Essential Healthcare Services Research Articles

Perspectives and experiences of healthcare providers on the response to the COVID-19 pandemic in three maternal and neonatal referral hospitals in Guinea in 2020: a qualitative study.

The COVID-19 pandemic has adversely affected access to essential healthcare services. This study aimed to explore healthcare providers' perceptions and experiences of the response to the COVID-19 pandemic in three referral maternal and neonatal hospitals in Guinea. We conducted a longitudinal qualitative study between June and December 2020 in two maternities and one neonatology referral ward in Conakry and Mamou. Participants were purposively recruited to capture diversity of professional cadres, seniority, and gender. Four rounds of in-depth interviews (46 in-depth interviews with 18 respondents) were conducted in each study site, using a semi-structured interview guide that was iteratively adapted. We used both deductive and inductive approaches and an iterative process for content analysis. We identified four themes and related sub-themes presented according to whether they were common or specific to the study sites, namely: 1) coping strategies & care reorganization, which include reducing staffing levels, maintaining essential healthcare services, suspension of staff daily meetings, insertion of a new information system for providers, and co-management with COVID-19 treatment center for caesarean section cases among women who tested positive for COVID-19; 2) healthcare providers' behavior adaptations during the response, including infection prevention and control measures on the wards and how COVID-19-related information influenced providers' daily work; 3) difficulties encountered by providers, in particular unavailability of personal protective equipment (PPE), lack of financial motivation, and difficulties reducing crowding in the wards; 4) providers perceptions of healthcare service use, for instance their fear during COVID-19 response and perceived increase in severity of complications received and COVID-19 cases among providers and parents of newborns. This study provides insights needed to be considered to improve the preparedness and response of healthcare facilities and care providers to future health emergencies in similar contexts.

The global burden of HIV

The global burden of HIV remains a formidable challenge, affecting millions. Despite significant progress in understanding, treatment, and prevention , HIV/AIDS continues to exert a substantial impact on personal and public health, particularly in sub-Saharan Africa, where the prevalence is highest. HIV not only poses a direct threat to the well-being of individuals but also contributes to social and economic disparities. Approximately 38 million people worldwide are living with HIV, with millions unaware of their status. Stigma and discrimination still hinder testing, starting and staying on treatment. Access to antiretroviral therapy has improved, yet disparities persist, with marginalized communities often facing barriers to essential health care services. Efforts to reduce new HIV infections and transmission include comprehensive prevention strategies, education, and increased access to testing and treatment. Addressing social determinants, reducing stigma, and ensuring equitable access to health care remain crucial to reach the ambitious goal of ending AIDS by 2030.

Work Related Problems Experienced By Community Health Workers during COVID-19 Pandemic

Background: Community Health Workers (CHWs) play a pivotal role in delivering essential healthcare services, particularly in resource-constrained settings. The outbreak of the COVID-19 pandemic posed unprecedented challenges for CHWs, amplifying the complexity of their work and exposing them to various occupational hazards. Objective: The study intended to assess the work related problems experienced by community health workers during COVID-19 pandemic. Methodology: A descriptive cross-sectional study was conducted among 361 Community Health Workers by face-to-face interview using a pretested semi-structured questionnaire from January 2021 to December 2021 at six Upazila health complex’s in Pabna District. Data were collected by convenience sampling technique. Statistical Package for Social Science (SPSS) version 23 was used to enter and analyze data. Results: A total 361 of respondents, 55.4% were female and the mean age of the respondents was 39±0.854 years. Here, 50.7% (183) protect themselves in pandemic situation by given special attention to hand hygiene, 12.7% (46) said PPE is interference with verbal communication. Majority 48.2% (174) respondents were always wear personal protection equipment (PPE) during procedure. Most of the respondents 53.5% (193) had not feeling of fear during their work. Conclusion: The study revealed a range of difficulties, including prolonged work hours in personal protective equipment (PPE), vision problems related to face shields and goggles, and communication barriers due to PPE.

Essential healthcare services during the COVID-19 pandemic: a cross-sectional study of community needs and perspectives in West Java, Indonesia

ObjectivesWhile issues in healthcare facilities during the COVID-19 pandemic have been widely discussed, little is known about health service issues from community (demand) sides. This study aimed to identify community...

