Increase Access To Health Care Research Articles

Video triage of children with respiratory symptoms at a medical helpline is safe and feasible-a prospective quality improvement study.

Young children are among the most frequent patients at medical call centers, even though they are rarely severely ill. Respiratory tract symptoms are among the most prevalent reasons for contact in pediatric calls. Triage of children without visual cues and through second-hand information is perceived as difficult, with risks of over- and under-triage. To study the safety and feasibility of introducing video triage of young children with respiratory symptoms at the medical helpline 1813 (MH1813) in Copenhagen, Denmark, as well as impact on patient outcome. Prospective quality improvement study including 617 patients enrolled to video or standard telephone triage (1:1) from February 2019-March 2020. Data originated from MH1813 patient records, survey responses, and hospital charts. Primary outcome was difference in patients staying at home eight hours after the call. Secondary outcomes weas hospital outcome, feasibility and acceptability. Adverse events (intensive care unit admittance, lasting injuries, death) were registered. Logistic regression was used to test the effect on outcomes. The COVID-19 pandemic shut the study down prematurely. In total, 54% of the included patients were video-triaged., and 63% of video triaged patients and 58% of telephone triaged patients were triaged to stay at home, (p = 0.19). Within eight and 24 hours, there was a tendency of fewer video-triaged patients being assessed at hospitals: 39% versus 46% (p = 0.07) and 41% versus 49% (p = 0.07), respectively. At 24 hours after the call, 2.8% of the patients were hospitalized for at least 12 hours. Video triage was highly feasible and acceptable (>90%) and no adverse events were registered. Video triage of young children with respiratory symptoms at a medical call center was safe and feasible. Only about 3% of all children needed hospitalization for at least 12 hours. Video triage may optimize hospital referrals and increase health care accessibility.

173 The State of Neurosurgical Disparities Research: Past, Present, and Future

INTRODUCTION: Social determinants of health (SDH), which influence health care access, patient outcomes, and population-level burden of disease, contribute to health disparities experienced by marginalized patient populations. METHODS: Embase, Ovid-MEDLINE, Scopus, Web of Science, Cochrane Library, and ProQuest Dissertations databases were queried for original research on health disparities regarding access to, outcomes of, or postoperative-management following neurosurgical procedures in the U.S. with at least one neurosurgical-affiliated author. RESULTS: Of 642 studies screened, 109 were included. Eighty-eight articles met all inclusion criteria other than having a neurosurgical-affiliated author and were excluded. Six studies were published prior to 2010 and 56 in the past 5 years with 62% utilizing national databases, 28% institutional databases, and 11% employing local/state/regional databases. Disparities analyzed were racial/ethnic (79%), economic/socioeconomic (59%), gender (19%), and disabled populations (0.9%) with 43% analyzing multiple/intersecting disparities. Common outcome measures were postoperative outcomes (59%), access to neurosurgical procedures (48%), and post-operative management (9%). Neuro-oncology was the most prevalent subspecialty evaluated (28%) followed by spine (26%), then pediatrics (14%), functional (11%), vascular (12%), general (7%), and trauma (3%). Senior authors with neurosurgical affiliations accounted for 87% of papers, 99% of whom were academically affiliated, and were most located in the South (29%), followed by the Northeast (28%), West (27%), and Midwest (15%). CONCLUSIONS: The majority of studies used national databases, assessed racial/ethnic disparities, and focused on postoperative outcomes. Many articles did not have a neurosurgery-affiliated author and the subspecialties of pediatrics, functional, vascular, and trauma were relatively underrepresented. Future research regarding SDH for neurosurgical patients will be crucial to increase healthcare access, improve outcomes, and achieve equity for marginalized patient populations. Moreover, it will be crucial for neurosurgery-affiliated researchers to engage in SDH research to increase visibility and impact of this area in neurosurgery.

