Health Care Services For People Research Articles

The Underutilization of Mental Health Care Services in the Lives of People with Blindness or Visual Impairment: A Literature Review on Rehabilitation Factors Toward Provision.

Roughly 3 million adult Americans have a visual impairment or blindness, and over 4 million adults aged 40 and older. Despite data demonstrating an elevated prevalence of mental health symptoms in people with BVI, this population remains largely untreated. Given that people with BVI often interface with multiple systems of rehabilitative care that are designed to improve quality of life, the relatively low rates of initiation of mental health care services are particularly alarming. In this review, the systematic processes of mental health care services across pertinent rehabilitation groups are identified and critically examined. A comprehensive literature review was conducted. The literature review utilized a critical systems typology, whereby relevant literature was selected, reviewed, and analyzed intra and extra organizationally. In addition, a thorough discussion of disability-related factors was provided, lending a socio-political lens to the problem. Considerable data indicates that short-term mental health care services for people with BVI are ineffective treatment methods, albeit primarily employed in health-rehabilitative processes. Multiple studies offered data indicating the presence of diverse and entangled mental health issues relative to vocational rehabilitation services, mobility tool utility, and emotional reactions to vision loss. Many studies suggested that disability identity work be integrated into health-rehabilitative processes for people with BVI. To improve the utility of mental health care services for people with BVI, a reenergization of the mental health care needs of this population must occur. A critical podcast or forum focused on educating listeners about the health-rehabilitation factors that influence the provision of mental health care services can aid to improve future mental health policy and practice for people with BVI. Disability scholars need to advance research on integrating critical theories in work with people with BVI and accelerate qualitative, community-based methods to enhance understanding of this population and their unique mental health needs.

Health literacy and cultural responsiveness of primary health care systems and services in Australia: reflections from service providers, stakeholders, and people from refugee backgrounds

BackgroundPrimary health care [PHC] services with general practitioners (GPs) as the first point of access to health care services for people from refugee backgrounds in Australia can play a crucial role in building health literacy and promoting access to culturally appropriate services. To achieve equitable access and engagement, services and systems must be responsive to diverse health literacy and cultural needs. This study aims to explore how primary health services respond as a system and organisation to the health literacy and cultural needs of people from refugee backgrounds in Australia.MethodsThis exploratory qualitative study involved 52 semi-structured interviews among 19 Africans from refugee backgrounds, 14 service providers, including GPs and nurses, and 19 other stakeholders, such as service managers/directors. Participants resided in New South Wales, Victoria, and Queensland. Interviews were audio-recorded, transcribed, and coded into QSR NVivo 12. Data analysis was guided by reflexive thematic analysis.FindingsThree interrelated themes were identified from the data relating to the health literacy and cultural responsiveness of PHC systems and services. The first theme, ‘variable and ad hoc organisational response to health literacy and culturally responsive care,’ demonstrated that some organisations did not systematically address the inherent complexity of navigating the health system nor the capacity of services and providers to respond to the cultural needs of people from refugee backgrounds. The second theme, ‘individual provider responsibility,’ captured the individual providers’ interpersonal and relational efforts in supporting the health literacy and cultural needs of people from refugee backgrounds based on their motivation and adaptation. The third theme, ‘refugee patient responsibility,’ encapsulated people from refugee backgrounds’ adaptations to and learning of the health system to navigate and access services.ConclusionHealth literacy and culturally responsive practices need to be systematised by PHC organisations to be implemented and sustained over time. There is a need for diversity in the organisational leadership and health care workforce, organisational commitment, health literacy and culturally responsive care policies, provider training, and auditing practice as essential components of the change process. Engaging with refugee communities would allow services to focus on people from refugee backgrounds’ needs by design.

Digital Health Equity and Tailored Health Care Service for People With Disability: User-Centered Design and Usability Study.

