scholarly journals Rural-Urban Differences in Availability of Telemedicine Services Among Medicare Beneficiaries During COVID-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 468-468
Author(s):  
Yvonne Jonk ◽  
Erika Ziller ◽  
Heidi O'Connor
Keyword(s):  
Urban Policy ◽  
Primary Care Providers ◽  
Health Service Delivery ◽  
Policy Implications ◽  
Screening Tests ◽  
Medicare Beneficiaries ◽  
Care Providers ◽  
Medicare Current Beneficiary Survey ◽  
Rural And Urban ◽  
Rural Patients

Abstract The COVID-19 pandemic has created substantial disruptions to all aspects of rural and urban U.S. life. At the same time, it has provided opportunities for shifts in health service delivery, including policy innovations to increase telehealth availability and use for diagnosis and treatment of health concerns. However, it is unclear whether rural residents, particularly older adults, have the same access to telehealth services as their urban counterparts. Rural providers may face unique barriers to delivering telehealth services, and rural patients may have more difficulty accessing those services from their homes. This study used the Fall and Summer 2020 Medicare Current Beneficiary Survey COVID-19 Supplement Public Use Files to examine rural-urban differences in the telemedicine services available to Medicare beneficiaries from their primary care providers, as well as their ability to access those services. Preliminary findings suggest that rural beneficiaries are less likely to have access to telehealth services during the pandemic, they were more likely to exhibit hesitancy towards receiving the COVID-19 vaccine, they were less likely to engage in preventive behaviors such as hand washing and sterilizing surfaces, and more likely to have missed diagnostic or medical screening tests (37%) compared to urban (27%) beneficiaries. Finally, rural beneficiaries were less likely to have a smartphone, computer, or tablet at home and less likely to have access to the internet (78% rural; 84% urban). Policy implications include the need for outreach efforts to better inform the provider community, and efforts to improve rural health system infrastructure available to support telehealth.

Primary care providers perform more neurologic visits than neurologists among Medicare beneficiaries

2020 ◽  
Author(s):  
Chun Chieh Lin ◽  
Chloe E. Hill ◽  
James F. Burke ◽  
Kevin A. Kerber ◽  
Sarah E. Hartley ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Medicare Beneficiaries ◽  
Care Providers

scholarly journals A Step towards Understanding and Tackling Health Inequalities: The Use of Secondary Prevention Services and the Need for Health Promotion in a Rural Setting

2021 ◽  
Vol 18 (16) ◽  
pp. 8492
Author(s):  
Monika Karasiewicz ◽  
Ewelina Chawłowska ◽  
Agnieszka Lipiak ◽  
Barbara Więckowska
Keyword(s):  
Public Health ◽  
Health Promotion ◽  
Cancer Screening ◽  
Health Inequalities ◽  
Primary Care Providers ◽  
Public Health Care ◽  
Rural Setting ◽  
Screening Tests ◽  
Population Increase ◽  
Care Providers

Poland has recently intensified its health promotion in an effort to extend healthy life expectancy and reduce health inequalities. Our aim was to reach a deprived rural population, increase its health literacy, and explore its use of and barriers to cancer screening and public health care. A CBPR study was conducted in one of the poorest districts in Wielkopolska region, Poland, among 122 beneficiaries of health education workshops. A self-developed questionnaire was used. The reported barriers to participation in cancer screening included: lack of time, lack of need, or feeling healthy (32.8%); long waiting times (17.2%); fear of costs (9%). Physicians seldom recommended screening to their patients. Only 7.4% of respondents had ever received dermatoscopy. Among women, 18.2% did not perform any breast exams and 25% had never had smear tests. Diagnostics was often financed out of pocket (thyroid ultrasound = 58.1%; smear test = 48.5%; breast ultrasound = 36.8%). The health system needs mentioned by participants included better access to physicians (65.6%), promotion of free screening tests (54.9%), and access to public health programmes (22.1%). There is an urgent need to translate national strategies into action. Health promotion and better access to care must become priorities in deprived areas, while primary care providers should become key figures in delivering these services.

scholarly journals Primary care providers’ beliefs and practices on colorectal cancer screening in Kuwait

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
E L Tolma ◽  
S M Aljunid ◽  
M N Amrizal ◽  
J Longenecker ◽  
A Al-Basmy ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Health System ◽  
Screening Test ◽  
Primary Care Providers ◽  
Screening Tests ◽  
Care Providers ◽  
Beliefs And Practices ◽  
Crc Screening

Abstract Background Colorectal cancer (CRC) is a major public health issue in the Arab region. In Kuwait, CRC is the second most frequent cancer, with an age-standardized (world) incidence rate of 13.2 cases/100,000 in 2018. Despite the national efforts to promote CRC screening the current participation rate is very low (5 to 17%). Primary Care Providers (PCPs) are considered as the gatekeepers of cancer screening globally. This is one of the first studies in Kuwait that examined the current beliefs/practices of PCPs on CRC screening. Methods This cross-sectional study was conducted at governmental primary care centers in Kuwait from 2015-2017. Of 564 PCPs invited to participate from all centers, 255 completed the self-administered questionnaires. The 14-page survey contained 75 questions on PCPs’ beliefs and practices of CRC screening. Data were analyzed by using descriptive statistics. Results The study sample consisted primarily of females (52.0%) and non-Kuwaiti (79%) physicians, with mean age =43.3 (SD: 11.2) years. Most respondents (92%) believed that colonoscopy is the most effective screening tool. The majority (78%) reported that they recommend CRC screening to their patients, with colonoscopy as the most frequent modality (87%) followed by the Faecal Occult Blood Test (FOBT) (52%). Around 40% of the respondents stated that they did not have time to discuss CRC screening with their patients. The majority (72%) believed that their patients did not complete their CRC screening tests. Health system related barriers included difficulties in obtaining test results from the gastroenterologist (61.4%), ordering follow-up test after a positive screening test (50.6%) and shortage of trained staff to conduct the screening test (44.2%). Conclusions A majority of PCPs in Kuwait recommend CRC screening to their patients, but not all patients follow through their recommendation. More research is needed to find out how to further enhance patient uptake of CRC screening. Key messages Colonoscopy is the most frequent screening CRC modality used in Kuwait. Health system related factors can be important future intervention targets to promote CRC screening.

scholarly journals Depression in adolescence: a review

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Diogo Beirão ◽  
Helena Monte ◽  
Marta Amaral ◽  
Alice Longras ◽  
Carla Matos ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Primary Care Providers ◽  
Scientific Data ◽  
Screening Tests ◽  
Medical Community ◽  
Main Body ◽  
Care Providers

Abstract Background Depression is a common mental health disease, especially in mid to late adolescence that, due to its particularities, is a challenge and requires an effective diagnosis. Primary care providers are often the first line of contact for adolescents, being crucial in identifying and managing this pathology. Besides, several entities also recommend screening for depression on this period. Thus, the main purpose of this article is to review the scientific data regarding screening, diagnosis and management of depression in adolescence, mainly on primary care settings. Main body Comprehension of the pathogenesis of depression in adolescents is a challenging task, with both environmental and genetic factors being associated to its development. Although there are some screening tests and diagnostic criteria, its clinical manifestations are wide, making its diagnosis a huge challenge. Besides, it can be mistakenly diagnosed with other psychiatric disorders, making necessary to roll-out several differential diagnoses. Treatment options can include psychotherapy (cognitive behavioural therapy and interpersonal therapy) and/or pharmacotherapy (mainly fluoxetine), depending on severity, associated risk factors and available resources. In any case, treatment must include psychoeducation, supportive approach and family involvement. Preventive programs play an important role not only in reducing the prevalence of this condition but also in improving the health of populations. Conclusion Depression in adolescence is a relevant condition to the medical community, due to its uncertain clinical course and underdiagnosis worldwide. General practitioners can provide early identification, treatment initiation and referral to mental health specialists when necessary.

scholarly journals Primary Care Provider Uptake of Intensive Behavioral Therapy for Obesity in Medicare Patients, 2012-2017

2020 ◽  
Author(s):  
Mounira Ozoor ◽  
Mark Gritz ◽  
Rowena J Dolor ◽  
Jodi S Holtrop ◽  
Zhehui Luo
Keyword(s):  
Primary Care ◽  
Behavioral Therapy ◽  
Primary Care Providers ◽  
Individual Therapy ◽  
Medicare Beneficiaries ◽  
Care Providers ◽  
Early Adopters ◽  
Medicare Patients ◽  
One Year ◽  
Procedure Codes

