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1.
Malaysian Journal of Medicine & Health Sciences ; 19:205-214, 2023.
Article in English | Academic Search Complete | ID: covidwho-2218304

ABSTRACT

Introduction: This study measured the outcome of the Optimal Health Program (OHP) among frontline healthcare workers during the COVID-19 pandemic. The OHP is a wellness-based self-management intervention focused on well-being to gain optimal health. OHP is originally from Australia and has been translated, culturally adapted and branded as the Program Kesihatan Optimum Sanubari (SANUBARI). The program was conducted as a psychosocial intervention and the outcomes measured were self-efficacy, coping styles and well-being. Methods: Eligible participants were nurses who actively managed COVID-19 inpatients in Hospital Kuala Lumpur and committed to complete the intervention. Those who did not provide consent or had comorbidity, unstable medical or psychiatry illnesses were excluded. 43 nurses were recruited through convenience sampling method and completed outcome measures from General Self-Efficacy Scale, Brief COPE and WHO-5 Well-being Index, before and 1-month after the intervention. The OHP was conducted via group-based, using OHP Sanubari workbook with 5 weekly sessions by trained facilitators and lasted for 60 to 90 minutes per session. Results: Significant improvement was observed 1-month post intervention for self-efficacy (t(42)=5.64, p <0.001) and well-being(t(42)=2.14, p<0.05);different approach coping strategies(acceptance, use of informational support, positive reframing, active coping, and planning) and avoidant coping strategies(distraction, venting, denial, and substance use). Whilst, humor coping reduced significantly 1-month post-intervention (t(42)=3.66, p<0.05). Conclusion: This study reports the positive outcome of OHP on the mental health status of healthcare workers during the pandemic. This program can be considered as a tool towards optimal health throughout their career. [ FROM AUTHOR]

2.
Pharmacy Education ; 21:362-372, 2021.
Article in English | EMBASE | ID: covidwho-2218256

ABSTRACT

Background: Student-pharmacists forced into remote-learning by the COVID-19 pandemic participated in a Virtual Mock Trial (VMT). Objective(s): Feasibility of VMTs was assessed by evaluating student VMT performance, student perceptions on technology and overall experiences. Method(s): The VMT was implemented via video conferencing technology in April 2020. Faculty-judges and student-jurors observed/rated student performance using pre-established rubrics. A post-VMT survey was administered electronically. Descriptive analyses were performed, and Wilcoxon-Mann-Whitney tests were conducted to compare programmes. Result(s): Forty-six students from Programme A (East Coast, USA) and 89 from Programme B (West Coast, USA) participated in the VMTs. The faculty-judges' evaluation scores for student performance ranged from 85.0% to 96.7%, while the student-jurors' evaluation scores ranged from 68.3% to 100%. Student perceptions on the four categories regarding technology use all had means > 5 on a 7-Point Likert Scale. More than 79.0% of students rated their VMT experience positively (i.e. 6 or 7). Conclusion(s): VMT is feasible for the current pandemic remote-learning environment, and it could be replicated in other pharmacy or healthcare programmes to enrich students' active learning in virtual education. Copyright © 2021 FIP.

3.
Annals of Emergency Medicine ; 80(4 Supplement):S40, 2022.
Article in English | EMBASE | ID: covidwho-2176221

ABSTRACT

Study Objectives: To evaluate the impact of a general practitioner (GP) programme on low-acuity patient load (patient acuity scale P3 or P4) presenting at a participating emergency department (ED) of a regional public hospital in Singapore. Secondly, to analyse the appropriateness of participating GPs' referrals to ED based on programme criteria. Study Design/Methods: This is a descriptive observational study of a regionally implemented, government funded programme called GPFirst, from 2014 to 2019 (pre-COVID). In this programme, a patient attended to at a GPFirst clinic and subsequently referred to ED, will qualify for an ED attendance fee discount. Data are retrospectively collected from referral letters of GPs participating in the programme and the hospital's electronic health record system. Results/Findings: During the study period, 207 GPs were progressively enrolled. The annual number of low acuity attendances reduced from 62,213 in 2013 (pre-GPFirst) to 53,480 in 2019 even though the annual number of ED attendances increased gradually from 138,784 in 2014 to 141,072 in year 2019. Moreover, the annual proportion of low-acuity, self-referred cases decreased from 63.4% (39,425) in 2013 to 57.1% (30,528) in year 2019. The annual percentage of GPFirst referrals to the ED which meet referral appropriateness criteria increased from 94.5% (FY2014) to 97.6% (FY2019) and 98.0% (FY2020). Overall, the roll out of GPFirst appears to coincide with a reduction in low acuity patient load without compromising the appropriateness of GP referrals to the ED. Conclusion(s): A multi-faceted regional programme which included campaigned public education, regular GP continuous education, a supportive administrative team and financial incentive for patients, is able to reduce low acuity attendances. An ecosystem emerges which contributes to GPFirst's success. Further research is needed to evaluate safety and the effects of scaling this programme to a national level. No, authors do not have interests to disclose Copyright © 2022

