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Wu JF, Abenoza N, Bosco JM, Minshew LM, Beckius A, Kastner M, Hilgeman B, Muntz MD. COVID-19 vaccination telephone outreach: an analysis of the medical student experience. Med Educ Online 2023; 28:2207249. [PMID: 37104856 PMCID: PMC10142334 DOI: 10.1080/10872981.2023.2207249] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/30/2023] [Accepted: 04/21/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The COVID-19 pandemic diminished opportunities for medical students to gain clinical confidence and the ability to contribute to patient care. Our study sought out to understand the value of telephone outreach to schedule COVID-19 vaccines on medical student education. MATERIALS AND METHODS Forty students engaged in telephone outreach targeting patients aged 65+ without active patient portals to schedule COVID-19 vaccines. Data consisted of a single administration retrospective pre/post survey inquiring about what students learned, expectations, other health-care processes that would benefit from outreach, and interest in a population health elective. Likert items were analyzed and open response analysis involved inductive coding and generation of thematic summaries by condensing codes into broader themes. Demographic data of patients called and subsequently received the vaccine were also collected. RESULTS There were 33 survery respondents. There was a statistically significant increase in net comfortability for pre-clerkship students for documenting in Epic, providing telehealth care, counseling on common health-care myths, having challenging conversations, cold-calling patients, and developing an initial trusting relationship with patients. The majority called and who received the vaccine were non-Hispanic Black, within the high SVI category, and had Medicare and/or Medicaid. Qualitative data showed that students emphasized communication, the role of trusted messengers, the need to be open minded, and meeting patients where they are. DISCUSSION Engaging students in telephone outreach early in the COVID-19 pandemic provided students the opportunity to develop their skills as physicians-in-training, contribute to combating the ongoing pandemic, and add value to the primary care team. This experience allowed students to practice patience, empathy, and vulnerability to understand why patients had not received the COVID-19 vaccine; this was an invaluable experience that helped students develop the skills to become empathetic and caring physicians, and supports the continued role of telehealth in future medical school curriculum.
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Affiliation(s)
- James F. Wu
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nathalie Abenoza
- Department of Medicine and Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Julia M. Bosco
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lana M. Minshew
- Robert D. and Patricia Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, WI, USA
- School of Pharmacy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Beckius
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mandy Kastner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brian Hilgeman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Martin D. Muntz
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Robert D. and Patricia Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, WI, USA
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Wu JF, Muntz MD, Maguire A, Beckius A, Kastner M, Hilgeman B. COVID-19 Vaccination Telephone Outreach: A Primary Care Clinic Intervention Targeting Health Equity. WMJ 2023; 122:438-443. [PMID: 38180942] [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] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
INTRODUCTION Equitable COVID-19 vaccine access is essential to ending the COVID-19 pandemic. In many instances, COVID-19 vaccination notification and scheduling occurred through online patient portals, for which socially vulnerable populations have limited access. Our objective was to reduce disparities in COVID-19 vaccine access for the Black and socially vulnerable populations unintentionally excluded by our health system's patient portal-driven vaccine outreach through a telephone outreach initiative. METHODS From February 1, 2021, through April 27, 2021, telephone outreach was directed towards patients aged 65 and older without patient portal access at a large urban academic general internal medicine clinic. Univariate and multivariate analyses between those who did and did not receive telephone outreach were completed to assess the odds of vaccination, accounting for outreach status, sex, age, race/ethnicity, payor status, social vulnerability index, and Elixhauser Comorbidity count. RESULTS A total of 1466 patients aged 65 and older without active patient portals were eligible to receive the COVID-19 vaccine. Of these patients, 664 received outreach calls; 382 (57.5%) of them got vaccinated compared to 802 patients who did not receive outreach calls, of which 486 (60.6%) got vaccinated (P = 0.2341). Patients who received outreach calls versus those who did not were more likely to be female, younger, non-Hispanic Black, from high social vulnerability index census tracts, and have higher Elixhauser Comorbidity counts. Logistical analysis revealed an odds ratio (OR) with a nonstatistically significant trend favoring higher vaccination likelihood in the no outreach cohort with univariate analysis with no changes when adjustment was made for age, sex, race/ethnicity, payor, social vulnerability index, and Elixhauser Comorbidity count (univariate analysis: OR 0.88 [95% CI, 0.71-1.09]; model 1: OR 0.89 [95% CI, 0.72 - 1.10]; model 2 - 0.89 (0.72 - 1.11); model 3: OR 0.87 (95% CI, 0.70 -1.09)]. CONCLUSIONS While our telephone outreach initiative was not successful in increasing vaccination rates, lessons learned can help clinicians and health systems as they work to improve health equity. Achieving health equity requires a multifaceted approach engaging not only health systems but also public health and community systems to directly address the pervasive effects of structural racism perpetuating health inequities.
