Ambulatory Care Facilities Research Articles

Identifying High-Cost, High-Need Patients in a Network of Community Hospitals.

We examined healthcare costs at HonorHealth, a community-based academic health center comprised of 5 hospitals and numerous ambulatory care facilities. Patient encounters that resulted in admission in 2019 were included in the study. Mean costs in 2019 for high costs and high needs (HCHN) patients were compared with all remaining patients using a framework developed by the National Academy of Medicine. HCHN patients were older (71 vs 52 years), with a lower percentage of females (41.7% vs 59.8%), more frequently White (90.1% vs 87.5%), less frequently married (52.4% vs 54.5%), with a longer length of stay (6.5 vs 3.0 days) and higher mean charges ($134 743 vs $16 414). The mean cost per patient in the HCHN group decreased by age group ($192, 963, $165 200, $144 584, $134 795, and $108 356) for 0 to 18, 19 to 44, 45 to 64, 65 to 84, and 85+ years, respectively. HCHN patients were more publicly insured (49% vs 38%). Targeted interventions to treat HCHN may lead to lower healthcare costs and improved health outcomes within this system.

Climate-related disaster impact on health care infrastructure in the USA

PurposeResearch on postdisaster health care accessibility and availability has largely focused on the short-term impacts of isolated disasters on specific health care services. We examined the distribution of health care facilities and climate-related weather disasters across counties in the United States across a 15-year period. MethodsLinking longitudinal data on disasters, health care, and demographic and socioeconomic characteristics, we created an annual panel dataset of counties in the United States from 2000 to 2014 (N = 3108). National Establishment Time Series data measured change in health care facilities, categorized into drug stores, hospitals, and ambulatory care. Using data from Spatial Hazards and Events Losses Database for the United States, we classified county-level disasters as moderate and severe. We used autoregressive linear models to estimate the per-capita number of health care establishments in 2014 associated with the total number of moderate and severe disasters (2000–2013), after adjustment for health care establishments, total population, and poverty in 2000. ResultsEach additional moderate disaster was associated with a significant increase in hospital infrastructure (0.14, 95% confidence interval [CI]: 0.02 to 0.25) while an increase in severe disasters was associated with a significant decrease in hospital infrastructure (−0.28, 95% CI: −0.45 to −0.12). Similar relationships were found with ambulatory care facilities (2.49, 95% CI: 0.89 to 4.09 and −5.78, 95% CI: −8.13 to −3.43, respectively). The association between disasters and drug store facilities was not statistically significant. ConclusionsGiven the increasing number and severity of climate-related disasters, the loss of health care facilities following severe disasters may lead to poor health outcomes, especially among vulnerable populations.

SWOT аналіз діяльності амбулаторних закладів охорони здоров'я київської області, які надають кардіологічну допомогу населенню

менеджмент в сфері охорони здоров’я передбачає стратегію управління як основні напрямки розвитку організації і шляхи досягнення її цілей зміцнення, зростання та виживання в довгостроковій перспективі на основі концентрації зусиль на визначених пріоритетах та у взаємодії із зовнішнім середовищем. Головною метою цього напрямку виступає підвищення доступності та якості надання медичних послуг для населення. Метою нашого дослідження був SWOT-аналіз оцінки діяльності амбулаторно-поліклінічних закладів (АПЗ) Київської області, які надають кардіологічну допомогу населенню, як спосіб стратегічного, економічного аналізу в управлінні закладом охорони здоров'я. Аналітичний метод дослідження механізмів та можливостей реалізації метода SWOT-аналізу при оцінці діяльності медичних закладів базувався на використанні системного підходу та економічного аналізу. Використання цього методу дає можливість знаходити нові шляхи для подальшого розвитку установи для забезпечення її конкурентоспроможності на ринку медичних послуг. У статті на підставі SWOT-аналізу представлені сильні і слабкі сторони амбулаторно-поліклінічних закладів (АПЗ) Київської області, які надають кардіологічну допомогу, а також визначено можливі загрози та реальні можливості в їх діяльності. Визначені основи для реалізації SWOT-аналізу у системі охорони здоров'я. Показано, що матриця SWOT-аналізу стосовно закладів охорони здоров'я включає в себе всю інформацію про наявність технологій діагностики і лікування, про структуру і склад організації, в тому числі про рівень підготовки медичних кадрів. За допомогою SWOT-аналізу розкриті існуючі проблеми в охороні здоров'я пацієнтів із хворобами системи кровообігу (ХСК) в регіоні і шляхи їх вирішення. Обґрунтовані основні принципи розвитку амбулаторно-поліклінічних закладів (АПЗ), де ключовим є впровадження механізмів державно-приватного партнерства (ДПП) у сфері охорони здоров'я. SWOT-аналіз є перспективним напрямком дослідження діяльності системи охорони здоров'я, який дозволяє закладу охорони здоров’я своєчасно адаптуватися до мінливих умов і факторів зовнішнього середовища, та найбільш ефективно розподіляти та використовувати надані ресурси. Це дозволяє замінити адміністративно-командний підхід до забезпечення якості медичної допомоги підходом, що базується на принципі управління процесом. Проведення SWOT-аналізу забезпечує облік усіх можливих факторів, які можуть впливати на рівень якості надання медичних послуг, безпеку пацієнтів, виявлення дефектів, причин цих дефектів та, у висновку, сприяння стратегічному реформуванню системи охорони здоров'я.