As digital health services advance, digital health equity has become a significant concern. However, people with disability and older adults still face health management limitations, particularly in the COVID-19 pandemic. An essential area of investigation is proposing a patient-centered design strategy that uses patient-generated health data (PGHD) to facilitate optimal communication with caregivers and health care service providers. This study aims to conceptualize, develop, and validate a digitally integrated health care service platform for people with disability, caregivers, and health care professionals, using Internet of Things devices and PGHD to contribute to improving digital health equity. The methodology consists of 5 stages. First, a collaborative review of the previous app, Daily Healthcare 1.0, was conducted with individuals with disabilities, caregivers, and health care professionals. Secondly, user needs were identified via personas, scenarios, and user interface sketches to shape a user-centered service design. The third stage created an enhanced app that integrated these specifications. In the fourth stage, heuristic evaluations by clinical and app experts paved the way for Daily Healthcare 2.0, now featuring Internet of Things device integration. Conclusively, in the fifth stage, an extensive 2-month usability evaluation was executed with user groups comprising individuals with disabilities using the app and their caregivers. Among the participants, "disability welfare information and related institutional linkage" was the highest priority. Three of the 14 user interface sketches the participants created were related to "providing educational content." The 11 heuristic evaluation experts identified "focusing on a single task" as a crucial issue and advocated redesigning the home menu to simplify it and integrate detailed menus. Subsequently, the app Daily Healthcare 2.0 was developed, incorporating wearable devices for collecting PGHD and connecting individuals with disabilities, caregivers, and health care professionals. After the 2-month usability evaluation with 27 participants, all participants showed an increase in eHealth literacy, particularly those who used the caregiver app. Relatively older users demonstrated improved scores in health IT usability and smartphone self-efficacy. All users' satisfaction and willingness to recommend increased, although their willingness to pay decreased. In this study, we underscore the significance of incorporating the distinct needs of individuals with disabilities, caregivers, and health care professionals from the design phase of a digital health care service, highlighting its potential to advance digital health equity. Our findings also elucidate the potential benefits of fostering partnerships between health consumers and providers, thereby attenuating the vulnerability of marginalized groups, even amid crises such as the COVID-19 pandemic. Emphasizing this imperative, we advocate for sustained endeavors to bolster the digital literacy of individuals with disabilities and champion collaborative cocreation, aiming to uphold the collective ethos of health and digital health equity.

Experiences With In-Person and Virtual Health Care Services for People With Chronic Obstructive Pulmonary Disease: Qualitative Study.

The World Health Organization and the European Commission predict increased use of health technologies in the future care for patients in Europe. Studies have shown that services based on telehealth, which includes components of education, as well as rehabilitation initiatives can support the self-management of individuals living with COPD. This raises an interest in how virtual and in-person interactions and roles can best be organized in a way that suits people living with COPD in relation to their treatment and rehabilitation. This study aims to investigate how individuals living with COPD experience different combinations of virtual and in-person care, to help us better understand what aspects are valued and how to best combine elements of these services in future care. Two rounds of semistructured interviews were conducted with 13 and 4 informants, respectively. The individuals were all recruited in relation to a research project led by the telehealth initiative Epital Health. The first round of interviews included 11 informants, as 2 dropped out. Of these, 7 received the telemedicine service provided by Epital Health, 3 participated in a 12-week COPD program provided by their respective municipality, and 1 did not receive any supplementary service besides the usual care. In the second round, which included 4 informants, all had at one point received the telemedicine service and participated in a municipality-based rehabilitation program. A content analysis of the interviews was performed based on deductive coding with 4 categories, namely, (1) Self-management, (2) Health-related support, (3) Digital context, and (4) Well-being. Medical and emotional support from health care professionals is a key aspect of care for individuals with COPD. Acute treatment with at-home medicine, monitoring one's own condition through technology, and having easy access and close contact with health care professionals familiar to them can promote self-management and well-being, as well as provide a feeling of security. Having regular meetings with a network of peers and health care professionals provides education, support, and tools to cope with the condition and improve own health. Furthermore, group-based activity motivates and increases the activity level of the individuals. Continued offers of services are desired as many experience a decrease in achieved benefits after the service ends. More emphasis is placed on the importance of the therapeutic and medical elements of care compared with factors such as technology. The identified barriers related to optimal utilization of the virtual service were related to differentiation in levels of contact depending on disease severity and skills related to the practical use of equipment. A combination of virtual and in-person services providing lasting medical and social support is suggested for the future. This should build upon the preferences and needs of individuals living with COPD and support relationships to caregivers and peers.

