Co-Author(s): Neha Shankar, Raghavee Neupane
We are interested in the potential role that telemedicine has in reducing barriers to accessing healthcare. As medical students, we recognize the landscape of primary care may be different once we begin practicing compared to when we began our training. We are passionate about reducing healthcare inequities, and we believe that telemedicine could play a vital role in effecting positive change for the future of primary care.
With increased interest in telemedicine since the COVID-19 pandemic, investigations of its use often analyze video- and phone-based care delivery together, even though they differ in their challenges and benefits. We sought to differentiate video- and phone-based telemedicine by assessing their common barriers, benefits, and perceived role in addressing health inequity according to primary care clinicians. Our study collected data from electronic surveys administered to a longitudinal cohort of primary care clinicians between September 2021 and November 2021. Clinician-reported barriers related to computer-based telemedicine included patient lack of computer literacy (83%), lack of broadband access (60%), and data plans that did not support video-based visits (43%). Phone-based care barriers included patient poor cell service (55%) and limited phone data plans (24%). However, clinicians reported that phone-based care demonstrated greater success in reducing the number of patients who ‘fall through the cracks’ (40%) compared to video-based care (27%), and reducing no-show rates (36% and 27% respectively). Forty-seven percent of clinicians also valued phone-based care’s ability to address health inequities more than that of video-based care (35%). Our data suggests clinicians viewed phone-based telemedicine as a promising mode of healthcare delivery due to its ability to reduce losses to follow-up and no-show rates compared to video-based care. This could be valuable for clinicians serving populations affected by health inequity and limited digital literacy, although more research on the barriers of each of these modes of telemedicine is needed.
Co-Author(s): Emily Bassett, Raghavee Neupane
For many of us, the COVID-19 pandemic dramatically changed our daily lives, mainly obligating us to rely heavily on technology and virtual means of communication. As medical students interested in primary care, we were fascinated by the increased use of telemedicine as a healthcare delivery tool during the pandemic and wondered how this could have impacted the field of primary care medicine for both clinicians and patients. We were also enthusiastic to learn more about how telemedicine integration could influence health disparities for possible future directions.
The COVID-19 pandemic revolutionized healthcare delivery, enabling primary care clinicians to embrace telemedicine on a larger scale than ever before. However, this rapid transition brought along several challenges related to telemedicine accessibility, namely the prevalence and detriment of digital illiteracy. We assessed the perceptions of primary care clinicians regarding the obstacles that hindered patients from accessing care through telemedicine during the pandemic, such as limited computer literacy and familiarity with technology. In our study, electronic surveys were utilized to collect responses from a longitudinal cohort of primary care clinicians, investigating their adoption of telemedicine during the COVID-19 pandemic from March 2021 to May 2021. Surveyed clinicians identified a lack of computer literacy among their patients as the primary barrier (87%) to patients using telemedicine. We also found that among clinical practices, 24% pre-screened patients for technical proficiency, 23% provided training on the telemedicine platform prior to visits, and 31% designated a ‘go-to’ person to troubleshoot and address issues encountered with the telemedicine platform. Further research is necessary to closely examine these obstacles and identify potential solutions that can empower patients with skills for successful participation in their healthcare, thus improving health outcomes as the usage of telemedicine continues in the post-pandemic era.
Co-Author(s): Rajesh Balkrishnan, Ph.D.
In one of my public health classes, I recall learning about the socioeconomic determinants of health and health disparities pertinent to vaccination. As I did some more research, I was surprised that these disparities were present with the flu vaccine given its relatively long history and importance. The low rates of flu vaccination nationwide was also an unexpected finding. Thus, I became interested in learning about how this issue is being addressed and possible interventions.
The “flu” refers to a viral infection caused by the influenza virus that can result in cough, fever, fatigue, and even death. In addition to its detrimental health effects, the flu imposes a large economic burden on the United States. The annual flu vaccine is recommended for most individuals over the age of 6 months as it has been shown to be effective in decreasing both the incidence and severity of flu-related illness. Despite these benefits, less than half of all adults in the U.S. received full vaccination coverage in the 2021-2022 influenza season. Increasing flu vaccination rates is a key public health goal given the clinical efficacy of the flu vaccine along with its significant health and economic benefits. Additionally, there is a need to address long-standing racial, socioeconomic, and geographic disparities in flu vaccination rates. This commentary first describes racial and socioeconomic disparities in the context of flu vaccination. Then, it considers how efforts to increase flu vaccination can be designed at the state level using the example of Rhode Island, the state with the highest adult flu vaccination rate in the United States. Strategies considered were expansion of Medicaid, implementation of Health Equity Zones, and enactment of flu vaccine mandates in healthcare settings. Identifying such initiatives highlights how a strong commitment to public health can promote flu vaccination at a state level.
