Theoretical concepts and instruments for measuring hospital discharge readiness: A scoping review.

Background: The Discharge Readiness of adult patients in a hospital setting is a multidimensional concept which is becoming increasingly important internationally as part of discharge planning. To date, there has been a lack of reviews of existing measurement instruments as well as theoretical concepts of discharge readiness. Objective: To provide an overview of existing measurement instruments and theoretical concepts regarding readiness for hospital discharge in adult patients. Design and methods: A scoping review was conducted in accordance with the Joanna Briggs Institute methodological manual and PRISMA ScR reporting principles. A literature search was conducted using the CINAHL and LIVIVO databases (including MEDLINE and PSYINDEX) in October 2021. After test screening, all identified articles were screened by two independent reviewers using predefined inclusion and exclusion criteria before the content was extracted and mapped. Results: Of the 1823 records identified, 107 were included in this review. Of these, 30 studies were included as development or validation studies of measurement instruments assessing discharge readiness, 68 were included as empirical studies with readiness for hospital discharge as the primary outcome or key concept, and nine publications were included as theoretical papers or reviews. Five dimensions of readiness for hospital discharge were extracted:1) Physical, 2) Psychological, 3) Education and Knowledge, 4) Adequate Individual Support, and 5) Social and Organisational Determinants. Of the 47 instruments identified for measuring discharge readiness, 33 were validated. The Readiness for Hospital Discharge Scale (RHDS) was the most frequently used instrument. Conclusions: The systematic measurement of readiness for hospital discharge, particularly from the patient's perspective combined with the nurse's perspective, might be useful in reducing negative outcomes such as readmissions. This review provides an overview of existing and validated instruments for the systematic assessment of discharge readiness in acute inpatient care, as well as an overview of the theoretical concepts of readiness for hospital discharge. Further research is needed on the relationship between organisational determinants and readiness for discharge.

Accessibility of Pelvic Floor Physiotherapy for Treating Urinary Incontinence in Older Women in Quebec: An Online Survey.

Purpose: This cross-sectional descriptive study describes available pelvic floor physiotherapy (PT) services for older women with urinary incontinence (UI) in Quebec, Canada, and identifies possible affordability barriers. Methods: From September to December 2019, Quebec physiotherapists practising pelvic floor PT were invited to complete a survey on their clinical practice and perceptions of the affordability of UI treatment for older women. Results: Eighty-four of the 225 registered pelvic floor physiotherapists (37.3%) filled out the online survey. They worked a median of 32 hours/week in PT, with 15 of those hours (46.9%) in pelvic floor PT and three hours (9.8%) treating UI in older women. Only 13.0% of them offered group treatment, while 84.3% were interested in it. Most of the physiotherapists (92.2%) had met older women in their practice who had reported financial barriers to completing their pelvic floor PT treatment. Conclusions: The accessibility of UI care in Quebec appears hampered by the limited availability of pelvic floor PT treatments, mainly in public settings, and potential financial constraints. Providing pelvic floor PT to groups could constitute a promising avenue to tackle both issues. Future studies should look at ways of implementing this option.

Objectif: Cette étude transversale décrit les services de physiothérapie du plancher pelvien (PPP) disponibles aux femmes âgées qui présentent de l'incontinence urinaire (IU) au Québec, Canada et en identifie les possibles barrières financières. Méthodologie: De septembre à décembre 2019, les physiothérapeutes du Québec pratiquant la PPP ont été invités à compléter un sondage sur leur pratique clinique et leurs perceptions quant à l'accessibilité financière du traitement de l'IU pour les femmes âgées. Résultats: Quatre-vingt-quatre des 225 physiothérapeutes en PPP du Québec (37,3%) ont complété le sondage. Leur semaine de travail médiane était de 32 heures/semaine en physiothérapie, dont 15 heures (46,9%) en PPP et trois heures (9,8%) pour le traitement de l'IU auprès de femmes âgées. Seulement 13,0% des physiothérapeutes offraient des traitements en groupe, bien que 84,3% avaient de l'intérêt pour ce format. La plupart (92,2%) avaient rencontré des femmes âgées avec des barrières financières limitant la poursuite de leur traitement en PPP. Conclusions: L'accessibilité des soins de continence au Québec apparaît limitée par la disponibilité restreinte des traitements de PPP, principalement dans le système public, et de possibles contraintes financières. La PPP en groupe pourrait constituer une avenue intéressante. D'autres études devront s'interroger sur l'implantation de telles options.

