Primary care network (PCN) based 'type 2 diabetes optimisation clinics' run by primary care clinicians are a cost effective and efficient way of improving treatment targets for patients with poorly controlled diabetes, despite the constraints of the Covid-19 pandemic

Background: Approximately 10% of people living with type 2 diabetes in Waltham Forest (WF) who are treated with oral hypoglycaemic agents (OHA) alone and not under specialist care have an HbA1c > 75mmol/mol. No optimisation clinic exists at PCN level in WF, despite maximum capacity reached in specialist community and secondary care clinics. Aim(s): To establish a remote PCN based optimisation clinic during the Covid-19 pandemic, using motivational and patient empowerment interviewing techniques. Improvement in HbA1c, blood pressure and lipid profile underpinned the study. The 'behaviour change model' was also used to assess patient engagement. Method(s): We identified and consulted with 43 patients using an extended consultation of 25 min. Engagement and recall after 3 months were facilitated by a dedicated administrator and optimal care was ensured via monthly remote consultant input. Result(s): 38 patients were optimised with oral hypoglycaemic agents (OHA) alone and completed the pilot. 31/38 patients had an HbA1c reduction of more than 11mmol/ mol, with a significant overall median reduction across the whole cohort (pre 88mmol/mol vs 70mmol/mol, p < 0.0001). There was also a significant median reduction in triglyceride level (pre 1.56mmol/l vs 1.20mmol/l, p = 0.0247). In terms of behaviour change, all but one patient improved their behaviour towards their diabetes significantly. The approximate cost of the pilot per patient was 263 (excluding medication). Conclusion(s): A PCN based optimisation clinic using active recall is a cost effective and efficient method for significantly improving glycaemic control in people living with type 2 diabetes.

Artificial intelligence and machine learning in clinical trial design and application

In 2020, COVID-19 changed how health care was approached both in the United States and globally. In the early phases, the vast majority of energy and attention was devoted to containing the pandemic and treating the infected. Toward the end of 2020, that attention expanded to vaccinating people across the globe. What was not being considered at the time were challenges to future health and clinical trials that power new treatments for COVID-19 and non-COVID-19 treatments. © 2023 Elsevier Inc. All rights reserved.

A Tale of Two Counties With the Same Telehealth Story: Experience with Cancer Genetics Testing During COVID-19 at a Community Hospital

Introduction: With the onset of the COVID-19 pandemic in 2020, the utilization of telemedicine now offered an alternative diagnostic and treatment resource to providers in many areas of medicine including oncology and cancer genetics. This care option paired with genetic testing labs' ability to send saliva-based DNA collection kits to patients, enabled our community hospital in Detroit to offer diagnostic testing without the patient coming to a healthcare setting for a host of reasons. Social determinants of health have been found to influence success with telehealth, and this study sought to analyze how successful telehealth cancer genetics care was throughout the Detroit Metro area. Methods: Patient demographics for in person visits six months before COVID were analyzed, and then compared with demographics of patients during the 2020-2021 pandemic period where visits were telehealth. Results: Pre-pandemic there were , 192 unique patients seen in person with the top three cities patients were from were Detroit (12.1%), Clinton Township (8.3%), and Saint Clair Shores (10.4%). During the pandemic, with telehealth as the major modality, the top three cities were Macomb (7.2%), Detroit (7%), and Clinton Township (7%). Detroit is in Wayne County, while St.Clair Shores and Clinton Township are in Macomb County. Per the US Census Bureau Macomb county has a median income of $64,641 and Wayne county has a median income of $49,359, and poverty level in Macomb county is 9.2% versus in Wayne the level is 20%. Conclusions: This paper outlines the challenges of initiating a telemedicine program in an urban community area and highlights the benefits of a concierge service in serving cancer patients who may have economic and historically poor perceived technologic abilities.

Researching nurses' use of digital technology during the COVID-19 pandemic.

