Abstract 221: Environmental Scan of Telemedicine Networks With Services for Hypertension Management, 2016

One of the barriers affecting continuity of hypertension care is access to health care, especially in low-income and rural areas. Telemedicine (TM) provides consultation and specialized treatment remotely, and reduces barriers of access to appropriate, high quality care. Common barriers include limited affordable transportation, job or other time constraints, and geographic isolation. TM use has increased, but there is limited information about the ease of finding TM networks and programs (TMNPs) by the general public. To address this gap, we conducted an environmental scan, during Sept.-Nov. 2016, assessing the ease of identifying existing TMNPs in the United States using simple internet searches (e.g., Google, Bing, Yahoo). First, we used the American Telemedicine Association’s 2015 Gap Analysis, Health Resources & Services Administration (HRSA) funded programs and 2013 Maryland telemedicine matrix as our template. After identifying the TMNPs, we assessed TM services provided, especially for hypertension (HTN). After compiling a consensus list of TMNPs in the US, we categorized the TMNPs based on their website’s list of services. Of the 50 states and District of Columbia (DC), we found 36 networks and 17 programs. Of these 53 TMNPs, only 1.9% (n=1) indicated that they provide TM services specifically for the management of HTN. However, there were 18 (34.0%) TMNPs that listed cardiology services. The only TMNP specifically focused on hypertension control was in the southeast, an area with a high burden of HTN. This TMNP was called the “Smartphone Medication Adherence Stops Hypertension” (SMASH), and was funded by the National Institutes of Health. The program has reported 95% control among their patient population with HTN in rural areas, including Hispanic and black adults. Other related programs included those focused on heart failure (5.7% (n=3) and diabetes management 9.4% (n=5). This initial environmental scan found most programs presented limited information about their population of interest. For example, 86.7% (n=46) did not provide information about the number of patients, area(s) served and number of partners and providers on their websites. Our results suggest common methods of obtaining information about TMNPs lack important information on TM services for HTN patients, and/or challenges in identifying existing services for patients to access. Using data collected from this environmental scan, our group will develop an exhaustive collection of data on existing TMNPs’ services (including how to participate), working directly with HRSA’s Telemedicine Resource Centers. The information from our environmental scan may produce regional and county-level telemedicine mapping to inform not only patients and their healthcare providers, but also clinicians, researchers, program managers, and decision makers on existing TMNPs that remotely provide effective HTN management.

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Assessing clinical quality performance and staffing capacity differences between urban and rural Health Resources and Services Administration-funded health centers in the United States: A cross sectional study

PLoS ONE ◽

10.1371/journal.pone.0242844 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0242844

Author(s):

Nadereh Pourat ◽

Xiao Chen ◽

Connie Lu ◽

Weihao Zhou ◽

Hank Hoang ◽

...

Keyword(s):

United States ◽

Low Income ◽

Rural Areas ◽

Health Resources ◽

Quality Measures ◽

The United States ◽

Health Centers ◽

Quality Performance ◽

Clinical Quality

Background In the United States, there are nearly 1,400 Health Resources and Services Administration-funded health centers (HCs) serving low-income and underserved populations and more than 600 of these HCs are located in rural areas. Disparities in quality of medical care in urban vs. rural areas exist but data on such differences between urban and rural HCs is limited in the literature. We examined whether urban and rural HCs differed in their performance on clinical quality measures before and after controlling for patient, organizational, and contextual characteristics. Methods and findings We used the 2017 Uniform Data System to examine performance on clinical quality measures between urban and rural HCs (n = 1,373). We used generalized linear regression models with the logit link function and binomial distribution, controlling for confounding factors. After adjusting for potential confounders, we found on par performance between urban and rural HCs in all but one clinical quality measure. Rural HCs had lower rates of linking patients newly diagnosed with HIV to care (74% [95% CI: 69%, 80%] vs. 83% [95% CI: 80%, 86%]). We identified control variables that systematically accounted for eliminating urban vs. rural differences in performance on clinical quality measures. We also found that both urban and rural HCs had some clinical quality performance measures that were lower than available national benchmarks. Main limitations included potential discrepancy of urban or rural designation across all HC sites within a HC organization. Conclusions Findings highlight HCs’ contributions in addressing rural disparities in quality of care and identify opportunities for improvement. Performance in both rural and urban HCs may be improved by supporting programs that increase the availability of providers, training, and provision of technical resources.

