Pandemic Challenges and Opportunities for Gender Equity in Clinical Research

In the arena of clinical research, gender equity accelerates research excellence: we need multiple perspectives and all the brain power we can muster to maximize research productivity and quality. [...]women physician investigators enhance enrollment of women as participants in clinical trials, which is crucial to our ability to generalize from the data and to maintain the health of women. Women are underrepresented among academic grand rounds speakers,14 speakers at medical conferences15, and award recipients from medical specialty societies.16 Time pressure is especially intense on young women faculty. Besides spending more time on domestic chores, they spend more time at work on teaching, service, and mentoring. Female primary care physicians spend more time with patients.22 Elderly hospitalized patients treated by female internists experience lower mortality and readmission rates.23 Patients undergoing coronary artery bypass grafting had shorter hospital length of stay when treated by an all-female physician team as compared with an all-male team.24 Female patients treated by male physicians following acute myocardial infarction have higher mortality than those treated by female physicians.25 Sex discordance between patient and surgeon is associated with increased likelihood of adverse postoperative outcomes-and that observation that is driven by worse outcomes for female patients treated by male physicians.26 Clinical trials play a fundamental role in bringing new medications and interventions to our patients, yet women have often been excluded from participation. Among 60 randomized controlled trials (RCTs) of lipidlowering therapies reported between 1990 and 2018, there was a modest increase in enrollment of women over time, but women remain underrepresented compared with the relative burden of disease.30 In another study of 317 RCTs of heart failure with reduced ejection fraction published in highimpact journals over the past 20 years, only 25% of participants overall were female, and females were under-enrolled in 72% of these trials.

Adaptive reuse of closed malls for dementia programs and services: Community focus group feedback

The double societal hit of dementia and infectious disease outbreaks like COVID-19 have raised a convergence of concerns for the future of care settings for people living with dementia. Images of institutionalized older adults who are quarantined in closed settings have led developers, government agencies, and care administrators to search for innovative options to create more autonomy and quality of life in care settings while protecting the health of residents. This chapter describes the qualitative work being conducted by a Midwestern university research team, laying the groundwork for the conceptual adaptive reuse of an 800,000 square-foot closed mall site for centralized dementia programs, services, housing, and an on-site quarantine and medical center. Focus group outcomes from architects and developers highlighted five principle themes relating to the barriers and benefits of adaptive reuse for this model which include: mixed-use precedents, linking the old with the new, economic factors, development partnerships, and sustainable building practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Creating hospitable service systems for refugees during a pandemic: Leveraging resources for service inclusion

Purpose: The overarching goal of this paper is to increase awareness among researchers and practitioners that refugees are disproportionally impacted by COVID-19, which increases their suffering. Second, it extends a recently introduced transformative refugee service experience framework by integrating and conceptualizing refugees' resource and service inclusion during a pandemic. Third, it explores lessons learned and implications from the COVID-19 pandemic for the future of service research and practice. Design/methodology/approach: This study synthesizes approaches on refugees, resources and transformative service research to develop an extended framework for addressing one of society's pressing issues during and after pandemics. Findings: Recognizing refugees as providing resources rather than just needing or depleting resources can enable more inclusion. It facilitates refugees' integration into society by drawing on their skills and knowledge. This requires hospitable refugee service systems that enable service inclusion and opportunities for refugee resource integration.Research limitations/implications: This article focuses on one vulnerable group in society. However, the extended framework presented warrants broader application to other contexts, such as subsistence marketplaces. Practical implications: Managers of service businesses and public policymakers should create more inclusive and hospitable service systems for refugees. This may result in redesigning services, changing consumer behavior and reformulating public policy.Social implicationsBetter inclusion and integration of refugees and their resources should increase their individual well-being, reduce social issues in society, increase overall societal well-being and productivity. Originality/value: This article presents a novel extended framework for service scholars and service providers to increase resource and service inclusion of refugees in a disaster context. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Design as the Mediator of New Social Health Culture. Towards a Co-benefits Model

