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Wong D, Cross IH, Ramers CB, Imtiaz F, Scott JD, Dezan AM, Armistad AJ, Manteuffel ME, Wagner D, Hunt RC, England WL, Kwong MW, Dizon RA, Lamers V, Plotkin I, Jolly BT, Jones W, Daly DD, Yeager M, Riley JA, Krupinski EA, Solomon AP, Wibberly KH, Struminger BB. Large-Scale Telemedicine Implementation for Outpatient Clinicians: Results From a Pandemic-Adapted Learning Collaborative. J Ambul Care Manage 2024; 47:51-63. [PMID: 38441558 DOI: 10.1097/jac.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Learning collaboratives are seldom used outside of health care quality improvement. We describe a condensed, 10-week learning collaborative ("Telemedicine Hack") that facilitated telemedicine implementation for outpatient clinicians early in the COVID-19 pandemic. Live attendance averaged 1688 participants per session. Of 1005 baseline survey respondents, 57% were clinicians with one-third identifying as from a racial/ethnic minoritized group. Practice characteristics included primary care (71%), rural settings (51%), and community health centers (28%). Of three surveys, a high of 438 (81%) of 540 clinicians had billed ≥1 video-based telemedicine visit. Our learning collaborative "sprint" is a promising model for scaling knowledge during emergencies and addressing health inequities.
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Affiliation(s)
- David Wong
- Author Affiliations: Healthcare Resilience Working Group, U.S. National COVID-19 Response, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services, Washington, District of Columbia (Drs Wong, Cross, Manteuffel, Hunt, England, and Jolly, and Ms Imtiaz, and Mr Jones, Mr Daly, Ms Yeager, and Ms Riley); Commissioned Corps of the U.S. Public Health Service (Drs Wong, Cross, and Manteuffel, Mr Daly, and Ms Riley); Laura Rodriguez Research Institute - Family Health Centers of San Diego, San Diego, California (Dr Ramers); ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, New Mexico (Drs Ramers and Struminger, Ms Dezan, and Ms Armistad); Deloitte Consulting, LLP, Arlington, Virginia (Ms Imtiaz and Ms Yeager); Digital Health, University of Washington, Seattle, Washington (Dr Scott); Yes And Leadership, LLC, Alexandria, Virginia (Mr Wagner); Center for Connected Health Policy, Sacramento, California (Ms Kwong and Mr Dizon); Public Health Foundation, Washington, District of Columbia (Ms Lamers and Mr Plotkin); Telehealth Consultant, Aveshka, Inc., Vienna, Virginia (Dr Jolly); Southwest Telehealth Resource Center, Tucson, Arizona (Dr Krupinski); Northeast Telehealth Resource Center, Augusta, Maine (Mr Solomon); Mid-Atlantic Telehealth Resource Center, Charlottesville, Virginia (Dr Wibberly)
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Johal A, Udongwo N, Imburgio S, Mararenko A, Akhlaq H, Dandu S, Abe T, Almendral J, Heaton J, Hansalia R. Negative effects of COVID-19 on the implantation rate of cardiac resynchronization therapy with defibrillator device. J Arrhythm 2024; 40:237-246. [PMID: 38586844 PMCID: PMC10995599 DOI: 10.1002/joa3.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/29/2023] [Accepted: 01/06/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction COVID-19 drastically impacted the landscape of the United States' medical system. Limited data is available on the nationwide implantation trends in Cardiac Resynchronization Therapy Defibrillator (CRT-D) devices before and during the pandemic. We aimed to explore the impact of the COVID-19 pandemic on CRT-D insertion rates and adverse outcomes related to delays in care. Methods and Results We conducted a retrospective cross-sectional analysis using the National Inpatient Sample database between 2017 and 2020. Variables were identified using their ICD-10 codes. Inclusion criteria: age ≥ 18 years, presenting for a nonelective admission, primary diagnosis of hypertensive heart disease, hypertensive heart, chronic kidney disease, or heart failure, and underwent insertion of a CRT-D. Between 2017 and 2020, CRT-D devices were inserted during 23,635 admissions. On average, 6198 devices were implanted yearly from 2017 to 2019, with only 5040 devices being implanted in 2020. Additionally, reduced implantation rates were noted for every cohort of hospital size, location, and teaching status during this year. The year 2020 also had the highest average death rate at 1.39%, but this difference was statistically insignificant (adjusted Wald test p = .767), and COVID-19 was not associated with an increased risk of inpatient mortality (OR 0.22, 95% CI 0.03-1.82, p = .162). Conclusion The COVID-19 pandemic has affected all facets of the healthcare system, especially surgical volume rates. CRT-D procedures significantly decreased in 2020. This is the first retrospective study highlighting the trend of reduced rates of CRT-D implantation as a response to the COVID-19 pandemic.
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Affiliation(s)
- Anmol Johal
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Ndausung Udongwo
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Steven Imburgio
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Anton Mararenko
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Hira Akhlaq
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Sowmya Dandu
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Temidayo Abe
- Department of CardiologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jesus Almendral
- Department of CardiologyJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Joseph Heaton
- Department of MedicineJersey Shore University Medical CenterNeptune CityNew JerseyUSA
| | - Riple Hansalia
- Department of CardiologyJersey Shore University Medical CenterNeptune CityNew JerseyUSA
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Tice JR, Brown WC, Boyle M, Martin RA, Castillo R, Mumba MN. Implementing Full Practice Authority for Advanced Practice Registered Nurses: A Case for Mitigating Critical Mental Health Services. J Am Psychiatr Nurses Assoc 2024; 30:418-423. [PMID: 35578408 DOI: 10.1177/10783903221096341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has highlighted some perverse health disparities that we know have long existed in the United States. Disparities related to access, affordability, and cultural appropriateness of care cannot be overemphasized. More importantly, disparities related to provider shortages continue to contribute to adverse patient outcomes, particularly in rural areas and other socioeconomically deprived communities. Despite the push from the National Council of State Boards of Nursing (NCSBN) to ensure adoption and implementation of full practice authority (FPA) of advanced practice registered nurses (APRNs), currently only 28 states in the United States have achieved this goal. In addition, there are some states such as Florida that recently passed legislation supporting FPA for primary care APRNs, yet still have practice restrictions for specialty APRNs, such as mental health. The evidence is clear that patients managed by APRNs have better or comparable outcomes to those managed by physicians; thus, more advocacy is needed to ensure that all states and territories achieve this very important milestone for the profession as it has the potential to foster a collaborative interdisciplinary approach to patient care, which at the same time produces positive patient outcomes, employee satisfaction, and a work environment in which all members of the care team feel valued and autonomous.
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Affiliation(s)
- Johnny R Tice
- Johnny R. Tice, DNP, MA, FNP-C, PMHNP-BC, Samford University, Birmingham, AL, USA
| | - Whitnee C Brown
- Whitnee C. Brown, DNP, FNP-C, PMHNP-BC, The University of Alabama, Tuscaloosa, AL, USA
| | - Madeleine Boyle
- Madeleine Boyle, BSN, RN, Partners in Home Care, Missoula, MT, USA
| | - Rebecca A Martin
- Rebecca A. Martin, DNP, FNP-BC, The University of Alabama, Tuscaloosa, AL, USA
| | - Rachael Castillo
- Rachael Castillo, BSN, RN, Duke University Medical Center, Durham, NC
| | - Mercy N Mumba
- Mercy N. Mumba, PhD, RN, CMSRN, FAAN, The University of Alabama, Tuscaloosa, AL, USA
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Wang Y, Zhang P, Zhou X, Rolka D, Imperatore G. Impact of the COVID-19 Pandemic on Medical Expenditures Among Medicare Fee-for-Service Beneficiaries Aged ≥67 Years With Diabetes. Diabetes Care 2024; 47:452-459. [PMID: 38227901 PMCID: PMC11005216 DOI: 10.2337/dc23-1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To compare total and out-of-pocket (OOP) medical expenditures between pre-COVID-19 (March 2019 to February 2020) and COVID-19 (March 2020 to February 2022) periods among Medicare beneficiaries with diabetes. RESEARCH DESIGN AND METHODS Data were from 100% Medicare fee-for-service claims. Diabetes was identified using ICD-10 codes. We calculated quarterly total and OOP medical expenditures at the population and per capita level in total and by service type. Per capita expenditures were calculated by dividing the population expenditure by the number of beneficiaries with diabetes in the same quarter. Changes in expenditures were calculated as the differences in the same quarters between the prepandemic and pandemic years. RESULTS Population total expenditure fell to $33.6 billion in the 1st quarter of the pandemic from $41.7 billion in the same prepandemic quarter; it then bounced back to $36.8 billion by the 4th quarter of the 2nd pandemic year. The per capita total expenditure fell to $5,356 in the 1st quarter of the pandemic from $6,500 in the same prepandemic quarter. It then increased to $6,096 by the 4th quarter of the 2nd pandemic year, surpassing the same quarter in the prepandemic year ($5,982). Both population and per capita OOP expenditures during the pandemic period were lower than the prepandemic period. Changes in per capita expenditure between the pre-COVID-19 and COVID-19 periods by service type varied. CONCLUSIONS COVID-19 had a significant impact on both total and per capita medical expenditures among Medicare beneficiaries with diabetes. The COVID-19 pandemic was associated with lower OOP expenditures.
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Affiliation(s)
- Yu Wang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xilin Zhou
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Deborah Rolka
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Yawn BP, Make B, Mannino D, Lopez C, Murray S, Thomashow B, Brown R, Dolor RJ, Joo M, Tapp H, Zittleman L, Meldrum C, Anderson S, Martinez FJ, Han MK. Impact of the COVID-19 Pandemic on Outcomes of CAPTURE: A Primary Care Chronic Obstructive Pulmonary Disease Screening Clinical Trial. Ann Am Thorac Soc 2024; 21:176-179. [PMID: 38099719 PMCID: PMC10867910 DOI: 10.1513/annalsats.202305-478rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Min Joo
- University of Illinois at ChicagoChicago, Illinois
| | - Hazel Tapp
- University of Illinois at ChicagoChicago, Illinois
| | - Linda Zittleman
- University of Colorado, High Plains Research NetworkAurora, Colorado
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McCormick N, Jackson BN, Durham SH, Hohmann NS, Westrick SC. Qualitative analysis of community pharmacy-based COVID-19 immunization service operations. J Am Pharm Assoc (2003) 2023; 63:1574-1582.e6. [PMID: 37394061 DOI: 10.1016/j.japh.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The unprecedented coronavirus disease 2019 (COVID-19) pandemic has generated worldwide impacts while positioning community pharmacies as easily accessible immunizers to rollout the COVID-19 vaccine. OBJECTIVES This study describes community pharmacists' experiences, success stories, and lessons learned from providing COVID-19 immunization services. METHODS This study was conducted in February to March 2022 using semistructured interviews with licensed pharmacists practicing full-time in Alabama community pharmacies. Transcribed interviews' content analysis was conducted by 2 independent coders in ATLAS.ti software. RESULTS Nineteen interviews were completed. Pharmacists' experiences in the implementation of COVID-19 immunization services are described across 4 themes: (1) on-site and off-site immunization locations, (2) roles and responsibilities of pharmacy personnel, (3) vaccine storage and administration, and (4) vaccine waste reduction and immunization uptake strategies. This study found that pharmacists' ability to adapt is vital to maintaining their ability to offer immunization services and other services. Pharmacists' capacity for adapting is exemplified through their ability to acclimate to becoming a primary hub of outpatient health care services, accommodating to COVID-19 social distancing and vaccine guidelines, and disseminating a novel vaccine with varying supply and demand. In addition, pharmacies gathered and maintained waitlists of patients and adopted an appointment-based model as to predict, plan, and provide for patients. Pharmacists also used reactive techniques and workflow aspects to dissuade COVID-19 vaccine waste such as in contacting interested patients on waitlists or switching to a walk-in acceptance model. The COVID-19 pandemic elicited unprecedented alterations to the legal, health care responsibilities granted to pharmacy staff with participants describing pharmacy technicians as making a considerable impact to pharmacies' workflow. CONCLUSIONS Pharmacists stepped up as frontline providers during a time of public health emergency with their diverse experiences granting policy makers and researchers much to learn from as, in their communities, pharmacists have continued to increase access to care during a national health crisis.
