Healthcare Encounters Research Articles

Caring for Undocumented Migrants: Significance of Recognition and Respect during Healthcare Encounters

Undocumented migrants are often in a position of extreme vulnerability and experience many barriers to accessing mental health care. It is crucial that health professionals understand this and quickly establish trust and respect. If the stressful living conditions that contribute to the distress of undocumented migrants are recognized, compassionate and trauma-informed care is enhanced. In this regard, it is important that health professionals understand the fear of being expelled from a country. This paper discusses problems that arise when health professionals interact with undocumented migrants and the need to quickly convey recognition to establish trust and respect. We argue that insights from Axel Honneth’s social philosophical theory of recognition and disrespect can further enhance health professionals strategies to improve their verbal and non-verbal communication and thereby increase access to health care for undocumented migrants. We suggest ideas for codifying this knowledge in health care policies and guidelines.

Prescription Opioid Exposure During Pregnancy and Risk of Spontaneous Preterm Delivery

Opioid exposure during pregnancy has been associated with preterm birth, but prior studies have not differentiated between spontaneous and indicated preterm birth or fully investigated these associations as functions of opioid dose. To determine whether prescription opioid use during pregnancy is associated with spontaneous preterm birth and whether the association is dose-dependent. This case-control study examined a retrospective cohort of pregnant patients enrolled in Tennessee Medicaid. Enrollment files were linked to health care encounters, hospital discharge information, birth certificate data, and prescription fills. Eligible participants were pregnant people ages 15 to 44 years without opioid use disorder who experienced birth of a single fetus at 24 weeks gestation or greater between 2007 and 2019 with linked birth certificate data. Cases of spontaneous preterm birth were matched with up to 10 controls based on pregnancy start date, race, ethnicity, age at delivery within 2 years, and history of prior preterm birth. Cases and matched controls were continuously enrolled in TennCare for at least 90 days prior to the index date (case delivery date). Total opioid MME filled during the 60 days prior to the index date. The primary outcome was spontaneous preterm birth determined by a validated algorithm using birth certificate data. Conditional logistic regression was used to estimate the association between spontaneous preterm birth and total opioid morphine milligram equivalents (MME) dispensed, adjusting for parity, prepregnancy body mass index, education level, tobacco use, hepatitis infections, and pain indications. A total of 25 391 cases (median [IQR] age, 23 [20-28] years; 127 Asian [0.5%], 9820 Black [38.7%], 664 Hispanic [2.6%]; 14 748 non-Hispanic White [58.1%]) with spontaneous preterm birth were identified and matched with 225 696 controls (median [IQR] age, 23 [20-27] years; 229 Asian [0.1%], 89 819 Black [39.8%], 3590 Hispanic [1.6%]; 132 002 non-Hispanic White [58.5%]) (251 087 patients total), with 18 702 patients (7.4%) filling an opioid prescription in the 60 days prior to the index date. Each doubling of nonzero opioid MME was associated with a 4% increase in the odds of spontaneous preterm birth compared with no opioid exposure (adjusted odds ratio, 1.04; 95% CI, 1.01-1.08). In this case-control study, a positive association was found between total prescription opioid dose dispensed and the odds of spontaneous preterm birth. These findings support guidance to minimize opioid exposure during pregnancy and prescribe the lowest dose necessary.

The inseparability of context and clinical reasoning.

Early descriptions of clinical reasoning have described a dual process model that relies on analytical or nonanalytical approaches to develop a working diagnosis. In this classic research, clinical reasoning is portrayed as an individual-driven cognitive process based on gathering information from the patient encounter, forming mental representations that rely on previous experienceand engaging developed patterns to drive working diagnoses and management plans. Indeed, approaches to patient safety, as well as teaching and assessing clinical reasoning focus on the individual clinician, often ignoring the complexity of the system surrounding the diagnostic process. More recent theories and evidence portray clinical reasoning as a dynamic collection of processes that takes place among and between persons across clinical settings. Yet, clinical reasoning, taken as both an individual and a system process, is insufficiently supported by theories of cognition based on individual clinicals and lacks the specificity needed to describe the phenomenology of clinical reasoning. In this review, we reinforce that the modern healthcare ecosystem - with its people, processesand technology - is the context in which health care encounters and clinical reasoning take place.

