A new study led by researchers at Boston University School of Public Health (BUSPH) shows that these closures are occurring disproportionately among communities with a majority of racial and ethnic minority residents.

Published in JAMA Network Open, the nationwide study found that predominantly White communities (defined by census block group) had more pharmacies than other racial and ethnic communities, both before and after the COVID-19 pandemic. Predominantly White neighborhoods had 15 percent more pharmacies per 10,000 people than neighborhoods with predominantly minority populations. Tracking movement of mobile devices, the researchers also examined frequency of pharmacy visits and found that people in White communities most commonly visited pharmacies in similar neighborhoods, while people in other racial and ethnic minority communities with fewer pharmacies tended to utilize pharmacy services in diverse neighborhoods, instead.

This unprecedented decline in pharmacy closures across the US is more than an inconvenience to community members; it may also lead to negative health outcomes. Data indicates that past pharmacy closures have led to a decline in both access and adherence to life-saving medications, including cardiovascular medicine and anticonvulsant medicine. Beyond medication pick-up sites, pharmacies have expanded to become trusted community health hubs over the last several decades, and these shutterings are leaving residents with a dearth of local resources for other clinical support.

“When a pharmacy is absent in a neighborhood because it closed or was never there, this can create barriers for residents to not only obtain medications, but other essential health services such as vaccines, testing and treatment for multiple diseases and conditions, and other health services,” says study lead and corresponding author Dr. Elaine Nsoesie, associate professor of global health at BUSPH, who was inspired to study pharmacy availability and visits after writing a 2024 opinion piece about the impact of pharmacy deserts on Black and Latino communities in The Boston Globe and receiving a variety of responses from the community. “Our findings show that individuals from predominantly Black and other racial-minority areas might prefer to visit pharmacies in diverse neighborhoods, if they do not have an available pharmacy.”

For the study, Dr. Nsoesie and colleagues from BUSPH and The Thayer School of Engineering at Dartmouth College analyzed mobility data from mobile phones in more than 112,000 census block groups across 45 states and Washington, DC between January 2019-January 2020 (before the pandemic) and from January 2023-January 2024 (after the acute phase of the pandemic). Examining demographics, pharmacy availability and visits, the team found that predominantly White and diverse neighborhoods had more pharmacies in 2019 and in 2023 than racial-minority neighborhoods. While White and diverse neighborhoods with at least one pharmacy had a higher median household income than neighborhoods with no pharmacies, neighborhoods with a majority of racial and ethnic minority residents had nearly the same median household income in areas with and without pharmacies, suggesting that race and ethnicity might be a stronger determinant of a pharmacy desert than income alone.

Vehicle ownership, percentage of single-family homes, and median age were linked to neighborhoods with an increase in pharmacies per 10,000 people, while percentage of females, increases in median household income, and percentage of residents born outside the US were linked to neighborhoods with a decrease in pharmacies per 10,000 people.

A number of factors are driving these closures, including thin profit margins, reduced reimbursement rates for medications, and a workforce shortage. The researchers hope this insight emphasizes the need to combine financial reforms with practical local policies that make it easier for residents in pharmacy deserts to access the medicines and care they need.

“Researchers have written about the need to develop policies and financing programs that encourage pharmacies to be located in pharmacy deserts,” Dr. Nsoesie says. “We suggest that such policies could be coupled with affordable and accessible transportation. However, any long-term solutions should consider the specific needs of the local community to ensure that solutions are effective.”

The study was coauthored by Andrew Philips, research fellow at BUSPH at the time of the study; Dr. Nina Cesare, research scientist in the Biostatistics and Epidemiology Data Analytics Center at BUSPH; and Zou Yang, a PhD student at The Thayer School of Engineering at Dartmouth at the time of the study.

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Obesity: a chronic, multifactorial disease

Despite classification by the World Health Organization as a chronic disease², obesity is still not consistently recognised as such in UK clinical practice, notes Ms Shahid. “It’s not as simple as eat less and move more,” she says. Genetics, epigenetics, social and cultural factors, environment, psychology and behaviour all contribute, meaning some people are more susceptible to weight gain than others.

Why weight loss is hard

Appetite and satiety are governed by three interacting brain systems: the mesolimbic system, which drives the hedonic “wanting and liking” of food; the hypothalamus, which regulates hunger, satiety and energy expenditure; and the prefrontal cortex, responsible for executive control and self-discipline. In a healthy weight, these pathways are balanced. In obesity, they become dysregulated: hunger hormone levels run higher than physiological need while satiety signalling is blunted, so patients eat more and register fullness later – a cycle that is not, Ms Shahid stresses, a failure of willpower.

GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide) are naturally occurring gut hormones released after eating. They act on receptors in the brain, pancreas and adipose tissue. Weight-loss medicines mimic the actions of one or both of these hormones, reducing hunger and cravings, increasing satisfaction with smaller portions, improving insulin sensitivity and secretion, reducing glucagon secretion, and delaying gastric emptying so patients feel fuller for longer.

The clinical case for weight loss

Modest weight loss produces measurable benefit. A reduction of up to 5% of body weight begins to improve blood glucose, blood pressure, lung and kidney function, and outcomes in polycystic ovary syndrome and infertility. Beyond 5%, the risk of obesity-related cancers falls and joint pain and mobility improve; beyond 10–15%, cardiovascular mortality risk is significantly reduced. Patients with a BMI of 40 or above already have a life expectancy reduced by 8 to 10 years, so bringing BMI down also reduces the risk of diabetes, heart attack, stroke and cancer, says Ms Shahid.

Tirzepatide: indications and trial evidence

Tirzepatide is licensed for weight management, alongside diet and exercise, in adults with a BMI of 30 or above, or 27 or above with a weight-related comorbidity such as sleep apnoea, prediabetes, diabetes, hypertension or dyslipidaemia; it is also indicated for type 2 diabetes.