I was involved in this patient’s care during her protracted clinical course. Initial workup and management for common causes of pneumonia did not yield the expected results. She then worsened to have necrotizing pneumonia and then our differential diagnosis widened. This helped us to identify the rare cause. So I learned how important it is to consider the broader clinical picture to aid in early detection and initiation of treatment.
Background: Necrotizing pneumonia (NP) is commonly caused by Staph aureus and Strep pneumonia (1). Studies have shown that tuberculosis can present as NP in immunocompromised children from areas with a high prevalence of TB and HIV (2). However, only a few similar cases have been reported in adults (3). Case: We present a 30-year-old woman who came with several weeks of productive cough, low-grade fever, and dyspnea. CT chest showed airspace disease of the left lung and right middle lobe. She was treated for multi-lobar pneumonia with azithromycin and cefdinir. Two days later, she returned with similar complaints and was admitted for severe sepsis. She improved clinically with Vancomycin, Flagyl, Doxycycline, and Cefepime in a week and was discharged. At her one-week follow-up, she was hypoxic, tachycardic, and tachypneic. She was readmitted for severe sepsis. Repeat CT chest showed necrotizing pneumonia. Infectious diseases and pulmonology were consulted. Workup for pneumonia, autoimmune etiology, and bronchoscopy was unremarkable except for acid-fast bacilli on the sputum. QuantiFERON-GOLD was negative. Given the high suspicion of tuberculosis, she received quadruple therapy and stress-dose steroids. She improved clinically and a repeat CT scan showed resolving necrosis. Sputum culture later showed Mycobacterium Tuberculosis. Discussion: Our patient migrated from Guatemala which has a high prevalence of TB and HIV. So, it is important to consider TB as a differential diagnosis to aid in early detection and initiation of treatment.
Co-Author(s): Daniel Rivkin, Gabriella Villalobos, Alex Krist MD, Jacqueline Britz MD
Much of my interest in Family Medicine as a specialty, and primary care as a whole, stems from a commitment to patient autonomy and dignity. As such, I have been extremely interested in the philosophy behind harm reduction, and in focusing on research that is community focused and community driven. This research project gave me the opportunity to learn more about a topic I am passionate about, work on developing educational resources for communities throughout Virginia, and interact with community members on the ground doing this important work. As a physician I want to continue to focus on what the community needs most, and this research project was both a great introduction to that, and will help communities throughout the state address the opioid epidemic in the ways that work best for them.
Virginia will receive funding from national-level opioid settlements termed the “Opioid Abatement Fund,” to address the opioid epidemic, which will be distributed through an established Opioid Abatement Authority (OAA). VCU was awarded an OAA grant to develop a toolkit to inform cities and counties as they implement programming to address opioid mortality. This project aimed to develop a framework for this toolkit. This presentation will provide an overview of an evidence-based framework developed by our team, which includes 6 key priority areas for interventions and programming, including harm reduction, housing, access to primary care, education, stigma, and community collaboration. While there are many guidelines for addressing the opioid epidemic, there is no easily accessible place consolidating key information for community leaders. A toolkit that provides accessible resources and education is vital in getting communities the support they need. This presentation will review the future vision for this toolkit, including developing a robust and adaptable resource that facilitates partnerships. The communities throughout Virginia are diverse and will have unique needs when it comes to supporting community members. Next steps must involve interfacing with the community: interviewing residents from across the Commonwealth with a focus on those with lived experience. No one knows better what a community needs than the community itself, and thus this toolkit must be community-driven.
Co-Author(s): Cecelia Hembrough, Alicia Richards, Jong Hyung Lee, Roy Sabo, Gabriela Villalobos, Alex Krist, Jacqueline Britz
I’ve been interested in the opioid epidemic since applying to medical school, so when Dr. Britz gave me the opportunity to work on a project that identified trends in community risk factors for opioid mortality I was pretty excited to work with her.
