State Level Efforts to Improve Rural Physician Retention: A Policy Analysis

Introduction: There exists a maldistribution of family physicians in the United States, resulting in unequal access to health care between urban and rural residents. Efforts to correct this have focused on recruitment but retention also merits attention. This paper seeks to address how state policies can be adjusted to improve retention. Methods: This policy brief reviewed current state policies regarding retention strategies. Seven interviews were conducted with stakeholders experienced in provider retention to assess priorities and feasibility. Stakeholders included state-level officials in Nebraska and Pennsylvania, persons involved in national retention efforts, and administrators at Pennsylvania health centers. Interview data were analyzed with standard qualitative methodologies including coding data and thematic analysis. Results: The literature, reinforced by stakeholder interviews, demonstrated that loan repayment programs are a powerful tool to draw physicians to high need areas, with variable results on retention. Interviews highlighted common themes of positive retention factors, such as provider integration into communities, readiness of the provider for rural practice, and the key role of the clinic administration in keeping a physician satisfied in employment. Interviews also emphasized the economic value that physicians bring to small towns and the high return on investment of loan repayment programs. Conclusion: Retaining physicians in high need rural areas is essential for health care equity as well as economic vitality. State offices should increase funding for state-run loan repayment programs. An additional funding priority is outreach to struggling clinics via technical and administrative assistance. It is vital to incorporate data monitoring in order to evaluate efficacy so that funding and outreach may be renewed or adjusted according to the evidence

Electronic Health Records: All That They’re Chalked Up To Be?

Introduction. The United States faces a challenge: how to improve access to healthcare with an aging physician workforce. An aging baby boomer population prompts higher medical demands, further heightening this challenge. Although measures to increase the longevity of practice for older physicians could help address this challenge, the federal government has lacked to create such policy. Methods. This study looked at the role of electronic health records and the American Recovery and Reinvestment Act in the ability of primary care physicians to continue practice through in-depth qualitative interviews. A total of N=5 interviews were conducted in-person and remotely using a set of standard questions. Interview data were coded and thematic analyses were used to derive data themes around the mandate’s impact on their practice with specific regards to the implementation of electronic health record systems. Results. Five physicians participated in the interviews, all of whom were over age 55. The participants noted that they incurred both financial and interpersonal stress from the American Recovery and Reinvestment Act’s mandate. The participants highlighted that electronic health records impaired the relationships with their patients and factored into their expected length of practice. Conclusion. Legislators should consider the impact electronic health record policy has on older physician’s ability to practice medicine. Eliminating the penalty for paper charts in older physician practices could remove financial stress and thus potentially increase length of careers and improve community healthcare access. Future research is needed to determine approaches that best mitigate electronic health record induced barriers to a strong physician-patient connection

Vaccination Exemptions for School-Aged Children in Delaware

Background: Current awareness around childhood vaccinations and associated requirements for school entry has been heightened both nationally and internationally as governments work to find a balance between protecting their residents’ health and personal freedoms. Scant research exists examining the characteristics of these vaccine exemptors, but as the percentage of students seeking these exemptions increases yearly, this yields an opportunity to identify trends and inform future policy. Question: What are the associations between reason for exemption from mandated vaccinations and the demographics of race and gender for school-aged children in the state of Delaware? Results: Drawing from school nurse vaccine exemption record data, we looked at student’s reason for vaccine exemption and used chi square analyses to study the association with race, disease(s) of vaccine, and gender. White race and male gender were significantly associated with having a religious vaccine exemption, X2 (1, N = 154) = 22.75, p = .000 and X2 (1, N = 154) = 8.71, p = .003, respectively. The varicella vaccine was the most common disease when the reason for exemption was having had the disease, while the Tdap vaccine was the most common vaccine exemption for religious reasons. Conclusion: The significant association of white race and religious vaccination exemptions implicates future policy that focuses on this proportion of exemptions, rather than prior exposure exemptions that do not impact herd immunity. While data was available for only one school district within the state of Delaware, the significance of the findings suggests further and broader inquiry is imperative in the on-going efforts to keep our populations safe from vaccine preventable diseases

Which oral antibiotics are best for acne?

