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1.
J Stroke Cerebrovasc Dis ; 33(6): 107702, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38556068

ABSTRACT

OBJECTIVE: To examine the relationship between stroke care infrastructure and stroke quality-of-care outcomes at 29 spoke hospitals participating in the Medical University of South Carolina (MUSC) hub-and-spoke telestroke network. MATERIALS AND METHODS: Encounter-level data from MUSC's telestroke patient registry were filtered to include encounters during 2015-2022 for patients aged 18 and above with a clinical diagnosis of acute ischemic stroke, and who received intravenous tissue plasminogen activator. Unadjusted and adjusted generalized estimating equations assessed associations between time-related stroke quality-of-care metrics captured during the encounter and the existence of the two components of stroke care infrastructure-stroke coordinators and stroke center certifications-across all hospitals and within hospital subgroups defined by size and rurality. RESULTS: Telestroke encounters at spoke hospitals with stroke coordinators and stroke center certifications were associated with shorter door-to-needle (DTN) times (60.9 min for hospitals with both components and 57.3 min for hospitals with one, vs. 81.2 min for hospitals with neither component, p <.001). Similar patterns were observed for the percentage of encounters with DTN time of ≤60 min (63.8% and 68.9% vs. 32.0%, p <.001) and ≤45 min (34.0% and 38.4% vs. 8.42%, p <.001). Associations were similar for other metrics (e.g., door-to-registration time), and were stronger for smaller (vs. larger) hospitals and rural (vs. urban) hospitals. CONCLUSIONS: Stroke coordinators or stroke center certifications may be important for stroke quality of care, especially at spoke hospitals with limited resources or in rural areas.


Subject(s)
Delivery of Health Care, Integrated , Fibrinolytic Agents , Ischemic Stroke , Quality Indicators, Health Care , Registries , Telemedicine , Thrombolytic Therapy , Time-to-Treatment , Tissue Plasminogen Activator , Humans , South Carolina , Male , Female , Time Factors , Aged , Treatment Outcome , Delivery of Health Care, Integrated/organization & administration , Middle Aged , Quality Indicators, Health Care/standards , Tissue Plasminogen Activator/administration & dosage , Fibrinolytic Agents/administration & dosage , Ischemic Stroke/therapy , Ischemic Stroke/diagnosis , Aged, 80 and over , Models, Organizational , Rural Health Services/organization & administration , Rural Health Services/standards , Hospital Bed Capacity , Outcome and Process Assessment, Health Care/standards , Hospitals, Rural/standards , Urban Health Services/standards , Urban Health Services/organization & administration , Stroke/therapy , Stroke/diagnosis
2.
J Trauma Acute Care Surg ; 96(5): 702-707, 2024 May 01.
Article in English | MEDLINE | ID: mdl-38189675

ABSTRACT

INTRODUCTION: Military experience has demonstrated mortality improvement when advanced resuscitative care (ARC) is provided for trauma patients with severe hemorrhage. The benefits of ARC for trauma in civilian emergency medical services (EMS) systems with short transport intervals are still unknown. We hypothesized that ARC implementation in an urban EMS system would reduce in-hospital mortality. METHODS: This was a prospective analysis of ARC bundle administration between 2021 and 2023 in an urban EMS system with 70,000 annual responses. The ARC bundle consisted of calcium, tranexamic acid, and packed red blood cells via a rapid infuser. Advanced resuscitative care patients were compared with trauma registry controls from 2016 to 2019. Included were patients with a penetrating injury and systolic blood pressure ≤90 mm Hg. Excluded were isolated head trauma or prehospital cardiac arrest. In-hospital mortality was the primary outcome of interest. RESULTS: A total of 210 patients (ARC, 61; controls, 149) met the criteria. The median age was 32 years, with no difference in demographics, initial systolic blood pressure or heart rate recorded by EMS, or New Injury Severity Score between groups. At hospital arrival, ARC patients had lower median heart rate and shock index than controls ( p ≤ 0.03). Fewer patients in the ARC group required prehospital advanced airway placement ( p < 0.001). Twenty-four-hour and total in-hospital mortality were lower in the ARC group ( p ≤ 0.04). Multivariable regression revealed an independent reduction in in-hospital mortality with ARC (odds ratio, 0.19; 95% confidence interval, 0.05-0.68; p = 0.01). CONCLUSION: Early ARC in a fast-paced urban EMS system is achievable and may improve physiologic derangements while decreasing patient mortality. Advanced resuscitative care closer to the point of injury warrants consideration. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.


