Latinx women) with CVVP about their perceptions and experiences with medical mistrust, healthcare seeking, and healthcare avoidance. RESULTS Using the suspicion subscale of the Group-Based Medical Mistrust Scale, we found significant racial and ethnic differences in medical suspicion scores, with non-Black Hispanic/Latinx women reporting the highest suspicion scores and non-Hispanic/Latinx Black women reporting the lowest scores. Racial differences disappeared, however, after examining medical mistrust and perceived discrimination as predictors for various healthcare outcomes related to the journey to diagnosis and healthcare avoidance behaviors. We found that while suspicion was a reliable predictor of increased diagnostic delay and healthcare avoidance in many contexts, the results for perceived discrimination were more varied, suggesting considerable nuance in the relationship between medical mistrust, perceived discrimination, and healthcare seeking outcomes. CONCLUSION These findings point to shared experiences of medical mistrust via suspicion that broadly characterize women of color's experiences in seeking CVVP-related care-future research is needed to examine nuances within racial and ethnic groups regarding their healthcare seeking experiences in the CVVP context.
Collapse
Affiliation(s)
- Olivia R Adams
- Department of Gender, Sexuality, and Women's Studies, University of Florida, Gainesville, USA.
- The Kinsey Institute, Indiana University Bloomington, Bloomington, USA.
| | - Amani R Holder-Dixon
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, USA
| | | | - Margaret Bennett-Brown
- The Kinsey Institute, Indiana University Bloomington, Bloomington, USA
- College of Media & Communication, Texas Tech University, Lubbock, USA
| | - Zoe Moscovici
- The Kinsey Institute, Indiana University Bloomington, Bloomington, USA
- Department of Gender Studies, Indiana University Bloomington, Bloomington, USA
| | | |
Collapse
|
111
|
McDonald-Lopez K, Murphy AK, Gould-Werth A, Griffin J, Bader MDM, Kovski N. A Driver in Health Outcomes: Developing Discrete Categories of Transportation Insecurity. Am J Epidemiol 2023; 192:1854-1863. [PMID: 37365831 PMCID: PMC10631295 DOI: 10.1093/aje/kwad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/17/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023] Open
Abstract
Research suggests that transportation is an important social determinant of health, because the ability to get around is consequential for accessing health care and nutritious food and for making social connections. We used an inductive mixed-methods approach and a quantitative k-means clustering approach to identify 5 categories of transportation insecurity using the validated 16-item Transportation Security Index. The resulting 5-category measure distinguished among respondents with qualitatively different experiences of transportation insecurity. Analyzing data from 2018 that were representative of the US adult population aged 25 years or older, we demonstrated a nonparametric association between transportation insecurity and 2 different health measures (self-rated health and depressive symptoms). There was a threshold relationship between self-rated health and any level of transportation insecurity. High transportation insecurity had a very strong relationship with depressive symptoms. The categorical Transportation Security Index will be useful for clinicians who wish to screen for transportation-related barriers to health care. It will also facilitate research investigating the influence of transportation insecurity on health outcomes and provide the basis for interventions designed to address health disparities.
Collapse
Affiliation(s)
- Karina McDonald-Lopez
- Correspondence to Karina McDonald-Lopez, Department of Sociology, College of Literature, Science, and the Arts, University of Michigan, 500 South State Street #2005, Ann Arbor, MI 48109 | (e-mail: )
| | | | | | | | | | | |
Collapse
|
112
|
Gligorić K, Kamath C, Weiss DJ, Bavadekar S, Liu Y, Shekel T, Schulman K, Gabrilovich E. Revealed versus potential spatial accessibility of healthcare and changing patterns during the COVID-19 pandemic. COMMUNICATIONS MEDICINE 2023; 3:157. [PMID: 37923904 PMCID: PMC10624905 DOI: 10.1038/s43856-023-00384-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 10/12/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Timely access to healthcare is essential but measuring access is challenging. Prior research focused on analyzing potential travel times to healthcare under optimal mobility scenarios that do not incorporate direct observations of human mobility, potentially underestimating the barriers to receiving care for many populations. METHODS We introduce an approach for measuring accessibility by utilizing travel times to healthcare facilities from aggregated and anonymized smartphone Location History data. We measure these revealed travel times to healthcare facilities in over 100 countries and juxtapose our findings with potential (optimal) travel times estimated using Google Maps directions. We then quantify changes in revealed accessibility associated with the COVID-19 pandemic. RESULTS We find that revealed travel time differs substantially from potential travel time; in all but 4 countries this difference exceeds 30 minutes, and in 49 countries it exceeds 60 minutes. Substantial variation in revealed healthcare accessibility is observed and correlates with life expectancy (⍴=-0.70) and infant mortality (⍴=0.59), with this association remaining significant after adjusting for potential accessibility and wealth. The COVID-19 pandemic altered the patterns of healthcare access, especially for populations dependent on public transportation. CONCLUSIONS Our metrics based on empirical data indicate that revealed travel times exceed potential travel times in many regions. During COVID-19, inequitable accessibility was exacerbated. In conjunction with other relevant data, these findings provide a resource to help public health policymakers identify underserved populations and promote health equity by formulating policies and directing resources towards areas and populations most in need.
Collapse
Affiliation(s)
- Kristina Gligorić
- Google Research, Mountain View, CA, USA
- Computer Science Department, Stanford University, Stanford, CA, USA
| | | | - Daniel J Weiss
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | | | - Yun Liu
- Google Research, Mountain View, CA, USA
| | | | - Kevin Schulman
- Clinical Excellence Research Center, School of Medicine and Graduate School of Business, Stanford University, Stanford, CA, USA
| | | |
Collapse
|
113
|
Landis RK, Stein BD, Griffin BA, Saloner BK, Terplan M, Faherty LJ. Disparities in Perinatal and Emergency Care Receipt Among Women With Perinatal Opioid Use Disorder in Medicaid, 2007 to 2012. J Addict Med 2023; 17:654-661. [PMID: 37934525 PMCID: PMC10759200 DOI: 10.1097/adm.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
OBJECTIVES This study aimed to better understand receipt of perinatal and emergency care among women with perinatal opioid use disorder (OUD) and explore variation by race/ethnicity. METHODS We used 2007-2012 Medicaid Analytic eXtract (MAX) data from all 50 states and the District of Columbia to examine 6,823,471 deliveries for women 18 to 44 years old. Logistic regressions modeled the association between (1) OUD status and receipt of perinatal and emergency care, and (2) receipt of perinatal and emergency care and race/ethnicity, conditional on OUD diagnosis and controlling for patient and county characteristics. We used robust SEs, clustered at the individual level, and included state and year fixed effects. RESULTS Women with perinatal OUD were less likely to receive adequate prenatal care (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.44-0.46) and attend the postpartum visit (aOR, 0.46; 95% CI, 0.45-0.47) and more likely to seek emergency care (aOR, 1.48; 95% CI, 1.45-1.51) than women without perinatal OUD. Among women with perinatal OUD, Black, Hispanic, and American Indian and Alaskan Native (AI/AN) women were less likely to receive adequate prenatal care (aOR, 0.68 [95% CI, 0.64-0.72]; aOR, 0.86 [95% CI, 0.80-0.92]; aOR, 0.71 [95% CI, 0.64-0.79]) and attend the postpartum visit (aOR, 0.85 [95% CI, 0.80-0.91]; aOR, 0.86 [95% CI, 0.80-0.93]; aOR, 0.83 [95% CI, 0.73-0.94]) relative to non-Hispanic White women. Black and AI/AN women were also more likely to receive emergency care (aOR, 1.13 [95% CI, 1.05-1.20]; aOR, 1.12 [95% CI, 1.00-1.26]). CONCLUSIONS Our findings suggest that women with perinatal OUD, in particular Black, Hispanic, and AI/AN women, may be missing opportunities for preventive care and comprehensive management of their physical and behavioral health during pregnancy.
Collapse
Affiliation(s)
- Rachel K Landis
- From the RAND Corporation, Arlington, VA (RKL, BAG); RAND Corporation, Pittsburgh, PA (BDS); Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (BKS); Friends Research Institute, Baltimore, MD (MT); RAND Corporation, Boston, MA (LJF); and Department of Pediatrics, Maine Medical Center, Portland, ME (LJF)
| | | | | | | | | | | |
Collapse
|
114
|
Rao M, Greene L, Nelson K, Maciejewski ML, Zulman DM. Associations Between Social Risks and Primary Care Utilization Among Medically Complex Veterans. J Gen Intern Med 2023; 38:3339-3347. [PMID: 37369890 PMCID: PMC10682359 DOI: 10.1007/s11606-023-08269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Social risks contribute to poor health outcomes, especially for patients with complex medical needs. These same risks may impact access to primary care services. OBJECTIVE To study associations between social risks and primary care utilization among patients with medical complexity. DESIGN Prospective cohort study of respondents to a 2018 mailed survey, followed up to 2 years after survey completion. PARTICIPANTS Nationally representative sample of 10,000 primary care patients in the Veterans Affairs (VA) health care system, with high (≥ 75th percentile) 1-year risk of hospitalization or death. MAIN MEASURES Survey-based exposures were low social support, no family member/friend involved in health care, unemployment, transportation problem, food insecurity, medication insecurity, financial strain, low medical literacy, and less than high school graduate. Electronic health record-based outcomes were number of primary care provider (PCP) encounters, number of primary care team encounters (PCP, nurse, clinical pharmacist, and social worker), and having ≥ 1 social work encounter. KEY RESULTS Among 4680 respondents, mean age was 70.3, 93.7% were male, 71.8% White non-Hispanic, and 15.8% Black non-Hispanic. Unemployment was associated with fewer PCP and primary care team encounters (incident rate ratio 0.77, 95% CI 0.65-0.91; p = 0.002 and 0.75, 0.59-0.95; p = 0.02, respectively), and low medical literacy was associated with more primary care team encounters (1.17, 1.05-1.32; p = 0.006). Among those with one or more social risks, 18.4% had ≥ 1 social work encounter. Low medical literacy (OR 1.95, 95% CI 1.45-2.61; p < 0.001), transportation problem (1.42, 1.10-1.83; p = 0.007), and low social support (1.31, 1.06-1.63; p = 0.01) were associated with higher odds of ≥ 1 social work encounter. CONCLUSIONS We found few differences in PCP and primary care team utilization among medically complex VA patients by social risk. However, social work use was low, despite its central role in addressing social risks. More work is needed to understand barriers to social work utilization.
