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Slatore CG, Scott JY, Hooker ER, Disher N, Golden S, Govier D, Hynes DM. Motivators, Barriers, and Facilitators to Choosing Care in VA Facilities Versus VA-Purchased Care. Med Care Res Rev 2024; 81:395-407. [PMID: 39075797 DOI: 10.1177/10775587241264594] [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: 07/31/2024]
Abstract
Many Veterans receive Department of Veterans Affairs (VA)-purchased care from non-VA facilities but little is known about factors that Veterans consider for this choice. Between May 2020 and August 2021, we surveyed VA-purchased care-eligible VA patients about barriers and facilitators to choosing where to receive care. We examined the association between travel time to their VA facility and their choice of VA-purchased care (VA-paid health care received in non-VA settings) versus VA facility and whether this association was modified by distrust. We received 1,662 responses and 692 (42%) chose a VA facility. Eighty percent reported quality care was in their top three factors that influenced their decision. Respondents with the highest distrust and who lived >1 hr from the nearest VA facility had the lowest predicted probability (PP) of choosing VA (PP 15%; 95% confidence interval: 10%-20%). Veterans value quality of care. VA and other health care systems should consider patient-centered ways to improve and publicize quality and reduce distrust.
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Affiliation(s)
- Christopher G Slatore
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Division of Pulmonary, Allergy and Critical Care, Oregon Health & Science University, Portland, OR, USA
- Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Jennifer Y Scott
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Elizabeth R Hooker
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Natalie Disher
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Sara Golden
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Division of Pulmonary, Allergy and Critical Care, Oregon Health & Science University, Portland, OR, USA
| | - Diana Govier
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Department of Health Systems Management & Policy, Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Denise M Hynes
- Center to Improve Veteran Involvement in Care, Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, OR, USA
- Health Management and Policy Program, College of Health and Center for Quantitative Life Sciences, Oregon State University; Corvallis, OR, USA
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
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Renn BN, Walker TJ, Edds B, Roots M, Raue PJ. Naturalistic use of a digital mental health intervention for depression and anxiety: A randomized clinical trial. J Affect Disord 2024:S0165-0327(24)01596-9. [PMID: 39299591 DOI: 10.1016/j.jad.2024.09.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 09/11/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Digital mental health interventions (DMHI) may offer scalable treatment for common mental health conditions. However, many commercially available apps have not been subjected to rigorous evaluation of effectiveness, particularly among users experiencing clinically significant symptomatology. We examined depression and anxiety symptom outcomes associated with a top-rated, commercially available self-guided DMHI based on cognitive behavioral therapy ("Sanvello") relative to waitlist control. METHODS This preregistered web-based, 2-arm, parallel-group randomized trial enrolled U.S. adults with self-reported elevated symptoms of depression and/or anxiety. Those assigned to the treatment condition were provided 8 weeks of access to Sanvello. Co-primary outcomes of depression (Patient Health Questionnaire [PHQ-9]) and anxiety (Generalized Anxiety Disorder 7-item scale [GAD-7]) severity were assessed at baseline and 2, 4, 6, and 8 weeks. RESULTS Intention-to-treat analyses included 280 participants (mean age 32.47 ± 9.32 years; 86.1 % women). Generalized linear mixed models showed a significant improvement in depression (F(4,779) = 6.51, p < .001) and anxiety (F(4,907) = 3.28, p = .01) associated with the DMHI over time. The intervention was also associated with a greater proportion of participants exhibiting depression response (25 [45.5 %] vs 26 [16.9 %]) and remission (10 [18.2 %] vs 7 [4.5 %]) on the PHQ-9, and anxiety response (31 [44.9 %] vs 39 [22.8 %]) and remission (20 [29.0 %] vs 27 [15.8 %]) on the GAD-7, relative to waitlist. LIMITATIONS Findings may not represent people with serious mental illness, suicidality, or the broader population of DMHI users. CONCLUSIONS A commercially available, self-guided DMHI was effective at improving symptoms in individuals experiencing depression or anxiety. TRIAL REGISTRATION ClinicalTrials.gov [NCT05373329].
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Affiliation(s)
- Brenna N Renn
- Department of Psychology, University of Nevada, Las Vegas, NV, USA.
| | - Teresa J Walker
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | | | | | - Patrick J Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Staloff J, Gunnink E, Rojas J, Wong ES, Nelson K, Reddy A. Identifying Patterns of Primary Care In-Person and Telemedicine Use in the Veterans Health Administration: A Latent Class Analysis. J Gen Intern Med 2024; 39:2241-2248. [PMID: 38619738 PMCID: PMC11347524 DOI: 10.1007/s11606-024-08751-5] [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] [Received: 11/28/2023] [Accepted: 03/29/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The Veterans Health Administration increased synchronous telemedicine (video and telephone visits) in primary care in response to the COVID-19 pandemic. OBJECTIVE Our objective was to determine veteran use patterns of in-person and telemedicine primary care when all modalities were available. DESIGN A retrospective cohort analysis. We performed a latent class analysis of primary care visits over a 1-year period to identify veteran subgroup (i.e., class) membership based on amount of primary care use and modality used. Then, we used multinomial logistic regression with a categorical outcome to identify patient characteristics associated with class identification. PARTICIPANTS A random national sample consisting of 564,580 primary care empaneled veterans in June 2021. MAIN MEASURES Latent class membership. KEY RESULTS We identified three latent classes: those with few primary care visits that were predominantly telephone-based (45%), intermediate number of visits of all modalities (50%), and many visits of all modalities (5%). In an adjusted model, characteristics associated with the "few" visits class, compared to the intermediate class, were older age, male sex, White race, further driving distance to primary care, higher Gagne, optimal internet speed, and unmarried status (OR 1.002, 1.52, 1.13, 1.004, 1.04, 1.05, 1.06, respectively; p < .05). Characteristics associated with membership in the "many" visits class, compared to the intermediate class, were Hispanic race, higher JEN Frailty Index and Gagne (OR 1.12, 1.11, 1.02, respectively; p < .05), and higher comorbidity by Care Assessment Need score quartile (Q2 1.73, Q3 2.80, Q4 4.12; p < 0.05). CONCLUSIONS Veterans accessing primary care in-person or via telemedicine do so primarily in three ways: (1) few visits, predominantly telephone; (2) intermediate visits, all modalities, (3) many visits, all modalities. We found no groups of veterans receiving a majority of primary care through video.
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Affiliation(s)
- Jonathan Staloff
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.
- Department of Family Medicine, University of Washington, Seattle, WA, USA.
| | - Eric Gunnink
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Jorge Rojas
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Edwin S Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Karin Nelson
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ashok Reddy
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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Radford SJ, Abdul-Aema B, Tench C, Leighton P, Coad J, Moran GW. Substantial cost savings of ultrasound-based management over magnetic resonance imaging-based management in an inflammatory bowel disease service. Scand J Gastroenterol 2024; 59:683-689. [PMID: 38501494 DOI: 10.1080/00365521.2024.2330588] [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] [Received: 12/19/2023] [Accepted: 03/08/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Imaging is used to monitor disease activity in small bowel Crohn's disease (CD). Magnetic Resonance Enterography is often employed as a first modality in the United Kingdom for assessment and monitoring; however, waiting times, cost, patient burden and limited access are significant. It is as yet uncertain if small bowel intestinal ultrasound (IUS) may be a quicker, more acceptable, and cheaper alternative for monitoring patients with CD. METHODS A clinical service evaluation of imaging pathways was undertaken at a single NHS site in England, United Kingdom. Data were collected about patients who were referred and underwent an imaging analysis for their IBD. Only patients who underwent a therapy change were included in the analysis. Data were collected from care episodes between 01 January 2021-30 March 2022. RESULTS A combined total of 193 patient care episodes were reviewed, 107 from the IUS pathway and 86 from the MRE pathway. Estimated costs per patient in the IUS pathway was £78.86, and £375.35 per patient in the MRE pathway. The MRE pathway had an average time from referral to treatment initiation of 91 days (SD= ±61) with patients in the IUS pathway waiting an average of 46 days (SD= ±17). CONCLUSIONS Findings from this work indicate that IUS is a potential cost-saving option when compared to MRE when used in the management of CD. This is in addition to the cost difference of the radiological modalities. A large, multicentre, prospective study is needed to validate these initial findings.
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Affiliation(s)
- Shellie J Radford
- Nottingham NIHR Biomedical Research Centre, Nottingham University Hospitals NHS trust and the University of Nottingham, United Kingdom of Great Britain and Northern Ireland
- University of Nottingham, Translational Medical Sciences, School of Medicine, Faculty of Medicine and Health Sciences, United Kingdom of Great Britain and Northern Ireland
| | - Buraq Abdul-Aema
- Nottingham NIHR Biomedical Research Centre, Nottingham University Hospitals NHS trust and the University of Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Chris Tench
- University of Nottingham, Translational Medical Sciences, School of Medicine, Faculty of Medicine and Health Sciences, United Kingdom of Great Britain and Northern Ireland
| | - Paul Leighton
- University of Nottingham, Translational Medical Sciences, School of Medicine, Faculty of Medicine and Health Sciences, United Kingdom of Great Britain and Northern Ireland
| | - Jane Coad
- University of Nottingham, School of Health Sciences, Faculty of Medicine and Health Sciences, United Kingdom of Great Britain and Northern Ireland
| | - Gordon W Moran
- Nottingham NIHR Biomedical Research Centre, Nottingham University Hospitals NHS trust and the University of Nottingham, United Kingdom of Great Britain and Northern Ireland
- University of Nottingham, Translational Medical Sciences, School of Medicine, Faculty of Medicine and Health Sciences, United Kingdom of Great Britain and Northern Ireland
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Resnik J, Miller CJ, Roth CE, Burns K, Bovin MJ. A Systematic Review of the Department of Veterans Affairs Mental Health-Care Access Interventions for Veterans With PTSD. Mil Med 2024; 189:1303-1311. [PMID: 37837200 DOI: 10.1093/milmed/usad376] [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: 02/02/2023] [Revised: 08/23/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Access to mental health care has been a priority area for the U.S. Department of Veterans Affairs (DVA) for decades. Access for veterans with PTSD is essential because untreated PTSD is associated with numerous adverse outcomes. Although interventions have been developed to improve access to DVA mental health care, the impact of these interventions on access for veterans with untreated PTSD has not been examined comprehensively, limiting guidance on appropriate implementation. MATERIALS AND METHODS We conducted a systematic review of PubMed and PTSDpubs between May 2019 and January 2022 to identify DVA access interventions for veterans with PTSD not engaged in DVA mental health care. We identified 17 interventions and 29 manuscripts reporting quantitative access outcomes. We categorized interventions into four major categories: Primary care mental health integration, other national initiatives, telemental health, and direct outreach. We evaluated five outcome domains: Binary attendance, number of sessions attended, wait time, number of patients seen, and care initiation. We assessed the risk of bias using the Cochrane Collaboration criteria. RESULTS Across articles, binary attendance generally improved, whereas the impact on the number of sessions attended was equivocal. Overall, the number of patients seen increased compared to control participants and retrospective data. The few articles that examined care initiation had mixed results. Only one article examined the impact on wait time. CONCLUSIONS Access interventions for veterans with PTSD demonstrated varied success across interventions and outcomes. The national initiatives-particularly primary care mental health integration -were successful across several outcomes; telemental health demonstrated promise in improving access; and the success of direct outreach varied across interventions. Confidence in these findings is tempered by potential bias among studies. Limited literature on how these interventions impact relevant preattendance barriers, along with incomplete data on how many perform nationally, suggests that additional work is needed to ensure that these interventions increase access for veterans with PTSD nationwide.
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Affiliation(s)
- Jack Resnik
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA 02130, USA
| | - Christopher J Miller
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Clara E Roth
- VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA
- Boston VA Research Institute (BVARI), Boston, MA 02130, USA
| | - Katharine Burns
- VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA
- Emmanuel College, Boston, MA 02115, USA
| | - Michelle J Bovin
- VA Boston Healthcare System, National Center for PTSD (116B-2), Boston, MA 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
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Toal-Sullivan D, Dahrouge S, Tesfaselassie J, Olejnik L. Access to primary health care: perspectives of primary care physicians and community stakeholders. BMC PRIMARY CARE 2024; 25:152. [PMID: 38711025 PMCID: PMC11071188 DOI: 10.1186/s12875-024-02312-9] [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: 07/10/2023] [Accepted: 02/15/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Action on the social determinants of health is important to strengthen primary health care and promote access among underserved populations. We report on findings from stakeholder consultations undertaken at one of the Canadian sites of the Innovative Models Promoting Access-to-Care Transformation (IMPACT) program, as part of the development of a best practice intervention to improve access to primary health care. The overarching objective of this qualitative study was to understand the processes, barriers, and facilitators to connect patients to health enabling community resources (HERs) to inform a patient navigation model situated in primary care. METHODS Focus groups and interviews were conducted with primary care physicians, and community health and social service providers to understand their experiences in supporting patients in reaching HERs. Current gaps in access to primary health care and the potential of patient navigation were also explored. We applied Levesque et al., (2013) access framework to code the data and four themes emerged: (1) Approachability and Ability to Perceive, (2) Acceptability and Ability to Seek, (3) Availability and Accommodation, and Ability to Reach, and (4) Appropriateness. RESULTS Determinants of access included patient and provider awareness of HERs, the nature of the patient-provider relationship, funding of HERs, integration of primary and community care services, and continuity of information. Participants' perspectives about the potential scope and role of a patient navigator provided valuable insight for the development of the Access to Resources in the Community (ARC) navigation model and how it could be embedded in a primary care setting. CONCLUSION Additional consultation with key stakeholders in the health region is needed to gain a broader understanding of the challenges in caring for primary care patients with social barriers and how to support them in accessing community-based primary health care to inform the design of the ARC intervention.
