Access To Care For Patients Research Articles

Crisis and curfew: Lived experiences of community members seeking emergency maternal and neonatal care before and during the COVID-19 pandemic on Mfangano Island, Lake Victoria, Kenya

Prior to the COVID-19 pandemic, families in rural sub-Saharan Africa faced numerous well-documented barriers in accessing timely care during maternal and neonatal health emergencies. We are now beginning to further appreciate the complex impacts that global disruptions, like the COVID-19 pandemic, can have on access to maternal care across vulnerable health systems, particularly for mothers seeking care in remote settings. In 2021, we initiated a qualitative follow-up study to the MOMENTUM (Monitoring Maternal Emergency Navigation and Triage on Mfangano) cohort study conducted within the remote communities of Mfangano Island on Lake Victoria, in Western Kenya, in 2019 and early 2020. Given the timing of this follow-up study, we sought to further qualify the barriers previously identified during the initial MOMENTUM quantitative survey, as well as explore specific ways that the COVID-19 pandemic impacted these barriers. In September 2021, 4 Focus Group Discussions (FGDs), with a total of 44 participants, were conducted among patients and families who had recently experienced maternal and neonatal emergencies. Additionally, 15 Key Informant Interviews (KIIs) were conducted with community leaders and health-care providers to allow reflection more broadly on their local emergency health-care system. A grounded theory methodology was utilized to analyze respondent themes. The lived experiences reported here by FGD and KII participants substantiate and validate numerous challenges previously identified in our prior study. Importantly, participants also highlighted specific ways that the pandemic intensified each of these factors, through the spread of misinformation, restricted mobility due to government curfews and lockdowns, increased frequency of health worker strikes, and worsening financial and resource constraints across the health system. Participants also described creative ways in which contextually experienced providers (i.e., Mfangano Health Navigators) facilitated critical coordination to help patients access care during the chaotic circumstances generated by the pandemic. These findings suggest that trained community health workers can play an influential role in improving emergency care coordination, particularly during future pandemics and similar public health disruptions within extremely resource-limited environments.

Geography and breast reconstruction: the complex business of using travel time to understand how patients access care after surgery

Geography and breast reconstruction: the complex business of using travel time to understand how patients access care after surgery

Palliative Care Professionals' Perceptions of Communication With Sexual and Gender Minority Patients.

For sexual and gender minority (SGM) individuals who identify as lesbian, gay, bisexual, transgender, queer, or any other sexual orientation or gender identity (LGBTQ+), the quality of palliative care can depend upon how clinicians view and communicate with this historically minoritized group. Prior literature has demonstrated that SGM patients access care at lower rates, and palliative care clinicians have suggested that SGM patients are more likely to experience discrimination than heterosexual patients. This study examined palliative care clinicians' perspectives and experiences regarding patient communication, care settings, the built environment, and inclusive care for SGM older adults with serious illness. The health disparities research framework informed a descriptive qualitative analysis of interview data with palliative care professionals (N = 20) across diverse healthcare settings within Colorado regarding their experiences and beliefs about communication and the care of SGM patients. Three main themes emerged: (1) Limited sexual orientation and gender identity (SOGI) data collection; (2) Organizational and environmental inclusivity, and the "neutral" space viewed as safe; (3) Missing training platforms regarding SGM patients and a lack of opportunity to identify and discuss SGM patient needs. Study findings illuminated the following barriers to providing SGM-inclusive care: perspectives around (1) limitations and preferences regarding collection of SOGI data, (2) organizational and environmental inclusivity, and (3) education and training regarding cultural humility and communication with SGM patients. Findings indicate the need for multidimensional research to better understand and address SGM health disparities and promote equitable care.

