Identifying Social Determinants of Health and Allocating Resources During the COVID-19 Pandemic.

Currently, the world has found itself in a global pandemic with coronavirus. At its start, to limit the spread of this virus, countries, states, and counties have implemented stay-at-home orders and shutdowns. These shutdowns had great impacts on people's well-being and exacerbated social determinants of health. This project aims to identify patient social determinants of health and their associations during the COVID-19 pandemic via telemedicine. METHODS: A total of 104 patients were surveyed within Pittsburgh, Pennsylvania, who had not been seen for at least 4 weeks before March 23, 2020 and who did not have a scheduled visit within 4 weeks of the initial survey. Based on a patient's specific response, resources were then allocated to them. RESULTS: Most patients surveyed identified at least 1 social determinant of health, the most common being financial issues (27%), mental health issues (26%), and access to food (19%). A statistically significant relationship was found between patients who identified finances with access to food, access to medication with struggling to care for themselves or others, and physical wellness with mental health. Lastly, an association was found between those who did not identify any difficulties and wanting more information. CONCLUSIONS: By identifying needed barriers via telemedicine, we can properly allocate resources to those who need it the most and hope to decrease the potential long-term effects of this current pandemic.

Improving Emergency Room Utilization During the COVID-19 Pandemic: A Telemedicine Social Determinants of Health Outreach Approach.

High-risk patients over the age of 65, who had chronic medical conditions, and had not yet had a primary care visit within 2020 were identified. A subgroup of patients participated in a survey to assess social determinants of health (SDOH) in the setting of a pandemic. Outcomes of those who participated in the survey, and those who did not participate were compared. Notably, those who were surveyed and lived within zip codes with low socioeconomic status had significantly decreased emergency department visits, which we defined as a discharge from the emergency department without hospitalization, as compared to those who did not receive outreach. Rates of inpatient hospitalization did not differ significantly. These findings suggest that patient outreach to evaluate SDOH during a pandemic leads to more appropriate emergency department and hospital resource utilization. This finding is particularly impactful given the current pandemic, which may place a strain on emergency department, and healthcare resources.

Rare case of pancrelipase therapy-induced neutropaenia.

A 61-year-old man was transferred to our facility from an outside hospital due to refractory neutropaenia of unknown aetiology. The patient presented to the referring hospital with a 5-day history of worsening diarrhoea and abdominal pain. Initial lab results at presentation showed severe neutropaenia with an absolute neutrophil count of 0. Investigations included a bone marrow biopsy which showed slightly hypocellular marrow with near absence of granulocytic precursors. A CT without contrast showed evidence of chronic pancreatitis and acute colitis. The patient's neutropaenia persisted despite granulocyte colony-stimulating factor therapy. The patient was, thus, transferred to our facility for a higher level of care. At our facility, the patient had rapid correction of neutropaenia after discontinuation of pancrelipase therapy. The patient's abdominal pain and diarrhoea also improved while off pancrelipase. Neutropaenia has completely resolved 6 weeks after discharge without any further therapy.