Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association.

Understanding and addressing the unique health needs of people residing in rural America is critical to the American Heart Association's pursuit of a world with longer, healthier lives. Improving the health of rural populations is consistent with the American Heart Association's commitment to health equity and its focus on social determinants of health to reduce and ideally to eliminate health disparities. This presidential advisory serves as a call to action for the American Heart Association and other stakeholders to make rural populations a priority in programming, research, and policy. This advisory first summarizes existing data on rural populations, communities, and health outcomes; explores 3 major groups of factors underlying urban-rural disparities in health outcomes, including individual factors, social determinants of health, and health delivery system factors; and then proposes a set of solutions spanning health system innovation, policy, and research aimed at improving rural health.

Policy Decisions and Use of Information Technology to Fight COVID-19, Taiwan.

Because of its proximity to and frequent travelers to and from China, Taiwan faces complex challenges in preventing coronavirus disease (COVID-19). As soon as China reported the unidentified outbreak to the World Health Organization on December 31, 2019, Taiwan assembled a taskforce and began health checks onboard flights from Wuhan. Taiwan's rapid implementation of disease prevention measures helped detect and isolate the country's first COVID-19 case on January 20, 2020. Laboratories in Taiwan developed 4-hour test kits and isolated 2 strains of the coronavirus before February. Taiwan effectively delayed and contained community transmission by leveraging experience from the 2003 severe acute respiratory syndrome outbreak, prevalent public awareness, a robust public health network, support from healthcare industries, cross-departmental collaborations, and advanced information technology capacity. We analyze use of the National Health Insurance database and critical policy decisions made by Taiwan's government during the first 50 days of the COVID-19 outbreak.

Preventive Medicine: A hidden asset for building a dominant culture of prevention.

We explore three issues related to the practice of preventive medicine. First, how does the dearth of preventive medicine physicians on state licensure boards affect quality of medical care? Second, should a process be established to assess the training and skills of candidates for population health positions, like the "credentialing" or "privilege-granting" process used by hospitals and health systems for clinical positions? And third, how should the pervasive lack of recognition of preventive medicine as a bona fide medical specialty be addressed? In exploring these issues, we conclude that preventive medicine physicians are critical to the US health care ecosystem at every level, and to building a dominant culture of prevention. Preventive medicine physicians are actively engaged in the practice of medicine and should be party to the same licensure, credentialing, and privilege-granting procedures as all other specialties. Further, we raise a call to action to our profession to define and raise awareness of preventive medicine, participate in state licensure boards, and establish clear standards of practice for which we are uniquely trained and capable.

The Influences of SES on Patient Choice of Doctor: A Systematic Review.

INTRODUCTION: As patients become increasingly involved in healthcare decision-making, it is important to examine the drivers behind patient choice of doctor (PCOD); the initial decision can have lasting impacts on patients' trust in providers and health outcomes. However, limited studies have explored PCOD relative to socioeconomic status (SES) or health disparity. This review identified similar preferences and varied decision criteria in PCOD across SES groups. METHODS: PubMed, PsycINFO, Web of Science, and relevant cross-references were searched for articles published between January 2007-September 2022. Papers were screened using Covidence. Included studies examined PCOD by income and/or educational levels. Analysis was performed in 2022-2023. RESULTS: From 4,449 search results, 29 articles were selected (16 countries, 14 medical specialties, total of 32,651 participants). Individuals of higher SES ranked physician characteristics (e.g., qualifications, empathy) or performance more important than cost or convenience. Individuals of lower SES often had to prioritize logistical factors (e.g., insurance coverage, distance) due to resource constraints and gaps in knowledge or awareness about options. Despite differing healthcare systems, such divergence in PCOD were relatively consistent across countries. Some patients, especially females and disadvantaged groups, favored gender-concordant physicians for intimate medical matters (e.g., gynecologist); this partiality was not limited to conservative cultures. Few researchers investigated the outcomes of PCOD and indicated that lower-SES populations inadvertently chose, experienced, or perceived lower quality of care. DISCUSSION: Patients' decision criteria varied by SES, even under national systems intended for universal access, indicating the impacts of social determinants and structural inequities. Health education supporting patient decision-making and research on how SES affects PCOD and outcomes could help reduce health disparity.

Group counselling improves quality for patients with limited health literacy.

BACKGROUND: The North County Health Centre in Reston, Virginia, recently enhanced the quality and accessibility of physician-coordinated behavioural counselling. METHODS: A patient survey confirmed that the clinic could improve behaviour change support. Physician time constraints, practice productivity issues and treatment priorities were identified barriers to systems change. Systems changes included teamwork, group visits, community engagement and trusted online consumer resources. Validated statistical process control (SPC) techniques evaluated variation in monthly 90-minute group visits for Spanish- and English-speaking patients during which we reviewed evidence-based recommendations, hosted community speakers and held brief individual encounters using encounter forms with built-in motivational interviewing techniques. RESULTS: On average, four English-speaking patients attended, with 42% of the participants who attended more than one meeting successfully achieving their self-reported goal. On average, nine Spanish-speaking patients attended, with eight (86%) of the participants achieving their goals. Documentation of recorded prevention counselling improved from 15% to 67%. Patients indicated that they found that what they learned is transferable to their everyday 1ives. CONCLUSION: The total number of patient encounters in a clinical session did not dramatically change. Language preference was not a hurdle. Teamwork among patients, providers, staff and community members was a key to success. Group visits improved the amount of prevention counselling and helped patients with limited health literacy achieve their prevention goals.