scholarly journals Implementing Telemedicine Visits in an Underserved Ophthalmology Clinic in the COVID-19 Era

2021 ◽  
Vol 12 ◽  
pp. 215013272199627
Author(s):  
Mona Adeli ◽  
William R. Bloom
Keyword(s):  
Latin America ◽  
High Risk ◽  
Vulnerable Populations ◽  
Low Income ◽  
Office Visit ◽  
Medically Underserved ◽  
Uninsured Patients ◽  
Potential Barriers ◽  
Ocular Morbidity

Introduction: Many of the potential barriers to providing telehealth services already disproportionately impact vulnerable populations. The purpose of this study was to assess the incorporation of synchronous ophthalmology telemedicine visits in a tertiary university-based ophthalmology clinic for low-income and uninsured patients in the COVID-19 era. Methods: The records of 18 patients who were due for an in-person visit in the medically underserved patient clinic at our institute were reviewed. Patients considered high risk of ocular morbidity progression were approved to proceed with an in-person visit. Patients with non-urgent visit indications were attempted to be contacted by telephone to be offered a telemedicine telephone visit as an alternative to a postponed in-person office visit. Results: Clinical triage by an attending ophthalmologist determined that 17 patients (94.4%, n = 18) had visit indications appropriate for evaluation by telemedicine. Six patients (35.3%, n = 17) were successfully contacted and offered a telemedicine visit as an alternative to a postponed in-person office visit. All 6 patients accepted, scheduled, and completed a telemedicine visit. Eleven patients (64.7%, n = 17) were not able to be successfully contacted to offer and schedule either a telemedicine visit or a postponed in-person office visit. Patients who were not able to be successfully contacted were on average younger in age and more likely to be female, Hispanic/Latino, from Latin America, with a preferred language of Spanish. Conclusions: Synchronous ophthalmology telemedicine visits can be successfully incorporated in a tertiary university-based setting for low-income and uninsured patients. The primary barrier to providing telemedicine visits in this population was the ability to successfully contact patients to offer and schedule these visits.

scholarly journals Impact of the Medicare hospital readmissions reduction program on vulnerable populations

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yunwei Gai ◽  
Dessislava Pachamanova
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Vulnerable Populations ◽  
Low Income ◽  
Hospital Readmissions ◽  
High Risk Patients ◽  
Reduction Program ◽  
Risk Patients ◽  
Linear Probability

Abstract Background The Hospital Readmissions Reduction Program (HRRP) was established by the 2010 Patient Protection and Affordable Care Act (ACA) in an effort to reduce excess hospital readmissions, lower health care costs, and improve patient safety and outcomes. Although studies have examined the policy’s overall impacts and differences by hospital types, research is limited on its effects for different types of vulnerable populations. The aim of this study was to analyze the impact of the HRRP on readmissions for three targeted conditions (acute myocardial infarction, heart failure, and pneumonia) among four types of vulnerable populations, including low-income patients, patients served by hospitals that serve a high percentage of low-income or Medicaid patients, and high-risk patients at the highest quartile of the Elixhauser comorbidity index score. Methods Data on patient and hospital information came from the Nationwide Readmission Database (NRD), which contained all discharges from community hospitals in 27 states during 2010–2014. Using difference-in-difference (DD) models, linear probability regressions were conducted for the entire sample and sub-samples of patients and hospitals in order to isolate the effect of the HRRP on vulnerable populations. Multiple combinations of treatment and control groups and triple difference (DDD) methods were used for testing the robustness of the results. All models controlled for the patient and hospital characteristics. Results There have been statistically significant reductions in readmission rates overall as well as for vulnerable populations, especially for acute myocardial infarction patients in hospitals serving the largest percentage of low-income patients and high-risk patients. There is also evidence of spillover effects for non-targeted conditions among Medicare patients compared to privately insured patients. Conclusions The HRRP appears to have created the right incentives for reducing readmissions not only overall but also for vulnerable populations, accruing societal benefits in addition to previously found reductions in costs. As the reduction in the rate of readmissions is not consistent across patient and hospital groups, there could be benefits to adjusting the policy according to the socioeconomic status of a hospital’s patients and neighborhood.

scholarly journals COVID-19 and Venezuelan Refugees

2021 ◽  
Author(s):  
Veronica Escobar Olivo
Keyword(s):  
Latin America ◽  
Social Isolation ◽  
Vulnerable Populations ◽  
Low Income ◽  
Host Countries ◽  
Social Distancing ◽  
The World