4.
Pediatric Infectious Disease Journal ; 42(1):E39, 2023.
Article in English | EMBASE | ID: covidwho-2190917
5.
Orphanet J Rare Dis ; 17(1):430, 2022.
Article in English | PubMed | ID: covidwho-2162398

ABSTRACT

BACKGROUND: Preliminary data suggest that COVID-19 pandemic has generated a switch from face-to-face to remote care for individuals with chronic diseases. However, few data are available for rare and undiagnosed diseases (RUDs). We aimed to assess the impact of the COVID-19 pandemic on the activities of the French reference network for RUDs in 2020. RESULTS: In this longitudinal retrospective study, we extracted and analyzed the data of the French national registry for RUDs collected between Jan 1, 2019 and Dec 31, 2020. We compared the annual longitudinal evolution of face-to-face and remote care activities between 2019 and 2020 focusing on adult and pediatric patients. Compared to 2019, rare diseases (RD) care activities showed a decrease in 2020 (- 12%) which occurred mostly during the first lockdown (- 45%) but did not catch up completely. This decrease was mainly in face-to-face care activities. Telehealth activities showed a 9-fold increase during the first lockdown and was able to cover for one third of the decrease in RD activities. Finally, the total number of patients receiving care was lower in 2020(- 9%) with a drastic decrease of cases with newly confirmed diagnosis (- 47%). CONCLUSION: Although telehealth was quickly introduced during the COVID-19 pandemic, RUD patient care was strongly affected in France with a decline in the number of patients treated and new patients recruited. This is likely to result in delays in patient diagnosis and care over the next few years.

6.
J Sch Health ; 2022 Nov 21.
Article in English | MEDLINE | ID: covidwho-2137072

ABSTRACT

BACKGROUND: As the COVID-19 pandemic spread, school district administrators in the United States were faced with difficult decisions regarding the implementation of virtual or in-person learning to reduce risk of infection throughout student and staff populations. While a coordinated effort with surrounding districts would be most beneficial when encountering a highly infectious respiratory-based infectious disease, the determinants of type of education delivery is unclear. METHODS: Data from the Missouri Department of Elementary and Secondary Education assessing education delivery method at each school district across the state of Missouri (n = 514) from August 2020 were used. This cross-sectional study, using results from a school district-level survey, local COVID-19 rates, and community-level sociodemographic characteristics, conducted a spatially adjusted analysis of variance (ANOVA) to determine associations between education delivery type and geographic-level sociogeographic characteristics. RESULTS: Among Missouri school districts, 172 (33.4%) reported starting the 2020-2021 academic year with an in-person policy, 52 (10.1%) with a distant/virtual policy, 242 (47.1%) in-person with a distance option, and 48 (9.3%) with a blended policy. This study found districts with lower household income levels were less likely to offer students any virtual learning options. Additionally, community COVID-19 infection rates were not associated with the selection of virtual or in-person education delivery. CONCLUSIONS: These findings suggest the presence of a specific school policy was spatially random in regard to neighboring community policies, even when accounting for community characteristics. The efficacy of policy is likely to benefit upon application of a spatial framework when addressing a crisis fundamentally tied to location. Future planning that highlights and focuses on regional coordination for community resilience in the face of a pandemic should incorporate data sources that inform decisions made for families, students, and communities.

7.
Cureus ; 14(10): e29918, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2121001

ABSTRACT

OBJECTIVES: Determine the impact of Narcan administrations in Peoria County, IL on the number of overdose deaths by testing the statistical significance of the association between monthly Narcan reversals and overdose mortality. As well as re-shedding the light on the opioid pandemic post-COVID. METHODS: We collected data on Narcan reversals from hospital emergency departments, Emergency Medical Services (EMS), the County Sheriff's Office, local police departments, and other agencies that distributed and/or administered Narcan in Peoria County from January through December 2018. Data for the 2018 overdose mortality was collected through vital records at the Peoria City/County Health Department. RESULTS: Results from simple linear regression suggest that a significant proportion of the total variation in overdose mortality over 2018 was predicted by the Narcan reversals, F(1, 11) = 5.872, p< 0.05. Multiple R2 indicates that approximately 30.7% of the variation in overdose mortality was predicted by the Narcan reversals. If there were 0 Narcan reversals, there would be 8.362 overdose deaths per month. CONCLUSIONS: Narcan is known to save lives in cases of opioid overdose, and the need for increased administration campaigns is warranted to further battle the opioid epidemic. As this study has proven, Narcan administration has the potential to significantly decrease overdose mortality.