Collapse
Affiliation(s)
- Mayuree Rao
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Liberty Greene
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Karin Nelson
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew L Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
115
|
Zheng DX, Cwalina TB, Stitzel HJ, Montgomery BK, Hoehn RS, Rothermel LD, Ocuin LM. Transport-Delayed Medical Care in a Nationally Representative Sample of Hepatopancreatobiliary Cancer Patients. J Gastrointest Surg 2023; 27:2571-2573. [PMID: 37353656 DOI: 10.1007/s11605-023-05760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/03/2023] [Indexed: 06/25/2023]
Affiliation(s)
- David X Zheng
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., OH, 44106, Cleveland, USA
| | - Thomas B Cwalina
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., OH, 44106, Cleveland, USA
| | - Henry J Stitzel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., OH, 44106, Cleveland, USA
| | - Brock K Montgomery
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., OH, 44106, Cleveland, USA
| | - Richard S Hoehn
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., OH, 44106, Cleveland, USA
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., OH, 44106, Cleveland, USA
| | - Lee M Ocuin
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., OH, 44106, Cleveland, USA.
| |
Collapse
|
116
|
Wong TL, Ang JL, Deol S, Buckmaster F, McTrusty AD, Tatham AJ. The relationship between multiple deprivation and severity of glaucoma at diagnosis. Eye (Lond) 2023; 37:3376-3381. [PMID: 36959313 PMCID: PMC10035976 DOI: 10.1038/s41433-023-02508-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/09/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Socioeconomic deprivation is associated with higher odds of chronic diseases, with many individuals living with more than one illness. This study aimed to examine the relationship between deprivation and severity of glaucoma at diagnosis, an important risk factor for glaucoma blindness. METHODS A retrospective study of 472 consecutive patients referred by community optometrists to the glaucoma clinic at a university hospital was performed. Glaucoma severity was determined by standard automated perimetry mean deviation (MD) in the worse eye. The Scottish Index of Multiple Deprivation (SIMD) was determined for each patient as a measure of deprivation based on postcode. Regression analyses were performed to determine the relationship between visual field MD and SIMD. RESULTS There was a significant relationship between higher levels of deprivation (lower SIMD) and worse severity of glaucoma at diagnosis. 32 of 472 patients (6.8%) had a MD of ≤-6 dB and 11 (2.3%) ≤-12 dB in their better eye. MD in the worse eye was 0.04 dB (95% CI 0.014 to 0.062 dB, P = 0.002) worse for each 100-point decrease in SIMD, with lower SIMD indicating a higher level of deprivation. A higher proportion of patients living in most deprived areas had a MD ≤ -6 dB or ≤ -12 dB at presentation compared to those living in the least deprived areas (14.3% versus 6.8% for ≤ -6 dB and 4.8% versus 0.8% for ≤ -12 dB). CONCLUSIONS Higher levels of deprivation were associated with worse glaucoma severity at presentation. The reasons for poorer outcomes in those from more deprived communities need further study so that inequalities can be addressed and the frequency of patients presenting with advanced glaucoma reduced.
Collapse
Affiliation(s)
- Thai Ling Wong
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Juan Lyn Ang
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK
| | - Sundeep Deol
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK
| | - Fiona Buckmaster
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Alice D McTrusty
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Andrew J Tatham
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK.
| |
Collapse
|
117
|
Masterson Creber R, Dodson JA, Bidwell J, Breathett K, Lyles C, Harmon Still C, Ooi SY, Yancy C, Kitsiou S. Telehealth and Health Equity in Older Adults With Heart Failure: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2023; 16:e000123. [PMID: 37909212 DOI: 10.1161/hcq.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Enhancing access to care using telehealth is a priority for improving outcomes among older adults with heart failure, increasing quality of care, and decreasing costs. Telehealth has the potential to increase access to care for patients who live in underresourced geographic regions, have physical disabilities or poor access to transportation, and may not otherwise have access to cardiologists with expertise in heart failure. During the COVID-19 pandemic, access to telehealth expanded, and yet barriers to access, including broadband inequality, low digital literacy, and structural barriers, prevented many of the disadvantaged patients from getting equitable access. Using a health equity lens, this scientific statement reviews the literature on telehealth for older adults with heart failure; provides an overview of structural, organizational, and personal barriers to telehealth; and presents novel interventions that pair telemedicine with in-person services to mitigate existing barriers and structural inequities.
Collapse
|
118
|
Samudra RP, Heboyan V. Examining the Connection Between Health Outcomes, State Political Ideology, and Food Access in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:E284-E292. [PMID: 37536664 DOI: 10.1097/phh.0000000000001786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
OBJECTIVES To estimate the impact of county-level income, access to food, availability of health resources, socioeconomic factors, and state political ideology on population obesity and mental health in US counties. DESIGN We compiled a county-level data set from the US Census, County Health Rankings, USDA Food Environment Atlas, the American Community Survey, and the State Ideology Database. We specify 2 multivariable regression models for county-level obesity rate and per capita poor mental health days and control for rurality, food access, income, availability of health care resources, state political ideology, and socioeconomic characteristics. RESULTS We find that higher food access reduces obesity in counties; an increase in per capita full-service restaurants by 1 unit is associated with reduction in obesity rate by 1.24 points and an increase in per capita grocery stores reduces poor mental health days by 0.14. We also find that counties in liberal-leaning states tend to have lower obesity rates. Access to primary care providers (increase in primary care physicians by 1 is associated with decline in obesity rate by 1.18 points and poor mental health days by 0.11 days), and recreational facilities (increase in recreational facilities per 1000 by 1 is associated with reduction in obesity rate by 3.16 points and poor mental health days by 0.47 days) reduces obesity rates and poor mental health days. Median income is associated with decrease in obesity rate and poor mental health days. Increase in median household income by 1% is associated with reduction in obesity rate 4.75% and reduction in poor mental health days by 1.39 days. CONCLUSIONS We find that access to food and health care at county level and state ideology through policy making affects health outcomes. Our analysis indicates that counties can improve access to food and health care by investing in these services thereby improving county-level health outcomes and save dollars in the process.
Collapse
Affiliation(s)
- Rhucha P Samudra
- Department of Social Sciences, Augusta University, Augusta, Georgia (Dr Samudra); and Health Economics and Policy Division, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia (Dr Heboyan)
| | | |
Collapse
|
119
|
Jamal O, Mallipatna A, Hwang SW, Dimaras H. Social Determinants of Health in Pediatric Ophthalmology Patients: Availability of Data in the Electronic Health Record and Association With Clinic Attendance. Transl Vis Sci Technol 2023; 12:36. [PMID: 38019501 PMCID: PMC10691384 DOI: 10.1167/tvst.12.11.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023] Open
Abstract
Purpose To characterize the availability of social determinants of health data in the electronic health record of pediatric ophthalmology patients and to examine the association of social determinants of health with attendance at scheduled operating room and clinic visits. Methods This was a retrospective cohort study of pediatric ophthalmology patients seen at The Hospital for Sick Children between June 1, 2018, and May 23, 2022. Data were collected on demographics, diagnosis, and management-plan. The χ2 tests and multivariable regression were used to examine associations between social determinants of health and attendance at scheduled operating room and clinic visits. Results The cohort consisted of 26,102 study subjects with 31,288 unique eye-related diagnoses representing 57 unique ICD-10 codes. Availability of data in the electronic health record ranged from 100% for sex, age and postal code to 0.1% for ethnic group. Female sex (P = 0.004) and urbanicity (P = 0.05) were associated with higher operating room visit cancellations. Female sex (P = 0.002), age group 0-13 (P ≤ 0.001), low-medium neighborhood income quintile (P ≤ 0.001), residence of Northern Ontario (P ≤ 0.001), and urbanicity (P ≤ 0.001) were associated with higher clinic visit cancellations and no-shows. Conclusions At a major tertiary-care hospital in Canada, key social determinant data such as ethnicity are not consistently available in the electronic health record of pediatric ophthalmology patients. Female sex, younger age, and living in a rural area or neighborhood with low-medium income quintile may be predictors of missed visits and require further study. Translational Relevance This study highlights a need for improved documentation of social determinants of health variables in electronic health records.
Collapse
Affiliation(s)
- Omer Jamal
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
- University of Toronto, Institute of Medical Sciences, Toronto, Canada
| | - Ashwin Mallipatna
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
- University of Toronto, Institute of Medical Sciences, Toronto, Canada
- Department of Ophthalmology & Vision Sciences, Faculty of Medicine & Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
120
|
Torrini I, Grassetti L, Rizzi L. Under-spending, over-spending or substitution among services? Spatial patterns of unexplained shares of health care expenditures. Health Policy 2023; 137:104902. [PMID: 37688951 DOI: 10.1016/j.healthpol.2023.104902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 04/03/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
Using individual-level administrative data, we investigate the spatial patterns of unexplained shares of health care expenditures (HCE) at the municipality level. The focus is on the elderly population in the Italian Region Friuli-Venezia Giulia observed over the period 2017-2019. The empirical analysis comprises two steps. First, random-effects two-part models are estimated to analyze the effect of age, morbidity, and death on the probability and amount of positive individual total HCE and its components. Second, the unexplained shares of HCE at the municipality level are examined to identify areas with under- or over-spending and substitution among services. Results confirm the existing findings on the determinants of HCE and reveal geographic patterns in the unexplained shares of expenditures. We identify clusters of municipalities with observed HCE higher than predicted for each type of service and clusters with substitution between home care and all other services. These findings are associated with the degree of urbanization of these areas and, consequently, with the ease of access to health care. This is crucial from a policy perspective, as it indicates specific policy targets for public health intervention.
Collapse
Affiliation(s)
- Irene Torrini
- Dept. of Economics and Statistics - University of Udine, Via Tomadini, 30/a, Udine, 33100, Italy
| | - Luca Grassetti
- Dept. of Economics and Statistics - University of Udine, Via Tomadini, 30/a, Udine, 33100, Italy
| | - Laura Rizzi
- Dept. of Economics and Statistics - University of Udine, Via Tomadini, 30/a, Udine, 33100, Italy.
| |
Collapse
|
121
|
Najarian M, Goudie A, Bona JP, Rezaeiahari M, Young SG, Bogulski CA, Hayes CJ. Socioeconomic Determinants of Remote Patient Monitoring Implementation Among Rural and Urban Hospitals. Telemed J E Health 2023; 29:1624-1633. [PMID: 37010391 PMCID: PMC11074434 DOI: 10.1089/tmj.2022.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 04/04/2023] Open
Abstract
Introduction: Remote patient monitoring (RPM) is a form of telehealth that improves quality of care for chronic disease treatment and reduces hospital readmission rates. Geographical proximity to health care is important for individuals of low socioeconomic status (SES) who face additional financial and transportation barriers. The goal of this study was to assess the association between social determinants of health and adoption of RPM. Methods: This cross-sectional study analyzed data from hospitals that responded to the American Hospital Association's Annual Survey (2018) and spatially linked census tract-level environmental and social determinants of health obtained from the Social Vulnerability Index (2018). Results: A total of 4,206 hospitals (1,681 rural and 2,525 urban hospitals) met study criteria. Rural hospitals near households in the lower middle quartile SES were associated with a 33.5% lower likelihood of having adopted RPM for chronic care management compared with rural hospitals near households in the highest quartile SES (adjusted odds ratios [aOR] = 0.665; 95% confidence interval [CI]: 0.453-0.977). Urban hospitals near households in the lowest quartile SES were associated with a 41.9% lower likelihood of having adopted RPM for chronic care management compared with urban hospitals near households in the highest quartile SES (aOR = 0.581; 95% CI: 0.435-0.775). Similar trends in accessibility were found with RPM for postdischarge services among urban hospitals. Conclusion: Our findings highlight the importance of hospital responsibility and state and federal policy approaches toward ensuring equitable access to RPM services for patients characterized by lower SES.