Missed opportunities for diagnosis of hepatitis B and C in individuals diagnosed with decompensated cirrhosis or hepatocellular carcinoma.

This study aimed to assess utilization of health-care services in people with decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC) and a "late diagnosis" of hepatitis B or hepatitis C. Hepatitis B and C cases during 1997-2016 in Victoria, Australia, were linked with hospitalizations, deaths, liver cancer diagnoses, and medical services. A late diagnosis was defined as hepatitis B or hepatitis C notification occurring after, at the same time, or within 2years preceding an HCC/DC diagnosis. Services provided during the 10-year period before HCC/DC diagnosis were assessed, including general practitioner (GP) or specialist visits, emergency department presentations, hospital admissions, and blood tests. Of the 25766 notified cases of hepatitis B, 751 (2.9%) were diagnosed with HCC/DC, and hepatitis B was diagnosed late in 385 (51.3%). Of 44317 cases of hepatitis C, 2576 (5.8%) were diagnosed with HCC/DC, and hepatitis C was diagnosed late in 857 (33.3%). Although late diagnosis dropped over time, missed opportunities for timely diagnosis were observed. Most people diagnosed late had visited a GP (97.4% for hepatitis B, 98.9% for hepatitis C) or had a blood test (90.9% for hepatitis B, 88.6% for hepatitis C) during the 10years before HCC/DC diagnosis. The median number of GP visits was 24 and 32, and blood tests 7 and 8, for hepatitis B and C, respectively. Late diagnosis of viral hepatitis remains a concern, with the majority having frequent health-care service provision in the preceding period, indicating missed opportunities for diagnosis.

“There’s a big tag on my head”: exploring barriers to treatment seeking with women who use methamphetamine in Sydney, Australia

BackgroundAustralia has a high prevalence of regular use of methamphetamine. While half of people who use methamphetamine regularly are women, they make up only one third of people seeking treatment for methamphetamine use disorder. There is a lack of qualitative research into the facilitators and barriers to treatment for women who use methamphetamine regularly. The study seeks a better understanding of the experiences and treatment preferences of women who use methamphetamine, to inform person-centred changes in practice and policy that break down barriers to treatment.MethodsWe conducted semi-structured interviews with 11 women who frequently use methamphetamine (at least once a week), and who are not engaged in treatment. Women were recruited from health services surrounding a stimulant treatment centre at an inner-city hospital. Participants were asked about their methapmhetamine use and health service needs and preferences. Thematic analysis was completed using Nvivo® software.ResultsThree themes were developed from participants’ responses around experiences of regular methamphetamine use and treatment needs: 1. Resistance of stigmatised identity including dependence; 2. Interpersonal violence; 3. Institutionalised stigma. A fourth set of themes on service delivery preferences were also elicited, including continuity of care, integrated health care, and provision of non-judgmental services.ConclusionGender-inclusive health care services for people who use methamphetamine should actively work to address stigma, support a relational approach to assessment and treatment, and seek to provide structurally competent health care that is trauma and violence informed, and integrated with other services. Findings may also have application for substance use disorders other than methamphetamine.

Personal and sexual boundaries: the experiences of people with intellectual disabilities

BackgroundPrevious research shows that people with intellectual disabilities have less knowledge about sexual health and are more vulnerable to victimisation. In cases of sexual abuse, they are likely to encounter the criminal justice system as vulnerable witnesses. Several challenges arise when people with intellectual disabilities are in communication with the criminal justice system. We aimed to explore the perceptions, experiences and knowledge of people with intellectual disabilities regarding personal and sexual boundaries in order to identify factors relevant for preventing sexual abuse, to develop future studies.MethodThe study had a qualitative design. Data were collected from seven people with mild intellectual disabilities (25–40 years; 2 men, five women) through one-to-one interviews in specialised health care services for people with intellectual disabilities (SHCS). The participants lived alone, in group homes and with their families. Many received professional support services. Data were analysed using thematic analysis.ResultsThe interviews identified that the participants want to be in romantic relationships and that some, consider sex to be unimportant. Many of them have had trouble finding someone to have a romantic relationship with. The participants were unsure about sexual consent related to sexual activity, though many could explain the concept of consent in other contexts. Many participants reported that they had experienced sexual abuse, including online sexual abuse. Those participants who had reported the sexual abuse had positive experiences obtaining assistance from the criminal justice system. The participants who had experienced sexual abuse reported trauma and fear related to their experiences.ConclusionThis study highlights the need for information about sexually abusive relationships, risks online and ways to get help. More attention should be given to the impact of trauma, police and mental health treatment following sexual abuse against people with intellectual disabilities.