8.
NeuroQuantology ; 20(10):9468-9476, 2022.
Article in English | EMBASE | ID: covidwho-2067327

ABSTRACT

Objectives: Some of the problems during the COVID-19 pandemic identified include delay in the distribution of contraception to the clients, and poor monitoring and evaluation of activities for the family planning program. These problems which occurred from task conflict would need to be managed so that the objectives of the family planning program could be achieved. The purpose of this study was to analyze the influence of conflict management on performance of family planning program Lamongan Indonesia. Methods: This was an observation study with a longitudinal prospective time series design. Thirty randomly selected teams from a total of 33 family planning program teams from both studied organizations in Lamongan were interviewed and observed. Structured questionnaires had been used while some data were obtained from the management. Data were then analyzed using liner regression. Results: There were few issues identified that had led to conflicts among the family planning program teams. The scored conflicts are in the unfavorable category with an average of 12.70 (t1), 13.13 (t2) and 13.73 (t3). Levene’s test showed that the data variants of conflict management for three periods were homogeneous (Sig. > 0.05). The beta coefficient value indicates that conflict management has a strong influence on inter-team family planning program performance of 0.581( p= 0.001). Conclusions: Conflicts between two organizations with the same goal should be managed as it can help to achieve the required performance. Policy on conflict identification and management should be developed in any health program.

9.
Pharmaceutical Journal ; 307(7956), 2022.
Article in English | EMBASE | ID: covidwho-2065014
11.
Kidney International Reports ; 7(9):S483, 2022.
Article in English | EMBASE | ID: covidwho-2041713

ABSTRACT

Introduction: For more than 75,000 years, tuberculosis (TB) has plagued humans over the planet. It is the greatest cause of infectious disease-related death worldwide, surpassing out HIV, though COVID-19 may overtake it. Approximately 1,200,000 individuals died as a direct result of this disease, and an additional 250,000 people who were HIV-positive died as a result of it, according to WHO estimates for 2018. Only eight nations, India (28%) China (9%) Indonesia (8%), Pakistan 6%, Nigeria 4% and Bangladesh 4%, account for two thirds of the world's TB infections, according to the World Health Organization (WHO) (3 percent) Needless to highlight India remains the top contributor for the disease. While Diabetes mellitus (DM) is one of the most common chronic disorders in our society. and incidentally India had been time and again given the name of Diabetic Capital of World. Interestingly animal models have been used to examine how hyperglycaemia affects the immunological response to M. tuberculosis, but a definite answer has not yet been established. Its widely accepted that DM is a risk factor for TB. Various published evidence point out that, if a person has both tuberculosis and diabetes, the risk of death increases. TB treatment results are negatively correlated with diabetes. Diabetes patients have a mortality risk ratio that is higher than that of the general population, even after correcting for age and other relevant confounders. Keeping in view of these facts and the paucity of published evidence when it comes to tribal hinterlands of Jharkhand we decided to do a cross sectional observation analysis of the Data avaialbel in Nikshay portal. Nikshay portal is Methods: District of Pakur in Jharkahnd was chosen as it is one of the districts sharing border with West Bengal, Bihar and Bangladesh is nearby.We used data from the adult population obtained from Nikshay portal for one year 2021, and divided into two subgroups. We conducted univariate analysis to find association of DM presence with different sociodemographic variables using chi square and unpaired t-test/Mann Whitney test for non -parametric data. Multivariable logistic regression models were used to predict the association of DM presence with epidemiological factors. Data was analysed using JASP software and p value <0.05 was considered statistically significant. Results: Out of 1687 registered TB patients we found 29 who were having Diabetes as co morbidity, Majority of them were male, while 19 of them were referred from private facility, three of them died and two were lost to follow up. Other predictors were found which increased the chances of having DM along with TB were middle age, and sex. Conclusions: As has been reported by others as well the problem of co infection of TB with DM is a reality and growing. The two programs are now being run under different heads which need to change. As seen most of the diabetics were from Private facilities meaning we might be missing more. More active case findings needs to be done so that no case of DM with TB is missed. Screening for DM among TB patients should be compulsory and treatment of co-morbidity should be included in adult health programmes. No conflict of interest

