Patient-provider Interactions Research Articles

Racial equity in and through medical interaction scholarship: A scoping review.

We conducted a systematic scoping review to characterize the landscape of communication scholarship within racial health equity in and through the patient-provider interaction. We employed three waves of data collection to identify relevant articles (N = 454) about racial equity within provider-patient interactions. We iteratively developed a codebook concerning article characteristics, coding for journal names, data source, descriptive characteristics for the study samples, and presence of theory and equity in sections of the manuscripts. This search identified studies (N = 206) that were published in 76 peer-reviewed scientific journals. The majority of studies reported primary data analyses and used survey and interview methodology. Many studies examined participants as patients generally rather than in reference to particular health conditions. Among those with a specific health condition, the largest proportion focused on cancer control. Very few studies included samples with Native American and Pacific Island heritage. Most studies included cisgender men and/or women, but none included transgender men or women. The vast majority of research focused on the patient experience; few centered on providers' and caregivers' experiences. The body of scholarship was largely atheoretical; the most frequently noted constructs were patient-provider communication (including patient-centered communication and patient-centered care), implicit/explicit racial bias, shared decision-making. There was wide variation in the extent to which equity was woven through the manuscripts. Equity is typically mentioned in the literature review, and racial identity in the sample may serve as a marker of racialized experiences. This study demonstrates the need for the development of theory that elevates the centrality of health equity to attend to the bi- or multi-directional flow of communication that shapes the quality of these interactions. These insights can serve as a strong foundation for the development of interventions to address equity in clinical interactions.

Understanding barriers and facilitators to implementation of a patient safety bundle for pregnancy-related severe hypertension in 3 North Carolina outpatient clinics: a qualitative study

BackgroundPregnancy related hypertension is a leading cause of preventable maternal morbidity and mortality in the US, with consistently higher rates affecting racial minorities. Many complications are preventable with timely treatment, in alignment with the Alliance for Innovation on Maternal Health’s Patient Safety Bundle (“Bundle”). The Bundle has been implemented successfully in inpatient settings, but 30% of preeclampsia-related morbidity occurs in outpatient settings in North Carolina. To address this, we have integrated community engagement and implementation science approaches to identify facilitators and barriers to Bundle implementation, which supports its adaptation for outpatient settings and identifies implementation strategies to be tested in a subsequent study.MethodsEleven key informant interviews were conducted across three clinics to assess the implementation needs for effectively utilizing the Bundle. The interview guide was created using the Consolidated Framework for Implementation Research domains to identify facilitators and barriers to implementation. Additionally, three focus group discussions with patient participants were conducted to understand lived experiences and perceptions of respectful care. A coalition of community partners, patients, providers, those with lived experience, and the research team reviewed materials from the formative study design to dissemination and planning for future study.ResultsBarriers included inadequate provider-patient interaction time, patients’ lack of transportation to access care, limited protocols to inform/assess/treat/escalate patients, and workforce capacity (staff training and turnover). Facilitators included staff recognition of the importance of treating preeclampsia, champion buy-in of the Bundle’s ability to improve outcomes, co-location of pharmacies for immediate treatment, and staff capacity. Respectful care principles were repeatedly identified as a facilitator for Bundle implementation, specifically for patient awareness of preeclampsia complications and treatment adherence.ConclusionsFindings highlight the importance of community-engaged approaches. Further, clinic staff regarded Bundle implementation as crucial for the outpatient setting. Identified barriers suggest that strategies should address systemic social supports (i.e., transportation, childcare) and improve access to and use of home blood pressure monitoring. Identified facilitators support improving communication, increasing clinic champion engagement, enabling systems for identifying at-risk patients, and training staff on accurate blood pressure measurement. Successful Bundle implementation requires addressing systemic barriers to delivering respectful care, such as limited time with patients.

A socioecological taxonomy of determinants to colorectal cancer screening in black men: Insights from a mixed-methods systematic review.