The COVID-19 pandemic accelerated the need for change, raising questions about the current approach to health. The re-definition of the role of health and well-being towards an interdisciplinary approach is knowledge-driven and technology-enabled and the focus of innovation is shifting from the treatment of disease to prediction and prevention. The new model of the ‘co-benefit belt' through design activates a process of systemic improvement and extends beyond the digital, pursuing the logic of interaction. The role of Design as a mediator is emphasized, lending itself to emergency situations, to the design of protection devices by implementing multifunctional and shared protection dynamics, intervening in rethinking the universe of devices with Human Centered Design approaches, optimizing methods and processes. The case study presented describes the development of the research project funded by the Campania Region, "Smart&Safe”. Design for new individual protection devices”, among the initiatives to fight against Covid-19. The research proposes an update in the redesign of individual Personal Protective Equipment (PPE), to explore a new dimension of the project that highlights the transition to an Individual and Intelligent Protection System (IIPS), reflecting on the various levels of safety faced during health emergencies. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Balancing burdens of infection control: Norwegian district medical officers' ethical challenges during the COVID-19 pandemic.

BACKGROUND: In several countries, district medical officers (DMOs) are public health experts with duties including infection control measures. The Norwegian DMOs have been key actors in the local handling of the COVID-19 pandemic. METHODS: The aim of the study was to explore the ethical challenges experienced by Norwegian DMOs during the COVID-19 pandemic, and how the DMOs have handled these challenges. 15 in-depth individual research interviews were performed and analyzed with a manifest approach. RESULTS: Norwegian DMOs have had to handle a large range of significant ethical problems during the COVID-19 pandemic. Often, a common denominator has been the need to balance burdens of the contagion control measures for different individuals and groups. In another large set of issues, the challenge was to achieve a balance between safety understood as effective contagion prevention on the one hand, and freedom, autonomy and quality of life for the same individuals on the other. CONCLUSIONS: The DMOs have a central role in the municipality's handling of the pandemic, and they wield significant influence. Thus, there is a need for support in decision-making, both from national authorities and regulations, and from discussions with colleagues.

The Use of a Single-Time Sit-To-Stand Test in Ambulatory Individuals With Spinal Cord Injury by Primary Health Care Providers.

Background: The uncertain health care situations, such as that created by the COVID-19 pandemic, has limited hospital access and facilitated a paradigm shift in health care toward an increased demand for standard home visits and community-based rehabilitation services, including by ambulatory individuals with spinal cord injury (SCI). Objectives: This 6-month prospective study explored the validity and reliability of a single-time sit-to-stand (STSTS) test when used by primary health care (PHC) providers, including a village health volunteer, caregiver, individual with SCI, and health professional. Methods: Eighty-two participants were assessed for the STSTS using four arm placement conditions (arms on a walking device, arms on knees, arms free by the sides, and arms crossed over the chest) and standard measures, with prospective fall data follow-up over 6 months. Thirty participants involved in the reliability study were also assessed and reassessed for the ability to complete the STSTS conditions by PHC providers. Results: Outcomes of the STSTS test, except the condition with arms on a walking device, could significantly discriminate lower extremity muscle strength (LEMS) and mobility of the participants (rpb = -0.58 to 0.69) with moderate concurrent validity. Outcomes of the tests without using the arms also showed moderate to almost-perfect reliability (kappa = 0.754-1.000) when assessed by PHC raters. Conclusion: The findings suggest the use of an STSTS with arms free by the sides as a standard practical measure by PHC providers to reflect LEMS and mobility of ambulatory individuals with SCI in various clinical, community, and home-based settings.

Response to COVID-19 Pandemic: Managing Inpatient Pharmacy Services at King Abdulaziz Medical City - Jeddah.

