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Alves, Luciana Valadão Vasconcelos, Sonia Acioli, Vanessa De Almeida Ferreira Corrêa e Juliana Roza Dias. "Características do acesso à visita domiciliar: visão de enfermeiros". Revista Recien - Revista Científica de Enfermagem 10, n. 31 (28 settembre 2020): 57–64. http://dx.doi.org/10.24276/rrecien2020.10.31.57-64.
Testo completoAbstract (sommario):
Caracterizar o acesso à visita domiciliar do enfermeiro da Estratégia Saúde da Família, em uma área de planejamento do município do Rio de Janeiro. Estudo descritivo, de abordagem qualitativa, cuja coleta de dados foi realizada por meio de entrevistas semiestruturadas, com 25 enfermeiros. Para análise dos dados utilizou-se a técnica hermenêutica-dialética. O acesso à visita domiciliar ocorre através da demanda de agentes comunitários de saúde, observações na consulta de enfermagem e pelo próprio usuário. São visitas voltadas às principais linhas de cuidado, acamados e com dificuldades de deambulação. O acesso à visita domiciliar do enfermeiro volta-se principalmente a agravos específicos e não às práticas de promoção da saúde. Essas informações podem apoiar a construção de estratégias voltadas à ampliação do acesso dos usuários a visita domiciliar do enfermeiro.Descritores: Saúde da Família, Enfermagem em Saúde Pública, Visita Domiciliar. Analysis of cognitive ergonomics in nursing in hemodialysis clinicAbstract: To characterize the access to home visits by nurses in the Family Health Strategy, in a planning area in the city of Rio de Janeiro. A descriptive study, with a qualitative approach, whose data collection was carried out through semi-structured interviews, with 25 nurses. For data analysis, the hermeneutic-dialectic technique was used. Access to home visits occurs through the demand for community health agents, observations in the nursing consultation and by the user himself. They are visits aimed at the main lines of care, bedridden and with walking difficulties. Access to the nurse's home visit is directed mainly to specific problems and not to health promotion practices. This information can support the construction of strategies aimed at expanding users access to nurses home visits.Descriptors: Family Health, Nurses Public Health, House Calls. Características del acceso a visitas domiciliarias: visión de las enfermeirasResumen: Caracterizar el acceso a las visitas domiciliarias por parte de enfermeras en la Estrategia de Salud Familiar, en un área de planificación en la ciudad de Río de Janeiro. Estudio descriptivo, con enfoque cualitativo, cuya recolección de datos se realizó mediante entrevistas semiestructuradas, con 25 enfermeras. Para el análisis de datos, se utilizó la técnica hermenéutica-dialéctica. El acceso a las visitas domiciliarias se produce a través de la demanda de agentes de salud comunitarios, observaciones en la consulta de enfermería y por el propio usuario. Son visitas dirigidas a las principales líneas de atención, encamadas y con dificultades para caminar. El acceso a la visita domiciliaria de la enfermera se dirige principalmente a problemas específicos y no a prácticas de promoción de la salud. Esta información puede apoyar la construcción de estrategias destinadas a ampliar el acceso de los usuarios a las visitas domiciliarias de las enfermeras.Descriptores: Salud Familiar, Visita Domiciliaria, Enfermería en Salud Pública.
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Kim, So Lim, Angela Everett, Susan J. Rehm, Steven Gordon e Nabin Shrestha. "Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study". Open Forum Infectious Diseases 4, suppl_1 (2017): S333—S334. http://dx.doi.org/10.1093/ofid/ofx163.791.
Testo completoAbstract (sommario):
Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value < 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P < 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.
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Master, Samip R., Poornima Ramadas e Richard Preston Mansour. "Telemedicine in Hematology: Tool to Improve Access and Patient Satisfaction". Blood 138, Supplement 1 (5 novembre 2021): 4937. http://dx.doi.org/10.1182/blood-2021-152108.
Testo completoAbstract (sommario):
Abstract Introduction: Telemedicine can transform the future of medicine, especially in rural settings by improving access to medical care. Here were present the patient satisfaction data from both telemedicine and regular visits in our Hematology & Oncology clinics. In Hematology, we have used tele medicine for sickle cell disease, benign hematology cases like iron deficiency, thrombocytopenia, leukocytosis etc., and in malignant hematology for new patient consults, toxicity checks, follow up of plasma cell disorders, chronic leukemias and low intensity chemotherapies. Methods: We retrospectively collected patient satisfaction survey data from March 2020 to April 2021 for both telemedicine and regular visits. The patients were allowed to give a score from 1 to 99 regarding their experience at visit. We collected data on the following: likelihood of recommending, care provider, access and overall assessment. Results: A total of 53 patient satisfaction survey were available for telemedicine and 462 for regular visits. Over 60 % of tele visits were non cancer related and 40% were cancer related. The average score for likelihood of recommending, care provider, access, and overall assessment for tele visit were 73.5, 41.5, 73.5 and 62 respectively. The average score for likelihood of recommending, care provider, access, and overall assessment for regular visit were 13.75, 7.5, 26.5, and 11 respectively. Conclusion: The patient satisfaction scores for likelihood of recommending, care provider, access and overall assessment were significantly better for tele visits compared to regular visits. Disclosures Master: Blue Bird Bio: Current holder of individual stocks in a privately-held company.
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Bishop, Kenneth D., Mary Anne Fenton, Tara Szymanski e Megan Begnoche. "Reduction of emergency department utilization via access to outpatient cancer care." Journal of Clinical Oncology 32, n. 30_suppl (20 ottobre 2014): 128. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.128.
Testo completoAbstract (sommario):
128 Background: Emergency department (ED) utilization for non-emergent medical problems is an inefficient use of medical resources. During calendar year 2013, 224 RIH adult cancer patients presented to the RIH ED. Retrospective review indicated up to 50% of these ED visits were avoidable. Methods: This project was developed for the ASCO Quality Training Program. A multidisciplinary team was assembled to address ED utilization. Retrospective chart review of ED visits included time and reason for visit and primary tumor site. The team selected the Lung Cancer as the target group, developed a cause-and-effect analysis for ED visits, administered a patient survey, and implemented a series of Plan-Do-Study-Act (PDSA) cycles. The team implemented a patient education process of nurse sick-line symptom management and same-day sick visits at RIH CCC as well as developing a single-page patient “sick-line tool” with oncology nurse sick-line contact telephone numbers. A patient navigator introduced the sick-line tool at the first visit and its usage was reinforced at subsequent visits. Results: For RIH CCC lung cancer patients, a standardized symptom-control education process correlated with 30% decrease in ED visits for any presenting complaint (42 visits vs. 60 visits) and 32% decrease in ED visits with presenting complaint of pain (13 visits vs. 19 visits) during January/February 2014 compared to January/February 2013. We did not find significant differences between the proportion of ED visits during Cancer Center business hours, evenings, or weekends. Sick-line calls were found to increase by 53% during January 2014 compared to December 2013 with an additional 35% increase in February 2014. Conclusions: A standardized patient education process resulted in a significant decrease in ED visits, concurrent with an increase in outpatient sick-line utilization. This may reflect an improvement in efficiency of outpatient cancer patient care in a single-institution setting. Given other reports of increased ED utilization by lung cancer patients for similar presenting reasons, these improvements may be generalizable to other institutions.
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Diana Palandri, Hanna Raber, Casey Tak, Elizabeth Bald, Katherine Hastings e Karen Gunning. "Improving Patient Access to Primary Care Providers Using a Pharmacist-Physician Co-Visit Model". INNOVATIONS in pharmacy 14, n. 2 (6 giugno 2023): 2. http://dx.doi.org/10.24926/iip.v14i2.5106.
Testo completoAbstract (sommario):
Background: Implementation of a clinical pharmacist in the primary care setting can offset provider time spent managing chronic diseases using Collaborative Practice Agreements (CPAs). The pharmacist-physician co-visit model presents an opportunity for pharmacists to increase patient access to their primary care provider (PCP). Studies of the co-visit model show that co-visits increase clinic efficiency by allowing the PCP to see additional patients and achieve more health care goals compared with independent visits. Objectives: The aim of this study was to increase patient access to their PCP by utilizing a pharmacist-physician co-visit model at the Madsen Health Center Family Medicine (MHC FM) Clinic. The primary outcome was to identify the number of co-visits completed compared to the number of possible co-visits, and the number of appointment slots made available. The secondary outcomes were to track the time spent with patients and to obtain provider feedback via a survey. Methods: The co-visit model was implemented as a 4-month pilot study at the MHC FM Clinic. Complex care appointments lasting 40 minutes were selected based on inclusion and exclusion criteria. Potential co-visit appointments were identified one week prior then provider consent was obtained to change the appointment into two separate 20-minute visits. Schedules were reviewed to determine if the appointment slot opened by the co-visit was filled by another patient. Upon completion of the study, a survey was distributed to providers to collect feedback. Results: A total of five co-visits were completed out of a possible 19 (26%). All the appointments made available were filled by another patient. On average, the provider and pharmacist spent 15 and 14 minutes with the patient, respectively. Conclusion: Implementation of the physician-pharmacist co-visit model increased the availability of the PCP to see more patients without disrupting clinic workflow and provider schedules.
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SEONAE YEO. "Language Barriers and Access to Care". Annual Review of Nursing Research 22, n. 1 (gennaio 2004): 59–73. http://dx.doi.org/10.1891/0739-6686.22.1.59.
Testo completoAbstract (sommario):
The purpose of this chapter is to examine how language barriers contribute to health disparities among ethnic and racial minorities in the United States. A literature search was systematically conducted using selected computer databases (MEDLINE and CINAHL). Searches were limited to English-language-published research in the years from 1985 to 2003. A total of 47 published articles were included in this review. Overall these studies indicate that language barriers are associated with longer visit time per clinic visit, less frequent clinic visits, less understanding of physician’s explanation, more lab tests, more emergency room visits, less follow-up, and less satisfaction with health services. The results also indicate that people who are older, poorer, and female tend to have severe language barriers compared to those who are younger, wealthier, and male. Improvement of communication between patients and providers in relation to health disparity consists of cultural competency and communication skills. Implications of these studies for practice and further research are outlined.
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Hu, Qinglin, Xiaobing Li e Mercedes M. Morales-Alemán. "Pathway analysis to characterize the relationships between healthcare access and healthcare visits in the United States using the health information national trends survey". International Journal Of Community Medicine And Public Health 9, n. 5 (27 aprile 2022): 1951. http://dx.doi.org/10.18203/2394-6040.ijcmph20221206.
Testo completoAbstract (sommario):
Background: Americans had fewer healthcare visits compared to their counterparts in other developed countries. The lack of regular check-ups can contribute to worsening health conditions. Insurance coverage, access to transportation to healthcare services, and having accessed health information via the internet are known to be associated with frequency of healthcare visits. However, there is limited literature detailing the direct and indirect influences of these variables on frequency of patients’ healthcare visits. We aimed to understand the interactive relationship between insurance coverage, access to transportation to healthcare services, and having accessed health information via the internet on frequency of patient healthcare visits.Methods: We used data from the 2018 Health Information National Trends Survey (N=3504), the only survey year providing the source for information on insurance coverage, access to transportation to healthcare services, and having accessed health information via the internet. We used descriptive statistics, random parameter binary logistic regression, and pathway analysis to describe and analyze the associations between these determinants of healthcare access and healthcare visits.Results: Results indicated that access to transportation to healthcare services (18.32%) and having insurance coverage (27.89%) were directly associated with healthcare visit frequency whereas the association between having accessed health information via the internet and reporting a healthcare visit, compare to the former two, was weaken (10.87%). Residential area (rural/urban), health conditions, age, race/ethnicity, employment status were directly associated with visit frequency whereas income status and education level were associated with healthcare visits indirectly through insurance.Conclusions: Better understanding interactive relationships between healthcare access determinants will be key to the development of healthcare access interventions aimed at reducing healthcare disparities.
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Banty, Andrea, Theodore Solomon, Susie Lee, Viankail Cedillo Castelan, Alyssa Parry, Joseph Davey, Jovina Paredes et al. "A NURSE LED INTERVENTION TO IMPROVE ACCESS TO CARE USING A TELEPHONE TRIAGE ALGORITHM". Inflammatory Bowel Diseases 29, Supplement_1 (26 gennaio 2023): S40—S41. http://dx.doi.org/10.1093/ibd/izac247.074.
