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UNSTRUCTURED The use of telemedicine has increased dramatically through the COVID-19 pandemic. While data is available about patient satisfaction with healthcare through telemedicine, little is known about the immigrant patient experience. We hypothesized that immigrant patients would prefer live visits as well as have higher ratings for interpersonal communication during live visits over telemedicine. We also expected that other satisfaction category ratings would be similar between immigrant and nonimmigrant patients. Patients seen by four Internal Medicine providers in both a live and telemedicine setting were surveyed. Patients seen via live visits were given a paper copy of the survey at the beginning of the visit and the same survey was administered by follow-up phone call for telemedicine visits. Surveys were administered in English, Spanish or Arabic. The survey consisted of 9 questions on a satisfaction scale of 1-5 assessing satisfaction under the categories of access to care, interpersonal interaction, quality of care and next visit preference. An additional question assessed reasons for next visit type preferences. Survey data were collected from 115 televisits and 108 live visits. These responses came from 60 immigrant and 163 non-immigrant patients. Across both patient populations, satisfaction with access to care, interpersonal interaction, and quality of care was universally high with no significant difference between patient groups. More common reasons for non-immigrants to prefer televisits included convenience. Immigrant patients more often prioritized time with the provider, some citing an advantage of not having to navigate the office and feeling as though they had the provider's undivided attention. Patients in both groups who preferred live visits cited visit quality as a driving factor of visit type selection. While satisfaction was equally high for both telemedicine and live visits across immigrant and non-immigrant populations, differences in patient satisfaction priorities arose and may suggest opportunities to minimize health equity barriers.

Background The use of telemedicine has increased dramatically through the COVID-19 pandemic. While data are available about patient satisfaction with health care through telemedicine, little is known about the immigrant patient experience. Objective We investigated whether immigrant patients would prefer in-person visits and have higher ratings for interpersonal communication during in-person rather than telemedicine visits. We hoped to identify the reasons behind immigrant visit preferences and consider these reasons to guide suggestions for more equitable use of and access to visit options. Methods Overall, 270 patients including 122 immigrants and 148 nonimmigrants were seen by 4 internal medicine providers in either an in-person (n=132) or telemedicine (n=138) university practice setting. Immigrants were defined as having been born outside of the United States. Patients were queried between February and April 2021 using an adaptation of a previously validated patient satisfaction survey containing standard questions developed by the Consumer Assessment of Healthcare Providers and Systems Program. Patients seen via in-person visits completed a paper copy of the survey. The same survey was administered by a follow-up phone call for telemedicine visits. Patients surveyed spoke English, Spanish, or Arabic and were surveyed in their preferred language. For televisits, the same survey was read to the patient by a certified translator. The survey comprised 9 questions on a 5-point Likert scale assessing satisfaction under the categories of access to care, interpersonal interaction, quality of care, and next visit preference. An additional write-in question assessed reasons for subsequent visit type preferences. Survey question responses were compared with paired t tests. Results Across both immigrant and nonimmigrant patient populations, satisfaction with perceived quality of care was universally high regardless of visit type (televisits: P=.80 and P=.60; in-person: P=.76 and P=.37). During televisits, immigrants were more likely than nonimmigrants to feel that providers spent sufficient time with them (P Conclusions While satisfaction was quite high for both telemedicine and in-person visits across immigrant and nonimmigrant populations, significant differences in patient priorities were identified. Immigrants found televisits desirable because they felt they spent more time with their providers and were able to avoid additional office logistics that are often challenging barriers for non-English speakers. This suggests opportunities to use information technology to provide cultural and language-appropriate information throughout the in-person and telemedicine visit experience of immigrants, such as assistance with call-in scheduling, appointment reminders, and portal access. A focus on diminishing these barriers will help reduce health care inequities among immigrant patients. Conflicts of Interest None declared.

PURPOSE. To determine whether tight glycemic control prevents development of basement membrane (BM) thickening in retinal and glomerular capillaries of diabetic rats and whether the extent to which BM thickening develops is linked to fibronectin (FN) overexpression and the degree of hyperglycemia. METHODS. Retinal and renal cortical tissues obtained from the tightly controlled diabetic (TC), poorly controlled diabetic (D), and nondiabetic (N) control rats were subjected to morphometric and biochemical analyses. In both tissues, capillary BM thickening was determined by electron microscopy, and FN protein level was assessed by Western blot analysis. Routine measurements of blood glucose level and glycohemoglobin level were performed throughout the study. RESULTS. The HbA1c level was significantly increased in D rats, but not in TC rats, compared with those of the N rats with a concomitant increase in capillary BM thickness and FN protein expression in retinal and renal tissues. A strong correlation was observed between retinal and glomerular capillary BM thickness (r = 0.79, P = 0.0001), between retinal and kidney FN protein levels (r = 0.7, P = 0.005), between HbAlc and FN protein levels in the retina (r = 0.66, P = 0.006) and kidney (r = .84, P = 0.0003), and between HbAlc level and BM thickness in retinal (r = 0.76, P = 0.0002) and renal tissues (r = 0.64, P = 0.004). CONCLUSIONS. In diabetes BM thickening develops in retinal and glomerular capillaries in a correlated manner. Tight glycemic control may be beneficial in preventing the pathologic development of capillary BM thickening and FN overexpression in retinal and renal tissues, two target tissues of diabetic microangiopathy.