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The association between rurality, dual Medicare/Medicaid eligibility and chronic conditions with telehealth utilization: An analysis of 2019-2020 national Medicare claims.

Telehealth services have the potential to increase healthcare access among underserved populations, such as rural residents and racial/ethnic minority groups. The COVID-19 public health emergency led to unprecedented growth in telehealth utilization, but evidence suggests the growth has not been equitable across all patient populations. This study aimed to explore whether telehealth utilization and expansion changed equitably from 2019 to 2020 among sub-groups of Medicare beneficiaries. We conducted an analysis of telehealth utilization among a 20% random sample of 2019-2020 Medicare beneficiaries on a national level. We fit multivariable logistic regression models and calculated average marginal effects (AME) to assess the association between demographic and clinical characteristics on telehealth utilization. We found telehealth utilization was less likely among non-Hispanic Black/African-American (2019: adjusted odds ratio [aOR] = 0.77, AME = -0.15; 2020: aOR = 0.85, AME = -3.50) and Hispanic (2019: aOR = 0.79, AME = -0.13; 2020: aOR = 0.87, AME = -2.89) beneficiaries, relative to non-Hispanic White beneficiaries in both 2019 and 2020, with larger disparities in 2020. Rural beneficiaries were more likely to utilize telehealth than urban beneficiaries in 2019 (aOR = 2.62, AME = 0.84), but less likely in 2020 (aOR = 0.57, AME = -14.47). In both years, dually eligible Medicare/Medicaid beneficiaries were more likely than non-dually eligible beneficiaries to utilize telehealth (2019: aOR = 4.75, AME = 0.84; 2020: aOR = 1.34, AME = 2.25). However, the effects of dual eligibility and rurality changed in both models as the number of chronic conditions increased. We found evidence of increasing disparities in telehealth utilization among several Medicare beneficiary sub-groups in 2020 relative to 2019, including individuals of minority race/ethnicity, rural residents, and dually eligible beneficiaries, with disparities increasing among individuals with more chronic conditions. Although telehealth has the potential to address health inequities, our findings suggest that many of the patients in greatest need of healthcare are least likely to utilize telehealth services.

AI in Healthcare

The integration of Artificial Intelligence (AI) into healthcare systems heralds a transformative era marked by unprecedented advancements in diagnosis, treatment, and patient care. This comprehensive review explores the multifaceted applications of AI in the healthcare domain, offering a synthesized perspective on the current state of knowledge and future implications. By examining the intersection of AI with medical imaging, predictive analytics, personalized medicine, and virtual health assistants, this research illuminates the promising trajectory of AI in reshaping the landscape of healthcare delivery. The initial segment of the review focuses on AI applications in medical imaging and diagnostics. Harnessing machine learning algorithms and deep neural networks, AI demonstrates remarkable capabilities in interpreting complex medical images, such as radiographs, MRIs, and CT scans. The paper evaluates the accuracy and efficiency of AI-driven diagnostic tools, addressing challenges and opportunities for integration into clinical workflows. Moving beyond diagnostics, the second thematic area explores the role of AI in predictive analytics for disease prevention and early intervention. By leveraging patient data, electronic health records, and genomic information, AI models contribute to identifying at-risk populations, predicting disease trajectories, and optimizing preventive strategies. The research assesses the ethical considerations and data privacy implications inherent in deploying predictive AI models within healthcare ecosystems. The third section investigates the paradigm shift towards personalized medicine facilitated by AI technologies. Analyzing patient-specific data, including genetic information and treatment response patterns, AI tailors treatment plans to individual characteristics, optimizing therapeutic outcomes. The review explores case studies and ongoing initiatives in precision medicine to showcase the tangible benefits and challenges associated with personalized healthcare. In the final thematic area, the review delves into the burgeoning field of virtual health assistants and AI-driven patient care. From chatbots offering real-time medical advice to virtual nurses monitoring patient well-being, AI enhances accessibility and engagement in healthcare delivery. The paper examines the potential for AI to improve patient outcomes, increase healthcare accessibility, and alleviate the burden on healthcare professionals. Throughout the review, ethical considerations surrounding patient privacy, algorithmic biases, and the responsible use of AI in clinical decision-making are critically evaluated. The research concludes with a forward-looking perspective, emphasizing the imperative of ongoing collaboration between healthcare professionals, technologists, and policymakers to harness the full potential of AI in fostering a more efficient, accessible, and patient-centric healthcare ecosystem