12.
Global Health ; 18(1): 64, 2022 06 21.
Article in English | MEDLINE | ID: covidwho-2038819

ABSTRACT

BACKGROUND: The rapid emergence and global spread of COVID-19 have caused substantial global disruptions that have impacted malaria programs worldwide. Innovative strategies to enable countries aiming to eliminate malaria as well as those that are already certified as malaria-free, are needed to address malaria importation in the context of the COVID-19 pandemic. China was certified as malaria-free in 2021 and now aims to prevent the malaria re-establishment. Nonpharmaceutical interventions such as entry screening, quarantining, and health education for individuals returning from international travel during the COVID-19 pandemic present both opportunities and challenges to the management of imported malaria. This study aimed to describe and analyze the operational challenges associated with an integrated surveillance and case management program in which malaria re-establishment prevention measures were incorporated into the COVID-19 program in China. METHODS: After the integration of malaria re-establishment prevention activities into the COVID-19 program for 10 months in Jiangsu Province, China, a focus-group discussion of public health workers working on preventing malaria re-establishment and controlling COVID-19 was held in June 2021, aiming to explore the operational challenges and lessons learned from the integrated approach. RESULTS: From 01 August 2020 to 31 May 2021, 8,947 overseas travelers with Yangzhou as the final destination underwent 14-day managed quarantine and 14-day home isolation. Of these travelers, 5,562 were from malaria-endemic regions. A total of 26,026 education booklets and materials were distributed to expand malaria-related knowledge. Twenty-two patients with unknown fever were screened for malaria with rapid diagnostic tests, and one patient was confirmed to have imported malaria. The challenges associated with the implementation of the integrated malaria surveillance and case management program include neglect of malaria due to COVID-19, lack of a standard operating procedure for malaria screening, mobility of public health providers, and difficulties in respecting the timeline of the "1-3-7" surveillance strategy. CONCLUSIONS: China's experience highlights the feasibility of integrated case surveillance and management of existing infectious diseases and new emerging infections. It also demonstrates the importance of a sound public health infrastructure with adequate, trained field staff for screening, testing, contact tracing, and providing health education, all of which are crucial for the success of both malaria re-establishment prevention program and the effective control of COVID-19.


Subject(s)
COVID-19 , Malaria , COVID-19/epidemiology , COVID-19/prevention & control , China/epidemiology , Humans , Malaria/epidemiology , Malaria/prevention & control , Pandemics/prevention & control , Quarantine
13.
HemaSphere ; 6:4034-4035, 2022.
Article in English | EMBASE | ID: covidwho-2032106

ABSTRACT

Background: ERN-EuroBloodNet was established in 2017 as the European Reference Network on Rare Hematological Disorders (RHDs) bringing together nationally recognized centres of excellence with the goal of promoting EU best health care in RHDs. ERN-EuroBloodNet has been recently enlarged integrating 103 HCP from 24 EU-MS. Aims: ERN-EuroBloodNet was conceived to contribute to innovative, efficient and sustainable health systems and facilitate access to better and safer healthcare for EU citizens while decreasing the cross-border health barriers. Methods: Since 2017, ERN-EuroBloodNet established the state-of-the art of RHD allowing the implementation of transversal and disease-specific strategies, where actions on very rare RHD were prioritized. Results: Profile. 182 expert profiles were created freely accessible. Expert centers follow 65,000 RHD patients and treat 5,000 new patients per year, while 24 patients requested support for cross-border health assistance. Expertise. The need to improve access to next-generation sequencing for non-oncological RHD and bone marrow transplantation for sickle cell disease (SCD) was identified. Also, significant disparities in the clinical practice of primary vitreoretinal lymphoma were found and we demonstrated that less than 30% of children with SCD benefit from adequate annual stroke risk monitoring. Guidelines. A repository of 68 Clinical Practice Guidelines (CPG) classified on quality of evidence and consensus approach was created. Recommendations for diagnosis and treatment of methemoglobinemia was published in collaboration with EHA. A CPG on Adult Burkitt Lymphoma is under development. Next topics focus long-term complications in hemoglobinopathies and patients' pathways&summary. Education. ERN-EuroBloodNet Webinars were launched for professionals with 26 Thursdays Webinars and 3 EBAH accredited Topic on Focus on Cutaneous Lymphoma, Thrombotic Microangiopathies, and Bone Marrow Failures. A collaboration was established for EHA & ERN-EuroBloodNet Spotlight on Castleman Disease. For patients, 3 Topic on Focus were launched for Myelodysplastic syndromes, SCD, and Cutaneous lymphoma. Past webinars are available at EuroBloodNet EDU Youtube channel. Preceptorships on SCD will be launched soon. Telemedicine. 43 complex cases have been inter-professionally discussed in the Clinical Patient Management System with 21 outcome reports delivered. Registries. 184 Registries were identified through the European Rare Blood Diseases Platform (ENROL), endorsed by the EHA. The ENROL project, which includes rare anemias, dendritic cell leukemia and von Villebrand's disease pilots, aims to collect exhaustive and therefore epidemiological data for RHDs. The final objective is a possibility of EU health planningl and the promotion of research by identifying cohorts of patients. ERNEuroBloodNet launched the collaborative platform on patients with red blood cells and COVID-19 containing so far 373 patients. Collaborations. collaborative research projects were encouraged like EC-funded projects i.e., genomics and personalized medicine in hematological diseases (GenoMed4All) and the properties and viability of erythrocytes (EVIDENCE), or the International Hemoglobinopathy Research Network (INHERENT) for genomic and phenotypic correlations. Summary/Conclusion: The implementation of well-defined strategies but above all adapted to the specific and not yet covered needs of RHD has led to the realization of concrete projects. This has laid the foundations to strengthen health systems in the field of RHD and allow them to flourish under the new EU4Health programme.