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Campos-Castillo C. Impact of Beliefs About Local Physician Supply and Self-Rated Health on Willingness to See a Nurse Practitioner During the COVID-19 Pandemic: Web-Based Survey and Experiment. JMIR Form Res 2023; 7:e38965. [PMID: 37347928 PMCID: PMC10434700 DOI: 10.2196/38965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic overburdened primary care clinicians. For nurse practitioners (NPs) to alleviate the burden, the public must be willing to see an NP over a physician. Those with poor health tended to continue seeking care during the pandemic, suggesting that they may be willing to see an NP. OBJECTIVE The aim of this study is to evaluate the public's willingness to see an NP for primary care and how this may be associated with their beliefs about the local supply of physicians and self-rated health. Two studies were conducted: (1) a survey to identify correlations and (2) an experiment to assess how willingness is dependent on information about the local supply of physicians. METHODS The survey and experiment were conducted digitally in April and December 2020, respectively. Participants were US adults recruited from Amazon's Mechanical Turk platform. The key independent variables were self-rated health, which was a dichotomized 5-point scale (excellent, very good, good vs fair, and poor), and beliefs about local physician supply. The survey measured beliefs about local physician supply, while the experiment manipulated beliefs by altering information the participants read about the local supply of physicians. Willingness to see an NP was assessed in 2 ways. First as an overall preference over a physician and the second as a preference given 2 clinically significant scenarios in which participants imagined they were experiencing either coughing or a headache (presentation order randomized). Multiple regressions and ANOVAs were used to assess how beliefs about the local physician supply and self-rated health were associated with overall willingness to see an NP. Bivariate probits simultaneously estimated willingness to see an NP in the 2 clinically significant scenarios. RESULTS The survey showed that concerns about physician supply were associated with lower willingness to see an NP among respondents with comparatively better health but a greater willingness among respondents with comparatively worse health. The experiment suggests that only the latter is causal. For the 2 clinically significant scenarios, these patterns appeared for the coughing scenario in the survey and the headache scenario in the experiment. CONCLUSIONS US adults with comparatively worse self-rated health become more willing to see an NP for primary care when they hear information that raises their concerns about the local physician supply. The differences between the survey and experiment results may be useful for interpreting findings from future studies. Findings may aid in managing finite health care resources during public health crises and crafting successful messaging by NP advocacy groups. Efforts to address nursing shortages will also be needed.
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Affiliation(s)
- Celeste Campos-Castillo
- Department of Media and Information, Michigan State University, East Lansing, MI, United States
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Yeager S, Serrano VB, Paltin D, Fisher A, Karris M, Aarons GA, Rangel A, Flynn R, Bolan R, Moore DJ, Montoya JL. Qualitative Examination of the Impact of the COVID-19 Pandemic on Access and Adherence to Pre-exposure Prophylaxis (PrEP) Among Sexual and Gender Minorities. AIDS Educ Prev 2023; 35:255-267. [PMID: 37535324 PMCID: PMC10849009 DOI: 10.1521/aeap.2023.35.4.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
During the COVID-19 pandemic, pre-exposure prophylaxis (PrEP) access and adherence decreased nationwide. This study examined pandemic-related disruptions to PrEP access and adherence among clients of a health center (Center) in Los Angeles, California. Clients (n = 25) and Center personnel (n = 11) completed qualitative interviews from March to July 2021. Although the Center provided options for remote PrEP care (i.e., telehealth, STI self-testing kits, and prescription delivery), clients experienced difficulty navigating services or lacked equipment for telehealth. More than half (n = 13) of clients discontinued PrEP during COVID-19 due to decreased sexual partners, relocation, or insurance status changes. Among those who continued PrEP, the majority reported no change in adherence, while a minority reported worsening adherence due to distractions/forgetting, prescription refill issues, lack of insurance coverage, and fear of completing in-person visits. Findings highlight the challenges of navigating PrEP services during COVID-19 and suggest PrEP services enhancement to adapt to crisis events.
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Affiliation(s)
- Samantha Yeager
- Department of Medicine, University of California San Diego (UCSD), San Diego, California
| | - Vanessa B Serrano
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
- Department of Psychiatry, UCSD
| | - Dafna Paltin
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
- Department of Psychiatry, UCSD
| | - Arin Fisher
- Department of Psychiatry, UCSD
- Pacific Institute for Research and Evaluation-Southwest Center, Albuquerque, New Mexico
| | - Maile Karris
- Department of Medicine, University of California San Diego (UCSD), San Diego, California
- San Diego Center for AIDS Research, San Diego, California, and the Altman Clinical and Translational Research Institute Dissemination and Implementation Sciences Center, UCSD
| | - Gregory A Aarons
- Department of Psychiatry, UCSD
- San Diego Center for AIDS Research, San Diego, California, and the Altman Clinical and Translational Research Institute Dissemination and Implementation Sciences Center, UCSD
- Child and Adolescent Services Research Center, UCSD
| | - Alvy Rangel
- Los Angeles LGBT Center, Los Angeles, California
| | - Risa Flynn
- Los Angeles LGBT Center, Los Angeles, California
| | - Robert Bolan
- Los Angeles LGBT Center, Los Angeles, California
| | - David J Moore
- Department of Psychiatry, UCSD
- San Diego Center for AIDS Research, San Diego, California, and the Altman Clinical and Translational Research Institute Dissemination and Implementation Sciences Center, UCSD
| | - Jessica L Montoya
- Department of Psychiatry, UCSD
- San Diego Center for AIDS Research, San Diego, California, and the Altman Clinical and Translational Research Institute Dissemination and Implementation Sciences Center, UCSD
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Ross CA, Kara S, Ferrer GF. COVID-19 and Psychiatric Admissions: A Comparative Study of Pre-pandemic and Post-pandemic Psychosis Admissions in a South Florida Emergency Department. Cureus 2023; 15:e40989. [PMID: 37503505 PMCID: PMC10370826 DOI: 10.7759/cureus.40989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
We noticed a subjective increase in psychosis admissions within our emergency department (ED) with the onset of the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to identify trends concerning admissions due to psychosis in the ED before and after the beginning of the COVID-19 pandemic. We analyzed 508 psychiatric admissions through the ED from October 2019 to October 2020, of which 367 cases of psychosis were identified. Statistical analysis was performed using T-tests and Pearson's correlation coefficient. T-testing showed mean psychosis admissions during the pandemic (March 2020 to July 2020) to be greater than admissions occurring during the pre-pandemic period (October 2019 to February 2020) (p = 0.04). Pearson's correlation coefficient identified the relationships between COVID-19 admissions and psychosis admissions during this time as positive (r = 0.5) but did not reach statistical significance (p = 0.06). Therefore, within our time frame, we did see a noted increase in psychosis by 22.9% during the pandemic compared to pre-pandemic times. Current research remains conflicted concerning psychiatric ED admissions during COVID-19, with some stating an increase and others finding a decrease. Our data showed a significant statistical increase in the mean number of psychosis cases when comparing pre-pandemic and pandemic admissions. These findings help add pertinent data to understand how psychosis admissions trended before and during the beginning of the COVID-19 pandemic, specifically in South Miami, Florida. It also provides a foundation for future studies by providing data points concerning mental illness within the vulnerable population of patients served in our community.
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Affiliation(s)
| | - Sam Kara
- Neurology, Larkin Community Hospital, Miami, USA
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10
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Frondizi F, Dolcetti L, Pittiruti M, Calabrese M, Fantoni M, Biasucci DG, Scoppettuolo G. Complications associated with the use of peripherally inserted central catheters and midline catheters in COVID-19 patients: An observational prospective study. Am J Infect Control 2023:S0196-6553(23)00357-7. [PMID: 37160191 PMCID: PMC10164288 DOI: 10.1016/j.ajic.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Among the many interesting aspects of clinical care during the SARS-CoV-2 pandemic, vascular access still deserves some attention. Peripherally inserted central catheters (PICCs) and midline catheters (MCs) are venous access devices inserted by ultrasound-guided puncture of veins of the arm, which have been associated with the possibility of minimizing infectious complications in different populations of patients. We have investigated their performance in SARS-CoV-2 patients. METHODS As the incidence of catheter-related bloodstream infections (CRBSI) in patients hospitalized for COVID-19 is still unclear, we have designed a single-center, prospective observational study enrolling all patients with established diagnosis of SARS-CoV-2 infection who were admitted to our hospital in the period between October 2020 and April 2021 and who required either a PICC or a MC. RESULTS We recruited 227 patients. The cumulative incidence of CRBSI was 4.35% (10 cases), that is, 3.5 episodes/1,000 catheter days. Four CRBSI occurred in patients with PICCs (4.5/1,000 catheter days) and 6 in those with MCs (3.2/1,000 catheter days). CONCLUSIONS Our data suggest that COVID-19 patients may have a more pronounced tendency for the development of catheter-related infections compared to other populations of patients.
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Affiliation(s)
- Federico Frondizi
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Laura Dolcetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mauro Pittiruti
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Calabrese
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Massimo Fantoni
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Guerino Biasucci
- Dipartimento di Scienze Cliniche e Medicina Translazionale, Università degli Studi di Roma Tor Vergata, Rome, Italy
| | - Giancarlo Scoppettuolo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Kim OM, Givens TK, Tang EG, Schimmer JJ, Ramsey T, Boyd K, Delate T. Real-World Outcomes of Proprotein Convertase Subtilisin Kexin-9 Inhibitor Use. J Cardiovasc Pharmacol 2023; 81:339-347. [PMID: 36795508 DOI: 10.1097/fjc.0000000000001404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023]
Abstract
ABSTRACT Although the proprotein convertase subtilisin kexin-9 inhibitors (PCSK9i) were shown to significantly lower low-density lipoprotein and reduce atherosclerotic cardiovascular disease events in clinical trials, there is a dearth of use data on these agents in real-world settings. This study compares PCSK9i use in a population of real-world patients with atherosclerotic cardiovascular disease or familial hypercholesterolemia. This was a matched cohort study of adult patients who were dispensed a PCSK9i along with adult patients who did not receive a PCSK9i. PCSK9i patients were matched on a propensity to have received a PCSK9i score up to 1:10 to non-PCSK9i patients. The primary outcomes were changes in cholesterol levels. Secondary outcomes included a composite outcome of all-cause mortality, major cardiovascular events, and ischemic strokes along with health care utilization during follow-up. Adjusted conditional, multivariate Cox proportional hazards, and negative binomial modeling were performed. Ninety-one PCSK9i patients were matched to 840 non-PCSK9i patients. Seventy-one percent of PCSK9i patients either discontinued or switched PCSK9i therapy. PCSK9i patients had greater median reductions in low-density lipoprotein (-73.0 mg/dL vs. -30.0 mg/dL) and total (-77.0 vs. -31.0) cholesterol (both P < 0.001). No adjusted between-group differences in the composite outcome or individual components of the composite outcome were identified (all P > 0.05). PCSK9i patients had a lower rate of medical office visits during follow-up (adjusted incidence rate ratio = 0.61, P = 0.019). These findings support the effectiveness of PCSK9i therapy in real-world settings but suggest that use may be limited by PCSK9i adverse reactions and patient cost barriers.
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Affiliation(s)
- Olivia M Kim
- Pharmacy Department, Kaiser Permanente Northwest, Portland, OR
| | - Tatyana K Givens
- Pharmacy Department, Kaiser Permanente Georgia, Atlanta, GA
- Pharmacy Department, VillageMD, Atlanta, GA; and
| | - Emily G Tang
- Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO
- Pharmacy Department, Yale New Haven Hospital, New Haven, CT
| | | | - Tanya Ramsey
- Pharmacy Department, Kaiser Permanente Northwest, Portland, OR
| | - Kayla Boyd
- Pharmacy Department, Kaiser Permanente Georgia, Atlanta, GA
| | - Thomas Delate
- Pharmacy Outcomes Research Group, Kaiser Permanente National Pharmacy Services, Aurora, CO
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Akter F, Haq A, Godman B, Chowdhury K, Kumar S, Haque M. Impact of Lockdown Measures on Health Outcomes of Adults with Type 2 Diabetes Mellitus in Bangladesh. Healthcare (Basel) 2023; 11:healthcare11081191. [PMID: 37108025 PMCID: PMC10137871 DOI: 10.3390/healthcare11081191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
COVID-19 lockdown measures appreciably affected patients' lifestyles, negatively impacting on their health. This includes patients with Type 2 Diabetes Mellitus (T2DM). Care of these patients was also negatively impacted due to a priority to treat patients with COVID-19, certainly initially, within hospitals and clinics in Bangladesh, combined with a lack of access to clinics and physicians due to lockdown and other measures. This is a concern in Bangladesh with growing rates of T2DM and subsequent complications. Consequently, we sought to critically analyze the situation among patients with T2DM in Bangladesh during the initial stages of the pandemic to address this information gap and provide future direction. Overall, 731 patients were recruited by a simple random sampling method among patients attending hospitals in Bangladesh, with data collected over 3 timescales: before lockdown, during the pandemic, and after lockdown. Data extracted from patients' notes included current prescribed medicines and key parameters, including blood sugar levels, blood pressure, and comorbidities. In addition, the extent of record keeping. The glycemic status of patients deteriorated during lockdown, and comorbidities as well as complications related to T2DM increased during this period. Overall, a significant proportion of key datasets were not recorded in patients' notes by their physician before and during lockdown. This started to change after lockdown measures eased. In conclusion, lockdown measures critically affected the management of patients with T2DM in Bangladesh, building on previous concerns. Extending internet coverage for telemedicine, introduction of structured guidelines, and appreciably increasing data recording during consultations is of the utmost priority to improve the care of T2DM patients in Bangladesh.