In the United States, African/Black American (henceforth Black) men face significantly higher mortality rates from colorectal cancer (CRC) compared to other gender, racial, and ethnic groups. Although CRC is preventable and treatable with early detection, screening rates among Black men remain low. This study aimed to synthesize existing literature on the barriers and facilitators (determinants) of CRC screening to offer guidance to primary care teams in their efforts to improve screening uptake. We performed a comprehensive systematic review of full-text, peer-reviewed studies published in English to explore the various determinants influencing CRC screening among Black men. Using key terms like "Black or African American," "male," and "colorectal cancer screening," we searched databases including PubMed, PsychInfo, CINAHL, and Embase, published between 2009 and 2022. The search identified 1235 articles, with 54 meeting the inclusion criteria. Most studies were cross-sectional, examining determinants across the socioecological system. Key barriers included a lack of CRC screening knowledge, poor patient-provider communication, lack of access to screening, and medical mistrust stemming from systemic racism. Significant facilitators included aging, receiving a provider recommendation, having social support, and effective culturally appropriate outreach strategies. Key themes and significant findings from the review provide actionable strategies for primary care teams. These include enhancing knowledge about CRC screening within the patient population, improving patient-provider interactions, and reducing barriers to accessing screening. Future research should aim to develop culturally appropriate and collaborative preventive care strategies to improve screening adherence and CRC-related outcomes.

Assessment of Pregnant Women's Satisfaction With the Model of Care Initiative: Antenatal Care Services at Primary Health Care Centers in the Qassim Health Cluster, Saudi Arabia.

Patient satisfaction is a critical indicator of healthcare quality, including high-quality antenatal care (ANC), and it directly impacts care continuity and health outcomes. This study assessed the satisfaction levels of pregnant women with ANC services provided at primary healthcare centers (PHCs) within the Qassim Health Cluster, Saudi Arabia. A cross-sectional survey was conducted among 646 pregnant women attending ANC services in the Qassim region. Participants completed a validated questionnaire assessing demographic characteristics, healthcare interactions, and satisfaction levels across various ANC service aspects, including waiting times, healthcare provider communication, and healthcare service quality. Statistical analyses, including Pearson's chi-squared tests, Fisher's exact tests, and regression analyses, were performed to identify predictors of satisfaction. The majority of participants (N=366, 90.6%) reported successfully booking their appointments, and 368 (91.1%) faced no challenges during the process. While 393 (97.3%)and 398 (98.5%) reported receiving weight and blood pressure measurements, respectively, only 312 (77.2%) were advised on diet, and 298 (73.8%) received explanations about alarming symptoms. Communication gaps were noted, with 71% (N=287) of participants indicating that physicians did not introduce themselves, and 307 (76%) reported that physicians did not disclose their specialties. Satisfaction levels were highest for maintaining privacy (273 (67.6%) highly satisfied) and healthcare staff attitudes (247 (61.1%) highly satisfied), with an overall satisfaction mean score of 4.31±0.869. Regression analyses identified healthcare service levels and years of marriage as significant predictors of satisfaction (p<0.05). While overall satisfaction with ANC services was high, areas such as physician communication and health education require improvement. Interventions focusing on enhancing patient-provider interactions, providing comprehensive health education, and optimizing service delivery could further improve satisfaction.

Implementation of a Digital Health Technology Platform Improves Neurosurgical Resident Communication Skills.

Surgical residency lacks standardized curricula for teaching interpersonal and communicationskills. We evaluated the utility of a digital health communication platform, Playback Health, that generates audiovisual recordings of patient-provider interactions as a tool for junior neurosurgical resident education. Junior (postgraduate year (PGY)-2 and PGY-3) neurosurgical residents rated their comfort working with five attending neurosurgeons (one of whom implemented Playback Health) across 10 categories, grouped into three overarching domains encompassing knowledge base, technical skills, and interpersonal skills on a 10-point Likert scale. Ratings were performed at the beginning of the rotation at the hospital as a baselineand then every two months for a total duration of six months. At baseline, resident ratings of their comfort working with each physician did not differ significantly between the four Playback Non-Users and the Playback User. Regarding knowledge base, significant improvements arose at the four- and six-month time points regarding imaging knowledge (p = 0.045 and p = 0.003, respectively) and preoperative management (p = 0.024 and p = 0.003, respectively), and additionally for intraoperative knowledge at four months (p = 0.021)and postoperative management knowledge (p = 0.002). Among interpersonal skills, there was a significant difference with the physician who implemented Playback Health compared to Playback Non-Users as early as two months across both categories evaluated (understanding of patient concerns and expectations (p = 0.028) and understanding of patient's support structure (p = 0.005)). This difference was sustained across four- and six-month time points. The implementation of a platform that generates customized audiovisual content during routine patient-provider interactions may be a valuable tool for resident education, particularly regarding interpersonal skills and understanding of patient specific concerns and support structures.

