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Background: Telegenetics is the provision of genetics services at a distance via telecommunication and information technologies. While telegenetics promises to increase access to underserved populations with rare diseases, providers must overcome additional challenges to reach remote and marginalized communities with telegenetics care provision. Method: We describe a series of case vignettes related to clinical care and barriers that were observed after using telegenetics in rural Appalachia. This geo-politically defined region is known for health disparities such as lower education levels, higher poverty levels, and greater healthcare shortage areas than the United States as a whole. Results: Although telegenetics improves access to care, the barriers experienced included (1) the digital divide in access to broadband, (2) telegenetics counseling in geriatric patients with limited computer literacy, (3) comorbidities that are common in the region, and (4) patients’ adherence to telegenetics services. Conclusion: These case studies emphasize the need for intervention studies to address implementation of telegenetics in populations who experience health disparities. In addition, future attention should also focus on administrative system evaluation and cost to reduce health disparities in disadvantaged groups.

This article describes how a state health authority capitalized on the increased popularity of the Internet among consumers by launching a website devoted to improving communication among persons i...

Obesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults.Based upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback.Primary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant.Documentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits.

Loneliness is a contributing factor to various health problems in older adults, including complex chronic illness, functional decline, and increased risk of mortality.A pilot study was conducted to learn more about the prevalence of loneliness in rural older adults with chronic illness and how it affects their quality of life. The purposes of the data analysis reported here were twofold: to describe loneliness, chronic illness diagnoses, chronic illness control measures, prescription medication use, and quality of life in a sample of rural older adults; and to examine the relationships among these elements.A convenience sample of 60 chronically ill older adults who were community dwelling and living in Appalachia was assessed during face-to-face interviews for loneliness and quality of life, using the University of California, Los Angeles (UCLA) Loneliness Scale (version 3) and the CASP-12 quality of life scale. Chronic illness diagnoses, chronic illness control measures, and medication use data were collected through review of participants' electronic medical records.Overall mean loneliness scores indicated significant loneliness. Participants with a mood disorder such as anxiety or depression had the highest mean loneliness scores, followed by those with lung disease and those with heart disease. Furthermore, participants with mood disorders, lung disease, or heart disease had significantly higher loneliness scores than those without these conditions. Loneliness was significantly related to total number of chronic illnesses and use of benzodiazepines. Use of benzodiazepines, diuretics, nitrates, and bronchodilators were each associated with a lower quality of life.Nurses should assess for loneliness as part of their comprehensive assessment of patients with chronic illness. Further research is needed to design and test interventions for loneliness.