Faculty Bibliography

BACKGROUND:In contrast to the current broad dissemination of telemedicine across medical specialties, previous research focused on the effectiveness of telemedicine in special populations and for behavioral health encounters; demonstrating that both physician and patient factors impact the efficacious use of telemedicine. OBJECTIVE:We evaluated physician perceptions of the appropriateness of telemedicine for patients attending the primary care practices of a federally qualified health center in New York City. METHODS:Anonymous cross-sectional survey including closed and open-ended questions. We used chi-square to test whether providers from certain specialties were more likely to state they would use telemedicine in the future. We used t-test to compare age between those who would vs. would not use telemedicine. Then, we used logistic regression to test whether age and specialty were both correlated with desire to use telemedicine in the future. We used thematic content analysis to describe the reasons providers felt they would not want to use telemedicine in the future, and to describe the situations for which they felt telemedicine would be appropriate. RESULTS:Of 272 FHC providers who were sent the electronic survey, 159(58%) responded within the 2-week survey time frame. Mean age of providers was 45 years (range 28-75). Overall, 81% stated they would use telemedicine in the future. Compared to the Family Medicine, Internal Medicine, Behavioral Health, Dental, and OB/GYN specialties, providers from Pediatrics, Med-Peds, Subspecialties and Surgery [Pro-telemedicine specialties] were more likely to believe telemedicine would be useful post pandemic (94% vs. 72%, p<0.05). Providers who reported they would use telemedicine in the future were younger [mean age 44(42-46) vs. 50(46-55), p<0.01). In regression analysis, both pro-telemedicine specialties and age were significantly associated with odds of reporting they would use telemedicine in the future [pro-specialties: 5.2(1.7-16.2); younger age: 1.05(1.01-1.08)]. Providers who did not want to use telemedicine in the future cited concerns about inadequate patient care, lack of physical patient interaction, technology issues, and lack of necessity. Providers who felt telemedicine would be useful cited the following situations: follow up visits, medication refills, urgent care, patient convenience, and specific conditions such has behavioral health, dermatology visits, and chronic care management. CONCLUSIONS:The majority of health providers in this resource poor setting in a federally qualified health center believed that telemedicine would be useful for providing care after the pandemic is over. CLINICALTRIAL/UNASSIGNED/:

BACKGROUND: Patient Portals(PP) allow access to medical records and interaction with providers; however activation(PPA) and use (PPU) are limited by language barriers, low health/computer literacy, and poor internet access which are prevalent issues in Federally Qualified Health Centers(FQHC). Little is known of the drivers and patterns of PPA in such settings. We aimed to describe the prevalence of PPA and PPU in adult patients of an FQHC; describe PPU activity, and test demographic, condition, and utilization-related correlates of PPA and PPU.
METHOD(S):We conducted a retrospective chart review in an FQHC that launched a PP in September 2016. We extracted demographics, PPA status(active/not) at data pull, PPU activities, presence of a chronic condition on the problem list, # emergency department, inpatient, subspecialty visits over past year (utilization summed, dichotomized >1 vs. 0-1 visit). Missing values for homelessness were coded to majority category( 0). Analyses included descriptive statistics, bivariate analyses, then logistic regression to test odds of PPA and PPU by. demographics, chronic conditions, and utilization. We report [adjusted odds ratios(confidence interval)].
RESULT(S): Data were analyzed for 62,610 adults [mean age 45(SD 17), 21% Black, 47% Hispanic, 46% Medicaid, 25% Selfpay, speaking English( 60%), Spanish (31%), Chinese(6%), Other(3%), with: hypertension( 19%), diabetes(11%), depression(8%), asthma(6%), CVD(5%); 21% had utilization>1. Overall 23,104(37%) activated the PP. PPU included viewing test results(69%), medications(62% ), immunizations( 51%), billing (38%), asking advice (29%), and scheduling appointments( 16%). PPA and PPU varied by demographics, chronic condition, and utilization, but were consistently higher for females, those who were not Medicaid recipients or Self-pay, English speakers and those with asthma, hypertension, and depression.
CONCLUSION(S): PPA was lower for non-whites and poorer patients, but higher for patients speaking the predominant languages of this FQHC, suggesting that language concordance helps engage patients. Patients with chronic conditions and more healthcare utilization had greater odds of PPA and PPU. On the other hand, Spanish-speakers were less likely to actively use the portal for functions such as scheduling appointments, suggesting that improvements in language capabilities of the platform are needed

OBJECTIVE:Functional gastrointestinal (GI) disorders (FGIDs), such as irritable bowel syndrome, functional abdominal pain and dyspepsia, are common causes of chronic GI symptoms in children. Prior studies found high comorbidity of FGID and asthma. This study aimed to assess the prevalence and comorbidities of FGID among pediatric patients with asthma at a university-affiliated urban community hospital. METHODS:This prospective, cross-sectional study assessed FGID prevalence, asthma control and symptoms of anxiety among pediatric patients with persistent asthma. The pediatric ROME III questionnaire was used to assess FGID. The Asthma Control Test assessed asthma control. The Beck Anxiety Inventory assessed symptoms of anxiety. RESULTS:Of the 110 enrolled patients, 18 (16.4%) met the diagnostic criteria for FGID, of which 10 were consistent with the diagnosis of functional abdominal pain disorder. Patients with FGID had a significantly lower mean asthma control score than patients without FGID (11.5 ± 4.9 vs 14.8 ± 5.3, P = 0.03; Cohen's d = 0.6) and higher mean anxiety scores than those without FGID (P < 0.01). Asthma control predicted the presence of FGID (OR 0.90, 95% CI 0.80-0.99, P = 0.03). However, after adjusted for anxiety, asthma control no longer predicted FGID presence (adjusted OR 0.90, 95% CI 0.83-1.05, P = 0.23). CONCLUSIONS:This study suggests a high prevalence of FGID among patients with persistent asthma. Moreover, patients with FGID had poor asthma control and increased anxiety. Clinicians should consider FGID in patients with poor asthma control and assess them for anxiety.

BACKGROUND:Childhood obesity is a growing health challenge. Recent studies show that children with late bedtime and late awakening are more obese independent of total sleep time. In adolescents and adults, a delayed sleep phase has been associated with higher caloric intake. Furthermore, an adult study showed a positive correlation between REM sleep and energy balance. This relationship has not been demonstrated in children. However, it may be important as a delayed sleep phase would increase the proportion of REM sleep. OBJECTIVES:This study investigated the relationship between hunger score and sleep physiology in a paediatric population. METHODS:Thirty-six patients referred for a polysomnogram for suspected obstructive sleep apnoea were enrolled in the study. Sleep stages were recorded as part of the polysomnogram. Hunger scores were obtained using a visual analogue scale. Mean age was 9.6 ± 3.5 years. RESULTS:Mean hunger scores were 2.07 ± 2.78. Hunger scores were positively correlated with percentage of total rapid eye movement (REM) sleep (r = 0.438, P < 0.01) and REM sleep duration in minutes (r = 0.471, P < 0.05). Percentage slow wave sleep (SWS) was negatively correlated with hunger score (r = -0.360, P < 0.05). There were no correlations between age, sex, body mass index percentiles, apnoea-hypopnoea index, total sleep time, sleep efficiency, sleep onset latency, stage 2 sleep duration and hunger scores. CONCLUSIONS:These findings suggest that delayed bedtime, which increases the proportion of REM sleep and decreases the proportion of SWS, results in higher hunger levels in children.