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Affiliation(s)
- Farhana Akter
- Department of Endocrinology, Chittagong Medical College Hospital, Chattogram 4203, Bangladesh
| | - Ahsanul Haq
- Infectious Diseases Division, icddr, b, Mohakhali, Dhaka 1212, Bangladesh
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
| | - Kona Chowdhury
- Department of Pediatrics, Gonoshasthaya Samaj Vittik Medical College, Dhaka 1344, Bangladesh
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar 382422, Gujarat, India
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia
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Pitts RA, Ban K, Greene RE, Kapadia F, Braithwaite RS. Sustaining PrEP Prescriptions at a Safety-Net Hospital in New York City During COVID-19: Lessons Learned. AIDS Behav 2023:10.1007/s10461-023-03977-6. [PMID: 36609708 PMCID: PMC9825066 DOI: 10.1007/s10461-023-03977-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2023] [Indexed: 01/09/2023]
Abstract
To understand the impact of COVID-19-related disruptions on PrEP services, we reviewed PrEP prescriptions at NYC Health + Hospitals/Bellevue from July 2019 through July 2021. PrEP prescriptions were examined as PrEP person-equivalents (PrEP PE) in order to account for the variable time of refill duration (i.e., 1-3 months). To assess "PrEP coverage", we calculated PrEP medication possession ratios (MPR) while patients were under study observation. Pre-clinic closure, mean PrEP PE = 244.2 (IQR 189.2, 287.5; median = 252.5) were observed. Across levels of clinic closures, mean PrEP PE = 247.3, (IQR 215.5, 265.4; median = 219.9) during 100% clinic closure, 255.4 (IQR 224, 284.3; median = 249.0) during 80% closure, and 274.6 (IQR 273.0, 281.0; median = 277.2) during 50% closure were observed. Among patients continuously prescribed PrEP pre-COVID-19, the mean MPR mean declined from 83% (IQR 72-100%; median = 100%) to 63% (IQR 35-97%; median = 66%) after the onset of COVID-19. For patients newly initiated on PrEP after the onset of COVID-19, the mean MPR was 73% (IQR 41-100%; median = 100%). Our ability to sustain PrEP provisions, as measured by both PrEP PE and MPR, can likely be attributed to our pre-COVID-19 system for PrEP delivery, which emphasizes navigation, same-day initiation, and primary care integration. In the era of COVID-19 as well as future unforeseen healthcare disruptions, PrEP programs must be robust and flexible in order to sustain PrEP delivery.
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Affiliation(s)
- Robert A. Pitts
- Department of Internal Medicine, Health and Hospitals/Bellevue, 462 First Avenue, New York, NY 10016 USA
| | - Kaoon Ban
- Department of Population Health, New York University Langone Health, New York, NY USA
| | - Richard E. Greene
- Department of Internal Medicine, Health and Hospitals/Bellevue, 462 First Avenue, New York, NY 10016 USA
| | - Farzana Kapadia
- New York University School of Global Public Health, New York, NY USA
| | - R. Scott Braithwaite
- Department of Population Health, New York University Langone Health, New York, NY USA
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Abstract
BACKGROUND The COVID-19 pandemic is a profound change event for U.S. primary care physicians and their medical practices. PURPOSE We examined how a group of U.S. primary care physicians and their medical practices used resiliency-based strategies, tactics, and mindsets to navigate pandemic-related change over the time period early 2020 through mid-2021. METHODOLOGY A 15-month longitudinal qualitative study of the same 10 physicians interviewed a total of 42 times at four time intervals during the 2020-2021 COVID-19 pandemic. Data were analyzed using a systematic coding approach consisting of first- and second-order code categories feeding into an overall interpretive framework of resiliency-based adaptations. RESULTS Primary care physicians and their practices engaged in two main resiliency-based strategic adaptations during the pandemic. These adaptations were labeled "keeping the business afloat" and "keeping primary care relevant for patients." Each consisted of different strategies and tactics that shared common features including proactiveness, innovativeness, and pragmatism. Specific resiliency-based mindsets were identified that helped physicians both initially engage in needed strategies and tactics while continuing to engage in them over time. CONCLUSIONS The results demonstrate how physicians use resiliency-based adaptation in response to profound change in their environments, defined by behavioral variety and motivated by self-interested and patient-centered imperatives. PRACTICE IMPLICATIONS Physicians are proactive and possess multiple adaptive capabilities. Seen in this more positive light, health care organizations should focus on greater engagement of their physician-employees in implementing innovation in care delivery and managing change, that is, as responsible partners rather than resistors to meeting organizational imperatives.
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15
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Wilson HA, Mocanu V, McLean C, Birch DW, Karmali S, Switzer NJ. Characterization of Pre- and Postpandemic 30-Day Follow-Up After Elective Bariatric Surgery: a Retrospective MBSAQIP Analysis of 834,646 Patients. Obes Surg 2023; 33:443-452. [PMID: 36539591 PMCID: PMC9767801 DOI: 10.1007/s11695-022-06423-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Effects of the COVID-19 pandemic on rates of early postoperative follow-up after bariatric surgery are poorly understood. Our study characterizes 30-day follow-up after bariatric surgery prior to COVID-19 (years 2015-2019) and during the pandemic of COVID-19 (year 2020) and evaluates general predictive factors of short-term follow-up. METHODS Data was extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015 to 2020. Cohorts were divided into pre-pandemic and pandemic years and patients with and without 30-day follow-up. Multivariable logistic regression analysis was used to identify general factors independently predictive of 30-day follow-up. The primary aim was to evaluate the impact of the COVID-19 pandemic on short-term 30-day follow-up adherence. A secondary outcome was to characterize general short-term postoperative 30-day follow-up associated with elective bariatric surgery and identify independent predictors of 30-day follow-up among bariatric surgery patients using multivariable logistic regression analysis. RESULTS A total of 834,646 patients were identified. Follow-up rates significantly increased in the COVID era in 2020 (p < 0.0001). Patients who achieved 30-day follow-up were older and had an increased burden of medical comorbidities, including non-insulin and insulin-dependent diabetes mellitus, hypertension, dyslipidemia, as well as increased BMI compared to patients lacking follow-up. The cohort with successful 30-day follow-up was more likely to receive gastric bypass and had increased rates of metabolic comorbidities. After adjusting for comorbidities, the greatest independent predictors of follow-up were the 2020 COVID-19 era year, Asian race, black race, and gastroesophageal reflux disease. CONCLUSIONS After adjusting for comorbidities, the 2020 COVID-19 era year was one of the greatest predictors of follow-up after bariatric surgery. Postoperative follow-up rates after elective bariatric surgery are excellent at > 95% and increased during the 2020 COVID-19 era year. Several independent predictors of follow-up were identified which may help in development of strategies aimed to mitigate lack of postoperative follow-up.
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Affiliation(s)
- Hillary A. Wilson
- Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB T6G 2R7 Canada
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Cheynne McLean
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Daniel W. Birch
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Noah J. Switzer
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2R7 Canada
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16
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Singer A, Kosowan L, LaBine L, Shenoda D, Katz A, Abrams EM, Halas G, Wong ST, Talpade S, Kirby S, Baldwin A, Francois J. Characterizing the use of virtual care in primary care settings during the COVID-19 pandemic: a retrospective cohort study. BMC Prim Care 2022; 23:320. [PMID: 36496379 PMCID: PMC9736717 DOI: 10.1186/s12875-022-01890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 10/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In March 2020, Canada implemented restrictions to curb viral transmission of COVID-19, which resulted in abrupt disruptions to conventional (in-person) clinical care. To retain continuity of care the delivery of primary care services shifted to virtual care. This study examined the nature of virtual visits, characterizing the use and users of virtual care in primary care settings from March 14/20 to June 30/20 of the COVID-19 pandemic. METHODS: Retrospective cohort study of primary care providers in Manitoba, Canada that participate in the Manitoba Primary Care Research Network (MaPCReN) and offered ≥ 1 virtual care visit between 03/14/20 and 06/30/20 representing 142,616 patients. Tariff codes from billing records determined the visit type (clinic visit, virtual care). Between 03/14/20, and 06/30/20, we assessed each visit for a follow-up visit between the same patient and provider for the same diagnosis code. Patient (sex, age, comorbidities, visit frequency, prescriptions) and provider (sex, age, clinic location, provider type, remuneration, country of graduation, return visit rate) characteristics describe the study population by visit type. Generalized estimating equation models describe factors associated with virtual care. RESULTS: There were 146,372 visits provided by 154 primary care providers between 03/14/20 and 06/30/20, of which 33.6% were virtual care. Female patients (OR 1.16, CI 1.09-1.22), patients with ≥ 3 comorbidities (OR 1.71, CI 1.44-2.02), and patients with ≥ 10 prescriptions (OR 2.71, 2.2-1.53) had higher odds of receiving at least one virtual care visit compared to male patients, patients with no comorbidities and patients with no prescriptions. There was no significant difference between the number of follow-up visits that were provided as a clinic visit compared to a virtual care visit (8.7% vs. 5.8%) (p = 0.6496). CONCLUSION Early in the pandemic restrictions, approximately one-third of visits were virtual. Virtual care was utilized by patients with more comorbidities and prescriptions, suggesting that patients with chronic disease requiring ongoing care utilized virtual care. Virtual care as a primary care visit type continues to evolve. Ongoing provision of virtual care can enhance quality, patient-centered care moving forward.
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Affiliation(s)
- Alexander Singer
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Leanne Kosowan
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Lisa LaBine
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Daniel Shenoda
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Alan Katz
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada ,grid.21613.370000 0004 1936 9609Departments of Community Health Science and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, MB Winnipeg, Canada ,grid.21613.370000 0004 1936 9609Manitoba Centre for Health Policy, Winnipeg, MB Canada
| | - Elissa M Abrams
- grid.21613.370000 0004 1936 9609Department of Pediatrics, Section of Allergy and Clinical Immunology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada ,grid.17091.3e0000 0001 2288 9830Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC Canada
| | - Gayle Halas
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Sabrina T. Wong
- grid.17091.3e0000 0001 2288 9830School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC Canada
| | - Siddhesh Talpade
- grid.416388.00000 0001 1245 5369Planning and Knowledge Management, Manitoba Health and Seniors Care, Winnipeg, MB Canada
| | - Sarah Kirby
- grid.21613.370000 0004 1936 9609George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, MB Winnipeg, Canada
| | - Alanna Baldwin
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
| | - Jose Francois
- grid.21613.370000 0004 1936 9609Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, D009-780 Bannatyne Ave, MB R3T2N2 Winnipeg, Canada
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Park YT, Lane C, Lee HJ, Lee J. Was size of healthcare institution a factor affecting changes in healthcare utilisation during the COVID-19 pandemic in Korea? A retrospective study design analysing national healthcare big data. BMJ Open 2022; 12:e064537. [PMID: 36600350 PMCID: PMC9729846 DOI: 10.1136/bmjopen-2022-064537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Many small-sized healthcare institutions play a critical role in communities by preventing infectious diseases. This study examines how they have been impacted by the global COVID-19 pandemic compared with large hospitals. DESIGN This study adopted a retrospective study design looking back at the healthcare utilisation of medical facilities according to size after the COVID-19 pandemic. The dependent variable was change in the number of outpatient health insurance claims before and after onset of the COVID-19 pandemic. The independent variable was an observation time point of the year 2020 compared with 2019. SETTING AND PARTICIPANTS The study was conducted in Korea having a competitive medical provision environment under the national health insurance system. The units of analysis are hospitals and clinics: tertiary hospitals (42), general hospitals (293), small hospitals (1272) and medical clinics (27 049). This study analysed all the health insurance claim data from 1 January 2019 to 31 December 2020. RESULTS Compared with 2019, in 2020, there were significant decreases in the number of claims (-14.9%), particularly in small hospitals (-16.8%) and clinics (-16.3%), with smaller decreases in general hospitals (-8.9%) and tertiary hospitals (-5.3%). The reduction in healthcare utilisation increased as the size of institutions decreased. The magnitude of decrease was significantly greatest in small hospitals (absolute risk (AR): 0.8317, 0.7758 to 0.8915, p<0.0001; relative risk (RR): 0.8299, 0.7750 to 0.888, p<0.0001) followed by clinics (AR: 0.8369, 0.8262 to 0.8478, p<0.0001; RR: 0.8362, 0.8255 to 0.8470, p<0.0001) even after controlling institutional covariates. CONCLUSION The external impact of the pandemic increased incrementally as the size of healthcare institutions decreased. Healthcare policy-makers need to keep in mind the possibility that small hospitals and clinics may experience reduced healthcare utilisation in the infectious disease pandemic. This fact has political implications for how healthcare policy-makers should prepare for the next infectious disease pandemic.
