HIV Infection and Risks of Morbidity and Death in Adults with Incident Heart Failure

Aims Human immunodeficiency virus (HIV) increases the risk of heart failure (HF), but whether it influences morbidity and mortality remains unclear. Methods and Results We investigated the risks of hospitalization for HF, HF-related emergency department (ED) visits, and all-cause death in an observational cohort of incident HF patients with and without HIV using data from three large U.S. integrated healthcare delivery systems. We estimated incidence rates and adjusted hazard ratios by HIV status at the time of HF diagnosis for subsequent outcomes. We identified 448 persons living with HIV (PLWH) and 3,429 without HIV who developed HF from a frequency-matched source cohort of 38,868 PLWH and 386,586 without HIV. Mean age was 59.5±11.3 years with 9.8% women and 31.8% Black, 13.1% Hispanic, and 2.2% Asian/Pacific Islander. Compared with persons without HIV, PLWH had similar adjusted rates of HF hospitalization (adjusted hazard ratio [aHR] 1.01 95% confidence interval [CI]:0.81-1.26) and of HF-related ED visits (aHR 1.22 [95%CI:0.99-1.50]), but higher adjusted rates of all-cause death (aHR 1.31 [95%CI:1.08-1.58]). Adjusted rates of HF-related morbidity and all-cause death were directionally consistent across a wide range of CD4 counts but most pronounced in the subset with a baseline CD4 count <200 or 200-499 cells/μl. Conclusions In a large, diverse cohort of adults with incident HF receiving care within an integrated healthcare delivery systems, PLWH were at an independently higher risk of all-cause death but not HF hospitalizations or HF-related ED visits. Future studies investigating modifiable HIV-specific risk factors may facilitate more personalized care to optimize outcomes for PLWH and HF.

The Changing Face of Physiotherapy Practice in COVID-19: Perspective of an Indian Physiotherapist

COVID-19 has taken up the world like a storm. It has placed unusual demands on healthcare delivery systems, including physiotherapy services worldwide. This challenge is even larger than the one placed by Severe Acute Respiratory Syndrome (SARS) or Ebola because of its sheer virulence. Times are changing; we need to do the same and accept the challenge head on. The role of a physiotherapist in the management of the COVID-19 patients is well established but an important issue is the management of non-COVID-19 as well as COVID-19 patients judiciously during these times. The various barriers to practice have increased manifold due to the condition as well as the associated problems which arose due to it. This commentary will comment on the likely impact of this pandemic over the existing physiotherapy delivery structure, challenges arising out of it and their probable solutions, ending with a brief note on India.

Doctors of chiropractic working with or within integrated healthcare delivery systems: a scoping review protocol

IntroductionBack and neck pain are the leading causes of disability worldwide. Doctors of chiropractic (DCs) are trained to manage these common conditions and can provide non-pharmacological treatment aligned with international clinical practice guidelines. Although DCs practice in over 90 countries, chiropractic care is rarely available within integrated healthcare delivery systems. A lack of DCs in private practice, particularly in low-income communities, may also limit access to chiropractic care. Improving collaboration between medical providers and community-based DCs, or embedding DCs in medical settings such as hospitals or community health centres, will improve access to evidence-based care for musculoskeletal conditions.Methods and analysesThis scoping review will map studies of DCs working with or within integrated healthcare delivery systems. We will use the recommended six-step approach for scoping reviews. We will search three electronic data bases including Medline, Embase and Web of Science. Two investigators will independently review all titles and abstracts to identify relevant records, screen the full-text articles of potentially admissible records, and systematically extract data from selected articles. We will include studies published in English from 1998 to 2020 describing medical settings that have established formal relationships with community-based DCs (eg, shared medical record) or where DCs practice in medical settings. Data extraction and reporting will be guided by the Proctor Conceptual Model for Implementation Research, which has three domains: clinical intervention, implementation strategies and outcome measurement. Stakeholders from diverse clinical fields will offer feedback on the implications of our findings via a web-based survey.Ethics and disseminationEthics approval will not be obtained for this review of published and publicly accessible data, but will be obtained for the web-based survey. Our results will be disseminated through conference presentations and a peer-reviewed publication. Our findings will inform implementation strategies that support the adoption of chiropractic care within integrated healthcare delivery systems.

Current Developments in Delivering Customized Care: A Scoping Review

Background In recent years, there has been a growing interest in healthcare personalization and customization (e.g. personalized medicine and patient-centered care). While some positive impacts of these approaches have been reported, there has been a dearth of research on how these approaches are implemented and combined for healthcare delivery systems. Objective The present study undertakes a scoping review of current developments for delivering customized care, according to theoretical and practical guidelines for customization delivery approaches. Methods Article searches were initially conducted in November 2018, and updated in January 2019 and March 2019, according to Prisma guidelines. Two investigators independently searched MEDLINE, PubMed, PyscINFO, Web of Science, Science Direct and JSTOR, The search was focused on articles that included “care customization”, “personalized service and healthcare”, individualized care” and “targeting population” in the title or abstract. Inclusion and exclusion criteria were defined. Disagreements on study selection and data extraction were resolved by consensus and discussion between two reviewers. Results We identified 70 articles published between 2008 and 2019. Most of the articles (n = 43) were published from 2016 to 2019. Four categories of patient characteristics used for segmentation analysis emerged: clinical, psychosocial, service and costs. We observed they often coexisted with the most commonly described combinations, namely clinical, psychosocial and service. A minority of articles (n = 18) reported assessments on quality of care, experiences and costs. Finally, few articles (n= 6) formally defined a conceptual basis related to mass customization, whereas only half of articles used existing theories to guide their analysis or interpretation. Conclusions There is no common theory based strategy for providing customized care. In response, we have highlighted three areas for researchers and managers to advance the customized development concept in healthcare delivery systems: better define the content of the segmentation analysis and the intervention steps, demonstrate its added value, in particular its economic viability, and align the logics of action that underpin current efforts of customization. It would allow them to use customization to reduce costs and improve quality of care.

Telepsychiatry and Outpatient Department Services

The utilization of telemedicine and telepsychiatry (TP) services in the outpatient department (OPD) has been increasing in recent years. The information about the technological, administrative, and clinical challenges is being addressed by the telemedicine and TP guidelines published by several individual nations. TP aims to address the treatment gaps, barriers for utilization, accessibility, diagnostic validity, financial implications, and individual client preferences. Utilization of TP in the OPD varies from country to country depending upon their healthcare delivery systems. It also varies in populations utilizing the TP services—urban, rural, child and adolescent, geriatric, and differently abled. TP services in the OPDs are being incorporated differentially by government organizations, insurance recognized psychiatric healthcare organizations, private psychiatric group practice deliverers, and individual, standalone psychiatric healthcare deliverers. TP may not replace the traditional in-person consultations completely. Covid-19 pandemic has hastened its utilization across several healthcare delivery systems. Healthcare organizations, clinicians, other healthcare deliverers, and end users are in the process of adapting to the new scenario. Incorporation of the big data, machine learning, artificial intelligence, virtual reality, and other technological advances in the psychiatric healthcare delivery systems into TP services in the OPDs would significantly contribute to the overall quality and efficacy of the psychiatric healthcare delivery systems in the future.