Unmet Care Need Research Articles

Unmet need for autism-aware care for gynaecological, menstrual and sexual wellbeing.

Autistic people often experience difficulties with healthcare, and are more likely than neurotypical people to have unmet healthcare needs. They may also be more likely to find menstruation and menopause more difficult than neurotypical women. Healthcare professionals (HCPs) often have insufficient training and support to work with autistic adults, and they often lack the skills or confidence to discuss reproductive and sexual health (RSH) with patients. When these two issues are combined, it would appear that autistic people may experience particular difficulties when seeking RSH care. The aim of this study was to explore autistic people's experiences of healthcare related to RSH in the United Kingdom. Surveys were distributed with assistance of an autism charity, and were completed by 136 adults. The survey consisted mainly of tick-box responses, but there were also several opportunities for participants to write comments about their experiences. Respondents felt that HCPs almost never seem to know how autism affects their RSH. There was broad agreement that HCPs need to be more aware of the impact of autism on healthcare experiences in general, and the specific impacts of autism on RSH. The data provide a clear picture of unmet needs for autism-aware healthcare for RSH, but further research is required to explore HCPs' knowledge about how autism affects RSH. Combined with our findings, such research could inform the development of resources and training to improve healthcare for autistic people.

Social determinants of unmet need for primary care: a systematic review

BackgroundDespite primary care being largely free at the point of delivery, many Canadians experience challenges in accessing the services they need. A systematic review was conducted to summarize the evidence on the level of unmet need for primary care in Canada and its social determinants.MethodsMEDLINE, Embase, Cochrane, and Web of Science databases were screened from inception to December 2023 using relevant search terms for primary care and unmet healthcare needs. Quantitative observational studies in the English language that included Canadian adults aged 18 years and older and focused on unmet needs for primary care were included. The risk of bias in the studies was assessed using either the Joanna Briggs Institute (JBI) critical appraisal checklist or the Newcastle–Ottawa Scale. The included studies were synthesized narratively.ResultsForty-six studies met the inclusion criteria for this review. Of the included studies, 96% were cross-sectional in design and 91% had low risk of bias. The prevalence of unmet need, mostly self-reported, varied between 6.6% and 25.2% in national studies. Social determinants of unmet needs were heterogeneous across studies. Findings suggest that unmet need for primary care is related to having low income, mental health diagnoses, and chronic conditions, and negatively associated with older age, having better-perceived health, and having a family physician.ConclusionsUniversal access to primary care is the founding principle of the Canadian healthcare system. However, we found evidence suggesting that the extent to which primary care needs are met is influenced by social determinants of health. Further research is needed to improve our understanding of the mechanisms of unmet primary care needs in Canada.Systematic review registrationPROSPERO CRD42021285074.

Association of insurance type with unmet need for menopause care in Oregon.

To determine unmet need for menopause care in Oregon and evaluate if insurance type is associated with receipt of care. We conducted a cross-sectional survey of patients using an Oregon Listserv. Our primary outcome was use of medication for the treatment of moderate or severe symptoms of menopause. We used the Menopause Rating Scale to evaluate respondents' symptoms: 0-4 none or little symptoms; 5-8 mild symptoms; 9-16 moderate symptoms; and 17+ severe symptoms. We abstracted demographic and clinical information including age, rurality, race, ethnicity, primary language, and insurance type. We used a regression model to determine the association between public insurance and treatment for moderate to severe menopause symptoms. We examined reasons for nonuse of therapy. Our sample included 845 perimenopausal or postmenopausal individuals who were predominantly White (93.0%), aged 45-49 (32.8%) or 50-54 years (39.1%), and privately insured (81.3%). Overall, 62.4% of individuals with moderate and severe symptoms of menopause were not receiving any therapy. After adjustment for age and rurality, public insurance was associated with an average of 47% increased odds of nontreatment for moderate or severe menopause symptoms (adjusted odds ratio: 1.47, 95% CI: 0.99-2.19). The most common reasons for nontreatment in both groups were "therapy was not recommended by a provider" (43%) and worries about safety or side effects (40%). Even in well-insured persons, the majority of people with moderate and severe symptoms of menopause are not receiving treatment. People who are publicly insured are more likely to go untreated than privately insured individuals.

