Table 3 - uploaded by Allison Vanderbilt
Content may be subject to copyright.
Source publication
Introduction:
In the current era of medical education and curriculum reform, medical schools across the United States are launching innovative approaches to teaching students in order to improve patient outcomes and increase patient safety. One such innovation is the use information technology (IT) that can be used to disseminate health information...
Context in source publication
Similar publications
Introduction:
Low-income, chronically ill adults disproportionately experience poor health outcomes despite increased health care use and costs. Complex care management (CCM) programs are an innovative approach to improving outcomes for these patients, but little is known about the patients' experiences in CCM programs in safety net primary care s...
Citations
... 14 Although barriers to universal technology access remain a concern, a number of studies have demonstrated that the majority of underserved patients living in urban areas of the US have access to mobile phones and internet and are interested in using telemedicine for routine cancer care and clinical trials. [15][16][17][18] Studies have also shown that internet and electronic communication are feasible and acceptable among oncology patients in rural and underserved regions in the US and improve access to healthcare despite barriers to providing these populations with remote clinical trial care. 19,20 In general, TM/RPM has the potential to meet the needs of research participants and expand patient access to cancer clinical trials. ...
Background
Since the onset of COVID-19, oncology practices across the US have integrated telemedicine (TM) and remote patient monitoring (RPM) into routine care and clinical trials. The extent of provider experience and comfort with TM/RPM in treatment trials, however, is unknown. We surveyed oncology researchers to assess experience and comfort with TM/RPM.
Methods
Between April 10 and June 1, 2022, we distributed email surveys to US-based members of the American Society of Clinical Oncology (ASCO) whose member records indicated interest or specialization in clinical research. We collected respondent demographic data, clinical trial experience, workplace characteristics, and comfort and experience with TM/RPM use across trial components in phase I and phase II/III trials. TM/RPM was defined as clinical trial-related healthcare and monitoring for patients geographically separated from trial site.
Results
There were 141 surveys analyzed (5.1% response rate). Ninety percent of respondents had been Principal Investigators, 98% practiced in a norural site. Most respondents had enrolled patients in phase I (82%) and phase II/III trials (99%). Across all phases and trial components, there was a higher frequency of researcher comfort compared to experience. Regarding remote care in treatment trials, 75% reported using TM, RPM, or both. Among these individuals, 62% had never provided remote care to trial patients before the pandemic.
Conclusion
COVID-19 spurred the rise of TM/RPM in cancer treatment trials, and some TM/RPM use continues in this context. Among oncology researchers, higher levels of comfort compared with real-world experience with TM/RPM reveal opportunities for expanding TM/RPM policies and guidelines in oncology research.
... Community health programs or community-directed healthcare interventions School-based primary healthcare [40][41][42][43][44][45][46][47][48] Student-led healthcare services [49][50][51][52][53] Outreach services or mobile clinics [54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] Family health program [72][73][74][75] Empanelment [76][77][78][79] Community health funding schemes [80][81][82][83][84][85][86][87][88][89][90] Telemedicine [91][92][93][94][95][96][97][98][99][100][101][102][103] Integrative medicine [104][105][106][107][108][109][110] Working with non-profit private sectors and non-governmental organizations [111][112][113][114][115][116][117][118][119][120][121][122][123][124][125] improving their health status. Community health financing could also improve risk pooling and reduce healthinduced impoverishment. ...
Background
To compile key strategies from the international experiences to improve access to primary healthcare (PHC) services in rural communities. Different innovative approaches have been practiced in different parts of the world to improve access to essential healthcare services in rural communities. Systematically collecting and combining best experiences all over the world is important to suggest effective strategies to improve access to healthcare in developing countries. Accordingly, this systematic review of literature was undertaken to identify key approaches from international experiences to enhance access to PHC services in rural communities.
Methods
All published and unpublished qualitative and/or mixed method studies conducted to improvement access to PHC services were searched from MEDLINE, Scopus, Web of Science, WHO Global Health Library, and Google Scholar. Articles published other than English language, citations with no abstracts and/or full texts, and duplicate studies were excluded. We included all articles available in different electronic databases regardless of their publication years. We assessed the methodological quality of the included studies using mixed methods appraisal tool (MMAT) version 2018 to minimize the risk of bias. Data were extracted using JBI mixed methods data extraction form. Data were qualitatively analyzed using emergent thematic analysis approach to identify key concepts and coded them into related non-mutually exclusive themes.
Results
Our analysis of 110 full-text articles resulted in ten key strategies to improve access to PHC services. Community health programs or community-directed interventions, school-based healthcare services, student-led healthcare services, outreach services or mobile clinics, family health program, empanelment, community health funding schemes, telemedicine, working with traditional healers, working with non-profit private sectors and non-governmental organizations including faith-based organizations are the key strategies identified from international experiences.
Conclusion
This review identified key strategies from international experiences to improve access to PHC services in rural communities. These strategies can play roles in achieving universal health coverage and reducing disparities in health outcomes among rural communities and enabling them to get healthcare when and where they want.
