Health Care Providers Research Articles

Osteopathic Family Physicians and the Care of Children in Special Education

Children and adolescents in special education have complex medical, neurodevelopmental, and psychological needs that require coordinated, multidisciplinary care. Osteopathic family physicians (OFPs), with their holistic, whole-person approach, are uniquely positioned to lead this care by integrating medical, behavioral, and social supports. This review summarizes current prevalence data for common chronic conditions (asthma, diabetes, epilepsy), acute illnesses (allergic reactions, infections), and neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). It also addresses the high rates of psychological concerns, including anxiety, depression, and behavioral disorders, often comorbid with neurodevelopmental conditions. Evidence-based strategies for diagnosis and management are presented alongside a review of family-centered resources—IDEA, Medicaid/CHIP, vocational rehabilitation, special needs trusts—and school-based supports such as individualized education programs (IEPs) and positive behavioral interventions and supports (PBIS). Emphasis is placed on long-term care planning, including legal and financial considerations (guardianship, special needs trusts), transition to adult services, community integration, and sustained care coordination. Early identification, continuous advocacy, and seamless collaboration among healthcare providers, educators, therapists, and family support networks are critical to optimizing health outcomes and quality of life for this vulnerable population.

Research evidence utilization barriers among camp health care providers and administrators

ABSTRACT Summer is a critical developmental period for children and adolescents, with camps serving as key environments for promoting healthy development. However, integrating research evidence into camp health care practices faces notable challenges. This study examined barriers to research evidence utilization among 155 camp health care providers and administrators. We found that camp health care providers and directors frequently access research evidence from health agencies like the Centers for Disease Control and Prevention and professional camp organizations such as the Alliance for Camp Health and the American Camp Association. Several barriers to research evidence utilization were identified, including the lack of compiled relevant literature, insufficient time to implement new ideas and read research, unclear implications for practice, complex statistical analyses, and delays in research publication. Our findings highlight the need for more accessible and practical research dissemination strategies within the camp community. Addressing these barriers could enhance the integration of evidence-based practices in camp health care, ultimately improving the quality of care and outcomes for camp participants. Future efforts should focus on providing targeted training and support to camp health care providers to facilitate the practical application of research findings in their daily practices.

Studying the Effectiveness of Video-Assisted Education in Teaching Ugandan Mothers to Monitor Their Hospitalised Infant.

To determine the time required for mothers to learn how to monitor their hospitalised infant using video-assisted education and to understand healthcare providers' perspectives on their role in maternal education. This was a two-part study in a neonatal hospital unit in Uganda. Using video-assisted education, we assessed the time required for mothers to learn how to assess danger signs, weigh their baby, and track feeds. Proficiency was tested with knowledge and skills assessments. Concurrently, healthcare providers completed a survey regarding maternal engagement. Fifty mothers participated, and 72% watched the training video only once. After viewing the video, 36% needed no additional nursing time to achieve proficiency. For mothers requiring nursing assistance, nurses spent a median time of 37 s (IQR 21-78 s). Ninety-four percent and 72% of mothers had perfect scores on the knowledge and skills assessment, respectively. Twelve healthcare providers were surveyed, and 58% reported having < 10 min to spend on maternal education. All providers cited recognition of danger signs as the most important skill for mothers to learn. Given Uganda's healthcare provider shortage, video-assisted education may be a valuable tool to teach mothers how they can participate in their hospitalised infant's care.

Enhancing oncodermatology support: assessing patient utilization and satisfaction with educational resources for managing dermatologic toxicities of cancer treatment.