MP54-03 THE EFFECT OF DUAL ELIGIBILITY ON ACCESS TO CARE IN PATIENTS WITH NEWLY DIAGNOSED PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP54-03 THE EFFECT OF DUAL ELIGIBILITY ON ACCESS TO CARE IN PATIENTS WITH NEWLY DIAGNOSED PROSTATE CANCER Kassem Faraj, Rodney Dunn, Brent Hollenbeck, and Lindsey Herrel Kassem FarajKassem Faraj More articles by this author , Rodney DunnRodney Dunn More articles by this author , Brent HollenbeckBrent Hollenbeck More articles by this author , and Lindsey HerrelLindsey Herrel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Dual eligible beneficiaries are a particularly vulnerable population, as they qualify for Medicare due to age and Medicaid due to low income. Though some dual eligible beneficiaries have access to additional social services, such as transportation coverage, others do not qualify for these services (i.e. partial dual eligibility). This heterogeneity in support services may impact access to treatment for dual eligible men with newly diagnosed prostate cancer, a condition that necessitates timely, repeated interactions with the healthcare system. METHODS: We performed a cohort study of Medicare beneficiaries who were diagnosed with prostate cancer between 2015 and 2019. Beneficiaries were required to have 12-months of eligibility before and after diagnosis date. We compared pre-diagnosis testing, post-diagnosis testing, and primary prostate cancer treatment between beneficiaries who have full dual-eligibility (full duals, “F”), partial dual-eligibility (partial duals, “P”) and those who are not dual-eligible (non-duals, “N”). RESULTS: In 138,785 men with newly diagnosed prostate cancer, 4,611 (3.3%) were full duals and 2,031 (1.5%) were partial duals. Full and partial duals (Figure 1) were more often of Black race than non-duals (p<0.001). Partial duals were less likely to have a PSA (p<0.001) or multiparametric MRI (p<0.001) prior to diagnosis, compared to both duals and non-duals. After diagnosis, full and partial duals less commonly underwent multiparametric MRI (F-17%, P-15%, N-24%, p<0.001) and more commonly underwent bone scan (F-43%, P-42%, N-33%, p<0.001) compared to non-duals. Regarding treatment (Figure 1), full and partial duals less commonly underwent surgery (F-12%, P-13%, N-20%) and more commonly received androgen deprivation therapy as a primary treatment (F-16%, P-13%, N-7%) compared to non-duals (p<0.001). CONCLUSIONS: Our findings demonstrate disparities in access for dual-eligible beneficiaries before and after a new prostate cancer diagnosis. A more advanced stage at diagnosis may be reflected by the higher rates of bone scan testing and treatment with primary androgen deprivation therapy in the duals. A deeper understanding of barriers in access to prostate cancer screening and treatment is needed for this particularly vulnerable population. Source of Funding: This study is supported by funding from the National Cancer Institute Advanced Training in Urologic Oncology T32 Grant No T32CA180984 (Faraj) and by funding from the Prostate Cancer Foundation-Pfizer Health Equity Grant No K08CA237638 (Herrel) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e754 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kassem Faraj More articles by this author Rodney Dunn More articles by this author Brent Hollenbeck More articles by this author Lindsey Herrel More articles by this author Expand All Advertisement PDF downloadLoading ...

Utility of hashing and salting algorithms in quality improvement studies: Practical way to link patient charts from multiple locations.

Owing to the complexity of our health care system, patients access care in various ways and settings, and their medical information is captured in an array of electronic medical records (EMRs) that do not always communicate with one another.[1][1] Thus, if you want to gather information about

Transmission dynamics and associated mortality of nosocomial COVID-19 throughout 2021: a retrospective study at a large teaching hospital in London

