THE USE OF INPATIENT VIRTUAL SHARED MEDICAL APPOINTMENTS FOR PATIENTS WITH ACUTE CEREBROVASCULAR PATHOLOGIES AND THEIR CAREGIVERS: A PILOT STUDY TO IMPROVE HEALTH LITERACY, PATIENT SELF-EFFICACY AND REDUCE PROVIDER BURNOUT

Objective Admission to the hospital for an acute cerebrovascular condition such as stroke or brain hemorrhage can be a traumatic and disorienting experience for patients and their family members. The COVID-19 pandemic has further intensified this experience in addition to exacerbating clinician and resident burnout. To ameliorate some of these concerns, a team of resident and medical student trainees implemented a virtual shared medical appointment (vSMA) program for inpatients with acute cerebrovascular disorders and their caregivers. This study hypothesized that an early intervention vSMA improves patient and caregiver health literacy and preparedness, simultaneously educates trainees on effective communication skills, and reduces clinician burnout. Methods Patients and caregivers of admitted patients were screened through the neurosurgery, neurocritical care, and neurology electronic medical record census. A weekly 60- minute secure virtual session consisted of introductions, a 10- minute standardized presentation on cerebrovascular disease management, followed by participant-guided discussion. Participants completed pre- and post-surveys. We report data on this feasibility study and present challenges, both expected and unforeseen. Results A total of 170 patients were screened;13 patients and 26 caregivers participated in at least 1 session. A total of 6 different healthcare providers facilitated sessions. The vSMA program received overwhelmingly positive feedback from caregivers. Surveys demonstrated 96.4% of caregivers and 75% of patients were satisfied with the session. 96.4% of caregivers and 87.5% of patients would recommend this type of appointment to a friend or family member. 88.8% of providers felt validated by conducting the session. The participant group had a 20% greater percentage of patients discharged home without home needs compared to the non-participant group. The primary obstacle encountered included technological frustrations with the consent process and the sessions themselves. Conclusions Implementation of a vSMA program at a tertiary care center during a pandemic was feasible. Themes caregivers expressed on the post-survey included better understanding of caring for a stroke patient, and coping with the unpredictability of a patient's prognosis. The pandemic has precipitated shifts towards telehealth, but our study highlights the importance of avoiding marginalization of the elderly and less technologically inclined populations (Table Presented).

EVALUATING VIRTUAL GROUP VISITS FOR DIABETES CARE DURING THE COVID-19 PANDEMIC

BACKGROUND: One strategy to aid patients in managing their diabetes is group visits (GVs) that include group education and individual medical visits with a provider. Though in-person GVs have been shown to benefit patients, few studies have evaluated virtual diabetes GVs. METHODS: In this single-arm trial, adult patients with A1c ≥ 8% from six community health centers were recruited to participate in monthly virtual GVs for 6 months. Patients completed surveys about diabetes self-care, support, distress, and the group visit concept before and after they participated in GVs. Health center staff trained to lead the GVs completed surveys pre and post virtual GVs. Linear mixed effects models were used to adjust cohort-based association and model the survey data over time for the time trend effect. RESULTS: Forty-five patients enrolled in the study and thirty-eight patients completed the baseline survey. The average age was 55 (range of 36-83) and 65% of enrollees were female. 63% were black/African American, 32% were white/Caucasian, and 8% were Hispanic/Latino. Thirty-four patients attended one or more GVs and twenty-one patients completed the post GV survey. Overall satisfaction with the virtual GVs was high with 18/20 (90%) of participants being very satisfied and 20/21 (95%) saying they would attend GVs in the future. Most participants agreed that GVs helped improve diabetes self-management skills (78%), motivated them to achieve health goals (89%), and introduced them to others living with diabetes (78%). Barriers to participation were the timing of the GVs and access to a computer, tablet, phone, and internet. Patients had an increase in their diabetes knowledge (mean (SD): 3.2/ 5 (0.9) to 3.6/5 (0.7), p= 0.02) and diabetes support (3.5/5 (0.64) to 4.1/5 (0.7), p <0.001) as well as decreased diabetes distress (2.9/6 (1.5) to 1.2/6 (0.5), p=0.03) from baseline to 6 months. Thirty-five staff enrolled in the study and seventeen completed a post GV survey. Most staff agreed that GVs provided patients with social support and more frequent contact with medical providers. Staff largely agreed that virtual GVs increased opportunity for teamwork and collaboration (94%), care coordination (82%), and understanding of patients (94%). However, only 5/17 (29%) and 3/17 (18%) staff members agreed that virtual GVs increased provider productivity or led to higher reimbursement, respectively. Staff cited other priorities at the health center, difficulty recruiting patients, and concerns about access to technology as the biggest barriers to implementing virtual GVs. CONCLUSIONS: Virtual GVs show promise as evidenced by high patient satisfaction and improvements in support, distress, and diabetes knowledge in patients. Staff also perceived virtual GV benefits to patients, staff, and health centers despite concerns about logistics such as productivity, reimbursement, and the health center's ability to continue visits virtually.