The SURMOUNT-1 trial randomised over 2,500 participants (average age 45, 67% female, mean 15 years living with obesity, baseline BMI around 38) to tirzepatide 5mg, 10mg or 15mg, or placebo. At week 72, placebo produced 2.4% weight loss, compared with 16% on 5mg, 21.4% on 10mg and 22.5% on 15mg – a difference of only one percentage point between the two highest doses. Waist circumference fell by almost 20cm on the 15mg dose, versus 3.4cm on placebo – “about eight belt holes,” says Ms Shahid. By week 20, patients on the 10mg and 15mg doses had already lost around 12.8% of body weight. DEXA scanning showed three times more total fat mass loss than lean mass loss, challenging the perception that tirzepatide causes disproportionate muscle loss – though some muscle loss accompanies any form of weight loss, and Ms Shahid counsels all patients on high-protein diets and strength training to help preserve muscle.

SURMOUNT-5, a head-to-head trial of tirzepatide 10mg/15mg against semaglutide 1.7mg/2.4mg in a similar population, found weight reduction of 21.6% with tirzepatide versus 15.4% with semaglutide at 72 weeks, and waist circumference reduction of 20cm versus 14.6cm. Notably, the results with higher dose semaglutide were comparable to those with tirzepatide 5mg – the second step of the titration schedule. Because most patients pay privately for treatment, Ms Shahid advises people to consider efficacy and time-to-target as well as cost. A longer titration period to reach equivalent results may not prove cheaper overall.

Individualising the dose

“It’s about slow and steady, not escalating every four weeks,” says Ms Shahid, who has no patients currently on the 15mg dose. Patients titrated too quickly to the maximum dose can find themselves with no further room to escalate once progress stalls. She increases the dose only when weight loss slows and appetite suppression wanes, provided side effects remain well controlled.

Safety and practical advice

Gastrointestinal effects – nausea, vomiting, constipation, diarrhoea, abdominal cramps – are common, particularly after starting or increasing the dose, but typically ease over time. Advice includes smaller, more frequent meals, mindful eating, 2–3 litres of daily fluid, and avoiding fatty, spicy or rich food, alcohol and fizzy drinks; a food diary can help identify triggers. Ms Shahid does not escalate the dose until side effects have settled.

Patients on insulin or sulfonylureas require dose adjustment to avoid hypoglycaemia, and prescribers should liaise with the clinician managing the patient’s diabetes. A history of pancreatitis warrants caution and patient education on warning signs such as severe abdominal pain radiating to the back; treatment should be discontinued if pancreatitis is suspected. Women of childbearing age should be advised to use barrier contraception for the first four weeks of treatment and at each dose escalation, since delayed gastric emptying may reduce oral contraceptive reliability.

Looking ahead

Ms Shahid is cautiously optimistic about retatrutide, a triple agonist currently in clinical trials, which may particularly benefit patients with a very high BMI or an inadequate response to existing agents. She warns strongly against unlicensed “black market” retatrutide already circulating: “please only ever use licensed medication.” She also welcomes the arrival of oral GLP-1 agonists, including newly launched oral formulations, which are bringing forward patients who had previously avoided treatment because of needle-phobia.

Ms Shahid also urges more careful language around obesity treatment, noting that terms like “skinny jabs” trivialise a prescription-only medicine for a chronic disease in a way clinicians would never apply to insulin or antihypertensives.

For Ms Shahid, the rewards of running a weight-management clinic lie well beyond the number on the scales. “You start peeling back all the layers,” she says, describing the improvements in confidence, relationships and comorbidities that follow sustained, individualised support.

References

1. NHS England. Health Survey for England, 2024. Jan 2026. https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2024
2. WHO Obesity and overweight. Dec 2025. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

About Sehar Shahid

Sehar Shahid is the founder and superintendent pharmacist of 24HR Pharmacy, a UK online pharmacy. She is an independent prescriber.

Sehar serves as a Board Director for Scotland at the National Pharmacy Association (NPA), contributes to clinical training in obesity management, and mentors professionals through leadership and empowerment initiatives. She was recognised as Independent Prescriber of the Year at the Pharmacy Business Awards 2025.

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Why discharge summaries matter

A discharge summary is the primary method of communicating what happened during a hospital stay to GPs, community teams, community pharmacists, and sometimes patients’ carers. When this transfer of information is delayed or incomplete, the consequences can be serious: GPs may fail to follow up appropriately, or may unknowingly re-prescribe medication that caused harm in the first place. Patients themselves are often unclear about their own medication changes, increasing the risk of errors after discharge. The project’s goal, says Mr Chan, was to “improve both the quality and the timeliness of discharge information while reducing the administrative burden on clinicians.”

A process under strain

Before the redesign, the discharge process was slow and highly variable. Clinicians often had to review hundreds of pages of notes before compiling a summary — a particular challenge on mental health wards, where admissions can range from 30 to 120 days. Completion rates within 24 hours of discharge varied considerably between wards, from around 70% down to just 30%. Ownership of the task was also unclear, with doctors and pharmacists sometimes each assuming the other was responsible, while junior doctors juggled competing priorities. The result was delay, and community clinicians left without timely information on diagnosis, treatment, and medication changes.

Redesigning the pathway before adding AI

Recognising that the problem could not be solved by one professional group alone, the trust convened a multidisciplinary co-production group, chaired by a consultant psychiatrist. The team used performance data and direct feedback from GPs to clarify responsibilities and standardise workflows before considering any technology. This groundwork alone raised the overall proportion of discharge summaries reaching GPs within 24 hours to around 60% — but progress then plateaued.