Creating Continuity of Care Within Student-Run Free Clinics

Student-run free clinics (SRFC) play an important role in filling gaps in the healthcare system by providing accessible, cost-free care to underserved populations. Continuity of care (CoC) can improve patient outcomes, but challenges such as inconsistent volunteer participation and patient follow-up can make CoC difficult to implement in SRFCs. The authors acknowledge the deficiencies in existing literature guiding SRFCs and highlight a systematic model to address barriers to CoC. This article proposes a structured CoC model for SRFCs, encompassing three levels: micro (patient-provider relationships), meso (clinic structure and volunteer management), and macro (coordination with external healthcare facilities). These levels aim to streamline patient-provider interactions, optimize clinic operations, and coordinate care beyond clinic visits. Some suggested strategies include fostering patient-provider trust through telehealth follow-ups, improving clinic organization with shared electronic medical records (EMRs), mitigating volunteer turnover with consistent leadership and team meetings, and partnering with local pharmacies. The implementation section explores limitations, including resource constraints and adaptability challenges, and proposes evaluation measures like tracking follow-up rates and collecting patient feedback to gauge the model's efficacy. This structured approach offers a framework adaptable to SRFCs' specific needs to enhance CoC and improve the overall quality of care patients receive.

Artificial intelligence-generated feedback on social signals in patient-provider communication: technical performance, feedback usability, and impact.

Implicit bias perpetuates health care inequities and manifests in patient-provider interactions, particularly nonverbal social cues like dominance. We investigated the use of artificial intelligence (AI) for automated communication assessment and feedback during primary care visits to raise clinician awareness of bias in patient interactions. (1) Assessed the technical performance of our AI models by building a machine-learning pipeline that automatically detects social signals in patient-provider interactions from 145 primary care visits. (2) Engaged 24 clinicians to design usable AI-generated communication feedback for their workflow. (3) Evaluated the impact of our AI-based approach in a prospective cohort of 108 primary care visits. Findings demonstrate the feasibility of AI models to identify social signals, such as dominance, warmth, engagement, and interactivity, in nonverbal patient-provider communication. Although engaged clinicians preferred feedback delivered in personalized dashboards, they found nonverbal cues difficult to interpret, motivating social signals as an alternative feedback mechanism. Impact evaluation demonstrated fairness in all AI models with better generalizability of provider dominance, provider engagement, and patient warmth. Stronger clinician implicit race bias was associated with less provider dominance and warmth. Although clinicians expressed overall interest in our AI approach, they recommended improvements to enhance acceptability, feasibility, and implementation in telehealth and medical education contexts. Findings demonstrate promise for AI-driven communication assessment and feedback systems focused on social signals. Future work should improve the performance of this approach, personalize models, and contextualize feedback, and investigate system implementation in educational workflows. This work exemplifies a systematic, multistage approach for evaluating AI tools designed to raise clinician awareness of implicit bias and promote patient-centered, equitable health care interactions.

Using Electronic Medical Records (EMRs) with Chronic Diseases: Trend Analysis Towards Online and Offline Factors Associated with Patient Utilization

Electronic medical records (EMRs) are associated with higher-quality healthcare; however, they also raise concerns about patient information privacy and security. Existing studies have strongly linked these privacy concerns to patients withholding their information, indicating perceived risks with EMRs. Furthermore, studies devoted to EMR usage in hospitals are lacking, particularly those on the EMR system in the contexts of clinical and privacy concerns based on multi-criteria perspectives. The proposed framework is based on how clinical factors and security and privacy determinants influence the use of EMR, utilizing data derived from chronic disease patients in the USA as a frame of reference. In this study, information forage theory is adopted. This research not only objectively analyzes the information privacy aspects of EMRs but also investigates the perceptions of patients with chronic diseases regarding online health information technology and offline patient–provider interactions. These are considered as clinical factors to understand the frequency of EMR adoption across Health Information National Trends Survey (HINTS) data from 2014 ( N = 2,415), 2017 ( N = 2,253), and 2018 ( N = 2,443). The study finds that the rate of information withholding, as a manifestation of information privacy and security concerns, has decreased over the three waves. In contrast, the frequency of EMR usage is found to have continually increased at the three assessment points. Additionally, factors such as confidence in EMR safeguards, electronic medical information maintenance, and the frequency of visiting healthcare providers are significant predictors of EMR utilization over time. The study concludes that addressing online privacy concerns over EMR as part of health information technology and considering offline clinical factors must occur together in order to achieve higher-quality healthcare among patients with chronic diseases and to transform the healthcare system overall.

