1
|
Su C, Wang Z, Dong X, Ma X. Experiences of seeking diabetic eye care among patients with diabetes in China: a community-based convergent mixed methods study. Public Health 2024; 234:24-32. [PMID: 38936116 DOI: 10.1016/j.puhe.2024.05.021] [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: 01/11/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES This study aimed to characterize the most updated utilization of eye care services and obtain a holistic understanding of barriers among patients with diabetes in China. STUDY DESIGN This was a convergent mixed methods study. METHODS A convergent triangulation mixed methods approach was used, with a quantitative cross-sectional survey of patients with diabetes and semistructured interviews involving patients and health workers. Following the conceptual framework of the World Health Organization Determinants of Health Behaviours, multivariate logistic regression for quantitative analysis and thematic analysis for qualitative data were used to examine barriers to seeking eye care among patients with diabetes. Triangulation was used to integrate quantitative and qualitative results. RESULTS Among 1167 surveyed patients who participated in the quantitative component, 29.1% had undergone eye examinations within the last 12 months, and 9.3% had received eye surgery. Awareness that diabetes causes eye diseases (P < 0.001) and knowing laser treatment can treat diabetic retinopathy (DR; P < 0.001) were associated with higher examination rates. In the qualitative component, involving 20 patients and 11 health workers, barriers were identified from individual, social, and cultural environmental factors. Integration of data highlighted the complex interplay of these factors in shaping care-seeking behaviors and the importance of non-economic factors, including patients' information about costs of DR services and cultural environmental factors. CONCLUSIONS Diabetic eye care utilization remains suboptimal in China, emphasizing the impact of cultural and contextual factors. Comprehensive education strategies, along with training for primary health workers and task-shifting, are likely to enhance eye care service utilization in underserved settings.
Collapse
Affiliation(s)
- C Su
- School of Public Health, Peking University, Beijing 100191, China; China Centre for Health Development Studies, Peking University, Beijing 100191, China
| | - Z Wang
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec H3S 1Z1, Canada
| | - X Dong
- School of Public Health, Peking University, Beijing 100191, China; China Centre for Health Development Studies, Peking University, Beijing 100191, China
| | - X Ma
- China Centre for Health Development Studies, Peking University, Beijing 100191, China.
| |
Collapse
|
2
|
Fawad I, Fischer KM, Yeganeh HST, Hanson KT, Wilshusen LL, Hydoub YM, Coons TJ, Vista TL, Maniaci MJ, Habermann EB, Dugani SB. Rurality and patients' hospital experience: A multisite analysis from a US healthcare system. PLoS One 2024; 19:e0308564. [PMID: 39116117 PMCID: PMC11309381 DOI: 10.1371/journal.pone.0308564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The association between rurality of patients' residence and hospital experience is incompletely described. The objective of the study was to compare hospital experience by rurality of patients' residence. METHODS From a US Midwest institution's 17 hospitals, we included 56,685 patients who returned a post-hospital Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. We defined rurality using rural-urban commuting area codes (metropolitan, micropolitan, small town, rural). We evaluated the association of patient characteristics with top-box score (favorable response) for 10 HCAHPS items (six composite, two individual, two global). We obtained adjusted odds ratios (aOR [95% CI]) from logistic regression models including patient characteristics. We used key driver analysis to identify associations between HCAHPS items and global rating (combined overall rating of hospital and recommend hospital). RESULTS Of all items, overall rating of hospital had lower odds of favorable response for patients from metropolitan (0.88 [0.81-0.94]), micropolitan (0.86 [0.79-0.94]), and small towns (0.90 [0.82-0.98]) compared with rural areas (global test, P = .003). For five items, lower odds of favorable response was observed for select areas compared with rural; for example, recommend hospital for patients from micropolitan (0.88 [0.81-0.97]) but not metropolitan (0.97 [0.89-1.05]) or small towns (0.93 [0.85-1.02]). For four items, rurality showed no association. In metropolitan, micropolitan, and small towns, men vs. women had higher odds of favorable response to most items, whereas in rural areas, sex-based differences were largely absent. Key driver analysis identified care transition, communication about medicines and environment as drivers of global rating, independent of rurality. CONCLUSIONS Rural patients reported similar or modestly more favorable hospital experience. Determinants of favorable experience across rurality categories may inform system-wide and targeted improvement.