Introducing AI

The trust had already been using an AI platform, Anathem, for about two years to support ambient voice transcription of outpatient consultations. Extending this technology to discharge summaries was, “a natural progression” says Mr Chan. The AI reviews up to 300 pages of clinical notes and drafts the two-part discharge document: a clinical summary and a medication summary, including the reason for admission, diagnosis, interventions, medication changes and reasons for stopping drugs, and follow-up requirements. Feedback from GPs showed they rarely read beyond two pages, so the AI-generated document was deliberately condensed to that length.

The impact on efficiency has been substantial. Producing a discharge summary manually took a junior doctor 45 minutes to an hour; with AI support, this has fallen to around 20 minutes. Timeliness has also improved sharply, with 24-hour completion rates rising from 60% to around 90%.

Safeguards and accountability

Crucially, the AI does not send documents automatically. The resident doctor must review, edit, and formally sign off the summary using a smart card before it is transmitted electronically to the GP, retaining full professional accountability. This reflects lessons learned from early problems, including “hallucinations or confabulations”; in one case, the AI mistakenly recorded a patient’s suicidal ideation as an intent toward strangulation. Such incidents reinforced the trust’s view that AI can support clinicians but cannot replace their judgement.

Access to the tool is similarly staged. Foundation-level doctors (F1 and F2) are excluded. Specialty Trainee (ST) level doctors must first demonstrate they can produce a discharge summary manually before AI access is granted — an approach Mr Chan compares to a pilot needing to be able to fly a plane manually before using autopilot.

What’s next

Having piloted the approach on three wards, the trust now plans to scale it across the wider hospital and into community services, while continuing to gather feedback from clinicians, GPs, and patients. Mr Chan believes the model is transferable across the NHS, since safe information transfer between care settings is a universal challenge, even if local workflows differ.

Looking ahead, he is clear that AI will not replace healthcare professionals. “The future is not about replacing healthcare professionals with machines,” he says. “It is about augmenting them… The combination of human judgment, compassion and professional accountability, supported by well-governed technology, will deliver the safest care to the patient.”

Poster presented at the Clinical Pharmacy Congress. London 8-9th May 2026

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A privileged but pressured role

GPs sit “at the forefront” of the NHS, seeing large numbers of patients each day, often within 10 or 15-minute consultations, says Dr Vautrey. The role spans the full spectrum of life, from young children to elderly patients living with long-term conditions or reaching the end of life. Much of the challenge lies in the unpredictability of each consultation: clinicians frequently do not know in advance what a patient will bring to them, making it a “real privilege” but also a demanding job, particularly when trying to spot emerging conditions among the many patients whose long-term conditions are already well understood.

What “seamless” means for patients

Patients simply expect their GP and pharmacist to be working from the same information, says Dr Vautrey. Electronic prescribing has already transformed this relationship, replacing handwritten and printed prescriptions with direct electronic transfer to the pharmacy. Where practices and pharmacies have a good working relationship, patients experience this as a single, joined-up local health service, with consistent messaging from both sides. Co-located or closely-linked pharmacies and surgeries tend to achieve this most effectively, he notes.

The 10-year plan: promising rhetoric, uncertain delivery

Asked about the NHS 10-year health plan, Dr Vautrey is cautiously optimistic but wary of a familiar pattern. The ambition to move care into the community and build up neighbourhood health services is “long overdue”, he says, but it must be matched by sustained investment, since community services – including community nursing – have been “overstretched and underfunded” for years. Real investment is needed not only in workforce but in premises, many of which are currently too small to expand services such as community cardiology, dermatology, ENT or gynaecology clinics that could otherwise be delivered locally.

Digital records and data confidence

General practice has led the NHS on digital records for years, says Dr Vautrey, citing electronic prescribing as a case in point: patients can now receive a prescription within minutes wherever they are in England, rather than having to track down a local GP while travelling. Increasing use of the NHS app and shared access to patient information is welcome, but any new digital systems must preserve patients’ confidence that their data will remain confidential and properly safeguarded, he emphasises.

Prevention: good intentions, but funding gaps remain

On the plan’s emphasis on tackling obesity and smoking, Dr Vautrey highlights the frustration many GPs feel at being unable to prescribe newer, highly effective weight-management medications more widely because of cost. He also points to years of cuts to locally commissioned preventive services – weight management, smoking cessation, drugs and alcohol and sexual health services – as local authority budgets have come under pressure, warning that a long-term, wholesale commitment to prevention funding is needed to reduce future NHS costs.

Wearables and shifting expectations

It is “too early to know for sure” how useful wearable technology will prove, says Dr Vautrey. Home blood pressure monitoring is already valuable, partly because it avoids the anxiety some patients feel in clinical settings, but other wearables can sometimes generate anxiety rather than reassurance. Simple tools such as phone step-counters, however, can meaningfully encourage physical activity. More broadly, patient expectations of living longer with long-term conditions are rising, and society will need honest conversations about what the NHS can sustainably provide versus what may need to be funded differently, particularly as highly specialised, expensive medicines become available.

Drug shortages: a persistent, largely economic problem

Medicine shortages remain a daily frustration for GPs, pharmacists and patients, says Dr Vautrey. The causes range from global manufacturing issues to manufacturers choosing to sell more profitably elsewhere rather than into the UK market. He believes government has yet to grapple seriously with the issue, including the case for greater domestic medicine production. At present, all too often, pharmacists bear the brunt of patients’ frustration when common medicines become hard to source.

A closing message

Reflecting on his years representing GPs nationally, Dr Vautrey’s message to government is unambiguous: practice teams, community pharmacists and other primary care professionals are already working closely together on patients’ behalf, but they need long-term, sustained investment. Strengthening these foundations, he argues, would improve care quality, ease pressure on secondary care, and ultimately leave both patients and the NHS as a whole better off.

About Dr Richard Vautrey

Dr Richard Vautrey is a GP partner, Meanwood Group Practice, Leeds and Clinical Director, Leeds Central North PCN.

