Type Of Appointment Research Articles

Integrated consultation and chemotherapy scheduling with stochastic treatment times

This paper studies the integrated scheduling of consultation and treatment appointments for chemotherapy patients, while taking into account the stochastic duration of injection. Patients may require one or both types of consultation and treatment appointments. The objective is to minimize the clinic’s overtime and the waiting time of patients in the clinic. To formulate the problem, we develop two two-stage stochastic programming models. We also propose a sample average approximation algorithm as the solution method. To improve the efficiency of our solution approach, we devise a specialized algorithm that quickly evaluates a given first-stage solution for a large set of scenarios, without solving the second-stage models. Several computational experiments are carried out to evaluate the performance of proposed models and algorithms.

Understanding student preferences for one to one writing appointments post-pandemic

The academic writing scheme at the university is a near-peer service, which provides students with the opportunity to book one to one appointments with an academic writing tutor. All academic writing tutors are currently studying for their PhD and offer support to students with planning assignments, being critical, structuring their writing, understanding tutor feedback and referencing. When launched in 2019, all appointments took place in-person in the university library. When Covid-19 hit in March 2020, the service moved online, with appointments taking place over Microsoft Teams. However, with this, we noticed a drop in appointment bookings. Within this study, an online survey was conducted, and the 701 responses analysed to investigate students’ preferences in relation to the delivery of one to one writing appointments post-pandemic. The results indicated a preference for in-person appointments to be available, with 55.8% of the respondents choosing this. The main factor was the preference for communicating in-person as it allows for more questions and a natural conversation. However, there is clearly still an appetite for appointments to be delivered online, with postgraduate students in particular expressing an interest in this format. Students indicated that the accessibility of appointments for students who are not on campus regularly as the biggest factor for choosing online as their preference. It can be concluded that a hybrid model, where students can choose between the two appointment types is most appropriate, which along with increased targeted promotion to specific faculties and year groups, should increase the usage of the service.

Effect of telehealth implementation on an adolescent metabolic and bariatric surgery program.

Pediatric severe obesity is a worldwide health concern. Treatment with metabolic and bariatric surgery can reduce morbidity and mortality. The COVID-19 pandemic not only has had a significant effect on rates of pediatric obesity but also has necessitated a rapid transition to virtual medicine. We aimed to identify and examine adolescent metabolic and bariatric surgery patient participation rates through our program's virtual telehealth programming as compared with prepandemic traditional in-person clinic appointments. This study took place at an academic pediatric quaternary care center. We evaluated 92 adolescent patients with a total of 2442 unique encounters between January 2018 and July2021. The rate of attendance was found to be greater for telehealth visits (83.1%) than for in-person appointments (70.5%) for all clinics regardless of appointment type (preoperative versus postoperative). Cancellation rates were lower for telehealth visits (9.9%) than for in-person appointments (22.5%). This study provides evidence that telehealth can be implemented successfully in an adolescent metabolic and bariatric surgery program and can improve attendance rates for all provider and appointment subtypes.

An investigation into the factors which influence attendance rates for psychology appointments in an adult intellectual disability service

PurposeThis study aims to investigate whether factors previously shown to influence attendance rates for appointments in general practice and general mental health services also influence attendance rates in services for people with intellectual disabilities (ID).Design/methodology/approachPost hoc data from 452 psychology appointments, ID diagnostic and initial screening (triage) appointments were collected from the health-care files of a community adult ID psychology service. Demographic factors (age, sex) and clinical factors (waiting time, time between appointment invitation being sent and appointment being held, presence of prior telephone call or letter, type of appointment, weekday, month) were recorded along with the attendance outcome (attended/did not attend [DNA]). The impact of the COVID-19 pandemic was also explored by documenting whether the appointment predated March 2020.FindingsNo significant associations were found between any variable investigated and attendance outcome when analysing appointment data as a whole and when splitting the data between appointment type. Weekday was found to significantly be associated with attendance outcome for appointments held during COVID-19, in which more DNA appointments occurred on a Wednesday compared to the other days of the week. No other associations were found for appointments held during the COVID-19 pandemic or for appointments held prior to the COVID-19 pandemic. These results suggest that factors which influence attendance rates in general health-care settings do not necessarily generalise to ID services.Originality/valueTo the best of the authors’ knowledge, this study is the first to examine whether certain demographic and clinical factors influenced attendance rates in an adult intellectual disability service.

