Visit Type Research Articles

Determinants of Patient No-Shows in a Multisite Urogynecology Clinic [ID: 1376316

INTRODUCTION: The objective of this study was to describe sociodemographic and clinical characteristics of patients who “no-show” urogynecology appointments and identify risk factors for “no-show” appointments. METHODS: We conducted an IRB-approved prospective chart review study of women aged 18 years or older scheduled for a urogynecology appointment at four outpatient clinical sites associated with an urban academic tertiary care referral center over 4 months. Patients were included in the no-show group if they did not show up for their appointment or cancelled their appointment the same day. For a comparison group, the patient immediately prior to or after the one who “no-showed” with the same visit type was included. Logistic regression was used to identify risk factors for “no-show” appointments. RESULTS: Four hundred twenty-six women were included, 213 in both the no-show and show groups. Women who “no-showed” were younger (median age 60 [interquartile range (IQR) 47–72] versus 69 [IQR 59–78], P<.001). More women in the no-show group were Hispanic (24.4% versus 13.1%) and non-Hispanic Black (7.51% versus 3.76%, P=.0093), had Medicaid (17.4% versus 6.57%, P=.0006), no-showed a previous appointment (24.9% versus 11.7% P=.0005), had to wait longer for an appointment (median 39 days [IQR 23.5–55.5] versus 30.5 days [IQR 12.8–47.0], P=.002), and made appointments for urinary incontinence (44.1% versus 26.8%, P=.0002). On multivariate logistic regression, women with Medicaid had significantly higher odds of “no-showing” their appointment (adjusted odds ratio, 2.11 [1.04–4.48], P=.0440). CONCLUSION: Women with Medicaid are particularly likely to “no-show” urogynecology appointments. Further research is needed to identify and address potential barriers this group faces when accessing care.

Place of care and costs associated with acute episodes and remission in schizophrenia.

BACKGROUND: Schizophrenia imposes significant economic burden on patients, families, caregivers, and society. To our knowledge, place of care and associated costs of acute schizophrenia episodes have not been well characterized. OBJECTIVE: To describe the care settings and costs associated with likely acute episodes and untreated remission periods among patients with schizophrenia. METHODS: Adults with schizophrenia were identified using the IBM MarketScan Commercial and Medicare Supplemental databases (2009-2018); claims for capitated benefits plans were excluded. Acute episode index date was defined as at least 1 inpatient schizophrenia claim or outpatient schizophrenia claim (frequency of claim dependent on visit type, such as hospitalization, emergency department, private practice, clinic, urgent care, or laboratory). Mental health-related medical costs (health plan+patient) associated with acute episodes were collected over a 2-month follow-up period and stratified by setting (inpatient vs outpatient); acute episode data were reported in subgroups of patients without or with prior clozapine use, as an indication of disease severity. Remission index date was defined as at least 1 outpatient claim with a schizophrenia diagnosis with no acute episode and no oral or injectable antipsychotic therapy. Remission costs were assessed over a 3-month period. All data were analyzed descriptively. RESULTS: A total of 14,824 patients with schizophrenia met criteria for an acute episode (12,896 [87.0%] without prior clozapine use; 1,427 [9.6%] with prior clozapine use). Most acute episodes were treated in an outpatient setting (all patients, 76.3%; without prior clozapine use, 74.5%; with prior clozapine use, 87.1%). When treated inpatient, mean (SD) episode medical costs were $17,045 ($28,101) for all patients, $16,060 ($22,786) for those without prior clozapine use, and $22,827 ($55,860) for those with prior clozapine use. When treated outpatient, mean (SD) medical costs for acute episodes were $2,478 ($6,961) for all patients, $2,609 ($7,068) for those without prior clozapine use, and $1,770 ($6,560) for those with prior clozapine use. For all patients with acute episodes, regardless of clozapine use, patient-incurred out-of-pocket costs were approximately 30% of total medical costs. For an untreated period of remission, 6,950 patients with schizophrenia met criteria. Total medical costs were $2,399 for these patients over a 3-month period. CONCLUSIONS: The majority of acute schizophrenia episodes were treated in the outpatient setting. For episodes that required inpatient care, inpatient episodes were approximately 7 times more costly than episodes treated in outpatient-only settings. For acute episodes and remission periods, health plans covered most costs; however, there were additional patient-incurred out-of-pocket costs. DISCLOSURES: All authors met the International Committee of Medical Journal Editors authorship criteria. Neither honoraria nor payments were made for authorship. Dr McIntyre has received research grant support from CIHR/GACD/National Natural Science Foundation of China (NSFC) and the Milken Institute; speaker/consultation fees from Lundbeck, Janssen, Alkermes, Neumora Therapeutics, Boehringer Ingelheim, Sage, Biogen, Mitsubishi Tanabe, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Sunovion, Bausch Health, Axsome, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge Pharmaceuticals, Viatris, AbbVie, Atai Life Sciences. Dr McIntyre is a CEO of Braxia Scientific Corp. Mr Doan, Dr Amari, and Mr Mercer are employees of Genesis Research, which was funded to perform the study. Ms Higa, Dr Gillard, and Dr Harrington were employees of AbbVie at the time of the study and may hold stock. This study was sponsored by AbbVie.