ChatGPT vs. Surgeons on Pancreatic Cancer Queries: Accuracy & Empathy Evaluated by Patients and Experts

BackgroundArtificial intelligence (AI) offers potential support in patient-clinician interactions, but its impact on such communication remains unexplored. MethodsIn this study, ChatGPT was compared with two pancreatic surgeons in responding to ten pancreatic cancer surgery-related questions, co-designed with the Patient Advisory Board of the Surgical Society's Study Center. A blind evaluation of these responses, considering content congruency and clarity for non-specialists, was conducted by patients and surgeons ResultsFrom June 23 to July 21, 2023, 24 patients and 25 surgeons participated, of which eleven patients and ten surgeons completed the survey in full. Utilizing a quantitative scale from 1 (strong disagreement) to 5 (full agreement), consensus was observed among patients and specialists concerning the content delivered by ChatGPT. The metrics for comprehensibility to a non-specialist audience consistently showed positive reception. In the evaluation of empathetic resonance, ChatGPT's responses mirrored those of the surgeons in the patient's view. A significant proportion of patients and surgeons ranked Surgeon 1's contributions foremost, followed closely by ChatGPT. DiscussionThis study demonstrates that the responses from surgeons and ChatGPT to common queries from patients regarding pancreatic cancer surgery are comparable regarding reliability, lay comprehension and empathy as evaluated by patients and surgical experts. These findings highlight the potential of AI in enhancing patient-provider interactions.

“Sometimes you have knowledge but lack the equipment to save a life”: perspectives on health system barriers to post-abortion care in Liberia and Sierra Leone

BackgroundAbortion is largely restricted in Liberia and Sierra Leone, with exceptions under limited conditions. Consequently, women and girls seeking induced abortion care in these settings resort to unsafe methods, resulting in severe complications. Post-abortion care (PAC) is a lifesaving obstetric intervention to address abortion-related complications, but access to quality and comprehensive PAC in health facilities is daunting. Research on barriers to PAC, drawing on perspectives from diverse stakeholders, is critical to inform specific programmatic improvements to enhance access to quality PAC services.ObjectivesThis study explored stakeholders’ perspectives on the barriers to quality PAC across health facilities in Liberia and Sierra Leone.MethodsThis cross-sectional qualitative study targeted PAC providers in selected health facilities and policy actors in Liberia and Sierra Leone. We conducted in-depth interviews with 33 healthcare providers – 8 in Liberia and 25 in Sierra Leone; and 13 policy actors – 8 in Liberia and 5 in Sierra Leone. The policy actors included representatives from religious institutions, ministries of health, civil society organizations, and non-government organizations working on sexual and reproductive health (SRH) issues. Audio files of the interviews were transcribed verbatim in the original language of the interview and translated into English by expert translators. A deductive and inductive approach was used to develop a codebook to code the interviews in Dedoose software. Data analysis was conducted using the thematic approach.FindingsDiverse viewpoints of what constitutes quality PAC existed among stakeholders in Sierra Leone and Liberia, and these variations are reflected in their practices and behavior around PAC services. Our analysis revealed some weaknesses and gaps in PAC delivery, including a lack of trained providers, which was more pronounced in Sierra Leone than in Liberia. In both countries, the absence of functional PAC equipment, inadequate PAC supplies, and infrastructure-related challenges (e.g., lack of rooms with audio-visual privacy during PAC service) were commonly cited. Limited audio-visual privacy complicated provider-patient interactions, with providers mentioning that this makes patients withhold vital information during history-taking. Providers had no or limited knowledge of the law, and best practices around PAC, leading to delays, denial of services, overcharging fees, and stigmatization of some patients.ConclusionDespite existing policies and interventions on post-abortion, many health facilities in Liberia and Sierra Leone lack essential post-abortion care equipment and supplies and trained providers. There is a need to recruit and train willing providers, along with a clear referral system. Further, sensitizing health providers, stakeholders, and communities on abortion-related policies, guidelines, and value clarification could help improve post-abortion care service provision and uptake.