Self-powered multifunctional body motion detectors based on highly compressible and stretchable ferroelectrets with an air-filled parallel-tunnel structure

The new kind of ferroelectret electroactive polymers for flexible film sensors represent an attractive opportunity for self-powered wearable devices, which could offer sustainable and convenient health care services for people without the problem of energy supply. However, due to the mechanical heterogeneity, obtaining ferroelectrets with both a high longitudinal and transverse piezoelectric response is still a great challenge, which limits its multifunctional sensing application, especially in body motion tracking. Herein, we develop an air-filled parallel tunnel ferroelectret-based self-powered body motion detectors. Ascribed to the high mechanical compression and tensile properties of the specially designed parallel tunnel void structure and excellent charge storage stability of the fluorinated polyethylene propylene (FEP) electret film, these laminated films exhibit many fascinating merits, including ultrahigh longitudinal piezoelectric response (piezoelectric coefficient of 6200 pC/N, pressure sensitivity of 1950 pC/kPa), wide pressure detection range (0.03–62 kPa), remarkable transverse piezoelectric response (tensile sensitivity of 1600 pC/mm), long-term durability (1,08,0000 cycles), and superior friction force detection capability. This is the first work, to our knowledge, that ever use one kind of piezoelectric mechanism in a single ferroelectret-based sensor to achieve longitudinal stress, transverse stress, and tangential friction force sensing. Furthermore, on the basis of such sensors and machine learning algorithms, we designed an intelligent gesture recognition system for future human-machine interaction applications. Looking forward, our material design methodologies offer an approach to the self-powered flexible multifunctional sensor with great prosperity in household healthcare, smart mobile medical electronics, and humanoid robots.

Disability type–specific mortality patterns and life expectancy among disabled people in South Korea using 10-year combined data between 2008 and 2017

People with disabilities have a higher mortality risk than non-disabled people. However, mortality patterns and life expectancy according to disability types are under-researched. This study investigated the sociodemographic characteristics and compared mortality and life expectancy among people with disabilities according to disability type in Korea using 10-year combined data between 2008 and 2017. The National Health Information Database from the National Health Insurance Service covering the total Korean population between 2008 and 2017 was obtained. This study described the age and income distributions of people with disabilities and calculated the mortality rate, proportional mortality ratio, and life expectancy according to disability type. Most disability subgroups had higher average ages than were found for non-disabled people. The proportion of the bottom 20% household income group was also higher in all types of disabilities than in non-disabled people. The crude mortality rate, age-standardized mortality rate, and life expectancy were all worse in people with all types of disabilities than in their non-disabled counterparts, but variations according to disability type were found. The composition of causes of death also varied across disability types. Although all types of disabilities were associated with higher mortality rates and lower life expectancy, the sociodemographic characteristics and mortality and life expectancy patterns differed across types of disability. People with disabilities experienced various health-related problems and financial burdens. Public assistance needs to be strengthened to guarantee adequate income and health care services for people with disabilities, considering their sociodemographic characteristics and mortality patterns.

Healthcare services for people with acquired disability in South-East Queensland, Australia: Assessing potential proximity and its association with service obstacles