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Meanwhile, traditional, in-person visits to the doctor’s office have rebounded since the pandemic. And although digital medicine has become a routine part of healthcare, it is supplementing rather than replacing in-person care. This evolution, researchers say, is reshaping how hospitals and clinics operate daily.

These are the main conclusions of the study, which was led by researchers at NYU Langone Health and represents the largest review ever performed on communications recorded by Epic electronic health records. The team’s analysis involved more than 140 million patient records from 2,067 hospitals and 47,100 health clinics in the US. As part of the study, the researchers evaluated over 8 billion patient-provider interactions that took place between January 2020 and December 2025.

Publishing in the Journal of the American Medical Association (JAMA) online June 22, the study team found that online portal messages more than doubled between 2020 and 2025 (by 153 percent). By contrast, total telephone calls decreased by 6 percent over the same period. The number of Americans with an active Epic health record went from 94 million in 2020 to 140 million in 2025. Thirty percent of active patients on Epic (42 million) sent a portal health app message to their clinician during the first three months of 2025.

Patient portal visits, however, are not replacing in-office visits, which have returned to an average of between two and three per year per patient. Messages from patients to healthcare providers have doubled since the pandemic, from an average pace of 2.2 per year in early 2020 to 5.4 per year in late 2025.

“Our study shows that use of patient portals, health apps, and messaging are now a routine part of everyday patient care across America, not simply side channels used occasionally,” said study senior investigator Michal A. Mankowski, PhD.

Dr. Mankowski, an assistant professor in the Department of Surgery at NYU Grossman School of Medicine, said the study demonstrates that patients now have much more direct access to physicians and other clinicians.

“Our findings reveal that while digital health tools have become a core part of healthcare, delivery is becoming more continuous, timeless, and no longer tied to scheduled appointments during routine work hours,” said Dr. Mankowski.

Among the study’s other findings was that since 2020, Americans have, as logged in Epic record systems, booked at least 1.77 billion in-person visits to health clinics, sent 1.34 billion messages to their healthcare providers, and received some 3.25 billion online portal messages from providers. Also documented in Epic were 1.59 billion telephone calls and 146 million virtual telehealth portal visits.

Study co-investigator Dorry L. Segev, MD, PhD, said that the digital delivery of healthcare does not replace the old ways of working; it just adds another layer of more steps to existing workflows. To manage this new patient reality, hospitals, clinics, and healthcare workers have to plan future staffing and support.

“Modern delivery of healthcare means increasingly that healthcare providers will have to balance their digital workload on top of their traditional clinical workload,” said Dr. Segev, a professor and vice chair in the Department of Surgery at NYU Grossman School of Medicine. “Clinical staff will need to be trained in mastering the tools of messaging in healthcare; in using AI support programs, including chatbots that can frame content to minimize its complexity; and in making the most effective use of clinician time needed for online billing and online counseling,” said Dr. Segev, who is also a profession in NYU Grossman’s Department of Population Health.

Already, he noted, NYU Langone uses AI support tools to speed up drafting of physician and provider notes.

Dr. Segev said the team next plans to look more specifically at digital-use trends within healthcare systems, including NYU Langone, to break down any regional and outpatient clinic-specific shifts that could affect operational planning.

For the study, the team used Epic Cosmos, a national dataset of the electronic health records of more than 300 million American patients. The dataset includes information from a majority of hospitals and clinics that use Epic, the nation’s largest vendor of electronic health record systems, which had no role in performing the study.

Funding support for the study was provided by NYU Langone.

Along with Drs. Mankowski and Segev, NYU Langone researchers involved in the study were lead investigator Jane J. Long, MD, and co-investigators Mara A. McAdams DeMarco, PhD; Mark D. Schwartz, MD; Joshua Chodosh, MD; and Eric K. Oermann, MD.

Dr. Mankowski was recently elected to serve on the governing board of Epic Cosmos. Dr. Schwartz reported being president-elect of the Society of General Internal Medicine. Dr. Segev has received consulting and/or speaking honoraria from Sanofi, CareDx, Moderna, AstraZeneca, Roche, Optum, OrganOx, Hansa, and Biosidus and is a journal editor for Springer. None of these activities are related to the current JAMA study. NYU Langone is managing the terms and conditions of these relationships in accordance with its policies and procedures.

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Primary care practices acquired by private equity tended to see more patients, provide more services to patients, complete more annual wellness visits and expand their staff, according to the study published in Health Affairs. 

“Our prior work has highlighted specific harms from private equity firms acquiring and consolidating physician practices, including higher prices for patients and insurers,” said lead study author Yashaswini Singh, an assistant professor of health services, policy and practice at Brown’s School of Public Health. “This study is a reminder that the relationship between private equity and patient care is more complicated than it first appears, and financial incentives shaped by payment policy play an outsized role in how private equity operates.”

Singh and the team from Brown’s Center for Advancing Health Policy through Research used national Medicare claims to track what happened at 225 primary care practices after they were acquired by private equity firms between 2016 and 2022.

They compared that data with similar primary care practices that remained independently owned to understand how private equity buyouts can change the day-to-day practice of primary care medicine, including physician workload, how many patients doctors see and the services those patients receive.

The team found that while private equity ownership does seem to increase productivity pressures on practices — with physicians billing for about 30% more services — practices saw about 11% more patients overall.

At a time when primary care is increasingly difficult to access nationwide, connecting more patients to primary care is generally viewed as a positive outcome, they said.

That context also applies to the roughly 13% more services received by individual patients in private equity owned practices compared to independent practices. The increase was largely driven by more preventative care, including lab tests and screenings, that can identify problems such as diabetes or high cholesterol before they become serious.

One notable finding was that the Medicare annual wellness visit drove much of the increase in services received. The visit is a comprehensive preventive checkup, which Medicare has long recommended but which independent practices have historically struggled to complete because of documentation requirements. Acquisitions prompted an increase in annual wellness visits by more than 20%.