Since early December 2019, the coronavirus disease 2019 (COVID-19) has been relentlessly spread worldwide and has hit the healthcare systems with terrible force. Pharmacists play a vital role in the healthcare system in providing medicines, therapeutics, vaccines, clinical services, and other pharmaceutical care services to patients. Therefore, to ensure all these services continued at King Abdulaziz Medical City - Jeddah during the COVID-19 pandemic, the Department of Pharmaceutical Care initiated a departmental crisis preparedness plan, as a part of general hospital preparedness plan. It started with adjusting medication dosing time, instituting a daily medication refill process, working remotely, expanding the use of automation, and modifying employee schedules. Other actions included the following: handling drug shortages, placing restrictions on some medications, using personal protective equipment, changing routine practices of pharmacy aides, revising the medication delivery process, starting a contingency training program, and restricting pneumatic tube operation. We took guidance from the Ministry of Health, our own institute's experience, World Health Organization recommendations, updated scientific research, and the American Society of Health-System Pharmacists regulatory updates. This article aims to describe how health services, policies, and systems were applied and adapted to address a specific problem while maintaining all pharmacy employees' safety. This article reviews the inpatient pharmacy's particular needs and responses to these needs to meet the COVID-19 pandemic challenges.

Barriers to providing internet-based home care services for urban older adults in China: a qualitative study of the service providers.

BACKGROUND: Due to the increasingly aging population in China and the changes in social and family structure, older adults' care problems are becoming more and more prominent. To meet the home care needs of urban older adults, the Chinese government has launched Internet-Based Home Care Services (IBHCS). Although this model innovation can significantly relieve care problems, more and more evidence shows that there are many barriers in the process of IBHCS supply. The current literature is mostly from the perspective of the service users, and there are very few studies on the experience of service providers. METHODS: In this study, we took a qualitative phenomenological approach and used semi-structured interviews to investigate service providers' daily experiences and the barriers they encounter. A total of 34 staff from 14 Home Care Service Centers (HCSCs) were included. Interviews were transcribed and analyzed using thematic analysis. RESULTS: We identified the barriers that service providers encounter in IBHCS supply: (1) bureaucratic repression: unreasonable policy plans, harsh assessment, excessive paperwork, different preferences of government leaders, and obstacles caused by COVID-19 control lead to a shift of focus in their work; (2) profitability crisis in the market: high service costs, dampened effective demand, government intervention in setting prices, and parent companies' excessively high sales targets hinder the service supply process; (3) client-related challenges: the crisis of confidence, the dilemma of popularizing new technology, and communication barriers lead to rejection by older adults; (4) job dissatisfaction: low and unstable salary, heavy tasks, poor social acceptance of occupations, and lack of professional value reduce work enthusiasm. CONCLUSION: We have investigated the barriers faced by service providers when providing IBHCS for urban older adults in China, providing empirical evidence in the Chinese context for the relevant literature. In order to provide IBHCS better, it is necessary to improve the institutional environment and market environment, strengthen publicity and communication, target customer needs, and adjust the working conditions of front-line workers.

Emerging fields of practice in American social work

Since its beginnings, American social work has evolved in response to social injustices and human needs confronting our society. Social workers have assisted immigrants in resettlement and developed policy for financial assistance and alleviation of poverty for millions of Americans. They engaged in the fight for civil rights;worked to combat stigma;and gained services for many disenfranchised groups, including those afflicted with HIV, the mentally ill, the addicted, the homeless, and survivors of violence. Increasingly, social workers are moving into spaces where they can provide help and support more readily and with less stigma than more traditional practice settings have afforded. And although social workers have long been involved in disasters as first responders, the COVID-19 pandemic is a strong impetus for the profession to reconceptualize the practice of social work in the face of a health crisis that requires a multidimensional response to needed social care. On the micro level, social workers who are skilled in trauma-based work will also find their skills and expertise in greater demand as many first responders, health care providers, and families who experienced the loss of loved ones will require mental health services. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Family caregiver involvement and role in hospital at home for adults: the patients' and family caregivers' perspective - a Norwegian qualitative study.

