WHAT IS THIS COVID? COMMUNITY PERCEPTIONS OF COVID-19

The COVID pandemic was complicated by the varied amounts and sources of information available on what exactly COVID was, e.g., CDC website, social media;some fact-based and some not. The purpose of the project was to learn how people defined COVID. The surveyed sample consisted of 155 community dwellers (M age = 45.7 years), with above average education, primarily female (66%), and slightly over one-half identifying as Caucasian and approximately 40% Latinx. The sample were all residents of the Southern Border region, having very high rates of COVID infection in this area, and a statewide mask mandate both inside and outside. The open-ended question inquiring "What is COVID?” was answered by the respondents and thematic analysis focused on two dimensions: 1) was the response factual or not (incorrect in some manner);and 2) the definition of COVID in terms of a virus, flu, etc. Interestingly, despite the median education being around 15 years, 44.5% of the sample gave an incorrect definition of COVID. The three most predominant themes emerging from the definitions were (in descending order): 1) a virus with specific facts noted;2) a disease/infection;and 3) an affective reaction such as annoying. The results highlight the diverse conceptualizations in a very high-risk area, especially focused on oftentimes an incorrect understanding of COVID.

LEARNING FROM ELDERS: WORKING WITH INDIGENOUS INTERGENERATIONAL MENTORS TO ADDRESS COMMUNITY NEEDS

Tribal Critical Race Theory (Brayboy, 2005) supports the use of decolonizing methodologies such as Community-Based Participatory Research when collaborating with Indigenous communities. This paper highlights the underlying processes in working with a Dine community on an intergenerational health project. COVID had culturally disruptive effects, e.g., social isolation, on New Mexico's Dine community. This project describes what can be best thought of as Community-Based Participatory Advocacy (Kopera-Frye, John, & Frank, 2021). Navajo students interviewed 13 area chapter elders on how COVID has impacted the community, particularly with Indigenous Ways of Knowing (IWOK). Thematic analysis indicated themes of loss, stress and social isolation, and health worker effects. Resilience was indicated in response to positive outcomes from COVID including a collaboration and coming together of community. Open dialogue workshops are ongoing to facilitate community healing from COVID. The results highlight the critical necessity of starting with the community elders and using decolonizing methodologies.

Adapting to the Times: Evaluating the Efficacy of Telehealth on Hcv Outcomes in a Safety-Net Population

Background: The Grady Liver Clinic (GLC) is a primary care-based hepatitis C (HCV) clinic that provides comprehensive care for an urban, primarily African American, underserved patient population at Grady Health System. At the onset of the COVID-19 pandemic, GLC pivoted to using a telehealth model for HCV treatment. With telehealth, treatment visits were conducted via telephone or video and HCV medications could be couriered to patients' residences. We aim to compare outcomes of the HCV telehealth treatment model to traditional, in-person treatment. Method(s): We performed a retrospective chart review of all patients who initiated HCV treatment at GLC from 03/2019-02/ 2020 (Pre-Pandemic) and 03/2020-02/ 2021 (Pandemic). The latter cohort was stratified into three types of visits: in-person only, telehealth only, and hybrid (mixture of in-person and telehealth). We compared demographic data and HCV treatment outcomes between groups. Result(s): Patients in pre-pandemic and pandemic cohorts were similar genders, ages, ethnicities, and used similar payor sources. The average number of days from referral to treatment initiation differed between cohorts (52 days vs 92 days) as did the treatment duration (84 vs 56 days). The rate of sustained virologic response (SVR12) was similar between cohorts, with SVR12 obtained in 59% of the pre-pandemic cohort that started treatment (96% of those who completed testing for SVR12) vs 61% of the pandemic cohort that started treatment (95% of those who completed testing for SVR12). A substantial proportion of patients in both groups did not follow-up for SVR12 testing. Importantly, there were similar rates of SVR12 in the pandemic in-person, telehealth, and hybrid subgroups (Figure 1, attached). Conclusion(s): Our results show that virtual delivery of healthcare is as effective as traditional in-person clinic visits for HCV treatment. Our data supports continued use of telehealth to improve access to HCV treatment for a vulnerable patient population who face chronic barriers to healthcare access. (Figure Presented).

NEPHROLOGY E-CONSULTS: A NOVEL APPROACH TO KIDNEY CARE IN A SAFETY-NET HOSPITAL

STATEMENT OF PROBLEM/QUESTION: With Chronic Kidney Disease (CKD) on the rise, Grady Health System (GHS) implemented a novel Electronic-Consultation (E-Consult) Service for outpatient Nephrology and we sought to determine the characteristics and outcomes of these patients to better recognize the utility in our new approach to kidney care. DESCRIPTION OF PROGRAM/INTERVENTION: The Nephrology EConsult service was launched in September 2020 across all primary care clinics at GHS, which is located in downtown Atlanta, GA, and serves a population of mainly Medicare/Medicaid and uninsured patients. With this service, Primary Care Providers (PCPs) submit an E- Consult and a single Nephrologist reviews the chart to communicate closed-loop recommendations via the patient's Electronic Health Record (EHR). If high-complexity factors are discovered (including nephrotic-range proteinuria, acute kidney injury (AKI), or CKD 4/5), the patient is scheduled for an in-person clinic visit with Nephrology. MEASURES OF SUCCESS: We retrospectively analyzed the charts of 200 randomly-selected E-Consults placed 09/2020-12/2021 to determine disease complexity, A1c and albuminuria screening rates, DM2 control, common comorbidities, renoprotective medication use, as well as the percentage of PCPs who completed the consultation recommendations. We identified the number of in-person Nephrology clinic visits that were prevented with this virtual service and compared waitlist times against a traditional referral to outpatient Nephrology. FINDINGS TO DATE: The majority of patients (55%) have low-complexity kidney disease, and nearly half of all E- Consults are managed entirely virtually, avoiding an in-person visit to Nephrology. Fewer E-Consults have high- complexity disease (45%), most of which involve AKI (60%) and/or CKD4 (35%), warranting an in-person Nephrology evaluation, and with this service an in-person visit occurs in 1/3 the time of traditionally-placed referrals. The most common comorbidities are hypertension (80%) and DM2 (51%), and interestingly, the majority of patients with DM2 have relative control of their disease with an A1c <7% (63%). However, the rate of screening A1c differs from albuminuria: most patients have a recent A1c (70%) while less than half of patients have a recent urine albumin. Very few patients are prescribed an SGLT2-inhibitor (5%) and more than a quarter of eligible patients are not on any renoprotective medications. Nearly a quarter of PCPs do not complete the e-consult recommendations, representing an area where EMR automatization may be useful. KEY LESSONS FOR DISSEMINATION: Our Nephrology E-Consult Service improves access to kidney care for all patients, reduces clinic wait times for those with high-complexity disease, and may play an important role during the Covid-19 pandemic by reducing healthcare-associated exposures. By providing a closed-loop method of communication between PCP and Nephrologist, guideline-based recommendations for routine screening and renoprotective strategies can be exchanged for the patient's benefit.