Association of sugammadex reversal of neuromuscular block and postoperative length of stay in the ambulatory care facility: a multicentre hospital registry study

BackgroundEncapsulation of rocuronium or vecuronium with sugammadex can reverse neuromuscular block faster than neostigmine reversal. This pharmacodynamic profile might facilitate patient discharge after ambulatory surgery. MethodsWe included patients who underwent ambulatory surgery with general anaesthesia and neuromuscular block between 2016 and 2021 from hospital registries at two large academic healthcare networks in the USA. The primary outcome was postoperative length of stay in the ambulatory care facility (PLOS-ACF). We examined post hoc whether the type of reversal affects postoperative nausea and vomiting and direct hospital costs. ResultsAmong the 29 316 patients included, 8945 (30.5%) received sugammadex and 20 371 (69.5%) received neostigmine for reversal. PLOS-ACF and costs were lower in patients who received sugammadex vs neostigmine (adjusted difference in PLOS-ACF: –9.5 min; 95% confidence interval [95% CI], –10.5 to –8.5 min; adjusted difference in direct hospital costs: –US$77; 95% CI, –$88 to –$66; respectively; P<0.001). The association was magnified in patients over age 65 yr, with ASA physical status >2 undergoing short procedures (<2 h) (adjusted difference in PLOS-ACF: –18.2 min; 95% CI, –23.8 to –12.4 min; adjusted difference in direct hospital costs: –$176; 95% CI, –$220 to –$128; P<0.001). Sugammadex use was associated with reduced postoperative nausea and vomiting (17.2% vs 19.6%, P<0.001), which mediated its effects on length of stay. ConclusionsReversal with sugammadex compared with neostigmine was associated with a small decrease in postoperative length of stay in the ambulatory care unit. The effect was magnified in older and high-risk patients, and can be explained by reduced postoperative nausea and vomiting. Sugammadex reversal in ambulatory surgery may also help reduce cost of care.

1 Ambulatory care visits and admissions for suicidal ideation and self-harm in Canadian adolescents during the COVID-19 pandemic: a population-based analysis

Abstract Background The COVID-19 pandemic has challenged the resiliency of Canada’s adolescent population. Understanding changes in mental healthcare utilization can shed light on the impact the pandemic has had on Canada’s youth. Objectives To assess if during the pandemic there has been an increase in the proportion of ambulatory care visits and admissions for suicidal ideation and self-harm among adolescents. Design/Methods This was a population-based, interrupted time-series analysis of adolescents 10-18 years presenting to an ambulatory care facility (including emergency department) or admitted to a healthcare facility with R458 (suicidal ideation and emotional symptoms), X60-69 (intentional self-poisoning), and X70-84 (intentional self-harm) codes based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA). We used the National Ambulatory Care Reporting System, Discharge Abstract Database, and Hospital Morbidity Database. The primary outcome was ambulatory care visits for a composite of suicidal ideation, intentional self-poisoning, and intentional self-harm. Results were stratified by age and sex and expressed as a rate (proportion of encounters with an outcome per 100 encounters). We compared the differences (delta) in slopes (average increase in outcomes) between April 1, 2015, to March 31, 2020, and April 1, 2020 to March 31, 2021 to determine if the expected rate (pre-pandemic) differed significantly from the observed rate (pandemic). Results From April 1, 2020, to March 31, 2021, compared to April 1, 2015, to March 31, 2020, the rate of ambulatory care visits and admissions for all conditions decreased. The average quarterly rate of ambulatory care visits for the composite among males 10-14 years, increased by 40.3%, from 0.57 to 0.8 (slope delta=0.1; 95% CI: 0.02, 0.18; p=0.012). Among females 10-14 years, the rate increased by 85.1%, from 1.81 to 3.35 (slope delta=0.7; 95% CI: 0.43, 0.97; p&amp;lt;0.001). Among males 15-18 years, the rate increased by 29.5%, from 1.56 to 2.02 (slope delta=0.13; 95% CI: -0.02, 0.28; p=0.078). Among females 15-18 years, the rate increased by 33.6%, from 3.18 to 4.25 (slope delta=0.26; 95% CI: -0.16, 0.68; p=0.192). The average quarterly rate of admissions was significant for females 10-14 years and increased by 27.7%, from 8.59 to 10.97 (slope delta=1.99; 95% CI: 0.57, 3.41; p=0.017). Conclusion The proportion of ambulatory care visits and admissions for emotional symptoms, suicidal ideation, and self-harm during the first year of the COVID-19 pandemic increased compared to pre-pandemic rates among adolescents 10-14 years in Canada. Our findings underscore the importance of promoting public health policies that mitigate the impact of pandemics on adolescent mental health.