Telemedicine and Disparities in Visit Attendance at a Rural Pediatric Primary Care Clinic During the COVID-19 Pandemic.

To determine whether the introduction of telemedicine at a rural pediatric clinic was associated with reduced disparities in visit attendance. A retrospective cohort study was conducted of all clinic visits from 1 January 2019 to 31 December 2021. Visit types were divided into telemedicine visits, in-person urgent, and in-person non-urgent visits. Visits were stratified into periods based on the statewide pandemic response. A total of 8,412 patients with 54,746 scheduled visits were analyzed. Visits were less likely to be completed for older patients, Black patients, and patients with Medicaid insurance than their counterparts. Despite a pandemic-era increase in telemedicine utilization, disparities in visit completion that were present in the pre-pandemic era persisted after stay-at-home orders were lifted. The adoption of telemedicine did not reduce pre-existing disparities in visit attendance. Further work is needed to identify the reasons for the disparities and improve visit attendance of historically disadvantaged patient populations.

Patient perspectives of telehealth for fertility care: a national survey.

To evaluate patient satisfaction using telehealth for fertility care. Cross-sectional survey using the validated telehealth usability questionnaire (TUQ) distributed nationally via fertility advocacy groups of fertility patients aged ≥ 18 years with self-reported use of telehealth for care. Patient satisfaction of telehealth for fertility care as determined by the TUQ questionnaire. The survey also included questions about telehealth related to usefulness, ease of use, effectiveness, reliability, and the option for patients to add open-ended comments related to their experiences using telehealth for fertility care. A total of 81 fertility patients completed the survey. Patients reported high rates of satisfaction (81.4%) with telehealth in areas of usefulness, ease of use, effectiveness, reliability, and satisfaction. However, many patients (60.5%) expressed a preference for in-person visits for their initial visit while the acceptability of telehealth increased for follow-up visits. Negative themes from respondent comments address that telehealth visits felt more impersonal and rushed. Fertility patients reported high satisfaction using telehealth for care. Patients still preferred in-person visits for initial consultations. For follow-up visits, most respondents favored telehealth or had no preference. Incorporation of telehealth in fertility practices should continue though it may be helpful for patients to be given options for visit types.

Evaluation of pharmacist impact on diabetes outcomes for telehealth and hybrid care delivery versus in-office visits

BackgroundFew studies have examined the effect of pharmacist-led telemanagement on diabetes outcomes during the COVID-19 pandemic. ObjectivesAssess for noninferiority for the absolute change in mean A1C between telehealth and hybrid groups versus the in-office group during the COVID-19 pandemic. Secondary objectives were to compare the percentage of patients achieving population health A1C goals and patient no-show rates between study groups. MethodsA retrospective, noninferiority analysis was conducted for patients seen by a primary care pharmacist from November 1, 2020 to May 31, 2021 across 17 primary care clinics in the Northeast Ohio region of Cleveland Clinic. The noninferiority margin was prespecified at > 0.3% A1C reduction. Patients with a baseline A1C of 8% or greater were included. Patients were separated into 3 study groups (telehealth, in-office, and hybrid) based on the visit types that were conducted by the pharmacist during the study period. ResultsHybrid care delivery (N = 366) was noninferior to in-office care delivery (N = 180), with regards to absolute change in mean A1C reduction (0.24% [95% CI: −0.13, 0.61], P = 0.002). Similar results were shown when comparing the telehealth group (N = 691) to the in-office group (0.04 [95% CI: −0.28, 0.36], P = 0.02). The mean A1C reduction in the in-office (1.36 ± 1.9), hybrid (1.60 ± 2.2), and telehealth (1.40 ± 2.0) groups were not significantly different (P = 0.23). Subgroup analyses showed that newly consulted patients had a larger reduction in A1C compared to the overall population, in all groups. No-show rates and percentage of patients achieving population health A1C goals were not significantly different based on visit type. ConclusionTelehealth and hybrid visit types were noninferior to in-office visits with regards to mean change in A1C reduction. Results demonstrate the importance of primary care pharmacists continuing to offer diverse visit types based on patient preference.

