Care For Underserved Populations Research Articles

Abstract B115: Intensive Course in genetic cancer risk assessment: Empowering clinicians, expanding clinical knowledge, and elevating care in underserved populations

Abstract Background: Despite efforts to integrate genetic cancer risk assessment (GCRA) services into mainstream medicine, the dearth of healthcare providers adequately trained in clinical cancer genetics remains a significant barrier to care, particularly in underserved communities. Since 2001, City of Hope has helped address this need through a distance mediated lntensive Course (IC) and Clinical Cancer Genomics Community of Practice (CCGCoP), with a focus on training and supporting clinicians who deliver care to underserved patient populations. Here we report on the reach, education, and practice outcomes from the past five annual cohorts of the IC in its pursuit to expand GCRA care to underserved areas and minority populations. Methods: Practice catchment area and patient population data were collected on the course application. Cancer genetics knowledge was assessed at baseline and immediate post-course; professional self-efficacy and practice changes were measured at baseline, immediate, and 12 months post-course. Results: Of 762 participants from five IC cohorts (2020-2024), 566 (74%) indicated they provide all or part of their care in an underserved area and/or to minority populations; 55 (10%) practice outside the U.S. Of these 566 clinicians, mean pre-to-post course knowledge scores increased 59%, and mean pre-to-post self-efficacy scores increased by 38%. Of 195 participants who completed a one-year post-course practice survey, 68 (35%) did not practice GCRA at baseline, of whom 61 (88%) reported implementing GCRA into their practice one-year post-course. Of 126 participants who were practicing GCRA at baseline, 55 (44%) reported an increase in their GCRA patient volume at one-year post-course. Open-ended feedback revealed that participants highly valued IC training and ongoing CCGCoP support for building and sustaining their GCRA skills, resources, and practices. Conclusions:Results demonstrate the efficacy of distance-mediated training and ongoing practice support in enhancing clinician competencies and knowledge of practicing GCRA therefore increasing access to GCRA services for underserved and minority patient populations. Efforts are underway to leverage the resources of the IC and CCGCoP to develop a more flexible, cost-effective course model and collaborate with champions to increase access to best practices in GCRA in diverse underserved settings across the US and internationally. Citation Format: Dev Tanna, John Luna, Alex Capasso, Kathleen Blazer. Intensive Course in genetic cancer risk assessment: Empowering clinicians, expanding clinical knowledge, and elevating care in underserved populations [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B115.

A Scoping Review of Medical Mistrust Among Racial, Ethnic, and Gender Minorities With Breast and Ovarian Cancer.

An overarching theme in clinical literature suggests an inherent mistrust among populations of color within the healthcare system and the importance of healthcare professionals to bridge this gap in care. This is especially true when addressing cancer care in underserved populations due to mistrust in providers, diagnostic tools, and treatments. Ovarian cancer is difficult to diagnose early in all populations; however, women of color who have an intrinsic mistrust of the medical community will delay or refuse screenings or treatments that could be greatly beneficial. Similarly, although breast cancer rates are high in women of color, many are reluctant to utilize genetic screenings or counseling services due to bad experiences with healthcare, both personally and within their community. Moreover, transgender patients are at a unique disadvantage, as they face barriers to accessing culturally competent care while also being at a higher risk for developing cancer. The objective of this study was to conduct a scoping review of the literature in order to synthesize knowledge about the climate of mistrust between medical providers and racial, ethnic, and gender minorities with breast cancer and ovarian cancer. It is imperative for healthcare workers to acknowledge medical mistrust and strive to reduce internalized bias, increase their availability to patients, and ensure patients feel heard, respected, and well cared for during visits. Improving care by physicians can enhance trust between underserved communities and healthcare workers, encouraging all people to actively seek proper medical care and cancer screening, potentially resulting in a reduction of mortality and morbidity rates.

New Frontiers in Breast Cancer Imaging: The Rise of AI.

