scholarly journals Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm

10.2196/24785 ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. e24785
Author(s):  
J Jeffery Reeves ◽  
John W Ayers ◽  
Christopher A Longhurst
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Access ◽  
Care Delivery ◽  
Patient Characteristics ◽  
Virtual Patient ◽  
Care Providers ◽  
Health Crisis ◽  
Care Access

The telehealth revolution in response to COVID-19 has increased essential health care access during an unprecedented public health crisis. However, virtual patient care can also limit the patient-provider relationship, quality of examination, efficiency of health care delivery, and overall quality of care. As we witness the most rapidly adopted medical trend in modern history, clinicians are beginning to comprehend the many possibilities of telehealth, but its limitations also need to be understood. As outcomes are studied and federal regulations reconsidered, it is important to be precise in the virtual patient encounter approach. Herein, we offer some simple guidelines that could assist health care providers and clinic schedulers in determining the appropriateness of a telehealth visit by considering visit types, patient characteristics, and chief complaint or disease states.

scholarly journals Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm (Preprint)

2020 ◽  
Author(s):  
J. Jeffery Reeves ◽  
John W. Ayers ◽  
Christopher A. Longhurst
Keyword(s):  
Health Care ◽  
Health Care Access ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Patient Characteristics ◽  
Virtual Patient ◽  
Unintended Consequences ◽  
Disease States ◽  
Care Access

UNSTRUCTURED The telehealth revolution has been heralded for its potential to improve health care access and improve the efficiency of health care delivery. However, virtual patient care can bring unintended consequences that eclipse the benefits including potentially limiting the patient-provider relationship, the quality of the examination, the efficiency of healthcare delivery, and the overall quality of care. Facing the most rapidly adopted medical trend in modern history, clinicians are beginning to grasp its possibilities, but we also need to understand its boundaries. As outcomes are studied and federal regulations reconsidered, it is important to be precise in the approach to the virtual patient encounter. We offer some simple guidelines to assist providers in determining the appropriateness of a telehealth visit, considering visit types, chief complaint or disease states, and patient characteristics.

Human rights-based conceptions of deservingness: health and precarity

2020 ◽  
Vol 16 (3) ◽  
pp. 279-292
Author(s):  
Sarah Marshall
Keyword(s):  
Health Care ◽  
Human Rights ◽  
Health Care Providers ◽  
Health Care Access ◽  
Migrant Health ◽  
Dominant Negative ◽  
Care Providers ◽  
Content Type ◽  
Care Access ◽  
Health Related

Purpose Ideas of health-related deservingness in theory and practise have largely been attached to humanitarian notions of compassion and care for vulnerable persons, in contrast to rights-based approaches involving a moral-legal obligation to care based on universal citizenship principles. This paper aims to provide an alternative to these frames, seeking to explore ideas of a human rights-based deservingness framework to understand health care access and entitlement amongst precarious status persons in Canada. Design/methodology/approach Drawing from theoretical conceptualizations of deservingness, this paper aims to bring deservingness frameworks into the language of human rights discourses as these ideas relate to inequalities based on noncitizenship. Findings Deservingness frameworks have been used in public discourses to both perpetuate and diminish health-related inequalities around access and entitlement. Although, movements based on human rights have the potential to be co-opted and used to re-frame precarious status migrants as “undeserving”, movements driven by frames of human rights-based deservingness can subvert these dominant, negative discourses. Originality/value To date, deservingness theory has primarily been used to speak to issues relating to deservingness to welfare services. In relation to deservingness and precarious status migrants, much of the literature focuses on humanitarian notions of the “deserving” migrant. Health-related deservingness based on human rights has been under-theorized in the literature and the authors can learn from activist movements, precarious status migrants and health care providers that have taken on this approach to mobilize for rights based on being “human”.

The Philippine Health Care Delivery System and Health Expenditure

2016 ◽  
pp. 457-470
Author(s):  
Abdulkadir Işık ◽  
Abdulhamid Mauyag Gunda ◽  
Birol Topçu
Keyword(s):  
Health Care ◽  
Health Care Access ◽  
Human Resources For Health ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
The Philippines ◽  
Human Right ◽  
Care Access ◽  
Out Of Pocket Payments

