scholarly journals Telehealth for Cancer Care in Veterans: Opportunities and Challenges Revealed by COVID

2020 ◽  
pp. OP.20.00520
Author(s):  
Cindy Y. Jiang ◽  
Nadeem T. El-Kouri ◽  
David Elliot ◽  
Jenna Shields ◽  
Megan E. V. Caram ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Cancer Care ◽  
The United States ◽  
Lessons Learned ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Potential Cost ◽  
Tertiary Center

The Veterans Health Administration system is one of the largest integrated health care providers in the United States, delivering medical care to > 9 million veterans. Barriers to delivering efficient health care include geographical limitations as well as long wait times. Telehealth has been used as a solution by many different health care services. However, it has not been as widely used in cancer care. In 2018, the US Department of Veterans Affairs (VA) Pittsburgh Healthcare System expanded the use of telehealth to provide antineoplastic therapies to rural patients by creating a clinical video telehealth clinic of the Virtual Cancer Care Network. This allows oncologists located at the tertiary center to virtually deliver care to remote sites. The recent COVID-19 pandemic forced oncologists across the VA system to adopt telehealth to provide continuity of care. On the basis of our review and personal experience, we have outlined opportunities for telehealth to play a role in every step of the cancer care journey from diagnosis to therapy to surveillance to clinical trials for medical, surgical, and radiation oncology. There are many advantages, such as decreased travel time and potential cost savings; however, there continues to be challenges with veterans having access to devices and the Internet as well as understanding how to use telehealth equipment. The lessons learned from this assessment of the VA telehealth system for cancer care can be adopted and integrated into other health systems. In the future, there needs to be evaluation of how telehealth can be further incorporated into oncology, satisfaction of veterans using telehealth services, overcoming telehealth barriers, and defining metrics of success.

scholarly journals “Availability of healthcare providers for rural veterans eligible for purchased care under the veterans choice act”

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Michael E. Ohl ◽  
Margaret Carrell ◽  
Andrew Thurman ◽  
Mark Vander Weg ◽  
Teresa Hudson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Rural Areas ◽  
Adult Population ◽  
Healthcare Providers ◽  
The United States ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Level Data

Abstract Background Military Veterans in the United States are more likely than the general population to live in rural areas, and often have limited geographic access to Veterans Health Administration (VHA) facilities. In an effort to improve access for Veterans living far from VHA facilities, the recently-enacted Veterans Choice Act directed VHA to purchase care from non-VHA providers for Veterans who live more than 40 miles from the nearest VHA facility. To explore potential impacts of these reforms on Veterans and healthcare providers, we identified VHA-users who were eligible for purchased care based on distance to VHA facilities, and quantified the availability of various types of non-VHA healthcare providers in counties where these Veterans lived. Methods We combined 2013 administrative data on VHA-users with county-level data on rurality, non-VHA provider availability, population, household income, and population health status. Results Most (77.9%) of the 416,338 VHA-users who were eligible for purchased care based on distance lived in rural counties. Approximately 16% of these Veterans lived in primary care shortage areas, while the majority (70.2%) lived in mental health care shortage areas. Most lived in counties that lacked specialized health care providers (e.g. cardiologists, pulmonologists, and neurologists). Counterintuitively, VHA played a greater role in delivering healthcare for the overall adult population in counties that were farther from VHA facilities (30.7 VHA-users / 1000 adults in counties over 40 miles from VHA facilities, vs. 22.4 VHA-users / 1000 adults in counties within 20 miles of VHA facilities, p < 0.01). Conclusions Initiatives to purchase care for Veterans living more than 40 miles from VHA facilities may not significantly improve their access to care, as these areas are underserved by non-VHA providers. Non-VHA providers in the predominantly rural areas more than 40 miles from VHA facilities may be asked to assume care for relatively large numbers of Veterans, because VHA has recently cared for a greater proportion of the population in these areas, and these Veterans are now eligible for purchased care.

Purchasing for Safety: A Human Factors-Influenced Procedure for Evaluating Medical Products

2017 ◽  
Vol 6 (1) ◽  
pp. 118-124 ◽  
Author(s):  
Helen J. A. Fuller ◽  
Nancy J. Lightner ◽  
Kyle D. Maddox ◽  
Hasan Shanawani ◽  
Tandi Bagian ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Health Care Providers ◽  
The United States ◽  
Health Administration ◽  
Care Providers ◽  
Purchasing Decisions ◽  
Medical Products ◽  
Safety Concerns ◽  
Technical Requirements

Safety reports related to products and devices used in health care have demonstrated that not all items can be considered equal in terms of usability, compatibility, and functionality, which can result in patient safety concerns. Hospital systems use a wide variety of products when providing care to patients. This variability may contribute to purchasers failing to fully understand and define the needs for these products. In addition, it is necessary to define what a high-quality product is, including what minimal technical requirements it must meet. The Veteran’s Health Administration (VHA) is the largest health care system in the United States; as such, it possesses the ability to learn from a large group of health care providers as well as a great deal of purchasing power. Purchasing for Safety is a procedure for investigating medical devices or products with an end goal of improving the purchasing decision. Purchasing for Safety can help hospitals and health care systems to systematically evaluate medical products and devices for issues that may lead to patient safety concerns. By conducting careful testing and documenting methods and findings, the test team can assist stakeholders in making purchasing decisions that may ultimately result in better patient care. The greater formality introduced in Purchasing for Safety will help hospitals justify purchasing decisions, and the thoroughness of the investigation will promote patient safety.

Successful Strategies to Address Disparities: Insurer and Employer Perspectives

2020 ◽  
pp. 292-300
Author(s):  
Manali I. Patel ◽  
Richard Snyder ◽  
Otis Brawley
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Low Income ◽  
Cancer Care ◽  
Care Delivery ◽  
The United States ◽  
Cancer Disparities ◽  
Care Providers ◽  
High Quality ◽  
Quality Cancer Care

Disparities in cancer have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Disparate cancer outcomes continue to affect many populations in the United States and globally, including racial and ethnic minorities, populations with low income and education, and residents of rural areas or low socioeconomic neighborhoods, among others. Addressing cancer disparities requires approaches that are multilevel. Addressing social determinants of health, such as removing obstacles to health (e.g., poverty, discrimination, access to housing and education, jobs with fair pay, and health care) can reduce cancer disparities. However, to achieve cancer health equity, multilevel approaches are required to ensure that access to high-quality cancer care and equitable receipt of evidence-based services can reduce cancer disparities. Policy, health system interventions, and innovative delivery and health care coverage approaches by private and public payers, employer-based payers, and labor union organizations can assist in ensuring access to and receipt of high-quality cancer care while addressing the high costs of care delivery. Partnerships among patients, caregivers, employers, health care providers, and health care payers can make impactful changes in the way in which cancer care is delivered and, in turn, can assist in reducing cancer disparities.

scholarly journals Formal Assessment of Teamwork Among Cancer Health Care Professionals in Three Large Tertiary Centers in Nigeria

2020 ◽  
pp. 560-568 ◽  
Author(s):  
Abiola F. Ibraheem ◽  
Mihai Giurcanu ◽  
Anthonia Chima Sowunmi ◽  
Olutosin Awolude ◽  
Muhammad Habeebu ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Cancer Care ◽  
The United States ◽  
Care Providers ◽  
Southwestern Nigeria ◽  
Major Barrier ◽  
Safety Attitudes ◽  
Quality Cancer Care

PURPOSE There are strategies to bring quality cancer care to underserved patients, but poor use of the principles of teamwork is a major barrier to achieving quality services. The intent of this study was to assess teamwork as perceived by health care workers caring for patients with cancer. METHODS We conducted a survey among health care professionals in cancer care at 3 tertiary centers in southwestern Nigeria from July to November 2016. Respondents rated teamwork using the Safety Attitudes Questionnaire; we focused on the teamwork climate subscale comparing health care providers and institutions using analysis of variance and on collaboration using logistic regression. RESULTS Three hundred seventy-three professionals completed the survey: 177 physicians (47%), 51 nurses (14%), 21 pharmacists (6%), 31 laboratory technicians (8%), and 88 others (24%); 5 (1%) participants had missing professional information. The average teamwork climate score across all professionals in the study was 70.5 (SD = 24.2). Pharmacists rated the teamwork climate the lowest, with a mean score of 63.9 (SD = 29.5); nurses and laboratory technicians rated teamwork higher, with means of 74.5 (SD = 21.7) and 74.2 (SD = 27.1), respectively; and physicians rated teamwork 66.0 (SD = 23.6). Collaboration with other health care providers was reported as poorer by physicians compared with nurses and pharmacists. CONCLUSION Although overall teamwork scores were consistent with ambulatory studies in the United States, important subgroup variations provide targets for intervention. Physicians rated collaboration as poor both intra- and interprofessionally. Pharmacists rated interprofessional teamwork with nurses as poor. Efforts to transform cancer care must focus on building trust among the key stakeholders. This is critical in low-resource settings, which must maximize the use of limited resources to improve patient outcomes.