In a Large Healthcare System in the Bronx, Teleretinal Triaging Was Found to Increase Screening and Healthcare Access for an Underserved Population with a High Incidence of T2DM and Retinopathy

The early treatment of diabetic retinopathy (DR) prevents vision-threatening proliferative retinopathy (PDR) and macular edema (DME). Our study evaluates telemedicine (teleretinal) screening for DR in an inner-city healthcare network with a high ethnic diversity and disease burden. Fundus photographs were obtained and graded in a centralized reading center between 2014 and 2016. Patients with positive screenings were referred to a retina specialist. An analysis of sensitivity and specificity and a subgroup analysis of prevalence, disease severity, and follow-up adherence were conducted. In 2251 patients, the '1-year' and 'Overall' follow-ups were 35.1% and 54.8%, respectively. Severe grading, male gender, and age were associated with better follow-up compliance. The DR, PDR, and DME prevalence was 24.9%, 4.1%, and 5.9%, respectively, and was significantly associated with HbA1c. The sensitivity and specificity for DR, PDR, and DME were 70% and 87%, 87% and 75%, and 37% and 95%, respectively. No prevalence differences were noted between ethnicities. Annual diabetic eye exam adherence increased from 55% to 85% during the study period. Teleretinal triaging is sensitive and specific for DR and improved diabetic eye exam compliance for underserved populations when integrated into large healthcare networks. The adherence to follow-up recommendations was better among older patients and among those with more severe retinopathy.

Teleneurology via tablet technology: an effective low-cost method to increase healthcare accessibility.

Telemedicine is a valuable tool to increase access to health care, especially for patients in rural areas who need to visit a specialist. In place of telemedicine robots, which are costly and complicated, hospitals have implemented successful telemedicine programs using lower-cost tablet technology; opting for tablet technology increases the organizational feasibility of a large-scale telemedicine program. Vanderbilt University Medical Center (VUMC), in Nashville, Tennessee, USA, launched its teleneurology network program in 2014 to serve patients in surrounding community hospitals who needed a neurology consult. Consults are conducted using an iPad, including examinations and the secure sharing of images and patient information. This article reports on teleneurology consult data and the results of patient and physician satisfaction surveys. Between February 2014 and November 2021, the VUMC teleneurology network program provided consultations for 14 241 patients with a wide variety of neurological diagnoses presenting to 12 community-based hospitals. Patient and community physician satisfaction surveys showed that 96% of physicians were satisfied with the overall care provided, and 89% of patients reported that the telehealth visits met their medical needs. One of the goals of telemedicine programs is to increase access to care. Therefore, it is important that the technology used to implement the program also be accessible in terms of cost and complexity. Tablets are low-cost technology, and their use in telemedicine has been shown to satisfy both physicians and patients with a wide variety of diagnoses.

Healthcare workers´ experiences and perceptions of the provision of health insurance benefits to the elderly in rural Tanzania: an explorative qualitative study

BackgroundHealthcare workers play an important part in the delivery of health insurance benefits, and their role in ensuring service quality and availability, access, and good management practice for insured clients is crucial. Tanzania started a government-based health insurance scheme in the 1990s. However, no studies have specifically looked at the experience of healthcare professionals in the delivery of health insurance services in the country. This study aimed to explore healthcare workers’ experiences and perceptions of the provision of health insurance benefits for the elderly in rural Tanzania.MethodsAn exploratory qualitative study was conducted in the rural districts of Igunga and Nzega, western-central Tanzania. Eight interviews were carried out with healthcare workers who had at least three years of working experience and were involved in the provision of healthcare services to the elderly or had a certain responsibility with the administration of health insurance. The interviews were guided by a set of questions related to their experiences and perceptions of health insurance and its usefulness, benefit packages, payment mechanisms, utilisation, and availability of services. Qualitative content analysis was used to analyse the data.ResultsThree categories were developed that describe healthcare workers´ experiences and perceptions of delivering the benefits of health insurance for the elderly living in rural Tanzania. Healthcare workers perceived health insurance as an important mechanism to increase healthcare access for elderly people. However, alongside the provision of insurance benefits, several challenges coexisted, such as a shortage of human resources and medical supplies as well as operational issues related to delays in funding reimbursement.ConclusionWhile health insurance was considered an important mechanism to facilitate access to care among rural elderly, several challenges that impede its purpose were mentioned by the participants. Based on these, an increase in the healthcare workforce and availability of medical supplies at the health-centre level together with expansion of services coverage of the Community Health Fund and improvement of reimbursement procedures are recommended to achieve a well-functioning health insurance scheme.

