Impact of rapid infliximab infusions on access at a large academic tertiary medical center.

PURPOSE: Infliximab promotes remission in patients with inflammatory bowel disease (IBD) and rheumatologic disease (RD). Rapid infliximab infusions (RI) reduce infusion time from 2 hours to 1 hour and can enhance access to care, as defined by capacity, safety, and patient characteristics. Our hypothesis for the study described here was that use of RI can enhance access for patients. METHODS: Data on all patients receiving infliximab for IBD or RD at our outpatient infusion center from February 2016 to August 2017 were retrospectively analyzed. Demographic and clinical information were collected. RESULTS: Of 348 patients who received infliximab, 205 had IBD and 143 had RD. In terms of capacity, 40% of patients received RI, resulting in a 16.1% decrease in average daily infusion time and a 9.8% increase in average daily available scheduled infusion chair time (P = 0.720). In terms of safety, 4 patients switched back to standard infusions after RI, after 3 specifically had reactions to RI. In terms of patient characteristics, more patients with RD versus IBD received RI (P = 0.020). Among the patients with RD, a lower proportion receiving RI were female (P = 0.043). For the patients with IBD, a higher proportion receiving RI were White (P = 0.048). Among both patients with RD and patients with IBD, a higher proportion receiving RI had private insurance (P = 0.016 and P = 0.018, respectively). CONCLUSION: RI were safe and increased available chair time. Females with RD, patients of non-White race with IBD, and patients with public insurance were less likely to receive RI. Future directions include patient surveys and evaluation of implicit bias against patient factors that may impact access to RI.

Building Support for Place-Based Solutions to Childhood Obesity: Findings From Missouri.

BACKGROUND: Place-based efforts offer promise in reducing childhood obesity. Yet, lack of public demand and support may hinder implementation. AIMS: This study aimed to assess whether the emphasis on place-based solutions, community-wide strategies, and multisector engagement in the Healthy Schools Healthy Communities (HSHC) initiative would shift public views on obesity including the need for greater public involvement and an increase in awareness and support for strategies. METHOD: As part of the evaluation, two surveys were conducted-in 2014 and 2016-to examine the relationship between HSHC strategies and changes in public perception, support, and awareness of obesity. Both surveys were cross-sectional and conducted with a randomized sample of households. RESULTS: Most respondents indicated that parents/family (84.3% in 2014; 87.8% in 2016) and children (70.9% in 2014; 74.8% in 2016) had a large/very large responsibility for addressing childhood obesity. A higher percentage of 2016 respondents indicated willingness to work with others to increase availability of healthy foods (71.3% vs. 64.2%, respectively; p = .0280) and increase the number of places to be physically active in their community (71.1% vs. 60.7%, respectively; p = .0015). DISCUSSION: Findings suggest awareness and support of place-based efforts and willingness to engage may help garner ongoing support. However, individuals and families are still perceived as primarily responsible for addressing childhood obesity. Countering this mindset remains an ongoing challenge. CONCLUSION: Streamlined messaging regarding the issue and associated solutions, enhanced skills and capacity to implement these efforts, and citizen engagement to garner support for place-based initiatives are important.

Association between multi-component initiatives and physical activity-related behaviors: interim findings from the Healthy Schools Healthy Communities initiative.

BACKGROUND: Although successful, assessment of multi-component initiatives (MCIs) prove to be very challenging. Further, rigorous evaluations may not be viable, especially when assessing the impact of MCIs on long-term population-level behavior change (e.g., physical activity (PA) and health outcomes (e.g., childhood obesity). The purpose of this study was to use intensity scoring, to assess whether higher intensity MCIs implemented as part of Healthy Schools Healthy Communities (HSHC) were associated with improved physical activity and reduced sedentary behaviors among youth (dependent variables). METHODS: PA-related interventions were assigned point values based on three characteristics: 1) purpose of initiative; 2) duration; and 3) reach. A MCI intensity score of all strategies was calculated for each school district and its respective community. Multivariate longitudinal regressions were applied, controlling for measurement period, Cohort, and student enrollment size. RESULTS: Strategy intensity scores ranged from 0.3 to 3.0 with 20% considered "higher-scoring" (score > 2.1) and 47% considered "lower-scoring" (< 1.2). Average MCI intensity scores more than tripled over the evaluation period, rising from 14.8 in the first grant year to 32.1 in year 2, 41.1 in year 3, and 48.1 in year 4. For each additional point increase in average MCI intensity score, the number of days per week that students reported PA for at least 60 min increased by 0.010 days (p < 0.01), and the number of hours per weekday that students reported engaging in screen time strategies decreased by 0.006 h (p < 0.05). An increase of 50 points in MCI intensity score was associated with an average 0.5 day increase in number of weekdays physically active and an increase of 55 points was associated with an average decrease of 20 min of sedentary time per weekday. CONCLUSIONS: We found a correlation between intensity and PA and sedentary time; increased PA and reduced sedentary time was found with higher-intensity MCIs. While additional research is warranted, practitioners implementing MCIs, especially with limited resources (and access to population-level behavior data), may consider intensity scoring as a realistic and cost effective way to assess their initiatives. At a minimum, the use of intensity scoring as an evaluation method can provide justification for, or against, the inclusion of an individual strategy into an MCI, as well as ways to increase the likelihood of the MCI impacting population-health outcomes.