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Britz JB, Huffstetler AN, Brooks EM, Richards A, Sabo RT, Webel BK, McCray N, Krist AH. Increased Organizational Stress in Primary Care: Understanding the Impact of the COVID-19 Pandemic, Medicaid Expansion, and Practice Ownership. J Am Board Fam Med 2024; 36:892-904. [PMID: 38092433 PMCID: PMC10860742 DOI: 10.3122/jabfm.2023.230145r2] [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: 04/15/2023] [Revised: 06/26/2023] [Accepted: 07/24/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Primary care is the foundation of health care, resulting in longer lives and improved equity. Primary care was the frontline of the COVID-19 pandemic public response and essential for access to care. Yet primary care faces substantial structural and systemic challenges. As part of a longitudinal analysis to track the capacity and health of primary care, we surveyed every primary care practice in Virginia in 2018 and again in 2022. METHODS Surveys were emailed or mailed up to 6 times and nonresponders received a phone call. Questions assessed organizational characteristics, scope of care, capacity, and organizational stress in the prior year. From respondents, 39 clinicians, nurses, staff, administrators, and practice managers were interviewed. RESULTS 526 out of 2296 primary care practices (23% response rate) completed the survey, with broad representation across geography, ownership, and payer mix. Compared with 2018, in 2022 there were increases in practices owned by health systems (25% vs 43%, P < .0001) and average percent of patients with Medicaid per practice (12% vs 22%, P < .0001). The percent of practices reporting any major stressor increased from 34% to 53% (P < .0001). The main increased stress was losing a clinician, with 13% of practices in 2018 versus 42% in 2022 reporting losing a clinician (P < .0001). CONCLUSIONS Primary care practices are resilient and continue to serve their communities, including a broad scope of services and care for underserved people. However, the COVID-19 pandemic caused significant stress. With an increase in clinicians leaving clinical practice, we anticipate worsening access to primary care.
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Affiliation(s)
- Jacqueline B Britz
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC). )
| | - Alison N Huffstetler
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
| | - E Marshall Brooks
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
| | - Alicia Richards
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
| | - Roy T Sabo
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
| | - Ben K Webel
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
| | - Neil McCray
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
| | - Alex H Krist
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (JBB, ANH, EMB, AR, RTS, BKW, AHK), Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (ANH), Virginia Department of Medical Assistance Services, Richmond, VA (NMC)
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Schoonover J, Rossetti A, Jacobs A, Rubin SE. Virtual Music Therapy for Substance Use Disorders in a Federally Qualified Health Center. J Am Board Fam Med 2024; 36:1043-1049. [PMID: 38092435 DOI: 10.3122/jabfm.2022.220316r3] [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] [Received: 09/15/2022] [Revised: 10/31/2022] [Accepted: 06/12/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Music therapy (MT) is an effective adjunctive treatment for substance use disorders (SUD), which is primarily available in inpatient treatment centers and rarely provided in outpatient primary care. METHODS We evaluated the feasibility and acceptability of a virtual group MT program for SUD in a Federally Qualified Health Center (FQHC), and secondarily assessed patient perceptions of its effect. Feasibility was measured by implementation-related process measures, attendance and use of technology. Qualitative interviews eliciting participant perceptions were conducted to evaluate acceptability and effect. Mood scores, substance use and craving were measured before and after the intervention. RESULTS Onboarding of the music therapist took 3.5 months. All MT sessions were attended by 1 to 5 individuals out of 6. Participants reported that group MT was "soothing" and "calming," gave them tools to treat cravings and stress, and created a sense of community. They reported that during sessions their cravings decreased. Anxiety and depression scores trended down, as did the number of days of substance use. They all stated they would seek out MT again. DISCUSSION Our results suggest that remote group MT is feasible and acceptable to our FQHC patients with SUD. Patients reported an improvement in mood and their ability to manage stress, and a decrease in substance use. CONCLUSION We wish to build on the results of this study to enhance our understanding of the effects of MT in the outpatient setting, and broaden our patients' access to MT in primary care.
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Affiliation(s)
- Julie Schoonover
- From the Institute for Family Health, New York, NY, USA (JS, AJ, SER), The Louis Armstrong Center for Music and Medicine at Mount Sinai Health Center, New York, NY, USA (AR).
