Who Will Tend the Safety Net?

Alston, Pamela Arbuckle; Knapp, J. Merrill; Luomanen, Jack

doi:10.1080/19424396.2014.12221321

Cited by 4 publications

(2 citation statements)

References 9 publications

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“…These findings underline the importance and potential impact of telehealth in improving access to specialist care, by overcoming barriers to the first specialist visit. As oral cancer outcomes are primarily determined by cancer stage at time of diagnosis, and an increase in the time up to treatment of as little as 2 months significantly increases risk of death [5,10], better compliance with specialist referral can serve as a powerful tool to address the inequitably high morbidity and mortality that are experienced by individuals in lowresource settings [6,7,11,47,48]. Referral compliance was greatly improved in the telehealth group, with significantly better referral compliance rates at 3 months and 6 months, and an almost three-times-greater rate of entry than the in-person group into the care continuum by the study end.…”

Section: Discussionmentioning

confidence: 99%

Compliance with Specialist Referral for Increased Cancer Risk in Low-Resource Settings: In-Person vs. Telehealth Options

Nguyen,

Takesh,

Parsangi

et al. 2023

Cancers

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Efforts are underway to improve the accuracy of non-specialist screening for oral cancer (OC) risk, yet better screening will only translate into improved outcomes if at-risk individuals comply with specialist referral. Most individuals from low-resource, minority, and underserved (LRMU) populations fail to complete a specialist referral for OC risk. The goal was to evaluate the impact of a novel approach on specialist referral compliance in individuals with a positive OC risk screening outcome. A total of 60 LRMU subjects who had screened positive for increased OC risk were recruited and given the choice of referral for an in-person (20 subjects) or a telehealth (40 subjects) specialist visit. Referral compliance was tracked weekly over 6 months. Compliance was 30% in the in-person group, and 83% in the telehealth group. Approximately 83–85% of subjects from both groups who had complied with the first specialist referral complied with a second follow-up in-person specialist visit. Overall, 72.5% of subjects who had chosen a remote first specialist visit had entered into the continuum of care by the study end, vs. 25% of individuals in the in-person specialist group. A two-step approach that uses telehealth to overcome barriers may improve specialist referral compliance in LRMU individuals with increased OC risk.

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Section: Discussionmentioning

confidence: 99%

Compliance with Specialist Referral for Increased Cancer Risk in Low-Resource Settings: In-Person vs. Telehealth Options

Nguyen,

Takesh,

Parsangi

et al. 2023

Cancers

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“…Therefore, early diagnosis and minimal time to treatment are crucial to improving outcomes, with the most impactful OC prevention intervention being the early detection and management of OPMLs. Individuals from LRMU populations are diagnosed later and have considerably poorer outcomes for OC than others [5][6][7][8][15][16][17][18][19]. Disparities in access to care, timely diagnosis and management are major drivers for these poor outcomes [20].…”

Section: Introductionmentioning

confidence: 99%

Novel Approach to Improving Specialist Access in Underserved Populations with Suspicious Oral Lesions

et al. 2023

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Late detection and specialist referral result in poor oral cancer outcomes globally. High-risk LRMU populations usually do not have access to oral medicine specialists, a specialty of dentistry, whose expertise includes the identification, treatment, and management of oral cancers. To overcome this access barrier, there is an urgent need for novel, low-cost tele-health approaches to expand specialist access to low-resource, remote and underserved individuals. The goal of this study was to compare the diagnostic accuracy of remote versus in-person specialist visits using a novel, low-cost telehealth platform consisting of a smartphone-based, remote intraoral camera and custom software application. A total of 189 subjects with suspicious oral lesions requiring biopsy (per the standard of care) were recruited and consented. Each subject was examined, and risk factors were recorded twice: once by an on-site specialist, and again by an offsite specialist. A novel, low-cost, smartphone-based intraoral camera paired with a custom software application were utilized to perform synchronous remote video/still imaging and risk factor assessment by the off-site specialist. Biopsies were performed at a later date following specialist recommendations. The study’s results indicated that on-site specialist diagnosis showed high sensitivity (94%) and moderate specificity (72%) when compared to histological diagnosis, which did not significantly differ from the accuracy of remote specialist telediagnosis (sensitivity: 95%; specificity: 84%). These preliminary findings suggest that remote specialist visits utilizing a novel, low-cost, smartphone-based telehealth tool may improve specialist access for low-resource, remote and underserved individuals with suspicious oral lesions.

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