The study also found that in contrast to other private equity–owned health care settings where staffing cuts are common, primary care practices instead expanded their workforces under private firms.

Compared to independent practices, they hired about 17% more physicians and 40% more nurse practitioners and physician assistants, suggesting the extra work of providing additional services and seeing more patients is likely being spread across larger teams rather than falling on individual doctors.

“Research has documented real harm from staffing cuts following private equity involvement in other settings, as in the case of hospitals and nursing homes, but we must resist a one-size-fits all takeaway,” Singh said. “What we see in primary care is more nuanced: practices grew their teams and drew on both physicians and advanced practice providers in the short term.”

Total Medicare spending per doctor increased by about 15% after private equity firms came in, but spending per patient stayed roughly the same. That means doctors were seeing more patients and billing for more services, researchers said, but individual patients weren’t receiving more expensive care.

For private equity firms, however, that increased volume meant more revenue because of Medicare’s fee-for-service system, where doctors are paid for each service they deliver.

The researchers note a number of limitations to the study, including that it only looked at Medicare patients, followed practices for a relatively short period, and cannot determine whether the changes actually improved patient health. There could also be unexamined harms to patients and doctors that the study does not capture, including reduced clinician autonomy and burnout.

According to the researchers, the biggest takeaway of the study and recent work from the team is that private equity may not operate the same way in every sector of health care.

“In many other settings, my colleagues and I have documented clear harms from private equity,” Singh said. “This study posits a different question: Under what market conditions and incentives can private equity actually deliver on the promises it makes around expanding access and improving care — and how do we create more of those conditions?”

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These services are frequently hosted on digital platforms which can be inaccessible to disabled people, the consequences of which can be life-altering.

Blind people, for example, have reported being unable to book vaccinations during the pandemic due to websites that block screen readers. Wheelchair users report having to give their secure card details to strangers when they cannot reach a payment kiosk.

Disabled voters may face challenges accessing online voter registration systems or digital voting platforms that are not designed with accessibility in mind, effectively excluding them from participating in democratic processes.

The new book Digital Accessibility Ethics: Disability Inclusion in all Things Tech, with contributions from a global coalition of experts and advocates, calls for urgent action.

“Digital accessibility is not a luxury, it’s a civil and human right,” the editors Lainey Feingold, Reginé Gilbert and Chancey Fleet argue. “Without it, disabled people are excluded from participating in society, and the digital world cannot be ethical.”

Inequity in the digital age

The team of 39 expert authors demonstrate how the digital accessibility gap, a component of the digital divide, harms disabled people, who make up over 1 billion of the global population according to the World Health Organisation.

The experts argue that inaccessibility is pervasive and a daily challenge. As more services move online and technology continues to advance, without digital accessibility the digital divide will continue to widen.

“Increasingly, everything is digital,” the editors explain. “Our devices help us find our next job, our next love, our community gathering places. Learning and teaching happen online – in and out of the classroom, the workplace, the library. We depend on computers for work, entertainment, shopping, civic participation, and connection. Digital tools allow us to withdraw our own money, listen to music, play games, follow our favourite teams, and participate in local government.

“Legal problems are increasingly handled online. Daily, we look to our phones to find our way. In an emergency, the digital devices in our pockets offer critical safety information and unite us with loved ones.

“None of this is possible for people with disabilities when digital tools and content are not accessible.”

Inaccessibility has economic and social consequences for disabled people, who are more likely to live in poverty, face higher unemployment rates and lack access to critical services due to systemic barriers. Employers also miss out on the skills and creativity of a large section of society when disabled people are blocked from leadership potential by inaccessible workplace tools.

Systemic exclusion

One example where the stakes could not be higher is in emergencies and crises. According to the United Nations, only 20% of disabled individuals can evacuate without support, but less than 40% of emergency plans mention disability at all.

“These statistics are not coincidences,” explains Erin E. Brown, a Bahamian Disability Inclusion Consultant. “They are symptoms of structural ableism, where emergency preparedness frameworks fail to incorporate basic accessibility, digital or otherwise. And in a world increasingly reliant on technology to issue warnings, give directions, and provide services, the absence of digital accessibility is more than a design flaw. It’s an ethical breach.”

Emergency alerts and news updates often fail to include captions, sign language interpretation or screen-reader-friendly formats, leaving deaf, blind and neurodivergent individuals without critical emergency information.

A roadmap for change

The authors introduce a Digital Accessibility Ethics Framework, a tool designed to guide governments, corporations and people in creating inclusive digital environments.

The authors call for immediate action in several key areas, including introducing the Ethics Framework into organisational decision-making before exclusion happens, calling for more government accountability and enforcing compliance with the growing number of digital accessibility legal requirements across the globe.

The authors also suggest organisations should focus on creating digital tools and content that disabled people can use just as easily and independently as everyone else. This means adopting policies to ensure all technologies, whether purchased, licensed, or free, provide equal access to everyone.

They also suggest organisations should provide accurate and current accessibility information about their products and services, including a clear roadmap for addressing accessibility gaps. A robust feedback loop should be established to capture, remediate, and report on issues identified by disabled individuals, ensuring their voices are heard and acted upon, they advise.

“While technology and law are rapidly changing, one thing remains constant: the continued growth of the digital world. In the coming years, more decisions will be made about digital tools and content that impact ever-increasing aspects of our lives. Digital accessibility ethics must be part of that decision‑making,” the editors conclude.

DOI: 10.1201/9781003616702 

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The findings are based on a nationally representative survey of more than 5,500 U.S. adults conducted from October through December 2025.

In the past 30 days, did you use an AI tool or chatbot for health-related information or advice for any of the following reasons?

% Yes, among adults who have used AI tools or chatbots for health-related information or advice in the past 30 days

Note. Categories are for descriptive purposes only and were not shown on the survey.

