OBJECTIVE: To examine variations in the delivery of teledentistry after the COVID-19 pandemic and to explore oral health professionals\' utilization of various teledentistry modes of delivery.
METHODS: In this mixed methods case study, we collected teledentistry claims data from patient electronic health records (n = 78,756) encompassing various types of teledentistry utilization in clinical settings and through community outreach from a Dental Support Organization (DSO) in Oregon from January 2021 to November 2022. We analyzed the patient demographic and claims data using descriptive statistics and logistic regression analyses to identify patterns of teledentistry service delivery. Qualitatively, we conducted virtual interviews (n = 13) through Microsoft Teams with oral health professionals about their experiences with teledentistry utilization. We used inductive and deductive coding to code individual transcripts and identify common themes among provider experiences.
RESULTS: Out of the 78,756 electronic health record claims for teledentistry, 75.7% used synchronous audio, 13.4% used synchronous video, and 10.9% used asynchronous teledentistry methods. We observed a 8.6% increase in synchronous audio teledentistry utilization at the end of the study period, compared with a 4.2% increase in synchronous video and a 4.4% decrease in asynchronous teledentistry. Oral health professionals interviewed reported choosing the type of teledentistry delivery based on patient and provider access to the virtual teledentistry platform.
CONCLUSIONS: Oral health professionals\' knowledge of and experiences with teledentistry need to be considered when developing policy and best practices for the use of teledentistry for patient care.

Homelessness in the United States is a significant public health issue, with dermatologic disease being the most prevalent health concern among the undomiciled and sheltered populations. Despite a growing need for dermatologic care, the supply of dermatologists remains insufficient, contributing to disparities in healthcare access for this vulnerable group. This review aims to detail the spectrum of dermatologic conditions experienced by homeless individuals, identify barriers to adequate care, and explore teledermatology as a potential solution to bridge these gaps. A comprehensive literature review was conducted, analyzing studies and reports on dermatologic issues prevalent among the homeless population and the efficacy of teledermatology in addressing these concerns. Homeless individuals face a wide range of dermatologic problems, from common conditions like acne and eczema to severe issues such as cellulitis, leg ulcers, and skin cancer. Drug abuse, domestic and sexual abuse, and parasitic infestations further complicate the dermatologic health of this population. Teledermatology has emerged as a promising tool to enhance access to dermatologic care, showing significant improvements in clinical outcomes and accessibility, especially in underserved urban settings. However, challenges remain, such as the digital divide affecting the elderly and low-income populations, which could potentially exacerbate disparities. Addressing the dermatologic needs of the homeless population requires a multifaceted approach. Teledermatology offers a viable solution to improve care access and efficiency, but additional efforts are necessary to ensure inclusivity and avoid further marginalization. Volunteer-driven multidisciplinary clinics also play a crucial role in providing care, though they face challenges in continuity and resource availability. Future strategies should focus on integrating teledermatology with other supportive services to create a comprehensive care model for this underserved population.

UNASSIGNED: Exposure to adverse social determinants of health (SDoH) in childhood is associated with poorer long-term health outcomes. Within structurally marginalized populations, there are disproportionately high rates of developmentally vulnerable children. The RICHER (Responsive, Intersectoral, Child and Community Health, Education and Research) social pediatric model was designed to increase access to care in marginalized neighborhoods. The purpose of this study was to describe the children and youth engaged with the RICHER model of service and characterize the needs of the population.
UNASSIGNED: A retrospective chart review was conducted on children and youth who accessed primary care services through the program between January 1, 2018 and April 30, 2021. Basic descriptive data analysis was done using Stata v15.1.
UNASSIGNED: A total of 210 charts were reviewed. The mean age in years at initial assessment was 6.32. Patients most commonly identified their race/ethnicity as Indigenous (33%) and 15% were recent newcomers to Canada. Evidence of at least 1 adverse SDoH was noted in 41% of charts; the most common included material poverty (34%), food insecurity (11%), and child welfare involvement (20%). The median number of diagnoses per patient was 4. The most frequently documented diagnoses were neurodevelopmental disorders (50%) including developmental delay (39%), ADHD (32%), and learning disability (26%). The program referred 72% of patients to general pediatricians and/or other subspecialists; 34% were referred for tertiary neuropsychological assessments and 35% for mental health services.
UNASSIGNED: Our data suggests that this low-barrier, place-based primary care RICHER model was able to reach a medically, developmentally, and socially complex population living in disenfranchised urban neighborhoods. Half of the patients identified in our review had neurodevelopmental concerns and a third had mental health concerns, in contrast to an estimated 17% prevalence for mental health, behavioral, or developmental disorders in North American general pediatric aged populations. This highlights the impact adverse SDoH can have on child health and the importance of working with community partners to identify developmentally vulnerable children and support place-based programs in connecting with children who may be missed, overlooked, or disadvantaged through traditional models of care.