County-level social vulnerability and nonfatal drug overdose emergency department visits and hospitalizations, January 2018–December 2020

BackgroundNonfatal drug overdoses (NFODs) are often attributed to individual behaviors and risk factors; however, identifying community-level social determinants of health (SDOH) associated with increased NFOD rates may allow public health and clinical providers to develop more targeted interventions to address substance use and overdose health disparities. CDC’s Social Vulnerability Index (SVI), which aggregates social vulnerability data from the American Community Survey to produce ranked county-level vulnerability scores, can help identify community factors associated with NFOD rates. This study aims to describe associations between county-level social vulnerability, urbanicity, and NFOD rates. MethodsWe analyzed county-level 2018–2020 emergency department (ED) and hospitalization discharge data submitted to CDC’s Drug Overdose Surveillance and Epidemiology system. Counties were ranked in vulnerability quartiles based on SVI data. We used crude and adjusted negative binomial regression models, by drug category, to calculate rate ratios and 95% confidence intervals comparing NFOD rates by vulnerability. ResultsGenerally, as social vulnerability scores increased, ED and hospitalization NFOD rates increased; however, the magnitude of the association varied across drugs, visit type, and urbanicity. SVI-related theme and individual variable analyses highlighted specific community characteristics associated with NFOD rates. ConclusionsThe SVI can help identify associations between social vulnerabilities and NFOD rates. Development of an overdose-specific validated index could improve translation of findings to public health action. The development and implementation of overdose prevention strategies should consider a socioecological perspective and address health inequities and structural barriers associated with increased risk of NFODs at all levels of the social ecology.

Evaluating the Efficiency and Equity of Autism Diagnoses via Telehealth During COVID-19

Given existing barriers to a timely autism diagnosis, this study compares the efficiency and equity of diagnoses conducted in-person vs. telehealth in a developmental behavioral pediatrics setting. The transition to telehealth was prompted by the COVID-19 pandemic. Eleven months of clinic data in electronic medical records were retrospectively analyzed for children diagnosed with autism in-person (N=71) vs. telehealth (N=45). Time to autism diagnosis, patient demographics, and deferred diagnoses did not significantly differ across visit types. However, privately insured patients and families living farther from the clinic had a longer time to diagnosis via telehealth vs. in-person. Results of this exploratory study highlight the feasibility of telehealth evaluations for autism and which families may benefit from additional support to ensure a timely diagnosis.

The Use of a Medical Center-Based Outpatient Breastfeeding Support Program with Telelactation to Provide Ongoing Breastfeeding Support to a Diverse Patient Population

Background: Patients from low-income, minoritized communities have limited access to outpatient breastfeeding support with International Board Certified Lactation Consultants (IBCLCs). Telelactation may increase access particularly when appointments can be self-scheduled. Objective: To describe a medical center-based, outpatient breastfeeding support program that includes telelactation and serves a diverse patient population. Methods and Study Design: A retrospective electronic chart review was performed for patients with in-person or telelactation visit types between April 2020 and December 2021. Impact of demographics (language, race/ethnicity, insurance) on scheduling patterns (self-scheduled versus traditionally scheduled), visit reasons, and impact of initial visit type and reason on subsequent follow-ups were determined. Feeding practice-to-feeding goal ratios were compared between initial and last visit to determine if breastfeeding goals were met. Descriptive statistics, linear regression, chi-square, and paired t-tests were performed. Results: Two thousand twenty-three patients (37.9% Spanish-speakers, 76.6% Latinx; 8.0% black/non-Latinx, 79.0% publicly insured) made 2,791 visits, of which 50.6% were for telelactation. Self-scheduling resulted in decreased no show rates (25.3% versus 42.8%, p < 0.001). Commercially insured patients had greater odds of self-scheduling versus publicly insured (adjusted odds ratio: 9.22; 95% confidence interval, CI [6.27-13.57]) with no impact of race/ethnicity or language. Reasons for visit differed slightly by initial visit type. Practice-to-feeding goal ratios increased regardless of initial visit type: telelactation visit (0.84 to 0.88 [difference 0.04; 95% CI: 0.006-0.066; p = 0.017]); and in-person visit (0.77 to 0.84 [difference 0.07; 95% CI: 0.044-0.11 p < 0.001]). Conclusions: Telelactation as part of a medical center-based outpatient breastfeeding support program is a promising modality for both initial and follow-up visits. Self-scheduling decreased no show rates.

Health care policy that relies on poor measurement is ineffective: Lessons from the hospital readmissions reduction program.

