scholarly journals Home Virtual Visits for Outpatient Follow-Up Stroke Care: Cross-Sectional Study (Preprint)

2019 ◽  
Author(s):  
Ramana Appireddy ◽  
Sana Khan ◽  
Chad Leaver ◽  
Cally Martin ◽  
Albert Jin ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Outpatient Care ◽  
Stroke Prevention ◽  
Personal Experience ◽  
Access To Health Care ◽  
Virtual Visits ◽  
The Impact ◽  
Prevention Clinic

BACKGROUND Timely, in-person access to health care is a challenge for people living with conditions such as stroke that result in frailty, loss of independence, restrictions in driving and mobility, and physical and cognitive decline. In Southeastern Ontario, access is further complicated by rurality and the long travel distances to visit physician clinics. There is a need to make health care more accessible and convenient. Home virtual visits (electronic visits, eVisits) can conveniently connect physicians to patients. Physicians use a secure personal videoconferencing tool to connect to patients in their homes. Patients use their device of choice (smartphone, tablet, laptop, or desktop) for the visit. OBJECTIVE This study aimed to assess the feasibility and logistics of implementing eVisits in a stroke prevention clinic for seniors. METHODS A 6-month eVisit pilot study was initiated in the Kingston Health Sciences Centre stroke prevention clinic in August 2018. eVisits were used only for follow-up patient encounters. An integrated evaluation was used to test the impact of the program on clinic workflow and patient satisfaction. Patient satisfaction was evaluated by telephone interviews, using a brief questionnaire. Access and patient satisfaction metrics were compared with concurrent standard of care (patients’ prior personal experience with in-person visits). Values are presented as median (interquartile range). RESULTS There were 75 subjects in the pilot. The patients were aged 65 (56-73.5) years, and 39% (29/75) resided in rural areas. There was a shorter wait for an appointment by eVisit versus in-person (mean 59.98 [SD 48.36] days vs mean 78.36 [SD 50.54] days; <italic>P</italic>&lt;.001). The eVisit was also shorter, taking on an average of only 10 min to deliver follow-up care with a high degree of patient satisfaction versus 90 (60-112) min for in-person care. The total time saved by patients per eVisit was 80 (50-102) min, 44 (21-69) min of which was travel time. Travel distance avoided by the patients was 30.1 km (11.2-82.2). The estimated total out-of-pocket cost savings for patients per eVisit was Can $52.83 (31.26-94.53). The estimated savings (opportunity cost for in-person outpatient care) for our eVisit pilot project was Can $23,832-$28,584. The patient satisfaction with eVisits was very good compared with their prior personal experience with in-person outpatient care. CONCLUSIONS The eVisit program was well received by patients, deemed to be safe by physicians, and avoided unnecessary patient travel and expense. It also has the potential to reduce health care costs. We plan to scale the project within the department and the institution.

scholarly journals Home Virtual Visits for Outpatient Follow-Up Stroke Care: Cross-Sectional Study

10.2196/13734 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e13734 ◽  
Author(s):  
Ramana Appireddy ◽  
Sana Khan ◽  
Chad Leaver ◽  
Cally Martin ◽  
Albert Jin ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Outpatient Care ◽  
Stroke Prevention ◽  
Personal Experience ◽  
Access To Health Care ◽  
Virtual Visits ◽  
The Impact ◽  
Prevention Clinic