Brief Report: Telehealth Satisfaction Among Caregivers of Pediatric and Adult Psychology and Psychiatry Patients with Intellectual and Developmental Disability in the Wake of Covid-19.

Telehealth has been shown to be both acceptable and effective in many areas of healthcare, yet it was not widely adopted prior to the SARS-CoV-2 (COVID-19) pandemic. Additionally, previous evaluations of telehealth for autism spectrum condition (ASC) and intellectual and developmental disability (IDD) populations are limited in both number and scope. Here, we investigated satisfaction amongst Psychology and Psychiatry patient caregivers at Cincinnati Children’s Hospital Medical Center (CCHMC) after the onset of the COVID-19 pandemic. Results (640 responses) showed high rates of satisfaction across departments, appointment types, and diagnoses, with 92% indicating overall satisfaction with their appointment. There were, however, notable decreases in satisfaction among Group Therapy respondents, and those whose diagnosis was classified as Other.

A TeleNutrition Program’s Impact on Outpatient Medical Nutrition Therapy for a Healthcare System in Response to the COVID-19 Pandemic

Participants will be able to describe how a TeleNutrition program impacts number of appointments, appointment type (in-person/TeleNutrition), RDN billable time, and number of referring providers during the COVID-19 pandemic.

How Does Political Appointment Affect Innovation Ambidexterity: The Case of China’s Central SOEs

Does political appointment affect innovation ambidexterity? To answer the interesting question, we distinguish two types of political appointments: government and party; and find that these different types of appointments do affect firms’ exploitative or exploratory innovations, inducing appointees by respectively incentive systems. Furthermore, we consider that these effects stem from time orientation and risk uncertainty and add two moderators: agent tenure and industry dynamism. We test our framework with a panel data set of central state-owned enterprises in China from 2006 to 2016. We find that agents appointed by the government will be more likely to pursue exploitative rather than exploratory innovation than agents appointed by the party, particularly when agent tenure is short and industry dynamism is low. Our research contributes to the literature on the effects of political appointment, the time and risk orientation of political appointment, and the relationship between corporate political activities and innovation ambidexterity

Implementation of Virtual Preoperative Evaluation During a Pandemic

<h3>Background Information</h3> Preadmission testing visits have historically been in-person and or via phone calls facilitated by nurse practitioners and registered nurses. Due to the pandemic, a change in process was required to address national and state social distancing recommendations. Project was conducted at a 171-bed community teaching hospital in the Northeast United States. <h3>Objectives of Project</h3> To implement a smooth transition from onsite preoperative evaluations via phone or in-person visit, to 100% virtual visit. <h3>Process of Implementation</h3> In October of 2020 the interdisciplinary leadership and Chief NP made the decision that all permanent RN staff would work from home and that all NP visits would become virtual. The Chief NP and Project Manager collaborated and created a Microsoft Teams account, revised paper resources, and uploaded them so that staff could access electronically. The Telecommunications team transferred existing telephone numbers and linked them with hospital provided laptops, head- sets and Jabber accounts for RN staff. They also provided cameras for the desktops utilized by the NPs. The Clinical Business Analysis team updated and created new appointment types to facilitate phone screens. The Chief NP updated the After Visit Summary which included, Covid screening, visitor restrictions and safe patient commitment. Education was provided to all staff regarding the change in process and available updated resources by the Chief NP and one staff NP. <h3>Statement of Successful Practice</h3> In November 2020 100% of all preoperative visits became remote or virtual. Staff are utilizing a messaging app for internal communication to communicate patient concerns, inquire with clinical questions, scheduling changes. Positive feedback from nursing staff regarding new process. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> High satisfaction and safety for patients and clinicians are the driving force behind these visits. To aid in addressing the long-standing concerns surrounding location and availability, telehealth provides greater flexibility to both patients and clinician while closing the service gap. Having local resources more broadly available via a common online resource, provides the clinician access to the most current clinical information while integrating care efforts that improve health outcomes.

