Patient preferences for telehealth versus in-person oncology visits

Background: The COVID-19 pandemic led to rapid adoption of telehealth (video or phone) visit modalities for oncology encounters not requiring in-person visits. We surveyed oncology patients regarding preferences for in-person versus telehealth modalities for different types of clinical encounters. Method(s): We surveyed adults who were undergoing treatment at Kaiser Permanente Northern California infusion centers between 11/2021 - 05/2022 using a self-administered questionnaire. Patients were asked about modality preferences for 6 types of clinical discussions, overall advantages and disadvantages of telehealth versus in-person encounters, and barriers to video visit use. Result(s): A total of 757 patients who completed surveys in English answered questions about visit modality preferences for different types of discussions with their oncologist. Respondents were 63% female, median age 63y, and majority White (61% White, 19% Asian, 11% Latino, 7% Black) and college-educated (28% some college, 45% > bachelor's degree). For the first post-diagnosis discussion, most patients preferred inperson (IP) visits (83%), followed by video visits (27%) and phone visits (18%). For follow-up visits during treatment, patients preferred IP (52%), video (50%) and phone (37%) visits. For discussions of bad news and sensitive topics, IP visits were preferred by 68% and 62%, video visits by 44% and 48%, and phone visits by 32% and 41%, respectively. Good news could come at IP (49%), video (52%) or phone (49%) visits. Approximately 20% of patients had no overall preference for IP versus telehealth visits. However, 58% of patients felt more personally connected with their doctor at IP visits. Patients also had more confidence in IP examinations (73%) and felt IP was easier for showing things (67%) and talking (51%) to the doctor. Patients felt telehealth visits saved them time (72%), reduced infection exposure (64%) and travel issues (45%), were cheaper (38%), and enabled inclusion of more people (28%). Of 24% of patients who felt video visits would be hard, 51% cited poor internet, 41% lack of an adequate device, and 28% difficulty signing on. Conclusion(s): The majority of oncology patients consider telehealth visits acceptable for most types of clinical discussions, with the exception of the first post-diagnosis visit. Only one-fourth of patients indicated potentially modifiable barriers to video visits. Our results support use of telehealth visits for most types of oncology encounters.

Module evaluation for emergency remote teaching: An oral hygiene case study during the COVID-19 pandemic

AFRICAN DEVELOPMENT : Background. The COVID-19 pandemic resulted in emergency remote teaching, with limited student contact time. For programmes with strong clinical and community-based requirements, such as the Bachelor of Oral Health, one had to be innovative to meet module outcomes.Objectives. To (i) evaluate the curriculum and pedagogy of two diverse modules in the second year;and (ii) explore contextual factors affecting teaching and learning.Methods. This evaluation study used a mixed-methods design. The sample comprised lecturers (n=3), clinical teachers (n=2), students (n=29) and documents for analysis. The modified concept-indicator method and the emergency remote teaching environment frameworks guided the data collection process. Tools included questionnaires, a focus group discussion and document analysis. Quantitative data were presented as frequencies and qualitative data were themed.Results. Student participation for the OHP213 module was 76% (n=19) and 68% for the LOS200 module (n=19). All the lecturers (n=3) participated. Overall, the content and teaching and learning specialists were satisfied with the modules, but made suggestions for improvement. Student experiences highlighted diversity in their learning styles and challenges, while lecturers articulated challenges and emphasised affordances during this period.Conclusions. The curricula were generally found to be aligned in terms of outcomes, content and assessment. Emergency remote teaching presented affordances from the perspective of students and lecturers, which could be explored further. If online teaching were to be a feature of university education, the affordances highlighted by students and staff may argue for a revised hybrid approach to delivering an oral health programme. However, such a system would require thorough research, with the necessary support built into the university as an ecosystem

Racial/Ethnic Differences in Social Health of Older Adults in a Northern California Healthcare System

Background: The COVID-19 pandemic heightened concerns about the social health of older adults and potential exacerbation of racial disparities in health, well-being, and healthcare access. Methods: We used weighted data for 4282 Kaiser Permanente Northern California (KPNC) members aged 65-85 who responded to the 2020 KPNC Member Health Survey to estimate prevalence of frequent loneliness, lack of social support, financial strains, and other stressors during the prior 12 months. Results: Overall, 5% often felt lonely or socially isolated, and 37% often did not get sufficient social/emotional support (Figure). While approximately 4% had problems “making ends meet”, 10% worried about financial security. Cost led to 2-3% being food insecure, eating less healthy foods, and delaying/foregoing medical care, and 11% delaying/foregoing dental care. Black adults were most likely to report these financial strains, as well as experience harassment/ discrimination and worry about neighborhood violence. Asian/Pacific Islander adults (API) were most likely (57%) and White adults least likely (32%) to report lack of social/emotional support. Conclusions: While many older adults experienced adverse financial and social circumstances during the pandemic, Black adults were more likely than White adults to indicate financial and healthcare access strains. More research is needed on effective screening for financial and other social risks in diverse older adult populations to deliver socially and culturally appropriate care to vulnerable populations.

Infection control for safety and quality

Health care-associated infections can be painful, potentially blinding, and even life threatening. Infection prevention and control is therefore a vital part of caring for the patients. The multidisciplinary nature of the infection control committee is an important reminder that everyone has a responsibility to reduce health care-associated infections and prevent harm to patients. This is particularly important with the emergence of antimicrobial resistance, as health care-associated infections are more likely to be multi-drug resistant and therefore difficult to treat. Hopefully, one of the lessons that will come out of the COVID-19 pandemic will be to pay more heed to routine infection prevention and control hygiene measures.