Introduction: The VCU Department of Family Medicine and Population Health has worked to identify risk factors for opioid mortality, including building a model predicting opioid mortality throughout Virginia based on risk factors. Data from 2020 when opioid mortality spiked has not been reviewed. Our aim was to identify differences between high-performing and low-performing communities with respect to this model. Methods: We used 2020 data from the American Community Survey (ACS) and Virginia all-payer claims database (APCD) for each zip-code tabulation area (ZCTA) in Virginia. We predicted mortality for each ZCTA and compared predicted mortality to actual mortality. We identified 30 communities with lower-than-predicted mortality (Bright Spots) and 30 communities with higher-than-predicted mortality (Cold Spots). We assessed community-level differences between Bright and Cold Spots using a variety of factors. Results: Bright Spots were more likely than Cold Spots to have higher rate of primary care visits (P<0.01), mental health diagnoses (p<0.01), and outpatient diagnoses of opioid use disorder (p<0.01). In contrast, Cold Spots were more likely to have a higher rate of Emergency Department visits for opioid overdose (p=0.02). Discussion: Bright Spot communities were more likely to have higher numbers of primary care visits, mental health diagnoses, and opioid use disorder diagnoses than Cold Spots indicating healthcare access may be a protective factor with respect to opioid mortality. Cold Spots were more likely to have elevated non-fatal overdose rates than Bright Spots. This indicates residents of these communities may benefit from earlier linkage to care, and some of these overdoses might be preventable.
Co-Author(s): Sarah Dalrymple, MD
I developed an interest in examining leadership styles for effective collaboration and conflict resolution in interprofessional healthcare teams to enhance patient outcomes due to the crucial role that leadership plays in shaping healthcare delivery. From both a personal and professional aspect, I have seen that effective leadership can foster teamwork, mitigate conflicts, and improve patient care, which aligns with my passion for advancing healthcare quality and patient safety. Understanding how leadership styles impact collaboration and conflict resolution can help me become a more effective leader in a family medicine setting, ultimately benefiting my patients by improving the quality of care and patient outcomes.
Introduction It is crucial to incorporate leadership skills training continuously throughout a clinician’s professional journey. Drawing from organizational theories, leadership models allow for nurturing of proper student leadership in interprofessional settings that lead to optimal patient outcomes. In our study, we utilized the conceptual framework of the Three Logics to investigate the leadership qualities that students developed within their team during a large-scale interprofessional learning activity. Methods In 2022, students of various health disciplines from institutions from across the world participated in the “International Interprofessional Case Competition (I2C2)”, organized by Virginia Commonwealth University. The I2C2 required students to work in small interprofessional teams of five or six students to manage a fictious patient case. Following team activities, students were recruited to be interviewed about their experiences. Interview transcripts were then analyzed using the Three Logics framework.Results A total of 2 interviews were analyzed. The most frequent comments were related to ‘integration’ (22/52, 42%). This was followed by comments categorized as ‘segregation’ (19/52, 36%), and ‘assimilation’ (11/52, 21%) leadership styles. Discussion Although most students demonstrated that an integrative leadership style led to optimal results, further research is needed to understand why this leadership style is successful. These findings will contribute to a better understanding of the leadership styles that are most effective in fostering collaboration and resolving conflicts within interprofessional healthcare teams. The results will inform healthcare organizations and leaders about the potential benefits of specific leadership approaches and provide guidance for enhancing interprofessional teamwork and conflict resolution strategies.
Mentorship has been influential on my path to becoming a family medicine physician. In college, I participated in several mentorship and pipeline programs aimed at students underrepresented in medicine, which helped me to view medical school as an attainable goal and build meaningful relationships. As a medical student, I became a leader for those same programs I was a part of and participated in numerous pipeline programs for primary care and family medicine. I aim to lift as I climb while undergoing training, and thankfully, the RMSMP program at UVA allows me to continue to do so. It’s important to me to share the work we are doing here and show how impactful mentorship can be for students and residents. After residency, I plan to pursue a career in academic family medicine and continue mentoring while striving to increase the family medicine workforce.
In 2015, residents at the University of Virginia (UVA) Family Medicine Residency started a program connecting UVA medical students interested in family medicine with family medicine resident mentors. The initial goal was to provide peer support for medical students navigating the Match. After the program’s second year, informal feedback from the residents on their experiences as mentors was overwhelmingly positive, suggesting a potential positive impact on resident well-being. The program has continued with approximately ten mentoring pairs yearly, with a hiatus from 2020-2022. Mentoring pairs are assigned based on self-reported interests and meet regularly throughout the academic year. At the end of the 2022-2023 academic year, we conducted a cross-sectional study of the mentoring program by surveying the medical student and resident participants. Eight of the 19 participants completed surveys. For the medical students, the results show improved confidence in family medicine as a career choice, increased comfort with the residency application and Match process, and a better understanding of the career options within family medicine. Among the residents, the results showed self-reported improvement in burnout. The study also provided opportunities for improvement of the program. The session will review the set-up of the program and the study, and the presenters will provide all materials for attendees to review and use, should they desire to create a similar program.