The Development and Use of a New Visual Tool (REVISIT) to Support Participant Recall: Web-Based Interview Study Among Older Adults.

Qualitative health services research often relies on semistructured or in-depth interviews to develop a deeper understanding of patient experiences, motivations, and perspectives. The quality of data gathered is contingent upon a patient's recall capacity; yet, studies have shown that recall of medical information is low. Threats to generating rich and detailed interview data may be more prevalent when interviewing older adults. We developed and studied the feasibility of using a tool, Remembering Healthcare Encounters Visually and Interactively (REVISIT), which has been created to aid the recall of a specific telemedicine encounter to provide health services research teams with a visual tool, to improve qualitative interviews with older adults. The REVISIT visual appointment summary was developed to facilitate web-based interviews with our participants as part of an evaluation of a geriatric telemedicine program. Our primary aims were to aid participant recall, maintain focus on the index visit, and establish a shared understanding of the visit between participants and interviewers. The authors' experiences and observations developing REVISIT and using it during videoconference interviews (N=16) were systematically documented and synthesized. We discuss these experiences with REVISIT and suggest considerations for broader implementation and future research to expand upon this preliminary work. REVISIT enhanced the interview process by providing a focus and catalyst for discussion and supporting rapport-building with participants.REVISIT appeared to support older patients' and caregivers' recollection of a clinical visit, helping them to share additional details about their experience. REVISIT was difficult to read for some participants, however, and could not be used for phone interviews. REVISIT is a promising tool to enhance the quality of data collected during interviews with older, rural adults and caregivers about a health care encounter. This novel tool may aid recall of health care experiences for those groups for whom it may be more challenging to collect accurate, rich qualitative data (eg, those with cognitive impairment or complex medical care), allowing health services research to include more diverse patient experiences.

MMPI-2-RF validity scales add utility for predicting treatment engagement during partial psychiatric hospitalizations.

Partial psychiatric hospitalizations are resource-intensive clinical services designed to stabilize patients in the short term, prevent inpatient hospitalizations, and encourage long-term recovery. Typically, providers base their referral decisions on categorical diagnoses and subjective impressions of patient distress without closely considering the evidence for reporting biases. The present study followed veterans (n = 430) participating in partial psychiatric hospitalization services. We evaluated the extent to which clinical diagnoses at intake predicted treatment variables and changes in later mental health care utilization. Using hierarchical linear regressions with bootstrap confidence intervals, Minnesota Multiphasic Personality Inventory-2-Restructured Form content-based validity scales demonstrated incremental utility for predicting patient outcomes beyond intake diagnoses. Elevated Fp-r ("Infrequent Psychopathology Responses") scores independently predicted an increased number of times arriving late for partial hospitalization programming, self-report of worse current functioning at intake, and a relative increase in mental health care encounters in the 12 months following discharge. Low K-r ("Adjustment Validity") scores independently predicted self-report of worse current functioning at both intake and later discharge from partial hospitalization. Thus, indicators of severe psychopathology overreporting as well as the unlikely disavowal of emotional adjustment (i.e., high Fp-r, low K-r) predicted engagement with health care services and self-presentations of symptoms over and above the diagnostic impressions from referring providers. We discuss how indicators of content-based invalid responding on the Minnesota Multiphasic Personality Inventory-2-Restructured Form have real-world value for understanding patient behavior and shaping clinical interventions among vulnerable populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Change in rate of healthcare encounters for respiratory infection from air pollution exposure after improved vehicle emissions standards in New York State

The introduction of Tier 3 light-duty vehicles with reduced emissions began in New York State (NYS) in 2017, with required compliance by 2025. We hypothesized that improved air quality during the early implementation of Tier 3 (2017–2019) would result in reduced rates of hospitalizations and emergency department (ED) visits for respiratory infection associated with increased PM2.5 compared to 2014–2016 (pre-Tier 3). Using data on adult patients hospitalized or having an ED visit for influenza, upper respiratory infection, culture-negative pneumonia, or respiratory bacterial infection, living within 15 miles of six air quality monitoring sites in NY, and a case-crossover design and conditional logistic regression, we estimated the rates of respiratory infection hospitalizations and ED visits associated with increased ambient PM2.5 concentrations in the previous 0–6 days and each week thereafter up to 1 month. Interquartile range (IQR) increases in PM2.5 in the previous 6 days were associated with 4.6% (95% CI: − 0.5, 10.1) and 11.9% (95% CI = 6.1, 18.0) increased rates of influenza hospitalizations in 2014–2016 and 2017–2019, respectively. This pattern of larger relative rates in 2017–2019 observed at all lag times was only present in males hospitalized for influenza but not other infections or in females. The rates of respiratory infection visits associated with increased PM2.5 were generally not reduced in this early Tier 3 implementation period compared to 2014–2016. Limited fleet penetration of Tier 3 vehicles and differences in particle deposition, infection type, and sex by period may all have contributed to this lack of improvement.