Distributed Opioids in Morphine Equivalent: A Global Measure of Availability for Palliative Care

ContextEstimates of serious health-related suffering (SHS) demonstrate immense unmet need for palliative care, predominately in low- and middle-income countries (LMICs). Because opioids are essential medicines in palliative care (PC), measuring their availability can be used to evaluate the capacity of health systems to meet need. ObjectivesPresent the methodology for calculating Distributed Opioids in Morphine Equivalents (DOME)— introduced in the Lancet Commission on Global Access to Palliative Care and Pain Relief report - and how it can be used as a simple indicator to quantify unmet pain relief and PC need. MethodsUsing International Narcotics Control Board (INCB) data, DOME applies relative potency estimates to convert the annualized quantities of clinically appropriate opioids procured by a country to oral morphine equivalent milligrams. To quantify unmet need, an expert group proposed health condition-specific estimates for opioid need and used available data on the burden of SHS to posit the annual opioid quantity required by country for symptomatic treatment of pain or breathlessness. Comparing this to DOME generates DOME%SHSNEED, the proportion of opioids needed for palliative care that can be fulfilled by the opioid procured by a country during a year. ResultsDOME and DOME%SHSNEED can be used to measure, over time, the capacity of countries to meet PC need, as a key component of universal health coverage. Identifying access gaps disproportionately impacting LMICs can promote better health system performance and guide countries and institutions in policy making. ConclusionDOME and DOME%SHSNEED can be used to monitor health system progress to redress disparities and promote access to medically indicated opioid therapy in palliative care.

Dental caries status and treatment need among pregnant women attending antenatal clinics in Dar-Es-Salaam region, Tanzania

BackgroundLiterature shows that pregnant women are more susceptible to dental caries due to several reasons, including changes in salivary flow, reduced pH in the oral cavity, and sugary dietary cravings. The unmet need for care is of special concern, as the failure to obtain treatment can affect the health status of the mother and her unborn child.ObjectivesTo determine dental caries status and treatment needs among pregnant women attending antenatal clinics in the Dar-es-Salaam region.Materials and methodsA descriptive cross-sectional hospital-based study was conducted among 461 pregnant women aged 14–47 years. Informed consent was obtained from participants during data collection. Dental caries status and treatment need were diagnosed according to the WHO criteria. The Data collected was cleaned and analyzed using SPSS version 23.0 software for generating frequency distribution tables, chi-square tests, and logistic regression analysis. The Confidence Interval was 95% (p < 0.05).ResultsThe overall prevalence of dental caries was 69%, with a mean DMFT score of 2.86 (± 3.39). Untreated dental decay was observed in 60.5% of study participants, which needed more restorative treatment (fillings & RCT) than a tooth extraction. Caries experiences differed significantly among the pregnant women in various gravidity. In logistic regression, dental caries experience was significantly higher among multigravida respondents (p-values = 0.04) (OR: 1.840, CI 1.021–3.319).ConclusionThis study demonstrated a high level of dental caries experience and the presence of treatment needs. Multiple pregnancies were a major factor that contributed to high levels of dental caries.

Co-Designing a Palliative Dementia Care Framework to Support Holistic Assessment and Decision Making: The EMBED-Care Framework.