Dermatologic toxicities resulting from cancer treatments are common, debilitating, and can significantly impact a patient's quality of life. In some cases, these toxicities may require dose adjustments or even discontinuation of treatment. Timely management of dermatologic adverse events (DAEs) is crucial to improving patient outcomes, and educational resources are instrumental in empowering patients to recognize and manage these issues. This cross-sectional survey study aims to characterize patient utilization of and satisfaction with educational resources regarding dermatologic toxicities of cancer treatments. Findings indicate that while 77.5% (n = 110) of patients received information on managing dermatologic toxicities, a larger proportion (n = 123; 86.5%) experienced these side effects. Healthcare providers were the primary source of information (n = 102/110; 92.7%), followed by self-searching on the internet (n = 59/110; 53.6%), and social media (n = 43/110; 39.1%). Despite most patients receiving educational content, patients expressed low satisfaction with both the quality and quantity of information provided, with only 31.3% (n = 41) reporting satisfaction with the amount of information and 33.8% (n = 44) reporting satisfaction with its quality, highlighting a significant gap in resource effectiveness. Notably, patients reported the highest satisfaction with information provided by healthcare providers, suggesting that integrating comprehensive dermatologic education into oncologic care could improve patient satisfaction and outcomes.

"I'm So Passive, Every Visit Is a Challenge": Stigma Experienced by Older People Living With HIV During Follow-up Health Care Visits in Wuxi, China-A Qualitative Study.

"I'm So Passive, Every Visit Is a Challenge": Stigma Experienced by Older People Living With HIV During Follow-up Health Care Visits in Wuxi, China-A Qualitative Study.

N-Acetylcysteine (NAC) for Trichotillomania and Excoriation Disorder: An Overview.

Trichotillomania and excoriation/skin-picking disorder involve repetitive behaviors, such as hair pulling leading to hair loss or skin picking leading to skin lesions, that cause physical complications, significant mental distress, and functional impairment despite attempts to stop. Currently, no first-line pharmacological treatments are approved for these disorders, although glutamatergic agents, select antidepressants, and other medications have demonstrated some benefit. The therapeutic potential of N-acetylcysteine (NAC) is promising. NAC helps maintain glutamate homeostasis in the brain, thereby reducing compulsive and habitual behaviors. In addition, NAC is recognized as a low-risk, well-tolerated, and accessible dietary supplement with valuable therapeutic potential. Deficiencies in pharmacological protocols and lack of government controls place individuals at risk; therefore, health care providers are well positioned to provide reliable information and educate individuals to make informed decisions about their health. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Association Between Patient Experience and Medical Dispute Costs.

Patient experience is increasingly being recognised as a core component of quality healthcare. It captures various dimensions of a patient's interaction with healthcare providers that may influence patient satisfaction and ultimately impact the incidence of complaints or disputes. However, only limited research has investigated the financial implications of patient experience, particularly its association with medical dispute costs. This study sought to understand whether patient experience scores correlate with medical dispute costs and to provide insights into cost-effective strategies in patient-centred care. We used a dataset that included patient experience scores and medical dispute costs over a defined period. Descriptive analysis, frequency distribution of disputes, and odds ratios were calculated to examine the initial patterns. Logistic regression models were applied using both logged and ratio-based dispute-cost transformations to assess the relationship between patient experience and dispute costs. The models were stratified according to patient experience type. The analysis revealed that higher patient experience scores were generally associated with reduced medical dispute costs, with significant relationships observed in specific models. In a cost-ratio model, doctor interactions showed a strong correlation with reduced dispute costs. For nurses, significant associations were observed in a logged cost model, suggesting that both nurses and doctors contributed uniquely to dispute costs. This study demonstrated that improving specific domains of patient experience, such as patient rights, may serve as a cost-effective strategy for reducing medical dispute costs. These findings emphasize the importance of fostering patient-centred care and addressing institutional and contextual factors. These insights provide a foundation for targeted strategies to enhance patient satisfaction while promoting financial and operational stability in healthcare institutions.

Examining the Roles of Communication and Trust in Patient–Provider Relationships and Their Association with Patient Satisfaction with Care

ABSTRACT Patient–provider relationships can significantly influence patients’ perceptions of quality of care and generally affect patient trust in healthcare providers. The purpose of this study was to investigate how communication based on CAT strategies can enhance the patient–provider relationship, ultimately improving patients’ perceptions of the quality of care they receive. Additionally, we examined the relationship between patients’ trust in the cancer- and health-related information provided by their doctors and their satisfaction with the quality of care. Data from the 2022 health Information National Trends Survey (HINTS 6, n = 6252 surveys) was used. Results demonstrate that the use of CAT strategies that encompass three domains – emotional expression, interpersonal control, and interpretability – play a larger role in patient satisfaction with quality of care than trust in health-related information from their doctor alone. To improve satisfaction with care, these findings show possible targetable domains of patient–provider relationship building in healthcare.