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Affiliation(s)
- Young-Taek Park
- HIRA Research Institute, Health Insurance Review & Assessment Service, Wonju-si, Korea (the Republic of)
| | - Chris Lane
- Health Workforce, Health New Zealand, Wellington, New Zealand
| | - Hyun-Ji Lee
- Department of Health Administration, Yonsei University Graduate School, Wonju-si, Korea (the Republic of)
| | - Jinhyung Lee
- Department of Economics, Sungkyunkwan University, Jongno-gu, Korea (the Republic of)
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Beste LA, Keddem S, Borgerding J, Lowy E, Gardella C, McFarland L, Comstock E, Fonseca GA, Van Epps P, Ohl M, Hauser RG, Ross D, Maier MM. Sexually Transmitted Infection Testing in the National Veterans Health Administration Patient Cohort During the Coronavirus Disease 2019 Pandemic. Open Forum Infect Dis 2022; 9:ofac433. [PMID: 36514443 PMCID: PMC9452156 DOI: 10.1093/ofid/ofac433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/21/2022] [Indexed: 12/15/2022] Open
Abstract
Background We performed a retrospective study of chlamydia, gonorrhea, syphilis, and human immunodeficiency virus (HIV) testing in the Veterans Health Administration (VHA) during 2019-2021. Methods We determined the annual number of chlamydia, gonorrhea, syphilis, and HIV tests from 2019 through 2021 using electronic health record data. We calculated rates by age, birth sex, race, census region, rurality, HIV status, and use of preexposure prophylaxis. Results The VHA system experienced a 24% drop in chlamydia/gonorrhea testing, a 25% drop in syphilis testing, and a 29% drop in HIV testing in 2020 versus 2019. By the conclusion of 2021, testing rates had recovered to 90% of baseline for chlamydia/gonorrhea, 91% for syphilis, and 88% for HIV. Declines and subsequent improvements in sexually transmitted infection (STI) testing occurred unequally across age, sex, race, and geographic groups. Testing for all 4 STIs in 2021 remained below baseline in rural Veterans. Excluding those aged <25 years, women experienced a steeper decline and slower recovery in chlamydia/gonorrhea testing relative to men, but quicker recovery in HIV testing. Asian Americans and Hawaiian/Pacific Islanders had a steeper decline and a slower recovery in testing for chlamydia/gonorrhea. Black and White Veterans had slower recovery in HIV testing compared with other race groups. People living with HIV experienced a smaller drop in testing for syphilis compared with people without HIV, followed by a near-total recovery of testing by 2021. Conclusions After dramatic reductions from 2019 to 2020, STI testing rates returned to near-baseline in 2021. Testing recovery lagged in rural, female, Asian American, Hawaiian/Pacific Islander, and Black Veterans.
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Affiliation(s)
- Lauren A Beste
- Correspondence: Lauren A. Beste, MD, MSc, VA Puget Sound Health Care System,1660 S Columbian Way, Seattle, WA 98108 ()
| | - Shimrit Keddem
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joleen Borgerding
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
| | - Elliott Lowy
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Carolyn Gardella
- Gynecology Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lorenzo McFarland
- Office of Specialty Care Services, Veterans Health Administration, Washington, District of Columbia, USA
| | - Emily Comstock
- Department of Infectious Diseases, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Giuseppe Allan Fonseca
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Puja Van Epps
- Division of Infectious Diseases, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Veterans Affairs Northeast Ohio Healthcare System,Cleveland, Ohio, USA
| | - Michael Ohl
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs, Iowa City, Iowa, USA
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ronald G Hauser
- Pathology and Laboratory Medicine Department, Veterans Affairs Connecticut Healthcare, New Haven, Connecticut, USA
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David Ross
- Office of Specialty Care Services, Veterans Health Administration, Washington, District of Columbia, USA
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Dugani SB, Kiliaki SA, Nielsen ML, Coons TJ, Fischer KM, Parikh RS, Pagali SR, Liwonjo A, Schroeder DR, Croghan IT, Burton MC. Post-discharge early assessment with remote video link (PEARL) initiative for patients discharged from hospital medicine services. Hosp Pract (1995) 2022; 50:379-386. [PMID: 36107464 PMCID: PMC9691619 DOI: 10.1080/21548331.2022.2125726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The COVID-19 pandemic impacted the availability and accessibility of outpatient care following hospital discharge. Hospitalists (physicians) and hospital medicine advanced practice providers (HM-APPs) coordinate discharge care of hospitalized patients; however, it is unknown if they can deliver post-discharge virtual care and overcome barriers to outpatient care. The objective was to develop and provide post-discharge virtual care for patients discharged from hospital medicine services. METHODS We developed the Post-discharge Early Assessment with Remote video Link (PEARL) initiative for HM-APPs to conduct a post-discharge video visit (to review recommendations) and telephone follow-up (to evaluate adherence) with patients 2-6 days following hospital discharge. Participants included patients discharged from hospital medicine services at an institution's hospitals in Rochester (May 2020-August 2020) and Austin (November 2020-February 2021) in Minnesota, US. HM-APPs also interviewed patients about their experience with the video visit and completed a survey on their experience with PEARL. RESULTS Of 386 eligible patients, 61.4% were enrolled (n = 237/386) including 48.1% women (n = 114/237). In patients with complete video visit and telephone follow-up (n = 141/237), most were prescribed new medications (83.7%) and took them as prescribed (93.2%). Among five classes of chronic medications, patient-reported adherence ranged from 59.2% (narcotics) to 91.5% (anti-hypertensives). Patient-reported self-management of 12 discharge recommendations ranged from 40% (smoking cessation) to 100% (checking rashes). Patients reported benefit from the video visit (agree: 77.3%) with an equivocal preference for video visits over clinic visits. Among HM-APPs who responded to the survey (88.2%; n = 15/17), 73.3% reported benefit from visual contact with patients but were uncertain if video visits would reduce emergency department visits. CONCLUSION In this novel initiative, HM-APPs used video visits to provide care beyond their hospital role, reinforce discharge recommendations for patients, and reduce barriers to outpatient care. The effect of this initiative is under evaluation in a randomized controlled trial.
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Affiliation(s)
- Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | | | - Megan L. Nielsen
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Trevor J. Coons
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - Karen M. Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Riddhi S. Parikh
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Anne Liwonjo
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Lake City, MN
| | | | - Ivana T. Croghan
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Department of Medicine, Clinical Research Office, Mayo Clinic, Rochester, MN
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Son KB. The impact of COVID-19 on the number of active small primary care businesses by severity of the pandemic: evidence from South Korea. BMC Prim Care 2022; 23:67. [PMID: 35379183 PMCID: PMC8978167 DOI: 10.1186/s12875-022-01676-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/28/2022] [Indexed: 08/30/2023]
Abstract
Background Health systems have become financially fragile owing to the economic recession caused by the COVID-19 pandemic. However, small primary care businesses have received less policy attention than public health and secondary care. We aimed to estimate the impact of COVID-19 on the number of active small primary care businesses in South Korea. Methods We selected clinics, dental clinics, oriental clinics, and pharmacies as primary care businesses. Our estimation took advantage of regional variations in COVID-19 cases in South Korea. We determined the number of active primary care businesses from 2019 1Q to 2021 1Q on a quarterly basis, and conducted interrupted time series analysis to estimate the effects of COVID-19 on this sector. Results This study found no significant increase or decrease in the number of clinics, dental clinics, and oriental clinics immediately after the pandemic began or in the time trends after the pandemic. However, there was a significant increase in the number of pharmacies immediately after the pandemic. The most affected area presented different trends in the number of pharmacies, dental clinics, and oriental clinics. Conclusions Impact of the pandemic on the number of active small primary care business were low in South Korea. However, the impact varied according to the type of primary care setting and severity of the pandemic. The additional public health role of primary care could be associated with the sustenance of primary care businesses. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01676-0.
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21
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Cushman DM, York E, Asay A, Ross B, Teramoto M, McCormick ZL. Changes in clinical practice perceptions and mental health of sports medicine physicians due to the SARS-CoV-2 pandemic. PHYSICIAN SPORTSMED 2022; 50:419-428. [PMID: 34176424 PMCID: PMC8727637 DOI: 10.1080/00913847.2021.1949252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The SARS-CoV-2 pandemic has had an immense impact on healthcare, but little has been published on its impact on sports medicine physicians. This study aimed to assess the perceived impacts of the pandemic on practice changes, financial implications, and mental health of the physician members of the American Medical Society for Sports Medicine (AMSSM). METHODS Online surveys were sent to physician members of the AMSSM, with questions asking about demographic information and personal associations to COVID-19. The main outcome measures included self-reported clinical practice volumes, visit types (telemedicine, face-to-face), Patient Health Questionnaire (PHQ-4) scores, personal finances, clarity of practice guidelines, and personal protective equipment (PPE) availability. RESULTS A total of 825 respondents completed the initial survey, with a subset completing follow-ups. In-person clinical and procedural volumes were reported to be reduced to just 17.9% and 13.7% of the pre-pandemic baseline volumes at the first survey (March 2020), but increased to 81.1% and 77.3% (August 2020), respectively. PHQ-4 anxiety subscores significantly decreased over time (p < 0.001); younger physicians and female physicians were more likely to have higher scores (p < 0.05). Reported physician income significantly increased over time (p < 0.05), and financial concerns steadily decreased (p < 0.001). The perception of having an adequate PPE significantly increased over the study (p < 0.001) but not for having clear practice guidelines (p > 0.05). Physicians have become increasingly aware of others testing positive for the virus, but not themselves or someone they live with. CONCLUSIONS Sports medicine physicians have been heavily impacted by the SARS-CoV-2 pandemic, with some recovery since it started. Sports medicine physicians should be aware of pandemic-related practice changes and resulting mental health and financial implications.
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Affiliation(s)
- Daniel M Cushman
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth York
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Alexandra Asay
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Brendon Ross
- Department of Orthopedic Surgery & Rehabilitation Medicine, University of Chicago, Chicago, IL, USA
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Zachary L McCormick
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT, USA
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Minoura A, Sugiyama T, Koyama T, Yoshioka T, Tabuchi T. Structural equation modeling of the effects of psychological distress and a fear of coronavirus disease 2019 on diabetes care in Japan: a cross-sectional study. Sci Rep 2022; 12:16142. [PMID: 36167976 DOI: 10.1038/s41598-022-20716-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to examine the effects of psychological distress and a fear of coronavirus disease 2019 (COVID-19) on diabetes care in Japan. We used data from a 2020 nationwide Internet survey in Japan involving 28,000 respondents aged 15–79 years. The question items included psychological factors (Kessler psychological distress scale and fear of COVID-19), employment, trust in neighbors, informal caregiving, and history of diabetes care. After excluding respondents with comorbidities and those who had not visited the hospital, 625 patients with diabetes were analyzed. Statistical mediation was then examined through a path analysis using structural equation modeling (SEM). Discontinued diabetes care was independently associated with psychological distress (risk ratio = 1.44, 95% confidence interval [1.01–2.06]) and a fear of COVID-19 (1.41 [1.01–1.95]). The SEM results indicated that a fear of COVID-19, employment, trust in neighbors, and informal caregiving were indirectly associated with continued diabetes care via psychological distress. These findings suggest that a fear of COVID-19 may affect psychological distress and continued diabetes care among patients with diabetes in Japan, and that trust in neighbors and family caregiving may be related to the discontinuation of diabetes care. Therefore, because psychological factors and socioeconomic status may affect diabetes care, it is important to consider a fear of COVID-19 among patients with diabetes to maintain diabetes treatment.
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Chhablani N, Choudhari SG. Behind the Frontline: A Review on the Impact of COVID-19 Pandemic on Healthcare Workers. Cureus 2022; 14:e29349. [PMID: 36284823 PMCID: PMC9583287 DOI: 10.7759/cureus.29349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
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Farina MP, Ailshire JA. Sociodemographic and health status differences in delaying medical care during the COVID-19 pandemic among older adults: findings from the Health and Retirement Study. BMC Public Health 2022; 22:1720. [PMID: 36088320 PMCID: PMC9463671 DOI: 10.1186/s12889-022-14118-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 09/02/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND During the COVID-19 Pandemic, adults in the United States reported delaying medical care, which may be tied risk of infection and local policies limiting appointment. Some populations may have been more likely to delay care than others, leading to other forms of health inequality during this period. To-date there is little research on delayed care among U.S. older adult. We determine the prevalence of delayed medical care among older adults and investigate sociodemographic and health status inequalities in delaying health care. METHOD We used data from the first public release of the nationally representative Health and Retirement Study COVID-19 Subsample (N = 3006). Using logistic regression, we assessed whether differences in delaying health care varied by age, sex, race/ethnicity, education, self-rated health (SRH), and having any Activity of Daily Living (ADL) limitation. We also conducted additional analysis that evaluated differences in delaying care by two care subtypes: doctor and dental care visits. RESULTS About 30% of U.S. older adults reported delaying care with the most common types of delayed care being dental or doctor visits. Adults ages 75 and older were less likely to delay care, while women, college educated, and those with poor SRH, and any ADL limitations were more likely to delay care. CONCLUSIONS Nearly one-third of older adults delayed care during the COVID-19 pandemic. The increased likelihood of delayed care among people with worse health suggests that there may be longer-term impacts on the health care system and population health from the COVID-19 pandemic, and may contribute to health inequalities in the near future.