Real-world treatment of metastatic hormone-sensitive prostate cancer in the USA, Europe and Asia.

Aim: To characterize real-world patients with metastatic hormone-sensitive prostate cancer (mHSPC) and treating physicians and evaluate treatment trends and baseline concordance versus guidelines internationally. Materials & methods: Retrospective, cross-sectional data from the Ipsos Global Oncology Monitor database 2018-2020 were used for descriptive analysis of mHSPC patients, treating physicians and treatment utilization. Results: Among the 6198 mHSPC patients from five countries, the most common treatment was either androgen deprivation therapy (ADT) monotherapy or first-generation androgen receptor inhibitor + ADT. Second-generation androgen receptor inhibitor use was only initiating but increasing over the study period. Conclusion: Despite contemporaneous guidelines recommending treatment intensification of ADT in combination with novel antihormonals or docetaxel, 76.1% of reported mHSPC patients received non-guideline-concordant care.

Prostate cancer is the second most common cancer among men worldwide and a leading cause of cancer-related death globally. Metastatic hormone-sensitive prostate cancer (mHSPC) refers to the stage of prostate cancer where it has spread to other parts of the body ('metastatic') but still responds to hormonal therapy ('hormone-sensitive'), such as androgen deprivation therapy (ADT). Treatment guidelines around the world for men with mHSPC have changed over time, but there remains a lack of understanding of how well guidelines are followed in real-world practice. Consequently, this study analyzes real-world data from five countries between 2018 and 2020 to understand treatment patterns, baseline concordance versus guidelines and potential drivers of treatment trends. The study found prevalent use of ADT monotherapy and older antihormonal agents, and only marginal but increasing use of novel antihormonals in real-world practice. These practices deviate from guidelines from the study period, which generally recommended ADT combination with either newer antihormonal agents or docetaxel for patients with mHSPC. Overall, the proportion of the 6198 patients treated with non­guideline-concordant therapies was 76.1%. Since guideline-recommended care is associated with better outcomes, this baselining finding highlights the need for appropriate treatment selection and intensification for mHSPC patients.

Health service and psychotropic medication use for mental health conditions among healthcare workers active during the Spain Covid-19 Pandemic - A prospective cohort study using web-based surveys.

Little is known about healthcare workers' (HCW) use of healthcare services for mental disorders. This study presents data from a 16-month prospective cohort study of Spanish HCW (n = 4,809), recruited shortly after the COVID-19 pandemic onset, and assessed at four timepoints using web-based surveys. Use of health services among HCW with mental health conditions (i.e., those having a positive screen for mental disorders and/or suicidal thoughts and behaviours [STB]) was initially low (i.e., 18.2 %) but increased to 29.6 % at 16-month follow-up. Service use was positively associated with pre-pandemic mental health treatment (OR=1.99), a positive screen for major depressive disorder (OR=1.50), panic attacks (OR=1.74), suicidal thoughts and behaviours (OR=1.22), and experiencing severe role impairment (OR=1.33), and negatively associated with being female (OR = 0.69) and a higher daily number of work hours (OR=0.95). Around 30 % of HCW with mental health conditions used anxiolytics (benzodiazepines), especially medical doctors. Four out of ten HCW (39.0 %) with mental health conditions indicated a need for (additional) help, with most important barriers for service use being too ashamed, long waiting lists, and professional treatment not being available. Our findings delineate a clear mental health treatment gap among Spanish HCW.

Interventions and Hospital Characteristics Associated With Patient Experience: An Update of the Evidence.

