Background
Telehealth is a promising alternative to primary care delivery in provider shortage areas. The purpose of this study was to evaluate the implementation of the 4Ms (i.e., Medication, Mentation, Mobility, What Matters) framework in telehealth-based primary care in provider shortage areas by ethnic status.
Methods
This study was a retrospective analysis of 184 older adults (60+) representing 5% of the total sample at urban primary care in ethnically and racially diverse populations. Data were retrieved from July 2020 to September 2021. 14 trained primary care providers participated in this study and provided the 4Ms as following: 1) Medication (e.g., deprescribe or reduce high-risk Medication); 2) Mentation (e.g., depression and cognition assessment with brief counseling); 3) Mobility (e.g., mobility and home safety assessments); 4) What matters (e.g., advance care planning). The current study measured components of the 4Ms per telehealth visit by ethnic/race status (white vs. non-white).
Results
Overall, advance care planning (i.e., what matters) was the most discussed via telehealth (79%), followed by mobility (46.2%), Medication (16.8%), and Mentation (14.7%). To examine the disproportion of accessing telehealth by patients’ racial background, the independence test of chi-square showed that non-white populations were less likely to have access to telehealth than white patients (p = .02).
Conclusion
There was an ethnic and racial disparity in the 4M framework application via telehealth in an urban primary care clinic. To sustain telehealth for patients in a healthcare shortage, ethnically and culturally specific training is needed, and linguistically diverse curricula are recommended.
Chronic pain is common after burn injuries, and post-burn neuropathic pain is the most important complication that is difficult to treat. Scrambler therapy (ST) is a non-invasive modality that uses patient-specific electrocutaneous nerve stimulation and is an effective treatment for many chronic pain disorders. This study used magnetic resonance imaging (MRI) to evaluate the pain network-related mechanisms that underlie the clinical effect of ST in patients with chronic burn-related pain. This prospective, double-blinded, randomized controlled trial (ClinicalTrials.gov: NCT03865693) enrolled 43 patients who were experiencing chronic neuropathic pain after unilateral burn injuries. The patients had moderate or greater chronic pain (a visual analogue scale (VAS) score of ≥5), despite treatment using gabapentin and other physical modalities, and were randomized 1:1 to receive real or sham ST sessions. The ST was performed using the MC5-A Calmare device for ten 45 min sessions (Monday to Friday for 2 weeks). Baseline and post-treatment parameters were evaluated subjectively using the VAS score for pain and the Hamilton Depression Rating Scale; MRI was performed to identify objective central nervous system changes by measuring the cerebral blood volume (CBV). After 10 ST sessions (two weeks), the treatment group exhibited a significant reduction in pain relative to the sham group. Furthermore, relative to the pre-ST findings, the post-ST MRI evaluations revealed significantly decreased CBV in the orbito-frontal gyrus, middle frontal gyrus, superior frontal gyrus, and gyrus rectus. In addition, the CBV was increased in the precentral gyrus and postcentral gyrus of the hemisphere associated with the burned limb in the ST group, as compared with the CBV of the sham group. Thus, a clinical effect from ST on burn pain was observed after 2 weeks, and a potential mechanism for the treatment effect was identified. These findings suggest that ST may be an alternative strategy for managing chronic pain in burn patients.
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