Assessment of Patient and Provider Satisfaction With the Change to Telehealth From In-Person Visits at an Academic Safety Net Institution During the COVID-19 Pandemic

INTRODUCTION

The 2019 novel coronavirus (COVID-19) caused a global pandemic that forced medical providers to rapidly alter methods of health care delivery. One month into this pandemic, we surveyed providers and patients to assess satisfaction or concerns with the change from in-person visits.

METHODS

We surveyed internal medicine (IM) and family medicine (FM) faculty and residents to ascertain satisfaction or concerns with the change to telehealth from in-person visits.

RESULTS

Of patients surveyed (129 IM, 94 FM), 84.4% of IM patients and 94% of FM patients agreed or strongly agreed that they enjoyed the televisits, and 82.9% of IM providers (47 surveyed) and 64% of FM providers (25 surveyed) felt the same. For continued televisits, 76.74% of IM patients and 84.1% of FM patients agreed or strongly agreed that they would not mind having virtual visits after the pandemic, compared with 89.44% of IM providers and 88% of FM providers, and 91% of IM providers and 88% of FM providers felt comfortable managing visits virtually.

CONCLUSION

Patients are open to the expanded use of telemedicine, and providers and hospital systems should be prepared to embrace it for the benefit of patient care.

Teachings After COVID-19 Outbreak From a Survey of Family Physicians

BACKGROUND

Since December 2019, the dramatic escalation in coronavirus (COVID-19) cases worldwide has had a significant impact on health care systems. Family physicians (FPs) have played a critical role in the coordination of care.

MATERIALS AND METHODS

In April 2020, we performed an online prospective survey to assess the impact of the pandemic on FPs' practices.

RESULTS

Three hundred FPs were included. Mean age was 53.6 ± 13.5 years. Before the pandemic, 60.2% reported >75 outpatient visits/week, which reduced down to an average of <20/week for 79.8% of FPs; 24.2% of FPs discontinued home visits, while for 94.7% of FPs there was a >50% increase in the number of telephone consultations. Concern related to the risk of contagion was elevated (≥3/5 in 74.6%) and even higher to the risk of infecting relatives and patients (≥3/5 in 93.3%). The majority of FPs (87%) supported the role of telemedicine in the near future. Satisfaction regarding the network with hospitals/COVID-19-dedicated wards received a score ≤2/5 in 46.9% of cases.

CONCLUSIONS

The COVID-19 pandemic has had a significant impact on the working practices of FPs. A collaboration is needed with well-established networks between FPs and referral centers to provide new insights and opportunities to inform future working practices.

Not Telehealth: Which Primary Care Visits Need In-Person Care?

The Coronavirus disease 2019 (COVID 19) pandemic has resulted in a rapid shift to telehealth and many services that need in-person care have been avoided. Yet, as practices and payment policies return to a new normal, there will be many questions about what proportion of visits should be done in-person vs telehealth. Using the 2016 National Ambulatory Medical Survey (NAMCS), we estimated what proportion of visits were amenable to telehealth before COVID-19 as a guide. We divided services into those that needed in-person care and those that could be done via telehealth. Any visit that included at least 1 service where in-person care was needed was counted as an in-person only visit. We then calculated what proportion of reported visits and services in 2016 could have been provided via telehealth, as well as what proportion of in-person only services were done by primary care. We found that 66% of all primary care visits reported in NAMCS in 2016 required an in-person service. 90% of all wellness visits and immunizations were done in primary care offices, as were a quarter of all Papanicolaou smears. As practices reopen, patients will need to catch up on many of the in-person only visits that were postponed such as Papanicolaou smears and wellness visits. At the same time, patients and clinicians now accustomed to telehealth may have reservations about returning to in-person only visits. Our estimates may provide a guide to practices as they navigate how to deliver care in a post-COVID-19 environment.

Translation, Adaptation and Validation of the European Portuguese Version of the NMS-Quest for Parkinson's Disease

INTRODUCTION

Non-motor symptoms are underrecognized features of Parkinson's disease that impair quality of life and increase mortality. In this study, we aim to translate, adapt and validate the European Portuguese version of the "Non-Motor Symptoms Questionnaire", which has proven to be a valid and reliable measurement tool of non-motor symptoms in other languages.