Access to healthcare among transgender women living with and without HIV in the United States: associations with gender minority stress and resilience factors

BackgroundTransgender women (TW) experience significant inequities in healthcare access and health disparities compared to cisgender populations. Access to non-transition related healthcare is understudied among TW. We aimed to assess the association between access to care and gender minority stress and resilience factors among TW living with and without HIV in eastern and southern United States.MethodsThis study was a cross-sectional analysis of baseline data drawn from a cohort of 1613 adult TW from the LITE Study. The cohort permitted participation through two modes: a site-based, technology-enhanced mode and an exclusively online (remote) mode. Exploratory and confirmatory factor analyses determined measurement models for gender minority stress, resilience, and healthcare access. Structural equation modeling was used to assess the relationships between these constructs. Models were evaluated within the overall sample and separately by mode and HIV status.ResultsHigher levels of gender minority stress, as measured by anticipated discrimination and non-affirmation were associated with decreased access to healthcare. Among TW living with HIV, higher levels of anticipated discrimination, non-affirmation, and social support were associated with decreased healthcare access. Among TW living without HIV in the site-based mode, resilience was positively associated with positive healthcare experiences and inversely associated with barriers to healthcare access. Among TW living without HIV in the online mode, anticipated discrimination was associated with barriers to healthcare access; resilience was positively associated with positive healthcare experiences and inversely associated with barriers to healthcare access.ConclusionsGender minority stress was associated with increased barriers to healthcare access among TW in the US, regardless of HIV status. Resilience factors did not mediate this effect. Interventions aiming to increase healthcare access among TW can be aided by efforts to mitigate drivers of gender minority stress and improve patient experiences in healthcare facilities.

Undiagnosed hypertension and type 2 diabetes mellitus among Marshallese adults in the Republic of the Marshall Islands.

Given the lack of healthcare access in the Republic of the Marshall Island (RMI) and the potential for complications related to type 2 diabetes mellitus (T2DM) and hypertension, it is crucial to examine these conditions among Marshallese in the RMI. This study aims to identify the proportion of Marshallese adults in the RMI with undiagnosed T2DM and hypertension. Using a community-based participatory research approach, screening events were conducted at 20 churches in Majuro Atoll. Participants completed a questionnaire and biometric data measures, including hemoglobin A1c and blood pressure. Among participants with blood pressure data (N = 528), 11.9% had readings indicative of hypertension, and 38.1% were undiagnosed. Among participants with hemoglobin A1c (HbA1c) data (N = 450), 45.3% had readings indicative of T2DM, and 39.2% were undiagnosed. This study utilized a community-based participatory research approach that promotes equitable and ethical research. Results reaffirm the need to identify strategies for increasing healthcare access and for research to address health disparities in the RMI.

The Role of Community Health Agents in Promoting Social Change in Peru.

Community health agents (CHAs) provide basic health services and increase health care access thereby improving health outcomes for peri-urban regions in Peru. Few studies analyze the effect that becoming a CHA has on women's interpersonal interactions. We aim to explore the impact CHAs may have on gender and social norms through their roles as trusted leaders in male-dominated communities. We conducted six 90-minute group discussions with CHAs working in Huancayo and Trujillo, Peru. We designed the discussions to extract data about family and community norms that changed as a result of working as a CHA. A total of 53 female CHAs participated in six discussion groups. CHAs reported shifting family support (a change in how their family supported them in their role as a CHA), gaining status within their family (feeling more valued for their knowledge and experience), and shifting family gender roles (men and boys taking on more household responsibilities) as a result of their work. CHAs also reported a change in community norms and felt they were more valued and respected within their communities as women leaders. Working as a CHA creates an opportunity to enact social change through altering family dynamics and community perceptions. Moreover, empowering women to become CHAs not only generates tangible benefits in community health, but can help create social change that ultimately improves the lives of women and realize their human rights.