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Affiliation(s)
- Darene Toal-Sullivan
- C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Canada
| | | | | | - Laura Olejnik
- Hamilton Health Sciences, McMaster University, Hamilton, Canada
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Hooley C, Adams DR, Ng WY, Wendt CLE, Dennis CB. Key actors in behavioral health services availability and accessibility research: a scoping review bibliometric analysis. DISCOVER MENTAL HEALTH 2024; 4:15. [PMID: 38700757 PMCID: PMC11068714 DOI: 10.1007/s44192-024-00068-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
This bibliometric review aims to identify key actors in the behavioral health services availability/accessibility literature. Coalescing information about these actors could support subsequent research efforts to improve the availability and accessibility of behavioral health services. The authors used a scoping review method and a bibliometric approach. The articles came from Medline, Embase, Web of Science, CINAHL, and PsycINFO. Articles were included if they assessed behavioral health service availability or accessibility quantitatively and were written in English. The final sample included 265 articles. Bibliometric data were extracted, coded, and verified. The authors analyzed the data using univariate and social network analyses. Publishing in this area has become more consistent and has grown since 2002. Psychiatric Services and Graduate Theses were the most frequently used publication venues. The National Institute on Drug Abuse, National Institute of Mental Health, and the Veterans Administration funded the most research. The most frequently used keyword was "health services accessibility." The findings suggest that this literature is growing. There are a few clusters of researchers in this area. Government organizations primarily fund this research. The paper and supplementary materials list the top researchers, publication venues, funding sources, and key terms to promote further behavioral health availability/accessibility research.
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Affiliation(s)
- Cole Hooley
- School of Social Work Brigham Young University, 2190 JFSB, Provo, UT, 84602, USA.
| | - Danielle R Adams
- Center for Mental Health Services Research Brown School of Social Work and Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Wai Yan Ng
- School of Social Work Brigham Young University, 2190 JFSB, Provo, UT, 84602, USA
| | - Carrie L E Wendt
- School of Social Work Brigham Young University, 2190 JFSB, Provo, UT, 84602, USA
| | - Cory B Dennis
- School of Social Work Brigham Young University, 2190 JFSB, Provo, UT, 84602, USA
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Ali M, Sullivan G. Racial Differences in Expanded Telemedicine Use During COVID-19: A Literature Review. Telemed J E Health 2024; 30:1394-1400. [PMID: 38064549 DOI: 10.1089/tmj.2023.0370] [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: 05/04/2024] Open
Abstract
Background: The COVID-19 pandemic prompted the widespread adoption of telemedicine to deliver health care services while minimizing in-person contact. However, concerns persist regarding equitable access to telemedicine, especially for vulnerable populations. This study examines the utilization patterns of telemedicine by race in the United States, considering different modalities, medical specialties, and geographic regions. Methods: A comprehensive review of 26 articles published between January 2020 and August 2022 was conducted to analyze racial disparities in telemedicine use during the pandemic. Data from electronic health records and self-reported race were compiled for analysis. Variations based on geography, clinical care types, telemedicine modalities (audio or video), and study design were explored. Results: The findings indicate the presence of racial disparities in telemedicine utilization, with minority groups exhibiting lower usage rates compared with Whites. The location of outpatient clinics and clinical care types did not significantly influence telemedicine use by race. Among studies comparing telemedicine modalities, African Americans were more likely to choose audio/phone visits over video visits. Studies employing a pre-post design were less likely to identify disparities in telemedicine use by race. Conclusions: This study consistently demonstrates increasing racial disparities in telemedicine use. Future research should focus on identifying contributing factors and developing strategies to address these disparities. Policymakers should consider implementing initiatives promoting equitable access to telemedicine, including financial assistance, improved broadband infrastructure, and digital literacy programs. By addressing these barriers, telemedicine can play a crucial role in reducing health care disparities and improving access to care for all Americans.
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Affiliation(s)
- Mohab Ali
- Center for Health services Research, Psychiatric Research Institute University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Greer Sullivan
- Center for Health services Research, Psychiatric Research Institute University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Anawade PA, Sharma D, Gahane S. A Comprehensive Review on Exploring the Impact of Telemedicine on Healthcare Accessibility. Cureus 2024; 16:e55996. [PMID: 38618307 PMCID: PMC11009553 DOI: 10.7759/cureus.55996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
Telemedicine has emerged as a transformative force in healthcare delivery, particularly in improving healthcare accessibility. This comprehensive review examines the impact of telemedicine on healthcare accessibility, exploring its ability to overcome geographical, financial, sociocultural, and infrastructural barriers to healthcare access. Through remote consultations, monitoring, and diagnosis facilitated by technology, telemedicine extends healthcare reach to remote and underserved areas while enhancing temporal accessibility with round-the-clock availability. By streamlining healthcare delivery systems, telemedicine reduces costs and promotes efficiency, ultimately fostering health equity and improving health outcomes. However, technological barriers, regulatory hurdles, and patient acceptance remain. To realize telemedicine's full potential, collaboration among stakeholders in the healthcare and technology sectors is imperative. Policymakers must enact supportive regulations, healthcare providers must integrate telemedicine into their practices, and technology companies must innovate to develop user-friendly platforms. Through concerted efforts, telemedicine can catalyze advancing healthcare accessibility and enhance the health and well-being of individuals worldwide.
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Affiliation(s)
- Pankajkumar A Anawade
- Management, School of Allied Sciences, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Deepak Sharma
- Management, School of Allied Sciences, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shailesh Gahane
- Science and Technology, School of Allied Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Laird B, Zuniga S, Hook JN, Van Tongeren DR, Joeman L, Huberty J. Mental Health and Well-Being in Racial or Ethnic Minority Individuals After Using a Faith and Prayer Mobile App (Pray.com): Feasibility and Preliminary Efficacy Trial. JMIR Form Res 2024; 8:e52560. [PMID: 38306173 PMCID: PMC10873801 DOI: 10.2196/52560] [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: 09/07/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Research is needed on how faith and prayer apps fit within the values of racial and ethnic minority (REM) groups, as well as whether such apps are effective in promoting mental health and well-being. OBJECTIVE This study aims to determine the feasibility and preliminary effectiveness of using the mobile app Pray.com on mental health and well-being among REM participants. METHODS This study was a single-group (N=77), 4-week feasibility trial in REM groups (65/77, 84% Black or African American). Participants were asked to use the Pray.com app at no cost for at least 5 times per week for 5 minutes per day. Participants completed questionnaires at the baseline and postintervention time points. Feasibility questionnaires were only completed at the postintervention time point, including qualitative interviews (n=15). The feasibility questions included acceptability (ie, satisfaction, intent to continue use, perceived appropriateness, and fit within culture), demand (ie, self-reported app use, expressed interest, and perceived demand), and practicality (ie, ease or difficulty of use, ability to use the app, and cost-effectiveness). Frequency and descriptive statistics were used to analyze feasibility outcomes. Changes in dependent variables were analyzed using paired-sample 2-tailed t tests. Partial correlations were conducted to explore the association between app use and outcomes, controlling for baseline scores. RESULTS Participants reported (54/72, 75% responded with "very likely" or "likely" to the feasibility questions) that they perceived the Pray.com app as acceptable. These findings were supported by qualitative interviews (n=15). Most participants (62/72, 86%) did not meet the app use prescription but expressed interest in using the app in the future and perceived demand for it in their communities. In addition, participants reported that the app was easy to use and perceived it to be inexpensive (US $7.99). Participants reported improved mental health (ie, stress and depressive and anxiety symptoms) and well-being (ie, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development) at postintervention despite relatively low average levels and high variability of app use (average total of 45.83, SD 111.90 min over the course of the study). Greater app use was significantly associated with improvements in mental health and spiritual well-being. However, app use and study methodology limitations suggest that the study results may not accurately capture the full impact of Pray.com use. CONCLUSIONS This is the first study to assess the feasibility of a faith and prayer app for mental health and well-being in a sample of REM individuals. Our findings suggest that the use of a faith and prayer app (ie, Pray.com) could be feasible and significantly impactful for the improvement of mental health symptoms and well-being in REM individuals and their communities, especially Black and African American individuals with a Christian affiliation. Further research is warranted.
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Affiliation(s)
| | - Sabrina Zuniga
- Department of Psychology, University of North Texas, Denton, TX, United States
| | - Joshua N Hook
- Department of Psychology, University of North Texas, Denton, TX, United States
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Wray CM, Myers U, Slightam C, Dardashti N, Heyworth L, Lewinski A, Kaboli P, Edes T, Trueman K, Zulman DM. Research Priorities to Expand Virtual Care Access for Patients in the Veterans Affairs Health Care System. J Gen Intern Med 2024; 39:14-20. [PMID: 38252237 PMCID: PMC10937889 DOI: 10.1007/s11606-023-08463-2] [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: 04/27/2023] [Accepted: 10/06/2023] [Indexed: 01/23/2024]
Abstract
The rapid expansion of virtual care is driving demand for equitable, high-quality access to technologies that are required to utilize these services. While the Department of Veterans Affairs (VA) is seen as a national leader in the implementation of telehealth, there remain gaps in evidence about the most promising strategies to expand access to virtual care. To address these gaps, in 2022, the VA's Health Services Research and Development service and Office of Connected Care held a "state-of-the-art" (SOTA) conference to develop research priorities for advancing the science, clinical practice, and implementation of virtual care. One workgroup within the SOTA focused on access to virtual care and addressed three questions: (1) Based on the existing evidence about barriers that impede virtual care access in digitally vulnerable populations, what additional research is needed to understand these factors? (2) Based on the existing evidence about digital inclusion strategies, what additional research is needed to identify the most promising strategies? and (3) What additional research beyond barriers and strategies is needed to address disparities in virtual care access? Here, we report on the workgroup's discussions and recommendations for future research to improve and optimize access to virtual care. Effective implementation of these recommendations will require collaboration among VA operational leadership, researchers, Human Factors Engineering experts and front-line clinicians as they develop, implement, and evaluate the spread of virtual care access strategies.
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Affiliation(s)
- Charlie M Wray
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Ursula Myers
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Mental Health Service Line, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Military Sciences Division, Medical University of South Carolina, Charleston, SC, USA
| | - Cindie Slightam
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
| | | | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, Washington, DC, USA
| | - Allison Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- School of Nursing, Duke University School of Medicine, Durham, NC, USA
| | - Peter Kaboli
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Thomas Edes
- Office of Geriatrics & Extended Care, Department of Veterans Affairs, Washington, DC, USA
| | - Kevin Trueman
- Department of Veterans Affairs, Independence, OH, USA
| | - Donna M Zulman
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Tisdale R, Der-Martirosian C, Yoo C, Chu K, Zulman D, Leung L. Disparities in Video-Based Primary Care Use Among Veterans with Cardiovascular Disease. J Gen Intern Med 2024; 39:60-67. [PMID: 38252244 PMCID: PMC10937859 DOI: 10.1007/s11606-023-08475-y] [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: 04/20/2023] [Accepted: 10/11/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Cardiovascular disease (CVD) is prevalent among Veterans, and video care enhances access to CVD care. However, it is unknown which patients with CVD conditions receive video care in primary care clinics, where a large proportion of CVD services is delivered. OBJECTIVE Characterize use of VA video primary care for Veterans with two common CVDs, heart failure and hypertension. DESIGN Retrospective cohort study. PATIENTS Veterans seen in VA primary care with diagnoses of heart failure and/or hypertension in the year prior to the COVID-19 pandemic and for the first two pandemic-years. MAIN MEASURES The primary outcome was use of any video-based primary care visits. Using multilevel regressions, we examined the association between video care use and patient sociodemographic and clinical characteristics, controlling for time and adjusting for patient- and site-level clustering. KEY RESULTS Of 3.8M Veterans with 51.9M primary care visits, 456,901 Veterans had heart failure and hypertension, 50,753 had heart failure only, and 3,300,166 had hypertension only. Veterans with heart failure and hypertension had an average age of 71.6 years. 2.9% were female, and 34.8% lived in rural settings. Patients who were male, aged 75 or older, or rural-dwelling had lower odds of using video care than female patients, 18-44-year-olds, and urban-dwellers, respectively (male patients' adjusted odds ratio [AOR] 0.73, 95% confidence interval [CI] 0.72-0.74; 75 years or older, AOR 0.38, 95% CI 0.37-0.38; rural-dwellers, AOR 0.71, 95% CI 0.70-0.71). Veterans with heart failure had higher odds of video care use than those with hypertension only (AOR 1.05, 95% CI 1.04-1.06). CONCLUSIONS Given lower odds of video primary care use among some patient groups, continued expansion of video care could make CVD services increasingly inequitable. These insights can inform equitable triage of patients, for example by identifying patients who may benefit from additional support to use virtual care.
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Affiliation(s)
- Rebecca Tisdale
- Veterans Affairs Palo Alto Healthcare System/Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA.
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
| | - Claudia Der-Martirosian
- Veterans Affairs Greater Los Angeles Healthcare System/Center for the Study of Healthcare Innovation, Implementation, & Policy (CSHIIP), Los Angeles, CA, USA
| | - Caroline Yoo
- Veterans Affairs Greater Los Angeles Healthcare System/Center for the Study of Healthcare Innovation, Implementation, & Policy (CSHIIP), Los Angeles, CA, USA
| | - Karen Chu
- Veterans Affairs Greater Los Angeles Healthcare System/Center for the Study of Healthcare Innovation, Implementation, & Policy (CSHIIP), Los Angeles, CA, USA
- Veterans Emergency Management Evaluation Center (VEMEC), North Hills, CA, USA
| | - Donna Zulman
- Veterans Affairs Palo Alto Healthcare System/Center for Innovation to Implementation (Ci2i), Palo Alto, CA, USA
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Lucinda Leung
- Veterans Affairs Greater Los Angeles Healthcare System/Center for the Study of Healthcare Innovation, Implementation, & Policy (CSHIIP), Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine & Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Gray C, Egelfeld J, Vashi A. Access to and accessibility of care for rural Veterans with disabilities: A qualitative evaluation of VA healthcare experiences. Disabil Health J 2024; 17:101515. [PMID: 37620242 DOI: 10.1016/j.dhjo.2023.101515] [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: 03/08/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Persons with disabilities experience significant physical, attitudinal, and communication-based barriers to accessing care. These challenges are exacerbated for rural-dwelling persons with disabilities. Although US Veterans experience disabilities at a higher rate than non-Veterans and are also more likely to dwell in rural locations, research examining the accessibility of VA care for rural Veterans with disabilities is limited. OBJECTIVES With a focus on access and accessibility, we sought to explore the experiences of rural Veterans with disabilities who receive care at VA. METHODS We conducted 30 qualitative interviews with rural-dwelling Veterans who experience at least one of three types of disabilities: hearing loss, vision loss, and mobility loss. Using a descriptive qualitative approach, we focused on creating a taxonomy of potential access barriers experienced among this population. RESULTS Participants reported experiencing access barriers in five main areas, including policies and operational processes at VA clinics; navigating VA campuses and clinics; limited transportation and parking options; communicating with healthcare personnel and occasional negative interactions; and challenges due to pandemic-related changes in policies and procedures. CONCLUSION These findings suggest that Veterans with disabilities may experience a host of challenges and access barriers while navigating the VA Healthcare system. While these challenges have been reported among individuals with disabilities receiving care in other healthcare settings, they have not been assessed in VA specifically. Given its focus on caring for Veterans with service-aggravated conditions and its commitment to equity and inclusion, addressing access barriers among Veterans with disabilities should be a high priority for VA.