People with dementia have complex palliative care needs that are often unmet, including physical and psycho-social needs. It is essential to empower people with dementia, family carers and professionals to better assess and manage care needs. We aimed to co-design a palliative dementia care Framework delivered through a digital app to support holistic assessment and decision making for care in the community and care homes-the EMBED-Care Framework. A systematic co-design approach was adopted to develop the EMBED-Care Framework across three stages: 1) Framework analysis to synthesise data from preceding evidence reviews, large routine clinical data and cohort studies of unmet palliative dementia care need; 2) Co-design using iterative workshops with people with dementia, family carers and health and social care professionals to construct the components, design of the app and implementation requirements; and 3) User testing to refine the final Framework and app, and strengthen use for clinical practice and methods of evaluation. The Framework was co-designed for delivery through an app delivered by aTouchAway. It comprised five main components: 1) holistic assessment of palliative care needs using the Integrated Palliative care Outcome Scale-Dementia (IPOS-Dem); 2) alert system of IPOS-Dem scores to highlight unmet needs; 3) IPOS-Dem scores and alerts enable shared decision making between the practitioner, patient and/or carer to support priority setting and goals of care; 4) evidence-informed clinical decision support tools automatically linked with identified needs to manage care; and 5) Training package for users incorporating face-to-face sessions, clinical champions who received additional face-to-face sessions, animated videos and manual covering the main intervention components and email and telephone support from the research team. This is a novel digital palliative dementia care intervention to link holistic assessment with clinical decision support tools that are practical and easy to use but address the complexity of palliative dementia care. The Framework is ready for feasibility testing and pilot studies for people with dementia residing at home or in a care home. We were guided by our Patient and Public Involvement (PPI) group consisting of three people with mild dementia, including younger onset dementia, and seven family carers throughout the project. They supported the overall development of the Framework, including planning of workshops, interpreting findings and testing the framework in our PPI meetings.

The impact of health insurance on hypertension care: a household fixed effects study in India

IntroductionHypertension is highly prevalent in India, but the proportion of patients achieving blood pressure control remains low. Efforts have been made to expand health insurance coverage nationwide with the aim of improving overall healthcare access. It is critical to understand the role of health insurance coverage in improving hypertension care.MethodsWe used secondary data from the nationally representative sample of adults aged 15–49 years from the 2015–2016 National Family Health Survey (NFHS) in India. We defined the hypertension care cascade as four successive steps of (1) screened, (2) diagnosed, (3) treated, and (4) controlled, and operationalized these variables using blood pressure measurements and self-reports. We employed household fixed effect models that conceptually matched people with and without insurance within the household, to estimate the impact of insurance coverage on the likelihood of reaching each care cascade step, while controlling for a wide range of additional individual-level variables.ResultsIn all 130,151 included individuals with hypertension, 20.4% reported having health insurance. For the insured hypertensive population, 79.8% (95% Confidence Interval: 79.3%-80.3%) were screened, 49.6% (49.0%-50.2%) diagnosed, 14.3% (13.9%-14.7%) treated, and 7.9% (7.6%-8.2%) controlled, marginally higher than the percentages for the uninsured 79.8% (79.5%-80.0%), 48.2% (47.9%-48.6%), 13.3% (13.1%-13.5%), and 7.5% (7.4%-7.7%) for each cascade step, respectively. From the household fixed effects model, health insurance did not show significant impact on the hypertension care cascade, with the estimated relative risks of health insurance 0.97 (0.93–1.02), 0.97 (0.91–1.03), 0.95 (0.77–1.30), and 0.97 (0.65–1.10) for each cascade step, respectively. We further performed stratified analyses by sociodemographic and behavioral risk factors and a sensitivity analysis with district fixed effects, all of which yielded results that confirmed the robustness of our main findings.ConclusionsHealth insurance did not show significant impact on improving hypertension care cascade among young and middle-aged adults with hypertension in India. Innovative strategies for overcoming practical barriers to healthcare services in addition to improving financial access are needed to address the large unmet need for hypertension care.

Understanding the Association Between Medical Mistrust and Unmet Medical Care Need in Gender and Sexually Diverse People of Color Assigned Female at Birth.