Barriers to Accessing Video-Based Telehealth Appointments at a Community Veterinary Clinic During the COVID-19 Pandemic.

ObjectiveTo assess veterinary needs of clients with low socioeconomic status during the COVID-19 pandemic, to explore the impact of the pandemic on marginalized communities, and to understand perceptions regarding barriers and incentives of telehealth appointments as a method to increase care access.Sample205 active Community Veterinary Medicine Clinic clients at Tufts at Tech Community Veterinary Clinic in Worcester, MA.ProceduresThis cross-sectional study used a survey-based method to assess veterinary needs of clients with low socioeconomic status during the COVID-19 pandemic. The survey measured client perceptions regarding potential barriers and incentives of telehealth appointments. Participants were randomly sampled from a list of active clients and completed the survey either by email or over the phone. The survey was available in both English and Spanish. Clients who completed the questionnaire received credit for a free examination.ResultsA total of 205 clients submitted survey responses. Factors affecting access to veterinary care were impacted by the COVID-19 pandemic. Access to reliable internet in the home was reported by 87% (n = 177) of participants. Digital access was correlated with education when controlling for race, income, age, and gender. Education was predictive of comfort with using video-chat (χ2 = 65, df = 24, p ≤ 0.01) and of whether or not clients reported need for assistance for using video-chat (χ2 = 52, df = 18, p ≤ 0.01). Patient education level was significantly predictive of wanting to use telehealth for at least one type of appointment (p ≤ 0.05).Conclusions and Clinical RelevanceThe findings indicate that implementing telehealth services at this Community Medicine Clinic is feasible for much of the active clientele and offers a new avenue to provide veterinary care during times of social distancing restrictions and beyond.

Evaluating the impact of a novel behavioural science informed animation upon breast cancer screening uptake: protocol for a randomised controlled trial

BackgroundBreast cancer screening is estimated to save 1300 lives annually in the United Kingdom. Despite this, uptake of invitations has fallen over the past decade. Behavioural science-informed interventions addressing the determinants of attendance behaviour have shown variable effectiveness. This may be due to the narrow repertoire of techniques trialled, and the difficulties of implementation at a population-scale. The aim of this study is to evaluate the impact on breast screening uptake of a novel behavioural video intervention which can contain more complex combinations of behavioural change techniques.MethodsA 3-armed randomised controlled trial will be undertaken in London comparing the impact of (1) the usual care SMS reminder, to (2) a behavioural plain text SMS reminder and (3) a novel video sent as a link within the behavioural plain text SMS reminder. A total of 8391 participants (2797 per group) will be allocated to one of the three trial arms using a computer randomisation process, based upon individuals’ healthcare identification numbers. The novel video has been co-designed with a diverse range of women to overcome the barriers faced by underserved communities and the wider population. The behavioural SMS content has also been co-designed through the same process as the video. Messages will be sent through the current reminder system used by the London screening programmes, with reminders 7 days and 2 days prior to a timed appointment. The primary outcome is attendance at breast cancer screening within 3 months of the initial invitation. Secondary outcomes will include evaluating the impact of each message amongst socio-demographic groups and according to the appointment type e.g. first invitation or recall.DiscussionIn addition to general declining trends in attendance, there is also concern of increasing healthcare inequalities with breast cancer screening in London. The current novel intervention, designed with underserved groups and the general population, incorporates several behavioural techniques to overcome the barriers to attendance. Understanding its potential impact in a real-world setting therefore may provide significant information on how to address reducing attendance and healthcare disparities.Trial RegistrationThis study was registered on ClinicalTrials.gov (NCT05395871) on the 27th May 2022.