Pediatric kidney replacement therapies in low-to-middle income countries: a review and white paper.

Acute kidney injury (AKI) disproportionately impacts children in low- and middle-income countries (LMICs), where up to 85% of AKI cases occur. As for pediatric chronic kidney disease (CKD), the true burden in LMICs remains unclear, as many cases go undiagnosed early, and other children succumb without adequate treatment. Unfortunately, these disparities result from limited access to kidney replacement therapy (KRT), kidney laboratory and imaging resources, healthcare provider shortages, and financial barriers. Pediatric kidney disease in LMICs often remains undiagnosed until advanced stages, magnified by limited access to lifesaving KRT, leading to significantly higher mortality rates compared to high-income countries. Additional challenges include community-acquired AKI from preventable causes such as infections and dehydration, compounded by the use of nephrotoxic remedies, poor healthcare seeking behavior, and lack of monitoring. Pediatric data for this vulnerable population is lacking. For children with CKD, barriers to sustained treatment-including dialysis and transplantation-further worsen outcomes. Socioeconomic inequalities, geographic barriers, and cultural factors additionally exacerbate outcomes. Efforts to address these disparities include implementing affordable, resource-efficient peritoneal dialysis (PD) programs, enhancing healthcare worker training, and adopting innovative diagnostic technologies. Successful international collaborations, such as the Sister Renal Program, Saving Young Lives, and the Affordable Dialysis Project, have demonstrated the potential for improving access and outcomes. Advocacy for sustainable government policies, resource allocation, and integration of community-based approaches is critical. This paper highlights global inequities in pediatric nephrology care and proposes targeted strategies to enhance diagnostics, treatment, and management of AKI and CKD in LMICs. A call to action is issued to foster international collaboration and prioritize the needs of resource-limited regions.

Off-label drugs in laryngology- what should the doctor and the patient know about such therapies? A consensus statement of the European Laryngological Society.

Off-label drugs are being used in laryngology. Prescribing of a medicinal product is a decision taken within the relationship between a patient and his/her treating health care provider (HCP). The purpose of this article is to discuss the medicolegal aspects of off-label drug use, to provide recommendations for obtaining informed patient consent for off-label treatment and to propose the place and role of scientific societies and specialist boards in shaping good practices in this area. The final aim is to present recommendations concerning off-label usage and propose special clauses in informed patients consent. The literature was reviewed regarding off-label applications in laryngology. Practical information on off-label use in various EU countries was collected. Registration data and pharmacokinetics of cidofovir, bevacizumab, Gardasil®, hyaluronic acid and mitomycin are provided. Off-label prescribing is not prohibited by EU law. Informed consent to treatment with an off-label drug exists in all EU countries. The risk that a court will accept liability of a HCP in case of off-label prescribing is higher than in case of on-label prescribing. If a HCP is held liable for the outcome of a medical treatment, the approval by the competent authorities and professional guideline is a strong defense. A patient's precise, explicit consent for the procedures including off-label drugs administration is mandatory. The second prerequisite is defining a need for creating based on recommendations by national or international scientific societies.

Awareness and Attitudes Regarding Adverse Drug Events and Reporting in South Africa.