Among Americans who have used AI for health-related information or advice in the past 30 days, the most frequently cited motivations are wanting answers quickly (71%) and wanting additional information (71%). Nearly seven in 10 (67%) say they were curious about what AI would say, and roughly six in 10 report using AI to do research on their own before (59%) or after (56%) seeing a doctor.

Regardless of the reason, almost half (46%) of Americans who used AI for healthcare information say the AI tool or chatbot made them feel more confident talking with or asking questions of a provider. Others say it helped them identify issues earlier (22%) or avoid unnecessary medical tests or procedures (19%).

“Artificial intelligence is already reshaping how Americans seek health information, make decisions and engage with providers, and health systems must keep pace,” said Tim Lash, President, West Health Policy Center, a nonprofit and nonpartisan organization focused on aging and healthcare affordability. “The risk isn’t that AI is moving too fast — it’s that health systems may move too slowly to guide its use in healthcare responsibly.”

A Smaller Share Turn to AI in Place of a Provider

While self-directed research is the primary driver of AI health use, a smaller but notable share of recent users report turning to AI instead of seeing a healthcare provider, particularly when faced with cost, access or quality barriers. Among recent AI health users, 27% say they didn’t want to pay for a doctor’s visit and 14% say they were unable to pay. One in five (21%) say they didn’t have time to make an appointment, and 16% say they couldn’t access a doctor or provider. Another 21% say they felt dismissed or ignored by a provider in the past, and 18% say they were too embarrassed to talk to a person.

In the past 30 days, did you use an AI tool or chatbot for health-related information or advice for any of the following reasons?

% Yes, among adults who have used AI for health-related information and advice in the past 30 days

Among recent AI health users, 84% still saw a healthcare provider, but 14% report not seeing a provider they otherwise would have seen because of information or advice they received from AI. When projected to the full U.S. adult population, this represents roughly 14 million Americans who did not see a provider after receiving AI-generated health information.

Trust in that AI-generated health information, however, remains divided. Among those who consulted it in the past 30 days, roughly one-third say they trust it (33%), one-third neither trust nor distrust it (33%), and about one-third distrust it (34%). However, only 4% say they strongly trust the accuracy, indicating that many Americans are making healthcare decisions based on AI-generated information without full confidence in its accuracy.

About one in 10 (11%) who report using AI for health information or advice in the past 30 days say that AI recommended healthcare information or advice they believed was unsafe.

“This data indicates that while some Americans may be using artificial intelligence as a substitute for going to the doctor’s office, many see it as a tool to complement their healthcare, helping them understand symptoms they might be feeling and clarify any diagnosis they receive from their doctors,” said Joe Daly, Global Managing Partner at Gallup.

Motivations Vary by Age and Income

While information-seeking is the dominant reason Americans turn to AI for health purposes, use patterns differ by demographics. Younger adults are more likely than older adults to use AI for self-directed research — 69% of adults aged 18 to 29 say they do research before seeing a doctor, compared with 43% of those 65 and older.

Income differences are most visible in barrier-driven motivations. Among adults earning less than $24,000 annually, 32% say they used AI because they could not pay for a doctor’s visit, compared with just 2% among those earning $180,000 or more.

Everyday Health Questions Top the List of AI Use Cases

Americans who used AI for health information or advice in the past 30 days most often report using it to gather information about everyday health concerns, including physical symptoms (58%) and nutrition or exercise (59%). But AI use extends beyond symptom-checking — Americans who used AI in the past 30 days also report using AI to understand medication side effects (46%), interpret medical information (44%), or research a diagnosis or medical condition (38%). Nearly one in four (24%) report using AI to explore mental health or emotional concerns.

Methodology

West Health-Gallup Center on Healthcare, October-December 2025

Results are based on a Gallup Panel study conducted Oct. 27-Dec. 22, 2025, with a sample of 5,660 adults aged 18 and older who are members of the Gallup Panel, a nationally representative, probability-based panel of U.S. adults. Gallup uses random selection methods to recruit Panel members, including random-digit-dial (RDD) phone interviews that cover landlines and cellphones and address-based sampling (ABS) methods. Respondents with internet access completed the questionnaire as a web survey, and those without regular internet access were sent a printed questionnaire to complete and return by mail. The sample for this study was weighted to be demographically representative of the U.S. adult population, using the most recent Current Population Survey figures. For results based on this sample, one can say that the maximum margin of sampling error is ±2.1 percentage points at the 95% confidence level. Margins of error are higher for subsamples. In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error and bias into the findings of public opinion polls.

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DIY test kits for human papillomavirus (HPV) – a group of viruses responsible for more than 90% cervical cancer cases – will be offered to women across the UK who have delayed or been unable to attend their traditional screenings.

Announced as part of the NHS 10-Year Health Plan, the kits contain a vaginal swab similar to a long cotton-wool bud. The scheme is due to be rolled out later this year. Traditional screenings, commonly known as ‘smear tests,’ are generally conducted in person at GP clinics.

The new scheme aims to tackle barriers that discourage women from attending in-person screenings, such as discomfort, embarrassment and cultural sensitivities. While there are currently no plans to routinely offer them as an option for physically Disabled women, at-home kits will be offered to women who are under-screened or have never been screened.

Disabled women often face unique barriers to traditional cervical screening, such as challenges in getting to appointments, a lack of accessible clinic facilities, difficulties in getting into the required position for the test, and a lack of understanding from healthcare providers.

The National Institute for Health and Care Research (NIHR)-funded study, which surveyed 1,493 UK-based women and people with a cervix with physical disabilities or impairments, found a broadly positive response to at-home testing:

• 63 per cent said they would be able to perform the test themselves.
• Over half would choose a home-testing kit over an in-person screening if given the choice.

