A quality improvement project regarding family communication within critical care

Introduction: Communication is central to high quality critical care (CC)1 and caring for family members is integral to the care of critically ill patients. Communication within the CC frequently does not meet families' needs,2 impacts informed decisions making3 and can result in psychological morbidity for patients and their families.4 During the COVID-19 pandemic communication was challenging with restricted family visiting. As part of our recovery strategy we aim to ensure that frequent, high quality communication remains a key aspect of critical care. There is currently no guidance relating to the frequency of family communication within critical care. Objective(s): Our aim was to review the frequency of family communication during CC admissions admission and to develop our own internal standards. Method(s): A retrospective audit was conducted of 110 admissions to Guys and St Thomas' CC from November 2021 - February 202. We reviewed all routine family discussions documented in the medical notes. Data regarding the patient's length of stay, time to first communication from admission, frequency of communication throughout admission and grade of clinician leading the communication was collected. Family discussion regarding adverse incidents and admissions less than 24hrs were excluded. If multiple communications occurred on the same day, the most senior communication was included. To complement the audit a short survey of the consultants, regarding expectations and standards of practice of family communication was completed. Result(s): 99 patients were included within the audit and 13 responses to the survey (34% response). The mean length of stay for all patients was 14 days for survivors and 16.5 days for those who died. 32% of patients received a document family communication within 24hrs of admission, 34% did not have a documented communication within 72 hours of admission. 58.3% of consultants felt a family update should happen within 24hrs of admission and 84.7% of consultants reported that families should be updated once every 3 days. On average families received a documented family communication every 5.5 days of a CC admission. When focusing just on patients who died there was an increase in the frequency of communication to once every 3 days. 23% of all documented family discussions were consultant led with the number rising to 44% in non-survivors. The audit also showed that the longer a patient stayed within critical care the less frequently a family communication became. The survey indicated that the two biggest barriers to family communication is time pressures and appropriate space. Conclusion(s): We demonstrated that documented family communication was less frequent than expected. To ensure that family commination remains a key component of CC within our department we have adopted or own internal standard of providing families with an update once every 3 days. We are exploring the role of communication facilitators5 and seeking patient/family feedback also to improve family communication further.

Specifically designed family communication booklet to help staff to communicate effectively with Intensive Care Unit patients' next of kin

Introduction: Families of patients admitted to the Intensive Care Unit (ICU) experience significant emotional distress.1 Visiting restrictions mandated during the COVID-19 pandemic presented new barriers to family communication, including a shift from regular bedside nursing updates and in-person family meetings to scheduled, clinician-led telephone calls and video calls.2 This resulted in loss of non-verbal clues and feedback during family discussions, difficulties establishing rapport with families and risked inconsistent messages and moral injury to staff.3 Objectives: We aimed to design a system where all ICU family discussions were documented in one place in a standardised format, thereby clarifying information given to families to date and helping staff give families a consistent message. In addition, we aimed to provide practical advice for the staff making family update telephone calls and strategies for managing difficult telephone conversations. Method(s): We designed and implemented an ICU family communication booklet: this was colour-coded blue;separate to other ICU documentation within the patient notes;and included communication aids and schematics to help staff optimise and structure a telephone update. Using Quality Improvement methodology, we completed four Plan-Do-Study-Act (PDSA) cycles and gathered qualitative and quantitative feedback: this occurred prior to the project and at one,12,18 and 21 months post introduction. We implemented suggested changes at each stage. We designed staff surveys with questions in a 5-point Likert scale format plus opportunity for free comments. Twenty-one months post implementation, we designed and delivered an MDT awareness campaign using the 'tea-trolley training' method,4 departmental induction sessions for new ICU doctors and nurses and a 'Message of the Week' initiative. An updated version of the booklet was introduced in February 2022 (Figure 1). Result(s): Staff survey results are shown in Table 1. Forty-six staff participated in tea trolley training, feedback form return rate 100%. Following feedback, the family communication booklet was updated to include the following: a prompt to set up a password;a new communication checklist at the front, including documentation of next of kin contact details, a prompt to confirm details for video calls, confirm primary contact and whether the next of kin would like updates during the night;consent (if the patient is awake) for video calls while sedated;information regarding patient property;prompt to give families our designated ICU email address to allow relatives to send in photographs to display next to patients' beds;prompts to encourage MDT documentation and patient diary entry. Conclusion(s): During unprecedented visiting restrictions in the COVID-19 pandemic, we implemented an ICU family communication booklet which has been so successful that we plan to use it indefinitely. We plan to further develop this tool by encouraging MDT involvement, seek further staff feedback in six months' time, incorporate this structure into our electronic patient information system when introduced and collect feedback from patients and their next of kin at our ICU follow up clinic. This communication booklet would potentially be reproducible and transferable to other ICUs and could be used as part of a national ICU family communication initiative.

