Difficulty Accessing Healthcare Services Research Articles

Behind Prep Decisions: Understanding User Patterns and Discontinuation Factors in Real-World.

This study aimed to characterize the epidemiological aspects of PrEP use and barriers to accessing this prophylaxis. This cross-sectional study was conducted between January 2021 and April 2022, encompassing 140 PrEP users treated at the Testing and Counseling Center (CTA) in Campo Grande, Mato Grosso do Sul. Data on sociodemographic characteristics and factors associated with PrEP discontinuation were obtained using a standardized questionnaire. Most PrEP users were cisgender men (92.00%), predominantly white (51.00%), over 30years of age (56.50%), homosexual-oriented (76.50%), and had a minimum of 12years of education (77.50%). Approximately 60.00% admitted to inconsistent condom use in recent sexual encounters, primarily involving anal intercourse. Approximately 88.00% perceived themselves as at risk of contracting STIs in the upcoming year. Regarding new presentation forms, 54.00% indicated a willingness to use "on-demand PrEP," and 92.00% expressed interest in using "injectable PrEP." After 6months of follow-up, 43.60% (95.00% CI: 35.50-52.00) discontinued PrEP use, primarily due to changes in sexual behavior (38.30%) and difficulties accessing healthcare services (21.28%). This study underscores the need to involve diverse key populations and highlights the significance of PrEP as an ongoing monitoring strategy for HIV/STI prevention in addition to the importance of incorporating new formulations such as daily oral PrEP into the Brazilian National Health System (SUS).

Did the Coronavirus Disease 2019 (COVID-19) Pandemic Cause a Delay in the Diagnosis of Breast Cancer Patients?

Introduction The coronavirus disease 2019 (COVID-19) outbreak, first reported in Wuhan, China, in December 2019, quickly hit the world in just one month, causing a global public health emergency. We aimed to investigate whether the COVID-19 pandemic caused a delay in the hospital admissions of breast cancer patients and diagnosis of breast cancer, thus increasing the tumor size and the stage of the disease. Materials and methods Included in the study were patients who underwent breast cancer surgery between 01/03/2019 and 01/03/2020 (pre-COVID-19, first period) and between 01/03/2020 and 01/03/2021 (post-COVID-19, second period). Three hundred and seventy patients with enough details were included, and details were analyzed retrospectively. Tumor characteristics of pre-COVID-19 breast cancer patients were compared with the tumor characteristics of post-COVID-19 breast cancer patients. Demographics, preoperative diagnosis, tumor properties, surgical procedure (breast-conserving surgery, modified radical mastectomy, simple mastectomy, skin-sparing mastectomy), tumor size, total lymph node number, metastatic lymph node number, locally advanced disease, metastatic disease, and neoadjuvant therapy were evaluated. Results The mean tumor size increased significantly in the post-COVID-19 primary surgery group (p=0.005). There is no significant relationship between the pre-COVID-19 and post-COVID-19 period and pT in the neoadjuvant received group (p>0.05). The presence of pT2+pT3+pT4 was statistically significantly higher in the post-COVID-19 primary surgery group (p=0.001). The mean value of metastatic lymph nodes dissected between pre-COVID-19 and post-COVID-19 primary surgery groups increased significantly (p=0.010). Pericapsular extension was higher in the post-primary surgery group (p=0.002). Conclusion During the COVID-19 outbreak, breast cancer patients have difficulty accessing healthcare services and hesitate to apply to hospitals to fear contracting the COVID-19 disease. This situation has led to delays in diagnosing breast cancer patients, increased tumor size and pT grade, increased number of metastatic lymph nodes, pericapsular extension, and the resulting disease often appearing in advanced sizes and stages.

Intersectional Model of Service Use: Understanding Transgender and Nonbinary Healthcare Access

Transgender and nonbinary (TNB) people often have difficulty accessing healthcare services because of the systemic forces of transphobia and cisgenderism. Despite this, there is little theory specifically designed to examine healthcare access among TNB people. We conducted a literature review to identify studies examining TNB healthcare access. We screened a total of 2,050 unique articles for inclusion, resulting in a final sample of 46 articles that met the review criteria. Theories used and key findings were coded to inform the development of the Intersectional Model of Service Use (IMSU) for TNB people. The IMSU builds upon current theoretical frameworks including the Behavioral Model for Vulnerable Populations (BMVP), which proposes that predisposing, enabling, and need factors drive healthcare utilization among vulnerable populations. The IMSU combines the predisposing, enabling, and need factors of the BMVP with TNB-specific healthcare access factors identified through this integrative review. The findings from this review suggest its effectiveness in informing research and interventions aimed at improving healthcare access among TNB people.