BACKGROUND: Hospital at home (HaH) provides acute healthcare services in patients' homes instead of traditional in-patient care. Research has reported positive outcomes for patients and reduced costs. Although HaH has developed into a global concept, we have little knowledge about the involvement and role of family caregivers (FCs) of adults. The aim of this study was to explore FC involvement and role during HaH treatment as perceived by patients and FCs in a Norwegian healthcare context. METHODS: A qualitative study was carried out among seven patients and nine FCs in Mid-Norway. The data was obtained through fifteen semi-structured interviews; fourteen were performed individually and one as duad interview. The age of the participants varied between 31 and 73 years, and mean age of 57 years. A hermeneutic phenomenological approach was used, and the analysis was performed according to Kvale and Brinkmann's description of interpretation. RESULTS: We identified three main categories and seven subcategories regarding FC involvement and role in HaH: (1) Preparing for something new and unfamiliar, including the subcategories `Lack of involvement in the decision process` and `Information overload affecting caregiver readiness`, (2) Adjusting to a new everyday life at home, including the subcategories `The critical first days at home`, `Coherent care and support in a novel situation`, and `Prior established family roles influencing the new everyday life at home`, (3) FCs` role gradually diminishes and looking back, including the subcategories `A smooth transition to life beyond hospital at home` and `Finding meaning and motivation in providing care`. CONCLUSIONS: FCs played an important role in HaH, although their tasks, involvement and effort varied across different phases during HaH treatment. The study findings contribute to a greater understanding of the dynamic nature of the caregiver experiences during HaH treatment, which can guide healthcare professionals on how they can provide timely and appropriate support to FCs in HaH over time. Such knowledge is important to decrease the risk of caregiver distress during HaH treatment. Further work, such as longitudinal studies, should be done to examine the course of caregiving in HaH over time to correct or support the phases described in this study.

Examining the care of noncommunicable diseases at the first level of providing services during the COVID-19 pandemic.

Aim: Providing services for patients with noncommunicable diseases is one of the main responsibilities of health systems. During the COVID-19 pandemic, the care of these patients faced problems. This study investigates the ways of providing optimal care to patients during pandemics like COVID-19. Subject and methods: This study was conducted in 2021 in Tehran province using an analytical cross-sectional method. Six hundred participants were selected for the study. In order to examine the challenges and solutions for receiving services, a questionnaire was completed and its reliability and validity were checked; finally, a telephone interview was completed over a period of 3 months. Results: Among study participants, 68.2% were female, and the highest percentage was in the age group of 50-60 years. Fifty-four percent were illiterate or had primary education, 48.8% had diabetes, 42.8% had high blood pressure, and 8.3% had both diseases. Forty-three percent of the interviewees had not used health care services during the COVID-19 pandemic, the main reason for which was the fear of contracting COVID-19. The outbreak of coronavirus disease had affected the care of noncommunicable diseases for 63% of the interviewees. Conclusion: The fundamental need for changes in the health system was revealed by the COVID-19 pandemic. The need for flexibility in the health system will inevitably arise when similar cases occur, and policymakers and managers should consider necessary measures in this regard. The use of new technologies is one of the ways to replace traditional models.

COVID-19 emergency operator support: Bologna Local Health Unit Prevention and Protection Service

At the start of the Covid-19 pandemic, the Bologna Local Health Unit Prevention and Protection Service began to receive a number of various requests. From this, the idea of setting up a programme for colleagues emerged, and a phone number was established to address the needs of operators. After an initial evaluation, operators were referred to specific professional figures. The service's psychologists dealt with the requests received by offering different types of interventions. This report presents and discusses the results of this experience regarding the operators who used the service, the interventions implemented and the feedback received. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Italian) All'inizio della pandemia da COVID-19 sono iniziate a pervenire numerose richieste di diversa natura presso il Servizio Prevenzione e Protezione dell'AUSL di Bologna. Da questi elementi e nata l'idea di pianificare un percorso dedicato ai colleghi attraverso l'istituzione di un numero telefonico per l'accoglienza dei bisogni degli operatori. A una prima accoglienza si rimandava a figure professionali specifiche. Gli psicologi del Servizio hanno preso in carico le richieste pervenute offrendo diverse tipologie di interventi. Nel presente elaborato sono presentati e discussi i risultati di questa esperienza relativi ai lavoratori che hanno usufruito del servizio, gli interventi attuati e i feedback ricevuti. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

[Management of COVID-19 pandemic in hospital at home in two regional Spanish hospitals. what it meant, who we cared for, who died and how assistance has evolved over time]. / Manejo de la pandemia de COVID-19 en hospitalización domiciliaria en dos hospitales comarcales españoles: qué significó, quiénes atendimos, quién falleció y como evolucionó la asistencia a lo largo del tiempo.