The adoption of digital technology by nurses accelerated during the coronavirus disease 2019 (COVID-19) pandemic. However, not all nurses were familiar with the various digital systems used in their organisations and there were reports of digital technology not being fit for purpose. This article describes a service evaluation that used an online survey to obtain nurses' feedback on the digital systems used to support patient care during the pandemic. Fifty-five respondents provided details about 85 separate digital systems. The usability of these systems varied significantly across technology types, while barriers to their use included nurses' lack of digital literacy and inadequate access to IT infrastructure. However, most of the nurse respondents felt that digital technology had supported effective patient care during the COVID-19 pandemic.

Post-Cures Act: Implications for Nurse Practitioners

The Cures Act of April 2021, gives the public full and immediate access to their medical records in 8 different categories, with 2 exemptions: civil and criminal suits and administrative actions and psychotherapy session notes. There is language prohibiting an individual or organization from blocking this access. This article examines how this legislation impacts nurse practitioners building on and expanding their relationship with their patients and how critical it is that patients become full participating members in their care. The level of patient engagement and their activation as partners are critical for patients to fully benefit from this increased access. Obstacles to increasing patient engagement include low health and computer literacy of patients, providers not encouraging their patients to become active in their care, system-related barriers, such as the organization having other priorities than increasing patient engagement, and community factors to include media that do not address cultural aspects. Nurse practitioners need to continue to maintain a positive, respectful, and supportive milieu in which the patient, the family, and health care team function in a partnership, one in which there is shared decision making with the patient at the center, encouragement of portal usage, and dealing with health and computer literacy and any other barriers to developing this partnership.<br />(c) 2022 Elsevier Inc. All rights reserved.

Population health management

Population health management (PHM) is a systematic approach that uses information technology and digital health tools to improve health and healthcare at the population-level. PHM programs identify individuals who could benefit from a set of PHM interventions;implement computable logic to stratify patients according to risk;and implement protocol-based logic to assign individuals within each stratum to specific interventions. PHM is a promising approach to help achieve the Quintuple Aim of healthcare: (i) improving population health through population-level interventions;(ii) enhancing the care experience by shifting healthcare from the clinic to the patient's home;(iii) reducing costs by focusing on health promotion and prevention;(iv) improving the work life of the health care workforce by reducing clinic workload;and (v) advancing health equity by maximizing reach through a combination of digital and human-based patient outreach interventions. This chapter discusses the components of a technical infrastructure to support PHM, including data sources (registries, electronic health records), data analytics tools, patient outreach and engagement tools, and patient tracking dashboards. We also describe real-world examples of PHM programs focused on chronic disease management, genetic testing for hereditary cancers, colorectal cancer screening, COVID-19 testing and vaccination, and tobacco cessation. PHM is expected to experience substantial growth with novel digital health technologies, such as sensors, phone apps, conversational agents, and virtual reality;artificial intelligence;and new data sources. © 2023 Elsevier Inc. All rights reserved.

Mobile phone access and preferences among medical inpatients at an urban Canadian hospital for post-discharge planning: A pre-COVID-19 cross-sectional survey.

Background: Digital health interventions are increasingly used for patient care, yet little data is available on the phone access type and usage preferences amongst medical ward inpatients to inform the most appropriate digital interventions post-discharge. Methods: To identify mobile phone ownership, internet access, and cellular use preferences among medical inpatients, we conducted a researcher-administered survey of patients admitted to five internal medicine units at Vancouver General Hospital (VGH) in January 2020. The survey was administered over 2 days separated by a 2-week period. Results: A total of 81 inpatients completed the questionnaire. Survey found that 85.2% of survey respondents had mobile phone access where 63.0% owned their own mobile phone, and 22.2% had access to a mobile phone via a proxy (or an authorized third-party) such as a family member. All participants with mobile phone access had cellular plans (i.e., phone and text); however, a quarter of respondents did not have data plans with internet access. Survey showed that 71.1% of males owned a mobile phone compared to only 52.8% of females. All participants at a "high" risk of readmission had access to a mobile phone, either as phone-owners or proxy-dependent users. Conclusion: Access to mobile phones among medical ward inpatients, 85.2%, was comparable to smartphone penetration rates amongst Canadians in 2019, 85.1%. More patients had cellular than data plans (i.e., internet and applications). Understanding patient-specific access is key to informing potential uptake of digital health interventions aimed at using patients' mobile phones (mHealth) from an effectiveness and equity lens.