As populations around the world adjust to a new reality shaped by the COVID-19 pandemic, across Latin America an estimated 113 million people living in low-income neighbourhoods are struggling to make ends meet with the ongoing lockdown and social isolation procedures (Phillips et al., 2020). In addition to the looming threat of infection, more impoverished populations must contend with the day-to-day struggle of trying to stay afloat financially and the actual feasibility of practising social distancing. Among the most vulnerable populations are refugees and migrants, who are exposed to even more significant hardships as governments attempt to navigate the pandemic (UNHCR, 2020). The already precarious financial situations and housing of most refugees have worsened as host countries make efforts to provide supports and programs for their populations – initiatives which do not necessarily take into account the situations of most refugees. For Venezuelan refugees in particular, the threat to their safety, security, and futures has been further compounded in the course of the pandemic.

scholarly journals COVID-19 and Venezuelan Refugees

2021 ◽  
Author(s):  
Veronica Escobar Olivo
Keyword(s):  
Latin America ◽  
Social Isolation ◽  
Vulnerable Populations ◽  
Low Income ◽  
Host Countries ◽  
Social Distancing ◽  
The World

As populations around the world adjust to a new reality shaped by the COVID-19 pandemic, across Latin America an estimated 113 million people living in low-income neighbourhoods are struggling to make ends meet with the ongoing lockdown and social isolation procedures (Phillips et al., 2020). In addition to the looming threat of infection, more impoverished populations must contend with the day-to-day struggle of trying to stay afloat financially and the actual feasibility of practising social distancing. Among the most vulnerable populations are refugees and migrants, who are exposed to even more significant hardships as governments attempt to navigate the pandemic (UNHCR, 2020). The already precarious financial situations and housing of most refugees have worsened as host countries make efforts to provide supports and programs for their populations – initiatives which do not necessarily take into account the situations of most refugees. For Venezuelan refugees in particular, the threat to their safety, security, and futures has been further compounded in the course of the pandemic.

Welfare Reform and the Delivery of Welfare-to-Work Programs to AAPIs: What Works?

2007 ◽  
Vol 5 (2) ◽  
pp. 77-97 ◽  
Author(s):  
Julian Chow ◽  
Grace Yoo ◽  
Catherine Vu
Keyword(s):  
High Risk ◽  
Welfare Reform ◽  
Asian American ◽  
Low Income ◽  
Personal Responsibility ◽  
Welfare To Work ◽  
Work Program ◽  
What Works ◽  
One Stop ◽  
The Impact

The passage of the Personal Responsibility and Work Opportunity Act (PRWORA) of 1996 has major implications for low-income Asian American and Pacific Islander (AAPI) populations. The purpose of this paper is to provide an overview of the research currently examining the impact of welfare reform on AAPI recipients and the welfare-to-work services available to this population. This article highlights AAPI participation and their timing-out rates in California’s CalWORKs program and their barriers to transitioning to work. Four welfare-to-work program models and recommendations are presented to illustrate strategies that can be used to address the unique needs of AAPI in order to alleviate their high risk for timing-out: one-stop-shops, transitional jobs programs, providing comprehensive and family focused services, and additional research and evaluation of programs specific to assisting the AAPI population on CalWORKs.

scholarly journals PNS105 ASSOCIATION OF LOW-INCOME SUBSIDY/DUAL ELIGIBILITY AND DISABILITY WITH HIGH-RISK MEDICATION USE AMONG PART D MEDICARE BENEFICIARIES

2020 ◽  
Vol 23 ◽  
pp. S303
Author(s):  
C. Chinthammit ◽  
S. Bhattacharjee ◽  
M. Slack ◽  
W. Lo-Ciganic ◽  
J.P. Bentley ◽  
...  
Keyword(s):  
High Risk ◽  
Low Income ◽  
Medication Use ◽  
Medicare Beneficiaries ◽  
Part D ◽  
Dual Eligibility

scholarly journals Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043837
Author(s):  
Usha Dutta ◽  
Anurag Sachan ◽  
Madhumita Premkumar ◽  
Tulika Gupta ◽  
Swapnajeet Sahoo ◽  
...  
Keyword(s):  
High Risk ◽  
Low Income ◽  
Tertiary Care ◽  
Low Risk ◽  
Transmission Risk ◽  
Healthcare Personnel ◽  
Risk Zone ◽  
Increased Risk ◽  
Medium Risk ◽  
Risk Zones

ObjectivesHealthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty.SettingOur tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless.ParticipantsWe recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone.ResultsBetween 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment.ConclusionA multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.