OBJECTIVE: Home Hospitalization (HH) is an alternative hospitalization modality that can be very useful in times of health stress such as the COVID-19 pandemic. This paper includes the management of patients admitted with COVID-19 in HH in two county spanish hospitals for two years. METHODS: A descriptive, observational and retrospective study of all patients admitted at HH with a diagnosis of COVID-19 disease was carried out. Subsequently, further analysis was carried out to characterize the patients who died in HH or 30 days after discharge and another to compare the management between the first phase of the study (2020) and the second one (2021 and part of 2022). RESULTS: A total of 167 patients were recruited. A 52.1% moved to watch that the recovery continued compared to 40.7% in which it was done to watch that they did not worsen. The patients who died in HAD were older (mean 87.5 years), more comorbid and more likely to have do-not resucitate orders (DNR) in case of cardiac arrest (85%). In the second phase of the study, older patients, more comorbid patients and with a greater degree of DNR orders were admitted than those admitted throughout 2020. CONCLUSIONS: HAD is a useful resource to increase the resilience of health systems in cases of stress such as the disease caused by COVID-19. The development and growth of existing units, as well as the creation of new ones where they do not exist, could be a basic tool for the medicine of the future.

[Barriers and facilitators to confronting HIV/aids and syphilis experienced by Venezuelan women living in BrazilFactores facilitadores y barreras que tienen las mujeres venezolanas residentes en Brasil respecto de la infección por el VIH/sida y la sífilis]. / Barreiras e facilitadores do enfrentamento de HIV/aids e sífilis por venezuelanas residentes no Brasil.

Objective: To describe the perception of Venezuelan women regarding access to health care, diagnosis, and treatment of HIV/aids and syphilis in Brazil. Method: This is a descriptive, exploratory study employing a qualitative approach, performed from February to May 2021 in the municipalities of Manaus, state of Amazonas, and Boa Vista, state of Roraima. The interviews with participants were fully transcribed, with identification of themes based on content analysis. Results: Forty women were interviewed (20 in Manaus and 20 in Boa Vista). Following transcription and translation of the accounts, two analytical categories were identified: barriers to healthcare access, with four subcategories - language, cost, adverse drug reactions, and COVID-19 pandemic; and facilitators of healthcare access, again with four subcategories - Unified Health System (SUS), National Policy of Comprehensive Women's Health, National Social Assistance Policy, and relationship between healthcare professionals and SUS users. Conclusion: The results showed the need to design strategies to mitigate the difficulties faced by migrant women from Venezuela living in Brazil regarding the diagnosis and treatment of HIV/aids and syphilis, going beyond the healthcare support guaranteed by law.

Objetivo: Describir la percepción de las mujeres venezolanas sobre el acceso a los servicios de salud, al diagnóstico y al tratamiento de la infección por el VIH/sida y la sífilis en Brasil. Métodos: Se trata de un estudio descriptivo y exploratorio, con enfoque cualitativo, realizado entre febrero y mayo del 2021 en los municipios de Manaos, estado de Amazonas, y Boa Vista, estado de Roraima. Las entrevistas con las participantes se transcribieron en su totalidad, y se exploraron los puntos de interés según el análisis del contenido. Resultados: Se entrevistaron 40 mujeres (20 en Manaos y 20 en Boa Vista). A partir de la transcripción y la traducción de las conversaciones, se establecieron dos categorías para el análisis del contenido: las barreras de acceso a los servicios de salud (subcategorías: idioma, costos relacionados con la salud, reacciones adversas a los medicamentos y pandemia de COVID-19); y los factores facilitadores del acceso (cuatro subcategorías: Sistema Único de Salud, Política nacional de Atención Integral a la Salud de la Mujer, Política Nacional de Asistencia Social y relación entre los profesionales de salud y las usuarias del Sistema Único de Salud). Conclusión: Los resultados mostraron la necesidad de formular estrategias para mitigar las dificultades que enfrentan las mujeres migrantes de Venezuela residentes en Brasil en relación con el diagnóstico y el tratamiento de la infección por el VIH/sida y la sífilis, más allá de la protección de la salud garantizada por la ley.

