Introduction: In recent years, high quality contraceptive care for adolescents has shifted away from tiered effectiveness counseling and toward youth-friendly, patient-centered counseling (YFPCCC). YFPCCC is essential in the South, which has higher rates of sexual activity, lower rates of contraception use, and higher teen birth rates. This study examined Southern clinics’ characteristics which support YFPCCC and youth’s perceptions of the contraceptive care they receive. Methods: This mixed methods study examined secondary data collected in two surveys and primary data collected through key-informant interviews. The first survey examined clinic characteristics impacting YFPCCC, and the second survey examined adolescents’ (aged 16-24) perspectives of their care. For each survey, outcome measures were dichotomized and examined through logistic regression models. Lastly, interviews with administrators at FQHCs and HDs in AL and SC and examined the facilitators and barriers to providing YFPCCC in these clinics. Results: FQHCs were 89% less likely to notify youth of their right to confidentiality (aOR 0.11, 95% CI (0.05, 0.26)) and 80% less likely to notify youth of their right to consent to care (aOF 0.20, 95% CI (0.10, 0.40)). Non-Hispanic Black youth were 47% less likely to receive patient-centered contraceptive care (aOR 0.53, 95% CI (0.40, 0.70)). Minor youth (ages 16-17) were 34% less likely to receive patient-centered contraceptive care (ages 20-24) (aOR 0.66, 95% CI (0.45, 0.98)). Clinic administrators noted the continued use of tiered effectiveness counseling. SC administrators noted that minor youth were allowed to consent to receiving the implant but could not consent to removing it. Discussion: Overall, clinic capacity to provide YFPCCC varied by clinic type, with FQHCs less likely to have notify youth of their rights to consent to and receive confidential contraceptive care. The receipt of YFPCCC varied by youth’s age and race/ethnicity, with minors and non-Hispanic Black youth being less likely to report YFPCCC. Clinic administrators noted that they continue to use the tiered effectiveness model of counseling, which may inadvertently pressure or coerce youth. To improve their capacity to provide YFPCCC, clinics should enhance their policies protecting consent and confidentiality and ensure that their providers are trained in patient-centered contraceptive care for youth.

Type 2 diabetes is a highly prevalent disease, projected to increase in prevalence, while expensive to treat. This study sought to identify significant predictors of each of the two study outcome variables—a higher quality of patient-provider communication, and a higher quality of life. The online sample (N=72) was 78% (n=56) female with a mean age of 55.3 years, while 71% Black/African American with a good overall health status. They rated the overall quality of care received from their provider between good and very good. Using the new Patient-Provider Communication Scale (PP-CS-07, patient-provider communication was closest to very good. Health literacy skills were closest to very good, and health literacy self-efficacy was closest to very good. Level of knowledge for caring for type 2 diabetes was closest to very good knowledge. Participants were in an action stage with 80% confidence (very good self-efficacy) to perform seven diabetes self-management behaviors. Some 43.1% experienced depression, 44.4% experienced anxiety, and 20.8% sought counseling in the past year. The mean quality of life rating was closest to good quality of life. While controlling for social desirability, backward stepwise regression showed better quality patient-provider communication was significantly predicted by: received diabetes education, higher rating of health care quality, higher level of health literacy skills, and, being in a lower stage of change for self-care behaviors—with 79.2% of variance explained by this model. Better quality of life was significantly predicted by: female gender, having received diabetes education, no past year anxiety, higher annual household income, lower weight status, higher health literacy self-efficacy, higher rating of knowledge of diabetes self-management—with 69.4% of the variance explained by this model. Findings make a compelling case for screening patients for depression and anxiety, using the brief tool used in this study; and future research evaluating the impact of health educators and providers being trained in motivational interviewing, while using the Patient-Provider Communication Scale (PP-CS-7) as a new tool to compare ratings by patients of providers trained in motivational interviewing. Healthcare policy should mandate such training in brief motivational interviewing, and evaluate the impact of training in containing costs.