Abstract Background: The delivery of Intensive Behavioral Therapy for obesity (IBT) by primary care providers (PCPs) has been covered by Medicare to support elderly obese individuals (BMI > 30 kg/m2) in managing their weight since 2011 for individual therapy and 2015 for group therapy. We sought to understand patterns of uptake of IBT for obesity services among PCPs serving the Medicare population across the U.S. Methods: We used the Centers for Medicare and Medicaid Services Provider Utilization and Payment Data from 2012 to 2017 to extract all PCPs who served more than 10 Medicare beneficiaries in each of the six-year period for form a longitudinal study. The procedure codes G0447 and/or G0473 were used to identify PCPs who provided IBT and their characteristics were compared by the IBT-using status. Results: Of the 452,127 eligible PCPs who served Medicare patients in all six years, only 0.9% were found to be IBT utilizers in at least one year from 2012 through 2017 (147 always users, 988 early adopters, and 3,062 late adopters). IBT utilizing providers shared a few common characteristics: they were more likely to be male, internal medicine and family practice providers, saw a higher number of unique Medicare beneficiaries, and practiced in the South and Northeast regions. The proportions of patients with hypertension, diabetes or hyperlipidemia were similar between IBT and non-IBT providers. Conclusions: Very few primary care providers continuously bill IBT services for Medicare patients. Further investigation is needed to identify barriers to the uptake of IBT services among PCPs. Trial registration: not applicable.

scholarly journals Telemedicine use in 2020 during the COVID-19 pandemic among community dwelling U.S. Medicare beneficiaries

2021 ◽  
Vol 10 (4) ◽  
pp. 32
Author(s):  
Mary Lynn Davis-Ajami ◽  
Zhiqiang K. Lu ◽  
Jun Wu
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Demographic Characteristics ◽  
Community Dwelling ◽  
Medicare Beneficiaries ◽  
Care Providers ◽  
Medicare Current Beneficiary Survey ◽  
Factors Associated ◽  
Utilization Patterns ◽  
Voice Calls

Objective: CMS reimbursement regulations for telemedicine changed after the onset of the COVID-19 pandemic. This study aimed to assess telemedicine utilization patterns offered by health care providers and used by Medicare beneficiaries during the COVID-19 pandemic during 2020.Methods: This study used the Fall 2020 Medicare Current Beneficiary Survey (MCBS) supplemental COVID-19 survey to identify Medicare beneficiaries (≥ 65 years) with a regular place for medical care that offered telemedicine during 2020. Major outcomes: prevalence for whether telemedicine was offered before and during the pandemic, telemedicine use, and digital access to telemedicine. Logistic regression identified the demographic factors associated with telemedicine use.Results: The study sample included 4,380 eligible individual Medicare beneficiaries ≥ 65 years. Of those, 42.9% made telemedicine visits during the pandemic. Approximately 60% of the telemedicine visits were conducted via telephone. Telemedicine was offered to 18% of the respondents before the pandemic vs. 64% during year 2020 of the pandemic. Among telemedicine users, 57.2%, 28.3%, and 14.5% used voice calls, video calls, and both voice and video calls for health care appointments, respectively. Overall telemedicine use varied by sex, race, and region. Individuals 65-74 years, female, living in a metropolitan area, with higher incomes were more likely to make video visits. Experience using telecommunications via the internet influenced telemedicine use significantly.Conclusions: Telemedicine offered to older Medicare beneficiaries increased dramatically after the onset of the COVID-19 pandemic. Yet, less than half used telemedicine and differences in utilization existed by demographic characteristics.

scholarly journals Opioid Use Among Rural Medicare Beneficiaries

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 335-335
Author(s):  
Yvonne Jonk ◽  
Heidi O'Connor ◽  
Karen Pearson ◽  
Zachariah Croll ◽  
John Gale
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Primary Care Providers ◽  
Community Dwelling ◽  
Prescribing Patterns ◽  
Medicare Beneficiaries ◽  
Care Providers ◽  
Opioid Prescription ◽  
Opioid Prescribing

Abstract This study examines differences in opioid prescribing rates among a nationally representative sample of Medicare beneficiaries across rural and urban areas, as well as among beneficiaries with chronic overlapping pain conditions (COPCs). We assess whether prescribing patterns exceed the Centers for Disease Control and Prevention guidelines for dose and duration, and identify socioeconomic and health risk factors associated with opioid prescribing using logistic regression analyses. Data were from the 2010-2017 Medicare Current Beneficiary Survey files. Rural-Urban Commuting Area codes were used to identify patients’ residential location. The Area Health Resource Files were used to identify market characteristics such as primary care and mental health shortage areas. With the exception of 2010, over years 2011-2017, higher percentages of community-dwelling rural beneficiaries received opioid prescriptions (21.8-25.4%) compared to their urban counterparts (19.1-23.7%). During the same time period, facility-dwelling rural beneficiaries were more likely to receive opioid prescriptions (39.8-47.2%) compared to their urban counterparts (28.8-35.0%). Higher percentages (18.8%) of the community dwelling population in rural had COPCs compared to urban (15.2%), and a higher percentage of rural beneficiaries with COPCs (31.4%) received an opioid prescription than their urban counterparts (22.2%). Previous research points to other factors contributing to a lack of alternatives to opioids for pain management in rural areas, including greater reliance on primary care providers, lack of access to chronic pain specialists and alternative therapies, and travel barriers. Improving the capacity of rural primary care to deal with COPCs and expanding access to specialists via telehealth warrants further attention from policymakers.