Artificial intelligence (AI) has been implemented in multiple fields of medicine to assist in the diagnosis and treatment of patients. AI implementation in radiology, more specifically for breast imaging, has advanced considerably. Breast cancer is one of the most important causes of cancer mortality among women, and there has been increased attention towards creating more efficacious methods for breast cancer detection utilizing AI to improve radiologist accuracy and efficiency to meet the increasing demand of our patients. AI can be applied to imaging studies to improve image quality, increase interpretation accuracy, and improve time efficiency and cost efficiency. AI applied to mammography, ultrasound, and MRI allows for improved cancer detection and diagnosis while decreasing intra- and interobserver variability. The synergistic effect between a radiologist and AI has the potential to improve patient care in underserved populations with the intention of providing quality and equitable care for all. Additionally, AI has allowed for improved risk stratification. Further, AI application can have treatment implications as well by identifying upstage risk of ductal carcinoma in situ (DCIS) to invasive carcinoma and by better predicting individualized patient response to neoadjuvant chemotherapy. AI has potential for advancement in pre-operative 3-dimensional models of the breast as well as improved viability of reconstructive grafts.

Telemedicine in diabetic eye care: A meta-analysis of its effectiveness in underserved populations

Telemedicine has emerged as a promising tool in diabetic eye care, particularly for underserved populations facing barriers to accessing traditional healthcare services. This meta-analysis aims to evaluate the effectiveness of telemedicine interventions in managing diabetic eye conditions within underserved communities. Through a systematic review of existing literature, encompassing diverse telemedicine approaches such as remote screening, teleconsultation, and telemonitoring. These studies were conducted across various regions with underserved populations, including rural areas, low-income urban neighborhoods, and underserved ethnic groups. The meta-analysis revealed significant improvements in several key outcome measures. Firstly, telemedicine interventions led to increased rates of early detection of diabetic retinopathy and other diabetic eye complications, facilitating timely intervention and preventing progression to more severe stages of the disease. Secondly, telemedicine facilitated better access to specialist care, overcoming geographical barriers and reducing the burden of travel for patients. Thirdly, telemedicine interventions were associated with improved patient compliance with follow-up appointments and treatment regimens, leading to better long-term management of diabetic eye conditions. Moreover, subgroup analyses revealed that telemedicine was particularly effective in reaching vulnerable populations such as elderly individuals, those with limited mobility, and ethnic minorities, thereby addressing disparities in healthcare access. Telemedicine holds great promise as an effective tool for diabetic eye care in underserved populations, offering a scalable and cost-effective approach to improving access to timely screening, diagnosis, and management of diabetic eye conditions. Further research and implementation efforts are warranted to optimize telemedicine interventions and ensure equitable access to quality eye care for all.

Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): Vision and refractive error results

ABSTRACT Clinical relevance Optometrists can play a key role in providing access to eye care in underserved populations by organising community-based eye health screenings that include optometric exams to detect vision impairment and uncorrected refractive error. Background Community-based eye health screenings and optometric exams were conducted in the NYC-SIGHT Study. Methods A sub-analysis of vision impairment and refractive error results within a 5-year prospective, cluster-randomised clinical trial. Eligible individuals (age ≥40 years) were recruited from 10 affordable housing developments in Upper Manhattan. Developments were randomised into usual care (received glasses prescription only) and intervention (free glasses) groups. Participants with 6/12 visual acuity or worse, intraocular pressure 23–29 mmHg, or an unreadable fundus image were scheduled with the study optometrist for refraction and a non-dilated exam. Visual improvement data were obtained by comparing the presenting acuity at screening compared to the best corrected acuity after refraction by the optometrist. Chi-square, two-sample t-tests, and a stepwise multivariate logistic regression model were used to determined factors associated with improvable visual impairment. Results Seven hundred and eight participants completed screening, 308 received an optometric exam. Those with improvable vision impairment (n = 251), mean age: 69.8 years, 70.5% female, 53% African American, 39.8% Hispanic, >95% had health insurance. Refractive error diagnosed in 87.8% of the participants; lines of improvement: 2 lines (n = 59), 3 to 5 lines (n = 120), and ≥6 lines (n = 72). Stepwise multivariate logistic regression analysis showed that participants with visual acuity 6/12 or worse (odds ratio 16.041, 95% confidence interval 6.009 to 42.822, p = 0.000) or a normal fundus image (odds ratio 2.783, 95% confidence interval 1.001 to 7.740, p = 0.05) had significantly higher odds of improvable vision impairment. Conclusion This innovative, targeted community-based study included an optometrist who detected high rates of refractive error and improvable vision impairment in an underserved population living in New York City.