Collapse
Affiliation(s)
- Matthew Najarian
- Division of Pharmaceutical Evaluation and Policy, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anthony Goudie
- Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jonathan P. Bona
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mandana Rezaeiahari
- Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sean G. Young
- Department of Environmental Health Sciences, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cari A. Bogulski
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Corey J. Hayes
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Psychiatry and Behavioral Sciences and University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
122
|
Sheehan JL, Jordan AA, Newman KL, Johnson LA, Eloubeidi D, Cohen-Mekelburg S, Berinstein JA, Tipirneni R, Higgins PDR. Are Depression and Anxiety Underdiagnosed in Socially Vulnerable Patients With Inflammatory Bowel Disease? Inflamm Bowel Dis 2023:izad246. [PMID: 37878586 DOI: 10.1093/ibd/izad246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Depression and anxiety are highly prevalent among individuals with inflammatory bowel disease (IBD); however, little is understood about how social determinants of health (SDOH) may impact mental health diagnoses in this population. The social vulnerability index (SVI) is a publicly available tool that can be used to study SDOH in IBD patients. METHODS Home addresses from a retrospective cohort of IBD patients at a single center were used to geocode patients to their individual census tract and corresponding SVI. We used multivariable logistic regression to examine the relationship between SVI and comorbid mental health diagnoses in patients with IBD. Secondarily, data from standardized health questionnaires were then used to determine if patients were adequately screened for depression and anxiety. RESULTS In all, 9644 patients were included; 18% had a diagnosis of depression, 21% anxiety, and 32% had a composite of "any mental health diagnosis." Depression (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.02-1.56) but not anxiety (OR, 0.87; 95% CI, 0.71-1.06) nor "any mental health diagnosis" (OR, 1.09; 95% CI, 0.92-1.30) was associated with higher levels of social vulnerability. However, overall rates of screening for depression and anxiety were low (15% and 8%, respectively), with the lowest screening rates among the most socially vulnerable (depression 8.2%, anxiety 6.3%). CONCLUSIONS Disparities in the diagnoses of depression and anxiety for socially vulnerable patients with IBD exist. Awareness of these inequities is the first step toward developing interventions to improve mental health screening, eliminate barriers and bias, and promote referrals for appropriate mental health management.
Collapse
Affiliation(s)
- Jessica L Sheehan
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Ariel A Jordan
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Kira L Newman
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Laura A Johnson
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Dala Eloubeidi
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Shirley Cohen-Mekelburg
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Jeffrey A Berinstein
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Renuka Tipirneni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Peter D R Higgins
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| |
Collapse
|
123
|
Llaneza AJ, Holt A, Stephens L, Seward J. Native American Community Perspectives on Oral Health Access: Understanding the Impact of Rurality. Healthcare (Basel) 2023; 11:2788. [PMID: 37893863 PMCID: PMC10606298 DOI: 10.3390/healthcare11202788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE Oral health disparities related to access persist for American Indian/Alaska Native (AI/AN) communities compared to the general population, especially in rural areas of the United States. The objective of this study was to better understand community perspectives of oral health, how rurality impacts access to care, and attitudes towards the implementation of dental therapists in Oklahoma, particularly among the AI/AN population. METHODS A descriptive, observational study design was utilized. An exploratory survey was conducted online and comprised of qualitative and quantitative data. The total frequencies and percentages were evaluated for the quantitative questions. The qualitative data was analyzed using thematic analysis. Utilizing descriptive and qualitative research methods, the focus was to describe the experiences of the respondents and their characteristics related to oral health in Oklahoma. RESULTS A total of 201 responses were obtained, where 65% (n = 131) identified as an enrolled member or employee of a tribe represented in Oklahoma. Key qualitative themes included community access to care, community concerns, and community motivated solutions. CONCLUSIONS AI/AN communities are an underserved group in healthcare. Although communities in rural areas face major barriers to oral health services, evidence-based solutions can be implemented.
Collapse
Affiliation(s)
- Amanda J. Llaneza
- Southern Plains Tribal Health Board, Oklahoma City, OK 73114, USA; (A.J.L.); (A.H.)
| | - Alex Holt
- Southern Plains Tribal Health Board, Oklahoma City, OK 73114, USA; (A.J.L.); (A.H.)
| | - Lancer Stephens
- Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
- Oklahoma Shared Clinical and Translational Resources, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Julie Seward
- Southern Plains Tribal Health Board, Oklahoma City, OK 73114, USA; (A.J.L.); (A.H.)
| |
Collapse
|
124
|
Forrest LN, Waschbusch DA, Pearl AM, Bixler EO, Sinoway LI, Kraschnewski JL, Liao D, Saunders EFH. Urban vs. rural differences in psychiatric diagnoses, symptom severity, and functioning in a psychiatric sample. PLoS One 2023; 18:e0286366. [PMID: 37796886 PMCID: PMC10553337 DOI: 10.1371/journal.pone.0286366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/15/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Identifying whether certain groups of people experience elevated rates or severities of psychiatric symptoms provides information to guide healthcare allocation. People living in urban areas have higher rates of some psychiatric disorders relative to people living in rural settings, however, it is unclear if psychiatric severity is more elevated in urban vs. rural settings. This study investigates the urban vs. rural differences in rates of psychiatric disorders and severity of psychiatric symptoms. METHOD A cohort of patients (63% women, 85% White) presenting to an outpatient psychiatric treatment center in the U.S. completed patient-reported outcomes at all clinic visits as part of standard care. Rurality was determined by municipality population density. Sociodemographic characteristics, psychiatric diagnoses, trauma exposure, psychiatric symptom severity, functioning, and suicidality were compared by rural vs. urban municipality. RESULTS There were virtually no differences between patients living in rural vs. urban municipalities on rates of psychiatric disorders, severity of psychiatric symptoms, functional impairment, and suicidality (ps≥.09). The only difference was that patients living in rural municipalities had higher exposure to serious accidents than patients living in urban municipalities (p < .01); exposure to nine other traumatic events did not differ between groups (p≥.07). CONCLUSIONS People living in urban and rural municipalities have a similar need for mental health treatment. Access to care may be one explanatory factor for the occasional rural-urban differences in rates of psychiatric disorders. In other words, if people living in rural areas can access care, their symptom presentations appear unlikely to differ from those of people living in urban areas.
Collapse
Affiliation(s)
- Lauren N. Forrest
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Dan A. Waschbusch
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Amanda M. Pearl
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Edward O. Bixler
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Lawrence I. Sinoway
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, United States of America
- Penn State Clinical and Translational Science Institute, Hershey, PA, United States of America
| | - Jennifer L. Kraschnewski
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, PA, United States of America
- Penn State Clinical and Translational Science Institute, Hershey, PA, United States of America
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States of America
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Duanping Liao
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| | - Erika F. H. Saunders
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, PA, United States of America
| |
Collapse
|
125
|
Parker SM, Ricks B, Zuniga J, Knarr BA. Comparison of virtual reality to physical box and blocks on cortical an neuromuscualar activations in young adults. Sci Rep 2023; 13:16567. [PMID: 37783719 PMCID: PMC10545674 DOI: 10.1038/s41598-023-43073-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
The purpose of this study was to assess the changes in neural activations when performing the box and block test (BBT) in virtual reality (VR) compared to the physical BBT. Young healthy participants performed three trials of the BBT with their left and right hands in both the VR BBT, using VR hand controllers, and physical BBT conditions. Electromyography sensors were placed on the upper extremity of both arms and functional near-infrared spectroscopy was used to measure motor cortex activations throughout each condition. While a reduction in BBT score and increased wrist extensor neuromuscular activity is exhibited during the VR condition, there is no statistical difference in motor cortex activation between the two BBT conditions. This work provides a basis for exploring cortical and neuromuscular responses to VR in patient populations.
Collapse
Affiliation(s)
- Sheridan M Parker
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Dr S., Omaha, NE, 68182, USA.
| | - Brian Ricks
- Department of Computer Science, University of Nebraska at Omaha, 1110 South 67th Street, Omaha, NE, 68182, USA
| | - Jorge Zuniga
- Department of Computer Science, University of Nebraska at Omaha, 1110 South 67th Street, Omaha, NE, 68182, USA
| | - Brian A Knarr
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Dr S., Omaha, NE, 68182, USA
| |
Collapse
|
126
|
Carmona C, Sullivan JE, Arceo R, Drogos J, Besser S, Gutierrez S, Jeteric Z, Wyman J, Yao J. Development and Preliminary Validity Study of a Modified Version of the Upper Extremity Fugl-Meyer Assessment for Use in Telerehabilitation. J Neurol Phys Ther 2023; 47:208-216. [PMID: 37314323 PMCID: PMC10487354 DOI: 10.1097/npt.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND/PURPOSE The Upper Extremity Fugl-Meyer Assessment (UEFMA, maximum 66) is widely used in clinics and research studies to examine poststroke upper extremity (UE) impairment. This study aimed to develop and provide pilot data to support the validity of a remote version of the UEFMA to examine UE impairment after stroke through telerehabilitation. METHODS Team members developed a remote version of the UEFMA for telerehabilitation (tUEFMA, maximum 44) using subscales II to IV and VII of the UEFMA. Twenty-two participants with moderate to severe arm impairment (UEFMA, median = 19) and chronic stroke (>1 year post) were evaluated using the UEFMA (face-to-face) and the tUEFMA (remotely). A prediction equation was used to identify the function to predict the UEFMA based on the tUEFMA. Intraclass correlation (ICC) was used to test the absolute agreement between the subscales included in the UEFMA and the tUEFMA, and between their 2 normalized total scores. RESULTS A strong and significant agreement was found between the total scores of the UEFMA and the projected value based on the tUEFMA (ICC = 0.79, P < 0.05). The ICC test also reported a good agreement in subscales II to IV and a poor agreement in subscale VII between the UEFMA and the tUEFMA using a real-time video link. DISCUSSION AND CONCLUSIONS The study findings suggest that the tUEFMA is a promising tool to remotely examine UE impairment in individuals with chronic stroke and moderate to severe arm impairment. Future research should evaluate additional psychometric properties and clinical utility of the tUEFMA across stroke participants with a broad range of arm impairments.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A441 ).
