Equity in Medical Care for People Living With Diabetes.

Disparities and inequities exist for individuals with diabetes in marginalized communities of color, especially among people with low socioeconomic status. Although these barriers are apparent, only a few care models have been designed for and examined in racially and ethnically diverse individuals. This article reviews models that have been developed and examined in a variety of different populations and focuses on how to implement elements from these programs in clinical practice. Health equity-promoting ideas and approaches that can be applied throughout the life span (children to seniors) are also included. As diabetes health care providers, researchers, educators, policymakers, and advocates, we must now combine our efforts and focus on historically excluded populations to bridge the gap to essential diabetes care.

Reasons for and predictors of patients' online health information seeking following a medical appointment.

BACKGROUND: Little is known about patients' online health information seeking after a primary care or specialist medical visit. OBJECTIVES: To examine predictors of patients' post-visit online health information seeking, reasons for seeking information and information sources used. METHODS: Survey of online support group members (N = 311) with a recent medical visit. Measures included eHealth literacy, patient-centred communication (PCC), post-visit changes in worry, online health information seeking and reasons for seeking information. Analyses were based on descriptive statistics and logistic regression. RESULTS: Eighty per cent of patients went online post-visit. The most common source used was others' forum posts (91%). The most common reason was curiosity (68%). Dissatisfaction with the physician's performance motivated information seeking for 40% of respondents. In a multivariate analysis, post-visit online health information seeking was highest among patients who were more eHealth literate [odds ratio (OR) = 1.73 (95% confidence interval (CI): 1.11, 2.71), P = 0.016], gave lower PCC ratings to their providers [OR = 0.45 (0.22, 0.90), P = 0.024] and experienced increased worry due to the visit [OR = 5.19 (1.36, 19.82), P = 0.016]. eHealth literate patients made greater use of specialized medical information (e.g. online medical journal articles) than less literate patients. Primary care physicians were rated as more patient centred than specialists. Visit-induced worry led to greater use of interpersonal channels (e.g. e-mailing other forum members). Patients who saw their doctor as less patient-centred were more likely to go online due to dissatisfaction with doctor performance. CONCLUSION: Online support forum members often turn to the Internet for health information following their medical visits. Their information seeking is shaped by patient, relational and visit factors.

The prepared patient: information seeking of online support group members before their medical appointments.

The authors examined online support group members' reliance on their Internet community and other online and offline health resources as they prepare for a scheduled medical appointment. Adult members of an online support group (N = 505) with an upcoming medical appointment completed an online questionnaire that included measures of illness perceptions, control preference, trust in the physician, and eHealth literacy; a checklist of actions one could take to acquire health information; and demographic questions. A factor analysis identified 4 types of information seeking: reliance on the online support group, use of other online health resources, use of offline health resources, and personal network contacts. Previsit information seeking on the Internet was extensive and typically augmented with offline information. Use of online health resources was highest among those who believed they had control over their illness, who attributed many symptoms and negative emotions to it, and who were more eHealth literate. Reliance on the online support group was highest among those who believed they had personal control over their illness, expected their condition to persist, and attributed negative emotions to it. Trust in the physician and preferences for involvement in decision making were unrelated to online information seeking. Most respondents intended to ask their physician questions and request clinical resources based on online information.

Specialized Technology Education for Pumps and Pens in Underserved Populations with Diabetes.

Background: Health care disparities in the use of diabetes devices are particularly prevalent, especially given the high levels of health literacy and numeracy needed to understand their use. Methods: To reduce this gap, we created lower literacy, English and Spanish multicultural guides for insulin pen and pump use. Focus groups provided input, nonbranded illustrations were designed, and simplified text was developed. The guides were implemented in our clinic for underresourced individuals in East Los Angeles, California. Subjects given the low literacy guides participated in guide-driven individual and group education, and measures were administered at baseline, 6 and 12 months. Results: Sixty-three adults with type 1 diabetes (T1D) were included, and 43 (68%) completed all 12 months of the study. Initial HbA1c was 9.2 ± 1.97 (standard deviation) with no change over the study course (12-month A1C = 9.3 ± 1.92). However, participants showed significantly reduced psychological distress due to diabetes, increased diabetes knowledge, improved self-report of health, and a trend toward reduced depression. There was also a reduction in rates of diabetic ketoacidosis (DKA). There was no change in rates of hypoglycemia, although there was an increase in fear of hypoglycemia. Conclusions: Appropriately targeted teaching guides can be used to improve various patient-reported outcomes in people with T1D, specifically, overall self-report of health, distress due to diabetes, and diabetes knowledge. Targeted teaching guides also achieved improvements in rates of DKA in T1D. While these results are encouraging, more work is needed to make a significant impact on glycemic control. Clinical Trials registration number: NCT04550585.

Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study.

BACKGROUND: Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient- or visit-related factors and trust play when in-person visits are eliminated. OBJECTIVE: The aim of this study is to examine correlates of patients' satisfaction with a telemedicine visit. METHODS: In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged ≥18 years who completed a telemedicine visit between March 10th and April 17th, 2020, were invited for a survey (n=1624). Measures included patient demographics, degree of interpersonal trust in patient-physician relationships (using the Trust in Physician Scale), and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression. RESULTS: Of 1624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (173/365, 47.4%) or satisfied (n=129, 35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.001). Visit-related factors with statistically significant correlation with Trust in Physician score were technical issues with the telemedicine visit (r=-0.16), concerns about privacy (r=-0.19), concerns about cost (r=-0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47; all P<.01). Visit-related factors associated with patients' satisfaction included fewer technical issues (P<.001), less concern about privacy (P<.001) or cost (P=.02), and successful face-to-face video (P<.001). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.001). Younger age was associated with higher satisfaction with the telemedicine visit (P=.005). CONCLUSIONS: There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients' satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed.

Lingering questions and doubts: online information-seeking of support forum members following their medical visits.

OBJECTIVE: To examine the prevalence and predictors of patients' post-appointment online health information-seeking and the reasons behind their information searches. METHODS: Survey of 274 Internet support community members who had been seen by a physician within 30 days. The questionnaire included measures of trust in the physician, health worries, changes in amount of worrying following the visit, online health information-seeking, and standard demographic and visit characteristics. RESULTS: A majority of respondents (68%) went online in search of information after their visits. In a logistic regression analysis, going online was associated with lower trust (P=.002), greater worrying (P=.049), and becoming more (P=.024) or less worried (P=.05) by the visit. Among those who went online, the most common reasons for doing so were sheer curiosity (71%) and disappointment with some aspect of the physician's behavior (32%). CONCLUSION: Patients in this online forum routinely turned to the Internet after their medical visits, but were especially likely to do so when trust in the physician was low, anxieties were high, and the visit altered (for better or worse) their anxiety levels. PRACTICE IMPLICATIONS: Since many patients seek online information after their appointments, physicians should suggest credible websites suited to the circumstances of each patient.

Encouraging patients with depressive symptoms to seek care: a mixed methods approach to message development.

OBJECTIVE: To assess the message preferences of individuals affected by depression as part of a project that will evaluate interventions to encourage at-risk patients to talk to their physicians about depression. METHODS: Adaptive Conjoint Analysis (ACA) of 32 messages defined by 10 message attributes. Messages were developed based on input from three focus groups comprised of individuals with a personal and/or family history of depression, then tested using volunteers from an Internet health community. In an online conjoint survey, 249 respondents with depression rated their liking of the messages constructed for each attribute. They were then presented with two message sets and rated their preferences. Preference utilities were generated using hierarchical Bayes estimation. RESULTS: The optimal communication approach described both psychological and physical symptoms of depression, recognized multiple treatment options, offered lifetime prevalence data, noted that depression can affect anyone, and acknowledged that finding an effective treatment can take time. CONCLUSION: Individuals with depression respond differently to depression care messages, underscoring the need for careful message development and evaluation. PRACTICE IMPLICATIONS: ACA, used in conjunction with focus groups, is a promising approach for developing and testing messages in the formative research stage of intervention development.