ABSTRACT
Advances in technology have resulted in increasing adoption of virtual dermatology services across the National Health Service. This has accelerated dramatically during the COVID-19 pandemic. Providing remote consultation alternatives empowers many patients to manage their health away from traditional in-person services. However, there is concern that universal implementation of such services may potentially widen healthcare inequalities for some patient groups. Reliably identifying at-risk groups is challenging. Co-design of health services has been proposed as a method to ensure equality and appropriateness of provision for all patients accessing a service by including them in the design process. In this study we profile the digital health literacy of patients with chronic skin conditions with the aim of using this information to redesign virtual services to support their long-term skin health. The Multidimensional Readiness and Enablement Index for Health Technology (READHY), comprising the eHealth Literacy Questionnaire (eHLQ), Health Literacy Questionnaire (HLQ) and Health Education Impact Questionnaire (heiQ), was used to assess patient skills, confidence and experience in using technology to manage their health. Consecutive patients under long-term follow-up in two specialist clinics supporting chronic skin conditions (organ transplant surveillance and biologics monitoring) completed questionnaires either in person or over the telephone. Between July and November 2021, 99 of 128 (77.3%) of patients invited to participate took part. Overall, these patients showed high levels of self-management skills, determination not to let health problems control their life and good support from family and healthcare professionals. In the domains related to digital skills, the responses were diverse. A cluster analysis identified multiple groups of patients with varying combinations of higher or lower level of digital health literacy, social and healthcare support, as well as capabilities in handling health condition and emotional responses. These preliminary data have provided important information for optimizing a co-design process aimed at tailoring services to support patients with chronic skin diseases. In particular, it has identified patient groups with distinct differences in terms of digital health literacy. Recognition of these groups and their differing profiles in terms of barriers to accessing virtual healthcare will be a key consideration in ensuring equitable representation in the service co-design process. It provides opportunities to target support to those patients with lower digital health literacy skills so that they may benefit from virtual services or adaptation of these services to address their specific needs. Alternatively, it allows recognition of patient groups who have higher digital health literacy and may safely benefit from alternative approaches to service provision such as patient-initiated follow-up.
ABSTRACT
Background: Hemodialysis (HD) patients are less likely to mount a response to the COVID-19 vaccination (CoVac). Poor sleep is associated with blunted vaccination response in the general population. We aim to explore the association between CoVac and sleep quality (SQ) in HD patients. Method(s): Patients from 3 HD clinics were enrolled if they were >=18 years and able to give written consent. Patients were administered the Insomnia Severity Index (ISI) and the Pittsburg Sleep Quality Index (PSQI). Blood specimen were collected after the primary series of COVID-19 vaccination. SARS-CoV-2 neutralization antibodies (nAB) were assayed using the GenScript SARS-CoV-2 Surrogate Virus Neutralization Test Kit (Cat#L00847-A). nAB titers are presented as Unit/ml on a natural log scale. PSQI scores of >5 were categorized as poor SQ and <=5 as good SQ. ISI scores were grouped as no clinically significant insomnia (NI;score 0-7), subthreshold insomnia (SI;score 8-14), and clinical insomnia (CI;score 14-28). T-test and ANOVA analysis were performed on PSQI and ISI scores, respectively, to determine the statistical association between SQ and nAB levels Results: 58 patients were included (60+/-9 years old, HD vintage 4.7+/-4.5 years, 62% male, 66% Black, 21% Hispanic). In the PSQI, 72% (n=42) had poor SQ. In the ISI, 52% = NI, 31% = SI, and 17% CI. Box plots of nAB levels with median and IQR are shown in Fig. 1. There is no association between SQ and nAB levels. Conclusion(s): There is no association between SQ and CoVac response. Given the immune dysfunction in this population, any modifying effect SQ has on CoVac, as observed in the general population, is unlikely. Other methods of improving CoVac response in this vulnerable population should be explored. (Figure Presented).
ABSTRACT
Background: On March 20, 2020, to stop the spread of the COVID-19, the New York State Governor issued a strict stay at home order for all tasks that were deemed as “nonessential” starting March 22 at 8PM. We would like to determine what change, if any, in physical activity levels (PAL) took place because of the lockdown order in HD patients. Methods: HD patients were enrolled from 4 clinics in New York City starting in May 2018 and followed for a period of up to 1 year. Patients ≥18 years, on HD ≥3 months, able to walk, and owning a smartphone were enrolled. PAL was defined by steps taken per day measured by with a wrist-based monitoring device (Fitbit Charge 2). Patients still in the study as of March 22, 2020 were included in the study cohort. Average steps per day was calculated for Jan 1-Feb 13, 2020 and the five weeks prior to and after the lockdown went into place. A linear mixed-effect model was used to estimate the average steps per day and 95% confidence intervals. Socioeconomic parameters such as age, race, employment status, and education level were taken at the beginning of the study. Results: 42 patients were included in this analysis. At enrollment patients were 55±11 years old with a dialysis vintage of 4.5±4.4 years, and a BMI of 28.9±8.6 kg/ m2. 33% lived alone, 48% were single, 50% unemployed, 69% were African American, and 50% had an education level of some college or higher. Results on average steps per day are presented in Figure 1. Steps per day decreased significantly after the lockdown order with the most significant drop when the COVID-19 pandemic was declared a national emergency Conclusions: There was a decrease in PAL due to the mandated lockdown. As sedentary behavior is a risk factor for negative outcomes in the HD population, we must implement interventions to promote PAL, such as intradialytic exercise. (Figure Presented).