Patient experience is a key hospital quality measure. We review and characterize the literature on interventions, care and management processes, and structural characteristics associated with better inpatient experiences as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Prior reviews identified several promising interventions. We update these previous efforts by including more recent peer-reviewed literature and expanding the review's scope to include observational studies of HCAHPS measures with process measures and structural characteristics. We used PubMed to identify U.S. English-language peer-reviewed articles published in 2017 to 2020 and focused on hospital patient experience. The two HCAHPS domains for which we found the fewest potential quality improvement interventions were Communication with Doctors and Quietness. We identified several modifiable processes that could be rigorously evaluated in the future, including electronic health record patient engagement functionality, care management processes, and nurse-to-patient ratios. We describe implications for future policy, practice, and research.

Access to quality care after injury in Northern Malawi: results of a household survey.

BACKGROUND: Most injury care research in low-income contexts such as Malawi is facility centric. Community-derived data is needed to better understand actual injury incidence, health system utilisation and barriers to seeking care following injury. METHODS: We administered a household survey to 2200 households in Karonga, Malawi. The primary outcome was injury incidence, with non-fatal injuries classified as major or minor (> 30 or 1-29 disability days respectively). Those seeking medical treatment were asked about time delays to seeking, reaching and receiving care at a facility, where they sought care, and whether they attended a second facility. We performed analysis for associations between injury severity and whether the patient sought care, stayed overnight in a facility, attended a second facility, or received care within 1 or 2 h. The reason for those not seeking care was asked. RESULTS: Most households (82.7%) completed the survey, with 29.2% reporting an injury. Overall, 611 non-fatal and four fatal injuries were reported from 531 households: an incidence of 6900 per 100,000. Major injuries accounted for 26.6%. Three quarters, 76.1% (465/611), sought medical attention. Almost all, 96.3% (448/465), seeking care attended a primary facility first. Only 29.7% (138/465), attended a second place of care. Only 32.0% (142/444), received care within one hour. A further 19.1% (85/444) received care within 2 h. Major injury was associated with being more likely to have; sought care (94.4% vs 69.8% p < 0.001), stayed overnight at a facility (22.9% vs 15.4% P = 0.047), attended a second place of care (50.3% vs 19.9%, P < 0.001). For those not seeking care the most important reason was the injury not being serious enough for 52.1% (74/142), followed by transport difficulties 13.4% (19/142) and financial costs 5.6% (8/142). CONCLUSION: Injuries in Northern Malawi are substantial. Community-derived details are necessary to fully understand injury burden and barriers to seeking and reaching care.

Correlation of morning dry mouth with clinical features of OSA in a community population: a cross-sectional study.

OBJECTIVES: Morning dry mouth, commonly seen in Obstructive Sleep Apnea (OSA) patients, is absent in current OSA screening tools. This study evaluated the link between morning dry mouth and OSA's clinical symptoms and complications, aiming to determine its viability as a screening indicator. METHODS: This research analyses baseline data from a prospective cohort study (the PIFCOPD study). Demographic information, medical history, and the presence of morning dry mouth symptoms were collected. The STOP-Bang questionnaire was performed for OSA screening. Logistic regression analyses were employed to establish the correlations between morning dry mouth and the clinical symptoms and comorbidities of OSA. RESULT: 1291 participants (62.1±7.5 years; 501 males, 790 females) were included, of which 416 reported morning dry mouth (32.2%). 42.6% in the high-risk OSA group and 22.1% in the low-risk group reported morning dry mouth. Individuals with morning dry mouth also showed higher STOP-Bang scores (3.3±1.6 vs. 2.3±1.4, P<0.01). Significant associations were found between morning dry mouth and loud snoring, observed sleep apnea, daytime fatigue, and hyperlipidemia (P<0.01), but not with alcohol consumption, tea consumption, diabetes, or hypertension. CONCLUSION: Morning dry mouth is associated with increased OSA risk and its clinical signs, suggesting its potential as an OSA screening symptom. CLINICAL TRIAL REGISTRATION: This study has been registered at www.ClinicalTrials.gov (registration identifier: NCT03532893) on 21 May 2018.

Chiropractic Care in a Multidisciplinary Sports Health Care Environment: A Survey of Canadian National Team Athletes.