Testo completoAbstract (sommario):
Abstract BACKGROUND Inflammatory bowel disease is a chronic inflammatory condition for which patients may require care on a more urgent basis. Response times can be delayed when clinics are inundated with calls or when providers are not available for immediate patient care. We developed and tested an algorithm to empower nurses to effectively triage phone calls and improve access. METHODS We created an algorithm for nurses handling phone calls and electronic messages to a tertiary care IBD clinic. Calls were divided into four categories: Needs Immediate Response, Disease Flare, Routine and Other. IBD nurses triaged calls to facilitate urgent visits with a nurse practitioner (NP) when deemed appropriate, bypassing physician review or response. We compared the time from call-to-visit during the 3 months before and 3 months after implementation of the algorithm. We also assessed clinical outcomes of these urgently scheduled visits including visit type (in-person or virtual), and whether there was a change in dose or type of therapy, new prescription of steroids, or emergency room referral. We used the Mann Whitney U Test to assess for pre-post changes. RESULTS We randomly assessed 60 visits per month in the 3 months before and 3 months after the algorithm was implemented (June 1, 2022), for a total of 360 visits. The median time from call-to-visit improved from 5 days during the 3 months prior to the algorithm implementation to 3.5 days during the 3 months after algorithm implementation (p=0.016). There was no significant change in visit type pre- and post-intervention. Overall clinical interventions during these visits included therapy change (36%), a new prescription of corticosteroids (9%), new diagnostic testing ordered (67%) and ER referral (1%); these did not significantly differ in the pre- and post-intervention periods. CONCLUSION Utilization of a phone call triage algorithm by nurses can help improve the time from call-to-visit without involvement of a physician. Urgently scheduled NP visits result in important clinical interventions including changes to therapy and diagnostic testing. Implementation of nurse-led triage algorithms can improve access to care in a tertiary IBD clinic.
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Majors, Lauren, e Mary Unangst. "Retrospective Analysis of a Nationwide Telelactation Program". Clinical Lactation 12, n. 2 (1 maggio 2021): 91–100. http://dx.doi.org/10.1891/clinlact-d-20-00009.
Testo completoAbstract (sommario):
BackgroundTelelactation is a modality for delivering remote clinical lactation care using telecommunications technology. Sonder Health, in partnership with Amwell, began offering synchronous video telelactation services to health plans and employer groups in 2016.MethodsWe completed a retrospective data analysis on a randomized selection of 1,087 telelactation visits covered by a health plan or employee-sponsored health plan conducted between 2016–2019. Our aim is to describe a telelactation model and review selected visits for technical modalities utilized, clinical workflow, top self-reported chief conditions, patient satisfaction, visit duration, acuity levels, alternative care options, peak visit time, visits conducted during or after business hours, and days visits took place, and discuss the potential for telelactation to bridge the gaps in timely access to IBCLC-level breastfeeding support.ResultsUsing a 5-star rating system, 95% of patients gave a 5-star rating; 52% of visits occurred outside normal business hours. Top three conditions identified: latching (31%), supply (24%), and nipple/breast pain (15%). Without access to the service, 59% reported they would have accessed an urgent care, emergency department, retail health clinic, or other office appointment; 41% reported they would have sought care “nowhere.”ConclusionsThis telelactation program provided access to skilled, comprehensive clinical lactation care and documents a strong use case for telelactation services.
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Goldstein, Karen M., Kathleen R. Perry, Allison Lewinski, Conor Walsh, Megan E. Shepherd-Banigan, Hayden B. Bosworth, Hollis Weidenbacher, Dan V. Blalock e Leah L. Zullig. "How can equitable video visit access be delivered in primary care? A qualitative study among rural primary care teams and patients". BMJ Open 12, n. 8 (agosto 2022): e062261. http://dx.doi.org/10.1136/bmjopen-2022-062261.
Testo completoAbstract (sommario):
ObjectiveThe 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.DesignQualitative data collection: one team member conducted all patient semistructured interviews and led all focus groups with four other team members taking notes during groups.Setting3 rural primary care clinics in the USA.Participants24 black veterans living in rural areas and three primary care teams caring for black veterans living in rural areas.Primary and secondary outcome measuresFindings from semistructured interviews with patients and focus groups with primary care teams.ResultsKey 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.ConclusionsInformed 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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Nelson, Ariel Ann, Christina Ladwig, Kristin Riemersma, Kathryn A. Bylow e Deepak Kilari. "Disparities in medical oncology visit adherence among African American (AA) men with prostate cancer (pCa)." Journal of Clinical Oncology 41, n. 16_suppl (1 giugno 2023): e18671-e18671. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.e18671.
Testo completoAbstract (sommario):
e18671 Background: AA patients (pts) with pCa tend to have worse outcomes when compared to Caucasians. Disparities in access to healthcare among AA pts with pCa is a significant barrier to improvement in outcomes. Medical oncology visit attendance among this population has not been thoroughly investigated. Methods: Pts with a diagnosis (dx) of pCa scheduled to see a provider (MD or advanced practice provider) at a single academic institution medical oncology clinic between January 2022 and December 2022 were retrospectively identified. Pts were categorized by self-identified race. The total number of scheduled clinic visits was recorded, and each visit was categorized by visit status; completed, cancelled, no-show, or left clinic. The reason for visit cancellation was assessed and cancelled visits for non-pt driven reasons (ie. scheduling error) were removed. The data were summarized using descriptive statistics. Z-test and Chi-square analysis were utilized to compare proportions of visits between AA and Caucasian pts and the association of race with visit status. Results: A total of 992 pts were selected, 80% (n = 792) were Caucasian and 16% (n = 162) were AA, representing 4231 clinic visits during the study period. AA pts accounted 18% (n = 763) of the total scheduled visits. 94% of visits (n = 3962) were follow up and 6% (n = 269) were new pt visits. 86% of all scheduled visits were completed and 10 % (n = 436) were cancelled for pt driven reasons. Roughly 3% (n = 135) of visits were no-show. AA pts had fewer completed visits compared to Caucasian pts, 78% vs 88% (p < 0.001) and a higher no-show rate of 10% vs 1.5% (p < 0.001). The cancellation rate was similar between AA and Caucasian pts, 11% vs 10% (p = 0.33). The combined no-show and cancellation rate for AA pts was 22% vs 12% for Caucasian pts (p < 0.001). There was a significant association between AA race and no-show visit status (p < 0.001). Conclusions: AA men with pCa have much poorer visit adherence to scheduled medical oncology visits compared to their Caucasian counterparts. Identifying reasons for no-show and visit cancellations and targeted interventions to improve access to care are needed to improve outcomes. [Table: see text]
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Iyer, Sowmya, Priyanka Mehta, Joanne Weith, Dat Hoang-Gia, Janet Moore, Chalise Carlson, Philip Choe, Erin Sakai e Christine Gould. "Converting a Geriatrics Clinic to Virtual Visits during COVID-19: A Case Study". Journal of Primary Care & Community Health 12 (gennaio 2021): 215013272110002. http://dx.doi.org/10.1177/21501327211000235.
Testo completoAbstract (sommario):
Background: To characterize the experience of converting a geriatrics clinic to telehealth visits in early stages of a pandemic. Design: An organizational case study with mixed methods evaluation from the first 8 weeks of converting a geriatrics clinic from in-person visits to video and telephone visits. Setting: Veteran’s Health Administration in Northern California Participants Community-dwelling older Veterans receiving care at VA Palo Alto Geriatrics clinic. Veterans had a mean age of 85.7 (SD = 6.8) and 72.1% had cognitive impairment. Intervention: Veterans with face-to-face appointments were converted to video or telephone visits to mitigate exposure to community spread of COVID-19. Measurements: Thirty-two patient evaluations and 80 clinician feedback evaluations were completed. This provided information on satisfaction, care access during pandemic, and travel and time savings. Results: Of the 62 scheduled appointments, 43 virtual visits (69.4%) were conducted. Twenty-six (60.5%) visits were conducted via video, 17 (39.5%) by telephone. Virtual visits saved patients an average of 118.6 minutes each. Patients and providers had similar, positive perceptions about telehealth to in-person visit comparison, limiting exposure, and visit satisfaction. After the telehealth appointment, patients indicated greater comfort with using virtual visits in the future. Thirty-one evaluations included comments for qualitative analysis. We identified 3 main themes of technology set-up and usability, satisfaction with visit, and clinical assessment and communication. Conclusion: During a pandemic that has limited the ability to safely conduct inperson services, virtual formats offer a feasible and acceptable alternative for clinically-complex older patients. Despite potential barriers and additional effort required for telehealth visits, patients expressed willingness to utilize this format. Patients and providers reported high satisfaction, particularly with the ability to access care similar to in-person while staying safe. Investing in telehealth services during a pandemic ensures that vulnerable older patients can access care while maintaining social distancing, an important safety measure.
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Jiang, Angela, Reem Kashlan, Christine Joseph, Amy Tang e Henry Lim. "Disparities in Access to Teledermatology During the COVID-19 Pandemic in Detroit, Michigan". SKIN The Journal of Cutaneous Medicine 5, n. 6 (5 novembre 2021): 639–48. http://dx.doi.org/10.25251/skin.5.6.6.
Testo completoAbstract (sommario):
Background: Teledermatology became a necessary modality for dermatologic patient care during the COVID-19 pandemic. Due to disparities in access to technology, “The Digital Divide” refers to worsening health care disparities despite telemedicine’s best efforts to improve access. Methods: Retrospective chart review was performed of all patients who were scheduled to be seen in dermatology during the first wave of pandemic (March 27, 2020 to April 27, 2020). Demographic characteristics of patients who pursued virtual visits was compared with those who did not. Results: Compared to patients who canceled office visits, patients who completed virtual visit appointments were more likely to be younger (mean age 37.8 versus 45.5 years), female (68.7% versus 62.9%, p=0.01), unmarried (68.7% versus 61.0%, p<0.01). Of the diagnoses rendered during virtual visits, 53.3% were associated with dermatoses. Conclusions: Patient populations above the age of 65 were less likely to complete a video visit, regardless of socioeconomic factors. Future policies must take marginalized populations into account to improve ease of access to technological services.
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Lindly, Olivia J., Katharine E. Zuckerman e Karen A. Kuhlthau. "Healthcare access and services use among US children with autism spectrum disorder". Autism 23, n. 6 (29 novembre 2018): 1419–30. http://dx.doi.org/10.1177/1362361318815237.
Testo completoAbstract (sommario):
This study aimed to determine associations of healthcare access problems with services use among US children with autism spectrum disorder. We analyzed 2011–2014 National Health Interview Survey data on 651 children with autism spectrum disorder aged 2–17 years. There were three measures of healthcare access problems: (1) delays accessing healthcare, (2) difficulty affording healthcare, and (3) trouble finding a primary care provider. There were five service use measures: (1) ⩾4 office visits, (2) ⩾1 well-child visit, (3) flu vaccine, (4) prescription medication, and (5) ⩾1 emergency department visit. Multivariable regression models estimated associations of ⩾1 healthcare access problem with each service use variable and effect modification by socioeconomic status and race and ethnicity. Twenty-nine percent of children with autism spectrum disorder had ⩾1 healthcare access problem. Having ⩾1 healthcare access problem was associated with lower adjusted odds of ⩾1 well-child visit or prescription medication use but higher adjusted odds of ⩾4 office visits or ⩾1 emergency department visit. No significant association was found for flu vaccine. Associations of healthcare access problems with emergency department use were most pronounced for higher socioeconomic status and White, non-Hispanic subgroups. Intervention, such as insurance expansion, is needed to improve healthcare access for children with autism spectrum disorder.
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Iqbal, Javaid, Rahim Moineddin, Robert Fowler, Monika K. Krzyzanowska, Christopher M. Booth, James Downar, Jenny Lau et al. "Association of socioeconomic status (SES) with use of specialist palliative care (SPC) among people who died with cancer before and during the COVID-19 pandemic." Journal of Clinical Oncology 41, n. 16_suppl (1 giugno 2023): e18504-e18504. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.e18504.