Mitigating the economic burden of GnRH agonist therapy for progestogen-resistant endometriosis: why not?

Is it possible to reduce the cost of GnRH agonist treatment for endometriosis by using non-standard dosing regimens? An extended-interval dosing regimen of a 3.75 mg depot formulation of triptorelin injected every 6 weeks instead of every 4 weeks reduces the cost by one-third without compromising the effect on pain relief. Cost constitutes a limit to prolonged GnRH agonists use. Alternative modalities to reduce the economic burden of GnRH agonist treatment have been anecdotally attempted. A systematic review was conducted to evaluate and compare the effect of three alternative modalities for GnRH use in women with endometriosis, i.e. intermittent oestrogen deprivation therapy, reduced drug dosage, and extended-interval dosing regimens of depot formulations. A PubMed and Embase search was initially conducted in October 2022 and updated in January 2023 using the following search strings: (endometriosis OR adenomyosis) AND (GnRH-agonists OR gonadotropin-releasing hormone agonists OR triptorelin OR leuprorelin OR goserelin OR buserelin OR nafarelin). Full-length articles published in English in peer-reviewed journals since 1 January 1980, and reporting original data on GnRH agonist treatment of pain symptoms associated with endometriosis were selected. Information was extracted on study design, GnRH-agonist used, dosage, total duration of therapy, side effects, treatment adherence, and pelvic pain relief. Reviews, commentaries, conference proceedings, case reports, and letters to the editor were excluded. Of the 1664 records screened, 14 studies regarding clinical outcomes associated with the 3 considered alternative modalities for GnRH agonist use were eventually included (intermittent oestrogen deprivation therapy, n = 2; low-dose or 'draw-back' therapy, n = 8; extended-interval dosing regimen, n = 4). Six studies were randomized controlled trials (RCTs) (double blind, n = 2) and eight adopted a prospective cohort design (non-comparative, n = 6; comparative, n = 2). A total of 776 women with endometriosis were recruited in the above studies (intermittent oestrogen deprivation therapy, n = 77; low-dose or 'draw-back' therapy, n = 528; extended-interval dosing regimen, n = 171). Robust data demonstrating cost saving without detrimental clinical consequences were available for the extended-interval dosing regimen only. In particular, the 3.75 mg triptorelin depot preparation inhibits ovarian function for a longer period compared with the 3.75 mg leuprorelin depot preparation, allowing injections every 6 instead of 4 weeks. Based on the cost indicated by the Italian Medicine Agency for the 3.75 mg triptorelin depot preparation, this would translate in a yearly saving of €744.60 (€2230.15-€1485.55; -33.4%). The quality of the evidence reported in the selected articles was not formally evaluated and a quantitative synthesis could not be performed. Some studies were old and the tested therapeutic approaches were apparently obsolete. Only cost containment associated with GnRH analogue use, and not cost-effectiveness, has been addressed. Consuming less resources without negatively impacting on health outcomes carries ethical and practical implications for individuals and the community, as this approach may result in overall increased healthcare access. This study was supported by the Italian Ministry of Health (Ricerca Corrente 2023, IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano). E.S. discloses payments from Ferring for research grants and honoraria from Merck-Serono for lectures. All other authors declare they have no conflict of interest. N/A.

An international survey of allied health & nursing professionals during the COVID-19 pandemic: Perspectives on facilitators of & barriers to care.