scholarly journals What Causes Racial Health Care Disparities? A Mixed-Methods Study Reveals Variability in How Health Care Providers Perceive Causal Attributions

2018 ◽  
Vol 55 ◽  
pp. 004695801876284
Author(s):  
Sarah E. Gollust ◽  
Brooke A. Cunningham ◽  
Barbara G. Bokhour ◽  
Howard S. Gordon ◽  
Charlene Pope ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Disparities ◽  
Qualitative Interviews ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Race And Racism ◽  
Causal Factors ◽  
Health Care Equity

Progress to address health care equity requires health care providers’ commitment, but their engagement may depend on their perceptions of the factors contributing to inequity. To understand providers’ perceptions of causes of racial health care disparities, a short survey was delivered to health care providers who work at 3 Veterans Health Administration sites, followed by qualitative interviews (N = 53). Survey data indicated that providers attributed the causes of disparities to social and economic conditions more than to patients’ or providers’ behaviors. Qualitative analysis revealed differences in the meaning that participants ascribed to these causal factors. Participants who believed providers contribute to disparities discussed race and racism more readily, identified the mechanisms through which disparities emerge, and contextualized patient-level factors more than those who believed providers contributed less to disparities. Differences in provider understanding of the underlying causal factors suggest a multidimensional approach to engage providers in health equity efforts.

scholarly journals Barriers to and Facilitators of Multimodal Chronic Pain Care for Veterans: A National Qualitative Study

Pain Medicine ◽  
2020 ◽  
Author(s):  
Chelsea Leonard ◽  
Roman Ayele ◽  
Amy Ladebue ◽  
Marina McCreight ◽  
Charlotte Nolan ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Health Care Providers ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Pain Care

Abstract Objective Chronic pain is more common among veterans than among the general population. Expert guidelines recommend multimodal chronic pain care. However, there is substantial variation in the availability and utilization of treatment modalities in the Veterans Health Administration. We explored health care providers’ and administrators’ perspectives on the barriers to and facilitators of multimodal chronic pain care in the Veterans Health Administration to understand variation in the use of multimodal pain treatment modalities. Methods  We conducted semi-structured qualitative interviews with health care providers and administrators at a national sample of Veterans Health Administration facilities that were classified as either early or late adopters of multimodal chronic pain care according to their utilization of nine pain-related treatments. Interviews were conducted by telephone, recorded, and transcribed verbatim. Transcripts were coded and analyzed through the use of team-based inductive and deductive content analysis. Results  We interviewed 49 participants from 25 facilities from April through September of 2017. We identified three themes. First, the Veterans Health Administration’s integrated health care system is both an asset and a challenge for multimodal chronic pain care. Second, participants discussed a temporal shift from managing chronic pain with opioids to multimodal treatment. Third, primary care teams face competing pressures from expert guidelines, facility leadership, and patients. Early- and late-adopting sites differed in perceived resource availability. Conclusions Health care providers often perceive inadequate support and resources to provide multimodal chronic pain management. Efforts to improve chronic pain management should address both organizational and patient-level challenges, including primary care provider panel sizes, accessibility of training for primary care teams, leadership support for multimodal pain care, and availability of multidisciplinary pain management resources.

scholarly journals Health Care Providers' Understanding of Health Care Beliefs and Preferences in Anabaptist Communities