Health for all: Primary care facility localization in Lesotho using qualitative research and GIS

BackgroundLesotho has made significant strides towards universal health coverage and yet a significant proportion of the population has difficulty accessing health care services due to mountainous terrain and long travel times to nearest health facility. There have been previous studies that utilized Geographical Information Systems (GIS) to assess access to healthcare and to identify optimal locations for placement of new health facilities, though never in Lesotho. MethodsThe authors employed a mixed-methods design. Qualitative research consisting of semi-structured interviews and focus group discussions was used to gain a deep understanding of the problem with access to healthcare and to allow for the perspectives of the people of Lesotho to guide decision-making about placement of new healthcare facilities. GIS analysis was done using ArcGIS Pro v. 2.3 software and modern satellite imagery to map current access to healthcare facilities and create site recommendations for new healthcare facilities. ResultsQualitative research revealed that walking was the primary mode of transport to healthcare facilities and that distance was the crucial barrier in limiting access to care. Decentralization in decision-making was identified as an important element in health policy decisions and study participants recommended placing health facilities centrally in large villages. GIS analysis identified that 77.7 % of the population was currently within 3-h walking distance to nearest health facility and that the addition of fifty new healthcare facilities would increase that proportion to 90.0 %. ConclusionThis study mapped current access to care in Lesotho in rural and urban areas. It also provided an objective strategy for identifying the location of new healthcare facilities while incorporating the voices of the people of Lesotho in the process. The findings can be used to assist policymakers, and the methodology can be employed in the allocation of other public-service facilities in different countries or regions.

Abstract 17863: Analysis of Social Determinants of Health, Burden of Treatment and Quality of Life in Patients With Heart Failure With Preserved and Reduced Ejection Fraction, a Single Center Study With Six Months Follow Up

Introduction: Heart failure (HF) is a chronic debilitating disease with immense burden on the patient’s life. This study aims to investigate the clinical characteristics, social determinants of health (SDOH), burden of treatment (BoT), and quality of life (QoL) of patients with heart failure with preserved and reduced ejection fraction (HFpEF and HFrEF). Methods: Data from 191 patients (63 HFpEF, 128 HFrEF) were collected from February 2022 to March 2023. Validated questionnaires including SDoH, BoT and QoL were filled by the patient on admission and in 6 months as a follow up. Descriptive statistics were used to compare the demographic and clinical characteristics of HFpEF and HFrEF patients. Inferential statistics, including logistic regression, were used to analyze the associations between SDOH, BoT, QoL, and 30-day readmission rates. Results: Distribution between both groups is similar to the general population. HFpEF patients experienced more interpersonal challenges and reported greater difficulty with self-care and usual activities. HFrEF patients had higher rates of substances, alcohol, and tobacco use. Regarding readmission, HFpEF patients with medication difficulties and HFrEF patients with difficulty accessing healthcare services were more likely to be readmitted. Both HFrEF and HFpEF patients showed significant improvement in SDOH, QoL and BoT in the follow up data (Table 1). Conclusions: The study findings highlight the distinct clinical characteristics, SDOH, BoT, and QoL factors associated with HFpEF and HFrEF. These findings can contribute to targeted interventions and improved patient care. Moreover, the study emphasizes the importance of addressing social and personal factors influencing HF outcomes, aiming to reduce healthcare disparities and improve patient well-being. The results have implications for healthcare providers, policymakers, and researchers in improving the management and outcomes of heart failure patients.

Social Connectedness and Perceived Stress Among Caregivers During the COVID-19 Pandemic: a Mixed-Methods Study.