Collapse
Affiliation(s)
- Carolina Carmona
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Jane E. Sullivan
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Riegele Arceo
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Justin Drogos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Sofie Besser
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Susana Gutierrez
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Zineyra Jeteric
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - James Wyman
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| | - Jun Yao
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois (C.C,. J.E.S., R.A., J.D., S.B., S.G., Z.J., J.W., J.Y.); and Northwestern University Interdepartmental Neuroscience, Northwestern University, and Department of Biomedical Engineering, Northwestern University, Chicago, Illinois (J.Y.)
| |
Collapse
|
127
|
Tian FF, Hall YN, Griffin S, Kranze T, Marcella D, Watnick S, O'Hare AM. The Complex Patchwork of Transportation for In-Center Hemodialysis. J Am Soc Nephrol 2023; 34:1621-1627. [PMID: 37527287 PMCID: PMC10561812 DOI: 10.1681/asn.0000000000000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/02/2023] [Indexed: 08/03/2023] Open
Abstract
Reliable transportation is an important determinant of access to health care and health outcomes that carries particular significance for people with ESKD. In the United States, there are almost half a million patients receiving treatment with in-center dialysis, translating into more than 70 million roundtrips to dialysis centers annually. Difficulty with transportation can interfere with patients' quality of life and contribute to missed or shortened dialysis treatments, increasing their risk for hospitalization. Medicare, the principal payer for dialysis in this country, has not traditionally provided coverage for nonemergency medical transportation, placing the burden of traveling to and from the dialysis center on patients and families and a range of other private and public entities that were not designed and are poorly equipped for this purpose. Here, we review the relationship between access to reliable transportation and health outcomes such as missed and shortened dialysis treatments, hospitalizations, and quality of life. We also describe current approaches to the delivery of transportation for patients receiving in-center hemodialysis, highlighting potential opportunities for improvement.
Collapse
Affiliation(s)
- Frances F. Tian
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
- Kidney Research Institute, University of Washington, Seattle, Washington
| | - Yoshio N. Hall
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
- Kidney Research Institute, University of Washington, Seattle, Washington
- VA Puget Sound Health Care System, Seattle, Washington
| | | | - Torie Kranze
- National Kidney Foundation of Louisiana New Orleans, Louisiana
| | | | - Suzanne Watnick
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
- VA Puget Sound Health Care System, Seattle, Washington
- Northwest Kidney Centers, Seattle, Washington
| | - Ann M. O'Hare
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
- Kidney Research Institute, University of Washington, Seattle, Washington
- VA Puget Sound Health Care System, Seattle, Washington
| |
Collapse
|
128
|
Issa TZ, Lee Y, Toci GR, Lambrechts MJ, Kalra A, Pipa D, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK. The role of socioeconomic factors as barriers to patient reported outcome measure completion following lumbar spine fusion. Spine J 2023; 23:1531-1539. [PMID: 37209966 DOI: 10.1016/j.spinee.2023.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/19/2023] [Accepted: 05/02/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND CONTEXT Although incorporating patient reported outcomes (PROMs) into practice allows healthcare systems to evaluate the value of care provided, research and policy reflecting PROMs can only be valid if they represent all patients. Few studies have evaluated socioeconomic barriers to PROM completion, and none have done so in a spine patient population. PURPOSE To identify patient barriers to PROM completion one year following lumbar spine fusion. STUDY DESIGN/SETTING Retrospective single-institution cohort study. PATIENT SAMPLE A total of 2,984 patients undergoing lumbar fusion between 2014 and 2020 OUTCOME MEASURES: Completion of Mental Component Score (MCS-12) and Physical Component Score (PCS-12) of Short Form-12 questionnaire 1 year postoperatively. METHODS A retrospective review was conducted of all patients undergoing 1-3-level lumbar fusion at a single urban tertiary center. PROMs were queried from our prospectively managed electronic outcomes database. Patients were considered to have complete PROMs if 1-year outcomes were available. Community-level characteristics were collected from patients' zip codes using the Economic Innovation Group Distressed Communities Index. Bivariate analyses were performed to assess factors associated with PROM incompletion along with multivariate logistic regression to control for confounders. RESULTS A total of 1,968 (66.0%) had incomplete 1-year PROMs. Patients with incomplete PROMs were more likely to be Black (14.5% vs 9.3%, p<.001), Hispanic (2.9% vs 1.6%, p=.027), reside in a distressed community (14.7% vs 8.5%, p<.001), and be active smokers (22.4% vs 15.5%, p<.001). On multivariate regression, Black race (OR: 1.46, p=.014, Hispanic ethnicity (OR: 2.19, p=.027), distressed community status (OR: 1.47, p=.024), workers' compensation status (OR: 2.82, p=.001), and active smoking (OR:1.31, p=.034) all were independently associated with PROM incompletion. Surgical characteristics, including primary surgeon, revision status, approach, and levels fused were not associated with PROM incompletion. CONCLUSIONS Social determinants of health impact completion of PROMs. Patients completing PROMs are overwhelmingly White, non-Hispanic, and reside in wealthier communities. Efforts should be taken to provide better education regarding PROMs and ensure closer follow-up of certain subgroups of patients to avoid furthering disparities in PROM research.
Collapse
Affiliation(s)
- Tariq Z Issa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA; Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL 60611, USA.
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Gregory R Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Mark J Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Andrew Kalra
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - David Pipa
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| |
Collapse
|
129
|
Danesh V, McDonald AD, McPeake J, Eaton TL, Potter K, Su H, Jackson JC, Boehm LM. Driving decisions after critical illness: Qualitative analysis of patient-provider reviews during ICU recovery clinic assessments. Int J Nurs Stud 2023; 146:104560. [PMID: 37531701 PMCID: PMC10528726 DOI: 10.1016/j.ijnurstu.2023.104560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/18/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Driving a vehicle is a functional task requiring a threshold of physical, behavioral and cognitive skills. OBJECTIVE To report patient-provider evaluations of driving status and driving safety assessments after critical illness. DESIGN Qualitative secondary analysis of driving-related dialog drawn from a two-arm pilot study evaluating telemedicine delivery of Intensive Care Unit Recovery Clinic assessments. Multidisciplinary providers assessed physical, psychological, and cognitive recovery during one-hour telemedicine ICU-RC assessments. Qualitative secondary analysis of patient-provider dialog specific to driving practices after critical illness. SETTING AND PATIENTS Multidisciplinary Intensive Care Unit Recovery clinic assessment dialog between 17 patients and their providers during 3-week and/or 12-week follow-up assessments at a tertiary academic medical center in the Southeastern United States. MAIN MEASURES AND KEY RESULTS Thematic content analysis was performed to describe and classify driving safety discussion, driving status and driving practices after critical illness. Driving-related discussions occurred with 15 of 17 participants and were clinician-initiated. When assessed, driving status varied with participants reporting independent decisions to resume driving, delay driving and cease driving after critical illness. Patient-reported driving practices after critical illness included modifications to limit driving to medical appointments, self-assessments of trip durations, and inclusion of care partners as a safety measure for new onset fatigue while driving. CONCLUSION We found that patients are largely self-navigating this stage of recovery, making subjective decisions on driving resumption and overall driving status. These results highlight that driving status changes are an often underrecognized yet salient social cost of critical illness. TRIAL REGISTRATION Clinicaltrials.gov: NCT03926533.
Collapse
Affiliation(s)
- Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA; School of Nursing, University of Texas at Austin, Austin, TX, USA.
| | - Anthony D McDonald
- College of Engineering, University of Wisconsin at Madison, Madison, WI, USA. https://twitter.com/hfml_lab
| | - Joanne McPeake
- Intensive Care Unit, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom; The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK. https://twitter.com/Jomcpeake22
| | - Tammy L Eaton
- National Clinician Scholars Program (NCSP), VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, University of Michigan, Ann Arbor, MI, USA; Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA. https://twitter.com/tammyeaton17
| | - Kelly Potter
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA. https://twitter.com/KP_ICURN
| | - Han Su
- School of Nursing, Vanderbilt University, Nashville, TN, USA. https://twitter.com/HanSu_hs
| | - James C Jackson
- Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA; VA Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Nashville, TN, USA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. https://twitter.com/jcjackson68
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA; Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA. https://twitter.com/boehmleanne
| |
Collapse
|
130
|
Gratz T, Goldhaber D, Willgerodt M, Brown N. The Frontline Health Care Workers in Schools: Health Equity, the Distribution of School Nurses, and Student Access. J Sch Nurs 2023; 39:357-367. [PMID: 34189973 DOI: 10.1177/10598405211024277] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The extent to which observed disparities in access to primary pediatric care are mirrored in student access to school nursing services is unknown. Using school employment records, we linked 1,346 nurses to school districts serving 1,141,495 students in Washington state. The percentage of students who are Black is negatively associated with the student-to-nurse ratio, while the percentage of students eligible for free-or-reduced-price lunch is positively associated, and relative to urban districts, rural districts have higher student-to-nurse ratios. Disparities in access to school nursing services mirror access gaps for pediatric care along socioeconomic status and geography. The increased number of nurses working in districts with more racial/ethnic minority students may play a protective role and ameliorate access gaps observed in pediatric primary care. States can likely use existing employment and licensing data to understand where school nurses work and therefore guide resource allocation decisions.
Collapse
Affiliation(s)
- Trevor Gratz
- University of Washington, Seattle, WA, USA
- Center for Education Data and Research, University of Washington, Seattle, WA, USA
| | - Dan Goldhaber
- Center for Education Data and Research, University of Washington, Seattle, WA, USA
- The Center for Analysis of Longitudinal Data in Education Research, American Institutes for Research, Arlington, VA, USA
| | - Mayumi Willgerodt
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Nate Brown
- University of Washington, Seattle, WA, USA
- Center for Education Data and Research, University of Washington, Seattle, WA, USA
| |
Collapse
|
131
|
Burhan E, Liu K, Marwali EM, Huth S, Wulung NGHML, Juzar DA, Taufik MA, Wijaya SO, Wati DK, Kusumastuti NP, Yuliarto S, Pratomo BY, Pradian E, Somasetia DH, Rusmawatiningtyas D, Fatoni AZ, Mandei JM, Lantang EY, Perdhana F, Semedi BP, Rayhan M, Tarigan TRS, White N, Bassi GL, Suen JY, Fraser JF. Characteristics and outcomes of patients with severe COVID-19 in Indonesia: Lessons from the first wave. PLoS One 2023; 18:e0290964. [PMID: 37747884 PMCID: PMC10519602 DOI: 10.1371/journal.pone.0290964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/18/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Indonesia's national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic. METHODS This is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes. RESULTS From 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered. CONCLUSIONS The mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response.
