Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 37
Filter
6.
Prev Chronic Dis ; 18: E65, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1291281

ABSTRACT

INTRODUCTION: Telehealth plays a role in the continuum of care, especially for older adults during the COVID-19 pandemic. Our objective was to examine factors associated with the accessibility of telehealth services during the COVID-19 pandemic among older adults. METHODS: We analyzed the nationally representative Medicare Current Beneficiary Survey COVID-19 Rapid Response Supplement Questionnaire of beneficiaries aged 65 years or older. Two weighted multivariable logistic regression models were used to examine associations between usual providers who offered telehealth 1) during the COVID-19 pandemic and 2) to replace a regularly scheduled appointment. We examined factors including sociodemographic characteristics, comorbidities, and digital access and literacy. RESULTS: Of the beneficiaries (n = 6,172, weighted n = 32.4 million), 81.2% reported that their usual providers offered telehealth during the COVID-19 pandemic. Among those offered telehealth services, 56.8% reported that their usual providers offered telehealth to replace a regularly scheduled appointment. Disparities in accessibility of telehealth services by sex, residing area (metropolitan vs nonmetropolitan), income level, and US Census region were observed. Beneficiaries who reported having internet access (vs no access) (OR, 1.75, P < .001) and who reported ever having participated in video, voice, or conference calls over the internet before (vs not) (OR, 2.18, P < .001) were more likely to report having access to telehealth. Non-Hispanic Black beneficiaries (versus White) (OR, 1.57, P = .007) and beneficiaries with comorbidities (vs none) (eg, 2 or 3 comorbidities, OR, 1.25, 95% P = .044) were more likely to have their usual provider offer telehealth to replace a regularly scheduled appointment. CONCLUSION: Although accessibility of telehealth has increased, inequities raise concern. Educational outreach and training, such as installing and launching an online web conferencing platform, should be considered for improving accessibility of telehealth to vulnerable populations beyond the COVID-19 pandemic.


Subject(s)
COVID-19 , Health Services Accessibility , Healthcare Disparities , Infection Control/methods , Medicare/statistics & numerical data , Telemedicine , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Comorbidity , Cross-Sectional Studies , Demography , Female , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/ethnology , Healthcare Disparities/organization & administration , Humans , Internet Access/statistics & numerical data , Male , Needs Assessment , SARS-CoV-2 , Socioeconomic Factors , Telemedicine/methods , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , United States/epidemiology
8.
J Clin Endocrinol Metab ; 106(12): e4887-e4902, 2021 11 19.
Article in English | MEDLINE | ID: covidwho-1175358

ABSTRACT

Unacceptable healthcare disparities in endocrine disease have persisted for decades, and 2021 presents a difficult evolving environment. The COVID-19 pandemic has highlighted the gross structural inequities that drive health disparities, and antiracism demonstrations remind us that the struggle for human rights continues. Increased public awareness and discussion of disparities present an urgent opportunity to advance health equity. However, it is more complicated to change the behavior of individuals and reform systems because societies are polarized into different factions that increasingly believe, accept, and live different realities. To reduce health disparities, clinicians must (1) truly commit to advancing health equity and intentionally act to reduce health disparities; (2) create a culture of equity by looking inwards for personal bias and outwards for the systemic biases built into their everyday work processes; (3) implement practical individual, organizational, and community interventions that address the root causes of the disparities; and (4) consider their roles in addressing social determinants of health and influencing healthcare payment policy to advance health equity. To care for diverse populations in 2021, clinicians must have self-insight and true understanding of heterogeneous patients, knowledge of evidence-based interventions, ability to adapt messaging and approaches, and facility with systems change and advocacy. Advancing health equity requires both science and art; evidence-based roadmaps and stories that guide the journey to better outcomes, judgment that informs how to change the behavior of patients, providers, communities, organizations, and policymakers, and passion and a moral mission to serve humanity.