This study described access potential in South-East Queensland, to healthcare services commonly used by people with acquired disability; and investigated the association between service proximity and perceived service obstacles. First, we described accessibility by conducting a spatial analysis to create maps of potential accessibility to health services in South-East Queensland. Queensland statistical area level 2 (SA2) locations were combined with the residential locations of participants from a longitudinal cohort study involving people with ABI and SCI. The locations of selected health services of interest were identified from Health Direct's National Health Service Directory. Travel times via motor vehicle were modelled with Robust Gaussian Stochastic Process, to smoothly interpolate between the sparse time-to-service observations. Probabilistic predicted values were generated from the model and were used to construct service accessibility maps of South-East Queensland. Disability population data were used to identify SA2s with relatively low service access but a high disability population. Second, we examined perceived service obstacles, by investigating the relationship between potential access to services and perceived service obstacles was examined using data from 63 people with ABI or SCI discharged from the specialist state-wide rehabilitation services, located in South-East Queensland. Obstacles to accessing service in relation to resource availability, transportation and finances were collected three-months after discharge, using the Service Obstacle Scale. Travel times to the closest health service were computed for each individual and were compared to their Service Obstacle Scale responses. Access potential was highly variable, particularly for allied health services. We identified several low-access, high-disability population areas. These hotpots of poor access were generally to the north and west of greater Brisbane. Longer travel times to allied health services were associated with 260% higher odds of agreeing that resource availability was an obstacle to accessing services. Policy makers should be concerned with the hotspots of poor access identified.

Common Data Elements and Features of a Recommender System for People Living with Fatty Liver Disease

Background: Fatty liver disease is rising as the most common liver disease in recent years. One of the new approaches to manage the disease is the use of intelligent systems. The recommender system is increasingly utilized in managing chronic conditions. This study was performed to identify the common data elements and features of a recommender system for people living with fatty liver.
 Methods: This study was a narrative review exploring the minimum data set for a recommender system in fatty liver disease. We aimed to review the current literature evidence to comprehend the specific requirements of the related knowledge. The search was carried out in November 2020 using PubMed, Scopus, Science Direct, and Web of Science databases. We searched the keywords including fatty liver, liver disease, nonalcoholic fatty liver disease, intelligent, smart system, recommender system, minimum data set, data element, and data requirements.
 Results: A review of the articles showed that the most common data elements of the administrative category were sex/gender (n=22), age (n=22), and ethnic group/race (n=8). We also identified the clinical data elements and technical features of a recommender system for people living with fatty liver. Based on the findings of this study, “diabetes and glucose status” (n=18), “AST” (n=15), “BMI” (n=13), and “ALT” (n=13) were the most frequent data elements of clinical category. Furthermore, “predicting and identifying” (n=8) was the most common technical feature mentioned in the reviewed articles.‎
 Conclusion: We determined the common elements and features of a recommender system in ‎three different categories: clinical data elements, demographic data elements, and technical ‎capabilities. Using these requirements, it is possible to structure data gathering, medication ‎adherence, and communication with healthcare providers in a standard manner. It is ‎suggested that appropriate policies and national grants be adopted to identify and prioritize a ‎minimum data set to support the healthcare services of people living with chronic conditions.

Access to primary and secondary health care services for people living with diabetes and lower-limb amputation during the COVID-19 pandemic in Lebanon: a qualitative study

BackgroundPeople living with chronic conditions and physical disabilities face many challenges accessing healthcare services. In Lebanon, in 2020, the COVID-19 pandemic and concomitant economic crisis further exacerbated the living conditions of this segment of the population. This study explored the barriers to accessing healthcare services among people living with diabetes and lower-limb amputation during the pandemic.MethodsWe conducted semi-structured, in-depth phone interviews with users of the Physical Rehabilitation Program, offered by the International Committee of the Red Cross. We used a purposive sampling technique to achieve maximum variation. Interviews were audio-recorded, transcribed, translated, and analyzed using thematic analysis following the “codebook” approach. Transcripts were coded and grouped in a matrix that allowed the development of themes and sub-themes inductively and deductively generated.ResultsEight participants (7 males, 1 female) agreed to be interviewed and participated in the study between March and April, 2021. Barriers to healthcare services access were grouped according to five emerging themes: (1) economic barriers, included increasing costs of food, health services and medications, transportation, shortage of medications, and limited income; (2) structural barriers: availability of transportation, physical environment, and service quality and availability; (3) cultural barriers: marginalization due to their physical disabilities; favoritism in service provision; (4) personal barriers: lack of psychosocial support and limited knowledge about services; (5) COVID-19 barriers: fear of getting sick when visiting healthcare facilities, and heightened social isolation due to lockdowns and physical distancing.ConclusionThe underlying economic crisis has worsened the conditions of people living with diabetes and lower-limb amputation. The pandemic has made these individuals more vulnerable to external and contextual factors that cannot be addressed only at an individual level. In the absence of a protective legal framework to mitigate inequalities, we provide recommendations for governments and nongovernmental institutions to develop solutions for more equitable access to healthcare for this segment of the population.

Studying intraprofessional and interprofessional learning processes initiated by an educational intervention applying a qualitative design with multimethod approach: a study protocol

IntroductionInterprofessional collaboration in education and practice has been highlighted as a premise for providing good care. Both the intraprofessional and interprofessional impacts have bearing on healthcare professionals’ performance and learning....

THE ROLE AND PLACE OF PSYCHOLOGICAL AID FOR INTERNALLY DISPLACED FAMILIES DURING MARTIAL LAW

The purpose of the article is to analyze the organization of the system of psychological aid to internally displaced families who have experienced crises (combat operations). The article generalizes scientific and methodological sources devoted to particularities of the organization of psychological aid to internally displaced families during martial law. The components of the system of mental health development and psychosocial support, which would contribute to the organization of self-help, adaptation and the formation of resistance to stress factors in the affected population, are specified. The author provides an example of the organization of psychological support for children and adults from the above-mentioned category, which includes psychological first aid and enrichment activities aimed at improving psychosocial resistance to stress in children, in particular, strengthening the role of positive activities, developing skills to manage psychological reactions, promoting positive thinking, and restoring supportive social ties. The primary objective of educational training with internally displaced families is to enhance the social-psychological response of children and their families affected by the crisis, reduce the social-psychological consequences of trauma, and ensure stable access to psychological help. In the context of a military conflict, timely first psychological aid becomes relevant. Such help is offered to people who have just or recently experienced traumatic events and have a negative mental state. Experts note that such help can be provided by everyone who is nearby, and not only by specialists through professional consultations. Psychological first aid involves providing the injured person with emotional, physical, and social support, strengthening the sense of security. First of all, internally displaced families want to meet their basic needs and access relevant services and assistance in solving their new problems. The most common needs are finding temporary housing, food, water, sanitation, renewing health care services for people with injuries or chronic diseases, or long-term health disorders, re-establishing contact with loved ones and friends, and accessing a special kind of support regarding the culture or religion of these people.

886. The Impact of the COVID-19 Pandemic on Clinical Follow-Up, Monitoring and Regimen Discontinuation for People Living with HIV in the US

BackgroundThe COVID-19 pandemic has disrupted health care services for people living with HIV (PLWH). This study aimed to compare rates of clinical visits, viral load monitoring and antiretroviral therapy (ART) regimen discontinuation among virally suppressed PLWH in the US before and during the COVID pandemic.MethodsThe study population consisted of ART-experienced PLWH ≥18 years of age and active in care in the OPERA cohort within 2 years prior to 31OCT2020. Virally suppressed PLWH (i.e., viral load < 200 copies/mL) were included if they switched to either dolutegravir/lamivudine or a dolutegravir- or bictegravir-based 3-drug regimen between 01MAY2019 and 30APR2020. The study periods spanned from 01MAY2019 to 28FEB2020 (pre-COVID) and 01MAR2020 to 31OCT2020 (during COVID). Incidence rates of clinical visits, viral load measurements and regimen discontinuation were estimated using univariate Poisson regression for both study periods. In-person visits comprised any scheduled or walk-in outpatient, inpatient, emergency or laboratory visit. Telehealth visits comprised any phone or video encounters.ResultsThe study included 4806 PLWH in the pre-COVID and 4992 in the COVID period. Rates of in-person visits were reduced almost 2-fold during COVID, while telehealth visits increased almost 9-fold, resulting in an overall reduction in any visits rates from 10.07 visits per person-year (95% CI: 9.93, 10.21) pre-COVID to 7.10 (95% CI: 7.01, 7.19) during COVID [Fig 1]. Rates of viral load measurements dropped from 2.99 viral loads per person-year (95% CI: 2.92, 3.07) pre-COVID to 1.97 (95% CI: 1.92, 2.02) during COVID [Fig 2]. Regimen discontinuation rates were also reduced from 14.3 discontinuations per 100 person-years pre-COVID (95% CI: 12.7, 16.1) to 9.6 (95% CI: 8.6, 10.8) during COVID [Fig 3]. In both study periods, virologic failures were detected in < 1% of PLWH with ≥ 1 viral load.Figure 1. Incidence rates for overall, in-person, and telehealth visits during the pre-COVID (open circle) and the COVID (filled circle) study periods Incidence rates for viral load measurements during the pre-COVID (open circle) and the COVID (filled circle) study periods Incidence rates for regimen discontinuation during the pre-COVID (open circle) and the COVID (filled circle) study periods ConclusionThe COVID pandemic has led to an important reduction in the frequency and type of clinical follow-up visits and viral load monitoring among virally suppressed PLWH in the US. A reduction in regimen discontinuation rates was also observed, presumably associated to less frequent follow-up. The long-term impact of the pandemic on HIV care remains uncertain.Disclosures Gerald Pierone, MD, Epividian (Board Member) Jennifer S. Fusco, BS, Epividian, inc (Employee) Laurence Brunet, PhD, Epividian, inc (Employee) Cassidy Henegar, PhD, GSK (Shareholder)ViiV Healthcare (Employee) Jean A. van Wyk, MB,ChB, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Supriya Sarkar, PhD, GSK (Shareholder)ViiV Healthcare (Employee) Vani Vannappagari, MBBS, MPH, PhD, ViiV Healthcare Limited (Employee) Andrew Zolopa, MD, GlaxoSmithKline (Shareholder)ViiV Healthcare (Employee) Michael B. Wohlfeiler, MD, Epividian, inc (Board Member)ViiV Healthcare (Research Grant or Support) Gregory Fusco, MD, MPH, Epividian, inc (Employee)