Background: The utilization of telehealth has had a substantial impact on transforming and enhancing the methods by which healthcare is presently delivered. The potential benefits of telehealth in improving the health of vulnerable populations and underserved communities are substantial. The aims of this study were to examine the association between social determinants of health and patient perceptions of their experiences with telehealth. We will analyze how perceptions differ across specialization, race, gender, and other key determinants; examine how patient’s self-rated physical health and mental health influences perceptions and attitudes about telehealth utilization; and evaluate differences in perceptions and attitudes, experience with patient interactions and overall telehealth experiences between mental health providers and non-mental health providers. Methods: A scoping review was completed to explore literature regarding telehealth administration and underserved populations following the PRIMSA-ScR guidelines. Multivariable logistic regression was then conducted to assess the relationship between self-rated mental health and self-rated physical health and the primary predictor variables telehealth usability, telehealth satisfaction, and telehealth experiences. Finally, a mixed-methods study was conducted to evaluate differences in perceptions and attitudes, experience with patient interactions and overall telehealth experiences mental health-care providers and non-mental healthcare providers. Results: The scoping literature review highlights how telehealth is used in diverse settings, but more research needs to be done to determine best practices for both healthcare providers and patients utilizing telehealth. The study focused on self-reported health found significant associations between high mean scores on telehealth usability, telehealth satisfaction, and telehealth experiences and good self-reported mental and physical health. Lastly, the study looking at provider differences highlighted that the reliability of the telemedicine platform, the ability to trust the telemedicine application, and video visits being a convenient form of healthcare delivery was greater for mental healthcare providers than non-mental healthcare providers. Implications: These findings highlight the need for studies examining telehealth satisfaction, telehealth usability and telehealth experiences amongst providers and patients in underserved areas. Further research is needed to gain a deeper understanding of the telehealth access requirements of underserved communities and can aid in the development of evidence-based guidelines for the delivery of telehealth services.

Although Radio Frequency Identification (RFID) and Real-Time Location System (RTLS) technologies for inventory tracking have been growing in popularity, the healthcare industry has been reluctant to adopt these technologies. One of the primary reasons for this lack of enthusiasm has been the risk associated with electromagnetic interference between RFID/RTLS systems and medical equipment functionality. The other reason has been the substantial cost and complexity of implementing RFID/RTLS in healthcare organizations. In this study, we show that there are several ways to safely install RFID/RTLS systems to improve the inventory management processes of hospitals and clinics. We then analyze the inventory shrinkage (loss and theft) data of the Veterans Health Administration VISN 10 (the Veterans Integrated Service Network of Ohio) using a mathematical model to estimate the annual shrinkage. Finally, we develop an economic cost/benefit analysis database system in Microsoft Access that can be used to calculate the breakeven point of RFID/RTLS implementations, as well as calculate the expected reduction in inventory- related operating costs. This system can be adapted for cost/benefit analyses in similar inventory-intensive environments.

<p>The practice of medicine has evolved from individual practice, mainly led by physicians, towards an interdisciplinary team-based activity that takes into consideration patients’ needs, preferences and values. This shift towards what is known as the patient-centered care (PCC) model requires better communication among medical staff and patients. Feedback is a key factor to improve team learning processes and also to understand patient perspectives. The objective of this thesis was to create a system to facilitate feedback processes within the Toronto General Hospital (TGH). To do so, a kiosk-based system was designed, allowing patients and health care providers to send feedback messages as well as positive recognition messages in appreciation of other people’s commitments and achievements. A pilot test was conducted by placing a kiosk in the General Internal Medicine unit at TGH for seven weeks. During this study, the application running the kiosk registered all user actions, with the objective of understanding how patients and staff interacted with the system. The kiosk was perceived as a positive, easy to use, and valuable tool by patients and providers. The different elements that need to be improved for future upgrades of the system are discussed. Overall, the use of kiosk-based systems to gather feedback should be considered when creating high performing teams in the health care domain.</p> / Master of Science (MSc)

Background: While value-based payment models emphasizing care coordination have been widely implemented to improve quality and lower expenditures, supporting empirical evidence is sparse. Our objective was to quantify the impact of specialist-to-primary care physician involvement within accountable care organization (ACO) and its association with lower spending. Methods: We conducted a retrospective cohort study of Medicare Shared Savings Program ACOs from 2012-2016 using publicly available data provided by the Centers for Medicare and Medicaid Services at the ACO level. We examined the association between the proportion of primary care services delivered by specialists versus other types of care providers and ACO spending using a generalized estimating equation model. Results: The analytic dataset included 1381 MSSP-years. When compared to ACOs at the lowest (60) levels of providing primary care services through specialists, ACOs who had 35% to 40% of primary care services delivered by specialists spent $1,124 (95% CI, $358 to $1,891) and $969 (95% CI, $250 to $1,688) less per capita, respectively. When stratified at varying levels of specialists providing primary care services, having four years of experience in the Medicare Shared Savings Program was consistently associated with lower spending when compared to having one to three years of experience. Conclusions and Relevance: The optimal portion of specialists providing primary care services - to reduce spending - was found to be 35% to 40%. These findings suggest that integrating specialists in to the activities and objectives of MSSP ACOs could lead to lower spending and better performance.

