Associations Between Telemedicine Use Barriers, Organizational Factors, and Physician Perceptions of Care Quality.

Introduction: Evaluating physician perceptions of telemedicine use and its impact on care quality among physician providers is critical to sustaining telemedicine programs, given the uncertainty of reimbursement policy, preferences, inadequate training, and technical difficulties. Physicians reported technical barriers to effectively practicing integrated medicine using telemedicine as patient volumes increased during the pandemic. The objective of this work was to examine whether perceived practice barriers and facilitators were associated with physician respondents' perceptions of telemedicine care quality compared with in-person care. Methods: This cross-sectional study analyzed the 2021 National Electronic Health Record Survey. The sample comprised 1,857 nonfederally employed physicians (weighted n = 403,013) delivering integrated patient care. Of those physicians, 1,630 (weighted n = 346,646) reported providing care through telemedicine. We reported frequencies and percentages of reported practice characteristics. Generalized ordinal logistic regressions examined relationships between practice factors and care quality for telemedicine care. Results: Most of the sample (n = 1,630) were male (66.1%), >50 years of age (66.1%), and worked in a single location (73.5%). A total of 70% of respondents reported that patients had difficulty using telemedicine platforms, and 64% reported limitations in patients' access to technology. Most respondents indicated having provided quality care to some extent (45%) and to a great extent (26%) during telemedicine visits compared to in-person visits. Associations between barriers, facilitators, and care quality perceptions were positive, underscoring resiliency in telemedicine programs among practices. Conclusion: Care modalities and the organizational, environmental, and personal facilitators drive quality perceptions among physicians. Perceived fit and usability determine perceptions of care quality for providers integrating telemedicine into their practice.

State-level regulations and opioid-related health outcomes.

INTRODUCTION: Due to the ongoing opioid use disorder crisis, improved access to opioid treatment programs (OTPs) is needed. However, OTPs operate in a complex regulatory environment which may limit their ability to positively affect health outcomes. The objective of this study was to examine how the number and type of state OTP regulations are associated with opioid-related deaths, hospitalizations, and emergency department visits. METHODS: Cross-sectional data capturing information about OTP state-level regulations collected by Jackson et al. was combined with other secondary sources. OTP regulations were categorized based on the nature of their focus. Analyses include bivariate and multivariable regressions that controlled for region and other state laws that can affect opioid outcomes. RESULTS: In bivariate analysis, a greater number of OTP regulations was positively correlated with both deaths and emergency visits. Moreover, a greater number of regulations in the Physical Facilities Management category (e.g., rules related to restrooms, lighting, and signage) was positively correlated with both deaths and hospitalizations. The number of regulations in the Staffing Requirement category was positively associated with emergency visits. In adjusted analysis, the number of regulations in the Physical Facilities Management category was positively associated with opioid-related deaths. CONCLUSIONS: States with a higher number of regulations had poorer opioid-related outcomes. Additional research is needed to support policy decisions that can improve access to OTPs and reduce avoidable deaths, hospitalizations, and emergency visits.

Characterizing variability in state-level regulations governing opioid treatment programs.

INTRODUCTION: The opioid use crisis has left nearly 1 million people in need of treatment. States have focused primarily on policies aimed at decreasing the prevalence of opioid use disorder. However, opioid treatment programs (OTPs), an evidence-based modality which can prevent and decrease opioid-related mortality and morbidity, remain highly complex with variation in treatment by state. Evidence-based state-level regulation of OTPs can be a powerful tool and may help improve the unmet need for treatment. This study characterized the variability in state laws that regulate OTPs and examines how this variability is associated with state characteristics. Our data provides an opportunity for policymakers to consider regulations that increase access to care and retention in OTPs, which could improve population health. MATERIALS AND METHODS: Utilizing policy mapping techniques, we identified all regulations governing OTPs in effect on January 1, 2017 and determined whether the most common regulations were consistent with best practices. We then examined how the number and type of regulations were associated with state characteristics. All policy mapping research was conducted between November 2017 and March 2019. RESULTS: We identified 89 different regulations, the most common of which exists in fewer than half of all states; and most exist in <25% of states. Eighteen of the 30 most common regulations were inconsistent with best practice recommendations. Overall, variability in the number and type of OTP regulations was related to geographic location as opposed to state size. CONCLUSIONS: Wide-ranging variability exists in the regulations of OTPs across the U.S. Most state OTP regulations are not congruent with best practices.

