ABSTRACT
BACKGROUND: Virtual care expanded rapidly during the COVID-19 pandemic, and how this shift affected healthcare disparities among subgroups of patients is of concern. Racial and ethnic minorities, older adults, individuals with less education, and lower-income households have lower rates of home broadband, smartphone ownership, and patient portal adoption, which may directly affect access to virtual care. Because primary care is a major access point to healthcare, perspectives of primary care providers are critical to inform the implementation of equitable virtual care. OBJECTIVE: The aim of this mixed methods study was to explore primary care physician experiences and perceptions of barriers and facilitators to equitable virtual care. DESIGN: We used an explanatory sequential mixed methods design, which consists of first collecting and analyzing quantitative survey data, then using those results to inform a qualitative follow-up phase to explain and expand on results. PARTICIPANTS: Primary care physicians in a family medicine department at an academic medical center responded to surveys (n = 38) and participated in interviews (n = 16). APPROACH: Participants completed a survey concerning frequency and preferences about video visits, pros and cons of video visits, communication aspects, and sufficiency of the technology. A purposeful sample of participants completed semi-structured interviews about their virtual care experiences with a focus on equity for subpopulations. KEY RESULTS: The results indicated that physicians have observed equity issues for unique patient populations. The results add to the understanding of nuanced ways in which virtual care can increase and decrease healthcare access for unique populations. Patients with limited English proficiency were particularly affected by inequity in virtual care access. CONCLUSION: Additional research and interventions are needed to improve portal access for those with limited English proficiency. Improvements should focus on health system interventions that expand access without requiring increased patient burden.
ABSTRACT
OBJECTIVE: To examine the feasibility of using social media to assess the consumer nutrition environment by comparing sentiment expressed in Yelp reviews with information obtained from a direct observation audit instrument for grocery stores. DESIGN: Trained raters used the Nutrition Environment Measures Survey in Stores (NEMS-S) in 100 grocery stores from July 2015 to March 2016. Yelp reviews were available for sixty-nine of these stores and were retrieved in February 2017 using the Yelp Application Program Interface. A sentiment analysis was conducted to quantify the perceptions of the consumer nutrition environment in the review text. Pearson correlation coefficients (ρ) were used to compare NEMS-S scores with Yelp review text on food availability, quality, price and shopping experience. SETTING: Detroit, Michigan, USA.ParticipantsNone. RESULTS: Yelp reviews contained more comments about food availability and the overall shopping experience than food price and food quality. Negative sentiment about food prices in Yelp review text and the number of dollar signs on Yelp were positively correlated with observed food prices in stores (ρ=0·413 and 0·462, respectively). Stores with greater food availability were rated as more expensive on Yelp. Other aspects of the food store environment (e.g. overall quality and shopping experience) were captured only in Yelp. CONCLUSIONS: While Yelp cannot replace in-person audits for collecting detailed information on the availability, quality and cost of specific food items, Yelp holds promise as a cost-effective means to gather information on the overall cost, quality and experience of food stores, which may be relevant for nutrition outcomes.