Prenatal And Postpartum Care Experiences Among Black Birthing People In The United States: An Integrative Review.

Among Black birthing people, high-quality, respectful care throughout pregnancy and postpartum is hindered by distrust, racial discrimination, and unsatisfactory care. The purpose of this integrative review was to examine prenatal and postpartum care experiences among Black birthing people in the United States. A literature search, spanning from inception through October 6, 2022, across 4 research databases, used a combination of keywords to capture reports on care experiences among Black birthing people. We included quantitative and qualitative studies in the United States with people who self-identified as Black or African American and reported prenatal or postpartum health care experiences. Intrapartum experiences were excluded. All studies were evaluated with the Mixed-Methods Appraisal Tool, National Institutes of Health Study Quality Assessment tool, or Joanna Briggs Institute critical appraisal checklist. Data were analyzed and synthesized using the Joanna Briggs Institute convergent integrated approach to incorporate quantitative and qualitative research. A total of 16 studies published over 27 years met the inclusion criteria. All studies examined the health care experiences of Black birthing people during prenatal or postpartum care. None of the studies focused solely on postpartum care experiences. The 2 most prominent themes were models of care and patient-provider interactions, encompassing both positive and negative experiences. Positive care experiences included collaborative patient-provider interactions, continuity of care, and culturally centered care. Adverse experiences were more frequently noted and involved discriminatory treatment during patient-provider interactions, fragmented care models, and a lack of cultural awareness. Black birthing people in the United States report some positive but more negative health care experiences during pregnancy and postpartum care, which may play an important role in health inequities. Promoting prenatal and postpartum care models that provide continuity and are high-quality, collaborative, and culturally centered were identified as high-priority targets to foster patient safety and improve clinical outcomes.

Power and racial differences in the communication experiences of Black and White patients living with advanced cancer and their care partners: An application of co-cultural theory

ABSTRACT We investigated power imbalances in racially discordant medical interactions in the context of advanced cancer care within the United States. We applied co-cultural theory to the transcripts of 43 interviews conducted with Black and White cancer patients and their care partners. We found Black patients and care partners perceived providers as dismissing their concerns. In response, they engaged in extensive preparation, rationalization, and utilizing liaisons. White patients and care partners recognized and took advantage of their privilege and utilized liaisons. Some patients acquiesced and conferred with others in response to power enacted by oncologists. We concluded co-cultural theory is useful in explaining what occurs in racially discordant patient-provider interactions. Our findings highlight the need for provider communication and de-biasing training. Trial registration: ClinicalTrials.gov identifier: NCT03780816..

Evaluation of the quality of physiotherapy service in university of Gondar comprehensive specialized hospital, northwest Ethiopia: A mixed method evaluation.

Currently, the number of people with physical disability and impairment is increasing significantly in Ethiopia, especially in the northern part. In that regard, the Ethiopian government has been providing physical rehabilitation services to recover patients. However, due to the widespread problem of healthcare service and the increase in patients seeking physiotherapy service, the quality of the service might be compromised, and the evidence is limited. Thus, this study aimed to evaluate the quality of physiotherapy services at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia. A single case study with concurrent mixed method research design was conducted from June 02- August 10, 2022. The evaluation used patient-centeredness, timeliness, compliance and availability dimensions with 27 indicators. A total of 415 systematically selected patients who came for physiotherapy service for exit interviews, 9 service providers and managers for key-informant interviews, and 8 patients for in-depth interviews participated in the study. Approximately 176 patient medical charts were reviewed, and direct observation of 14 patient-provider interactions was performed. Binary logistic regression analysis was computed to identify factors associated with patient-centeredness. In the final model, variables with a p value < 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare statistical significance. Thematic analysis for the qualitative data using OPEN CODE version 4.03 was performed. Finally, the dimensions and overall quality of physiotherapy service were judged using predetermined criteria. The overall quality of the physiotherapy service was found to be fair or intermediate (66.5%), computed from the availability of resources 63.4%, compliance of service providers 68.6%, timelines 64.2%, and patient centeredness 73.1%. Qualitative findings also revealed that insufficient staffing and heavy workload, lack of resources, inconvenient facilities, relocation of resources in the academic division of physiotherapy department, lack of training and continuous professional development opportunities, lack management attention and institutional support and nonexistence of multidisciplinary approaches leads to significant gaps in quality service delivery. Attending primary school (AOR = 3.22, 95% CI: 1.56, 6.61), secondary (AOR = 4.24, 1.91, 9.41), and higher education (AOR = 4.79, 1.94, 11.84) and being a private employee (AOR = 0.34, 95% CI: 0.16, 0.76) were significantly associated with patient centeredness. The overall quality of physiotherapy service was deemed intermediate and needs further improvement. The required resources, such as clinical assessment tools, therapeutic exercise equipment, electrotherapy modalities and infrastructure, were not adequate. Educational level and occupation were significantly associated with patient centeredness.

