Examining differences in time to appointment and no-show rates between rural telehealth users and non-users.

Background: Telehealth has undergone widespread implementation since 2020 and is considered an invaluable tool to improve access to healthcare, particularly in rural areas. However, telehealth's applicability may be limited for certain populations including those who live in rural, medically underserved communities. While broadband access is a recognized barrier, other important factors including age and education influence a person's ability or preference to engage with telehealth via video telehealth or a patient portal. It remains unclear the degree to which these digital technologies lead to disparities in access to care. Purpose: The purpose of this analysis is to determine if access to healthcare differs for telehealth users compared with non-users. Methods: Using electronic health record data, we evaluated differences in "time to appointment" and "no-show rates" between telehealth users and non-users within an integrated healthcare network between August 2021 and January 2022. We limited analysis to patient visits in endocrinology or outpatient behavioral health departments. We analyzed new patients and established patients separately. Results: Telehealth visits were associated with shorter time to appointment for new and established patients in endocrinology and established patients in behavioral health, as well as with lower no-show rates for established patients in both departments. Conclusions: The findings suggest that those who are unwilling or unable to engage with telehealth may have more difficulty accessing timely care.

Co-opting the E3 ligase KLHDC2 for targeted protein degradation by small molecules.

Targeted protein degradation (TPD) by PROTAC (proteolysis-targeting chimera) and molecular glue small molecules is an emerging therapeutic strategy. To expand the roster of E3 ligases that can be utilized for TPD, we describe the discovery and biochemical characterization of small-molecule ligands targeting the E3 ligase KLHDC2. Furthermore, we functionalize these KLHDC2-targeting ligands into KLHDC2-based BET-family and AR PROTAC degraders and demonstrate KLHDC2-dependent target-protein degradation. Additionally, we offer insight into the assembly of the KLHDC2 E3 ligase complex. Using biochemical binding studies, X-ray crystallography and cryo-EM, we show that the KLHDC2 E3 ligase assembles into a dynamic tetramer held together via its own C terminus, and that this assembly can be modulated by substrate and ligand engagement.

Exploring Multiple Dimensions of Access to and Preferences for Telehealth Use.

Introduction: During the pandemic, telehealth became critically important in care provision. Yet, research exposed the inequities facing various groups of people in terms of accessing telehealth. The purpose of this analysis was to examine the various dimensions of access that impact a person's ability to use and preference for telehealth. Methods: We used a mixed-methods approach framed by Levesque's Access to Health care model. In August, 2021, a stratified random sample of 500 patients of an integrated rural health care network was invited to participate in a survey designed to capture familiarity with, use of, and preference for digital technologies in general as well as with telehealth. In addition, key informant interviews were conducted between January 2022 and June 2022. Results: Patients' willingness to use telehealth was influenced by multiple dimensions of access, including approachability of the resource, acceptability, availability, affordability, and appropriateness. Clinician beliefs and attitudes as well as health care system policies affected how a patient perceived, sought, reached, and engaged with telehealth. Conclusions: Access is a dynamic, multifaceted concept that is influenced by individual-, organization-, and systemic-level factors. Looking beyond patient determinants and examining different dimensions of access is important to better facilitate implementation and sustainment of telehealth.