Preparing behavioral health clinicians for success and retention in rural safety net practices.

This study assesses how, among behavioral health clinicians working in rural safety net practices, the amount of exposure to care in rural underserved communities received during training relates to confidence in skills important in their work settings, successes in jobs and communities, and anticipated retention. This study uses survey data from Licensed Clinical Social Workers, Licensed Professional Counselors, and Psychologists working in rural safety net practices in 21 states while receiving educational loan repayment support from the National Health Service Corps, from 2015 to April 2022. Of the 778 survey respondents working in rural counties, 486 (62.5%) reported they had formal education experiences with medically underserved populations during their professional training, for a median of 47 weeks. In analyses adjusting for potential confounders, the estimated amount of rural training exposure was positively associated with a variety of indicators of clinicians' integration and fit with their communities as well as with longer anticipated retention within their rural safety net practices. The amount of training in care for rural underserved populations was not associated with clinicians' confidence levels in various professional skills or successes in their work, including connection with patients and work satisfaction. Formal training in care for underserved populations is a large part of the education of behavioral health clinicians who later work in rural safety net practices. More training in rural underserved care for these clinicians is associated with greater integration and fit in their communities and longer anticipated retention in their practices, but not with skills confidence or practice outcomes.

The Chicagoland Free Clinics Consortium: A Model for Student-Run Free Clinic Collaboration.

While student-run free clinics (SRFCs) play an important role in care for underserved populations, few mechanisms exist to promote collaboration among regional SRFCs. To address this gap, the Chicagoland Free Clinics Consortium (CFCC) was formed to (1) facilitate collaboration between Chicagoland SRFCs, (2) provide innovation grant funding, and (3) host an annual conference. In 2018, students from the Pritzker School of Medicine founded the CFCC and partnered with peers from area schools to implement programming. Between 2018 and 2022, CFCC engaged 23 SRFCs representing all 6 Chicagoland schools, held 4 annual conferences, and distributed $15,423 in grants to 19 projects at 14 SRFC sites. A total of 176 students from 5 schools attended the 4 conferences. In 2022, 82 unique participants were surveyed, and 66% (54/82) responded. Eighty percent (43/54) reported they were "more likely to collaborate with other Chicagoland free clinics." In 2022, all grant sites were surveyed and 84% (16/19) responded. Most (87%,14/16) agreed the grant "allowed them to implement a project that would not have otherwise been accomplished" and 21% (4/19) were inter-institutional collaborations. To our knowledge, CFCC is the first student-led organization to promote sustained collaboration across SRFCs in a metropolitan area.

Podcast on Identifying and Understanding Barriers to Care in Underserved Populations With MS in the United States.

Multiple sclerosis (MS) can affect people from all racial and ethnic backgrounds, but, historically, the incidence of MS in the United States was thought to be highest in White individuals. More recent data suggest that the incidence of MS in Black or African American individuals is comparable to that in White individuals. In Hispanic or Latino individuals, incidence of MS is lower, but age of onset may be earlier compared with White individuals. Additionally, there are important differences in MS disease severity, disease progression, and mortality in Black or African American and Hispanic or Latino populations. Compared with their White counterparts, individuals from these underrepresented groups are more likely to be affected by MS in specific areas of the nervous system, such as accelerated loss of retinal and brain tissue in Black or African American individuals and optic neuritis in Hispanic individuals. Additionally, Black or African American individuals with MS tend to have an aggressive disease course, earlier disability, and higher risk of requiring ambulatory assistance. Although these differences may be attributed to genetic factors, systemic racism and biases and barriers to accessing care may perpetuate health disparities. Moreover, non-White communities remain broadly underrepresented in clinical trials; however, it is vital that these populations are appropriately represented so that any potential differences in drug efficacy or safety implications are detected. Thus, it is important to increase awareness of MS in these populations. In this podcast, the authors discuss characteristics of MS in Black or African American and Hispanic or Latino populations, identify barriers to care, and propose solutions to improve access to MS care in these populations. MP4 (358385 KB).