An evolving engagement programme for patients with photodermatoses

We previously reported on our experience of an in-person Scottish Photobiology Service (SPS) patient engagement event in 2019 and of its utility in defining what matters to patients with photosensitivity. We identified key issues with delays in referral from primary care, lack of availability of peer support and a need for disease-specific information to raise awareness of photosensitivity for family and employers. Through a follow- up workshop, we identified a workstream of activities planning to address these issues, which were modified by the subsequent COVID-19 pandemic. However, we successfully moved our programme to a virtual platform, and we report on our progress. Twice-yearly virtual TEAMS patient engagement half-day events, attended by patients and staff, provided patients with a forum to discuss with each other issues that they have identified as being important to them. These ranged from the isolation, anxiety and embarrassment associated with photosensitivity, dealing with friends who do not understand their condition, through to coping mechanisms and practicalities, such as sourcing sun protective clothing, dealing with sports activities and photoprotective measures in schools. The virtual events have received extremely positive feedback both in terms of content and utility for patients, as well as the convenience of the virtual format. To supplement these activities, we have also distributed twice-yearly SPS newsletters since 2020, initiated at the start of the COVID-19 pandemic, to ensure our patients knew we were there for them, despite the challenges of the pandemic and, again, this was most positively received. Regarding delays in referral from primary care, patient feedback indicated that this was mainly due to not being taken seriously, possibly due to a lack of understanding of photosensitivity in community care. We are addressing this by developing a 'photosensitivity red flag' poster for distribution throughout primary care in Scotland to raise awareness of the symptoms to look out for in photosensitivity conditions. Finally, we have also embarked on creating a series of diseasespecific podcasts. These involve an informal discussion between a patient with photosensitivity and a consultant photodermatologist, with a mediator present, to raise awareness of the true impact of a range of photodermatoses on many aspects of life. We demonstrate this ongoing programme of diverse patient engagement and educational activities in photodermatology, to highlight the model of a multifaceted hybrid approach to provide additional support for patients with photodermatoses. Acknowledgments: we wish to acknowledge all our SPS patients, their families and staff for their invaluable contributions.