Health care policy that relies on poor measurement is ineffective: Lessons from the hospital readmissions reduction program.

Comparison of Delivery of Care Before and During COVID-19 Within an Academic Outpatient Psychiatry Practice.

Introduction: The COVID-19 pandemic has challenged outpatient mental health clinics. This article compares care delivery and patient characteristics before and during the COVID-19 pandemic in outpatient mental health clinics within an academic health system. Methods: A retrospective cohort study was conducted in patients who received outpatient psychiatric services at two clinics (A and B). The investigators compared care delivery with patients with mental health conditions prepandemic (January 1-December 31, 2019) and midpandemic (January 1-December 31, 2020) periods. Care delivery was defined as the number and type of new and return visits (telehealth and face-to-face visits), patients with recorded measurement-based care (MBC) outcomes, and communication capability between patients and providers. Results: During the prepandemic period, 6,984 patients were seen in Clinics A and B, resulting in 57,629 visits. In the midpandemic period, 7,110 patients were served, resulting in 61,766 total visits. Medication management visits increased from 2019 to 2020; number of visits with documented outcome measures increased by 90% in Clinic A and 15% in Clinic B. The number of MyChart messages per patient increased more than twofold during the midpandemic period. The number of new visits with primary diagnosis of anxiety disorders increased in CY2020 and the number of visits with primary diagnosis of major depressive/mood disorders decreased in CY2020. Payor mix did not vary between the two periods although there was variability between payor mix at the two primary clinic locations. Discussion: The study suggests that there was no detrimental impact on access to care between the prepandemic and midpandemic periods within the health system. Mental health visits while pivoting to telehealth increased during the midpandemic period. Transition to telepsychiatry improved the ability to administer and document MBC.

SUBDISTRICT CLUSTERING IN WEST JAVA PROVINCE BASED ON DISEASE INCIDENCE OF JKN PARTICIPANTS PRIMARY SERVICES

One of the efforts that can be done to optimize health services and the distribution of facilities and infrastructure efficiently in a wide scope is by profiling and clustering areas in the province of West Java to the scope of sub-districts that have similar characteristics of disease category. The methods that will be compared to get the best clustering are hierarchical clustering and ensemble clustering. The data used as the object of research is the BPJS Kesehatan capitation primary service sample data for the 2017-2018 period. Some of the important variables used include: primary disease diagnosis data (ICD-10) of patients at the puskesmas, service time, type of visit, and location of service sub-district. This study uses several evaluation metrics Silhouette coefficient, Dunn index, Davies-Bouldin index, and C-index to determine the optimal number of clusters formed. In addition, descriptive analysis and visualization of the clustering results are also used as considerations in selecting the optimal cluster. Based on the evaluation results, the optimal method is hierarchical clustering with complete linkage. This method produces three clusters: cluster 1 consists of 5 sub-districts that have a high/dominant mean value in almost all disease categories, cluster 2 consists of 26 sub-districts that have a medium mean value, and cluster 3 consists of 589 sub-districts that have a low mean value. Most of the members of clusters 1 and 2 are sub-districts located in the districts/cities around the national capital (DKI Jakarta) and the provincial capital (Bandung) while the members of cluster 3 are mostly sub-districts located in suburban districts/cities or far from the central government.

Comparison of Transplant Pharmacist Treatment Decisions Between Telehealth and Clinic Visits.

Introduction: Implementation of telehealth in high-risk patient populations provides opportunities for continuous interactions and has previously been shown to positively impact practice. However, there is a paucity of studies focused on telehealth in the liver transplant population specific to pharmacist care. Project Aim: Describe the importance of transplant pharmacist treatment decisions between telehealth, in-clinic, and asynchronous (eg chart review and electronic message support) visit types. Design: This was a single-center comparative evaluation of adult liver transplant recipients transplanted between May 1, 2020 and October 31, 2020 with a transplant pharmacist visit between May 1, 2020 and November 30, 2020. The primary outcome was the average number of treatment decisions per encounter and the average number of important treatment decisions per encounter. The importance of these treatment decisions was determined by a panel of three clinicians. Results: Twenty-eight patients met the inclusion criteria with 85 in-clinic, 42 telehealth, and 55 asynchronous visits. For all treatment decisions, there was no statistical difference in average number of treatment decisions per encounter between telehealth visits and in-clinic visits with an odds ratio (OR) of 0.822 (95% CI, 0.674-1.000; P = 0.051). Similarly, for important treatment decisions, there was no statistical difference between telehealth visits and in-clinic visits (OR 0.847; 95% CI, 0.642-1.116; P = 0.238). Conclusion: Transplant pharmacists can deliver recommendations with similar importance via telehealth compared to in-clinic visits based on the number of total and important treatment decisions.