A Quality Improvement Project Impacts Resident Satisfaction with the Depart Process

Purpose of Study The current depart process resulted in slow work-flow and patient safety and equity concerns. The QI project aimed to improve resident satisfaction with the hospital discharge process. Methods Used The QI project was designed using the Model for Improvement. Starting April 2020, Plan-Do-Study-Act cycles included: hiring clinical team coordinators;creating standard depart instructions for diabetic ketoacidosis, pyelonephritis, seizures, croup and dehydration;uploading instructions to Powerchart;and clinician reminders to use instructions with families. Measures examined monthly, included resident satisfaction and patient readmissions. Summary of Results Resident satisfaction improved from 4.8 (February 2020) to 7.8 (August 2020) for the overall discharge process;from 5.3 to 7.9 for family education on all key points;from 6.0 to 7.7 for smooth transition of care;from 3.0 to 7.4 for no language barriers;and from 3.0 to 6.7 for no unnecessary delays, on a scale of 0/strongly disagree/ terrible to 10/strongly agree/excellent. Readmissions also trended downward. Conclusions During this QI project to address the depart process, resident satisfaction improved and readmissions declined. These results are encouraging, but should be interpreted in the context of decreased patient census due to COVID-19 and non-respiratory season, which may have decreased workload and increased education time and interpreter access. Next steps include PDSAs related to health literacy and Spanish translation.

A qualitative study into the barriers and facilitators to effective communication with people with age-related hearing loss in community pharmacy settings

Introduction: One in six adults are affected by hearing loss, and this number increases with age.(1) Inadequate communication is a barrier to the delivery of effective care for people with hearing loss.(2) Communication regarding medicines is particularly relevant to the pharmaceutical care of older people who are more likely to be living with hearing loss, have multiple comorbidities and experience polypharmacy, a risk factor for adverse drug events. This study sought to explore factors that facilitate and impede communication with people with age-related hearing loss (presbycusis) in the community pharmacy, to provide a base upon which to identify solutions/ interventions to improve these interactions. Aim(s): To explore the barriers and facilitators to effective communication with people with age-related hearing loss in the community pharmacy setting. Method(s): This qualitative study consisted of semistructured interviews with people with age-related hearing loss (presbycusis), older people (>50 years old) without hearing loss, and focus groups and interviews with community pharmacists, conducted between March - June 2022. Participants were recruited purposively via advert and snowballing. Interviews and focus groups were conducted using Microsoft Teams or Zoom;two interviews were held by telephone. Data was analysed using the framework method. Result(s): Sixteen people with age-related hearing loss and three older people without hearing loss took part. Eight community pharmacists took part across two focus groups and one interview. Four main themes were identified. The first was 'grappling with the environment'. This theme reflects the multitude of environmental barriers to communication and person-centred pharmaceutical care such as heavy workload, time constraints, lack of privacy, noise levels and Covid-19 safety measures on communication. The second was 'promoting acknowledgment and inclusion of hearing loss in the pharmacy'. This theme captures the perception among patients that their hearing loss is not relevant to the community pharmacy setting and that more could be done to signify that a pharmacy recognises the needs of those with hearing loss. Third, 'patient perceptions and use of community pharmacy services'. This theme highlights the awareness and perceptions of the role of the pharmacy that is, primarily or exclusively as a place to collect prescriptions and the limited interaction with pharmacy personnel. The final theme was 'differing perceptions of patients and pharmacists about communication'. This theme articulates the varying patient-provider perceptions about communication and levels of awareness among pharmacists about the key facilitators to communication. Conclusion(s): This study garnered rich insights about the experiences of accessing and providing pharmaceutical care for people with age-related hearing loss within the community pharmacy setting. However, due to the Covid- 19 pandemic, data collection was chiefly conducted online and the findings cannot be considered reflective of the experiences of older people facing digital exclusion. There is clearly a need to improve pharmacists' awareness of, access to and implementation of strategies, adaptations, and assistive technologies to facilitate communication with people with hearing loss. Future research should identify interventions to support the implementation of strategies/adaptations that are tailored to the needs of people with hearing loss and pharmacists in order to engender hearing-friendly community pharmacies.