Background Timely, in-person access to health care is a challenge for people living with conditions such as stroke that result in frailty, loss of independence, restrictions in driving and mobility, and physical and cognitive decline. In Southeastern Ontario, access is further complicated by rurality and the long travel distances to visit physician clinics. There is a need to make health care more accessible and convenient. Home virtual visits (electronic visits, eVisits) can conveniently connect physicians to patients. Physicians use a secure personal videoconferencing tool to connect to patients in their homes. Patients use their device of choice (smartphone, tablet, laptop, or desktop) for the visit. Objective This study aimed to assess the feasibility and logistics of implementing eVisits in a stroke prevention clinic for seniors. Methods A 6-month eVisit pilot study was initiated in the Kingston Health Sciences Centre stroke prevention clinic in August 2018. eVisits were used only for follow-up patient encounters. An integrated evaluation was used to test the impact of the program on clinic workflow and patient satisfaction. Patient satisfaction was evaluated by telephone interviews, using a brief questionnaire. Access and patient satisfaction metrics were compared with concurrent standard of care (patients’ prior personal experience with in-person visits). Values are presented as median (interquartile range). Results There were 75 subjects in the pilot. The patients were aged 65 (56-73.5) years, and 39% (29/75) resided in rural areas. There was a shorter wait for an appointment by eVisit versus in-person (mean 59.98 [SD 48.36] days vs mean 78.36 [SD 50.54] days; P<.001). The eVisit was also shorter, taking on an average of only 10 min to deliver follow-up care with a high degree of patient satisfaction versus 90 (60-112) min for in-person care. The total time saved by patients per eVisit was 80 (50-102) min, 44 (21-69) min of which was travel time. Travel distance avoided by the patients was 30.1 km (11.2-82.2). The estimated total out-of-pocket cost savings for patients per eVisit was Can $52.83 (31.26-94.53). The estimated savings (opportunity cost for in-person outpatient care) for our eVisit pilot project was Can $23,832-$28,584. The patient satisfaction with eVisits was very good compared with their prior personal experience with in-person outpatient care. Conclusions The eVisit program was well received by patients, deemed to be safe by physicians, and avoided unnecessary patient travel and expense. It also has the potential to reduce health care costs. We plan to scale the project within the department and the institution.

scholarly journals The Effect of Ethiopia’s Community-Based Health Insurance Scheme on Revenues and Quality of Care

2020 ◽  
Vol 17 (22) ◽  
pp. 8558
Author(s):  
Zemzem Shigute ◽  
Anagaw D. Mebratie ◽  
Robert Sparrow ◽  
Getnet Alemu ◽  
Arjun S. Bedi
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Health Insurance ◽  
Access To Health Care ◽  
Sub Saharan Africa ◽  
Community Based ◽  
Community Based Health Insurance ◽  
The Impact

Ethiopia’s Community-Based Health Insurance (CBHI) scheme was established with the objectives of enhancing access to health care, reducing out-of-pocket expenditure (OOP), mobilizing financial resources and enhancing the quality of health care. Previous analyses have shown that the scheme has enhanced health care access and led to reductions in OOP. This paper examines the impact of the scheme on health facility revenues and quality of care. This paper relies on a difference-in-differences approach applied to both panel and cross-section data. We find that CBHI-affiliated facilities experience a 111% increase in annual outpatient visits and annual revenues increase by 47%. Increased revenues are used to ameliorate drug shortages. These increases have translated into enhanced patient satisfaction. Patient satisfaction increased by 11 percentage points. Despite the increase in patient volume, there is no discernible increase in waiting time to see medical professionals. These results and the relatively high levels of CBHI enrollment suggest that the Ethiopian CBHI has been able to successfully negotiate the main stumbling block—that is, the poor quality of care—which has plagued similar CBHI schemes in Sub-Saharan Africa.

Abstract 207: The Stroke Prevention Clinic, Extending Care Past The Stroke Center

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Brenda Johnson ◽  
Binta Bojang ◽  
Jaime Butler ◽  
Victor C Urrutia
Keyword(s):  
Stroke Prevention ◽  
Randomized Clinical Trials ◽  
The United States ◽  
Screening Tools ◽  
List Type ◽  
Incidence And Mortality ◽  
Stroke Center ◽  
The Impact ◽  
Prevention Clinic