Inpatient virtual shared medical appointments to improve health literacy, increase patient self-efficacy, and reduce provider burnout in acute cerebrovascular pathology patients and their caregivers: a pilot study.

OBJECTIVE: Admission to the hospital for an acute cerebrovascular condition such as stroke or brain hemorrhage can be a traumatic and disorienting experience for patients and their family members. The COVID-19 pandemic has further intensified this experience in addition to exacerbating clinician and resident burnout. To ameliorate some of these concerns, a team of resident and medical student trainees implemented a virtual shared medical appointment (vSMA) program for inpatients with acute cerebrovascular disorders and their caregivers. The authors hypothesized that an early intervention in the form of a vSMA improves patient and caregiver health literacy and preparedness while simultaneously educating clinical trainees on effective communication skills and reducing clinician burnout. METHODS: Patients and caregivers of admitted patients were identified through a census of neurosurgery, neurocritical care, and neurology electronic medical records. A weekly 60-minute secure virtual session consisted of introductions and a 10-minute standardized presentation on cerebrovascular disease management, followed by participant-guided discussion. Participants completed presession and postsession surveys. Through this small feasibility study data were obtained regarding present challenges, both expected and unforeseen. RESULTS: A total of 170 patients were screened, and 13 patients and 26 caregivers participated in at least 1 vSMA session. A total of 6 different healthcare providers facilitated sessions. The vSMA program received overwhelmingly positive feedback from caregivers. Survey responses demonstrated that 96.4% of caregivers and 75% of patients were satisfied with the session, 96.4% of caregivers and 87.5% of patients would recommend this type of appointment to a friend or family member, and 88.8% of providers reported feeling validated by conducting the session. The participant group had a 20% greater percentage of patients discharged home without home needs compared to the nonparticipant group. The primary obstacles encountered included technological frustrations with the consent process and the sessions themselves. CONCLUSIONS: Implementation of a vSMA program at a tertiary care center during a pandemic was feasible. Themes caregivers expressed on the postsession survey included better understanding of caring for a stroke patient and coping with the unpredictability of a patient's prognosis. The pandemic has precipitated shifts toward telehealth, but this study highlights the importance of avoiding marginalization of elderly and less technologically inclined populations.

Assessing Post-Acute Sequelae of COVID- 19 (PASC) in a Pilot Cohort of Patients Participating in Integrative Medical Group Visits

Methods: The first adapted IMGV was delivered as weekly twohour telehealth visits cofacilitated by a physician and yoga instructor over the course of 8 weeks (June to August 2021). Interviews were conducted with 16 patients, aged 22 to 67, prior to participation in the groups about their symptoms and experience with PASC. The perceived stress scale (PSS) was used to measure stress levels as well. Descriptive statistics were performed on quantitative data and qualitative data were analyzed using thematic content analysis. Results: The mean PSS score was 19.00 with a standard deviation of 5.52, which corresponds to moderate stress levels. Primary symptoms reported by patients include fatigue, shortness of breath, and brain fog. Patients reported factors that exacerbate symptoms include physical activity and stress related to work and everyday activities. Factors that improve symptoms included antiinflammatory diets and self-care activities. Feelings of frustration and anxietywere common as patients cannot quickly recover and there are no rapid treatments. Adaptations to this cohort of IMGV included discussions about COVID-related news and research, COVID vaccinations, PASC-related conditions, neuroplasticity, meditation practices, and nature-based resources that parallel resilience and growth. Background: With the rising number of patients experiencing the onset of Post-Acute Sequelae of COVID-19 (PASC), there is a need to find effective treatment options. The Integrative Medicine Group Visit (IMGV) is an evidencebased programusing complementary and traditional modalities in a group setting to treat patients with various conditions. The objective of this study is to assess the symptoms of patients diagnosed with PASC to adapt an existing IMGV model. Conclusion: By understanding the symptoms patients encounter with PASC, clinicians will be able to provide holistic care to meet the needs of each patient. The analysis from this pilot cohort will give clarity on a condition that currently has been hard to manage and treat.

Long COVID Shared Medical Appointments: Lifestyle and Mind-Body Medicine with Peer Support