Testo completoAbstract (sommario):
e18504 Background: Access to high-quality care, including SPC, is known to vary according to SES. The effect of SES on access to SPC during the COVID-19 pandemic remains unknown. We measured the association of SES with SPC use in different care settings among people who died with cancer before and during the COVID-19 pandemic. Methods: This retrospective, population-based cohort study included 173,915 adult patients who died with cancer from 16/3/2015 to 15/3/2020 (pre-pandemic), and from 16/3/2020 to 15/3/2021 (pandemic period), in Ontario, Canada; March 16, 2020 coincided with the start of pandemic-related hospital entrance screening. The primary outcome was access to SPC in the last 30 days of life, measured as the percentage of people with at least one SPC visit and the rate of visits/patient/30 days across home, hospital inpatient, and outpatient care settings. We used an interrupted time series analysis with segmented linear regression accounting for serial correlation to examine the immediate and gradual changes due to the pandemic. Analyses were stratified by SES, defined using area-level material deprivation quintiles (Q1, least to Q5, most deprived). Results: In total, 100,462 (57.8%) people received SPC in the last 30 days of life. The access to SPC increased steadily by 0.13% per 30 days over the pre-pandemic period ( P<0.001), with a drop of 5.34% at the start of pandemic ( P<0.001) and a trend increase of 0.19% during the pandemic period ( P = 0.10). The table shows study outcomes by care setting and SES. At baseline, patients in Q5 (vs Q1) had lower rates of SPC home visits, while rates of inpatient visits and outpatient visits were similar. Pre-pandemic for Q1 and Q5, inpatient visits were decreasing, outpatient visits were increasing, and home visits were stable. For both Q1 and Q5, there was an immediate decrease in home visits and increase in outpatient visits at pandemic onset, followed by a recovery in home visits; trends for inpatient and outpatient visits were unchanged. Conclusions: The COVID-19 pandemic led to an immediate decrease in access to SPC among people who died with cancer, particularly for home visits. SES was significantly associated with access to home visits, both before and during the pandemic. [Table: see text]
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Dias, Carolina, Marcus Borin, Juliana Alvares, Augusto Guerra e Francisco Acurcio. "PP76 Providing Information About Rheumatoid Arthritis Guideline In Brazil". International Journal of Technology Assessment in Health Care 34, S1 (2018): 96–97. http://dx.doi.org/10.1017/s0266462318002313.
Testo completoAbstract (sommario):
Introduction:Specialized Component of Pharmaceutical Service (SCPS) is a strategy to access high cost medicines in the National Health System (NHS) of Brazil, ensuring the completeness of medical treatment in which lines of care are defined in the Clinical Protocols and Therapeutic Guidelines (CPTG). To access the SCPS, the physician has to give to the patient a filled form, following some requirements and the CPTGs. In order to improve rational prescription and to facilitate patients’ access to medicines, we visited physicians and presented key information regarding the CPTGs of rheumatoid arthritis (RA) and the SCPS medicines request process; then, we sought to know their perceptions.Methods:From August to September 2017, 43 specialists and general practitioners that prescribed medicines of SCPS in Minas Gerais were visited by researchers about the CPTG of RA and how to prescribe to provide easier access to these medicines to their patients. After the visits, a researcher contacted the physicians by phone to evaluate their satisfaction with the visits and about the program through a brief questionnaire.Results:Twenty-eight physicians answered to our phone call, providing a response to the questionnaire. Sixty-eight percent indicated they were very satisfied with the visit. Fifty percent stated that the content of the visit was relevant to their practice, and 60.7 percent said that the distributed material was going to be useful for their professional practice. Regarding the guidelines, 43 percent affirmed that the visit really helped them to improve their understanding of medicine requests in the NHS and 42.9 percent said that the visit increased their understanding of which patients are eligible for RA treatment in the SCPS; 57.1 percent of those affirmed that the visits increased their knowledge.Conclusions:The physicians, who were mostly specialists, already had knowledge about CPTG and prescription practices of SCPS’s medicines, nevertheless, they showed interest in the visits to review and improve their knowledge and clinical practice.
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Burdette, Samantha, Nathan Handley, Katlin Birchmeier, Atrayee Basu Mallick, Joanne Filicko e Adam Binder. "Implementation of a post discharge video visit telehealth initiative." Journal of Clinical Oncology 37, n. 27_suppl (20 settembre 2019): 274. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.274.
Testo completoAbstract (sommario):
274 Background: Telehealth is increasingly used as a means to influence four domains of healthcare: access, cost, experience, and effectiveness. The medical oncology service at Thomas Jefferson University implemented a post-discharge video visit program for all patients discharged from the Advanced Practice Provider (APP) service following scheduled inpatient chemotherapy. Data were collected to assess clinical interventions that occurred. Barriers to participation in the visits were also assessed. Methods: All patients on the APP service were screened for eligibility for a post discharge video visit. Patients who were eligible (requirements: reliable internet connection, access to a smart device, active patient portal account, English language speaker) had video visits scheduled prior to discharge. Data regarding the visits (including patient demographics, eligibility, patient interest, and interventions performed) were recorded. Results: One hundred forty nine admissions were included in the analysis. Sixty (40.27%) resulted in the scheduling of a post discharge video visit; 37 (61.67%) of these visits were completed. Medication reconciliation/education occurred in 22 encounters (59.46%); symptom management occurred in 17 encounters (45.95%).The most common reason for not completing a visit was the patient not answering the video visit call (17 encounters (73.91%)). Of the 89 encounters in which patients were ineligible or declined, technological barriers were the most common reason for not participating (29.21%), followed by disinterest (17.10%) and non-English speaking (16.85%). Conclusions: While significant barriers to implementation of post-discharge video visits exist, when visits did occur, frequent interventions occurred. Further research to understand and alleviate barriers to telehealth implementation are merited. Care must be taken to avoid creating disparities among patient populations.
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Stamenova, Vess, Payal Agarwal, Leah Kelley, Jamie Fujioka, Megan Nguyen, Michelle Phung, Ivy Wong, Nike Onabajo, R. Sacha Bhatia e Onil Bhattacharyya. "Uptake and patient and provider communication modality preferences of virtual visits in primary care: a retrospective cohort study in Canada". BMJ Open 10, n. 7 (luglio 2020): e037064. http://dx.doi.org/10.1136/bmjopen-2020-037064.
Testo completoAbstract (sommario):
ObjectivesTo evaluate the uptake of a platform for virtual visits in primary care, examine patient and physician preferences for virtual communication methods and report on characteristics of visits and patients experience of care.DesignA retrospective cohort study.SettingPrimary care practices within five regions in Ontario, Canada after 18 months of access to virtual care services.Participants326 primary care providers and 14 291 registered patients.InterventionsProviders used a platform that allowed them to connect with their patients through synchronous (audio/video) and/or asynchronous (secure messaging) communication.Main outcome measuresUser-level data from the platforms including patient demographics, practice characteristics, communication modality used, visit characteristics and patients’ satisfaction.ResultsAmong the participants, 44% of registered patients and 60% of registered providers used the platform at least once. Among patient users, 51% completed at least one virtual visit. The majority of virtual visits (94%) involved secure messaging. The most common patient requests were for medication prescriptions (24%) and follow-up from previous appointment (22%). The most common provider request was to follow-up on test results (59%). Providers indicated that 81% of virtual visits required no follow-up for that issue and 99% of patients reported that they would use virtual care services again.ConclusionsWhile there are a growing number of primary care video visit services, our study found that both patients and providers in rostered practices prefer secure messaging over video. Despite fears that virtual visits would be overused by patients, when patients connected with their own primary care provider, many virtual visits appeared to replace in-person visits, and patients did not overwhelm physicians with requests. This approach may improve access and continuity in primary care.
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Kirby, Sue E., Sarah M. Dennis, Upali W. Jayasinghe e Mark F. Harris. "Unplanned return visits to emergency in a regional hospital". Australian Health Review 36, n. 3 (2012): 336. http://dx.doi.org/10.1071/ah11067.
Testo completoAbstract (sommario):
Objective. The aim of this study was to determine the patient characteristics associated with unplanned return visits, using routinely collected hospital data, to assist in developing strategies to reduce their occurrence. Methods. Emergency department data from a regional hospital were analysed using univariate and multivariate methods to determine the influence of clinical, service usage and demographic patient characteristics on unplanned return visits. Results. Around 80% of the 16 000 patients attending emergency presented on only one occasion in a year. Five per cent of patients presented with an unplanned return visit. Older patients, those with minor and low urgency conditions and with non-psychotic mental health conditions, those presenting during winter and after hours were significantly more likely to present as unplanned return visits. Conclusion. Although patient characteristics associated with unplanned return visits have been identified, the reasons underpinning the unplanned return visit rate, such as patient service preference and attitudes, need to be more fully investigated. What is known about the topic? Patients who present as unplanned return visits are older and have a range of chronic and acute conditions. Some unplanned return visits occur because of limited access to other non-hospital service. What does this paper add? This paper adds to the field by providing information from a regional hospital in NSW Australia on the patient characteristics associated with unplanned return visits. It provides a basis for differentiating between other groups of frequent emergency department patients. However, the reasons behind the unplanned return visit rate need to be more fully investigated. What are the implications for practitioners? The implications of the findings of this study for policy makers, administrators and clinicians are that access to alternative services for the conditions associated with unplanned return visits need to be further investigated in the context of the role for emergency department services.
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Hsiao, Vivian, Thevaa Chandereng, Robin L. Lankton, Jeffrey A. Huebner, Jeffrey J. Baltus, Grace E. Flood, Shannon M. Dean, Amye J. Tevaarwerk e David F. Schneider. "Disparities in Telemedicine Access: A Cross-Sectional Study of a Newly Established Infrastructure during the COVID-19 Pandemic". Applied Clinical Informatics 12, n. 03 (maggio 2021): 445–58. http://dx.doi.org/10.1055/s-0041-1730026.
Testo completoAbstract (sommario):
Abstract Background The COVID-19 pandemic led to dramatic increases in telemedicine use to provide outpatient care without in-person contact risks. Telemedicine increases options for health care access, but a “digital divide” of disparate access may prevent certain populations from realizing the benefits of telemedicine. Objectives The study aimed to understand telemedicine utilization patterns after a widespread deployment to identify potential disparities exacerbated by expanded telemedicine usage. Methods We performed a cross-sectional retrospective analysis of adults who scheduled outpatient visits between June 1, 2020 and August 31, 2020 at a single-integrated academic health system encompassing a broad range of subspecialties and a large geographic region in the Upper Midwest, during a period of time after the initial surge of COVID-19 when most standard clinical services had resumed. At the beginning of this study period, approximately 72% of provider visits were telemedicine visits. The primary study outcome was whether a patient had one or more video-based visits, compared with audio-only (telephone) visits or in-person visits only. The secondary outcome was whether a patient had any telemedicine visits (video-based or audio-only), compared with in-person visits only. Results A total of 197,076 individuals were eligible (average age = 46 years, 56% females). Increasing age, rural status, Asian or Black/African American race, Hispanic ethnicity, and self-pay/uninsured status were significantly negatively associated with having a video visit. Digital literacy, measured by patient portal activation status, was significantly positively associated with having a video visit, as were Medicaid or Medicare as payer and American Indian/Alaskan Native race. Conclusion Our findings reinforce previous evidence that older age, rural status, lower socioeconomic status, Asian race, Black/African American race, and Hispanic/Latino ethnicity are associated with lower rates of video-based telemedicine use. Health systems and policies should seek to mitigate such barriers to telemedicine when possible, with efforts such as digital literacy outreach and equitable distribution of telemedicine infrastructure.
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Ganguli, Ishani, E. John Orav, Ruth Hailu, Joyce Lii, Meredith B. Rosenthal, Christine S. Ritchie e Ateev Mehrotra. "Patient Characteristics Associated With Being Offered or Choosing Telephone vs Video Virtual Visits Among Medicare Beneficiaries". JAMA Network Open 6, n. 3 (29 marzo 2023): e235242. http://dx.doi.org/10.1001/jamanetworkopen.2023.5242.
Testo completoAbstract (sommario):
ImportanceAfter the rapid expansion of telemedicine during the COVID-19 pandemic, there is debate about the role and reimbursement of telephone vs video visits. Missing is an understanding of what type of virtual visits clinicians may offer or patients may choose when given the option.ObjectiveTo evaluate characteristics of Medicare beneficiaries associated with practices and clinicians offering telephone visits only and patients receiving telephone visits only, when both telephone and video were available.Design, Setting, and ParticipantsThis survey study used 2019-2020 nationally representative Medicare Current Beneficiary Survey data. Participants included community-dwelling Medicare beneficiaries with a usual source of medical care who attended a practice offering telemedicine. Data were analyzed from May 3 to August 23, 2022.Main Outcomes and MeasuresMultivariable regression analysis was used to identify patient sociodemographic (age, sex, race, ethnicity, educational level, income, English proficiency, housing type, and number living at home), clinical (dementia, mental illness, self-rated health, hearing impairment, and vision impairment), and technology (technology access and prior use of video visits) factors associated with respondents’ report of (1) practices offering telephone virtual visits only, (2) being offered telephone visits only when both video and telephone visits were available, and (3) receiving telephone visits only when both video and telephone visits were offered.ResultsOf 4691 respondents (representing 27 887 642 Medicare beneficiaries; mean [SD] age, 71.3[8.1] years; 55.0% female) reporting that their practice offered telemedicine, 1234 (23.3% weighted) reported that their practices offered telephone virtual visits only; factors associated with being in a practice offering telephone only included older age (adjusted odds ratio [aOR], 1.62 [95% CI, 1.10-2.39] for those aged ≥85 years vs 18-64 years), male sex (aOR, 1.36 [95% CI, 1.12-1.64]), Hispanic ethnicity (aOR, 1.41 [95% CI, 1.03-1.95]), lower income (aOR, 1.89 [95% CI, 1.43-2.49] for those with income ≤100% vs &gt;200% of the federal poverty level), poor self-rated health (aOR, 1.25 [95% CI, 1.01-1.56]), and less technology access (aOR, 2.05 [95% CI, 1.61-2.60] for those with low vs high access). Of the 1593 patients in practices offering both video and telephone visits, 297 (16.7% weighted) were themselves offered telephone visits only; factors associated with being offered telephone only included Hispanic ethnicity (aOR, 1.96 [95% CI, 1.13-3.41]), limited English proficiency (aOR, 3.05 [95% CI, 1.28-7.31]), and less technology access (aOR, 1.68 [95% CI, 1.00-2.81] for those with low vs high access). Finally, of the 711 respondents who were themselves offered both video and telephone visits, 304 (43.1% weighted) had a telephone visit; factors associated with receiving telephone visits only were older age (aOR, 2.68 [95% CI, 1.21-5.92] for those aged 75-84 years vs 18-64 years) and less technology access (aOR, 2.65 [95% CI, 1.12-6.25] for those with moderate vs high access]). Among those who used video calls in other settings and were offered a choice, 122 (28.5%, weighted) chose telephone visits.Conclusions and RelevanceIn this survey study of Medicare beneficiaries, respondents often reported being offered or choosing telephone visits even when video visits were available. Study findings suggest that policy makers and clinical leaders should support the use of telephone visits to the extent that telephone is appropriate, while addressing both practice-level and patient-level barriers to video visits.
