Clinical staff impressions on implementation of a teleophthalmology program to improve diabetic retinopathy surveillance informed by implementation science frameworks (Preprint)

2021 ◽  
Author(s):  
Rajeev S. Ramchandran ◽  
Reza Yousefi-Nooraie ◽  
Porooshat Dadgostar ◽  
Sule Yilmaz ◽  
Jesica Basant ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Care Coordination ◽  
Low Income ◽  
Safety Net ◽  
The United States ◽  
Eye Care ◽  
Continuous Training ◽  
Effective Care ◽  
Store And Forward

BACKGROUND Store and forward camera based evaluation or teleophthalmology is considered an effective way to identify diabetic retinopathy, the leading cause of blindness in the United States, but uptake has been slow. OBJECTIVE Understanding the barriers and facilitators of implementing teleophthalmology programs from those actively adopting, running, and sustaining such programs is important for widespread adoption. METHODS This qualitative study in three urban low-income, largely minority-serving safety-net primary care clinics in Rochester, NY, USA interviewed nurses and doctors on implementing a teleophthalmology program using questions informed by Practical, Robust Implementation and Sustainability Model (PRISM) and Consolidated Framework for Implementation Research (CFIR) frameworks. RESULTS Primary care nurses operationalizing the program in their clinics saw increased work burden and lack of self-efficacy as barriers. Continuous training on the teleophthalmology process for nurses, doctors, and administrative staff through in-service and peer-training by champions/super-users were identified by interviewees as needs. Facilitators included the perceived convenience for the patient and a perceived educational advantage to the program as it gave an opportunity for providers to discuss the importance of eye care with patients. Concerns in making and tracking referrals to ophthalmology due to challenges related to care coordination were highlighted. Financial aspects of the program (e.g. patient coverage and care provider reimbursement) were unclear to many staff, influencing adoption and sustainability. CONCLUSIONS Streamlining of processes and workflows, training and assigning adequate staff, effective care coordination between primary care and eye care to improve follow-ups, and ensuring financial viability can all help streamline the adoption of teleophthalmology.

scholarly journals 2424

2017 ◽  
Vol 1 (S1) ◽  
pp. 78-78
Author(s):  
Brianna M. D’Orazio ◽  
Joel Correa da Rosa ◽  
Jonathan N. Tobin
Keyword(s):  
Primary Care ◽  
Medical Care ◽  
Ambulatory Care ◽  
Low Income ◽  
Health Workers ◽  
Safety Net ◽  
Emergency Department Visits ◽  
Data Set ◽  
Care Survey ◽  
Ambulatory Medical Care

OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. The number of emergency department visits for SSTIs increased from 1993 to 2005 from 0.48 to 1.16 ED visits per 100 US residents (95% CI 0.94 to 1.39; p<0.001); high safety-net status EDs saw a 4-fold increase in visits. The CA-MRSA Project (CAMP2) comparative effectiveness research (CER) study aims to evaluate a home-based intervention implemented by Community Health Workers (CHWs) or “promotoras” to prevent recurrence and transmission of CA-MRSA in primarily low-income, minority patients presenting to primary care with SSTIs. The intervention disseminates and implements methods found effective in the REDUCE MRSA trial. The present analysis was conducted using publically available data set to characterize the national patterns of healthcare utilization for treatment of SSTIs. METHODS/STUDY POPULATION: An analysis was conducted using data downloaded from the CDC National Ambulatory Medical Care Survey (NAMCS) and the CDC National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2012 (most recent data available) to evaluate the addition of Emergency Departments (EDs) as compared to Ambulatory Care as recruitment sources for a clinical trial to reduce CA-MRSA SSTI recurrence and household transmission. “Low-income” population was defined using “Expected Source of Payment” categories “Medicaid” and “Uninsured,” and ICD-9-CM dermatologic diagnosis codes for SSTIs and ICD-9-CM Procedure Codes for Incision and Drainage (I&D) were used to define a visit for SSTI treatment. RESULTS/ANTICIPATED RESULTS: In all patients, I&D was performed at a higher rate in EDs as compared with the ambulatory care setting (49.57 vs. 1.44 per 10,000 US residents in Medicaid and Uninsured; 44.48 vs. 5.24 per 10,000 US residents in all other insurance types). Nationally, low-income patients are 4 times more likely to have I&D procedure performed (OR 4.05, 95% CI 0.614–26.759, p<0.0001) and 5 times more likely to be diagnosed with an SSTI (OR 5.10, 95% CI 2.987–8.707, p<0.001) in the ED setting. DISCUSSION/SIGNIFICANCE OF IMPACT: These results confirm that low income patients seek primary care for SSTIs in both EDs and ambulatory care, such as Federally Qualified Health Centers (FQHCs). This also confirms the trend we have experienced in FQHCs in NYC, many of whom refer patients to the ED for the I&D procedure, and those patients return to the FQHC for follow-up. Thus, the most comprehensive test of using CHWs to disseminate and implement the findings from the REDUCE MRSA trial would engage both EDs and Ambulatory Care/FQHCs for patient identification and recruitment.