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"Taming the Monster aka Uncontrolled Diabetes: A Viewpoint" (Preprint)

10.2196/preprints.25150 ◽

2020 ◽

Author(s):

Swati Anand ◽

Amardeep Kalsi ◽

Jonathan Figueroa ◽

Parag Mehta

Keyword(s):

Blood Glucose ◽

Diabetes Management ◽

Positive Impact ◽

The United States ◽

Phone Call ◽

Diabetic Patients ◽

Dietary Compliance ◽

Glucose Levels ◽

Uncontrolled Diabetes ◽

Number Of Patients

BACKGROUND HbA1c between 6% and 6.9% is associated with the lowest incidence of all‐cause and CVD mortality, with a stepwise increase in all‐cause and cardiovascular mortality in those with an HbA1c >7%. • There are 30 million individuals in the United States (9.4% of the population) currently living with Diabetes Mellitus. OBJECTIVE Improving HbA1C levels in patients with uncontrolled Diabetes with a focused and collaborative effort. METHODS Our baseline data for Diabetic patients attending the outpatient department from July 2018 to July 2019 in a University-affiliated hospital showed a total of 217 patients for one physician. • Of 217 patients, 17 had HbA1C 9 and above. We contacted these patients and discussed the need for tight control of their blood glucose levels. We intended to ensure them that we care and encourage them to participate in our efforts to improve their outcome. • We referred 13 patients that agreed to participate to the Diabetic educator who would schedule an appointment with the patients, discuss their diet, exercise, how to take medications, self-monitoring, and psychosocial factors. • If needed, she would refer them to the Nutritionist based on patients’ dietary compliance. • The patients were followed up in the next two weeks via telemedicine or a phone call by the PCP to confirm and reinforce the education provided by the diabetes educator. RESULTS Number of patients that showed an improvement in HbA1C values: 11 Cumulative decrease in HbA1C values for 13 patients: 25.3 The average reduction in HbA1C: 1.94 CONCLUSIONS Our initiative to exclusively target the blood glucose level with our multidisciplinary approach has made a positive impact, which is reflected in the outcome. • It leads to an improvement in patient compliance and facilitates diabetes management to reduce the risk for complications CLINICALTRIAL NA

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Satisfaction with health care system: A comparative study between market-based insurance model of the United States and “out-of-pocket” model in developing and low-income countries

International Journal of Healthcare ◽

10.5430/ijh.v6n1p41 ◽

2020 ◽

Vol 6 (1) ◽

pp. 41

Author(s):

Ram Lakhan ◽

Sean Y. Gillette ◽

Sean Lee ◽

Manoj Sharma

Keyword(s):

United States ◽

Health Care ◽

Health Care System ◽

Undergraduate Students ◽

Low Income ◽

Access To Health Care ◽

The United States ◽

Low Income Countries ◽

Healthcare Needs ◽

Care System

Background and purpose: Access to healthcare services is an essential component for ensuring the quality of life. Globally, there is inequity and disparities regarding access to health care. To meet the global healthcare needs, different models of healthcare have been adopted around the world. However, all healthcare models have some strengths and weaknesses. The purpose of this study was to examine the satisfaction among a group of undergraduate students from different countries with their health care models namely, insurance-based model in the United States and “out-of-pocket” model prevalent in low-income countries.Methods and materials: The study utilized a cross-sectional research design. Undergraduate students, representing different nationalities from a private Southeastern College, were administered a researcher-designed 14-item self-reported electronic questionnaire. Independent t-test and χ2 statistics were used to examine the differences between two health care systems and the qualitative responses were analyzed thematically.Results: Satisfaction towards health care system between the United States and low-income countries was found significantly different (p < .05). However, students in both settings experienced an inability toward affording quality healthcare due to economic factors and disparities.Conclusions: There is dissatisfaction with health care both in the United States and low-income developing countries among a sample of undergraduate students representing these countries. Efforts to ensure low-cost affordable health care should be a global goal.

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The Uneven Perils of Unemployment and Underemployment: The Role of Employment Structure in explaining Rural-Urban Poverty Differences, 1970-2018.

10.31235/osf.io/a9qex ◽

2019 ◽

Author(s):

Matthew M Brooks

Keyword(s):

Labor Force ◽

Low Income ◽

Rural Areas ◽

Urban Poverty ◽

Group Analysis ◽

The United States ◽

Poverty Rate ◽

Employment Structure ◽

Discouraged Workers ◽

Urban And Rural Areas

There has been a persistent gap in the poverty rate between urban and rural areas of the United States. Much of this gap has be attributed to industrial composition, however employment composition also likely plays a key role. Underemployment and labor force non-participation have been become significant issues in rural areas. This study uses data from the Current Population Survey for 1970 to 2018 to understand how poverty rates among 6 employment groups —(1) not in the labor force, (2) discouraged workers, (3) unemployed workers, (4) low hours workers, (5) low income workers, and (6) adequately employed workers— can explain the persistent gap in poverty between urban and rural areas. Demographic standardization and decomposition techniques reveal that majority of the poverty gap is explained by differences in poverty rates for the employment groups. Rural individuals in all employment group have higher poverty rates than urban individuals in the same group. Analysis also shows that if rural America had either the employment structure or the employment specific poverty rates of urban America than poverty rates would be much lower in rural areas.

