Health Care Access and Follow-Up of Chlamydial and Gonococcal Infections Identified in an Emergency Department

Background Video-based health care can help address access gaps for patients and is rapidly being offered by health care organizations. However, patients who lack access to technology may be left behind in these initiatives. In 2016, the US Department of Veterans Affairs (VA) began distributing video-enabled tablets to provide video visits to veterans with health care access barriers. Objective This study aimed to evaluate veterans’ experiences with VA-issued tablets and identify patient characteristics associated with preferences for video visits vs in-person care. Methods A baseline survey was sent to the tablet recipients, and a follow-up survey was sent to the respondents 3 to 6 months later. Multivariate logistic regression was used to identify patient characteristics associated with preferences for care, and we examined qualitative themes around care preferences using standard content analysis methods for coding the data collected in the open-ended questions. Results Patient-reported access barriers centered around transportation and health-related challenges, outside commitments, and feeling uncomfortable or uneasy at the VA. Satisfaction with the tablet program was high, and in the follow-up survey, approximately two-thirds of tablet recipients preferred care via a tablet (194/604, 32.1%) or expressed that video-based and in-person care were “about the same” (216/604, 35.7%), whereas one-third (192/604, 31.7%) indicated a preference for in-person care. Patients were significantly more likely to report a preference for video visits (vs a preference for in-person visits or rating them “about the same”) if they felt uncomfortable in a VA setting, reported a collaborative communication style with their doctor, had a substance use disorder diagnosis, or lived in a place with better broadband coverage. Patients were less likely to report a preference for video visits if they had more chronic conditions. Qualitative analyses identified four themes related to preferences for video-based care: perceived improvements in access to care, perceived differential quality of care, feasibility of obtaining necessary care, and technology-related challenges. Conclusions Many recipients of VA-issued tablets report that video care is equivalent to or preferred to in-person care. Results may inform efforts to identify good candidates for virtual care and interventions to support individuals who experience technical challenges.

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Health care access problems of medically indigent emergency department walk-in patients

Annals of Emergency Medicine ◽

10.1016/s0196-0644(05)80832-7 ◽

1991 ◽

Vol 20 (7) ◽

pp. 730-733 ◽

Cited By ~ 84

Author(s):

Gregg A Pane ◽

Michael C Farner ◽

Kym A Salness

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Access ◽

Care Access ◽

Access Problems

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Predictors of post-surgical race-specific prostate cancer progression.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.5048 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 5048-5048

Author(s):

Jennifer Cullen ◽

Huai-Ching Kuo ◽

Lauren Hurwitz ◽

Inger L. Rosner ◽

Timothy Rebbeck ◽

...

Keyword(s):

Prostate Cancer ◽

Health Care ◽

Health Care Access ◽

National Database ◽

Comorbid Conditions ◽

Free Survival ◽

Care Access ◽

Pathologic Features ◽

Risk Stratum

5048 Background: Disparity in prostate cancer (CaP) incidence and mortality for African American (AA) versus Caucasian American (CA) men may reflect tumor biology, comorbidity, treatment, follow-up care, and/or health care access. In a racially diverse cohort of patients undergoing radical prostatectomy (RP), this study examined how race, comorbidity, and PSA doubling time (PSADT) impact CaP progression. Methods: Enrollees in the Center for Prostate Disease Research (CPDR) Multi-Center National Database from 1989-2014 who underwent RP within 12 months of CaP diagnosis were eligible. Biochemical recurrence (BCR) was defined as PSA ≥0.2 ng/mL post-RP. Comorbid conditions included coronary artery disease (CAD), cerebral vascular incident (CVI), Type II diabetes (DB), hypertension (HT), elevated cholesterol (EC), lung disease (COPD), prostatitis (PS), renal insufficiency (RI) and other cancer (OC). Multivariable Cox proportional hazards (PH) analysis was used to examine comorbid conditions (yes vs. no) and PSADT ( < 3, 3-8.9, 9-14.9, and ≥15 mos) to predict BCR, controlling for age at RP, D’Amico risk stratum, pathology features, and adjuvant treatment. Results: A total of 6,785 patients were eligible; 22% AA and 78% CA. Median age and follow-up was 62 and 6.1 years, respectively. Across race, comparable median follow-up time, distributions of pathologic features and adjuvant treatments were observed. However, AA vs. CA patients had greater HT (53 vs. 39% p < 0.0001), DB (17 vs. 7%, p < 0.0001), and RI (3 vs. 1%, p = 0.002). Alternatively, CA vs. AA patients had greater CVD (10 vs. 7%, p = 0.0008) and OC (3 vs. 0.5%, p < 0.0001). Cox PH analysis showed poorer BCR-free survival for AA vs. CA men (HR = 1.28, CI = 1.11, 1.48, p = 0.0009) adjusting for D’Amico risk stratum, pathology, and treatment. PSADT, not comorbidity, was a critical predictor of BCR, with poorest outcome at extremes: HR PSADT < 3 vs. > = 15 months = 41.5, CI = 33.6, 51.3, p < 0.0001). Conclusions: Despite comparable health care access and distribution in clinical risk stratum and pathology features, race persisted in predicting poor CaP outcome. Disparate comorbidity for AA and CA men did not eliminate this difference. PSADT remained the most striking determinant of poor BCR-free survival.

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What Will Keep Me Coming Back to the Clinic: Factors Identified by Filipino Colorectal Cancer Patients Seen at a National Academic Referral Center

Journal of Patient Experience ◽

10.1177/2374373519857654 ◽

2019 ◽

Vol 7 (4) ◽

pp. 460-463

Author(s):

Danielle Benedict Sacdalan ◽

Josephine Anne Lucero ◽

Frederic Ivan Ting ◽

Dennis Lee Sacdalan

Keyword(s):

Health Care ◽

Health Care Access ◽

The Philippines ◽

Health Care Decisions ◽

Curative Intent ◽

Care Access ◽

Multidisciplinary Clinic ◽

Colorectal Cancer Patients ◽

The University

Health-care decisions in the Philippines are widely affected by various factors such as family, community, health-care access, and educational attainment. We designed a questionnaire to evaluate patient views at the University of the Philippines–Philippine General Hospital colorectal multidisciplinary clinic to identify factors that contribute to continued follow-up at the colorectal multidisciplinary clinic. A total of 128 patients, 62% of whom were being treated with curative intent participated in the study. We found that trust in their physicians, presence of family support, and affordability of treatment were factors highly valued by patients consulting at the clinic.

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