Systematic Review and Meta-Analysis of the Magnitude of Structural, Clinical, and Physician and Patient Barriers to Cancer Clinical Trial Participation

Barriers to cancer clinical trial participation have been the subject of frequent study, but the rate of trial participation has not changed substantially over time. Studies often emphasize patient-related barriers, but other types of barriers may have greater impact on trial participation. Our goal was to examine the magnitude of different domains of trial barriers by synthesizing prior research.

We conducted a systematic review and meta-analysis of studies that examined the trial decision-making pathway using a uniform framework to characterize and quantify structural (trial availability), clinical (eligibility), and patient/physician barrier domains. The systematic review utilized the PubMed, Google Scholar, Web of Science, and Ovid Medline search engines. We used random effects to estimate rates of different domains across studies, adjusting for academic vs community care settings.

We identified 13 studies (nine in academic and four in community settings) with 8883 patients. A trial was unavailable for patients at their institution 55.6% of the time (95% confidence interval [CI] ¼ 43.7% to 67.3%). Further, 21.5% (95% CI ¼ 10.9% to 34.6%) of patients were ineligible for an available trial, 14.8% (95% CI ¼ 9.0% to 21.7%) did not enroll, and 8.1% (95% CI ¼ 6.3% to 10.0%) enrolled. Rates of trial enrollment in academic (15.9% [95% CI ¼ 13.8% to 18.2%]) vs community (7.0% [95% CI ¼ 5.1% to 9.1%]) settings differed, but not rates of trial unavailability, ineligibility, or non-enrollment.

These findings emphasize the enormous need to address structural and clinical barriers to trial participation, which combined make trial participation unachievable for more than three of four cancer patients.

The full article can be downloaded below.  

Accenture 2019 Digital Health Consumer Survey

Healthcare consumers today are changing, and their expectations for convenience, affordability and quality are redefining how they engage at each stage of care.  Younger consumers are not satisfied with healthcare's status quo and consumers of all generations are more willing to try non-traditional services.  The providers and payers who heed the shifts and deliver what patients are looking for will be the ones to earn loyalty, navigate disruption and be strongly positioned as the future of healthcare consumerism unfolds.  

The full Accenture survey results can be downloaded below.  

Telemedicine’s challenge: Getting patients to click the app

Walmart workers can now see a doctor for only $4. The catch? It has to be a virtual visit.

The retail giant recently rolled back the $40 price on telemedicine, becoming the latest big company to nudge employees toward a high-tech way to get diagnosed and treated remotely.

But patients have been slow to embrace virtual care. Eighty percent of mid-size and large U.S. companies offered telemedicine services to their workers last year, up from 18 percent in 2014, according to the consultant Mercer. Only 8 percent of eligible employees used telemedicine at least once in 2017, most recent figures show.

“There’s an awful lot of effort right now focused on educating the consumer that there’s a better way,” said Jason Gorevic, CEO of telemedicine provider Teladoc Health.

Widespread smartphone use, looser regulations and employer enthusiasm are helping to expand access to telemedicine, where patients interact with doctors and nurses from afar, often through a secure video connection. Supporters say virtual visits make it easier for patients to see a therapist or quickly find help for ailments that aren’t emergencies. But many still fall back to going to the doctor’s office when they’re sick.

The full Associated Press article can be viewed at this link.  

Patients Suffer As Insurers And Big Health Systems Spar For Market Share​

Contract disputes between insurers and medical providers have been a regular feature of the national health industry for a long time. But the stakes have risen as big players on both sides have expanded to gain market share and leverage in network negotiations.

Most negotiations are completed before the old contract expires, and consumers usually don't hear about these behind-the-scenes disagreements. But when insurers and providers fail to reach an agreement on time, it can force patients to pay higher prices for care that is no longer covered by their health plans. At the least, it can cause considerable anxiety.

The full NPR article can be viewed at this link.  

Assessing the Unintended Consequences of Health Policy on Rural Populations and Places 

Because of the complexity of the U.S. health care system, thoughtfully designed health policies carry a risk of having unintended consequences, particularly for health systems in rural places that have place-based fundamentals that deviate substantially from urban and suburban areas. Policies developed without consideration of rural contexts are likely to create unanticipated and negative consequences for rural residents, providers, and communities.

When health policies are being developed, a number of themes that emerge are useful to keep in mind. Specifically, how will this policy impact the ability of a rural health system to offer essential, affordable, and high-quality services to rural populations? How might this policy result in disparate outcomes and widen health inequities, such as threatening access, slowing quality improvement, or creating financial barriers to obtaining health insurance or buying health care services?

The rural-proofing framework presented in this paper is a policy analysis tool for thinking about what the unintended consequences of a policy may be on rural populations and places vis-à-vis the objectives of a high-performance rural health system. Policy analysis must be applied to all sources of authoritative actions given that policies are produced not just in the legislative context, but also through judicial, administrative, and rulemaking actions.

The full report can be downloaded below.  

Not the same old, same old

New physicians, no matter their specialty, are likely to care for elderly patients, says Mandi Sehgal, MD, director of the Geriatrics Curriculum Thread at FAU.  And in the future this will be increasingly important because fewer new physicians are choosing geriatric medicine: The AAMC’s 2018 Physician Specialty Data Report found that the number of first-year residents and fellows studying geriatrics declined 14.3% between 2012 and 2017.