Estimates of Direct Medical and Indirect Costs Associated With COVID-19 Among U.S. Active Duty Army Soldiers.

This study estimated the direct medical and indirect costs associated with coronavirus disease 2019 (COVID-19) diagnoses among U.S. active duty (AD) Army service members (SMs). These cost estimates provide the U.S. Military with a better understanding of the financial burden of COVID-19 and provide a foundation for cost-effectiveness estimates. The study was approved as Public Health Practice (#17-605) by the U.S. Army Public Health Center, Public Health Review Board. U.S. AD Army SMs with COVID-19 were identified using an Army COVID-19 testing and surveillance database. Encounters for these SMs were captured from medical record where International Classification of Disease Tenth Revision, Clinical Modification code U07.1 was in the first or second diagnostic position. Analyses were conducted on SMs with COVID-19 who either had no healthcare encounters in the Military Health System (MHS); at least one MHS COVID-19 inpatient hospitalization; or at least one MHS outpatient COVID-19 encounter. Coronavirus disease 2019 (COVID-19) costs captured from the encounters were used to develop direct medical cost estimates. Literature on COVID-19 recovery post-hospitalization, along with the number of COVID-19 hospitalizations and outpatient visits from encounters were used to describe the intensity of COVID-19 care. Estimates of the indirect cost of lost duty were based on SMs salary information, along with recovery time, bed days, or outpatient visit time. The indirect cost of limited duty was estimated using the time associated with the Department of Defense (DoD) COVID-19 pandemic mitigation strategies in place when these SMs were identified as positive for COVID-19. Coronavirus disease 2019 (COVID-19) cost estimates were developed for the Army using data from 19,086 SMs identified as positive for COVID-19 between June 1, 2020, and December 31, 2020. Direct medical costs, or the amount paid by the DoD to facilities for COVID-19 care, averaged $606 per SM with an encounter. Indirect costs for lost duty or the cost for recovery and the time taken to seek care for COVID-19 averaged $319 per SM, while indirect costs for limited duty or isolation associated with COVID-19 averaged $4,111 per SM or $411 per day. Service members (SMs) with an inpatient hospitalization averaged 4.8 bed days (range 1-43) and 266 recovery hours while SMs who sought outpatient care for COVID-19 averaged two outpatient visits (range 1-60 visits). The direct medical costs of a COVID-19 encounter in the MHS ($606) are a small portion of the costs for a SM with COVID-19. Indirect costs of lost and limited duty associated with COVID-19 averaged seven times higher ($4,331) and accounted for the vast majority of costs. Recognition of these costs is important especially given that soldiers in the hospital or in quarters being quarantined are complete losses of manpower to the Army. While the COVID-19 pandemic is ongoing and prevention, treatment, and mitigation efforts continue to evolve, having reliable estimates of direct medical and indirect costs from this study allows the U.S. Army and MHS to better account for the cost of this pandemic for its population.

Being met as a person and not as a diagnosis – Meanings of healthcare encounters for women with chronic obstructive pulmonary disease stage III or IV

Our study seeks to elucidate meanings of healthcare encounters for women with chronic obstructive pulmonary disease stage III or IV. We conducted 12 narrative interviews which were analyzed using phenomenological hermeneutic interpretation. Our analysis revealed one theme; being met as a person and not as a diagnosis with three subthemes: getting sufficient time and feeling involved in care; fulfillment of personal needs; and experiencing disrespect and injustice. We found that meanings of healthcare encounters center on the expectation of being seen as a person. Feeling disrespected and injust leaves women unsupported and could pose serious health risks.

Principlism and contemporary ethical considerations for providers of transgender health care

Background : Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims : We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method : This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results : The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion : We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound.