Purpose: The present study investigated associations of sexual orientation and/or gender identity-based medical mistrust and racial/ethnic-based medical mistrust, respectively, with unmet medical care need among lesbian, gay, bisexual, transgender, queer, and/or sexually or gender diverse (LGBTQ+) people of color (POC) assigned female at birth (AFAB). We also tested the interaction of the two types of medical mistrust on unmet medical care need. Methods: Participants were 266 LGBTQ+ POC AFAB. Participants completed measures of medical mistrust based on race/ethnicity and LGBTQ+ identity. Unmet medical care need was assessed using the item: "During the past 12 months, was there ever a time where you felt that you needed health care but you didn't receive it?" Multivariate logistic regression models were run with either type of medical mistrust, as well as their interaction, as the predictor and unmet medical care need as the outcome variable. Results: There were no significant main effects of either type of medical mistrust on unmet medical care need. However, there was an interaction between the two types of medical mistrust, such that associations between each type of medical mistrust and unmet medical care needs were stronger at higher levels of the other type of medical mistrust. Racial/ethnic medical mistrust was associated with a greater likelihood of unmet medical needs at high, but not low, levels of LGBTQ+ medical mistrust. Conclusions: Racial/ethnic medical mistrust and LGBTQ+ medical mistrust exacerbate each other's influence on unmet medical care need. These results underscore the need for inclusive clinical practices for LGBTQ+ POC.

Addressing unmet need for primary care in Canada.

Primary care is the key health system strategy for improving health, enhancing patient and clinician experience, saving money, and promoting equity. Once a pioneer in primary care, Canada now fails to provide access to millions of people. This crisis is widely recognized, but policy responses are varied and mostly incremental and piecemeal. The goal of providing primary care to everyone seems unrealistic and elusive in Canada, yet it has long been attained in many other countries. Without an explicit policy goal of primary care for all, most likely on a geographic basis, Canada will continue to underinvest and underperform in primary care, with ramifications that include rapidly escalating costs, emergency department and hospital overcrowding and a growing and inequitable burden of preventable suffering. A commitment to work towards this goal is needed now to ensure that Canadians have access to high-quality well-organized care for everyone.

Variations in Unmet Health Care Needs by Perceptions of Social Media Health Mis- and Disinformation, Frequency of Social Media Use, Medical Trust, and Medical Care Discrimination: Cross-Sectional Study.

Unmet need for health care is defined as choosing to postpone or completely avoid necessary medical treatment despite having a need for it, which can worsen current conditions or contribute to new health problems. The emerging infodemic can be a barrier that prevents people from accessing quality health information, contributing to lower levels of seeking medical care when needed. We evaluated the association between perceptions of health mis- and disinformation on social media and unmet need for health care. In addition, we evaluated mechanisms for this relationship, including frequency of social media use, medical trust, and medical care discrimination. Data from 3964 active adult social media users responding to the 2022 Health Information National Trends Survey 6 (HINTS 6), a nationally representative survey, were analyzed. The outcome was unmet need for medical care, defined as delaying or not getting the necessary medical care. The predictor variables were perception of social media health mis- and disinformation, frequency of social media use, level of trust in the health care system, and perceived racial and ethnic discrimination when receiving health care. Multivariable logistic regression models indicated that perception of substantial social media health mis- and disinformation (odds ratio [OR] 1.40, 95% CI 1.07-1.82), daily use of social media (OR 1.34, 95% CI 1.01-1.79), low medical trust (OR 1.46, 95% CI 1.06-2.01), and perceived discrimination (OR 2.24, 95% CI 1.44-3.50) were significantly associated with a higher likelihood of unmet need for medical care. Unmet need among adults who did not use social media daily and who did not perceive substantial mis- and disinformation (24%; 95% CI 19%-30%) was lower compared to daily social media users who perceived substantial mis- and disinformation (38%; 95% CI 32%-43%). Adults who perceived substantial mis- and disinformation and had low trust in health care had the highest probability of reporting unmet need (43%; 95% CI 38%-49%) compared to the other three groups. Adults who perceived substantial mis- and disinformation and experienced medical care discrimination had a statistically significant higher probability of reporting unmet need (51%; 95% CI 40%-62%) compared to adults who did not experience medical care discrimination and did not perceive substantial mis- and disinformation (29%; 95% CI 26%-32%). Unmet need for medical care was higher among individuals who perceived a substantial degree of social media mis- and disinformation, especially among those who used social media daily, did not trust the health care system, and experienced racial or ethnic discrimination when receiving health care. To counter the negative effects of social media mis- and disinformation on unmet need for health care, public health messaging must focus on daily social media users as well as improving trust and reducing structural racism in the health care system.