scholarly journals OLD AND FORGOTTEN? CARE FOR ELDERS IN MEXICO AND THE U.S.

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S64-S65
Author(s):  
Emma Aguila ◽  
Jaqueline L Angel ◽  
Kyriakos Markides
Keyword(s):  
United States ◽  
Old Age ◽  
Low Income ◽  
Health Care Financing ◽  
Safety Net ◽  
The United States ◽  
Welfare States ◽  
The Government ◽  
The U.S

Abstract The United States and Mexico differ greatly in the organization and financing of their old-age welfare states. They also differ politically and organizationally in government response at all levels to the needs of low-income and frail citizens. While both countries are aging rapidly, Mexico faces more serious challenges in old-age support that arise from a less developed old-age welfare state and economy. For Mexico, financial support and medical care for older low-income citizens are universal rights, however, limited fiscal resources for a large low-income population create inevitable competition among the old and the young alike. Although the United States has a more developed economy and well-developed Social Security and health care financing systems for the elderly, older Mexican-origin individuals in the U.S. do not necessarily benefit fully from these programs. These institutional and financial problems to aging are compounded in both countries by longer life spans, smaller families, as well as changing gender roles and cultural norms. In this interdisciplinary panel, the authors of five papers deal with the following topics: (1) an analysis of old age health and dependency conditions, the supply of aging and disability services, and related norms and policies, including the role of the government and the private sector; (2) a binational comparison of federal safety net programs for low-income elderly in U.S. and Mexico; (3) when strangers become family: the role of civil society in addressing the needs of aging populations; and (4) unmet needs for dementia care for Latinos in the Hispanic-EPESE.

Diagnosis of retinal detachments by a tele-ophthalmology screening program

2018 ◽  
Vol 25 (3) ◽  
pp. 190-192 ◽  
Author(s):  
Sarah A McCord ◽  
Mary G Lynch ◽  
April Y Maa
Keyword(s):  
Primary Care ◽  
Screening Program ◽  
Medical Center ◽  
Case Reports ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Eye Care ◽  
Primary Care Clinics ◽  
The Usa

In 2015, a tele-ophthalmology program was undertaken at the Atlanta Veterans Affairs Medical Center to provide screening eye care for veterans in their primary care clinics. Though this program was developed as a screening tool, the availability of these services in primary care clinics has enabled triage of certain acute eye complaints. These case reports describe two patients who were diagnosed with retinal detachments through this program, although their primary care providers had triaged them as requiring non-urgent referrals to the eye clinic. Although many patients are seen for acute ocular complaints in primary care clinics and emergency departments, providers in such settings may lack the ability to adequately examine eyes and thus triage ocular complaints. These cases demonstrate the ability of tele-ophthalmology to assist in diagnosing urgent ocular conditions in primary care clinics. Though tele-ophthalmology has been accepted in some parts of the world, in the United States of America it remains widely underutilized. These cases highlight the ability of tele-ophthalmology to close the gap in acute eye care coverage that exists in the USA, most prominently in rural regions.

scholarly journals Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians' Offices

2016 ◽  
Vol 52 (2) ◽  
pp. 807-825 ◽  
Author(s):  
Valy Fontil ◽  
Kirsten Bibbins-Domingo ◽  
Oanh Kieu Nguyen ◽  
David Guzman ◽  
Lauren Elizabeth Goldman
Keyword(s):  
United States ◽  
Primary Care ◽  
Community Health ◽  
Community Health Centers ◽  
Safety Net ◽  
The United States ◽  
Health Centers ◽  
Safety Net Clinics

scholarly journals Transportation and Other Nonfinancial Barriers Among Uninsured Primary Care Patients