Challenges of using evidence in managerial decision-making of the primary health care system

BackgroundManagerial Evidence-Based Decision-Making [EBDM] in the primary is a systematic approach that directs the decision-maker in a conscientious, explicit, and judicious utilization of reliable and best evidence based on the professional experiences and preferences of stakeholders and patients from various sources. This study aimed to investigate the challenges primary healthcare managers encounter while undertaking decision-making processes.MethodA systematic review was conducted in 2022 with the aim of identifying and collecting all qualitative articles pertaining to evidence-based decision-making in the primary healthcare system. To achieve this, a meticulous search was conducted using the relevant keywords, including primary health care and evidence-based decision making, as well as their corresponding synonyms, across the databases Web of Science, Scopus, and Pubmed. Importantly, there were no limitations imposed on the timeframe for the search. To carefully analyze and consolidate the findings of this systematic review, the meta-synthesis approach was employed.ResultsA total of 22 articles were assessed in this systematic review study. The results revealed the main categories including evidence nature, EBDM barriers, utilizing evidence, decision-makers ability, organizational structure, evidence-based, EBDM support, communication for EBDM, evidence sides, EBDM skill development, public health promotion, and health system performance improvement.ConclusionThe primary healthcare system is crucial in improving health outcomes and ensuring access to healthcare services for all individuals. This study explored the utilization of evidence-based EBDM within the primary healthcare system. We identified five key dimensions: causal, contextual, and intervening conditions, strategies, and consequences of EBDM as a core phenomenon. The findings will help policymakers and administrators comprehend the importance of evidence-based decision-making, ultimately leading to enhanced decision quality, community well-being, and efficiency within the healthcare system. EBDM entails considering the best reliable evidence, and incorporating community preferences while also exploiting the professional expertise and experiences of decision-makers. This systematic review has the potential to provide guidance for future reforms and enhance the quality of decision-making at the managerial level in primary healthcare.

“Atypical Interactions” in Healthcare: A State-of-the-Art Literature Review of Conversation-Analytic Research, with Reflections on Equity, Diversity, and Inclusion

ABSTRACT Our state-of-the-art review examines conversation-analytic (CA) research on healthcare encounters in which the patient has a disability that can affect their communication, using the lens of the social relational model of disability. We report findings via the following themes: where (and why) interactional challenges arise, practitioner barriers and facilitators to effective communication, how behaviors interpreted medically as symptoms can be understood as interactional competencies, and understanding the role of companion. We reflect on equity, diversity, and inclusion in CA research, arguing that labeling interactions as “atypical” can lead to assumptions that findings are circumscribed and have no wider applicability. Existing research has focused on specialist settings created for people with one particular condition, overlooking their healthcare interactions with other healthcare services. We argue that CA research on healthcare and beyond should include a more diverse range of interactants and also discuss why. Data in examples are in multiple languages.

Cultivating Critical Love to Improve Black Maternal Health Outcomes.

Racism is responsible for the maldistribution of power in society and manifests as persistent disparities in maternal health among Black women in the United States. Testimonial injustice is an expression of prejudice that uses identity to undermine individuals' credibility as authoritative "knowers" of their own bodies, selves, and experiences. Among Black women, experiences of testimonial injustice in health care encounters are common and likely contribute to disparities in Black maternal health. To promote more equitable power distribution and prioritize testimonial justice in clinical encounters, this article proposes a conceptual framework for fostering critical-racial consciousness among health professions students and trainees. The goal is for critical-racial consciousness development and refinement to stimulate antiracist actions in medical decision making and, ultimately, lead to a more equitable health care system in which Black women can thrive.

Capturing patient experiences of care with digital technology to improve service delivery and quality of care: A scoping review.