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Affiliation(s)
- Caroline Gray
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA; 795 Willow Rd., C-102, Menlo Park, CA 94025, USA.
| | - Jacqueline Egelfeld
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA; 795 Willow Rd., Menlo Park, CA 94025, USA.
| | - Anita Vashi
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, CA, USA; 795 Willow Rd., Menlo Park, CA 94025, USA; Department of Emergency Medicine, University of California, 505 Parnassus Ave, San Francisco, CA 94143, USA.
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14
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Hawkins EJ, Lott AM, Danner AN, Malte CA, Dulin P, Fortney J, Sayre GG, Baer JS. U.S. veterans' experiences and factors associated with use of a smartphone application to self-manage unhealthy alcohol use. Psychol Serv 2023; 20:908-917. [PMID: 36227298 PMCID: PMC10097825 DOI: 10.1037/ser0000716] [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: 11/08/2022]
Abstract
Unhealthy alcohol use is common among Operations Enduring and Iraqi Freedom (OEF/OIF) veterans, yet barriers discourage treatment-seeking. Mobile applications (apps) that deliver alcohol interventions have potential to address these barriers and increase treatment receipt. Few studies have qualitatively assessed users' experiences with apps to manage alcohol use. We assessed OEF/OIF veterans' experiences with Step Away, an app to reduce alcohol-related risks, to identify factors that may influence engagement. This single-arm pilot study recruited OEF/OIF veterans with positive alcohol screens nationwide using mail/telephone. Veterans aged 18-55 who exceeded drinking guidelines and owned an iPhone were eligible. Twenty-one (16 men, 5 women) of 55 participants completed interviews. Interviews were analyzed using thematic analysis. Participants found Step Away easy to use, although setup was time consuming. Participants reported increased awareness of alcohol use, highlighting daily assessment, weekly feedback, goal setting, and high-risk notification features as helpful and associated awareness with an intent to decrease use. Participants described Step Away as informative, with over half reporting they would use it outside of the study and most recommending it. Suggestions for improvement included greater personalization and control over features. Step Away features appear to influence engagement and increase users' awareness about alcohol consumed and factors associated with drinking, as well as intent to change. Assessment, feedback, and customization features of apps may facilitate app engagement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Eric J. Hawkins
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Aline M. Lott
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Anissa N. Danner
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Carol A. Malte
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA, United States
| | - Patrick Dulin
- Department of Psychology, University of Alaska Anchorage, Anchorage, AK, United States
| | - John Fortney
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - George G. Sayre
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States
- Department of Health Services, University of Washington, Seattle, WA, United States
| | - John S. Baer
- Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, WA, United States
- Department of Psychology, University of Washington, Seattle, WA, United States
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15
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Rose DE, Leung LB, McClean M, Nelson KM, Curtis I, Yano EM, Rubenstein LV, Stockdale SE. Associations Between Primary Care Providers and Staff-Reported Access Management Challenges and Patient Perceptions of Access. J Gen Intern Med 2023; 38:2870-2878. [PMID: 37532877 PMCID: PMC10593665 DOI: 10.1007/s11606-023-08172-w] [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: 06/20/2022] [Accepted: 03/13/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND/OBJECTIVE Optimizing patients' access to primary care is critically important but challenging. In a national survey, we asked primary care providers and staff to rate specific care processes as access management challenges and assessed whether clinics with more of these challenges had worse access outcomes. METHODS Study design: Cross sectional. National Primary Care Personnel Survey (NPCPS) (2018) participants included 6210 primary care providers (PCPs) and staff in 813 clinics (19% response rate) and 158,645 of their patients. We linked PCP and staff ratings of access management challenges to veterans' perceived access from 2018-2019 Survey of Healthcare Experiences of Patients-Patient Centered Medical Home (SHEP-PCMH) surveys (35.6% response rate). MAIN MEASURES The NPCPS queried PCPs and staff about access management challenges. The mean overall access challenge score was 28.6, SD 6.0. The SHEP-PCMH access composite asked how often veterans reported always obtaining urgent appointments same/next day; routine appointments when desired and having medical questions answered during office hours. ANALYTIC APPROACH We aggregated PCP and staff responses to clinic level, and use multi-level, multivariate logistic regressions to assess associations between clinic-level access management challenges and patient perceptions of access. We controlled for veteran-, facility-, and area-level characteristics. KEY RESULTS Veterans at clinics with more access management challenges (> 75th percentile) had a lower likelihood of reporting always receiving timely urgent care appointments (AOR: .86, 95% CI: .78-.95); always receiving routine appointments (AOR: .74, 95% CI: .67-.82); and always reporting same- or next-day answers to telephone questions (AOR: .79, 95% CI: .70-.90) compared to veterans receiving care at clinics with fewer (< 25th percentile) challenges. DISCUSSION/CONCLUSION Findings show a strong relationship between higher levels of access management challenges and worse patient perceptions of access. Addressing access management challenges, particularly those associated with call center communication, may be an actionable path for improved patient experience.
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Affiliation(s)
- Danielle E Rose
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Lucinda B Leung
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael McClean
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Karin M Nelson
- VA Puget Sound Healthcare System, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | | | - Elizabeth M Yano
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Lisa V Rubenstein
- Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Fielding School of Public Health, UCLA, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Susan E Stockdale
- VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
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16
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Iyer SS, Ngo V, Humber MB, Chen P, Pallaki M, Dolinar T, Brodrick MFB, Gould CE, Trivedi RB. Caregiver Experience of Tele-dementia Care for Older Veterans. J Gen Intern Med 2023; 38:2960-2969. [PMID: 37131102 PMCID: PMC10153773 DOI: 10.1007/s11606-023-08188-2] [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: 12/12/2022] [Accepted: 03/22/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND For the 5 million persons living with dementia (PLWD) in the USA, telemedicine may improve access to specialty care from their homes. OBJECTIVE To elicit informal caregiver perceptions of tele-dementia care provided during COVID-19. DESIGN Qualitative, observational study using grounded theory. PARTICIPANTS Informal caregivers aged 18 + who cared for an older adult who received tele-dementia services at two major VA healthcare systems participated in 30-60-min semi-structured telephone interviews. INTERVENTIONS Interviews were designed using Fortney's Access to Care model. MAIN MEASURES Thirty caregivers (mean age = 67, SD = 12, 87% women) were interviewed. KEY RESULTS Five major themes were (1) Tele-dementia care avoids routine disruption and pre-visit stress; (2) Transportation barriers to in-person visits include not only travel logistics but navigating the sequelae of dementia and comorbid medical conditions. These include cognitive, behavioral, physical, and emotional challenges such as balance issues, incontinence, and agitation in traffic; (3) Tele-dementia care saves time and money and improves access to specialists; (4) Tele-dementia facilitated communication between caregiver and provider without hindering communication between PLWD and provider; and (5) Caregivers described ideal future dementia care as a combination of virtual and in-person modalities with in-home help, financial and medical support, and dementia-sensitive caregiver access. Caregivers interviewed saved 2.6 h ± 1.5 h (range: 0.5 to 6 h) of travel time. Multiple caregivers described disruption of routines as difficult in PLWD and appreciated the limited preparation and immediate return to routine post telemedicine visit as positives. CONCLUSIONS Caregivers found tele-dementia care convenient, comfortable, stress reducing, timesaving, and highly satisfactory. Caregivers would prefer a combination of in-person and telemedicine visits, with an opportunity to communicate with providers privately. This intervention prioritizes care for older Veterans with dementia who have high care needs and are at higher risk for hospitalization than their same age counterparts without dementia.
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Affiliation(s)
- Sowmya S Iyer
- Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.
- Division of Primary Care and Population Health, Geriatrics Section, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Victoria Ngo
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Health Services Research & Development, U.S. Department of Veteran Affairs, Palo Alto, CA, USA
- Department of Health Policy, Freeman Spogli Institute & Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marika Blair Humber
- Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Peijun Chen
- Geriatric Research, Education, and Clinical Center, VA Northeast Ohio Health Care System, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Muralidhar Pallaki
- Geriatric Research, Education, and Clinical Center, VA Northeast Ohio Health Care System, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Teresa Dolinar
- Geriatric Research, Education, and Clinical Center, VA Northeast Ohio Health Care System, Cleveland, OH, USA
| | | | - Christine E Gould
- Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ranak B Trivedi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, San Francisco, CA, USA
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Mathias H, Rohatinsky N, Murthy SK, Novak K, Kuenzig ME, Nguyen GC, Fowler S, Benchimol EI, Coward S, Kaplan GG, Windsor JW, Bernstein CN, Targownik LE, Peña-Sánchez JN, Lee K, Ghandeharian S, Jannati N, Weinstein J, Khan R, Im JHB, Matthews P, Davis T, Goddard Q, Gorospe J, Latos K, Louis M, Balche N, Dobranowski P, Patel A, Porter LJ, Porter RM, Bitton A, Jones JL. The 2023 Impact of Inflammatory Bowel Disease in Canada: Access to and Models of Care. J Can Assoc Gastroenterol 2023; 6:S111-S121. [PMID: 37674496 PMCID: PMC10478809 DOI: 10.1093/jcag/gwad007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Rising compounding prevalence of inflammatory bowel disease (IBD) (Kaplan GG, Windsor JW. The four epidemiological stages in the global evolution of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol. 2021;18:56-66.) and pandemic-exacerbated health system resource limitations have resulted in significant variability in access to high-quality, evidence-based, person-centered specialty care for Canadians living with IBD. Individuals with IBD have identified long wait times, gaps in biopsychosocial care, treatment and travel expenses, and geographic and provider variation in IBD specialty care and knowledge as some of the key barriers to access. Care delivered within integrated models of care (IMC) has shown promise related to impact on disease-related outcomes and quality of life. However, access to these models is limited within the Canadian healthcare systems and much remains to be learned about the most appropriate IMC team composition and roles. Although eHealth technologies have been leveraged to overcome some access challenges since COVID-19, more research is needed to understand how best to integrate eHealth modalities (i.e., video or telephone visits) into routine IBD care. Many individuals with IBD are satisfied with these eHealth modalities. However, not all disease assessment and monitoring can be achieved through virtual modalities. The need for access to person-centered, objective disease monitoring strategies, inclusive of point of care intestinal ultrasound, is more pressing than ever given pandemic-exacerbated restrictions in access to endoscopy and cross-sectional imaging. Supporting learning healthcare systems for IBD and research relating to the strategic use of innovative and integrative implementation strategies for evidence-based IBD care interventions are greatly needed. Data derived from this research will be essential to appropriately allocating scarce resources aimed at improving person-centred access to cost-effective IBD care.
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Affiliation(s)
- Holly Mathias
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Kerri Novak
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Geoffrey C Nguyen
- Mount Sinai IBD Centre of Excellence, Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sharyle Fowler
- Department of Gastroenterology and Hepatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Coward
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | - Nazanin Jannati
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rabia Khan
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Quinn Goddard
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kate Latos
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | - Naji Balche
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | - Ashley Patel
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | | | | | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Manuel JK, Purcell N, Abadjian L, Cardoos S, Yalch M, Hill C, McCarthy B, Bertenthal D, McGrath S, Seal K. Virtual Worlds Technology to Enhance Training for Primary Care Providers in Assessment and Management of Posttraumatic Stress Disorder Using Motivational Interviewing: Pilot Randomized Controlled Trial. JMIR MEDICAL EDUCATION 2023; 9:e42862. [PMID: 37639299 PMCID: PMC10495852 DOI: 10.2196/42862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/10/2023] [Accepted: 06/16/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Many individuals with posttraumatic stress disorder (PTSD) first present to primary care rather than specialty mental health care. Primary care providers often lack the training required to assess and treat patients with PTSD. Virtual trainings have emerged as a convenient and effective way of training primary care providers in PTSD assessment and communication methods (ie, motivational interviewing [MI]). OBJECTIVE The aim of this study was to conduct a pilot randomized controlled trial of a synchronous Virtual Worlds (VW; a virtual world where learners were immersed as avatars) training versus an asynchronous web-based training on PTSD and MI, comparing the feasibility, acceptability, usability, and preliminary efficacy of 2 different training platforms among primary care providers. METHODS Participating primary care providers were randomized to a VW and a web-based PTSD training. Outcomes were collected at baseline, posttraining, and 90-days follow-up. Standardized patient interviews measured participants' communication skills in assessing and managing patients with PTSD symptoms. RESULTS Compared to the web-based training, the VW training platform achieved larger learning gains in MI (ie, partnership and empathy) and in discussing pharmacotherapy and psychotherapy for PTSD. Both VW and web-based trainings led to increases in PTSD knowledge and primary care providers' self-confidence. CONCLUSIONS The asynchronous web-based PTSD training improved PTSD-related knowledge and self-confidence but was not as effective as the VW immersive experience in teaching MI or clinical management. Because VW training is synchronous and new for many learners, it required more time, facilitation, and technical support. As computer technology improves, VW educational interventions may become more feasible, particularly in teaching clinical skills. TRIAL REGISTRATION ClinicalTrials.gov NCT03898271; https://tinyurl.com/mu479es5.
