Lessons learnt from facilitating care home placements for counselling and psychotherapy students during the COVID-19 pandemic

Purpose: In 2021, an opportunity arose to place four counselling and psychotherapy (C&P) students in three care homes across Greater Manchester as part of a 6-week interprofessional education (IPE) care home scheme. Whilst, due to ethical concerns around confidentiality, the C&P students could not participate in interprofessional activities as intended, they still undertook their clinical placement in the home to provide accessible therapy support for care home staff. This paper aims at reporting on the varied factors that influenced the implementation of C&P student placements in care homes. Methods: At the start and end of their placement, four C&P students were interviewed about their experiences. We draw on data from these eight interviews and two reflective vignettes: one from a C&P student and the other from the C&P programme coordinator (C&PPC). Results: The data were thematically analysed, and two key themes and six subthemes were constructed. They broadly unpack the factors that facilitate and challenge the implementation of C&P student placements in care homes. Conclusion: This paper highlights the value of utilising care homes as placement sites for C&P students. We propose four key recommendations for future practice: (1) it is important to establish clear lines of communication, support and collaboration;(2) a dual-space supervisory approach supports student learning in this "new” placement environment;(3) preplacement supportive frameworks are important to clarify initial role uncertainties within the care home;and (4) opportunities to provide therapy services should be well defined and referral processes put in place before the student arrives. © 2023 The Authors. Counselling and Psychotherapy Research published by John Wiley & Sons Ltd on behalf of British Association for Counselling and Psychotherapy.

The Ments Criteria - Can We Apply It in Dialysis Access Surgery?

Introduction: Dialysis access surgery, in the UK, is almost always performed in NHS healthboard-run hospitals. During the height of the COVID-19 pandemic, in which access to elective operating theatres became limited, arrangements were made in our vascular access service, to perform some dialysis access surgery in a local private hospital. Patients were selected such that those deemed suitable as day-case and unlikely to require in-patient stay were chosen. A scoring system, 'Medically Necessary Time-Sensitive' (MeNTS) criteria, was proposed recently to assist in such decision-making processes by considering procedural, disease, and patient factors (Prachand et al, J Am Coll Surg.2020). The cumulative MeNTS score ranges from 21 to 105, with a score >65 signifying a 'too high risk to be justified' procedure. The aim of this study was to use MeNTS scores retrospectively to determine whether correct decisions were made in performing dialysis-access operations in the usual NHS university healthboard (UHB) setting vs local private hospital (Spire). Method(s): MeNTS scores were calculated for all patients who underwent dialysis access surgery at both sites between March 2020 - March 2021. Outcomes assessed included patient survival and COVID-19 infection Results: 213 Patients underwent dialysis access surgery at UHB and 76 at Spire. Mean cumulative MeNTS scores were 40.03(+/-0.30) and 39.97(+/-0.46) for the UHB and Spire groups, respectively (P=.922). COVID-19 infection occurred in four patients at UHB, and none in Spire (P=.576). Successful dialysis access was achieved in 76.06% and 69.74% in UHB and Spire patients, respectively (P=.287). At 30 days, one UHB patient had died whilst all Spire patients were alive (P>.999). Discussion and conclusion: Dialysis access surgery can take place safely during the COVID-19 pandemic, with necessary precautions. A modified version of the MeNTS score to make it more renal-specific would allow maximum benefit to be achieved from it in this field.

Implementation of a Dedicated Social Worker/Coach for Emergency Medicine (EM) Residents

