Background: Globally, Neurodivergent, Disability, and Chronic Illness (NDCI) populations face significant health disparities. Lack of physician knowledge about NDCI is a key mechanism underlying these disparities. The current study aimed to describe medical students’ perceptions, knowledge, and competence regarding NDCI. Methods: A cross-sectional study was carried out using an online survey of medical students at a large public university with no NDCI-specific curriculum (n = 97; response rate = 18%). The survey asked about students’ perceptions, knowledge, and competence pertaining to NDCI populations. Results: Most (n = 93, 96%) indicated it is important for physicians to understand the influence of NDCI on patient health and clinical encounters. Yet, only 7 (7%) and 15 (15%) reported that the NDCI curriculum in their medical school was sufficient and they felt comfortable taking care of patients with NDCI, respectively. Most (n = 87, 90%) wanted their medical school to provide additional NDCI training. Few reported high knowledge about ableism (n = 12, 12%), self-determination (n = 7, 7%), coordinating care (n = 4, 4%) and accommodations (n = 10, 10%). Few indicated high competence in cognitive, physical, social-emotional, and other NDCI types (n = 7 – 32, 7-33%). Existing knowledge often came from personal experiences or the news and media. Conclusion: Findings demonstrated the gaps in medical education, as exemplified by medical students surveyed in one U.S. public university. Results can inform efforts to ameliorate global health disparities associated with a lack of physician knowledge about NDCI.
Objective To describe the development process of a patient-centered initiative focused on improving primary care health outcomes of patients with intellectual and developmental disabilities (IDD) and needle-related anxiety using evidence-based practices and novel approaches that can be implemented in outpatient settings. The overall outcome of the program is to increase vaccine uptake and accessibility in the IDD population as well as improve needle-related procedures in primary care settings to be more humane and effective. Methods The development process occurred in the context of a large healthcare system serving a diverse patient population in the U.S. and was led by an expert committee made of an multidisciplinary team of physicians, psychologists, ambulatory and clinic nurses, pharmacists, and anesthesiologists committed to promoting quality healthcare for the IDD population. Committee members were recruited within the healthcare system based on their relevant expertise. The methodology included an iterative and collaborative process that took place over three development phases: ideation and design, literature review and synthesis, and expert engagement. The ideation and design phase included a series of planning meetings among the expert committee, in which committee members identified preliminary concerns based on their expertise in the field and background knowledge on the current procedures related to improving routine care for individuals with IDD and/or needle-related anxiety. The literature review and synthesis phase led to the development of an annotated bibliography of research and clinical guidelines that synthesized findings on needle anxiety in clinical care. The expert engagement phase included all Committee members meeting for a final discussion to establish a tiered approach to utilizing evidence-based strategies that could be implemented across clinics within the healthcare system. Results The multidisciplinary team of experts developed a three-tier system, deployed sequentially as needed. The first tier focuses on training nurses in evidence-based behavioral modification strategies to implement as standard of care. The second tier uses the addition of a distraction device and topical analgesic to reduce anxiety in patients with slightly elevated procedural anxiety. The third tier involves a novel minimal sedation protocol using intranasal midazolam for patients with needle phobia that can be administered in an outpatient setting. Conclusion The Needle Anxiety Program eases the administration of needle-related medical procedures in the primary care setting for patients with IDD and needle-related anxiety. The use of evidence-based practices and a novel minimal sedation protocol for individuals with needle phobia assists in the completion of routine healthcare procedures, such as vaccinations and phlebotomy, in a patient-preferred setting. The purpose of delineating needle-related processes and procedures thro...
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