“Even pediatricians will,” Sehgal says. “Sometimes people will bring grandchildren to the office and that pediatrician may see that the grandparent might be a fall risk or may see signs of cognitive impairment. It applies across the spectrum.”

FAU is one of the medical schools putting geriatrics front and center. The college of medicine hired the former President of the American Geriatrics Society, Joseph Ouslander, MD, to develop and direct the geriatrics program, and the school weaves geriatrics education into almost every single one of its classes, says Sehgal.

For example, a neuroscience and behavior course includes an entire section on dementia, and staff and caregivers are brought in from the local memory and wellness center.

“The principles of geriatric medicine are just good medicine,” Sehgal says.

R. Sean Morrison, MD, agrees. The Ellen and Howard C. Katz professor and chair for the Brookdale department of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai is leading the effort there to get its students up to speed on aging and the physiology of aging, not by requiring a separate class or curriculum, but by incorporating the care of older adults into all preclinical experiences, Morrison says. Students are required to make house calls and spend time in ambulatory care practices where patients skew older.

The full AAMC News article can be viewed at this link.  

You can now look up charges at your local hospital. Good luck understanding them.

The Trump administration rang in 2019 by enacting a seemingly great health care policy: requiring all hospitals to list the price of their most common procedures on their websites.

The whole idea was to make the American health care system more transparent, allowing patients to research the cost of care at thousands of hospitals across the country.

All in all, it seemed like a common-sense and well-intentioned policy to liberalize health care data. And, on January 1, the policy rolled out into the real world. We’ve quickly seen some big shortcomings in this effort to increase price transparency — ones that tell us a lot about how hard it is to give patients good cost estimates in a health care system rife with secretive prices.

One of the biggest shortcomings? The data that hospitals are posting can be hard to find, and difficult to parse. I looked up the prices at some of my local hospitals in DC.

It usually took me about five to 10 minutes of searching around their websites to locate the price data — not great, but not terrible either. Once I did find it. ... That’s where things got interesting.

The full Vox article can be viewed at this link.  

Doctor’s career path offers economic insight on patient choices

As a physician, a portion of your patients will smoke, avoid seatbelts or skip doses of medication. In those instances, patients are doing things that are not in their own best interest.

Rather than ask the obvious question—why do patients act against their own interests?—one physician is taking a different tack when it comes to such self-defeating behaviors.

“We will be much more effective at improving health behavior if we work with the irrational parts of our nature ... instead of ignoring them or fighting against them,” said David Asch, MD, MBA. “When it comes to health care, understanding our irrationality is just another tool in our tool box. And harnessing that irrationality, that maybe the most rational move of all.”

The full American Medical Association article can be viewed at this link.  

Implementation of Patient Engagement in the Netherlands: A Stimulating Environment within a Large Academic Medical Centre- Best Practices

Patients are the official third party of the Dutch healthcare system, apart from healthcare providers and insurers.  Radboud university medical center (Radboudumc) is a regional centre for specialized secondary care in the Netherlands.  Here innovation is recognized as a decisive factor when it comes to the implementation of patient engagement.  Therefore, all employees are invited to innovate, experiment, fail and implement promising innovations into practice.  In this paper, we demonstrate how this stimulating environment led to a rich collection of patient engagement activities in organizational (re-)design and in educational programs for students and employees.

Best Practices

• Support experimentation - Support the non-homogeneous evolution of engagement in which employees are free and motivated to experiment.  Allow initiatives to fail.
• Involve patients - Build long-term relationships with patients by involving them from the beginning until the end.
• Create a comfortable environment that makes involvement meaningful - For patient engagement at the organizational design and governance levels, ensure that patients stay in their role of patient, guaranteeing that they make a unique and complementary contribution.  For patient engagement at the level of direct care, ensure that each patient is seen as a person, with a unique and complementary perspective on healthcare.
• Prepare and organize - Prepare patients for their efforts in patient engagement and organize patient engagement in a professional manner to ensure that it is valuable to the organization.

The full article can be downloaded below.  

Consumer perceptions of health IT utilization and benefits

The objective of this article is to examine consumer perceptions of health information technology (health IT) utilization and benefits through an integrated conceptual framework.

This article employs an integrated conceptual framework to examine consumer perceptions of health IT. A consumer survey yielded 1125 completed responses. A factor-based scale was developed for each sub-construct. Bivariate analysis using v2 tests was performed to determine differences in the percentage of respondents who agreed with each sub-construct based on whether their physician used an electronic health record (EHR) system. Multivariable logistic regression that controlled for demographic characteristics of respondents was performed to determine adjusted odds of agreeing with selected opinions of health information exchange (HIE).

Results indicate that respondents whose physicians used an EHR system were significantly more likely to agree that there was a perceived benefit with HIE and to care provided; that the patient should have control over the record; that they trust the physician and security of the medical information; that they understand the need for HIE, and that HIE must be easy to use.

The results suggest that consumers who have experienced the use of one technology in the healthcare setting can recognize the potential benefit of another technology. Race/ethnicity, gender, and education played some role in respondents’ views of EHRs and HIE, more specifically, non-Hispanic African American participants indicated lower levels of trust in HIE when compared with non-Hispanic Whites.

This cross-sectional survey indicated that physician use of EHRs significantly increases the odds of consumers’ seeing perceived benefits of HIE and understanding the need for HIE.

The full article can be downloaded below.