Racism and Health Among Aotearoa New Zealand Young People Aged 15–24 years: Analysis of Multiple National Surveys

PurposeThis Aotearoa New Zealand–based study addresses a gap in literature focusing on individual experiences of racism among adolescents and young adults and its links to health. MethodsThis cross-sectional study uses data from multiple instances of the New Zealand Health Survey (2002/03, 2006/07, 2011/12, 2016/17) and General Social Survey (2008–2016) restricted to participants aged 15–24 years. Prevalence of reported experiences of racism are estimated. Meta-analytic techniques to pool data and multiple regression analyses are used to examine associations between experiences of racism and outcomes measures (mental and physical health, general health and well-being, life satisfaction, inability to access health care, and identity). The study used an ethical co-design process between university researchers and a rangatahi Māori (Māori young people) partnership group. ResultsRacism was higher among Māori, Pacific, and Asian young people compared to European young people. Racism was associated with all negative health and well-being measures examined for young people, including negative mental and physical health measures (12-Item Short Form Survey, Kessler Psychological Distress Scale), lower self-rated health, negative life satisfaction, higher unmet need for primary care, and identity measures (feelings of not belonging in New Zealand, less able to express their identity). DiscussionThe results of this study are concerning. Non-European young people disproportionately bear the burden of racism in Aotearoa New Zealand with a potentially substantial impact on their health and well-being. This is a breach of Indigenous (for Māori) and other international human rights and should be motivation to act to eliminate racism in all its forms.

Persistent unmet need for surgical care in Western Uganda.

Treatable surgical diseases account for a significant proportion of the global burden of disease, particularly in low- and middle-income communities. The number of deaths owing to poor surgical care or its non-availability has been reported to exceed those from HIV/AIDS, tuberculosis and malaria combined. The Ugandan government and its development partners aim to put in place measures to achieve universal health coverage for all communities. These include construction and equipping health facilities, training of health workers, opening up road networks, and poverty alleviation programmes. However, these efforts have, as yet, fallen short as evidenced by external hernias remaining the leading cause of intestinal obstruction for more than 40 years. We recommend establishment of global surgery collaborations with rural-based medical training schools and other health facilities, essential surgical skills training for medical students, task shifting in surgical care and integration of regular surgical camps in the Uganda's healthcare delivery model.

Quantifying the Burden of Unmet Upper Extremity Care Need in Low-Middle Income Countries: A Four-Country, Cluster-Randomized Study

Currently, no nationally implementable survey exists to identify the burden of hand and upper extremity conditions at the household level in low-middle income countries (LMICs). This study describes a randomized cluster survey approach to estimating the burden of hand and upper extremity conditions in four LMICs using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey. Additionally, this study identifies factors associated with responses of unmet surgical need at the multinational level. The SOSAS instrument is a cluster-randomized, cross-sectional, countrywide survey of households administered in Nepal, Rwanda, Sierra Leone, and Uganda from 2011 to 2014. We identified nationwide trends for sociodemographic, anatomic, condition type, mechanism, prevalence, subjective disability, and barriers to care for upper extremity survey responses. A multivariable model identified factors associated with unmet upper extremity need across the four nations. Across the four countries, 13,763 individuals participated in the survey, with 883 conditions of the upper extremity identified (7.4% of all surgical conditions surveyed). Fractures accompanied many of the injuries (32.3%). Although most conditions were acquired, congenital conditions comprised 11% of all etiologies. Overall, open fire/explosion was the most common mechanism (22.9%). Rwandans had the highest proportion of individuals seeking care (91.0%) and receiving care (88.6%). Sierra Leone indicated the fewest seeking and receiving care (71% and 63%, respectively). Chronic injuries were significantly associated with receiving care, whereas illiteracy and worsening subjective disability were barriers to receiving care. In this survey of upper extremity conditions from four LMICs, upper extremity conditions primarily resulted from fire/explosions, and many reported sustaining a fracture. Illiteracy and more disabling conditions decreased the odds of receiving care by 30% to 40%, respectively. The SOSAS survey may provide a reproducible means to evaluate the unmet need for upper extremity care across similar LMICs.