Collapse
Affiliation(s)
- Erlina Burhan
- Faculty of Medicine, Department of Pulmonology and Respiratory Medicine, Universitas Indonesia and Persahabatan Hospital, Jakarta, Indonesia
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Eva M. Marwali
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Samuel Huth
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Dafsah A. Juzar
- Departement of Cardiology and Vascular Medicine, Intensive Cardiovascular Care Unit, National Cardiovascular Center Harapan Kita and Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad A. Taufik
- Anesthesiology and Critical Care Department, Fatmawati General Hospital, Jakarta, Indonesia
| | - Surya O. Wijaya
- Intensive Care Unit, Sulianti Saroso Hospital, Jakarta, Indonesia
| | - Dyah K. Wati
- Pediatric Intensive Care Unit, Sanglah Hospital, Denpasar, Bali, Indonesia
| | - Neurinda P. Kusumastuti
- Pediatric Intensive Care Unit, Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | - Saptadi Yuliarto
- Pediatric Intensive Care Unit, Saiful Anwar Hospital, Malang, East Java, Indonesia
| | | | - Erwin Pradian
- Intensive Care Unit, Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Dadang H. Somasetia
- Pediatric Intensive Care Unit, Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | | | - Arie Z. Fatoni
- Intensive Care Unit, Saiful Anwar Hospital, Malang, East Java, Indonesia
| | - Jose M. Mandei
- Pediatric Intensive Care Unit, RSUP Prof Dr R. D. Kandou Manado, Indonesia
| | - Eka Y. Lantang
- Intensive Care Unit, RSUP Prof Dr R. D. Kandou Manado, Indonesia
| | - Fajar Perdhana
- Intensive Care Unit, Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | | | - Muhammad Rayhan
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Tiffany R. S. Tarigan
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | - Gianluigi L. Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Jacky Y. Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
132
|
Mago A, Yang YS, Shim JH, John AA. Wearable Device for Cumulative Chlorobenzene Detection and Accessible Mitigation Strategies. SENSORS (BASEL, SWITZERLAND) 2023; 23:7904. [PMID: 37765961 PMCID: PMC10536231 DOI: 10.3390/s23187904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
Chronic exposure to low concentrations of volatile organic compounds (VOCs), such as chlorobenzene, is not being monitored in industrializing countries, although VOC exposure is associated with carcinogenic, organ-toxic, and endocrine-disrupting effects. Current VOC-sensing technologies are inaccessible due to high cost, size, and maintenance or are ineffective due to poor sensitivity or reliability. In particular, marginalized individuals face barriers to traditional prescription VOC treatments due to cost, lack of transportation, and limited access to physicians; thus, alternative treatments are needed. Here, we created a novel cumulative wearable color-changing VOC sensor with a paper-based polydiacetylene sensor array for chlorobenzene. With a single smartphone picture, the sensor displays 14 days of logged chlorobenzene exposure data, interpreted by machine-learning (ML) techniques, including principal component analysis. Further, we explored the efficacy of affordable and accessible treatment options to mitigate a VOC's toxic effects. Vitamin D and sulforaphane are naturally found in cruciferous vegetables, like broccoli, and can be used to treat chlorobenzene-mediated bone degradation. Our platform combines these components into a smartphone app that photographs the sensor's colorimetric data, analyzes the data via ML techniques, and offers accessible treatments based on exposure data.
Collapse
Affiliation(s)
- Aryan Mago
- Department of Medicine, Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Yeon-Suk Yang
- Department of Medicine, Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Jae-Hyuck Shim
- Department of Medicine, Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
- Horae Gene Therapy Center, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
- Li Weibo Institute for Rare Diseases Research, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Aijaz Ahmad John
- Department of Medicine, Division of Rheumatology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| |
Collapse
|
133
|
Shour AR, Jones GL, Anguzu R, Doi SA, Onitilo AA. Development of an evidence-based model for predicting patient, provider, and appointment factors that influence no-shows in a rural healthcare system. BMC Health Serv Res 2023; 23:989. [PMID: 37710258 PMCID: PMC10503036 DOI: 10.1186/s12913-023-09969-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND No-show appointments pose a significant challenge for healthcare providers, particularly in rural areas. In this study, we developed an evidence-based predictive model for patient no-shows at the Marshfield Clinic Health System (MCHS) rural provider network in Wisconsin, with the aim of improving overbooking approaches in outpatient settings and reducing the negative impact of no-shows in our underserved rural patient populations. METHODS Retrospective data (2021) were obtained from the MCHS scheduling system, which included 1,260,083 total appointments from 263,464 patients, as well as their demographic, appointment, and insurance information. We used descriptive statistics to associate variables with show or no-show status, logistic regression, and random forests utilized, and eXtreme Gradient Boosting (XGBoost) was chosen to develop the final model, determine cut-offs, and evaluate performance. We also used the model to predict future no-shows for appointments from 2022 and onwards. RESULTS The no-show rate was 6.0% in both the train and test datasets. The train and test datasets both yielded 5.98. Appointments scheduled further in advance (> 60 days of lead time) had a higher (7.7%) no-show rate. Appointments for patients aged 21-30 had the highest no-show rate (11.8%), and those for patients over 60 years of age had the lowest (2.9%). The model predictions yielded an Area Under Curve (AUC) of 0.84 for the train set and 0.83 for the test set. With the cut-off set to 0.4, the sensitivity was 0.71 and the positive predictive value was 0.18. Model results were used to recommend 1 overbook for every 6 at-risk appointments per provider per day. CONCLUSIONS Our findings demonstrate the feasibility of developing a predictive model based on administrative data from a predominantly rural healthcare system. Our new model distinguished between show and no-show appointments with high performance, and 1 overbook was advised for every 6 at-risk appointments. This data-driven approach to mitigating the impact of no-shows increases treatment availability in rural areas by overbooking appointment slots on days with an elevated risk of no-shows.
Collapse
Affiliation(s)
- Abdul R Shour
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Garrett L Jones
- Information Technology and Digital Services Analytics, Gundersen Health System, Marshfield, WI, USA
| | - Ronald Anguzu
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Suhail A Doi
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar
| | - Adedayo A Onitilo
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA.
| |
Collapse
|
134
|
Ilgunas A, Fjellman-Wiklund A, Häggman-Henrikson B, Lobbezoo F, Visscher CM, Durham J, Lövgren A. Patients' experiences of temporomandibular disorders and related treatment. BMC Oral Health 2023; 23:653. [PMID: 37684660 PMCID: PMC10492274 DOI: 10.1186/s12903-023-03230-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/14/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Temporomandibular disorders (TMD) are common and therefore managed by dentists on a daily basis. However, patients with TMD consistently go undetected and therefore untreated in dentistry. The reasons for these shortcomings have not been fully explored, specifically with regard to patients' perspectives. Therefore, this study aimed to explore patients' experiences of TMD and related treatment, with special focus on the experiences of having TMD, factors related to seeking care, and perspectives on received treatment. METHODS Purposive sampling was used to recruit adult patients at the Public Dental Health services (PDHS) in the Region of Västerbotten, Sweden, during 2019. Individual semi-structured interviews were conducted and analysed using Qualitative Content Analysis. Sixteen patients were interviewed (ten women and six men, 20-65 years). The interviews probed the patients' perspectives of having TMD, seeking care, and receiving treatment. All participants were also examined according to the Diagnostic Criteria for TMD (DC/TMD) and qualified for at least one DC/TMD diagnosis. RESULTS The data analysis led to the main theme Seeking care when the situation becomes untenable, but dental care fails to meet all needs. The patients expressed worry and social discomfort because of the symptoms but still strived to have an as normal daily life as possible. However, severe symptoms and associated consequences compelled them to seek professional help. Experiences of distrust together with challenges to access the PDHS were identified and related to the patients' unfulfilled expectations. CONCLUSIONS Patients' reported experiences indicate that receiving timely and appropriate care is more of an unfulfilled expectation than the current state of management of patients with TMD in dentistry.
Collapse
Affiliation(s)
- Aurelia Ilgunas
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | | | | | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Justin Durham
- School of Dental Sciences, Newcastle University, Newcastle, UK
- Newcastle Hospitals' NHS Foundation Trust, Newcastle, UK
| | - Anna Lövgren
- Department of Odontology/Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden.
| |
Collapse
|
135
|
Gerber BS, Biggers A, Tilton JJ, Smith Marsh DE, Lane R, Mihailescu D, Lee J, Sharp LK. Mobile Health Intervention in Patients With Type 2 Diabetes: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2333629. [PMID: 37773498 PMCID: PMC10543137 DOI: 10.1001/jamanetworkopen.2023.33629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/05/2023] [Indexed: 10/01/2023] Open
Abstract
Importance Clinical pharmacists and health coaches using mobile health (mHealth) tools, such as telehealth and text messaging, may improve blood glucose levels in African American and Latinx populations with type 2 diabetes. Objective To determine whether clinical pharmacists and health coaches using mHealth tools can improve hemoglobin A1c (HbA1c) levels. Design, Setting, and Participants This randomized clinical trial included 221 African American or Latinx patients with type 2 diabetes and elevated HbA1c (≥8%) from an academic medical center in Chicago. Adult patients aged 21 to 75 years were enrolled and randomized from March 23, 2017, through January 8, 2020. Patients randomized to the intervention group received mHealth diabetes support for 1 year followed by monitored usual diabetes care during a second year (follow-up duration, 24 months). Those randomized to the waiting list control group received usual diabetes care for 1 year followed by the mHealth diabetes intervention during a second year. Interventions The mHealth diabetes intervention included remote support (eg, review of glucose levels and medication intensification) from clinical pharmacists via a video telehealth platform. Health coach activities (eg, addressing barriers to medication use and assisting pharmacists in medication reconciliation and telehealth) occurred in person at participant homes and via phone calls and text messaging. Usual diabetes care comprised routine health care from patients' primary care physicians, including medication reconciliation and adjustment. Main Outcomes and Measures Outcomes included HbA1c (primary outcome), blood pressure, cholesterol, body mass index, health-related quality of life, diabetes distress, diabetes self-efficacy, depressive symptoms, social support, medication-taking behavior, and diabetes self-care measured every 6 months. Results Among the 221 participants (mean [SD] age, 55.2 [9.5] years; 154 women [69.7%], 148 African American adults [67.0%], and 73 Latinx adults [33.0%]), the baseline mean (SD) HbA1c level was 9.23% (1.53%). Over the initial 12 months, HbA1c improved by a mean of -0.79 percentage points in the intervention group compared with -0.24 percentage points in the waiting list control group (treatment effect, -0.62; 95% CI, -1.04 to -0.19; P = .005). Over the subsequent 12 months, a significant change in HbA1c was observed in the waiting list control group after they received the same intervention (mean change, -0.57 percentage points; P = .002), while the intervention group maintained benefit (mean change, 0.17 percentage points; P = .35). No between-group differences were found in adjusted models for secondary outcomes. Conclusions and Relevance In this randomized clinical trial, HbA1c levels improved among African American and Latinx adults with type 2 diabetes. These findings suggest that a clinical pharmacist and health coach-delivered mobile health intervention can improve blood glucose levels in African American and Latinx populations and may help reduce racial and ethnic disparities. Trial Registration ClinicalTrials.gov Identifier: NCT02990299.