Hospital at Home: Paying for What It's Worth

Am J Manag Care. 2021;27(9):369-371. https://doi.org/10.37765/ajmc.2021.88739 _____ Takeaway Points A framework centered around cost, quality, and equity is essential to define the value of hospital-at-home programs. * Validated disease-specific tools should be consistently used to measure process metrics, outcome metrics, quality-of-life measures, and caregiver satisfaction measures. * Equity-focused process metrics, care utilization measures, and risk-adjusted outcome metrics should be reported. * Total costs of care for hospital-at-home programs should be consistently measured through a time-driven activity-based costing method. * Personal, societal, technical, and allocative value should be considered when determining the value of hospital-at-home programs. _____ In recent years, home health care has grown to 3% of overall US health care spending.1 Investment in home health care delivery including telemedicine grew considerably during the COVID-19 pandemic.2 One area that has lagged in terms of growth has been the hospital-at-home model. For home health agencies (different from hospital-at-home programs, which provide more acute care services), CMS uses a more comprehensive Home Health Quality Reporting process to assess risk-adjusted process measures, outcomes measures, occurrences of adverse events, utilization of care measures, and cost measures.9 After the COVID-19 pandemic, similar reporting processes should be implemented for measuring the quality and outcomes of hospital-at-home programs. Because hospital-at-home programs share features of both inpatient hospital admissions and home health agencies, they are uniquely positioned to both treat the patient acutely and improve the living conditions and resources that led to the acute illness. The American Heart Association's Get With the Guidelines – Heart Failure, an in-hospital program, describes a comprehensive, robust set of quality measurements including process and outcome measurements for heart failure management.11 Process metrics include assessment of left ventricular ejection fraction, adherence to guideline-recommended medical therapy at discharge, and scheduled follow-up;process metrics correlate well to high-quality heart failure care.12 Outcome metrics include 30-day mortality and 30-day readmission rates.12 Although hospital-at-home programs have been associated with lower costs, these cost reductions are mostly due to reduced length of hospitalization,13 number of consultations,14 and clinical testing.13 It is yet unclear if the reduction in services utilized also leads to a reduction in value for the patient—either through fewer completed process metrics or significantly increased caregiver burden. Of 34 studies included in a meta-analysis comparing the costs of hospital at home with those of hospitalizations, 32 studies found hospital at home to cost less.3 For example, in a recent randomized controlled trial evaluating patients treated in a hospital-at-home program compared with those treated in a traditional hospital, the risk-adjusted cost reduction of home care management was 19%.15 In this trial, costs were calculated by summing the costs of labor, equipment, medications, laboratory tests, imaging tests, and transport during the period of hospitalization.15 In hospital-at-home models, cost savings are thought to be achieved due to reduced length of hospitalization,13 decreased number of consultations,14 reduced nursing labor costs,15 and decreased clinical testing.13 However, no uniform method exists to track and assess costs,16 and there is worry that the costs of hospital-at-home programs are underestimated.17 To fill this gap, these programs should report and analyze the total costs of care—including costs incurred by patients and their caregivers—rather than simply the reimbursement rates for care.

Telemedicine Use by Age in Louisiana Medicaid During COVID-19: Claims-Based Longitudinal Analysis.