... [4] But in our study, participants felt that the use of computers in independent decisionmaking could serve justice in the form of equity and equality in the reach of health care to patients and reduce discrimination among patients. The result of our study agrees with the pilot study conducted by Ryan et al., [35] who reported that difficulties faced by low-income and medically underserved communities in accessing healthcare services could be bridged by technology. During the lockdown and movement restrictions due to the COVID pandemic, health professionals were unable to reach out to rural communities and provide health care. ...
Background: Medical professionals are under tremendous stress due to various occupational stressors, and Artificial Intelligence (AI) geared toward patient care might look like a preferable solution in alleviating some amount of stress. Hence, the study assessed the level of awareness and perception of the ethical dilemmas of health professionals on intelligent computer programs in independent healthcare decision-making. Materials and Methods: The present study is a cross-sectional, non-interventional, and questionnaire-based descriptive study. This study was done in a Deemed to be University Hospital, Karnataka, India. Of the total 96 participants, 30 were medical participants, 36 were dentists, and 30 were nurses. A pretested and validated questionnaire was used to collect the participants’ responses. Results: Medical and nursing participants opined that intelligent computer programs can take both major and minor independent decisions in inpatient care when the physician is unavailable. The majority of the participants felt that in the decisions made by the intelligent computer programs, patients’ rights and wishes might not be respected, compromising autonomy. The majority agreed that computer-assisted information extraction helps in better treatment of patients causing beneficence. Medical and dental participants thought that intelligent computer programs cannot communicate well with patients, do not have a conscience, and can be hacked causing maleficence. Participants opined that the use of intelligent computer programs could serve justice in the form of equity and equality in health care. Conclusion: Breach of patient autonomy due to data mining, loss of confidentiality, and disrespect for patients’ rights and wishes are major concerns when AI takes independent decisions in health care. One of the most desirable outcomes of AI in health care could be an increase in equity and equality of the reach in health care to the rural population.
... While 62.2% of women in our sample reported at least weekly computer use, 96.4% were using a cell phone at least weekly. The near universal report of cell phone ownership and use among our community-based sample is consistent with that of the general U.S. population [1] and clinicbased samples of urban predominantly lower socioeconomic status patients [22,[24][25][26][27][28]. Yet with respect to smartphone ownership our findings differed from previous analyses. ...
... On average, Latinos use more data (Duggan & Smith, 2013;Lopez, Gonzalez-Barrera, & Patten, 2013;Nielsen, 2010Nielsen, , 2014Smith, 2015), send and receive more text messages, make more phone calls (Nielsen, 2010), and rely more on their smartphone as their sole access to the Internet (Lopez et al., 2013;Smith, 2015) than other ethnic groups. Latinos are more likely than Whites to use their phones to look for health or medical information online (Fox & Duggan, 2012;Krebs & Duncan, 2015;Ryan, Yoder, Flores, Soh, & Vanderbilt, 2016). This pilot study examines the feasibility and acceptability of delivering the theory-informed smartphone relapse prevention system CASA-CHESS to Spanish-speaking Latinos who successfully completed residential treatment and analyzes the specific usage data from this recovery tool (e.g., sustained app usage, specific services utilized). ...
Objective:
Addressing alcohol and other drug disorders (AOD) and other mental disorders (MD) among adult Hispanics/Latinos is of critical concern being one of the fastest growing ethnic groups with a disproportionate rate of disease, mental disorders, and poverty. Although improvement in outcomes is associated with sustained participation in ongoing treatment for co-occurring AOD/MD, continuing care is rare for these chronic conditions, especially for Latinos with more limited access to culturally and linguistically competent services.
Methods:
The evidence-based smartphone recovery application Addiction-Comprehensive Health Enhancement Support System (A-CHESS; (Gustafson et al., 2014 ; McTavish, Chih, Shah, & Gustafson, 2012)) was translated and adapted for Spanish-speaking Latinos with AOD/MD; thus, developing CASA-CHESS to address high level of need for services, high rates of relapse, and lack of existing culturally competent services for Latinos.
Results:
Of the 79 Latino clients who completed residential treatment and received a smartphone equipped with CASA-CHESS 26.6% discontinued using CASA-CHESS and 73.4% remained active for four or more months. CASA-CHESS usage was sustained over the four months across all three tenets of Self-Determination Theory (competence, relatedness, and autonomy), with the most commonly utilized services being relevant to relatedness (e.g., messaging, discussion boards). CASA-CHESS clients demonstrated a similar pattern of usage to A-CHESS clients.
Conclusions:
Findings illustrate that Spanish-speaking Latinos with AOD/MD will use a smartphone application to assist with their recovery, continuing their access to resources, case management, and quality information after leaving residential treatment. Consistent with previous findings, our results also emphasize the importance of social support during the four months post-discharge. Such evidence-based, theory-driven digital interventions may extend access to culturally and linguistically competent services.
Background: The lack of healthcare providers and financial resources in medically vulnerable areas results in reduced access to timely emergency care, leading to higher mortality rates. Utilizing information and communication technology (ICT) in the emergency medical services (EMS) system can potentially reduce health disparities and supplement the shortage of medical personnel. This study introduces the Chungbuk Smart Emergency Medical Service Project to improve EMS in Chungbuk province using ICT.Current Concepts: To improve regional EMS, the Chungbuk EMS Collaboration Committee initiated an ICT-EMS project that incorporates an algorithm-based patient triage system and real-time hospital selection for patient transfers. This initiative is funded by the Smart City Challenge project, which fosters a more comprehensive EMS system by promoting collaboration among local government agencies, local hospitals, and fire headquarters. The system allows the sharing of patients’ information from the notification stage through hospital transfer, thus ensuring efficient treatment and seamless communication between paramedics and health care providers.Discussion and Conclusion: Effective use of ICT for information sharing and coordination during EMS, from ambulance dispatch to hospital treatment, is essential for improving regional EMS. Clear communication, cooperation, and well-defined roles are necessary for the efficient use of ICT by emergency healthcare providers. Making healthcare providers understand the purpose of ICT equipment is crucial for its successful implementation. Verification of the effectiveness of ICT-based EMS improvement projects will lead to their global expansion, besides benefitting domestic EMS.
Introduction: Hospitals are a major source of care for underserved populations in the United States. However, little is known about how hospital-based health information technology (HIT) can improve the efficiency of care and reduce disparities. Objective: We examined the variation of preventable emergency department (ED) visits and associated racial disparities by hospital adoption of HIT patient engagement (HIT-PE) functionalities. Methods: This was an observational study of 6,543,514 non-Hispanic Black (Black) and non-Hispanic White (White) adult patients using 2019 datasets of seven states (Arizona, Florida, Kentucky, Maryland, North Carolina, Vermont, Wisconsin) from the State Emergency Department Databases, American Hospital Association Annual Survey & Information Technology Supplement, and Area Health Resources File. Results: High HIT-PE adoption was associated with lower rates of preventable ED (odds ratio [OR] = 0.992, p < 0.001). Specific HIT-PE functions such as importing medical records from other organizations into the patient portal (OR = 0.977, p < 0.001), electronically sending medical information to a third party (OR = 0.970, p < 0.001), and scheduling appointments online (OR = 0.987, p < 0.001) were also associated with reduced preventable ED rates. Black patients had higher rates of preventable ED compared with Whites (OR = 1.386, p < 0.001); however, the interaction of Black patients and high HIT-PE adoption was associated with lower rates of preventable ED (OR = 0.977, p < 0.001). Our results also showed that higher HIT-PE adoption was associated with a reduction in preventable ED visits among Black patients with comorbidities and Black patients living in low-income areas. Conclusions: The results of our study suggest that there is potential to reduce preventable ED rates and racial disparities through hospital-based HIT-PE functionalities.
Objectives
: Mobile health technologies have gained increasing popularity in the healthcare industry, even though inequity in their adoptions have been documented. This study aimed to describe sociodemographic and clinical vulnerabilities among non-adopters of smartphones, identify their alternative ways of seeking health information, and explore potential outreach venues to these individuals.
Methods
: Smartphone users, basic cell phone users, and nonusers of mobile devices were identified from a recent US national survey. The three groups were compared on sociodemographic and clinical characteristics. Their health information seeking outcomes were compared in latent factor models, path models, and multinomial regression models.
Results
: Compared to smartphone users, the nonusers were more likely to be older, less educated, have lower income, speak English less well, have a chronic condition, report poorer health, have lower self-care efficacy, and less likely to have family and friends to talk about their health. In the covariate adjusted models for health information seeking characteristics, compared to smartphone users, two groups of nonusers showed persistent disparities (less tendency) in search of health information with technology (p’s<.001) and access to online medical records (p’s <.01). Nonusers of smartphones were more likely to report no internet access and feeling uncomfortable with computers as the reasons not to access online medical records.
Conclusion
: mHealth technologies may create additional barriers to health equity in the absence of equitable distributions of socioeconomic resources and access to mobile devices and the Internet. Education and training are warranted to make technology beneficial to the vulnerable population.
Rural homelessness is an undeniable public health issue that is understudied in the research literature. The purpose of this study was to determine the sociodemographics, physical and mental health status, barriers to access to care, and perspectives on potential technological advances of homeless individuals. A structured 45–90 min interview was utilized to gather demographic, physical health, mental health, mobility, and technology use data from a sample of 75 homeless individuals within three shelters in three micropolitan Nebraska cities. Individuals in this region were more likely to be white, unmarried, and mobile who have various physical and mental health disorders. Adherence to treatment of mental health disorders ranged from 43–60 percent. This population had increased employment, access to healthcare services, and use of technology than predicted. Leaders from all over the country can use these data to help improve state and local efforts to better cater to this vulnerable population's needs. © 2019
Cancer care continues to stress the US healthcare system with increases in life expectancy, cancer prevalence, and survivors' complex needs. These challenges are compounded by socioeconomic, racial, and cultural disparities that are associated with poor clinical outcomes. One innovative and resource-wise strategy to address this demand on the system is expanded use of telehealth. This paradigm has the potential to decrease healthcare and patient out-of-pocket costs and improve patient adherence to recommended treatment and/or surveillance.