Collapse
Affiliation(s)
- Iman Fawad
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Karen M. Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, United States of America
| | | | - Kristine T. Hanson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Laurie L. Wilshusen
- Mayo Clinic Quality, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Yousif M. Hydoub
- Division of Cardiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Trevor J. Coons
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Tafi L. Vista
- Mayo Clinic Quality, Mayo Clinic, Phoenix, Arizona, United States of America
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Elizabeth B. Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| |
Collapse
|
3
|
Lancaster BD, Hefner T, Leslie-Miller CJ, Sexton K, Bakula DM, Van Allen J, Cushing CC, Lim CS, Janicke DM, Jelalian E, Dayani K, Davis AM. Systematic review and meta analysis of psychological interventions to prevent or treat pediatric chronic disease in rural communities. J Pediatr Psychol 2024:jsae054. [PMID: 38981115 DOI: 10.1093/jpepsy/jsae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to examine the effectiveness of psychological interventions at improving physical or mental health outcomes for youth living in rural communities who have, or are at-risk for, any chronic medical condition in comparison to control interventions conducted in rural communities. METHODS Following prospective registration (OSF.IO/7TDQJ), 7 databases were searched through July 1, 2023. Studies were included if they were a randomized control trial of a psychological intervention conducted with youth living in a rural area who had, or were at-risk for, a chronic medical condition. Risk of bias was assessed with the Cochrane risk of bias version 2 tool. A qualitative synthesis and meta-analysis were conducted. RESULTS 15 studies met inclusion criteria. Obesity studies (n = 13) primarily focused on body mass index metrics, with limited significant findings across studies. Asthma treatment interventions (n = 2) showed no impact on hospitalizations. 3 studies evaluated mental health outcomes with no significant group differences observed. We meta-analytically analyzed 9 studies that evaluated body mass index z-scores and identified an overall null effect (Hedge's g = 0.01, 95% CI [-0.07, 0.09], p = .85). CONCLUSIONS Most included studies focused on pediatric obesity, and there was a limited range of health outcomes reported. Compared to controls, minimal significant improvements in health outcomes were identified for psychological interventions for youth living in rural communities. Future efforts may benefit from situating this work more systematically within a health disparities framework with a focus on understanding mechanisms of disparities and translating this work into interventions and policy changes.
Collapse
Affiliation(s)
- Brittany D Lancaster
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, United States
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, United States
| | - Tristen Hefner
- Clinical Psychology Program, Texas Tech University, Lubbock, TX, United States
| | | | - Kody Sexton
- Counseling Psychology Program, University of Tennessee Knoxville, Knoxville, TN, United States
| | - Dana M Bakula
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, United States
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, United States
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Jason Van Allen
- Clinical Psychology Program, Texas Tech University, Lubbock, TX, United States
| | - Christopher C Cushing
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, United States
- Schiefelbusch Life Span Institute, University of Kansas, Lawrence, KS, United States
| | - Crystal S Lim
- Department of Health Psychology, University of Missouri, Columbia, MO, United States
| | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Katie Dayani
- Department of Library Services, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Ann M Davis
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, United States
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, United States
| |
Collapse
|
4
|
Phillips G, Millhollon R, Elenwo C, Ford AI, Bray N, Hartwell M. Associations of clinical personnel characteristics and telemedicine practices. J Osteopath Med 2024; 0:jom-2024-0023. [PMID: 38855816 DOI: 10.1515/jom-2024-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024]
Abstract
CONTEXT The use of telemedicine strategies has been increasing in the United States for more than a decade, with physicians taking advantage of this new tool to reach more patients. Determining the specific demographics of physicians utilizing telemedicine most in their practice can inform recommendations for expanded telemedicine use among all physicians and aid in mitigating the need for local physicians in urban and rural populations. OBJECTIVES This study aims to assess the use of telemedicine by physicians in 2021, based on four demographics utilizing the National Electronic Health Record Survey (NEHRS): physician age, sex, specialty, and training. METHODS We performed a cross-sectional study of the 2021 NEHRS to determine the relationship between physician characteristics and telemedicine practices. Differences between groups were measured through design-based chi-square tests. RESULTS Compared to male physicians, female physicians were more likely to utilize telemedicine services (X 2=8.0; p=0.005). Compared to younger physicians, those over the age of 50 were less likely to utilize telemedicine services (X 2=4.1; p=0.04). Compared to primary care physicians, medical and surgical specialty physicians were less likely to utilize telemedicine services, with surgical specialty physicians being the least likely overall (X 2=11.5; p<0.001). We found no significant differences in telemedicine use based on degree (Osteopathic and Allopathic). CONCLUSIONS Our results showed a statistically significant difference between physician's age, sex, and specialty on telemedicine use in practice during 2021. Efforts to increase telemedicine use among physicians may be needed to provide more accessible care to patients. Thus, by increasing physician education on the importance of telemedicine for modern patients, more physicians may decide to utilize telemedicine services in practice.