Patient experience significantly impacts healthcare quality, outcomes, resource utilisation and treatment adherence. Digital technologies offer promising approaches for capturing real-time, multi-faceted patient experiences. This scoping review investigated how digital technologies are used to capture patient experience during healthcare encounters and their potential to improve health service delivery and care. A scoping review was conducted to determine associations between patients' use of digital technology and subsequent outcomes. Four electronic databases were searched using six combination search terms in titles and/or abstracts published between 2016 and 2022. Inclusion criteria focused on studies where patients were primary users of digital technology, reporting on their experience during care. Studies had to report on at least one outcome: health service delivery, quality of care or patient experience. Screening, data extraction and analysis were performed systematically. Of the 377 studies retrieved, 20 were included. Most studies incorporated aspects allowing patients to share experiences with digital technologies. Eighty percent (n = 16) of studies reported improvements in patient experiences, 75% (n = 15) enhancements in service delivery aspects and 50% (n = 10) indicated improved quality of care associated with the use of digital technologies. Real-time journaling and narrative methods alongside treatment were linked to improved communication, healthcare efficiencies and patient agency. Technologies facilitating bidirectional communication were particularly associated with positive effects on patients' sense of agency. Digital technologies facilitating documentation of patient experiences demonstrate potential in enhancing care quality through increased patient voice, collaboration and agency. Technologies designed to map and evaluate patients' healthcare experiences represent a promising approach to improving healthcare outcomes, service delivery and overall patient experience. Further research is needed to establish standardised methodologies and evaluate long-term impacts across diverse populations. Integrating digital narrative medicine principles may offer valuable insights for future interventions aimed at capturing and enhancing patient experiences in healthcare.

Risk of Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) Among Patients with Type 2 Diabetes Mellitus on Anti-Hyperglycemic Medications.

Observed activity of metformin in reducing the risk of severe COVID-19 suggests a potential use of the anti-hyperglycemic in the prevention of post-acute sequelae of SARS-CoV-2 infection (PASC). We assessed the 3-month and 6-month risk of PASC among patients with type 2 diabetes mellitus (T2DM) comparing metformin users to sulfonylureas (SU) or dipeptidyl peptidase-4 inhibitors (DPP4i) users. We used de-identified patient level electronic health record data from the National Covid Cohort Collaborative (N3C) between October 2021 and April 2023. Participants were adults ≥ 18 years with T2DM who had at least one outpatient healthcare encounter in health institutions in the United States prior to COVID-19 diagnosis. The outcome of PASC was defined based on the presence of a diagnosis code for the illness or using a predicted probability based on a machine learning algorithm. We estimated the 3-month and 6-month risk of PASC and calculated crude and weighted risk ratios (RR), risk differences (RD), and differences in mean predicted probability. We identified 5596 (mean age: 61.1 years; SD: 12.6) and 1451 (mean age: 64.9 years; SD 12.5) eligible prevalent users of metformin and SU/DPP4i respectively. We did not find a significant difference in risk of PASC at 3 months (RR = 0.86 [0.56; 1.32], RD = -3.06 per 1000 [-12.14; 6.01]), or at 6 months (RR = 0.81 [0.55; 1.20], RD = -4.91 per 1000 [-14.75, 4.93]) comparing prevalent users of metformin to prevalent users of SU/ DPP4i. Similar observations were made for the outcome definition using the ML algorithm. The observed estimates in our study are consistent with a reduced risk of PASC among prevalent users of metformin, however the uncertainty of our confidence intervals warrants cautious interpretations of the results. A standardized clinical definition of PASC is warranted for thorough evaluation of the effectiveness of therapies under assessment for the prevention of PASC.

Anticipating multisectoral use of services with the support of AI

Introduction: This paper presents the preliminary results of a collaborative R&D project which aims at developing artificial intelligence (AI) supported anticipation of multisectoral use of services. If we were able to predict the escalation of health and social problems of clients and the use of several different services, we could plan and offer them early preventive services with the objective of improving the quality of life and reducing the costs of service provision in the longer term.
 Approach and methods: The multidisciplinary project in progress collaborates at four spheres of research and development within the elderly care of one welfare region in Finland.
 1) Anticipatory management practices concerning risk client groups and anticipatory case management practices concerning individual clients in risk are being developed supported by predictive AI technology. The requirements concerning the information the AI based prediction model should produce to the managers and to the case managers have provisionally been defined. The current practices are co-studied, and the new practices supported by AI are co-designed by involving the “relevant” health and social care managers and practitioners in the welfare region.
 2) A machine learning (ML) predictive model based on health and social care data is being developed. The prediction model will be developed based on retrospective analysis of health and social data of the welfare region. The available data includes clinical data recorded during healthcare encounters, decisions, and usage of social services as well as physical function assessments. The data is used to train and test potential machine learning algorithms for predicting future service use of the elderly individuals based on their current health status and past use of services.
 3) The implementation of the AI/ML model within the IT infrastructure and information systems (IS) in use will be supported and investigated. The developed ML model would eventually be integrated into the IT/IS environment of the case organization. That entails connecting the specific data sources, running the model computations, and passing the results to the digital workflow of the care production management for knowledge management.
 