Subject(s)
Emergency Medical Services , Hospital Mortality , Humans , Male , Female , Adult , Emergency Medical Services/methods , Prospective Studies , Patient Care Bundles/methods , Resuscitation/methods , Middle Aged , Injury Severity Score , Urban Health Services/organization & administration , Registries , Hemorrhage/therapy , Hemorrhage/mortality , Wounds, Penetrating/therapy , Wounds, Penetrating/mortality , Wounds and Injuries/therapy , Wounds and Injuries/mortality
3.
CMAJ Open ; 9(4): E1080-E1096, 2021.
Article in English | MEDLINE | ID: mdl-34848549

ABSTRACT

BACKGROUND: Rurality strongly correlates with higher pay-for-performance access bonuses, despite higher emergency department use and fewer primary care services than in urban settings. We sought to evaluate the relation between patient-reported access to primary care and access bonus payments in urban settings. METHODS: We conducted a cross-sectional, secondary data analysis using Ontario survey and health administrative data from 2013 to 2017. We used administrative data to calculate annual access bonuses for eligible urban family physicians. We linked this payment data to adult (≥ 16 yr) patient data from the Health Care Experiences Survey to examine the relation between access bonus achievement (in quintiles of the proportion of bonus achieved, from lowest [Q1, reference category] to highest [Q5]) and 4 patient-reported access outcomes. The average survey response rate to the patient survey during the study period was 51%. We stratified urban geography into large, medium and small settings. In a multilevel regression model, we adjusted for patient-, physician- and practice-level covariates. We tested linear trends, adjusted for clustering, for each outcome. RESULTS: We linked 18 893 respondents to 3940 physicians in 414 bonus-eligible practices. Physicians in small urban settings earned the highest proportion of their maximum potential access bonuses. Access bonus achievement was positively associated with telephone access (Q2 odds ratio [OR] 1.18, 95% confidence interval [CI] 0.98-1.42; Q3 OR 1.34, 95% CI 1.10-1.63; Q4 OR 1.46, 95% CI 1.19-1.79; Q5 OR 1.87, 95% CI 1.50-2.33), after hours access (Q2 OR 1.26, 95% CI 1.09-1.47; Q3 OR 1.46, 95% CI 1.23-1.74; Q4 OR 1.77, 95% CI 1.46-2.15; Q5 OR 1.88, 95% CI 1.52-2.32), wait time for care (Q2 OR 1.01, 95% CI 0.85-1.20; Q3 OR 1.17, 95% CI 0.97-1.41; Q4 OR 1.27, 95% CI 1.05-1.55; Q5 OR 1.63, 95% CI 1.32-2.00) and timeliness (Q2 OR 1.29, 95% CI 0.98-1.69; Q3 OR 1.29, 95% CI 0.94-1.77; Q4 OR 1.58, 95% CI 1.16-2.13; Q5 OR 1.98, 95% CI 1.38-2.82). When stratified by geography, we observed several of these associations in large urban settings, but not in small urban settings. Trend tests were statistically significant for all 4 outcomes. INTERPRETATION: Although the access bonus correlated with access in larger urban settings, it did not in smaller settings, aligning with previous research questioning its utility in smaller geographies. The access bonus may benefit from a redesign that considers geography and patient experience.