The COVID-19 pandemic has created unprecedented stressors for caregivers due to social distancing requirements that simultaneously increased their responsibilities and reduced opportunities for social connection and support. This concurrent embedded mixed-methods study examined differences between caregivers and non-caregivers regarding the effects of social connectedness on perceived stress and explored challenges caregivers experienced related to social connectedness and perceived stress. A national online survey containing forced-choice and free-response questions was administered between April and June 2020. The survey was distributed via social media advertisements and a crowdsourcing platform to eligible adult residents in the United States (US) fluent in either English or Spanish. Multivariable regression and thematic analysis were used to analyze the quantitative and qualitative data. Mixed-methods integration occurred during the data analysis, interpretation, and reporting phases. The study sample comprised 1540 US adults (1275 non-caregivers, 265 caregivers; 65% women; 36% racial/ethnic minorities). Relative to non-caregivers, caregivers had lower levels of social connectedness and higher levels of perceived stress. Social connectedness was also inversely related to perceived stress for non-caregivers (p < 0.001) and slightly but not significantly positively related to perceived stress for caregivers. Qualitative findings showed caregivers experienced a variety of stressors including fear of COVID-19 exposure to their care recipients, disruption to usual care routines, and difficulty accessing healthcare services that may have contributed to decrements in social connectedness and higher levels of perceived stress. Findings suggest social connectedness may be beneficial for reducing perceived stress, but its impact can vary depending on individual circumstances. Overall, findings support the idea that caregivers are a particularly vulnerable sub-group of the population and may benefit from more targeted support and interventions.

Examining healthcare needs and decisions to seek health services among Venezuelan migrants living in Trinidad and Tobago using Andersen's Behavioral Model.

Beginning in 2016, Trinidad and Tobago experienced increasing flows of migrants and refugees from Venezuela. Through a Government Registration Exercise in 2019, followed by a Re-registration Exercise in 2020, migrants and refugees benefitted from access to publicly available primary care and emergency medical services. By applying Andersen's Behavioral Model for Health Service Use, our study examined the non-communicable disease care needs of migrants, and factors influencing their decision to seek public and private health services. Between September and December 2020, a health questionnaire was administered via telephone to n = 250 migrants from Venezuela. Descriptive statistics summarized the constructs of Andersen's Behavioral Model. The model comprised of predisposing factors including migrants' social characteristics; enabling factors namely monthly earnings, education level and most trusted source of information on medical needs; need for care factors such as migrants self-reported health status, presence of non-communicable health conditions and having visited a doctor in the past 12 months; and the outcome variables which were migrants' decisions to seek public and private health services. Pearson χ2 tests, odds ratios and multivariable logistic regression with backward elimination examined the factors influencing a migrant's decision to seek health services. Overall, 66.8% of migrants reported they would seek public health services, while 22.4% indicated they would seek private health services. Predisposing factors namely length of time residing in Trinidad and Tobago (p = 0.031) and living with family/friends (p = 0.049); the enabling factor of receiving information from publicly available sources (p = 0.037); and the need for care factor of visiting a doctor for a physical health problem (p = 0.010) were significant correlates of their decision to seek care in the public sector. Predisposing factors namely living with family/friends (p = 0.020) and the enabling factor of having difficulty accessing healthcare services (p = 0.045) were significant correlates of their decision to seek care from private providers. Our findings demonstrated the positive association between social networks and a migrant's decision to use public and private health services, thus underscoring the importance of family and friends in facilitating health service use, promoting proper health practices and preventing diseases. Overall, the use of Andersen's Behavioral Model aided in identifying the factors associated with the use of health services by Venezuelan migrants in Trinidad and Tobago. However, further studies are needed to better understand their need for ongoing care, to inform policy, and to plan targeted health interventions for addressing the gaps in health service access, barriers and use.

Abstract P026: Exploring factors associated with preferences for human papillomavirus (HPV) self-sampling among racially-and ethnically-diverse women: a cross-sectional study