 4) The EU and Finnish legislation that regulate the use of personal health and social data in the development and use of AI based predictive models is being analyzed. Requirements and potential limitations imposed by current legislation on the use of predictive models are identified. In particular, the strict conditions applicable to making automated risk assessments of individuals for purposes of taking anticipatory measures are analyzed and avenues for meeting them by health and social care organizations are discussed.
 Results and outputs: Working on these four spheres, the project produces a generic model on developing the anticipation practices of multisectoral use of services with the help of AI technology. The model will available to all the organizations which are developing AI based anticipation of multisectoral use of services.
 Key words: Anticipation, prediction, health and social services usage, machine learning model, AI software, legislation, elderly care

Utilizing interprofessional education to foster diversity, equity, and inclusion concepts related to gender affirming care

Interprofessional education (IPE) is on the rise in healthcare fields for several reasons. IPE teaches the collaborative skills necessary for healthcare students to succeed in an increasingly diverse workforce. IPE also creates space for healthcare organizations to develop diversity, equity, and inclusion (DEI) objectives within curriculum and clinical practice. IPE's focus on diversity is important because recent research indicates a lag in DEI initiatives in healthcare. To better integrate DEI objectives into healthcare curricula, faculty from an OTD and MAT program developed an interprofessional assignment that could be implemented across multiple programs. The assignment was designed to improve DEI and IPE competence in OT and AT education.An OTD and a MAT course were chosen to pilot the IPE assignment. These courses were selected for two reasons: curricular content and logistic feasibility. A virtual synchronous and asynchronous format was determined as the best structure for the assignment. Students were asked to complete assigned readings and review a video about culturally sensitive topics, meet as an interprofessional group to discuss a healthcare encounter between a clinical staff and a transgender individual, and participate in an intraprofessional discussion board activity.The primary student learning outcomes for this assignment were threefold 1) Demonstrate use of interprofessional collaborative skills such as communication and roles responsibilities 2) Analyze how interprofessional collaborative skills might be utilized to care for diverse populations and 3) Integrate the use of DEI constructs within discussions of planned care. A rubric was used to assess students in each of these areas. Additionally, a thematic analysis was generated to understand how students’ use of interprofessional education skills and knowledge could enhance the care of diverse populations.Both groups of students in the pilot scored well. The average overall grade for occupational students was 37.25/40 (93 %) and the average overall grade for the athletic training students was 36/40 (90 %). The assignment analysis identified three improvements in student understanding, specifically enhanced quality of care, decreased knowledge gaps, and greater ability to check biases and accountability.

The Impact of Living Situation on Healthcare Encounters for Individuals With Intellectual Disability.

Introduction The living situation of individuals with intellectual disabilities (ID) has evolved throughout the years and ranges from living at home with family caregivers to group homes to independent living arrangements. Living situations can affect access to care and thus healthcare utilization seen by healthcare encounters for individuals with ID. Methods The researchers conducted a chart review of 112 patients to assess demographics, living situations, and healthcare encounters between 2019 and 2021. Living situation categories included independent, biological family, group home, home with other support, and others. Statistical analyses were conductedusing R version 4.2.1 (The R Foundation for Statistical Computing, Vienna, Austria). Univariable analyses consisted of the Shapiro-Wilk test of normality, Kruskal-Wallis rank sum test, and pairwise Wilcoxon rank sum test with multiple comparisons correction using the Bonferroni method. Statistical testing for multivariable analysis included the Kruskal-Wallis rank sum test, Spearman's rank correlation, and the negative binomial model. Results Results showed a statistically significant difference in median total encounter value between independently living individuals with ID compared to all other living situations, Χ2 = 4.230, df = 1, p-value = 0.040. Additionally, there is a significant association between medication count and total encounter count, rho = 0.341, S = 154322, p-value < 0.001. Conclusion The study showed that individuals with ID who live independently have fewer healthcare encounters compared to all other living situations. This may be due to various factors such as increased autonomy and free choice, increased barriers to healthcare, or better overall health requiring less medical attention in independently living individuals with ID.