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Epstein, Jeremy A., Zoljargal Lkhagvajav, Tempest Young, Amanda Bertram, Hsin-Chieh Yeh e Casey Overby Taylor. "Will the Doctor “See” You Now? The Development and Implementation of a Targeted Telemedicine System for Primary Care". ACI Open 07, n. 02 (luglio 2023): e71-e78. http://dx.doi.org/10.1055/s-0043-1776038.
Testo completoAbstract (sommario):
Abstract Objectives The coronavirus disease 2019 (COVID-19) pandemic led to a rapid adoption of telehealth. For underserved populations lacking internet access, telemedicine was accomplished by phone rather than an audio–video connection. The latter is presumed a more effective form and better approximation of an in-person visit. We sought to provide a telehealth platform to overcome barriers for underserved groups to hold video visits with their health care providers and evaluate differences between the two telehealth modalities as assessed by physicians and patients. Methods We designed a simplified tablet solution for video visits and piloted its use among patients who otherwise would have been completing audio-only visits. Patients consented to participation and were randomized in a 1:1 fashion to continue with their scheduled phone visit (control) versus being shipped a tablet to facilitate a video visit (intervention). Participants and providers completed communication and satisfaction surveys. Results Tablet and connectivity design features included removal of all functions but for the telemedicine program, LTE always-on wireless internet connectivity, absence of external equipment (cords chargers and keyboard), and no registration with a digital portal. In total, 18 patients were enrolled. Intervention patients with video-enabled devices compared to control patients agreed more strongly that they were satisfied with their visits (4.75/5 vs. 3.75/5, p = 0.02). Conclusion The delivered simplified tablet solution for video visits holds promise to improve access to video visits for underserved groups. Strategies to facilitate patient acceptance of devices are needed to expand the scope and potential impact of this effort.
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Konstantelos, Natalia, Ahmad Shakeri, Daniel McCormack, Anabel Campos-Meade, Tara Gomes, Michelle Murti, Valérie Pierre-Pierre e Mina Tadrous. "Regional differences in access to direct-acting antiviral treatments for hepatitis C across Ontario: A cross-sectional study". Canada Communicable Disease Report 48, n. 4 (6 aprile 2022): 170–78. http://dx.doi.org/10.14745/ccdr.v48i04a08.
Testo completoAbstract (sommario):
Background: Direct-acting antivirals (DAAs) are curative treatments for hepatitis C virus (HCV) infection, a condition affecting over 100,000 Ontarians. Although DAAs are covered under the public drug programs in Ontario, receiving prescriptions depends on access to healthcare. The aim of this study is to understand the relationship between DAA treatment rates and distance to prescriber in Ontario, Canada. Methods: We conducted a cross-sectional study and identified patients who filled a DAA prescription through the Ontario Drug Benefit (ODB) in 2019. We calculated crude (per 100,000 ODB recipients) and adjusted (by a regional HCV infection rate) DAA treatment rates by public health unit (PHU). We reported median distances to provider for all visit types, in-person visits, virtual visits, and proportions of visits that were virtual. Results: In 2019, the crude DAA treatment rate for Ontario is 83.0 patients per 100,000 ODB recipients. The HCV-adjusted DAA treatment rate ranges from 28.2 (Northwestern Ontario) to 188.5 (Eastern Ontario) per 100,000. In our primary analysis, patients in rural PHUs, including Northwestern and Porcupine, were among the highest median distances to prescriber for all visit types (1,195 km and 556 km, respectively). These PHUs also had the highest proportions of virtual visits (greater than 60%). Urban PHUs, such as Toronto and Ottawa, had smaller median distances for all visit types, with smaller proportions of virtual visits (10.8% and 12.4%, respectively). Conclusion: We observed heterogeneity in treatment rates, distance to DAA prescribers and use of virtual care in the management of HCV. Increasing use of telemedicine in regions with limited utilization of DAAs may improve access.
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Shah, Suken, Joseph Erinjeri, Qiu Xia Guan, Christian Otto e Stephen Barnett Solomon. "Telemedicine visits reduce time to biopsy, travel time and costs for interventional radiology patients." Journal of Clinical Oncology 38, n. 15_suppl (20 maggio 2020): 2082. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.2082.
Testo completoAbstract (sommario):
2082 Background: Telemedicine has been utilized to increase access to care for patients in primary care practices and more recently, specialty practices. The purpose of the study was to test the hypothesis that adding a telemedicine clinic practice could decrease the time to biopsy, travel time and cost for interventional radiology (IR) clinic patients. Methods: Telemedicine visits were performed by a physician or advanced practice provider (PA or NP) at a single institution, academic medical center to patients at 3 MSK regional locations in NY and NJ. Total patient encounters and data from November 2017 to October 2019 were analyzed. Primary outcome measures were wait time from the IR referral to biopsy procedure visits, patient travel time and travel cost, stratified by in-person vs telemedicine visit. Round-trip travel distance and costs for patients were calculated by determining the offset travel. Cost (economic) benefit was the sum of: Federal cost per mile for travel, toll and parking costs, and doctor visit lost wages. Results: There were 172 MSK Regional site telemedicine visits. There was a significant reduction in time from referral to biopsy for telemedicine visits compared to in-person visits (12 vs 17 days, p < 0.0001). Additionally, there was a significant reduction in travel time for telemedicine visits vs travel time to Manhattan for an in-person visit (p < 0.0001). Telemedicine visit patients had to travel 367 less hours than an in-person visit and saved a total of 11,222 in miles that they did not have to travel. Telemedicine patients accrued $14,652 in economic benefits due to reduced travel costs and lost wages from work. Conclusions: Telemedicine significantly reduced the time to biopsy, travel time and cost for Interventional Radiology patients compared to in-person visits. Telemedicine for IR patients increases access to care for patients and allow for more efficient use of physician time and resources.
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Bouzigard, Rory, Mark Arnold, Jacob Player, Norman Mang, Michael Lane, Trish Perl e Laila Castellino. "Outpatient parenteral antimicrobial therapy (OPAT) in a safety-net hospital: Opportunities for improvement". Antimicrobial Stewardship & Healthcare Epidemiology 3, S2 (giugno 2023): s96. http://dx.doi.org/10.1017/ash.2023.364.
Testo completoAbstract (sommario):
Background: Parkland Health is a 900-bed safety-net hospital that serves Dallas County, Texas. It has an OPAT program in which patients are managed via self-administration (S-OPAT), home-health/hemodialysis (H-OPAT), and skilled nursing facilities (SNF-OPAT). We evaluated the reasons for unscheduled emergency department (ED) visits by patients in these groups to identify strategies to decrease unexpected healthcare utilization and to improve safety. Methods: We performed a retrospective chart review of all adult patients discharged from Parkland Health on OPAT between April and June 2021. Demographic, medical, and healthcare utilization information, including the date and reason of first unscheduled ED visit after discharge, was collected utilizing a standardized instrument. The institutional review board approved this study. Results: In total, 184 patients were discharged with OPAT. Among them, 32% were female and 55% identified as Hispanic; 41% were non-English speakers, and 45% were treated for a musculoskeletal infection. Among all OPAT models of care, 43.4% were S-OPAT patients, 31.5% were H-OPAT patients, and 25% were SNF-OPAT patients (Table 1). The groups differed, and fewer African Americans received H-OPAT. Also, 45% were being treated for musculoskeletal infections and were more likely to be discharged with H- or SNF-OPAT. In addition, 41% were being treated for endovascular infections and 21.7% were being treated for genitourinary infections. The total length of stay in the hospital was longer for SNF-OPAT patients and shorter for S-OPAT patients (Table 2). Among 184 OPAT patients, 41 patients (22.2%) had an ED visit: 17.3% SNF-OPAT patients, 27.6% H-OPAT patients, and 21.3% S-OPAT patients (Table 2). ED visits were attributed to intravenous (IV) access–related problems (12 of 41, 29.0%), worsening of known infection (3 of 41, 7.3%), and abnormal blood test results (2 of 41, 4.9%). Also, 24 ED visits (58%) were not related to underlying infection or OPAT. However, when examined by the OPAT care model, 41% of ED visits among S-OPAT patients, 20% among H-OPAT visits, and 25% among SNF-OPAT visits were related to IV access issues. Among S-OPAT ED visits pertaining to IV access, 71% were for minor issues such as dressing changes or line occlusion or malfunction. Conclusions: One-fifth of OPAT patients had an unscheduled ED visit, of whom 20%–41% had issues with IV access. Many of these visits could be avoided with enhanced outreach to patients discharged with OPAT and improved ambulatory capabilities to provide standard services related to maintenance of IV access.Disclosures: None
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Palakshappa, Jessica A., Erica R. Hale, Joshua D. Brown, Carol A. Kittel, Emily Dressler, Gary E. Rosenthal, Sarah L. Cutrona, Kristie L. Foley, Emily R. Haines e Thomas K. Houston II. "Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System". Journal of Medical Internet Research 26 (8 aprile 2024): e54008. http://dx.doi.org/10.2196/54008.
Testo completoAbstract (sommario):
Background Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic. Objective This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges. Methods A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations. Results A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits (“Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video?”) was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5% (156/511) selecting it as a challenge in 2020 and 37.1% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3% in 2020 and 137/615, 22.3% in 2021, P=.73). Conclusions During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology.
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Khan, Shaida, Alan Kramer, Johnathan McIver, Leah Cady e Jaya R. Trivedi. "New patient access via telehealth in neuromuscular medicine during COVID-19". Work 69, n. 3 (16 luglio 2021): 715–19. http://dx.doi.org/10.3233/wor-210503.
Testo completoAbstract (sommario):
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has changed the face of health care delivery. Health care institutions rapidly transitioned to telehealth to provide care to patients. Prior to the pandemic, telehealth services extended mostly to patients with established diagnoses. Driven by a necessity to provide care to all patients during the pandemic, neurologists started evaluating new patients also via telehealth. OBJECTIVE: To explore opportunities, challenges, and feasibility of telehealth for new patients with neuromuscular disorders. METHODS: New patient visits performed in our neuromuscular clinic were analyzed from March 18, 2020 - July 31, 2020. Data collected included visit volume, demographics, geographic distance of patient’s residence from our institution, and no-show and cancellation rates. RESULTS: Total number of patients seen was 1,471; 472 (32%) were new patients. No-show and cancellation rates for telehealth visits were lower than historical in-person visits. There was a wide range of ages (35–74 years) with representation of new patients from a large geographical territory. CONCLUSION: This study advances our understanding regarding the adoption and implementation of telehealth for new patients. Our clinic was able to provide timely access and care to a significant number of patients who could not travel to our institution during COVID-19.
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Corace, Kim, Kednapa Thavorn, Kelly Suschinsky, Melanie Willows, Pamela Leece, Meldon Kahan, Larry Nijmeh et al. "Rapid Access Addiction Medicine Clinics for People With Problematic Opioid Use". JAMA Network Open 6, n. 11 (22 novembre 2023): e2344528. http://dx.doi.org/10.1001/jamanetworkopen.2023.44528.