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Affiliation(s)
- Jennifer K Manuel
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Natalie Purcell
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Linda Abadjian
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Stephanie Cardoos
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Matthew Yalch
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
| | - Coleen Hill
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Brittan McCarthy
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel Bertenthal
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Sarah McGrath
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
| | - Karen Seal
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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19
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Pham TV, Doorley J, Kenney M, Joo JH, Shallcross AJ, Kincade M, Jackson J, Vranceanu AM. Addressing chronic pain disparities between Black and White people: a narrative review of socio-ecological determinants. Pain Manag 2023; 13:473-496. [PMID: 37650756 PMCID: PMC10621777 DOI: 10.2217/pmt-2023-0032] [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: 03/27/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
A 2019 review article modified the socio-ecological model to contextualize pain disparities among different ethnoracial groups; however, the broad scope of this 2019 review necessitates deeper socio-ecological inspection of pain within each ethnoracial group. In this narrative review, we expanded upon this 2019 article by adopting inclusion criteria that would capture a more nuanced spectrum of socio-ecological findings on chronic pain within the Black community. Our search yielded a large, rich body of literature composed of 174 articles that shed further socio-ecological light on how chronic pain within the Black community is influenced by implicit bias among providers, psychological and physical comorbidities, experiences of societal and institutional racism and biomedical distrust, and the interplay among these factors. Moving forward, research and public-policy development must carefully take into account these socio-ecological factors before scaling up pre-existing solutions with questionable benefit for the chronic pain needs of Black individuals.
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Affiliation(s)
- Tony V Pham
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - James Doorley
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Martha Kenney
- Department of Anesthesiology, Duke University Medical Centre, Durham, NC 27710, USA
| | - Jin Hui Joo
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amanda J Shallcross
- Wellness & Preventative Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Michael Kincade
- Center for Alzheimer's Research & Treatment, Massachusetts Alzheimer's Disease Research Centre, Boston, MA 02129, USA
| | - Jonathan Jackson
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
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20
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Hilgeman MM, Lange TM, Bishop T, Cramer RJ. Spreading pride in all who served: A health education program to improve access and mental health outcomes for sexual and gender minority veterans. Psychol Serv 2023; 20:596-608. [PMID: 35113622 PMCID: PMC10189955 DOI: 10.1037/ser0000604] [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] [Indexed: 11/08/2022]
Abstract
Access to effective, replicable services is critical to reduce known mental health disparities for sexual and gender minority or LGBTQ+ veterans (lesbian, gay, bisexual, transgender, queer, questioning, and related identities). This paper examines the impact of a manualized 10-week health education group, called PRIDE in All Who Served on veteran patient experience, protective factors (e.g., identity acceptance), and mental health outcomes (e.g., suicide risk) at 10 Department of Veterans Affairs (VA) facilities. Implementation facilitation strategies (e.g., consultation, staff training) supported adoption at new sites and initial facilitators and barriers are described. Forty-four veterans (M = 47.21 years old) completed outcome surveys before and after the group. Significant improvement in acceptance concerns, identity uncertainty, community involvement, and likelihood of future suicide attempts were observed; other changes in mental health symptoms were not replicated in this sample (e.g., depression, anxiety). Open-ended veteran feedback reflected improved social support and engagement and increased self-understanding as the most frequent themes. At the facility level, Healthcare Equality Index scores (a Human Rights Campaign measure of affirmative care climate) improved from 30% to 90% achieving top-performer/leader status from pre- to postimplementation. Manualized approaches, like PRIDE in All Who Served, that are based on established minority stress models and can be spread for use with diverse LGBTQ+ veterans (e.g., age, race, gender identity, sexual orientation, rurality, housing) are needed. The PRIDE in All Who Served program is an increasingly available resource to VA clinicians advocating for greater health equity within a national healthcare setting. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Michelle M. Hilgeman
- Research & Development Service (151), Tuscaloosa VA Medical Center, 3701 Loop Rd., Tuscaloosa, AL 35404
- Psychology Department & Alabama Research Institute on Aging, University of Alabama, Tuscaloosa, AL 35487
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | | | - Teddy Bishop
- Research & Development Service (151), Tuscaloosa VA Medical Center, 3701 Loop Rd., Tuscaloosa, AL 35404
| | - Robert J. Cramer
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223
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21
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Loup J, Smith K, Snow AL, Hilgeman MM. Illustrating Resource Needs through Data Visualization: Creation of Life-Space Maps for Rural Veterans with Dementia and their Caregivers. J Appl Gerontol 2023; 42:1631-1641. [PMID: 36812462 DOI: 10.1177/07334648231159084] [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: 02/24/2023] Open
Abstract
Rural-dwelling individuals with dementia and their caregivers face unique challenges compared to urban-dwelling peers. Barriers to accessing services and supports are common, and individual resources and informal networks available to support rural families can be difficult to track for providers and healthcare systems outside of the local community. This study uses qualitative data from rural-dwelling dyads, individuals with dementia (n = 12) and informal caregivers (n = 18), to demonstrate how rural patients' daily life needs can be summarized through life-space map visualizations. Thirty semi-structured qualitative interviews were analyzed using a two-step process. First, rapid qualitative analysis was completed to generate daily-life needs of the participants' home and community context. Next, life-space maps were developed to synthesize and visualize dyads' met and unmet needs. Results suggest life-space mapping may offer a pathway for improved needs-based information integration for busy care providers and time-sensitive quality improvement efforts by learning healthcare systems.
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Affiliation(s)
- Julia Loup
- Department of Psychology, The University of Alabama System, Tuscaloosa, AL, USA
- Alabama Research Institute on Aging, The University of Alabama System, Tuscaloosa, AL, USA
- Research and Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
| | - Kate Smith
- Department of Psychology, The University of Alabama System, Tuscaloosa, AL, USA
- Alabama Research Institute on Aging, The University of Alabama System, Tuscaloosa, AL, USA
| | - A Lynn Snow
- Department of Psychology, The University of Alabama System, Tuscaloosa, AL, USA
- Alabama Research Institute on Aging, The University of Alabama System, Tuscaloosa, AL, USA
- Research and Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
| | - Michelle M Hilgeman
- Department of Psychology, The University of Alabama System, Tuscaloosa, AL, USA
- Alabama Research Institute on Aging, The University of Alabama System, Tuscaloosa, AL, USA
- Research and Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
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22
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Dodge JR, Youles B, Caldararo J, Sears ED, Caverly TJ, Michael Ho P, Shimada SL, Kaboli P, Albright K, Robinson SA, McNeal DM, Damschroder L, Saini SD, Adams MA. Engaging Operational Partners Is Critical for Successful Implementation of Research Products: a Coincidence Analysis of Access-Related Projects in the Veterans Affairs Healthcare System. J Gen Intern Med 2023; 38:923-930. [PMID: 37340262 PMCID: PMC10356702 DOI: 10.1007/s11606-023-08115-5] [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: 06/17/2022] [Accepted: 02/24/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND/OBJECTIVE The Veterans Health Administration (VHA) has prioritized timely access to care and has invested substantially in research aimed at optimizing veteran access. However, implementing research into practice remains challenging. Here, we assessed the implementation status of recent VHA access-related research projects and explored factors associated with successful implementation. DESIGN We conducted a portfolio review of recent VHA-funded or supported projects (1/2015-7/2020) focused on healthcare access ("Access Portfolio"). We then identified projects with implementable research deliverables by excluding those that (1) were non-research/operational projects; (2) were only recently completed (i.e., completed on or after 1/1/2020, meaning that they were unlikely to have had time to be implemented); and (3) did not propose an implementable deliverable. An electronic survey assessed each project's implementation status and elicited barriers/facilitators to implementing deliverables. Results were analyzed using novel Coincidence Analysis (CNA) methods. PARTICIPANTS/KEY RESULTS Among 286 Access Portfolio projects, 36 projects led by 32 investigators across 20 VHA facilities were included. Twenty-nine respondents completed the survey for 32 projects (response rate = 88.9%). Twenty-eight percent of projects reported fully implementing project deliverables, 34% reported partially implementing deliverables, and 37% reported not implementing any deliverables (i.e., resulting tool/intervention not implemented into practice). Of 14 possible barriers/facilitators assessed in the survey, two were identified through CNA as "difference-makers" to partial or full implementation of project deliverables: (1) engagement with national VHA operational leadership; (2) support and commitment from local site operational leadership. CONCLUSIONS These findings empirically highlight the importance of operational leadership engagement for successful implementation of research deliverables. Efforts to strengthen communication and engagement between the research community and VHA local/national operational leaders should be expanded to ensure VHA's investment in research leads to meaningful improvements in veterans' care. The Veterans Health Administration (VHA) has prioritized timely access to care and has invested substantially in research aimed at optimizing veteran access. However, implementing research findings into clinical practice remains challenging, both within and outside VHA. Here, we assessed the implementation status of recent VHA access-related research projects and explored factors associated with successful implementation. Only two factors were identified as "difference-makers" to adoption of project findings into practice: (1) engagement with national VHA leadership or (2) support and commitment from local site leadership. These findings highlight the importance of leadership engagement for successful implementation of research findings. Efforts to strengthen communication and engagement between the research community and VHA local/national leaders should be expanded to ensure VHA's investment in research leads to meaningful improvements in veterans' care.
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Affiliation(s)
- Jessica R Dodge
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Bradley Youles
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jennifer Caldararo
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Erika D Sears
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Tanner J Caverly
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - P Michael Ho
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Stephanie L Shimada
- VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Peter Kaboli
- Iowa City VA Center for Access and Delivery Research and Evaluation (CADRE), Iowa VA Healthcare System, Iowa City, IA, USA
| | - Karen Albright
- Iowa City VA Center for Access and Delivery Research and Evaluation (CADRE), Iowa VA Healthcare System, Iowa City, IA, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stephanie A Robinson
- VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Demetria M McNeal
- Iowa City VA Center for Access and Delivery Research and Evaluation (CADRE), Iowa VA Healthcare System, Iowa City, IA, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laura Damschroder
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Sameer D Saini
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Megan A Adams
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
- University of Michigan Medical School, Ann Arbor, MI, USA.
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA.
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23
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Katon JG, Bossick AS, Tartaglione EV, Enquobahrie DA, Haeger KO, Johnson AM, Ma EW, Savitz D, Shaw JG, Todd-Stenberg J, Yano EM, Washington DL, Christy AY. Assessing Racial Disparities in Access, Use, and Outcomes for Pregnant and Postpartum Veterans and Their Infants in Veterans Health Administration. J Womens Health (Larchmt) 2023; 32:757-766. [PMID: 37186805 DOI: 10.1089/jwh.2022.0507] [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: 05/17/2023] Open
Abstract
Objective: Limited population-based data examines racial disparities among pregnant and postpartum Veterans. Our objective was to determine whether Black/white racial disparities in health care access, use, and Veteran and infant outcomes are present among pregnant and postpartum Veterans and their infants using Veterans Health Administration (VA) care. Methods: The VA National Veteran Pregnancy and Maternity Care Survey included all Veterans with a VA paid live birth between June 2018 and December 2019. Participants could complete the survey online or by telephone. The independent variable was self-reported race. Outcomes included timely initiation of prenatal care, perceived access to timely prenatal care, attendance at a postpartum check-up, receipt of needed mental health care, cesarean section, postpartum rehospitalization, low birthweight, preterm birth, admission to a neonatal intensive care unit, and breastfeeding. Nonresponse weighted general linear models with a log-link were used to examine associations of race with outcomes. Cox regression was used to examine the association of race with duration of breastfeeding. Models adjusted for age, ethnicity, urban versus rural residence, and parity. Results: The analytic sample consisted of 1,220 Veterans (Black n = 916; white n = 304) representing 3,439 weighted responses (Black n = 1,027; white n = 2,412). No racial disparities were detected for health care access or use. Black Veterans were more likely than white Veterans to have a postpartum rehospitalization (RR 1.67, 95% CI: 1.04-2.68) and a low-birthweight infant (RR 1.67, 95% CI: 1.20-2.33). Conclusion: While no racial disparities were detected for health care access and use, we identified disparities in postpartum rehospitalization and low birthweight, underscoring that access is not sufficient for ensuring health equity.