Health is recognized by the Philippine constitution as a basic human right. The Philippines, compared to most Asian countries, produces more and better human resources for health. However, the Philippines are challenged by attracting and retaining staff in the under-served areas of the country. Philippine allotted 4.2-4.4% of its GDP to health from 2009 to 2011. Furthermore, considerable inequities in health care access and outcomes between Socio-economic groups remain. The Phil Health's limited breadth and depth of coverage has resulted in high levels of out of pocket payments. The implementation of the reforms in financing, service delivery and regulation which are aimed to tackle the inefficiencies and inequalities in the health system has been challenged by the decentralized environment and the presence of private sector, often creating fragmentation and variation in the quality of health services across the country.

scholarly journals Standards and outcome measures in Cardiovascular Rehabilitation. Position Paper GICR/IACPR

2015 ◽  
Vol 78 (4) ◽  
Author(s):  
Raffaele Griffo ◽  
Marco Ambrosetti ◽  
Giuseppe Furgi ◽  
Roberto Carlon ◽  
Carmine Chieffo ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Cardiovascular Diseases ◽  
Health Care Providers ◽  
Professional Competence ◽  
Care Delivery ◽  
Position Paper ◽  
Care Providers ◽  
Cardiac Events

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic problem in Italy. Costs and resources required are increasing in close correlation to both the improved quality of care and to the population ageing. There is an overwhelming evidence of the efficacy of cardiac rehabilitation (CR) in terms of reduction in morbidity and mortality after acute cardiac events. CR services are by definition multi-factorial and comprehensive. Furthermore, systematic analysis and monitoring of the process of delivery and outcomes is of paramount importance. The aim of this position paper promoted by the Italian Association for Cardiovascular Prevention and Rehabilitation (GICR-IACPR) is to provide specific recommendations to assist CR staff in the design, evaluation and development of their care delivery organization. The position paper should also assist health care providers, insurers, policy makers and consumers in the recognition of the quality of care requirements, standards and outcome measure, quality and performance indicators, and professional competence involved in such organization and programs. The position paper i) include comprehensive CR definition and indications, ii) describes priority criteria based on the clinical risk for admission to both inpatient or outpatient CR, and iii) defines components and technological, structural and organizing requirements for inpatient or outpatient CR services, with specific indicators and standards, performance measures and required professional skills. A specific chapter is dedicated to the requirements for highly specialized CR services for patients with more advanced cardiovascular diseases.

Neurobiology of Female Homicide Perpetrators

2019 ◽  
pp. 088626051986007 ◽  
Author(s):  
Kathleen Brewer-Smyth ◽  
Ann Wolbert Burgess
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Access ◽  
Brain Injuries ◽  
Care Providers ◽  
Crime Severity ◽  
Care Access ◽  
Frontal Lobe Damage ◽  
Prevention Interventions ◽  
Life Threatening

Neurobiology of female homicide perpetrators is not well understood. Data from private interviews and examinations of females were re-analyzed comparing those who committed homicide ( n = 9); other violent crimes, no known homicide ( n = 51); nonviolent crimes, no known violent convictions ( n = 49); and noncriminals ( n = 12). Homicide perpetrators suffered the most childhood sexual abuse (CSA); most recent abuse; had the most neurological histories, mainly traumatic brain injuries (TBIs); most health care access for abuse-related injuries; lowest AM and PM salivary cortisol; and greatest proportion who committed crime under the influence of alcohol. Only CSA, years since last abuse, TBI, neurological histories, and health care access for abuse-related injuries were significant. Those who committed homicide under the influence of alcohol suffered the most recent abuse and had the lowest AM cortisol and flattest diurnal cortisol slope (DCS) compared with others; though the n precludes determining significance. Amount of time since last abuse, AM cortisol and DCS progressively decreased as crime severity increased; other variables progressively increased as crime severity increased. These preliminary findings suggest that low AM cortisol, flat DCS, greater CSA frequency and severity, recent abuse, TBIs, and health care access for abuse-related injuries could be risk factors for females committing homicide. Further study is needed due to the small n of homicide perpetrators. Abuse victims may be at greater risk for alcohol use and cortisol dysregulation associated with perpetrating violence, especially homicide. Frontal lobe damage from TBIs may decrease ability to control behaviors associated with emotions from the limbic system. Health care providers released these women when their abuse-related injuries were not life-threatening; yet, they were life-threatening for victims of their subsequent homicides. Females accessing health care for abuse-related injuries present a critical opportunity for violent crime prevention interventions.

scholarly journals Health Care Access and Utilization for American Indian Elders: A Concept-Mapping Study