Reporting of adverse drug events (ADEs), by consumers enhances medication-related risk surveillance, public awareness, and understanding of medicine safety. The aim of this study was to explore adults' awareness of ADEs, attitudes towards reporting and perceptions of their role in reporting ADEs in South Africa. We conducted a cross-sectional, analytical study in which adults residing in South Africa completed an online questionnaire. The data collected was analysed using both descriptive and inferential statistics. We received responses from 350 participants. Most participants (86.2%, n = 302; N = 350) reported having heard about ADEs and the majority of participants (94.4%, n = 301; N = 319) indicated that reporting of ADEs was important. The Med Safety App was not widely known (17.3%, n = 58; N = 336) while the South African Health Products Regulatory Authority (SAHPRA) was relatively well known (77.4%, n = 260; N = 336). Healthcare providers only educated 55.7% (n = 180; N = 323) of the participants about ADEs and only 50.5% (n = 163; N = 323) of the participants asked their healthcare providers about ADEs. Awareness regarding ADEs was significantly higher (p < 0.001) among healthcare professionals (HCPs) compared to non-healthcare professionals (non-HCP). Most participants were aware of ADEs and agreed it was important to report ADEs although reporting tools, such as the Med Safety App, were not well known. We recommend awareness campaigns on reporting processes because this could improve consumer reporting of ADEs in South Africa.

Port REMoval Outcomes (PREMO) study: A pilot study for functional, microbial, radiological, and macroscopic assessment of totally implantable venous access devices.

According to current guidelines Totally Implantable Venous Access Devices (TIVADs) require regular maintenance (i.e. flushing with 0.9% Sodium Chloride solution) when not in use. Existing evidence suggests that extending flushing intervals up to 12 weeks does not compromise catheter function, but longer intervals or omitting flushes require more research. To facilitate a future randomized controlled trial (RCT), various methods were evaluated for assessing functional (CINAS classification, vacutainer filling time (VFT)), microbial (tip culture, swabs), radiological (linogram), and macroscopic (visual inspection) changes in TIVADs after a 12-weekly maintenance regimen. TIVADs from 70 patients were assessed upon TIVAD removal. Concerns over the perceived invasiveness of the linogram resulted in only 36% of eligible patients eventually consenting to participate in the trial. Eighty-six percent had normal TIVAD function, with an average VFT of 23 s/10 mL (SD 5 s/10 mL). Linograms were aberrant in 15% of patients, but the majority of anomalies did not correlate with visible thrombus on inspection or functional issues. No positive microbial cultures were found. The primary end point of any future research on TIVAD maintenance should primarily be focused on the functionality of the TIVAD. The CINAS classification effectively standardizes reporting of TIVAD functionality. Although VFT offers a precise measurement of aspiration function, optimal target values remain unclear and clinical relevance might be limited in a functional TIVAD. The added value of a linogram seems to be negligible. An RCT trial comparing 12-weekly TIVAD maintenance versus no maintenance would be invaluable for both patients and health care providers. Clinical Trials register (NCT03948958).

From Roots to Canopy: Understanding Chronic Pelvic Pain Through a Tree-Inspired Model.

Chronic pelvic pain affects approximately 25% of women. Despite its prevalence, health care providers often find it challenging and may feel underprepared to offer effective care. Using the metaphor of a tree provides a simplified, systematic approach to better understanding andthusmanaging this condition. The tree model unites both the biopsychosocial and neuroinflammatory models of chronic pain. In this metaphor, the tree's roots represent nociceptive inputs, the trunk represents nociplastic changes, and the canopy signifies psychosocial factors. The bark symbolizes protective behaviors adopted by the individual, whereas the sap represents the bidirectional nature of pain messaging. This metaphor provides a relatable visual framework for understanding chronic, persistent pelvic pain and serves as a foundation for history taking, physical examination, and care planning.The tree metaphor can help patients understand their pain and serve as a starting point for discussing treatment options. It helps to deconstruct the complexity of chronic, persistent pelvic pain into manageable components, offering a practical tool for both individuals with chronic pelvic pain and providers.

A Compassionate Release Pilot in New Orleans.

The prison population is aging and health care costs are rising. Compassionate release for the terminally ill and disabled is underutilized, especially in Louisiana, which is the state with the highest incarceration rate. This article evaluates the utilization of community physicians to improve compassionate release rates. Health care providers at a contract hospital for the Louisiana Department of Public Safety and Corrections collaborated with attorneys, the Louisiana Department of Health, and the Louisiana Department of Public Safety and Corrections to facilitate compassionate release for eligible individuals. A retrospective analysis of patients referred for compassionate release between August 01, 2022 and December 31, 2023 was completed. Outcomes included release rates and underlying conditions. During this time, 18 patients were eligible; most were 56 to 75 years of age, consistent with national trends. Of the 18 eligible patients, four were released, eight died while incarcerated, and six remained incarcerated. This retrospective review shows that a coordinated, multidisciplinary approach can have a significant impact.