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Affiliation(s)
- Jodie G Katon
- Health Services Research and Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Andrew S Bossick
- Department of Public Health Sciences, Henry Ford Healthcare System, Detroit, Michigan, USA
| | - Erica V Tartaglione
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, HSR&D, Seattle, Washington, USA
| | | | - Kristin O Haeger
- Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Amanda M Johnson
- Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
| | - Erica W Ma
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, HSR&D, Seattle, Washington, USA
| | - David Savitz
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jonathan G Shaw
- VA Palo Alto Healthcare System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Jeffery Todd-Stenberg
- U.S. Department of Veterans Affairs (VA) Puget Sound Healthcare System, Center of Innovation for Veteran-Centered and Value-Driven Care, HSR&D, Seattle, Washington, USA
| | - Elizabeth M Yano
- Health Services Research and Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Jonathan and Karen Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Donna L Washington
- Health Services Research and Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Alicia Y Christy
- Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia, USA
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24
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Kalofonos I, McCoy M, Altman L, Gelberg L, Hamilton AB, Gabrielian S. A Sanctioned Encampment as a Strategy for Increasing Homeless Veterans' Access to Housing and Healthcare During the COVID-19 Pandemic. J Gen Intern Med 2023; 38:857-864. [PMID: 37340271 PMCID: PMC10356730 DOI: 10.1007/s11606-023-08124-4] [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: 06/19/2022] [Accepted: 02/24/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND The COVID-19 pandemic intersected with a housing crisis for unsheltered Veterans experiencing homelessness (VEHs); congregate settings became high risk for viral spread. The VA Greater Los Angeles responded by creating the Care, Treatment, and Rehabilitation Service (CTRS), an outdoor, low-barrier-to-entry transitional housing program on VA grounds. This novel emergency initiative offered a protected outdoor environment ("sanctioned encampment") where VEHs lived in tents and had access to three meals a day, hygiene resources, and health and social services. OBJECTIVE To identify contextual factors that supported and impeded CTRS participants' access to healthcare and housing services. DESIGN Multi-method, ethnographic data collection. PARTICIPANTS VEHs residing at CTRS, CTRS staff. APPROACH Over 150 hours of participant observation were conducted at CTRS and at eight town hall meetings; semi-structured interviews were conducted with 21 VEHs and 11 staff. Rapid turn-around qualitative analysis was used to synthesize data, engaging stakeholders in iterative participant validation. Content analysis techniques were used to identify key factors that impacted access to housing and health services among VEHs residing in CTRS. KEY RESULTS Staff varied in their interpretation of CTRS' mission. Some conceptualized access to health services as a central tenet, while others viewed CTRS as an emergency shelter only. Regardless, staff burnout was prevalent, which lead to low morale, high turnover, and worsened access to and quality of care. VEHs endorsed trusting, long-term relationships with CTRS staff as paramount for facilitating access to services. Though CTRS addressed basic priorities (food, shelter, etc.) that traditionally compete with access to healthcare, some VEHs needed on-site healthcare services, at their tents, to access care. CONCLUSIONS CTRS provided VEHs access to basic needs and health and housing services. To improve access to healthcare services within encampments, our data suggest the value of longitudinal trusting relationships, adequate staff support, and on-site health services.
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Affiliation(s)
- Ippolytos Kalofonos
- HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- UCLA/VA Center for Excellence for Veteran Resilience and Recovery in Homelessness and Behavioral Health, Los Angeles, CA, USA.
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
- UCLA International Institute, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
| | - Matthew McCoy
- HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- UCLA/VA Center for Excellence for Veteran Resilience and Recovery in Homelessness and Behavioral Health, Los Angeles, CA, USA.
| | - Lisa Altman
- HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- UCLA/VA Center for Excellence for Veteran Resilience and Recovery in Homelessness and Behavioral Health, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Lillian Gelberg
- HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- UCLA/VA Center for Excellence for Veteran Resilience and Recovery in Homelessness and Behavioral Health, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alison B Hamilton
- HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- UCLA/VA Center for Excellence for Veteran Resilience and Recovery in Homelessness and Behavioral Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sonya Gabrielian
- HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- UCLA/VA Center for Excellence for Veteran Resilience and Recovery in Homelessness and Behavioral Health, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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25
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Wilson SM, Mulcahy AC, Lange TM, Eldridge MR, Weidenbacher HJ, Jackson GL, Gierisch JM, Crowley MJ, Calhoun PS, Hilgeman MM. Rolling out PRIDE in All Who Served: Barriers and Facilitators for Sites Implementing an LGBTQ+ Health Education Group for Military Veterans. J Gen Intern Med 2023:10.1007/s11606-023-08204-5. [PMID: 37340269 DOI: 10.1007/s11606-023-08204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND/OBJECTIVE The Veterans Health Administration (VHA) PRIDE in All Who Served health education group (PRIDE) was developed to improve health equity and access to care for military veterans who are lesbian, gay, bisexual, transgender, queer, and/or other sexual/gender-diverse identities (LGBTQ+). This 10-week program rapidly spread to over 30 VHA facilities in 4 years. Veterans receiving PRIDE experience improved LGBTQ+ identity-related resilience and reductions in suicide attempt likelihood. Despite PRIDE's rapid spread across facilities, information is lacking on implementation determinants. The current study's goal was to clarify determinants of PRIDE group implementation and sustainment. METHODS A purposive sample of VHA staff (N = 19) with experience delivering or implementing PRIDE completed teleconference interviews January-April 2021. The interview guide was informed by the Consolidated Framework for Implementation Research. Rapid qualitative matrix analysis was completed with methods to ensure rigor (e.g., triangulation and investigator reflexivity). RESULTS Key barriers and facilitators of PRIDE implementation were heavily related to facility inner setting (what is happening inside the facility), including implementation readiness (e.g., leadership support for LGBTQ+-affirming programming, access to LGBTQ+-affirming care training) and facility culture (e.g., systemic anti-LGBTQ+ stigma). Several implementation process facilitators enhanced engagement at sites, such as a centrally facilitated PRIDE learning collaborative and a formal process of contracting/training for new PRIDE sites. DISCUSSION/CONCLUSION Although aspects of the outer setting and larger societal influences were mentioned, the majority of factors impacting implementation success were at the VHA facility level and therefore may be more readily addressable through tailored implementation support. The importance of LGBTQ+ equity at the facility level indicates that implementation facilitation should ideally address institutional equity in addition to implementation logistics. Combining effective interventions with attention to local implementation needs will be required before LGBTQ+ veterans in all areas will benefit from PRIDE and other health equity-focused interventions.
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Affiliation(s)
- Sarah M Wilson
- Mental and Behavioral Health Service, Durham VA Healthcare System, Durham, NC, USA.
- Center of Innovation to Accelerate Discovery and Practice Transformation (Health Services Research and Development), Durham VA Healthcare System, Durham, NC, USA.
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Abigail C Mulcahy
- Center to Improve Veteran Involvement in Care (Health Service Research and Development), Portland VA Healthcare System, Portland, OR, USA
- School of Public Health, Oregon Health and Science University/Portland State University School of Public Health, Portland, OR, USA
| | | | - Madeleine R Eldridge
- Center of Innovation to Accelerate Discovery and Practice Transformation (Health Services Research and Development), Durham VA Healthcare System, Durham, NC, USA
| | - Hollis J Weidenbacher
- Center of Innovation to Accelerate Discovery and Practice Transformation (Health Services Research and Development), Durham VA Healthcare System, Durham, NC, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (Health Services Research and Development), Durham VA Healthcare System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer M Gierisch
- Center of Innovation to Accelerate Discovery and Practice Transformation (Health Services Research and Development), Durham VA Healthcare System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation (Health Services Research and Development), Durham VA Healthcare System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Patrick S Calhoun
- Mental and Behavioral Health Service, Durham VA Healthcare System, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (Health Services Research and Development), Durham VA Healthcare System, Durham, NC, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Michelle M Hilgeman
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
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26
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Kaboli PJ, Shimada SL. A Decade of Focus on and Improvement in Access to Care in the Veterans Health Administration. J Gen Intern Med 2023:10.1007/s11606-023-08208-1. [PMID: 37340265 DOI: 10.1007/s11606-023-08208-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
- Peter J Kaboli
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA.
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Alam MS, Tabassum NJ, Tokey AI. Evaluation of accessibility and equity to hospitals by public transport: evidence from six largest cities of Ohio. BMC Health Serv Res 2023; 23:598. [PMID: 37291565 PMCID: PMC10251528 DOI: 10.1186/s12913-023-09588-0] [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: 11/25/2022] [Accepted: 05/22/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION In the United States, health care has long been viewed as a 'right,' and residents of the state of Ohio are no exception. The Ohio Department of Health ensures that this right exists for all residents of Ohio. Socio-spatial characteristics, however, can have an impact on access to health care, particularly among vulnerable groups. This article seeks to measure the spatial accessibility to healthcare services by public transport in the six largest cities of Ohio based on population and to compare the accessibility of healthcare to vulnerable demographic groups. To the authors' knowledge, this is the first study to analyze the accessibility and equity of hospitals by public transit across different cities in Ohio, allowing the identification of common patterns, difficulties, and knowledge gaps. METHODOLOGY Using a two-step floating catchment area technique, the spatial accessibility to general medical and surgical hospitals through public transportation was estimated, considering both service-to-population ratios and travel time to these health services. The average accessibility of all census tracts and the average accessibility of the 20% of most susceptible census tracts were determined for each city. Using Spearman's rank correlation coefficient between accessibility and vulnerability, an indicator was then devised to evaluate vertical equity. FINDINGS Within cities (except Cleveland), people of vulnerable census tracts have less access to hospitals via public transportation. These cities (Columbus, Cincinnati, Toledo, Akron, and Dayton) fail in terms of vertical equity and average accessibility. According to this, vulnerable census tracts in these cities have the lowest accessibility levels. CONCLUSION This study emphasizes the issues connected with the suburbanization of poverty in Ohio's large cities and the need to provide adequate public transportation to reach hospitals on the periphery. In addition, this study shed light on the need for additional empirical research to inform the implementation of guidelines for healthcare accessibility in Ohio. Researchers, planners, and policymakers who want to make healthcare more accessible for everyone should take note of the findings in this study.
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Affiliation(s)
- M. S. Alam
- Department of Geography and Planning, The University of Toledo, Toledo, OH United States
| | - N. J. Tabassum
- Department of Geography and Planning, The University of Toledo, Toledo, OH United States
| | - A. I. Tokey
- Department of Geography, Ohio State University, Columbus, OH United States
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Hynes DM, Thomas KC. Realigning theory with evidence to understand the role of care coordination in mental health services research. INTERNATIONAL JOURNAL OF CARE COORDINATION 2023; 26:55-61. [PMID: 37333504 PMCID: PMC10273861 DOI: 10.1177/20534345231153801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Current theoretical models intended to guide health services research and evaluation lack care coordination-its features and impacts. These aspects are critical for understanding the role of care coordination in healthcare use, quality, and outcomes. In this Focus article, we briefly review the well-known Andersen individual behavioral model (IBM) of healthcare use and the Donabedian health system and quality model (HSQM) together with recent practice-based evidence. We propose a new integrated theoretical model of healthcare and care coordination. The model can serve as a guide for future research to better understand the variation in care coordination services and delivery and its added value to improving mental health in different real-world settings.
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Affiliation(s)
- Denise M Hynes
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy; Cecil G. Sheps Center for Health Services Research and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hilabi BS, Alghamdi SA, Almanaa M. Impact of Magnetic Resonance Imaging on Healthcare in Low- and Middle-Income Countries. Cureus 2023; 15:e37698. [PMID: 37081900 PMCID: PMC10112545 DOI: 10.7759/cureus.37698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 04/22/2023] Open
Abstract
Magnetic resonance imaging (MRI) played a significant role in the digital health platforms that influenced and supported modern medicine. However, there is a shortage of MRI in low- and middle-income countries (LMICs). The International Society of Radiology offers a detailed plan for LMICs to advance imaging quality in the global health agenda. The overarching objective of this scoping review was to determine the impact of MRI in healthcare in LMICs. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify available evidence. We systematically searched four academic databases for peer-reviewed literature published between 2018 and 2021, namely, Medline, PubMed, Web of Science, and Scopus, as well as Google Scholar as a source for gray literature. The search identified 54 articles. We identified a range of reasons for introducing MRI in LMICs. Nonetheless, some challenges to accepting MRI as a method of healthcare have been reported, including technological, regulatory, and economical challenges. To implement the proposed plan, the involvement of professional and international organizations is considered crucial. The establishment of an International Commission on Medical Imaging under the umbrella of international organizations is suggested and collaboration with other diagnostic disciplines is encouraged to raise awareness of the importance of upscale diagnostics at large and to foster its integration into the care pathway globally.
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Donovan LM, Parsons EC, McCall CA, He K, Sharma R, Gamache J, Pannick AP, McDowell JA, Pai J, Epler E, Duan KI, Spece LJ, Feemster LC, Kapur VK, Au DH, Palen BN. Impact of mail-based continuous positive airway pressure initiation on treatment usage and effectiveness. Sleep Breath 2023; 27:303-308. [PMID: 35347655 PMCID: PMC8960106 DOI: 10.1007/s11325-022-02608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/15/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE In-person visits with a trained therapist have been standard care for patients initiating continuous positive airway pressure (CPAP). These visits provide an opportunity for hands-on training and an in-person assessment of mask fit. However, to improve access, many health systems are shifting to remote CPAP initiation with equipment mailed to patients. While there are potential benefits of a mailed approach, relative patient outcomes are unclear. Specifically, many have concerns that a lack of in-person training may contribute to reduced CPAP adherence. To inform this knowledge gap, we aimed to compare treatment usage after in-person or mailed CPAP initiation. METHODS Our medical center shifted from in-person to mailed CPAP dispensation in March 2020 during the COVID-19 pandemic. We assembled a cohort of patients with newly diagnosed obstructive sleep apnea (OSA) who initiated CPAP in the months before (n = 433) and after (n = 186) this shift. We compared 90-day adherence between groups. RESULTS Mean nightly PAP usage was modest in both groups (in-person 145.2, mailed 140.6 min/night). We did not detect between-group differences in either unadjusted or adjusted analyses (adjusted difference - 0.2 min/night, 95% - 27.0 to + 26.5). CONCLUSIONS Mail-based systems of CPAP initiation may be able to improve access without reducing CPAP usage. Future work should consider the impact of mailed CPAP on patient-reported outcomes and the impact of different remote setup strategies.
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Affiliation(s)
- Lucas M Donovan
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA.