The impact of nosocomial SARS-CoV-2 infections has changed significantly since 2020. However, there is a lack of up-to-date evidence of the epidemiology of these infections which is essential in order to appropriately guide infection control policy. To identify the secondary attack rate of SARS-CoV-2 infection and associated mortality across different variants of concern. A single-centre retrospective study of all nosocomial SARS-CoV-2 exposure events was conducted between 31st December 2020 and 31st December 2021. A secondary attack rate was calculated for nosocomial acquisition of SARS-CoV-2 infection and time to positivity. Positive contacts were assessed for all-cause 30-day mortality. A total of 346 sequential index exposure events were examined, and 1378 susceptible contacts identified. Two hundred susceptible contacts developed SARS-CoV-2 infection (secondary attack rate of 15.5%). The majority of index cases (59%) did not result in any secondary SARS-CoV-2 infection. Where close contacts developed SARS-CoV-2 infection, 80% were detected within the first five days since last contact with the index case. The overall associated mortality among positive contacts across 2021 was 9%, with an estimated reduction of 68% when comparing periods of high Omicron versus Alpha transmission. Our findings describe that most SARS-CoV-2 infections are detected within five days of contact with an index case; we have also demonstrated a considerably lower mortality rate with the Omicron variant in comparison to previous variants. These findings have important implications for informing and supporting infection control protocols to allow movement through the hospital, and ensure patients access care safely.

Patient-reported Differences in Obstructive Sleep Apnea Care between Jurisdictions with and without Government Funding for Continuous Positive Airway Pressure.

Rationale: Funding for obstructive sleep apnea (OSA) treatment may impact how patients access care, wait times, and costs of care. Objectives: The aim of this study was to compare differences in diagnosis and treatment of OSA between Canadian jurisdictions with and without public funding for continuous positive airway pressure (CPAP). Methods: We administered an anonymous internet survey to Canadian adults reporting a physician diagnosis of OSA. Responses were categorized on the basis of whether the respondent's province provided full or partial funding for CPAP therapy for all patients. We assessed wait times for diagnosis and treatment, patient-borne costs, and model of care delivery compared between jurisdictions with and without universal CPAP funding. Results: We received 600 responses representing all Canadian provinces and territories. The median (interquartile range) age was 59 (49-66) years; 57% were male, and 21% were from rural settings. Patients living in provinces without public CPAP funding (n = 419) were more likely to be diagnosed using home sleep apnea testing (69% vs. 20%; P = 0.00019). Wait times were similar after adjustment for demographics, disease characteristics, and model of care. Although patient-borne costs of care were similar between jurisdictions, patients from regions without CPAP funding reported that cost had a greater influence on the choice of therapy. Sleep specialists were more commonly involved in OSA care in regions with CPAP funding. There was no difference in the current use of therapy between jurisdictions with and without public funding. Conclusions: This survey study demonstrates that public funding for CPAP therapy impacts how Canadians access OSA care but is not associated with differences in wait times or costs. Future research is required to determine the impact of different funding models for OSA care on clinical outcomes.

35159 The dermatology education series: A digital approach to improving patient engagement

Dermatology is unique in that not only are there a shortage of dermatologists in the United States but patient access care to is largely disproportionate. As a response to the chasm of access that exists, many patients have relied on the Internet to obtain information on how to address their concerns, and this often comes at the cost of non-evidence based remedies being promoted. The inception of the 2020 COVID-19 pandemic has led many physicians to restrategize their approach to patient care. Fortunately, utilization of a virtual model has been integral to this process.

The Effects of COVID-19 on Patient’s Perspective of Health Care

Introduction: The COVID-19 Pandemic has changed the way patients access care. While some facilities saw a significant increase in alternative methods of conducting care, such as utilizing telemedicine [1], other areas of care suffered as patients were forced to delay care [2]. These healthcare delivery and reception changes may have altered patients' feelings towards healthcare and potentially disrupted patient/provider trust. This mix-blend study served to identify patients' feelings towards healthcare through a targeted, anonymous survey. Methods: A quality improvement study was implemented in two primary care settings. Data was collected via voluntary and anonymous surveys. The surveys assessed the level of trust the patient had regarding their healthcare pre-COVID-19 and currently. The survey results were then analyzed to determine if there was a correlation between the level of trust and previous healthcare utilization. Results from 74 collected surveys were analyzed to identify if the patient level of trust in the healthcare system had decreased during the COVID-19 pandemic. The raw data was analyzed using Microsoft Excel, and results did show statistical significance between satisfaction and trust pre and during COVID-19. Conclusion: This study showed that the COVID-19 pandemic did alter patient trust in the healthcare system.

