Resena de la obra de Don A. Dillman, Jolene D. Smyth y Leah Melani Christian: Internet, Phone, Mail and Mixed-Mode Surveys. The Tailored Design Method. New Jersey: John Wiley and Sons

https://dialnet.unirioja.es/descarga/articulo/7287796.pdf

Internet, phone, mail and mixed-mode surveys: the tailored design method: reseña

This paper combines SHARE Corona Survey and SHARE Wave 7 data for 25 European countries and Israel (N = 40,919) with institutional and epidemic-related country characteristics to investigate healthcare access for Europeans aged 50+ during the outbreak of COVID-19. We use a micro-macro approach to examine whether and to what extent barriers to accessing healthcare measured by reported unmet healthcare needs vary within and between countries. We consider various aspects of barriers and distinguish among: (1) respondents who forewent medical treatment because they were afraid of becoming infected with the Coronavirus; (2) respondents who had pre-scheduled medical appointments postponed by health providers due to the outbreak; and (3) respondents who tried to arrange a medical appointment but were denied one. Limited access to healthcare during the initial outbreak was more common for the occupationally active, women, the more educated and those living in urban areas. A bad economic situation, poor overall health and higher healthcare utilisation were robust predictors of unmet healthcare. People aged 50+ in countries of 'Old' Europe, countries with higher universal health coverage and stricter containment and closure policies were more likely to have medical services postponed. Policymakers should address the healthcare needs of older people with chronic health conditions and a poor socio-economic status who were made more vulnerable by this pandemic. In the aftermath of the health crisis, public health systems might experience a great revival in healthcare demand, a challenge that should be mitigated by careful planning and provision of healthcare services.

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Access to healthcare for people aged 50+ in Europe during the COVID-19 outbreak.

Importance The 2017 Addendum Guidelines for the Prevention of Peanut Allergy in the United States recommend that pediatricians assess infant peanut allergy risk and introduce peanut in the diet at age 4 to 6 months. Early introduction has the potential to prevent peanut allergy development. Objectives To measure the rates of guideline awareness and implementation and to identify barriers to and factors associated with implementation among US pediatricians. Design, Setting, and Participants This population-based study survey used a 29-item electronic survey instrument that was administered to pediatricians practicing across the United States from June 1, 2018, to December 1, 2018. Invitations to complete a survey were emailed to all pediatricians in the American Academy of Pediatrics vendor database. Eligible participants were nonretired US-based pediatricians providing general care to infants aged 12 months or younger. Main Outcomes and Measures The primary outcome was the prevalence of guideline implementation, which was measured by 1 survey item about awareness followed by a second item about implementation. Secondary outcomes included identification of guidelines-focused services provided by pediatricians, knowledge of the guidelines (measured with 3 clinical scenarios), barriers to guideline implementation, need for training, and facilitators of guideline implementation. Results A total of 1781 pediatricians were eligible to participate and completed the entire survey. Most respondents self-identified as white (1287 [72.5%]) and female (1210 [67.4%]) individuals. Overall, 1725 (93.4%; 95% CI, 92.2%-94.5%) pediatricians reported being aware of the guidelines. Of those pediatricians who had knowledge of the guidelines, 497 (28.9%; 95% CI, 26.8%-31.1%) reported full implementation and 1105 (64.3%; 95% CI, 62.0%-66.6%) reported partial implementation. Common barriers to implementation included parental concerns about allergic reactions (reported by 575 respondents [36.6%; 95% CI, 34.3%-39.1%]), uncertainty in understanding and correctly applying the guidelines (reported by 521 respondents [33.2%; 95% CI, 30.9%-35.6%]), and conducting in-office supervised feedings (reported by 509 respondents [32.4%; 95% CI, 30.1%-34.8%]). Many pediatricians (1175 [68.4%; 95% CI, 66.1%-70.5%]) reported a need for further training on the guidelines. Conclusions and Relevance This survey found that most pediatrician respondents appeared to know of the 2017 guidelines, but less than one-third of respondents reported full implementation. Results of this study may inform future efforts to eliminate barriers to guideline implementation and adherence, thereby reducing the incidence of peanut allergy in infants.

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Assessment of Pediatrician Awareness and Implementation of the Addendum Guidelines for the Prevention of Peanut Allergy in the United States.

Background Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care. Methods We launched the initiative “Bridging the Chasm between Pregnancy and Health across the Life Course” in 2018, bringing together patients, advocates, providers, researchers, policymakers, and systems innovators to create a National Agenda for Research and Action. We held a 2-day conference that blended storytelling, evidence analysis, and consensus building to identify key themes related to gaps in care and root causes of inequities. In 2019, more than 70 stakeholders joined six working groups to reach consensus on strategic priorities based on equity, innovation, effectiveness, and feasibility. Findings Working groups identified six key strategic areas for bridging the chasm. These include: 1) progress toward eliminating institutional and interpersonal racism and bias as a requirement for accreditation of health care institutions, 2) infrastructure support for community-based organizations, 3) extension of holistic team-based care to the postpartum year and beyond, with integration of doulas and community health workers on the team, 4) extension of Medicaid coverage and new quality and pay-for-performance metrics to link maternity care and primary care, 5) systems to preserve maternal narratives and data across providers, and 6) alignment of research with women's lived experiences. Conclusions The resulting agenda presents a path forward to remedy the structural chasms in women's health care, with key roles for advocates, policymakers, researchers, health care leaders, educators, and the media.

Bridging the Chasm between Pregnancy and Health over the Life Course: A National Agenda for Research and Action.