Methods: We describe our novel shared medical appointment (SMA) program developed to provide lifestyle education, mindfulness training, and group peer support for patients with long COVID symptoms. Patients virtually attended two-hour weekly visits for six weeks. The SMAs are co-led by a medical provider and a holistic psychotherapist. Every session includes mindfulness practice and peer support with daily homework consisting of lifestyle goals and mindfulness practices. Our objective was to provide patients education and support to recuperate from Long COVID symptoms. For quantitative outcomes, we assessed pre-and post-intervention change in symptoms using Medical Questionnaire Symptom Score (MSQ) and Patient-Reported Outcomes Measurement Information System (PROMIS) Global -10 measures. We used a two-tailed paired t-test. Thematic analysis of patients' feedback of the program is reported. Results: Since May 2021, nine SMA cohorts have been conducted, and 64 patients have completed the program. We have analyzed 40 MSQ's to date, which shows significant improvement in symptoms (mean difference -16.4, P = 0.001). PROMIS-10 scores for 38 patients have been analyzed. Most patients show improvements in PROMIS-10 scores, but the findings were not statistically significant (p = 0.12). Patients felt educated, connected, and supported (“I amnot alone, I amnot crazy.” “This class gives me tools to help myself”). Background: Long COVID is a new rising health concern where patients have multiple distressing symptoms with no clear treatment guidelines. Early evidence indicates the role of cytokines and chronic inflammatory processes in developing long COVID. Healthy lifestyle behaviors and modifying stress responses reduce chronic systemic inflammation. Conclusion: Shared medical appointments with lifestyle education, mindfulness practices, and peer support can effectively support patients with Long COVID symptoms. We anticipate additional data from the current ongoing cohorts will demonstrate continued improvement in patient symptoms and possible significant improvement in PROMIS 10 scores.

PATIENT-REPORTED BARRIERS, FACILITATORS, AND ACCEPTABILITY OF CARE FROM A UNITED STATES OSTEOARTHRITIS MANAGEMENT PROGRAM

Purpose: Osteoarthritis (OA) is a chronic and disabling disease, affecting both morbidity and mortality. Prevalence is rising as the age and weight of the general population increase. Despite its high prevalence, nearly half of patients do not receive recommended treatments. Multiple barriers to receipt of evidence-based care have been identified and OA Management Programs (OAMPs) have been posited as an alternative care model to facilitate treatment. This mixed-methods study was designed to examine and evaluate patients’ perceptions of the acceptability and effectiveness of an OAMP at a U.S. academic medical center. Methods: Eligible patients included adults with knee or hip OA who completed at least one visit in the OAMP from July 1, 2017, to January 15, 2021 (n=938). These patients were divided into three groups based on the number of completed visits: 1 visit, 2-3 visits, or 4+ visits. Seventy patients from each group were randomly selected to receive a mailing that included: 1) the Osteoarthritis Quality Indicator (OA-QI) which queried receipt of guideline-recommended care;2) an invitation to participate in an interview regarding their OAMP care experience;3) the study’s informed consent document;and 4) an addressed, stamped envelope to return the completed OA-QI and consent form to investigators. Interviews of consenting patients were conducted in person or over the phone by a trained medical student who followed a semi-structured interview script. Interviews were recorded, transcribed, and analyzed using NVivo QSR 12, supplemented by a manual analysis to confirm themes. Results: Fifty-six patients (26.67%) completed the OA-QI and reported receiving an average of 13.24 (±2.85) of the 17 quality indicators. Thirty-four participants (60.7%) reported receiving at least 80% of the included quality indicators, 11 reported receiving 60-80%, and 11 (17.2%) reported receiving less than 60%. There was no statistical difference in OA-QI scores based on the number of OAMP appointments attended. Less than 60% of respondents reported being seen by a specialist for weight management. Every patient who returned the OA-QI had met with a registered dietitian for weight management as part of OAMP care. Seventeen patients (30%) reported not being referred to a joint specialist to evaluate for surgery for their severe symptoms. A total of 17 patient interviews were conducted, at which time data saturation was reached. Seventy-seven percent affirmed having had enough time to discuss their joint disease and treatment recommendations, 64.7% reported positive changes in their knowledge or beliefs about OA, and 64.7% had made at least some progress toward achieving their goals. Thirty percent cited a lack of proactiveness, motivation, or proper time management as barriers to starting or maintaining their treatment goals. Fifteen of the 17 participants responded to a query regarding confidence in self-managing their OA: 40% reported increased confidence, 40% reported no change, and one person reported a decrease. Two interviewees reported no change in confidence, but felt affirmed that they were “doing the right thing”. Rapport with providers was highly endorsed (88.2%), and telemedicine visits were mentioned as a mechanism for support and encouragement. Forty-one percent of interviewees had attended a group medical visit;non-attendance was attributed to distance to the clinic and group visit unavailability when COVID-19 arose. Fifty-nine percent of the interviewees endorsed a belief that OA could be managed without surgery;however, only 47% knew anyone who had successfully done so. Conclusions: Patients reported receiving a very high number of OA quality indicators, higher than reported in the literature for general populations. Interviewees were very satisfied with OAMP providers and nearly two-thirds affirmed positive changes in knowledge or beliefs regarding OA and progress toward meeting goals. Many patients did not recognize that the OAMP offers specialized care. They reported not receiving care from a specialist f r weight management despite having met with a registered dietitian. Others reported not being referred to a joint specialist to discuss surgery for their severe symptoms, although this discussion is a routine part of the OAMP’s services. These gaps in perception could potentially influence satisfaction and adherence. They suggest that improved communication regarding the OAMP’s specialized, evidence-based care may need to be provided. Additionally, many patients still believed that surgical intervention is an inevitable part of having OA, which may impede buy-in to minimally invasive OA management.