| | - Andrew Rossetti
- From the Institute for Family Health, New York, NY, USA (JS, AJ, SER), The Louis Armstrong Center for Music and Medicine at Mount Sinai Health Center, New York, NY, USA (AR)
| | - Ariel Jacobs
- From the Institute for Family Health, New York, NY, USA (JS, AJ, SER), The Louis Armstrong Center for Music and Medicine at Mount Sinai Health Center, New York, NY, USA (AR)
| | - Susan E Rubin
- From the Institute for Family Health, New York, NY, USA (JS, AJ, SER), The Louis Armstrong Center for Music and Medicine at Mount Sinai Health Center, New York, NY, USA (AR)
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McPeake K, Jeanes L, Nelson D, Selby P, Cooke S, Gussy M, Kane R. Developing a 'Living with Cancer' programme in a rural and coastal setting: Experiences of collaborative and innovative co-production across an Integrated Health System. J Cancer Policy 2023; 38:100452. [PMID: 37931888 DOI: 10.1016/j.jcpo.2023.100452] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/10/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION With projected increases in cancer prevalence, and demonstrated unmet need, there is an urgency for a collaborative approach to improving the lives of those living with cancer particularly in rural and coastal areas where cancer survivors face unique challenges. We report on an innovative 'Living with Cancer' (LWC) programme in the rural and coastal English county of Lincolnshire. METHODS In 2016, the Lincolnshire LWC programme was established to develop person-centred, local support for people living with cancer, their carers and significant others in Lincolnshire. This article reports on the setup of the LWC programme, our innovative approach to delivering cancer care in a rural and coastal setting, as well as our most salient achievements. RESULTS This work, developed within a policy context of tackling health inequalities and personalised approaches to care, started with stakeholder and community engagement where people described the challenges to living well after cancer and the need to focus on 8 themes further exacerbated by rurality. Recognising the limitations of conventional approaches, led to the development of a strategy underpinned by a shared set of principles and a philosophy of the importance of a transformative, whole-system, place-based, asset-based, and person-centred approaches. The strategy is now being coordinated and delivered across all cancer pathways and Lincolnshire communities. In 2022, permanent funding was secured, and our success was also demonstrated by a national Macmillan Integration Excellence award. DISCUSSION The initial success of the LWC programme in Lincolnshire is a result of an explicit focus on 'transformation' rather than 'improvement', and a programme not solely situated in an acute setting, which needed a whole systems approach with a focus on person-centred support and community engagement.
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Affiliation(s)
- Kathie McPeake
- National Health Service Lincolnshire Integrated Care Board, Sleaford, UK; Macmillan Cancer Support, London, UK
| | - Louise Jeanes
- National Health Service Lincolnshire Integrated Care Board, Sleaford, UK
| | - David Nelson
- Macmillan Cancer Support, London, UK; Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK.
| | - Peter Selby
- School of Medicine, University of Leeds, Leeds, UK; Lincoln Medical School, Universities of Nottingham and Lincoln, Lincoln, UK
| | - Samuel Cooke
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Mark Gussy
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
| | - Ros Kane
- School of Health and Social Care, University of Lincoln, Lincoln, UK
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Stowers PN, Hiraoka M, Khozaim K, Stickley E, Adrian C, Uohara J, Zalud I. Perceived Impact of a Core Rotation on Hawai'i Island on Future Career Intentions among Obstetrics and Gynecology Residents. Hawaii J Health Soc Welf 2023; 82:89-93. [PMID: 37034057 PMCID: PMC10074448] [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] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Hawai'i Island faces a growing shortage of obstetric and gynecology providers. Increased exposure of obstetrics and gynecology residents to rural rotations during their core training may increase their interest in rural practice after graduation. In an effort to address the health care needs of women on Hawai'i Island, the University of Hawai'i Obstetrics and Gynecology Residency Program established a 4-week required gynecology rotation in the town of Hilo. Between July 2019 and June 2020, third- and fourth-year obstetrics and gynecology residents provided outpatient gynecologic care and participated in gynecologic surgeries at Hilo-based medical facilities. A total of 9 residents participated in this Hilo-based rotation. This retrospective study extracted data from post-rotation evaluations. Eight out of 9 participating residents (89%) felt that the rotation slightly or far exceeded their expectations. After the rotation, 7 residents (78%) reported an interest in practicing in a rural community, while only 3 residents (33%) reported having this interest prior to the rotation. Underserved rural areas seeking to recruit and retain obstetrics and gynecology physicians may benefit from partnering with residency training programs.
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Affiliation(s)
- Paris N. Stowers
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Mark Hiraoka
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Kareem Khozaim
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Emilie Stickley
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Celeste Adrian
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - John Uohara
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Ivica Zalud
- Department of Obstetrics, Gynecology, and Women’s Health, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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Bachmann CJ, Plener PL, Mechels M, Lempp T. [Maintaining a comprehensive provision of inpatient child and adolescent mental health services in the years to come-a German perspective]. Neuropsychiatr 2023; 37:39-46. [PMID: 36717530 PMCID: PMC9886204 DOI: 10.1007/s40211-023-00458-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] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND A considerable number of child and adolescent psychiatry inpatient units in Germany suffer from a significant shortage of doctors, which endangers the current system of nation-wide availability of high-quality child and adolescent inpatient services. METHODS Drawing on recent data, this article pictures the status quo of child and adolescent psychiatry inpatient services in Germany. The authors then discuss the pros and cons of different suggestions of how to cope with the doctor shortage crisis in child and adolescent psychiatry. RESULTS The following options for action are suggested: reduction of service provision across the board, shift from personnel-intensive inpatient towards home-based treatment, trans-sectoral cooperation by means of tele-psychiatry, delegation of clinical responsibilities to psychologists, limiting ward physicians' tasks to mere medical care of patients, improvement of working conditions in inpatient units, recruitment of doctors from abroad, and increased recruiting efforts at medical school level. From the authors' viewpoint, the latter option offers the best chance of lasting success; however, this requires a long-term, nationwide approach and considerable efforts of all departments involved.