Comparing cancer genetic counselling using telegenetics with in-person and telephone appointments: Results of a partially randomised patient-preference pilot study

Introduction Direct-to-patient telegenetics, which uses video conferencing to connect health professionals directly to patients’ devices, has been widely adopted during the pandemic. However, limited evidence currently supports its use in cancer genetic counselling. Methods Before the pandemic, we conducted a two-arm partially randomised patient-preference pilot trial to evaluate direct-to-patient telegenetics for patients and genetic counsellors. Patients were randomised to a standard care (telephone/in-person) or direct-to-patient telegenetics appointment. Patients completed questionnaires before, during and after appointments measuring: psychological distress, perceived genetic counsellor empathy, telegenetics satisfaction and technical challenges. Genetic counsellor-reported outcomes –measured using purpose-designed questionnaires– included telegenetics satisfaction, therapeutic alliance and time for assessment. Open-ended patient and genetic counsellor questionnaire responses were synthesised using content analysis. Results Fifty-six patients and seven genetic counsellors participated. Thirteen patients switched appointment type. No significant differences in distress (P = 0.84) were identified between direct-to-patient telegenetics and standard care. Perceived genetic counsellor empathy was high for all appointment types. There was no evidence of differences in reported maximum empathy scores between direct-to-patient telegenetics and standard care [telephone (P = 0.57); in-person (P = 0.44)]. Patients reported high direct-to-patient telegenetics satisfaction despite technical challenges in most appointments (65%). Genetic counsellors were satisfied with direct-to-patient telegenetics and perceived high therapeutic alliance irrespective of appointment type. No significant differences in genetic counsellor time were identified between direct-to-patient telegenetics and standard care [telephone (P > 0.90); in-person (P = 0.35)]. Discussion Our results suggest that direct-to-patient telegenetics is a satisfactory service delivery model that does not appear to compromise patient–genetic counsellor relationships or increase patient distress. These findings support direct-to-patient telegenetics use in cancer genetic counselling, although larger trials are needed.

Genetics and Genomics Teaching in Nursing Programs in a Latin American Country.

Although the importance of genetics and genomics in nursing education has been widely recognized, surveys carried out in several countries show that these subjects are still limited in nursing undergraduate programs. In Latin America, the teaching of genetics and genomics in nursing programs has never been previously documented. Considering this scenario, we aimed to investigate how genetics and genomics have been taught in undergraduate nursing programs in Brazil. A total of 138 undergraduate nursing program coordinators and 49 faculty members were recruited to participate in this cross-sectional study. After IRB approval, data were collected using an online survey, covering curriculum design, faculty credentials, genetics and/or genomics teaching, as well as their impressions regarding the document “Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics”. Genetics is taught in most of the investigated courses (67.3%), mainly by biologists (77.6%), with master’s degree (83.7%), and with the syllabus mainly focused on molecular biology. More instructors agreed with Competency 2 (C2) which refers to advocating for clients’ access to desired genetic/genomic services and/or resources including support groups as well as C23 which refer to using health promotion/disease prevention practices that incorporate knowledge of genetic and genomic risk factors, than coordinators. That is, the participants’ type of appointment (instructors vs. coordinators) had a significant effect on their agreement level with competencies C2 (χ2 = 6.23, p = 0.041) and C23 (χ2 = 9.36, p = 0.007). Overall, a higher number of participants with both master’s and Ph.D. degrees significantly agreed with competencies C2, C4, which refer to incorporating genetic and genomic technologies and information into registered nurse practice, and C5—demonstrating in practice the importance of tailoring genetic and genomic information and services to clients based on their culture, religion, knowledge level, literacy, and preferred language, when compared to those with Ph.D. only, and those with a master’s degree only (χ2 = 8.73, p = 0.033; χ2 = 8.61, p = 0.033; χ2 = 8.61, p = 0.033, respectively). Our results support reflections on ways to prepare the nursing workforce to deliver personalized nursing care. Additionally, they can be an aid in establishing guidelines for the undergraduate nursing curricula in Brazil and in other Portuguese-speaking countries, as well as in Latin America.