Attitudes and acceptability of children, caregivers, and healthcare providers about using telemedicine for pediatric HIV care in a resource-limited setting.

BackgroundThe Pediatric HIV Telemedicine Initiative is a video-linked delivery of expert services, designed to reach those previously unable to access expert HIV care. The present qualitative study was designed to understand the acceptability of telemedicine [TM] by patients, their caregivers and health care providers in the anti-retroviral therapy (ART) centers in Maharashtra.MethodsWe conducted focus group discussions with caregivers at six ART centres (three linked with TM facilities and three not linked with TM). We also conducted in-depth interviews with medical officers, counselors, and pharmacists at each centre. The data from the interviews were transcribed and translated into English for analysis. The qualitative data were analyzed using thematic framework approach.ResultsChildren and caregivers who had participated in telemedicine consultation through video conference found the process acceptable, were comfortable communicating during these sessions, and did not have any specific problem to report. The advantages of TM were: consultation without having to travel to other cities; economic advantage; and prompt consultation. The total time spent during the process and technical difficulties during the TM sessions were some of the challenges. The medical officers had the opportunity to discuss difficult cases with the expert during the TM session. Some sessions were also considered a ’group counseling’ session, wherein several children and caregivers were able to interact and learn from each other and motivate each other. The health care providers at the three centers that did not currently have TM facilities expressed a desire to have these services at their centers as well. According to them, these facilities will help them address complicated and difficult pediatric HIV cases. Currently, they send their patients to referral centers or other hospitals. Since, many of these referral hospitals are situated in bigger cities, less than 50% of patients access care at these centers This is mostly due to the time constraints and finances (travel/stay) required for accessing these centres.DiscussionTM was a feasible, acceptable, and desired approach for care of children living with HIV/AIDS. It provides support to their caregivers as well as their care providers. The ART staff from the telemedicine-linked peripheral centers were supportive of the use of TM and wanted these services to be initiated in the non-linked centers.

Driving Access and Quality: A Shift to Value-Based Behavioral Health Care.

Multiple barriers exist to accessing behavioral health care, and several are related to payment. The national shortage of behavioral health providers is exacerbated by their not joining health insurance networks, often shifting the cost of treatment to patients. In the face of high out-of-network expenses, deductibles, and copays, many insured patients forgo behavioral health treatment altogether. However, even when patients access care, health outcomes are not routinely measured, and there is reason to suspect that the quality of care is poor. To address these issues, value-based reimbursement for behavioral health care offers a sustainable pathway to increase payment for providers in return for improved population health outcomes and costs. This article describes a comprehensive collaborative effort between a payer and a health care technology and services organization to support behavioral health providers to enter into value-based care. This approach changes financial incentives to drive improvements in behavioral health care access and quality.

Health Care for Transgender and Gender Diverse Individuals: ACOG Committee Opinion Summary, Number 823.

An estimated 150,000 youth and 1.4 million adults living in the United States identify as transgender. This Committee Opinion offers guidance on providing inclusive and affirming care as well as clinical information on hormone therapy and preventive care; it also cites existing resources for those seeking information on the care of transgender adolescents. The social and economic marginalization of transgender individuals is widespread, which leads to health care inequities and poorer health outcomes for this population. To reduce the inequities experienced by the transgender community, the provision of inclusive health care is essential. Obstetrician-gynecologists should strive to make their offices open to and inclusive for all individuals and should seek out education to address health care disparities, both in their individual practices and in the larger health care system. In order to provide the best care for patients, it is useful to know which health care professionals to include in a referral network for primary care and to have many clinician and surgeon options given the many different therapies available and the different sites at which these therapies are offered. It is important to remember that although hormone therapy is a medically necessary treatment for many transgender individuals with gender dysphoria, not all transgender patients experience gender dysphoria and not everyone desires hormone treatment. Gender-affirming hormone therapy is not effective contraception. Sexually active individuals with retained gonads who do not wish to become pregnant or cause pregnancy in others should be counseled about the possibility of pregnancy if they are having sexual activity that involves sperm and oocytes. Although being knowledgeable about the medications used for gender transition and potential risks and side effects is important, specific certification for prescribing them is not required and should not be a limiting factor in helping patients access care.