Subject(s)
Health Services Accessibility , Primary Health Care , Reimbursement, Incentive/statistics & numerical data , Urban Health Services , Adult , After-Hours Care/statistics & numerical data , Cross-Sectional Studies , Female , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Humans , Male , Ontario/epidemiology , Patient Reported Outcome Measures , Physicians, Family/economics , Primary Health Care/methods , Primary Health Care/organization & administration , Telemedicine/statistics & numerical data , Urban Health Services/organization & administration , Urban Health Services/statistics & numerical data , Waiting Lists
4.
Med Care ; 59(12): 1107-1114, 2021 12 01.
Article in English | MEDLINE | ID: mdl-34593712

ABSTRACT

BACKGROUND: The performance of existing predictive models of readmissions, such as the LACE, LACE+, and Epic models, is not established in urban safety-net populations. We assessed previously validated predictive models of readmission performance in a socially complex, urban safety-net population, and if augmentation with additional variables such as the Area Deprivation Index, mental health diagnoses, and housing access improves prediction. Through the addition of new variables, we introduce the LACE-social determinants of health (SDH) model. METHODS: This retrospective cohort study included adult admissions from July 1, 2016, to June 30, 2018, at a single urban safety-net health system, assessing the performance of the LACE, LACE+, and Epic models in predicting 30-day, unplanned rehospitalization. The LACE-SDH development is presented through logistic regression. Predictive model performance was compared using C-statistics. RESULTS: A total of 16,540 patients met the inclusion criteria. Within the validation cohort (n=8314), the Epic model performed the best (C-statistic=0.71, P<0.05), compared with LACE-SDH (0.67), LACE (0.65), and LACE+ (0.61). The variables most associated with readmissions were (odds ratio, 95% confidence interval) against medical advice discharge (3.19, 2.28-4.45), mental health diagnosis (2.06, 1.72-2.47), and health care utilization (1.94, 1.47-2.55). CONCLUSIONS: The Epic model performed the best in our sample but requires the use of the Epic Electronic Health Record. The LACE-SDH performed significantly better than the LACE and LACE+ models when applied to a safety-net population, demonstrating the importance of accounting for socioeconomic stressors, mental health, and health care utilization in assessing readmission risk in urban safety-net patients.


Subject(s)
Patient Readmission/trends , Risk Assessment/standards , Safety-net Providers/standards , Adult , Aged , Female , Humans , Logistic Models , Male , Middle Aged , Odds Ratio , Patient Readmission/statistics & numerical data , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , Safety-net Providers/methods , Safety-net Providers/statistics & numerical data , Urban Health Services/organization & administration , Urban Health Services/statistics & numerical data
6.
BMC Emerg Med ; 21(1): 74, 2021 06 28.
Article in English | MEDLINE | ID: mdl-34182927

ABSTRACT

BACKGROUND: In March 2020 we faced a huge spread of the epidemic of SARS-CoV2 in northern Italy; the Emergency Departments (ED) and the Emergency Medical Services (EMS) were overwhelmed by patients requiring care. The hospitals were forced to reorganize their services, and the ED was the focal point of this challenge. As Emergency Department in a metropolitan area of the region most affected, we saw an increasing number of patients with COVID-19, and we made some structural and staff implementations according to the evolution of the epidemic. METHODS: We analysed in a narrative way the weaknesses and the point of strength of our response to COVID-19 first outbreak, focusing point by point on main challenges and minor details involved in our ED response to the pandemics. RESULTS: The main stems for our response to the pandemic were: use of clear and shared contingency plans, as long as preparedness to implement them; stockage of as much as useful material can be stocked; training of the personnel to be prepared for a fast response, trying to maintain divided pathway for COVID-19 and non-COVID-19 patients, well-done isolation is a key factor; preparedness to de-escalate as soon as needed. CONCLUSIONS: We evaluated our experience and analysed the weakness and strength of our first response to share it with the rest of the scientific community and colleagues worldwide, hoping to facilitate others who will face the same challenge or similar challenges in the future. Shared experience is the best way to learn and to avoid making the same mistakes.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Disease Outbreaks/prevention & control , Emergency Service, Hospital/organization & administration , Hospitals, University/organization & administration , Urban Health Services/organization & administration , COVID-19/diagnosis , COVID-19/therapy , Humans , Italy/epidemiology
9.
Australas J Dermatol ; 62(3): 331-335, 2021 Aug.
Article in English | MEDLINE | ID: mdl-34004028