Testo completoAbstract (sommario):
ImportanceNew approaches are needed to provide care for individuals with problematic opioid use (POU). Rapid access addiction medicine (RAAM) clinics offer a flexible, low-barrier, rapid access care model for this population.ObjectiveTo assess the associations of RAAM clinics with emergency department (ED) visits, hospitalizations, and mortality for people with POU.Design, Setting, and ParticipantsA retrospective cohort study involving a matched control group was performed using health administrative data from Ontario, Canada. Anonymized data from 4 Ontario RAAM clinics (cities of Ottawa, Toronto, Oshawa, and Sudbury) were linked with health administrative data. Analyses were performed on a cohort of individuals who received care at participating RAAM clinics and geographically matched controls who did not receive care at a RAAM clinic. All visits occurred between October 2, 2017, and October 30, 2019, and data analyses were completed in spring 2023. A propensity score–matching approach was used to balance confounding factors between groups, with adjustment for covariates that remained imbalanced after matching.ExposuresIndividuals who initiated care through the RAAM model (including assessment, pharmacotherapy, brief counseling, harm reduction, triage to appropriate level of care, navigation to community services and primary care, and related care) were compared with individuals who did not receive care through the RAAM model.Main Outcomes and MeasuresThe primary outcome was a composite measure of ED visits for any reason, hospitalization for any reason, and all-cause mortality (all measured up to 30 days after index date). Outcomes up to 90 days after index date, as well as outcomes looking at opioid-related ED visits and hospitalizations, were also assessed.ResultsIn analyses of the sample of 876 patients formed using propensity score matching, 440 in the RAAM group (mean [SD] age, 36.5 [12.6] years; 276 [62.7%] male) and 436 in the control group (mean [SD] age, 36.8 [13.8] years; 258 [59.2%] male), the pooled odds ratio (OR) for the primary, 30-day composite outcome of all-cause ED visit, hospitalization, or mortality favored the RAAM model (OR, 0.68; 95% CI, 0.50-0.92). Analysis of the same outcome for opioid-related reasons only also favored the RAAM intervention (OR, 0.47; 95% CI, 0.29-0.76). Findings for the individual events of hospitalization, ED visit, and mortality at both 30-day and 90-day follow-up also favored the RAAM model, with comparisons reaching statistical significance in most cases.Conclusions and RelevanceIn this cohort study of individuals with POU, RAAM clinics were associated with reductions in ED visits, hospitalizations, and mortality. These findings provide valuable evidence toward a broadened adoption of the RAAM model in other regions of North America and beyond.
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Cousins, Matthew M., Monica Van Til, Emma Steppe, Sophia Ng, Chandy Ellimoottil, Yilun Sun, Matthew Schipper e Joseph R. Evans. "Age, race, insurance type, and digital divide index are associated with video visit completion for patients seen for oncologic care in a large hospital system during the COVID-19 pandemic". PLOS ONE 17, n. 11 (17 novembre 2022): e0277617. http://dx.doi.org/10.1371/journal.pone.0277617.
Testo completoAbstract (sommario):
Introduction The COVID-19 pandemic drove rapid adoption of telehealth across oncologic specialties. This revealed barriers to telehealth access and telehealth-related disparities. We explored disparities in telehealth access in patients with cancer accessing oncologic care. Materials/Methods Data for all unique patient visits at a large academic medical center were acquired pre- and intra-pandemic (7/1/2019-12/31/2020), including visit type (in-person, video, audio only), age, race, ethnicity, rural/urban (per zip code by Federal Office of Rural Health Policy), distance from medical facility, insurance, and Digital Divide Index (DDI; incorporates technology/internet access, age, disability, and educational attainment metrics by geographic area). Pandemic phases were identified based on visit dynamics. Multivariable logistic regression models were used to examine associations of these variables with successful video visit completion. Results Data were available for 2,398,633 visits for 516,428 patients across all specialties. Among these, there were 253,880 visits from 62,172 patients seen in any oncology clinic. Dramatic increases in telehealth usage were seen during the pandemic (after 3/16/2020). In multivariable analyses, patient age [OR: 0.964, (95% CI 0.961, 0.966) P<0.0001], rural zip code [OR: 0.814 (95% CI 0.733, 0.904) P = 0.0001], Medicaid enrollment [OR: 0.464 (95% CI 0.410, 0.525) P<0.0001], Medicare enrollment [OR: 0.822 (95% CI 0.761, 0.888) P = 0.0053], higher DDI [OR: 0.903 (95% CI 0.877, 0.930) P<0.0001], distance from the facility [OR: 1.028 (95% CI 1.021, 1.035) P<0.0001], black race [OR: 0.663 (95% CI 0.584, 0.753) P<0.0001], and Asian race [OR: 1.229 (95% CI 1.022, 1.479) P<0.0001] were associated with video visit completion early in the pandemic. Factors related to video visit completion later in the pandemic and within sub-specialties of oncology were also explored. Conclusions Patients from older age groups, those with minority backgrounds, and individuals from areas with less access to technology (high DDI) as well as those with Medicare or Medicaid insurance were less likely to use video visits. With greater experience through the pandemic, disparities were not mitigated. Further efforts are required to optimize telehealth to benefit all patients and avoid increasing disparities in care delivery.
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Park, S., E. T. Momany, M. P. Jones, R. A. Kuthy, N. M. Askelson, G. L. Wehby, P. C. Damiano e D. L. Chi. "The Effects of Medical Well Baby Visits in Promoting Earlier First Dental Visits for Children". JDR Clinical & Translational Research 3, n. 1 (23 agosto 2017): 91–100. http://dx.doi.org/10.1177/2380084417728237.
Testo completoAbstract (sommario):
The objective of the study was to assess the effects of medical well baby visits in promoting earlier first dental visits. We analyzed Iowa Medicaid claims data (2000–2013). The sample included 4 cohorts of children born in 2000, 2003, 2007, or 2010 and enrolled in Medicaid from birth ( N = 38,211). Children were followed for 3 y. The independent variables were cohort year and medical well baby visit frequency during 3 time periods (birth to age 10 mo, ages 11–19 mo, ages 20–36 mo). We used survival analyses to estimate first dental visit rates. First dental visit rates improved significantly from 2000 to 2013, with children in latter cohorts having significantly earlier first dental visits. Children with more medical well baby visits before age 11 mo had significantly delayed first dental visit rates than children with fewer medical well baby visits. The opposite was observed for children with more medical well baby visits between ages 11 to 19 mo and ages 20 to 36 mo. First dental visit rates for Medicaid-enrolled children have improved, but there continues to be a need for early interventions to improve age 1 dental visits and other preventive oral health behaviors. Knowledge Transfer Statement: The results of this study can be used by policy makers when developing strategies to improve access to dental care for young children in Medicaid. With consideration to promoting earlier preventive dental visits for publicly insured children, this study could lead to early interventions and improved health outcomes.
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Baker, Lawrence, Elizabeth L. Munnich e Ashley M. Kranz. "Medicaid Managed Care and Pediatric Dental Emergency Department Visits". JAMA Health Forum 5, n. 6 (14 giugno 2024): e241472. http://dx.doi.org/10.1001/jamahealthforum.2024.1472.
Testo completoAbstract (sommario):
ImportanceMillions of economically disadvantaged children depend on Medicaid for dental care, with states differing in whether they deliver these benefits using fee-for-service or capitated managed care payment models. However, there is limited research examining the association between managed care and the accessibility of dental services.ObjectiveTo estimate the association between the adoption of managed care for dental services in Florida’s Medicaid program and nontraumatic dental emergency department visits and associated charges.Design, Setting, and ParticipantsThis cohort study used an event-study difference-in-differences design, leveraging Florida Medicaid’s staggered adoption of managed care to examine its association with pediatric nontraumatic dental emergency department visits and associated charges. This study included all Florida emergency department visits from 2010 to 2014 in which the patient was 17 years or younger, the patient was a Florida resident, Medicaid paid for the visit, and a primary or secondary International Classification of Diseases, Ninth Revision, code was used to classify a nontraumatic dental condition. Analyses were conducted between May 2023 and April 2024.ExposureThe county of residence transitioning Medicaid dental services from fee-for-service to a fully capitated managed care program managed by a dental plan.Main Outcomes and MeasuresThe rate of nontraumatic dental emergency department visits per 100 000 pediatric Medicaid enrollees and the associated mean charges per visit. Nontraumatic dental emergency department visits are a well-documented proxy for access to dental care. Data on emergency department visit counts came from the Florida Agency for Health Care Administration. Medicaid population denominators were derived from the American Community Survey’s 5-year estimates.ResultsAmong the 34 414 pediatric nontraumatic dental emergency department visits that met inclusion criteria across Florida’s 67 counties, the mean (SD) age of patients was 8.11 (5.28) years, and 50.8% of patients were male. Of these, 10 087 visits occurred in control counties and 24 327 in treatment counties. Control counties generally had lower rates of NTDC ED visits per 100 000 enrollees compared with treatment counties (123.5 vs 132.7). Over the first 2.5 years of implementation, the adoption of managed care was associated with an 11.3% (95% CI, 4.0%-18.4%; P = .002) increase in nontraumatic dental emergency department visits compared with pre-implementation levels. There was no evidence that the average charge per visit changed.Conclusions and RelevanceIn this cohort study, Florida Medicaid’s adoption of managed care for pediatric dental services was associated with increased emergency department visits for children, which could be associated with decreased access to dental care.
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O’Shea, Amy M. J., Aaron Baum, Bjarni Haraldsson, Ariana Shahnazi, Matthew R. Augustine, Kailey Mulligan e Peter J. Kaboli. "Association of Adequacy of Broadband Internet Service With Access to Primary Care in the Veterans Health Administration Before and During the COVID-19 Pandemic". JAMA Network Open 5, n. 10 (17 ottobre 2022): e2236524. http://dx.doi.org/10.1001/jamanetworkopen.2022.36524.
Testo completoAbstract (sommario):
ImportanceAlthough telemedicine expanded rapidly during the COVID-19 pandemic and is widely available for primary care, required broadband internet speeds may limit access.ObjectiveTo identify disparities in primary care access in the Veterans Health Administration based on the association between broadband availability and primary care visit modality.Design, Setting, and ParticipantsThis cohort study used administrative data on veterans enrolled in Veterans Health Administration primary care to identify visits at 937 primary care clinics providing telemedicine and in-person clinical visits before the COVID-19 pandemic (October 1, 2016, to February 28, 2020) and after the onset of the pandemic (March 1, 2020, to June 30, 2021).ExposuresFederal Communications Commission–reported broadband availability was classified as inadequate (download speed, ≤25 MB/s; upload speed, ≤3 MB/s), adequate (download speed, ≥25 &lt;100 MB/s; upload speed, ≥5 and &lt;100 MB/s), or optimal (download and upload speeds, ≥100 MB/s) based on data reported at the census block by internet providers and was spatially merged to the latitude and longitude of each veteran’s home address using US Census Bureau shapefiles.Main Outcomes and MeasuresAll visits were coded as in-person or virtual (ie, telephone or video) and counted for each patient, quarterly by visit modality. Poisson models with Huber-White robust errors clustered at the census block estimated the association between a patient’s broadband availability category and the quarterly primary care visit count by visit type, adjusted for covariates.ResultsIn primary care, 6 995 545 veterans (91.8% men; mean [SD] age, 63.9 [17.2] years; 71.9% White; and 63.0% residing in an urban area) were seen. Adjusted regression analyses estimated the change after the onset of the pandemic vs before the pandemic in patients’ quarterly primary care visit count; patients living in census blocks with optimal vs inadequate broadband had increased video visit use (incidence rate ratio [IRR], 1.33; 95% CI, 1.21-1.46; P &lt; .001) and decreased in-person visits (IRR, 0.84; 95% CI, 0.84-0.84; P &lt; .001). The increase in the rate of video visits before vs after the onset of the pandemic was greatest among patients in the lowest Area Deprivation Index category (indicating least social disadvantage) with availability of optimal vs inadequate broadband (IRR, 1.73; 95% CI, 1.42-2.09).Conclusions and RelevanceThis cohort study found that patients with optimal vs inadequate broadband availability had more video-based primary care visits and fewer in-person primary care visits after the onset of the COVID-19 pandemic, suggesting that broadband availability was associated with video-based telemedicine use. Future work should assess the association of telemedicine access with clinical outcomes.
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Longmore, Avery, Nicole Veloce, Marck Mercado, Katie Dainty e Lisa K. Hicks. "Understanding what drives patients with cancer to visit the emergency department: A qualitative study." Journal of Clinical Oncology 36, n. 30_suppl (20 ottobre 2018): 173. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.173.