Racial and ethnic diversity of National Comprehensive Cancer Network (NCCN) committee members.

81 Background: Racial and ethnic disparities are pervasive in cancer care including within the workforce and in leadership. A diverse workforce can increase patient satisfaction, treatment adherence, and improve optimal care in underserved populations. NCCN committees set the standard of care for cancer diagnosis, treatment, and survivorship, but little is known about the diversity of committee members. Methods: All NCCN organ-specific treatment guidelines from 2022 were reviewed; demographics including degree and leadership role were documented. Photographs were collected via online search and race, ethnicity, and gender were determined using a combination of facial recognition software and manual review. Academic rank and H-index were collected from professional profiles and Scopus, respectively. Multivariate analysis (MVA) assessed diversity of committees of the deadliest cancers in Black and Hispanic patients (breast, cervical, colon, gastric, gastrointestinal, hepatobiliary, multiple myeloma, non-small cell lung, pancreatic, prostate, rectal, small cell lung, and uterine cancers). Results: 1,172 unique members were found, representing 62 NCCN committees (median: 33.5 members; range: 24-40). Photographs could not be identified for 3, leaving 1,169 as the final sample. NCCN members were 74% White, 24% Asian, 2% Black, and 3% Hispanic. Members were mostly male (62%) and senior faculty (71%). Women were more likely to be junior faculty (25% vs 37% men, p<0.001) with lower median H-Index (20 vs 30 men, p<0.001). Less than half of committees (42%) had at least 1 Black member; most (76%) had at least 1 Hispanic member. The majority (82%) had at least 1 Black or Hispanic member. Of 63 Chairs, most were White (81%) and the remainder were Asian (19%). Of 59 Vice Chairs, 80% were White, 14% were Asian, and 7% were Black. There were no identified Hispanic committee Chairs or Vice Chairs. Committees for the deadliest cancers in Black and Hispanic patients were no more likely to have a respective Black (OR=1.25, 95%CI 0.58-2.71, p=NS) or Hispanic (OR=1.08, 95%CI 0.59-1.97, p=NS) committee member. On MVA, being female (OR=1.27; 95%CI: 1.01-1.58; p=0.038) and having a higher H-index (16-30: OR=1.41; 95%CI: 1.03-1.94; p=0.033; >30: OR=1.83; 95%CI: 1.32-2.55; p<0.001) were associated with increased odds of serving on a committee of a cancer deadliest in Black and Hispanic patients; neither race nor ethnicity increased the odds of serving on these committees. Conclusions: NCCN committee members in 2022 were predominantly White and Asian, with few Chair positions held by Black or Hispanic members. Less than half of committees had any Black member and committees providing guidelines for cancers with high mortality rates in Black and Hispanic patients were no more likely to have diverse members. Future efforts should focus on both diversifying the physician workforce and within leadership positions in oncology.

Retention in an mHealth App Aiming to Promote the Use of HIV Pre-Exposure Prophylaxis Among Female Sex Workers in Dar es Salaam, Tanzania: Prospective Cohort Study.

Increasing access to smartphones in sub-Saharan Africa offers an opportunity to leverage mobile health (mHealth) technology to improve access to health care in underserved populations. In the domain of HIV prevention, mHealth interventions can potentially contribute to solving the challenges of suboptimal adherence to pre-exposure prophylaxis (PrEP) and low retention in PrEP services among populations most vulnerable to HIV acquisition. However, there is a gap in the knowledge about the use of such interventions in sub-Saharan Africa. This study aims to evaluate the extent and predictors of retention in an mHealth app (Jichunge) that aims to promote adherence to PrEP and retention in PrEP care among female sex workers in Dar es Salaam, Tanzania. A prospective cohort of female sex workers residing in Dar es Salaam were recruited, using respondent-driven sampling. All participants were provided with the Jichunge app as they started PrEP. A questionnaire was used to collect data on sociodemographics and other structural factors, while app use data for the 60-day period following the first 150 days of being in the intervention arm were extracted from the app's back end. A multivariable log-binomial model was used to determine predictors of 6-month retention in the Jichunge app. A total of 470 female sex workers were recruited. Nearly three-quarters of participants (206/284, 72.5%) who came to the 6-month follow-up interview no longer had the Jichunge app on their phones. The majority of these participants (193/206, 93.7%) no longer had access to the app because of issues related to their phones. Data extracted from the back end of the app showed that the use of the app declined over time, and only 13.4% (63/470) of the participants were retained (continued to use the app) after 6 months of intervention. At 6 months, women aged ≥35 years were >2 times more likely to use the app than women aged 18 to 24 years (adjusted risk ratio [aRR] 2.2, 95% CI 1.2-4.1; P=.01). Furthermore, retention in the app was higher among participants who demonstrated high PrEP awareness at baseline (aRR 1.8, 95% CI 1.1-3; P=.01) and among those who had experienced financial difficulties due to health care spending (aRR 1.9, 95% CI 1.2-3.2; P=.01). Most female sex workers (206/284, 72.5%) who were enrolled in PrEP care in Tanzania no longer used the Jichunge app after 6 months. Retention in the app at 6 months was predicted by older age, high PrEP awareness, and financial difficulties due to health care spending. Strategies for the long-term retention of participants in mHealth apps, such as systems for reinstallations of apps, should be considered during the design phase.