Graduation and Academic Placement of Underrepresented Racial/Ethnic Minority Doctoral Recipients in Public Health Disciplines, United States, 2003-2015.

OBJECTIVES: Given public health's emphasis on health disparities in underrepresented racial/ethnic minority communities, having a racially and ethnically diverse faculty is important to ensure adequate public health training. We examined trends in the number of underrepresented racial/ethnic minority (ie, non-Hispanic black, Hispanic, American Indian/Alaska Native, Native Hawaiian, and Pacific Islander) doctoral graduates from public health fields and determined the proportion of persons from underrepresented racial/ethnic minority groups who entered academia. METHODS: We analyzed repeated cross-sectional data from restricted files collected by the National Science Foundation on doctoral graduates from US institutions during 2003-2015. Our dependent variables were the number of all underrepresented racial/ethnic minority public health doctoral recipients and underrepresented racial/ethnic minority graduates who had accepted academic positions. Using logistic regression models and adjusted odds ratios (aORs), we examined correlates of these variables over time, controlling for all independent variables (eg, gender, age, relationship status, number of dependents). RESULTS: The percentage of underrepresented racial/ethnic minority doctoral graduates increased from 15.4% (91 of 592) in 2003 to 23.4% (296 of 1264) in 2015, with the largest increase occurring among black graduates (from 6.6% in 2003 to 14.1% in 2015). Black graduates (310 of 1241, 25.0%) were significantly less likely than white graduates (2258 of 5913, 38.2%) and, frequently, less likely than graduates from other underrepresented racial/ethnic minority groups to indicate having accepted an academic position (all P < .001). CONCLUSIONS: Stakeholders should consider targeted programs to increase the number of racial/ethnic minority faculty members in academic public health fields.

Employment Trends Among Public Health Doctoral Recipients, 2003-2015.

OBJECTIVES: To examine postgraduation employment trends among graduates of doctoral programs in public health from 2003 to 2015. METHODS: We analyzed pooled cross-sectional data from a census of graduates receiving a research doctorate from US accredited institutions. The outcome of interest was employment status. Covariates included public health discipline, sociodemographic characteristics, and institutional attributes. RESULTS: Of 11 771 graduates, nearly two thirds secured employment in either academic (34.8%) or nonacademic (31.4%) settings at the time of graduation. The proportion of those still seeking employment increased over time. Individuals who were White, younger, trained in either biostatistics or epidemiology, or from an institution with the highest level of research intensity were significantly more likely to secure employment. Academic employment was the most common setting for all 5 public health disciplines, but we observed differences in employment patterns (e.g., government, nonprofit, for-profit) across disciplines. CONCLUSIONS: Certain characteristics among public health doctoral recipients are correlated with postgraduation employment. More research is needed, but the observed increase in individuals still seeking employment may be attributable to increases in general public health graduates from for-profit institutions.

Interdisciplinary Dissertation Research Among Public Health Doctoral Trainees, 2003-2015.

OBJECTIVES: Given the call for more interdisciplinary research in public health, the objectives of this study were to (1) examine the correlates of interdisciplinary dissertation completion and (2) identify secondary fields most common among interdisciplinary public health graduates. METHODS: We analyzed pooled cross-sectional data from 11 120 doctoral graduates in the Survey of Earned Doctorates, 2003-2015. The primary outcome was interdisciplinary dissertation completion. Covariates included primary public health field, sociodemographic characteristics, and institutional attributes. RESULTS: From 2003 to 2015, a total of 4005 of 11 120 (36.0%) doctoral graduates in public health reported interdisciplinary dissertations, with significant increases observed in recent years. Compared with general public health graduates, graduates of environmental health (odds ratio [OR] = 1.74; P < .001) and health services administration (OR = 1.38; P < .001) doctoral programs were significantly more likely to report completing interdisciplinary dissertation work, whereas graduates from biostatistics (OR = 0.51; P < .001) and epidemiology (OR = 0.76; P < .001) were less likely to do so. Completing an interdisciplinary dissertation was associated with being male, a non-US citizen, a graduate of a private institution, and a graduate of an institution with high but not the highest level of research activity. Many secondary dissertation fields reported by interdisciplinary graduates included other public health fields. CONCLUSION: Although interdisciplinary dissertation research among doctoral graduates in public health has increased in recent years, such work is bounded in certain fields of public health and certain types of graduates and institutions. Academic administrators and other stakeholders may use these results to inform greater interdisciplinary activity during doctoral training and to evaluate current and future collaborations across departments or schools.