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Affiliation(s)
- Mateo P Farina
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA.
| | - Jennifer A Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, 90089, USA
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25
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Sagy YW, Cicurel A, Battat E, Saliba W, Lavie G. The impact of COVID-19 pandemic on emergency department visits and associated mortality during 14 months of the pandemic in Israel. Intern Emerg Med 2022; 17:1699-1710. [PMID: 35576046 PMCID: PMC9108137 DOI: 10.1007/s11739-022-02991-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/10/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND A substantial drop in emergency department (ED) visit volume was previously demonstrated at the onset of the COVID-19 pandemic. OBJECTIVE To examine changes in the number of non-COVID adult ED visits and their associated 30-day mortality during 14 months of the pandemic in Israel. METHODS This is a retrospective cohort study including 1,285,270 adult ED visits between 1st March, 2018 and 30th April, 2021 to the internal and surgical EDS in eight general hospitals of the largest healthcare organization in Israel. The 14 months of the pandemic period (March 2020-April 2021) were divided into seven periods according to dates of the three lockdowns. Exposure to each of these periods was compared to the parallel period during the two previous years. March 2020-April 2021 was compared to the parallel periods in 2018 and 2019. RESULTS During the pandemic period, the largest decline in ED visits (44.6% and 50.9% for internal and surgical EDs, respectively) and the highest excess 30-day mortality following an ED visit (internal EDs Adjusted OR (ORadj), 1.49; 95% CI, 1.34-1.66 and surgical EDs: ORadj 1.50; CI, 1.16-1.94) were 95%, observed during the first lockdown. Both gradually levelled-off subsequently until near-normalization was reached in March-April 2021 for both parameters. CONCLUSIONS A substantial decline in non-COVID ED visits and excess mortality at the beginning of the pandemic, are probably the results of social distancing restrictions alongside patients' fear of exposure to COVID-19, which gradually moderated thereafter, until near normalization was reached after 14 months. Gradual return to pre-pandemic ED utilization patterns were noticed as the population and the healthcare system acclimatize to life alongside COVID.
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Affiliation(s)
- Yael Wolff Sagy
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv, Israel
| | - Assi Cicurel
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv, Israel
- Southern District and Faculty of Health Sciences, Clalit Health Services, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Erez Battat
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv, Israel
| | - Walid Saliba
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Lavie
- Branch of Planning and Strategy, Clalit Health Services, Tel Aviv, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Kendzerska T, Zhu DT, Pugliese M, Manuel D, Sadatsafavi M, Povitz M, Stukel TA, To T, Aaron SD, Mulpuru S, Chin M, Kendall CE, Thavorn K, Robillard R, Gershon AS. Trends in all-cause mortality and inpatient and outpatient visits for ambulatory care sensitive conditions during the first year of the COVID-19 pandemic: A population-based study. J Hosp Med 2022; 17:726-737. [PMID: 35929531 PMCID: PMC9539068 DOI: 10.1002/jhm.12920] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on the management of ambulatory care sensitive conditions (ACSCs) remains unknown. OBJECTIVES To compare observed and expected (projected based on previous years) trends in all-cause mortality and healthcare use for ACSCs in the first year of the pandemic (March 2020 to March 2021). DESIGN, SETTING AND PARTICIPANTS We conducted a population-based study using provincial health administrative data on general adul population (Ontario, Canada). OUTCOMES AND MEASURES Monthly all-cause mortality, and hospitalizations, emergency department (ED) and outpatient visit rates (per 100,000 people at-risk) for seven combined ACSCs (asthma, chronic obstructive pulmonary disease, angina, congestive heart failure, hypertension, diabetes, and epilepsy) during the first year were compared with similar periods in previous years (2016-2019) by fitting monthly time series autoregressive integrated moving-average models. RESULTS Compared to previous years, all-cause mortality rates increased at the beginning of the pandemic (observed rate in March to May 2020 of 79.98 vs. projected of 71.24 [66.35-76.50]) and then returned to expected in June 2020-except among immigrants and people with mental health conditions where they remained elevated. Hospitalization and ED visit rates for ACSCs remained lower than projected throughout the first year: observed hospitalization rate of 37.29 versus projected of 52.07 (47.84-56.68); observed ED visit rate of 92.55 versus projected of 134.72 (124.89-145.33). ACSC outpatient visit rates decreased initially (observed rate of 4299.57 vs. projected of 5060.23 [4712.64-5433.46]) and then returned to expected in June 2020.
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Affiliation(s)
- Tetyana Kendzerska
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
- ICESOntarioCanada
| | - David T. Zhu
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of Social and Behavioral SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Michael Pugliese
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- ICESOntarioCanada
| | - Douglas Manuel
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- ICESOntarioCanada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical SciencesThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Marcus Povitz
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Therese A. Stukel
- ICESOntarioCanada
- Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoOntarioCanada
| | - Teresa To
- ICESOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Research InstituteThe Hospital of Sick ChildrenTorontoOntarioCanada
| | - Shawn D. Aaron
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Sunita Mulpuru
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Melanie Chin
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Claire E. Kendall
- ICESOntarioCanada
- Bruyère Research InstituteOttawaOntarioCanada
- Department of Family MedicineUniversity of OttawaOttawaOntarioCanada
| | - Kednapa Thavorn
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- ICESOntarioCanada
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOntarioCanada
| | | | - Andrea S. Gershon
- ICESOntarioCanada
- Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Research InstituteThe Hospital of Sick ChildrenTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
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Amill-Rosario A, Lee H, Zhang C, dosReis S. Psychotropic Prescriptions During the COVID-19 Pandemic Among U.S. Children and Adolescents Receiving Mental Health Services. J Child Adolesc Psychopharmacol 2022; 32:408-414. [PMID: 36067121 DOI: 10.1089/cap.2022.0037] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective: Increased mental health problems among children and adolescents during the COVID-19 pandemic may have impacted psychotropic medication use. This study describes trends in monthly psychotropic medications before and early in the COVID-19 pandemic among 2- to 17-year-old children and adolescents with mental health disorders. Methods: A cross-sectional study design using the 2019-2020 IQVIA™ prescription and medical commercial claims data to estimate the proportion of children and adolescents with any psychotropic prescription in the month out of all with any mental health-related medical or prescription services in the month and the year-over-year percent change. We assessed monthly proportions of youth who filled a psychotropic prescription overall and by psychotropic class, stratified by age and gender. Results: Of the 8,896,713 children and adolescents in the sample, 24.7% received psychotropic medication during the study period. The proportion of the cohort prescribed a psychotropic medication in a given month averaged 27%-28% from January 2019 to February 2020, peaked at 36.9% in April 2020, and gradually declined to 28.7% in September 2020. The largest year-over-year percent change was in April for antipsychotic (41.9%) and antidepressant (37.9%) medication, which remained higher in September 2020 compared to September 2019, particularly among ages 6 years or older and females. Conclusion: The proportion of youth with a psychotropic prescription increased at the onset of the COVID-19 pandemic, later returning to prepandemic levels. However, antipsychotics and antidepressants remained higher than prepandemic, highlighting the need to further understand the long-lasting effects of the pandemic on children and adolescents.
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Affiliation(s)
- Alejandro Amill-Rosario
- Department of Pharmaceutical Health Services Research, PAVE Center, School of Pharmacy, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Haeyoung Lee
- Department of Pharmaceutical Health Services Research, PAVE Center, School of Pharmacy, University of Maryland, Baltimore, Baltimore, Maryland, USA.,Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Chengchen Zhang
- Department of Pharmaceutical Health Services Research, PAVE Center, School of Pharmacy, University of Maryland, Baltimore, Baltimore, Maryland, USA.,Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Susan dosReis
- Department of Pharmaceutical Health Services Research, PAVE Center, School of Pharmacy, University of Maryland, Baltimore, Baltimore, Maryland, USA.,Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Baltimore, Maryland, USA
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Bishop A, Borski J, Wang HH, Donaldson TG, Michalk A, Montgomery A, Heldman S, Mogg M, Derouen Z, Grant WE, Teel PD. Increasing Incidence of Spotted Fever Group Rickettsioses in the United States, 2010-2018. Vector Borne Zoonotic Dis 2022; 22:491-497. [PMID: 36037000 DOI: 10.1089/vbz.2022.0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Spotted fever group Rickettsia species are intracellular bacteria transmitted by tick or mite vectors and that cause human diseases referred to as spotted fever group rickettsioses, or spotted fevers. In the United States, the most recognized and commonly reported spotted fevers are Rocky Mountain spotted fever (RMSF) (Rickettsia rickettsii), Rickettsia parkeri rickettsiosis, Pacific Coast tick fever (Rickettsia species 364D), and rickettsialpox (Rickettsia akari). In this study, we summarize and evaluate surveillance data on spotted fever cases reported to the Centers for Disease Control and Prevention (CDC) through the National Notifiable Diseases Surveillance System from 2010 to 2018. During this period, there were 36,632 reported cases of spotted fevers with 95.83% (N = 35,104) reported as meeting the case definition as probable and 4.17% (N = 1528) reported as meeting the case definition as confirmed. The average national incidence of total cases, both probable and confirmed, was 12.77 cases per million persons per year. The highest statewide incidence was in Arkansas, with 256.84 per million per year, whereas the lowest incidence occurred in California, with 0.32 per million per year (note that spotted fevers were not notifiable in Hawaii and Alaska). Cases of spotted fevers were reported more frequently among males by gender, White by race, and non-Hispanic by ethnicity. The incidence of spotted fevers increased significantly from 2010 to 2018, but it is uncertain how many of the reported cases were RMSF and how many developed from more moderate spotted fevers. Improvement of the ability to differentiate between spotted fever group Rickettsia species is needed.
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Affiliation(s)
- Alexandra Bishop
- Department of Biology, Texas A&M University, College Station, Texas, USA
| | - Jennifer Borski
- Department of Wildlife and Fisheries Sciences, Texas A&M University, College Station, Texas, USA
| | - Hsiao-Hsuan Wang
- Department of Ecology and Conservation Biology, Texas A&M University, College Station, Texas, USA
| | - Taylor G Donaldson
- Department of Entomology, Texas A&M University, College Station, Texas, USA
| | - Avery Michalk
- Department of Biomedical Science, Texas A&M University, College Station, Texas, USA
| | - Annie Montgomery
- Department of Wildlife and Fisheries Sciences, Texas A&M University, College Station, Texas, USA
| | - Samantha Heldman
- Department of Biology, Texas A&M University, College Station, Texas, USA
| | - Michael Mogg
- Department of Management, and Texas A&M University, College Station, Texas, USA
| | - Zakary Derouen
- Department of Ecosystem Science and Management, Texas A&M University, College Station, Texas, USA
| | - William E Grant
- Department of Ecology and Conservation Biology, Texas A&M University, College Station, Texas, USA
| | - Pete D Teel
- Department of Entomology, Texas A&M University, College Station, Texas, USA
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Arnetz BB, Goetz C, vanSchagen J, Baer W, Smith S, Arnetz JE. Patient-reported factors associated with avoidance of in-person care during the COVID-19 pandemic: Results from a national survey. PLoS One 2022; 17:e0272609. [PMID: 35930581 PMCID: PMC9355185 DOI: 10.1371/journal.pone.0272609] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background There has been a substantial decline in in-person care in inpatient and outpatient settings during the ongoing COVID-19 pandemic. Avoidance of needed in-person care may contribute to an avoidable decline in patient health and an increase in mortality. While several systems and behavioral theories have been put forward to explain the decline, there is a lack of studies informed by patients’ own experiences. The current study applied a socio-ecological model encompassing patient, environmental, and institutional-related variables to examine patient-reported factors associated with avoidance of in-person care. Methods Between October and December 2020, a total of 3840 persons responded to a nationwide online questionnaire that was administered using ResearchMatch and Facebook. Self-reported avoidance of in-person care among those who needed it was the main outcome. Multivariable logistic regression analysis was used to identify factors associated with avoidance of needed care. Findings Out of a total of 3372 respondents who reported that they needed in-person care during the early phase of the pandemic, 257 (7.6%) avoided it. Patient-related variables associated with avoiding needed care included younger age (odds ratio (OR), 1.46, 95% CI 1.11 to 1.94, p<0.01; <45 y/o vs 45+), inability to afford care (OR = 1.65, 95% CI 1.17 to 2.34, p<0.01), and greater COVID-related stress (OR = 1.36, CI 1.01 to 1.83, p<0.05). More frequent discussions about COVID with family and friends was the only significant environment-related avoidance of care variable (OR = 1.39, 95% CI 1.01–1.91, p < .05). Institution-related care avoidance variables included a negative patient healthcare experience rating (OR 1.83, 95% CI 1.38 to 2.42, p<0.001), poor awareness of the institution’s safety protocol (OR = 1.79, 95% CI 1.28 to 2.51, p<0.01), and low ratings of the institution’s effectiveness in communicating their safety protocol (OR = 3.45, 95% CI 1.94 to 6.12, p<0.001). The final model predicted 11.9% of the variance in care avoidance. Conclusions These results suggest that care avoidance of in-person care during the initial phase of the pandemic was influenced by a patient’s demographics as well as environmental and healthcare institutional factors. Patients’ previous experiences and their awareness of healthcare systems’ safety protocols are important factors in care avoidance.