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Affiliation(s)
- Christian J Bachmann
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Steinhövelstr. 5, 89075, Ulm, Deutschland. .,Wiener Gesundheitsverbund, Wien, Österreich.
| | - Paul L Plener
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Steinhövelstr. 5, 89075, Ulm, Deutschland.,Universitätsklinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Wien, Wien, Österreich
| | - Malte Mechels
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Agaplesion Diakoniekrankenhaus, Rotenburg/Wümme, Deutschland
| | - Thomas Lempp
- Klinik für Kinder- und Jugendpsychosomatik, Clementine Kinderhospital, Frankfurt am Main, Deutschland
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Abstract
PURPOSE There is little information as to how America's broadband infrastructure might impact recent efforts to expand access to virtual care for underserved communities. OBJECTIVE To examine potential and realized access to broadband internet services within Medically Underserved Areas (MUAs) that rely on community health care service providers for primary care. METHODS This cross-sectional study included 214,946 US Census Block Group estimates from the 2017 and 2019 American Community Survey and the corresponding Federal Communications Commission database. Changes in household broadband subscription rates and Healthy People 2020 access thresholds within MUAs were assessed. FINDINGS In 2019, 24,304 MUA households (31.9%) met Healthy People 2020 targets for broadband subscription rates, compared to 64.4% of non-MUA households (n = 89,285). On average, 74.7% of MUA households had a broadband internet subscription compared to 85.2% of non-MUA households, whereas 61.1% (n = 46,635) of MUA households had access to broadband speeds of at least 25.0 Mbps, compared to 75.6% (n = 104,696) of non-MUA households. Within urban households, there was a 0.8 to 1.3 to 1.6 annual percentage point convergence in MUA versus non-MUA broadband disparities between across quintiles (P < .05). Rural MUA households showed little improvement in broadband access between 2017 and 2019. CONCLUSIONS There has been an overall convergence of broadband access disparities between MUA and non-MUA households over time, but less improvements in access among the most rural households. Reimbursement for audio-only telehealth visits by state Medicaid agencies would help drive down barriers to virtual health care options for populations residing in MUAs.
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Affiliation(s)
- Nathaniel Bell
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Peiyin Hung
- Health Services Policy and Management, University of South Carolina, Rural and Minority Health Research Center, Columbia, South Carolina, USA
| | - Ana Lòpez-De Fede
- Division of Integrated Health and Policy Research at the Institute for Families in Society, University of South Carolina, Columbia, South Carolina, USA
| | - Swann A Adams
- College of Nursing and Epidemiology & Biostatistics, University of South Carolina, Columbia, South Carolina, USA
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Adepoju OE, Tran L, Agwuncha R, Chae M, Franco-Castano J, Angelocci T, Liaw W. Associations between Patient- and Provider Level Factors, and Telemedicine Use in Family Medicine Clinics. J Am Board Fam Med 2022; 35:457-64. [PMID: 35641037 DOI: 10.3122/jabfm.2022.03.210416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Increased telemedicine implementation may promote primary care access. However, gaps in telemedicine uptake may perpetuate existing disparities in primary care access. This study assessed provider- and patient-level factors associated with telemedicine use in community-based family practice clinics. METHODS This retrospective study used electronic medical records data from a large Federally Qualified Health Center. A 3-level mixed-effects logistic regression model explored predictors of telemedicine use, with provider and patient as random effects. RESULTS The analytic sample included 37,428 unique patients with 106,567 primary care encounters with 42 family medicine providers. Fifty-seven percent of the sample identified as Hispanic, 28% non-Hispanic White, and 11% non-Hispanic Black. Compared to Hispanics, non-Hispanic White patients had 61% higher odds of a telemedicine visit, and non-Hispanic Black patients had 32% higher odds of a telemedicine visit. The odds of telemedicine use were lower for those who were uninsured. Those residing in metropolitan areas or medically underserved areas had greater odds of a telemedicine appointment. Commute time exhibited a dose-response relationship with telemedicine use. Provider characteristics were not significantly associated with telemedicine use. DISCUSSION While provider characteristics were not associated with telemedicine use, greater focus on patient characteristics specific to the population served is necessary.
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Hall JD, Danna MN, Hoeft TJ, Solberg LI, Takamine LH, Fortney JC, Nolan JP, Cohen DJ. Patient and Clinician Perspectives on Two Telemedicine Approaches for Treating Patients with Mental Health Disorders in Underserved Areas. J Am Board Fam Med 2022; 35:465-74. [PMID: 35641048 DOI: 10.3122/jabfm.2022.03.210377] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/10/2022] [Accepted: 02/08/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Primary care practices in underserved and/or rural areas have limited access to mental health specialty resources for their patients. Telemedicine can help address this issue, but little is known about how patients and clinicians experience telemental health care. METHODS This pragmatic randomized effectiveness trial compared telepsychiatry collaborative care, where telepsychiatrists provided consultation to primary care teams, to a referral approach, where telepsychiatrists and telepsychologists assumed responsibility for treatment. Twelve Federally Qualified Health Centers in rural and/or underserved areas in 3 states participated. RESULTS Patients and clinicians reported that both interventions alleviated barriers to accessing mental health care, provided quality treatment, and offered improvements over usual care. Telepsychiatry collaborative care was identified as better for patients with difficulty developing trust with new providers. This approach also required more primary care involvement than referral care, creating more opportunities for clinician learning related to mental health diagnosis and treatment. The referral approach was identified as better suited for patients with higher complexity or desiring specific psychotherapies. CONCLUSIONS Both approaches addressed patient needs and provided access to specialty mental health care. Each approach better aligned with different patients' needs, suggesting that having both approaches available to practices is optimal for supporting patient-centered care.