A period prevalence study of palliative care need in adult outpatients

High levels of unmet palliative care need are reported globally. There is limited research that investigates unmet palliative care need in outpatient contexts. Early access to palliative care services is associated with better symptom management and reduced healthcare costs. This semi-replication study aimed to gain an understanding of palliative care need and service utilisation in adult outpatients attending a hospital outpatient day treatment unit. An observational period prevalence study was conducted using the Gold Standard Framework Proactive Indication Guidance to assess for palliative care need. Data were collected directly from the electronic medical records of patients who attended an outpatient day treatment unit, at a private-not-for-profit hospital over five days in January 2022. The indicators for the 12 conditions outlined in the Gold Standards Framework Proactive Indication Guidance were used to assess for palliative care need. Based on the review 41% (n = 115) of adult outpatients may have benefitted from palliative care. Of these, 13% (n = 15) were currently receiving palliative care, and most patients (87%, n = 100) were not receiving palliative care. There was evidence of high levels of unmet palliative care need, with most patients who could benefit from not receiving palliative care.

Therapeutic agents for machine perfusion of donor organs

Background. The urgency of the unmet need for transplant care dictates the necessity to use organs from suboptimal donors. Machine perfusion, which is actively developing at the present time, is designated to solve this problem. The literature presents novel technologies of ex vivo and in vivo machine perfusion of donor organs, which make it possible to improve their functions and perform a successful transplant. The most promising areas of research both in animals and in humans may be identified by reviewing the literature sources on this subject.The aim was to analyze the world experience of using therapeutic agents in machine perfusion of donor organsMaterial and methods: sources from 2015 to 2023 found in PubMed, Google Scholar, eLibrary databasesConclusion. The rapid progress in lung, liver and kidney transplantation has made it possible to use grafts from asystolic donors for patients in urgent need of donor organs. In turn, these advances have also prompted the study of potential therapeutic agents that can be used during perfusion.

Treatment Gap in Mental Health Care for Victims of Road Traffic Accidents.

Road traffic accidents (RTAs) are among the most frequent negative life-events. About one in five RTA survivors is susceptible to posttraumatic stress disorder (PTSD). Knowledge about needs for, and usage of, mental health services (MHSs) may improve options for care for RTA victims. The current study aimed to assess rates of victims using different MHSs, including psychotherapy, pharmacotherapy and support groups, and to explore correlates of needs for and use of these MHSs. Further, we aimed to estimate the treatment gap in post-RTA care, defined as including people with probable PTSD who did not use MHSs and people wanting but not getting help from MHSs. Dutch victims of nonlethal RTAs (N = 259) completed self-report measures on needs for and use of MHSs and PTSD. Results showed that 26% of participants had utilized care from psychotherapy, pharmacotherapy or support groups. Among people with probable PTSD, this was 56%. Increased posttraumatic stress was the strongest correlate of MHS use. Forty-eight participants (17.8%) had an unmet care need and represented the treatment gap. Commonly reported reasons and barriers preventing MHS use were perceptions that problems were limited or would disappear without care and financial worries. Regarding possible future care, participants reported a preference for face-to-face (over online) help from a psychologist (over other professionals). The treatment gap for Dutch RTA victims may be limited. However, a significant number of RTA victims need care but do not obtain this care. Care options may be improved by reducing practical barriers to MHSs and increasing mental health literacy and acceptability of different forms of care (besides face-to-face care).

Health system utilization and perceived quality among adults in Lao PDR: evidence from a nationally representative phone survey