Can You Spare 100 Days? Allogeneic Hematopoietic Cell Transplant Caregiver Requirements from the Perspective of Recipients and Caregivers

Allogeneic hematopoietic cell transplantation (alloHCT) is a potentially curative treatment for individuals diagnosed with blood cancers (e.g., acute myeloid leukemia) and blood disorders (e.g., sickle cell disease). Most transplant centers (TCs) require a caregiver to proceed with alloHCT. Caregiver requirements can be one of many barriers to alloHCT, as individuals without a caregiver can have limited or no access to this treatment. Few studies have described TC caregiver requirements, particularly from the perspective of recipients and caregivers. To learn more about alloHCT caregiver requirements and perspectives on those requirements, we conducted web-based interviews with adult alloHCT recipients and adult caregivers of adult alloHCT recipients in the United States (US) starting in May 2022. Recipients needed to be between 100 days and 1-year post-HCT and in remission;Table 1 describes participant demographics.(Table Presented)The majority of participants noted that their TC required a caregiver to proceed to alloHCT;however, there was variation in the length of time required to have a caregiver. When asked their perspective on the amount of time the TC required, the majority of participants noted that the actual length of time depended on the recipient's recovery (with some noting more time was needed and others noting less). Participants were also asked to share barriers they faced regarding the caregiver role. A common barrier included not fully understanding the specifics of the caregiver requirements, or what it would entail. Some recipients described being provided with too much information, making it difficult to sort through, while others reported feeling like they did not receive enough information. Other barriers identified by recipients included competing priorities of the caregiver (such as work/ home responsibilities and childcare), language barriers, and finances. Common barriers identified by caregivers included: feeling like they could not take time for themselves/their own health suffered and needing to be trained to perform medical tasks. Many recipients and caregivers also noted the impact of the COVID-19 pandemic (e.g., postponing alloHCT, trepidation about going to the TC, post-alloHCT housing restrictions, and increased telework for caregivers). Preliminary analysis of recipients and caregivers interviews showed variation in caregiver requirements across TCs. There is a need for clear, accessible information to help recipients and caregivers understand the caregiver role and requirements. This study included recipients and caregivers;further research is needed to identify barriers faced by individuals unable to access alloHCT. Results from this study will help facilitate the development of programs to help improve access to alloHCT.Copyright © 2023 American Society for Transplantation and Cellular Therapy

COVID-19 Pneumonia Virtual Follow-up Service in Greater Glasgow and Clyde: Effectiveness and Outcomes

A COVID-19 pneumonia virtual follow-up service was established within Glasgow Greater and Clyde Health Board in line with national guidance. We aim to evaluate this service and identify patient factors which may predict likelihood of attendance. Using digital clinical systems, we retrospectively collected data on all patients referred to the service between March and August 2020. 802 patients were invited to attend our service. 82.7% of patients were discharged after virtual clinic review;609 patients (75.9%) had radiological resolution and 54 patients (6.7%) failed to attend follow-up chest x-ray. Persistent radiological changes prompted a face to face (13 patients) or telephone (93 patients) clinic review, and patients could self-refer to the service if they had persistent symptoms. Subsequent investigations were organised for 150 patients inclusive of imaging, clinical physiology, blood tests and speciality referrals. Post-COVID19 diagnoses were made in 104 patients (12.9%) of the follow-up population including parenchymal lung disease, pulmonary thromboembolism and long COVID. We identified age, requirement for translator and number of household members as predictors for attending follow up. Patients were more likely to attend with increasing age (p <0.001) and with increased household numbers (p <0.001). The requirement of an interpreter significantly reduced the likelihood to attend (p=0.005). In conclusion, our follow-up service was effective in discharging patients with radiological resolution, identifying complications of COVID-19 and had low non-attendance rate. Developing the service to address language barriers and aid attendance for the elderly would be beneficial.

Qualitative research for the analysis and evaluation of obstetrical assistance to immigrant women in labor and delivery: the woman's point of view

Objective. To analyse, through the experience of the women interviewed, the impact that the migratory experience has had on them in the context of pregnancy and childbirth, and the quality of the obstetric care received during labor and childbirth. Materials and Methods. For this study, a qualitative methodology was adopted known as Cohen's phenomenology. The study was conducted in the period between January 2022 - March 2022 recruiting a sample of 11 immigrant women at the Policlinico of Bari and the Societa Cooperativa Sociale OASI 2 San Francesco Onlus. Results. From the analysis of the interviews, five main themes emerged: Migration, Memory, Assistance to immigrant women, The language barrier, Loneliness. The stories uncovered the basic needs that bring every woman together during pregnancy and childbirth and the cultural aspects, bringing out the impact of migratory trauma. The women reported that they had received good obstetric care, defining the image of a midwife as the one who stands beside. However, several difficulties emerged, from the language barrier to loneliness, burdened by the restrictions imposed by the COVID-19 pandemic. Conclusions. It emerged from the interviews that the preparation of the midwife in the transcultural field is essential in order to be able to provide appropriate and personalized assistance. The goal of health workers is to create a mental attitude of openness towards confrontation and knowledge, and suspension from judgment. It is important to approach the life of immigrant women and tear down barriers, embracing the possibility of other narratives of body, health and disease.

