Improving Patient Health Literacy During Telehealth Visits Through Remote Teach-Back Methods Training for Family Medicine Residents: Pilot 2-Arm Cluster, Nonrandomized Controlled Trial.

BACKGROUND: As telemedicine plays an increasing role in health care delivery, providers are expected to receive adequate training to effectively communicate with patients during telemedicine encounters. Teach-back is an approach that verifies patients' understanding of the health care information provided by health care professionals. Including patients in the design and development of teach-back training content for providers can result in more relevant training content. However, only a limited number of studies embrace patient engagement in this capacity, and none for remote care settings. OBJECTIVE: We aimed to design and evaluate the feasibility of patient-centered, telehealth-focused teach-back training for family medicine residents to promote the use of teach-back during remote visits. METHODS: We codeveloped the POTENTIAL (Platform to Enhance Teach-Back Methods in Virtual Care Visits) curriculum for medical residents to promote teach-back during remote visits. A patient participated in the development of the workshop's videos and in a patient-provider panel about teach-back. We conducted a pilot, 2-arm cluster, nonrandomized controlled trial. Family medicine residents at the intervention site (n=12) received didactic and simulation-based training in addition to weekly cues-to-action. Assessment included pre- and postsurveys, observations of residents, and interviews with patients and providers. To assess differences between pre- and postintervention scores among the intervention group, chi-square and 1-tailed t tests were used. A total of 4 difference-in-difference models were constructed to evaluate prepost differences between intervention and control groups for each of the following outcomes: familiarity with teach-back, importance of teach-back, confidence in teach-back ability, and ease of use of teach-back. RESULTS: Medical residents highly rated their experience of the teach-back training sessions (mean 8.6/10). Most residents (9/12, 75%) used plain language during training simulations, and over half asked the role-playing patient to use their own words to explain what they were told during the encounter. Postintervention, there was an increase in residents' confidence in their ability to use teach-back (mean 7.33 vs 7.83; P=.04), but there was no statistically significant difference in familiarity with, perception of importance, or ease of use of teach-back. None of the difference-in-difference models were statistically significant. The main barrier to practicing teach-back was time constraints. CONCLUSIONS: This study highlights ways to effectively integrate best-practice training in telehealth teach-back skills into a medical residency program. At the same time, this pilot study points to important opportunities for improvement for similar interventions in future larger-scale implementation efforts, as well as ways to mitigate providers' concerns or barriers to incorporating teach-back in their practice. Teach-back can impact remote practice by increasing providers' ability to actively engage and empower patients by using the features (whiteboards, chat rooms, and mini-views) of their remote platform.

Equal work for unequal pay: the gender reimbursement gap for healthcare providers in the United States.

INTRODUCTION: Gender disparities in income continue to exist, and many studies have quantified the gap between male and female workers. These studies paint an incomplete picture of gender income disparity because of their reliance on notoriously inaccurate or incomplete surveys. We quantified gender reimbursement disparity between female and male healthcare providers using objective, non-self-reported data and attempted to adjust the disparity against commonly held beliefs as to why it exists. METHODS: We analysed over three million publicly available Medicare reimbursement claims for calendar year 2012 and compared the reimbursements received by male and female healthcare providers in 13 medical specialties. We adjusted these reimbursement totals against how hard providers worked, how productive each provider was, and their level of experience. We calculated a reimbursement differential between male and female providers by primary medical specialty. RESULTS: The overall adjusted reimbursement differential against female providers was -US$18 677.23 (95% CI -US$19 301.94 to -US$18 052.53). All 13 specialties displayed a negative reimbursement differential against female providers. Only two specialties had reimbursement differentials that were not statistically significant. CONCLUSIONS: After adjustment for how hard a physician works, his/her years of experience and his/her productivity, female healthcare providers are still reimbursed less than male providers. Using objective, non-survey data will provide a more accurate understanding of this reimbursement inequity and perhaps lead the medical profession (as a whole) towards a solution that can reverse this decades-old injustice.

A church-based intervention to change attitudes about physical activity among Black adolescent girls: a feasibility study.

OBJECTIVE: To feasibility test a 12-week church-based physical activity intervention that was culturally sensitive, age- and gender specific directed at changing attitudes of Black adolescent girls' to be more physically active. DESIGN AND SAMPLE: A one-group pre- and posttest design was used. A convenience sample of Black adolescent girls between the age of 12-18 (n = 41). INTERVENTION: A 60-min 12-week church-based program that included interactive educational sessions followed by a high energy dance aerobics class was used. MEASURES: Data were collected on biophysical measures. Surveys were used to assess the following variables: attitudes, enjoyment, self-efficacy, intention, social and family support, and PA levels. RESULTS: Paired t-tests and repeated measures ANOVA revealed no significant changes in key variables. Positive changes were noted in the odds ratios for attitudes, self-efficacy, and intention. Body mass index, metabolic equivalent tasks, and fitness showed positive trends from pre to post intervention. Family support was significantly correlated with physical activity level (p < .01). CONCLUSIONS: The study showed that physical activity programs in Black churches aimed at Black adolescent girls are feasible. Participants evaluated the intervention very favorably. Family support may be a key factor in increasing physical activity levels in Black adolescent girls.

Physical inactivity in female African-American adolescents: consequences, costs, & care.

Physical inactivity is a major public health problem and there is a higher prevalence of physical inactivity in female African-American adolescents. Physical inactivity is an independent risk factor for many chronic diseases such as heart disease, hypertension, diabetes, and obesity, which are associated with increased morbidity and mortality. Therefore, addressing physical inactivity during adolescence may be a key to reducing health disparities and to improving the health of female African-American adolescents both now and in their future womanhood. This paper presents an overview of the substantial health and economic consequences that are associated with physical inactivity. In addition, family focused, community-oriented, and church-based strategies that are aimed at increasing physical activity in female African-American adolescents are discussed.