Annual direct health care expenditures and employee absenteeism costs in high-risk, low-income mothers with major depression

2016 ◽  
Vol 190 ◽  
pp. 386-394 ◽  
Author(s):  
Robert T. Ammerman ◽  
Jie Chen ◽  
Peter J. Mallow ◽  
John A. Rizzo ◽  
Alonzo T. Folger ◽  
...  
Keyword(s):  
Health Care ◽  
High Risk ◽  
Major Depression ◽  
Low Income ◽  
Health Care Expenditures ◽  
Employee Absenteeism ◽  
Low Income Mothers

scholarly journals Nutritional and Functional Assessment of Hospitalized Elderly: Impact of Sociodemographic Variables

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Emam M. M. Esmayel ◽  
Mohsen M. Eldarawy ◽  
Mohamed M. M. Hassan ◽  
Hassan Mahmoud Hassanin ◽  
Walid M. Reda Ashour ◽  
...  
Keyword(s):  
High Risk ◽  
Functional Status ◽  
Low Income ◽  
Barthel Index ◽  
Nutritional Risk ◽  
Moderate Risk ◽  
Sociodemographic Variables ◽  
Hospitalized Elderly ◽  
Ward Nurse ◽  
Good Nutrition

Background.This work was constructed in order to assess the nutritional and functional status in hospitalized elderly and to study the associations between them and sociodemographic variables.Methods.200 elderly patients (>65 years old) admitted to Internal Medicine and Neurology Departments in nonemergency conditions were included. Comprehensive geriatric assessments, including nutritional and functional assessments, were done according to nutritional checklist and Barthel index, respectively. Information was gathered from the patients, from the ward nurse responsible for the patient, and from family members who were reviewed.Results.According to the nutritional checklist, 56% of participants were at high risk, 18% were at moderate risk of malnutrition, and 26% had good nutrition. There was a high nutritional risk in patients with low income and good nutrition in patients with moderate income. Also, there was a high nutritional risk in rural residents (61.9%) in comparison with urban residents (25%). Barthel index score was significantly lower in those at high risk of malnutrition compared to those at moderate risk and those with good nutrition.Conclusions.Hospitalized elderly are exposed to malnutrition, and malnourished hospitalized patients are candidates for functional impairment. Significant associations are noticed between both nutritional and functional status and specific sociodemographic variables.

Abstract 183: School-Centered CPR Education to Improve Survival from Out-of-Hospital Cardiac Arrest in High-Risk Neighborhoods

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Tom Califf ◽  
René Ramon ◽  
Wendy Morrison ◽  
Ariann Nassel ◽  
Comilla Sasson
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Low Income ◽  
Skills Training ◽  
Seventh Grade ◽  
Post Intervention ◽  
Train The Trainer ◽  
The People ◽  
Cpr Training ◽  
Hospital Cardiac Arrest

Background: Low-income and Latino neighborhoods are at high risk for having low provision of bystander CPR for victims of out-of-hospital cardiac arrest (OHCA). Novel community-based intervention is needed in these neighborhoods to increase awareness of CPR techniques and, ultimately, to decrease mortality from OHCA. Objective: To determine the feasibility of a train-the-trainer hands-only CPR program as a required assignment in a middle school. Methods: Design: Prospective survey-based interventional study. Setting: Public charter school in the Denver, CO metropolitan area. Population: Cohort of 118 subjects was recruited out of 134 eligible seventh grade students. Observations: Participants completed a 6-question test to assess baseline knowledge of CPR. Subjects then completed a group hands-only CPR training lasting 1 hour using the CPR Anytime kit, which included both an educational DVD and hands-on practical skills training with an inflatable mannequin. Participants were then asked to use these kits to train other community members over a 2-week period. At the end of the study, students were asked to complete the same 6-question survey to assess their retention of knowledge. Two-sample t-tests were conducted to assess for differences in hands-only CPR knowledge pre- and post-CPR training. Results: Demographics are given for the entire seventh grade class ( Table 1 ). Students were mostly white (71.6%), and 11 (8.2%) participated in the Free & Reduced Lunch program. Of 134 seventh graders attending the school, 118 (88%) completed a pre-intervention survey and 74 (55%) completed a post-intervention survey. Between the surveys, the mean number of questions answered correctly increased ( Table 2 ), as did performance on the question asking where to place AED pads on the chest (p < .001). Students performed poorest in both pre- and post-testing on identifying the appropriate situation for performing hands-only CPR. Conclusion: Implementation of a school-based train-the-trainee CPR education program is a feasible endeavor. Students demonstrated increased knowledge of CPR techniques two weeks after training compared to baseline. Future studies will need to be conducted to assess the people who are then trained by these students using the CPR Anytime Kits.

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