Collapse
Affiliation(s)
- Gunnar Phillips
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Tahlequah, OK, USA
| | - Robert Millhollon
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, USA
| | - Covenant Elenwo
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, USA
| | - Alicia Ito Ford
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Natasha Bray
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, USA
| | - Micah Hartwell
- Oklahoma State University College of Osteopathic Medicine at Cherokee Nation, Office of Medical Student Research, Tahlequah, OK, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| |
Collapse
|
5
|
Charlly N, Swedlund M. Can You Hear Me Now? Patient Perceptions of Telehealth in a Rural Primary Care Population. Telemed J E Health 2024; 30:e1719-e1726. [PMID: 38452338 DOI: 10.1089/tmj.2023.0554] [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: 03/09/2024] Open
Abstract
Background: The COVID-19 pandemic significantly increased telehealth adoption. Rural communities experience challenges relating to telehealth, including a shortage of clinicians, low health literacy, mistrust of medicine, and limited technology access, yet rural perceptions have not been a subject of robust study. The setting of this study was a rural Midwestern family medicine clinic within an academic health system. Methods: Surveys were given to all patients of age 18 or older visiting the clinic over a one-week period. Those who expressed interest were contacted for a semistructured interview. Descriptive statistics and chi-square testing were used to analyze survey results for significant relationships, while interview transcripts were analyzed for themes. Results: Of respondents, 27% indicated prior telehealth use and were more likely to prefer telehealth visits (p = 0.03). Perceptions of telehealth were sorted into themes, including scope of care, convenience, and technology. Telehealth was preferred for discussing test results or mental health. Barriers such as travel time and transportation access favored telehealth. Although more convenient, telehealth was found to be less effective for relationship building. The absence of physical examination during phone visits was a concern. Phone visits were more prevalent due to failure of video-based technology. Conclusions: Despite the potential to address these unique challenges in rural communities, telehealth acceptance is poor. Barriers such as accessibility of technology can be improved through governmental and health systemwide measures. Future work can help develop interventions that counter negative perceptions of telehealth while increasing interest and uptake in rural communities.
Collapse
Affiliation(s)
- Nithin Charlly
- Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew Swedlund
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
6
|
Rowe Ferrara M, Chapman SA. Rural Patients' Experiences with Synchronous Video Telehealth in the United States: A Scoping Review. Telemed J E Health 2024; 30:1357-1377. [PMID: 38265694 DOI: 10.1089/tmj.2023.0410] [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: 01/25/2024] Open
Abstract
Background: Telehealth can help increase rural health care access. To ensure this modality is accessible for rural patients, it is necessary to understand rural patients' experiences with telehealth. Objectives of this scoping review were to explore how rural patients' telehealth experiences have been measured, assess relevant research, and describe rural telehealth patient experiences. Methods: We searched five databases for articles published from 2016 through 2022. Primary research reports assessing rural adult patient experiences with synchronous video telehealth in the United States in any clinical area were included. Data collected pertained to study characteristics and patient experience assessment characteristics and outcomes. Quality of included studies was assessed using the Quality Assessment with Diverse Studies tool. Review findings were presented in a narrative synthesis. Results: There were 740 articles identified for screening, and 24 met review inclusion criteria. Most studies (70%, n = 16) assessed rural telehealth patient experience using questionnaires; studies employed interviews (n = 11) alone or in combination with surveys. The majority of surveys were study developed and not validated. Quantitative patient experience outcomes fell under categories of patient satisfaction, telehealth care characteristics, patient-provider rapport, technology elements, and access. Qualitative themes were most often presented as telehealth benefits or facilitators, and drawbacks or barriers. Conclusions: Available research indicates positive patient experiences with rural telehealth services. However, study weaknesses limit generalizability of findings. Future research should apply established definitions for participant rurality and clearly group samples by rurality. Efforts should be made to use validated telehealth patient experience measures.