2018 ◽  
Vol 5 ◽  
pp. 233339281774968 ◽  
Author(s):  
Akiko Kamimura ◽  
Samin Panahi ◽  
Zobayer Ahmmad ◽  
Mu Pye ◽  
Jeanie Ashby
Keyword(s):  
Health Care ◽  
Low Income ◽  
Underserved Populations ◽  
Unmet Need ◽  
Care Facility ◽  
Well Being ◽  
Safety Net ◽  
The United States ◽  
Free Clinic ◽  
Transportation Barriers

Introduction: Nonfinancial barriers are frequent causes of unmet need in health-care services. The significance of transportation barriers can weigh more than the issues of access to care. The purpose of this cross-sectional study was to examine transportation and other nonfinancial barriers among low-income uninsured patients of a safety net health-care facility (free clinic). Methods: The survey data were collected from patients aged 18 years and older who spoke English or Spanish at a free clinic, which served uninsured individuals in poverty in the United States. Results: Levels of transportation barriers were associated with levels of other nonfinancial barriers. Higher levels of nonfinancial barriers were associated with elevation in levels of stress and poorer self-rated general health. Higher educational attainment and employment were associated with an increase in other nonfinancial barriers. Conclusion: Focusing only on medical interventions might not be sufficient for the well-being of the underserved populations. Future studies should examine integrative care programs that include medical treatment and social services together and evaluate such programs to improve care for underserved populations.

Sociodemographic Correlates of Food Insecurity Among New York City Tobacco Users

2020 ◽  
Vol 34 (6) ◽  
pp. 664-667
Author(s):  
Christina N. Wysota ◽  
Scott E. Sherman ◽  
Elizabeth Vargas ◽  
Erin S. Rogers
Keyword(s):  
New York ◽  
New York City ◽  
Food Insecurity ◽  
Low Income ◽  
York City ◽  
Safety Net ◽  
The United States ◽  
United States Department ◽  
Poverty Level ◽  
Sociodemographic Correlates

Purpose: To identify rates and sociodemographic correlates of food insecurity among low-income smokers. Design: Cross-sectional analysis of baseline survey data from a randomized controlled trial (N = 403) testing a smoking cessation intervention for low-income smokers. Setting: Two safety-net hospitals in New York City. Sample: Current smokers with annual household income <200% of the federal poverty level. Measures: Food insecurity was measured using the United States Department of Agriculture 6-item food security module. Participant sociodemographics were assessed by self-reported survey responses. Analysis: We used frequencies to calculate the proportion of smokers experiencing food insecurity and multivariable logistic regression to identify factors associated with being food insecure. Results: Fifty-eight percent of participants were food insecure, with 29% reporting very high food insecurity. Compared to married participants, separated, widowed, or divorced participants were more likely to be food insecure (adjusted odds ratio [AOR] = 2.33, 95% confidence interval [CI]: 1.25-4.33), as were never married participants (AOR = 2.81, 95% CI: 1.54-5.14). Conclusions: Health promotion approaches that target multiple health risks (eg, smoking and food access) may be needed for low-income populations. Interventions which seek to alleviate food insecurity may benefit from targeting socially isolated smokers.

Managing Director’s Global Policy Agenda to the International Monetary and Financial Committee

Policy Papers ◽  
2015 ◽  
Vol 2015 (59) ◽  
Author(s):  
Keyword(s):  
Capacity Building ◽  
Low Income ◽  
Financial Stability ◽  
Technical Assistance ◽  
Safety Net ◽  
The United States ◽  
International Taxation ◽  
Structural Reforms ◽  
Financial Conditions ◽  
Trade Offs

