Parent, Physician, and Therapist Experience of In-Person, Hybrid, and All-Virtual Models of Physiatry Care for Children with Special Health Care Needs.

OBJECTIVE: The purpose of this study was to compare three models of pediatric physiatry care (in-person, hybrid, and all-virtual) in terms of parent experience and physician- and therapist-reported quality of care. We hypothesized that the all-virtual model would have lower parent experience scores and lower quality scores compared with the other two models of care. METHODS: We designed a convergent parallel mixed methods study incorporating a cluster-randomized crossover design. Quantitative data included surveys of parents, physicians, and therapists after visits to 13 medical therapy units in Northern California between January 2020 and January 2022. Qualitative data were collected in six focus groups with parents, physicians, and therapists. RESULTS: A total of 2455 visits were completed for 1281 unique children during the study period, including 507 in-person visits, 246 hybrid visits, and 1702 all-virtual visits. There were no differences in parent experience scores between the three models of care. Physicians and therapists rated all-virtual visits significantly lower in terms of quality of care, parent education, and physical exam, compared with the other two models of care, but qualitative results highlighted specific instances where all-virtual visits could be useful. CONCLUSIONS: Our findings suggest that parents, therapists, and physicians find a hybrid virtual model is an acceptable model of care that maintains the quality of care and facilitates parent education. All-virtual models may be appropriate for specific circumstances but are perceived as lower quality. Research exploring implementation of these models would be valuable for providing practical guidance in the future.

Adapting telehealth to address health equity: Perspectives of primary care providers across the United States.

BACKGROUND: Telehealth has the potential to increase access to care for medically underserved patients. This qualitative study aimed to identify telecare practices used during the COVID-19 pandemic to meet the needs of patients experiencing homelessness, patients with disabilities, and patients with language preference other than English (LOE). METHODS: We conducted a secondary qualitative data analysis of 47 clinician interviews at Federally Qualified Health Centers (FQHCs) around the country. Using thematic analysis, transcripts were coded by line-by-line by five qualitative researchers. A multidisciplinary team of telehealth experts, researchers and primary care clinicians reviewed memos and excerpts to generate major themes. RESULTS: We identified six main areas demonstrating how community providers developed strategies or practices to improve access to care for vulnerable patients: reaching patients experiencing homelessness, serving deaf and hard of hearing patients, improving access for patients with disabilities, serving patients with LOE, improving access for mental and behavioral health services, and educating patients about telehealth. During the pandemic, FQHCs developed innovative solutions to provide access to care for the unhoused, including using telehealth in shelters, vans, and distributing devices like mobile phones and tablets. Telehealth reduced transportation burdens for patients with disabilities and reduced no-show rates for mental health services by adapting group therapy via telehealth features (like break-out rooms) and increasing provider capacity. CONCLUSION: Our study identified strategies adopted by FQHCs to serve underserved populations during the COVID-19 pandemic. Our findings highlight the need for enduring strategies to improve health equity through telehealth..

Intercollegiate student athlete use of nutritional supplements and the role of athletic trainers and dietitians in nutrition counseling.

A survey of university student athletes was conducted to determine supplement use, perceived efficacy of supplements, availability and use of nutrition services, and perceived nutrition knowledge of athletic trainers. Results from 236 athletes showed that 88% used one or more nutritional supplements, yet perceived efficacy was moderate (2.9 or less; 5-point scale). Classes (69.4%), brochures (75%), and individual counseling (47%) were available and were used by 29.9%, 33.2%, and 17.9% of athletes, respectively. Primary sources of nutrition information were athletic trainers (39.8%), strength and conditioning coaches (23.7%), and dietitians (14.4%). Athletes perceived athletic trainers to have strong nutrition knowledge (mean=3.8+/-0.9; 5-point scale). Many (23.5%) did not know whether a dietitian was available. Dietitians must accelerate their marketing efforts to student athletes, work closely with athletic trainers to provide sound nutrition information, and provide services that meet the needs of a diverse population of student athletes.