Background: While the incidence and mortality from stroke in the United States has declined in the past 20 years, there are still more than 795,000 strokes per year, of which 185,000 are recurrent events. There remains great disparity between racial groups -the incidence and mortality among African Americans, is two to four times higher than Non-Hispanic Whites. Despite great advances in drug therapies, the impact on stroke prevention has not been fully realized. There is a need for improved delivery of effective treatments. Several randomized clinical trials have demonstrated the effectiveness of a comprehensive; clinic based, navigator-assisted approach to disease management, although in the context of specific clinical situations. Examples are, SAMMPRIS, and Look AHEAD. We propose that learning from the development of the “stroke center” for acute stroke care, we may apply a similar model to stroke prevention. We have created a Stroke Prevention Clinic (SPC), organized like an outpatient “stroke center”, offering evaluation, treatment, and long-term follow up of patients for risk factor control and lifestyle interventions for secondary prevention. Our Stroke Prevention Nurse is an integral part of this model. In this abstract we report the impact of this program on follow up rates. Methods: In 2011 we launched our SPC. The specific elements of this program included: A Stroke Prevention Nurse: a. Meets the patient in the hospital. b. Facilitates scheduling of appointments, including in the SPC, which is given to the patient upon discharge. c. Calls the patient within 7 days to do medication reconciliation and answer questions. Also, at 90 days for a modified Rankin score and whenever it is necessary to follow up on blood pressure readings. d. Administers screening tools upon follow up, consents for research studies. e. Educates the patient on stroke prevention. Dedicated day for clinic. All providers in the same area. Use of Advance Practice Nurse and stroke fellows, as well as vascular neurology attending. Database. We assessed the proportion of completed appointments within 90 days after discharge from the hospital and compared it with the year prior to implementation. Results: A sample from July 2010 to February 2011 revealed completed follow up by 90 days of 28.3% (70/247), for the period July 2011 to February 2012 the proportion was 35.6% (89/250). During calendar year 2014, 54.3% (233/429) completed their appointments within 90 days. Conclusion: Implementation of the Stroke Prevention Clinic increased follow up completion within 90 days of discharge.

scholarly journals The Impact of Internalized Stigma on LGBT Parenting and the Importance of Health Care Structures: A Qualitative Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5373
Author(s):  
Carolina Alday-Mondaca ◽  
Siu Lay-Lisboa
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Health Care Services ◽  
Universal Access ◽  
Civil Society Organizations ◽  
Support Network ◽  
Internalized Stigma ◽  
Lgbt People ◽  
Mental Health Programs ◽  
The Impact

Research on LGBTIQ+ families has focused on the effects of being in a diverse family on the development of children. We seek to show the experience of parenthood from the perspective of LGBTIQ+ people, considering its particularities and the role that health care services play as a potential support network. We used the biographical method through open-ended interviews, participants were LGBT people, and key informants from Chile, Colombia, and Mexico were selected based on a sociostructural sampling. We found that internalized stigma impacts LGBTIQ+ parenting in five ways: the impossibility of thinking of oneself as a parent, fear of violating children’s rights, fear of passing on the stigma, fear of introducing their LGBTIQ+ partner, and the greater discrimination that trans and intersex people suffer. We identified gaps in health care perceptions: the need to guarantee universal access to health care, the need to include a gender perspective and inclusive treatment by health personnel, mental health programs with a community approach, access to assisted fertilization programs, and the generation of collaborative alliances between health services, civil society organizations, and the LGBTIQ+ community. We conclude that the health system is a crucial space from which to enable guarantees for the exercise of rights and overcome internalized stigma.

scholarly journals Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elaine Thumé ◽  
Marciane Kessler ◽  
Karla P. Machado ◽  
Bruno P. Nunes ◽  
Pamela M. Volz ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Rio Grande ◽  
Cognitive Testing ◽  
Rio Grande Do Sul ◽  
Primary Health ◽  
The Impact

Abstract Background The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study. Methods/design The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up). Results Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.

Advocacy for a Digital Oral Health That Leaves No One Behind

2021 ◽  
pp. 238008442110266
Author(s):  
N. Giraudeau ◽  
B. Varenne
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Access To Health Care ◽  
Universal Access ◽  
Digital Health ◽  
World Health ◽  
Noncommunicable Diseases ◽  
Central Component ◽  
Health Coverage ◽  
The Impact

