Accessibility in a Modern Era

Accessibility has been the buzzword and anchor to the work I have done throughout my undergraduate career. My future goal as a physician is to define and work towards the definition of accessibility in healthcare: making sure that anyone who wants care can receive it. Now that may be an over-simplification as accessibility also means having the knowledge to advocate for oneself and the resources to be able to get was it so necessary. With that in mind, my HSPM 500 course, Introduction to Healthcare Management and Organization required us to work in a group for the entirety of a semester on a Case Study relating to hospital management. Watching the other presentation there was a common theme whether they related to the patient, a physician, a nurse or administration, if there were better healthcare literacy and access to healthcare when needed many of the situations would not have transpired. For example, if a patient has a caretaker who can check on them and insurance that covers medication for COPD they are much less likely to use the Emergency Department as their primary source of healthcare. If a physician is burnt out and provided with an hour of the week and an in-hospital counselor then they may not end up in a mental health crisis. This course examined the complications and nuances of healthcare and health systems but also gave me a chance to discover how we could improve upon access for patients in whatever setting they required it. 

 

In the context of the research completed by the ACORN Center, chronic conditions are inextricably linked to the accessibility of care and more specifically aids in care (home health, caregivers, virtual aid). I contributed to work on two studies directly related to accessibility in these ways. The first was a study on the use of virtual home assistants in dyads of older adults and their support persons. I would travel to their homes to interview them and help set up the system and answer any questions they had about what they would be doing and how to use their Alexa. It was here that I realized we were not only creating more direct access to their support person but may be providing access to even more resources. Some of these older people did not have a reliable internet connection, which can be a harbinger of more access issues. Consider the way that Covid vaccine enrollment was initially launched, with appointments needing to be made online (or else risking the hours-long wait in a line). I saw this first-hand when volunteering at Gamecock Park helping to enroll adults who couldn't make appointments for their vaccines in 2020. 

In another study I contributed to the focus was not on older adults but rather on college-aged women taking oral contraceptive pills (OCP). In conjunction with the College of Engineering and Computing, an app was developed for Amazon Alexa (via Echo Dot or Show) that would remind the women to take their OCP.  I was tasked with interviewing each of them at the conclusion of the study on how the reminders had changed their adherence, and how they thought the app could be used for reminding people who needed to take their medication. This feasibility study was conducted with the intention of developing and fine-tuning the app before using it in studies of Older Adults, so it was heartening to hear our participants mention that it may be useful for a grandparent who struggles to remember their medication. While the side-effects of missing an oral contraceptive are not to be diminished, consistent medication use for those managing multiple comorbid chronic conditions may mean keeping someone out of the hospital or even preventing a greater level of sickness by months or years. 

 

In my future career as a physician-researcher, the value of understanding multi-modal accessibility is crucial to being a more empathetic and creative provider. There is no assumption we can make about a person's life or access to anything: food, shelter, healthcare, or technology. When we consider this, we also see an opportunity to explore how to change that assumption, hopefully moving towards a day when we can assume accessibility and move on to the next issue on the horizon.