BACKGROUND: Headache disorders are the largest contributor to all years lived with disability attributed to neurological disorders. In sub-Saharan Africa (SSA), with 1.2 billion inhabitants, headache prevalence is similar to that of Western countries but with widely inadequate access to care. Cost of transport to healthcare facilities hampers access to care, leading to abandonment and low retention. The aim of this observational study in Malawi was to investigate cost of transport and its likely impact on implementation of WHO\'s-Intersectoral Global Action Plan (IGAP) in an HIV+ population also complaining of, and requiring treatment for, an active headache disorder.
METHODS: The study was conducted at the Disease Relief through Excellent and Advanced Means (DREAM) centre in Blantyre, Malawi, in collaboration with the Global Campaign against Headache as an extension of a previous study. Enquiries about distance and costs of travel were added to the previously published questionnaire.
RESULTS: We included 495 consecutive HIV+ patients aged 6-65 years who had been followed for at least 1 year. One-year prevalence of any headache was 76.6%; 28.7% missed at least one appointment because of transport costs. Higher costs of transport were associated with higher probability of missing visits (p < 0.001), while costs were higher for those living in rural areas than for those in urban (p < 0.001).
CONCLUSIONS: Awareness of cost and affordability of transport in SSA may suggest strategies to improve access to headache care. Given the disability attributable to headache, this is necessary if the IGAP strategic objectives and targets are to be achieved.

BACKGROUND: Relaxed licensing restrictions on telehealth use during the COVID-19 pandemic allowed broad use irrespective of visit type. As these telehealth waivers expire, optimal uses of telehealth must be assessed to inform policy and clinical care. We evaluated patient experience associated with telehealth and in-person new or established visits.
METHODS: Patients seen in-person and via telehealth for urologic cancer care from August 2019 to June 2022 received a survey on satisfaction with care, perceptions of communication during their visit, travel time, travel costs, and days of work missed. We assessed survey responses with descriptive statistics.
RESULTS: Surveys were completed for 1,031 patient visits (N = 494 new visits, N = 537 established visits). Satisfaction rates were high for all visit modalities among new and established patients (mean score range 59.9-60.7 [maximum 63], P > 0.05). Patient-rated quality of the encounter did not differ by visit type and modality (P > 0.05, for nearly all comparisons). New in-person patient visits were associated with significantly higher travel costs (mean $496.10, SD $1021) compared with new telehealth visits (mean $26.60, SD $141; P < 0.001); 27% of new in-person patients required plane travel and 41% required a hotel stay (P < 0.001 vs. 0.8% and 3.2% of new telehealth patients, respectively).
CONCLUSIONS: Satisfaction outcomes among patients with urologic cancer receiving new patient telehealth care equaled those of new patients cared for in-person while costs were significantly lower. Offering telehealth exemption beyond COVID-19 licensing waivers to include new patient visits would allow for ongoing delivery of high-quality urologic cancer care irrespective of geographic location.

