Configuration and Delivery of Primary Care in Rural and Urban Settings

Fraze, Taressa; Lewis, Valerie A.; Wood, Andrew; Newton, H. D.; Colla, Carrie H.

doi:10.1007/s11606-022-07472-x

Cited by 13 publications

(6 citation statements)

References 26 publications

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“…Interestingly, differential internet connectivity is often suggested as a potential explanation for rural/urban disparities in telemedicine use, but we observed similar rates of primary care telemedicine use across categories reflecting device ownership, internet service, and survey modality. An alternative explanation for lower primary care telemedicine use among nonmetropolitan residents that warrants exploration could be differential ability to offer and sustain telemedicine in rural primary care practices, perhaps due to technology barriers or workforce capacity [32,33].…”

Section: Discussionmentioning

confidence: 99%

Parent-Reported Use of Pediatric Primary Care Telemedicine: Survey Study

Ray¹,

Wittman²,

Burns³

et al. 2023

J Med Internet Res

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Background Telemedicine delivered from primary care practices became widely available for children during the COVID-19 pandemic. Objective Focusing on children with a usual source of care, we aimed to examine factors associated with use of primary care telemedicine. Methods In February 2022, we surveyed parents of children aged ≤17 years on the AmeriSpeak panel, a probability-based panel of representative US households, about their children’s telemedicine use. We first compared sociodemographic factors among respondents who did and did not report a usual source of care for their children. Among those reporting a usual source of care, we used Rao-Scott F tests to examine factors associated with parent-reported use versus nonuse of primary care telemedicine for their children. Results Of 1206 respondents, 1054 reported a usual source of care for their children. Of these respondents, 301 of 1054 (weighted percentage 28%) reported primary care telemedicine visits for their children. Factors associated with primary care telemedicine use versus nonuse included having a child with a chronic medical condition (87/301, weighted percentage 27% vs 113/753, 15%, respectively; P=.002), metropolitan residence (262/301, weighted percentage 88% vs 598/753, 78%, respectively; P=.004), greater internet connectivity concerns (60/301, weighted percentage 24% vs 116/753, 16%, respectively; P=.05), and greater health literacy (285/301, weighted percentage 96% vs 693/753, 91%, respectively; P=.005). Conclusions In a national sample of respondents with a usual source of care for their children, approximately one-quarter reported use of primary care telemedicine for their children as of 2022. Equitable access to primary care telemedicine may be enhanced by promoting access to primary care, sustaining payment for primary care telemedicine, addressing barriers in nonmetropolitan practices, and designing for lower health-literacy populations.

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Section: Discussionmentioning

confidence: 99%

Parent-Reported Use of Pediatric Primary Care Telemedicine: Survey Study

Ray¹,

Wittman²,

Burns³

et al. 2023

J Med Internet Res

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“…The rural health zones in crisis in the DRC are similar in their organization and in the challenges they face (17,20,27,29,41), we believe that the results from these eight study areas will largely re ect the situation of all other areas in the same context. These results could represent one of the worst cases of the state of the DRC health system, with the crisis context playing as an aggravating factor (17,41) on the rural context, which is even worse than the urban context (42)(43)(44). However, for this speci c point, further studies are needed to con rm this assumption.…”

Section: Discussionmentioning

confidence: 99%

Ensuring leadership at the operational level of a health system in protracted crisis context. A cross-sectional qualitative study covering 8 health districts in Eastern Democratic Republic of Congo

Bigirinama

Makali

Mothupi

et al. 2023

Preprint

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Background This study examines how leadership is provided at the operational level of a health system in a protracted crisis context. Despite advances in medical science and technology, health systems in low- and middle-income countries struggle to deliver quality care to all their citizens. The role of leadership in fostering resilience and positive transformation of a health system is established. However, there is little literature on this issue in Democratic Republic of the Congo (DRC). This study describes leadership as experienced and perceived by health managers in crisis affected health districts in Eastern DRC. Methods A qualitative cross-sectional study was conducted in eight rural health districts (corresponding to health zones, in DRC’s health system organization), in 2021. Data were collected through in-depth interviews and non-participatory observations. Participants were key health actors in each district. The study deductively explored six themes related to leadership, using an adapted version of the Leadership Framework conceptual approach to leadership from the United Kingdom National Health Service’s Leadership Academy. From these themes, an inductive analysis extracted emerging subthemes. Results The study has revealed deficiencies regarding Management and Organisation of the health zones, Internal collaboration within their management teams as well as collaboration between these teams and the health zone’s external partners. Communication and clinical and managerial capacities were identified as key factors to be strengthened in improving leadership within the districts. The findings have also highlighted the detrimental influence of vertical interventions from external partners and hierarchical supervisors in health zones on planning, human resource management and decision-making autonomy of district leaders, weakening their leadership. Conclusions Despite their decentralized basic operating structure, which has withstood decades of crisis and insufficient government investment in healthcare, the districts still struggle to assert their leadership and autonomy. The authors suggest greater support for personal and professional development of the health workforce, coupled with increased government investment, to further strengthen health system capacities in these settings.

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“…The database includes demographic, training, and practice-related data from the American Medical Association (AMA) Physician Masterfile and other sources. 23…”

Section: Methodsmentioning

confidence: 99%

Benefits and barriers to implementing precision preventive care: results of a national physician survey

Vassy

Kerman

Harris

et al. 2022

Preprint

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Background: Clinical implementation of polygenic risk scores (PRS) for precision prevention depends on the utility and barriers primary care physicians (PCPs) perceive to their use. Methods: An online survey asked PCPs in a national database about the clinical utility of PRS they perceived for categories of medical decision-making and perceived benefits of and barriers to that use. Latent class analysis (LCA) was used to identify subgroups of PCPs based on response patterns. Results: Among 367 respondents (email open rate 10.8%; participation rate 96.3%; completion rate 93.1%), mean (SD) age was 54.9 (12.9) years, 137 (37.3%) were female, and mean (SD) time since medical school graduation was 27.2 (13.3) years. Respondents reported greater perceived utility for more clinical action (e.g., earlier or more intensive screening, preventive medications, or lifestyle modification) for patients with high-risk PRS than for delayed or discontinued prevention actions for low-risk patients (p<0.001). Respondents most often chose out-of-pocket costs (48%), lack of clinical guidelines (24%), and patient insurance discrimination concerns (22%) as extreme barriers to PRS implementation. LCA identified 3 subclasses of respondents. Skeptics (n=83, 22.6%) endorsed less agreement with individual clinical utilities, saw patient anxiety and insurance discrimination as significant barriers, and agreed less often that PRS could help patients make better health decisions. Learners (n=134, 36.5%) and enthusiasts (n=150, 40.9%) expressed similar levels of agreement that PRS had utility for preventive actions and that PRS could be useful for patient decision-making. Compared with enthusiasts, however, learners perceived greater barriers to the clinical use of PRS. Conclusion: PCPs generally endorsed using PRS to guide medical decision-making about preventive care, with a preference for more clinical action over less. Barriers identified suggest interventions to address the needs and concerns of PCPs along the spectrum of acceptance and uptake.

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Configuration and Delivery of Primary Care in Rural and Urban Settings

Cited by 13 publications

References 26 publications

Parent-Reported Use of Pediatric Primary Care Telemedicine: Survey Study

Parent-Reported Use of Pediatric Primary Care Telemedicine: Survey Study

Ensuring leadership at the operational level of a health system in protracted crisis context. A cross-sectional qualitative study covering 8 health districts in Eastern Democratic Republic of Congo

Benefits and barriers to implementing precision preventive care: results of a national physician survey

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