2019 ◽  
Vol 76 (1) ◽  
pp. 141-151 ◽  
Author(s):  
David H Sommerfeld ◽  
Elise Trott Jaramillo ◽  
Erik Lujan ◽  
Emily Haozous ◽  
Cathleen E Willging
Keyword(s):  
Health Care ◽  
American Indian ◽  
Concept Mapping ◽  
Health Care Providers ◽  
Health Care Access ◽  
National Policy ◽  
Health Care Use ◽  
Care Providers ◽  
Factors Affecting ◽  
Care Access

Abstract Objectives Inequities in access to and utilization of health care greatly influence the health and quality of life of American Indian elders (AIEs). This study explores the importance and perceived prevalence of factors affecting health care use within this population and assesses the changeability of these factors to produce a list of action items that are timely and relevant to improving health care access and utilization. Method Concept mapping was conducted with AIEs (n = 65) and professional stakeholders (n = 50), including tribal leaders, administrators of public-sector health systems, outreach workers, and health care providers. Data were analyzed using multidimensional scaling and cluster analyses. Results The final concept-map model comprised nine thematic clusters related to factors affecting elder health care: Difficulties Obtaining and Using Insurance; Insecurity from Lack of Knowledge; Limited Availability of Services; Scheduling Challenges; Provider Issues and Relationships; Family and Emotional Challenges; Health-Related Self-Efficacy and Knowledge; Accessibility and Transportation Barriers; and Tribal/National Policy. Discussion Findings suggest that improvements in access to and utilization of health care among AIEs will require actions across multiple domains, including health system navigation services, workforce improvements, and tribal, state, and federal policy. A multilevel socioecological approach is necessary to organize and undertake these actions.

scholarly journals “I was trying to speak to their human side” coping responses of Belgium’s undocumented migrants to barriers in health-care access

2020 ◽  
Vol 16 (3) ◽  
pp. 253-267
Author(s):  
Dirk Lafaut ◽  
Gily Coene
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Access ◽  
Access To Health Care ◽  
Undocumented Migrants ◽  
Care Providers ◽  
Content Type ◽  
Coping Responses ◽  
Care Access ◽  
Access To Health

Purpose Undocumented migrants experience major legal constraints in their health-care access. Little is known on how undocumented migrants cope with these limitations in health-care access as individuals. The purpose of this study is to explore the coping responses of undocumented migrants when they experience limited health-care access in face-to-face encounters with health-care providers. Design/methodology/approach The authors conducted multi-site ethnographic observations and 25 semi-structured in-depth interviews with undocumented migrants in Belgium. They combined the “candidacy model” of health-care access with models from coping literature on racism as a framework. The candidacy model allowed them to understand access to health care as a dynamic and interactive negotiation process between health-care workers and undocumented migrants. Findings Responses to impaired health-care access can be divided into four main strategies: (1) individuals can react with a self-protective response withdrawing from seeking further care; (2) they can get around the obstacle; (3) they can influence the health-care worker involved by deploying discursive or performative skills; or (4) they can seek to confront the source of the obstacle. Research limitations/implications These findings point to the importance of care relations and social networks, as well as discursive and performative skills of undocumented migrants when negotiating barriers in access to health care. Originality/value This study refines the candidacy model by highlighting how individuals respond on a micro-level to shifts towards exclusionary health policies and, by doing so dynamically, change provision of health-care services.

Fachärzte bevorzugen Privatpatienten – Gesetzlich Versicherte warten mehr als doppelt so lange auf Termine wie Privatpatienten

2020 ◽  
Vol 25 (04) ◽  
pp. 186-186
Author(s):  
Keyword(s):  
Health Care ◽  
Field Experiment ◽  
Health Care Providers ◽  
Health Care Access ◽  
Care Providers ◽  
Cornell University ◽  
Care Access ◽  
Randomized Field Experiment ◽  
Inequality In Health ◽  
Cream Skimming

Werbeck A, Wübker A, Ziebarth NR. Cream Skimming by Health Care Providers and Inequality in Health Care Access: Evidence From a Randomized Field Experiment. Ruhr Economic Papers #846. DOI: 10.4419/86788981 Immer wieder heißt es, dass Privatpatientinnen und Privatpatienten in Deutschland schneller einen Arzttermin bekämen als gesetzlich Versicherte. Wissenschaftliche Erkenntnisse gab es dazu bislang jedoch kaum. Eine Studie des RWI – Leibniz-Institut für Wirtschaftsforschung und der Cornell University bestätigt nun den Verdacht.

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