Collapse
Affiliation(s)
- Meghan Rowe Ferrara
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Susan A Chapman
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
7
|
Peng W, Huang Q, Mao B. Evaluating variations in the barriers to colorectal cancer screening associated with telehealth use in rural U.S. Pacific Northwest. Cancer Causes Control 2024; 35:635-645. [PMID: 38001334 DOI: 10.1007/s10552-023-01819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE The incidence and mortality rates of colorectal cancer (CRC) remain consistently high in rural populations. Telehealth can improve screening uptake by overcoming individual and environmental disadvantages in rural communities. The present study aimed to characterize varying barriers to CRC screening between rural individuals with and without experience in using telehealth. METHOD The cross-sectional study surveyed 250 adults aged 45-75 residing in rural U.S. states of Alaska, Idaho, Oregon, and Washington from June to September 2022. The associations between CRC screening and four sets of individual and environmental factors specific to rural populations (i.e., demographic characteristics, accessibility, patient-provider factors, and psychological factors) were assessed among respondents with and without past telehealth adoption. RESULT Respondents with past telehealth use were more likely to screen if they were married, had a better health status, had experienced discrimination in health care, and had perceived susceptibility, screening efficacy, and cancer fear, but less likely to screen when they worried about privacy or had feelings of embarrassment, pain, and discomfort. Among respondents without past telehealth use, the odds of CRC screening decreased with busy schedules, travel burden, discrimination in health care, and lower perceived needs. CONCLUSION Rural individuals with and without previous telehealth experience face different barriers to CRC screening. The finding suggests the potential efficacy of telehealth in mitigating critical barriers to CRC screening associated with social, health care, and built environments of rural communities.
Collapse
Affiliation(s)
- Wei Peng
- Edward R. Murrow College of Communication, Washington State University, Murrow Hall 211, Pullman, WA, 99164, USA.
| | - Qian Huang
- Department of Communication, University of North Dakota, Grand Forks, ND, USA
| | - Bingjing Mao
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
8
|
Menza TW, Jensen A, Hixson LK. Predictors of Viral Suppression Among People Living with HIV in Rural Oregon. AIDS Behav 2024; 28:154-163. [PMID: 37610534 DOI: 10.1007/s10461-023-04145-6] [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] [Accepted: 07/19/2023] [Indexed: 08/24/2023]
Abstract
With recent outbreaks of HIV in rural areas of the United States, it has become increasingly important to understand the factors affecting health outcomes of people with HIV living in rural areas. We assessed predictors of durable HIV viral suppression among rural participants using a pooled 7-year dataset from the Medical Monitoring Project (MMP), a cross-sectional, representative sample of individuals receiving HIV medical care in Oregon. Only 77.3% of rural participants achieved durable HIV viral suppression, while 22.7% had at least one detectable HIV viral load measurement within the past 12 months. The primary predictors of viral suppression were ARV adherence, poverty, and reported heavy drinking in the past 30 days. These results highlight the influence of social factors on health outcomes for persons with HIV living in rural areas and inform areas for policy and program change.
Collapse
Affiliation(s)
- Timothy W Menza
- Public Health Division, Oregon Health Authority, Portland, OR, USA.
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
| | - Ann Jensen
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA
| | - Lindsay K Hixson
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| |
Collapse
|
9
|
Jain N, Jersovs K, Safina T, Pilmane M, Jansone-Ratinika N, Grike I, Petersons A. Medical education in Latvia: an overview of current practices and systems. Front Med (Lausanne) 2023; 10:1250138. [PMID: 37809335 PMCID: PMC10551541 DOI: 10.3389/fmed.2023.1250138] [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: 06/29/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Located in northern Europe, Latvia is one of the three Baltic States with a population of 1.9 million. The country has a rich history of medical education spanning a century and is becoming an emerging global hub for medical education. Although the surge in international students has been beneficial for the development of educational and research infrastructure, increasing demands from local students, along with institutional capacity constraints, have overburdened the available resources. Substantial investments are being made to adapt to the rapidly changing geopolitical and techno-biomedical landscape. This perspective paper presents an overview of the country's medical education system, its challenges, and prospects from pre-university to doctoral level.