Abstract Background: Cervical cancer rates have declined since the implementation of cervical cancer screening methods such as Pap tests. However, Pap tests are still underutilized by many minority women due to limited awareness about human papillomavirus (HPV) and cervical cancer, difficulties accessing health care services, and cultural or religious beliefs. HPV self-sampling has been proposed as an alternative to overcome some of these barriers. This study aimed to assess awareness, self-efficacy, and preferences of HPV self-sampling among racially- and ethnically-diverse women. Methods: From May – November 2021, women, ages 30-65 years old, were recruited in person and virtually to complete an online survey. The survey included 15 sociodemographic questions and five outcome measures related to HPV self-sampling: (1) awareness of test; (2) self-efficacy to conduct test; (3) location preference of test (clinic vs. home); 4) collector preference for screening strategy (self-collected vs. clinician-collected); and 5) preference of cervical cancer screening strategy (HPV self-sampling vs. Pap test). Modified Poisson regression was conducted to assess exploratory associations between sociodemographic variables and each outcome measure; relative risks were adjusted for age. Results: A total of 420 women completed the online survey, of which 32.4% identified as non-Hispanic white, 22.2% as Hispanic, 12.6% as Black/African American, 28.3% as Asian, 1.9% as American Indian/Alaskan Native, and 1.4% as more than two races. The majority of women had not heard of HPV self-sampling (93.5%) but reported high self-efficacy (75.3%). Women also reported higher preferences for completing an HPV test in the clinic (52.2%) and for performing a self-collected HPV test themselves (58.7%) yet would choose a traditional Pap test over HPV self-sampling (56.0%). Conclusion: The low level of HPV self-sampling awareness, across all racial and ethnic groups, suggests a strong opportunity to promote widespread educational efforts around this new tool. While many women, including those that are racially- and ethnically-diverse, still prefer the Pap test, the biggest barrier to their potential uptake of HPV self-sampling is a strong reliance on provider expertise. Future research should leverage the provider role in HPV self-sampling interventions as well as explore the feasibility of home-based or clinic-based HPV self-sampling approaches. Citation Format: Serena Xiong, Rahel Ghebre, Shalini Kulasingam, Susan M. Mason, Rebekah J. Pratt, DeAnn Lazovich. Exploring factors associated with preferences for human papillomavirus (HPV) self-sampling among racially-and ethnically-diverse women: a cross-sectional study. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P026.

Difficulties accessing health care in Canada during the COVID-19 pandemic: Comparing individuals with and without chronic conditions.

Individuals with chronic conditions have higher levels of health care usage and may be at higher risk of more severe outcomes from COVID-19. Therefore, they may have experienced greater difficulty accessing health care during the pandemic because of restrictions on health care services. Data from the Survey on Access to Health Care and Pharmaceuticals During the Pandemic were used to estimate the proportion of individuals in Canada, with and without chronic conditions, who experienced difficulties accessing health care services during the pandemic. Multivariate analyses examined associations between demographic, socioeconomic and health characteristics and the likelihood of experiencing difficulties accessing health care during the pandemic. Nearly one-third (32.0%) of individuals who self-reported having one or more chronic conditions and 24.2% of those who reported no conditions had one or more medical appointments cancelled, rescheduled or delayed because of COVID-19. Smaller proportions of individuals with (19.5%) and without (16.8%) chronic conditions delayed contacting a medical professional because of fear of exposure to COVID-19 in health care settings. Individuals who were younger or had a disability were also more likely than older individuals or those without a disability, respectively, to have had a medical appointment cancelled, rescheduled or delayed because of the pandemic. Women, immigrants, and individuals with multiple chronic conditions were more likely than their counterparts (men, Canadian-born individuals, and individuals with no chronic conditions, respectively) to have delayed contacting a medical professional because of fear of exposure to COVID-19. Individuals with chronic conditions were more likely than those with no chronic conditions to have experienced difficulties accessing health care during the pandemic. Consequently, these individiuals may be at greater risk of experiencing health challenges in the future.

Impact of Implementing Welcoming Clinic Space Indicators on Sexual and Gender Minority Patients' Health Care Experience.

It has been well established that those identifying as a member of the sexual and gender minority (SGM) have difficulties accessing health care services. This is strongly associated with the desire to avoid discriminatory health care practices and prejudicial providers that many SGM individuals have encountered. Implementation of specific welcoming clinic space indicators (WCSIs) has been recommended to mitigate prior health care alienation experienced by SGM individuals. The project supported three HIV clinical care sites in Louisiana to implement and maintain identified SGM WCSIs as one of its interventions to improve sexually transmitted infection screening, testing, and treatment in people with and at-risk of HIV. This project found that SGM WCSIs had a positive impact on SGM individuals and were predominately unnoticed by those that were non-SGM-identifying individuals. Further, across the entire sample, the SGM WCSIs had an extremely low (<1%) level of negative impact, eliminating the misconception that SGW WCSI implementation may offend non-SGM individuals. There were differences in the implementation of the SGM WCSIs across the three sites associated with their governance structure and priority community. Implementation of SGM WCSIs should be considered as an important component of assuring culturally competent health care for SGM individuals.