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Young People and Disadvantaged Environments in Affluent Countries

Childhood Studies ◽

10.1093/obo/9780199791231-0214 ◽

2019 ◽

Author(s):

Kirsten Visser

Keyword(s):

Young People ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Personal Characteristics ◽

Well Being ◽

The United States ◽

Structural Factors ◽

Social Scientists ◽

Rural Environments

Many social scientists over the last decades have focused on the question of the impacts of poverty on people. Studies in this field primarily examine the effects of social, cultural, and economic resources and structural factors on the development, social outcomes, and well-being of an individual. In the last decades, scholarly interest has increasingly focused on poverty among children and adolescents (hereafter “young people”). Young people are seen as a nation’s future, which forms a reason for societal concern with their well-being and developmental outcomes. In addition, scholars increasingly acknowledge that poverty is multidimensional and heterogenous: the effects of poverty differ according to personal characteristics such as age, gender, race/ethnicity, or disability, but they are also exemplified by the disadvantaged environments in which young people find themselves, such as dysfunctional families, deprived neighborhoods, and low-quality schools. This article gives an overview of the most important works in the field of the effects of poverty and disadvantaged environments on young people (0–18 years of age). As the nature of poverty differs significantly between affluent countries and low-income developing countries, this review is focused on studies in the United States, Europe, Australia, and New Zealand. Given the fact that disadvantage, and the different effects thereof on young people, can be approached from the perspectives offered by different social sciences, publications from geography, sociology, social work, anthropology, economics, and (environmental) psychology are included in this review. This article departs from the idea of ecological models, assuming that poverty impacts children within their various contexts such as the home, school, and neighborhood. After presenting general works on poverty among young people, attention is given to the impacts of disadvantages in home, neighborhood, and school environments. Most studies that are discussed in this review deal with disadvantage in urban areas, reflecting the focus of the overall literature in affluent countries. However, poverty and disadvantage also differ between urban and rural environments. Therefore, the article ends with an overview of literature on poverty among young people in rural areas.

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Barriers and Opportunities

The Diabetes Educator ◽

10.1177/0145721714559131 ◽

2014 ◽

Vol 41 (1) ◽

pp. 86-94 ◽

Cited By ~ 32

Author(s):

Emily Ann Hallgren ◽

Pearl Anna McElfish ◽

Jellesen Rubon-Chutaro

Keyword(s):

United States ◽

Focus Groups ◽

Health Beliefs ◽

Access To Health Care ◽

Diabetes Management ◽

Transportation Cost ◽

The United States ◽

Self Management ◽

Management Interventions ◽

Management Behaviors

PurposeThis study investigates the beliefs and perceptions related to type 2 diabetes that influence diabetes self-management behaviors for Marshallese in the United States. Using the health belief model as a theoretical framework, the researchers seek to better understand the underlying beliefs that motivate or impede diabetes self-management behaviors.MethodsThe community-based participatory research (CBPR) collaborative engaged in 14 months of preliminary fieldwork and conducted 2 tiers of focus groups for this project as part of the long-term commitment to reducing health inequalities in the Marshallese community. The CBPR team conducted an initial round of 2 exploratory focus groups (n = 15). Based on the knowledge gained, researchers held a second round of focus groups (n = 13) on health beliefs regarding diabetes. All participants were Marshallese, aged 18 years and older, and included men and women. Participants either had a diagnosis of diabetes or were a caretaker of someone with diabetes.ResultsThe findings elucidate the structural and nonstructural barriers to successful diabetes self-management for Marshallese in the United States. Barriers include eating differently from the rest of the family, social stigma of diabetes, transportation, cost, lack of access to health care, and cultural and language barriers.ConclusionsWhile there are significant barriers to improving diabetes self-management, there are also areas of opportunity, including family and peer reinforcement to encourage proper diabetes management behaviors and a growing community desire to lift the stigma of diabetes. The CBPR team offers recommendations to make diabetes management interventions more culturally appropriate and effective for the Marshallese population.