Changes in Performance Measures and Service Volume at US Federally Qualified Health Centers During the COVID-19 Pandemic

Stay-at-home orders, site closures, staffing shortages, and competing COVID-19 testing and treatment needs all potentially decreased primary care access and quality during the COVID-19 pandemic. These challenges may have especially affected federally qualified health centers (FQHCs), which serve patients with low income nationwide. To examine changes in FQHCs' quality-of-care measures and visit volumes in 2020 to 2021 vs prepandemic. This cohort study used a census of US FQHCs to calculate changes in outcomes between 2016 and 2021 using generalized estimating equations. Twelve quality-of-care measures and 41 visit types based on diagnoses and services rendered, measured at the FQHC-year level. A total of 1037 FQHCs were included, representing 26.6 million patients (63% 18-64 years old; 56% female) in 2021. Despite upward trajectories for most measures prepandemic, the percentage of patients served by FQHCs receiving recommended care or achieving recommended clinical thresholds showed a statistically significant decrease between 2019 and 2020 for 10 of 12 quality measures. For example, declines were observed for cervical cancer screening (-3.8 percentage points [pp]; 95% CI, -4.3 to -3.2 pp), depression screening (-7.0 pp; 95% CI, -8.0 to -5.9 pp), and blood pressure control in patients with hypertension (-6.5 pp; 95% CI, -7.0 to -6.0 pp). By 2021, only 1 of these 10 measures returned to 2019 levels. From 2019 to 2020, 28 of 41 visit types showed a statistically significant decrease, including immunizations (incidence rate ratio [IRR], 0.76; 95% CI, 0.73-0.78), oral examinations (IRR, 0.61; 95% CI, 0.59-0.63), and supervision of infant or child health (IRR, 0.87; 95% CI, 0.85-0.89); 11 of these 28 visits approximated or exceeded prepandemic rates by 2021, while 17 remained below prepandemic rates. Five visit types increased in 2020, including substance use disorder (IRR, 1.07; 95% CI, 1.02-1.11), depression (IRR, 1.06; 95% CI, 1.03-1.09), and anxiety (IRR, 1.16; 95% CI, 1.14-1.19); all 5 continued to increase in 2021. In this cohort study of US FQHCs, nearly all quality measures declined during the first year of the COVID-19 pandemic, with most declines persisting through 2021. Similarly, most visit types declined in 2020; 60% of these remained below prepandemic levels in 2021. By contrast, mental health and substance use visits increased in both years. The pandemic led to forgone care and likely exacerbated behavioral health needs. As such, FQHCs need sustained federal funding to expand service capacity, staffing, and patient outreach. Quality reporting and value-based care models must also adapt to the pandemic's influence on quality measures.

Persistent Disparities in Pediatric Health Care Engagement During the COVID-19 Pandemic.

The COVID-19 pandemic has disrupted traditional health care, including pediatric health care. We described the impact of the pandemic on disparities in pediatric health care engagement. Using a population-based cross-sectional time-series design, we compared monthly ambulatory care visit volume and completion rates (completed vs no-show and cancelled visits) among pediatric patients aged 0-21 years in 4 states in the mid-Atlantic United States during the first year of the COVID-19 pandemic (March 2020-February 2021) with the same period before the pandemic (March 2019-February 2020). We used unadjusted odds ratios, stratified by visit type (telehealth or in-person) and sociodemographic characteristics (child race and ethnicity, caregiver primary language, geocoded Child Opportunity Index, and rurality). We examined 1 556 548 scheduled ambulatory care visits for a diverse pediatric patient population. Visit volume and completion rates (mean, 70.1%) decreased during the first months of the pandemic but returned to prepandemic levels by June 2020. Disparities in in-person visit completion rates among non-Hispanic Black versus non-Hispanic White patients (64.9% vs 74.3%), patients from socioeconomically disadvantaged versus advantaged communities as measured by Child Opportunity Index (65.8% vs 76.4%), and patients in rural versus urban neighborhoods (66.0% vs 70.8%) were the same during the remainder of the first year of the pandemic as compared with the previous year. Concurrent with large increases in telehealth (0.5% prepandemic, 19.0% during the pandemic), telehealth completion rates increased. Disparities in pediatric visit completion rates that existed before the pandemic persisted during the pandemic. These findings underscore the need for culturally tailored practices to reduce disparities in pediatric health care engagement.

The effect of the COVID-19 pandemic on hospital admissions and outpatient visits in Ontario, Canada.

