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1. US direct-to-consumer medical service advertisements fail to provide adequate information on quality and cost of care

   https://doi.org/10.1136/medethics-2020-106458  

   Park, Sung-Yeon; Yun, Gi Woong; Friedman, Sarah; Hill, Kylie; Ryu, So Young; Schwenk, Thomas L; Coppes, Max J (October 2020, Journal of Medical Ethics)

   null (Ed.)

   Background In the 1970s, the Federal Trade Commission declared that allowing medical providers to advertise directly to consumers would be “providing the public with truthful information about the price, quality or other aspects of their service.” However, our understanding of the advertising content is highly limited. Objective To assess whether direct-to-consumer medical service advertisements provide relevant information on access, quality and cost of care, a content analysis was conducted. Method Television and online advertisements for medical services directly targeting consumers were collected in two major urban centres in Nevada, USA, identifying 313 television advertisements and 200 non-duplicate online advertisements. Results Both television and online advertisements reliably conveyed information about the services provided and how to make an appointment. At the same time, less than half of the advertisements featured insurance information and hours of operation and less than a quarter of them contained information regarding the quality and price of care. The claims of quality were substantiated in even fewer advertisements. The scarcity of quality and cost information was more severe in television advertisements. Conclusion There is little evidence that medical service advertising, in its current form, would contribute to lower prices or improved quality of care by providing valuable information to consumers. 

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2. Patient-Centered Care and Healthcare Consumerism in Online Healthcare Service Advertisements: A Positioning Analysis

   https://doi.org/10.1177/23743735221133636  

   Park, Sung-Yeon; Yun, Gi Woong; Friedman, Sarah; Hill, Kylie; Coppes, Max J (January 2022, Journal of Patient Experience)

   Patient-centered care and healthcare consumerism are the two most dominant ideas about the relationship between patients and providers in the United States. To identify providers’ positions between the two perspectives, we analyzed the content of direct-to-consumer healthcare service advertisements. The advertisements were collected in the state of Nevada ( N = 323) and their landing pages were analyzed for provider attributes, patient experience features, and terms referring to patients and providers. The results showed that the advertisements fully embraced the notion of patient-centeredness by commonly claiming patient-centered care and frequently using the term “patient.” The advertisements also contained multiple indicators of healthcare consumerism, although they avoided using the terms “consumer/customer/client” closely associated with consumerism. Contrary to the prominence of patient experience features, provider attributes were not common. An additional analysis of inter-specialty differences in advertising features confirmed the strong consumerism position of cosmetic surgery providers. Application of the healthcare service advertising analytic scheme developed for this study could help providers and healthcare administrators recognize how their advertising messages may reflect their values. 

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3. Analysis of Direct-To-Consumer Healthcare Service Advertisements on Television: An Application of the Patient Expectation Framework

   https://doi.org/10.1080/10410236.2022.2051349  

   Park, Sung-Yeon; Hill, Kylie; Yun, Gi Woong; Friedman, Sarah; Coppes, Max J. (March 2022, Health Communication)

   Direct-to-consumer advertisements for healthcare services constitute a rare channel of public communication where consumers see and hear directly from their local providers and healthcare organizations. Although spending on these advertisements has increased drastically during the past decades, research on their content and effects remains rare. To fill this gap, we analyzed primetime television advertisements for healthcare services directly targeting consumers. The advertisements were collected from the two largest media markets in Nevada for one month. In total, 795 advertisements were identified, and 106 of them were non-duplicates. Analysis revealed that the advertisements focused on patients’ good health outcomes by showing them smiling, going out and about, having fun with others, and enjoying rigorous physical activities. On the other hand, the advertisements focused less on the providers. Although the advertisements often showed providers in clinical settings, basic information about their professional degrees was often missing. Mentions of providers’ other qualifications and professional experiences were even scarcer. Also, a substantial number of advertisements failed to show providers interacting with patients. Additional analysis of patient and provider characteristics revealed under-representation of racial or ethnic minority and older adult patients. Representation of women and minorities as providers was even more uncommon. We discussed the implications of these findings from the perspective of patient expectation and made suggestions to help providers improve their direct-to-consumer advertisements. 

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4. The Impact of Telemedicine on Physicians’ After-hours Electronic Health Record “Work Outside Work” During the COVID-19 Pandemic: Retrospective Cohort Study

   https://doi.org/10.2196/34826  

   Lawrence, Katharine; Nov, Oded; Mann, Devin; Mandal, Soumik; Iturrate, Eduardo; Wiesenfeld, Batia (January 2022, JMIR Medical Informatics)

   Background Telemedicine as a mode of health care work has grown dramatically during the COVID-19 pandemic; the impact of this transition on clinicians’ after-hours electronic health record (EHR)–based clinical and administrative work is unclear. Objective This study assesses the impact of the transition to telemedicine during the COVID-19 pandemic on physicians’ EHR-based after-hours workload (ie, “work outside work”) at a large academic medical center in New York City. Methods We conducted an EHR-based retrospective cohort study of ambulatory care physicians providing telemedicine services before the pandemic, during the acute pandemic, and after the acute pandemic, relating EHR-based after-hours work to telemedicine intensity (ie, percentage of care provided via telemedicine) and clinical load (ie, patient load per provider). Results A total of 2129 physicians were included in this study. During the acute pandemic, the volume of care provided via telemedicine significantly increased for all physicians, whereas patient volume decreased. When normalized by clinical load (ie, average appointments per day by average clinical days per week), telemedicine intensity was positively associated with work outside work across time periods. This association was strongest after the acute pandemic. Conclusions Taking physicians’ clinical load into account, physicians who devoted a higher proportion of their clinical time to telemedicine throughout various stages of the pandemic engaged in higher levels of EHR-based after-hours work compared to those who used telemedicine less intensively. This suggests that telemedicine, as currently delivered, may be less efficient than in-person–based care and may increase the after-hours work burden of physicians. 

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5. Children’s and Adults’ Perceptions of Religious and Secular Interventions for Incarcerated Individuals in the United States

   https://doi.org/10.3390/rel14070821  

   Cohen, Aaron; Dunlea, James P.; Solomon, Larisa Heiphetz (July 2023, Religions)

   Religious involvement is prevalent in prisons, a context where questions of moral redemption are particularly salient. We probed the developmental origins of adults’ perceptions that religion might lead to redemption following transgressions. Six- to eight-year-olds (n = 50 United States residents) and adults (n = 53 United States residents) learned about incarcerated characters who had taken religion classes, art classes, or life classes (about right and wrong) while imprisoned. They then rated their agreement with statements assessing attitudes toward the incarcerated individuals, the effectiveness of each character’s time in prison, and their likelihood of recidivism. Children were more likely than adults to report that classes, in general, would effectively rehabilitate incarcerated individuals. However, participants of all ages reported more positive attitudes toward people who took religion classes and life classes rather than art classes. Further, participants of all ages reported that people who took art classes, versus religion or life classes, would be more likely to continue transgressing. These findings highlight the important role that religious and secular learning plays in perceptions of redemption across development. 

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