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173 Background: Visits to the emergency department (ED) are common among patients with cancer (PWCs). Previous research suggests that few ED visits are precipitated by true oncologic emergencies (Diaz-Couselo 2004). Designing initiatives to reduce ED visits requires a rich understanding of factors that drive PWCs to visit the ED. Methods: Standardized interviews were conducted with 12 oncology clinicians at an academic oncology clinic in Toronto, Canada. Interviews were also conducted with 10 PWCs. Interviews explored factors that may drive ED visits, and interviewees’ insights into interventions to prevent ED visits. Interviews were audio recorded and transcribed. Transcriptions were qualitatively analyzed by two independent reviewers using the constant comparison method (Strauss and Corbin 1998). Results: Ten themes were identified as factors that may drive ED visits, with little overlap between themes identified by clinicians versus those identified by PWCs. Clinicians identified low socioeconomic status, lack of social support, advanced age, comorbidities, anxiety and non-adherence as important factors. In contrast, PWCs focused on the severity and expectedness of symptoms, lack of access to afterhours oncology advice and care, and adherence with medical and non-medical advice as drivers of ED visits. Regarding potential interventions, there was broad agreement between clinicians and PWCs regarding what might be helpful. Both groups identified improved access to expert cancer advice/care, improved coordination of care between clinics and ancillary health services, and patient education as important interventions. Clinicians also believed increasing community supports would help prevent ED visits. PWCs emphasized that some ED visits are not preventable. Conclusions: Clinicians and PWCs have different views on what drives ED visits. Despite identifying different drivers, clinicians and PWCs identified common solutions for reducing ED visits.
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Chang, Eva, Robert B. Penfold e Nancy D. Berkman. "Patient Characteristics and Telemedicine Use in the US, 2022". JAMA Network Open 7, n. 3 (22 marzo 2024): e243354. http://dx.doi.org/10.1001/jamanetworkopen.2024.3354.
Testo completoAbstract (sommario):
ImportanceTelemedicine use was common during the COVID-19 pandemic, expanding many patients’ approaches to accessing health care. Of concern is whether telemedicine access was poorer among higher-needs and disadvantaged populations.ObjectiveTo assess patient characteristics associated with telemedicine use and telemedicine mode and describe telemedicine visit experiences by telemedicine mode.Design, Setting, and ParticipantsThis cross-sectional study included data from the 2022 Health Information National Trends Survey and included US adults with a health care visit. Data were analyzed from May to September 2023.ExposurePatient characteristics.Main Outcomes and MeasuresAny telemedicine visits vs in-person visits only; telemedicine mode (video vs audio-only). Multivariable logistic models assessed patient characteristics associated with telemedicine visits and mode. Bivariate analyses compared telemedicine experiences by mode.ResultsThe study included 5437 adult patients (mean [SE] age, 49.4 [0.23] years; 3136 females [53.4%]; 1928 males [46.6%]). In 2022, 2384 patients (43%) had a telemedicine visit; 1565 (70%) had a video visit while 819 (30%) had an audio-only visit. In multivariable models, older age (≥75 years: adjusted odds ratio [aOR], 0.63; 95% CI, 0.42-0.94), no internet use (aOR, 0.62; 95% CI, 0.48-0.81), and living in the Midwest (aOR, 0.50; 95% CI, 0.35-0.70) were negatively associated with having telemedicine visits. Female sex (aOR, 1.43; 95% CI, 1.12-1.83), having chronic conditions (aOR, 2.13; 95% CI, 1.66-2.73), and multiple health care visits (2-4 visits: aOR, 1.77; 95% CI, 1.23-2.54; ≥5 visits: aOR, 3.29; 95% CI, 2.20-4.92) were positively associated. Among individuals who used telemedicine, older age (65-74 years: aOR, 2.13; 95% CI, 1.09-4.14; ≥75 years: aOR, 3.58; 95% CI, 1.60-8.00), no health insurance (aOR, 2.84; 95% CI, 1.42-5.67), and no internet use (aOR, 2.11; 95% CI, 1.18-3.78) were positively associated with having audio-only visits. We observed no significant differences in telemedicine use or mode by education, race and ethnicity, or income. Patients’ experiences using telemedicine were generally similar for video and audio-only except more individuals who used audio-only had privacy concerns (20% vs 12%, P = .02).Conclusions and RelevanceIn this cross-sectional study of adults with health care visits, many patients, including those with the greatest care needs, chose telemedicine even after in-person visits were available. These findings support continuing this care delivery approach as an option valued by patients. Differences were not observed by most common measures of socioeconomic status. Continued monitoring of telemedicine use is needed to ensure equitable access to health care innovations.
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García-Martín, Miguel Ángel, María J. Fuentes, Isabel M. Bernedo e María D. Salas. "The views of birth families regarding access visits in foster care". Journal of Social Work 19, n. 2 (2 marzo 2018): 173–91. http://dx.doi.org/10.1177/1468017318757399.
Testo completoAbstract (sommario):
Summary This study aims to give voice to parents and gather their views about contact visits in foster care. Participants were 23 birth families who had contact visits with 35 children in non-kinship foster care. Semistructured individual interviews were conducted in order to explore two key aspects: the parents’ opinions regarding the contact visits and the main areas they felt needed improving. The interviews were transcribed and the transcripts were examined using an inductive method by Atlas.ti. Findings The main themes to emerge concerned their general view of contact visits, the input and support from social workers, the contribution of foster families, the contact venue, and the organization of visits. In general, the birth families’ comments were positive about the support and treatment received from social workers. However, they also mentioned certain aspects should be improved, such as supervision during visits. Applications The results suggest several ways to improve social work practice. Social workers should aim to involve birth families more in the process of drawing up contact arrangements and offering birth families adequate preparation prior to visits. Child protection agencies also have a role to play in relation to improving the facilities in which visits are held, as well as their overall organization, such as, the venue should provide a space that enables everyday family relationships to take place, and in the absence of this, attempts should be made to organize visits outside the official meeting place.
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Iasiello, John A., Arvind Rajan, Emmanuel Zervos, Alexander A. Parikh e Rebecca A. Snyder. "Abstract B105: Patient-reported access to telehealth: An important and unmeasured social determinant of health". Cancer Epidemiology, Biomarkers & Prevention 32, n. 1_Supplement (1 gennaio 2023): B105. http://dx.doi.org/10.1158/1538-7755.disp22-b105.
Testo completoAbstract (sommario):
Abstract Background: The recent COVID-19 pandemic expanded opportunities for remote oncology telehealth visits. However, reliable internet connectivity, digital literacy, and patient comfort with virtual medical visits may differ among patients, especially socially disadvantaged groups. The primary aim of this study was to identify patient demographics and social determinants of health (SDOH) which might limit access to remote telehealth services. Methods: First, a retrospective analysis was performed of composite administrative data of all patient visits to a large regional cancer center over the COVID-19 pandemic (3/2020-4/2022). Second, a prospective, cross-sectional study was conducted of patients with known or suspected malignancy presenting to the same center over six-months (11/2021-5/2022). Participants were asked a standard set of survey questions regarding telehealth accessibility during an in-person clinic visit. Demographics and SDOH were abstracted from the electronic health record (EHR). Results: Although Black patients comprised 43% (n=9,021) of all patient visits (n=20,953), the proportion of telehealth visits conducted among Black patients (29%; n=889) was significantly lower compared to White patients (71%, n=2,142, p<0.0001). Within the cross-sectional study cohort (n=149), 51% (n=76) were Black, 39% (n=58) resided in a rural county, and 8.7% (n=13) were uninsured or Medicaid-insured. Black participants were more likely to self-report lack of internet access (73.7% vs. 90.4%, p<0.01) and were less likely to report having access to or actively using a patient portal in the EHR compared to White patients (47.4% and 79.5%, respectively; p<0.001). Rates of self-reported access to video-capable devices (82.9% vs. 90.4%) and confidence in conducting video visits without assistance (59.2% vs. 68.5%) were similar among Black and White patients (p>0.05). The most common self-identified challenge to telehealth usage among both races was limited digital literacy. Conclusions: Black patients disproportionally under-participated in telehealth visits, suggesting underlying structural disparities in access to digital care. A greater proportion of Black participants self-reported lack of internet access and access to a patient portal to the EHR compared to White patients. Ensuring equal internet access and digital literacy will be critical to reduce further disparities in cancer care among racial minorities. Citation Format: John A. Iasiello, Arvind Rajan, Emmanuel Zervos, Alexander A. Parikh, Rebecca A. Snyder. Patient-reported access to telehealth: An important and unmeasured social determinant of health [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B105.
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Dreibelbis, Sarah, Anna Grassi, Daniel Jiang e John Dougherty. "Use of Telemedicine in an OBGYN Residency Clinic During COVID". Transformative Medicine 1, n. 3 (settembre 2022): 53–56. http://dx.doi.org/10.54299/tmed/jhpl5159.
Testo completoAbstract (sommario):
INTRODUCTION:Telemedicine can address healthcare disparities by improving access to care and eliminating barriers to in-office appointments. The primary goal of this study is to compare the number of completed telemedicine appointments to the number of completed in-office appointments for an OBGYN residency clinic during the early months of the COVID pandemic. The study also aims to evaluate patient demographics and types of visits performed using telemedicine. METHODS: All OBGYN residency clinic visits at a single institution from March 2020 – May 2020 were included and reviewed. Proportions of the visit type were evaluated for completion as well as the inability to complete the appointment through the telemedicine format. Information collected for the telemedicine visits includes the patient age, primary language spoken, and use of an interpreter during the visit. For patients who were a “no show” to a telemedicine appointment, appointments were reviewed to assess if the patient rescheduled or was lost to follow up. Overall appointment completion rates were compared between telemedicine and in-office visits using a Chi-squared test. RESULTS: Between March - May 2020, there were 598 telemedicine visits at the residency clinic, with 479 (80.1%) completed and 119 (19.9%) not completed. By comparison, in-office visits totaled 3,158 visits, with 78% (2,473) completed and 22% (685) not completed. Chi-squared test comparing telemedicine versus in office visits resulted in a non-significant p-value of 0.32. CONCLUSION:The overall visit completion rate between telemedicine and in-office visits from March - May 2020 was similar. The p-value comparing the completion rates was nonsignificant at 0.32, suggesting the telemedicine visit completion rate is comparable to in-office appointment completion rate.
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Made, Felix, Vusi Ntlebi, Tahira Kootbodien, Kerry Wilson, Nonhlanhla Tlotleng, Angela Mathee, Mpume Ndaba, Spo Kgalamono e Nisha Naicker. "Illness, Self-Rated Health and Access to Medical Care among Waste Pickers in Landfill Sites in Johannesburg, South Africa". International Journal of Environmental Research and Public Health 17, n. 7 (27 marzo 2020): 2252. http://dx.doi.org/10.3390/ijerph17072252.
Testo completoAbstract (sommario):
Waste pickers are exposed to various environmental health hazards, and self-rated health (SRH) could influence their medical care access. This study investigated the association between illness, clinic visits and SRH, and assessed if SRH can increase clinic visits. A cross-sectional study was conducted. SRH was defined as “very good”, “good”, “fair”, and “poor”. The illnesses were mental health, infectious, and chronic diseases. Medical care access included clinic visits in the previous 12 months. An ordinal logistic regression model was fitted to assess the association. There were 361 participants, 265 (73.41%) were males. Median age was 31 years, (interquartile range (IQR): 27–39). SRH: poor (29.89%), fair (15.92%), good (43.30%) very good (10.89%). Ever smoked (adjusted odds ratio (AOR): 1.72; 95% confidence interval (CI): 1.11–2.66), mental health (AOR: 1.87; 95% CI: 1.22–2.84), chronic (AOR: 2.34; 95% CI:1.47–3.68) and infectious (AOR: 2.07; 95% CI: 1.77–3.63) diseases were significantly associated with increased odds of reporting poor health. Clinic visit was not associated with SRH. From 99 (31%) individuals who rated their health as poor and ill, 40% visited a clinic (p = 0.0606). Acute and chronic illnesses were associated with poor SRH but this did not increase clinic visits. Provision of mobile clinic services at the landfill sites could increase access to medical care.
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Hartuti Hartuti, Meldawati Meldawati e Siti Noor Hasanah. "Gerakan Sweeping Kunjungan Rumah Ibu Hamil Di Wilayah Kerja Puskesmas Sungai Turak". Jurnal Pengabdian Ilmu Kesehatan 4, n. 1 (27 febbraio 2024): 21–28. http://dx.doi.org/10.55606/jpikes.v4i1.3547.
Testo completoAbstract (sommario):
A country's success in improving maternal health can be seen from the reduction in maternal and infant mortality rates. Empowering posyandu cadres and community leaders plays an important role in improving the health of pregnant women and reducing MMR. Based on an analysis of the situation in society, there are still pregnant women who do not have their pregnancies checked early at the Community Health Center or Posyandu. The proposed solution is to carry out sweeping home visits for pregnant women, who are recorded as not having made ANC visits to health services. The home visit method is carried out to provide education and facilitate access to services and information to families and/or relatives about pregnancy health. From the activity steps, it was found that there were 3 pregnant women who had not made a K2 return visit to the Puskesmas, and 1 pregnant mother who had not made a K3 visit. Sweeping visits to pregnant women's homes were carried out in January 2024. The visits were carried out by midwives, together with cadres, on 4 pregnant women.