OBJECTIVE: The purpose of this study was to describe the utilization of health team practitioners among national-level athletes and report their injury profile as well as access to and knowledge of chiropractic care. METHODS: This study was a retrospective analysis of non-identifiable, cross-sectional survey data that were previously collected from members of the AthletesCAN organization who voluntarily completed a web-based, bilingual survey in July or August 2017. The sport of the athlete, number of years on a national team, number and type of injuries, health care practitioners visited, and specific details on chiropractic care were collected. Descriptive statistics were performed to summarize the responses in terms of frequencies and percentages. RESULTS: There was an 11% response rate (198/1733), with 67 unique sports identified (21 winter sports [50 athletes] and 46 summer sports [148 athletes]). Athletics and swimming were the sports with the most respondents. Fewer than half (43.9%) of the 198 respondents were members of AthletesCAN for 2 to 5 years. Seventy percent reported 1 to 5 injuries over their career, with ankle, low back, and shoulder the most likely body parts affected. A majority of athletes (93.4%) reported visiting multiple practitioners, including medical physicians, physiotherapists, athletic therapists, massage therapists, and chiropractors. Two-thirds (67%) of athletes sought chiropractic treatment, most typically for neck or back pain (81.3%), despite nearly half (45.7%) being unsure about access to chiropractic care. CONCLUSION: This sample of Canadian national team athletes who experience an injury may seek care from multiple types of health care providers and include chiropractic as part of their approach to health care.

Decision making in breast implant selection for breast reconstruction: A mixed-method study among plastic surgeons.

Background: Breast implants and the (dis)advantages of their characteristics (shape, filling, surface, and brand) have been studied extensively. When selecting a specific breast implant, a plastic surgeon makes a trade-off between the various (dis)advantages. However, the factors affecting the choice of their preferred breast implant have not been studied in detail. Methods: This is a mixed-method study. First, five plastic surgeons were interviewed to identify factors that influence their choice of a breast implant in a reconstructive setting. Second, 42 plastic surgeons were asked to state their preferred implant, weigh the collected factors, and indicate when they would deviate from their preferred implant. Results: The interviews produced a varied list of factors that influenced the choice of breast implant, including complication rates, marketing, economic, and logistic factors. The results from the survey showed variation in preferred implant and substantial variations in the weighing of these factors. The two most important factors were "study outcomes" and "brand reputation". Ninety percent of the respondents were willing to deviate from their preferred implant, with the patient's preference being the main indication to deviate. Conclusions: The list of factors that influence the plastic surgeons' choice of a breast implant in a reconstructive setting is extensive and their weighing showed substantial variation. Implant choice was not based solely on scientific evidence. Brand reputation was valued highly, implying that media and marketing may have considerable influence. Therefore, patients must be informed extensively about all aspects of breast implants during shared decision making to obtain true informed consent.

Venous thromboembolism prophylaxis for hospitalized adult patients: a survey of US health care providers on attitudes and practices.

Background: Venous thromboembolism (VTE) is a leading cause of preventable mortality among hospitalized patients, but appropriate risk assessment and thromboprophylaxis remain underutilized or misapplied. Objectives: We conducted an electronic survey of US health care providers to explore attitudes, practices, and barriers related to thromboprophylaxis in adult hospitalized patients and at discharge. Results: A total of 607 US respondents completed the survey: 63.1% reported working in an academic hospital, 70.7% identified as physicians, and hospital medicine was the most frequent specialty (52.1%). The majority of respondents agreed that VTE prophylaxis is important (98.8%; 95% CI: 97.6%-99.5%) and that current measures are safe (92.6%; 95% CI: 90.2%-94.5%) and effective (93.8%; 95% CI: 91.6%-95.6%), but only half (52.0%; 95% CI: 47.9%-56.0%) believed that hospitalized patients at their institution are on appropriate VTE prophylaxis almost all the time. One-third (35.4%) reported using a risk assessment model (RAM) to determine VTE prophylaxis need; 44.9% reported unfamiliarity with RAMs. The most common recommendation for improving rates of appropriate thromboprophylaxis was to leverage technology. A majority of respondents (84.5%) do not reassess a patient's need for VTE prophylaxis at discharge, and a minority educates patients about the risk (16.2%) or symptoms (18.9%) of VTE at discharge. Conclusion: Despite guideline recommendations to use RAMs, the majority of providers in our survey do not use them. A majority of respondents believed that technology could help improve VTE prophylaxis rates. A majority of respondents do not reassess the risk of VTE at discharge or educate patients about this risk of VTE at discharge.