ABSTRACT

This is the largest study of Aboriginal and Torres Strait Islander dermatologic presentations to an urban specialist clinic within a community-controlled health organisation. It adds to our understanding of Aboriginal and Torres Strait Islander dermatoepidemiology. Patient files were reviewed over the five-year audit period, with age, gender, Indigenous status, diagnosis, disease category, 'new' or 'review consultation' and 'did not attend' (DNA) data recorded. Our study shows that eczema and benign, pre-malignant or malignant neoplasms are the most common presentations for urban Aboriginal and Torres Strait Islander patients. Lupus erythematosus and cutaneous infections were less prominent in comparison to data from rural and remote populations. Overall, a broad casemix of dermatologic presentations was observed. Similar to other studies, adult male patients were under-represented. Most skin malignancies were diagnosed in this cohort; this, therefore, identifies a possible target for public health intervention. A high ratio of new to review patients is consistent with the clinic offering a consultation model of care facilitated by primary health-care providers' support within Aboriginal Community-Controlled Health Service. DNA rates in this study were lower than hospital outpatient rates in a comparative study and may be attributed to specialist dermatology care being offered in a more culturally sensitive environment. The dermatology clinic at the Victorian Aboriginal Health Services (VAHS) provides a good breadth of specialist dermatology care. The community health-care model could be replicated in centres elsewhere, including interstate, to help overcome barriers to specialist dermatology care experienced by Aboriginal and Torres Strait Islander populations. Additionally, this model improves trainee exposure and understanding of Aboriginal and Torres Strait Islander health.


Subject(s)
Health Services, Indigenous/organization & administration , Native Hawaiian or Other Pacific Islander/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Patient Medication Knowledge/statistics & numerical data , Adult , Female , Humans , Male , Middle Aged , Urban Health Services/organization & administration , Victoria/epidemiology
10.
J Public Health Manag Pract ; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward: S57-S62, 2021.
Article in English | MEDLINE | ID: mdl-33239563

ABSTRACT

Large urban health departments developed and implemented various approaches to prevent COVID-19 outbreaks and promote the health and well-being of individuals experiencing homelessness and housing insecurity throughout the pandemic. Reviewing the approaches of several large urban health departments, the most frequent practices included increasing housing options, on-the-ground outreach and resource allocation, and integrated communications. Key steps necessary to develop and implement these policies and procedures are discussed, and innovative approaches are highlighted.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Ill-Housed Persons/statistics & numerical data , Pandemics/prevention & control , Pandemics/statistics & numerical data , United States Public Health Service/organization & administration , Urban Health Services/organization & administration , Cities/epidemiology , Humans , SARS-CoV-2 , United States/epidemiology , United States Public Health Service/statistics & numerical data , Urban Health Services/statistics & numerical data
11.
Popul Health Manag ; 24(2): 166-173, 2021 04.
Article in English | MEDLINE | ID: mdl-33264055

ABSTRACT

The Philadelphia region responded to the shortage of health care resources imposed by the 2020 COVID-19 pandemic through the creation of the COVID-19 Surge Facility at Temple University's basketball arena. The facility was designed as an acute care medical unit capable of supporting COVID-19 patients who were stable enough to be released from the intensive care unit but not ready for discharge home. Safety was optimized through the application of recommendations from the Joint Commission and Centers for Disease Control and Prevention (CDC). The safety goals include those established by the Joint Commission with regard to patient identification, security, identification of patient safety threats, communication, fire safety, laboratory services, and pharmacologic services. COVID-19-specific goals outlined by the CDC also are addressed and include recommendations for facility layout, managing staff respite and personal protective equipment, patient care areas, supply storage, airflow, and patient hygiene. Although the goal was to meet all of these recommendations, some were not possible due to the austere environment of the arena. However, these shortcomings were met with innovative solutions that provided the next best options. By sharing these experiences, the authors hope to guide future alternate care facilities in their efforts to optimize safety.