Subject(s)
COVID-19/mortality , Endocrine System Diseases/therapy , Healthcare Disparities , Patient Care , Racism , Biomedical Research/ethics , Biomedical Research/legislation & jurisprudence , Biomedical Research/organization & administration , Biomedical Research/statistics & numerical data , COVID-19/psychology , Endocrine System Diseases/epidemiology , Endocrine System Diseases/mortality , Health Equity/organization & administration , Health Equity/trends , Health Policy/legislation & jurisprudence , Health Policy/trends , Healthcare Disparities/organization & administration , Healthcare Disparities/trends , Humans , Pandemics , Patient Care/ethics , Patient Care/standards , Patient Care/trends , Racism/prevention & control , Racism/trends , SARS-CoV-2
9.
Emerg Med J ; 38(6): 474-476, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1120760

ABSTRACT

The use of telemedicine has grown immensely during the COVID-19 pandemic. Telemedicine provides a means to deliver clinical care while limiting patient and provider exposure to the COVID-19. As such, telemedicine is finding applications in a variety of clinical environments including primary care and the acute care setting and the array of patient populations who use telemedicine continues to grow. Yet as telehealth becomes ubiquitous, it is critical to consider its potential to exacerbate disparities in care. Challenges accessing technology and digital literacy, for example, disproportionately impact older patients and those living in poverty. When implemented with the consideration of health disparities, telemedicine provides an opportunity to address these inequities. This manuscript explores potential mechanisms by which telemedicine may play a role in exacerbating or ameliorating disparities in care. We further describe a framework and suggested strategies with which to implement telemedicine systems to improve health equity.


Subject(s)
Digital Divide , Health Equity/organization & administration , Telemedicine/organization & administration , COVID-19/epidemiology , COVID-19/therapy , Health Equity/statistics & numerical data , Healthcare Disparities/organization & administration , Healthcare Disparities/statistics & numerical data , Humans , Telemedicine/statistics & numerical data
10.
Ann Glob Health ; 87(1): 17, 2021 02 15.
Article in English | MEDLINE | ID: covidwho-1106313

ABSTRACT

Member States at this year's World Health Assembly 73 (WHA73), held virtually for the first time due to the COVID-19 pandemic, passed multiple resolutions that must be considered when framing efforts to strengthen surgical systems. Surgery has been a relatively neglected field in the global health landscape due to its nature as a cross-cutting treatment rather than focusing on a specific disease or demographic. However, in recent years, access to essential and emergency surgical, obstetric, and anesthesia care has gained increasing recognition as a vital aspect of global health. The WHA73 Resolutions concern specific conditions, as has been characteristic of global health practice, yet proper care for each highlighted disease is inextricably linked to surgical care. Global surgery advocates must recognize how surgical system strengthening aligns with these strategic priorities in order to ensure that surgical care continues to be integrated into efforts to decrease global health disparities.


Subject(s)
Anesthesia/standards , COVID-19 , General Surgery , Global Health , Health Services Accessibility/organization & administration , Healthcare Disparities/organization & administration , Obstetrics/standards , COVID-19/epidemiology , COVID-19/therapy , General Surgery/organization & administration , General Surgery/standards , Global Health/standards , Global Health/trends , Humans , Quality Improvement , SARS-CoV-2
12.
J Diabetes Sci Technol ; 15(5): 1005-1009, 2021 09.
Article in English | MEDLINE | ID: covidwho-1085175

ABSTRACT

The COVID-19 pandemic raised distinct challenges in the field of scarce resource allocation, a long-standing area of inquiry in the field of bioethics. Policymakers and states developed crisis guidelines for ventilator triage that incorporated such factors as immediate prognosis, long-term life expectancy, and current stage of life. Often these depend upon existing risk factors for severe illness, including diabetes. However, these algorithms generally failed to account for the underlying structural biases, including systematic racism and economic disparity, that rendered some patients more vulnerable to these conditions. This paper discusses this unique ethical challenge in resource allocation through the lens of care for patients with severe COVID-19 and diabetes.


Subject(s)
COVID-19/therapy , Diabetes Complications/therapy , Diabetes Mellitus/therapy , Resource Allocation , COVID-19/complications , COVID-19/epidemiology , Diabetes Complications/economics , Diabetes Complications/epidemiology , Diabetes Mellitus/economics , Diabetes Mellitus/epidemiology , Health Services Accessibility/economics , Health Services Accessibility/ethics , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Health Status Disparities , Healthcare Disparities/economics , Healthcare Disparities/ethics , Healthcare Disparities/organization & administration , Healthcare Disparities/statistics & numerical data , Humans , Pandemics , Racism/ethics , Racism/statistics & numerical data , Resource Allocation/economics , Resource Allocation/ethics , Resource Allocation/organization & administration , Resource Allocation/statistics & numerical data , Triage/economics , Triage/ethics , United States/epidemiology , Ventilators, Mechanical/economics , Ventilators, Mechanical/statistics & numerical data , Ventilators, Mechanical/supply & distribution
13.
Soc Work Health Care ; 60(1): 78-92, 2021.
Article in English | MEDLINE | ID: covidwho-1075337

ABSTRACT

The COVID-19 pandemic necessitated an immediate response and rapid transition from traditional face-to-face behavioral health services to behavioral telehealth at an organization serving sexual and gender diverse (SGD) individuals in Chicago. In this practice innovations article, we explore the unfolding public health crisis and the impact on service delivery for SGD individuals. Using a large multi-service organization as a case study, this paper describes how key members of the staff and leadership team shifted services online as a means of responding to isolation, loneliness, and disparities in access to healthcare for Chicago SGD communities. Lessons learned and practice recommendations are presented.