Healthcare services for people with dementia in Vietnam: A situational analysis

AbstractBackgroundVietnam is facing rapid population ageing, with one in four Vietnamese citizens being over 60 years old by 2050. This has contributed to a boom of chronic and non‐communicable diseases, such as dementia. In order to develop a national dementia plan as recommended by the World Health Organization (WHO) and increase the preparedness of the healthcare system to tackle dementia, a situational analysis of the current healthcare services related to dementia is needed.MethodIn late 2019, we conducted a situational analysis desk review of the healthcare system in Vietnam, focusing on health service delivery for the elderly, using the guidance developed by the Strengthening Responses to Dementia In Developing Countries (STRiDE) project. The WHO’s six‐building‐block framework was used to analyse the healthcare system in Vietnam, followed by the thematic and SWOT (Strengths, Weaknesses, Opportunities and Threats) analyses of dementia‐related healthcare services.ResultAlthough Vietnam has achieved significant improvement in healthcare in general, there are still inefficiencies in health service delivery. There are also discrepancies in health service readiness and quality across areas of healthcare. Despite of extensive primary healthcare system, grassroots‐level facilities have inadequate infrastructure required for basic care delivery and none for dementia. There are few healthcare facilities at central and provincial levels, mainly located in the three biggest cities of Hanoi, Ho Chi Minh and Danang, providing services for people with dementia. There is limited training in dementia diagnosis and management for health professionals.ConclusionDeveloping a national dementia plan, including transforming the current healthcare services to better cope with rapid population ageing and dementia disease is urgently needed in Vietnam. Integrating dementia services into existing health and social services for the elderly and the disabled, making use of the extensive primary healthcare system in detection, early interventions, management and support for people with dementia at community level are strategic solutions to deal with dementia in a sustainable way. To this end, a whole‐system approach in transformation and operation with implementing a patient centred care model is necessary.

Health care services satisfaction and associated factors among people living with HIV/AIDS at Kibuye referral hospital, Rwanda