BACKGROUND: The NASEM Primary Care Report and Primary Care scorecard highlighted the importance of primary care physician (PCP) capacity and having a usual source of care (USC). However, research has found that PCP capacity and USC do not always correlate. This exploratory study compares geographic patterns and the characteristics of counties with similar rates of PCP capacity but varying rates of USC.
METHODS: Our county-level, cross-sectional approach includes estimates from the Robert Graham Center and data from the Robert Wood Johnson County Health Rankings (CHR). We utilized conditional mapping methods to first identify US counties with the highest rates of social deprivation (SDI). Next, counties were stratified based on primary care physician (PCP) capacity and usual source of care (USC) terciles, allowing us to identify 4 types of counties: (1) High-Low (high PCP capacity, low USC); (2) High-High (high PCP capacity, high USC); (3) Low-High (low PCP capacity, high USC); and (4) Low-Low (low PCP capacity, low USC). We use t test to explore differences in the characteristics of counties with similar rates of primary care capacity.
RESULTS: The results show clear geographic patterns: High-High counties are located primarily in the northern and northeastern US; High-Low counties are located primarily in the southwestern and southern US. Low-High counties are concentrated in the Appalachian and Great Lakes regions; Low-Low counties are concentrated in the southeastern US and Texas. Descriptive results reveal that rates of racial and ethnic minorities, the uninsured, and social deprivation are highest in counties with low rates of USC for both high PCP and low PCP areas.
CONCLUSIONS: Recognizing PCP shortages and improving rates of USC are key strategies for increasing access to high-quality, primary care. Targeting strategies by geographic region will allow for tailored models to improve access to and continuity of primary care. For example, we found that many of the counties with the lowest rates of USC are found in non-Medicaid expansion states (Texas, Georgia, and Florida) with high rates of uninsured populations, suggesting that expanding Medicaid and improving access to health insurance are key strategies for increasing USC in these states.

BACKGROUND: US health care delivery and financing arrangements are changing rapidly as payers and providers seek greater efficiency, effectiveness, and safety. The Centers for Medicare & Medicaid Services uses grants and technical assistance to drive such development through innovative demonstration programs, including for oral health care. The authors reviewed these dental demonstrations to identify common themes and identify barriers to and facilitators of implementation.
METHODS: The authors compared 12 identified demonstrations across 6 domains: grant and technical assistance, stakeholders, inner care settings, outer contextual settings, interventions, and outcomes. They developed program summaries for each demonstration and interviewed key informants using a semistructured guide to review, correct, clarify, and expand on program summaries.
RESULTS: Common across all programs were engagement of nontraditional providers, care in nontraditional settings, payment as a critical externality for program adoption, interventions that integrate medical and oral health care, use of alternative payment models, and tracking process measures. Adoption facilitators included an engaged oral health champion and obtaining mission support and alignment among stakeholders. Common barriers included unanticipated organizational disruptions, poor information technology infrastructure, cultural resistance to nontraditional care models, and lack of providers in high-need areas.
CONCLUSIONS: Descriptive findings suggest that oral health care may evolve as a more accountable, integrated, and accessible health service with an expanded workforce; collaboration between providers and payers will remain key to creating innovative, sustainable models of oral health care.
CONCLUSIONS: The Centers for Medicare & Medicaid Services\' efforts to advance health equity, expand coverage, and improve health outcomes will continue to drive similar initiatives in oral health care.

In the Brazilian Amazon, snakebite envenomations (SBEs) disproportionately affect Indigenous populations, and have a significantly higher incidence and lethality than in non-Indigenous populations. This qualitative study describes the Indigenous and biomedical healthcare domains for SBE care from the perspective of the Indigenous medical and nursing students in Manaus, Western Brazilian Amazon. In-depth interviews were conducted with five Indigenous students from the Amazonas State University, between January and December 2021. The interviews were analyzed using inductive content analysis. We organized an explanatory model with five themes: (1) participants\' identities; (2) causality levels in Indigenous and biomedical systems; (3) therapeutic itineraries in Indigenous and biomedical systems; (4) ideological implications of adding biomedical devices to Indigenous healing systems; and (5) therapeutic failure in and efficacy of Indigenous and biomedical systems. From a noncolonial perspective and seeking to increase the quality and acceptability of health care for the Indigenous populations of the Brazilian Amazon, the training of Indigenous health professionals presents itself as a promising strategy. For this goal, universities should serve as empowering settings for Indigenous health students that support them in their growth and development, raise their awareness of injustice, and catalyze change toward a culturally adapted and effective service for the users.