Allied health and nursing professionals (AHNP) are integral members of transplant teams. During the COVID-19 pandemic, they were required to adapt to changes in their clinical practices. The goal of the present study was to describe AHNP perceptions concerning the impact of the pandemic on their roles, practice, and resource allocation. An online survey was distributed globally via email by the International Pediatric Transplant Association to AHNP at transplant centers from September to December 2020. Responses to open-ended questions were collected using an electronic database. Using a thematic analysis approach, coding was conducted by three independent coders who identified patterns in responses, and discrepancies were resolved through discussion. The majority of respondents (n=119) were from North America (78%), with many other countries represented (e.g., the United Kingdom, Europe, Australia, New Zealand, South Africa, and Central and South America). Four main categories of impacts were identified: (1) workflow changes, (2) the quality of the work environment, (3) patient care, and (4) resources. Participants indicated that the pandemic heightened existing barriers and resource challenges frequently experienced by AHNP; however, the value of team connections and opportunities afforded by technology were also highlighted. Virtual care was seen as increasing healthcare access but concerns about the quality and consistency of care were also expressed. A notable gap in participant responses was identified; the vast majority did not identify any personal challenges connected with the pandemic (e.g., caring for children while working remotely, personal stress) which likely further impacted their experiences.

Using Punctuated Equilibrium Theory: Policy Momentum in Traditional Medicare Telehealth Reimbursement During COVID-19.

This article seeks to understand the changes in federal health care policy that led to greater telehealth adoption during COVID-19 pandemic. For decades, telehealth was identified as a possibility for increasing health care access, but the policies needed for greater telehealth reimbursement were stalled until the public health emergency was declared. Applying the dynamic concepts within punctuated equilibrium theory (PET) model to traditional fee-for-service Medicare policy, the influential factors are identified and specify how policy change occurred as a response to the pandemic, resulting in swift and large-scale changes in Medicare telehealth reimbursement requirements and widespread telehealth adoption. The model also explains how the same forces that led to Medicare policy response are at work to maintain and broaden or contract and limit the future of telehealth reimbursement as the public health emergency recedes.

School-based health centers and rural community health

ABSTRACT School-based health centers (SBHCs) provide comprehensive health care services to children through facilities that are located directly within their school. Although traditionally located in low-income urban communities, SBHCs are becoming more prevalent in rural schools, and we propose that they may have important positive impacts in those communities. By reducing distance to care providers, capitalizing on the role of schools as a known local institution, providing consistent preventive care, and leveraging understanding of community challenges in providing health care services, SBHCs can increase health care access and positively impact social determinants of health. They may also contribute to community development if establishing and maintaining the SBHCs community activates community capitals and enhances resource sharing, communication and relationship building. We expand on these ideas by providing a case study of SBHC development and outcomes using data from a not-for-profit healthcare organization that operates a network of SBHCs in four adjacent rural counties of New York state.

Access to episodic primary care: a cross-sectional comparison of walk-in clinics and urgent primary care centers in British Columbia.

This study aimed to identify publicly reported access characteristics for episodic primary care in BC and provided a clinic-level comparison between walk-in clinics and UPCCs. Walk-in clinics are non-hospital-based primary care facilities that are designed to operate without appointments and provide increased healthcare access with extended hours. Urgent and Primary Care Centres (UPCCs) were introduced to British Columbia (BC) in 2018 as an additional primary care resource that provided urgent, but not emergent care during extended hours. This cross-sectional study used publicly available data from all walk-in clinics and UPCCs in BC. A structured data collection form was used to record access characteristics from clinic websites, including business hours, weekend availability, attachment to a longitudinal family practice, and provision of virtual services. In total, 268 clinics were included in the analysis (243 walk-in clinics, 25 UPCCs). Of those, 225 walk-in clinics (92.6%) and two UPCCs (8.0%) were attached to a longitudinal family practice. Only 153 (63%) walk-in clinics offered weekend services, compared to 24 (96%) of UPCCs. Walk-in clinics offered the majority (8,968.6/ 78.4%) of their service hours between 08:00 and 17:00, Monday to Friday. UPCCs offered the majority (889.3/ 53.7%) of their service hours after 17:00. Most walk-in clinics were associated with a longitudinal family practice and provided the majority of clinic services during typical business hours. More research that includes patient characteristics and care outcomes, analyzed at the clinic level, may be useful to support the optimization of episodic primary healthcare delivery.