THE IMPACT OF THE COVID-19 PANDEMIC RESTRICTIVE MEASURES ON THE DIAGNOSIS OF ADENOMATOUS POLYPS AND COLORRECTAL ADENOCARCINOMA IN A POPULATION SUBMITTED TO COLONOSCOPY.

•The impact of the COVID-19 pandemic on the diagnosis of adenomatous polyps and colorectal cancer. •A cross-sectional study evaluating COL performed during the periods from 20 March to 31 October of 2019 and of 2020, which analyzed 10,232 colonoscopies. •There was a 51,0% reduction in the number of COL performed in 2020 when compared to 2019. Of the altered exams, adenomatous polyps were diagnosed in 68.8% in 2019 and 78.3% in 2020. CRC was diagnosed in 0.9% in 2019 and 1.6% in 2020. •The increase in adenomatous polyps and colorectal cancer diagnoses was observed, it was not enough to compensate for the reduction in the number of exams. Colorectal cancer (CRC) is globally the third most common malignant neoplasm and the second leading cause of cancer-related death worldwide. The COVID-19 pandemic led to the suspension of routine screening tests by health services. A 35.5% drop in total cancer diagnoses in 2020 is estimated when compared to 2019. To evaluate the impact of the COVID-19 pandemic on the diagnosis of adenomatous polyps (AP) and CRC in a population undergoing colonoscopy (COL) in a clinic in Goiânia, Brazil. A cross-sectional study evaluating COL performed during the periods from 20 March to 31 October of 2019 and of 2020, was approved by the Research Ethics Committee (CAAE-45631421.0.0000.0037). We analyzed data related to identification, referral for medical examination, colonoscopic and histopathological findings. We evaluated 10,232 (93.4%) COL, divided into two groups according to the year of performance. In 2019, 6,777 (66.2%) COL were performed and in 2020, 3,455 (33.8%), demonstrating a reduction of 51.0%. A total of 3,267 (31.9%) colonoscopies found polyps, 72.1% of which were AP (68.8% in 2019 and 78.3% in 2020, P<0.001). High-grade dysplasia was found in 5.0% of the AP (4.9% in 2019 and 5.8% in 2020, P<0.34). CRC was diagnosed in 121 (1.2%) (0.9% in 2019 and 1.6% in 2020, P<0.001). The COVID-19 pandemic significantly reduced COL in 2020, mainly due to infection fears and restrictions. However, the detection rate of cancer and polyps per procedure increased, indicating more symptomatic patients sought medical attention. Despite this, the absolute number of tumors and adenomas found decreased, potentially causing diagnostic losses and fewer prevented colorectal cancer cases. Thus, adaptive strategies are vital for maintaining essential healthcare services during similar crises.

Socio-ecological Analysis of the Coping Mechanisms of Filipino Rural Health Midwives during the Pandemic

Midwives played crucial roles in the grassroots healthcare system in the Philippines, especially at the peak of the COVID-19 pandemic. Despite numerous challenges, midwives coped with several physical, emotional, and professional challenges while dispensing vital community health services. This phenomenological research investigated the coping mechanisms of Rural Health Midwives during the pandemic. The study utilized the Collaizi Method to steer the thematic identification and analysis. Using the five foci Socio-ecological Model as the theoretical lens, five immense themes for the coping mechanisms emerged: weaving social connections, bridging relationship gaps, suppressing anxieties, forging innovative solutions, and anchoring trust in the authorities. The findings underscore the pandemic-forged coping mechanisms of Rural Health Midwives, which propelled them through countless complexities in the face of the COVID-19 pandemic. While sustaining their unwavering commitments, a collective imperative intervention from the government, health sectors, and stakeholders is crucial in optimizing their well-being during and beyond the pandemic. A comprehensive support system, including mental health, professional advancement opportunities, and adequate resource allocation, is crucial for bolstering the resilience of Rural Health Midwives and ensuring the continuity of essential healthcare services in rural communities.