14.
Journal of the Formosan Medical Association ; 121(9):1617-1621, 2022.
Article in English | Scopus | ID: covidwho-2015654
15.
Annals of the Rheumatic Diseases ; 81:1873, 2022.
Article in English | EMBASE | ID: covidwho-2009098

ABSTRACT

Background: Systemic lupus erythematosus (SLE) prognosis is determined by a wide range of factors, such as the severity of the disease manifestations, the psychosocial aspects of patients, the proper management of comorbidities, adoption of a healthy lifestyle and adherence to treatment. Studies on chronic diseases highlight the value of patient education to foster treatment adherence and improve prognosis. Objectives: To promote health education to SLE patients and their families providing accessible and comprehensive Scientific information, in order to improve adherence to treatment and the patient's prognosis. Methods: The Waiting Room Project is linked to the Extension Health Care Program for SLE patients and their families of Universidade Federal de Minas Gerais, Brazil, since 2011. A total of 700 patients under SLE treatment at the Rheumatology Unit of the University Hospital are involved. Medical students and rheumatology fellows, altogether, developed high-quality informative texts, with clear content and layman language appropriate for the patient, under the supervision of the rheumatology professors. The texts are illustrated by the team of the Communication Department of the Medical School and medical students, and are printed in a leafet format. The material is handed out to the patients, while they wait for their medical appointment, by the students and the care team. The content of the leafets is discussed, making sure that all the concerns and doubts are properly addressed Results: The Waiting Room Project has produced 17 leafets, addressing different aspects of SLE, comorbidities, and treatment. The texts approach the traditional cardiovascular risk factors (Smoking, Arterial Hypertension, Diabetes, Obesity, Physical Activity), and some medical conditions related to general health and SLE treatment (Sun Protection, Healthy Food, Oral Care, Vaccination, Pregnancy, Osteoporosis). In 2020 and 2021, two leafets about Covid-19 were produced in order to clarify important aspects of this disease, its impact on lupus patients and to solve questions about SLE medications: one regarding the association between Lupus and Covid-19 and another about the treatment of lupus and Covid-19. Other four leafets were produced concerning SLE treatment, including Adherence to Treatment, the use of Antimalarials, Corticos-teroids, and Immunosuppressants. Information about the drugs, general importance on lupus treatment, recommendations and possible adverse events were described. Futhermore, additional content is currently in production with themes such as Intravenous Corticosteroid and Cyclophosphamide, Human Papilloma-virus Infection, Malignant Neoplasm, and specifc cancers frequently affecting women, such as Colorectal Cancer, Cervical Cancer, and Breast Cancer. The leafets are also available online on the Medical School website in Portuguese and in English (medicina.ufmg.br/alo/material-didatico/), on the Minas Gerais Rheumatology Society website (reumatologia.org.br/orientacoes-ao-paciente/), and on the Instagram page @lupusufmg Conclusion: The leafets have been an important source of information and health education for SLE patients and their families, improving student/physician-patient communication. Despite the adversities caused by the coronavirus pandemic, the Waiting Room Project has kept its purpose to make each patient with SLE an agent of their healthcare. Improving the patients' access to evidence-based information must be a goal of healthcare professionals that treat patients with SLE.