BACKGROUND: The 2018 International Evidence Based Guidelines (IEBG) for PCOS were created, in part, in response to poor patient satisfaction on international surveys. Patient satisfaction in the US, before and after these guidelines has not yet been characterized.
OBJECTIVE: To evaluate care patterns and patient attitudes among women with PCOS in the US before and after IEBG.
METHODS: Cross-sectional.
METHODS: A population-based community sample of women in the US.
METHODS: Women with PCOS confirmed by a care provider.
METHODS: None.
METHODS: Standardized questionnaires on care patterns and satisfaction in care.
RESULTS: 1056 respondents, aged 23±6 years at diagnosis were included. 69.2% had to wait >1 year and 72.9% saw >1 provider prior to receiving a diagnosis. <45% strongly agreed or agreed with statements regarding trusting their doctor. <27% were very or somewhat satisfied with care across all questions. In multivariable analyses, composite outcome of trusting your physician was associated with insurance type (uninsured vs private) (OR (95% CI), 0.5 (0.3-0.9), p=0.020)), race (Hispanic vs Caucasian) (0.6 (0.5-0.9), p=0.007), (Black vs Caucasian) (1.6 (1.0-2.4), p=0.045) and timing of diagnosis (within 5 years vs >5 years) (1.3 (1.0-1.7), p=0.038). Care satisfaction was associated with insurance type (public vs private) (0.6 (0.4-0.9), p=0.010), (uninsured vs private) (0.5 (0.3-0.9), p=0.021), and timing of diagnosis (within 5 years vs >5 years) (1.4 (1.1-1.9), p=0.010).
CONCLUSIONS: Satisfaction and trust in care is overall poor among patients with PCOS in the US. Higher scores among those diagnosed within the past 5 years, compared to those with a more remote diagnosis, may indicate an improving trend in care.

UNASSIGNED: Hospital admissions for cardiogenic shock have increased in the United States. Temporary mechanical circulatory support (tMCS) can be used to acutely stabilize patients. We sought to evaluate the presence of racial, ethnic, and socioeconomic inequities in access to MCS in the United States among patients with cardiogenic shock.
UNASSIGNED: Medicare data were used to identify patients with cardiogenic shock admitted to hospitals with advanced tMCS (microaxial left ventricular assist device [mLVAD] or extracorporeal membranous oxygenation [ECMO]) capabilities within the 25 largest core-based statistical areas, all major metropolitan areas. We modeled the association between patient race, ethnicity, and socioeconomic status and use of mLVAD or ECMO.
UNASSIGNED: After adjusting for age and clinical comorbidities, dual eligibility for Medicaid was associated with a 19.9% (95% CI, 11.5%-27.4%) decrease in odds of receiving mLVAD in a patient with cardiogenic shock (P < .001). After adjusting for age, clinical comorbidities, and dual eligibility for Medicaid, Black race was associated with 36.7% (95% CI, 28.4%-44.2%) lower odds of receiving mLVAD in a patient with cardiogenic shock. Dual eligibility for Medicaid was associated with a 62.0% (95% CI, 60.8%-63.1%) decrease in odds of receiving ECMO in a patient with cardiogenic shock (P < .001). Black race was associated with 36.0% (95% CI, 16.6%-50.9%) lower odds of receiving ECMO in a patient with cardiogenic shock, after adjusting for Medicaid eligibility.
UNASSIGNED: We identified large and significant racial, ethnic, and socioeconomic inequities in access to mLVAD and ECMO among patients presenting with cardiogenic shock to metropolitan hospitals with active advanced tMCS programs. These findings highlight systematic inequities in access to potentially lifesaving therapies.