MATERIAL AND METHODS

Acceptability was evaluated regarding the range of values, ceiling and floor effects. Reliability was measured in terms of internal consistency (Cronbach's alpha) and reproducibility (intra-class correlation coefficient). For criterion validity analysis, Movement Disorders Society - Unified Parkinson's Disease Part I domains' scores were compared to those of the "Non-Motor Symptoms Questionnaire". For convergent validity, correlations between the "Non-Motor Symptoms Questionnaire" and the Movement Disorders Society - Unified Parkinson's Disease Part III, Mini-Mental State Examination score, disease duration, and severity were obtained.

RESULTS

Seventy nine Parkinson's disease patients were recruited, with a mean age of 67.2 ± 10.7 years and a disease duration of 10.8 ± 8.8 years. The European Portuguese version of the "Non-Motor Symptoms Questionnaire" total score was free of significant ceiling and floor effects. With the exception of the cardiovascular domain, adequate overall internal consistency was achieved. The questionnaire domains and the corresponding Movement Disorders Society - Unified Parkinson's Disease Part I dimensions were significantly correlated, although the total questionnaire score was modestly correlated with disease duration and severity, motor and non-motor symptoms severity and cognitive dysfunction.

DISCUSSION

This is the first study to translate, adapt and validate a widely used screening instrument of non-motor symptoms of European Portuguese speaking Parkinson's disease patients.

CONCLUSION

The European Portuguese version of "Non-Motor Symptoms Questionnaire" is a valid and reliable tool for screening nonmotor symptoms in patients with Parkinson's disease.

Feasibility of Group Visits for Advance Care Planning Among Patients with Heart Failure and Their Caregivers

BACKGROUND

Group visits have the potential to help patients identify their health care values and engage in the emotionally and cognitively challenging task of advance care planning (ACP) in a resource-efficient manner by providing a forum for social learning and social support.

OBJECTIVE

To evaluate the feasibility and acceptability of disease-specific group visits for patients with heart failure and their caregivers.

DESIGN

Feasibility trial of a 90-minute group visit held for 10 separate groups and led by a trained facilitator using the video-based PREPARE for Your Care ACP tool.

SETTING/SUBJECTS

Older adults with recent hospitalization for heart failure (n = 36; median age, 74 years) and their caregivers (n = 21).

MEASUREMENTS

Pre- and post-visit surveys and a postvisit telephone interview assessing perceived value and acceptability; structured nonparticipant observations to assess process and feasibility.

RESULTS

Mean scores from the postgroup visit evaluation showed that participants reported that they felt comfortable discussing ACP in a group (4.59), understood the information covered (4.70), and were able to identify and clarify their health care values (4.43). Interview and observation data demonstrated that participants were able to identify and clarify their preferences by listening and learning from a diverse range of perspectives in the group and that the disease-focused nature of the group visit created a supportive space for participants to share their experiences.

CONCLUSIONS

Disease-focused ACP group visits were feasible to conduct and acceptable to participants, underscoring their value as an efficient intervention to engage patients and caregivers in the otherwise time- and resource-intensive task of ACP.

The relationship between smartphone addiction and musculoskeletal pain prevalence among young population: a cross-sectional study

Background

In the literature, there have been debates as to whether smartphone use has negative effects on physical and mental health. The present study investigated the extent to which smartphone addiction impacts on musculoskeletal pain prevalence among university students.

Methods

The questionnaire consisted of three sections demographic information, the Smartphone Addiction Scale (SAS), and the modified Nordic Musculoskeletal Questionnaire.

Results

A total of 249 participants were included in this cross-sectional study. The body parts that were reported with highest prevalence of musculoskeletal pain were the upper back (70.3%), neck (65.9%), and wrists/hands (68.7%). The SAS scores were correlated with duration of smartphone use on a typical day (P = 0.001), duration of owning a smartphone (P = 0.027), and musculoskeletal pain prevalence in the neck (P = 0.001), wrists/hands (P = 0.001), shoulders (P = 0.025), and upper back (P = 0.023). The SAS score was significantly associated with prevalence of musculoskeletal pain in the neck (odd ratio [OR], 1.08; 95% confidence interval [CI], 0.98-1.10; P = 0.002), wrists/hands (OR, 1.07; 95% CI, 0.97-1.09; P = 0.001), and upper back (OR, 1.10; 95% CI, 0.98-1.11; P = 0.033).

Conclusions

The findings indicated that the upper back, neck, and wrists/hands have a higher prevalence of musculoskeletal pain among smartphone users, particularly those with a smartphone addiction. Smartphone addiction scores were correlated with duration of smartphone use on a typical day, duration of owning smartphone, and musculoskeletal pain prevalence in the neck, wrists/hands, shoulders, and upper back.