Subject(s)
COVID-19/epidemiology , Healthcare Disparities/organization & administration , Mental Health Services/organization & administration , Sexual and Gender Minorities , Telemedicine/organization & administration , Chicago/epidemiology , Humans , Pandemics , SARS-CoV-2
16.
Am J Respir Crit Care Med ; 203(3): 287-295, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1058133

ABSTRACT

The burdens of the coronavirus disease (COVID-19) pandemic have fallen disproportionately on disadvantaged groups, including the poor and Black, Latinx, and Indigenous communities. There is substantial concern that the use of existing ICU triage protocols to allocate scarce ventilators and critical care resources-most of which are designed to save as many lives as possible-may compound these inequities. As governments and health systems revisit their triage guidelines in the context of impending resource shortages, scholars have advocated a range of alternative allocation strategies, including the use of a random lottery to give all patients in need an equal chance of ICU treatment. However, both the save-the-most-lives approach and random allocation are seriously flawed. In this Perspective, we argue that ICU triage policies should simultaneously promote population health outcomes and mitigate health inequities. These ethical goals are sometimes in conflict, which will require balancing the goals of maximizing the number of lives saved and distributing health benefits equitably across society. We recommend three strategies to mitigate health inequities during ICU triage: introducing a correction factor into patients' triage scores to reduce the impact of baseline structural inequities; giving heightened priority to individuals in essential, high-risk occupations; and rejecting use of longer-term life expectancy and categorical exclusions as allocation criteria. We present a practical triage framework that incorporates these strategies and attends to the twin public health goals of promoting population health and social justice.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Critical Care/organization & administration , Healthcare Disparities/organization & administration , Triage/organization & administration , Vulnerable Populations/statistics & numerical data , Health Status Disparities , Humans
17.
Heart ; 107(5): 358-365, 2021 03.
Article in English | MEDLINE | ID: covidwho-1033548

ABSTRACT

The goals of this review are to evaluate the impact of socioeconomic (SE) status on the general health and cardiovascular health of individuals during the COVID-19 pandemic and also discuss the measures to address disparity. SE status is a strong predictor of premature morbidity and mortality within general health. A lower SE status also has implications of increased cardiovascular disease (CVD) mortality and poorer CVD risk factor profiles. CVD comorbidity is associated with a higher case severity and mortality rate from COVID-19, with both CVD and COVID-19 sharing important risk factors. The COVID-19 pandemic has adversely affected people of a lower SE status and of ethnic minority group, who in the most deprived regions are suffering double the mortality rate of the least deprived. The acute stress, economic recession and quarantine restrictions in the wake of COVID-19 are also predicted to cause a decline in mental health. This could pose substantial increase to CVD incidence, particularly with acute pathologies such as stroke, acute coronary syndrome and cardiogenic shock among lower SE status individuals and vulnerable elderly populations. Efforts to tackle SE status and CVD may aid in reducing avoidable deaths. The implementation of 'upstream' interventions and policies demonstrates promise in achieving the greatest population impact, aiming to protect and empower individuals. Specific measures may involve risk factor targeting restrictions on the availability and advertisement of tobacco, alcohol and high-fat and salt content food, and targeting SE disparity with healthy and secure workplaces.


Subject(s)
COVID-19 , Cardiovascular Diseases , Healthcare Disparities/organization & administration , Socioeconomic Factors , COVID-19/epidemiology , COVID-19/prevention & control , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Humans , Risk Factors , SARS-CoV-2
18.
Bull World Health Organ ; 98(12): 826-827, 2020 Dec 01.
Article in English | MEDLINE | ID: covidwho-1021823

ABSTRACT

Significant challenges need to be overcome to ensure eventual COVID-19 vaccines get to everyone who needs them. Andréia Azevedo Soares reports.


Subject(s)
COVID-19 Vaccines/supply & distribution , Health Services Accessibility/organization & administration , Healthcare Disparities/organization & administration , Brazil , Developing Countries , Humans , Pandemics , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL