Characteristics of programmes designed to link community-dwelling older adults in high-income countries from community to clinical sectors: a scoping review protocol.

INTRODUCTION: Research on effectively navigating older adults into primary care is urgently needed. Community-clinic linkage models (CCLMs) aim to improve population health by linking the health and community sectors in order to improve patients' access to healthcare and, ultimately, population health. However, research on community-based points of entry linking adults with untreated medical needs into the healthcare sector is nascent. CCLMs implemented for the general adult population are not necessarily accessible to older adults. Given the recency of the CCLM literature and the seeming rarity of CCLM interventions designed for older adults, it is appropriate to employ scoping review methodology in order to generate a comprehensive review of the available information on this topic. This protocol will inform a scoping review that reviews characteristics of community-based programmes that link older adults with the healthcare sector. METHODS AND ANALYSIS: The present protocol was developed as per JBI Evidence Synthesis best practice guidance and reporting items for the development of scoping review protocols. The proposed scoping review will follow Levac and colleagues' update to Arksey and O'Malley's scoping review methodology. Healthcare access at the system and individual levels will be operationalised in data extraction and analysis in accordance with Levesque and colleagues' Conceptual Framework of Access to Health. The protocol complies with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Beginning in August 2023 or later, citation databases (AgeLine (Ebsco); CINAHL Complete; MEDLINE (PubMed); Scopus Advanced (Elsevier); Social Services Abstracts (ProQuest); Web of Science Core Collection (Clarivate)) and grey literature (Google; American Public Health Association Annual Meeting Conference Proceedings; SIREN Evidence & Resource Library) will be searched. ETHICS AND DISSEMINATION: The authors plan to disseminate their findings in conference proceedings and publication in a peer-reviewed journal and deposit extracted data in the Figshare depository. The study does not require Institutional Review Board approval. REGISTRATION DETAILS: Protocol registered in Open Science Framework (DOI https://doi.org/10.17605/OSF.IO/2EF9D).

Utilization and Staff Perspectives on an On-Demand Telemedicine Model for People with Intellectual and Developmental Disabilities Who Reside in Certified Group Residences.

Background: Non-emergent medical problems that arise when a usual provider is unavailable can often result in emergency department or urgent care visits, which can be particularly distressing to people with intellectual and developmental disabilities (PIDD). On-demand, synchronous telemedicine may be a promising supplement when immediate care from usual sources is unavailable. Prior research demonstrated that high-quality telemedicine can be effectively delivered to PIDD. The aim of this article is to describe the utilization and staff perspectives on the implementation of the Telemedicine Triage Project (TTP), an innovative model that provides telemedicine consultations for PIDD who reside in state-certified group residences and present with an urgent but non-emergent medical concern when their usual provider is unavailable. Methods: Call frequency data for calendar years 2020 and 2021 were reviewed. The study team conducted semi-structured interviews, with 19 key informants representing organizational- and agency-level leadership and staff. The interview data were analyzed using a protocol-driven, rapid qualitative methodology. Results: Telemedicine consultations increased from 7953 in 2020 to 15,011 calls in 2021, and call volume peaked between 10 am and 1 pm. Key informants reported high satisfaction with TTP; universal benefits and a few barriers to implementation; and strong interest in maintaining the program beyond the grant period. Discussion: Over the first 2 years of its implementation, the TTP program was widely utilized and proved extremely feasible and acceptable to staff. This model is a promising and highly feasible way to provide equitable access to telemedicine for PIDD by addressing barriers to and disparities in access to health care that affect PIDD.

Technology, Training, and Task Shifting at the World's Largest Mass Gathering in 2025: An Opportunity for Antibiotic Stewardship in India.

The role of antibiotic overuse in intensifying selection pressures and contributing to the emergence of antimicrobial resistance is well established. The Kumbh Mela, a religious festival that occurs in 4 Indian cities of spiritual significance, is the world's largest mass gathering, attracting over 80 million pilgrims in 2013. Digital syndromic surveillance from the 2013 and 2015 Melas demonstrated a consistent pattern of antibiotic overuse, with an antibiotic prescribing rate of up to 31% for all patient encounters. As preparations for the 2025 Kumbh Mela begin, task shifting, point-of-care diagnostic and digital tools, robust clinician training, and community awareness can promote the restrained and evidence-based use of antibiotics, minimizing the potential for the emergence of antimicrobial resistance at the world's largest mass gathering.

Health and Health Determinant Metrics for Cities: A Comparison of County and City-Level Data.

We evaluated whether using county-level data to characterize public health measures in cities biases the characterization of city populations. We compared 4 public health and sociodemographic measures in 447 US cities (percent of children living in poverty, percent of non-Hispanic Black population, age-adjusted cardiovascular disease mortality, life expectancy at birth) to the same measures calculated for counties that contain those cities. We found substantial and highly variable city-county differences within and across metrics, which suggests that use of county data to proxy city measures could hamper accurate allocation of public health resources and appreciation of the urgency of public health needs in specific locales.