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Food Security and Climate Change: Differences in Impacts and Adaptation Strategies for Rural Communities in the Global South and North

Frontiers in Sustainable Food Systems ◽

10.3389/fsufs.2021.691191 ◽

2022 ◽

Vol 5 ◽

Author(s):

Subhashni Raj ◽

Sam Roodbar ◽

Catherine Brinkley ◽

David Walter Wolfe

Keyword(s):

Climate Change ◽

United States ◽

Food Security ◽

Rural Communities ◽

Low Income ◽

Rural Areas ◽

Food Production ◽

Climate Adaptation ◽

The United States ◽

Global North

This research highlights the mismatch between food security and climate adaptation literature and practice in the Global North and South by focusing on nested case studies in rural India and the United States during the COVID-19 pandemic. The United States is one of the wealthiest countries in the world, but also has one of the largest wealth gaps. Comparatively, India has one of the largest populations of food insecure people. To demonstrate how adaptive food security approaches to climate change will differ, we first review the unique climate, agricultural, demographic, and socio-economic features; and then compare challenges and solutions to food security posed by the COVID-19 pandemic. While both countries rely on rural, low-income farmworkers to produce food, the COVID-19 pandemic has highlighted how agricultural and food security policies differ in their influence on both food insecurity and global hunger alike. Emphasis on agricultural production in developing regions where a majority of individuals living in rural areas are smallholder subsistence farmers will benefit the majority of the population in terms of both poverty alleviation and food production. In the Global North, an emphasis on food access and availability is necessary because rural food insecure populations are often disconnected from food production.

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Prescreening to Increase Therapeutic Oncology Trial Enrollment at the Largest Public Hospital in the United States

JCO Oncology Practice ◽

10.1200/op.21.00629 ◽

2021 ◽

Author(s):

Jennifer Wu ◽

Amin Yakubov ◽

Maher Abdul-Hay ◽

Erica Love ◽

Gianna Kroening ◽

...

Keyword(s):

Clinical Trials ◽

Low Income ◽

Underserved Populations ◽

The United States ◽

Public Health Care ◽

Tumor Board ◽

Cancer Center ◽

Therapeutic Trial ◽

Improvement Program ◽

Number Of Patients

PURPOSE: The recruitment of underserved patients into therapeutic oncology trials is imperative. The National Institutes of Health mandates the inclusion of minorities in clinical research, although their participation remains under-represented. Institutions have used data mining to match patients to clinical trials. In a public health care system, such expensive tools are unavailable. METHODS: The NYU Clinical Trials Office implemented a quality improvement program at Bellevue Hospital Cancer Center to increase therapeutic trial enrollment. Patients are screened through the electronic medical record, tumor board conferences, and the cancer registry. Our analysis evaluated two variables: number of patients identified and those enrolled into clinical trials. RESULTS: Two years before the program, there were 31 patients enrolled. For a period of 24 months (July 2017 to July 2019), we identified 255 patients, of whom 143 (56.1%) were enrolled. Of those enrolled, 121 (84.6%) received treatment, and 22 (15%) were screen failures. Fifty-five (38.5%) were referred to NYU Perlmutter Cancer Center for therapy. Of the total enrollees, 64% were female, 56% were non-White, and overall median age was 55 years (range: 33-88 years). Our participants spoke 16 different languages, and 57% were non–English-speaking. We enrolled patients into eight different disease categories, with 38% recruited to breast cancer trials. Eighty-three percent of our patients reside in low-income areas, with 62% in both low-income and Health Professional Shortage Areas. CONCLUSION: Prescreening at Bellevue has led to a 4.6-fold increase in patient enrollment to clinical trials. Future research into using prescreening programs at public institutions may improve access to clinical trials for underserved populations.

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Health Care Delivery System in the United States: Lessons for Africa

International Social Work ◽

10.1177/002087288002300105 ◽

1980 ◽

Vol 23 (1) ◽

pp. 29-36 ◽

Cited By ~ 1

Author(s):

Takarinda Samuel Agere

Keyword(s):

Health Care ◽

Delivery System ◽

Health Care Delivery ◽

Rural Areas ◽

Care Delivery ◽

Health Resources ◽

The United States ◽

Health Care Delivery System ◽

Racial Groups ◽

Urban And Rural Areas

[ ABSTRACT: This paper examines how an African country, Zambia, reproduces patterns of health care delivery system of the West characterized by U.S. The replication of pattern of health discriminates against the poor, and rural in habitants. First, a brief theoretical analysis of underdevelopment is provided. Secondly, the structure of the present U.S health care delivery system is provided high lighting t'he role of the academic-medical component. The analysis shows how health care resources are distributed among socio- economic, racial groups and between urban and rural areas. 'The major part of the paper examines health care delivery system in Zambia, outlining those areas that are replicated. The paper emphasizes that this should serve as lessons for Africa. This replication is made possible by the indigenous African middle class through which Western values are transmitted. This class (elites) is in control of state machinery and makes decisions on the distribution, and consumption of health resources. In conclusion, I recommend a radical economic and political transforma tion of these societies if resources have to be distributed equitably.]

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