16.
Surgery for Obesity and Related Diseases ; 18(8):S49, 2022.
Article in English | EMBASE | ID: covidwho-2004514

ABSTRACT

Peter Ng Raleigh NC1, Afton Carducci Raleigh NC1, Lindsey Sharp Raleigh NC1, Dustin Bermudez Raleigh NC1, Linda Youngwirth Durham NC1, Tricia Burns Raleigh NC1, Erica McKearney Raleigh NC1, Lauren Massey Raleigh NC2 UNC Rex Bariatric Specialist1 UNC REX Hospital2 Introduction: The COVID-19 pandemic stressed inpatient hospital capacity and restricted elective surgery, limiting bariatric access. A novel outpatient home health program was introduced to support early discharge after bariatric surgery and preserve inpatient healthcare resources for COVID. This retrospective study evaluates the clinical/financial impact of enhanced home health in early post-operative bariatric recovery. Methods: Our program offered enhanced home health (EHH) to all bariatric patients with insurance inclusion. Patients were separated into 3 care tiers based on BMI and comorbidity with each tier adding complementary services. Tier 1 provided home intravenous hydration, anti-emetics x 3 days, and home nursing care. Tier 2 (BMI>50 kg/m2) added physical therapy. Tier 3 (plus comorbidity) added virtual primary care medical consultation. Patients were planned for scheduled discharge on post-operative day one by 10 am, if deemed medically appropriate. Results: From December to June 2021, 355 bariatric cases were performed, 158 non-EHH patients and 197 EHH patients with the following combined case mix: duodenal switch (54.6%), revision (17.2%), sleeve gastrectomy (16.6%), SADI-S (7.7%), and Roux-en-Y gastric bypass (3.9%). The prior year average hospital length of stay (LOS) was 2.0 days, non-EHH LOS of 2.0 days, versus EHH LOS of 1.5 days. A 6% reduction in direct variable costs per case was demonstrated, $9607 non-EHH versus $9036 EHH. Comparative readmission rates for nausea/vomiting/dehydration (NVD) equaled 3.8% for non-EHH and 1.5% for EHH patients. Conclusion: Enhanced home health preserved access to bariatric care while decreasing length of stay, variable costs, and reduced readmission for NVD.

17.
Journal of General Internal Medicine ; 37:S284-S285, 2022.
Article in English | EMBASE | ID: covidwho-1995782

ABSTRACT

BACKGROUND: The COVID-19 pandemic magnified the digital health divide among marginalized populations when health systems scaled back inperson visits as a public health precaution. We conducted this qualitative study during the pandemic to solicit patient and provider perceptions of use of digital health programs (patient portals, telemedicine, remote hypertension/diabetes monitoring) and to inform strategies to surmount barriers to accessing remote care. METHODS: We conducted semi-structured interviews with 40 patients and 29 primary care providers (PCPs) from northern and southeastern Louisiana who were recruited within an integrated delivery health system and an FQHC between May and July 2021. We used constant comparative method of grounded theory to identify themes. Commonalities/differences in perspectives between patients and PCPs were analyzed. RESULTS:Most patients recruited to the study self-identified as Black (68%), female (73%), mean age 51, lived in an urban area (77%), and had Medicaid (58%). Most PCPs were White (79%), male (52%), mean age 39, and reported Medicaid as the predominant insurer (59%). Most patients reported using smartphones for accessing the internet for health and non-health activities. Some participants used apps to track their health but noted internet/data/storage limits. PCPs noted increased uptake of misinformation on the internet prompting them to proactively recommend websites and apps. Most patients had used a patient portal and reported convenience of messaging their PCP, getting refills, scheduling appointments, and reviewing test results. PCPs noted a concurrent increase in their in-basket workload with a particular concern for frequent messaging like cellphone texting. Most patients had telemedicine video visits using their smartphones - some of which converted to audio when technology problems arose. Patients and PCPs noted telemedicine is appropriate for routine follow-up but preferred in-person visits. PCPs noted additional workflow disruption when moving from in-person to video visits in the same clinic session. Few patients were enrolled in a digital health program for remote monitoring;however, patients and PCPs agreed these programs provide valuable adjuncts to chronic care. PCPs reported patient limitations in accessing such programs due to the need for smartphones/internet/WiFi and select insurance coverage which can lead to further disparities in access to care. CONCLUSIONS: Health policies that support broadband/internet/ smartphone service as a standard utility and insurance coverage for digital health programming are paramount for surmounting major patient barriers. Clinical practice procedures which optimize technical support for patients and providers are also needed. RESULTS: Of the 236 women in the study, there was a mean age of 66.5 years ± 7.1;67 self-identified as Black, 93 as White, 49 as Hispanic and 16 as Other. Median CA anxiety score was 3 while DM anxiety score was 2.5 (p<0.001). For the anxiety groups, 67 (28%) were in the high CA/high DM group, 52 (22%) in the high CA/low DM group, 15 (6%) in the low CA/high DM group, and 94 (39%) in the low CA/low DM group. Participants in the high CA/low DMand low CA/low DMgroups were more likely to adhere to a healthy diet (73% and 71% compared with 51% for high CA/high DM and 53% for low CA/high DM, p= 0.02). They also had an increased likelihood of consuming at least 5 servings of fruits and veggies daily (69% and 57% vs. 45% for high CA/high DM and 40% for low CA/high DM, p= 0.03) and adhering to oral DM medications (62% and 75% vs. 52% for high CA/high DM and 20% for low CA/high DM, p= 0.05). CONCLUSIONS: Older breast cancer survivors with DM have different levels of anxiety about CA versus DM and those with high DM anxiety are less likely to adhere to DMSMBs. Our findings suggest that increased anxiety might hinder one's ability to achieve disease control, making anxiety management vital to supporting patient adherence and health.