The wave-over-wave effect of the COVID-19 pandemic on hospital visits for non-COVID-19-related diagnoses in Ontario, Canada remains unknown. We compared the rates of acute care hospitalizations (Discharge Abstract Database), emergency department (ED) visits, and day surgery visits (National Ambulatory Care Reporting System) during the first five "waves" of Ontario's COVID-19 pandemic with prepandemic rates (since January 1, 2017) across a spectrum of diagnostic classifications. Patients admitted in the COVID-19 era were less likely to reside in long-term-care facilities (OR 0.68 [0.67-0.69]), more likely to reside in supportive housing (OR 1.66 [1.63-1.68]), arrive by ambulance (OR 1.20 [1.20-1.21]) or be admitted urgently (OR 1.10 [1.09-1.11]). Since the start of the COVID-19 pandemic (February 26, 2020), there were an estimated 124,987 fewer emergency admissions than expected based on prepandemic seasonal trends, representing reductions from baseline of 14% during Wave 1, 10.1% in Wave 2, 4.6% in Wave 3, 2.4% in Wave 4, and 10% in Wave 5. There were 27,616 fewer medical admissions to acute care, 82,193 fewer surgical admissions, 2,018,816 fewer ED visits, and 667,919 fewer day-surgery visits than expected. Volumes declined below expected rates for most diagnosis groups, with emergency admissions and ED visits associated with respiratory disorders exhibiting the greatest reduction; mental health and addictions was a notable exception, where admissions to acute care following Wave 2 increased above prepandemic levels. Hospital visits across all diagnostic categories and visit types were reduced at the onset of the COVID-19 pandemic in Ontario, followed by varying degrees of recovery.

Audio or Video? Access to Pediatric Neurology Outpatient Services Varies by the Type of Telehealth, Especially for Black Children.

Children of minority race/ethnicity face barriers to accessing specialty services. During the COVID pandemic, health insurance companies reimbursed telehealth services. Our objective was to evaluate the effect of audio versus video visits on children's access to outpatient neurology services, particularly for Black children. Using Electronic Health Record data, we collected information about children who had outpatient neurology appointments in a tertiary care children's hospital in North Carolina from March 10, 2020, to March 9, 2021. We used multivariable models to compare appointment outcomes (canceled vs completed, and missed vs completed) by visit type. We then conducted similar evaluation for the subgroup of Black children. A total of 1250 children accounted for 3829 scheduled appointments. Audio users were more likely to be Black and Hispanic, and to have public health insurance than video users. Adjusted odds ratio (aOR) for appointments completed versus canceled was 10 for audio and 6 for video, compared to in-person appointments. Audio visits were twice as likely as in-person visits to be completed versus missed; video visits were not different. For the subgroup of Black children, aOR for appointments completed versus canceled for audio was 9 and video was 5, compared to in-person appointments. For Black children, audio visits were 3 times as likely as in-person visits to be completed versus missed; video visits were not different. Audio visits improved access to pediatric neurology services, especially for Black children. Reversal of policies to reimburse audio visits could deepen the socioeconomic divide for children's access to neurology services.