Subject(s)
COVID-19/therapy , Facility Regulation and Control/organization & administration , Intensive Care Units/organization & administration , Patient Safety/standards , Urban Health Services/organization & administration , COVID-19/epidemiology , Humans , Philadelphia
12.
Health Educ Behav ; 48(1): 29-33, 2021 02.
Article in English | MEDLINE | ID: mdl-33322924

ABSTRACT

Decreased engagement in preventive services, including vaccination, during the COVID-19 pandemic represents a grave threat to global health. We use the case of the Bom Retiro Public Health Clinic in São Paulo, Brazil, to underscore how continuity of care is not only feasible, but a crucial part of health as a human right. The long-standing relationship between the clinic and neighborhood residents has facilitated ongoing management of physical and mental health conditions. Furthermore, we demonstrate how the clinic's history of confronting infectious diseases has equipped it to adapt preventive services to meet patients' needs during the pandemic. Our academic-community partnership used a multidisciplinary approach, relying on analysis of historical data, ethnographic data, and direct clinical experience. We identify specific prevention strategies alongside areas for improvement. We conclude that the clinic serves as a model for continuity of care in urban settings during a pandemic.


Subject(s)
COVID-19/epidemiology , Preventive Health Services/organization & administration , Primary Health Care/organization & administration , Urban Health Services/organization & administration , Brazil/epidemiology , Community-Institutional Relations , Humans , Pandemics , SARS-CoV-2 , Socioeconomic Factors , Universities/organization & administration
13.
J Gerontol B Psychol Sci Soc Sci ; 76(7): e268-e274, 2021 08 13.
Article in English | MEDLINE | ID: mdl-33367752

ABSTRACT

OBJECTIVES: Mexico is among the countries in Latin America hit hardest by coronavirus disease 2019 (COVID-19). A large proportion of older adults in Mexico have high prevalence of multimorbidity and live in poverty with limited access to health care services. These statistics are even higher among adults living in rural areas, which suggest that older adults in rural communities may be more susceptible to COVID-19. The objectives of the article were to compare clinical and demographic characteristics for people diagnosed with COVID-19 by age group, and to describe cases and mortality in rural and urban communities. METHOD: We linked publicly available data from the Mexican Ministry of Health and the Census. Municipalities were classified based on population as rural (<2,500), semirural (≥2,500 and <15,000), semiurban (≥15,000 and <100,000), and urban (≥100,000). Zero-inflated negative binomial models were performed to calculate the total number of COVID-19 cases, and deaths per 1,000,000 persons using the population of each municipality as a denominator. RESULTS: Older adults were more likely to be hospitalized and reported severe cases, with higher mortality rates. In addition, rural municipalities reported a higher number of COVID-19 cases and mortality related to COVID-19 per million than urban municipalities. The adjusted absolute difference in COVID-19 cases was 912.7 per million (95% confidence interval [CI]: 79.0-1746.4) and mortality related to COVID-19 was 390.6 per million (95% CI: 204.5-576.7). DISCUSSION: Urgent policy efforts are needed to mandate the use of face masks, encourage handwashing, and improve specialty care for Mexicans in rural areas.


Subject(s)
COVID-19/epidemiology , Health Services Accessibility/statistics & numerical data , Health Status Disparities , Poverty/statistics & numerical data , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data , Age Factors , Aged , COVID-19/therapy , Female , Humans , Male , Mexico/epidemiology , Rural Health Services/organization & administration , Urban Health Services/organization & administration
14.
Gynecol Oncol ; 160(2): 477-484, 2021 02.
Article in English | MEDLINE | ID: mdl-33218682

ABSTRACT

OBJECTIVE: Up to one-third of women with ovarian cancer in the United States do not receive surgical care from a gynecologic oncologist specialist despite guideline recommendations. We aim to investigate the impact of rurality on receiving surgical care from a specialist, referral to a specialist, and specialist surgery after referral, and the consequences of specialist care. METHODS: We utilized a retrospective cohort created through an extension of standard cancer surveillance in three Midwestern states. Multivariable adjusted logistic regression was utilized to assess gynecologic oncologist treatment of women 18-89 years old, who were diagnosed with primary, histologically confirmed, malignant ovarian cancer in 2010-2012 in Kansas, Missouri and Iowa by rurality. RESULTS: Rural women were significantly less likely to receive surgical care from a gynecologic oncologist specialist (adjusted odds ratio (OR) 0.37, 95% confidence interval (CI) 0.24-0.58) and referral to a specialist (OR 0.37, 95% CI 0.23-0.59) compared to urban women. There was no significant difference in specialist surgery after a referral (OR 0.56, 95% CI 0.26-1.20). Rural women treated surgically by a gynecologic oncologist versus non-specialist were more likely to receive cytoreduction and more complete tumor removal to ≤1 cm. CONCLUSION: There is a large rural-urban difference in receipt of ovarian cancer surgery from a gynecologic oncologist specialist (versus a non-specialist). Disparities in referral rates contribute to the rural-urban difference. Further research will help define the causes of referral disparities, as well as promising strategies to address them.


