Transportation barriers to care among frequent health care users during the COVID pandemic

Objective: To investigate transportation barriers to accessing health care services during the COVID-19 pandemic among high-frequency health care users.Data Sources: Between June 21 and July 23, 2021, primary survey data were collected for a sample of patients in North Carolina.Study Design: The study analyzed the prevalence of arriving late to, delaying, or missing medical care and examined how transportation barriers contributed to negative health care outcomes. Data Collection Methods: A web-based survey was administered to North Carolina residents aged 18 and older in the UNC Health system who were enrolled in Medicaid or Medicare and had at least six outpatient medical appointments in the past year. 323 complete responses were analyzed to investigate the prevalence of reporting transportation barriers that resulted in having arrived late to, delayed, or missed care, as well as relationships between demographic and other independent variables and transportation barriers. Qualitative analyses were performed on text response data to explain transportation barriers.Principal Findings: Approximately 1 in 3 respondents experienced transportation barriers to health care between June 2020 and June 2021. Multivariate logistic regressions indicate individuals aged 18–64 were significantly more likely to encounter transportation barriers. Costs of traveling for medical appointments and a lack of driver or car availability emerged as major transportation barriers; however, respondents explained that barriers were often complex, involving circumstantial problems related to one’s ability to access and pay for transportation as well as to personal health.Conclusions: To address transportation barriers, we recommend more coordination between transportation and health professionals and the implementation of programs that expand access to and improve patient awareness of health care mobility services. We also recommend transportation and health entities direct resources to address transportation barriers equitably, as barriers disproportionately burden younger adults under age 65 enrolled in public insurance programs.

Developing a Graphical User Interface for an Artificial Intelligence-Based Voice Assistant

Artificial intelligence machineries have been extensively active in human life in recent times. Self-governing devices are enhancing their way of interacting with both human and devices. Contemporary vision in this topic can pave the way for a new process of human-machine interaction in which users will get to know how people can understand human language, adapting and communicating through it. One such tool is voice assistant, which can be incorporated into many other brilliant devices. In this article, the voice assistant will receive the audio from the microphone and then convert that into text, later with the help of ‘pyttsx3', and then the text response will be converted into an audio file; then the audio file will be played. The audio is processed using the voice user interface (VUI). This article develops a functional intelligent personal assistant (IPA) and integrates it with a graphical user interface that can perform mental tasks such as ON/OFF of smart applications based on the user commands.

First-passage behavior of under-damped asymmetric bistable system driven by Lévy noise

In this paper, the first-passage behavior of under-damped asymmetric bistable system driven by Lévy noise is studied. The two aspects considered are the mean first-passage time (MFPT) and the distribution of first-passage time in two opposite directions. To begin with, using the Janicki–Weron algorithm to generate Lévy noise, the system driven by Lévy noise is simulated through the fourth-order Runge–Kutta algorithm. Then the first-passage time of [Formula: see text] response tracks is calculated, and the MFPT and the distribution of first-passage time are obtained. Finally, the influence of Lévy noise and system parameters on MFPT and the distribution of first-passage time are analyzed. Moreover, the noise enhanced stability (NES) effect is found.

Survey of physician attitudes to using multisource feedback for competence assessment in Alberta

BackgroundThe use of multisource feedback (MSF) for assessing physician performance is widespread and rapidly growing. Findings from early very small research studies using highly selected participants suggest high levels of satisfaction and support. However, after nearly two decades of experience using MSF to evaluate all physicians in Alberta, we are sceptical of this.ObjectivesTo determine physicians’ actual opinions of MSF using the entire physician population of Alberta, CanadaDesignOnline survey.SettingAlberta, Canada.ParticipantsAll physicians with a full licence to practice in Alberta in 2015.InterventionsAll participants were asked to grade how well they thought MSF was at assessing various aspects of physician performance using a 10-point Likert-type scale. There was also a text response field for written comments.OutcomesMean responses to quantitative questions. Qualitative content and thematic analysis of open-ended text responses.We analysed the data using SPSS V.23 and NVivo V.11 and built a multivariate model highlighting the predictors of high and low opinions of MSF.ResultsSurvey response rate was high for physicians with 2215 responses (25%). The mean rating for how successful MSF was at assessing a variety of dimensions, varied from a low of 5.03/10 for medical knowledge to a high of 6.38/10 for professionalism and communication. Canadian-trained MDs rated MSF significantly lower on every dimension by approximately 20% compared with non-Canadian-trained MDs.ConclusionsAlberta physicians have much lower opinions about the ability of MSF to measure any dimension of their performance than what has been suggested in the literature. Canadian-trained MDs have a particularly low opinion of MSF for reasons that remain unclear. The results of this survey offer a serious challenge to the effectiveness of a programme that is designed to promote self-reflection and performance improvement.

The Notion of Presence in a Telematic Cross-Disciplinary Program for Music, Communication and Technology

This chapter examines how students in a two-campus, cross-disciplinary program in Music, Communication and Technology (MCT) experience the sense of presence of peer students and teachers, some physically co-localized while others are present via an audiovisual communications system. The chapter starts by briefly delineating the MCT program, the audiovisual communications system and the learning space built around it, named the Portal, and the research project SALTO which frames the current study. We then review research literature on presence relevant to this particular context and use this as a basis for the design of an online survey using a combination of Likert items and free text response. Our main findings, based on responses from the 16 students who participated in the survey, are that the mediating technologies of the Portal affect the experience of presence negatively, but that formal learning scenarios are less affected than informal scenarios that require social interaction.