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Shah, Suken, e Stephen Barnett Solomon. "Telemedicine visits result in a significantly lower rate of cancellations compared to in-person visits for interventional oncology clinic patients." Journal of Clinical Oncology 39, n. 15_suppl (20 maggio 2021): e13624-e13624. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e13624.
Testo completoAbstract (sommario):
e13624 Background: Telemedicine allows increased access to specialists, less time in a waiting room and on-demand options with little to no transportation costs. These changes have been accelerated by the COIVD-19 pandemic. The purpose of the study was to test the hypothesis that a virtual telemedicine clinic would significantly decrease no-show rates and cancellations compared to in-person visits for interventional oncology (IO) clinic patients. Methods: Telemedicine visits were performed by a physician or advanced practice provider (PA or NP) at a single institution, academic medical center including 5 regional sites to patients at home in multiple states. Total patients encounters and data from January 2020 to December 2020 were analyzed. Visit types included new visits and follow up visits. Phone only visits were excluded. Primary outcome measures were an analysis of total cancelled visits (both same day and rescheduled visits), completed visits, and total scheduled visits with calculation of the telemedicine and in-person cancellation rates. Results: There was a total of 9,044 IR clinic visits in 2020 from 6,348 unique patients across the MSK Main Campus and Regional Network. Of these clinic visits, 5586 were telemedicine visits and 3458 were in-person visits. There was a significant decrease in no show and cancellation rates for telemedicine patients (6.3%) compared to in-person visits (8.1%) (p-value <0.00001). Conclusions: Telemedicine visits resulted in a significantly lower rate of visit cancellation compared to in-person visits. This reduction in no-show and cancellation rates may yield significant cost savings by eliminating gaps in the interventional oncology clinic schedule to allow for more efficient use of physician time and resources.
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Tilhou, Alyssa Shell, Arjun Jain e Thomas DeLeire. "Telehealth Expansion, Internet Speed, and Primary Care Access Before and During COVID-19". JAMA Network Open 7, n. 1 (5 gennaio 2024): e2347686. http://dx.doi.org/10.1001/jamanetworkopen.2023.47686.
Testo completoAbstract (sommario):
ImportancePrimary care (PC) receipt is associated with better health outcomes. How telehealth expansion and internet speed are associated with PC use is unclear.ObjectiveTo examine the association of telehealth and internet speed with PC use across sociodemographic determinants of health.Design, Setting, and ParticipantsThis cohort study performed difference-in-differences regression of the change in in-person and telehealth PC visits between pre–COVID-19 public health emergency (PHE) (June 1, 2019, to February 29, 2020) and an initial (March 1, 2020, to May 31, 2020) and prolonged (March 1, 2020, to December 31, 2021) PHE period among continuously enrolled nonpregnant, nondisabled Wisconsin Medicaid beneficiaries aged 18 to 64 years. Data were analyzed from March 2022 to March 2023.ExposurePHE-induced telehealth expansion.Main Outcomes and MeasuresChange in PC telehealth (using Current Procedural Terminology codes) visits: (1) count; (2) visit share completed by telehealth; (3) percentage of PHE-induced visit decline offset by telehealth. High-speed internet (HSI) defined as living in a census block group with a median block maximum download speed of 940 megabits per second or greater (June 2020 Federal Communications Commission broadband data); other census block groups classified as low-speed internet (LSI).ResultsIn the total cohort of 172 387 participants, 102 989 (59.7%) were female, 103 848 (60.2%) were non-Hispanic White, 34 258 (19.9%) were non-Hispanic Black, 15 020 (8.7%) were Hispanic, 104 239 (60.5%) were aged 26 to 45 years, and 112 355 (66.0%) lived in urban counties. A total of 142 433 (82.6%) had access to HSI; 72 524 (42.1%) had a chronic condition. There was a mean (SD) of 0.138 (0.261) pre-PHE PC visits per month. In the pre-PHE period, visit rates were significantly higher for female than male participants, non-Hispanic White than non-Hispanic Black individuals, urban than rural residents, those with HSI than LSI, and patients with chronic disease than patients without. In the initial PHE period, female participants had a greater increase in telehealth visits than male participants (43.1%; 95% CI, 37.02%-49.18%; P &lt; .001), share (2.20 percentage point difference [PPD]; 95% CI, 1.06-3.33 PPD; P &lt; .001) and offset (6.81 PPD; 95% CI, 3.74-9.87 PPD; P &lt; .001). Non-Hispanic Black participants had a greater increase in share than non-Hispanic White participants (5.44 PPD; 95% CI, 4.07-6.81 PPD; P &lt; .001) and offset (15.22 PPD; 95% CI, 10.69-19.75 PPD; P &lt; .001). Hispanic participants had a greater increase in telehealth visits than Non-Hispanic White participants (35.60%; 95% CI, 25.55%-45.64%; P &lt; .001), share (8.50 PPD; 95% CI, 6.75-10.26 PPD; P &lt; .001) and offset (12.93 PPD; 95% CI, 6.25-19.60 PPD; P &lt; .001). Urban participants had a greater increase in telehealth visits than rural participants (63.87%; 95% CI, 52.62%-75.11%; P &lt; .001), share (9.13 PPD; 95% CI, 7.84-10.42 PPD; P &lt; .001), and offset (13.31 PPD; 95% CI; 9.62-16.99 PPD; P &lt; .001). Participants with HSI had a greater increase in telehealth visits than those with LSI (55.23%; 95% CI, 42.26%-68.20%; P &lt; .001), share (6.61 PPD; 95% CI, 5.00-8.23 PPD; P &lt; .001), and offset (6.82 PPD; 95% CI, 2.15-11.49 PPD; P = .004). Participants with chronic disease had a greater increase in telehealth visits than those with none (188.07%; 95% CI, 175.27%-200.86%; P &lt; .001), share (4.50 PPD; 95% CI, 3.58-5.42 PPD; P &lt; .001), and offset (9.03 PPD; 95% CI, 6.01-12.04 PPD; P &lt; .001). Prolonged PHE differences were similar. Differences persisted among those with HSI.Conclusions and RelevanceIn this cohort study of Wisconsin Medicaid beneficiaries, greater telehealth uptake occurred in groups with higher pre-PHE utilization, except for high uptake among Hispanic and non-Hispanic Black individuals despite low pre-PHE utilization. HSI did not moderate disparities. These findings suggest telehealth and HSI may boost PC receipt, but will generally not close utilization gaps.
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Handley, Nathan, Adam Binder, Megan Sabonjian e Ana Maria Lopez. "Evaluation of scheduled video visits for cancer care at the Sidney Kimmel Cancer Center at Thomas Jefferson University." Journal of Clinical Oncology 37, n. 27_suppl (20 settembre 2019): 277. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.277.
Testo completoAbstract (sommario):
277 Background: Telehealth is currently undergoing exponential growth as a result of improved access through less costly, more portable, and better quality technology and through increased broadband internet proliferation. Telehealth has been shown to improve access and decrease costs while maintaining quality of care and high levels of patient satisfaction. One approach to telehealth is the video visit, in which audiovisual technology is used to connect patients and providers virtually. We implemented a pilot scheduled video visit program in a large academic cancer center (SKCC). Methods: Oncology clinical teams were trained in the use of JeffConnect, the video visit platform developed at our institution. Clinical teams were encouraged to utilize video visits in instances they deemed appropriate (i.e. post hospital follow-up, post-chemotherapy evaluations). All participating patients received a link to an evaluation following completion of the video visit. A subset of patients receiving more detailed survey questions. We reviewed evaluations occurring between 9/1/2016 and 3/31/2019. Results: Sixty-nine unique clinicians and 759 unique patients engaged in 865 completed telemedicine visits. For these, 118 surveys were completed and returned (14.03% of total visits), a similar response rate for other services. Average likelihood to recommend JeffConnect to a friend or colleague was 9.1 (scale 0-10). The majority of patients reported video visits saved them time (Figure 1) and money. For the subset of patients receiving the more detailed survey (n=30), average distance from SKCC at the time of the visit was 125 miles (range 10-963 miles, median 50) and average financial savings were $61.15 (range $8-$300, median $45). Conclusions: Scheduled cancer care video visits were feasible, resulted in high patient satisfaction, and saved patients time and money. Evaluating patient and clinician perceptions of the benefits of and barriers to telemedicine in greater detail is necessary for broader implementation. Patient-reported time saved by telemedicine. [Table: see text]
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Kakani, Preeti, Adam E. Singer, Manying Cui, Chad Villaflores, Sitaram S. Vangala, Cheryl Damberg, John Mafi e Catherine Sarkisian. "The association between telemedicine visits and downstream utilization among patients with cancer at a large academic health center." JCO Oncology Practice 19, n. 11_suppl (novembre 2023): 515. http://dx.doi.org/10.1200/op.2023.19.11_suppl.515.
Testo completoAbstract (sommario):
515 Background: The COVID-19 pandemic and associated policies such as lockdowns spurred the widespread adoption of telemedicine throughout the U.S. Telemedicine has played a particularly important role for oncology patients by reducing potential exposure to infection and improving access for patients with poor performance status. However, as policymakers consider extending payment for telemedicine into the post-pandemic era, it is important to understand the impact of telemedicine on downstream care utilization in this population. We conducted a retrospective cohort study investigating the relationship between telemedicine use in oncology and subsequent outpatient oncology encounters, emergency department (ED) visits and hospitalizations at a large academic health center. Methods: We studied all outpatient oncology encounters occurring between 2018 and 2022 at the University of California, Los Angeles (UCLA) Health system, including in-person visits and telemedicine (audio-visual & audio-only) visits. We used multiple linear regression to predict the number of outpatient visits, ED visits, and hospitalizations within 30 days of an index visit based on visit modality, adjusting for demographic and clinical characteristics including patient age, race, ethnicity, sex, insurance, distance to clinic, distance to the nearest UCLA hospital, hospice referral, palliative care visits, median visit interval, appointment length, whether the visit occurred off the patient’s chemotherapy schedule, and the month and year of visit. Results: Our cohort included 62,815 patients with 672,427 outpatient encounters, of which 623,890 (92.7%) were in-person visits, 40,392 (6.0%) were video visits, and 8,145 (1.2%) were telephone visits. Overall, patients on average had 0.90 downstream outpatient visits, 0.16 ED visits, and 0.18 hospitalizations within 30 days of an index outpatient encounter. In our adjusted analyses, telemedicine encounters were associated with less outpatient utilization (270 fewer downstream visits [95% CI: 241 to 299] per 1000 encounters; p < 0.001). Telemedicine was also associated with greater ED visits (42.1 more ED visits [95% CI 18.5 to 65.8] per 1000 encounters; p < 0.001) and hospitalizations (54.8 more admissions [95% CI 33.6 to 76.1] per 1000 encounters; p < 0.001). Conclusions: Oncology patients who had a telemedicine visit rather than an in-person visit were less likely to have a follow-up outpatient encounter but more likely to have an ED visit or hospitalization within 30 days. Our findings suggest that telemedicine has largely played a substitutive role in the outpatient setting, but patients may require higher levels of care after these visits when compared to in-person visits. Additional research should further evaluate the effectiveness of telemedicine in oncology and define appropriate contexts for telemedicine use in this population.
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Tiagi, Raaj. "Access to and utilization of health care services among Canada’s immigrants". International Journal of Migration, Health and Social Care 12, n. 2 (13 giugno 2016): 146–56. http://dx.doi.org/10.1108/ijmhsc-06-2014-0027.
Testo completoAbstract (sommario):
Purpose – The purpose of this paper is to analyze patterns of health services utilization – visits to family practitioner and visits to an emergency room – by recent immigrants (those who have lived in Canada for less than ten years) and “established” immigrants (those who have resided in Canada for ten years or longer) relative to their Canadian-born counterparts. Design/methodology/approach – The 2009/2010 files of the Canadian Community Health Survey were used for the analysis. A logit model was used to analyze utilization while a zero-inflated negative binomial model was used to measure the intensity of health services utilization. Findings – Results suggest that relative to native-born Canadians, recent immigrants are more likely to visit an emergency room and are less likely to visit a family/general practitioner. The opposite effect is observed for “established” immigrants. In terms of intensity of use, native-born Canadians are more likely to use physicians’ services intensively compared with either recent or established immigrants. Originality/value – The paper’s findings suggest that provincial governments in Canada will need to focus effort to ensure that recent immigrants have access to a family/general practitioner. This will be necessary given the recent primary care reform initiatives introduced across Canada that emphasize the physician as the first point-of-contact with the health system.
