Contributing Factors to Delays in COVID-19-Related Hospitalization Among Latinx and Spanish-Speaking Patients/Factores Que Contribuyen a Retrasos en Hospitalizaciones Relacionadas con COVID-19 Entre Pacientes Latinos e Hispano-Hablantes.

BACKGROUND: Latinx populations have been more heavily impacted by the COVID-19 pandemic than the general population of the US, including higher rates of hospitalization due to COVID-19 in eastern Massachusetts. We conducted a qualitative study to better understand the experiences of Latinx and Spanish-speaking patients who had clinically significant COVID-19 in the early months of the pandemic. METHODS: Thirteen qualitative, semistructured, phone interviews were conducted between December 2020 and April 2021 with Latinx and Spanish-speaking patients who had experienced clinically significant COVID-19 in the metro-north Boston area. Interviews were recorded and transcribed in their original languages. An a priori code tree was developed which was later iteratively revised based on emerging themes. Transcripts were thematically analyzed. RESULTS: Participants discussed their overall experiences contracting the COVID-19 infection, as well as their experiences with the disease and with being hospitalized and the months after in recovery. Family and social networks were a common support, both emotional and financial. Although they survived the disease, hospitalization had serious impacts on the mental and physical health of participants, including the remnants of trauma from hospitalization itself. IMPLICATIONS: Latinx and Spanish-speaking patients in eastern Massachusetts had specific experiences in the early months of the COVID-19 pandemic that were shaped by their living conditions and culture. It is important for health care professionals to understand these experiences so that they can design appropriate medical interventions as well as target outreach efforts that are culturally appropriate. Finally, serious attention should be paid to the mental health-related consequences of hospitalization and policies that can alleviate them.

Risk Factors for Hospitalization Among Patients with COVID-19 at a Community Ambulatory Clinic in Massachusetts During the Initial Pandemic Surge.

Among patients with COVID-19 evaluated in outpatient settings, factors associated with hospitalization remain poorly understood. Multivariable regressions were used to assess sociodemographic and clinical factors associated with increased odds of hospitalization among patients with confirmed COVID-19 between March 18, 2020 through April 25, 2020 at a community-based outpatient clinic in Massachusetts. Older age, BMI ≥ 25, self-reported dizziness/lightheadedness, temperature ≥ 99.5°F, tachycardia, and oxygen saturation < 95% were associated with increased odds of hospitalization after adjustment for age, sex, and BMI. There was also an association between speaking Spanish as primary language and increased odds of hospitalization (compared to English, adjusted OR = 2.99 [95% CI 1.39, 6.39]). Speaking Portuguese as primary language was not associated with increased odds of hospitalization (compared to English, adjusted OR = 1.83 [0.78, 4.28]). In addition to several clinical risk factors established among inpatients, our study found that primarily speaking Spanish, but not Portuguese, was a marker of hospitalization risk among a diverse outpatient cohort of patients with COVID-19.

Coaching skills for medical education in a VUCA world.

The world is in the midst of the COVID-19 pandemic. Healthcare professionals and students globally are experiencing an increasingly 'VUCA' (volatile, uncertain, complex and ambiguous) healthcare and educational climate. Our future medical workforce needs skillsets to manage the personal and emotional challenges of work, uncertainty and change. These include organization, time management, proactive and consistent clinical skill development, effective communication, person-centred approaches, self-reflection and self-care. This is critical for success during undergraduate medical education and ongoing clinical practice to build personal resilience, provide the best possible clinical care in a different healthcare ecosystem, innovate for better healthcare systems and advocate for more vulnerable communities. Our faculty and students have been eager to learn and apply solution-oriented coaching skills to help to mitigate against burnout, hold more rewarding, person-centred conversations in clinical practice and enable them personally to respond flexibly and adapt constructively to change. Coaching training should comprise an essential component of the undergraduate medical curriculum and continuing professional development, supporting our medical workforce to derive joy from the practice of humanistic healthcare and develop the leadership skills to help shape a way forward through the challenges we are experiencing in an increasingly VUCA healthcare climate.

Community health training for internal medicine residents working with community partners.

Graduate and undergraduate medical training are incorporating public health curricula into their programs to enable future physicians to participate in public health activities and improve the health of the communities. This paper highlights two approaches to a community health curriculum implemented at the Cambridge Health Alliance Internal Medicine Training Program from 2008-2010. Between 2008 and 2009, the residency program incorporated a longitudinal curriculum for first-year residents. The goal of the curriculum was to expose residents to basic community health research models while giving them time to participate in a 1-year practicum with the Cambridge Public Health Department. Strengths included increasing resident knowledge about the local public health department and providing residents with an opportunity to work with staff and patients in that setting. Limitations of such a design included staff time constraints for coordinating with community partners as well as resident dissatisfaction with being involved in only select portions of an evolving project. This curriculum was therefore revised into a 1-month ambulatory block consisting of didactics and a practicum with the local YWCA in September 2010. Residents felt that this design yielded more time in didactics than in the practicum. Both designs offer important learning points in terms of practically incorporating public health activities in a tightly scheduled residency-training program. The current paper highlights the importance of partnering with a community organization such as a public health department or the YWCA. Emphasis is placed on the contributions that residents can make to these organizations while they learn how to integrate clinical and community health activities.

Training Latin American primary care physicians in the WPA module on depression: results of a multicenter trial.

BACKGROUND: In order to improve care for people with depressive disorders and to reduce the increasing burden of depression, the American Regional Office of the World Health Organization has launched a major region-wide initiative. A central part of this effort was directed to the primary care system where the diagnosis and treatment of depression are deficient in many countries. This study evaluated the materials developed by the World Psychiatric Association in a training program on depression among primary care physicians by measuring changes in their knowledge, attitudes, and practice (KAP). METHOD: One hundred and seven physicians and 6174 patients from five Latin American countries participated in the trial. KAP were assessed 1 month before and 1 month following the training program. In addition, the presence of depressive symptoms was measured in patients who visited the clinic during a typical week at both times using the Zung Depression Scale and a DSM-IV/ ICD-10 major depression checklist. RESULTS: The program slightly improved knowledge about depression and modified some attitudes, but had limited impact on actual practice. There was no evidence that the diagnosis of depression was made more frequently, nor was there an improvement in psychopharmacological management. The post-training agreement between physician diagnosis and that based on patient self-report remained low. The physicians, however, seemed more confident in treating depressed patients after training, and referred fewer patients to psychiatrists. CONCLUSIONS: Traditional means of training primary care physicians in depression have little impact on clinical practice regardless of the quality of the teaching materials.