- University of Washington, Seattle, WA, USA.
| | - Elizabeth C Parsons
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
- University of Washington, Seattle, WA, USA
| | - Catherine A McCall
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
- University of Washington, Seattle, WA, USA
| | - Ken He
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
- University of Washington, Seattle, WA, USA
| | - Rahul Sharma
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
- University of Washington, Seattle, WA, USA
| | - Justina Gamache
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
- University of Washington, Seattle, WA, USA
| | - Anna P Pannick
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
| | - Jennifer A McDowell
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
| | - James Pai
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
| | - Eric Epler
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
| | - Kevin I Duan
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
- University of Washington, Seattle, WA, USA
| | - Laura J Spece
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
- University of Washington, Seattle, WA, USA
| | - Laura C Feemster
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
- University of Washington, Seattle, WA, USA
| | | | - David H Au
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
- University of Washington, Seattle, WA, USA
| | - Brian N Palen
- HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA, 98108, USA
- University of Washington, Seattle, WA, USA
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Blatnik P, Bojnec Š. Optimal Network of General Hospitals in Slovenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4235. [PMID: 36901246 PMCID: PMC10001727 DOI: 10.3390/ijerph20054235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/12/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
This article explores how the minimum number of general hospital locations can be determined with optimal population coverage. Due to the increasing financial problems of hospitals and the poor organization of general hospital healthcare, Slovenia is currently working to reform the healthcare system. Defining the optimal network of hospital providers is one of the key elements in reforming the healthcare system. To define the optimal network of general hospitals, the allocation-location model was used, and the maximize attendance model was used as the central method. The chief purpose of maximize attendance model is to optimize the demand attendance with respect to distance and time spent getting to the point of demand. In the analysis of optimal locations and the number of Slovenian general hospitals, we used data on the locations of settlements with their number of inhabitants and data on the Slovenian road network, based on which we defined average travel speeds on the categorized road network. The hypothetical locations of general hospitals and the number of optimally located general hospitals that provide access to the nearest provider were determined in three different time intervals. We found that the same accessibility to hospital services as provided by the existing network of general hospitals can be achieved with only ten optimally located general hospitals within a 30-min time interval. This means that two general hospitals could be rationalized or reorganized, which would bring significant savings in the field of hospital activity, which creates a large loss in the health system in Slovenia.
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Santoyo-Sánchez G, Reyes-Morales H, Flores-Hernández S, Pelcastre-Villafuerte BE, Merino-Soto C. Psychometric Properties of the Access of Older Adults to Outpatient Primary-Care Health Services Scale. Eval Health Prof 2023; 46:159-169. [PMID: 36821795 DOI: 10.1177/01632787231158806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
This study evaluates the psychometric properties of the Access of Older Adults to Outpatient Primary-Care Health Services Scale (AOAOPHSS), in research conducted among 707 Mexican older adults selected by convenience from 14 rural and one urban locations. The AOAOPHSS explores 10 dimensions of two integrated subscales: Accessibility and Personal Abilities. Data analysis was performed in five phases. First, potentially biased responses were identified. Second, the response efficiency of the items and their association with external variables were evaluated. Third, the basic properties of the scores for the subscales' dimensions of the AOAOPHSS were identified using non-parametric Mokken Scaling Analysis (MSA). Fourth, the Structural Equation Modeling methodology was used to identify the properties of the internal structure of the latent construct. Finally, reliability and internal consistency were evaluated at both score and item levels. The following findings emerged. 13 items with inefficient response options were removed, and 24 were retained using the MSA. The latent structure of the latter was defined based on 21 items of five Accessibility Subscale dimensions. Its internal consistency reliability ranged between 0.67 and 0.81 (omega coefficients) and between 0.61 and 0.78 (alpha coefficients). Accordingly, this paper discusses the overall implications of using the Accessibility Subscale.
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Affiliation(s)
- Gerardo Santoyo-Sánchez
- School of Public Health of Mexico, National Institute of Public Health in Mexico, Cuernavaca, Mexico
| | - Hortensia Reyes-Morales
- Center for Health Systems Research, 37764National Institute of Public Health in Mexico, Cuernavaca, Mexico
| | - Sergio Flores-Hernández
- Center for Evaluation and Surveys, 37764National Institute of Public Health in Mexico, Cuernavaca, Mexico
| | | | - César Merino-Soto
- Psychology Research Institute, 33226San Martin de Porres University, Lima, Peru
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Bhat A, Goud BR, Kalidindi B, Ruben JP, Devadass D, Waghmare A, Collins PY, Raj T, Srinivasan K. Mobile Mental Health in Women's Community-Based Organizations: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e42919. [PMID: 36753310 PMCID: PMC9947759 DOI: 10.2196/42919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Of every 10 women in rural India, 1 suffers from a common mental disorder such as depression, and untreated depression is associated with significant morbidity and mortality. Several factors lead to a large treatment gap, specifically for women in rural India, including stigma, lack of provider mental health workforce, and travel times. There is an urgent need to improve the rates of detection and treatment of depression among women in rural India without overburdening the scarce mental health resources. OBJECTIVE We propose to develop, test, and deploy a mental health app, MITHRA (Multiuser Interactive Health Response Application), for depression screening and brief intervention, designed for use in women's self-help groups (SHGs) in rural India. METHODS We will use focus groups with SHG members and community health workers to guide the initial development of the app, followed by iterative modification based on input from a participatory design group consisting of proposed end users of the app (SHG members). The final version of the app will then be deployed for testing in a pilot cluster randomized trial, with 3 SHGs randomized to receive the app and 3 to receive enhanced care as usual. RESULTS This study was funded in June 2021. As of September 2022, we have completed both focus groups, 1 participatory design group, and app development. CONCLUSIONS Delivering app-based depression screening and treatment in community settings such as SHGs can address stigma and transportation-related barriers to access to depression care and overcome cultural and contextual barriers to mobile health use. It can also address the mental health workforce shortage. If we find that the MITHRA approach is feasible, we will test the implementation and effectiveness of MITHRA in multiple SHGs across India in a larger randomized controlled trial. This approach of leveraging community-based organizations to improve the reach of depression screening and treatment is applicable in rural and underserved areas across the globe. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42919.
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Affiliation(s)
- Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | | | | | - Johnson Pradeep Ruben
- St John's Medical College, Bengaluru, India
- St John's Research Institute, Bengaluru, India
| | | | | | - Pamela Y Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Tony Raj
- St John's Research Institute, Bengaluru, India
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Taylor KK, Ibrahim AM, Scott JW. A Proposed Framework for Measuring Access to Surgical Care in the United States. JAMA Surg 2022; 157:1075-1077. [PMID: 36129695 DOI: 10.1001/jamasurg.2022.3184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In this Viewpoint, the authors evaluate access to surgical care using the domains of timeliness, workforce density, infrastructure, safety, and affordability and discuss how such a framework could be applied in the United States.
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Affiliation(s)
- Kathryn K Taylor
- National Clinician Scholars Program, University of Michigan, Ann Arbor.,Department of Surgery, Stanford University, Stanford, California
| | - Andrew M Ibrahim
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor
| | - John W Scott
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor
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Zahedi FM, Zhao H, Sanvanson P, Walia N, Jain H, Shaker R. My Real Avatar has a Doctor Appointment in the Wepital: A System for Persistent, Efficient, and Ubiquitous Medical Care. INFORMATION & MANAGEMENT 2022. [PMCID: PMC9487169 DOI: 10.1016/j.im.2022.103706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
COVID-19 created a great deal of personal, social, and economic anxiety in the USA and across the globe and exposed the inadequacy of traditional medical systems in handling large-scale emergencies. While telemedicine and virtual visits have become popular as a result, they end once a visit is over, hence lacking data persistence and continuity in caring for patients. Using the design science research approach with support from the theory of affordances, this paper proposes the design of a medical system (called wepital) in which patients receive care through their real avatars, enabling hospitals and other medical centers to provide immediate care that can continue for as long as a patient needs it. Real avatars are digital representations of patients that embody their real-time vital signs and health information. We have created a functional prototype to demonstrate how the proposed design can work. To assess the usability of the design, we have used the prototype in an experiment to provide medical advice to patient volunteers. Based on a theory-based conceptual model, we collected survey data after the experiment to identify factors contributing to the success of such a system, as measured by patient satisfaction. We report the factors that significantly contribute to the patients’ satisfaction. As part of the application and policy implications of our work, we propose a nationwide system that could supplement and expand the capacity of medical systems at the national or even global level.
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Maphane D, Ngwenya BN, Kolawole OD, Motsholapheko MR, Pagiwa V. Community Knowledge, Perceptions and Experiences on Healthcare Services for Malaria Prevention and Treatment in the Okavango Delta, Botswana. J Community Health 2022; 48:325-337. [PMID: 36436166 DOI: 10.1007/s10900-022-01172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/28/2022]
Abstract
This paper analyses community knowledge, perceptions, and experiences of effectiveness of healthcare service provision on malaria prevention/treatment in two disease-endemic villages of the Okavango Delta panhandle in northern Botswana. A stratified random sampling of 355 households was conducted in October-November 2015. Follow-up retrospective cohort interviews were undertaken in August 2016 from 79 households that reported malaria incidences during the household survey. Data were also collected from 16 key informant interviews and 2 focus group discussions participants. Descriptive statistics and content analyses were used to summarise quantitative and qualitative data, respectively. Results indicate that communities in the study sites had positive perceptions about efficiency of health services based on availability, accessibility and utilization, adequacy of prevention and treatment interventions. Local health clinics were crucial information channels used by respondents. Additionally, factors related to acceptability, availability and accessibility are likely to contribute to perceived effectiveness of the interventions provided by healthcare service providers. Affirmation of efficiency health service provision against malaria has public health implications for adherence to treatment/prevention and participation in community health education campaigns and program implementation in the Okavango Delta region.
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Affiliation(s)
- Dirontsho Maphane
- Okavango Research Institute, University of Botswana, Private Bag 285, Maun, Botswana
| | - Barbara N Ngwenya
- Okavango Research Institute, University of Botswana, Private Bag 285, Maun, Botswana
| | - Oluwatoyin D Kolawole
- Okavango Research Institute, University of Botswana, Private Bag 285, Maun, Botswana
| | | | - Vincent Pagiwa
- Okavango Research Institute, University of Botswana, Private Bag 285, Maun, Botswana.
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Kriegshauser KD, Sexton CC, Bozsik FM, Blossom JB, Wiese AD, Adams Larsen M, Hale LR. The Feasibility of a Family-Focused CBT Skills Self-Help App. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Baldomero AK, Kunisaki KM, Wendt CH, Bangerter A, Diem SJ, Ensrud KE, Nelson DB, Henning-Smith C, Bart BA, Hammett P, Hagedorn HJ, Dudley RA. Drive Time and Receipt of Guideline-Recommended Screening, Diagnosis, and Treatment. JAMA Netw Open 2022; 5:e2240290. [PMID: 36331503 PMCID: PMC9636523 DOI: 10.1001/jamanetworkopen.2022.40290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
IMPORTANCE Many patients do not receive recommended services. Drive time to health care services may affect receipt of guideline-recommended care, but this has not been comprehensively studied. OBJECTIVE To assess associations between drive time to care and receipt of guideline-recommended screening, diagnosis, and treatment interventions. DESIGN, SETTING, AND PARTICIPANTS This cohort study used administrative data from the National Veterans Health Administration (VA) data merged with Medicare data. Eligible participants were patients using VA services between January 2016 and December 2019. Women ages 65 years or older without underlying bone disease were assessed for osteoporosis screening. Patients with new diagnosis of chronic obstructive pulmonary disease (COPD) indicated by at least 2 encounter codes for COPD or at least 1 COPD-related hospitalization were assessed for receipt of diagnostic spirometry. Patients hospitalized for ischemic heart disease were assessed for cardiac rehabilitation treatment. EXPOSURES Drive time from each patient's residential address to the closest VA facility where the service was available, measured using geocoded addresses. MAIN OUTCOMES AND MEASURES Binary outcome at the patient level for receipt of osteoporosis screening, spirometry, and cardiac rehabilitation. Multivariable logistic regression models were used to assess associations between drive time and receipt of services. RESULTS Of 110 780 eligible women analyzed, 36 431 (32.9%) had osteoporosis screening (mean [SD] age, 66.7 [5.4] years; 19 422 [17.5%] Black, 63 403 [57.2%] White). Of 281 130 patients with new COPD diagnosis, 145 249 (51.7%) had spirometry (mean [SD] age, 68.2 [11.5] years; 268 999 [95.7%] men; 37 834 [13.5%] Black, 217 608 [77.4%] White). Of 73 146 patients hospitalized for ischemic heart disease, 11 171 (15.3%) had cardiac rehabilitation (mean [SD] age, 70.0 [10.8] years; 71 217 [97.4%] men; 15 213 [20.8%] Black, 52 144 [71.3%] White). The odds of receiving recommended services declined as drive times increased. Compared with patients with a drive time of 30 minutes or less, patients with a drive time of 61 to 90 minutes had lower odds of receiving osteoporosis screening (adjusted odds ratio [aOR], 0.90; 95% CI, 0.86-0.95) and spirometry (aOR, 0.90; 95% CI, 0.88-0.92) while patients with a drive time of 91 to 120 minutes had lower odds of receiving cardiac rehabilitation (aOR, 0.80; 95% CI, 0.74-0.87). Results were similar in analyses restricted to urban patients or patients whose primary care clinic was in a tertiary care center. CONCLUSIONS AND RELEVANCE In this retrospective cohort study, longer drive time was associated with less frequent receipt of guideline-recommended services across multiple components of care. To improve quality of care and health outcomes, health systems and clinicians should adopt strategies to mitigate travel burden, even for urban patients.