Preliminary Workforce Outcomes of an Urban Longitudinal Integrated Clerkship.

The authors examined whether students participating in an urban longitudinal integrated clerkship (LIC) with a curriculum focused on care for underserved populations have a sustained commitment to urban underserved care through residency training and into practice. This mixed-methods study collected data from medical student application essays to the Denver Health LIC (DH-LIC), end-of-course surveys, residency match outcomes, and postgraduation surveys annually for academic years 2014 to 2022. The authors analyzed students' responses to the surveys on interest in working with underserved patients, understanding the rewards and challenges of working in safety net institutions, working in the community to improve health, and working at DH. The authors qualitatively coded the 70 application essays of all selected students using summative content analysis. Seventy DH-LIC students were compared with 1,450 medical students between 2014 and 2022. Qualitative analysis of LIC application essays revealed 3 themes: interest in working with underserved populations, work experience with underserved populations, and personal experience with medical vulnerability. Fifty-seven DH-LIC participants (81.4%) expressed high levels of career interest in working with underserved populations, 45 (64.3%) had high levels of work experience with underserved populations, and 18 (25.7%) expressed high levels of personal experience. Graduates of the DH-LIC program demonstrated a high degree of continuing interest in practicing in urban underserved settings throughout medical school and postgraduate training. Ten graduates (71.4%) in practice work in urban underserved settings. Participants reported a high or very high level of interest and commitment to working with underserved populations (96.7%-100%), understanding the safety net health care system (91.7%-98.6%), and working in communities (95.0%-100%) at all time points studied. Early data indicate high rates of graduates working in urban underserved settings. These preliminary outcomes suggest the LIC may support the development of a committed workforce for urban underserved communities.

Recruiting Populations at Higher Risk for Glaucoma and Other Eye Diseases Experiencing Eye Health Disparities

ABSTRACT Purpose We compared recruitment of participants at high risk for glaucoma and other eye diseases in three community-based studies designed to improve access to eye care in underserved populations in New York City, Alabama, and Michigan. Methods We used (1) participant data collected at enrollment (e.g. demographic, medical conditions, healthcare access, and method of hearing about study) and (2) interviews with study staff to assess effective recruitment strategies in enrolling people at high risk for eye disease. We analyzed participant data using descriptive statistics and interview data using content analysis to categorize responses to questions. Results In these community-based studies, all sites recruited greater proportions of populations with increased risk of eye disease compared to their estimates in the US population. High-risk characteristics varied based on the setting (i.e. Federally Qualified Health Centers or affordable housing buildings). Older adults represented 35% to 57%; 43% to 56% identified as Black; 1% to 40% as Hispanic/Latino; 20% to 42% reported a family history of glaucoma; 32% to 61% reported diabetes; and 50% to 67% reported high blood pressure. Social risk factors for under-utilization of eye care due to poverty included that 43% to 70% of participants had high school or lower education; 16% to 40% were employed; and 7% and 31% had no health insurance. From a qualitative perspective, active, personalized, culturally sensitive methods were most effective in recruiting participants. Conclusion Implementing eye disease detection interventions in community-based settings facilitated recruiting individuals at high risk for glaucoma and other eye diseases.