Social Health Security Program and Poor: A Case Study of Dhangadhi Sub-Metropolitan City

It is a well-known fact that Alma Ata Conference on Primary Health Care held in Kazakhstan in 1978 called for all the countries to implement primary health care for increasing health care access to all the people at affordable cost and achieving the targets of "Health for All" by the year 2000.The conference had also emphasized the provision of preventive, promotive, curative, and rehabilitative services up to the community level for addressing main health problems (Gilllam, 2008). The World Health Organization also affirms that: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” To ensure these rights to its citizens, every state has to invest organizational, human and financial resources to its optimum level.

IMPACT OF RECEIVING HOME-BASED PRIMARY CARE FOR PERSONS LIVING WITH DEMENTIA: PATIENT AND CAREGIVER PERSPECTIVES

Abstract Homebound persons living with dementia (PWD) require healthcare services that proliferate with physical and cognitive changes over time. PWD often experience fragmented care that results in poor health outcomes and delayed healthcare access. The objective of the Virginia at Home Program (VaH), a recently initiated home-based primary care (HBPC) program, is to promote long-term sustainability and proliferation of HBPC. The study purpose was to examine the impact of VaH on the overall care and outcomes of homebound PWD and their families. We used quantitative and qualitative methods to describe the impact of VaH on patient care and outcomes over six months. We compared clinical outcomes (e.g., activities of daily living, frailty, behavioral symptoms) at baseline and six months using paired t-tests. We also conducted semi-structured phone interviews at baseline and six months with PWD-caregiver dyads. Thirty PWD-caregiver dyads enrolled. Of the 17 dyads that completed both visits, PWD’s physical function and caregiver’s burden decreased significantly over time (ps < .05). There was a significant improvement in PWD’s behavioral symptoms over the six-month period (p=.03). Three preliminary themes emerged from qualitative data: 1) participants established trusting relationships with the VaH team, 2) VaH supported caregivers in their caregiving responsibilities, and 3) participants met their pre-program goals through increased healthcare access. Findings suggest that the HBPC intervention improved care satisfaction and healthcare access and alleviated caregiver burden. Future studies should consider introducing HBPC programs in this hard-to-reach population to decrease acute care utilization and health care costs while improving care satisfaction and quality.

HEALTH INSURANCE COVERAGE, AGE, AND IMMIGRATION-RELATED FACTORS AMONG KOREAN AMERICANS

Abstract The purpose of this study was to examine health insurance coverage and its association with demographic and immigration-related factors (English proficiency, generational status, and age at immigration) among Korean Americans (KAs, n=11,462). Data were drawn from the 2017 American Community Survey. KA older adults aged 65+ had significantly higher odds of having any health insurance compared to those aged 41 to 64. KAs who speak English well or only speak English were more likely to have any health insurance compared to those with limited English proficiency (i.e., don’t speak English well or at all). First-generation KAs had lower odds of having any health insurance compared to those born in the U.S. Those who immigrated after 41 years of age were less likely to have health insurance compared to those born in the U.S. These findings underscore the need to consider immigration-related factors in efforts to increase healthcare accessibility for KAs.

The Impact of the COVID-19 Pandemic on eHealth Use in the Daily Practice and Life of Dutch-Speaking General Practitioners in Belgium: Qualitative Study With Semistructured Interviews.