Health Care for Transgender and Gender Diverse Individuals: ACOG Committee Opinion, Number 823.

An estimated 150,000 youth and 1.4 million adults living in the United States identify as transgender. This Committee Opinion offers guidance on providing inclusive and affirming care as well as clinical information on hormone therapy and preventive care; it also cites existing resources for those seeking information on the care of transgender adolescents. The social and economic marginalization of transgender individuals is widespread, which leads to health care inequities and poorer health outcomes for this population. To reduce the inequities experienced by the transgender community, the provision of inclusive health care is essential. Obstetrician-gynecologists should strive to make their offices open to and inclusive for all individuals and should seek out education to address health care disparities, both in their individual practices and in the larger health care system. In order to provide the best care for patients, it is useful to know which health care professionals to include in a referral network for primary care and to have many clinician and surgeon options given the many different therapies available and the different sites at which these therapies are offered. It is important to remember that although hormone therapy is a medically necessary treatment for many transgender individuals with gender dysphoria, not all transgender patients experience gender dysphoria and not everyone desires hormone treatment. Gender-affirming hormone therapy is not effective contraception. Sexually active individuals with retained gonads who do not wish to become pregnant or cause pregnancy in others should be counseled about the possibility of pregnancy if they are having sexual activity that involves sperm and oocytes. Although being knowledgeable about the medications used for gender transition and potential risks and side effects is important, specific certification for prescribing them is not required and should not be a limiting factor in helping patients access care.

Search Trends and Quality of Online Resources Regarding Thyroidectomy.

Thyroidectomy is one of the most common procedures performed in head and neck surgery. The quality of online resources for thyroidectomy is unknown. We aim to evaluate search trends and online resource quality regarding thyroidectomy. Cross-sectional analysis. Websites appearing on Google search. The first 30 Google websites for thyroidectomy were reviewed, excluding research, video, and restricted sites. Search patterns were obtained with Google Trends. Quality was measured by readability (Flesch Reading Ease and Flesch-Kinkaid Grade Level), understandability and actionability (Patient Education Materials Assessment Tool), and clinical practice guideline (CPG) compatibility. Fleiss kappa interrater reliability analysis was performed for 2 raters. Twenty-one sites were evaluated. Search popularity for thyroidectomy has increased since 2004. Median reading ease was 42.2 (range, 15.4-62.7) on a scale from 1 to 100, with 100 indicating maximum readability. Median reading grade level was 12 (range, 7-16). Thyroidectomy resources were poorly understandable (median, 66%; range, 21%-88%) and actionable (median, 10%; range, 0%-60%). Median CPG compatibility was 4 out of 5 (range, 0-5). Interrater reliability ranged from substantial to moderate for understandability (0.78), actionability (0.57), and CPG compatibility (0.58), with P < .05 for all results. Online resources about thyroidectomy vary in quality and reliability and are written at grade levels above the average reading level of the public. Providers should be aware of existing resources and work to create education resources that meet universal health literacy guidelines. The framework provided in this article may also serve as a guide and provide tangible steps that providers can take to help patients access care.

Centers of excellence: Are there standards?