Grado de satisfacción de los cuidadores de pacientes que necesitan cuidados paliativos domiciliarios a través de una encuesta / Degree of satisfaction among caregivers of patients needing home palliative care assessed using a survey

Objetivos: Conocer el grado de satisfacción de los cuidadores principales de pacientes fallecidos en relación con la prestación sanitaria recibida por un equipo de soporte en cuidados paliativos domiciliarios.Pacientes y métodos: Estudio descriptivo, transversal y observacional. Análisis de encuestas de satisfacción (agosto de 2019 a junio de 2022). Total de pacientes atendidos: 1157, y total de encuestas recibidas: 402. Se diseñó una encuesta de satisfacción que evaluó los siguientes ámbitos de intervención: tiempo de espera, trato recibido, competencia e información. Fue contestada una vez transcurrido un mes desde el fallecimiento. Se enviaron las encuestas a través de correo ordinario con franqueo pagado desde el hospital junto a una carta de condolencias.Resultados: Los pacientes fallecidos fueron 561 y respondieron la encuesta un total de 402 cuidadores (71,65 %) de los cuales un 61,19 % eran mujeres y un 63,5 % mayor de 60 años. La puntuación > 8 puntos en los 4 ítems fue otorgada en un 92,2 % en varones y en un 92,7 % en mujeres. El ítem mejor valorado tanto en hombres como en mujeres fue el trato recibido (97,4 y 96,7 %, respectivamente). La valoración global > 8 puntos fue de un 95,6 % en hombres y de un 96,7 % en mujeres.Conclusiones: Se percibe una satisfacción alta por parte de los cuidadores principales con respecto a la asistencia recibida en el domicilio. Las áreas de mejora detectadas por el equipo fueron sobre todo en lo que afecta al proceso y algo menos en los recursos de personal.(AU)

Objectives: To know the degree of satisfaction of the main caregivers of deceased patients in relation to the health care received from a support team in home palliative care.Patients and methods: A descriptive, cross-sectional, observational study. Analysis of satisfaction surveys (August 2019 to June 2022). Total number of patients attended: 1157, and total number of surveys received: 402. A satisfaction survey was designed that evaluated the following areas of intervention: waiting time, treatment received, competence and information. It was answered one month after the patient’s death. The surveys were sent via postage-paid regular mail from the hospital, together with a letter of condolences.Results: A total of 402 caregivers for 561 deceased patients (71.65 %) answered the survey; 61.19 % were women and 63.5 % were older than 60 years. A score > 8 points in the 4 items was awarded by 92.2 % of men and 92.7 % of women. The best valued item by both men and women was the treatment received (97.4 % and 96.7 %, respectively). Overall assessment > 8 points was 95.6 % for men and 96.7 % for women.Conclusions: A high satisfaction is perceived on the part of main caregivers with respect to the assistance received at home. Areas for improvement detected by the team included mainly aspects related to the process rather than personnel resources.(AU)

Assessing the Measurement Properties of the Self-Administered Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R): A Rasch Analysis.

OBJECTIVE: The self-administered version of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) is used to monitor function and disease progression in individuals with amyotrophic lateral sclerosis (ALS). However, the performance of the self-administered ALSFRS-R has not been assessed using Rasch Measurement Theory. Therefore, the purpose of this study was to examine the psychometric properties of the self-administered ALSFRS-R using Rasch analysis. METHODS: Rasch analysis was performed on self-administered ALSFRS-R data from individuals with ALS across Canada. The following 6 aspects of Rasch analysis were examined using RUMM2030: fit via residuals and chi-square statistics, targeting via person-item threshold maps, dependency via item residual correlations, unidimensionality through principal components analysis of residuals, reliability via person separation index, and stability through differential item functioning analyses for sex, age, and language. RESULTS: Analysis was performed on 122 participants (mean age: 52.9 years; 62.8% men). The overall scale demonstrated good fit, reliability, and stability; however, multidimensionality was found. To address this issue, items were divided into 3 subscales (bulbar, motor, and respiratory function), and Rasch analysis was performed for each subscale. The subscales demonstrated good fit, reliability, stability, and unidimensionality. However, there were still issues with item dependency for all subscale and targeting for bulbar and respiratory subscales. CONCLUSIONS: The self-administered ALSFRS-R is reliable, internally valid, and stable across sex, age, and language subgroups; however, it is recommended that the ALSFRS-R be scored by subscale. Future studies can look at revising and/or adding items to tackle misfit, redundancy, and ceiling effects. IMPACT: Self-administered measures are simple to administer and inexpensive. The self-administered ALSFRS-R was found to be psychometrically sound and can be used as a tool to monitor disease progression and function in ALS.