The COVID-19 crisis has led to rapid and far-reaching changes in digital health care, but little is known about what, why, and how changes occurred in eHealth use in Flemish general practice during the pandemic. This study aims to understand how general practitioners (GPs) perceive and evaluate eHealth solutions and their eHealth experience during the COVID-19 pandemic. This qualitative study was conducted using in-depth 1-on-1 semistructured interviews with the help of an interview guide. Several areas were identified beforehand to help assess the impact of the COVID-19 pandemic: perceptions of digital technologies in GP practices; changes in the use of these technologies during and after the COVID-19 pandemic; GPs' adaptation to digitalization, benefits, risks, and challenges of eHealth; GPs motivations to change practice; and future perspectives on eHealth. In this study, purposive sampling and snowballing methods were used. Between October 2021 and April 2022, we interviewed 15 Dutch-speaking GPs in the Flemish region via the Zoom online conferencing tool. GPs indicated that eHealth was used more frequently during the COVID-19 pandemic than before, a change that helped them reduce their workload, enabling greater accessibility to health care services and the complementary use of digital and physical consultations. Our findings suggest that physicians underwent a significant cognitive shift in their perceptions, causing them to be more open and prepared to adopt eHealth solutions. However, there remains significant doubt and uncertainty about digital literacy for certain groups, privacy, data security, reimbursement, and the burden of technical information and communication technologies (ICT) issues. The COVID-19 pandemic seems to have been a turning point for eHealth by Flemish GPs. eHealth is an essential complementary health care service that can reduce pressure on health care as well as increase health care accessibility. Sensitive aspects, such as privacy, data security, digital literacy, reimbursement, and the burden of technical ICT issues, are particularly emphasized. With our results, we can offer recommendations to health IT policymakers and developers that will help maintain the continuity of eHealth solutions beyond the COVID-19 pandemic, considering the expectations and sensitivities presented in the study.

P087Medical management of early pregnancy in emergency departments compared to outpatient: Evaluating a covid-19 institutional policy change to increase healthcare access

<h3>Objectives</h3> To assess the safety and efficacy of prescribing mifepristone and misoprostol for medical management of abnormal early pregnancy in emergency departments (EDs) compared to outpatient management at a complex family planning office, and to compare post-treatment follow-up. <h3>Methods</h3> We conducted a retrospective cohort study after implementing mifepristone and misoprostol prescription in three Bronx, NY EDs during the COVID-19 pandemic's first wave. All patients receiving medical management between April 1, 2020 and March 31, 2021 were reviewed. Outcomes were compared by treatment setting. Induced abortion only occurred in the outpatient setting. Treatment success was defined as pregnancy resolution after one dose of mifepristone and misoprostol. Safety outcomes included emergent interventions and blood transfusion. We assessed rates of post-treatment follow-up. <h3>Results</h3> Some 167 patients received medical management: 33 (19.8%) in the ED and 134 (80.2%) outpatient. ED patients were older (aged 30.9±6.9 vs. 28.1±5.9, p=0.02) and more likely to have Medicaid insurance (81.8% vs. 51.5%, p=0.003). Treatment success occurred for 23 (69.7%) ED and 119 (88.8%) office patients. A multivariate logistic regression adjusting for age, insurance status, and pregnancy diagnosis showed lower odds of treatment success in the ED vs. outpatient setting, but was not statistically significant (adjusted OR (aOR), 0.60; 95% CI, 0.17–2.09; p=0.42). ED safety outcomes included two emergent uterine aspirations, one uterine artery embolization, and two blood transfusions. Outpatient safety outcomes included one admission for intravenous antibiotics. Follow-up was similar: 28 (84%) ED vs 121 (90.3%) outpatients (p=0.36). <h3>Conclusions</h3> Medical management of abnormal early pregnancy with mifepristone and misoprostol in the ED is effective. Larger studies are needed to better quantify ED safety outcomes.

Variations in Perioperative Telemedicine Use During the COVID-19 Pandemic Without Impact on Postoperative Outcomes