Impact of Mobile Medical Units on Anaemia Prevalence and Treatment Adherence in Rural India

Background Anaemia poses a significant health challenge in rural India particularly among women. Limited access to healthcare services exacerbates this issue. Mobile Medical Units MMUs have been introduced to address this gap by providing essential healthcare services to underserved populations. Objective This study investigates the effectiveness of MMUs in reducing anaemia prevalence and improving treatment adherence among women in rural areas of Uttar Pradesh and Jharkhand. Methodology A mixed-methods approach was employed combining quantitative surveys and qualitative interviews. The study surveyed 399 women across four districts Ranchi and Khunti in Jharkhand and Prayagraj and Bahraich in Uttar Pradesh. Data on anaemia prevalence treatment adherence and barriers to accessing MMU services were collected and analyzed. Results The findings revealed a high prevalence of anaemia 88 among the surveyed women with moderate-to-severe anaemia constituting 45. MMUs significantly contributed to treatment adherence with 96 of women following medical advice. However 13.5 of participants received no medication indicating gaps in service delivery. The study also identified barriers such as lack of awareness and inconvenient timing of MMU visits. Conclusion MMUs play a crucial role in addressing anaemia in rural India by improving treatment adherence and reducing anaemia prevalence. However gaps in service delivery and barriers to access need to be addressed. Recommendations include strengthening community engagement improving awareness campaigns and promoting dietary diversification to enhance the effectiveness of MMU interventions.

All-cause excess mortality among end-stage renal disease (ESRD) patients during the COVID-19 pandemic in Thailand: a cross-sectional study from a national-level claims database

ObjectivesCOVID-19 infection increased nephrology-related risks and mortality rate among end-stage renal disease (ESRD) patients. The pandemic also disrupted essential healthcare services. We aim to explore all-cause excess mortality among ESRD...

The relationship between quick return shift schedules and burnout among nurses: A prospective repeated measures multi-source study

BackgroundIn today's world, essential health care services are expected round the clock, leading to distinct shift work requirements. A notable aspect is the “quick return,” where the rest interval between nursing shifts is <11 h. Preliminary research suggests a potential association between quick return schedules, diminished sleep quality, and possible nurse burnout. Yet, the motivation of nurses could potentially moderate this relationship. ObjectiveTo examine a moderated-mediation model, whereby sleep duration and nurse's motivation act together to mediate the link between quick return schedules and nurse's burnout. DesignA prospective repeated measures (4–5 nursing shifts per nurse) multi-source (self-report and objective measures) study. SettingInternal and surgical departments across one large and one medium scale teaching hospitals in Israel. ParticipantsRegistered nurses who provide direct patient care (n = 79) across 369 shifts. MethodsNurses completed a questionnaire containing personal information and information regarding their shifts during the study week. They wore an accelerometer (a wrist worn device that monitors and records an individual's activity level) during a work-week to objectively determine their sleep duration, completed a motivation questionnaire at the beginning of each shift, and completed a burnout questionnaire at the end of the week. Mixed-model regression analysis was used to test a moderated-mediation model following Hayes' recommendations, whereby the joint effect of sleep duration and motivation mediates the link between quick return schedules and burnout. ResultsThe moderated-mediation model was supported. Quick return schedules were negatively statistically significantly associated with sleep duration (b = −126.54, SE = 20.85, p < 0.001); so that more frequent quick return schedules were related to shorter sleep duration. However, no direct correlation was observed between sleep duration and burnout (p = 0.171). A statistically significant interaction was observed between sleep duration and motivation (b = 0.00, SE = 0.00, p < 0.001) concerning burnout. Thus, nurses with lower motivation were prone to experiencing higher levels of burnout with shorter sleep duration compared to nurses with higher motivation. ConclusionsThe mediating role of sleep duration, moderated by motivation, plays a role in the connection between quick return schedules and burnout. This indicates that nurses can sustain their work motivation even within the demands of quick return schedules, consequently mitigating burnout levels. To prioritize employees' well-being, organizations should adopt shift work structures that minimize quick return schedules and extend nurses' sleep duration. Consequently, managers must employ strategies to enhance nurses' motivation when addressing scenarios that necessitate quick return schedules.