Accessing Bereavement Support: A Secondary Analysis of Uk Commission on Bereavement (Ukcb) Evidence

Introduction There are significant social and healthcare inequalities in the provision and access to bereavement services. With the increase in deaths and experiences of bereavement, the Covid-19 pandemic accelerated the need to address this crucial area of psychological, social and healthcare support. The UKCB was set up to respond to the challenges of the pandemic by hearing about the lived experience of bereavement. Aims The study aimed to draw on UKCB data to analyse the experiences of those bereaved in the last five years to explore how age, gender, ethnicity, and sexual orientation were associated with inequalities relating to access, effectiveness, satisfaction, and delivery of services. Methods An in-depth qualitative thematic secondary analysis was conducted of free text data from 1119 individual and 130 organisational UKCB survey responses. Results Age Those over 50 reported not wanting to cause a fuss, saw seeking help as a weakness and were reluctant to access digital support. Family pressures, lack of time, and perceptions of less support available for younger people were reported in respondents under 50 years. Ethnicity: The value of support was compromised where there were language barriers and a lack of cultural and religious understanding. Sexuality: LBGTQ + respondents valued non-judgemental understanding and a feeling of belonging from support where this is lacking on a wider level. Gender: Men leaned toward a preference for more informal and practical support. In more formal support they found difficulties in talking with those unconnected with family and friends. Conclusions Age, gender, ethnicity, or sexual orientation affected many respondents' access to formal and informal bereavement support as well as the effectiveness, satisfaction, and delivery of services. Impact The study contributed recommendations which add to those of the UKCB, that can help to reduce inequalities in effective bereavement support.

Psychotraumatology of the war in Ukraine: The question of the psychological care of victims who are refugees or who remain in Ukraine

The war in Ukraine is a major poly-traumatic event, which leads to massive population displacements. The question of the evaluation and psychological care of psychotraumatised people is an urgent matter. As many countries hosting refugees are well endowed with a good number of psychologists, some of these interested professionals should mobilise themselves and make themselves known to carry out these clinical acts. Priority should be given to trained and experienced psychologists to support victims. The language barrier will have to be overcome. Initially, it would be desirable to make contact or get closer to local and national refugee centres to facilitate these operations. Face-to-face or remote consultations, as developed during the Covid-19 pandemic, are possible. Reinforcements of the number of available and dedicated psychologists, including remotely, from the countries hosting the most refugees, are also desirable. The issue of detection, assessment and care of psychologically traumatised people who remained on the Ukrainian territory is probably even more massive. Whether non-combatants or combatants, part of the international psychological community should mobilise, in addition to local colleagues, to provide them with this psychological help. These humanitarian actions would be feasible depending on the evolution of the conflict. Whether it is psychological support for refugees or people still on the Ukrainian soil, models for organising and coordinating these actions must be carefully considered and implemented in an evolving way to optimise their effectiveness. © 2022

Planning and executing a health fair to bridge accessibility gaps and language barriers for the Hispanic community in Mobile County, Alabama

Purpose of Study: Community health fairs have been developed to address the unmet needs for disease prevention and health education among underserved communities. Hispanic communities experience significant non-financial barriers (e.g., cultural and linguistic) that also contribute to lower rates of access and utilization of health care services, including important preventive screening services. Around 3% of Mobile County's population is Hispanic. The aim of this event was: (1) To perform basic health screening, provide health education, and administer COVID-19 and Influenza vaccines to children under the age of 18 years. (2) To act as a bridge between the Hispanic families in the community and the available resources to help them overcome barriers to accessing quality care. Methods Used: We started by identifying and finalizing the location and the date for the health fair with help from the Guadalupe Center (a faith-based organization). We planned to divide the health fair into three specialized zones: Health Screening, Health Education, and Vaccination. The Health Screening zone would include anthropometry, developmental screening, and vision screening. The Health Education zone would educate the families on asthma care, breastfeeding, drowning prevention, road safety, safe sleep practices, oral hygiene, adverse childhood experiences, and healthy lifestyle. The Vaccination Zone would administer COVID-19 and Influenza vaccines. We designed and printed brochures for all health education topics in English and in Spanish. Age and gender appropriate 'Health Passports' with growth charts and other key parameters to record the child's health status were also created. Resident and medical student volunteers were trained regarding documentation, health screening, health education, and referrals to early intervention or specialist services that accepted uninsured or Medicaid patients. Summary of Results: A total of 49 children underwent health screening and health education. Each child's health status was documented in age and gender appropriate 'Health Passport'. In addition to this, these children and their parents were educated at the various health education stations and provided with brochures. Around 40% of the children that were screened had an abnormal vision screen, the parents of these children were given a list of available resources for further follow-up. Six children with developmental delay were identified and early intervention forms were filled out for two and more information regarding the Individualized Education Program (IEP) was given to the other four families. Eight children were vaccinated for COVID-19 and five were vaccinated for Influenza. Conclusion(s): The Hispanic community has persistently faced barriers to access healthcare due to literacy and socioeconomic status. Academic institutions and community- based organizations must work to develop and sustain culturally relevant health education and outreach events to reduce these disparities. Copyright © 2023 Southern Society for Clinical Investigation.