INTRODUCTION: Telemedicine is designed to increase healthcare access. However, its effect on surgical outcomes is not yet known. We aimed to characterize perioperative telemedicine use and determine whether it was associated with postoperative complication. METHODS: Surgical appointments at a tertiary care academic center in Alabama were reviewed from March 1, 2020, to October 4, 2021 (n = 3,207 visits, 1,759 patients). Visits closest to and within 60 days of operation were cross-referenced with institutional American College of Surgeons NSQIP data. t-tests and logistic regression were performed to characterize perioperative telemedicine use and determine associations with postoperative surgical site infection (SSI) and 30-day readmission. RESULTS: Data was available for 1,953 preoperative and 2,054 postoperative visits. Telemedicine was used similarly preoperatively (16.5%) and postoperatively (16.9%, p = 0.8). Telemedicine preoperative visits were closer to operation than in-person (22.2 vs 23.7 days, p = 0.003). Telemedicine postoperative visits were further from operation (27.9 vs 23.7 days, p < 0.001). Preoperative telemedicine visits were more often with general surgery (ref: orthopedic, adjusted odds ratio [aOR]: 4.47, 95% CI: 3.05 to 6.55), for outpatient operation (aOR: 1.84, 95% CI: 1.39 to 2.42), and for lower American Society of Anesthesiologists score patients (aOR: 0.71, 95% CI: 0.54 to 0.94). There was no significant association between telemedicine use and age, race, or BMI. Similar findings existed for postoperative visits. SSI was lower among operations with telemedicine preoperatively (aOR: 0.46, 95% CI: 0.21 to 0.99) and postoperatively (aOR: 0.37, 95% CI: 0.17 to 0.8) without significant association with 30-day readmission. CONCLUSION: Most perioperative appointments are currently in-person, with telemedicine use typically occurring for healthier patients undergoing outpatient operation. Perioperative telemedicine use is not associated with increased SSI or readmission and should be considered as an option to improve surgical access while maintaining quality care.

News &amp; Notes

The FSMB has released a video recording of “Understanding the VA’s National Standards of Practice,” a webinar it hosted on September 8, 2022.The US Department of Veterans Affairs (VA) affirmed its right under the US Constitution to establish national standards of practice, a standardized set of services that all health care professionals in each occupation can perform if their facility performs such services and they have the proper education, training, and skill. The Veterans Health Administration (VHA) is working to develop these national standards of practice to ensure safe, high-quality care for the nation’s veterans in VA’s integrated health care system. National standards of practice are designed to increase health care access, improve health outcomes for veterans, support staff in moving across VA, and provide VA staff support to the country in disaster and times of national crisis. During this webinar, the VA informed the state medical board community about these standards and described the formal process for sharing input.The webinar was moderated by Lisa A. Robin, MA, FSMB’s Chief Advocacy Officer, and the speakers were Elizabeth Brill, MD, MBA, FACOG, Deputy to the Assistant Under Secretary for Health for Clinical Services Integration, and M. Christopher Saslo, DNS, ARNP-BC, FAANP, Acting Assistant Under Secretary for Health for Patient Care Services. The recording is available at https://www.pathlms.com/fsmb/courses/46090.Recognizing the importance of the role of state medical board service, the nation’s state and territorial medical boards have launched a program in partnership with the FSMB to better educate and prepare new members of state medical boards for their duties as public servants.FSMB’s Workgroup on Board Education Service and Training (BEST), working with the state boards, developed a variety of new resources to support the roles and responsibilities associated with board service.At the core of these materials is “Understanding Medical Regulation in the United States,” a series of online multi-media educational modules that examine various components of service on a state medical board.Nine modules are planned for the series, the first three of which are now available. Content in the modules is intended to provide a general overview of medical regulation, supplementing more specific and detailed information about regulation in the states in which new board members will assume their duties.Users of the modules can watch them online or download a text version of the narration. The modules are available at https://www.fsmb.org/education/understanding-medical-regulation-in-the-united-states/The Center for Connected Health Policy (CCHP), which is the federally designated National Telehealth Resource Center for Policy, has released its 10-year anniversary report. For the past decade, CCHP has tracked and followed policy development for all 51 jurisdictions in the United States (District of Columbia included) as well as at the federal level. This past decade has also represented the period that encompasses some of the most significant telehealth policy developments seen to date. In celebration of this ten-year milestone, CCHP is offering this overview of the development of telehealth policy from 2012 – 2022.The report is meant to provide an overview of some of the more significant developments that CCHP has been able to capture and follow over the years given its unique position. The document serves as a report of what has transpired, as well as a means of setting the stage for the next chapter.The report is available at https://www.cchpca.org/resources/a-decade-of-telehealth-policy-our-10-year-anniversary-report-2/

'I Am Not The Doctor For You': Physicians' Attitudes About Caring For People With Disabilities.