Measuring impact of a quality improvement initiative on glaucoma clinic flow using an automated real-time locating system

BackgroundLean methodology helps maximize value by reducing waste, first by defining what value and waste are in a system. In ophthalmology clinics, value is determined by the number of patients flowing through the clinic for a given time. We aimed to increase value using a lean-methodology guided policy change, then assessed its impact on clinic flow using an automated radiofrequency identification (RFID) based real-time locating system (RTLS).MethodsA total of 6813 clinical visits occurred at a single academic institution’s outpatient glaucoma clinic between January 5, 2018 to July 3, 2018. Over that period, 1589 patients comprising 1972 (29%) of visits were enrolled, with 1031 clinical visits occurring before and 941 visits after a policy change. The original policy was to refract all patients that improved with pinhole testing. The policy change was not to refract patients with a visual acuity ≥20/30 unless a specific request was made by the patient. Pre-post analysis of an automated time-motion study was conducted for the data collected 3 months before and 3 months after the policy change occurred on March 30, 2018. Changes to process and wait times were summarized using descriptive statistics and fitted to linear mixed regression models adjusting for appointment type, clinic volume, and daily clinic trends.ResultsOne thousand nine hundred twenty-three visits with 1588 patients were included in the analysis. Mean [SD] age was 65.9 [14.7] years and 892 [56.2%] were women. After the policy change, technician process time decreased by 2.9 min (p < 0.0001) while daily clinical patient volume increased from 51.9 ± 16.8 patients to 58.4 ± 17.4 patients (p < 0.038). No significant difference was found in total wait time (p = 0.18) or total visit time (p = 0.83).ConclusionsReal-time locating systems are effective at capturing clinical flow data and assessing clinical practice change initiatives. The refraction policy change was associated with reduced technician process time and overall the clinic was able to care for 7 more patients per day without significantly increasing patient wait time.

A Physiotherapist-Led Paediatric Fracture Clinic was a Safe and Efficient Alternative to Traditional Outpatient Orthopaedic Care: A Preliminary Evaluation

Background: Demand for publicly funded orthopaedic outpatient services is growing rapidly which affects a health service’s ability to provide timely care. The current study describes the implementation and preliminary evaluation of a novel physiotherapist-led paediatric fracture clinic, which was introduced to provide more timely care to children. The study evaluated 1) the length of time patients spent in the outpatient department per appointment, 2) did-not-attend rates and 3) unplanned re-presentations to the clinic for the same problem. Methods: The study was conducted at a large regional hospital in Victoria, Australia. A physiotherapist-led paediatric fracture clinic was introduced in 2013 to provide care to children with acute simple limb fractures. Descriptive data for all patients seen in the clinic between 1st January 2013 and 31st December 2018 were collected prospectively. The performance of the new service was evaluated by comparing it to the pre-existing orthopaedic surgeon-led fracture clinic for the six months prior to the introduction of the new service for 1) the total time patients spent in the outpatient department per appointment and 2) the number of patients that failed to attend an appointment. The pre-existing surgeon-led clinic was also compared to the surgeon-led clinic for the six months following the introduction of the physiotherapist-led clinic. Total time spent in the department per appointment was compared between groups using linear regression, controlling for age, diagnosis and appointment type (new or review). The proportion of patients who did not attend an appointment were compared between groups using the chi square test. The number of unplanned representations to either clinic was assessed between 01/01/2013 and 31/12/2018. Results: Between 2013 and 2018, there were 4337 attendances at the physiotherapist-led clinic. Total time in the department was significantly less (p&lt;.05) for patients seen in the physiotherapist-led clinic when compared to the pre-existing surgeon-led clinic (median difference 82 minutes). Total time in the surgeon-led clinic also reduced following the introduction of the new service (median difference 21 minutes). Did-not-attend rates (10.3%) and unplanned re-presentations (0.6%) were similar (p&gt;.05) between the groups. Conclusions: The physiotherapist-led clinic improved the timeliness of care for paediatric patients without evidence of compromised patient safety. KEYWORDS: Paediatrics, musculoskeletal health, service evaluation, service redesign, workforce reform, fractures, orthopaedics.