Pediatric type 1 diabetes technology use: hispanic caregiver's perspective

Background/Objective: Studies have shown that Hispanics have low use of insulin pumps and continuous glucose monitors (CGM) when compared to Whites. (Agarwal, S, 2021, Apr). Racial disparities in technology use and diabetes outcomes persist regardless of insurance status. (Lipman, TH, 2021, Mar). Our aim was to obtain a better understanding of barriers that keep people from using advanced technology and prevent health disparities. Method(s): We completed semi-structured interviews and two focus groups with a sample group of Hispanic parents of type 1 diabetes (T1D) patients. We focused our interview on four main topics: sensor usage, pump vs. smart pen vs. MDI, training via video conferencing versus in-person, and suggestions to improve care. We compared the results to study what we did with Black parents. Result(s): We gathered data from 9 Hispanic mothers of T1D patients. The interview format was chosen by parents-22% individual interview, 11% email, and 66% focus group. All parents preferred interviews in Spanish. 100% reported using sensors regularly, 33% insulin pump, 55% smart pen, and one patient used neither. Key barriers to technology use were fear of doing something wrong at the beginning, difficulty with initial telemedicine training during COVID, and insurance problems, including language barriers and refills. Conclusion(s): Overall, when compared to our Black focus group, we received similar results. They are satisfied with the technology and feel it increases their understanding of diabetes. Insurance plays a limiting role. More studies are needed to increase understanding of our population and increase device use..

Family Communication in the Icu: Challenges and Solutions

INTRODUCTION: The COVID-19 pandemic created major barriers to communication with patient families, impacting patient care and staff satisfaction. We surveyed an interprofessional group of medical intensive care unit (MICU) stakeholders to identify their concerns surrounding family communication and solicited recommendations for performance improvement. METHOD(S): An anonymous survey was distributed electronically to 260 MICU physicians, advanced practice providers (APPs), nurses, and physical, occupational, and respiratory therapists, with a 1 week reminder. The results were analyzed using thematic analysis. RESULT(S): Thirty-nine participants (response rate 15%) completed the survey, providing 95 unique comments. Major themes included challenges created by visitor policy restrictions (providers unable to connect well with families by phone;families not understanding how to work video platforms;frequent misunderstandings);medical system distrust (antivaccine and overall hostility, unrealistic expectations, challenging treatment decisions);trainee communication concerns (lack of communication training, not seeing the "big picture", nurse not knowing whether families were contacted/what was discussed), and A2F bundle failures (F component not organized, family updates too infrequent, distorted messages). This feedback prompted a quality improvement initiative to strengthen our family communication process. The responsible resident or APP is now encouraged to use a "Get to Know Me Board" to structure the collection of relevant social history with patient and family on admission, establishing an initial relationship and line of communication. Our rounding template was modified to discuss the family communication plan each day using a tiered structure (brief summary/introduction on admission;update;serious update/acute event;goals of care;transition to comfort) and clarify which team members will be present for the conversation. Afternoon rounds were also modified to routinely confirm successful family contact and address any concerns. CONCLUSION(S): We describe the results of our interprofessional survey to define the barriers to family communication during the COVID-19 pandemic, and process improvements in our MICU to make daily family involvement and contact feasible and efficient within our daily workflow.

For the Parent, by the Parent: Creating a Program to Empower Parents of Refugee Background Using Novel Participatory Approaches