IntroductionCenters of Excellence (CoEs) are intended to label hospitals that have met certain quality, process, volume and infrastructure guidelines. However, there are largely no standardized metrics to designate what qualifies as a CoE, leading to entities across the healthcare spectrum creating their own designations. Empirical studies on the impact of CoEs on quality do not consistently show improved care. Given the variability in definitions and outcomes for CoEs, the study evaluated the current status of defining and using CoE designations. MethodsWe conducted semi-structured interviews with executives from 10 healthcare organizations (including hospitals, insurers, employers, and benefits managers) who have a role in determining or using CoE designations to make decisions for their organizations. The interviews were conducted in 2016 and 2017. The interviews were audio recorded, transcribed, and de-identified for thematic analysis. ResultsWe found that there is significant variability in the process for defining CoEs. There are also many operational challenges that hinder the success of a CoE program, including how patients access care at a CoE, the right geographical distribution of CoEs in a network, and coordinating care between the CoE and local providers. ConclusionsThe lack of standardization for designating CoEs not only prevents CoEs from fully achieving their intended effects of signaling “excellent” hospitals, but also causes confusion for patients, employers and payers, which dilutes the meaning of the CoE label. ImplicationsWe suggest that the designation and implementation of CoEs should be standardized in healthcare.

An examination of the relationship between patient satisfaction with healthcare and quality of life in a geriatric population with cancer in the Southeastern United States.

Understanding factors that impact patient satisfaction with cancer care within the growing population of older adults living with cancer will contribute to tailoring programs that address patient needs and expectations. Further, patient satisfaction is a determinant of healthcare organizations' institutional performance. The purpose of this study was to investigate the relationship between patient satisfaction with care and health-related quality of life (HRQoL) among Medicare recipients with common cancers types (breast, prostate, or lung cancer). Cross-sectional analysis of survey data from 637 Medicare beneficiaries (≥65 years) with breast (n = 304), lung (n = 158), or prostate cancer (n = 175) in twelve hospitals in the Southeastern United States. Participants responded eighteen satisfaction questions across five domains. HRQoL was measured with the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the SF-12.v2 instrument. SF-12 scores were positively associated with satisfaction domain scores. The magnitude of these associations was small with covariate-adjusted effect sizes r ranging from 0.05 to 0.12. Satisfaction scores were highest within the Quality of Care domain and lowest within the Patient Engagement domain. Patient satisfaction domains had only modest association with HRQoL, indicating that these constructs should not be assumed to correlate. Satisfaction domains, including how patients access care, coordinate care, and engage within the healthcare system, were identified as potential areas for improvement. Patient satisfaction assessment across age groups may inform oncology care providers on ways in which their patients perceive the quality of care received, which ultimately affect healthcare organizations' accreditation, ranking, and reimbursement.

The transformation of health care for patients: Information and communication technology, digiceuticals, and digitally enabled care.

The way patients access care and interact with health care systems is rapidly changing through the use of information and communication technology (ICT). Health care is being transformed through digital innovations, such as wearable technology, remote monitoring, patient portals, mobile applications (apps), and new service models such as telemedicine and virtual visits. Through a review of the current literature, this article presents the use of digitally enabled tools and ICT, including electronic health records, telehealth, remote patient monitoring, and mobile health apps. These effective and innovative digitally enabled tools have expanded options for patients interested in actively engaging in their own health. Information and communication technology can improve health outcomes, enhance the patient experience, and curtail costs. Providers must stay fluent with ICT options to best collaborate with patients. Although providers recognize that patient-centered care can improve effectiveness and efficiency, many have been slow to incorporate digital therapeutics, or "digiceuticals," into practice.

Accuracy of Prehospital Identification of Stroke in a Large Stroke Belt Municipality