scholarly journals Knowledge, Attitudes, and Behaviors of Pediatric Primary Care Providers on Management of Cholestasis

2019 ◽  
Vol 6 ◽  
pp. 2333794X1982975
Author(s):  
Timothy Joseph Menz ◽  
Michael Herzlinger ◽  
Albert Ross ◽  
Mark R. Zonfrillo
Keyword(s):  
Primary Care ◽  
Biliary Atresia ◽  
Primary Care Providers ◽  
Comfort Level ◽  
Screening Tests ◽  
Pediatric Primary Care ◽  
Care Providers ◽  
Pediatric Residency ◽  
Parent Groups ◽  
Definition Of

Biliary atresia is a common cause of cholestasis in infants and is a time-sensitive diagnosis. A survey was distributed to pediatric primary care providers in order to assess variations in diagnosis and management of cholestasis. Participants were identified from physician parent groups on social media and regional pediatric residency programs. Information on knowledge and interpretation of screening tests, past experience/behavior, confidence, and comfort level managing cholestasis, as well as demographic information was collected. Out of 116 eligible respondents, 94.8% were confident in diagnosing hyperbilirubinemia but only 10.3% knew the biochemical definition of direct hyperbilirubinemia. Of the 56% of providers who had some knowledge of the guidelines, 18.5% stated the guidelines changed the way they evaluate cholestasis. These results demonstrate a gap in knowledge of diagnosing and evaluating cholestasis, which could provide the framework for standardized screening, leading to earlier identification of biliary atresia.

scholarly journals Geographic accessibility to primary care providers: Comparing rural and urban areas in Southwestern Ontario

2019 ◽  
Vol 64 (1) ◽  
pp. 65-78 ◽  
Author(s):  
Tayyab I. Shah ◽  
Andrew F. Clark ◽  
Jamie A. Seabrook ◽  
Shannon Sibbald ◽  
Jason A. Gilliland
Keyword(s):  
Primary Care ◽  
Urban Areas ◽  
Primary Care Providers ◽  
Care Providers ◽  
Rural And Urban Areas ◽  
Geographic Accessibility ◽  
Rural And Urban

scholarly journals Sharing Cancer Survivorship Care between Oncology and Primary Care Providers: A Qualitative Study of Health Care Professionals’ Experiences

2020 ◽  
Vol 9 (9) ◽  
pp. 2991
Author(s):  
Karolina Lisy ◽  
Jennifer Kent ◽  
Jodi Dumbrell ◽  
Helana Kelly ◽  
Amanda Piper ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Qualitative Study ◽  
Health Care Professionals ◽  
Primary Care Providers ◽  
Shared Care ◽  
Policy Implications ◽  
Suitable Model ◽  
Survivorship Care ◽  
Care Providers

Survivorship care that is shared between oncology and primary care providers may be a suitable model to effectively and efficiently care for the growing survivor population, however recommendations supporting implementation are lacking. This qualitative study aimed to explore health care professionals’ (HCPs) perceived facilitators and barriers to the implementation, delivery and sustainability of shared survivorship care. Data were collected via semi-structured focus groups and analysed by inductive thematic analysis. Results identified four overarching themes: (1) considerations for HCPs; (2) considerations regarding patients; (3) considerations for planning and process; and (4) policy implications. For HCPs, subthemes included general practitioner (GP, primary care physician) knowledge and need for further training, having clear protocols for follow-up, and direct communication channels between providers. Patient considerations included identifying patients suitable for shared care, discussing shared care with patients early in their cancer journey, and patients’ relationships with their GPs. Regarding process, subthemes included rapid referral pathways back to hospital, care coordination, and ongoing data collection to inform refinement of a dynamic model. Finally, policy implications included development of policy to support a consistent shared care model, and reliable and sustainable funding mechanisms. Based on study findings, a set of recommendations for practice and policy were developed.

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