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Brooks EM, Huffstetler A, Britz J, Webel B, Lail Kashiri P, Richards A, Sabo R, O'Loughlin K, Cunningham P, Barnes A, Kuzel T, Krist AH. The Distressed State of Primary Care in Virginia Pre-Medicaid Expansion and Pre-Pandemic. J Am Board Fam Med 2021; 34:1189-1202. [PMID: 34772774 PMCID: PMC8620191 DOI: 10.3122/jabfm.2021.06.210046] [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: 02/02/2021] [Revised: 06/07/2021] [Accepted: 07/21/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Primary care is crucial to the health of individuals and communities, but it faces numerous structural and systemic challenges. Our study assessed the state of primary care in Virginia to prepare for Medicaid expansion. It also provides insight into the frontline of health care prior to an unprecedented global COVID-19 pandemic. METHODS We surveyed 1622 primary care practices to understand organizational characteristics, scope of care, capacity, and organizational stress. RESULTS Practices (484) varied in type, ownership, location, and care for medically underserved and diverse patient populations. Most practices accepted uninsured and Medicaid patients. Practices reported a broad scope of care, including offering behavioral health and medication-assisted therapy for opioid addiction. Over half addressed social needs like transportation and unstable housing. One in three practices experienced a significant stress in 2019, prepandemic, and only 18.8% of practices anticipated a stress in 2020. CONCLUSIONS Primary care serves as the foundation of our health care system and is an essential service, but it is severely stressed, under-resourced, and overburdened in the best of times. Primary care needs strategic workforce planning, adequate access to resources, and financial investment to sustain its value and innovation.
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Affiliation(s)
- E Marshall Brooks
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (EMB, AH, JB, BW, PLK, AR, RS, KO, TK, AHK); Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (AR, RS); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (PC, AB); Department of Psychology, Virginia Commonwealth University, Richmond. VA (KO)
| | - Alison Huffstetler
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (EMB, AH, JB, BW, PLK, AR, RS, KO, TK, AHK); Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (AR, RS); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (PC, AB); Department of Psychology, Virginia Commonwealth University, Richmond. VA (KO)
| | - Jacqueline Britz
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (EMB, AH, JB, BW, PLK, AR, RS, KO, TK, AHK); Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (AR, RS); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (PC, AB); Department of Psychology, Virginia Commonwealth University, Richmond. VA (KO)
| | - Benjamin Webel
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (EMB, AH, JB, BW, PLK, AR, RS, KO, TK, AHK); Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (AR, RS); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (PC, AB); Department of Psychology, Virginia Commonwealth University, Richmond. VA (KO)
| | - Paulette Lail Kashiri
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (EMB, AH, JB, BW, PLK, AR, RS, KO, TK, AHK); Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (AR, RS); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (PC, AB); Department of Psychology, Virginia Commonwealth University, Richmond. VA (KO)
| | - Alicia Richards
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (EMB, AH, JB, BW, PLK, AR, RS, KO, TK, AHK); Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (AR, RS); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (PC, AB); Department of Psychology, Virginia Commonwealth University, Richmond. VA (KO)
| | - Roy Sabo
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (EMB, AH, JB, BW, PLK, AR, RS, KO, TK, AHK); Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (AR, RS); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (PC, AB); Department of Psychology, Virginia Commonwealth University, Richmond. VA (KO)
| | - Kristen O'Loughlin
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (EMB, AH, JB, BW, PLK, AR, RS, KO, TK, AHK); Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (AR, RS); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (PC, AB); Department of Psychology, Virginia Commonwealth University, Richmond. VA (KO)
| | - Peter Cunningham
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (EMB, AH, JB, BW, PLK, AR, RS, KO, TK, AHK); Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (AR, RS); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (PC, AB); Department of Psychology, Virginia Commonwealth University, Richmond. VA (KO)
| | - Andrew Barnes
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (EMB, AH, JB, BW, PLK, AR, RS, KO, TK, AHK); Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (AR, RS); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (PC, AB); Department of Psychology, Virginia Commonwealth University, Richmond. VA (KO)
| | - Tony Kuzel
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (EMB, AH, JB, BW, PLK, AR, RS, KO, TK, AHK); Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (AR, RS); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (PC, AB); Department of Psychology, Virginia Commonwealth University, Richmond. VA (KO)
| | - Alex H Krist
- From the Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA (EMB, AH, JB, BW, PLK, AR, RS, KO, TK, AHK); Department of Biostatistics, Virginia Commonwealth University, Richmond, VA (AR, RS); Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA (PC, AB); Department of Psychology, Virginia Commonwealth University, Richmond. VA (KO).