Health providers readiness in managing intimate partner violence in public health institutions, Ethiopia.

Intimate Partner Violence (IPV) is a worldwide public health problem and major human and legal rights abuses of women. It affects the physical, sexual, and psychological aspects of the victims therefore, it requires complex and multifaceted interventions. Health providers are responsible for providing essential healthcare services for IPV victims. However, there is a lack of detailed information on whether or not health providers are ready to identify and manage IPV. Therefore, this study aimed to assess health providers' readiness and associated factors in managing IPV in public health institutions at Hawassa, Ethiopia. Institutional based cross-sectional study was conducted through a simple random sample of 424 health providers. Data was collected with an anonymous questioners using physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool. Linear regression analysis was used to examine relationships among variables. The strength of association was assessed by using unstandardized β with 95% CI. The mean score of perceived provider's readiness in managing IPV was 26.18± 6.69. Higher providers age and providers perceived knowledge had positive association with provider perceived readiness in managing IPV. Whereas not had IPV training, absence of a protocol for dealing with IPV management, and provider attitude had a negative association with provider perceived readiness in managing IPV. This study reviled that health providers had limited perceived readiness to manage IPV. Provision of training for providers and develop protocol for IPV managements have an important role to improve providers readiness in the managements of IPV.

PERCEPTIONS OF THE ROLE PLAYED BY LIVING ALONE IN PROVIDING SERVICES TO PATIENTS WITH COGNITIVE IMPAIRMENT IN THE US

Abstract Given the estimated 4.3 million older adults from diverse racial/ethnic backgrounds who are living alone with cognitive impairment in the US, the objective of this study was to identify the potential moderating role of living alone in the use of healthcare and social services for patients with cognitive impairment by eliciting providers’ perceptions of caring for diverse patients with cognitive impairment living alone, in comparison to counterparts living with others. This study used semi-structured interviews conducted between March 2021 and June 2022 with purposively sampled providers of services to patients with cognitive impairment in MI, CA, and TX. An inductive content analysis was used to analyze the data. The majority of the 76 interviewed providers cared for racially/ethnically diverse patientt. Providers represented 20 professions. Providers elucidated specific factors that made serving people living alone with cognitive impairment (PLACI) more challenging, as well as specific factors that increased their concerns when serving PLACI. Providers also elucidated reasons for systematic unmet needs of PLACI for essential healthcare and social services. The vast majority of providers underscored the critical, yet understudied, role of living alone in moderating access to essential healthcare and social services among patients with cognitive impairment. Findings suggest that living arrangement are a social determinant to health among patients with cognitive impairment because PLACI are more likely to experience gaps in services because they are more challenging to serve than counterparts living with others and the healthcare system is not equipped to address these challenges.

When sanctuaries of humanity turn into corridors of horror: The destruction of healthcare in Gaza

The people of Gaza endure physical traumas, and psychological and social wounds directly linked to the combination of military occupations and the closing of its border, essentially forcing and trapping them in despair. The destruction of healthcare infrastructure in particular, has methodically added strain on an already hopeless situation, severely affecting the availability and accessibility of essential healthcare services for the population, which further perpetuates the cycle of peoples suffering. Such suffering has escalated to extreme proportions in 2023. As the violence and attacks continue with flagrant disregard of the Geneva and Hague conventions, the Rome Statute, occupational law, and international and humanitarian law, amid outcries from the international community, we see hospitals, that are traditionally regarded as sanctuaries of humanity transform into corridors of horror.

The effectiveness of a government-sponsored health protection scheme in reducing financial risks for the below-poverty-line population in Bangladesh.