The use of drones for the delivery of diagnostic test kits and medical supplies to remote First Nations communities during Covid-19

BackgroundHealth care inequity in remote and rural Indigenous communities often involves difficulty accessing health care services and supplies. Remotely Piloted Aircraft Systems, or drones, offer a potentially cost-effective method for reducing inequity by removing geographic barriers, increasing timeliness, and improving accessibility of supplies, equipment, and remote care. MethodsWe assessed the feasibility of drones for delivery of supplies, medical equipment, and medical treatment across multiple platforms, including drone fleet development and testing; payload system integration (custom fixed-mount, winch, and parachute); and medical delivery simulations (COVID-19 test kit delivery and return, delivery of personal protective equipment, and remote ultrasound delivery and testing). ResultsDrone operational development has led to a finalized, scalable fleet of small to large drones with functional standard operating procedures across a range of scenarios, and custom payload systems including a fixed-mount, winch-based and parachute-based system. Simulation scenarios were successful, with COVID-19 test swabs returned to the lab with no signal degradation and a remote ultrasound successfully delivered and remotely guided in the field. Discussion/ConclusionsDrone-based medical delivery models offer an innovative approach to addressing longstanding issues of health care access and equity and are particularly relevant in the context of SARS-CoV-2.

POSB10 Identification of Medication-Related Problems Among RURAL Community-Dwelling Patients Receiving Telephonic Medication Therapy Management Services

Rural community-dwelling patients often have difficulty accessing healthcare services and experience poorer health outcomes. The objective of this study was to evaluate medication-related problems identified through a novel, collaborative medication therapy management (MTM) program for underserved patients in Arizona.

Sepsis: A Systematic Review of Antibiotic Resistance and Antimicrobial Therapies

Sepsis is a medical emergency that depicts the body’s systemic immune reaction to an infectious process that could result in organ dysfunction and death. Early sepsis pathogen identification and early delivery of antimicrobial therapy result in better clinical outcomes for patients diagnosed with sepsis and septic shock. Method: Systematic reviews and meta-analyses that discussed sepsis pathogen identification, antibiotic resistance and timing in the treatment of sepsis were taken into account irrespective of the approach of the included studies, quantitative or qualitative. This literature review gathers data from twelve primary studies to perform a systematic review and evaluate existing empirical antibiotic therapies in order to treat the various degrees of sepsis and minimize antibiotic resistance. The remaining reviews, case studies, etc., were used as supplementary references. The studies compiled data from laboratory tests including lactate levels, fluid resuscitation, and diagnostic diagnostics like the SOFA score. Results: This paper identifies multiple factors that must be taken into account when treating individuals with sepsis. Prior to the administration of broad-spectrum empiric antibiotics, the severity and morbidity of the disease must be addressed. Excessive antibiotic usage has been associated with increased sepsis hospitalized mortality rates, and thus it is crucial to minimize antibiotic misuse in non-septic patients. This can be accomplished by differentiating between Gram-negative and Gram-positive bacteria, the purpose of biomarkers and identifying the antibiotic resistance pathway. Many patients from low economic statuses may experience difficulties accessing healthcare services and resources for sepsis treatment when diagnosed with sepsis. Additionally, through educational efforts, promoting awareness of sepsis and the relevance of timing in sepsis therapy can help dispel misconceptions about the illness and minimize sepsis patients from receiving insufficient care.

Difficulties accessing health care services during the COVID-19 pandemic in Canada: examining the intersectionality between immigrant status and visible minority status

BackgroundDifficulties accessing health care services can result in delaying in seeking and obtaining treatment. Although these difficulties are disproportionately experienced among vulnerable groups, we know very little about how the intersectionality of realities experienced by immigrants and visible minorities can impact their access to health care services since the pandemic.MethodsUsing Statistics Canada’s Crowdsourcing Data: Impacts of COVID-19 on Canadians—Experiences of Discrimination, we combine two variables (i.e., immigrant status and visible minority status) to create a new variable called visible minority immigrant status. This multiplicative approach is commonly used in intersectionality research, which allows us to explore disadvantages experienced by minorities with multiplicative identities.ResultsMain results show that, compared to white native-born, visible minority immigrants are less likely to report difficulties accessing non-emergency surgical care (OR = 0.55, p < 0.001), non-emergency diagnostic test (OR = 0.74, p < 0.01), dental care (OR = 0.71, p < 0.001), mental health care (OR = 0.77, p < 0.05), and making an appointment for rehabilitative care (OR = 0.56, p < 0.001) but more likely to report difficulties accessing emergency services/urgent care (OR = 1.46, p < 0.05).ConclusionWe conclude that there is a dynamic interplay of factors operating at multiple levels to shape the impact of COVID-19 related needs to be addressed through changes in social policies, which can tackle unique struggles faced by visible minority immigrants.