The Local Market of Major Teaching Hospitals.

The purpose of this study was to describe the local communities served by major teaching hospitals. Using a dataset of hospitals around the United States provided by the Association of American Medical Colleges, we identified major teaching hospitals (MTHs) using the Association of American Medical Colleges' definition of those with an intern-to-resident bed ratio above 0.25 and more than 100 beds. We defined the local geographic market surrounding these hospitals as the Dartmouth Atlas hospital service area (HSA). Using MATLAB R2020b software, data from each ZIP Code Tabulation Area from the US Census Bureau's 2019 American Community Survey 5-Year Estimate Data tables were grouped by HSA and attributed to each MTH. One-sample t tests were used to evaluate for statistical differences between the HSAs and the US average data. We further stratified the data into regions as defined by the US Census Bureau: West, Midwest, Northeast, and South. One-sample t tests were used to evaluate for statistical differences between MTH HSA regional populations with their respective US regional population. The local population surrounding 299 unique MTHs covered 180 HSAs and was 57% White, 51% female, 14% older than 65 years old, 37% with public insurance coverage, 12% with any disability, and 40% with at least a bachelor's degree. Compared with the overall US population, HSAs surrounding MTHs had higher percentages of female residents, Black/African American residents, and residents enrolled in Medicare. In contrast, these communities also showed higher average household and per capita income, higher percentages of bachelor's degree attainment, and lower rates of any disability or Medicaid insurance. Our analysis suggests that the local population surrounding MTHs is representative of the wide-ranging ethnic and economic diversity of the US population that is advantaged in some ways and disadvantaged in others. MTHs continue to play an important role in caring for a diverse population. To support and improve policy related to the reimbursement of uncompensated care and care of underserved populations, researchers and policy makers must work to better delineate and make transparent local hospital markets.

677 Need for improved access to dermatologic care in underserved populations

677 Need for improved access to dermatologic care in underserved populations

APAF Receives Grant to Expand Diversity Leadership Fellowship

Back to table of contents Previous article Next article APA & MeetingsFull AccessAPAF Receives Grant to Expand Diversity Leadership FellowshipKatie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:28 Dec 2022https://doi.org/10.1176/appi.pn.2023.01.1.41AbstractThe Sozosei Foundation awarded the APA Foundation a $230,000, two-year grant to expand the APA/APAF Diversity Leadership Fellowship, allowing 10 additional fellows to participate in field placements where they can receive hands-on experience in delivering culturally competent psychiatric care.Many trainees start their residencies harboring hopes of the good they will do as psychiatrists but become disheartened over time, said Muniza Majoka, M.B.B.S. Yet the APA/APA Foundation (APAF) Diversity Leadership Fellowship reminds them of what a huge difference they can make, inspiring them to do even more, said Majoka, who was the 2021-2022 APA/APAF SAMHSA/Diversity Leadership Fellowship Program chair. Now, 10 new fellowship slots will be available for trainees interested in getting hands-on experience serving communities that are all-too-often overlooked, thanks to a $230,000, two-year grant from the Sozosei Foundation. The philanthropic arm of Otsuka Pharmaceuticals, the Sozosei Foundation has a primary focus on eliminating the criminalization of mental illness. The grant will be used to create the Community Diversity Fellowship so 10 fellows can participate in a field component, as well as the other Diversity Leadership fellowship offerings, said APAF Executive Director Rawle Andrews Jr., Esq. “A lot of our patients face problems with incarceration, not having appropriate access to care and facing various social determinants of mental health,” Majoka said. “Grants like this, which increase the availability of training for the new generation of psychiatrists to provide better care for underserved populations, are extremely encouraging.” APA/APAF’s Diversity Leadership Fellowships provide mentorship to fellows; provides stipends to attend professional meetings; and provide opportunities to gain leadership experience serving on APA’s councils, committees, and workgroups. They also allow fellows to develop relationships with a diverse group of peers who have similar career interests and goals. “This new funding opportunity for the APA Foundation moves the needle toward destigmatizing mental illness and appreciating mental health as a central element of all health and well-being,” says Petros Levounis, M.D., M.A.“We are doing something right whenever we capitalize on an opportunity to encourage the next generation of psychiatrists to get involved with APA and advocate for our patients,” said APA President-elect Petros Levounis, M.D., M.A. “Fellows will sharpen their skills in research, public speaking, and administration—skills that will help them become the leaders of our future. But beyond that, the experience will also instill in them a deeper love for psychiatry as they work closely with people who have dedicated their lives to our patients and our profession.” Fellows will be matched with a host site where they can receive hands-on experience in psychiatry in a community-based setting, providing culturally competent care to underrepresented populations. APAF is in the process of selecting host sites, such as the HOPE Center in Harlem, which seeks to minimize the stigma around communities of color when seeking mental health services (“Partnership Between Psychiatrists, Faith Leaders Untapped Key to Expanding Reach of MH Care”). Levounis was awarded an APA Minority Fellowship while he trained in addiction psychiatry at New York University. He conducted a research project on homeless people who have substance use disorders and other severe psychiatric disorders. “I can say that this experience was the springboard for my engagement both with academic psychiatry as well as advocacy,” he said. “People with mental illness have been discriminated against, disenfranchised, and stigmatized,” he continued. “Just by being a psychiatrist, we have the added responsibility to fight for our patients.”“For many people, adverse childhood experiences [ACEs] create a slippery slope,” Andrews said. “They find themselves trapped as they grow up, and they cannot break what has become a vicious cycle of overincarceration. We also know that instances of depression and anxiety continue to rise at alarming rates. When mental health problems arise, many families don’t know what to do or they are leery about the financial costs, so they suffer in silence. We believe that our community psychiatrists have a more complete, holistic view of what is happening inside the homes in our communities, and grants like these grow the capacity to help many more community members take the first step toward well-being.” ■“APA Foundation Receives $230,000 Grant from the Sozosei Foundation to Support Diversity Leadership Fellowships” ISSUES NewArchived