Translation and validation of the English-language instrument Orthognathic Quality of Life Questionair into Swedish

INTRODUCTION

In orthognathic surgery, understanding the patient's motives for treatment is a key factor for postoperative patient satisfaction and treatment success. In countries/systems where orthognathic surgery is funded by public means, patients are referred mainly due to functional problems, although studies of quality of life related changes after treatment indicate that psychosocial and aesthetic reasons might be equal or more important for the patient. There is no available validated condition specific instruments in the Swedish language for quality of life evaluation of patients with dentofacial deformities. Aims/objectives: Cross cultural translation and adaptation of the English-language instrument 'Orthognathic Quality of Life Questionnaire' (OQLQ) into Swedish. Methods: OQLQ was translated into Swedish. A total of 121 patients in four groups were recruited and the Swedish version of the OQLQ (OQLQ-S) was tested by psychometric methods. Reliability was assessed by internal consistency and test-retest reliability. Validity was evaluated by face, convergent and discriminant validity. Results/findings and conclusions: OQLQ-S is reliable and showed good construct validity and internal consistency and can be used in a Swedish speaking population as a complement to clinical variables to evaluate patients with dentofacial deformity.

Evaluating gender bias in an eating disorder risk assessment questionnaire for athletes

Due to stigma, eating disorders are under-researched, underdiagnosed and undertreated among men. This is particularly pertinent among athletes, as athletic goals are a major risk factor for disordered eating in men. This gender stereotype may be reinforced by eating disorder risk assessment tools that better reflect female symptoms. We examine an eating disorder risk assessment questionnaire in a population of athletes to assess both (1) gender bias in individual items and (2) gender differences on a cognitive and behavioral subscale, identified through a factor analysis. Controlling for eating disorder risk, we found that female gender significantly predicted high risk scores on four items; male gender significantly predicted high risk scores on four other items. We also found that women were more likely to score above the median on a cognitive subscale than men with the same level of eating disorder risk, while men were more likely to score above the median on a behavioral subscale. These results may be applied practically to allow eating disorder risk assessment tools to better capture eating disorder risk independent of gender. These methods may be applied to other questionnaires and other social identities, to expand the scope of eating disorder research and treatment.

US Primary Care Physicians' Viewpoints on HPV Vaccination for Adults 27 to 45 Years

INTRODUCTION

In June 2019, the Advisory Committee on Immunization Practices (ACIP) recommended shared clinical decision making (SCDM) regarding human papillomavirus (HPV) vaccination for adults 27 to 45 years. Our objectives were to assess among primary care physicians 1) recent practice regarding HPV vaccination for adults 27 to 45 years, 2) knowledge of HPV and the new SCDM recommendation, and 3) attitudes toward and anticipated effect of the new SCDM recommendation.

METHODS

From October to December 2019, we administered an Internet and mail survey to national networks of 494 general internist (GIM) and 474 family physician (FP) members of the American College of Physicians and American Academy of Family Physicians, respectively.

RESULTS

Response rate was 64% (617/968; GIM, 57%; FP, 71%). Fifty-eight percent were aware of the new ACIP recommendation; 42% had recommended HPV vaccination to adults 27 to 45 years, but most had administered HPV vaccine to very few of these patients (73% to 0% and 22% to 1 to 3). Fifty-five percent and 63% were unaware that HPV vaccination does not prevent progression of existing HPV-related cancers or infections, respectively and 57% were not sure what to emphasize when having a SCDM conversation about HPV vaccination. A majority reported they will be more likely recommend HPV vaccination to adults in the 27-to-45-year age range as a result of the new recommendation.

CONCLUSIONS

Physicians are interested in recommending HPV vaccination for adults age 27 to 45 years despite ACIP not routinely recommending it in this age range. The majority need more education about the optimal use of HPV vaccine in this age group.

Advancing the Patient EXperience (APEX) in COPD Registry: Study Design and Strengths

The Advancing the Patient Experience (APEX) in Chronic Obstructive Pulmonary Disease (COPD) registry (https://www.apexcopd.org/) is the first primary care health system-based COPD registry in the United States. While its ultimate goal is to improve the care of patients diagnosed with COPD, the registry is also designed to describe real-life experiences of people with COPD, track key outcomes longitudinally, and assess the effectiveness of interventions. It will retrospectively and prospectively collect information from 3000 patients enrolled in 5 health care organizations. Information will be obtained from electronic health records, and from extended annual and brief questionnaires completed by patients before clinic visits. Core variables to be collected into the APEX COPD registry were agreed on by Delphi consensus and fall into 3 domains: demographics, COPD monitoring, and treatment. Main strengths of the registry include: 1) its size and scope (in terms of patient numbers, geographic spread and use of multiple information sources including patient-reported information); 2) collection of variables which are clinically relevant and practical to collect within primary care; 3) use of electronic data capture systems to ensure high-quality data and minimization of data-entry requirements; 4) inclusion of clinical, database development, management and communication experts; 5) regular sharing of key findings, both at international/national congresses and in peer-reviewed publications; and 6) a robust organizational structure to ensure continuance of the registry, and that research outputs are ethical, relevant and continue to bring value to both patients and physicians.