Place of Death for People with Schizophrenia and Bipolar Disorder in New Zealand: A National Retrospective Cohort Study.

Inequities in access to physical health care for those with mental health conditions and substance use disorders are well recognised, and evidence of unequal access to palliative care is emerging. This study uses complete national data to examine the place of death for those with specific mental health conditions in Aotearoa New Zealand. Methods: Mortality data between 2013 and 2018 was linked to secondary mental health service usage. Place and cause of death were compared between those with diagnoses of bipolar affective disorder or schizophrenia and those without, stratified by ethnicity. Results: A cohort of 498,293 individuals was identified. People diagnosed with bipolar disorder and schizophrenia had different patterns of cause and place of death from other New Zealanders. This group was less likely to die in hospices, even after adjustment for differences in cause of death and age (adjusted OR 0.59, CI 0.52-0.68). Patterns of place of death differed by ethnicity. Conclusions: Inequities in healthcare provision for those diagnosed with psychotic disorders continue at the end of life, with reduced access to hospice facilities. Further research is needed to understand the quality of healthcare provision and wishes of those with mental health conditions in end-of-life care.

Immigration changes a huge risk for social and healthcare provision, say sector leaders.

Immigration changes a huge risk for social and healthcare provision, say sector leaders.

Economic outcomes of diabetes self-management education among older Medicare beneficiaries with diabetes

BackgroundDiabetes self-management education (DSME) has significant clinical benefits on diabetic glycemic control and reduction in the onset of complications. However, the economic benefits of DSME in older Medicare beneficiaries are not well known. The objective of this study is to examine the effect of DSME on different types of costs in older Medicare beneficiaries with diabetes.MethodsThis was a pooled cross-sectional study using the Medicare Current Beneficiary Survey (MCBS). The use of DSME was reported by survey respondents. Economic outcomes included total medical costs, total diabetes-related medical costs, total prescription costs, and total anti-diabetic prescription costs were measured based on Medicare claims and prescription drug events data from the perspective of the Medicare system. All costs were adjusted to 2012 U.S. dollars using the Consumer Price Index (CPI). Generalized linear models, with a log link and gamma distribution, were used to examine the effect of DSME on different costs.ResultsA total of 3,003 older Medicare beneficiaries with diabetes were included, among whom 35.50% (n = 1,066) had DSME. Individuals who did not have DSME had significantly higher total prescription costs than those who had DSME ($4,398.19 vs. $3,966.82, P =.0134). After adjusting for covariates, compared to those who did not have DSME, those who had DSME had 16.36% (95% CI: 9.69% to 22.54%) lower total medical costs and 12.83% (95% CI: 6.41% to 18.80%) lower total prescription costs.ConclusionThis study found that DSME is associated with significantly lower spending in total medical and prescription costs for older Medicare beneficiaries. Given the economic benefits associated with DSME, different healthcare providers should further promote and increase the awareness of DSME to ensure sustained activities, enrollment, and patient retention in older Medicare beneficiaries with diabetes.

Proof of Concept for a Digital Framework to Support a Shared Agenda at Surgical Ward Rounds: Participatory Design Study.

Surgical ward rounds (SWRs) are often unstructured and deprioritized compared to traditional surgical tasks, leading to limited interdisciplinary collaboration, unprepared patients, and low family attendance. This study aimed to co-design and develop a digital framework to facilitate a shared agenda for SWRs, ensuring all core participants can attend and participate effectively. Participatory Design (PD) methodologies were employed, utilizing user-engaging activities within an iterative process. A multidisciplinary team, including patients, relatives, healthcare providers, technology designers, and researchers, collaborated in workshops and testing to translate user needs into prototypes of technologies consisting of the digital framework. A logistics system was developed for nurses to pre-book the SWRs in designated time slots, enabling them to prepare relevant data and partake in the dialogue with patients. Additionally, a mobile health application (mHealth app) displayed the schedule for patients and relatives, helping them to participate and prepare questions in advance. Multiple iterations ensured that the digital framework met user needs and was feasible for clinical practice. Our findings underscore the importance of collaboration between users and technology designers in developing digital health technologies. Engaging the users helped identify technical and organizational constraints that needed to be addressed to integrate the digital framework into clinical settings.