2020 ◽  
Vol 1 (1) ◽  
pp. 13
Author(s):  
Dawn Garrett-Wright ◽  
M. Eve Main ◽  
M. Susan Jones
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Thematic Analysis ◽  
The United States ◽  
Structured Interview ◽  
Lessons Learned ◽  
Care Providers ◽  
Health Care Practices ◽  
Health Care Beliefs ◽  
Professional Health

Anabaptist communities are among the fastest growing communities in the United States. Reviews of medical and sociological literature consistently demonstrate that members of Anabaptist communities hold health care beliefs and preferences that differ from the mainstream culture. However, the professional health care literature is lacking in information regarding health care providers' understanding of health care beliefs and preferences in Anabaptist groups. The purpose of this study was to explore the understanding of Anabaptist patients' health care beliefs and preferences as well as lessons learned from providers who have experience delivering health care for this culturally diverse population. A qualitative descriptive approach was used to collect data with a sample of health care providers (N = 18) selected via purposive sampling. The study participants provided informed consent to be interviewed and videotaped responding to a set of semi-structured interview questions. The videotaped interviews were transcribed before thematic analysis was conducted independently and then collectively by a group of three researchers familiar with Anabaptist health care practices. Through thematic analysis, seven themes were identified among the participants relating to their understanding of the beliefs and preferences of Anabaptist community members they served.

The Special Perils of Being Old and Sick in Prison

2020 ◽  
Vol 32 (5) ◽  
pp. 276-284
Author(s):  
William J. Jefferson
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Care ◽  
Health Care Providers ◽  
The United States ◽  
United States Constitution ◽  
Care Providers ◽  
Medical Practitioners ◽  
Medical Needs ◽  
Access To Medical Care

The United States Supreme Court declared in 1976 that deliberate indifference to the serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain…proscribed by the Eighth Amendment. It matters not whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards intentionally denying or delaying access to medical care or intentionally interfering with treatment once prescribed—adequate prisoner medical care is required by the United States Constitution. My incarceration for four years at the Oakdale Satellite Prison Camp, a chronic health care level camp, gives me the perspective to challenge the generally promoted claim of the Bureau of Federal Prisons that it provides decent medical care by competent and caring medical practitioners to chronically unhealthy elderly prisoners. The same observation, to a slightly lesser extent, could be made with respect to deficiencies in the delivery of health care to prisoners of all ages, as it is all significantly deficient in access, competencies, courtesies and treatments extended by prison health care providers at every level of care, without regard to age. However, the frailer the prisoner, the more dangerous these health care deficiencies are to his health and, therefore, I believe, warrant separate attention. This paper uses first-hand experiences of elderly prisoners to dismantle the tale that prisoner healthcare meets constitutional standards.

Medical Informatics and the Quality of Health: New Approaches to Support Patient Care

2003 ◽  
Vol 42 (02) ◽  
pp. 185-189 ◽  
Author(s):  
R. Haux ◽  
C. Kulikowski ◽  
A. Bohne ◽  
R. Brandner ◽  
B. Brigl ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Informatics ◽  
Health Care Providers ◽  
Medical Knowledge ◽  
Lessons Learned ◽  
Care Providers ◽  
Access To Health Services ◽  
Leading Role ◽  
Future Challenges

Summary Objectives: The Yearbook of Medical Informatics is published annually by the International Medical Informatics Association (IMIA) and contains a selection of excellent papers on medical informatics research which have been recently published (www.yearbook.uni-hd.de). The 2003 Yearbook of Medical Informatics took as its theme the role of medical informatics for the quality of health care. In this paper, we will discuss challenges for health care, and the lessons learned from editing IMIA Yearbook 2003. Results and Conclusions: Modern information processing methodology and information and communication technology have strongly influenced our societies and health care. As a consequence of this, medical informatics as a discipline has taken a leading role in the further development of health care. This involves developing information systems that enhance opportunities for global access to health services and medical knowledge. Informatics methodology and technology will facilitate high quality of care in aging societies, and will decrease the possibilities of health care errors. It will also enable the dissemination of the latest medical and health information on the web to consumers and health care providers alike. The selected papers of the IMIA Yearbook 2003 present clear examples and future challenges, and they highlight how various sub-disciplines of medical informatics can contribute to this.

Sign in / Sign up

Export Citation Format

Share Document