Sue Sherman, a Professor of Psychology from the University of Sheffield, said: “Physically Disabled women face significant barriers when it comes to accessing healthcare, and cervical screening is no different.

“Our study is the first of its kind to explore the attitudes of physically Disabled women and people with a cervix to self-testing as an alternative to clinician-led cervical screening.

“Our research indicates that many physically Disabled women – particularly those who have delayed, missed or never attended a screening – would find this option easier and preferable.

“Ultimately, introducing self-testing will move us closer to ensuring that everyone has access to potentially life-saving screening, regardless of their physical condition.”

Contributor to the study Alycia Hirani, who lives with Osteogenesis Imperfecta (colloquially known as ‘brittle bone disease’), said: “Disabled women deserve choice in healthcare. Expanding testing options and knowledge of alternatives like HPV screening can give so much more access, autonomy and can be life-saving to so many people.”

The study also found that over 70 per cent of the women surveyed had concerns about performing the test correctly. To help address this, researchers recommend

tailored instructions catering to different physical needs and improved training for clinicians to ensure equitable screening access for all.

Read the study in full in the Journal of Medical Screening.

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Why it matters: As hospitals close in some areas, practices consolidate and telehealth expands, older adults may tolerate long trips for care — but not equally. The study suggests socioeconomic status affects willingness to travel.

What’s new: A study published recently in JAMA Network Open finds that many Americans age 65 and older are willing to travel more than an hour for routine or specialized medical care.

What happened: Researchers at the USC Dornsife Center for Economic and Social Research (CESR) surveyed a nationally representative group of older adults.

• Questions centered on how long respondents currently travel for care and how much farther they would be willing to go before deciding to delay or skip an appointment.

Results: On average, respondents would tolerate about an hour or more of travel time, particularly for specialty care.

Growth of telehealth may be impacted by how willing patients are to take long trips for in-person care versus receiving remote clinical care. (Image source: iStock.)

• For primary care visits, they would travel 68 minutes.
• For a diagnostic test, such as an MRI, 113 minutes.
• For a specialist visit, 128 minutes.

What they’re saying: “This shows older adults place a high value on access to care,” said Soeren Mattke, professor (research) of economics, director of the Brain Health Observatory at CESR and study senior author. “They are often willing to travel significant distances before delaying or forgoing care.”

Yes, but: The averages mask important differences.

• Older adults in poorer health, those living in large metropolitan areas and those who had previously struggled with transportation were less willing to travel long durations.
• In contrast, those with higher incomes, more education and reliable access to a car reported greater willingness to spend more time traveling.

Study first author Jeremy Burke, senior economist at CESR, said those gaps matter for health equity.

• “If someone is already dealing with health challenges or transportation barriers, even modest increases in travel time can become a real obstacle,” Burke said. “Those are the patients most at risk of delaying care.”

The big picture: Health systems are consolidating, with some services moving into regional hubs rather than neighborhood clinics. Policymakers often debate how far is “too far” for patients to travel, especially for older adults.

• This study suggests that distance alone isn’t the full story. The type of visit, transportation options and personal resources all shape decisions.

The findings also have implications for telehealth.

• Virtual visits can reduce travel burdens, but they may not fully replace in-person care, especially for diagnostic tests or specialist consultations that require equipment or physical exams.
• “Telehealth is an important tool, but it’s not a cure-all,” Mattke said. “We still need to think carefully about where services are located and how patients physically get there.”

What else? Transportation policy plays a role, too. Programs that offer ride services, improved public transit or partnerships with community organizations could make a meaningful difference for vulnerable seniors.

Between the lines: Older adults living in big cities were less willing to travel long durations.

• This might boil down to traffic, parking and other travel complexities, which make even short drives feel burdensome.
• But rural residents, who often already travel long distances for care, appeared more accepting of extended trips.

Bottom line: Many older Americans are willing to travel surprisingly long distances for medical care — but willingness depends on health, resources and access to transportation.

• As care delivery models evolve, understanding those differences may help health systems and policymakers design services that better match patients’ needs and circumstances.

About the study

The findings are based on data from the Understanding America Study, a nationally representative internet panel administered by CESR. For this study, researchers surveyed a representative sample of 2,650 adults age 65 or older between April 23 and June 8, 2025, about their willingness to travel for primary care, specialty care and one-time diagnostic appointments.

In addition to Mattke and Burke, authors on the study include USC Dornsife researchers Tabasa Ozawa, Ying Liu and Wei Ye, all from the USC Brain Health Observatory based at USC Dornsife.

The study was funded by National Institute on Aging grants 1R01AG083189 and 1U01AG077280.

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The emergence of online healthcare via mobile apps has brought about changes in the availability of and demand for health care. The current study, published in The Economic Journal, analyzes the consumption patterns of 19- and 20-year-olds.

The study is based on data from young people in the regions of Stockholm and Västra Götaland. During the study period, 1 9-year-olds were not charged a co-pay for online consultations, while 20-year-olds had to pay a fee..

Price sensitivity among patients was evident. Those who had turned 20 had on average half the number of online consultations compared to 19-year-olds. Women generally had higher consultation rates than men, and experienced a sharper decline once they turned 20.

The value of easing worries

“People often seek online healthcare for simple ailments, a type of care for which price generally matters more,” says Gustav Kjellsson, a researcher in health economics at the University of Gothenburg. “This doesn’t necessarily mean that it is unwarranted care. It’s important to bear in mind that without access to medical expertise, it is difficult to determine which healthcare needs you actually have. Easing people’s worries also has a value.”

The researchers estimate that 45% of the online consultations by 19-year-olds substituted a physical visit, while the remaining 55% represented care that would not have taken place without easy access to online care.

“These often relate to respiratory infections, skin conditions, and healthcare related to sexual and reproductive health, such as contraceptive management, which would typically be handled by a midwife,” he continues. “What we are seeing is a shift toward more care provided by doctors.”