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Stewart MP, Fink R, Kosirog E, Saseen JJ. Bridging health disparities: a national survey of ambulatory care pharmacists in underserved areas. Pharm Pract (Granada) 2021; 19:2359. [PMID: 34221204 PMCID: PMC8221749 DOI: 10.18549/pharmpract.2021.2.2359] [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: 03/12/2021] [Accepted: 05/09/2021] [Indexed: 11/14/2022] Open
Abstract
Background There is a shortage of primary care medical providers, particularly in rural communities and communities of racial and ethnic minority groups. Clinical pharmacists can help fill gaps in care among these vulnerable populations. Objective To identify characteristics of ambulatory care pharmacists that pursue and maintain employment within underserved areas. Methods An original survey was distributed nationwide to ambulatory care clinical pharmacists in underserved settings. Respondent characteristics were analyzed using descriptive statistics. Results Of the 111 completed surveys, a majority of respondents were White, non-Hispanic, female, with English as their only spoken language. A majority of pharmacists completed a clinical experience or specialized training focused on underserved care prior to their position. The top three motivators for pharmacists accepting their clinical position as well as staying at their job were passion for caring for underserved populations, the presence of a faculty appointment, or the freedom and flexibility of advanced clinical roles. Conclusions With a large majority of our respondents identifying as White and unilingual, there remains a large opportunity to increase diversity in the clinical pharmacy ambulatory care workforce caring for underserved populations. There is an observed correlation between early experiential or specialized training in underserved care and pharmacists pursuing employment in these areas. Thus, one potential long-term strategy to diversify and grow the ambulatory care clinical pharmacist workforce in underserved settings is for clinical practice sites to partner with colleges of pharmacy to recruit and maintain quality individuals who can meet the needs of diverse patient populations as well as expand student and resident training opportunities in underserved settings.
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Affiliation(s)
- Morgan P Stewart
- PharmD, BCACP, BC-ADM. Clinical Assistant Professor. CommUnityCare Health Centers, Division of Pharmacy Practice, College of Pharmacy, University of Texas at Austin. Austin, TX (United States).
| | - Rhianna Fink
- PharmD, BCACP, BC-ADM. Assistant Professor, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO (United States).
| | - Emily Kosirog
- PharmD, BCACP. Director of Clinical Pharmacy Services, Salud Family Health Centers. Aurora, CO (United States).
| | - Joseph J Saseen
- PharmD, BCPS, BCACP. Professor. Departments of Clinical Pharmacy and Family Medicine, Skaggs School of Pharmacy and Pharmaceutical Sciences and School of Medicine, University of Colorado. Aurora, CO (United States).
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11
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Westby A, Nissly T, Gieseker R, Timmins K, Justesen K. Achieving Equity in Telehealth: "Centering at the Margins" in Access, Provision, and Reimbursement. J Am Board Fam Med 2021; 34:S29-32. [PMID: 33622814 DOI: 10.3122/jabfm.2021.S1.200280] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 11/08/2022] Open
Abstract
The SARS-CoV-2 epidemic has led to rapid transformation of health care delivery and access with increased provision of telehealth services despite previously identified barriers and limitations to this care. While telehealth was initially envisioned to increase equitable access to care for under-resourced populations, the way in which telehealth provision is designed and implemented may result in worsening disparities if not thoughtfully done. This commentary seeks to demonstrate the opportunities for telehealth equity based on past research, recent developments, and a recent patient experience case example highlighting benefits of telehealth care in underserved patient populations. Recommendations to improve equity in telehealth provision include improved virtual visit technology with a focus on patient ease of use, strategies to increase access to video visit equipment, universal broadband wireless, and inclusion of telephone visits in CMS reimbursement criteria for telehealth.
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12
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Baldoni S, Pallotta G, Traini E, Sagaro GG, Nittari G, Amenta F. A survey on feasibility of telehealth services among young Italian pharmacists. Pharm Pract (Granada) 2020; 18:1926. [PMID: 32802217 PMCID: PMC7416313 DOI: 10.18549/pharmpract.2020.3.1926] [Citation(s) in RCA: 8] [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: 04/20/2020] [Accepted: 07/05/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Telemedicine is defined as “the use of medical information exchanged
from one site to another via electronic communications to improve a
patient’s health status”. This relatively new concept of
healthcare is based on the fusion between medical assistance and Information
and Communication Technology (ICT) to provide support to people located in
remote and underserved areas. It can be found not only in hospitals, but
also in other healthcare facilities such as pharmacies. Starting from 2010,
telemedicine or telehealth was formally introduced in the Italian
pharmaceutical context with the “Pharmacy of Services Decree”.
In spite of this regulatory framework, the implementation of this technology
was very slow and there are no data about the spreading and use of these
services in Italian pharmacies. Objective: The present study has therefore developed a survey to collect information on
the diffusion of telemedicine/telehealth services within Italian
pharmacies. Methods: A two-part questionnaire in Italian was developed using SurveyMonkey, setting
a mechanism aimed to have different outcomes according to the answers given.
Six hundred eighty-three respondents returned the questionnaire. The results
were then analysed statistically. Results: The questionnaire results have shown a limited diffusion of
telemedicine/telehealth services among Italian pharmacies and an apparently
limited interest of health authorities in supporting the integration of this
technology. Conclusions: More efforts should be spent by national public health stakeholders to better
analyse the contribution of telemedicine services available in public
pharmacies and to find the best solutions to implement this innovative
technology as an established service.