Objective: Strokes are a leading cause of morbidity and mortality in the United States, especially in the “stroke belt” of the southeast. Up to 65% of stroke patients access care by calling 9–1-1. The primary objective of this study is to measure the accuracy of emergency medical dispatchers (EMD) and paramedics, in the prehospital identification of stroke. Methods: The study was based at Grady Emergency Medical Services, which is Atlanta, Georgia's public emergency medical services (EMS) provider. A retrospective analysis of all medically related 9–1-1 calls to Grady EMS classified as “stroke” between January 1, 2012, and December 31, 2012 was performed. A database was created using deterministic linkage between records from Grady EMS, Grady Hospital Emergency Department (ED), and the Grady Hospital Stroke Registry. Patients excluded were less than 18 years of age, had previous or concurrent head injuries, were transferred from another inpatient facility, and/or had incomplete patient records in any one of the three databases. Descriptive analysis, linear regression, and logistic multivariable regression were performed to discover the accuracy of stroke identification and contributory prehospital factors. Results: A total of 548 patients were included: 475 were transported with EMS impression of stroke and 73 with an impression other than stroke. The median age was 59 years, 87.4% were black, and 52.6% were female. Paramedics adhered to all seven elements of the Grady EMS stroke protocol in 76.4% (n = 363) of suspected stroke cases. Sensitivity and positive predictive value for paramedic stroke identification was 76.2% and 49.3%, respectively, and for EMD, was 48.9% and 24%, respectively. Identification of hemorrhagic strokes had a relatively lower sensitivity. Paramedics were more likely to positively identify strokes when the Cincinnati Prehospital Stroke Scale (CPSS) screen was positive, or when classified by EMD as stroke. Paramedics were less likely to identify stroke in female patients. Paramedics' diagnostic accuracy was similar regardless of their adherence to the EMS stroke care protocol. Conclusions: EMD and EMS personnel in a large city in the Southeastern United States, with high stroke prevalence, had a relatively high sensitivity in identifying acute stroke patients. Paramedic accuracy was augmented by positive CPSS screening and by EMD recognition of stroke.

Enhancing palliative care patient access to outpatient and outreach counseling services.

184 Background: MD Anderson’s interdisciplinary out-patient clinic, palliative care team includes mental health professionals who provide psychological care, including 3 full time Master’s level counselors. Counseling sessions are offered during the patient’s clinic appointments. To increase opportunity and access for additional counseling, patients are offered follow-up counseling through an outreach program which includes videoconferencing or telephone sessions. The data presented represents almost 2 years of our Master’s level clinicians’ practices. Methods: Retrospective chart review of 2041 consecutive patients (3606 total contacts) seen for psychology counseling services in the Supportive Care Center between 6/2015 and 3/2017. Results: Counselors saw 2041 consecutive patients (52% of the patients seen at the out-patient Supportive Care Center). Most patients only had 1 session in clinic (63%); almost 1/3 received 2-5 sessions (33.9%). Median time for the follow-up visit was 30.5 days. Approximately 25% (N = 511) were offered outreach services; 79% (N = 405) of those offered received these services. Median number of outreach sessions received was 1 (57%); 2-5 (38%); 6-9 (4%) and 10+ (1%). Sessions lasted 10-15 minutes (58%); 20-35 minutes (31%); and 40+ minutes (11%). Patient preferred mode of outreach included telephone (93%), Facetime (5.0%), and videoconferencing (2%). In total, 798 outreach sessions were provided representing 18% of total counseling sessions offered. Conclusions: The out-patient palliative care service is able to offer psychological assessment and counseling to more than half of the patients they serviced due to the addition of 3 Master’s level counselors embedded in the clinic. Follow-up counseling for these patients can be challenged for those residing in rural areas, with limited resources and/or transportation problems, and with physical limitations that make travel difficult. Our outreach program has successfully enhanced access to services to patients who otherwise may have had limited to no follow-up psychosocial care.

Challenges in Primary Care Delivery and the Opportunities for Point-of-Care Testing

© 2017 Wolters Kluwer Health, Inc. All rights reserved. Health care systems around the world are changing to improve access and quality, as well as seeking to contain costs. These changes are being sought against a backcloth of improvements in both diagnosis and treatment, and increased patient life expectancy. Health care delivery for the past few decades has become very hospital centric and with consolidation of facilities to manage increasing specialization of care, as well as promoting efficiency - including in the field of diagnostics. However, these latter developments have had an adverse impact on patient access to care, with increasing pressure on primary care. Point-of-care testing technologies offer a means of improving access to diagnostic and monitoring decision-making - for clinician, carer, and patient. The opportunities for the use of point-of-care testing in primary care are discussed in the context of changes in health care delivery, from a UK perspective.