IOT-Enabled Smart Healthcare: Developing Predictive Models for Chronic Disease Management Using Wearable Sensors

Abstract: Real-time monitoring and prediction models will be used to assess the efficiency of the IoT-enabled smart healthcare solutions in managing chronic diseases. From this study, in addition to the quantitative data, including the performance of the model, patient engagement, and cost savings, qualitative information obtained from the patients and healthcare professionals will be employed using a mixed-methods research approach. This collected rich data from surveys, performance measurements, real-time monitoring data, and cost analyses with 50 health professionals and 200 chronic disease patients. The results of the study indicate that predictive models, more particularly the Neural Network, enhanced the ability to identify cases of chronic illness with an accuracy of 92.4%. Extremely high patient satisfaction rates: 9.0 out of 10. Real-time monitoring shows hospital admissions falling by as much as 50% among those suffering with respiratory disease. Cost-benefit analysis also documented financial sustainability, with overall annual cost reduction at 43.3%. Soon after implementation, usage metrics also revealed that the average user uses it three times a day, while patient-provider interactions increased by 150%. This study highlights how IoT technologies would benefit patients' clinical conditions, improve chronic disease management, and save healthcare expenses.

Co-designing a blueprint for spreading person-centered, Whole Health care to HIV specialty care settings: a mixed methods protocol

BackgroundSince 2013, the Veterans Health Administration (VHA) has advanced a person-centered, Whole Health (WH) System of Care, a shift from a disease-oriented system to one that prioritizes “what matters most” to patients in their lives. Whole Health is predicated on patient-provider interactions marked by a multi-level understanding of health and trusted relationships that promote well-being. Presently, WH implementation has been focused largely in primary care settings, yet the goal is to effect a system-wide transformation of care so that Veterans receive WH across VHA clinical settings, including specialty care. This sort of system-wide cultural transformation is difficult to implement.MethodsThis three-aim mixed methods study will result in a co-designed implementation blueprint for spreading WH from primary to specialty care settings. Taking HIV specialty care as an illustrative case- because of its diverse models of relationships to primary care - to explore how to spread WH through specialty care settings. We will use the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to organize quantitative and qualitative data and identify key determinants of WH receipt among Veterans living with HIV. Through a co-design process, we develop an adaptable implementation blueprint that identifies and matches implementation strategies to different HIV specialty care configurations.DiscussionThis study will co-design a flexible implementation blueprint for spreading WH from VHA primary care throughout HIV specialty care settings. This protocol contributes to the science of end-user engagement while also answering calls for greater transparency in how implementation strategies are identified, tailored, and spread.

TB Care in Ukraine: Understanding Access Barriers at the Primary Healthcare Level