An innovative model using Promotores or Community Health Workers for home based dementia care

AbstractBackgroundHealth disparities and issues with trust building and relationship building are prominent in Hispanic and underserved populations in south Texas. Community health workers can play a bridging role with underserved communities and may be essential in improving the quality and value of health care. The Texas Health and Human Services Commission certifies the training Community Health Workers under the label of “promotores”.MethodCommunity health workers were integrated into the primary health care team to serve as a bridge between patient/caregiver dyads and the health care team.ResultCommunity health workers (CHWs) connected patients to social determinants of health resources such as transportation, food pantries and/or social benefits, Medicaid services, and home care provider services. Caregiver education and resources for respite care, caregiver support in person and virtually. Additionally, CHW’s provided education on dementia care resources, caregiver support, recruiting and engaging Hispanic underserve participants in research. Our team was able to increase home visits by 229% to homebound patients throughout several underserved zip codes in Bexar County. This is a success as our team was able to increase health care access to persons with dementia that are homebound that may have not been seen by a healthcare provider until they required emergency care. In fact, we saw roughly 11% decrease of inpatient admissions between 2021 and 2022.ConclusionTrust and familiarity allows the promotores to easily communicate interventions with cultural sensitivity and experiential knowledge of community values, leading to foster rapport with patients and families. The rapport and trust developed with the patients also helped to engage, and recruit Hispanic and underserved participants for research in dementia.

Preferences and Perspectives of Black Male Barbershop Patrons on Receiving Health Care in Nontraditional Settings.

Non-Hispanic Black men experience a disproportionate rate of morbidity and mortality from hypertension, cardiovascular disease, and other chronic conditions in the United States. Studies have demonstrated the efficacy of community-based health outreach in settings not traditionally utilized for health care. Understanding how potential future participants view health care services in nontraditional settings is a necessary step to ascertain the success of these interventions in the real world. Our study objective was to explore the preferences of Black male barbershop patrons regarding health care-provided services in these nontraditional settings. We recruited patrons of a Black-owned barbershop in the San Francisco Bay Area. Study participants were asked to complete a survey assessing individual attitudes and preferences toward the idea of receiving health care services in traditional and nontraditional settings. Among non-Hispanic Black males (n=17), 81% agreed or strongly agreed that they would prefer to receive health care in traditional clinics. Receiving care at the pharmacy (56% agreed or strongly agreed) and the patient's own home (53% agreed or strongly agreed) were the next most preferred locations. A minority of participants agreed or strongly agreed that they preferred to receive health care in nontraditional settings: 47% for barbershops, 19% for churches, and 6% for grocery stores. Participants expressed preference for traditional over nontraditional settings, despite listing barriers that may be addressed, in part, by nontraditional settings. One potential reason for this is simply a lack of familiarity. Establishing and normalizing nontraditional clinical settings may allow for enhanced acceptance within Black communities, ultimately increasing health care access.

Scaling the optimizing care model in community pharmacy using implementation mapping and COM-B theoretical frameworks

BackgroundThere has been increasing evidence that “task shifting,” when a provider entrusting specific responsibilities to another member of their team, can increase care access and may lead to better patient care outcomes. This has been particularly underscored in underserved communities throughout the world where task shifting has led to increased health care access in areas of provider shortages. Within the profession of pharmacy, pharmacy technicians are the primary pharmacist assistants and recipients of pharmacist-delegated tasks. Recently, such task delegation has placed the pharmacist in more direct patient care responsibilities beyond medication dispensing—and one such model with a growing evidence base is the optimizing care model. The optimizing care model is an novel approach to community pharmacy practice centered on expanded clinical service delivery by means of task delegation. Through task shifting, the optimizing care model has been shown to reduce medication errors and increase the quantity of patient care services offered by the pharmacist. However, means to spread and scale the model have yet to be reported in the literature. MethodsThis article describes the development of a package of implementation strategies designed to facilitate implementation of the optimizing care model in a single division of nationwide supermarket pharmacy chain. The implementation mapping approach was used to systematically develop strategies. In this approach, a protocol is prospectively developed to guide the implementation of a novel evidence-based interventions into a given setting, including the development of implementation strategies. ResultsThe application of the 5 steps of implementation mapping is described in detail. Implementation objectives, models, and strategies are outlined, as well as the final implementation protocol. There was an overall increase in weeks meeting the 10% optimizing care model threshold—33% at baseline to 83% after the intervention. ConclusionsThe implementation mapping process led to development of multifaceted implementation strategy for implementing the optimizing care model into community pharmacy practice. The strategy improved optimizing care model implementation. Further research is needed to understand which strategies were most impactful.