A survey of cancer care institutions in Nepal to inform design of a pain management mobile application

BackgroundOne way to improve the delivery of oncology palliative care in low and middle-income countries (LMICs) is to leverage mobile technology to support healthcare providers in implementing pain management guidelines (PMG). However, PMG are often developed in higher-resourced settings and may not be appropriate for the resource and cultural context of LMICs.ObjectivesThis research represents a collaboration between the University of Virginia and the Nepalese Association of Palliative Care (NAPCare) to design a mobile health application (‘app’) to scale-up implementation of existing locally developed PMG.MethodsWe conducted a cross-sectional survey of clinicians within Nepal to inform design of the app. Questions focused on knowledge, beliefs, and confidence in managing cancer pain; barriers to cancer pain management; awareness and use of the NAPCare PMG; barriers to smart phone use and desired features of a mobile app.FindingsSurveys were completed by 97 palliative care and/or oncology healthcare providers from four diverse cancer care institutions in Nepal. 49.5% (n = 48) had training in palliative care/cancer pain management and the majority (63.9%, n = 62) reported high confidence levels (scores of 8 or higher/10) in managing cancer pain. Highest ranked barriers to cancer pain management included those at the country/cultural level, such as nursing and medical school curricula lacking adequate content about palliative care and pain management, and patients who live in rural areas experiencing difficulty accessing healthcare services (overall mean = 6.36/10). Most nurses and physicians use an Android Smart Phone (82%, n = 74), had heard of the NAPCare PMG (96%, n = 88), and reported frequent use of apps to provide clinical care (mean = 6.38/10, n = 92). Key barriers to smart phone use differed by discipline, with nurses reporting greater concerns related to cost of data access (70%, n = 45) and being prohibited from using a mobile phone at work (61%; n = 39).ConclusionsSmart phone apps can help implement PMG and support healthcare providers in managing cancer pain in Nepal and similar settings. However, such tools must be designed to be culturally and contextually congruent and address perceived barriers to pain management and app use.

Qualitative Study for Health Care Service Use among the Visually Impaired in Korea

Individuals with visual impairments face many challenges in their daily lives, and among these challenges is accessibility to health care services. Despite increasing awareness of the importance of accessibility for the disabled, research focused on the actual conditions of health care use among the visually impaired is insufficient. This study investigates the health care service utilization of individuals with visual impairments and identifies coping strategies for guaranteeing their rights to accessible health care services and support. Comprehensive interviews with 15 participants were conducted and data were analyzed using the principles of grounded theory. Through this analysis, 29 subcategories emerged from 63 concepts, and these were categorized into 13 main categories. The study revealed that the visually impaired were significantly more likely to report difficulties accessing health care services. Participants had a higher probability of experiencing a variety of barriers, including lack of information, difficulty with transportation, difficulty using facilities, discrimination by others, and anxiety or lack of confidence as a result of these barriers. Therefore, significant changes to the provision of health care services is needed as the current barriers are likely to exacerbate health inequalities for the visually impaired and may increase the likelihood of developing additional ailments.

Impact of the COVID-19 pandemic on unmet healthcare needs in Seoul, South Korea: a cross-sectional study

ObjectivesThis study investigated the factors influencing unmet healthcare needs of people during the early stage of the COVID-19 pandemic in Seoul, South Korea. The findings help to identify people who...