Collapse
Affiliation(s)
- Nityanand Jain
- Faculty of Medicine, Riga Stradinš University, Riga, Latvia
- Institute of Anatomy and Anthropology, Riga Stradinš University, Riga, Latvia
| | - Kirils Jersovs
- Faculty of Medicine, Riga Stradinš University, Riga, Latvia
| | - Taira Safina
- Faculty of Medicine, Riga Stradinš University, Riga, Latvia
| | - Mara Pilmane
- Institute of Anatomy and Anthropology, Riga Stradinš University, Riga, Latvia
| | | | - Ieva Grike
- Faculty of Residency, Riga Stradinš University, Riga, Latvia
| | - Aigars Petersons
- Faculty of Medicine, Riga Stradinš University, Riga, Latvia
- Children's Clinical University Hospital, Riga, Latvia
| |
Collapse
|
10
|
Devanbu VGC, R N, A S, Kumar N. Situational Analysis of Healthcare Delivery and User Perspectives of Mobile Diagnostics (mDiagnostics) in Chennai, Tamil Nadu, India: A Mixed-Method Study. Cureus 2023; 15:e45808. [PMID: 37876401 PMCID: PMC10591228 DOI: 10.7759/cureus.45808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Situational analysis of exciting infrastructure including mobile health services is crucial for comprehensive healthcare delivery. The concept of mDiagnostics has gained traction as it addresses the challenges of accessibility, affordability, and availability of healthcare services in remote regions. Purpose The study was to do a situational analysis of the availability of medical diagnostic facilities and identify the challenges and barriers faced in the implementation and utilisation of mDiagnostics. Material and methods The present study was a mixed mixed-method study conducted in rural and urban areas of Chennai, Tamil Nadu, India. A total of 1,489 households were included. Situational analysis of existing healthcare facilities and the availability of Ayushman Bharat Health Account (ABHA) numbers for study participants in both urban and rural areas was assessed. In-depth interviews on user perspective, affordability, awareness of existing health services, and perception of the utility of mobile lab services and focus group discussions with healthcare professionals, community members, and key stakeholders were carried out. Thematic analysis for qualitative data, proportion, and means were calculated for the quantitative component. Result Out of 1,489 households included, 711 were from rural areas, and 778 were from urban areas. The distance traveled from their residence to both the lab and health facility was less than 5 km in urban areas, while it is more than 5 km in rural areas. The mean expenditure in availing healthcare services is above five thousand rupees per annum in nearly half of the rural households (46%) and 60% of urban. The analyses of interviews explored the availability, acceptability, and affordability under seven thematic areas for situational analysis of healthcare facilities, and a focused group discussion was held to explore the community member's barrier to healthcare services. Conclusion The study reveals a comprehensive understanding of healthcare delivery access disparities between rural and urban areas in Tamil Nadu. The findings highlighted the potential benefits of mobile lab initiatives in improving healthcare access and early disease detection in underserved rural communities.
Collapse
Affiliation(s)
| | - Narendranath R
- Community Medicine, KMCH Institute of Health Sciences and Research, Coimbatore, IND
| | - Sanjutha A
- Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, IND
| | - Neeta Kumar
- Social Health Implementation, Indian Council of Medical Research (ICMR), New Delhi, IND
| |
Collapse
|
11
|
Zhu X, Zhang P, Kang H, Marla L, Robles Granda MI, Ebert-Allen RA, Stewart de Ramirez S, Oderwald T, McGee M, Handler JA. Derivation of a Unique, Algorithm-Based Approach to Cancer Patient Navigator Workload Management. JCO Clin Cancer Inform 2023; 7:e2200170. [PMID: 37207310 PMCID: PMC10569769 DOI: 10.1200/cci.22.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/05/2023] [Accepted: 03/15/2023] [Indexed: 05/21/2023] Open
Abstract
PURPOSE Cancer patient navigators (CPNs) can decrease the time from diagnosis to treatment, but workloads vary widely, which may lead to burnout and less optimal navigation. Current practice for patient distribution among CPNs at our institution approximates random distribution. A literature search did not uncover previous reports of an automated algorithm to distribute patients to CPNs. We sought to develop an automated algorithm to fairly distribute new patients among CPNs specializing in the same cancer type(s) and assess its performance through simulation on a retrospective data set. METHODS Using a 3-year data set, a proxy for CPN work was identified and multiple models were developed to predict the upcoming week's workload for each patient. An XGBoost-based predictor was retained on the basis of its superior performance. A distribution model was developed to fairly distribute new patients among CPNs within a specialty on the basis of predicted work needed. The predicted work included the week's predicted workload from a CPN's existing patients plus that of newly distributed patients to the CPN. Resulting workload unfairness was compared between predictor-informed and random distribution. RESULTS Predictor-informed distribution significantly outperformed random distribution for equalizing weekly workloads across CPNs within a specialty. CONCLUSION This derivation work demonstrates the feasibility of an automated model to distribute new patients more fairly than random assignment (with unfairness assessed using a workload proxy). Improved workload management may help reduce CPN burnout and improve navigation assistance for patients with cancer.