18.
Journal of General Internal Medicine ; 37:S561, 2022.
Article in English | EMBASE | ID: covidwho-1995681

ABSTRACT

STATEMENT OF PROBLEM/QUESTION: The United States healthcare system is plagued by rising healthcare costs, variable care quality and patient outcomes, and highly fragmented service delivery with many transitions of care. Mobile integrated healthcare (MIH) programs can add value by bringing healthcare to patients' homes. DESCRIPTION OF PROGRAM/INTERVENTION: The aim of our MIH program is to bring medical resources to patients' homes to increase the availability and intensity of medical care at vulnerable times, during which patients have high risk of escalation of care to an emergency department (ED) or hospitalization. Patients must be age ≥17, live within a 3-county area, and have medical needs that require significant surveillance or would otherwise necessitate hospitalization. Once referred, a MIH paramedic (MIH-P) schedules and performs an in-home visit. MIH physicians are available for phone or video consultation. Primary exclusions include unsafe living environment or homelessness and active substance use disorder. Insurance is not a consideration. The program received an initial startup grant from Blue Cross Blue Shield and financial support for operations is primarily provided by Henry Ford Health System. MEASURES OF SUCCESS: Outcome measures are tracked with an interactive dashboard. Process measures include time from referral to patient visit, percent of competed referrals, number of interventions performed during home visits. Key outcome measures include number of subsequent ED visits and hospitalizations. FINDINGS TO DATE: From April 20, 2020 to December 31,2021, the MIH program received 4979 referrals and completed 3264 initial appointments (65.6% of referrals received) with a total of 5528 encounters completed. Referrals came from providers in the ED (42.3%), internal medicine inpatient and outpatient (27.2%), family medicine (4.1%), a COVID monoclonal antibody infusion program (18.6%), and medical/ surgical specialists (7.2%). Average travel time was 20.3 minutes and average time on scene was 69 minutes. Approximately 55.2% of patients had an estimated income of ≤ $41,000 based on US Census data. About 44.1% of patients were age ≥ 70. Patients were 49.7% non-Hispanic Black, 36.8% non-Hispanic White, 1.8% Asian/ Middle Eastern, 0.2% Hispanic, 11.4% other/ unknown/ declined. Of all MIH encounters, there was a 23.7% ED visit rate within 90 days (34% within 7 days, 30% 8-30 days, 36% 31-90 days) and a 10.5% hospitalization rate within 90 days (40% within 7 days, 24% 8-30 days, 36% 31-90 days). KEY LESSONS FOR DISSEMINATION: Implementation and success of our MIH program relied on a group of dedicated paramedics, health system investment, and continued outreach to referring providers. Promoting sustainability will require continued efforts to demonstrate value of the program and to obtain reimbursement for the valuable and unique services provided by MIH.