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Affiliation(s)
- Simone Baldoni
- Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino. Camerino (Italy).
| | - Graziano Pallotta
- Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino. Camerino (Italy).
| | - Enea Traini
- Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino. Camerino (Italy).
| | - Getu G Sagaro
- Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino. Camerino (Italy).
| | - Giulio Nittari
- Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino. Camerino (Italy).
| | - Francesco Amenta
- Telemedicine and Telepharmacy Center, School of Medicinal and Health Products Sciences, University of Camerino. Camerino (Italy).
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Coffman M, Wilkinson E, Jabbarpour Y. Despite Adequate Training, Only Half of Family Physicians Provide Women's Health Care Services. J Am Board Fam Med 2020; 33:186-8. [PMID: 32179601 DOI: 10.3122/jabfm.2020.02.190293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 11/08/2022] Open
Abstract
Access to services related to reproductive and sexual health is critical to the health of women but has been threatened in recent years. Family physicians are trained to provide a range of women's health care services and are an essential part of the health care workforce in rural and underserved areas, where access to these services may be limited.
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Kim MS, Kim KH, Park SM, Lee JG, Ko YS, Cho AR, Ku YS. Comparison of Health Status in Primary Care Underserved Area Residents and the General Population in Korea. Korean J Fam Med 2019; 41:119-125. [PMID: 31852174 PMCID: PMC7093676 DOI: 10.4082/kjfm.18.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/01/2018] [Accepted: 01/29/2019] [Indexed: 12/30/2022] Open
Abstract
Background This study compared chronic diseases and health-related quality of life (HRQoL) in between primary care underserved areas residents and the general population. Methods Underserved areas were identified according to accessibility and the time relevance index for primary care. Overall, 279 participants aged ≥60 years from four counties enrolled voluntarily. A total of 1,873 individuals were assigned in the control group using the Korea National Health and Nutrition Examination Survey database. We assessed the differences in prevalence, awareness, and control of hypertension and diabetes and HRQoL using both subjective health status and the Korean version of the EuroQol-5D (EQ-5D) questionnaire using multivariate logistic regression analysis between the two groups. Results For hypertension, prevalence did not differ significantly between the two groups, whereas awareness and control were lower in the underserved areas than that in the general population; the adjusted odds ratios (95% confidence interval) were 0.40 (0.25–0.64) and 0.27 (0.18–0.41), respectively. For diabetes, differences in prevalence, awareness, and control were statistically insignificant. The proportion reporting poor subjective health status and problems in four EQ-5D indexes (ability to exercise, daily activities, pain/discomfort, anxiety/depression) was higher in the underserved areas, which also had a lower EQ-5D index, than that in the general population. Conclusion Primary care underserved area residents were underdiagnosed and under-controlled for hypertension and reported poorer subjective health and HRQoL compared to the general population. Primary care is the attributable factor to awareness and control of chronic diseases and subjective health and QoL in communities.
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Affiliation(s)
- Min So Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyae Hyung Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Institute for Public Health and Medical Service, Seoul National University Hospital, Seoul, Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Goo Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeon Seo Ko
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - A Ra Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yoon Su Ku
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
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15
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Kwak MY, Lee SM, Lee TH, Eun SJ, Lee JY, Kim Y. Accessibility of Prenatal Care Can Affect Inequitable Health Outcomes of Pregnant Women Living in Obstetric Care Underserved Areas: a Nationwide Population-Based Study. J Korean Med Sci 2019; 34:e8. [PMID: 30618515 PMCID: PMC6318447 DOI: 10.3346/jkms.2019.34.e8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 01/12/2018] [Accepted: 10/11/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND As of 2011, among 250 administrative districts in Korea, 54 districts did not have obstetrics and gynecology clinics or hospitals providing prenatal care and delivery services. The Korean government designated 38 regions among 54 districts as "Obstetric Care Underserved Areas (OCUA)." However, little is known there are any differences in pregnancy, prenatal care, and outcomes of women dwelling in OCUA compared to women in other areas. The purposes of this study were to compare the pregnancy related indicators (PRIs) and adequacy of prenatal care between OCUA region and non-OCUA region. METHODS Using National Health Insurance database in Korea from January 1, 2012 to December 31, 2014, we constructed the whole dataset of women who terminated pregnancy including delivery and abortion. We assessed incidence rate of 17 PRIs and adequacy of prenatal care. All indicators were compared between OCUA group and non-OCUA group. RESULTS The women dwelling in OCUA regions were more likely to get abortion (4.6% in OCUA vs. 3.6% in non-OCUA) and receive inadequate prenatal care (7.2% vs. 4.4%). Regarding abortion rate, there were significant regional differences in abortion rate. The highest abortion rate was 10.3% and the lowest region was 1.2%. Among 38 OCUA regions, 29 regions' abortion rates were higher than the national average of abortion rate (3.56%) and there were 10 regions in which abortion rates were higher than 7.0%. In addition, some PRIs such as acute pyelonephritis and transfusion in obstetric hemorrhage were more worse in OCUA regions compared to non-OCUA regions. CONCLUSION PRIs are different according to the regions where women are living. The Korean government should make an effort reducing these gaps of obstetric cares between OCUA and non-OCUA.
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Affiliation(s)
- Mi Young Kwak
- Center for Public Health, National Medical Center, Seoul, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Ho Lee
- Center for Public Health, National Medical Center, Seoul, Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Yong Lee
- Public Health Medical Service, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
| | - Yoon Kim
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
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16
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Mann DJ, Mattox R. Chiropractic Management of a Patient With Chronic Pain in a Federally Qualified Health Center: A Case Report. J Chiropr Med 2018; 17:117-120. [PMID: 30166968 DOI: 10.1016/j.jcm.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/28/2017] [Revised: 12/01/2017] [Accepted: 12/13/2017] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of this case report is to describe the response of a patient with chronic pain who received chiropractic care in a federally qualified health center. Clinical Features A 61-year-old female patient with neck and back pain after a traumatic motor vehicle accident 3 years prior was referred for chiropractic care. She had neck pain, low back pain, knee pain, and pain associated with over 20 surgeries, as well as depression, opioid dependence, and low quality of life. Interventions and Outcomes The patient was treated with chiropractic manipulation for her low back and neck pain and was counseled on nutrition and exercise. After 6 months, she reported improvements in pain, improved quality of life, and discontinuation of opioid pain medication. Conclusion This patient improved after a course of chiropractic care that was integrated into a federally qualified health center.
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Affiliation(s)
- David J Mann
- Department of Integrated Clinics, Logan University, St. Louis, Missouri
| | - Ross Mattox
- Department of Integrated Clinics, Logan University, St. Louis, Missouri
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17
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Douaiher J, Inciarte DJ, Silva E. The Intersection of National Immigration and Healthcare Policy. J Am Board Fam Med 2018; 31:163-5. [PMID: 29330250 DOI: 10.3122/jabfm.2018.01.170204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 09/03/2017] [Accepted: 09/23/2017] [Indexed: 11/08/2022] Open
Abstract
Immigration policy and health care policy remain principal undertakings of the federal government. The two have recently been pursued independently in the judicial and legislative arenas. Unbeknownst to many policymakers, however, national immigration policy and health care policy are linked in ways that, if unattended, could undermine the well-being of a significant portion of the US population, specifically medically underserved rural and urban populations. Using current data from a workforce report of the Association of American Colleges and the published literature, we demonstrate the significant impact that contemporary immigration policy directives may have on the number and distribution of international medical graduates who currently provide-and by the year 2025 will provide-a significant portion of primary health care in the United States, especially in underserved small urban and rural communities.
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18
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Eldredge JD, Hall LJ, McElfresh KR, Warner TD, Stromberg TL, Trost J, Jelinek DA. Rural providers' access to online resources: a randomized controlled trial. J Med Libr Assoc 2016; 104:33-41. [PMID: 26807050 DOI: 10.3163/1536-5050.104.1.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The research determined the usage and satisfaction levels with one of two point-of-care (PoC) resources among health care providers in a rural state. METHODS In this randomized controlled trial, twenty-eight health care providers in rural areas were stratified by occupation and region, then randomized into either the DynaMed or the AccessMedicine study arm. Study participants were physicians, physician assistants, and nurses. A pre- and post-study survey measured participants' attitudes toward different information resources and their information-seeking activities. Medical student investigators provided training and technical support for participants. Data analyses consisted of analysis of variance (ANOVA), paired t tests, and Cohen's d statistic to compare pre- and post-study effects sizes. RESULTS Participants in both the DynaMed and the AccessMedicine arms of the study reported increased satisfaction with their respective PoC resource, as expected. Participants in both arms also reported that they saved time in finding needed information. At baseline, both arms reported too little information available, which increased to "about right amounts of information" at the completion of the study. DynaMed users reported a Cohen's d increase of +1.50 compared to AccessMedicine users' reported use of 0.82. DynaMed users reported d2 satisfaction increases of 9.48 versus AccessMedicine satisfaction increases of 0.59 using a Cohen's d. CONCLUSION Participants in the DynaMed arm of the study used this clinically oriented PoC more heavily than the users of the textbook-based AccessMedicine. In terms of user satisfaction, DynaMed users reported higher levels of satisfaction than the users of AccessMedicine.
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Messiah A, Dietz NA, Byrne MM, Hooper MW, Fernandez CA, Baker EA, Stevens M, Ocasio M, Sherman RL, Parker DF, Lee DJ. Combining Community-Based Participatory Research (CBPR) with a Random-Sample Survey to Assess Smoking Prevalence in an Under-Served Community. J Natl Med Assoc 2015; 107:97-101. [PMID: 27269496 DOI: 10.1016/s0027-9684(15)30030-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/28/2022]
Abstract
ACKNOWLEDGMENTS The authors would like to thank Laura McClure for her help with the manuscript submission, the Liberty City Community Health Advisory Board for its collaboration on this study, as well as the survey interviewers, and the survey participants. INTRODUCTION Underserved communities might lag behind Healthy People 2010 objectives of smoking reduction because of smoking behavior disparities. This possibility was investigated through a random-sample survey conducted in a disenfranchised community in Miami-Dade County, Florida, using a Community-Based Participatory Research (CBPR) framework. The survey was triggered by our finding that this community had higher than expected incidence of tobacco-associated cancers. METHODS Survey methods, resulting from a dialog between the Community Advisory Board and academic researchers, included: (a) surveying adult residents of a public housing complex located within the community; (b) probability sampling; (c) face-to-face interviews administered by trained community residents. 250 households were sampled from 750 addresses provided by the county Public Housing Agency. The completed surveys were reviewed by the academic team, yielding 204 questionnaires for the current analysis. RESULTS Of the 204 respondents, 38% were current smokers. They estimated the percentages of smokers in their household and among their five best friends at 33% and 42%, respectively, and among adults and youth in the community at 72% and 53%, respectively. CONCLUSIONS A mix of state-of-art methodology with CBPR principles is seldom encountered in the current literature. It allowed the research team to find a high smoking prevalence in an underserved community, twice the statewide and nationwide estimates. Similar or higher levels of smoking were perceived in respondent's entourage. Such disparity in smoking behavior, unlikely to result from self-selection bias because of our rigorous methodology, calls for community-specific tobacco control efforts commensurate to the magnitude of the problem.
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Affiliation(s)
- Antoine Messiah
- INSERM research unit U-1178 "Mental Health and Public Health", Research team IPSOM "Psycho trauma and Suicide in Overseas Territories" Villejuif, France.
| | - Noella A Dietz
- Department of Epidemiology & Public Health, Miller School of Medicine, University of Miami
| | - Margaret M Byrne
- Department of Epidemiology & Public Health, Miller School of Medicine, University of Miami
| | | | - Cristina A Fernandez
- Department of Epidemiology & Public Health, Miller School of Medicine, University of Miami
| | | | - Marsha Stevens
- Disparities and Community Outreach Core, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | - Manuel Ocasio
- Department of Epidemiology & Public Health, Miller School of Medicine, University of Miami
| | - Recinda L Sherman
- Florida Cancer Data Systems, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | - Dorothy F Parker
- Disparities and Community Outreach Core, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami
| | - David J Lee
- Department of Epidemiology & Public Health, Miller School of Medicine, University of Miami
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Abstract
The objective of this study was to assess the use of telemedicine services at
community health centers. A national survey was distributed to all federally
qualified health centers to gather data on their use of health information
technology, including telemedicine services. Over a third of responding health
centers (37%) provided some type of telemedicine service while 63% provided no
telemedicine services. A further analysis that employed ANOVA and chi-square
tests to assess differences by the provision of telemedicine services (provided
no telemedicine services, provided one telemedicine service, and provided two or
more telemedicine services) found that the groups differed by Meaningful Use
compliance, location, percentage of elderly patients, mid-level provider,
medical, and mental health staffing ratios, the percentage of patients with
diabetes with good blood sugar control, and state and local funds per patient
and per uninsured patient. This article presents the first national estimate of
the use of telemedicine services at community health centers. Further study is
needed to determine how to address factors, such as reimbursement and provider
shortages, that may serve as obstacles to further expansion of telemedicine
services use by community health centers.
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Abstract
"The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital's facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.
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Affiliation(s)
- Baeg Ju Na
- Department of Preventive Medicine, College of Medicine, Konyang University, Daejeon, Korea
| | - Hyun Joo Kim
- Department of Public Health, The Graduate School, Konyang University, Daejeon, Korea
| | - Jin Yong Lee
- Public Health Medical Service, Seoul National University Boramae Medical Center, Seoul, Korea
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Xierali IM, Phillips RL Jr, Green LA, Bazemore AW, Puffer JC. Factors influencing family physician adoption of electronic health records (EHRs). J Am Board Fam Med 2013; 26:388-93. [PMID: 23833153 DOI: 10.3122/jabfm.2013.04.120351] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Physician and practice characteristics associated with family physician adoption of electronic health records (EHRs) remain largely unexplored but may be important for tailoring policies and interventions. METHODS This was a cross-sectional study of EHR adoption using American Board of Family Medicine certification census data (2006-2011) for over 41,000 family physicians to test associations between demographic, geographic, and practice characteristics and EHR adoption. RESULTS EHR adoption rates for family physicians grew from 37% in 2006 to 68% in 2011. No significant association was found with rural status (odds ration [OR], 0.985; 95% confidence interval [CI], 0.932-1.042). Practicing in a medically underserved location (OR, 0.868; 95% CI, 0.822-0.917) or geographic health professional shortage areas (OR, 0.904; 95% CI, 0.831-0.984), or being an international medical graduate (OR, 0.769; 95% CI, 0.748-0.846) were negatively associated with adoption. Compared with physicians in group practices, physicians in solo practices (OR, 0.465; 95% CI, 0.439-0.493) and small practices (OR, 0.769; 95% CI, 0.720-0.820) were less likely to adopt EHRs, whereas those in health maintenance organizations (OR, 5.482; 95% CI, 4.657-6.454) or with faculty status (OR, 1.527; 95% CI, 1.386-1.684) were more likely. CONCLUSIONS Variation in EHR adoption is associated with physician and practice characteristics that may help guide intervention. These findings may be important to other specialties and could instruct interventions to improve adoption. Certification boards could play an important role in tracking EHR adoption and help target resources and facilitation.
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