Advocacy and Adoption of Technology and Disparities in India

The number of people with diabetes globally, is rising at an alarming rate. South Asia is one of the hot spots of the diabetes epidemic. In India alone, there are over 74 million people with diabetes today. Unfortunately, 70% of the doctors in India practice in urban areas while 70% of India's population lives in rural areas. This mismatch between the availability of health care professionals and the rapid spread of diabetes in rural areas, provides an opportunity to use technology to deliver the diabetes care to remote rural areas. The first part of this presentation will talk about a model of successful delivery of diabetes health care in rural India. The Chunampet Rural Diabetes Program was carried out in a group of 42 villages in Kancheepuram District in Tamilnadu. Using a Mobile van, a population of 27,014 individuals (86.5% of the adult population) were screened for diabetes. All those detected with diabetes were offered a follow up care at a rural diabetes centre which was set up during the project. The results were very impressive and led to good improvement in A1c levels using low cost generic drugs. The second use of technology was during the COVID - 19 pandemic and the lock down which was enforced in India and many other countries. Thankfully, Telemedicine was also legalized in India at that time. Using technology, a system was created whereby the doctor and the patient stayed at home but blood tests were arranged at home for the patient.With the results, teleconsultation was done by doctors using the Electronic Medical Records which were made available on their mobile phones. Thus, despite the lockdown, patients managed to get their tests and diabetes consultations done remotely. The third use of technology is through our network of diabetes clinics across India. Even at centres where there was no ophthalmologist, retinal photographs were obtained using a lowcost retinal camera and were uploaded for centralized diabetic retinopathy grading unit where the images were read by trained retina specialists. The eye reports were sent back to the peripheral clinics in real time. Over one year period, 25,316 individuals with diabetes could have their eyes screened for diabetic retinopathy. Only 11.4 % needed referral to an ophthalmologist for further management. Finally, the use of mobile Apps has revolutionized diabetes treatment. Recently, we have developed three diabetes related tools. 'DIA' - an AI powered chatbot to assist people through automated digital conversations, 'DIALA' - a patientfriendly mobile app and 'DIANA' - a healthcare application for precision diabetes care. The details of these three tools are briefly described below : DIA : The Conversational AI Virtual Assistant 'DIA' can interact in English with its unique conversational AI technology and intuitive interface, it has proved to be a useful solution for patients, providing complex dialogues, with quick response time and offers comprehensive solutions for patients with diabetes. DIA's uses range from scheduling appointments and reminders for visits, lab tests and teleconsultation, to addressing enquiries on available medicines, treatments, and facilities.During an emergency, health crisis or in pandemic situations, it connects with caregivers and patients to take proper action as per the seriousness of their conditions. Further, it shares notifications, updates patient engagement and special offers. In addition to this, DIA can assist patients through reminders on their medicine refill via WhatsApp or SMS notifications and even facilitate purchase and tracking of medicine orders. DIALA : 'DIALA' is a DIAbetes Lifestyle Assistant Mobile Application. This app helps deliver superior and positive patient outcomes with weight tracking, step counts, diet plan adjustment, prescription refilling, availing reports of tests done, glucose monitoring data, scheduling appointments and sends reminders. It can help to monitor one's health and manage diabetes effectively. It is currently available in Android. DIANA : An advanced machine learning tool DIANA (DIAbetes Novel subgroup Assessment) is used to classify individuals with newly detected type 2 diabetes into specific subgroups such as insulin deficient or insulin resistance forms. This tool also gives the estimates of the risk for developing diabetes complications like eye or kidney disease. This machine learning approach has been developed based on published real world clinical data and will help the clinician offer individualized care for people with diabetes. In conclusion, judicious use of technology can help to bridge the socioeconomic and geographical challenges in delivering diabetes health care in developing countries.

The impact of a 12 month Music Therapy pilot on patients and staff within a NHS, in-patient, neurorehabilitation unit during the Covid-19 pandemic

Introduction: The UK Stroke pathway has been well developed since the introduction of the National Stroke Strategy in 2007 (Department of Health, 2007). Music Therapy (MT) is an AHP that has less presence within the current stroke pathway. In line with the national guidelines for Stroke rehabilitation (NICE, 2013), music therapy targets specific patient rehabilitation goals integrating a multi-disciplinary approach to therapy. Chiltern Music Therapy funded a 12-month, 1 day a week pilot MT service at Buckinghamshire Neuro Rehab Unit between 2020-2021. Method(s): The MT service comprised of a mixture of individual and group sessions. 27 patients were seen. Demographics, techniques, outcomes and feedback data was collected by the therapist, aiming to identify the benefits of MT for patients during the pandemic and how the pilot service enhanced standard therapies. Result(s): Patients accessed 86.5 hours of face-to-face (FtF) MT during the Covid-19 pandemic. 72% of SMART goals were fully or partially achieved. Data suggests MT reduces stress and anxiety, improves mood, and helps patients feel hopeful about the future;MT enhances patient engagement with therapy interventions;MT input increases patient's positive development in the areas of communication, cognition, motor skills, emotional expression, sense of self and behaviour. Staff and patient feedback was overwhelmingly positive. Conclusion(s): Introducing a MT service into existing therapy provision for stroke patients provided opportunities for FtF interaction during the Covid-19 pandemic. MT meets multiple national standards and guidelines for stroke. MT enhances patient engagement with therapy interventions, assists achieving rehab goals whilst reducing stress and anxiety and improving mood.