BACKGROUND: Limited availability of in-person health care services and fear of contracting COVID-19 during the pandemic promoted an increased reliance on telemedicine. However, long-standing inequities in telemedicine due to unequal levels of digital literacy and internet connectivity among different age groups raise concerns about whether the uptake of telemedicine has exacerbated or alleviated those inequities. OBJECTIVE: The aim of this study is to examine changes in telemedicine and in-person health service use during the COVID-19 pandemic across age groups for Medicaid beneficiaries in the state of Louisiana. METHODS: Interrupted time series models were used on Louisiana Medicaid claims data to estimate trends in total, in-person, and telemedicine monthly office visit claims per 1000 Medicaid beneficiaries between January 2018 and December 2020. Changes in care pattern trends and levels were estimated around the infection peaks (April 2020 and July 2020) and for an end-of-year infection leveling off period (December 2020). Four mutually exclusive age categories (0 to 17, 18 to 34, 35 to 49, and 50 to 64 years) were used to compare the differences. RESULTS: Prior to the COVID-19 pandemic, telemedicine services accounted for less than 1% of total office visit claim volume across the age groups. Each age group followed similar patterns of sharp increases in April 2020, downward trends until sharp increases again in July 2020, followed by flat trends thereafter until December 2020. These sharp increases were most pronounced for older patients, with those aged 50 to 64 years seeing increases of 184.09 telemedicine claims per 1000 Medicaid beneficiaries in April 2020 (95% CI 172.19 to 195.99) and 120.81 in July 2020 (95% CI 101.32 to 140.31) compared with those aged 18 to 34 years, seeing increases of 84.47 (95% CI 78.64 to 90.31) and 57.00 (95% CI 48.21 to 65.79), respectively. This resulted in overall changes from baseline to December 2020 levels of 123.65 (95% CI 112.79 to 134.51) for those aged 50 to 64 years compared with 59.07 (95% CI 53.89 to 64.24) for those aged 18 to 34 years. CONCLUSIONS: Older Medicaid beneficiaries in Louisiana had higher rates of telemedicine claim volume during the COVID-19 pandemic compared with younger beneficiaries.

The Evaluation of Health Care Services for Children and Adolescents With Post-COVID-19 Condition: Protocol for a Prospective Longitudinal Study.

BACKGROUND: Some children and adolescents suffer from late effects of a SARS-CoV-2 infection despite a frequently mild course of the disease. Nevertheless, extensive care for post-COVID-19 condition, also known as post-COVID-19 syndrome, in children and young people is not yet available. A comprehensive care network, Post-COVID Kids Bavaria (PoCo), for children and adolescents with post-COVID-19 condition has been set up as a model project in Bavaria, Germany. OBJECTIVE: The aim of this study is to evaluate the health care services provided within this network structure of care for children and adolescents with post-COVID-19 condition in a pre-post study design. METHODS: We have already recruited 117 children and adolescents aged up to 17 years with post-COVID-19 condition who were diagnosed and treated in 16 participating outpatient clinics. Health care use, treatment satisfaction, patient-reported outcomes related to health-related quality of life (the primary endpoint), fatigue, postexertional malaise, and mental health are being assessed at different time points (at baseline and after 4 weeks, 3 months, and 6 months) using routine data, interviews, and self-report questionnaires. RESULTS: The study recruitment process ran from April 2022 until December 2022. Interim analyses will be carried out. A full analysis of the data will be conducted after follow-up assessment is completed, and the results will be published. CONCLUSIONS: The results will contribute to the evaluation of therapeutic services provided for post-COVID-19 condition in children and adolescents, and avenues for optimizing care may be identified. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41010.

Identification of Key Factors for Optimized Health Care Services: Protocol for a Multiphase Study of the Dubai Vaccination Campaign.