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Affiliation(s)
- Arianne K. Baldomero
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Ken M. Kunisaki
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
| | - Chris H. Wendt
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
| | - Ann Bangerter
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Susan J. Diem
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Kristine E. Ensrud
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- General Internal Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - David B. Nelson
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Division of Biostatistics, University of Minnesota, Minneapolis
| | | | - Bradley A. Bart
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Cardiology, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Patrick Hammett
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Division of Biostatistics, University of Minnesota, Minneapolis
| | - Hildi J. Hagedorn
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - R. Adams Dudley
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
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Gray KE, Rao M, Gunnink E, Eschenroeder L, Geyer JR, Nelson KM, Reddy A. Home Telehealth in the Veterans Health Administration: Trends and Correlates of Length of Enrollment from 2010 to 2017. J Gen Intern Med 2022; 37:3089-3096. [PMID: 35230624 PMCID: PMC8886698 DOI: 10.1007/s11606-022-07452-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 02/03/2022] [Indexed: 10/26/2022]
Abstract
BACKGROUND Home telehealth (HT) programs enable communication and remote monitoring of patient health data between clinician visits, with the goal of improving chronic disease self-management and outcomes. The Veterans Health Administration (VHA) established one of the earliest HT programs in the country in 2003; however, little is known about how these services have been utilized and expanded over the last decade. OBJECTIVE To describe trends in use of VHA's HT program from 2010 through 2017 and correlates of length of enrollment in HT services. DESIGN Retrospective observational cohort study. PARTICIPANTS Patients enrolled in HT between January 1, 2010 and December 31, 2017. MAIN MEASURES We described the number and characteristics of patients enrolled in HT, including the chronic conditions managed. We also identified length of HT enrollment and examined patient and facility characteristics associated with longer enrollment. KEY RESULTS The total number of patients enrolled in HT was 402,263. At time of enrollment, half were >65 years old, 91% were male, and 59.3% lived in urban residences. The most common conditions addressed by HT were hypertension (28.8%), obesity (23.9%), and diabetes (17.0%). The median time to disenrollment in HT was 261 days (8.6 months) but varied by chronic condition. In a multivariable Cox proportional hazards model, covariates associated with higher likelihood of staying enrolled were older age, male gender, non-Hispanic Black race/ethnicity, lower neighborhood socioeconomic status, living in a more rural setting, and a greater burden of comorbidities per the Gagne index. CONCLUSIONS Across 8 years, over 400,000 veterans engaged in HT services for chronic disease management and over half remained in the program for longer than 8 months. Our work provides a real-world evaluation of HT service expansion in the VHA. Additional studies are necessary to identify optimal enrollment duration and patients most likely to benefit from HT services.
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Affiliation(s)
- Kristen E Gray
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - 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.
| | - Eric Gunnink
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Lee Eschenroeder
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - John R Geyer
- 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
| | - Karin M Nelson
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Systems and Population Health, School of Public Health, University of Washington, 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
| | - Ashok Reddy
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Systems and Population Health, School of Public Health, University of Washington, 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
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Santoyo-Sánchez G, Merino-Soto C, Flores-Hernández S, Pelcastre-Villafuerte BE, Reyes-Morales H. Content Validity of a Scale Designed to Measure the Access of Older Adults to Outpatient Health Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610102. [PMID: 36011737 PMCID: PMC9407808 DOI: 10.3390/ijerph191610102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 05/20/2023]
Abstract
The objective of this work was to validate the content of a scale formulated in Spanish for older adults in Mexico, with the aim of comprehensively measuring the access of this population group to outpatient primary-care services. To this end, we carried out a methodological content-validity study in four stages: (1) construction of the scale; (2) evaluation of item legibility; (3) quantitative content evaluation by two groups of judges selected by convenience: participant-judges including older adults with adequate reading comprehension, surveyed in person (n = 23), and expert-judges comprised of researchers specialized in the fields of health services, psychometrics and aging, surveyed online (n = 7); and (4) collection of qualitative feedback from several of the participant-judges (older adults, n = 4). The content was validated both by sequentially examining the level of consensus in the responses of both groups of judges, using the Tastle and Wierman method, and by calculating Aiken's Validity Coefficient with a 90% confidence interval. The scale contained 65 items pertaining to 10 dimensions of two major constructs: accessibility (n = 39) and personal abilities (n = 26). Five items were eliminated in accordance with the minimum-consensus criterion (0.5). This is the first psychometric scale to be developed in Mexico with the view of integrating the characteristics of health-care services and the abilities of the older adults in a single questionnaire designed to measure the access of this population group to outpatient primary-care services.
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Affiliation(s)
- Gerardo Santoyo-Sánchez
- School of Public Health of Mexico, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico
| | - César Merino-Soto
- Psychology Research Institute, San Martin de Porres University, Avenue Tomás Marsano 232, Lima 34, Peru
| | - Sergio Flores-Hernández
- Center for Evaluation and Surveys, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico
| | - Blanca Estela Pelcastre-Villafuerte
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico
| | - Hortensia Reyes-Morales
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca 62100, Morelos, Mexico
- Correspondence: ; Tel.: +52-(777)-329-3028
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Goldstein KM, Perry KR, Lewinski A, Walsh C, Shepherd-Banigan ME, Bosworth HB, Weidenbacher H, Blalock DV, Zullig LL. How can equitable video visit access be delivered in primary care? A qualitative study among rural primary care teams and patients. BMJ Open 2022; 12:e062261. [PMID: 37919249 PMCID: PMC9361743 DOI: 10.1136/bmjopen-2022-062261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic sparked exponential growth in video visit use in primary care. The rapid shift to virtual from in-person care exacerbated digital access disparities across racial groups and rural populations. Moving forward, it is critical to understand when and how to incorporate video visits equitably into primary care. We sought to develop a novel clinical algorithm to guide primary care clinics on how and when to employ video visits as part of care delivery. DESIGN Qualitative data collection: one team member conducted all patient semistructured interviews and led all focus groups with four other team members taking notes during groups. SETTING 3 rural primary care clinics in the USA. PARTICIPANTS 24 black veterans living in rural areas and three primary care teams caring for black veterans living in rural areas. PRIMARY AND SECONDARY OUTCOME MEASURES Findings from semistructured interviews with patients and focus groups with primary care teams. RESULTS Key issues around appropriate use of video visits for clinical teams included having adequate technical support, encouraging engagement during video visits and using video visits for appropriate clinical situations. Patients reported challenges with broadband access, inadequate equipment, concerns about the quality of video care, the importance of visit modality choice, and preferences for in-person care experience over virtual care. We developed an algorithm that requires input from both patients and their care team to assess fit for each clinical encounter. CONCLUSIONS Informed matching of patients and clinical situations to the right visit modality, along with individual patient technology support could reduce virtual access disparities.
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Affiliation(s)
- Karen M Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kathleen R Perry
- Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - Allison Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- School of Nursing, Duke University, Durham, NC, USA
| | - Conor Walsh
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Megan E Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- School of Nursing, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Hollis Weidenbacher
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
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Enabling AI and Robotic Coaches for Physical Rehabilitation Therapy: Iterative Design and Evaluation with Therapists and Post-stroke Survivors. Int J Soc Robot 2022. [DOI: 10.1007/s12369-022-00883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractArtificial intelligence (AI) and robotic coaches promise the improved engagement of patients on rehabilitation exercises through social interaction. While previous work explored the potential of automatically monitoring exercises for AI and robotic coaches, the deployment of these systems remains a challenge. Previous work described the lack of involving stakeholders to design such functionalities as one of the major causes. In this paper, we present our efforts on eliciting the detailed design specifications on how AI and robotic coaches could interact with and guide patient’s exercises in an effective and acceptable way with four therapists and five post-stroke survivors. Through iterative questionnaires and interviews, we found that both post-stroke survivors and therapists appreciated the potential benefits of AI and robotic coaches to achieve more systematic management and improve their self-efficacy and motivation on rehabilitation therapy. In addition, our evaluation sheds light on several practical concerns (e.g. a possible difficulty with the interaction for people with cognitive impairment, system failures, etc.). We discuss the value of early involvement of stakeholders and interactive techniques that complement system failures, but also support a personalized therapy session for the better deployment of AI and robotic exercise coaches.
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Grubbs KM, Abraham TH, Pyne JM, Greene CJ, Teng EJ, Fortney JC. Enhancing Problem-Solving Therapy With Smartphone Technology: A Pilot Randomized Controlled Trial. Psychiatr Serv 2022; 73:805-808. [PMID: 35139654 DOI: 10.1176/appi.ps.201900254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Development of smartphone apps for mental health care has outpaced research on their effectiveness. This pilot study tested Moving Forward, an app designed to support problem-solving therapy (PST). METHODS Thirty-three veterans seeking mental health care in U.S. Department of Veterans Affairs primary care clinics were randomly assigned to receive six sessions of PST accompanied by either the Moving Forward app (N=17) or a workbook (N=16). Participants completed measures of anxiety, depression, stress, problem-solving style, satisfaction, and between-session practice at baseline and 6- and 12-week follow-ups. Qualitative interviews were used to elicit feedback. RESULTS Participants in both groups reported high satisfaction and reductions in depression, anxiety, and stress. Veterans who used the app reported skills practice, and qualitative data indicated that patients perceived the app as valuable, with the potential to reduce barriers to care. CONCLUSIONS This study provides preliminary evidence to support the ability of the Moving Forward app to augment brief psychotherapy in primary care clinics.
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Affiliation(s)
- Kathleen M Grubbs
- Center for Mental Health Outcomes Research, Health Services Research and Development, and South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock (Grubbs, Abraham, Pyne); Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Grubbs, Abraham, Pyne, Greene); Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock (Greene); Department of Psychology, Michael E. DeBakey VA Medical Center, Houston (Teng); Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Teng); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, School of Medicine, University of Washington, Seattle (Fortney)
| | - Traci H Abraham
- Center for Mental Health Outcomes Research, Health Services Research and Development, and South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock (Grubbs, Abraham, Pyne); Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Grubbs, Abraham, Pyne, Greene); Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock (Greene); Department of Psychology, Michael E. DeBakey VA Medical Center, Houston (Teng); Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Teng); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, School of Medicine, University of Washington, Seattle (Fortney)
| | - Jeffrey M Pyne
- Center for Mental Health Outcomes Research, Health Services Research and Development, and South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock (Grubbs, Abraham, Pyne); Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Grubbs, Abraham, Pyne, Greene); Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock (Greene); Department of Psychology, Michael E. DeBakey VA Medical Center, Houston (Teng); Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Teng); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, School of Medicine, University of Washington, Seattle (Fortney)
| | - Carolyn J Greene
- Center for Mental Health Outcomes Research, Health Services Research and Development, and South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock (Grubbs, Abraham, Pyne); Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Grubbs, Abraham, Pyne, Greene); Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock (Greene); Department of Psychology, Michael E. DeBakey VA Medical Center, Houston (Teng); Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Teng); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, School of Medicine, University of Washington, Seattle (Fortney)
| | - Ellen J Teng
- Center for Mental Health Outcomes Research, Health Services Research and Development, and South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock (Grubbs, Abraham, Pyne); Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Grubbs, Abraham, Pyne, Greene); Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock (Greene); Department of Psychology, Michael E. DeBakey VA Medical Center, Houston (Teng); Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Teng); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, School of Medicine, University of Washington, Seattle (Fortney)
| | - John C Fortney
- Center for Mental Health Outcomes Research, Health Services Research and Development, and South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock (Grubbs, Abraham, Pyne); Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock (Grubbs, Abraham, Pyne, Greene); Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock (Greene); Department of Psychology, Michael E. DeBakey VA Medical Center, Houston (Teng); Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Teng); Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle (Fortney); Department of Psychiatry, School of Medicine, University of Washington, Seattle (Fortney)
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McBain RK, Cantor J, Kofner A, Stein BD, Yu H. Ongoing Disparities in Digital and In-Person Access to Child Psychiatric Services in the United States. J Am Acad Child Adolesc Psychiatry 2022; 61:926-933. [PMID: 34952198 PMCID: PMC9209557 DOI: 10.1016/j.jaac.2021.11.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/22/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the number and geographic distribution of children and adolescents in the United States who reside in counties with neither child and adolescent psychiatrists nor sufficient Internet broadband to support telepsychiatry services. METHOD This analysis combined data from the Health Resources and Services Administration's Area Health Resource Files on child psychiatrist workforce with Federal Communications Commission information on broadband coverage to generate a composite of in-person and digital access to child psychiatric services throughout the United States. Using multivariable fixed-effects Poisson regression analysis, we estimated the number of children and adolescents (aged 5-19 years) without access to psychiatric services and examined disparities across counties in the United States. RESULTS We estimate that 6,035,402 children and adolescents in the United States (approximately 10%) have inadequate in-person and digital availability of child psychiatric services within their counties. Although this was true for only 3% of children and adolescents in urban counties, this applied to more than half (51%) in rural counties (adjusted odds ratio [AOR] = 2.71; 95% CI = 1.94, 3.78; p < .001). Likewise, only 3% of children and adolescents in high-income counties had insufficient digital and physical access, compared to more than 4 in 10 children and adolescents (41%) in low-income counties (AOR = 0.43; 95% CI = 0.30-0.61; p < .001). Counties with a higher density of Black and Hispanic residents had greater likelihood of service availability (p < 0.001), potentially a function of living in metropolitan communities. CONCLUSION Although telehealth holds promise for promoting access to child and adolescent psychiatric services, large disparities in overall access to services persists in rural and low-income communities.
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Affiliation(s)
| | | | | | | | - Hao Yu
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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45
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Jones JE, Damery SL, Phillips K, Retzer A, Nayyar P, Jolly K. Real-time remote outpatient consultations in secondary and tertiary care: A systematic review of inequalities in invitation and uptake. PLoS One 2022; 17:e0269435. [PMID: 35657995 PMCID: PMC9165897 DOI: 10.1371/journal.pone.0269435] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Health policies in most high income countries increasingly recommend provision of routine outpatient care via remote (video and/or telephone) appointments, especially due to the pandemic. This is thought to improve access to care and promote efficiency within resource-constrained health services. There is limited evidence about the impact on existing inequalities in the invitation and uptake of health services when remote outpatient care is offered. AIM To systematically review the evidence on the offer and/or uptake of real-time remote outpatient consultations in secondary and tertiary care, assessed according to key sociodemographic characteristics. METHODS Seven electronic bibliographic databases were searched for studies reporting the proportion of patients with key characteristics (following PROGRESS Plus criteria) who were offered and/or accepted real-time remote outpatient consultation for any chronic condition. Comparison groups included usual care (face-to-face), another intervention, or offer/uptake within a comparable time period. Study processes were undertaken in duplicate. Data are reported narratively. RESULTS Twenty-nine studies were included. Uptake of video consultations ranged from 5% to 78% and telephone consultations from 12% to 78%. Patients aged over 65, with lower educational attainment, on lower household incomes and without English as a first language were least likely to have a remote consultation. Females were generally more likely to have remote consultations than males. Non-white ethnicities were less likely to use remote consultations but where they did, were significantly more likely to choose telephone over video appointments (p<0.001). CONCLUSIONS Offering remote consultations may perpetuate or exacerbate existing health inequalities in access to healthcare. More research is needed on current health disparities by sociodemographic characteristics and to explore what works well for different patient groups and why so that processes can be designed to ameliorate these health disparities. TRIAL REGISTRATION PROSPERO registration no: CRD42021241791.