Improving shared decision making in virtual breast cancer surgery consultations

With the COVID19 pandemic, use of telehealth has expanded rapidly in subspecialties with limited prior telehealth experience. While telehealth offers many opportunities to improve patient convenience, access, and comfort, the virtual platform poses unique challenges for shared decision making. In this review article, we describe what occurs within a standard in-person breast surgery consult and propose a model for an ideal virtual breast surgery consult, including strategies to foster patient engagement and shared decision making. Our model incorporates pre-visit preparation, deliberate pauses, and targeted engagement as ways to encourage patients to integrate information and actively participate in treatment decisions. Intentional strategies such as these must be adopted to improve shared decision making on the virtual platform.Copyright © 2022 Elsevier Inc.

Evaluation of Crimean-Congo Hemorrhagic Fever Cases During the COVID-19 Pandemic Period.

Introduction: Crimean-Congo Hemorrhagic Fever (CCHF) is a zoonotic disease that progresses with fever and bleeding and is endemic in our region. In this study, we aimed to determine the symptoms, transmission routes and risk factors in CCHF patients who have similar clinical features with COVID-19, and to investigate the relationship between CCHF cases and COVID-19 restrictions in our region where CCHF is endemic. Material(s) and Method(s): One hundred fifty-nine patients diagnosed with CCHF in the infectious diseases and clinical microbiology clinic between April 2021 and September 2021 were included in the study. A questionnaire consisting of a set of questions was filled in for patients diagnosed with CCHF, in which demographic data, admission complaints, risk factors and habits during the COVID-19 pandemic were evaluated. Result(s): The mean age of the 159 CCHF patients included in the study was 50.9 +/- 18.5 years and 59.7% were male. The most frequently reported complaints by the patients were fatigue (94.5%), muscle-joint pain (79.9%) and fever (74.2%). During the disease period, COVID-19 was suspected in 62.3% of them, PCR test was applied to all of them, and the result was positive in only one patient. There was no change of residence of the patients during the illness period. There was no significant increase in the population of the residence area or the frequency of visits due to the pandemic. The number of patients who reported an increase in the number of ticks in their environment was 44 (27.8%). It was determined that there was no significant increase in the number of activities such as visiting rural areas or having a picnic due to the COVID-19 pandemic. Only 32.2% of patients engaged in animal husbandry or field work reported an increase in the frequency of these jobs compared to the pre-pandemic period. Conclusion(s): The reason for the increase in the number of CCHF cases in our center was not associated with the increase in the frequency of visits to rural areas or the change of residence during the COVID-19 pandemic period.Copyright © Telif Hakki 2022 Flora.

Analyzing models of patient-centered care in Canada through a scoping review and environmental scan.

AIM: The objective of this study was to identify and synthesize models of patient-centered care in Canada and compare them with the normative models described in the literature. SUBJECT AND METHODS: Patient-centered care has gained momentum in the twenty-first century as a component of quality care. During the Covid-19 pandemic, the crisis often shifts the focus to the disease rather than the patient. The multiplicity of Canadian systems, including the federal, provincial, and territorial contexts, made a good case to search for a variety of models. This study was conducted using a scoping review method supported by an environmental scan to identify patient-centered care models in Canada. RESULTS: The study identified 19 patient-centered interventions across Canada. The interventions included bedside interventions, patient-engagement projects at the organizational level, and citizen advisory panels at the system level. The organizational model was the most common. The goals of interventions ranged from enhancing the patient's experience of care to identifying ways to cut costs. In most organizational-level projects, there was a marked tendency to engage patients as members of quality improvement committees. Respecting patient dignity and autonomy in one-on-one clinical interactions was minimally addressed in the models. CONCLUSION: Health systems are not only technical, biomedical organizations but also socio-political institutions with goals of financial protection, the fair distribution of services and resources, and the meaningful inclusion of the citizens in the system, and thus patients need to be respected as individuals and as collectives within the healthcare system.