Cost-neutral increase in volume

The researchers found no measurable negative medical effects from the shift toward more online and fewer in-person consultations, either on follow-up care or complication rates. A secondary finding is that young men, who are generally less inclined to seek healthcare, increased their visits to youth clinics.

“This may be an effect of an initial online doctor consultation,” says Gustav Kjellsson. “Accessibility may make it easier to seek help for conditions that are sensitive in nature, such as sexually transmitted diseases.”

The Swedish debate on online doctors involves quality of healthcare, resource allocation, the extent to which the burden on primary care is relieved, and not least how the regions reimburse private online doctor consultations. Against this background, there is another finding in the study that the researchers say stands out: The increased consumption of healthcare among 19- and 20-year-olds did not result in higher total production costs.“Interestingly, our estimates indicate that the increased volume of healthcare is more or less cost neutral. The regions’ costs for digital healthcare are not primarily due to production costs, but to the reimbursement models of private online consultation.”

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Uveitis

Uveitis is an umbrella term for inflammation affecting the uvea, the middle layer of the eye. Patients can present with pain, photophobia, blurred vision and floaters. Uveitis can be caused by infections but can also be associated with auto-immune inflammatory diseases such as rheumatoid arthritis, Crohn’s disease or Behcet’s disease. If untreated, uveitis can impair vision permanently; “There is potential for vision loss from this inflammation and the damage that it causes. It can induce macular oedema, which is leaky fluid in the eye and if that fluid accumulates at the macula, which is responsible for your central vision, then it can impact your vision temporarily, but if left untreated can lead to permanent vision loss”, explains Ms Goacher.

Treatment of uveitis

The primary goal of treatment is the control of inflammation to prevent damage such as macular oedema. The clinical approach to uveitis is determined by the anatomical site of the inflammation. Anterior uveitis, affecting the front of the eye, is typically managed with topical steroid or anti-inflammatory drops. However, topical treatments cannot penetrate deeply enough for intermediate, posterior, or panuveitis, and systemic steroids are the standard first-line treatment. “If we can’t control patients on systemic steroids or …. if you can’t get patients off the steroids without them flaring back up with their uveitis you would then move on to secondary immunosuppressive medications. So, commonly we’d use mycophenolate or azathioprine”, says Ms Goacher. The biological, adalimumab is available as a third-line treatment, she adds.  Immunosuppressive treatment is steroid-sparing and can enable patients to transition off systemic steroids and avoid long-term side effects. Despite these options, an unmet need persists for patients who do not tolerate immunosuppressants, those who require maximal treatment but still experience flares, or those for whom systemic steroids are contraindicated.  Fluocinolone acetonide intravitreal implants (Iluvien ®), which provide local treatment, can be useful in these situations.

Fluocinolone intravitreal implants

The fluocinolone acetonide implant is a miniature device, measuring only 3.5 mm in length and 0.37 mm in diameter—roughly the size of a grain of rice. It is designed to be injected into the vitreous (the jelly-like part of the eye), where it slowly elutes the medication over a period of up to three years.

The implantation is performed as an outpatient procedure.  After the administration of numbing drops, the device is injected; the process typically takes 10 to 20 minutes, followed by a course of antibiotic drops. Once implanted, the patient cannot feel the device, and the polymer shell remains in the eye after the drug has been fully eluted.

Real-world clinical outcomes

Ms Goacher conducted an evaluation of 45 eyes (34 patients) treated with fluocinolone implants since 2019. The study group included patients with associated systemic inflammatory diseases, such as rheumatoid arthritis or Crohn’s disease. The findings highlighted several key clinical benefits:

• Visual acuity: 58% of patients experienced an improvement in visual acuity.
• Macular oedema resolution: At the six-month mark, 80% of patients with macular oedema saw the condition resolve.
• Systemic treatment reduction: 84% of patients taking systemic immunosuppressive medication were able to reduce their dosage, and three patients were able to stop systemic treatment entirely.
• Topical treatment reduction: There was a 20% reduction in the need for topical drops among the study group.

While the implant is designed to last three years, the audit found the average time to treatment failure (defined as the need for rescue therapy, such as increased drops or additional implants) was approximately 15 months. However, not all the patients had reached the three-year time point, notes Ms Goacher. Nevertheless, one-third of the patients in the study did reach the three-year mark without requiring further intervention, she says.

Managing complications

The use of local steroids in the eye is associated with known complications, primarily cataract development and increased intraocular pressure (IOP). In this audit,16% of patients developed cataracts post-insertion, with the average time to surgery being 12 months. Furthermore, 11% of patients experienced an IOP rise at the three-month mark. While three patients required surgery to manage this pressure, most cases were manageable with glaucoma drops.

From a clinical perspective, these complications are often viewed as a necessary trade-off; as Ms Goacher notes, cataract surgery is a routine, “bread and butter” procedure, whereas uncontrolled inflammation can lead to permanent, irreversible blindness.

Conclusion and future directions

The real-world data suggests that fluocinolone implants offer a robust option for stabilising uveitis and reducing the systemic medication burden on patients. Current efforts are focused on refining this data by looking at long-term outcomes for patients who have had the implant for two or more years to provide further insights into treatment efficacy.

Ophthalmology specialist pharmacist

The role of the specialist pharmacist in ophthalmology is expanding. Although initially Ms Goacher’s role was concerned with oversight of high-cost drugs, it has since grown considerably. The ophthalmology team at the Sussex Eye Hospital was welcoming and supportive and she soon found that ophthalmology offered many opportunities for pharmacy input. “It may not be that obvious on the outset but as soon as you scratch the surface there’s a lot to do in ophthalmology for pharmacy”, she says. For pharmacists looking to specialise in this important field, Ms Goacher highlights the support available through the UK Ophthalmic Pharmacy Group (UK OPG), which provides a network for advice and collaboration.

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