BACKGROUND: Mass vaccination of the global population against the novel COVID-19 outbreak posed multiple challenges, including effectively administering millions of doses in a short period of time while ensuring public safety and accessibility. The government of Dubai launched a mass campaign in December 2020 to vaccinate all its citizens and residents, targeting the population aged >18 years against COVID-19. The vaccination campaign involved a transformation of multiple commercial spaces into mass vaccination centers across the city of Dubai, the largest of which was the Dubai One Central (DOC) vaccination center. It was operational between January 17, 2021, and 27 January 27, 2022. OBJECTIVE: The multiphase research study aims to empirically explore the opinions of multiple health care stakeholders, elicit the key success factors that can influence the effective delivery of emergency health care services such as a COVID-19 mass vaccination center, and explore how these factors relate to one another. METHODS: To understand more about the operations of the DOC vaccination center, the study follows a multiphase design divided into 2 phases. The study is being conducted by the Institute for Excellence in Health Professions Education at Mohammed Bin Rashid University of Medicine and Health Sciences between December 2021 and January 2023. To elicit the key success factors that contributed to the vaccination campaign administered at DOC, the research team conducted 30 semistructured interviews (SSIs) with a sample of staff and volunteers who worked at the DOC vaccination center. Stratified random sampling was used to select the participants, and the interview cohort included representatives from the management team, team leaders, the administration and registration team, vaccinators, and volunteers. A total of 103 people were invited to take part in the research study, and 30 agreed to participate in the SSIs. To validate the participation of various stakeholders, phase 2 will analytically investigate one's subjectivity through Q-methodology and empirically investigate the opinions obtained from the research participants during phase 1. RESULTS: As of July 2022, 30 SSIs were conducted with the research participants. CONCLUSIONS: The study will provide a comprehensive 2-phase approach to obtaining the key success factors that can influence the delivery of high-quality health care services such as emergency services launched during a global pandemic. The study's findings will be translated into key factors that could support designing future health care services utilizing evidence-based practice. In line with future plans, a study will use data, collected through the DOC vaccination center, to develop a simulation model outlining the process of the customer journey and center workflow. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42278.

Managers' strategies in handling the COVID-19 pandemic in Norwegian nursing homes and homecare services.

PURPOSE: This study aims to explore nursing home and home care managers' strategies in handling the COVID-19 pandemic. DESIGN/METHODOLOGY/APPROACH: This study has a qualitative design with semistructured individual interviews conducted digitally by videophone (Zoom). Eight managers from nursing homes and five managers from home care services located in a large urban municipality in eastern Norway participated. Systematic text condensation methodology was used for the analysis. FINDINGS: The managers used several strategies to handle challenges related to the COVID-19 pandemic, including being proactive and thinking ahead in terms of possible scenarios that might occur, continuously training of staff in new procedures and routines and systematic information sharing at all levels, as well as providing different ways of disseminating information for staff, service users and next-of-kins. To handle staffing challenges, managers used strategies such as hiring short-term staff that were temporary laid off from other industries and bringing in students. ORIGINALITY/VALUE: The COVID-19 pandemic heavily affected health-care systems worldwide, which has led to many health-care studies. The situation in nursing homes and home care services, which were strongly impacted by the pandemic and in charge of a vulnerable group of people, has not yet received enough attention in research. This study, therefore, seeks to contribute to this research gap by investigating how managers in nursing homes and home care services used different strategies to handle the COVID-19 pandemic.

Acceptability of contact management and care of simple cases of COVID-19 at home: a cross-sectional study in Senegal.

BACKGROUND: COVID-19 is a major public health problem. In mid-2020, due to the health system challenges from increased COVID-19 cases, the Ministry of Health and Social Action in Senegal opted for contact management and care of simple cases at home. The objective of the study was to determine the acceptability of contact and simple case management of COVID-19 at home and its associated factors in Senegal. METHODS: This was a descriptive and analytical cross-sectional study. We collected data from 11 June to 10 July 2020. We used a marginal quota sampling strategy. A total of 813 individuals took part in the survey. We collected data using a telephone interview. RESULTS: The care of simple cases of COVID-19 at home was well accepted (78.5%). The use of home contact management was less accepted (51.4%). Knowledge of the modes of transmission of the virus and confidence in institutional information were associated with the acceptability of home care for simple cases. Regularly searching for information on COVID-19 and confidence in the government's control of the epidemic were associated with the acceptability of managing contacts at home. CONCLUSIONS: Authorities should take these factors into account for better communication to improve the acceptability and confidence in home-based care for COVID-19 and future epidemics.