Collapse
Affiliation(s)
- Ben S. Gerber
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
- Department of Medicine, College of Medicine, University of Illinois Chicago, Chicago
| | - Alana Biggers
- Department of Medicine, College of Medicine, University of Illinois Chicago, Chicago
| | - Jessica J. Tilton
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago
| | - Daphne E. Smith Marsh
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago
| | - Rachel Lane
- Center for Clinical and Translational Science, University of Illinois Chicago, Chicago
| | - Dan Mihailescu
- Department of Endocrinology, Cook County Health, Chicago, Illinois
| | - JungAe Lee
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester
| | - Lisa K. Sharp
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago
| |
Collapse
|
136
|
Gala P, Kamano JH, Vazquez Sanchez M, Mugo R, Orango V, Pastakia S, Horowitz C, Hogan JW, Vedanthan R. Cross-sectional analysis of factors associated with medication adherence in western Kenya. BMJ Open 2023; 13:e072358. [PMID: 37669842 PMCID: PMC10481848 DOI: 10.1136/bmjopen-2023-072358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES Poor medication adherence in low-income and middle-income countries is a major cause of suboptimal hypertension and diabetes control. We aimed to identify key factors associated with medication adherence in western Kenya, with a focus on cost-related and economic wealth factors. SETTING We conducted a cross-sectional analysis of baseline data of participants enrolled in the Bridging Income Generation with Group Integrated Care study in western Kenya. PARTICIPANTS All participants were ≥35 years old with either diabetes or hypertension who had been prescribed medications in the past 3 months. PRIMARY AND SECONDARY OUTCOME MEASURES Baseline data included sociodemographic characteristics, wealth and economic status and medication adherence information. Predictors of medication adherence were separated into the five WHO dimensions of medication adherence: condition-related factors (comorbidities), patient-related factors (psychological factors, alcohol use), therapy-related factors (number of prescription medications), economic-related factors (monthly income, cost of transportation, monthly cost of medications) and health system-related factors (health insurance, time to travel to the health facility). A multivariable analysis, controlling for age and sex, was conducted to determine drivers of suboptimal medication adherence in each overarching category. RESULTS The analysis included 1496 participants (73.7% women) with a mean age of 60 years (range 35-97). The majority of participants had hypertension (69.2%), 8.8% had diabetes and 22.1% had both hypertension and diabetes. Suboptimal medication adherence was reported by 71.2% of participants. Economic factors were associated with medication adherence. In multivariable analysis that investigated specific subtypes of costs, transportation costs were found to be associated with worse medication adherence. In contrast, we found no evidence of association between monthly medication costs and medication adherence. CONCLUSION Suboptimal medication adherence is highly prevalent in Kenya, and primary-associated factors include costs, particularly indirect costs of transportation. Addressing all economic factors associated with medication adherence will be important to improve outcomes for non-communicable diseases. TRIAL REGISTRATION NUMBER NCT02501746.
Collapse
Affiliation(s)
- Pooja Gala
- Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Manuel Vazquez Sanchez
- Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Richard Mugo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Vitalis Orango
- Medicine, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sonak Pastakia
- Center for Health Equity and Innovation, Purdue University College of Pharmacy Nursing and Health Sciences, West Lafayette, Indiana, USA
| | - Carol Horowitz
- Medicine and Population Health Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph W Hogan
- Biostatistics, Brown University, Providence, Rhode Island, USA
| | - Rajesh Vedanthan
- Medicine and Population Health, New York University Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
137
|
Lin Q, Mathers A, Tilli T, Baker J, Bhaidani S, Grootendorst P, Cadarette SM, Dolovich L. Implementation of the appointment-based model in community pharmacies: An analysis of refills and adherence. Res Social Adm Pharm 2023; 19:1286-1291. [PMID: 37286385 DOI: 10.1016/j.sapharm.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Traditionally, much of community pharmacy practice relies on patients to request their own medication refills. These refills are often not aligned, which has been shown to decrease adherence and workflow efficiencies. The appointment-based model (ABM) is designed to proactively synchronize refills and schedule patient-pharmacist appointments. OBJECTIVES To describe the characteristics of patients enrolled in the ABM; and to compare the number of distinct refill dates, number of refills, and adherence for antihypertensives, oral antihyperglycemics, and statins 6-months and 12-months pre-post ABM implementation. METHODS In September 2017, the ABM was implemented across independent community pharmacies within a pharmacy banner in Ontario, Canada. In December 2018, a convenience sample of three pharmacies was extracted. Demographic and clinical characteristics were collected on program enrollment (index) date for individual patients and their medication fill histories were used to investigate adherence measures including distinct number of refill dates, number of refills, and proportion of days covered. Descriptive statistics were analyzed using StataCorp. RESULTS Analysis of 131 patients (48.9% male; mean age 70.8 years ± 10.5 SD) filled on average 5.1 ± 2.7 medications with 73 (55.7%) experiencing polypharmacy. Patients had a significant reduction in mean number of refill dates (6.8 ± 3.8 SD six-months pre-enrollment, 4.9 ± 3.1 SD six-months post-enrollment, p < 0.0001). Adherence to chronic medications remained high (PDC ≥95%). CONCLUSION The ABM was implemented for a cohort of established users, already highly adherent to their chronic medications. Results demonstrate reduced filling complexity and fewer refill dates while also sustaining the high baseline adherence across all chronic medications studied. Future studies should investigate patient perspectives and potential clinical benefits of the ABM.
Collapse
Affiliation(s)
- Qiqi Lin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Annalise Mathers
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Tiana Tilli
- WholeHealth Pharmacy Partners, Markham, Ontario, Canada
| | - Jen Baker
- WholeHealth Pharmacy Partners, Markham, Ontario, Canada
| | | | - Paul Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Suzanne M Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Eshelman School of Pharmacy, University of North Carolina, North Carolina, United States
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
138
|
Ong H, Ong J, Cheng R, Wang C, Lin M, Ong D. GPT Technology to Help Address Longstanding Barriers to Care in Free Medical Clinics. Ann Biomed Eng 2023; 51:1906-1909. [PMID: 37355478 DOI: 10.1007/s10439-023-03256-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/26/2023]
Abstract
The implementation of technology in healthcare has revolutionized patient-centered decision making by providing contextualized information about a patient's healthcare journey, leading to increased efficiency (Keyworth et al. in BMC Med Inform Decis Mak 18:93, 2018, https://doi.org/10.1186/s12911-018-0661-3 ). Artificial intelligence has been integrated within Electronic Health Records (EHR) to prompt screenings or diagnostic tests based on a patient's holistic health profile. While larger hospitals have already widely adopted these technologies, free clinics hold lower utilization of these advanced capability EHRs. The patient population at a free clinic faces a multitude of factors that limits their access to comprehensive care, thus requiring necessary efforts and measures to close the gap in healthcare disparities. Emerging Artificial Intelligence (AI) technology, such as OpenAI's ChatGPT, GPT-4, and other large language models (LLMs) have remarkable potential to improve patient care outcomes, promote health equity, and enhance comprehensive and holistic care in resource-limited settings. This paper aims to identify areas in which integrating these LLM AI advancements into free clinics operations can optimize and streamline healthcare delivery to underserved patient populations. This paper also identifies areas of improvements in GPT that are necessary to deliver those services.
Collapse
Affiliation(s)
- Hannah Ong
- College of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rebekah Cheng
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, USA
| | - Calvin Wang
- College of Medicine - Robert Wood Johnson, Rutgers University, New Brunswick, NJ, USA
| | - Murong Lin
- Distinguished Engineer, Verizon, San Jose, CA, USA
| | - Dennis Ong
- Amazon Web Services, Amazon, Seattle, WA, USA
| |
Collapse
|
139
|
Wong MS, Frochen S, Steers WN, Washington DL. Hospital Catchment Areas Characteristics and Geographic Regions Associated With Higher COVID-19 Veterans Health Administration Hospitalization During the Omicron Surge. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:E198-E207. [PMID: 37104066 PMCID: PMC10363212 DOI: 10.1097/phh.0000000000001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
CONTEXT Surges in the ongoing coronavirus-19 (COVID-19) pandemic and accompanying increases in hospitalizations continue to strain hospital systems. Identifying hospital-level characteristics associated with COVID-19 hospitalization rates and clusters of hospitalization "hot spots" can help with hospital system planning and resource allocation. OBJECTIVE To identify (1) hospital catchment area-level characteristics associated with higher COVID-19 hospitalization rates and (2) geographic regions with high and low COVID-19 hospitalization rates across catchment areas during COVID-19 Omicron surge (December 20, 2021-April 3, 2022). DESIGN This observational study used Veterans Health Administration (VHA), US Health Resource & Services Administration's Area Health Resources File, and US Census data. We used multivariate regression to identified hospital catchment area-level characteristics associated with COVID-19 hospitalization rates. We used ESRI ArcMap's Getis-Ord Gi* statistic to identify catchment area clusters of hospitalization hot and cold spots. SETTING AND PARTICIPANTS VHA hospital catchment areas in the United States (n = 143). MAIN OUTCOME MEASURES Hospitalization rate. RESULTS Greater COVID-19 hospitalization was associated with serving more high hospitalization risk patients (34.2 hospitalizations/10 000 patients per 10-percentage point increase in high hospitalization risk patients; 95% confidence intervals [CI]: 29.4, 39.0), fewer patients new to VHA during the pandemic (-3.9, 95% CI: -6.2, -1.6), and fewer COVID vaccine-boosted patients (-5.2; 95% CI: -7.9, -2.5).We identified 2 hospitalization cold spots located in the Pacific Northwest and in the Great Lakes regions, and 2 hot spots in the Great Plains and Southeastern US regions. CONCLUSIONS Within VHA's nationally integrated health care system, catchment areas serving a larger high hospitalization risk patient population were associated with more Omicron-related hospitalizations, while serving more patients fully vaccinated and boosted for COVID-19 and new VHA users were associated with lower hospitalization. Hospital and health care system efforts to vaccinate patients, particularly high-risk patients, can potentially safeguard against pandemic surges.Hospitalization hot spots within VHA include states with a high burden of chronic disease in the Great Plains and Southeastern United States.