Use of Colorectal Cancer Screening Among People With Mobility Disability.

GOALS: We aimed to assess use of colorectal cancer screening (CRCS) as per United States Preventive Task Force guidelines among people with mobility disability using a nationally representative data set. BACKGROUND: Individuals with mobility disability have decreased access to health care services, but the impact of mobility disability on CRCS has not been investigated. STUDY: Data from the 2013 National Health Interview Survey were used to estimate sociodemographic characteristics of adults with mobility disability, prevalence of CRCS, and odds of CRCS given mobility disability among Americans aged 50 to 75. RESULTS: In total, 56.8% of the entire sample (n=81,953,585) were up-to-date with CRCS. Mobility disability was not associated with CRCS status on univariable analysis but was significantly associated after adjustment for covariates including age and comorbidities, with an inverse relationship between the degree of mobility disability and odds of CRCS. Odds ratio for CRCS given progressively severe disability were 0.78 (0.66 to 0.93), 0.71 (0.53 to 0.94), 0.65 (0.31 to 1.19). CONCLUSIONS: The present study indicates reduced CRCS among people with mobility disability and highlights the need for CRCS to be especially targeted toward this group. Future research should identify the specific systemic, social, and/or physical barriers to CRCS for this subgroup so that they can be addressed.

Integration of Slack, a cloud-based team collaboration application, into research coordination.

BACKGROUND: Practitioners of epidemiology require efficient real-time communication and shared access to numerous documents in order to effectively manage a study. Much of this communication involves study logistics and does not require use of Protected Health Information. Slack is a team collaboration app; it archives all direct messages and group conversations, hosts documents internally, and integrates with the Google Docs application. Slack has both desktop and mobile applications, allowing users to communicate in real-time without the need to find email addresses or phone numbers or create contact lists. METHOD: We piloted the integration of Slack into our research team of one faculty member, one research coordinator, and approximately 20 research assistants. Statistics describing the app's usage were calculated twelve months after its implementation. RESULTS: Results indicating heavy usage by both research professionals and assistants are presented. Our Slack group included a cumulative 51 users. Between October 2015 and November 2016, approximately 10,600 messages were sent through Slack; 53% were sent by RA's and 47% were sent by us. Of the 106 files stored on Slack, 82% were uploaded by research staff. In a January 2016 survey, 100% of RA's agreed or strongly agreed that Slack improved communication within the team. CONCLUSION: We demonstrate a model for integration of communication technology into academic activities by research teams. Slack is easily integrated into the workflow at an urban, academic medical center and is adopted by users as a highly effective tool for meeting research teams' communication and document management needs.

Seeing is believing? A mixed-methods study exploring the quality and perceived trustworthiness of online information about chronic conditions aimed at children and young people.

The numbers of children and young people with chronic conditions are increasing. While their information needs may vary, providing health care information can have considerable benefits, including better emotional health, less distress during treatments, and greater satisfaction with medical care. The Internet is increasingly being used to communicate health-related information to children about a range of chronic conditions. However, the quality of such websites is underexplored. Thus, the objectives of this study were to evaluate the reliability and quality of online information for children about chronic conditions using a standardized evaluation tool, and to explore children's and young people's perceptions of quality and trustworthiness regarding online health information. The study consisted of two phases. In Phase 1, websites about common pediatric chronic conditions aimed at children and containing treatment or management options were identified and the quality assessment tool DISCERN was completed. Test-retest and interrater reliability were calculated. In Phase 2, two focus groups with laptop computers were conducted with children and young people with a chronic condition to explore their perceptions of trustworthiness of online health information. In Phase 1, 165 websites were identified and 100 met the criteria and were assessed. The mean DISCERN score of all sites was 48.16 out of 75 (SD = 7.97, range 28-71, min 15 to max 75). Quality scores varied widely across the sample. The internal consistency and interrater reliability scores were both lower than previously reported in studies using the DISCERN to assess information for adults. In Phase 2, two focus groups with a total of six participants aged 11-23 years revealed a relative lack of concern about the quality and trustworthiness of online health information. Older participants reported judging the source and authorship of websites, but other participants did not question the source of the information they found online. Although personal websites were perceived to be less reliable than those from well-known medical institutions, they were still valued by many of the participants. Overall, there were relatively few websites about pediatric chronic conditions aimed at children, with variable quality and reliability. However, DISCERN's use with pediatric websites across a broad spectrum of developmental stages is limited. Children and young people demonstrated a need for more guidance around assessing trustworthiness of online information. A more appropriate quality assessment tool is warranted, which could usefully be employed by health care professionals, children, and parents.