Prevalence and Impact of Asthma and Allergy on Daily Life, Health Outcomes and Use of Healthcare Services in Children: A Population-Based Study

Introduction: Studies on the prevalence of asthma and allergies often lack representation of the pediatric population, and their impact has not been examined using children without these diseases as a reference group. This study aimed to determine the prevalence of asthma and allergies in children under 14 years old in Spain and their impact on health-related quality of life, activities, healthcare utilization, and environmental and household exposure risk factors. Methods: Data came from a Spanish population-based representative survey of children aged <14 years (N=6297). A sample of controls (1:4) from the same survey was matched using propensity score matching. Logistic regression models and population-attributable fractions were calculated to determine the impact of asthma and allergy. Results: The population prevalence of asthma was 5.7% (95% CI: 5.0%, 6.4%), and of allergy was 11.4% (95% CI: 10.5%, 12.4. In children with lower percentiles of health-related quality of life (≤20th), 32.3% (95% CI, 13.6%, 47.0%) was attributed to asthma and 27.7% (95% CI: 13.0%, 40.0%) to allergy. Forty-four percent of restrictions in usual activity were attributed to asthma (OR: 2.0, p-value: <0.001), and 47.9% to allergy (OR: 2.1, p-value: <0.001). 62.3% of all hospital admissions were attributed to asthma (OR: 2.8, p-value: <0.001), and 36.8% (OR: 2.5, p-value: <0.001) of all specialist consults to allergy. Conclusions: The high prevalence of atopic disease and its impact on daily life and healthcare utilization call for an integrated healthcare system focused on children and caregivers’ needs with continuity of care across education and healthcare settings. (AU)

Health care needs and health services utilization of people with spinal cord injury living in Jiangsu and Sichuan provinces of China: a cross-sectional community survey.

PURPOSE: We aimed to investigate health care needs, health service utilization, and their socio-economic and health-related determinants in people with spinal cord injury (SCI) living in Jiangsu and Sichuan Provinces of China. MATERIALS AND METHODS: A total of 1355 participants with SCI living in the community were recruited using a multi-stage stratified random sample and surveyed by telephone or online. Outcomes evaluated included the presence of health care needs, mode of health service utilization, and specific provider types seen within 12 months preceding the survey. RESULTS: The prevalence of healthcare needs was 92%. Needs were higher in Sichuan (98%) as compared to Jiangsu (80%). Of those in need of health care, 38% reported not having utilized care, more in Sichuan (39%) than in Jiangsu (37%). In Jiangsu, inpatient care was more often used than in Sichuan (46% vs. 27%), while in Sichuan outpatient services were utilized more often (33% vs. 17%). On average, 1.6 provider types were seen, with Sichuan reporting fewer different provider types. CONCLUSIONS: Considerable differences in the prevalence of health care needs and service utilization patterns were found between provinces, mostly in favour of the economically more developed Jiangsu Province.Implications for RehabilitationPeople with low income, particularly those below the World Bank poverty line for middle-income countries, had increased health care needs but utilized health care less often.Moreover, environmental barriers contributed significantly to unmet health care needs.This implies the necessity to provide better accessible and more affordable rehabilitation services for people with spinal cord injury (SCI) in China such as community-based rehabilitation programming.Policies for alleviation of poverty in the case of SCI including insurance for catastrophic health expenditure should also be reviewed and adapted where applicable.

