Qualitative Perspective on the Learning Health System: How the Community Health Applied Research Network Paved the Way for Research in Safety-Net Settings.

BACKGROUND: Safety-net populations are underrepresented in health research networks. To address this deficit, the Community Health Applied Research Network (CHARN) was created to promote integration of research in health centers (HCs). CHARN embodies a learning health system (LHS) model to advance the evidence base for improved care in safety-net settings. OBJECTIVES: We sought to identify lessons learned from the development of research infrastructure to promote the inclusion of safety-net populations in research. METHODS: We conducted nine qualitative interviews with a purposive sample of CHARN members, as well as content analysis of work plans and project reports, and identified barriers and facilitators to building research capacity in HCs. RESULTS: Lessons learned include the importance of linking research to the HC mission, encouraging mentoring, and investing in data infrastructure at HCs to tailor health services to communities. CONCLUSIONS: Findings can inform safety-net providers on the process of building research infrastructure and capacity.

Telehealth In Health Centers: Key Adoption Factors, Barriers, And Opportunities.

Telehealth services have the potential to improve access to care, especially in rural or urban areas with scarce health care resources. Despite the potential benefits, telehealth has not been fully adopted by health centers. This study examined factors associated with and barriers to telehealth use by federally funded health centers. We analyzed data for 2016 from the Uniform Data System using a mixed-methods approach. Our findings suggest that rural location, operational factors, patient demographic characteristics, and reimbursement policies influence health centers' decisions about using telehealth. Cost, reimbursement, and technical issues were described as major barriers. Medicaid reimbursement policies promoting live video and store-and-forward services were associated with a greater likelihood of telehealth adoption. Many health centers were implementing telehealth or exploring its use. Our findings identified areas that policy makers can address to achieve greater telehealth adoption by health centers.

Examining the FDA's oversight of direct-to-consumer advertising.

Our analysis examined the effects of the Food and Drug Administration's (FDA's) 1997 draft guidance regarding advertisements for prescription drugs broadcast directly to consumers. We found that although direct-to-consumer (DTC) advertising spending by pharmaceutical companies has increased, more than 80 percent of their promotional spending is directed to physicians. DTC advertising appears to increase the use of prescription drugs among consumers. The FDA's oversight has not prevented companies from making misleading claims in subsequent advertisements, and a recent policy change has lengthened the FDA's review process, raising the possibility that some misleading campaigns could run their course before review.