BACKGROUND: With more than 28 million individuals of refugee or asylum-seeking background globally, the current situation has been described as one of the largest humanitarian crises of all time. Families of refugee background have complex, multigenerational mental health and developmental needs that are not accounted for in current programming frameworks. Difficulties in resettlement have been further compounded by COVID-19-related lockdowns, straining parental mental health and placing children at an increased risk for developmental or behavioural problems. Providing appropriate support services and educational resources that address the multigenerational concerns of families of refugee background will address these challenges, allowing for improved parental mental health, family cohesion, and developmental outcomes for children. OBJECTIVE(S): To gather data about the experiences, resources, referral pathways and barriers that impact the experience of parents of refugee background in the Greater Toronto Area (GTA) and to develop a novel, multi-dimensional parenting program model using Community-Based Participatory Research (CBPR) principles. DESIGN/METHODS: This was a qualitative community-based participatory study using a formative research framework, in accordance with COREQ guidelines. In-depth interviews (IDIs) were conducted with parents of refugee background and care providers that work closely with this population. Data were recorded, transcribed, and coded using deductive and inductive coding methods by two independent coders. RESULT(S): A total of 20 IDIs were conducted (7 parents and 13 care providers). The main topics that were identified to be incorporated into the program include features of child development, how to address resettlement issues, child advocacy, and parenting in the Canadian context. Participants felt that tackling the language barriers, addressing the overlapping responsibilities of the mothers attending the sessions, providing incentives, increasing awareness of the program, and using an anti-racist and anti-oppressive approach is key to the program's success. Participants emphasized the need for trauma-informed mental health support within the program model. CONCLUSION(S): This study describes the key considerations for a novel parenting program for families of refugee background, by engaging them as key stakeholders in the program design process. Future iteration of this project would involve a pilot and evaluation of the program.

Facilitators and barriers to latent tuberculosis infection diagnosis and care in Massachusetts: a convergent mixed methods study of clinicians

Background. Understanding barriers and facilitators to latent tuberculosis infection (LTBI) diagnosis and care is needed to successfully treat children/adolescents with LTBI in the US. We explored physicians' perspectives on pediatric LTBI diagnosis and care, and strategies to improve care. Methods. We conducted a convergent mixedmethods study with physicians in Massachusetts. Participants were purposefully sampled from primary care clinics (n=10), clinics seeing immunocompromised patients (n=2), and TB clinics (n=2). Physicians participated in individual qualitative semi-structured interviews exploring experience and comfort with LTBI care, and perceived barriers and facilitators to care. We used applied thematic analysis to analyze transcripts. Participants completed surveys to assess comfort with LTBI care and volume of LTBI patients in their care. Results. Of the 25 physicians invited, 14 participated. Most participants reported 'medium' or 'high' comfort with current LTBI guidelines;volume of LTBI care varied by physician type (Table 1). Analysis revealed perceived barriers (Figure 1) at four steps of care: 1) identification of risk and testing for LTBI (e.g., family/patient risk perception, physician knowledge gaps), 2) completion of referral after a positive test (e.g., communication barriers), 3) treatment acceptance and initiation (e.g., lack of social support), and 4) treatment adherence and completion (e.g., adolescents' emerging autonomy). Facilitators such as protocolized screening, counseling strategies, free medication, and telehealth (Figure 2) overcame some barriers. Important emergent themes included: 1) COVID-19 has induced rapid positive and negative changes in LTBI care in primary care clinics;2) immigrant adolescents are uniquely at risk for disengagement due to lack of social support;and 3) physicians and clinics are ill-equipped to provide TB care for patients' close contacts, despite knowledge of need for care. (Table Presented) Conclusion. Lack of perceived risk, family and clinic resource constraints, and accessibility challenges hindered LTBI care;protocolized screening, telehealth, and free medications were among the facilitators that overcame some but not all barriers. These results will inform improvement of LTBI care within and between clinics.

Impact of telehealth on improving access to pregnancy care in an underserved population

Objective: Social determinants of health (SDOH) contribute to health inequities in pregnancy. The availability, convenience, and timeliness of access to care affects healthcare utilization. The COVID-19 pandemic exposed the need for efficient and widespread implementation of telehealth services. However, expanding telehealth services has changed adherence to maternal fetal medicine (MFM) at a large, urban, Federally Qualified Health Center (FQHC). We describe the utilization of these services and its effect on adherence to MFM visits. Study Design: This is a retrospective, quality improvement project comparing non-adherence to scheduled visits looking at two time frames: 1) Pre-COVID (8/1/2018-2/29/2020) in-person only 2) Post-COVID 1/1/2021-7/31/2022 in-person or virtual. All encounters in MFM at FQHC were included during these periods. In the Post-COVID period, patients had the option for either in-person or virtual visit at the time of scheduling, while in pre-COVID period, in-person visit was the only option. Chi-square was used to compare differences between groups, with p< 0.05 defined as significant. Result(s): A total of 1,607 encounters were included, n=609 in the pre-COVID and n=998 in the post-COVID group. Encounter completion rates differed between the pre-COVID and post-COVID groups (80% vs. 86%, p= 0.001), Table. In the post-COVID group, when telehealth was an alternative option, non-adherence rates were significantly lower in comparison to when telehealth was not an option in the pre-COVID group. However, in the post-COVID group, the non-adherence rate between virtual only or in-person only visits were not significantly different (p=0.178). Conclusion(s): The availability of either in-person or virtual visits improved compliance and access to MFM care in a FQHC. While the option of telehealth services can improve patient compliance with visits, this may exacerbate other disparities due to limited internet services, access to remote devices, or language barriers. Further research is needed to understand how telehealth can be an ongoing solution to overcome the SDOH that create inequity. [Formula presented] [Formula presented] Copyright © 2022