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Affiliation(s)
- James F Wu
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin,
| | - Martin D Muntz
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- Division of General Internal Medicine, Section of Primary Care, Medical College of Wisconsin, Milwaukee, Wisconsin
- Robert D. and Patricia Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ann Maguire
- Division of General Internal Medicine, Section of Primary Care, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anna Beckius
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mandy Kastner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian Hilgeman
- Division of General Internal Medicine, Section of Primary Care, Medical College of Wisconsin, Milwaukee, Wisconsin
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Nyitray AG, Nitkowski J, McAuliffe TL, Brzezinski B, Swartz MD, Fernandez ME, Deshmukh AA, Ridolfi TJ, Lundeen SJ, Cockerham L, Wenten D, Petroll A, Hilgeman B, Smith JS, Chiao EY, Giuliano AR, Schick V. Home-based self-sampling vs clinician sampling for anal precancer screening: The Prevent Anal Cancer Self-Swab Study. Int J Cancer 2023. [PMID: 37158105 DOI: 10.1002/ijc.34553] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/26/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
Sexual minority men are at increased risk for anal squamous cell carcinoma. Our objective was to compare screening engagement among individuals randomized to self-collect an anal canal specimen at home or to attend a clinic appointment. Specimen adequacy was then assessed for human papillomavirus (HPV) DNA genotyping. A randomized trial recruited cisgendered sexual minority men and transgender people in the community and assigned them to use a home-based self-collection swabbing kit or attend a clinic-based swabbing. Swabs were sent for HPV genotyping. The proportions of participants completing screening in each study arm and the adequacy of their specimens for HPV genotyping were assessed. Relative risks were estimated for factors associated with screening. A total of 240 individuals were randomized. Age (median, 46 years) and HIV status (27.1% living with HIV) did not differ by study arm. A total of 89.2% and 74.2% of home-arm and clinic-arm individuals returned the swab, respectively (P = .003), difference between groups, 15.0% (95% CI 5.4%-24.6%). Among black individuals, 96.2% and 63.2% in the home and clinic arms screened (P = .006). Among individuals with HIV, 89.5% and 51.9% in the home and clinic arms screened (P < .001). Self-collected swabs and clinician-collected swabs were comparable in adequacy for HPV genotyping (96.3% and 93.3%, respectively). People at highest risk for anal cancer may be more likely to screen if they are able to self-collect swabs at home rather than attend a clinic.
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Affiliation(s)
- Alan G Nyitray
- Clinical Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jenna Nitkowski
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Timothy L McAuliffe
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bridgett Brzezinski
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Sciences Center at Houston School of Public Health, Houston, Texas, USA
| | - María E Fernandez
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Sciences Center at Houston School of Public Health, Houston, Texas, USA
| | - Ashish A Deshmukh
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Cancer Control Program, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Timothy J Ridolfi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sarah J Lundeen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Dave Wenten
- Holton Street Clinic, Milwaukee, Wisconsin, USA
| | - Andrew Petroll
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brian Hilgeman
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer S Smith
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Vanessa Schick
- Department of Management, Policy, and Community Health, The University of Texas Health Sciences Center at Houston School of Public Health, Houston, Texas, USA
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Diaz R, Walker RJ, Lu K, Weston BW, Young N, Fumo N, Hilgeman B. The relationship between adverse childhood experiences, the frequency and acuity of emergency department utilization and primary care engagement. Child Abuse Negl 2022; 124:105479. [PMID: 35026607 DOI: 10.1016/j.chiabu.2021.105479] [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] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/08/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION A history of adverse child experiences (ACEs) is associated with increased high-risk adult behaviors, morbidity, mortality, and use of the emergency department. This study was designed to understand the relationship between ACEs and the characteristics of emergency department use and primary care engagement. METHODS An in-person survey was conducted at an academic emergency department (ED) assessing ACE score, emergency department utilization and acuity, and primary care engagement. RESULTS The prevalence of ACEs was 71.1% with 1+ ACE and 32.5% with 4+ ACE. ACE scores of four or more were associated with three or more ED visits in the past year compared those with an ACE score of zero (OR 3.22; p < 0.05) and when adjusted for sociodemographic factors (OR 3.22; p < 0.10). Higher ACE scores were associated with lower acuity presentations as indicated by the Emergency Severity Index before (ACE score 1 OR 3.91 p < 0.05; ACE score 2-3 OR 2.35 p < 0.05; ACE score 4+ OR 3.95 p < 0.05) and after adjustment (ACE score 1 OR 3.80 p < 0.10; ACE 2-3 OR 3.50 p < 0.10; ACE 4+ OR 4.36 p < 0.05). There was no association between ACE score and having a primary care provider (PCP), frequency of PCP visits, or PCP rating. CONCLUSION Higher ACE scores were associated with higher emergency department utilization and lower acuity presentations but not associated with levels of primary care engagement. Additional investigations are needed to adequately characterize the discrete causal mechanisms behind these current findings.
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Affiliation(s)
- Robert Diaz
- Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Kaiwei Lu
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Benjamin W Weston
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Nicholas Young
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States of America; Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Nicole Fumo
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Brian Hilgeman
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States of America; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States of America.
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Hilgeman B, Egede L, Silverstein R, Kastner M, Stulac-Motzel W, Dawson A, Walker R, Simms A, Ayala K, MacKinney T. Details of developing and implementing an intensive interdisciplinary care program for high need, high cost patients. Healthc (Amst) 2021; 9:100452. [PMID: 33607519 DOI: 10.1016/j.hjdsi.2020.100452] [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] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/26/2020] [Accepted: 07/09/2020] [Indexed: 11/20/2022]
Abstract
1. Developing and implementing an intensive interdisciplinary medical home within a large academic medical center was feasible. 2. Deploying a complex care management program that shared staff and resources with an intensive primary care program was not successful. 3. Barriers included traversing legal barriers to text messaging patients, making hospital consults feasible financially, managing challenging patients, team wellness, provider back up, managing homebound patients, and discharging patients. 4. Although expensive, this model may have hidden benefits including improved patient satisfaction, quality of care, and providing a solid care system for a health system's most challenging and vulnerable population.
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Affiliation(s)
- Brian Hilgeman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Leonard Egede
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Roy Silverstein
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mandy Kastner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Aprill Dawson
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah Walker
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andre Simms
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kelly Ayala
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Theodore MacKinney
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Herrera AV, Hilgeman B, Buelow M, Lemke MA. Mailed At-Home FIT Intervention to Increase Colorectal Screenings at Sixteenth Street Community Health Centers. J Patient Cent Res Rev 2015. [DOI: 10.17294/2330-0698.1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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