Engagement of Small to Medium-Sized Primary Care Practices in Quality Improvement Efforts

BACKGROUND

Engaging primary care practices in quality improvement (QI) efforts has been challenging. Literature provides little guidance on the engagement of small to medium-sized practices in QI. This study examined the association between practice readiness and practice characteristics and engagement during a targeted QI effort.

METHODS

The study analyzed cross-sectional data collected by the Heart of Virginia Health care, a cardiovascular disease QI intervention study with 195 practices. Data sources include 1) coach-assessed practice engagement in 7 domains (outcome), 2) surveys of readiness completed by 2529 clinicians and staff, a response rate of 86%, and 3) surveys of practice characteristics completed by a physician leader or practice manager. We used descriptive statistics and ordered logit regression for the analysis.

RESULTS

Associations between readiness and engagement were statistically significant for clinician engagement (odds ratio [OR] = 5,74; 95% CI, 1.79-18.42; P = .003) and leadership engagement (OR = 3.19; 95% CI, 1.10-9.24; P = .032). Adjusting for covariates, being a hospital-owned practice was associated with a lower level of clinician engagement (OR = 0.35; 95% CI, 0.16-0.76; P = .009) relative to independent practices.

DISCUSSION

Our study highlights the importance of clinician and leadership engagement as drivers of practice readiness to change in a QI effort. Lack of clinician engagement in hospital-owned practices could be driven by other factors such as burnout that need to be explored in future studies.

CONCLUSIONS

Clinicians and leadership involvement in QI efforts is critical. The findings suggest that QI plans should involve clinicians and leaders early in the process to foster commitment, establish practice readiness, and sustain improvement efforts.

Changing Pharmaceutical Industry Interaction in US Family Medicine Residencies: A CERA Study

BACKGROUND

Pharmaceutical interaction in US residencies is common. This study explores the extent and type of learner interactions in US family medicine residencies with the pharmaceutical industry and compares interactions from 2008, 2013, and 2019.

METHODS

We surveyed program directors of 628 family medicine residencies with 8 questions using the 2019 Council of Academic Family Medicine Educational Research Alliance Survey and compared the responses to 2008 and 2013 results.

RESULTS

The survey response rate was 39%; 81% of responding residencies did not allow food or gifts, 86% did not allow drug samples, 84% did not allow industry to interact with medical students or residents, and 81% did not allow industry-sponsored residency activities. These numbers were statistically significantly higher than both 2008 and 2013. In 2019, 151 responding programs (64%) were pharma-free, that is, they answered "No" to all 4 questions about interactions. Pharma-free residencies were increased in 2019 compared with 26% in 2008% and 49% in 2013. University-based family medicine programs were more likely to be pharma-free. Only 21% of responding programs had a formal curriculum that explores the interaction between physicians and the pharmaceutical industry. Factors cited for decreasing interaction included: institutional policy, ethical concerns, faculty input, and local response to national legislation.

CONCLUSIONS

Interaction between trainees in US family medicine residencies and the pharmaceutical industry continued to decrease. A changing national legislative landscape combined with institutional policies and concerns about industry influence on prescribing habits may be important factors driving the limiting of interactions.

Factors Associated with Time Spent Practicing Sports Medicine by Those with a Certificate of Added Qualification

PURPOSE

To determine those factors associated with family physicians certified in sports medicine (SM-FPs) devoting 75% or more of their professional time to the exclusive practice of sports medicine.

METHODS

Data from the American Board of Family Medicine sports medicine examination registration questionnaires from 2003 to 2017 were analyzed. The characteristics of SM-FPs devoting 75% or more of their time to sports medicine were compared with those SM-FPs spending less than 75% time. Multiple regression analysis was used to determine characteristics that independently predicted devoting 75% or more of their professional time to the practice of sports medicine.