Reducing Health Inequities Through Telehealth

In March 2020, the United States responded to the COVID-19 pandemic. With this response of quarantining, social distancing, and other precautions, a need to ensure that access to healthcare occurred. Technology in the form of telemedicine and virtual visits addresses this need. Patients can use telemedicine and virtual healthcare services to improve convenience, improve access, and reduce other healthcare and pharmacy service barriers. The continuation and expansion of telemedicine and virtual visits in the practice of pharmacy provide more equitable access to healthcare and offer solutions to health disparities concerning language barriers and cultural differences, provided practitioners utilize effective communication. Copyright © 2022, Jobson Publishing Corporation. All rights reserved.

The IDEAL (ISPAE diabetes education and learning) virtual pediatric diabetes educator training model is affordable and accessible in limited-resource settings. Can it be sustainable and replicable as well?

Introduction: Structured diabetes education (DE) is vital to manage pediatric diabetes (PD) but educators are scarce in developing countries. Due to familiarity with virtual teaching in the COVID pandemic, a virtual PDE course was planned for India. Objective(s): Evaluate outcomes of a virtual PDE course in a limitedresource (LR) setting. Method(s): A 9-member ISPAE (Indian Society for Pediatric & Adolescent Endocrinology) committee, with 47 experienced volunteer faculty planned a 12-week comprehensive curriculum (delivered in English, fee INR 5000 = US$65) basic & advanced skills: diagnosis, pathophysiology, insulin, SMBG, CGMS, CSII, MNT, exercise, psychology, toddlers, adolescents, type 1&2, other special situations: 17 teaching +5 feedback sessions, exit exam;practical assignments for each session. Result(s): Trainees working with T1D selected from across India: semiurban were preferred. Lengthy course with 90%-95% attendance (highly motivated) possible as no leave, travel, or stay costs needed. Easier for women to join. Significant rise in post-test scores that is, knowledge improved. Certification was based on stringent criteria. Other advantages: intense interaction, personal commitment, continued networking, and awareness of resources. Challenges: widely varied resource, language, and social settings: language barriers, limited resources, variable baseline knowledge. Conclusion(s): The IDEAL PDE training model being virtual & intensive is an affordable & accessible alternative to a physical program in LR settings. We hope to make it high quality, sustainable, and replicable.

Assessing technology needs and satisfaction of virtual appointments during the pandemic

Introduction: COVID-19 imposed constraints on in-person medical care, challenging pediatric diabetes care. Patients and healthcare providers (HCP) can benefit from telehealth virtual visits at this time. Objective(s): Assess the access to and utilization of technology as it relates to videoconferencing and telehealth services. Assess patient and HCP satisfaction with the current virtual care services offered. Method(s): A survey was sent to patients, primary caregivers, and HCP at the clinic. Questions related to technology access, usage, and satisfaction with virtual care. Interviews were then conducted with HCP. The baseline characteristics were summarized descriptive results relating to technology access and usage were included, along with mean and median satisfaction scores. Answers to the open-ended questions and interviews were transcribed and analyzed using theme analysis. Result(s): Response rate was highest among patients with HbA1C of 7- 7.9% and lowest with HbA1C > 10%. Access to appropriate technology was high, patient and HCP satisfaction with virtual care was high. Patients preferred virtual education focused visits and in-person clinical visits. Benefits to virtual care include convenience, efficiency, money saving and challenges include lack of physical exam, excess coordination, lack of personal connection, technology issues, increased administrative burden on the HCP and a decrease in interprofessional collaboration. HCP prefer to continue with virtual care with 30%-80% of their practice. Conclusion(s): Virtual care appointments were satisfactory with few technology concerns. Participants in study were high income, high education, and spoke English. Suggestions to improve virtual care from the HCP and patient perspective were provided to include a technology support team, appointment reminders, notification for delayed appointments & better organization of blood requisitions. Further evaluation required assessing clinical outcomes of virtual care, needs of patients with language barriers, low-income & higher HbA1C.