Perceived disrespectful treatment in low-income healthcare settings through the lens of intersectionality

Race and gender differences in the quality of one’s health care encounters are widely documented, but few studies explore the multiplicative impacts of race and gender. Drawing on intersectionality frameworks, we contrast white, Black, Hispanic, Asian, and Native American men’s and women’s perceptions of disrespectful treatment from health care providers and staff (e.g., receptionists, clerks) in low-income health settings. Data are from the 2014 Health Center Patient Survey (N = 5385), a nationally representative survey of community-dwelling patients receiving care at health centers funded through Section 330 of the Public Health Service Act. Our results show race and sex differences in the study outcomes, yet weak support for intersectional effects. Asian and Native American patients report more disrespectful treatment from providers, relative to other ethnic groups. Women are more likely than men to report disrespectful treatment from staff. Asians also report disrespectful treatment from staff. Health care providers and staff may require training focused on the distinctive needs of Asian patients, for whom “saving face” may be a salient goal. Structural changes to reduce wait times and employ medical interpreters to ensure clear communication, and staff training focused on verbal and nonverbal communication may mitigate against actions perceived as disrespectful in low-income health settings.

A CHECKLIST-BASED INTERVENTION TO SUPPORT FAMILY CAREGIVERS IN PRIMARY CARE

Abstract Family caregivers commonly accompany older adults to their routine medical visits, but caregivers’ own needs and concerns are not systematically identified or addressed in clinical practice. Collaborative Healthcare Encounters with Caregivers (CHEC) is a checklist-based intervention that uses a prioritization approach to help caregivers efficiently identify and communicate their most salient concerns to primary care providers. This presentation will report findings from a pilot randomized controlled trial of N=37 patient-caregiver dyads who were randomized to CHEC (N=21) or usual care (n=16). The goals of the pilot trial were to evaluate CHEC’s impact on medical visit duration and communication (using time-stamped audio-recordings and a structured coding system) and caregivers’ perceptions of CHEC’s utility (using questionnaires and interviews). Total visit duration was comparable across treatment groups (CHEC: 29.3 minutes vs. UC: 32.8 minutes; p=0.55), but a greater proportion of the visit time was spent addressing caregivers’ concerns among CHEC group participants, as compared to usual care participants (25% vs. 6%; p&amp;lt;.001). In post-visit interviews, caregivers commented that CHEC was useful in helping them to prepare for the visit by thinking about their questions in advance and prompting providers to acknowledge their concerns. Findings from this study explicitly address the RAISE Act’s recommendation for integrating evidence-based caregiver assessment instruments into clinical care delivery (Outcome 2.2) and indicate CHEC’s potential as an efficient, clinically feasible intervention that can support greater inclusion of caregivers in primary care discussions.

"I was screaming hallelujah": Patient and provider perceptions of blood-based testing for colorectal cancer screening.

Blood-based tests for colorectal cancer (CRC) screening can offer many advantages over stool-based tests such as FIT. Yet, we know little about patients' and providers' perceptions of this type of test. We report findings from a qualitative study comparing patient and provider perceptions of blood-based testing for CRC screening. Patient participants were aged 45-75 years and members of a large, integrated health system. Participants were mailed, but did not complete, a FIT through an organized FIT-screening program and were scheduled for a health-care encounter at any of nine clinical sites. Participants were consented to complete a blood draw. We used purposive sampling to select and recruit patients (who did and did not complete the blood test) and providers/specialists who would be involved in offering the blood test to patients or explaining results. We administered telephone interviews using a semi-structured interview guide and recorded and transcribed all interviews, then coded and analyzed content. We interviewed 15 patients (11 completed and 4 did not complete the blood test) and 5 providers (3 primary care providers, one gastroenterologist (GI), and one GI medical assistant). Patients were enthusiastic about completing a blood test, citing the simplicity, ease, convenience, and high perceived accuracy of the test. Providers were also receptive to a blood-based option, if adequate test performance could be achieved and if they have information that informs patients about the pros and cons of blood-based screening versus other screening tests. Patients and providers were willing and enthusiastic about blood-based CRC screening tests. Future research focusing on performance and communication is needed.