Collapse
Affiliation(s)
- Xiyitao Zhu
- University of Illinois at Urbana-Champaign, Champaign, IL
| | - Peng Zhang
- University of Illinois at Urbana-Champaign, Champaign, IL
| | - Hyojung Kang
- University of Illinois at Urbana-Champaign, Champaign, IL
| | - Lavanya Marla
- University of Illinois at Urbana-Champaign, Champaign, IL
| | | | | | - Sarah Stewart de Ramirez
- OSF HealthCare System, Peoria, IL
- University of Illinois College of Medicine at Peoria, Peoria, IL
| | | | | | - Jonathan A. Handler
- OSF HealthCare System, Peoria, IL
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
12
|
Daubman BR, Rosenberg LB, Meier DE. Beyond the Fight: Why President Biden's Cancer Moonshot Must Include Palliative Care. J Clin Oncol 2023; 41:1189-1192. [PMID: 36103638 PMCID: PMC9940938 DOI: 10.1200/jco.22.00838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/30/2022] [Accepted: 07/29/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bethany-Rose Daubman
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Leah B. Rosenberg
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Diane E. Meier
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
13
|
Lewis LF, Brower PM, Narkewicz S. "We Operate as an Organ": Parent Experiences of Having a Child With Type 1 Diabetes in a Rural Area. Sci Diabetes Self Manag Care 2023; 49:35-45. [PMID: 36594452 DOI: 10.1177/26350106221144962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE The purpose of this study is to explore the experiences of parents of children with type 1 diabetes mellitus (T1DM) who are living in rural areas. Individuals living in rural areas face barriers to accessing health care that lead to significant health disparities with increased morbidity and mortality. There is a need to understand the unique experiences of those living in rural communities to support their health needs. METHODS In this qualitative study, a convenience sample of 11 parents of children who were diagnosed with T1DM in the last 10 years living in Vermont were recruited through connections with local health professionals and family support networks and interviewed about their experiences. Interviews were transcribed verbatim and analyzed using Braun and Clarke's 6-step approach to reflexive thematic analysis. RESULTS Five themes were identified to capture the experience of parenting a child with T1DM in a rural community, including enduring emotional traumas, living life on call, adapting to everyday challenges, lacking a safety net for support, and finding a rhythm. CONCLUSIONS Although findings echo many themes found in previous studies on experiences of parents of children with T1DM, participants also identified unique barriers such as physical distance from formal and informal support systems, unreliable and/or insufficient technological resources, and lack of understanding of T1DM by their communities, including among child care and schools. Diabetes care and education specialists working with families living in rural areas must explore ways to educate key supports to these families to minimize isolation, stigma, and burnout among parents.
Collapse
Affiliation(s)
| | | | - Sarah Narkewicz
- Department of Nursing, University of Vermont, Burlington, Vermont
| |
Collapse
|
14
|
Interventions for Increasing Digital Equity and Access (IDEA) among rural patients who smoke: Study protocol for a pragmatic randomized pilot trial. Contemp Clin Trials 2022; 119:106838. [PMID: 35760340 DOI: 10.1016/j.cct.2022.106838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cigarette smoking prevalence is higher among rural compared with urban adults, yet access to cessation programming is reduced. The Increasing Digital Equity and Access (IDEA) study aims to evaluate three digital access and literacy interventions for promoting engagement with an online evidence-based smoking cessation treatment (EBCT) program among rural adults. METHODS The pilot trial will use a pragmatic, three-arm, randomized, parallel-group design with participants recruited from a Midwest community-based health system in Minnesota, Wisconsin, and Iowa. All participants will receive an online, 12-week, EBCT program, and written materials on digital access resources. Participants will be stratified based on state of residence and randomly assigned with 1:1:1 allocation to one of three study groups: (1) Control Condition-no additional study intervention (n = 30); (2) Loaner Digital Device-Bluetooth enabled iPad with data plan coverage loaned for the study duration (n = 30); (3) Loaner Digital Device + Coaching Support-loaner device plus up to six, 15-20 min motivational interviewing-based coaching calls to enhance participants' digital access and literacy (n = 30). All participants will complete study assessments at baseline and 4- and 12-weeks post-randomization. Outcomes are cessation program and trial engagement, biochemically confirmed smoking abstinence, and patient experience. RESULTS A rural community advisory committee was formed that fostered co-design of the study protocol for relevance to rural populations, including the trial design and interventions. CONCLUSION Study findings, processes, and resources may have relevance to other health systems aiming to foster digital inclusion in smoking cessation and chronic disease management programs and clinical trials in rural communities.
Collapse
|