Objective To determine whether people of Color experienced disparate levels of employment loss in frontline versus nonfrontline occupations during the onset of the COVID-19 pandemic. Methods The Bureau of Labor Statistics Current Population Survey data was analyzed in a cross-sectional study. Percent change in number employed was tabulated quarterly for groups by race and ethnicity (Black or African American, Asian American, or Hispanic or Latinx compared to White or non-Hispanic or Latinx) and frontline occupation status between January 1 and June 30, 2020. Two-tailed two-sample tests of proportions were used to compare groups statistically. Results More dramatic declines in number employed occurred in the Black or African American, Asian American, and Hispanic or Latinx groups. When stratified by sector, greater declines were noted in the Hispanic or Latinx and Asian American frontline, and Black or African American non-frontline groups when compared to the referent groups. Conclusions Structural racism has further affected people of Color through differential employment loss during the onset of the pandemic, both overall and by sector. However, the effect of sector varies dramatically across racial and ethnic groups. Policy Implications Because employment is an important social determinant of health and a potential risk factor for contracting COVID-19, these trends may provide important context for the prioritization of PPE and immunizations, as well as the provision of stable health insurance and income support for vulnerable workers.

Diagnosis and management of melanoma in SFT is comparable to FTF care.

Index of Relative Rurality (IRR) captures multiple indicators of health care access but is underrepresented in the primary care literature. This research investigates trends in primary care physician supply in US counties with respect to IRR and time since the Affordable Care Act (ACA) was passed. Methods:In this ecologic study, annual ratio of primary care physicians per 100,000 population in US counties was computed for 2010-2017 (3,138 counties over 8 years, N = 25,104). IRR assigned in 2010 placed counties on a rural-urban continuum without the use of a threshold. Primary outcomes were associations of IRR and year with physician ratio and annual change in physician ratio. Multivariable regression models were used to detect associations. The a priori hypothesis was that neither rurality nor year was associated with physician ratio or annual growth.Results: IRR and year were independently inversely associated with the ratio of primary care physicians per 100,000 and annual growth in physician ratio. A post-hoc analysis of highly rural US states revealed positive median growth rates in some areas.Conclusions: Despite significant policies in the ACA designed to address the maldistribution of the US primary care physician workforce, more funding and further innovative reforms are urgently necessary to avert a rural workforce crisis in the coming decades. IRR may be a useful continuous, threshold-free metric of rurality in future health services research.

Background: Store-and-forward teledermatology (SFT) readers can only diagnose what is imaged. This limitation has caused concern regarding the ability of primary care to direct imaging of lesions suspicious for melanoma. Melanomas not imaged by primary care providers (PCPs) are termed unimaged melanomas. Objective: To determine the frequency of unimaged melanomas among Veterans referred for care in a SFT program. Materials and Methods: All SFT patients with melanoma diagnosis were ascertained by query of the VA corporate data warehouse, Veterans Integrated Service Network 20 store-andforward program database, and the VA Computerized Patient Record System. Results: Between July 1, 2009 and December 31, 2011, 12,863 SFT consultations were conducted on 7,960 Veterans. Sixty-nine melanomas met inclusion and exclusion criteria; 13 melanomas were unimaged. The frequency of unimaged melanoma was 10.1 per 10,000 consultations. Discussion: Our calculated frequency of unimaged melanomas associates SFT with noninferiority to face-to-face care. This study was conducted on an exclusively Veteran population, precluding generalizability to the general population. Conclusions: PCPs referring to store-and-forward teledermatology may fail to image melanomas.

No abstract

No abstract

IntroductionMost patients with diabetes mellitus are prescribed medications to control their blood glucose. The implementation of the Affordable Care Act (ACA) led to improved access to healthcare for patients with diabetes. However, impact of the ACA on prescribing trends by diabetes drug category is less clear. This study aims to assess if long-acting insulin and novel agents were prescribed more frequently following the ACA in states that expanded Medicaid compared with non-expansion states.Research design and methodsIn this analysis of a natural experiment, prescriptions reimbursed by Medicaid (US public insurance) for long-acting insulins, metformin, and novel agent medications (DPP4 inhibitors, sodium/glucose cotransporter 2 inhibitor antagonists, and glucagon-like peptide-1 receptor agonists) from 2012 to 2017 were obtained from public records. For each medication category, we performed difference-in-differences (DID) analysis modeling change in rate level from pre-ACA to post-ACA in Medicaid expansion states relative to Medicaid non-expansion states.ResultsExpansion and non-expansion states saw a decline in both metformin and long-acting insulin prescriptions per 100 enrollees from pre-ACA to post-ACA. These decreases were larger in non-expansion states relative to expansion states (metformin: absolute DID = +0.33, 95% CI=0.323 to 0.344) and long-acting insulin (absolute DID: +0.11; 95% CI=0.098 to 0.113). Novel agent prescriptions in expansion states (+0.08 per 100 enrollees) saw a higher absolute increase per 100 Medicaid enrollees than in non-expansion states (absolute DID= +0.08, 95% CI=0.079 to 0.086).ConclusionsThere was a greater absolute increase for prescriptions of novel agents in expansion states relative to non-expansion states after accounting for number of enrollees. Reducing administrative barriers and improving the ability of providers to prescribe such newer therapies will be critical for caring for patients with diabetes—particularly in Medicaid non-expansion states.