Development of an Implementation Science Telehealth Toolkit to Promote Research Capacity in Evaluation of Telehealth Programs.

The field of telehealth is rapidly growing and expanding access to quality health care, although there have been varied implementation outcomes in telehealth modalities. Dissemination and implementation (D&I) research can provide a systematic approach to identifying barriers and facilitators to telehealth implementation processes and outcomes. An interdisciplinary research and clinical team developed an implementation science telehealth toolkit to guide D&I evaluations of new and existing telehealth innovations. The toolkit includes a separate section to correspond to each step in the D&I evaluation process. Each section includes resources to guide evaluation steps, telehealth specific considerations, and case study examples based on three completed telehealth evaluations. The field of telehealth is forecasted to continue to expand, with potential to increase health care access to populations in need. This toolkit can help guide health care stakeholders to develop and carry out evaluations to improve understanding of telehealth processes and outcomes to maximize implementation and sustainability of these valuable innovations.

Enhancing Patient Autonomy in Home Hemodialysis: Innovations in 3D Printed Aids for Independent Tubing Connection

Home Hemodialysis(HD) is an advantageous alternative to in-center treatments, offering greater convenience, flexibility, and improved quality of life [1]. The rising prevalence of end-stage renal disease (ESRD) globally has increased the demand for accessible renal replacement therapies [2]. Factors such as an aging population, higher rates of chronic conditions, improved survival rates for chronic kidney disease patients, and increased healthcare access contribute to the growing burden on healthcare systems [3]. Home HD has gained prominence by enabling patients to receive treatment at home, providing control over their healthcare management [1]. It offers flexibility in scheduling, reduces travel time and costs, and creates a relaxed environment that positively impacts the patient experience [4]. Improved clinical outcomes, including better blood pressure control and enhanced quality of life, have been associated with home HD. However, challenges persist during the inlet/ outlet preparation and tubing connection phase, involving awkward elbow and wrist maneuvers, which can cause joint stress and discomfort [5]. Limited mobility or dexterity can further complicate the task, leading to potential complications. Addressing these challenges and promoting patient autonomy in tubing connection are crucial for improved treatment experiences and outcomes. Innovative solutions are being developed to facilitate independent tubing connection in home HD, empowering patients and reducing complications. Evaluations of the aids have shown promising results, enhancing patient outcomes and satisfaction [6].

Telenursing and Remote Patient Monitoring in Cardiovascular Health.

Background: Since the decline in death rates from cardiovascular diseases has slowed down recently, promoting cardiovascular health in patients and the general public has become more important than ever, particularly for elder and rural patients. This study is a collaborative effort between a regional health network in Virginia and associated organizations to implement and assess telenursing and remote patient monitoring (RPM) to help home care patients better manage their own cardiovascular related diseases and promote sustainable health delivery options. Method: Eighty cardiovascular patients with diabetes, congestive heart failure, or both who had a recent disease-related hospital stay were enrolled in the RPM program to receive services, including care coordination, coaching, referral for behavioral health, and aging-related services for 90+ days. The program used telenursing and RPM through home care monitoring equipment to coach patients on effective measures to stay compliant with posthospitalization regimens, track and evaluate readmissions, and assess physiological status and mental health. Result: There was a decline in hospital admissions of 65%, 85% for observations and related inpatient services for enrolled CVD patients in the RPM program. In addition, the longer the patient was enrolled the less likely they were to readmit. The program saved ∼$615,127 in patient claims costs and had net savings of $390,296, ∼173% of the total program expenses. Discussion: Evidence showed that 90+ day enrollments are sufficient for realization of readmissions and Emergency Department reductions, increased health care access, and lower costs. This resulted from consistent monitoring using the technology to alert nurses and care coordinators who were able to respond and facilitate patients accessing care in the most helpful and generally less costly care environment. Conclusion: The study has confirmed that care coordination and RPM are effective in supporting self-management of chronic conditions and cost reductions through telenursing and RPM.

Successful development and implementation of a clinical practice site with community partners to engage family nurse practitioner students in health equity.

Family nurse practitioner (FNP) student clinical practice site availability is limited. Concurrently, many populations lack healthcare access, a common health inequity. Collaboration with community partners to develop clinical practice sites offer students active learning opportunities to increase their engagement and understanding of health equity. Using community collaboration, develop and implement an FNP student clinical practice site that can provide learning opportunities in addressing health equity. Local health data was reviewed, and health gaps were associated with social determinant of health inequities. A community partner was identified with the goal of facilitating students to provide proactive health care to homeless women. Health promotion and disease identification has been the focus of care provided by FNP students and faculty during an early-program clinical course, increasing access to care for an underserved population. A community-academic partnership has developed where FNP students provide health promotion and safety net health care to homeless women since 2017. Student reflections have shown a positive impact on their understanding of health equity. The community partner has identified positive impacts to client health. This partnership has impacted health equity by increasing healthcare access for an underserved population while facilitating FNP student learning.

Factors correlated with neuropathic pain among industrial workers in Vietnam: a multi-site cross-sectional study.

Neuropathic pain is a debilitating condition resulting from various etiologies such as diabetes, multiple sclerosis, and infection, and is associated with decreased quality of life, poor health outcomes, and increased economic burden. However, epidemiological studies on neuropathic pain have been largely limited in Vietnam. A cross-sectional study was conducted on adult Vietnamese industrial workers across three manufacturing plants. Demographic, socioeconomic, occupational and health data were collected. Prevalence of neuropathic pain was assessed using the Douleur Neuropathique 4 (DN4) scale. Regression modeling was utilized to identify predictors of pain. Among 276 workers, 43.1 and 24.3% reported that they had suffered from spinal pain and osteoarthritis pain, respectively. In terms of work conditions, people maintaining constant posture when working from 30 to 60 min (OR = 3.15, 95% CI = 1.07; 9.29), or over 60 min (OR = 2.59; 95% CI = 1.12; 5.98) had a higher risk of suffering from spinal pain. People who worked in conditions lacking adequate lighting and with exposures to toxic chemicals were also likely to be suffering from osteoarthritis pain with OR = 4.26, 95% CI = 1.02; 17.74 and Coef. = 1.93; 95% CI = 1.49; 2.50, respectively. Regular health examinations and higher expenditure for healthcare were correlated with a lower prevalence of neuropathic pain. These results may inform the adoption of pain screening and other programs that increase health care access for this population, as well as more stringent occupational health and safety standards.

Unpacking the Racial Gap: Helicobacter pylori Infection Clearance Among Different Racial Groups.

Introduction Helicobacter pylori (H. pylori) is a bacteria causing chronic stomach infections, influenced by various factors, including host traits and bacterial virulence. It uses both urease-dependent and independent mechanisms to survive acidic gastric environments. Management entails diagnosis, treatment, and eradication verification. Combining drugs is key to overcoming resistance and ensuring bacteria elimination, thus preventing recurrence and complications. H. Pylori eradication mitigates gastric cancer risk and alleviates symptoms. Racial disparities persist despite declining H. pylori and gastric cancer incidence in the United States (US). African Americans (AA) have higher gastric cancer risks than non-Hispanic Whites. Addressing these disparities is crucial to protect high-risk populations. Methods This study retrospectively compiled H. pylori infection data from 2009 to 2022, categorized by race. Propensity score matching balanced initial group characteristics before analysis. Chi-squared and odds ratio tests were used on the cohort, with Kaplan Meier and Log Rank methods evaluating disease clearance in ethnic groups. Data were extracted from the Sunrise Electronic Medical Record software, including patient demographics, health details, and treatment specifics. Patients aged 18-65 with H. pylori infection at Nassau University Medical Center, who followed their treatment, were selected. Data were processed using Statistical Package for the Social Sciences (SPSS) and RStudio software. Results The study initially included 10,040 H. pylori-diagnosed patients, with 9,288 meeting the study's criteria after attrition. Predominantly female (64.7%), the cohort was racially diverse. A longer disease clearance time was noted among Hispanics (p=0.044). Binomial logistic regression analysis identified influential factors like high school graduation rates, poverty level income, and language proficiency on disease clearance. An odds ratio analysis further emphasized language barriers (HR 0.346, p=0.043) and education status (HR 0.756, p=0.025) as primary covariates impacting disease clearance, underlining the role of socio-economic factors and language proficiency in health outcomes. Conclusion The study highlights racial disparities in H. pylori clearance rates, particularly among Hispanics, necessitating culturally sensitive interventions. It advocates for improved diagnostics, increased healthcare access, and social determinants of health-focused initiatives. It identifies socio-economic status and language proficiency as key factors impacting health outcomes, calling for actions to bridge these disparities. Addressing these differences can decrease healthcare inequalities and economic burden, improving overall health outcomes and reducing costs associated with H. pylori clearance.

Problems with accessing healthcare and associated factors among reproductive-aged women in the Gambia using Gambia Demographic and Health Survey 2019/2020: a cross-sectional study

ObjectivesTo assess problems with accessing healthcare and its associated factors among reproductived-age women in the Gambia using the Gambia Demographic and Health Survey 2019/2020.DesignA community-based cross-sectional study.SettingThis study was based...

Changes in Telehealth Experienced by Advanced Practice RNs During COVID-19: US Survey Results.

The sudden, expanded need for telehealth during the COVID-19 pandemic added to the challenges advanced practice RNs face in the United States. The purposes of this article are to summarize advanced practice RNs' responses about the use of telehealth before and during the pandemic and to analyze free-text comments about how the use of telehealth changed during the pandemic. A 20-item survey was distributed using convenience sampling to advanced practice RNs from June 1 to September 23, 2020. Analyses of descriptive and open text responses related to telehealth were conducted. Most of the respondents did not use telehealth prior to the pandemic (n = 5441 [73%]), but during the pandemic, half used telehealth at least daily (n = 3682 [49%]). The most common barriers related to telehealth were about the difficulty some populations had in accessing the necessary technology. The most common favorable comments cited by respondents were related to some patients' improved access to care. Telehealth use is unlikely to return to prepandemic levels. As a result, considerations of telehealth-related recommendations provided for advanced practice RN education, policy, and practice are encouraged for the purpose of increasing healthcare access.

Teen Clinic - An integrated primary healthcare model that improves access for young people in rural communities.

Young people in rural Australia have limited access to health care and are at increased risk of poor health outcomes. The Teen Clinic model was developed to increase access to health care for young people, particularly school-aged young people (12-18 years) living in small rural towns (<5000 people). To determine the extent the Teen Clinic model meets its accessibility objective and to determine the barriers and enablers to sustainable delivery of the Teen Clinic service. A multimethod case study approach was used to assess access (multidimensional framework for patient-centred access) and determine the barriers and enablers to sustainable delivery. Data collection included a survey of young people in the included rural communities and key stakeholder interviews. The survey of young people indicated Teen Clinic model was accessible across multiple dimensions. From a practice perspective, accessibility was achieved by varying from usual care to a nurse-led, young person-centred drop-in model. This required skilled nurses working at the top of their scope; however, unpredictable demand and patient complexity made accounting for the time and therefore funding somewhat complex. The Teen Clinic model meets its objective of increasing healthcare access for young rural people. Relational and cultural factors were more important facilitators of practice integration than organisational processes. A key challenge to the ongoing provision of Teen Clinic was dedicated sustainable funding. Teen Clinic is an integrated primary healthcare model that increases access for young people in small rural communities. Sustainable implementation would benefit from dedicated funding.

Scaling and Sustaining Facilitated Telemedicine to Expand Treatment Access Among Underserved Populations: A Qualitative Study.

Background: Opioid treatment programs are an essential component of the management of opioid use disorder (OUD). They have also been proposed as "medical homes" to expand health care access for underserved populations. We utilized telemedicine as a method to increase access for hepatitis C virus (HCV) care among people with OUD. Methods: We interviewed 30 staff and 15 administrators regarding the integration of facilitated telemedicine for HCV into opioid treatment programs. Participants provided feedback and insight for sustaining and scaling facilitated telemedicine for people with OUD. We utilized hermeneutic phenomenology to develop themes related to telemedicine sustainability in opioid treatment programs. Results: Three themes emerged on sustaining the facilitated telemedicine model: (1) Telemedicine as a Technical Innovation in Opioid Treatment Programs, (2) Technology Transcending Space and Time, and (3) COVID-19 Disrupting the Status Quo. Participants identified skilled staff, ongoing training, technology infrastructure and support, and an effective marketing campaign as key to maintaining the facilitated telemedicine model. Participants highlighted the study-supported case manager's role in managing the technology to transcend temporal and geographical challenges for HCV treatment access for people with OUD. COVID-19 fueled changes in health care delivery, including facilitated telemedicine, to expand the opioid treatment program's mission as a medical home for people with OUD. Conclusions: Opioid treatment programs can sustain facilitated telemedicine to increase health care access for underserved populations. COVID-19-induced disruptions promoted innovation and policy changes recognizing telemedicine's role in expanding health care access to underserved populations. ClinicalTrials.gov Identifier: NCT02933970.

Analytic Framework to Improve Access for a State Medicaid Agency

Analytics can help identify strategies to improve the equity and capacity of health services for populations. However, many government agencies experience challenges with heavy workloads, limited time for continued analytic education, and employee turnover among contracted staff. Therefore, streamlining analytical workflows has the potential to (1) improve labor cost-efficiencies and (2) identify strategies to improve health among enrollees. We describe an analytic framework design that automates several empirical methods and provides recommendations for increasing healthcare access for Alabama Medicaid Agency (AMA) enrollees. The described framework, which includes descriptive and prescriptive elements, has been successfully used to inform various day-to-day analyses conducted by AMA’s Analytics Department and comprehensively analyze AMA-enrolled youths’ accessibility to licensed dentists. Specifically, in the dental context, the framework assisted in identifying (1) dental procedures that were ideal candidates for increased reimbursement payments and (2) geographical locations that AMA should target for interventions to improve physical access to care for AMA’s youth enrollees. The insights offered by the framework for dental care impact more than 0.5 million underserved youth and roughly $90 million of annual revenue for licensed dentists through reimbursements. History: This paper was refereed. Funding: D. Lewis, J. Parton, M. Hudnall, R. Tramp, X. T. Yang, and S. Samsel received salary support from the Alabama Medicaid Agency during the execution of this study. B. Cambron, T. Tyner, N. Biligowda, and D. Rush were employed at the Alabama Medicaid Agency during the execution of this study. The other authors do not declare the receipt of funding associated with entities affiliated with this study.

Healthcare Access and Utilization in Rural Communities of Indonesia

In this research, look at how people in Indonesia's rural areas gain entry to and make use of medical treatment. 500 households were randomly selected from four rural villages in Central Java for a cross-sectional study. High rates of unmet healthcare needs and low healthcare utilization rates were found to suggest that healthcare access and utilization are poor in rural regions of Indonesia. Distance, cost, and a dearth of services are all factors that limit people's ability to receive medical treatment when they need it. Healthcare access and usage were also found to be significantly influenced by socioeconomic status, education, and health literacy. Conclusions Significant efforts should be made to increase healthcare access and utilization in Indonesia's rural regions, according to the results.