RESULTS

One thousand one hundred twelve SM-FPs recertifying in sports medicine between 2003 to 2017 were studied. They were predominately male (85.2%), allopathic (91.7%) physicians with a mean age of 47.3 years (interquartile range (IQR), 42.1-54.2) and devoted a median 50% of their professional time (IQR, 25-80) to sports medicine. Age less than 47.3 years (odds ratio (OR), 1.53; 1.12-2.08), service as a collegiate team physician (OR 1.66; 1.10-2.50), recertification in sports medicine in 2011 to 2017 compared with earlier years (OR 2.47; 1.62-3.78), and practicing in a sports medicine clinic (OR, 6.43; 4.15-9.95) predicted greater odds of spending 75% or more of their time devoted to sports medicine.

CONCLUSIONS

Those factors found to be associated with spending 75% or more of their time practicing sports medicine by SM-FPs seem to be consistent with recent trends in the recruitment and employment of these physicians and their ability to provide added value to the health care system by virtue of their additional training and expertise.

Provision of Early Pregnancy Loss Care in New York Federally Qualified Health Centers

BACKGROUND

Office-based early pregnancy loss (EPL) care is safe and suitable to Federally Qualified Health Centers (FQHCs); prevalence of provision in FQHCs is unknown.

METHODS

We conducted a mailed site-level survey of FQHCs in New York State (n = 405). Sites that offered prenatal care were eligible for analysis. Questions included provision of and barriers to providing EPL care options. Content analysis was used for write-in responses to barriers. We conducted bivariate analyses using Fisher's Exact tests and risk ratios to investigate associations between EPL care provision and the independent variables site urbanicity, prenatal clinician type, and ultrasound access.

RESULTS

Of 181 mailings returned, 63 sites were eligible (response rate 44.7%); 88.9% provided expectant management, 53.9% medication management, and 23.8% uterine aspiration. Common barriers included lack of clinical infrastructure, poor ultrasound access, and insufficient training. Some held perceived barriers regarding uterine aspiration. Sites with regular ultrasound access were 1.85 times as likely to provide uterine aspiration as sites without regular ultrasound access (95% CI, 1.16-2.95).

CONCLUSIONS

Few New York FQHCs provided comprehensive EPL care. Supporting FQHCs to overcome barriers may expand access to EPL treatment in primary care and increase continuity and patient centeredness.

Improving the Reporting of Primary Care Research: An International Survey of Researchers

PURPOSE

To assess opportunities to improve reporting of primary care (PC) research to better meet the needs of its varied users.

METHODS

International, interprofessional online survey of PC researchers and users, 2018 to 2019. Respondents used Likert scales to rate frequency of difficulties in interpreting, synthesizing, and applying PC research reports. Free-text short answers were categorized by template analysis to record experiences, concerns, and suggestions. Areas of need were checked across existing reporting guidelines.

RESULTS

Survey yielded 255 respondents across 24 nations, including 138 women (54.1%), 169 physicians (60%), 32 scientists (11%), 20 educators (7%), and 18 public health professionals (6%). Overall, 37.4% indicated difficulties using PC research reports "50% or more of the time." The most common problems were synthesizing findings (58%) and assessing generalizability (42%). Difficulty was reported by 49% for qualitative, 46% for mixed methods, and 38% for observational research. Most users wanted richer reporting of theoretical foundation (53.7%); teams, roles, and organization of care (53.4%); and patient involvement in the research process (52.7%). Few reported difficulties with ethics or disclosure of funding or conflicts. Free-text answers described special challenges in reporting PC research: context of clinical care and setting; practical details of interventions; patient-clinician and team relationships; and generalizability, applicability and impact in the great variety of PC settings. Cross-check showed that few current reporting guidelines focus on these needs.

CONCLUSIONS

Opportunities exist to improve the reporting of PC research to make it more useful for its many users, suggesting a role for a PC research reporting guideline.

Parents' Report of Their Children's Underinsurance Status After the Affordable Care Act

OBJECTIVE

To determine the prevalence and correlates of children's underinsurance pre- and post-implementation of the Affordable Care Act (ACA).

STUDY DESIGN

A cross-sectional survey of a convenience sample of 5043 parents of children greater than 6 months old who had health insurance in the previous 12 months. Respondents completed the Medical Expenses for Children Survey. Pre-ACA data were collected in summer/fall of 2009 to 2011 (n = 3966); post-ACA data were collected in summer/fall 2016 (n = 1077). All data were collected within the Southwestern Ohio Ambulatory Research Network (SOAR-Net).

RESULTS

Some study parents (16.3%) were unable to follow at least 1 recommendation of their child's pediatrician due to their inability to pay for it, and 17.3% reported it had become more difficult to obtain "needed health care" in the past 3 years. Factors associated with underinsurance after adjusting for demographic factors did NOT include pre/post-ACA, but did include annual household income < $50,000 (adjusted odds ratio [AOR] = 2.71; 95% CI, 2.15-3.40). Poor child health was also a significant risk factor for underinsurance(AOR = 3.71; 95% CI, 2.61-5.29).

CONCLUSIONS

About 1 in 6 study children were underinsured. The ACA did not affect the underinsurance rate. Parents continued to report that it had become more difficult to obtain needed health care over the past 3 years post-ACA. About one third of study parents consistently reported that the health of their underinsured child had suffered because they could not afford to pay for their child's health care.

Reliability and Validity of the Turkish Version of the Oxford Participation and Activities Questionnaire in Older People

Background

Activities and participation play important roles in the maintenance of healthy aging. The maintenance of these factors optimizes social life to increase the quality of life with aging. However, there is a lack of questionnaires in Turkish to evaluate activity and participation among older people. This study translated and cross-culturally adapted the Oxford Participation and Activities Questionnaire (Ox-PAQ) into Turkish and investigated its psychometric properties in the older adult population.

Methods

The Turkish version of the Ox-PAQ was produced after a translation and back-translation process. The Ox-PAQ was administered to 230 and 60 individuals for construct validity and reliability analyses, respectively. To assess the test-retest reliability of the Turkish Ox-PAQ, the questionnaire was reapplied 7 days after the first interview. Cronbach’s alpha (α) was used to evaluate the internal consistency. The Ox-PAQ was compared to the Short Form-12 and the Katz Index of Independence in Activities of Daily Living Scale to determine its validity.

Results

The Turkish Ox-PAQ showed excellent internal consistency (α=0.98) and test-retest reliability (intraclass correlation coefficient=0.98, 0.96, and 0.97 for the subscales of routine activity level, social engagement, and emotional well-being, respectively). In the validity analysis, factor analysis demonstrated a probable structure of the three factors that together explained 66.35% of the total variance. The Turkish Ox-PAQ was correlated with the other comparison measures used in this study.

Conclusion

The Turkish Ox-PAQ is a reliable and valid questionnaire to evaluate the participation and activity levels of older people (Clinical Trial Number: NCT04368754).

[Quality of life in patients who suffered erectile dysfunction and underwent penile implant surgery in terms of sexual satisfaction of the patient and partner]

BACKGROUND

Erectile dysfunction is a condition that shows a continuously growing prevalence in the male population. The penis prosthesis implant (PPI) qualifies as an effective form of therapy.

OBJECTIVES

The aim of this study was to analyze the sexual satisfaction rate and quality of life in patients who had suffered from erectile dysfunction and who were treated with a penile prosthesis. The patient's partners were also surveyed.

METHODS

We collected data from patients who underwent surgery in the Center of Excellence for Penile Implants, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. Questionnaires with validated scores (EDITS, EDITS Partner) were sent to all patients and their partners via mail.

RESULTS

The satisfaction rate in this study was high which shows that the patients and partners are pleased, and the high sexual satisfaction rate led to a higher quality of life.

CONCLUSION

The penile prosthesis implantation as a last option of therapy for erectile dysfunction is useful and brings more than adequate results.

Pharmacy professionals' preparedness to use Mental Health First Aid (MHFA) behaviors

Background:

There is a need to train healthcare professionals to provide first aid to people experiencing a mental health crisis. Research testing the association between Mental Health First Aid (MHFA) training and the use of MHFA behaviors could provide evidence of program effectiveness in the pharmacy setting.

Objectives:

The objectives of this study were to measure the preparedness of pharmacy professionals to function in a MHFA role, and compare preparedness and the use of MHFA behaviors based on demographic characteristics.

Methods:

Pharmacists and student pharmacists attended MHFA training under a multi-state pharmacy initiative in 2018. An anonymous electronic survey was administered to 227 participants using 4 contacts in May to June, 2019. The survey evaluated if participants had recommended MHFA to others, their preparedness to engage in MHFA behaviors (13 items), and their frequency of performing a set of MHFA behaviors (7 items). Descriptive statistics, bivariate analysis, and ANOVA were used to describe the sample and compare these variables across groups.

Results:

The analysis was based on 96 responses (42.3%). Almost all respondents (96%) had recommended MHFA training to others. Respondents reported that the training program prepared them to provide a range of MHFA behaviors for multiple mental health conditions, particularly for depression and anxiety. Participants most often reported asking about a distressed mood and listening non-judgmentally. Almost half of participants had asked someone if they were considering suicide and a similar percent had referred someone considering suicide to resources. Those reporting the highest levels of preparedness engaged in significantly more MHFA behaviors than those with lower levels of preparedness (p=0.017). Preparedness and use of MHFA behaviors were not significantly associated with respondent demographic characteristics.

Conclusion:

These data suggest that pharmacy professionals who had MHFA training felt prepared to engage in MHFA and many used behaviors like asking about suicide and making referrals since being trained in MHFA. Research is warranted to better understand what makes someone feel maximally prepared to use MHFA behaviors compared to lower feelings of preparedness.

Reporting Survey Based Studies - a Primer for Authors

The coronavirus disease 2019 (COVID-19) pandemic has led to a massive rise in survey-based research. The paucity of perspicuous guidelines for conducting surveys may pose a challenge to the conduct of ethical, valid and meticulous research. The aim of this paper is to guide authors aiming to publish in scholarly journals regarding the methods and means to carry out surveys for valid outcomes. The paper outlines the various aspects, from planning, execution and dissemination of surveys followed by the data analysis and choosing target journals. While providing a comprehensive understanding of the scenarios most conducive to carrying out a survey, the role of ethical approval, survey validation and pilot testing, this brief delves deeper into the survey designs, methods of dissemination, the ways to secure and maintain data anonymity, the various analytical approaches, the reporting techniques and the process of choosing the appropriate journal. Further, the authors analyze retracted survey-based studies and the reasons for the same. This review article intends to guide authors to improve the quality of survey-based research by describing the essential tools and means to do the same with the hope to improve the utility of such studies.

The pharmacy workforce in public primary healthcare centers: promoting access and information on medicines

Background:

Only few studies have analyzed the pharmaceutical workforce in primary healthcare centers, and a global recommendation calls for better understanding of the trends that shape workforce development and capacity.

Objective:

To analyze the distribution of the pharmaceutical workforce in primary healthcare centers in the national health system [Sistema Único de Saúde (SUS)] in Brazil.

Methods:

The study was conducted using data from the National Survey on Access, Use and Promotion of Rational Use of Medicines in Brazil. Secondary data referring to the socioeconomic indicators of each municipality were obtained from national public databases. Data stratification in geographic regions was considered, and data on workers in the management of the municipal pharmaceutical services and medicines dispensing centers were analyzed. Crude and adjusted prevalence ratios were calculated by Poisson regression in the study investigating the factors associated with low and high-density pharmacists per 10,000 inhabitants.

Results:

The results showed that most Brazilian municipalities have a rate of 1 or more pharmacist per 10,000 inhabitants in primary healthcare public facilities, with a higher concentration of pharmacists in small municipalities. Even in Brazilian municipalities with lower economic capacity, the conditions of access to medicines and pertinent information on medicines were directly related to the number of pharmacists available in these centers.

Conclusions:

This study showed a high number of pharmacists in the public health system. The higher density of pharmacists in primary healthcare public facilities correlated to increased access to medicines information and better municipal social development.

Relationship between medical students' career priority and specialty choice: A nationwide multicenter survey

BACKGROUND

The shortage of physicians in several specialties has been brought to public attention in several countries. However, little is known about factors affecting medical students' specialty choice. The objectives of our study were to illustrate medical students' career priority clusters and to assess their association with specialty preference.

METHODS

We conducted a nationwide multicenter survey in 2015 at 17 medical schools. The study participants were asked their top three specialty preferences, demographic characteristics, and 14 career priority questions. Multilevel logistic regression models were used to determine the effect of each variable on student career choice.

RESULTS

A total of 1264 responses were included in the analyses. The top five specialty choices were internal medicine: 833, general practice: 408, pediatrics: 372, surgery: 344, and emergency medicine: 244. An exploratory factor analysis mapped the 14 career priorities into 3-factor solution: "primary care orientation," "advanced and specific care," and "personal life orientation." Multilevel logistic regression models yielded satisfactory accuracy with the highest ROC curve (AUROC) noted in surgery (0.818), general practice (0.769), and emergency medicine (0.744). The career priorities under "primary care orientation" had positive association with choosing general practice, emergency medicine, internal medicine, and pediatrics. The "advanced and specific care" career priorities facilitated surgery and emergency medicine choice, while reducing the likelihood of choosing less procedure-oriented specialties, such as internal medicine, general practice, and pediatrics.

CONCLUSIONS

Our results demonstrated medical students' career priorities and their association with specialty preference. Individualized career support may be beneficial for both medical students and each specialty fields.