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Affiliation(s)
- Janet E. Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Sarah L. Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Ameeta Retzer
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Pamela Nayyar
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Cole HVS, Franzosa E. Title: advancing urban health equity in the United States in an age of health care gentrification: a framework and research agenda. Int J Equity Health 2022; 21:66. [PMID: 35546673 PMCID: PMC9092322 DOI: 10.1186/s12939-022-01669-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 04/20/2022] [Indexed: 11/22/2022] Open
Abstract
Background Access to health care has traditionally been conceptualized as a function of patient socio-demographic characteristics (i.e., age, race/ethnicity, education, health insurance status, etc.) and/or the system itself (i.e., payment structures, facility locations, etc.). However, these frameworks typically do not take into account the broader, dynamic context in which individuals live and in which health care systems function. Purpose The growth in market-driven health care in the U.S. alongside policies aimed at improving health care delivery and quality have spurred health system mergers and consolidations, a shift toward outpatient care, an increase in for-profit care, and the closure of less profitable facilities. These shifts in the type, location and delivery of health care services may provide increased access for some urban residents while excluding others, a phenomenon we term “health care gentrification.“ In this commentary, we frame access to health care in the United States in the context of neighborhood gentrification and a concurrent process of changes to the health care system itself. Conclusions We describe the concept of health care gentrification, and the complex ways in which both neighborhood gentrification and health care gentrification may lead to inequitable access to health care. We then present a framework for understanding health care gentrification as a function of dynamic and multi-level systems, and propose ways to build on existing models of health care access and social determinants of health to more effectively measure and address this phenomenon. Finally, we describe potential strategies applied researchers might investigate that could prevent or remediate the effects of health care gentrification in the United States.
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Affiliation(s)
- Helen V S Cole
- Barcelona Lab for Urban Environmental Justice and Sustainability, Institut de Ciencia i Tecnologia Ambientals (ICTA-UAB), Universitat Autonoma de Barcelona, Barcelona, Spain. .,Healthy Cities research group, Department of Epidemiology and Public Health, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
| | - Emily Franzosa
- Research Health Science Specialist, Geriatric Research Education and Clinical Center (GRECC), James J. Peters VA Medical Center, Bronx, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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Golembiewski EH, Gravholt DL, Torres Roldan VD, Lincango Naranjo EP, Vallejo S, Bautista AG, LaVecchia CM, Patten CA, Allen SV, Jaladi S, Boehmer KR. Rural Patient Experiences of Accessing Care for Chronic Conditions: A Systematic Review and Thematic Synthesis of Qualitative Studies. Ann Fam Med 2022; 20:266-272. [PMID: 35606138 PMCID: PMC9199043 DOI: 10.1370/afm.2798] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/09/2021] [Accepted: 09/29/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Access to health care is a long-standing concern for rural patients; however, administrative measures fail to capture the subjective patient experience of accessing health care. The purpose of this review was to synthesize the qualitative literature on patient and caregiver experiences of accessing health care services for chronic disease management among US residents of rural areas. METHODS We searched Embase, MEDLINE, PsycInfo, CINAHL, and Scopus to identify qualitative studies published during 2010-2019. A thematic synthesis approach was used to analyze findings from included studies. RESULTS A total of 62 studies involving 1,354 unique participants were included. The largest share of studies (24.2%) was focused on the experience of patients with cancer, followed by behavioral health (16.1%), HIV and AIDS (14.5%), and diabetes (12.9%). We identified 4 primary analytic themes of barriers and facilitators associated with the experience of accessing health care services for chronic disease management in rural areas: (1) navigating the rural environment, (2) navigating the health care system, (3) financing chronic disease management, and (4) rural life (ie, common elements of a distinct "rural" way of thinking and behaving). CONCLUSIONS In this comprehensive review, we found that important cultural, structural, and individual factors influenced the rural patient's experience of health care access and use, including barriers and facilitators posed by geographic and built environments, and distinct rural mores. Our findings can inform policies and programs that both facilitate structural aspects of access and include culturally appropriate interventions.VISUAL ABSTRACT.
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Affiliation(s)
| | - Derek L Gravholt
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota
| | | | - Eddy P Lincango Naranjo
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota.,Hospital Vozandes Quito, Quito, Ecuador
| | | | | | - Christina M LaVecchia
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota.,School of Arts and Sciences, Neumann University, Aston, Pennsylvania
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Summer V Allen
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota
| | - Soumya Jaladi
- School of Medicine, University of Louisville, Louisville, Kentucky
| | - Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota.,Division of Healthcare Delivery Research, Mayo Clinic, Rochester, Minnesota
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Fortney JC, Carey EP, Rajan S, Rise PJ, Gunzburger EC, Felker BL. A Comparison of Patient-Reported Mental Health Outcomes for the Department of Veterans Affairs' Regional Telehealth and Community Care Programs. Health Serv Res 2022; 57:755-763. [PMID: 35467011 PMCID: PMC9264470 DOI: 10.1111/1475-6773.13993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare patient‐reported outcomes for veterans with limited access to Department of Veterans Affairs (VA) mental health services referred to the Veterans Community Care Program (VCCP) or regional telehealth Clinical Resource Hubs‐Mental Health (CRH‐MH). Data Sources This national evaluation used secondary data from the VA Corporate Data Warehouse, chart review, and primary data collected by baseline survey between October 8, 2019 and May 27, 2020 and a 4‐month follow‐up survey. Study Design A quasi‐experimental longitudinal study design was used to sample 545 veterans with VCCP or CRH‐MH referrals for new treatment episodes. Patient‐reported outcomes included symptom severity, perceived access, utilization, and patient‐centeredness. Data Collection During the baseline and follow‐up surveys, all veterans were administered the Patient Health Questionnaire‐8 (PHQ‐8) to assess depression severity, and veterans with a provisional diagnosis of posttraumatic stress disorder (PTSD) were also administered the PTSD Checklist for DSM‐5 (PCL‐5) to assess PTSD symptom severity. The 4‐month follow‐up survey also asked about perceived access using the Perceived Access Inventory, the number of encounters, and patient‐centeredness of care using the Patient‐Centered Care portion of the Veterans Satisfaction Survey. Principal Findings Results indicated that compared to VCCP consults, veterans with CRH‐MH consults reported 0.65 (CI95 = 0.51–0.83, p < 0.01) times the number of barriers to care, but a non‐significant lower number of encounters (−0.792, CI95 −2.221, 0.636, p = 0.28). There was no significant (p = 0.24) difference in satisfaction with patient‐centeredness, with both groups “agreeing” on average to positively worded questions. Veterans in both groups experienced little improvement in depression or PTSD symptom severity, and there were no clinically meaningful differences between groups. Conclusions Overall findings indicate that the CRH‐MH and VCCP generate similar patient‐reported outcomes. Future research should compare the quality and cost of care delivered by the VCCP and CRH‐MH programs.
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Affiliation(s)
- John C Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.,Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
| | - Evan P Carey
- Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA.,Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Denver, Colorado, USA
| | - Suparna Rajan
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
| | - Peter J Rise
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
| | - Elise C Gunzburger
- Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Denver, Colorado, USA
| | - Bradford L Felker
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.,Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA
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McNeal DM, Fehling K, Ho PM, Kaboli P, Shimada S, Saini SD, Youles B, Albright K. Engaging Stakeholders in Identifying Access Research Priorities for the Department of Veterans Affairs. J Gen Intern Med 2022; 37:14-21. [PMID: 35349024 PMCID: PMC8993958 DOI: 10.1007/s11606-021-07195-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Veterans Access Research Consortium (VARC), a Department of Veterans Affairs (VA) Consortium of Research focused on access to healthcare, has been funded by VA's Health Services Research and Development Service (HSR&D) to develop a research roadmap for healthcare access. The goal of the roadmap is to identify operationally aligned research questions that are most likely to lead to meaningful improvements in Veterans' healthcare access. OBJECTIVES To describe the process of soliciting diverse stakeholder perspectives about key priorities on which VA's HSR&D access agenda should focus and identify the results of that process. METHODS We used a modified Delphi approach to engage researchers and VA operational partners in a process to develop recommendations regarding the access-related research questions VA should prioritize. We then collaborated with three Veteran Engagement Groups (VEGs) across the country to solicit Veterans' reactions to the Delphi results and their perspectives about access-related issues affecting access to VA health care. RESULTS The Delphi panel consisted of 22 research and operational experts, both internal and external to VA. The Delphi process resulted in five research questions identified by the panelists as highest priority for VA to pursue, each representing one of the following domains: (1) measurement of access, (2) barriers to access, (3) equity and subpopulations, (4) effective interventions to improve access, and (5) consequences of poor/better access. Veterans' perspectives focused primarily on the barriers to access domain. Veterans indicated several barriers that might be addressed through research or operational initiatives, including poor communication about services, weak connections to and partnerships with local community care facilities, and poor provision of telehealth resources and education. CONCLUSIONS Engaging multiple methods to solicit stakeholder perspectives enables more nuanced understanding of access-related priorities for VA. Future research should consider utilizing such an approach to identify additional research and/or operational priorities.
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Affiliation(s)
- Demetria M McNeal
- Division of General Internal Medicine, University of Colorado School of Medicine, Academic Office One, 12631 E 17th Avenue, Aurora, CO, 80045, USA
| | - Kelty Fehling
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - P Michael Ho
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Peter Kaboli
- Iowa City VA Center for Access Delivery Research, Iowa VA Healthcare System, 601 Highway 6 West, Iowa City, IA, 52246, USA
| | - Stephanie Shimada
- VA Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, Building 70, Bedford, MA, 01730, USA
| | - Sameer D Saini
- VA Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA
| | - Bradley Youles
- VA Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA
| | - Karen Albright
- Division of General Internal Medicine, University of Colorado School of Medicine, Academic Office One, 12631 E 17th Avenue, Aurora, CO, 80045, USA.
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Hilgeman MM, Cramer DRJ, Hoch MC, Collins AN, Zabelski S, Heebner NR. A Pilot Study Comparing Two Measures of Perceived Health Services Access Among Military Veterans With Musculoskeletal Injuries and Mental Health Conditions. Mil Med 2022; 188:usac072. [PMID: 35311993 PMCID: PMC9383606 DOI: 10.1093/milmed/usac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/17/2022] [Accepted: 03/03/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Service members endure a number of musculoskeletal injuries (MSIs) during service (e.g., ankle sprains and chronic back pain). Musculoskeletal injuries can reduce engagement in physical activity after military service and contribute to a sedentary lifestyle that diminishes physical health and elevates the risk for psychological distress including suicide-related behaviors. Yet, little is known about barriers and facilitators to accessing care in veterans with co-occurring MSI and mental health conditions. The purpose of this study was to pilot two brief measures of barriers and facilitators to rehabilitation and mental health services in military veterans with musculoskeletal and mental health conditions. Self-report tools vary in their response formats in ways that can impact usability, data quality, and completeness. We examine two response styles (i.e., checklist vs. thermometer) for two health services (mental health and rehabilitation) to determine usability, patterns in item endorsement, and veteran preference. MATERIALS AND METHODS Barriers and facilitators informed by the Fortney Veterans Healthcare Access model were assessed by veterans (n = 31) on the newly developed 22-item, paper-and-pencil scale with separate ratings for mental health and rehabilitation services. All participants completed scales with both response styles and the order of administration was randomized (i.e., either the checklist first or the thermometer-style response first). Data also included self-reported demographics, musculoskeletal and mental health diagnoses, health-related quality of life, physical activity levels, mental health symptoms, suicide risk, and coronavirus disease of 2019 pandemic-related stress. RESULTS Veterans reported no differences in ease of use across response formats; however, 83.9% (n = 26) preferred the checklist style, with only 3.22% (n = 1) preferring the thermometer format. Checklist items also resulted in less missing data (i.e., range 0.00%-6.45%) than the thermometer-style option (i.e., range 6.45%-61.30%). On the checklist, total number of perceived barriers was low for mental health and rehabilitation services (i.e., M = 1.58 and M = 1.61, respectively). Distance to care and problems related to symptoms were the most frequently identified barriers for both services. Facilitators outnumbered barriers for mental and rehabilitation services, and nearness of the clinic/hospital was the top-rated facilitator for both. On the thermometer, the perceived strength of each mental health (M = 39.37) and rehabilitation (M = 39.81) service barrier was moderate (0-100 scale), while the average perceived strength of each mental health (M = 61.66) and rehabilitation service (M = 61.84) facilitator was higher. Associations between barrier and facilitator scores with mental and physical health indicators were small with exceptions. For instance, suicide attempt likelihood was positively correlated with rehabilitation services barriers; mental health burden was positively associated with both barriers and facilitators. CONCLUSIONS Results of this pilot comparing two measurement approaches identified actionable next steps. Brief barriers and facilitators checklists were viable for veteran ratings across type of health. The thermometer-based tool captured the perceived strength of barriers and facilitators but yielded problematic rates of missing data in its current form and was not preferred by veterans.
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Affiliation(s)
- Michelle M Hilgeman
- Clinical Research Psychologist, Research & Development Service (151), Tuscaloosa VA Medical Center, Tuscaloosa, AL 35404, USA
| | - Dr Robert J Cramer
- Department of Public Health Sciences, UNC Charlotte, Charlotte, NC 28223, USA
| | - Matthew C Hoch
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
| | - Amber N Collins
- Research & Development Service (151), Tuscaloosa VA Medical Center, Tuscaloosa, AL 35404, USA
| | - Sasha Zabelski
- Department of Public Health Sciences, UNC Charlotte, Charlotte, NC 28223, USA
| | - Nicholas R Heebner
- Sports Medicine Research Institute, University of Kentucky, Lexington, KY 40506, USA
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