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Razani, Nooshin, Nancy K. Hills, Doug Thompson e George W. Rutherford. "The Association of Knowledge, Attitudes and Access with Park Use before and after a Park-Prescription Intervention for Low-Income Families in the U.S." International Journal of Environmental Research and Public Health 17, n. 3 (21 gennaio 2020): 701. http://dx.doi.org/10.3390/ijerph17030701.
Testo completoAbstract (sommario):
We conducted secondary data analyses of pooled data from a clinical trial that prescribed park visits to children and their caregivers in a low-income, urban setting. Data were collected at the prescribing visit (baseline) and at one and three months of follow up from 78 families. Family characteristics were identified at baseline; regression models were used to explore changes during follow up in associations of park use with knowledge, attitudes and perceived access to parks. At baseline, park users differed from non-users in demographics, knowledge of park locations, attitudes about the value of park visits, but not affinity for nature. Park users were also more likely than non-users to feel that their neighborhood was safe for children to play in. Changes in knowledge of park locations, nature affinity, and perceived access to parks were each significantly associated with increased park use by families at one and three months after the park prescription. Adjusting for age, gender, race, poverty, and US birth, increases in knowing the location of parks were associated with an increase of 0.27 weekly park visits (95% CI 0.05, 0.49; p = 0.016); increases in feeling a caregiver had money to visit parks were associated with 0.48 more weekly park visits (95% CI 0.28, 0.69; p < 0.001); increases in perceived money for park outings were associated with 0.24 increased park visits per week (95% CI 0.05, 0.42; p = 0.01); each unit increase in nature affinity was associated with 0.34 more weekly park visits (95% CI 0.09, 0.59; p = 0.007). In other words, knowing where to go, valuing nature, and having time, and money contributed to increased likelihood of visiting a park. We discuss in terms of health behavior theory how demographics, knowledge, attitudes and perceived barriers to park use can inform park prescription interventions.
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Barzi, Afsaneh, Juanjuan Zhang, Lihua Liu e Sue Kim. "The inequity in emergency room utilization prior to colorectal cancer diagnosis and the opportunity to improve access to colorectal cancer screening." Journal of Clinical Oncology 41, n. 4_suppl (1 febbraio 2023): 79. http://dx.doi.org/10.1200/jco.2023.41.4_suppl.79.
Testo completoAbstract (sommario):
79 Background: The opportunity for early detection of colorectal cancer via screening is not fully realized. Previous efforts to maximize use of screening had targeted patients and primary care providers. Other wildly used healthcare settings may be suitable targets for intervention. We explored emergency room (ER) utilization in patients with colorectal cancer prior to their diagnosis using the linkage between California Cancer Registry (CCR) and OSHPD (Office of Statewide Health Planning and Development). Methods: Patients with diagnosis of colorectal cancer 2010-2015 were identified in the CCR and their records were linked with OSHPD (2009 – 2016) to assess ER utilization. This study aimed to evaluate the patterns of ER utilization (all and nay reason for ER visit) prior to the diagnosis of colorectal cancer. Results: A total of 66,451 colorectal cancer patients were identified, of which 57,876 (87%) were linked with OSHPD data. Among the linked population, 41% (23,890) had at least one ER visit prior to their diagnosis of colon cancer. Of the 23,890 with ER visit, 14% had 3 or more ER visits. The median number of days from first ER visit to diagnosis was 539 days (range: 2551 – 1). A total of 14,372 patients (25%) had an ER visit within one year of their colorectal cancer diagnosis. The median age of patients who had ER visits was younger than those who didn’t have an ER visit, 66 vs. 68 years. There was no difference in the number of ER visits between patients 50 and younger and those older than 50 years. There was no significant difference in the stage at presentation between those with prior ER visit and those without. Patients in high socioeconomic status were less likely to have an ER visit prior to colorectal cancer diagnosis (44%) compared to those with low SES status (36%). Patients with private insurance had a significantly lower likelihood of ER visits compared to those with federal and state funded insurance. Conclusions: A significant percentage of patients with colorectal cancer had ER visit prior to their diagnosis, many within one year of their diagnosis. Inequity in access to care, measured via poor SES and insurance type, was associated with higher chance of ER visit among colorectal cancer patients. Emergency room may be a targetable opportunity to remind and coordinate screening for colorectal cancer.
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Hong, Arthur, Hannah Fullington, Navid Sadeghi, John V. Cox, Stephanie Clayton Hobbs, John W. Sweetenham, D. Mark Courtney, Simon Craddock Lee e Ethan Halm. "Are ED visits in cancer patients preventable? Care patterns before an ED visit." Journal of Clinical Oncology 38, n. 15_suppl (20 maggio 2020): 2023. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.2023.
Testo completoAbstract (sommario):
2023 Background: Medicare’s Oncology Care Model alternative payment program participation requires 24-hr patient access to clinician phone advice. Many participating practices have established oncology urgent care clinics to reduce the frequent ED visits in the early phase after cancer diagnosis. However, little is known about patients’ use of pre-ED visit clinical advice via phone. We combined EHR data on phone/secure messaging encounters, outpatient visits, and regional ED visits, to assess how often patients visit the ED without prior clinical advice, and to compare ED visit severity between those with and without preceding clinical advice. Methods: We linked adults ages 18+ from Parkland Health and Hospital System (PHHS), the Dallas County public safety net system, and UT Southwestern (UTSW) NACR Gold-certified cancer registry (2012-2018), to their respective EHR, and identifiably linked patients to a regional health information exchange of ED and hospital encounters. Exchange data included hospital name, ED disposition, diagnoses, and ED Severity Of Illness. We tallied ED visits within 6 months (180 days) after cancer diagnosis and EHR clinical contacts for 24 hours prior to ED visit (telephone/secure messaging, outpatient visits). After descriptive statistics, we used mixed-effects multivariate logistic regression clustering at patient level to model ED disposition after a pre-ED clinical contact. Results: We matched 8,289 Parkland (54% female, 78% Medicaid/charity assistance) and 10,817 UTSW patients (50% female, 12% Medicaid), who generated 21,009 and 22,696 ED visits, respectively. Two-thirds of all ED visits occurred without preceding clinical contact (70.2% PHHS, 66.7% UTSW); large shares of ED visits were to 67 other regional hospitals (22.2% PHHS, 69.5% UTSW). Telephone encounters and outpatient visits to any specialty were the most common contact before ED visit (UTSW: 28.2 and 12.4%; PHHS: 8.7 and 16.1%), but while nearly all UTSW clinic visits were to oncology, only 30% of PHHS clinic visits were to oncology. Though ED visit severity was slightly higher for ED visits without preceding clinical contact (46% vs. 43% ≥Major severity, p < 0.01), patients were discharged home more often if clinical contact preceded ED visits (aOR of hospitalization 0.82, 95% CI: 0.74 – 0.90). Conclusions: Two-thirds of ED visits occurred without prior clinical contact, and though these no-contact ED visits had higher severity of illness, they were more often discharged home from the ED. Future work should identify patient-oriented options to optimize the use of clinical care and the ED.
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Sharma, Anjana E., Elaine C. Khoong, Maribel Sierra, Natalie A. Rivadeneira, Malini A. Nijagal, George Su, Courtney R. Lyles, Triveni DeFries, Delphine S. Tuot e Urmimala Sarkar. "System-Level Factors Associated With Telephone and Video Visit Use: Survey of Safety-Net Clinicians During the Early Phase of the COVID-19 Pandemic". JMIR Formative Research 6, n. 3 (10 marzo 2022): e34088. http://dx.doi.org/10.2196/34088.
Testo completoAbstract (sommario):
Background The COVID-19 pandemic prompted safety-net health care systems to rapidly implement telemedicine services with little prior experience, causing disparities in access to virtual visits. While much attention has been given to patient barriers, less is known regarding system-level factors influencing telephone versus video-visit adoption. As telemedicine remains a preferred service for patients and providers, and reimbursement parity will not continue for audio visits, health systems must evaluate how to support higher-quality video visit access. Objective This study aimed to assess health system–level factors and their impact on telephone and video visit adoption to inform sustainability of telemedicine for ambulatory safety-net sites. Methods We conducted a cross-sectional survey among ambulatory care clinicians at a hospital-linked ambulatory clinic network serving a diverse, publicly insured patient population between May 28 and July 14, 2020. We conducted bivariate analyses assessing health care system–level factors associated with (1) high telephone adoption (4 or more visits on average per session); and (2) video visit adoption (at least 1 video visit on average per session). Results We collected 311 responses from 643 eligible clinicians, yielding a response rate of 48.4%. Clinician respondents (N=311) included 34.7% (n=108) primary or urgent care, 35.1% (n=109) medical, and 7.4% (n=23) surgical specialties. Our sample included 178 (57.2%) high telephone adopters and 81 (26.05%) video adopters. Among high telephone adopters, 72.2% utilized personal devices for telemedicine (vs 59.0% of low telephone adopters, P=.04). Video nonadopters requested more training in technical aspects than adopters (49.6% vs 27.2%, P<.001). Primary or urgent care had the highest proportion of high telephone adoption (84.3%, compared to 50.4% of medical and 37.5% of surgical specialties, P<.001). Medical specialties had the highest proportion of video adoption (39.1%, compared to 14.8% of primary care and 12.5% of surgical specialties, P<.001). Conclusions Personal device access and department specialty were major factors associated with high telephone and video visit adoption among safety-net clinicians. Desire for training was associated with lower video visit use. Secure device access, clinician technical trainings, and department-wide assessments are priorities for safety-net systems implementing telemedicine.
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Hu, Tina, Melissa Snider-Adler, Larry Nijmeh e Adam Pyle. "Buprenorphine/naloxone induction in a Canadian emergency department with rapid access to community-based addictions providers". CJEM 21, n. 4 (22 aprile 2019): 492–98. http://dx.doi.org/10.1017/cem.2019.24.
Testo completoAbstract (sommario):
ABSTRACTObjectivesOpioid-related emergency department (ED) visits have increased significantly in recent years. Our objective was to evaluate an ED-initiated buprenorphine/naloxone program, which provided rapid access to an outpatient community-based addictions clinic, for patients in opioid withdrawal.MethodsA retrospective chart review was completed within a health system encompassing four community EDs in Ontario, Canada. Patients were screened for opioid withdrawal between April 2017-December 2017 and offered buprenorphine/naloxone treatment and referral to outpatient addictions follow-up. The main outcome measure was treatment retention in the six-month period after the index visit.ResultsThe overall sample (N = 49) showed high healthcare utilization in the year prior to the index ED visit. 88% of patients (n = 43) consented to ED-initiated buprenorphine/naloxone and were referred to outpatient addictions follow-up, with 54% attending the initial follow-up visit. In the 6-month follow-up period from the index ED visit, 35% of patients were receiving ongoing buprenorphine/naloxone treatment and 2.3% were weaned off opioids. Patients with ongoing treatment had significantly lower number of ED visits at 3 and 6 months (3 and 10, respectively) compared to patients who did not show up for outpatient follow-up (28, 40) or started/stopped treatment (23, 41).ConclusionsScreening for opioid use disorder in the ED and initiating buprenorphine/naloxone treatment with rapid referral to an outpatient community-based addictions clinic led to a 6-month treatment retention rate of 37% and a significant reduction in ED visits at 3 and 6 months. Buprenorphine/naloxone initiation in the ED appears to be an effective intervention, but further research is needed.
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DeShetler, Lori M. "Virtual medical education accreditation survey visits and viability for the future". MedEdPublish 12 (27 maggio 2022): 39. http://dx.doi.org/10.12688/mep.19160.1.
Testo completoAbstract (sommario):
Coronavirus disease 2019 (COVID-19) drastically disrupted daily life and abruptly forced curricular modifications in undergraduate medical education. Despite level of preparedness, medical schools moved instruction online for students to access remotely. Similarly, accreditation visits by the Liaison Committee for Medical Education (LCME) were also moved from in-person to virtual formats during these chaotic times. Little guidance was available to transition to the new process. Medical schools that were scheduled for a virtual survey visit were required to pivot without tried experience on how to prepare for and conduct these high stakes online visits. New processes needed to be developed to successfully navigate a virtual accreditation visit. To date, there has been nothing in the literature from those who have participated on LCME teams nor from medical schools who have undergone a virtual survey visit. This article accounts for one medical school’s experience from its 2021 LCME virtual visit and makes recommendations to consider when planning for such a significant event. The future of virtual visits is taken into account as this method has its benefits including elimination of travel and the associated time and cost. Yet, the perspectives from others who have participated in a virtual LCME accreditation visit should be studied. While the LCME will return to in-person visits in 2022-23, it is important for medical schools to share their experiences and lessons learned from their virtual accreditation visit should the need arise to reinstate virtual visits in the future.