Inpatient virtual shared medical appointments to improve health literacy, increase patient self-efficacy, and reduce provider burnout in acute cerebrovascular pathology patients and their caregivers: a pilot study.

Admission to the hospital for an acute cerebrovascular condition such as stroke or brain hemorrhage can be a traumatic and disorienting experience for patients and their family members. The COVID-19 pandemic has further intensified this experience in addition to exacerbating clinician and resident burnout. To ameliorate some of these concerns, a team of resident and medical student trainees implemented a virtual shared medical appointment (vSMA) program for inpatients with acute cerebrovascular disorders and their caregivers. The authors hypothesized that an early intervention in the form of a vSMA improves patient and caregiver health literacy and preparedness while simultaneously educating clinical trainees on effective communication skills and reducing clinician burnout. Patients and caregivers of admitted patients were identified through a census of neurosurgery, neurocritical care, and neurology electronic medical records. A weekly 60-minute secure virtual session consisted of introductions and a 10-minute standardized presentation on cerebrovascular disease management, followed by participant-guided discussion. Participants completed presession and postsession surveys. Through this small feasibility study data were obtained regarding present challenges, both expected and unforeseen. A total of 170 patients were screened, and 13 patients and 26 caregivers participated in at least 1 vSMA session. A total of 6 different healthcare providers facilitated sessions. The vSMA program received overwhelmingly positive feedback from caregivers. Survey responses demonstrated that 96.4% of caregivers and 75% of patients were satisfied with the session, 96.4% of caregivers and 87.5% of patients would recommend this type of appointment to a friend or family member, and 88.8% of providers reported feeling validated by conducting the session. The participant group had a 20% greater percentage of patients discharged home without home needs compared to the nonparticipant group. The primary obstacles encountered included technological frustrations with the consent process and the sessions themselves. Implementation of a vSMA program at a tertiary care center during a pandemic was feasible. Themes caregivers expressed on the postsession survey included better understanding of caring for a stroke patient and coping with the unpredictability of a patient's prognosis. The pandemic has precipitated shifts toward telehealth, but this study highlights the importance of avoiding marginalization of elderly and less technologically inclined populations.

An implementation guide to improve accuracy and efficiency for outpatient referrals using EHR functionality

Mayo Clinic adopted one electronic health record (EHR) across all 70 locations in five different states in 2017 and 18. A post-implementation review addressed concerns, and new workflows, processes and functionalities were adjusted. A common issue raised by multiple departments related to difficulty in accessing the right referral orders. Referrals between departments at Mayo Clinic are orders driven; scheduling is dependent on accurate ordering. Mayo Clinic’s vast size and number of specialties resulted in a very large catalogue of referral orders mapping to appointment types specific to each specialty. Providers found ordering in the new system time-consuming and looking for specific orders tedious. Often, wrong orders were selected, resulting in scheduling errors, reordering, rescheduling and staff and patient dissatisfaction. To solve this problem, an innovative functionality, EZ Panels, was created, which uses a panel-within-panel approach to group orders by speciality, displaying a much shorter list to providers. This functionality improved ordering capabilities, making it easier for providers to access the correct orders and make referrals accurately and efficiently. All 70 practices built and implemented EZ Panels in less than one year. Our fast-paced build and implementation approach can be modified and used by any healthcare system experiencing similar issues.