Prevalence and Impact of Asthma and Allergy on Daily Life, Health Outcomes and Use of Healthcare Services in Children: A Population-Based Study.

INTRODUCTION: Studies on the prevalence of asthma and allergies often lack representation of the pediatric population, and their impact has not been examined using children without these diseases as a reference group. This study aimed to determine the prevalence of asthma and allergies in children under 14 years old in Spain and their impact on health-related quality of life, activities, healthcare utilization, and environmental and household exposure risk factors. METHODS: Data came from a Spanish population-based representative survey of children aged <14 years (N=6297). A sample of controls (1:4) from the same survey was matched using propensity score matching. Logistic regression models and population-attributable fractions were calculated to determine the impact of asthma and allergy. RESULTS: The population prevalence of asthma was 5.7% (95% CI: 5.0%, 6.4%), and of allergy was 11.4% (95% CI: 10.5%, 12.4. In children with lower percentiles of health-related quality of life (≤20th), 32.3% (95% CI, 13.6%, 47.0%) was attributed to asthma and 27.7% (95% CI: 13.0%, 40.0%) to allergy. Forty-four percent of restrictions in usual activity were attributed to asthma (OR: 2.0, p-value: <0.001), and 47.9% to allergy (OR: 2.1, p-value: <0.001). 62.3% of all hospital admissions were attributed to asthma (OR: 2.8, p-value: <0.001), and 36.8% (OR: 2.5, p-value: <0.001) of all specialist consults to allergy. CONCLUSIONS: The high prevalence of atopic disease and its impact on daily life and healthcare utilization call for an integrated healthcare system focused on children and caregivers' needs with continuity of care across education and healthcare settings.

Healthcare Providers' Experience Using Telehealth During the Onset of the COVID-19 Pandemic in a Predominantly Rural Patient Base: An Online Survey.

INTRODUCTION: COVID-19 led to the rapid adoption of telemedicine with a significant spike in the literature concerning the patients' perspective of its use. The providers' perspective has been less well studied. Med Center Health is a healthcare network that provides services in 10 southern Kentucky counties that are home to over 300,000 people with approximately 61% of this population living in areas defined as rural. The goal of this article was to compare the experience of providers serving a predominantly rural population to their patients and compare the experience of providers between each other based on the obtained demographic data. METHODS: An online electronic survey was developed and sent out from July 13th, 2020 to July 27th, 2020 for completion to the 176 physicians of the Med Center Health Physician group. The survey gathered basic demographic information, telemedicine use during COVID-19, and perceptions of telemedicine use during and the role of telemedicine after COVID-19. Perceptions of telemedicine were gauged using Likert and Likert-style questions. Cardiology provider responses were compared to the previously published patient responses. Differences between providers were also analyzed based on the demographic data obtained. RESULTS: Fifty-eight providers responded to the survey with nine providers indicating that they did not use telemedicine during COVID-19. Significant differences between eight cardiologists' and cardiology patients' perceptions of telemedicine visits were seen for internet connectivity (p < 0.001), privacy (p = 0.01), and clinical exam (p < 0.001) with cardiologists ranking these as more concerning or worse in all instances. These results continued when comparing perceptions of patients' in-person experience and providers' perception of telemedicine visits with significant differences observed with clinical exam (p < 0.001), communication (p = 0.048), and overall experience (p = 0.02). No statistically significant differences were seen between cardiologists and other providers. Providers who indicated more than 10 years of practice rated their experience with telemedicine significantly lower in the domains of effective communication (p = 0.004), level of care provided (p = 0.02), thoroughness of clinical exam (p = 0.047), patient comfort discussing concerns (p = 0.04), and overall experience (p = 0.048). Despite this, only three providers indicated that they would not use telemedicine post-pandemic with a majority indicating that they would feel comfortable using telemedicine for follow-up visits and medication refill visits. CONCLUSION: This is the first study to our knowledge to compare patient and provider satisfaction concerning telemedicine across a wide array of topics using Likert-style and Likert scale questions and the first to investigate the perception of providers who serve a predominantly rural patient base during the COVID-19 pandemic. Similar results have been found in a few previous studies concerning telemedicine being less favorably rated by more experienced providers. Further studies need to be conducted to identify and correct the barriers that exist for providers and the adoption of telemedicine.