Collapse
Affiliation(s)
- Michelle S Wong
- VA HSR&D Center for the Study of Healthcare
Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare
System, Los Angeles, CA
| | - Stephen Frochen
- VA HSR&D Center for the Study of Healthcare
Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare
System, Los Angeles, CA
| | - W. Neil Steers
- VA HSR&D Center for the Study of Healthcare
Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare
System, Los Angeles, CA
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare
Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare
System, Los Angeles, CA
- Division of General Internal Medicine and Health Services
Research, Department of Medicine, University of California Los Angeles Geffen School
of Medicine, Los Angeles, CA
| |
Collapse
|
140
|
Gibbons JB, Harris SJ, Solomon KT, Sugarman O, Hardy C, Saloner B. Increasing overdose deaths among Black Americans: a review of the literature. Lancet Psychiatry 2023; 10:719-726. [PMID: 37236218 DOI: 10.1016/s2215-0366(23)00119-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/13/2023] [Accepted: 03/26/2023] [Indexed: 05/28/2023]
Abstract
In 2020, opioid overdose fatalities among Black Americans surpassed those among White Americans for the first time in US history. This Review analyses the academic literature on disparities in overdose deaths to highlight potential factors that could explain these increases in overdose deaths among Black Americans. Overall, we find that differences in structural and social determinants of health; inequality in the access, use, and continuity of substance use disorder and harm reduction services; variability in fentanyl exposure and risk; and changes in social and economic circumstances since the onset of the COVID-19 pandemic are central to explaining this trend. We conclude with a discussion of opportunities for US policy reform and opportunities for future research.
Collapse
Affiliation(s)
- Jason B Gibbons
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Samantha J Harris
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Olivia Sugarman
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos Hardy
- Maryland Recovery Organization Connecting Communities, Baltimore, MD, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
141
|
Youn GM, Shah JP, Agrawal Y, Wei EX. Vestibular Vertigo and Disparities in Healthcare Access Among Adults in the United States. Ear Hear 2023; 44:1029-1035. [PMID: 36920251 PMCID: PMC10440212 DOI: 10.1097/aud.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Vertigo and dizziness have a high lifetime prevalence with significant impacts on daily life. We sought to explore differences in access to and ability to afford care among adults with vestibular vertigo by race/ethnicity, income, and insurance type. DESIGN This is a cross-sectional study using the 2016 National Health Interview Survey. A total of 32,047 adults who completed the 2016 National Health Interview Survey Balance Supplement were analyzed. We used a previously validated definition of vertigo defined as (1) positional vertigo, (2) rotational vertigo, or (3) recurrent dizziness with nausea and either oscillopsia or imbalance. We examined several self-reported measures of healthcare utilization and access. RESULTS Among adults with vestibular vertigo, African Americans had significantly increased odds of delayed care due to lack of transportation; Hispanic ethnicity was associated with decreased odds of skipping medication doses and asking a doctor for a lower-cost medication. Adults with public insurance had significantly lower odds of reporting delayed care due to worry about cost, not receiving medical care due to cost, and delayed filling of a prescription, but had greater odds of reporting delayed care due to lack of transportation. Lack of insurance and lower income were associated with increased odds of delaying and not receiving care due to cost. CONCLUSION These findings demonstrate significant differences in access to care among adults with vestibular vertigo in the United States based on race, income, and health insurance status.
Collapse
Affiliation(s)
- Gun Min Youn
- Stanford University School of Medicine, Stanford, California
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Jay P. Shah
- Stanford University School of Medicine, Stanford, California
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric X. Wei
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
142
|
Topmiller M, McCann J, Hoang H, Rankin J, Grandmont J, Pelzer M, Sripipatana A. Health centres and social determinants of health: an analysis of enabling services provision and clinical quality. Fam Med Community Health 2023; 11:e002227. [PMID: 37775110 PMCID: PMC10546097 DOI: 10.1136/fmch-2023-002227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE It is well known that social determinants of health (SDOH), including poverty, education, transportation and housing, are important predictors of health outcomes. Health Resources and Services Administration (HRSA)-funded health centres serve a patient population with high vulnerability to barriers posed by SDOH and are required to provide services that enable health centre service utilisation and assist patients in navigating barriers to care. This study explores whether health centres with higher percentages of patients using these enabling services experience better clinical performance and outcomes. DESIGN AND SETTING The analysis uses organisational characteristics, patient demographics and clinical quality measures from HRSA's 2018 Uniform Data System. Health centres (n=875) were sorted into quartiles with quartile 1 (Q1) representing the lowest utilisation of enabling services and quartile 4 (Q4) representing the highest. The researchers calculated a service area social deprivation score weighted by the number of patients for each health centre and used ordinary least squares to create adjusted values for each of the clinical quality process and outcome measures. Analysis of variance was used to test differences across enabling services quartiles. RESULTS After adjusting for patient characteristics, health centre size and social deprivation, authors found statistically significant differences for all clinical quality process measures across enabling services quartiles, with Q4 health centres performing significantly better than Q1 health centres for several clinical process measures. However, these Q4 health centres performed poorer in outcome measures, including blood pressure and haemoglobin A1c control. CONCLUSION These findings emphasise the importance of how enabling services (eg, translation services, transportation) can address unmet social needs, improve utilisation of health services and reaffirm the challenges inherent in overcoming SDOH to improve health outcomes.
Collapse
Affiliation(s)
- Michael Topmiller
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Jessica McCann
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Hank Hoang
- US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Rockville, Maryland, USA
| | - Jennifer Rankin
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Jene Grandmont
- HealthLandscape, American Academy of Family Physicians, Leawood, Kansas, USA
| | - Molly Pelzer
- US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Rockville, Maryland, USA
| | - Alek Sripipatana
- US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Rockville, Maryland, USA
| |
Collapse
|
143
|
Peano A, Politano G, Gianino MM. Determinants of COVID-19 vaccination worldwide: WORLDCOV, a retrospective observational study. Front Public Health 2023; 11:1128612. [PMID: 37719735 PMCID: PMC10501313 DOI: 10.3389/fpubh.2023.1128612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/19/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction The COVID-19 pandemic has resulted in numerous deaths, great suffering, and significant changes in people's lives worldwide. The introduction of the vaccines was a light in the darkness, but after 18 months, a great disparity in vaccination coverage between countries has been observed. As disparities in vaccination coverage have become a global public health issue, this study aimed to analyze several variables to identify possible determinants of COVID-19 vaccination. Methods An ecological study was conducted using pooled secondary data sourced from institutional sites. A total of 205 countries and territories worldwide were included. A total of 16 variables from different fields were considered to establish possible determinants of COVID-19 vaccination: sociodemographic, cultural, infrastructural, economic and political variables, and health system performance indicators. The percentage of the population vaccinated with at least one dose and the total doses administered per 100 residents on 15 June 2022 were identified as indicators of vaccine coverage and outcomes. Raw and adjusted values for delivered vaccine doses in the multivariate GLM were determined using R. The tested hypothesis (i.e., variables as determinants of COVID-19 vaccination) was formulated before data collection. The study protocol was registered with the grant number NCT05471635. Results GDP per capita [odds = 1.401 (1.299-1.511) CI 95%], access to electricity [odds = 1.625 (1.559-1.694) CI 95%], political stability, absence of violence/terrorism [odds = 1.334 (1.284-1.387) CI 95%], and civil liberties [odds = 0.888 (0.863-0.914) CI 95%] were strong determinants of COVID-19 vaccination. Several other variables displayed a statistically significant association with outcomes, although the associations were stronger for total doses administered per 100 residents. There was a substantial overlap between raw outcomes and their adjusted counterparts. Discussion This pioneering study is the first to analyze the association between several different categories of indicators and COVID-19 vaccination coverage in a wide complex setting, identifying strong determinants of vaccination coverage. Political decision-makers should consider these findings when organizing mass vaccination campaigns in a pandemic context to reduce inequalities between nations and to achieve a common good from a public health perspective.
Collapse
Affiliation(s)
- Alberto Peano
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Polytechnic of Turin, Turin, Italy
| | - Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy
| |
Collapse
|
144
|
Ceccarelli A, Minotti A, Senni M, Pellegrini L, Benati G, Ceccarelli P, Federici A, Mazzini S, Reali C, Sintoni F, Gori D, Montalti M. Healthcare Service Quality Evaluation in a Community-Oriented Primary Care Center, Italy. Healthcare (Basel) 2023; 11:2396. [PMID: 37685430 PMCID: PMC10486978 DOI: 10.3390/healthcare11172396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/12/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Community-oriented primary care (COPC) is an inclusive healthcare approach that combines individual care with a population-based outlook, striving to offer effective and equitable services. This study concentrates on assessing the perceived quality of a "Casa della Comunità" (CdC) implemented by the Romagna Local Health Authority, which embraces the COPC model. Through the examination of user experiences, the study aims to comprehend the influence of the CdC's care delivery model on the community's perception of service quality. From 13-18 March 2023, paper questionnaires were distributed by trained healthcare professionals and volunteers. The cross-sectional study enrolled participants aged 18 or older, capable of understanding written Italian, and willing to take part voluntarily. A total of 741 questionnaires were collected, resulting in an overall acceptance rate of 85.6%. Among the respondents, 37.9% were female, with an average age of 55.4 ± 16.2 years. While the respondents generally held a positive view of the quality, the results displayed varying levels of satisfaction across the different areas. Multivariate analysis revealed significant associations between factors such as gender, employment status, financial resources, education level, and distance from the healthcare center with the perceived quality of the facility in terms of accessibility, environment, staff, continuity of care, and overall satisfaction. The study yielded valuable insights, identifying strengths and areas for improvement and underscoring the importance of ongoing monitoring studies to enhance patient satisfaction continuously.