Doxycycline is effective (strength of recommendation [SOR]: B, randomized controlled trial) and the antibiotic of choice (SOR: C, expert opinion) for moderate to severe inflammatory acne requiring oral treatment. Limiting side effects include photosensitivity and gastrointestinal (GI) disturbance. Other members of the tetracycline family are considered second-line agents because of their side-effect profile and are contraindicated in pregnancy and for children younger than 12 years (SOR: A, meta-analysis, and C, expert opinion). For these patients, erythromycin is effective and better studied than azithromycin (SOR: C, expert opinion). Otherwise, emerging resistance and GI disturbances make erythromycin a third-line treatment. The use of oral antibiotics should be limited to moderate to severe inflammatory acne unresponsive to topical therapies, including retinoids and antibiotics (SOR: C, expert opinion). Oral antibiotics should be used for at least 6 to 8 weeks and discontinued after 12 to 18 weeks of therapy (SOR: C, expert opinion)

Cost Savings and Patient Satisfaction Following Implementation of an Online Blockchain-Based Healthcare Payment Portal

Introduction. Although most patients prefer e-billing, many providers use paper. On average, over three paper bills are sent before payment is received. This means wasted time, money, energy, and decreased patient satisfaction. Could the implementation of an online, blockchain-based healthcare payment portal increase cost savings and patient satisfaction while maintaining confidentiality? Methods. Transaction data was collected by MAPay through their portal system from about 100 providers in 50 locations in the NYC area, all through IntegraConnect. This study analyzes trends in how patients pay their medical bills and how much they pay. Results. From March through September, all electronic methods increase in amount – especially portal payments which increase from ~$21k to ~$100k, while lockbox drops from a high of ~$24k in April down to ~$13k in September. The average rate of increase in transactions per month is: IVR – 84.5, E-Check – 24.5, Lockbox – 34.5, Portal – 243.8. In March there were 10.8k statements sent for a total of $32.7k of billing, compared to September which saw only 18.5k for$151.3k, indicating significant paper/administrative savings associated with billing (~$0.80/user) following portal implementation. Conclusion. The numbers show that portal is the most popular and fastest growing payment method by number of transactions and dollar amount. The rate of growth of portal payments is much faster than that of lockbox, indicating that people prefer electronic payment methods as compared to paper. There were also implied paper/admin savings following implementation of the portal. Based on these results, a payment portal such as MAPay’s is a viable alternative to paper billing

The Effect of Perceived Physician Opinion on Breastfeeding in Women with Opioid Use Disorder Who Are Receiving Medication-Assisted Treatment

Women who receive medication-assisted treatment (MAT) for opioid use disorder (OUD) are less likely to breastfeed than the general population despite the many possible benefits to the newborn. The ongoing study examines the effect of perceived physician opinion on the outcome of breastfeeding in women receiving MAT for OUD. Women who were receiving MAT for OUD at Thomas Jefferson University’s Family Center were given a survey during their third trimester (n=45), and at 1 month postpartum (n=33) to gather information on the perceived opinion of their physicians on how they should feed their baby and the importance of those opinions. Information was also gathered on whether or not participants obtained information on breastfeeding from various healthcare professionals (doctor, nurse, or other). Descriptive statistics on our sample revealed that 48.5% of participants reported breastfeeding their child at some point. Results also showed that 73.3% reported obtaining information about breastfeeding from a health professional during their pregnancy. Additionally, 51.2% didn’t know or thought their OBGYN didn’t have an opinion on how their baby should be fed despite ­­­­­86.1% viewing their OBGYN’s opinion as somewhat or very important. For their child’s pediatrician, 42.8% didn’t know or thought the physician didn’t have an opinion with 86.5% viewing their opinion as somewhat or very important. Preliminary results of this ongoing study reveals that breastfeeding prevalence in women receiving MAT for OUD could be improved with increased intervention by physicians and improved perception of physicians’ opinions on how their infant should be fed

Impact of Long-Term Doula Services on Maternal and Fetal Health Outcomes in Women in Treatment for Opioid Use Disorder

This study analyzed the impact of doula services on maternal and fetal health outcomes in pregnant women seeking treatment for opioid use disorder. Understanding the impact of doula services is critical in reducing inequities in health outcomes experienced by this vulnerable population. Retrospective and prospective data was collected from surveys, focus groups, and maternal and infant birth data from 100 women in treatment for opioid use disorder, with fifty utilizing doulas and fifty not utilizing doulas. Standardized data abstraction of quantitative and qualitative measures were collected into an SPSS database and Nvivo, respectively, and analyzed using SPSS. Measures of importance included number of birth complications (maternal or infant), psychosocial outcomes, breastfeeding initiation, and parenting behaviors. The preliminary study is ongoing. While data is limited, preliminary results show no difference amongst control vs. doula group in PSI (PSI Mean = 67.53) (STD=11.81) or PSS (PSS Mean =14.87) (STD=5.18) scores, reflecting no change in psychosocial outcomes. Qualitative analyses of preliminary data reflect working with a doula as a generally positive experience that has assisted with family reunification, health advocacy, resource assistance, and recovery support, all of which showed the lasting positive impact of doula support on parenting behaviors. Further data collection and analyses need to be conducted to determine the impact on birth complications and health outcomes. Doula services should be included in Medicaid coverage, due to its potential to reduce complications and inequities in health outcomes, improve psychosocial support, and its cost-effectiveness