Patient interpretations vary for questions in the Patient-Reported Outcomes Measurement Information System Upper Extremity.

The Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE) is frequently used in research/clinical care, but how it is understood by patients is unknown. We conducted a qualitative study including 12 cognitive interviews with patients with hand/upper extremity conditions and those purposively sampled for mixed literacy. Using framework analysis, we identified six themes total: difficulty answering questions due to insufficient information; uncertainty about whether to respond with the ability to perform the task with the injured extremity alone, either the injured or healthy extremity, or both; lack of experience doing certain tasks; uncertainty about whether to answer questions based on ability to perform the task with or without adaptive techniques; answering questions based on limitations not related to upper extremity function; and uncertainty regarding whether to answer questions on the basis of ability or pain. This study demonstrates the challenges in completing questionnaires and that variability may limit the reliability, validity and responsiveness of the PROMIS-UE.

Teleneuropsychology during the COVID-19 pandemic in Mexico: the perspective from a middle-income country.

INTRODUCTION: The use of teleneuropsychology (TeleNP) increased as a result of the COVID-19 pandemic; however, there have been no studies of the benefits and difficulties with this modality in middle-income countries. This study aimed to assess the current use of TeleNP in Mexico. METHOD: Mexican neuropsychologists were invited to participate in an online survey regarding the use of TeleNP during the COVID-19 pandemic. The survey was based on issues from a literature review and consisted of 36 questions requiring yes/no, multiple choice, or ordinal answers. The survey was created using Google Forms and asked respondents to provide informed consent. A total of 107 clinical neuropsychologists completed the survey. RESULTS: 82% of participants currently use TeleNP, and most reported learning about TeleNP through personal experience, literature research, and colleagues. Brief evaluations, delivery of results, and intervention were the principal services provided, most frequently on a home-to-home basis. Almost 30% of clinicians reported not requiring informed consent for use of the modality. Consultations included children, adolescents, and adults in similar numbers; older adults were less frequent. Technological limitations were the most frequent reason for ruling out the modality with particular patients. Perceived benefits included the ability to continue consultations despite social distancing measures, lesser risk of COVID-19 infection, and the possibility of seeing patients with limited access to neuropsychological services. Reasons for not using TeleNP included a lack of standardized instruments, not feeling comfortable with the modality, and lack of technological resources and skills. CONCLUSIONS: Despite the socioeconomic differences between Mexico and high-income countries, most of our findings were similar to reports from those countries. However, technological limitations were common, and smartphones were commonly used, contrary to recommendations in the literature. The future use of TeleNP in Mexico should include formal training and ethical guidelines.

Feedback reports to the general practitioner (GP) on the patients' experiences: are GPs interested, and is this interest associated with GP factors and patient experience scores?

BACKGROUND: Patient experience feedback is key in patient centred health systems, but empirical evidence of general practitioner (GP) interest in it is sparse. We aimed to: (i) quantitatively estimate the level of GP interest for feedback reports on patient experience; (ii) explore determinants of such interest; and (iii) examine potential association between a priori interest and patient experience. METHODS: The patient experience survey included maximum 300 randomly selected patients for each of 50 randomly selected GPs (response rate 41.4%, n = 5,623). GPs were sent a postal letter offering feedback reports and were grouped according to their replies: (i) interested in the report; (ii) not interested. Associations between interest and GP variables were assessed with Chi-square tests and multivariate logistic regression, while associations between interest and scores for 5 patient experiences scales were assessed with multilevel regression models. RESULTS: About half (n = 21; 45.7%) of the GPs showed interest in the report by asking to receive the report. The only GP variable associated with a priori interest was being a specialist in general practice (58.6% vs. 23.5% for those without) (P = 0.021). Interest was significantly associated with the practice patient experience scale (4.1 higher score compared with those not interested, P = 0.048). Interest in the report had small and nonsignificant associations with the remaining patient experience scales. CONCLUSIONS: Almost half of the GPs, and almost 3 in 5 of specialists in general practice, were interested in receiving a GP-specific feedback report on patient experiences. Interest in the report was generally not related to patient experience scores.