Personalized Telehealth: Redesigning Complex Care Delivery for the 65+ During the COVID Pandemic: a Survey of Patients, Caregivers, and Health-care Providers.

Background: In the context of the ongoing COVID-19 pandemic, rapid transitions have been made towards telehealth. Optimal use of telehealth in elderly patients remains poorly understood and adaptation challenges persist. Our study aimed at identifying perceptions, barriers, and possible facilitators to telehealth use amongst elderly patients with comorbidities, their caregivers, and health-care providers (HCPs). Methods: Health-care providers, patients 65 years and older with multiple comorbidities, and caregivers were recruited from outpatient clinics and invited to complete an electronic self-administered or telephone-administered survey on their perceptions of telehealth and of barriers to its implementation. Results: A total of 39 health-care providers, 40 patients, and 22 caregivers responded to the survey. Most patients (90%), caregivers (82%), and HCPs (97%) had experienced telephone visits, but few were conducted via videoconference platforms. Patients and caregivers showed interest in pursuing some future telehealth visits (68%, 86%, respectively), but felt they lacked access to technology and skills (n=8, 20%), and some felt that telehealth visits may be inferior to in-person visits (n=9, 23%). HCPs showed interest in incorporating telehealth visits into practice (n=32, 82%), but identified challenges in lack of administrative support (n=37), lack of HCP (n=28) and patient (n=37) technological skills, and limited infrastructure (n=37)/internet access (n=33). Conclusions: Older patients, caregivers, and HCPs show interest in pursuing future telehealth visits but elucidate similar barriers. Facilitating access to technology, as well as to administrative and technology support guides, could promote high quality and equal access to virtual care for the older adult.

Recent Developments in Islet Biology: A Review With Patient Perspectives.

Navigating the coronavirus disease-2019 (COVID-19, now COVID) pandemic has required resilience and creativity worldwide. Despite early challenges to productivity, more than 2,000 peer-reviewed articles on islet biology were published in 2021. Herein, we highlight noteworthy advances in islet research between January 2021 and April 2022, focussing on 5 areas. First, we discuss new insights into the role of glucokinase, mitogen-activated protein kinase-kinase/extracellular signal-regulated kinase and mitochondrial function on insulin secretion from the pancreatic ß cell, provided by new genetically modified mouse models and live imaging. We then discuss a new connection between lipid handling and improved insulin secretion in the context of glucotoxicity, focussing on fatty acid-binding protein 4 and fetuin-A. Advances in high-throughput "omic" analysis evolved to where one can generate more finely tuned genetic and molecular profiles within broad classifications of type 1 diabetes and type 2 diabetes. Next, we highlight breakthroughs in diabetes treatment using stem cell-derived ß cells and innovative strategies to improve islet survival posttransplantation. Last, we update our understanding of the impact of severe acute respiratory syndrome-coronavirus-2 infection on pancreatic islet function and discuss current evidence regarding proposed links between COVID and new-onset diabetes. We address these breakthroughs in 2 settings: one for a scientific audience and the other for the public, particularly those living with or affected by diabetes. Bridging biomedical research in diabetes to the community living with or affected by diabetes, our partners living with type 1 diabetes or type 2 diabetes also provide their perspectives on these latest advances in islet biology.

Social media for early characterization of pandemic symptoms: A qualitative analysis of patient-reported COVID-19 experiences.