Patient Attitudes Toward Telemedicine in Head and Neck Oncology

Introduction: Despite dramatic expansion of telehealth visits across health disciplines during the COVID-19 pandemic, little is known about attitudes toward telehealth offerings among patients affected by head and neck neoplasms. We investigate patient responses regarding their desire for telemedicine, personal attitudes, and barriers in availing telemedicine visits for head and neck oncology-related care. Method(s): Retrospective analyses of patient surveys prospectively administered between August and October 2021 to adult patients at a tertiary care head and neck oncology clinic. Level of interest in telemedicine appointments was the assessed primary outcome. Covariates including demographics, place of residence, primary neoplastic condition, speech/communication barriers, access to internet-enabled devices or reliable internet, personal preferences, and qualitative self-reporting of attitudes toward telemedicine were assessed for association with interest in telemedicine appointments. Result(s): Of 633 survey responses, 50.6% were male. More than 70% of surveyed patients were older than 56 years. Overall, 49.7% demonstrated interest in telehealth visits. Limitations in access to technology (17.7% [112 of 633 respondents]) and lack of reliable internet connection (13.74% [87 of 633 respondents]) were considered key barriers. Only 6% patients expressed concerns about missing key elements of care or quality of care delivered through telemedicine visits. Conclusion(s): Limited access to technology platforms and unreliable internet were key concerns for 1 in 2 patients considering telemedicine appointments for head and neck oncologic care. Understanding the needs and attitudes of specific patient populations may be important for organizations pivoting to telemedicine platforms for improving health care access. Key interventions to enhance participation in telemedicine- based care delivery could include identifying rural connectivity hubs and ensuring availability of connected devices through grant or device loan programs, and employing userfriendly technology platforms.

SUBOPTIMAL UPTAKE OF OUTPATIENT PULMONARY REHABILITATION FOLLOWING DISCHARGE FOR A COPD EXACERBATION: ONE HOSPITAL'S EXPERIENCE

SESSION TITLE: Practice Management Beyond Coding and Staffing SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Despite reduced health care utilization and mortality for COPD patients participating in pulmonary rehabilitation (PR) after hospitalization, few enroll in this intervention. Reasons were explored in a post-discharge survey to inform new ways to market or restructure PR. METHODS: IRB-approved, telephone survey and record review of patients with COPD discharged from one hospital over 1-year period. Inclusion criteria for analysis: 1) Principal diagnosis of COPD or respiratory failure;2) Discharge home;3) PR indicated or not contraindicated. Inclusion criteria for survey: 1) Telephone consent;2) Fluency in English. RESULTS: 191 were studied. Of these, 51 (27%) were not in a home setting (26 died, 25 not discharged home), 32 (16%) had no indication for PR (11 had an incorrect diagnosis, 21 not medically indicated). Of the remaining, 62 could not be surveyed (38 not reachable, 8 language barrier, 16 refused consent), leaving 46 (24% of total group) surveyed at 132 ± 89 days following discharge. Of those surveyed, 89% had a primary care provider, 72% had a pulmonologist, 43% had heard of PR, but only 24% ever participated in this intervention. 28% were ever referred to PR. Pulmonologists were the most common referrers. Desirable outcomes and factors that might influence the patient’s decision to participate in PR are in the Table. Table. Survey Results, n = 46 Mean rankings of Importance to Patients: 1 = least important, 5= most important Potential Outcomes of Importance to Patient Reduced Hospitalization Risk 4.80 Improvement in Dyspnea 4.54 Learn More About Lung Disease 4.34 Increase in Ability to do Things 4.26 Fewer Flare-ups of Lung Disease 4.26 Decrease in Tiredness or Fatigue 4.09 Reduced anxiety or nervousness 3.94 Opportunity to Interact with Others 3.49 Factors that Might Positively Influence Decision for PR Likelihood of Beneficial Outcome 4.34 Low Cost 4.23 Short Travel Distance to PR 4.00 Less Concern over Excessive Dyspnea during Exercise 3.54 Convenient Transportation to PR 3.37 Fewer Weather-Related Issues 2.89 Not Having to Get Up in the AM to Go to PR 2.66 No Family Responsibility Conflicts in Attending PR 1.97 Not Too Soon After Hospitalization 1.60 No Employment Conflicts in Attending PR 1.37 CONCLUSIONS: Despite reasonably good access to medical care, uptake of PR was poor. Important factors in under-utilization include non-indication or contraindication or non-referral to PR. CLINICAL IMPLICATIONS: A major limitation of this survey is that it was conducted during the COVID-19 pandemic when PR facilities were closed. Those never participating in PR nevertheless listed desirability of outcomes typically attributed to PR. Although repeating the survey post-pandemic may yield more accurate results, current data indicates the need for improved patient education and referral to PR. This is a potential target for future interventions to increase PR usage. DISCLOSURES: No relevant relationships by Osama Elsankary No relevant relationships by Antarpreet Kaur No relevant relationships by Hnin Hnin Oo No relevant relationships by Jane Reardon No relevant relationships by Ryan Talbert No relevant relationships by Richard ZuWallack