RESUMO
Background: Televisits have become a more widely used since the COVID pandemic in 2020. However, pts in underserved populations may not be as knowledgable about electronic health resources and may not be able to access this type of health care visit, worsening health care disparities. We examined the relationship between electronic health literacy and acceptance of televisits in an underserved inner-City population of pts with CKD. Method(s): 38 randomly selected CKD pts were surveyed in a face to face fashion including a demographics section, the eHEALS electronic health literacy assessment (scored from 8 to 40), and additional sections on televisit history. eHEALS is a validated 8 question survey that characterizes the subjective ability to find and use electronic health resources. Result(s): Mean age of the pts. was 67+/-15 yrs. 66% were female, 74% did not attend any college, 60% make less than $25,000 per year. 21% did not have any Internet access, 5.3% did not own a cell phone, and 5.3% of cell phone owners did not own a smart phone. 61% need help using the internet. The mean eHEALS of those who need help using the internet is 21.1+/-6.0 vs 27.5+/-8.6 (p=<0.05) for those who do not need help.76% of pts. had a televisit before the survey, of which 76% were telephone only and 24% had visits by both telephone and video. No participant had only used video. Those who had televisits did not differ based on age, education, gender and income from those who did not. Of the 24% of participants who did not have televisits, 100% need help using the internet vs 48% who had televisits (p=0.006). Mean eHEALS score of those who had a televisit was 25.1+/-7.9 vs 18.9+/-4.9 for those who did not (p=0.01). Conclusion(s): In our population of older inner-city CKD patients, 1. Almost one quarter had no home internet access, and over half needed help using it 2. Pts who needed help had lower eHealth literacy and were less likely to have televisits. 3. Televisit use related to eHealth literacy rather than age, education or income. 4. Administering eHEALS may identify people who would benefit most from in person visits, directed educational materials to help with televisits or for whom support should be provided 5. The rise in use of telehealth may further health resource inequities if eHealth literacy is not recognized as a potential negative social determinant in vulnerable populations.
RESUMO
Background: Studying how vaccination hesitancy has changed since the onset of the pandemic and understanding what changed people's opinions could help improve vaccination rate in susceptible populations with high background refusal rates. Method(s): Randomly selected hemodialysis patients in an inner-City Unit were surveyed in 2020 (19 by telephone) and 2021 (31 face to face) about vaccination history and attitudes towards vaccines. In 2020 participants were asked if they would receive a COVID-19 vaccine if available and in 2021 if they had received the vaccine. Respondents who planned to received the vaccine (2020) or received one or both doses (2021) were counted as VACYES while those who were unsure or refused were classified as VACNO. Respondents were also asked their primary reasons for their choice. Result(s): The 2021 group had a mean age of 56.1 +/- 17.9 yrs., mean time on dialysis was 6.2 +/- 7.2 yrs. There were 18 (58%) women and 13 (42%) men, 28 (90%) identified as black. The 2020 and 2021 groups were similar with respect to age, time on dialysis, sex, and race. In 2020, 21% were classified as VACYES compared to 84% of the 2021 sample (p < 0.001). Among VACNO pts the most commonly cited reason was "Safety" (80%). Between vaccinated and unvaccinated patients in 2021, there were no statistically significant differences with respect to age, time on dialysis, sex, race, education, insurance status and presence of diabetes. Among VACYES pts. the three most commonly cited reasons for their choice were "Recommended for people with underlying conditions" (38%), "Trust in healthcare" (45%), and "Safety of the vaccine" (44%). Conclusion(s): In our inner-city population: 1. Although people in our catchment have a low vaccination rate the majority of the dialysis population studied received the vaccine despite initial hesitancy. 2. Recommendations related to underlying conditions, improved confidence in the safety of the vaccine and trust in healthcare were the most important reasons for acceptance. 3. With vaccine efforts still underway, education programs should continue to focus on stressing the importance in people with underlying conditions, improving patient-provider partnering, and disseminating information regarding vaccine safety in order to improve adherence in our kidney disease patients, in whom almost 20% remain unvaccinated.