Similar Accuracy of Surgical Plans After Initial In-Person and Telemedicine Evaluation of Spine Patients

The aim of this study was to compare accuracy of surgical plans generated from in-person and telemedicine evaluations and assess the reasons for surgical plan changes between initial evaluation and surgery. The secondary objective was to assess the effect of changes in surgical planning on postoperative outcomes. In this retrospective cohort study, consecutive patients who were evaluated as new patients by orthopaedic spine faculty between 2019 and 2021 were divided by appointment type: telemedicine (n= 39) and in-person (n= 92). Patients were included if the surgeon documented a definitive surgical plan at the initial visit. The primary outcome was change in surgical plan from initial assessment to actual procedure performed. There was no significant difference in the accuracy of initial surgical plans between the telemedicine and in-person cohorts (79.5% vs. 82.6%, P= 0.673). The most common modification in the surgical plan (79%) was change in the number of operated levels, of which 18 of 19 patients had 1 added operated level. Less common reasons were change in approach (13%) and change in procedure (8%). Patients with changes to their surgical plan experienced longer length of stay (3.1 vs. 2.0 days, P= 0.027) than patients with consistent surgical plans. Telemedicine and in-person evaluations generated similarly accurate surgical plans. Changes to the initial surgical plans most often involved adding operative levels. Our findings show that telemedicine visits are an acceptable option for preoperative assessment to generate surgical plans; however, further research is needed.

Failure to attend radiation oncology appointments during COVID-19: Analysis of data from an Australian public hospital.

IntroductionCOVID‐19 has impacted lives worldwide. Public health guidance has advocated for minimisation of infection risk by encouraging social isolation and physical distancing. In response, many health services have changed delivery practices to increased use of telehealth. We undertook an audit of hospital attendance data collected from a radiation oncology service in a large public hospital in Victoria, Australia between January and September in 2019, and the same period in 2020. The aim was to discern the impact of COVID‐19 on attendance at appointments and whether attendance rates differed by appointment type.MethodsAttendance data and appointment type for the two targeted periods (a total of 62,528 appointments for 3383 patients) were extracted from the database maintained by the radiation oncology service. Logistic generalised estimating equation (GEE) models were run with the final model including the COVID‐19 period (pre, during) and all patient and appointment characteristics.ResultsResults indicated a small decrease in attendance in 2020 (OR = 1.13, 95% CI 1.01–1.25, P = 0.026) with this predominantly reported for the non‐treatment appointments, which consisted of follow‐up appointments, nurse appointments, and treatment review appointments.ConclusionAttendance for radiation oncology treatment was largely unaffected by COVID‐19 although other services experienced slight reductions. Changes to work practices, specifically the increased use of telehealth, may have moderated the impact. Given the focus on one service in one location, it is not possible to generalise these results and future research should closely monitor both patient and staff satisfaction with services delivered via modified processes.

Rural disparities in head and neck cancer from 2017 to 2021: a single institution analysis

Abstract Introduction: This study aims to look at the trends in our head and neck cancer patient population over the past 5 years with an emphasis on the past 2 years to evaluate how the coronavirus disease 2019 (COVID-19) pandemic has impacted our disparities and availability of care for patients, especially those living in rural areas. An additional aim is to identify existing disparities at our institution in the treatment of head and neck patients and determine solutions to improve patient care. Materials and Methods: A retrospective chart review was performed to identify patients who were consulted and subsequently treated with at least one fraction of radiation therapy at our institution with palliative or curative intent. Patient demographic information was collected including hometown, distance from the cancer centre based on zip-codes and insurance information and type of appointment (in-person or telehealth). Rural–urban continuum codes were used to determine rurality. Results: A total of 490 head and neck cancer patients (n = 490) were treated from 2017 to 2021. When broken down by year, there were no significant trends in patient population regarding travel distance or rurality. Roughly 20–30% of our patients live in rural areas and about 30% have a commute &gt; 50 miles for radiation treatment. A majority of our patients rely on public insurance (68%) with a small percentage of those uninsured (4%). Telehealth visits were rare prior to 2019 and rose to 5 and 2 visits in 2020 and 2021, respectively. Conclusions: Head and neck cancer patients, despite rurality or distance from a cancer centre, may present with alarmingly enough symptoms despite limitations and difficulties with seeking medical attention even during the COVID-19 pandemic in 2020. However, providers must be aware of these potential disparities that exist in the rural population and seek to address these.