Background Congress has enacted 2 major pieces of legislation to improve access to care for Veterans within the Department of Veterans Affairs (VA). As a result, the VA has undergone a major transformation in the way that care is delivered to Veterans with an increased reliance on community-based provider networks. No studies have examined the relationship between VA and contracted community providers. This study examines VA facility directors' perspectives on their successes and challenges building relationships with community providers within the VA Community Care Network (CCN). Objectives To understand who VA facilities partner with for community care, highlight areas of greatest need for partnerships in various regions, and identify challenges of working with community providers in the new CCN contract. Research design We conducted a national survey with VA facility directors to explore needs, challenges, and expectations with the CCN. Results The most common care referred to community providers included physical therapy, chiropractic, orthopedic, ophthalmology, and acupuncture. Open-ended responses focused on 3 topics: (1) Challenges in working with community providers, (2) Strategies to maintain strong relationships with community providers, and (3) Re-engagement with community providers who no longer provide care for Veterans. Conclusions VA faces challenges engaging with community providers given problems with timely reimbursement of community providers, low (Medicare) reimbursement rates, and confusing VA rules related to prior authorizations and bundled services. It will be critical to identify strategies to successfully initiate and sustain relationships with community providers.

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Understanding VA's Use of and Relationships With Community Care Providers Under the MISSION Act.

Access to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care. A systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions. Despite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation, appropriateness, and ability to perceive. Four new identified dimensions were: government and insurance policy, health organization and operations influence, stigma, and primary care and specialist influence. While findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.

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Access to specialty healthcare in urban versus rural US populations: a systematic literature review.

Aims To identify significant patient and system access barriers and facilitators to dermatology care in one rural health system with limited dermatology appointment availability. Design Mixed methods study using data from electronic medical records, patient surveys, stakeholder semi-structured interviews, and service area dermatologist demographics. Retrospective data were collected between 1 January 2017-1 March 2018, and interviews and surveys were conducted between June 1-August 31, 2018. Participants were recruited from two primary care practices in one rural Maine regional health system. Methods Findings from thematic analyses, descriptive statistics, and statistical modelling were integrated using Chi-square tests for homogeneity to develop a unified understanding. Statistical modelling using odd-ratio logistic and linear regression were performed for each outcome variable of interest. Results Urgent referrals by primary care increased the likelihood of dermatology care overall (OR: 6.771; p = .007) and at nearby sites with limited availability (OR: 4.024; p = .024), but not at geographically further sites with higher capacities (p = .844). Referral under-diagnosis occurred in 20.8% of those biopsied. Older (p = .041) or non-working (p = .021) patients were more likely to remain unevaluated than seek more available but geographically further care. Conclusions In rural areas with scarce appointment availability, primary care provider diagnostic accuracy may be an important barrier of dermatology care receipt and health outcomes, especially among at-risk populations. Impact Although melanoma mortality rates are decreasing throughout the US, little is known about why rates in Maine continue to rise. This study applied a comprehensive approach to identify several patient and system access barriers to dermatology care in one underserved rural regional health system. While specific to this population and large service area, these findings will inform improvement efforts here and support broader future research efforts aimed at understanding and improving health outcomes in this rural state.

A mixed methods analysis of access barriers to dermatology care in a rural state

Background: Withmalignantmelanoma incidence rates at a historic national high and greater tumor thickness being the most significant prognostic determinant, early lesion detection and treatment remain the most crucial factors for improving health outcomes. Objective: The aim of this study was to design and pilot a survey instrument to document patients’ perceived barriers to dermatology care access. Methods: A retrospective, descriptive design and a convenience sample of 50 adult participants via a conceptually derived survey were used. Data analyses included descriptive statistics and frequencies; the survey was designed to be analyzed in a subsequent study with other types of data that were not collected as part of this pilot. Results: Twenty-one (42%) of participants reported receipt of dermatology care, five (10%) reported no care, and 24 (48%) did not respond to this question. Overall, 30 surveys (60%) were returned incomplete to varying degrees. Limitations: Limitations included a small sample size from a homogenous populationwith access to dermatology care. The reliability and validity of this tool were not evaluated. Conclusions: It was unclear whether lower completion rates were attributed to the survey or study design, but several research-driven suggestions were made that may be helpful in improving this tool for future use.

Piloting a Tool to Measure Patient-Perceived Barriers to Dermatology Access

Timely access to dermatology care is poor across the US, especially in underserved geographical areas. Rural regions with fewer practising dermatologists and constrained resources often experience insufficient care access and health outcomes, underscoring the importance of addressing these disparities. However, potential interventions are difficult to compare due to their disruptiveness, time and resource requirements, and institutional resistance, given their uncertain impacts. Queueing and computer simulation models were used to analyse several potential interventions to reduce dermatology appointment delays and gain insights into dynamics and structural inter-relationships. Model logic, candidate interventions, and cost–benefit considerations were developed from mixed-methods analyses of rural access processes and barriers. Sensitivity analyses were conducted. The best of ten investigated interventions reduced internal dermatology access delays from roughly 150 weeks with 95% provider utilisation currently to 0.49 and 72%, respectively. Two other interventions reduced travel for external dermatology care by an estimated 68.1%. Model logic and inputs were developed from the literature and a six-facility rural health system, which may differ in other geographic regions. Model simplifications may not capture all access dynamics, and resources required for some interventions may not be available. Model-based analysis of rural care access disparities can help evaluate and screen potential interventions, develop useful insights, and identify policies worth further evaluating or testing in actual practise. In our rural setting, two interventions appear cost-effective in reducing patient access delays and provider over-utilisation; two others performed too poorly to warrant investing resources to implement or test in practise.

Melissa E. Cyr

Papers

Access to specialty healthcare in urban versus rural US populations: a systematic literature review.

A mixed methods analysis of access barriers to dermatology care in a rural state

Piloting a Tool to Measure Patient-Perceived Barriers to Dermatology Access

Modelling policy interventions to improve patient access to rural dermatology care