Evaluation of changes in pediatric healthcare activity during the Covid-19 state of alarm in the Canary Islands

ObjectiveDuring the SARS-CoV-2 state of alarm (SoA), a 30–70% reduction was observed in the number of visits to Pediatric Emergency Departments (ED), as well as frequent delay in diagnosis or difficulty accessing healthcare services. Here we evaluate modifications observed in pediatric healthcare activity during the SoA. Study designDescriptive retrospective observational study of the hospital pediatric activity. MethodWe compared the use of pediatric healthcare services during the SoA (March 11th – June 25th, 2020) versus the use during the equivalent periods of years 2018 and 2019, in the “Complejo Hospitalario Universitario Insular Materno Infantil de Canarias” (Mother and Child University Hospital of the Canary Islands). ResultsThe number of patients visiting the pediatric ED decreased by 66.75% on average (95%CI: -65.6; - 67.7; p < 0.001), with a peak reduction (70.4%; 95%CI: -69.0; −71.7; p < 0.001) during the lockdown. We observed an increase in the number of cases of psychiatric disorders, foreign body ingestions and intoxications, as well as a decrease in respiratory conditions. Hospital admissions decreased by 45.5% (95%CI: - 38.9; −51.3; p < 0.001), while the ratio and duration of hospital stay increased. A proportion of 3.95% of admitted patients experienced complications caused by delayed visit to the ED. ConclusionsThe study shows that more patient education campaigns are needed to improve the efficiency of emergency services. It is important to reinforce the message that adequate healthcare service management is necessary.

Clinical audit of the inclusion of the Lester Tool details in discharge documents at Foss Park Hospital, York

AimsPatients with serious mental health illnesses die on average 15–20 years before the rest of the general population. Anti-psychotic medication, lifestyle and difficulty accessing healthcare services all have a detrimental effect on their life expectancy. To improve outcomes for these patients the Lester Tool; a method to assess the cardiovascular health of patients and implement change, was developed. Including the Lester Tool information in discharge letters allows transfer of information to other care providers (mainly GP's) who can implement and monitor any interventions made, improving outcomes for our patients. With this in mind, discharge documents should contain all of the information listed in the Lester Tool.We aimed to check if 100% of data required by the Lester Tool is included in discharge documents of the inpatients at Foss Park Hospital.Method20 patients from each of the male and female wards at Foss Park hospital, discharged in September or October 2020, were identified. A review of the discharge documents established whether the smoking status, BMI, ECG, blood pressure and blood results of each patient were recorded.ResultOf the 40 discharges, none had 100% compliance. On average across both wards; only 23% of the Lester tool information was included in the documents. On the female ward, 40% had none of data recorded, while on the male ward, 15% had none of the data recorded. Across both wards, not a single patient had details about their cholesterol ratio recorded, only 50% of BMI's were recorded and only 27% had a smoking status included.ConclusionOur results have shown that compliance with the Lester Tool falls short of what is expected. As a result, information about the physical health of our patients is not being communicated effectively with other care providers. This in turn can prevent patients being offered interventions needed to improve their cardiovascular health.Identifying this shortcoming in the transfer of information will allow us to educate the staff in our organisation and ensure that all the necessary physical health details will be included in future discharge documents. The result being improved outcomes and longer life expectancy of patients with serious mental illnesses, satisfying the purpose of the Lester Tool.

A national survey of caregiver\u2019s own experiences and perceptions of U.S. health care system when addressing their health and caring for an older adult

BackgroundCaregiving is a demanding role that can negatively impact a person’s health and well-being. As such, adequate access to health care is important for maintaining the family caregiver’s own personal health. The aims of this study were to identify if family caregivers of older adults had more difficulty accessing health care services than non-caregivers and to identify if family caregivers felt access to additional services would be beneficial for maintaining their own personal health care.MethodsNational survey of 3026 US adults aged 30 to 89 years old. Participants were grouped based on self-reported caregiving experience. Survey asked about access to care, importance of health care services and whether caregivers had support needed. Descriptive statistics were used to compare caregiver and non-caregiver’s responses. Multivariate logistic regression model assessed correlates of caregivers not having the support they needed.ResultsCaregivers were older, female, lower educational attainment, lower income, had more multiple chronic health conditions and health condition or disability that impacts their daily life. Caregivers reported difficulty accessing mental health services, dental services, medications, and supportive services at home. Caregivers felt it was important to have care coordinator, long-term relationship with primary care provider and access to house calls, telemedicine, and medications delivered to the home. Age, ethnicity, chronic conditions and confidence in finances were factors influencing whether caregiver had support needed to provide assistance to older care recipient.ConclusionCaregivers provide needed support and care to older adults while also needing support for themselves. Health care services delivered in the home were highly desirable to caregivers and could help them maintain their health and well-being.