BackgroundThe World Health Organization (WHO) defines quality health services as being effective, safe, people-centered, timely, equitable, integrated and efficient. It is critical to understand people’s perspectives and care experiences to measure progress against these goals. However, many low- and middle-income governments do not routinely collect such information. In this study, we aim to measure health systems performance from the perspective of the adult population of users and non-users in Lao PDR.MethodsUsing the People’s Voice Survey (PVS), a novel phone-based survey designed to integrate people’s voices into primary care performance measurement, we conducted a cross-sectional survey of the general adult (18+) population in Lao PDR in 2022. We analyzed health care utilization patterns, user-reported quality of care, and coverage of key preventive health services. Data from the most recent MICS survey was used to create sampling weights generating nationally representative estimates.ResultsA total of 2007 adults completed interviews in approximately 3.5 months. About two thirds (65%) of respondents reported visiting a health facility in the past year and, of these, the majority (61%) visited a hospital as opposed to a health center or clinic. Among those that recently visited health facilities, 28% rated their experience as “poor” or “fair”. 16% had unmet need for care and 12% reported discrimination during treatment in the past year. 12% of women over 50 years old reported receiving a mammogram and 59% of adults reported receiving blood pressure screening in the previous year.ConclusionsThe study presents data from the first nationally representative survey in Lao PDR to measure health system performance. The results indicate that, despite progress towards universal coverage of health insurance in Lao PDR, significant gaps remain, particularly with respect to bypassing of primary care facilities, significant unmet need for care, experiences of discrimination, and overall low perceptions of quality of care.

A review of the evidence that people with learning disabilities experience eye health inequalities: What policies can better ensure an equal right to sight?

AbstractBackgroundPeople with a learning disability experience challenges accessing primary health care services, including eye care services.MethodsEye care needs of people with a learning disability, and how well they are met by existing services in England, were explored. Barriers and enablers to accessing these services were investigated. This was informed by a scoping review of the literature and a historic literature library.FindingsAdults with a learning disability are 10 times more likely than other adults to have a serious sight problem and children with learning disabilities are 28 times more likely. There is good evidence of high levels of unmet eye care need special schools in England with over 4 in 10 children attending having no history of any eye care.ConclusionThe authors discuss possible systemic changes to address these inequalities in England. These include automatic entitlement to an NHS sight test annually, specialist pathways in community opticians, eye care services in special schools, and peer to peer and peer to professional promotion of services by people with lived experience. Dedicated care pathways have improved uptake of services in other areas of primary care. Research into the effectiveness of lived experience eye health advocacy is needed.

The association between frailty, care receipt and unmet need for care with the risk of hospital admissions.

Frailty is characterised by a decline in physical, cognitive, energy, and health reserves and is linked to greater functional dependency and higher social care utilisation. However, the relationship between receiving care, or receiving insufficient care among older people with different frailty status and the risk of unplanned admission to hospital for any cause, or the risk of falls and fractures remains unclear. This study used information from 7,656 adults aged 60 and older participating in the English Longitudinal Study of Ageing (ELSA) waves 6-8. Care status was assessed through received care and self-reported unmet care needs, while frailty was measured using a frailty index. Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for demographic and socioeconomic confounders. Around a quarter of the participants received care, of which approximately 60% received low levels of care, while the rest had high levels of care. Older people who received low and high levels of care had a higher risk of unplanned admission independent of frailty status. Unmet need for care was not significantly associated with an increased risk of unplanned admission compared to those receiving no care. Older people in receipt of care had an increased risk of hospitalisation due to falls but not fractures, compared to those who received no care after adjustment for covariates, including frailty status. Care receipt increases the risk of hospitalisation substantially, suggesting this is a group worthy of prevention intervention focus.

Smart Devices in Optometry: Current and Future Perspectives to Clinical Optometry.

There is a huge unmet need for eye care with more than a hundred million people living without basic eye care services and facilities. There is an exigency to deploy adequate resources in terms of manpower and equipment to address this. The usage of smart devices in optometry and eye care practice has been gaining momentum for last half a decade, due to the COVID-19 pandemic and technological advancements in telemedicine. These smart devices will help facilitate remote monitoring of important visual functions, ocular signs and symptoms, thus providing better eye care services and facilities and promoting outreach services. Smart devices in optometry exist in the form of gadgets that can be worn in the wrist, and spectacle-mounted or head-mounted devices. On the other hand, with the ubiquitous nature of smartphones, a large number of smartphone applications have been developed and tested for advanced optometry and primary eye care practice, which may potentially reduce the burden of inadequate resources and the unmet need for eye care. This article aims to give an overview of the current trends and future perspectives on the application of such smart devices in optometric practice.