Clinician-initiated written communication for families of patients at a long-term acute care hospital

Objective To assess the experience of families and clinicians at a long term acute care hospital (LTACH) after implementing a written communication intervention. Methods Written communication templates were developed for six clinical disciplines. LTACH clinicians used templates to describe the condition of 30 mechanically ventilated patients at up to three time points. Completed templates were the basis for written summaries that there were sent to families. Impressions of the intervention among families (n = 21) and clinicians (n = 17) were assessed using a descriptive correlational design. Interviews were analyzed using thematic content analysis. Results We identified four themes during interviews with families: Written summaries 1) facilitated communication with LTACH staff, 2) reduced stress related to COVID-19 visitor restrictions, 3) facilitated understanding of the patient condition, prognosis, and goals and 4) facilitated communication among family members. Although clinicians understood why families would appreciate written material, they did not feel that the intervention addressed their main challenge – overly optimistic expectations for patient recovery among families. Conclusion Written communication positively affected the experience of families of LTACH patients, but was less useful for clincians. Innovation Use of written patient care updates helps LTACH clinicians initiate communication with families.

Effects of triple combination therapy on quality of life and psychosocial outcomes: A longitudinal study

Background: Cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulator triple combination therapy (TCT) is available to approximately 85% of the U.S. CF population. Clinical trials of TCT demonstrate numerous improvements in physical health and healthrelated quality of life (HRQoL), but fewstudies have examined the effects of TCTon mental health and psychosocial outcomes, and little is known about whether gains in HRQoL are sustained over time.We aimed to describe the HRQoL and psychosocial outcomes of people with CF (PwCF) initiating TCT and explored changes in these outcomes up to 1 year after starting TCT. Method(s): This longitudinal study enrolled PwCF aged 14 and older who were followed at a large, combined pediatric and adult CF center. Questionnaires were administered within 6 months of initiating TCT (baseline) and 3, 6, and 12 months later. Study self-report measures evaluated were HRQoL (Cystic Fibrosis Questionnaire-Revised;CFQ-R), optimism, self-efficacy, medication-related beliefs (Medication Beliefs Questionnaire;MBQ), perceived social stigma of illness, and body image. Data were also collected from medical charts on measures of health and mental health screening. Four open-ended questionswere included at each timepoint to elicit qualitative data on experiences starting TCT. Longitudinal data were analyzed using linear mixed-effects models for repeated measures. Result(s): Sixty-three adults and adolescents with CF completed the full set of surveys at baseline. Mean participant age was 30.0 +/- 14.2. Fifty-four percent identified as female, 43% as male, and 2% as nonbinary. Seventyfour percent had private insurance. Mean percentage predicted forced expiratory volume in 1 second (FEV1pp) at baseline was 76.0 +/- 24.1%, and mean body mass index (BMI) was 22.9 +/- 3.1 kg/m2. At 12 months, mean FEV1pp was 80.8 +/- 21.9%, and mean BMI was 24.5 +/- 4.1 kg/m2. On standard measures used in CF mental health screening, mean baseline Patient Health Questionnaire (PHQ-9) score was 3.4 +/- 3.5, and mean General Anxiety Disorder score was 3.4 +/- 3.7. Mean PHQ-9 (3.5 +/- 4.0) and GAD-7 (3.4 +/- 3.7) scores at 12 months were similar to baseline. We found no statistically significant differences between the survey time points in participants' physical, respiratory, or emotional functioning on the CFQ-R, but there was a significant change in social functioning ( p < 0.001). There was no statistically significant change over time in optimism or selfefficacy, but there was a significant difference in CF medication beliefs between the four survey time points ( p = 0.008 for MBQ Importance subscale), with a decrease in perceived importance from baseline to 12 months. Conclusion(s): Whereas lung function and BMI increased in our sample by 12 months, similar improvementswere not seen in standard mental health outcomes. There was no change over time in physical, respiratory, or emotional functioning, optimism, or self-efficacy. Only CFQ-R social functioning had changed by 12 months, perhaps reflecting decreased COVID-related social isolation. There was also a change in medicationrelated beliefs, with a decrease in perceived importance of taking CF medications at 12 months. Future directions include conducting qualitative analyses of open-ended questions and further examining data on social stigma, motivation to take medications, and body image, as well as examining relationships between outcome variables and baseline FEV1 and BMICopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.