Background: Patient satisfaction surveys have gained great attention as meaningful parameters for evaluating quality improvement in healthcare organizations. At Kibuye referral hospital, healthcare utilization and health care services for people living with HIV/AIDS (PLWHA) has been low, as attested by poor adherence to medication and weakening of patients due the disease progression. The main objective of this study was to assess healthcare services satisfaction and associated factors among people living with HIV/AIDS Kibuye referral hospital, Rwanda. Methods: An institutional-based cross-sectional design was used to select 277 study participants who were interviewed by use of a structured questionnaire, and the data analyzed quantitatively. Two focus group discussions (FGDs) were performed, after which the interviews were transcribed in verbatim and analyzed thematically.Results: The overall level of PLWHA satisfaction was 95.0%. In multivariate analysis, social class and age were found to be the main predictors of PLWHA satisfaction (AOR=10.218, 95% CI=1.39, 74.88, p=0.002) and (AOR=0.39, CI=0.121 to 1.186, p=0.005), respectively. Qualitative study outcome showed that health care service delivery at Kibuye referral hospital is measured by a number of factors, including timeliness of health care service delivery, meeting needs of clients and paying attention in provision of health care services.Conclusions: The level of patient satisfaction was found to be high. When individual was of high-class status in the society, and were above 20 years of age, his or her satisfaction increased. The study recommends that PLWAs are treated equally so as to improve service delivery, particularly among people living HIV/AIDS.

Urbanicity, Health, and Access to Services for People With Intellectual Disability and Developmental Disabilities.

Previous research suggests that residence in non-metropolitan areas is associated with lower access to preventive care and poorer health. However, this research has been largely restricted to the general population, despite data demonstrating disparities in health status and access to healthcare services for people with intellectual and developmental disabilities (IDD). The current study examined several hypotheses involving the effects of rurality on access to preventive healthcare and services and health status: (1) individuals in non-metropolitan areas will have lower preventive healthcare utilization, (2) individuals in non-metropolitan areas will have poorer health outcomes, and (3) individuals in non-metropolitan areas will have poorer access to services. The current study uses data from the National Core Indicators (NCI) Adult Consumer Survey 2015-2016: Final Report which included Rural-Urban Commuting Area (RUCA) Codes for the first time. Results of logistic regression suggest that, despite connection to disability services, the health status and access to preventive healthcare services of people with IDD generally follow patterns similar to those observed in the general population. Namely, people with IDD in non-metropolitan areas have decreased access to healthcare services, preventive healthcare utilization, and health status. Despite some exceptions, it appears effects of rurality are not completely mitigated by current state and federal efforts.

SOCIAL AND ECONOMIC ASPECTS OF THE INCREASING INCIDENCE OF DIABETES IN VARNA AND BULGARIA

Objective: The impact of socio-economic factors on the increased incidence of chronic diseases requires changes in the policy of health authorities. In view of that, the study tried to investigate the role and consequences of those factors on T2DM and thus contribute to future development of comprehensive programmes for screening, diagnostics and treatment. Methods and materials: Forecasting the incidence rates of diabetes on a national and regional scale using regression analysis of results from municipal programs between 2015 and 2019 in Varna. The following models were studied: linear, cubic, quadratic, exponential, logarithmic, power, growth and inversion. Data processing and analysis were performed with the software set SPSS Statistics and graphical analysis with Microsoft Excel. Results: A constant rise in the number of diabetes cases was identified. At national level, mortality among females was higher than mortality in males, while at local level (Varna), such correlation was not established. Costs for the studied groups steadily increased during the studied period. Healthcare services for people with diabetes mellitus cost 2.5 times more than that of people without diabetes of the same age group.

Connecting Smart Homes to Healthcare Services for People with Neurodegenerative disorders.

The objective of this research is to provide an approach for the design of what we have called ‘connected homes’ with a study case for elderly people with dementia living alone. These homes would be connected to a center of surveillance for direct and automatic view of multiple status of the day such as patient security and general health indicators (body temperature, heart rate, blood pressure etc.), detect the intake of meals, eating motivation, humor detection prevention of falls, Alcohol consumption detection, safe use of medicines and emergency situations and other Human Activity Recognition (HAR). The model may also predict situations by using past data accumulation. The model could even send alerts in case of emergency.&#x0D; This service would mean that there would minimum intervention from caregivers thanks to the Artificial Intelligence.&#x0D; As a case study, we proposed a new approach for the conception of connected homes for people with dementia to a central office for automatic human activity detection and help and support accordingly. Such conception includes home design concepts according to standard recommendations and the implementation of new added assistive technology tools to permit the automatic surveillance without violating the ethic requirements.&#x0D; Two installation models will be proposed to consider the financial situation of the patient: a unit or appliance at the patient’s home or a home that is connected to a central office.