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. This reform, it is argued, is projected to increase insurance coverage of pre-existing conditions, to expand access to insurance for more than 30 million Americans, and to increase estimated National medical spending while lowering projected Medicare spending. This thesis sought to investigate and analyze the perceptions of senior citizens in Central Florida about PPACA and their perceived effects on the healthcare quality provided to them under this law. Four sections of PPACA bill, thought to specifically pertain to the elderly, were selected for this study; respondents were asked their opinions regarding PPACA's aspects of: (1) the reform on preventive healthcare services; (2) Medicare Part D (prescription drugs); (3) Medicare; and (4) Medicaid. This thesis employed both qualitative and quantitative methodologies; data were collected and analyzed with findings presented and discussed.

Psychiatric nurse practitioner (NP) turnover is a significant cost to healthcare employers. Psychiatric NP turnover due to private practice creation is not well understood. The purpose of this study was to better understand the transition of Psychiatric NPs as they moved from ambulatory/outpatient employment to private practice. Using a hybrid Grounded Theory approach, 17 Psychiatric NPs in private practice were interviewed from October - December 2023. Facilitating factors to private practice creation were: The COVID-19 pandemic, changes to telehealth regulation during the pandemic, increased demand for psychiatric services and decreased supply of providers, and progress within the NP full practice authority movement. While employed, NPs reported experiencing burnout, high patient load, poor schedule, poor compensation, increased administrative tasks not budgeted within the NP workday, and rampant disrespect of the NP role. NPs reported being managed by inappropriate supervisors from other disciplines, and reported little opportunity for growth. Most participants voiced an initial reluctance to enter private practice, and reported being “pushed” to entrepreneurship out of concern for their long term wellbeing. These factors combined contributed to poor NP job satisfaction and NP turnover. Strategies to improve the job satisfaction of employed psychiatric NPs were recommended.

In 1993, the last health reform “Law 100” was introduced in Colombia. It has been over 30 years since its implementation, and there have been many changes to the healthcare system in Colombia ever since. The policy increased health insurance coverage to almost 95% of the population, providing better and more affordable patient care. However, increasing the availability of resources does not necessarily make them accessible to all of Colombia’s residents. This study aims to analyze the outcomes of “Law 100” to the system and studies critical obstacles that halt healthcare equity in Colombia, particularly for those in rural and low-income populations. Disparities in access to quality healthcare, a shortage of healthcare professionals, and insufficient preventative measures are persisting problems that have challenged the Colombian healthcare system. In addition, this study explores models from Brazil, Thailand, and Finland, which have healthcare systems similar to Colombia's and have faced and overcome comparable concerns. Based on these successful models, policy recommendations adapted to fit the Colombian healthcare system include implementing community-based healthcare teams, creating educational incentives for healthcare workers in underserved areas, and launching public health prevention campaigns. This study offers actionable improvements for Colombian policymakers to reduce healthcare disparities and develop a fairer system for all citizens.

The purpose of the study was to describe the effects of an EMR on patient management in selected HIV clinics in Johannesburg. A quantitative, descriptive, cross-sectional study was undertaken in four HIV clinics in Johannesburg. The subjects (N=44) were the healthcare workers selected by stratified random sampling. Consent was requested from each subject and from the clinics in Johannesburg. Data was collected using structured questionnaires. Median age of subjects was 36, 82% were female. 86% had tertiary qualifications. 55% were clinicians. 52% had 2-3 years work experience. 80% had computer experience, 86% had over one year EMR experience. 90% used the EMR daily, 93% preferred EMR to paper. 93% had EMR training, 17% used EMR to capture clinical data. 87% perceived EMR to have more benefits; most felt doctor-patient relationship was not interfered with. 89% were satisfied with the EMR’s overall performance. The effects of EMR benefit HIV patient management. / Health Studies / MA (Public Health)