Comparison of patient demographics at a free clinic prior to versus during the COVID-19 pandemic

To the Editor: The COVID-19 pandemic exacerbated barriers to health care. A lack of health insurance impedes access; thus, uninsured patients rely on free clinics, emergency departments, and urgent cares for their health care needs.1Newton M.F. Keirns C.C. Cunningham R. Hayward R.A. Stanley R. Uninsured adults presenting to US emergency departments: assumptions vs DATA.JAMA. 2008; 300: 1914-1924Crossref PubMed Scopus (136) Google Scholar Access to specialty care is scarce for patients who are uninsured, belong to a minority, and have a lower socioeconomic status.2Buster K.J. Stevens E.I. Elmets C.A. Dermatologic health disparities.Dermatol Clin. 2012; 30: 53-viiiAbstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar This study assessed who was seen, how they were seen, and what was treated at a free clinic during a pandemic versus “normal” times. With institutional review board approval, a retrospective chart review was performed on all dermatology visits during the COVID-19 pandemic (June 1, 2020, through December 31, 2020) and prior to COVID-19 (June 1, 2019, through December 31, 2019). The information collected included demographics, diagnosis, treatment, procedures performed, appointment type (in-person vs telemedicine), and overall attendance rates. In 2020, the clinic transitioned to 41% synchronous-only telemedicine appointments, which were largely audio-only given the general socioeconomic status of this patient population. Demographics did not significantly differ (Fig 1). However, the no-show rate significantly improved in 2020 (P = .002). No-show was defined as patients who did not attend their in-person appointment or who did not answer their phone after 3 call attempts. This improvement in 2020 suggests that either patients perceived that their condition warranted the risk to be seen in-person or telemedicine increased access to care by circumventing external factors such as transportation, childcare, or work hours. Notably, significantly fewer (P = .002) new patients were seen in 2020. Cutaneous malignancies and benign lesions (seborrheic keratoses, actinic keratoses, dermatofibromas, and warts) were more common in 2019, which we attributed to in-person only visits and more Caucasian patients being seen (51% in 2019 vs 44% in 2020) (Fig 2). Rashes included psoriasis, atopic dermatitis, and other eczema variants. Chronic, stable conditions appeared to be ideal for telemedicine, and they accounted for 61% of the telemedicine visits. Infections were uncommonly treated both years, and we suspect that these patients sought care at urgent cares or emergency departments. Roughly the same number of autoimmune conditions (discoid lupus erythematosus, systemic lupus erythematosus, pemphigus vulgaris, and lichen planus) were treated between 2019 and 2020. Interestingly, even these chronic-stable patients were effectively managed via telemedicine. Finally, patients seen in 2020 were more likely to receive prescription treatment, including both refills and new prescriptions. There was a statistically significant increase in prescriptions written during the 2020 telemedicine versus in-person appointments both years (2019 [P = .013], 2020 [P = .032]); supporting the use of telemedicine for stable patients requiring refills. Differences in treatment types (ie, topicals, oral medications, etc.) did not reach significance between the years or appointment types. Topicals included steroids and antifungals. Oral medications included antibiotics, methotrexate, prednisone, and nonsteroidal anti-inflammatory drugs. Biologics included apremilast, adalimumab, and ustekinumab. More procedures were performed per in-person appointment in 2020 than in 2019 (P = .244). This suggests that the clinic allocated in-person appointments to patients who were more likely to require physical interventions. This study demonstrates that a free clinic can manage a variety of dermatologic conditions not limited to cutaneous malignancies. It also supports the continued use of telemedicine in dermatology because this may increase access to care for established patients. None disclosed.