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Affiliation(s)
- Bengt B. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, United States of America
- * E-mail:
| | - Courtney Goetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, United States of America
| | - John vanSchagen
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, United States of America
- Trinity Health Saint Mary’s, Grand Rapids, Michigan, United States of America
| | - William Baer
- Trinity Health Saint Mary’s, Grand Rapids, Michigan, United States of America
| | - Stacy Smith
- Trinity Health Saint Mary’s, Grand Rapids, Michigan, United States of America
| | - Judith E. Arnetz
- Department of Family Medicine, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, United States of America
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Muschol J, Heinrich M, Heiss C, Knapp G, Repp H, Schneider H, Thormann U, Uhlar J, Unzeitig K, Gissel C. Assessing Telemedicine Efficiency in Follow-up Care With Video Consultations for Patients in Orthopedic and Trauma Surgery in Germany: Randomized Controlled Trial. J Med Internet Res 2022; 24:e36996. [PMID: 35896015 PMCID: PMC9377439 DOI: 10.2196/36996] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/31/2022] [Accepted: 06/12/2022] [Indexed: 02/06/2023] Open
Abstract
Background Telemedicine can help mitigate important health care challenges, such as demographic changes and the current COVID-19 pandemic, in high-income countries such as Germany. It gives physicians and patients the opportunity to interact via video consultations, regardless of their location, thus offering cost and time savings for both sides. Objective We aimed to investigate whether telemedicine can be implemented efficiently in the follow-up care for patients in orthopedic and trauma surgery, with respect to patient satisfaction, physician satisfaction, and quality of care. Methods We conducted a prospective randomized controlled trial in a German university hospital and enrolled 60 patients with different knee and shoulder conditions. For follow-up appointments, patients received either an in-person consultation in the clinic (control group) or a video consultation with their physician (telemedicine group). Patients’ and physicians’ subsequent evaluations of these follow-up appointments were collected and assessed using separate questionnaires. Results On the basis of data from 52 consultations after 8 withdrawals, it was found that patients were slightly more satisfied with video consultations (mean 1.58, SD 0.643) than with in-clinic consultations (mean 1.64, SD 0.569), although the difference was not statistically significant (P=.69). After excluding video consultations marred by technical problems, no significant difference was found in physician satisfaction between the groups (mean 1.47, SD 0.516 vs mean 1.32, SD 0.557; P=.31). Further analysis indicated that telemedicine can be applied to broader groups of patients and that patients who have prior experience with telemedicine are more willing to use telemedicine for follow-up care. Conclusions Telemedicine can be an alternative and efficient form of follow-up care for patients in orthopedic and trauma surgery in Germany, and it has no significant disadvantages compared with in-person consultations in the clinic. Trial Registration German Clinical Trials Register DRKS00023445; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023445
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Affiliation(s)
- Jennifer Muschol
- Department of Health Economics, Justus Liebig University Giessen, Giessen, Germany
| | - Martin Heinrich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Gero Knapp
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Holger Repp
- Department of Health Economics, Justus Liebig University Giessen, Giessen, Germany
| | - Henning Schneider
- Institute of Medical Informatics, Justus Liebig University Giessen, Giessen, Germany
| | - Ulrich Thormann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Johanna Uhlar
- Institute of Medical Informatics, Justus Liebig University Giessen, Giessen, Germany
| | - Kai Unzeitig
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, Giessen, Germany
| | - Christian Gissel
- Department of Health Economics, Justus Liebig University Giessen, Giessen, Germany
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Albright JA, Rebello E, Kosinski LR, Patel DD, Spears JR, Gil JA, Katarincic JA. Characterization of the Epidemiology and Risk Factors for Hand Fractures in Patients Aged 1 to 19 Presenting to United States Emergency Departments: A Retrospective Study of 21,031 Cases. J Pediatr Orthop 2022; 42:335-340. [PMID: 35475776 DOI: 10.1097/bpo.0000000000002164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hand fractures are among the most common injuries presenting in pediatric emergency departments (EDs) with incidence reported as high as 624 hand fractures per 100,000 person-years. If gone untreated, these injuries can lead to pain, loss of function, and psychological trauma. The purpose of this study was to identify risk factors and characterize pediatric hand fractures over a 5-year period. METHODS The National Electronic Injury Surveillance System (NEISS) was queried for all hand fractures in patients aged 1 to 19 years presenting to US EDs between 2016 and 2020. Incidence was calculated using US census data. Cases were retrospectively analyzed using age, location of the injury, sex, coronavirus disease-2019 (COVID-19) era, and etiology of injury. Bivariate logistic regression was used where appropriate. RESULTS A total of 21,031 pediatric hand fractures were identified, representing an estimated 565,833 pediatric hand fractures presenting to EDs between 2016 and 2020. The mean incidence of pediatric hand fractures was 138.3 fractures for 100,000 person-years [95% confidence interval (CI): 136.2-140.4], with a 39.2% decrease in incidence occurring between 2019 and 2020. It was found that 42.2% of the fractures were in patients aged 10 to 14. The incidence of hand fractures for males and females was 97.9 (95% CI: 96.2-99.7) and 40.4 (95% CI: 39.2-41.5), respectively, with the male rate peaking at age 14 and the female rate peaking at age 12. Age, sex, location of the injury, and injury during the COVID-19 pandemic were demonstrated to influence the frequency and etiology of the fracture. CONCLUSION This study determined the incidence of pediatric hand fractures presenting to EDs across the United States. In addition, it identified risk factors for common hand fracture etiologies (sports-related, falling, crush, punching) and demonstrated the change in rates of different etiologies of pediatric hand fractures that presented to US EDs during the COVID-19 pandemic. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Affiliation(s)
| | | | - Lindsay R Kosinski
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI
| | - Devan D Patel
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI
| | - J Reid Spears
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI
| | - Julia A Katarincic
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI
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Li J, Long X, Zhang Q, Fang X, Luo H, Fang F, Lv X, Zhang D, Sun Y, Li N, Hu S, Li J, Xiong N, Lin Z. Pearson's patterns correlational of clinical risks at admissions with hospitalization outcomes during initial COVID-19 outbreak. iScience 2022; 25:104415. [PMID: 35600840 PMCID: PMC9113760 DOI: 10.1016/j.isci.2022.104415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/13/2022] [Accepted: 05/12/2022] [Indexed: 11/24/2022] Open
Abstract
COVID-19 outbreaks have crushed our healthcare systems, which requires clinical guidance for the healthcare following the outbreaks. We conducted retrospective cohort studies with Pearson's pattern-based analysis of clinical parameters of 248 hospitalized patients with COVID-19. We found that dysregulated neutrophil densities were correlated with hospitalization duration before death (p = 0.000066, r = -0.45 for % neutrophil; p = 0.0001, r = -0.47 for neutrophil count). As such, high neutrophil densities were associated with mortality (p = 4.23 × 10-31 for % neutrophil; p = 4.14 × 10-27 for neutrophil count). These findings were further illustrated by a representative "second week crash" pattern and validated by an independent cohort (p = 5.98 × 10-11 for % neutrophil; p = 1.65 × 10-7 for neutrophil count). By contrast, low aspartate aminotransferase (AST) or lactate dehydrogenase (LDH) levels were correlated with quick recovery (p ≤ 0.00005). Collectively, these correlational at-admission findings may provide healthcare guidance for patients with COVID-19 in the absence of targeted therapy.
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Affiliation(s)
- Jingwen Li
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xi Long
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qing Zhang
- Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Xi Fang
- Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Huiling Luo
- Department of Anesthesiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Fang Fang
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Xuefei Lv
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Dandan Zhang
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Yu Sun
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Na Li
- Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Shaoping Hu
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Jinghong Li
- Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Nian Xiong
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Zhicheng Lin
- McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
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Lurie T, Bonnin N, Rea J, Tuteja G, Dezman Z, Wilkerson RG, Buganu A, Chasm R, Haase DJ, Tran QK. Patterns of opioid prescribing in emergency departments during the early phase of the COVID-19 pandemic. Am J Emerg Med 2022; 56:63-70. [PMID: 35367681 PMCID: PMC8956353 DOI: 10.1016/j.ajem.2022.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/09/2022] [Accepted: 03/20/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction The COVID-19 pandemic was superimposed upon an ongoing epidemic of opioid use disorder and overdose deaths. Although the trend of opioid prescription patterns (OPP) had decreased in response to public health efforts before the pandemic, little is known about the OPP from emergency department (ED) clinicians during the COVID-19 pandemic. Methods We conducted a pre-post study of adult patients who were discharged from 13 EDs and one urgent care within our academic medical system between 01/01/2019 and 09/30/2020 using an interrupted time series (ITS) approach. Patient characteristics and prescription data were extracted from the single unified electronic medical record across all study sites. Prescriptions of opioids were converted into morphine equivalent dose (MED). We compared the “Covid-19 Pandemic” period (C19, 03/29/2020–9/30/2020) and the “Pre-Pandemic” period (PP, 1/19/2020–03/28/2020). We used a multivariate logistic regression to assess clinical factors associated with opioid prescriptions. Results We analyzed 361,794 ED visits by adult patients, including 259,242 (72%) PP and 102,552 (28%) C19 visits. Demographic information and percentages of patients receiving opioid prescriptions were similar in both groups. The median [IQR] MED per prescription was higher for C19 patients (70 [56–90]) than for PP patients (60 [60–90], P < 0.001). ITS demonstrated a significant trend toward higher MED prescription per ED visit during the pandemic (coefficient 0.11, 95% CI 0.05–0.16, P = 0.002). A few factors, that were associated with lower likelihood of opioid prescriptions before the pandemic, became non-significant during the pandemic. Conclusion Our study demonstrated that emergency clinicians increased the prescribed amount of opioids per prescription during the COVID-19 pandemic compared to the pre-pandemic period. Etiologies for this finding could include lack of access to primary care and other specialties during the pandemic, or lower volumes allowing for emergency clinicians to identify who is safe to be prescribed opioids.
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Aragão IO, Alencar TGC, Soares AKA, da Rocha CS, Ventura CV. Effects of COVID-19 pandemic on stress level of residents and fellows during ophthalmology training. Indian J Ophthalmol 2022; 70:2170-2173. [PMID: 35648006 PMCID: PMC9359222 DOI: 10.4103/ijo.ijo_401_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose: To evaluate the impact of coronavirus disease 2019 (COVID-19) on the mental health of residents and fellows in ophthalmology. Methods: A questionnaire composed of 42 questions was applied to Brazilian residents and fellows in Ophthalmology. The questionnaire addressed the demographics of participants, their working conditions before and during the COVID-19 pandemic, and the Perceived Stress Scale (PSS-10). Results: The study had a total of 271 participants in Ophthalmology training, from which 100 were fellows and 171 were residents. Before the pandemic, Ophthalmology residents and fellows had a higher workload (P < 0.001), and residents worked more hours than fellows (P = 0.001). During the pandemic, the workload of both residents and fellows decreased and equalized (P = 0.195). No correlation was found between the working hours during the pandemic and their stress level were observed (P = 0.760). Higher stress scores were identified in women ophthalmologists (P = 0.001) as well as in residents and fellows that had their surgical training interrupted during the pandemic (P < 0.001). Conclusion: The stress level of residents and fellows during the COVID-19 pandemic was similar, however, those that had their surgical training interrupted during the pandemic presented higher level of stress. Female physicians also presented higher level of stress compared to male physicians.
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Affiliation(s)
- Itamara O Aragão
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil
| | | | | | | | - Camila V Ventura
- Department of Ophthalmology; Department of Research, Altino Ventura Foundation, Recife, Brazil
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Abstract
Women represent approximately one-third of all anesthesiologists in the United States. Before the COVID-19 pandemic, research regarding gender bias in anesthesiology defined the scope of the problem. Unfortunately, the pandemic exposed and expanded the imbalances associated with gender, placing women anesthesiologists as both primary caregivers in the home and on the frontlines of health care. These systemic inequities exacerbated burnout in women anesthesiologists. Several initiatives that can improve well-being and the work culture for all anesthesiologists, including women, will also be discussed.
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Affiliation(s)
- Elizabeth B Malinzak
- Department of Anesthesiology, Duke University, DUMC 3094, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Stephanie I Byerly
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Goddard KS, Schulz J, Nzuki I, Hall JP. Examining the Impacts of the Coronavirus Pandemic and Social Distancing on the Health of People With Mobility Disabilities. Front Public Health 2022; 10:875880. [PMID: 35570911 PMCID: PMC9092371 DOI: 10.3389/fpubh.2022.875880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To understand the effects of the coronavirus pandemic on the health and participation of people with mobility disabilities living in the community. Methods Participants responded to a survey designed to assess the effects of the coronavirus pandemic on their health and access to health care. Participants identified if various life situations were worsened, unchanged, or improved during the pandemic. Participants could provide further information on their improved or worsened lived experience in open-ended questions. Results A total of 39 people with mobility disabilities responded to the survey. Results indicate that many experienced a worsening of life situations related to health, including access to medications, health care services, and transportation. Conclusions Results show that many experiences were caused by the lack of appropriate policies, rather than the pandemic itself. Therefore, there is a need to modify pandemic preparedness plans and other policies to meet the needs of people with disabilities.
