ABSTRACT
Purpose : To evaluate the impact of the COVID-19 pandemic on diabetic retinopathy screening (DRS) to uninsured, predominantly Latino patients at the UC San Diego Student-Run Free Clinic Project (SRFCP). Methods : A retrospective analysis of the electronic medical records of all diabetic patients seen in the years 2019, 2020, and 2021 (N = 196, 183, and 178 respectively) at the SRFCP was performed. Ophthalmology specialty clinic metrics from before, during, and after the COVID-19 pandemic-related lockdowns were compared to assess the impact of the COVID-19 pandemic lockdowns on DRS rates. All statistical analyses were performed in Microsoft Excel. Results : In patients with available demographic data (N=164), 92.1% were Latino, 69.5% female, with a mean age of 58.7 years (SD=10.6). A chi-squared test for goodness of fit showed that the distribution of patients seen (p<0.001), referred (p=0.012), or scheduled (p<0.001) in 2020 and 2021 differed significantly when compared to 2019. In 2019, 99 (50.5%) of 196 patients requiring DRS were referred, of which 97 (49.5%) were scheduled, and 89 (45.4%) were seen by the ophthalmology clinic (Figure 1). In 2020, a similar percentage of patients were referred (76/183 patients, or 41.5%), but the number of patients scheduled and seen dropped to 37 (20.2%) and 21 (11.4%), respectively. In 2021, clinic performance recovered with 113 (63.5%) of 178 patients eligible for DRS referred, 100 (56.2%) scheduled, and 82 (46.1%) seen. No-shows and cancellations constituted 12 (12.4%) and 6 (6.2%) of the 97 encounters in 2019. Conversely, of the 37 encounters scheduled in 2020, the no-show (10.8%) and cancellation (40.5%) rates were notably higher. Conclusions : The COVID-19 pandemic significantly diminished the delivery of eye care to patients at the SRFCP. 2020 saw a meaningful decline from 2019 in all clinic performance metrics which was reversed in 2021. These results show the current need for annual DRS surpassed the ability of the ophthalmology specialty clinic to schedule and deliver care to these patients in all years evaluated, especially in 2020 due to COVID-19 restrictions. SRFCP patients may benefit from telemedicine-based DRS programs such as remote imaging during primary care visits to further improve screening capacity. (Figure Presented).
ABSTRACT
BACKGROUND: The East Harlem Health Outreach Partnership (EHHOP) is a student-run clinic that serves a particularly vulnerable patient population lacking access to basic health insurance, largely because many do not meet USA residency requirements. COVID-19 has exacerbated the existing health disparities faced by our patients, who are predominantly Black and/or Hispanic/Latino living in East Harlem, one of the hardest hit neighborhoods in NYC. We hypothesized that high engagement in longitudinal care through the student-run clinic is associated with especially high rates of vaccine confidence and vaccine uptake. METHODS: This study included phone interviews with 63 EHHOP patients between 12/13/20 and 3/3/21. We asked 14 questions in order to measure vaccine confidence, COVID-19 sentiment, and patient trust. Patients were ages 21-78 with an even distribution of male and female patients. Most interviews were conducted in Spanish with professional translators, and the survey was created both in English and Spanish. All questions were scored on a 1-5 scale of agreement with a given. Patients were then followed through December of 2021 in order to ascertain vaccine uptake over time. RESULTS: 95.2% of those interviewed are now confirmed to be vaccinated (60/63), 3.2% have refused (2/63), and only 1.6% have unknown status (1/63). Both patients who chose not to be vaccinated had responded they were unlikely to get the COVID-19 vaccine. When comparing those likely to get the vaccine versus those who were not, the most highly significant differences in scores came when asking whether patients are more likely to take the vaccine due to their physician recommending it, and when asked whether they generally trusted those recommending they get the vaccine (p = 4.8E-5 and 4.3E-6 respectively). The next most significant differences were in perceptions of whether the vaccine would be effective and whether they felt the vaccine was created too quickly (p = 3.3E-2 and 5.3E-3 respectively). We also have precise day of first dose information for 51/60 vaccinated respondents. While there may be confounders, we found that choosing to be vaccinated earlier correlated most significantly with whether individuals were likely to take the vaccine, whether the trusted those recommending the vaccine, and whether they felt the vaccine was created too quickly (p = 3.6E-2, 1.5E-2, and 1.4E-2 respectively). CONCLUSIONS: These data indicate that the strongest predictors of vaccine uptake rate and timing are not just vaccine confidence in general, but specifically trust in those recommending the vaccine. This indicates that even in the context of marginalized populations often underserved by the healthcare system, longitudinal trust-building relationships may be a significant part of successful vaccine uptake. Those with the highest burden of disease should be given preferential treatment with high-quality, longitudinal care, and such care is shown to make a great difference in the context of vaccine uptake.
ABSTRACT
OBJECTIVES: The COVID-19 pandemic led to the closure of the IDEA syringe services program medical student-run free clinic in Miami, Florida. In an effort to continue to serve the community of people who inject drugs and practice compassionate and non-judgmental care, the students transitioned the clinic to a model of TeleMOUD (medications for opioid use disorder). We describe development and implementation of a medical student-run telemedicine clinic through an academic medical center-operated syringe services program. METHODS: Students advertised TeleMOUD services at the syringe service program on social media and created an online sign-up form. They coordinated appointments and interviewed patients by phone or videoconference where they assessed patients for opioid use disorder. Supervising attending physicians also interviewed patients and prescribed buprenorphine when appropriate. Students assisted patients in obtaining medication from the pharmacy and provided support and guidance during home buprenorphine induction. RESULTS: Over the first 9 weeks in operation, 31 appointments were requested, and 22 initial telehealth appointments were completed by a team of students and attending physicians. Fifteen appointments were for MOUD and 7 for other health issues. All patients seeking MOUD were prescribed buprenorphine and 12/15 successfully picked up medications from the pharmacy. The mean time between appointment request and prescription pick-up was 9.5 days. CONCLUSIONS: TeleMOUD is feasible and successful in providing people who inject drugs with low barrier access to life-saving MOUD during the COVID-19 pandemic. This model also provided medical students with experience treating addiction during a time when they were restricted from most clinical activities.