Advanced Nursing Practice and Advanced Practice Nursing roles within low and lower-middle-income countries.

Population health initiatives rely on the availability and skills of an appropriate workforce to meet required goals. One global workforce initiative with demonstrated ability to expand health care services and improve access to care is the development of Advanced Nursing Practice and Advanced Practice Nursing roles. Given the sparse published information about these roles in Low and Lower-Middle-Income countries, this study seeks to describe their development and application in these countries. The researchers developed a descriptive cross-sectional multilingual survey for online distribution to nursing experts within the targeted countries. Survey questions addressed demographic information on the population served, Advanced Nursing Practice and Advanced Practice Nursing titles, the time frame and rationale for creating the title, and how the roles relate to the International Council of Nurses' Advanced Practice Nursing guidelines characteristics of education, practice, and regulation. Of the 167 responses received, only 24 participants met the inclusion criteria. This represented five low-income countries and nineteen lower-middle-income countries from four World Bank regions. Seventy-one roles were identified. Roles emerged predominantly over the last 20 years, focusing on care for underserved populations, with an almost even spread across primary and acute care settings. There were differences in education, practice, and regulation amongst the roles. Roles that required a master's education or higher with practice-related characteristics had a broader scope of practice, which is consistent with international guidelines. This paper describes how Advanced Nursing Practice and Advanced Practice Nursing roles from Low and Lower Middle-Income Countries have been implemented to address gaps in service and highlights disparities in education, practice and regulation compared to international guidelines. Maintaining and increasing support from organizations and universities internationally may be required to assist in developing and expanding educational programs for advanced nursing roles in these countries. Understanding how these advanced nursing roles are operationalized in relation to education, practice, and regulation in Low and Lower-Middle-Income countries can provide baseline information that will inform workforce development policies to address healthcare needs in similar jurisdictions.

Benefits and challenges to ophthalmology training via the Specialist Training Program.