19.
Journal of General Internal Medicine ; 37:S573, 2022.
Article in English | EMBASE | ID: covidwho-1995678

ABSTRACT

STATEMENT OF PROBLEM/QUESTION: Even though they face a higher risk of COVID-19-related morbidity and mortality, racial and ethnic minorities in the Greater Boston area have had less access to COVID-19 testing and vaccinations. DESCRIPTION OF PROGRAM/INTERVENTION: We implemented a novel, community-based mobile health unit program by repurposing transportation vans with COVID-19 testing equipment, preventive hygiene kits, and mRNA vaccines. Our goal was to expand testing and vaccine availability in highly affected communities in the Greater Boston area. We used a “double equity” model by hiring workers from a local transportation company whose staff were at risk of unemployment. The vans were staffed with racially/ ethnically diverse and multilingual staff, including members of the target communities themselves. We incorporated a system of “trusted messengers” to answer questions about COVID-19 and in particular, vaccination from the community. We implemented this program with crucial input from community-based organizations and municipal public health departments. Van location sites were guided by community partners, in some cases incorporating SARS-CoV-2 wastewater surveillance data to meet rapidly changing community needs. MEASURES OF SUCCESS: Our goals were to (1) demonstrate the feasibility of a COVID-19 testing program guided by community partnerships and SARS-CoV-2 wastewater surveillance data;(2) improve access to COVID-19 testing in underserved communities;and (3) improve access to COVID-19 vaccination among racial/ethnic minorities. We collected ongoing feedback (e.g. through the local community advisory groups etc) on the mobile health program from community partners, patients, and staff. We compared sociodemographic characteristics of mobile health participants with the general population of the state of Massachusetts and the population of the target communities. FINDINGS TO DATE: From January 2021 - January 2022, our mobile health units have tested greater than 4500 persons in predominantly low socioeconomic communities that have been highly impacted by the pandemic. From May 2021 - January 2022, we vaccinated 5480 persons in these communities. An analysis of our program from January 2021 - January 2022 demonstrated that mobile health unit participants receiving COVID-19 vaccines were significantly more likely to be non-White and Hispanic compared with the general vaccinated population of the state of Massachusetts and of the target communities, and these findings were statistically significant. We also found that the mobile health units vaccinated more youth and adolescents in the target community compared with the general state vaccination data. KEY LESSONS FOR DISSEMINATION: Delivery of preventive COVID19 care via mobile health units is feasible and associated with high usage from affected communities when implemented with high stakeholder engagement and expertise from local public health departments. Employing diverse, multilingual, and well-trained healthcare staff as trusted messengers likely improved COVID-19 vaccine uptake in this population.

20.
Journal of General Internal Medicine ; 37:S635-S636, 2022.
Article in English | EMBASE | ID: covidwho-1995636

ABSTRACT

SETTING AND PARTICIPANTS: Our goal was to create an interactive inpatient electronic health record orientation session with our incoming house officers and assess their confidence level in completing common daily tasks. We also strived to improve new house officer work flow, with hopes in leading to fewer work hour violations and coding queries in their first month of training. DESCRIPTION: We developed a 2-hour, interactive inpatient electronic health record (EHR) curriculum that our new internal medicine house officers completed prior to starting their residency training. The curriculum included how to log into the EHR, create patient lists, navigate and customize a patient's chart, placed admissions orders, generate a H&P note, update problem lists, generate daily Progress notes, update Hospital courses, place discharge orders, and how to execute transfers. We surveyed the interns on their confidence level of performing the above tasks before, immediately after, and 1 month after completing the course. We also compared the number of work hour violations and number of coding queries of the 2021 incoming house officers to the 2019 incoming house officers (similar rotation scheduling and excluding the coronavirus-2019 pandemic of 2020) who did not complete a programspecific EHR orientation curriculum. EVALUATION: We found that new house officer confidence in completing all EHR tasks significantly improved immediately after the training session, including improved confidence in use of the EHR (3 [2-4] vs 4 [3.75-5, p<0.001), input of past medical history (3 [2-4] vs 4 [4-4], p<0.001) and home medications (2 [1-3] vs 4 [3.75-4], p<0.001), and completion of thorough discharge summaries (2 [2-3] vs 4 [3-4], p<0.001). Confidence level was maintained on reassessment one month later. When assessing 8-hour work violations, we saw a decrease from 15 violations in 2019 down to 1 in 2021 (p<0.001). There was also no statistical difference in average number of hours worked per week between the two groups. In 2019, new house officers averaged 60.9 hours per week, while in 2021 they averaged 60.8 hours per week (p=0.99). Neither group had any violations of average 80- hours per week. Total number of coding queries for resident documentation significantly improved across the first month of resident rotations on General Internal Medicine units in July 2021 as compared to 2019 (-9.12, p=0.001). DISCUSSION / REFLECTION / LESSONS LEARNED: The incorporation of an interactive inpatient EHR curriculum specific to our health program's EHR system significantly improved our new house officer confidence levels prior to starting their rotations. The curriculum significantly improved their daily work flow by showing a decrease in the number of 8-hour work violations with no impact on the average hours worked weekly by our new house officers, and a decrease in coding queries.

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