Subject(s)
Gynecology/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Medical Oncology/statistics & numerical data , Ovarian Neoplasms/surgery , Rural Health Services/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Cytoreduction Surgical Procedures/statistics & numerical data , Female , Gynecology/organization & administration , Health Services Accessibility/organization & administration , Health Services Accessibility/statistics & numerical data , Humans , Iowa , Kansas , Medical Oncology/organization & administration , Middle Aged , Missouri , Ovarian Neoplasms/diagnosis , Ovariectomy/statistics & numerical data , Referral and Consultation/organization & administration , Referral and Consultation/statistics & numerical data , Retrospective Studies , Rural Health Services/organization & administration , Rural Population/statistics & numerical data , Travel/statistics & numerical data , Urban Health Services/organization & administration , Urban Health Services/statistics & numerical data , Urban Population/statistics & numerical data , Young Adult
16.
BMC Pregnancy Childbirth ; 20(1): 671, 2020 Nov 07.
Article in English | MEDLINE | ID: mdl-33160332

ABSTRACT

BACKGROUND: One approach for improving breastfeeding support and alleviating breastfeeding disparities is the implementation of a clinic-based peer counselor. Our objective was to assess the "real life" effects of an autonomous peer counselor who provides tailored support to low-income, minority women based on individual needs rather than a pre-determined research protocol. METHODS: This is a secondary analysis of a prospective cohort study of women receiving publicly funded prenatal care during the 6 months before and after introduction of a peer counselor in a single prenatal clinic. The peer counselor provided one-on-one antenatal and postpartum lactation support. Electronic medical record and survey data were collected. The primary outcome was breastfeeding continuation at 6 weeks postpartum. Secondary outcomes included breastfeeding comfort, confidence, and training satisfaction, any breastfeeding, and total breastfeeding duration. Bivariable and multivariable analyses were performed. RESULTS: Peer counselor exposure was not associated with the primary outcome of continued breastfeeding at 6 weeks (55.6% with peer counselor versus 49.1% without; aOR 1.26, 95% CI 0.69-2.31). However, women with peer counselor exposure were more likely to be satisfied with breastfeeding training at the time of delivery (98.2% vs. 83.6%, p = 0.006) and were more likely to have performed any breastfeeding (89.8% vs. 78.9%, p = 0.04), which remained significant on multivariable analysis (aOR 2.85, 95% CI 1.11-7.32). CONCLUSIONS: Peer counselor interventions are a promising approach to increase breastfeeding initiation. Further research is required to inform the most efficacious approach while also allowing peer counselors to operate independently and in line with the specific needs of their clients.


Subject(s)
Breast Feeding/psychology , Counseling/organization & administration , Mothers/education , Peer Group , Prenatal Care/organization & administration , Adult , Chicago , Counselors/organization & administration , Female , Health Plan Implementation , Humans , Minority Groups/psychology , Mothers/psychology , Peer Influence , Personal Satisfaction , Poverty , Pregnancy , Prenatal Care/psychology , Program Evaluation , Prospective Studies , Tertiary Care Centers/organization & administration , Urban Health Services/organization & administration , Young Adult
17.
Australas Psychiatry ; 28(6): 644-648, 2020 12.
Article in English | MEDLINE | ID: mdl-32997521