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Affiliation(s)
- Kelsey Shinnick Goddard
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS, United States
| | - Jonathan Schulz
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS, United States.,Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Isaac Nzuki
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS, United States
| | - Jean P Hall
- Research and Training Center on Independent Living, University of Kansas, Lawrence, KS, United States
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Javed AA, Habib JR, Kinny-Köster B, Hodgin M, Parish L, Cunningham D, Hacker-Prietz A, Burkhart RA, Burns WR, Shubert CR, Cameron JL, Zaheer A, Chu LCH, Kawamoto S, Thompson ED, Shin EJ, Narang A, Zheng L, Laheru DA, Hruban RH, He J, Wolfgang CL, Fishman EK, Lafaro K. The Impact of the COVID-19 Pandemic on Multidisciplinary Clinics: A High-Volume Pancreatic Cancer Center Experience. Curr Probl Diagn Radiol 2022; 51:675-679. [PMID: 35750529 PMCID: PMC9131444 DOI: 10.1067/j.cpradiol.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023]
Abstract
The unprecedented impact of the Sars-CoV-2 pandemic (COVID-19) has strained the healthcare system worldwide. The impact is even more profound on diseases requiring timely complex multidisciplinary care such as pancreatic cancer. Multidisciplinary care teams have been affected significantly in multiple ways as healthcare teams collectively acclimate to significant space limitations and shortages of personnel and supplies. As a result, many patients are now receiving suboptimal remote imaging for diagnosis, staging, and surgical planning for pancreatic cancer. In addition, the lack of face-to-face interactions between the physician and patient and between multidisciplinary teams has challenged patient safety, research investigations, and house staff education. In this study, we discuss how the COVID-19 pandemic has transformed our high-volume pancreatic multidisciplinary clinic, the unique challenges faced, as well as the potential benefits that have arisen out of this situation. We also reflect on its implications for the future during and beyond the pandemic as we anticipate a hybrid model that includes a component of virtual multidisciplinary clinics as a means to provide accessible world-class healthcare for patients who require complex oncologic management.
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Affiliation(s)
- Ammar A Javed
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Joseph R Habib
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Benedict Kinny-Köster
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Hodgin
- Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lindsay Parish
- Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dea Cunningham
- Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Hacker-Prietz
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard A Burkhart
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William R Burns
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher R Shubert
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John L Cameron
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Atif Zaheer
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Linda C H Chu
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Satomi Kawamoto
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth D Thompson
- Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eun J Shin
- Department of Gastroenterology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amol Narang
- Department of Radiation Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lei Zheng
- Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel A Laheru
- Department of Medical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph H Hruban
- Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Elliot K Fishman
- Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Kelly Lafaro
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Wenger NS, Stanton AL, Baxter-King R, Sepucha K, Vavreck L, Naeim A. The Impact of COVID-19 on Routine Medical Care and Cancer Screening. J Gen Intern Med 2022; 37:1450-1456. [PMID: 35013931 PMCID: PMC8744580 DOI: 10.1007/s11606-021-07254-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND COVID-19 restrictions and fear dramatically changed the use of medical care. Understanding the magnitude of cancelled and postponed appointments and associated factors can help identify approaches to mitigate unmet need. OBJECTIVE To determine the proportion of medical visits cancelled or postponed and for whom. We hypothesized that adults with serious medical conditions and those with higher anxiety, depressive symptoms, and avoidance-oriented coping would have more cancellations/postponements. DESIGN Four nationally representative cross-sectional surveys conducted online in May, July, October, and December 2020. PARTICIPANTS 59,747 US adults who completed 15-min online surveys. 69% cooperation rate. MEASURES Physical and mental health visits and cancer screening cancelled or postponed over prior 2 months. Plan to cancel or postpone visits over the next 2 months. Relationship with demographics, medical conditions, local COVID-19 death rate, anxiety, depressive symptoms, coping, intolerance of uncertainty, and perceived COVID-19 risk. KEY RESULTS Of the 58% (N = 34,868) with a medical appointment during the 2 months before the survey, 64% had an appointment cancelled or postponed in May, decreasing to 37% in December. Of the 41% of respondents with scheduled cancer screening, 20% cancelled/postponed, which was stable May to December. People with more medical conditions were more likely to cancel or postpone medical visits (OR 1.19 per condition, 95% CI 1.16, 1.22) and cancer screening (OR 1.20, 95% CI 1.15, 1.24). Race, ethnicity, and income had weak associations with cancelled/postponed visits, local death rate was unrelated, but anxiety and depressive symptoms were strongly related to cancellations, and this grew between May and December. CONCLUSIONS Cancelled medical care and cancer screening were more common among persons with medical conditions, anxiety and depression, even after accounting for COVID-19 deaths. Outreach and support to ensure that patients are not avoiding needed care due to anxiety, depression and inaccurate perceptions of risk will be important.
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Affiliation(s)
- Neil S Wenger
- Division of General Internal Medicine and Health Sciences Research, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue #804, Los Angeles, CA, 90024, USA.
| | - Annette L Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Ryan Baxter-King
- Department of Political Science, UCLA College, Los Angeles, CA, USA
| | - Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lynn Vavreck
- Departments of Political Science and Communication, UCLA College, Los Angeles, CA, USA
| | - Arash Naeim
- UCLA Center for SMART Health, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Balio CP, Riley SR, Grammer D, Weathington C, Barclay C, Jonas DE. Barriers to recruiting primary care practices for implementation research during COVID-19: A qualitative study of practice coaches from the Stop Unhealthy (STUN) Alcohol Use Now trial. Implementation Research and Practice 2022; 3:26334895221094297. [PMID: 37091109 PMCID: PMC9924268 DOI: 10.1177/26334895221094297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The COVID-19 pandemic has brought widespread change to health care practice and research. With heightened stress in the general population, increased unhealthy alcohol use, and added pressures on primary care practices, comes the need to better understand how we can continue practice-based research and address public health priorities amid the ongoing pandemic. The current study considers barriers and facilitators to conducting such research, especially during the COVID-19 pandemic, within the context of recruiting practices for the STop UNhealthy (STUN) Alcohol Use Now trial. The STUN trial uses practice facilitation to implement screening and interventions for unhealthy alcohol use in primary care practices across the state of North Carolina. Methods: Semistructured interviews were conducted with a purposive sample of 15 practice coaches to discuss their recruitment experiences before and after recruitment was paused due to the pandemic. An inductive thematic analysis was used to identify themes and subthemes. Results: Pandemic-related barriers, including challenges in staffing, finances, and new COVID-19-related workflows, were most prominent. Competing priorities, such as quality improvement measures, North Carolina's implementation of Medicaid managed care, and organizational structures hampered recruitment efforts. Coaches also described barriers specific to the project and to the topic of alcohol. Several facilitators were identified, including the rising importance of behavioral health due to the pandemic, as well as existing relationships between practice coaches and practices. Conclusions: Difficulty managing competing priorities and obstacles within existing practice infrastructure inhibit the ability to participate in practice-based research and implementation of evidence-based practices. Lessons learned from this trial may inform strategies to recruit practices into research and to gain buy-in from practices in adopting evidence-based practices more generally. Plain Language Summary What is known: Unhealthy alcohol use is a significant public health issue, which has been exacerbated during the COVID-19 pandemic. Screening and brief intervention for unhealthy alcohol use is an evidence-based practice shown to help reduce drinking-related behaviors, yet it remains rare in practice. What this study adds: Using a qualitative approach, we identify barriers and facilitators to recruiting primary care practices into a funded trial that uses practice facilitation to address unhealthy alcohol use. We identify general insights as well as those specific to the COVID-19 pandemic. Barriers are primarily related to competing priorities, incentives, and lack of infrastructure. Facilitators are related to framing of the project and the anticipated level and type of resources needed to address unhealthy alcohol use especially as the pandemic wanes. Implications: Our findings provide information on barriers and facilitators to recruiting primary care practices for behavioral health projects and to implementing these activities. Using our findings, we provide a discussion of suggestions for conducting these types of projects in the future which may be of interest to researchers, practice managers, and providers.
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Affiliation(s)
- Casey P. Balio
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sean R. Riley
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Debbie Grammer
- North Carolina Area Health Education Centers, CB 7165, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chris Weathington
- North Carolina Area Health Education Centers, CB 7165, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colleen Barclay
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Daniel E. Jonas
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Qeadan F, Tingey B, Egbert J, Pezzolesi MG, Burge MR, Peterson KA, Honda T. The associations between COVID-19 diagnosis, type 1 diabetes, and the risk of diabetic ketoacidosis: A nationwide cohort from the US using the Cerner Real-World Data. PLoS One 2022; 17:e0266809. [PMID: 35439266 PMCID: PMC9017888 DOI: 10.1371/journal.pone.0266809] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the risk of new-onset type 1 diabetes mellitus (T1D) diagnosis following COVID-19 diagnosis and the impact of COVID-19 diagnosis on the risk of diabetic ketoacidosis (DKA) in patients with prior T1D diagnosis. RESEARCH DESIGN AND METHODS Retrospective data consisting of 27,292,879 patients from the Cerner Real-World Data were used. Odds ratios, overall and stratified by demographic predictors, were calculated to assess associations between COVID-19 and T1D. Odds ratios from multivariable logistic regression models, adjusted for demographic and clinical predictors, were calculated to assess adjusted associations between COVID-19 and DKA. Multiple imputation with multivariate imputation by chained equations (MICE) was used to account for missing data. RESULTS The odds of developing new-onset T1D significantly increased in patients with COVID-19 diagnosis (OR: 1.42, 95% CI: 1.38, 1.46) compared to those without COVID-19. Risk varied by demographic groups, with the largest risk among pediatric patients ages 0-1 years (OR: 6.84, 95% CI: 2.75, 17.02) American Indian/Alaskan Natives (OR: 2.30, 95% CI: 1.86, 2.82), Asian or Pacific Islanders (OR: 2.01, 95% CI: 1.61, 2.53), older adult patients ages 51-65 years (OR: 1.77, 95% CI: 1.66, 1.88), those living in the Northeast (OR: 1.71, 95% CI: 1.61, 1.81), those living in the West (OR: 1.65, 95% CI: 1.56, 1.74), and Black patients (OR: 1.59, 95% CI: 1.47, 1.71). Among patients with diagnosed T1D at baseline (n = 55,359), 26.7% (n = 14,759) were diagnosed with COVID-19 over the study period. The odds of developing DKA for those with COVID-19 were significantly higher (OR 2.26, 95% CI: 2.04, 2.50) than those without COVID-19, and the largest risk was among patients with higher Elixhauser Comorbidity Index. CONCLUSIONS COVID-19 diagnosis is associated with significantly increased risk of new-onset T1D, and American Indian/Alaskan Native, Asian/Pacific Islander, and Black populations are disproportionately at risk. In patients with pre-existing T1D, the risk of developing DKA is significantly increased following COVID-19 diagnosis.
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Affiliation(s)
- Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola Univesity Chicago, Maywood, Illinois, United States of America
- * E-mail:
| | - Benjamin Tingey
- Parkinson School of Health Sciences and Public Health, Loyola Univesity Chicago, Maywood, Illinois, United States of America
| | - Jamie Egbert
- Parkinson School of Health Sciences and Public Health, Loyola Univesity Chicago, Maywood, Illinois, United States of America
| | - Marcus G. Pezzolesi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Mark R. Burge
- Department of Internal Medicine, University of New Mexico Hospital, Albuquerque, New Mexico, United States of America
| | - Kathryn A. Peterson
- Department of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Trenton Honda
- School of Clinical and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
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Collins C, Petek D, Diaz E, Muñoz MA. General Practice/Family Medicine Research During the Pandemic: Showing The Links to the EGPRN Research Strategy. Euras J Fam Med 2022. [DOI: 10.33880/ejfm.2022110101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
General Practice/Family Medicine is at the forefront of the clinical response to the COVID-19 crisis just as it is known to be a critical component of healthcare systems globally.
A large number of COVID-19 related papers have been published and dedicated funding calls were available in many countries and across the European Union. However, General Practice/Family Medicine does not feature as strongly as it should in COVID-19 high impact publications or successful funding applications.
In this paper, we take a look at the findings on which the recommendations of the “European General Practice Research Network (EGPRN) Research Strategy for General Practice in Europe 2021” are based and highlight how these align with the COVID-19 experience of General Practice/Family research.
To elaborate on this, the issues identified and the recommendations of the EGPRN Research Strategy are grouped into three broad areas on which we need to focus – capacity, collaboration, and complexity (3-Cs).
Apparent or presumed deficiencies in these 3-Cs are possibly why the General Practice/Family research impact during COVID-19 does not match its position on the ground in fighting the pandemic and supporting patients. The EGPRN Research Strategy identifies how we might work to position ourselves better in the future and gain the recognition deserved, in terms of publications, research funding, and prominence.
Keywords: general practice, research, pandemics, publications, financing
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Affiliation(s)
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana
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Dubé T, Boucher MC, Champagne L, Garand MÈ, Rinfret J. [Teaching in a pandemic: the transformation of teaching and clinical supervision]. Can Med Educ J 2022; 13:65-74. [PMID: 35321417 PMCID: PMC8909815 DOI: 10.36834/cmej.72643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The COVID-19 pandemic is an event that deeply impacts our personal, professional, and collective lives. How do we teach in these times of great upheaval? What are the main changes that have occurred? METHOD Using the Cartel logic, four professors and a qualitative researcher carried out an autoethnographic research aimed at documenting the main changes that have occurred in the teaching of family medicine in their respective practices located in four different academic family medicine groups at the University of Sherbrooke. RESULTS Five key moments in teaching that occurred during a pandemic were identified: a) the declaration of a pandemic, b) the approach with the graduating/advanced cohort of residents, c) the anticipation and preparation for the arrival of new residents, d) arrival of first year residents and e) adaptation to the second wave. For each moment, we present the issues encountered in our care and teaching practices under three transversal relational axes: the relationship of humans to their cultural context, the patient-doctor relationship, and the teacher-resident relationship. CONCLUSION Our analysis shows that the transmission of medical knowledge and the art of medicine cannot take place without specific attention to the overall cultural context, the contextual relationship of clinical care, and the teaching relationship. Our study also makes it possible to recommend the opening of spaces for reflection and dialogue in our teaching environments.