The Government of Bangladesh is piloting a non-contributory health protection scheme called Shasthyo Surokhsha Karmasuchi (SSK) to increase access to quality essential healthcare services for the below-poverty-line (BPL) population. This paper assesses the effect of the SSK scheme on out-of-pocket expenditure (OOPE) for healthcare, catastrophic health expenditure (CHE) and economic impoverishment of the enrolled population. A comparative cross-sectional study was conducted in Tangail District, where the SSK was implemented. From August 2019 to March 2020, a total of 2315 BPL households (HHs) (1170 intervention and 1145 comparison) that had at least one individual with inpatient care experience in the last 12 months were surveyed. A household is said to have incurred CHE if their OOPE for healthcare exceeds the total (or non-food) HH's expenditure threshold. Multiple regression analysis was performed using OOPE, incidence of CHE and impoverishment as dependent variables and SSK membership status, actual BPL status and benefits use status as the main explanatory variables. Overall, the OOPE was significantly lower (P < 0.01) in the intervention areas (Bangladeshi Taka (BDT) 23 366) compared with the comparison areas (BDT 24 757). Regression analysis revealed that the OOPE, CHE incidence at threshold of 10% of total expenditure and 40% of non-food expenditure and impoverishment were 33% (P < 0.01), 46% (P < 0.01), 42% (P < 0.01) and 30% (P < 0.01) lower, respectively, in the intervention areas than in the comparison areas. Additionally, HHs that utilized SSK benefits experienced even lower OOPE by 92% (P < 0.01), CHE incidence at 10% and 40% threshold levels by 72% (P < 0.01) and 59% (P < 0.01), respectively, and impoverishment by 27% at 10% level of significance. These findings demonstrated the significant positive effect of the SSK in reducing financial burdens associated with healthcare utilization among the enrolled HHs. This illustrates the importance of the nationwide scaling up of the scheme in Bangladesh to reduce the undue financial risk of healthcare utilization for those in poverty.

Providers’ perceptions of the role played by living alone in providing services to diverse patients with cognitive impairment in the US

AbstractBackgroundThe potential moderating role of living alone in either facilitating or hampering access to services to older adults with cognitive impairment is largely unknown. Given the estimated 4.3 million older adults from diverse racial/ethnic backgrounds who are living alone with cognitive impairment in the United States, it is critical to understand directly from providers of healthcare and social services whether living alone creates barriers to supportive services for racially/ethnically diverse patients with cognitive impairment. The objective of this study was to identify the potential moderating role of living alone in the use of healthcare and social services for patients with cognitive impairment by eliciting providers’ perceptions of caring for diverse patients with cognitive impairment living alone, in comparison to counterparts living with others.MethodThis qualitative study used semi‐structured interviews conducted between March 2021 and June 2022 with purposively sampled providers of services to diverse patients with cognitive impairment in Michigan, California, and Texas. An inductive content analysis was used to analyze the data.ResultThe majority of the 76 interviewed providers belonged to communities of color and cared for racially/ethnically diverse patients with cognitive impairment. Providers included physicians, nurses, social workers, home care aides, for a total of 20 professions. Providers elucidated specific factors that made serving people living alone with cognitive impairment (PLACI) more challenging, as well as specific factors that increased their concerns when serving PLACI, including a crisis‐dominated healthcare system. Providers also elucidated reasons for systematic unmet needs of PLACI for essential healthcare and social services, such as policies limiting access to home‐care aides.ConclusionThe vast majority of providers underscored the critical, yet understudied, role of living alone in moderating access to essential healthcare and social services among patients with cognitive impairment. Findings suggest that living arrangement are a social determinant to health among patients with cognitive impairment because patients with cognitive impairment who live alone are more likely to experience gaps in services because they are more challenging to serve than counterparts living with others and the healthcare system is not designed to address these challenges.

Disruption Of Non-COVID-19 Health Care In Latin America During The Pandemic: Effects On Health, Lessons For Policy.

COVID-19 had severe direct and indirect effects on health and well-being in Latin America. To understand the extent to which disruptions among non-COVID-19-related health services affected population health, we used administrative data from the period 2015-21 to examine public hospital discharges and mortality for conditions amenable to health care in four Latin American countries: Brazil, Ecuador, Mexico, and Peru. Between March 2020 and December 2021, hospitalization rates for these conditions declined by 28percent and mortality rates increased by 15percent relative to prepandemic years. Noncommunicable diseases accounted for 89percent of this rise in mortality. The poorest states in each country experienced relatively larger increases in mortality. Our results, which focus on the health effects of service disruption, suggest that maintaining health care services in this region during the pandemic could have avoided at least 96,000 deaths. Policies should focus on maintaining essential health care services during emergencies, particularly for patients with noncommunicable diseases, and on minimizing negative consequences by ensuring coordinated and continuous care; leveraging alternative modalities of care, such as telemedicine; broadening the role of nonphysician health care workers; and expanding options for medication delivery.