People with disabilities face barriers when attempting to gain access to health care settings. Using qualitative analysis of three physician focus groups, we identified physical, communication, knowledge, structural, and attitudinal barriers to care for people with disabilities. Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations. Some physicians reported that because of these concerns, they attempted to discharge people with disabilities from their practices. Increasing health care access for people with disabilities will require increasing the accessibility of space and the availability of proper equipment, improving the education of clinicians about the care of people with disabilities, and removing structural barriers in the health care delivery system. Our findings also suggest that physicians' bias and general reluctance to care for people with disabilities play a role in perpetuating the health care disparities they experience.

The invisibility of Black and Latina women in sexual health care: shifting from biological individualism to intersectionality

Black and Latinx women have long endured racist healthcare practices and policies that influence their sexual health outcomes. Despite having increased health care access, Black and Latina women continue to have higher rates of sexually transmitted infections compared to their white counterparts. We utilised Critical Race Theory to examine the myriad ways in which Black and Latina women and their unmet needs may be invisible to healthcare providers and to better understand the compounding factors that may affect Black and Latina women’s engagement with sexual health services. Eighteen individual semi-structured interviews were conducted with healthcare providers, administrators and policy advocates working to address sexual health needs of Black and Latina women in California. Interviews were recorded and transcribed verbatim. Qualitative data were analysed using an inductive thematic approach. Two primary themes and subthemes were developed during our analysis. Within the healthcare system there is a lack of recognition of (1) intersectional identities of Black and Latina women, including intersectional oppressions and systemic vulnerabilities; and (2) structural barriers that mediate their sexual health treatment engagement. Recognition of intersectional identities and addressing structural barriers can potentially improve the sexual health of Black and Latina women and support efforts to address disparities in sexual health care.

High Satisfaction with Patient-Centered Telemedicine for Hepatitis C Virus Delivered to Substance Users: A Mixed-Methods Study.

Background: While telemedicine may increase health care access for vulnerable populations, data are limited on whether people with opioid use disorder (PWOUD) are satisfied with telemedicine. We assessed PWOUD satisfaction with telemedicine and identified factors that increase telemedicine satisfaction. Methods: We conducted a mixed-methods study among hepatitis C virus (HCV)-infected persons enrolled at 12 opioid treatment programs (OTPs) throughout New York State. Participants successfully completed HCV treatment either through telemedicine integrated into OTPs (N = 238) or through offsite referral (N = 106). We evaluated Patient Satisfaction Questionnaire (PSQ) response scores at the initial and final health care encounters and subsequently interviewed telemedicine study participants (N = 25) to assess their experiences with telemedicine. Results: All participants (N = 344) successfully completed HCV treatment. We observed no differences in PSQ scores between telemedicine and in-person encounters (98.3% and 98.7% of telemedicine participants provided PSQ scores of satisfied or highly satisfied at each timepoint, respectively). Study participants indicated that attributes associated with high telemedicine encounter satisfaction included: (1) communicating study information, (2) gaining trust, and (3) delivering patient-centered care. Participants weighted "General Satisfaction" and "Time Spent with Doctor" higher than "Accessibility and Convenience," and female participants were significantly more satisfied than males. Satisfaction with health care delivery among all participants increased significantly comparing timepoints. Conclusions: Participants were highly satisfied with HCV telemedicine encounters equivalent to in-person encounters. Communication augments trust facilitating delivery of patient-centered care through telemedicine. Participants value empathy and trust with providers over accessibility and convenience. In summary, PWOUD are highly satisfied with the facilitated telemedicine model and value empathetic and trusting providers. ClinicalTrials.gov Identifier: NCT02933970.