Factors Associated With Medication Adherence Among Patients With Attention-Deficit/Hyperactivity Disorder (ADHD).

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common behavioral health condition that impacts 5% to 8% of children and 2.5% of adults worldwide. The symptoms of ADHD are effectively managed with medication, yet patients with ADHD may inconsistently take their medication. We assessed medication adherence among patients with ADHD and identified factors associated with medication adherence that may be utilized to optimize adherence. This is a retrospective, observational study among patients aged 4 years and older with a diagnosis of ADHD at primary care and multispecialty outpatient clinics during May 2021 to May 2023. We assessed sociodemographic characteristics, stratified by medication adherence status (Percentage of Days Covered ≥ 80%) using simple proportion, Student's t-test, and Chi-square test. We conducted univariable and multivariable logistic regression analyses to assess potential medication adherence factors, including sociodemographic characteristics, depressive symptoms, suicide risk, health service utilization, and social determinants of health (SDOH). We found 7,661 patients diagnosed with ADHD, with a mean (SD) age of 21.8 (14.8) years. The ADHD prevalence was 5.5% for patients aged 4 to 12, 4.4% for 13 to 17, and 0.8% for 18+ years old. Most patients were male (56.9%), non-Hispanic White (37.6%), and privately insured (55.1%). Among these patients, only 4,242 (55.4%) were treated with medication. Among 4,011 patients with medication adherence information, the average adherence rate was 56%, and only 1,113 patients (27.5%) met our threshold for adherence to ADHD treatment (80%). Adherence was positively associated with being adults, having more BH and PCP visits, and negatively associated with racial and ethnic minorities and more severe depressive symptoms. Only half of patients with ADHD were treated with medication. Of those treated, less than a third adhered to medication. Age, race and ethnicity, depressive symptoms, and BH and PCP visits were statistically associated with medication adherence. Healthcare providers may need to address factors such as coexisting depressive symptoms, and unmet SDOH needs to improve medication adherence among patients with ADHD. Also, patients reaching adolescence may need enhanced medication management.

"I Didn't Know Him Before the Pandemic… Now He's on My Speed Dial": Strengthening Collaboration Between Infectious Diseases Physicians and State and Local Public Health for Future Public Health Emergencies.

Infectious diseases (ID) physicians play a crucial role in public health emergencies. Effective collaboration between public health agencies and healthcare providers is essential for a coordinated response. However, there is limited information on how ID physicians and health departments collaborate and which areas need to be improved. Here, we identify ways to enhance public health preparedness through increased collaboration between ID physicians and state, tribal, local, and territorial health departments. We performed a secondary qualitative analysis of 37 telephone interviews conducted using a semistructured discussion guide. Interviews were conducted from July 2023 through September 2023 as part of a pandemic preparedness needs assessment by the Infectious Diseases Society of America's COVID-19 Real-Time Learning Network. Participants included ID physicians (n = 13), public health workers (n = 7), healthcare facility-based pandemic leaders (n = 7), and national stakeholders (n = 10). While some jurisdictions had robust connections between ID physicians and public health staff, lack of coordination in other areas led to duplication of efforts, confusion, and underutilization of resources. Respondents indicated that collaboration can be strengthened over time. Recommendations included better data systems, standardized reporting procedures, early dissemination of updates, and training of ID physicians in the incident command structure and media communication. The opportunity to build on institutional knowledge from the coronavirus disease 2019 pandemic will be lost without a commitment of time, resources, and planning. Public health officials can use this experience as a catalyst for building strong collaborative relationships between ID physicians and public health practitioners, a cornerstone of future pandemic response.