During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, the lockdown enforced led to considerable disruption to the activities of dental services, even leading to closures. To mitigate the impact of the lockdowns, systems were quickly put in place in most countries to respond to dental emergencies, giving priority to distance screening, advice to patients by remote means, and treatment of urgent cases while ensuring continuous care. Digital health was widely adopted as a central component of this new approach, leading to new practices and tools, which in turn demonstrated its potential, limitations, and possible excesses. Political leaders must become aware of the universal availability of digital technology and make use of it as an additional, safe means of providing services to the public. In view of the multiple uses of digital technologies in health—health literacy, teaching, prevention, early detection, therapeutics, and public health policies—deployment of a comprehensive program of digital oral health will require the adoption of a multifaceted approach. Digital tools should be designed to reduce, not increase, inequalities in access to health care. It offers an opportunity to improve healthy behavior, lower risk factors common to oral diseases and others noncommunicable diseases, and contribute to reducing oral health inequalities. It can accelerate the implementation of universal health coverage and help achieve the 2030 Sustainable Development Agenda, leaving no one behind. Digital oral health should be one of the pillars of oral health care after COVID-19. Universal access to digital oral health should be promoted globally. The World Health Organization’s mOralHealth program aims to do that. Knowledge Transfer Statement: This position paper could be used by oral health stakeholders to convince their government to implement digital oral health program.

scholarly journals COVID-19: Stroke Admissions, Emergency Department Visits, and Prevention Clinic Referrals

2020 ◽  
Vol 47 (5) ◽  
pp. 693-696 ◽  
Author(s):  
Maria Bres Bullrich ◽  
Sebastian Fridman ◽  
Jennifer L. Mandzia ◽  
Lauren M. Mai ◽  
Alexander Khaw ◽  
...  
Keyword(s):  
Emergency Department ◽  
Stroke Prevention ◽  
Stroke Unit ◽  
Emergency Department Visits ◽  
Related Factors ◽  
Hospital Policies ◽  
The Government ◽  
Stroke Center ◽  
The Impact ◽  
Prevention Clinic

Abstract:We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London’s regional stroke center, serving a population of 1.8 million in Ontario, Canada. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.

scholarly journals 482. Impact of COVID-19 Pandemic on Psychosocial and Clinical Factors among people with and without HIV living in Miami

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S308-S308
Author(s):  
Patricia RaccamarichClaudia S Uribe ◽  
Ana S Salazar Zetina ◽  
Emily K Montgomerie ◽  
Douglas Salguero ◽  
Alejandro M Mantero ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Access ◽  
Access To Health Care ◽  
People Living With Hiv ◽  
Coping With Stress ◽  
Care Access ◽  
Significant Difference ◽  
Physical Consequences ◽  
The Impact ◽  
Hiv Negative

Abstract Background As the COronaVIrus Disease 2019 (COVID-19) continues to unfold, drastic changes in daily life pose significant challenges on mental and clinical health. While public health interventions such as national lockdowns and social distancing are enforced to reduce the spread of COVID-19, the psychosocial and physical consequences have yet to be determined that may disproportionately affect people living with HIV (PLWH). Methods To evaluate the impact of COVID-related stress on mental and clinical health, we conducted a 20-minute questionnaire eliciting sociodemographic information, clinical and psychological factors from people living in Miami, Fl. All individuals &gt;18 years with or without a history of COVID-19 were included. Participating PLWH were recruited from an existing HIV registry and HIV uninfected participants from community flyers and word of mouth. Results A total of 135 participants were recruited from 05/2020-06/2020. The mean age was 50 years old, 73/135 (54%) were female, and 102/135 (75%) were PLWH. Among participating PLWH, 60/102 (58.8%) self-identified as African American, and 9/102 (8.8%) were positive for COVID-19 by a commercially approved test. Among HIV-negative participants, 15/33 (45.5%) self-identified as White and 11/33 (33%) were positive for COVID-19. Both PLWH and HIV-negative participants described significant disruptions in health care access (47%), difficulty paying basic needs (41%), and feelings of anxiety and depression (48%); there was no statistically significant difference by HIV status. However, HIV negative participants were less likely to experience job loss and income disruption compared to PLWH during the pandemic (70% for HIV-negative vs 48% for PLWH; OR 0.40, p=0.03). Conclusion The impact of COVID-19 on emotional and clinical health is significant in both PLWH and HIV-negative groups. These findings highlight the need for providing mental and physical health care during the pandemic, especially for coping with stress and anxiety during these difficult times and ensuring adequate access to health care. Disclosures All Authors: No reported disclosures

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