Predicting health insurance uptake in Kenya using Random Forest: An analysis of socio-economic and demographic factors.

Universal Health Coverage (UHC) is a global objective aimed at providing equitable access to essential and cost-effective healthcare services, irrespective of individuals' financial circumstances. Despite efforts to promote UHC through health insurance programs, the uptake in Kenya remains low. This study aimed to explore the factors influencing health insurance uptake and offer insights for effective policy development and outreach programs. The study utilized machine learning techniques on data from the 2021 FinAccess Survey. Among the models examined, the Random Forest model demonstrated the highest performance with notable metrics, including a high Kappa score of 0.9273, Recall score of 0.9640, F1 score of 0.9636, and Accuracy of 0.9636. The study identified several crucial predictors of health insurance uptake, ranked in ascending order of importance by the optimal model, including poverty vulnerability, social security usage, income, education, and marital status. The results suggest that affordability is a significant barrier to health insurance uptake. The study highlights the need to address affordability challenges and implement targeted interventions to improve health insurance uptake in Kenya, thereby advancing progress towards achieving Universal Health Coverage (UHC) and ensuring universal access to quality healthcare services.

Improving healthcare for substance users: the moderating role of psychological flexibility on stigma, mental health, and quality of life

PurposeStigma is a major impediment to human rights in health care that causes discrimination, isolation and the exclusion of individuals from essential health-care services. It fosters fear, leading to negative stereotyping of individuals based on their social, cultural or health status and undermines their dignity and respect, consequently violating their right to health. Therefore, the purpose of this study is to evaluate the moderating role of psychological flexibility in the relationship between stigma (enacted, anticipated and internalized), mental health and the quality of life of substance users.Design/methodology/approachThis study was based on a cross-sectional design and included 200 male patients with an age range of 18–65 years from 23 rehabilitation centers in four cities in Pakistan. The purposive sampling technique was used, and the sample size ranged from 4 to 23 participants for each site. Four scales were used to measure stigma, general mental health, quality of life and psychological flexibility in substance users.FindingsThe data were analyzed using SPSS and Smart PLS, which showed that stigma (enacted, anticipated and internalized) had a detrimental effect on substance users’ mental health and quality of life. Additionally, psychological flexibility acts as an efficient moderator between them.Originality/valueThis research unveils the moderating role of psychological flexibility in mitigating stigma’s adverse effects on individuals with substance use disorders. Future investigations should prioritize interventions aimed at enhancing psychological flexibility to ameliorate the repercussions of stigma, ultimately enhancing the well-being and quality of life of substance users.

Bridging Healthcare Disparities: Telemedicine Triumphs in Georgia's Rural Landscape

In the wake of the COVID-19 crisis, Georgia has witnessed a groundbreaking transformation in its healthcare landscape, particularly in rural areas. A collaborative initiative between the European Union, four United Nations organizations, and the Ministry of IDPs from the Occupied Territories, Labour, Health, and Social Affairs of Georgia has led to the implementation of 50 telemedicine facilities. This pioneering project has not only connected remote communities to essential healthcare services but has also broken barriers for over 500 patients who previously lacked access to medical care due to geographical constraints.The implementation of telemedicine in Georgia's rural areas, although transformative, was not without its challenges. This article delves into the hurdles faced during the telemedicine project, focusing on internet connectivity issues and other obstacles encountered. It highlights the innovative solutions devised to overcome these challenges, underscoring the resilience and determination that paved the way for successful telemedicine integration in remote communities.Together, these narratives illuminate the transformative journey of telemedicine in Georgia, emphasizing the collaboration, determination, and innovative solutions that have bridged healthcare disparities in underserved regions and empowered communities previously hindered by geographical constraints.

Is health insurance really benefitting Indian population? Evidence from a nationally representative sample survey.