BACKGROUND: Patients use social media forums to discuss their medical history and healthcare experiences, providing early insight into real-world patient experiences. We analyzed COVID-19 patient experiences from Reddit social media posts. METHODS: We extracted Reddit Application Programming Interface data for the subreddit/COVID-19 positive from March to August 2020 and selected users tagged as "Tested Positive" or "Tested Positive- Me" flair and who posted at least thirty times in any calendar month, excluding users who explicitly stated location outside of the U.S. For tested-positive patients (users), we created and reviewed individual case profiles summarizing their COVID-19 symptoms, testing, and medications or treatments. Data were imported to Nvivo qualitative analysis software and qualitative coding was conducted. FINDING: There were 31 759 posts and comments from 720 users in March to May 2020 (Q1) and 40 446 posts and comments from 1649 users from June to August 2020 (Q2). Final count of "Tested Positive" was 1296 users (280 in Q1 and 1016 in Q2). Across both quarters, frequently reported symptoms included sore throat, headaches, fevers, or chills. Loss of sense of smell or taste were reported by users in early March, prior to the inclusion of this symptom to the CDC list in April and GI-related symptoms and fatigue were reported in the March to May data, before they were added as a COVID-19 associated symptom in July 2020. Users also reported in-depth descriptions of their symptoms, motivations for testing, and long-term impacts such as post-viral fatigue. INTERPRETATION: Social media data can potentially serve as an early surveillance data source in a pandemic and offer preliminary insights into patient disease experiences.

Do All Patients Prefer Telehealth Care?

Background. COVID-19 has threatened health care for many individuals. Restriction of resources, redeployment of staff, and patient reluctance to make clinic appointments disrupts continuity of care of existing patients and limits access to care of new ones. To overcome this, our HIV clinic aggressively promoted a telehealth, MyChart (MC) application, and provided smart phone technology to those in need. Despite these efforts, we found that utilization of telehealth accounted for 4.7% of HIV clinic visits, compared to 25% in internal medicine clinics. In this report, we sought to obtain reasons why our patients were reluctant to use telehealth even in the midst of a pandemic. Methods. All Ryan White (RW) people living with HIV (PLWH) at Henry Ford Hospital that were initiated in our telehealth pilot program were surveyed on the underutilization of MC. Utilization was determined by if PLWH responded to aMC notification sent by the telehealth navigator. Activity level was established on MC (Figure 1), and if PLWH did not respond, they were called as a follow up for survey answers. Results. From 10/2020 - 01/2022, 206 PLWH were enrolled into our pilot program and given telehealth education. Of those successfully enrolled: 83.7% were black, 73% male, 57% were older than 45 years, 88% lived in Wayne County, and 27 needed and received pre-loaded smart phones. When contacted, 90 (44%) interacted on MC, 61 (29%) were unable to be reached and 55 (27%) successfully completed the survey (Figure 2). When asked why telehealth was not utilized, 27 (49%) stated they preferred in-person visits (Figure 3). Conclusion. Telehealth programs can help overcome barriers to HIV care and maintain patient engagement when crises interrupt traditional care models. However, our study suggests that our PLWH preferred and felt safe engaging with inperson visits despite telehealth education and smartphone supplementation even in a pandemic. As the future of medicine moves towards telehealth management, we must not forget our vulnerable populations and find opportunities to safely engage with inperson visits.

Improving Substance Use Treatment Capability in Collaborative Care

Background: In 2019, Beth Israel Lahey Health Behavioral Services (BILH BS) began system-wide implementation of Collaborative Care (CoCM). CoCM is an evidence based model of integrated care designed to treat persistent behavioral health conditions within primary care, including substance use disorders (SUD). The onset of the COVID-19 pandemic presented an increase in substance use at a state and national level, while a dearth of available treatment options drove increased demand for substance use treatment in primary care (NIDA 2022;Ornell 2020). An internally distributed provider survey served to determine a baseline of substance use treatment capability within BILH CoCM, as well as a gap in provider confidence and capability in meeting these treatment needs. Method(s): BILH BS CoCM partnered with an addictions psychiatrist to develop a comprehensive training module for Behavioral Health Clinicians (BHC) specific to treating substance use disorders within the CoCM model. A pre-module self-assessment was distributed to 25 participating BHC to score provider comfort and knowledge in assessing and treating substance use disorders. Providers responded according to a 5-point Likert scale. BHC are required to attend three 60-minute interactive didactics. A post-module self-assessment will be distributed to assess change in BHC comfort and knowledge of treating SUD and how new skills have been incorporated into patient care. Result(s): 25 BHCs completed the pre-module self-assessment. Results represented a diverse range of answers, with the majority of BHCs reporting moderate comfort and familiarity in assessing and treating substance use disorders. The final data collection and analysis will be completed in May 2022. Conclusion(s): At this time, BILH CoCM BHCs have completed 2/3 lectures in the training module. We anticipate that BHCs will self-assess an improvement in overall comfort and knowledge in assessing and treating substance use disorders in the context of CoCM. BHCs are expected to report a change in their patient engagement practices and treatment planning. This training module may prove essential in building provider capability in the treatment of substance use disorders within primary care. There is an opportunity to continue to assess gaps in provider knowledge, and enhance continuing education with periodic provider surveys and training expansion. References: NIDA. (2022, February 25). COVID-19 & Substance Use. Ornell, F et al. The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment. 2020;Psychiatry research;2020:289. Copyright © 2022

Patient Engagement in Management of Recurrent Urinary Tract Infections

Purpose of Review: Recurrent urinary tract infections (rUTIs) are highly prevalent among women and can be challenging to manage for both clinicians and patients. This review aims to outline and analyze important studies relevant to clinical care and provide patient-centered recommendations. Recent Findings: The current literature supports that the treatment of rUTIs is multifaceted, and improving patient engagement requires clinical strategies that prioritize improving women's quality of life. Culture-directed treatment of recurrent infections to prevent collateral damage from antibiotics is supported by the 2019 Recurrent Uncomplicated Urinary Tract Infections in Women Guidelines published by the American Urological Association, Canadian Urology Association, and Society of Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction. Qualitative studies have identified important considerations for patients such as antibiotic and non-antibiotic treatment options, financial costs, as well as physical and mental health impairments. Summary: Solely treating the physical symptoms caused by recurrent urinary tract infections without discussing prevention strategies and quality of life challenges caused by rUTIs will likely lead to poor patient engagement and satisfaction. Building a medical practice with ancillary physician support to expedite and increase convenience may help meet patient expectations and ease the burden of care identified in prior studies. Physicians should prioritize antibiotic stewardship and be mindful that microbiome research has demonstrated that healthy bladders have been found to have commensal bacteria, which may act as barriers against uropathogens, thus helping prevent urinary tract infections. Copyright © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Patient and provider experiences with virtual care during the COVID-19 pandemic: A mixed methods study

The COVID-19 pandemic prompted the rapid uptake of Virtual Care (VC). Positive patient outcomes with VC are previously reported but little is known about the experiences of patients and providers using VC during the pandemic. We aimed to describe patient and primary care provider experiences, satisfaction, perceptions, and attitudes to VC during the COVID-19 pandemic that might explain adoption of VC across the continuum of care and inform sustained uptake. We conducted a sequential explanatory mixed methods study using online surveys and virtual interviews with a convenience sample of primary care providers and patients in a Canadian province (July – December 2020). Eligible participants included patients and primary care providers using VC during the COVID-19 pandemic. Survey responses and interviews were analyzed using descriptive statistics and thematic analysis, respectively. Overall satisfaction was compared using the Mann-Whitney U test. Eighty-five patients and 94 primary care providers responded to the surveys. Patients reported higher overall satisfaction with VC than primary care providers (median [interquartile range]: 4.4 [4.0-4.7] and 3.7 [3.4-3.9] p < 0.001). Ten patients and 11 primary care providers were interviewed. Both groups strongly appreciated VC’s increased access and convenience, identified the lack of compensation as a pre-pandemic barrier to providing VC, and reported willingness to continue VC post-COVID-19 pandemic. The COVID-19 pandemic provided an opportunity for patients and primary care providers to rapidly adopt VC with high satisfaction. Patients and primary care providers viewed VC positively due to its convenience and accessibility;both intend to continue using VC post-pandemic. © The Author(s), 2022.