PURPOSE: Our study examined whether telemedicine use in primary care is associated with risk factor assessment and control for patients with diabetes mellitus. METHODS: This was a retrospective, 1:1 propensity score matched cohort study conducted in a primary care network between February 2020 and December 2020. Participants included patients with diabetes mellitus, ages 18 to 75. Exposure of interest was any telemedicine visit. We determined whether hemoglobin A1c (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) were assessed for each patient. For each risk factor, we also determined whether the risk factor was controlled when they were assessed (i.e., last HbA1c < 8.0%, BP < 130/80 mmHg, LDL-C < 100 mg/dL). RESULTS: After 1:1 propensity score matching, we identified 1,824 patients with diabetes during the study period. Telemedicine use was associated with a lower proportion of patients with all three risk factors assessed (162/912 [18%], versus 408/912 [45%], p < 0.001). However, when individual risk factors were assessed, telemedicine use did not impact risk factor control. When compared with patients with in-person visit only, the odds ratio (OR) for HbA1c < 8% was 1.04 (95% CI 0.74 to 1.46, p = 0.23) for patients with any telemedicine visit. Similarly, the OR for BP < 130/80 mmHg was 1.08 (95% CI 0.85-1.36 p = 0.53), and the OR for LDL-C < 100 mg/dL was 1.14 (95% CI 0.76-1.72, p = 0.52). CONCLUSIONS: Telemedicine use was associated with gaps in risk factor assessment for patients with diabetes during the COVID-19 pandemic, but had limited impact on whether risk factors were controlled.

COVID-19 related worries and sleep disturbances in patients previously hospitalized with COVID-19 illness

Introduction: In patients hospitalized for COVID-19 illness, sleep disturbances after discharge may impact quality of life and prognosis. We examined the relationship of COVID-19-related worries with sleep disturbances in patients three months after COVID-19 hospitalization. Methods: Patients hospitalized for COVID-19 illness completed a survey three months post-discharge (n=153). We measured COVID- 19-related worry along two domains: worry directly related to the disease (COVID-illness worry) and worry related to the socioeconomic impact of the pandemic (COVID-impact worry). COVID-illness worry included worry regarding: 1) getting COVID again, 2) dying from COVID, 3) family members getting COVID, 4) losing a loved one to COVID, 5) unknowingly infecting others with COVID, 6) having significant financial burdens because of COVID. COVID-impact included worry regarding: 1) employment loss, 2) not having enough food, 3) not having access to medical care/medications, 4) not having access to mental health care/medications, 5) reduction in interactions with other people, 6) separation from family members, 7) being lonely. Patients rated how much they worried about each item on a 4-point scale (not at all, a little, moderately, extremely). Scores on each domain were summed to reflect overall severity. Past month sleep was assessed for insomnia symptoms (none, mild, moderate, severe, very severe) and self-reported sleep duration. Binary logistic regression was used to evaluate the association of COVID-illness worry and COVID-impact worry, separately, with sleep measures, adjusting for age, sex, race/ethnicity, and presence of persistent COVID-related symptoms. Results: The prevalence of insomnia (moderate, severe, or very severe symptoms) and short sleep duration (<6 h/day) was 47.0% and 39.2%, respectively. COVID-illness worry severity was significantly associated with presence of insomnia (OR: 1.91, 95% CI: 1.13-3.23, p=0.016) and short sleep (OR: 2.20, 95% CI: 1.25-3.86, p=0.006). In a separate model, COVID-impact worry severity was significantly associated with presence of insomnia (OR: 1.98, 95% CI: 1.23-3.19, p=0.005) and short sleep (OR: 2.11, 95% CI: 1.26-3.55, p=0.005). Conclusion: Sleep disturbances are common among patients previously hospitalized with COVID-19 illness, and COVID-19 related worries are associated with insomnia and short sleep. Additional research is needed to determine whether addressing COVID-19 related worries reduces sleep disturbance, which in turn may promote post- COVID recovery.