Collapse
Affiliation(s)
- Andrea Ceccarelli
- Operative Unit of Hygiene and Public Health of Forlì-Cesena, Department of Public Health, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Alice Minotti
- Nursing Unit, Primary Care and Community Medicine Department of Forlì-Cesena, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Marco Senni
- Nursing Unit, Primary Care and Community Medicine Department of Forlì-Cesena, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Luca Pellegrini
- Nursing Unit, Primary Care and Community Medicine Department of Forlì-Cesena, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Giuseppe Benati
- Primary Care and Community Medicine Department of Forlì-Cesena, Romagna Local Health Authority, 47121 Forlì, Italy
| | - Paola Ceccarelli
- Nursing Unit, Primary Care and Community Medicine Department of Forlì-Cesena, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Andrea Federici
- Operative Unit of Hygiene and Public Health of Forlì-Cesena, Department of Public Health, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Silvia Mazzini
- Nursing Unit, Primary Care and Community Medicine Department of Forlì-Cesena, Romagna Local Health Authority, 47121 Forlì, Italy
| | - Chiara Reali
- Operative Unit of Hygiene and Public Health of Forlì-Cesena, Department of Public Health, Romagna Local Health Authority, 47521 Cesena, Italy
| | - Francesco Sintoni
- Rubicone Health District, Romagna Local Health Authority, 47522 Cesena, Italy
| | - Davide Gori
- Hygiene Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| | - Marco Montalti
- Operative Unit of Hygiene and Public Health of Forlì-Cesena, Department of Public Health, Romagna Local Health Authority, 47521 Cesena, Italy
- Hygiene Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy
| |
Collapse
|
145
|
Pandey M, Clark M, Beresh E, Nilson S, Kay C, Campbell T, Nicolay S, Skinner S. Wellness Wheel Clinics: A First Nation community-partnered care model improving healthcare access, from healthcare providers' perspectives. Health Promot Int 2023; 38:daad079. [PMID: 37590386 DOI: 10.1093/heapro/daad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
First Nation people residing in rural and remote communities have limited primary healthcare access, which often affects chronic disease management leading to poor health outcomes. Individuals with lived experiences of chronic disease and substance use, along with health directors, advocated for improved services. Subsequently, an urban healthcare team in partnership with four First Nation communities developed an Outreach clinic to address healthcare access barriers. Established in 2016, this community-led clinic improves primary care access and chronic disease management in First Nation communities. Employing a qualitative research design, interviews were conducted with 15 clinic providers and 9 community members to explore the clinic's 1-year post-implementation impacts. Thematic data analysis indicated that engagement and approval by community leadership, support from Elders and community members and collaboration with existing community healthcare staff were crucial for establishing the Outreach clinic. Initial logistical challenges with space allocation, equipment, medical supplies, funding, staffing, medical records and appointment scheduling were resolved through community consultation and creative solutions. A nurse coordinator ensured continuity of care and was integral to ensuring clients receive seamless care. The commitment of the outreach team and the collective goal of providing client-centered care were instrumental in the clinic's success. In partnership with communities, access to healthcare in First Nation communities can be enhanced by coordinating Outreach clinics through existing community healthcare facilities.
Collapse
Affiliation(s)
- Mamata Pandey
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Megan Clark
- Department of Academic Family Medicine, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
- Wellness Wheel Clinic, Regina, Saskatchewan, Canada
| | - Erin Beresh
- Department of Academic Family Medicine, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
| | - Solveig Nilson
- Department of Academic Family Medicine, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
| | - Cynthia Kay
- Health, TouchWood Agency Tribal Council, Punnichy, Saskatchewan, Canada
| | | | | | - Stuart Skinner
- Research Department, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
- Wellness Wheel Clinic, Regina, Saskatchewan, Canada
- Department of Medicine, University of Saskatchewan College of Medicine, Regina, Saskatchewan, Canada
| |
Collapse
|
146
|
Masison J, Kodumudi V, Beltrami EJ, Feng H. Travel Distance and Time to Pulsed Dye Laser Treatment for Port-Wine Birthmark in the Pediatric Population. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2023; 16:44-46. [PMID: 37636248 PMCID: PMC10452483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Prior research has demonstrated that early treatment of port-wine birthmark (PWB) with pulsed dye laser (PDL) yields optimal patient outcomes. Given the known variations in practice patterns among dermatologists offering PDL, we conducted a cross-sectional analysis in order to determine the travel distance and time to practice locations offering PDL therapy for PWB among the pediatric population. We determined the travel time and distance from each county population center in the United States to the nearest PDL site using ArcGIS and linked the data to demographic characteristics in each census tract. 1,243 practice sites were identified that offer PDL treatment for PWB for patients under the age of 18. Children living in urban areas were found to have a significantly shorter median travel time and distance to PDL sites (6.1 miles, 11.8 minutes) compared to children living in rural areas (60.9 miles, 66.7 minutes). Additionally, uninsured children were found to travel longer average distances (32.2 miles) than insured children (24.2 miles). These findings suggest that certain socioeconomically disadvantaged groups have increased travel burden when obtaining PDL treatment for PWB. Transportation resources and support may need to be given to certain patients to ensure timely and effective PDL treatment.
Collapse
Affiliation(s)
- Joseph Masison
- Drs. Masison and Beltrami are with the University of Connecticut School of Medicine in Farmington, Connecticut
| | - Vijay Kodumudi
- Dr. Kodumudi is with the Internal Medicine Department at Waterbury Hospital, and the Yale School of Medicine in New Haven, Connecticut
| | - Eric J. Beltrami
- Drs. Masison and Beltrami are with the University of Connecticut School of Medicine in Farmington, Connecticut
| | - Hao Feng
- Dr. Feng is with the Department of Dermatology at the University of Connecticut Health Center in Farmington, Connecticut
| |
Collapse
|
147
|
Youn EJ, Shin C, Haratian R, Guzman A, Kim JY, McGahan P, Chen JL. Income and Insurance Status Impact Access to Health Care for Hip Osteoarthritis. Arthrosc Sports Med Rehabil 2023; 5:100747. [PMID: 37645390 PMCID: PMC10461205 DOI: 10.1016/j.asmr.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/18/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To explore differences in the affordability of and accessibility to health care among adults with hip osteoarthritis with respect to race/ethnicity, income, and insurance status. Methods This cross-sectional retrospective study was conducted using 2016 National Health Interview Survey (NHIS) data. NHIS data collection occurred continuously from January to December 2016. Individuals belonging to households and noninstitutionalized groups were included in the study. Because NHIS randomized surveys are conducted face-to-face on an annual basis, follow-up data are not collected. Results Answers from 38,158,634 weighted respondents with a mean age of 58.33 ± 0.33 years were assessed. Among adults with hip osteoarthritis, those with public insurance had increased odds of delaying care owing to lack of transportation and had decreased odds of delaying care and follow-up care owing to cost. Individuals who were uninsured or who belonged to lower income brackets were associated with increased odds of being unable to afford or utilize health care. Conclusions In this study, we found that income bracket and insurance status affect the accessibility to health care among adults with hip osteoarthritis in the United States. Level of Evidence Level IV, prognostic case series.
Collapse
Affiliation(s)
- Erin J. Youn
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
- Williams College, Williamstown, Massachusetts, U.S.A
| | - Caleb Shin
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Ryan Haratian
- Department of Orthopaedic Surgery, Sports Medicine & Rehabilitation, Wright State University Boonshoft School of Medicine, Dayton, Ohio, U.S.A
| | - Alvarho Guzman
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Joo Yeon Kim
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Patrick McGahan
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - James L. Chen
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| |
Collapse
|
148
|
Oridota O, Shetty A, Elaiho CR, Phelps L, Cheng S, Vangeepuram N. Perspectives from diverse stakeholders in a youth community-based participatory research project. EVALUATION AND PROGRAM PLANNING 2023; 99:102305. [PMID: 37178515 PMCID: PMC10330503 DOI: 10.1016/j.evalprogplan.2023.102305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION TEEN HEED (Help Educate to Eliminate Diabetes) is a community-based youth participatory action research (YPAR) study in which prediabetic adolescents from a predominantly low-income, non-white neighborhood in New York City participated in a peer-led diabetes prevention intervention. The aim of the current analysis is to evaluate the TEEN HEED program through examination of multiple stakeholder perspectives to identify strengths and areas for improvement that may inform other YPAR projects. METHODS We conducted 44 individual in-depth interviews with representatives from six stakeholder groups (study participants, peer leaders, study interns and coordinators, and younger and older community action board members). Interviews were recorded, transcribed, and analyzed using thematic analysis to identify overarching themes. RESULTS Dominant themes identified were: 1) YPAR principles and engagement, 2) Youth engagement through peer education, 3) Challenges and motivations for research participation, 4) Study improvements and sustainability, and 5) Professional and personal impacts of the study. CONCLUSIONS Emergent themes from this study provided insights on the value of youth participation in research and informed recommendations for future YPAR studies.
Collapse
Affiliation(s)
| | - Anuradha Shetty
- SUNY Downstate Health Sciences University College of Medicine, USA
| | - Cordelia R Elaiho
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, USA
| | - LaTanya Phelps
- TEEN HEED Community Action Board, Icahn School of Medicine at Mount Sinai, USA
| | - Stephen Cheng
- University of New England College of Osteopathic Medicine Icahn School of Medicine at Mount Sinai TEEN HEED Intern, USA
| | - Nita Vangeepuram
- Departments of Pediatrics and Population Health Science and Policy, Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, USA.
| |
Collapse
|
149
|
Kleinman RA, Bozinoff N. Access to Telephone and Internet-Based Telemedicine in Canadian Households. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:623-626. [PMID: 36855823 PMCID: PMC10411364 DOI: 10.1177/07067437231159348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Robert A. Kleinman
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nikki Bozinoff
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
150
|
Wien S, Guest JL, Luisi N, Taussig J, Kramer MR, Stephenson R, Millett G, del Rio C, Sullivan PS. Racial differences in the association of undetectable HIV viral load and transportation to an HIV provider among men who have sex with men in Atlanta, Georgia: a health equity perspective. AIDS Care 2023; 35:1154-1163. [PMID: 36878481 PMCID: PMC10426396 DOI: 10.1080/09540121.2023.2182871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
There are inequities in HIV outcomes among Black gay, bisexual, and other sexual minority men who have sex with men (GBMSM) compared to GBMSM overall, including access to transportation to HIV care. It is unclear if the relationship between transportation and clinical outcomes extends to viral load. We assessed the relationship between transportation dependence to an HIV provider and undetectable viral load among Black and White GBMSM in Atlanta. We collected transportation and viral load information from GBMSM with HIV from 2016-2017 (n = 345). More Black than White GBMSM had a detectable viral load (25% vs. 15%) and took dependent (e.g. public) transportation (37% vs. 18%). Independent (e.g. car) transportation was associated with undetectable viral load for White GBMSM (cOR 3.61, 95% CI 1.45, 8.97) but was attenuated by income (aOR. 2.29, 95% CI 0.78, 6.71), and not associated for Black GBMSM (cOR 1.18, 95% CI 0.58, 2.24). One possible explanation for no association for Black GBMSM is that there are more competing barriers to HIV care for Black GBMSM than White GBMSM. Further investigation is needed to confirm whether 1) transportation is unimportant for Black GBMSM or 2) transportation interacts with additional factors not considered in this analysis.
Collapse
Affiliation(s)
- Simone Wien
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jodie L. Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer Taussig
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Populations, and Leadership, School of Nursing, and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Greg Millett
- American Foundation for AIDS Research, Washington DC, USA
| | - Carlos del Rio
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|