ABSTRACT

OBJECTIVE: Private practice psychiatry in Australia was largely office-based until the Commonwealth Government introduced new psychiatrist Medicare Benefits Schedule (MBS) telehealth items in response to the first wave of the COVID-19 pandemic. We investigate the uptake of (1) video and telephone telehealth consultations in April-May 2020, and (2) the overall changing rates of consultation, i.e. total telehealth and in-person consultations across the larger states of Australia. METHOD: MBS item service data were extracted for COVID-19 psychiatrist video- and telephone-telehealth item numbers and compared with a baseline of the 2018-2019-financial-year monthly average of in-person consultations for New South Wales, Queensland, Victoria, and Western Australia. RESULTS: Total psychiatry consultations (telehealth and in-person) rose during the first wave of the pandemic by 10%-20% compared to the previous year. The majority of private practice was conducted by telehealth in April but was lower in May as new COVID-19 case rates fell. Most telehealth provision was by telephone for short consultations of ⩽15-30 min. Video consultations increased from April into May. CONCLUSIONS: For large states, there has been a rapid adoption of the MBS telehealth psychiatrist items, followed by a trend back to face-to-face as COVID-19 new case rates reduced. There was an overall increased consultation rate (in-person plus telehealth) for April-May 2020.


Subject(s)
Coronavirus Infections , Mental Health Services , Pandemics , Pneumonia, Viral , Private Practice , Remote Consultation/methods , Telemedicine/methods , Videoconferencing , Adult , Australia/epidemiology , Betacoronavirus , COVID-19 , Communicable Disease Control/methods , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Female , Humans , Insurance Claim Review , Male , Mental Health Services/organization & administration , Mental Health Services/statistics & numerical data , Organizational Innovation , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Private Practice/organization & administration , Private Practice/statistics & numerical data , SARS-CoV-2 , Urban Health Services/organization & administration
18.
Am J Public Health ; 110(S2): S204-S210, 2020 07.
Article in English | MEDLINE | ID: mdl-32663081

ABSTRACT

Objectives. To examine changes in the scope of activity and organizational composition of public health delivery systems serving rural and urban US communities between 2014 and 2018.Methods. We used data from the National Longitudinal Survey of Public Health Systems to measure the implementation of recommended public health activities and the network of organizations contributing to these activities in a nationally representative cohort of US communities. We used multivariable regression models to test for rural-urban differences between 2014 and 2018.Results. The scope of recommended activities implemented in rural areas declined by 3.4 percentage points between 2014 and 2018, whereas it increased by 1.4 percentage points in urban areas. The rural-urban disparity in scope of activities grew by a total of 4.8 percentage points (P < .05) over this time. The disparity in network density grew by 2.3 percentage points (P < .05).Conclusions. Urban public health systems have enhanced their scope of activities and organizational networks since 2014, whereas rural systems have lost capacity. These trends suggest that system improvement initiatives have had uneven success, and they may contribute to growing rural-urban disparities in population health status.


Subject(s)
Public Health/statistics & numerical data , Rural Health Services/statistics & numerical data , Urban Health Services/statistics & numerical data , Humans , Longitudinal Studies , Public Health Administration/statistics & numerical data , Rural Health Services/organization & administration , United States , Urban Health Services/organization & administration
20.
Rev Peru Med Exp Salud Publica ; 37(1): 164-168, 2020.
Article in Spanish | MEDLINE | ID: mdl-32520181

ABSTRACT

During the 18th century, the city of Lima was affected by a series of natural disasters and epidemics that depleted both the population and agricultural production. Next, we will analyze the case of the earth quake in Lima on October 28, 1746 and its impact on the city's health system, given the magnitude of the destruction of infrastructure and the high number of deaths it marked a milestone in Lima's society at the time.


Durante el siglo XVIII la ciudad de Lima fue afectada por una serie de desastres de origen natural y de epidemias que mermaron tanto la población como la producción agrícola. A continuación, analizaremos el caso del terremoto producido en Lima el 28 de octubre de 1746 y su impacto en el sistema de salud de la ciudad. Dada la magnitud de su destrucción en la infraestructura y el alto número de muertes, marcó un hito en la sociedad limeña de la época.


Subject(s)
Earthquakes , Urban Health Services , Urban Health , Cities , Earthquakes/history , History, 18th Century , Humans , Peru , Urban Health/history , Urban Health Services/history , Urban Health Services/organization & administration
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