Abstract Background In the WHO European Region, Ukraine is a high-priority country for TB control, being one of nine globally with high rates of multidrug-resistant TB. The WHO emphasizes patient-centered TB care, prioritizing patients as key figures in the care continuum. Thus, our aim was to explore barriers impacting the accessibility of TB services for patients at the primary healthcare level (PHC) in Ukraine. Methods During December 2022-June 2023, a qualitative study was conducted across eight PHC facilities in the Kyiv, Odesa, Mykolayiv, and Volyn regions. The study comprised: 4 focus groups involving 27 family doctors, 16 in-depth interviews with managers and health authorities from regional and national levels, as well as 25 interviews with TB patients. All data was transcribed, manually coded and deductively analyzed. Results All participants highlighted the benefits for patients of providing TB care continuum at the PHC level, yet the program lacks clear requirements for training of family doctors and nurses. Overall family doctors perceived positively various TB training they received; but despite this, they expressed doubts and reported a lack of practical skills, affecting the quality of care provided. Patients highlighted several barriers in interacting with healthcare providers, including stigma and cases of dismissive behavior of healthcare workers, communication challenges, and breaches of patientś data confidentiality. Patients also mentioned self-stigma, and perceptions of family doctors as poorly trained in TB. Still, patients who received healthcare services from the same family doctor “during long time” positively described their experience with TB services too. Conclusions Establishing robust patient-provider interaction at the PHC level can help overcome persistent barriers to TB care continuum in Ukraine. To achieve this, a comprehensive TB training program tailored for PHC family doctors and nurses should be developed and implemented. Key messages • Expanding TB healthcare services to primary healthcare levels in Ukraine can be beneficial for patients. Training primary healthcare staff can enhance TB care quality. • Establishing robust patient-provider interaction at the PHC level can help overcome persistent barriers to TB care continuum in Ukraine.

Early exposure to (hetero)sexism in medical settings: young patients’ experiences with gynaecology

Abstract Background Gynaecology is a highly gendered specialty where gender norms are particularly susceptible to shape patient-provider interactions. Consultations about contraceptive practices, reproductive choices, and sexual activity are fertile settings for the potential confrontation of different sets of gender-related expectations, and the expression of gender-based discrimination, i.e. sexism and heterosexism. We therefore investigated young patients’ first experiences with gynaecological care in Germany with a focus on their experiences of (hetero)sexism. Methods We conducted 15 qualitative interviews with a gender-inclusive sample of patients aged 16-25 who narrated their first consultations and experiences of gynaecological care. We analysed the data thematically. Results Cis-gender heterosexual women composed the majority of the sample; a trans man and two persons who reported being at some point in same-sex relationships were also included. The main reasons for a first consultation were painful periods and contraception. Participants narrated examples of gender-based discrimination, with providers making what was perceived as gender-insensitive, demeaning, or plainly homophobic remarks. Those were particularly present in relation to conversations about the contraceptive pill, with either providers refusing to prescribe it on the account that the patient didn’t have sex or “real sex” (i.e. heterosexual intercourse) or with providers pushing for use of the pill “just in case”, even when patients didn’t need nor want it. Additionally, sexist, unrequited arguments about how the pill could enhance a patient’s breast or skin occurred in several conversations. Conclusions Our study shows clear occurrences of (hetero)sexism on the part of gynaecologists, from demeaning comments to more subtle reminders of sexist gender norms. It highlights the need to implement more patient-centred, gender-sensitive gynaecological practise to support the promotion of respectful care. Key messages • Young patients are exposed to various forms of gender-based discrimination in gynaecological care in Germany, highlighting how entrenched traditional, (hetero)sexist gender norms are among providers. • Promoting more gender-sensitive, respectful care could start with a reflection on consultations around the contraceptive pill, as they often crystallise the manifestation of damaging gender norms.

Patient-provider interactions about cannabis for therapeutic purposes vary as a function of provider type: A pilot study.

Limited evidence guides the efficacy and safety of cannabis for therapeutic purposes (CTP). Healthcare providers lack requisite knowledge to advise and support patients. This study aimed to describe and compare several aspects of initial CTP interactions across different provider types. Adult cannabis consumers (N = 507) from the United States completed an anonymous online survey about their initial CTP interaction with their healthcare provider. Providers were categorized into four groups (Mental Health [MH], Family Medicine [FM], Medical Clinics [MC], and Other Specialty [OS]). Analyses compared several aspects of the interaction (e.g., risk mitigation, recommendations, satisfaction/confidence) across groups. Less than half of the sample reported discussion of cannabis risks (44.0%) or follow-ups at subsequent visits (46.7%). Recommendations (where to obtain, consumption method, dose, frequency, and authorization) were uncommon (9.7%-25.2%). While the MH group reported the highest rates of risk mitigation behaviors, regression models adjusted for sociodemographic and cannabis characteristics were largely nonsignificant. For recommendations, the MC group was more likely than the MH group to report receiving all recommendations (p < .05). Younger age and greater cannabis-related problems increased likelihood of risk mitigation and recommendations. CTP interactions focused on risk but generally lacked comprehensive recommendations that could potentially promote safe use. Data from provider perspectives could support the need for CTP guidelines and develop training for healthcare providers to promote safe CTP practices. For the first time, this study explored several aspects of CTP interactions and compared experiences across a variety of providers.