The Specialist Training Program (STP) is a commonwealth funding initiative to support specialist medical training positions in regional, rural and remote areas, and in private settings. The program helps to improve the skills and distribution of the specialist medical workforce by providing trainees experience of a broader range of healthcare settings. To examine the benefits and challenges of ophthalmology training delivered by the STP in regional, rural, remote, and/or private settings across Australia. Qualitative design involving semi-structured in-depth interviews with thirty-two participants experienced in the delivery of ophthalmology training at STP posts including ophthalmology trainees (n=8), STP supervisors and clinical tutors (n=16), and other stakeholders (n=8). Training delivered at STP posts was reportedly beneficial for ophthalmology trainees, their supervisors and the broader community given it enabled exposure to regional, rural, remote and private settings, access to unique learning opportunities, provided workforce support and renewal, and affordable ophthalmic care. However, all participants also reported challenges including difficulties achieving work/life balance, unmet training expectations, a lack of professional support, and financial and administrative burden. Malalignment between trainee preferences for STP posts, low STP literacy and limited regional, rural and remote training experiences were also seen as missed opportunities to foster future rural ophthalmic workforce development. The STP improves access to ophthalmic care in underserved populations while enabling valuable rural and/or private practice exposure for medical specialist trainees and workforce support for supervising ophthalmologists. Efforts are needed to improve the quality of training experiences provided at STP posts and post sustainability. Although research is needed to investigate the longer-term benefits of the STP to rural and/or private workforce recruitment and retention, RANZCO should develop further regional, rural and remote STP posts to help realise future rural practice intention amongst ophthalmology trainees.

Effective Low-Cost Ophthalmological Screening With a Novel iPhone Fundus Camera at Community Centers.

Ophthalmologic care is inaccessible to many people due to a variety of factors, including the availability of providers, cost of equipment for ophthalmologic care, and transportation to clinics and appointments. Because many causes of blindness are both highly prevalent and preventable once identified, it is essential to address gaps in care for underserved populations. We developed a novel 3D-printed mobile retinal camera. In this study, we organized recurring student-run screening events around New York City that took place in community centers and churches, at which we utilized our device to take retinal images. Our screening events reached a diverse population of New Yorkers, disproportionately those with lower household income, many of whom had not had recent eye exams. To validate the device for use in telehealth ophthalmologic visits, we transmitted the images to a remote ophthalmologist for evaluation and compared the result with an on-site attending physician’s dilated eye exam. The subjective assessment indicated that 97% of images captured with the mobile retinal camera were acceptable for telehealth analysis. Remote image assessment by achieved 92% sensitivity and 83% specificity in detecting optic disc cupping, compared to the gold-standard on-site dilated eye exam. In addition, the device was portable, affordable, and able to be used by those with relatively little ophthalmologic training. We have demonstrated the utility of this affordable mobile retinal camera for telehealth ophthalmologic evaluation during community screening events that reached an underserved population to detect disease and connect with long-term care.

Occupational Therapy in Primary Health Care for Underserved Populations: A Scoping Review

The aim of this scoping review was to identify what current and potential opportunities exist for occupational therapy in primary healthcare for underserved populations. Search phrases were utilized across several databases and Occupational Therapy specific journals were hand searched. Nineteen articles met inclusion criteria: English, 2009–2021, services delivered by occupational therapy practitioners or supervised students, for underserved populations/individuals, in community-based care, and primary health care settings. Five synergistic themes emerged from the literature are discussed: Client-centered, team collaboration, holistic and preventative health and wellness, evidence-based program evaluation, and innovative service delivery.

Reaching underserved people during the pandemic

Background: As the COVID-19 crisis evolved, many emergency medical technicians (EMTs) and community paramedics (CPs) were already positioned to engage with both the community and the health system. Aim: This project, based in Indiana, USA, aimed to provide resources for EMTs and CPs to build knowledge and skills necessary to use promising practices related to COVID-19 and provide culturally competent care using telehealth to improve access to care for underserved populations during the pandemic. Methods: Between May 2020 and April 2021, EMT and CP participants completed a retrospective pre-test and post-test assessing self-efficacy around best practices related to COVID-19 and culturally competent care using telehealth. Findings: Forty-nine EMTs and CPs completed the project and results demonstrate a significant (P<0.05) improvement in self-reported level of preparedness to demonstrate best practices related to COVID-19 culturally competent care using telehealth. Conclusion: The project identified a potentially effective strategy for increasing practitioner self-efficacy, resulting in a more effective system for caring for vulnerable individuals during a pandemic.