PD18-12 A 225% INCREASE IN VASECTOMY CONSULTS: MALE IMPLICATIONS OF THE DOBBS DECISION

You have accessJournal of UrologyCME1 Apr 2023PD18-12 A 225% INCREASE IN VASECTOMY CONSULTS: MALE IMPLICATIONS OF THE DOBBS DECISION Alex Zhu, Miriam Hadj-Moussa, Catherine Nam, Devon Gingrich, Nik Patel, Stephanie Daignault-Newton, Susanne Quallich, James M. Dupree, and Dana Ohl Alex ZhuAlex Zhu More articles by this author , Miriam Hadj-MoussaMiriam Hadj-Moussa More articles by this author , Catherine NamCatherine Nam More articles by this author , Devon GingrichDevon Gingrich More articles by this author , Nik PatelNik Patel More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Susanne QuallichSusanne Quallich More articles by this author , James M. DupreeJames M. Dupree More articles by this author , and Dana OhlDana Ohl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003273.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: On June 24, 2022, the U.S. Supreme Court eliminated the federal protection of abortion rights in Dobbs vs. Jackson Women’s Health Organization. Since this decision, many urologists have anecdotally reported seeing more men, particularly younger men and those without children, for vasectomy consultation. We aimed to determine the impact of Dobbs on the number and types of men seeking vasectomy. METHODS: A retrospective chart review was performed on all patients who completed a vasectomy consult appointment at a single health system in Michigan in the three months following Dobbs (6/24/2022 – 9/24/2022). This was compared to a similar time frame in 2021 (6/24/2021 – 9/24/2021). We calculated the number of new vasectomy consults seen in these periods. We evaluated for differences in men seeking vasectomy consults between time frames with logistic regression accounting for patient demographics, location seen, and visit type. RESULTS: In the three months after Dobbs, there was a 2.25× increase in new vasectomy consult appointments completed compared to a similar timeframe in 2021 (342 vs. 152 patients). The youngest patient seen for vasectomy consult after Dobbs was 19 years old, versus 25 years old in 2021. Those seeking vasectomy consult were more likely to have no children versus those with 3 or more children (OR 2.79, p=0.01). There was a 2.3× increase in agnostic/atheist/non-religious men seeking vasectomy consults (232 vs 100 patients), and these men were twice as likely to seek vasectomy consults post-Dobbs than Catholic men (OR 2.1, p=0.048). Compared to men who were married, those seeking vasectomy consults post-Dobbs were more likely to be partnerless/divorced (OR 4.7, p=0.004) or in a non-married relationship (OR 2.4, p=0.018). Men were more likely to seek vasectomy consults post-Dobbs in community hospitals versus academic hospitals (OR 3.3, p=0.006). There were no significant differences pre- and post-Dobbs in men seeking vasectomy consults by age, income, race, or insurance type. CONCLUSIONS: After the Dobbs decision, 2.25× more men sought vasectomy consults. Those seeking vasectomy consults post-Dobbs were more likely to be childless, agnostic/atheist/non-religious, and non-married. The changing abortion landscape has led to significant effects in male reproductive healthcare. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e507 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Zhu More articles by this author Miriam Hadj-Moussa More articles by this author Catherine Nam More articles by this author Devon Gingrich More articles by this author Nik Patel More articles by this author Stephanie Daignault-Newton More articles by this author Susanne Quallich More articles by this author James M. Dupree More articles by this author Dana Ohl More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-13 NO DETECTABLE ASSOCIATION BETWEEN VIRTUAL SETTING FOR VASECTOMY CONSULTATION AND VASECTOMY COMPLETION RATE

You have accessJournal of UrologyCME1 Apr 2023MP19-13 NO DETECTABLE ASSOCIATION BETWEEN VIRTUAL SETTING FOR VASECTOMY CONSULTATION AND VASECTOMY COMPLETION RATE Ari Bernstein, Hunter Hernandez, Ethan Zhu, Bryce Saba, Eli Rapoport, and Bobby Najari Ari BernsteinAri Bernstein More articles by this author , Hunter HernandezHunter Hernandez More articles by this author , Ethan ZhuEthan Zhu More articles by this author , Bryce SabaBryce Saba More articles by this author , Eli RapoportEli Rapoport More articles by this author , and Bobby NajariBobby Najari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has fueled widespread incorporation of telehealth into Urology practices. Vasectomy consultation via telehealth is convenient and improves access to care for male contraception. However, it does not allow for physical examination, inherently leading to possible day-of-procedure cancellations due to unforeseen anatomic concerns. This study aimed to compare vasectomy completion rates between patients undergoing virtual versus in-person consultation. METHODS: All patients seen by a single provider at NYU Langone Health for vasectomy consultation between October 2016 and June 2022 were included in the study. Most patients seen before March 2020 had in-person consultations, whereas the majority of patients seen afterwards had virtual consultations due to the emergence of COVID-19. All patients seen virtually were examined in a consult room prior to being prepped for the vasectomy in the procedure room. Visit type, demographic information, and clinical outcomes data were collected for all patients. A chi-squared test was used to compare the rate of vasectomy completion between those with in-person and virtual consultation. Analysis was performed using R, version 4.0.5. RESULTS: 491 patients were seen by a single provider for vasectomy consultation between October 2016 and June 2022. 197 (40.1%) consultations were performed virtually and 294 (59.9%) consultations were performed in-person. 370 (75.4%) of all patients seen for consultation (both virtual and in-person) ultimately underwent vasectomy. There was no evidence of difference in rate of completing vasectomy after virtual (75.6%) and in-person (75.2%) consultation (p=.91). Two of the 197 (1%) patients who consulted virtually had their vasectomy procedures cancelled on the day of the procedure based on their pre-operative exam; one because of abnormal epididymal sensitivity after prior scrotal infection, the other because of a history of orchiopexy that the patient was not aware of until the surgeon started inquiring about scrotal scars present. CONCLUSIONS: Despite the lack of physical examination, virtual vasectomy consultation is both feasible and effective, with rates of vasectomy completion comparable to traditional in-person consultation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e270 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ari Bernstein More articles by this author Hunter Hernandez More articles by this author Ethan Zhu More articles by this author Bryce Saba More articles by this author Eli Rapoport More articles by this author Bobby Najari More articles by this author Expand All Advertisement PDF downloadLoading ...