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Affiliation(s)
- Tim Dubé
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Quebec, Canada
| | - Marie-Christine Boucher
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Quebec, Canada
| | - Louise Champagne
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Quebec, Canada
| | - Marie-Ève Garand
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Quebec, Canada
| | - Joanie Rinfret
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Quebec, Canada
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Changulani R, Shukla D, Bhadoria S, Bansal M. Evolution of the pandemic: Analysis of demographic characteristics of COVID-19-infected patients during its two waves in Gwalior district of central India. J Family Med Prim Care 2022; 11:1314-1321. [PMID: 35516675 PMCID: PMC9067213 DOI: 10.4103/jfmpc.jfmpc_1189_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Materials and Methods: Results: Conclusion:
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Abstract
The objective of this study was to describe the system's initial pandemic response from the perspectives of perinatal health workers and to identify opportunities for improved future preparedness. An exploratory survey was designed to identify perinatal practice changes and workforce challenges during the initial weeks of the COVID-19 pandemic. The survey included baseline data collection and weekly surveys. A total of 181 nurses, midwives, and physicians completed the baseline survey; 84% completed at least 1 weekly survey. Multiple practice changes were reported. About half of respondents (50.8%) felt the changes protected patients, but fewer (33.7%) felt the changes protected themselves. Most respondents providing out-of-hospital birth services (91.4%) reported increased requests for transfer to out-of-hospital birth. Reports of shortages of personnel and supplies occurred as early as the week ending March 23 and were reported by at least 10% of respondents through April 27. Shortages were reported by as many as 38.7% (personal protective equipment), 36.8% (supplies), and 18.5% (personnel) of respondents. This study identified several opportunities to improve the pandemic response. Evaluation of practice changes and timing of supply shortages reported during this emergency can be used to prepare evidence-based recommendations for the next pandemic.
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Affiliation(s)
- Jennifer Vanderlaan
- School of Nursing, University of Nevada Las Vegas Las Vegas (Dr Vanderlaan); and Frontier Nursing University, Versailles, Kentucky (Dr Woeber)
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Kakarala SE, Prigerson HG. Covid-19 and Increased Risk of Physician Suicide: A Call to Detoxify the U.S. Medical System. Front Psychiatry 2022; 13:791752. [PMID: 35222114 PMCID: PMC8864162 DOI: 10.3389/fpsyt.2022.791752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/14/2022] [Indexed: 11/21/2022] Open
Abstract
Suicide among physicians is a longstanding problem, with risk factors exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. In this article, we explore suicidal thoughts and behaviors among physicians and risk factors created or intensified by the work environment, such as overwork and loss of autonomy. We discuss the ways in which the COVID-19 pandemic has made the medical work environment more stressful (e.g. greater exposure to traumatic experiences and employment insecurity) and, consequently, elevated physician suicide risk. We also review evidence that the medical system in the United States has not adequately protected physicians' mental health. Lack of confidentiality, stigma, cost, and time, as well as intrusive medical licensing applications, remain barriers to physicians seeking help. Work pressures imposed by insurance companies and financial incentives to increase revenue while cutting costs compound physicians' work stress. We conclude that system-wide changes to the practice of medicine and policies regarding healthcare delivery are needed to improve physicians' work environments, as is research addressing the impact of the interventions to reduce their suicidal risk. The proposed changes, and greater access to timely and confidential mental health services amid and in the aftermath of the pandemic, may prove promising approaches to reduce physicians' suicide risk.
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Affiliation(s)
- Sophia E Kakarala
- Cornell Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Holly G Prigerson
- Cornell Center for Research on End-of-Life Care, Department of Medicine, Weill Cornell Medicine, New York, NY, United States.,Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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Yeo YH, Gao X, Wang J, Li Q, Su X, Geng Y, Huang R, Wu C, Ji F, Sundaram V, Noureddin M, Buti M, Ayoub WS. The impact of COVID-19 on the cascade of care of HCV in the US and China. Ann Hepatol 2022; 27:100685. [PMID: 35192964 PMCID: PMC8857763 DOI: 10.1016/j.aohep.2022.100685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/08/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The COVID-19 pandemic imperiled the global health system. We aimed to determine the impact of COVID-19 on the care continuum of HCV-infected patients. MATERIAL AND METHODS Two hundred and fifty-six patients who were prescribed a course of DAA therapy at three tertiary medical centers in the US and China between January 1, 2019 to June 30, 2020 were included. We assessed the proportions of patients who completed DAA therapy and had HCV RNA testing during and after the end of therapy. We also assessed the impact of utilization of telemedicine. RESULTS The proportion of patients undergoing HCV RNA testing during DAA treatment decreased from >81.7% before pandemic to 67.8% during the pandemic (P=0.006), with a more prominent decrease in the US. There were significant decreases in HCV RNA testing >12 (P<0.001) and >20 weeks (P<0.001) post-treatment during COVID-19 era. Compared to pre-COVID period, post-treatment clinic encounters during COVID-19 era decreased significantly in China (Xi'an: 13.6% to 7.4%; Nanjing: 16.7% to 12.5%) but increased in the US (12.5% to 16.7%), mainly due to the use of telemedicine. There was a 4-fold increase in utilization of telemedicine in the US. CONCLUSIONS COVID-19 pandemic carried profound impact on care for HCV patients in both the US and China. HCV cure rate assessment decreased by half during COVID era but the proportion of patients finishing DAA therapy was not significantly affected. Increased utilization of telemedicine led to increased compliance with DAA therapy but did not encourage patients to have their laboratory assessment for HCV cure.
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Affiliation(s)
- Yee Hui Yeo
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Xu Gao
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian Wang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qingyu Li
- School of Medicine, University of California, Los Angeles, CA, USA
| | - Xingyang Su
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yu Geng
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Fanpu Ji
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Vinay Sundaram
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mazen Noureddin
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maria Buti
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain,CIBEREHD del Instituto Carlos III, Barcelona, Spain
| | - Walid S. Ayoub
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Corresponding author
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Gupta S. Challenge of a dual burden in rapidly aging Delaware: Comorbid chronic conditions and subjective cognitive decline. PLOS Glob Public Health 2022; 2:e0000579. [PMID: 36962745 PMCID: PMC10021351 DOI: 10.1371/journal.pgph.0000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epidemiologic trends forecast a "dual burden"- increase in both physical chronic diseases and Alzheimer's disease (AD)- for Delaware. Estimating the burden and characteristics of this "dual burden" is critical. Cognizant of the unavailability of precise models to measure AD, SCD-a population-based measure- was used as an alternative. The primary objective was to delineate selected chronic conditions among Delaware adults with SCD in order to present: (i) prevalence of SCD by select sociodemographic characteristics, (ii) compare the prevalence of chronic conditions among people with and without SCD, and (iii) compare the prevalence of SCD associated functional limitations in Delawareans with and without comorbid chronic conditions. METHODS Combined data (2016 and 2020) for Delaware were obtained from the Behavioral Risk Factor Surveillance System. Analyses included 4,897 respondents aged 45 years or older who answered the SCD screening question as "yes" (n = 430) or "no" (n = 4,467). Descriptive statistics examined sociodemographic characteristics and chronic conditions in Delawareans with and without SCD. RESULTS Overall, 8.4% (CI: 7.4-9.5) of Delaware adults reported SCD. Delawareans with SCD were more likely to be in the younger age group (45-54 years), less educated, low income and living alone. Over 68 percent had not discussed cognitive decline with a health care professional. More than three in four Delawareans with SCD had a 1.5 times higher prevalence of having any one of the nine select chronic conditions as compared to those without SCD. Adults with SCD and at least one comorbid chronic condition were more likely to report SCD-related functional limitations. CONCLUSIONS Delaware cannot afford to postpone public policies to address the dual burden of SCD and chronic conditions. Results from this study can help public health stakeholders in Delaware to be informed and prepared for the challenges associated with cognitive decline and comorbidity.
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Affiliation(s)
- Sangeeta Gupta
- Department of Public and Allied Health Sciences Delaware State University, Dover, Delaware, United States of America
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Min TL, Xu L, Choi JD, Hu R, Allen JW, Reeves C, Hsu D, Duszak R, Switchenko J, Sadigh G. COVID-19 Pandemic-Associated Changes in the Acuity of Brain MRI Findings: A Secondary Analysis of Reports Using Natural Language Processing. Curr Probl Diagn Radiol 2021; 51:529-533. [PMID: 34955284 PMCID: PMC8636309 DOI: 10.1067/j.cpradiol.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/15/2021] [Accepted: 11/28/2021] [Indexed: 11/22/2022]
Abstract
Rationale and Objectives We aimed to assess early COVID-19 pandemic-associated changes in brain MRI examination frequency and acuity of imaging findings acuity. Methods Using a natural language processing model, we retrospectively categorized reported findings of 12,346 brain MRI examinations performed during 6-month pre-pandemic and early pandemic time periods across a large metropolitan health system into 3 acuity levels: (1) normal or near normal; (2) incidental or chronic findings not requiring a management change; and (3) new or progressive findings requiring a management change. Brain MRI frequency and imaging finding acuity level were compared over time. Results Between March and August of 2019 (pre-pandemic) and 2020 (early pandemic), our health system brain MRI examination volumes decreased 17.0% (6745 vs 5601). Comparing calendar-matched 6-month periods, the proportion of higher acuity findings increased significantly (P< 0.001) from pre-pandemic (22.5%, 43.6% and 34.0% in acuity level 1, 2, and 3, respectively) to early pandemic periods (19.1%, 40.9%, and 40.1%). During the second 3 months of the early pandemic period, as MRI volumes recovered to near baseline, the proportion of higher acuity findings remained high (42.6% vs 34.1%) compared with a similar pre-pandemic period. In a multivariable analysis, Black (B coefficient, 0.16) and underinsured population (B coefficient, 0.33) presented with higher acuity findings (P< 0.05). Conclusions As the volume of brain MRI examinations decreased during the early COVID-19 pandemic, the relative proportion of examinations with higher acuity findings increased significantly. Pandemic-related changes in patient outcomes related to reduced imaging access merits further attention.
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Affiliation(s)
- Taejin L Min
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Liyan Xu
- Department of Computer Science, Emory University(,) Atlanta, GA
| | - Jinho D Choi
- Department of Computer Science, Emory University(,) Atlanta, GA
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Christopher Reeves
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Derek Hsu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Jeffrey Switchenko
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
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Abstract
The coronavirus disease 2019 pandemic has touched nearly every aspect of medical care in the United States, including the provision of well-child care to pediatric patients. According to the American Academy of Pediatrics, well-child visits are a crucial component of ensuring the optimal health and well-being of children of all ages.1 The pandemic has generated challenges to providing effective and timely well-child visits, which has led to effects at the population level, the practice level, for special patient populations, and for individual patients and families. This article aims to outline these effects and identify solutions and remedies for pediatric providers. [Pediatr Ann. 2021;50(12):e488-e493.].
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Liu DZ, Gallo G, Babikow E, Wiesen C, Jackson TH, Mitchell K, Jacox LA. Impacts of the COVID-19 Pandemic on Dentists’ Workforce Confidence and Workflow. J Am Dent Assoc 2021; 153:610-624.e8. [PMID: 35183351 PMCID: PMC8749130 DOI: 10.1016/j.adaj.2021.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/20/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022]
Abstract
Background The COVID-19 pandemic has affected the US economy and workforce, including marked effects on small businesses. Researchers have evaluated workers’ views of financial confidence and advancement, but there has been limited focus on the dental industry. Methods To extend investigations to dentistry, the authors used published scales and pretested questions to determine workforce confidence and workflow changes among dentists. Data were evaluated using descriptive and bivariate statistics. In the wake of the pandemic, surveys were distributed to the memberships of the American Dental Association and American Association of Orthodontists (n = 656). Results Dentists’ top concern was increased cost of providing treatment (57.4%; 95% CI, 53.5% to 61.3%), associated with widely adopted workflow changes including reduced patient volumes (66.0%; 95% CI, 62.4% to 69.6%) and increased safety protocols and equipment (health screening: 75.5%; 95% CI, 72.2% to 78.8%; KN/N95 respirators: 76.7%; 95% CI, 73.5% to 80.0%). However, most respondents did not expect their personal or practice finances to be negatively affected after the pandemic, as only 18.5% (95% CI, 15.4% to 21.7%) predicted their practice’s gross revenue would decrease. Conclusions Dentists were optimistic in the wake of vaccinations and lifting restrictions. Most expected their finances and practice performance to remain the same or grow in the short term and expected long-term improvements postpandemic. Practical Implications Results suggest that despite shutdowns and workflow changes, dentists have rebounded financially and anticipate future growth.
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