Learning Objectives: The pandemic exposed the mismatch between trainee mental health needs and their access to support services;therefore, the objective of our innovation was to support an opportunity for residents to work with a social worker/coach who could provide coaching on an emergent, urgent, or regular basis. Introduction/Background: EM training requires sleep-wake disruptions, includes potentially traumatizing encounters, all during the COVID-19 pandemic while many residents relocate away from their customary psychosocial supports for training. The shift-based training model limits access to psychosocial care and services, so trainees need just-in-time resources which can support them before mental health concerns develop. Educational Objectives: The objective of our innovation was to support an opportunity for our residents to work with a professional social worker who could provide coaching on an emergent, urgent, or regular basis. Curricular Design: The leadership team identified a clinical social worker and trained coach to provide small group and individual coaching sessions to residents (4-year urban safety-net program with 68 residents) budgeted at an initial cost of $15,000. It was agreed that what was shared in the discussion would not be shared without consent and legal limits to confidentiality were followed. Impact: From October 1, 2020 when implemented to October 1, 2021 there were 49 group and 73 individual sessions. After implementation in 2021, we compared this rotational mean score as ranked by all residents to all other wellness initiatives. Overall response rate was 80.88%. The overall mean score of the initiative was 2.25 (1-lowest and 4-highest) versus 3.73, the mean of all other wellness initiatives. Summary comments from the residents revealed the innovation was useful but shared concern regarding ability to attend sessions and capacity of social worker to relate with them. If other programs are considering implementation of a similar program recruiting someone with ED/graduate medical education experience or making sure they are oriented is key. Application of a social worker coaching program in an EM residency appears to be a feasible novel wellness intervention with potential to improve well-being, but needs framing to benefit trainees.

Managing Medications During a Pandemic: A Mixed-Methods Study of Perception of Adult Kidney Transplant Recipients and Those Waiting for a Kidney Transplant

Purpose: Patients interact with healthcare providers (HCP) and pharmacists to manage medications. Little is known about the impact of COVID-19 on medication management. The purpose of this study was to describe medication management, HCP/pharmacist interactions, and adherence, including initiation, implementation and persistence, during the COVID-19 pandemic in kidney transplant (KT) patients and those on the KT wait list. Method(s): The IRB determined this study was exempt. Using a mixed methods design, 340 adults at a transplant center in the midwestern US were recruited. The Managing Medications in the Midst of a Pandemic Survey measured HCP/pharmacy encounters and medication management. The Basel assessment of adherence to medications scale measured medication adherence. Result(s): The sample average age was 58.2 years, 61% male, and 86% White. During the COVID-19 pandemic, 90% had/were currently practicing socially distancing, 87% had /were currently wearing a face mask when out in public, 19% had/were currently diagnosed with COVID-19, and 84% received the vaccine. Additional survey results include: Medication management: 82% percent plan/organize their own medications. Healthcare team interactions: 98% talked with their HCP since the beginning of social distancing;13% delayed seeing a HCP because of COVID-19 concerns. Pharmacy interactions: 11% changed their method of obtaining medications from pharmacy due to social distancing and 3.5% delayed refilling medications. Medication adherence-Initiation: 2.5% were prescribed a new medication but did not begin taking it. Medication adherence-Implementation: in the 4 weeks prior to the survey, 19% missed a dose, 6.7% skipped a dose, 16% took a medication more than 2-hour time difference from the prescribed time, and 2.5% altered prescribed amount. Medication adherence- Persistence: 3.4% stopped taking a prescribed medication without a doctor's order during the pandemic. Conclusion(s): A majority of the patients waiting for a KT and KT patients acted to prevent COVID-19 but some still contracted the virus. The pandemic changed medication management interactions with HCP and pharmacists. Adherence implementation problems were nearly 20%. Findings are relevant to transplant HCP and pharmacists, who must support patients attempting to manage and adhere to prescribed medications during the pandemic.

The sickening truth of the digital divide: Digital health reforms and digital inequality

The use of digital technology has become increasingly commonplace within the United Kingdom, with many public services, including healthcare, becoming 'digital by default' in response to COVID-19 pandemic and pledged government objectives. Digital healthcare delivery has shown to be a beneficial mode of delivery, yet it is unclear whether the benefits of digital healthcare are experienced evenly throughout society. Individuals from lower income households, individuals residing in areas with poor digital infrastructure, and individuals without adequate digital skills are at risk of being excluded from digital healthcare. It is imperative that the determinants of digital inequality are addressed to ensure that vulnerable members of society can assess healthcare that is increasingly being delivered digitally. To achieve this, stakeholders spanning many sectors should collaborate to understand and address the impact that digital inequality has upon health inequality.