Universal health coverage (UHC) is the centrepiece of the sustainable development goals and aims to ensure access to essential and quality healthcare services to all without facing financial hardships. Several health insurance programmes have been launched in India to progress towards UHC. This study aims to assess the impact of health insurance (overall health insurance, government sponsored health insurance (GSHI), and private voluntary health insurance) on accessibility and utilization of inpatient care, out-of-pocket health expenditure (OOPE), catastrophic health expenditure (CHE), and impoverishment in India. The 75th round of National Sample Survey Office was used in the study, which covered 555,115 individuals, 113,823 households, and 91,445 hospitalization incidence all over India. Descriptive statistics, multivariable logistic regression, and propensity score matching (PSM) methods were employed. Enrolment under health insurance has impacted the accessibility and utilization pattern of hospitalization to some extent for the insured. PSM showed that enrolment under GSHI schemes reduced OOPE by INR 3314 (USD 49) and CHE incidence by 1%-4% at various thresholds. Among poor persons, there was a marginal but statistically significant reduction of OOPE among those enrolled under GSHI schemes (p<0.05). However, GSHI schemes did not statistically significantly reduce the CHE burden for poor persons enrolled (p>0.05). Furthermore, enrolment under private voluntary health insurance reduced OOPE by INR 13,511 (USD 198) and CHE by 13.47% at 10% threshold, 4.61% at 25% threshold, and 2.65% at 40% threshold. However, its uptake was primarily confined to richer economic quintiles and urban areas that exacerbates equity concerns. All the results were confirmed through robustness measures employed. There is a necessity to increase awareness and uptake of health insurance, along with introducing comprehensive insurance packages covering both inpatient and outpatient care. Also, increasing public health spending, strengthening public healthcare facilities, and improving regulatory implementation of private healthcare providers are imperative to augment financial protection.

82 Development of a Hybrid Teleneuropsychology Clinic within a VA Medical Center: A Qualitative Evaluation of Patient and Clinician Expectations and Experiences.

Objective:Gaining access to specialty care services, including neuropsychology, can be challenging, especially for older adults and individuals who live in rural areas. In addition to these barriers, the ongoing COVID-19 pandemic further disrupted patient access to essential healthcare services. Telehealth, which underwent rapid expansion in response to service disruptions due to COVID-19, offers opportunities to prevent or reduce disruptions in patient care, including neuropsychological assessment. Here we describe the development and implementation of a teleneuropsychology (telenp) clinic within a major VA medical center and discuss salient clinical observations and patient feedback gathered during telenp evaluations.Participants and Methods:A hybrid telenp clinic was developed at the Tennessee Valley VA Healthcare system to serve patients referred for neuropsychological evaluations whose access to services was impacted by the COVID-19 pandemic. Patients presented to the VA and were connected to neuropsychology providers seated in separate rooms of the hospital through synchronous video. Test batteries were created to closely approximate in-person evaluations while allowing for minor procedural modifications so tests could be administered virtually. All tests were administered by on-site trained staff. After the evaluation, anecdotal information about patient experiences and satisfaction and salient clinical observations were gathered to elucidate potential benefits and shortcomings of hybrid telenp model.Results:65 telenp neuropsychological evaluations were conducted between December 2020 and April 2021. Overall, patients consistently and strikingly reported a high degree of openness and acceptance towards telenp services, even despite initial technological apprehension. Importantly, patients ubiquitously reported believed they were able to adequately engage in telenp assessments, and no perceptible barriers were identified. Clinically, examiners consistently expressed surprise at the relative ease with which the evaluations could be adapted to a telenp program. Additionally, clinicians generally felt confident in the validity of the results and that the data gathered were sufficient to answer the referral question and make salient treatment recommendations and referrals. Importantly, there were some notable limitations to telenp assessment and not all patients were testable via telehealth.Conclusions:Qualitatively, hybrid telenp evaluations are feasible and acceptable, and appear to be a valid alternative to face to face neuropsychological assessments. Future research should focus on establishing the reliability and validity of telenp testing compared to face-to-face testing, collective quantitative data regarding patient and clinician experiences of telenp and identify methods for implementing telenp in clinics in rural catchment areas to increase access to neuropsychological services.