The Executive Summary is also available in: Arabic , Chinese, French, Japanese, Russian, and Spanish. The membership is facing a rapidly changing and uncertain world. The United States is poised to raise interest rates amid ongoing recovery, China’s expected slowdown as it rebalances growth is creating larger-than-anticipated spillovers, and commodity producers are facing the end of a long cycle of high commodity prices. These necessary transitions pose challenges, particularly for emerging and low-income developing countries, where prospects have dwindled the most. Policymakers are increasingly grappling with difficult policy trade-offs. Faced with limited room to maneuver and the need to adapt to new realities, what relative weight should be placed on supporting demand and current activity, on reducing financial risks as financial conditions tighten, and on implementing urgently needed structural reforms to revive future growth? Policies need to reflect country circumstances and coalesce into a new multilateralism. Mutually reinforcing policies are needed to support growth today, invest in resilience and safeguard financial stability, and implement the structural reforms needed for a sustainable and inclusive future. Policies should reflect member circumstances and also add up to a coherent whole—to ensure that demand is created not substituted, market resilience is enhanced not circumvented, and that structural reforms are enacted not delayed. Cooperation is vital in areas such as the global financial safety net, trade, climate change, international taxation, sustainable development goals (SDGs), and demographic transitions and migration. The Fund will support the membership at this juncture. The Fund has both the universal membership and mandate to address growth and economic stability issues at the national and global levels. To support the membership most effectively, the Fund will focus on three priorities that best reflect this new AIM: • Agility. Advice will focus on policies to support members cope with evolving transitions—respond to tighter and more volatile financial conditions and implement effective macro-structural reforms. The lending framework will deliver financial assistance quickly where needed. Delivery of technical assistance and training will be enhanced by greater use of online tools. • Integration. In the face of growing policy trade-offs, the Fund will support its members by better integrating policy advice across sectors, embracing evolving priorities, promoting integration of global, regional, and bilateral safety nets, and better leveraging synergies between surveillance and capacity building. • Member-Focused. With policy concerns evolving rapidly and advice becoming more dependent on country-specifics, the Fund will deepen its engagement with members, better deliver its knowledge, and ensure faster feedback to policymakers. The Fund continues to refine its core work—surveillance, lending, and capacity building—and to attain greater intellectual and cultural diversity to respond to this changing global environment and its corresponding policy challenges. To further improve services to the membership, Fund activities need to be fully supported by adequate financial, human, budgetary, and technological resources.

Essay I Local Health Departments and a Primary Care Safety Net

2015 ◽  
pp. 216-221
Author(s):  
Robert M. Pestronk
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Safety Net ◽  
The United States ◽  
Local Health ◽  
Community Members ◽  
Policy Makers ◽  
Public Health Professionals ◽  
Primary Care Clinicians ◽  
The Right

Drawing on the experiences of hundreds of public health and primary care clinicians from across the United States, this book explains why population health is receiving so much attention from policy makers in states and federal agencies, the practical steps that clinicians and public health professionals can take to work together to meet the needs of their community, signs that you are on the right track (or not) and how to sustain successes to the benefit of patients, community members, and the health care and public health teams that care for them.

scholarly journals Cukorbetegség és retinopathia diabetica regionális egyenlőtlenségei Magyarországon az 50 éves és idősebb korú lakosság körében

2017 ◽  
Vol 158 (10) ◽  
pp. 362-367 ◽  
Author(s):  
Gábor Tóth ◽  
Dorottya Szabó ◽  
Gábor László Sándor ◽  
Anita Pék ◽  
Irén Szalai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Diabetic Retinopathy ◽  
Screening Program ◽  
Rapid Assessment ◽  
Fundus Examination ◽  
Eye Care ◽  
Care Services ◽  
Eye Screening ◽  
Retinopathia Diabetica

Abstract: Introduction: Diabetes mellitus (DM) is one of the main causes of blindness among persons aged 50 years and older. Aim: The purpose of our survey was to estimate the prevalence of DM and diabetic retinopathy (DR), as well as to assess the coverage of diabetic eye care services in different regions of Hungary. Method: In 105 clusters, 3675 people aged 50 years and older were included in the survey. The standardized rapid assessment of avoidable blindness (RAAB) with the diabetic retinopathy module (DRM) was used to examine the participants. Thereafter, differences between West-, Middle- and East-Hungary were analysed. Results: Prevalence of DM was higher in East-Hungary (20.9%), than in West- (19.5%) and in Middle-Hungary (19.5%). Prevalence od DR was higher in West-Hungary (24.1%), than in Middle- (17.8%) and in East-Hungary (19.6%). Proportion of participants who never had a fundus examination for DR was the lowest in Middle-Hungary (19.1%). Conclusions: Primary care should be strenghten mainly in country settlements or telemedical eye screening program should be started to decrease the prevalence of diabetic eye complications. Orv. Hetil., 2017, 158(10), 362–367.

scholarly journals Disparities in Access to Oral Health Care

2020 ◽  
Vol 41 (1) ◽  
pp. 513-535 ◽  
Author(s):  
Mary E. Northridge ◽  
Anjali Kumar ◽  
Raghbir Kaur
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Low Income ◽  
Safety Net ◽  
The United States ◽  
Oral Health Care ◽  
Oral Diseases ◽  
Patient Centered ◽  
Obesity And Diabetes ◽  
Centered Care

In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations who have suboptimal access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course.

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