Development and Evaluation of Bluetooth Low-Energy Device for Electronic Encounter Metrics

The coronavirus disease 2019 (COVID-19) pandemic led to the need for tracking of physical contacts and potential exposure to disease. Traditional contact tracing can be augmented by electronic tools called "electronic contact tracing" or "exposure notification.". Some methods were built to work with smartphones;however, smartphones are not prevalent in some high-contact areas (e.g., schools and nursing homes). We present the design and initial testing of low-cost, highly privacy preserving wearable exposure notification devices. Several devices were constructed based on existing hardware and operated independently of a smartphone. The method (devices and analyses) was not able to reliably use the received signal strength indicator (RSSI) as a proxy for distance between pairs of devices;the accuracy of RSSI as a proxy for distance decreased dramatically outside of the idealized conditions. However, even an imperfect device could be useful for research on how people use and move through spaces. With some improvement, these devices could be used to understand disease spread and human or animal interaction in indoor environments.

Experiences of participants of a dietary intervention trial for African Americans with hypertension and CKD

Background: African Americans are disproportionately affected by hypertension (HTN) and CKD and evidence suggests dietary modifications towards a more Dietary Approaches to Stop Hypertension (DASH)-accordant diet could improve outcomes for this population. We aimed to explicate barriers and facilitators of healthy eating, and the perceived benefits of the intervention among completed participants of a dietary intervention trial for African Americans with HTN and CKD. Participants were randomized to one of two groups: 1) Self-Shopping DASH (S-DASH) diet group with $30/week grocery allowance for 4 mo. but no specific guidance on purchases, followed by no food allowance for 8 mo.;or 2) Coaching DASH (C-DASH) diet advice group with a $30/week food allowance and assistance in purchasing foods for 4 mo., followed by intermittent coaching without food allowance for 8 mo. Methods: We performed a content analysis of transcripts from semi-structured interviews with participants who completed the trial (13 C-DASH;12 S-DASH were randomly selected). Thematic analyses followed 5 stages: 1) reading and rereading all transcripts and utilizing audio recordings as needed for clarity;2) three coders reading two of the same transcripts, coding them, and comparing codes which were then used to create the initial coding framework;3) defining codes, coding additional transcripts, discussing/ revising the coding framework;4) formulating initial themes and 5) diagramming relationships among initial themes to merge overlapping themes. Results: Participants were a mean age of 62 ± 9.3 years, 36% were male. Key themes included healthy diet facilitators (food tracking, motivation, social support, and perception of healthy foods);barriers (transportation, past eating habits, stress and COVID mitigation);and impact of the trial on knowledge and health. Conclusions: Participants of a dietary intervention trial for African Americans with HTN and CKD identified several facilitators and barriers to healthy eating that could inform future efforts to address disease burden in this population.

0035 Ride safe reboot

Statement of purposeThe goal of the Ride Safe Pilot Program is to reduce motor vehicle crash (MVC) injuries among American Indian/Alaskan Native (AI/AN) children by promoting child safety seat use. Initially developed in 2003, the Ride Safe Pilot Program was revised and implemented in collaboration with tribal partners and the Phoenix Area Indian Health Service Division of Environmental Health.Methods/ApproachThe Ride Safe Program utilizes a community-based approach coupled with the following to achieve its goal: 1.) Distribution of a child passenger safety (CPS) curriculum tailored for AI/AN communities;2.) Provision of child safety seats;and 3.) Completion of evaluation activities.ResultsThe program was implemented in six tribal communities in Arizona, California, and Nevada. A total of 657 car seats were acquired and 75% were distributed.ConclusionsThe pilot project is a promising community-based compliment to evidence-based CPS activities aimed at addressing MVC. At the start of the initiative, a majority of the participating programs had below 50% CPS usage rates;unfortunately due to COVID-19, the sites were not able to collect post observational data. A positive outcome is the development of the COVID-19 CPS protocol to assist in the next cycle of the pilot program.SignificanceIn 2017, MVCs were the leading cause of death for AI/AN ages 5–24, with the youngest family members disproportionately affected. These losses are even more tragic because the majority of MVC injuries and deaths are preventable through the proper use of a child safety seat or seatbelt. Ride Safe can be easily replicated in any community to reduce MVC-related injuries among children. This serves as a testimony to the power of simple, well-informed, community-based models intended to reduce MVC injuries among children.