Implementation of a Meaning-Centered Psychotherapy training (MCPT) program for oncology clinicians: a qualitative analysis of facilitators and barriers

The Meaning-Centered Psychotherapy training program (MCPT) is a multimodal, intensive, in-person program that trains cancer care providers in the evidence-based psychosocial treatment Meaning-Centered Psychotherapy (MCP). This analysis aimed to identify barriers and facilitators to clinical implementation (CI) at 1 year post-training. Trainee feedback regarding CI was collected via a mixed-methods questionnaire, including rating the ease of CI and free-text response identifying facilitators and barriers to CI. Descriptive statistics and thematic content analysis of follow-up data from the first five MCPT training cohorts (n = 55) were performed to assess CI and its facilitators and barriers. One third of participants indicated that it was at least somewhat difficult to implement MCP in clinical practice. Trainee-identified facilitators and barriers to CI were characterized within four main categories: program, patient, treatment, and institution. Within each of these factors, clinicians reported a variety of components that contributed to or hindered their ability to implement MCP. MCPT itself was reported as a facilitator. Patient access and interest were simultaneously identified as facilitators for some and barriers for others. Some trainees found the MCP treatment structure helpful in addressing important patient psychosocial needs, while others felt it was too restrictive. Institutional support played an important role in whether trainees felt hindered or helped to implement MCP. These initial results provide important insight into the program’s strengths and have fostered improvements to the MCPT program to better facilitate CI. Further study of MCPT CI is warranted, and theme refinement will be possible with a larger sample.

A randomized trial of a mercaptopurine (6MP) adherence-enhancing intervention in children with acute lymphoblastic leukemia (ALL): A COG ACCL1033 study.

10007 Background: We previously reported that > 40% of children with ALL are non-adherent to 6MP, and > 52% of ALL relapses are attributable to 6MP non-adherence. The most common barrier is forgetting to take 6MP; the most common facilitator is parental vigilance. These observations informed a randomized trial to enhance 6MP adherence (COG-ACCL1033, #NCT01503632; 89 COG sites). Results are described here. Methods: The Intervention Package (IP) consisted of: i) Education; ii) 6MP schedules; iii) daily personalized text message reminders from physician to patient and caregiver, to prompt iv) directly supervised therapy (DST), with text back response by patient/caregiver. Baseline adherence was measured for 4 wks, followed by intervention for 16 wks to examine the impact of IP vs. Edu (education) on 6MP adherence (measured electronically by MEMs Cap) in all patients, ≥12yo, < 12yo. Longitudinal binomial logistic regression using generalized estimating equations was used. Missing data were handled by multiple imputation. Results: 444 patients were randomly assigned to IP (n = 230) or Edu (n = 214). Baseline characteristics (age at study: 8.6y vs 7.5y; males: 67% vs 69%; non-Hispanic whites: 40% vs 42%) and adherence rates (92% vs 94%) were comparable (except paternal education: 49% vs 38%, p = 0.04). No study arm*time interaction was found; thus, the 16-week overall mean fitted adherence rates were compared between IP and Edu, adjusting for baseline adherence, time on study, parental education. All patients: Adherence rates were marginally higher on IP (94% vs 92.5%, p = 0.09). On IP, for times with a record of text response, adherence rates were higher (94%) when compared with times with no response (89%), p = 0.002. < 12yo: Adherence rates were comparable (IP: 94.4% vs Edu: 93.7%, p = 0.5). ≥12yo: Adherence rates were significantly higher on IP (93.1% vs 90.0%, p = 0.037). ≥12yo with baseline adherence < 90%: IP had the highest impact for this subgroup (83.4% vs 74.6%, p = 0.008). Conclusions: A 16-week comprehensive intervention resulted in higher 6MP adherence rates in children with ALL who were 12y or older at study. IP was most impactful in adolescents with baseline non-adherence. Clinical trial information: #NCT01503632.

P025: Improving senior resident engagement at academic core rounds

Introduction: Royal College Emergency Medicine (EM) trainees at the University of Ottawa participate in weekly Academic Full Days (AFD) that consist of didactic activities, simulation-based learning, and core content sessions referred to as Core Rounds (CR). Despite CR being intentioned for all EM trainees, an attendance attrition has been noted as trainees progress towards their senior (SR) years (PGY3-5). The objectives of this study were to (1) identify barriers to SR trainee CR attendance and (2) identify areas for CR improvement. Methods: An on-line survey was administered to SR EM trainees (PGY3-5, n = 28) and recent graduates from our program (practice year 1-2, n = 20) to explore perceptions of the value of AFDs, CR attendance barriers, and areas for CR improvement. The survey consisted of 5-point Likert scales and free-text responses. Quantitative responses were analyzed using Microsoft Excel. Free-text responses were analyzed qualitatively using thematic analysis. Each free-text response was reviewed independently by two investigators (JML, MCL) and underwent line-by-line coding. Through joint discussions, the codes from each response were synthesized and themes were identified. Results: Of the 48 trainees and attendings surveyed, 32 responded (response rate 67%). Most respondents (90%) stated they benefited from SR trainee attendance when they were at a junior (JR) level. The majority perceived they benefited less from CR as a SR trainee compared to when they were a JR trainee (85%). Further, 87% responded that CR were not tailored to a SR level, and that they would attend more frequently if sessions were geared to their level (81%). From our thematic analysis, three themes emerged relating to SR trainee absenteeism: 1) CR quality, 2) External Factors (eg. trainee fatigue) and 3) Malalignment with trainees’ own education plan. We also identified three themes relating to areas for CR improvement: 1) CR content, 2) CR format and 3) SR trainee involvement. Conclusion: Respondents indicated a benefit to having SR trainee presence at CR. This study identified barriers to SR resident attendance at CR and areas for improvement. With the transition to competency based medical education it is critical that trainees engage in effective educational experiences, especially as the RCPSC does not mandate AFDs for EM training in this new curriculum. A culture-change initiative and CR reformat is now underway at our institution with planned post-implementation analysis.