Association of Patient-Provider Teach-Back Communication with Diabetic Outcomes: A Cohort Study

BACKGROUND AND OBJECTIVES

The purpose of this study is to examine the patterns of patient teach-back experience (also known as "interactive communication loop") and determine its association with risk for diabetic complications and hospitalization, and health expenditures among individuals with diabetes.

METHODS

A retrospective cohort study of 2901 US adults aged 18 years or older with a confirmed diagnosis of diabetes was conducted using data from the 2011 to 2016 Longitudinal Medical Expenditure Panel Survey. Survey-design adjusted multivariable models were used to examine whether having patient teach-back experience at the baseline year (Year 1) is associated with development of diabetic complications, hospitalization, and health expenditure at follow-up year (Year 2). Health expenditures were adjusted for inflation and expressed in 2017 US dollars. All adjusted models included patient sociodemographic and clinical characteristics.

RESULTS

Analyses found that patients with teach-back experience were less likely to develop diabetic complications (adjusted odds ratio [AOR], 0.70; 95% CI, 0.52-0.96) and be admitted to the hospital due to diabetic complications (AOR, 0.51; 95% CI, 0.29-0.88) at 1-year followup. Patients having teach-back experience also had a significantly smaller increase in total expenditures of $1920 compared with those not having teach-back of $3639 (a differential change of -$1579; 95% CI, -$1717 to -$1443; P < .001).

CONCLUSIONS

Teach-back could be an effective communication strategy that has potential to improve health outcomes, resulting in savings in diabetes care.

Patients' Understanding of the Relationship Between Their Diabetes and Periodontal Disease

INTRODUCTION

There is a paucity of research on awareness, education, and interventions that address increased risk of developing periodontal disease, the sixth complication of diabetes. Examining the knowledge of patients with diabetes and understanding of the bidirectional relationship between periodontal disease and diabetes could inform future diabetes self-management care. We assessed the knowledge and understanding of the bidirectional relationship between diabetes and periodontal disease; examined gender, education, and income differences in this knowledge and understanding, as well as other differences in dental hygiene practices.

METHODS

A Web-based survey was conducted using a convenience sample of patients with diabetes.

RESULTS

A total of 927 patients with diabetes participated in the study. Gender and education were significantly associated with knowledge and understanding of the bidirectional relationship between diabetes and periodontal disease in patients with diabetes. After controlling for diabetes duration, dental insurance status, and other covariates, males had less knowledge and understanding of the bidirectional relationship between diabetes and periodontal disease compared with females (P < .0001). Those with higher education (P < .002) and those who received health care provider recommendations to obtain regular dental visits (P < .00001) had greater understanding of the association between diabetes and periodontal disease.

CONCLUSIONS

This study highlights the need for 1) educating male and low-education patients with diabetes in particular about their increased risk of periodontal disease and the need for regular dental visits, and 2) health care providers and dental health providers to work together to address the needs of their diabetic patients.

Barriers to Patient Portal Access and Use: Evidence from the Health Information National Trends Survey

BACKGROUND

Patient access to their medical records through patient portals (PPs) facilitates information exchange and provision of quality health care. Understanding factors that characterize patients with limited access to and use of PPs is needed.

METHODS

Data were from the 2017-2018 Health Information National Trends Survey 5, Cycles 1 and 2, a nationally representative survey of US adults ≥ 18 years old (n = 6789). Weighted multivariate logistic regressions modeled the associations between patient characteristics and access to, facilitators of use, and use of PPs and their functions.

RESULTS

Individuals without (vs with) a regular doctor (adjusted odds ratio [aOR], 0.4; CI, 0.3-0.5) or health insurance (aOR, 0.4; CI, 0.2-0.7), those with high school (aOR 0.4; CI, 0.3-0.5) or with vocational/some college (aOR, 0.5; CI, 04.-0.7) education (vs college/postgraduate), or those with limited English proficiency (vs those who speak English very well) (aOR, 0.7; CI, 0.5-0.9) were less likely to report accessing their personal medical records. Women (vs men) were more likely to report accessing their medical records (aOR, 1.5; CI, 1.2-1.8). Similar patterns were found for PPs access and facilitators of use. Less consistent associations emerged between patient characteristics and use of PP functionalities.

CONCLUSIONS

PP access and use are low. Having a primary care clinician, patient's educational attainment, and being a woman were factors associated with PP access and use, but not race/ethnicity. Once access was achieved, use of PP functionalities was generally uniform across demographic segments. Facilitating PP access and use among all patient populations is warranted.