Overcoming Barriers to Childhood and Adolescent Vaccination: Opportunities in Precision Health Promotion

Abstract Background Vaccination remains one of the greatest success stories in public health as cost-effective interventions to reduce morbidity and mortality from infectious diseases at the population level. However, the COVID-19 pandemic created unprecedented challenges to the immunization sector. Uptake of routine childhood and adolescent vaccinations was forestalled by challenges related to pandemic lockdowns/quarantine, reduced patient-provider interactions, parental reluctance to seek preventative services, poor access to health services, and loss of income and/or health insurance. Compared to pre-pandemic estimations, the pandemic era brought a consequential decline in coverage of all vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). This study sought to address suboptimal adolescent vaccine delivery systems and bolster uptake in the post-pandemic era with the introduction of precision health promotion strategies centered around the use of Personal Health Libraries (PHL). Methods Leveraging artificial intelligence (AI), and semantic web technologies to integrate contextual knowledge (i.e., clinical, biomedical, and SDoH data) with patient preferences, proposed PHL platforms could aid in generating personalized evidence-based recommendations useful to both care provider promotion of vaccination and mitigating patient and caregiver hesitancy. The proposed application stands to provide customized digital health interventions by 1) facilitating remote knowledge acquisition, exchange, and visualization of the benefits of on-time vaccination, 2) improving health information-seeking behaviors to reduce hesitancy, 3) bolstering patient reminder and recall systems for follow-up and series completion, and 4) learning usage patterns to incorporate end-user preferences to empower patients, promote best practices, and enable them to make informed health decisions. Results The proposed PHL would serve as an ecosystem to manage and deliver tailored vaccine-related information to inform health decision-making regarding ACIP-recommended immunizations. Such a resource could administer health education and promotion that addresses common misconceptions regarding vaccination, alleviate safety, efficacy, and side effect concerns, and deliver evidence-based support of vaccines as primary protective measures (i.e., cancer prevention). Conclusion The use of PHL would enable rapid and real-time collection and interpretation of patient data beyond the traditional clinical setting, supplying care providers with tools for optimal vaccination recommendation to bolster uptake in the post-pandemic era. Moreover, the application would enable patients and caregivers to readily access vital health information and play a crucial role in addressing the obstacles encountered when seeking accurate and dependable vaccine-related information.

Race and ethnicity and self-reported racial/ethnic discrimination in breast cancer patient interactions with providers in the Pathways Study.

To examine the association of race and ethnicity groups with self-reported racial/ethnic discrimination in patient-provider interactions during the diagnosis and treatment for breast cancer. We analyzed data from the Pathways Study, a prospective cohort of women diagnosed with breast cancer from 2006-2013 in the Kaiser Permanente Northern California Health Care System. Racial/ethnic discrimination in patient-provider interactions was assessed with two questions from the Interpersonal Processes of Care survey at baseline and 6-months and 24-months post-diagnosis. Logistic regression was performed to compare women who self-identified as racial or ethnic minorities with Non-Hispanic White (NHW) women. Covariates included age at diagnosis, country of origin, education level, income, marital status, and medical provider's race/ethnicity. Our sample included 1836 participants: 1350 NHW women and 486 women (87 Black, 208 Asian American, 153 Hispanic, 38 American Indian/Alaskan Native/Pacific Islander [AIANPI]) from racial or ethnic minority groups. In multivariate analysis, minority women were more likely to report racial/ethnic discrimination in patient-provider interactions than NHW women (adjusted odds ratio [aOR]: 4.73; 95% confidence interval [CI] 3.45-6.50). Specifically, Black women were most likely to self-report racial/ethnic discrimination in patient-provider interactions (aOR: 9.65; 95% CI 5.92-15.70), followed by Asian (aOR: 5.39; 95% CI 3.46-8.40), Hispanic (aOR: 2.55; 95% CI 1.54-4.14), and AIANPI (aOR: 1.74; 95% CI 0.58-4.25) women, compared with NHW women. Racial/ethnic discrimination was more likely self-reported from minority women diagnosed with breast cancer. Additional studies are needed to understand the mechanisms and impact of racial/ethnic discrimination in patient-provider interactions on disparities.