The Impact of Doula-Supported Care on Stress Levels of Women Receiving Opioid Addiction Treatment

Introduction: Mothers suffering from opioid addiction are at high risk for experiencing extreme stress levels which prevents them from providing a healthy and nurturing environment for their family. The aim of this project is to explore if a doula-supported care team alleviates the parenting stress of new mothers participating in opioid addiction rehabilitation. Methods: A total of 35-40 women in treatment at the Montair program for substance use disorder rehabilitation were recruited to participate in the City of Philadelphia’s Community Doula project. The Parenting Stress Index Score (PSI) was recorded and compared to a control group composed of women in the same rehabilitation program who did not utilize the doula services. Additional qualitative interviews were recorded through phone interviews. Results: Parenting women with opioid use disorders experience high levels of stress. We hypothesize that women who utilize the doula program will have significantly lower PSIs than those who do not. Major results of this study show (placeholder). This project originally aimed to explore the effect of the doula program on attachment styles on women participating in substance abuse rehabilitation through a comparison using the Keys to Interactive Parenting Scale (KIPS). However due to limitations imposed by the COVID-19 pandemic this original goal could not be accomplished. Conclusions: We hypothesize that the implementation of doula-supported services will alleviate parenting stress to a significant degree. If our hypothesis is correct the results of this program would support future funding for the continuation and expansion of the City of Philadelphia’s Community Doula program

Exploring Political Awareness and Civic Engagement Among Women Utilizing MATER Services

Introduction: High levels of civic engagement by United States citizens sustains the integrity of the democratic system. Health organizations, such as The Maternal Addiction Treatment Education and Research (MATER) program, are in a position to help marginalized voting-eligible individuals overcome barriers to voting. Methods: The target population was women utilizing MATER services. The study design consisted of a survey collecting data including demographic information, political engagement, perceived barriers, and interest in future advocacy. Following the survey, participants were offered more voting resources. Results: One hundred percent of participants reported utilizing public assistance. Forty-eight percent reported a social network as their source of voting information and 28% reported social media. Seventy-seven percent reported no interest in future advocacy, 13% reported interest, and 10% were unsure. Forty-one percent of participants reported not being registered as their reason for not voting (the most common reason) and 29% reported not being interested in the election (second most common). Not knowing where to go was the most prevalent barrier to voting, with 36% of participants reporting this as the case. Conclusion: It is crucial for women at MATER to be civically engaged. Information was obtained regarding their degree of civic engagement and their barriers to engagement and voting. These results are instrumental in increasing civic engagement among the target population and related populations, as well as potentially promoting better health outcomes, more effective healthcare and drug treatment services, improved relations with political entities, sociopolitical empowerment, and more effective democracy

Parental Perceptions of the HPV Vaccine for Prevention of Anogenital and Oropharyngeal Cancers

Background and Objectives Human papillomavirus (HPV) is implicated in the development of both anogenital and oropharyngeal cancers. Although HPV vaccination prevents the majority of anogenital and head and neck cancers (HNC), vaccination rates remain low, especially among males. Known barriers to vaccination are knowledge gaps and vaccine acceptability. The objective of this study is to explore parental knowledge, perceptions, and decision-making processes about HPV and HPV vaccination for both anogenital and HNC. Methods This qualitative study recruited parents of children and adolescents aged 8–18 to participate in semi-structured telephone interviews. Data were analyzed using thematic analyses, informed by an inductive approach. Results A total of 31 parents participated in the study. Six themes emerged: 1) knowledge about HPV vaccines, 2) perceptions and attitudes toward cancers, 3) role of child’s sex in HPV vaccination, 4) decision-making processes around HPV vaccination, 5) communication with health care providers about HPV vaccines, and 6) influence of social networks. There were significant knowledge gaps about the vaccine’s indications and effects, especially for males and HNC prevention. Parents had concerns related to risks of the HPV vaccine. They cited pediatricians as important sources of information about vaccination and critical to their decision-making. Conclusions This study identified many parental knowledge gaps related to HPV vaccination, with information about males, HNC prevention, and risks particularly lacking. As parents identified pediatricians as the most important sources of information regarding HPV vaccination, this should empower pediatricians to educate families about this important preventive health measure, with a focus on addressing concerns about vaccine risks