MP53-16 TELEMEDICINE HERE TO STAY? KEY INDICATORS TO PATIENT SATISFACTION

You have accessJournal of UrologyCME1 Apr 2023MP53-16 TELEMEDICINE HERE TO STAY? KEY INDICATORS TO PATIENT SATISFACTION Gideon Harianja, Michael Reimer, Cayde Ritchie, Matthew Buell, Akin S. Amasyali, Kai Wen Cheng, Catherine Chen, David Chamberlin, and Joshua Chamberlin Gideon HarianjaGideon Harianja More articles by this author , Michael ReimerMichael Reimer More articles by this author , Cayde RitchieCayde Ritchie More articles by this author , Matthew BuellMatthew Buell More articles by this author , Akin S. AmasyaliAkin S. Amasyali More articles by this author , Kai Wen ChengKai Wen Cheng More articles by this author , Catherine ChenCatherine Chen More articles by this author , David ChamberlinDavid Chamberlin More articles by this author , and Joshua ChamberlinJoshua Chamberlin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic initiated rapid widespread utilization of telemedicine affecting all health care providers, including those in pediatric urology. Understanding the factors of patient and parent satisfaction can aid in health care delivery. The aim of this study was to identify key indicators of patient and parent satisfaction with pediatric urology telemedicine visits. METHODS: We conducted a prospective cross-sectional survey of all patients evaluated with a telehealth visit from October 2021 - April 2022. We included all consecutive patients aged 0-18 years who received an outpatient pediatric urology telehealth visit. All patients received an 8-question patient/parent reported outcome (PRO) survey via email within 30 days of the visit, including 5 satisfaction questions regarding various aspects of telemedicine rated on a scale of 1-5. Statistical analysis was performed using Pearson correlation, Mann-Whitney U, and Chi Squared tests, with p<0.05 considered significant. RESULTS: A total of 1213 patients completed a telehealth visit, of which 83 (7%) completed the PRO survey. Visit type included 40 (48%) post-operative, 29 (35%) follow-up, and 14 (17%) new consults. From the survey responses, 84% reported time savings, 31% reported money savings, 30% avoided time away from work, and 27% of children avoided missing school. No technical issues were experienced in 86% of the visits. Satisfaction with telehealth was highest for the post-operative patient, 4.8/5 after orchiopexy and 4.4/5 after circumcision. Patients saved a median travel distance of 22 miles [IQR: 15-41]. Patients living farther than 22 miles had higher satisfaction scores in terms of simplicity and preference to in-person visits compared to those who lived closer (p=0.019). Patients living in zip codes below the median household income had significantly higher satisfaction scores (p=0.032). Patients with public health insurance had significantly higher overall satisfaction scores compared to those with private health insurance (p=0.022). There was no difference in satisfaction based on parent age or whether the patient was evaluated for a new, follow-up, or post-operative video visit. CONCLUSIONS: Children and their caregivers were satisfied with pediatric urology telehealth visits when seen as a new, follow-up, or post-operative patient. Indicators for satisfaction may include long travel distance to the clinic, lower than median household income zip codes, and public health insurance. Appropriate use of telehealth may provide better access to care and optimize healthcare delivery. Source of Funding: AOA Research Fellowship Grant © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e718 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gideon Harianja More articles by this author Michael Reimer More articles by this author Cayde Ritchie More articles by this author Matthew Buell More articles by this author Akin S. Amasyali More articles by this author Kai Wen Cheng More articles by this author Catherine Chen More articles by this author David Chamberlin More articles by this author Joshua Chamberlin More articles by this author Expand All Advertisement PDF downloadLoading ...

Tensions between police training and practice for the risk assessment of registered sex offenders in England and Wales

ABSTRACT In UK, police officers are specially trained to become Management of Sexual or Violent Offenders (MOSOVO) officers. MOSOVO officers risk assess Registered Sex Offenders during home visits. We aimed to examine the MOSOVO training and home visits, and determine whether there is an alignment between training and practice. Three police forces in UK participated. Firstly, the MOSOVO training course was observed at each force. Secondly, MOSOVO officers in each force recorded home visits over a two-week period; the authors randomly selected 12 recordings for analysis. Field notes and transcripts were analysed using thematic analysis. Four themes were developed: unspecialised trainers lead to distrust and disengagement; the training does not prepare officers for all types of home visit; tensions between standard police policies and MOSOVO role; police suspicion of RSOs influences home visit implementation. We provide recommendations to improve MOSOVO training and the home visit process.