Proxy use of patient portals on behalf of children: Federally Qualified Health Centers as a case study.

Objective: This study examined the proxy use of patient portals for children in a large Federally Qualified Health Centers (FQHC) network in Texas. Methods: We used de-identified individual-level data of patients, 0-18 years, who had 1+ visits between December 2018 and November 2020. Logistic regression was used to examine patient-, clinic-, and geographic-level factors associated with portal usage by an assumed proxy (i.e. parent or guardian). Results: The proxy portal usage rate increased from 28% in the pre-pandemic months (November 2018-February 2020) to 34% in the pandemic months (March-Nov 2020). Compared to patients 0-5 years, patients aged 6 to 18 years had lower odds of portal usage (6-10 OR: 0.77, p < 0.001; 11-14 OR: 0.62, p < 0.001; 15-18 OR: 0.51, p < 0.001). Minoritized groups had significantly lower odds of portal usage when compared to their non-Hispanic White counterparts (non-Hispanic Black OR: 0.78, p < 0.001; Hispanic OR 0.63, p < 0.001; Asian OR: 0.69, p < 0.001). Having one chronic condition was associated with portal usage (OR: 1.57, p < 0.001); however, there were no significant differences in portal usage between those with none or multiple chronic conditions. Portal usage also varied by service lines, with obstetrics and gynecology (OR: 1.84, p < 0.001) and behavioral health (OR 1.82, p < 0.001) having the highest odds of usage when compared to pediatrics. Having a telemedicine visit was the strongest predictor of portal usage (OR: 2.30, p < 0.001), while residence in zip codes with poor broadband internet access was associated with lower odds of portal usage (OR: 0.97, p < 0.001). Conclusion: While others have reported portal usage rates as high as 64% in pediatric settings, our analysis suggests proxy portal usage rates of 30% in pediatric FQHC settings, with race/ethnicity, age group, and chronic disease status being significant drivers of portal non-usage. These findings highlight the need for appropriate and responsive health information technology approaches for vulnerable populations receiving care in low-resource settings.

Comparing In-Person Only, Telemedicine Only, and Hybrid Health Care Visits Among Older Adults in Safety-Net Clinics.

Introduction: Older adults face challenges in seeking health care. This study examined factors associated with in-person only versus telemedicine only versus hybrid health care visits among adults 65+ in safety-net clinics. Methods: Data were obtained from a large Texas-based Federally Qualified Health Center (FQHC) network. The dataset included 12,279 appointments for 3914 unique older adults between March and November 2020. The outcome of interest was a 3-level indicator of telemedicine visits: in-person visits only, telemedicine visits only, and hybrid (in person + telemedicine) visits during the study period. We used a multinomial logit model adjusting for patient level characteristics to assess the strength of the relationships. Results: Compared to their white counterparts, black and Hispanic older adults were significantly likely to have telemedicine only visits versus in-person only visits (black RRR: 0.59, 95% confidence interval [CI]: 0.41-0.86; Hispanic RRR: 0.46, 95% CI: 0.36-0.60). However, there were no significant racial and ethnic differences in hybrid utilization (black RRR: 0.91, 95% CI: 0.67-1.23; Hispanic RRR: 0.86, 95% CI: 0.70-1.07). Discussion: Our findings suggest that hybrid opportunities may bridge racial and ethnic disparities in access to care. Clinics should consider building capacity for both in-person and telemedicine opportunities as complementary strategies.

Low Molecular Weight Bio-Polyamide 11 Composites Reinforced with Flax and Intraply Flax/Basalt Hybrid Fabrics for Eco-Friendlier Transportation Components.

The transportation sector is striving to meet the more severe European legislation which encourages all industrial fields to embrace more eco-friendly policies by exploiting constituents from renewable resources. In this framework, the present work assessed the potential of a bio-based, low molecular weight PA11 matrix reinforced with flax and intraply flax/basalt hybrid fabrics. To this aim, both quasi-static and impact performance were addressed through three-point bending and low-velocity impact tests, respectively. For hybrid composites, the effect of stacking sequence, i.e., [0/0] and [0/90], and fiber orientation were considered, while the effect of temperature, i.e., -40 °C, room temperature and +45 °C, was investigated for laminates' impact response. The mechanical experimental campaign was supported by thermal and morphological analyses. The results disclosed an improved processability of the low molecular weight PA11, which ensured a manufacturing temperature of 200 °C, which is fundamental to minimize flax fibers' thermal degradation. Both quasi-static and impact properties demonstrated that hybridization is a good solution for obtaining good mechanical properties while preserving laminates' lightness and biodegradability. The [0/90] configuration proved to be the best solution, providing satisfying flexural performance, with an increase between 62% and 83% in stiffness and between 19.6% and 37.6% in strength compared to flax-based laminates, and the best impact performance, with a reduction in permanent indentation and back crack extent.