Financial management and perioperative leadership in the ambulatory setting journal title: Best practice in clinical research.

A large portion of US healthcare is ambulatory. Strong leadership is vital for the safety and efficiency of perioperative patients in this setting. Good leaders communicate respectfully and openly and ensure effective systems in the delivery of high-level healthcare. In general, to promote patient safety and treatment efficacy, ambulatory care leaders must improve communication. Effective administration is unattainable without leadership and communication in an operating room. When considering outpatient perioperative therapy, it is equally crucial to consider medical costs. Given the unsustainable rate of healthcare spending growth, all attempts to improve our present systems are necessary. Ambulatory care facilities must utilize data regarding resource consumption to be financially viable related to escalating expenses. The present review describes perioperative and financial leadership in the ambulatory setting, effective systems, and relevant clinical strategies.

SARS-CoV-2 infections and attitudes towards COVID-19 vaccines among healthcare workers in the New York Metropolitan area, USA

ObjectiveBecause of their increased interaction with patients, healthcare workers (HCWs) face greater vulnerability to COVID-19 exposure than the general population. We examined prevalence and correlates of ever COVID-19 diagnosis and...

Walk the Talk: A Program Model of Community-Oriented Primary Health Care

While there is a dearth of value-based primary care services in low- and middle-income countries, primary care has been demonstrated to be associated with enhanced access to health services and better health outcomes. The demonstrated barriers to high-quality primary care are under-resourcing, inadequate payment models, lack of community linkages, limited scope and comprehensiveness, limited integration with other components of the health system, and unexciting/unattractive conditions for physicians. Based on global data, we propose a transformative community-oriented primary care program model with a network of ambulatory, virtual, and comprehensive community services. Community-oriented primary care is medical practice that undertakes responsibility for the health of a defined population. Key components of this medical service program are 1. Community health workers (CHWs) responsible for specific populations, with expanded portfolios to provide communicable and noncommunicable disease home health care, health education, and disease registry maintenance; 2. A 24/7 virtual care service to back up and supplement CHW activities; 3. A primary care ambulatory service facility with major paraprofessional-specialist conduct of routine processes and record-keeping utilizing algorithmic guidelines; 4. Multiple point-of-care diagnostic capacities and immediate tele-consults for both ambulatory facility and CHW services; 5. A customized interoperable electronic medical record system, focused on patient care functionalities such as charting and decision-support; 6. Wireless broadband connections for all program workers; and 7. Sustainable economics with revenue from locally determined subscription systems, sliding scale fees for services from ambulatory care facilities, limited CHW service fees, core per capita government support, research projects, and philanthropy.

969-P: Changes in Patterns of Care in Diabetes via Virtual Care Delivery Prior to and During COVID-Pandemic

Background: The COVID-pandemic and virtual care has impacted the care delivery of many health care conditions including diabetes. This study aimed to compare how patterns of care for diabetes have changed as a result of virtual care and the COVID-pandemic at a large academic ambulatory care facility in Toronto, Canada. Methods: Patients were included who had an initial diabetes visit between September 15, 20 and September 20, 2020. Fisher's exact test was used to determine differences in care patterns between visits pre and during COVID- (after March 14, 2020) . Results: Pre-COVID-19, there were 240 (72.7%) completed initial visits and 90 (27.3%) follow-up visits, including 27.5% and 36.7% for type 1 diabetes, respectively. During COVID-19, there were 235 (44.1%) initial visits and 298 (56%) follow-up visits including 29.4% and 27.2% for type 1 diabetes, respectively. Including all visits, there were more no-shows during COVID-19, 4.5% vs. 1.5%; p&amp;lt;0.05. Out of 330 pre-COVID-visits, all (100%) were done in-person. During COVID-19, out of 533 visits, 89.3% were done by phone, 7.5% by video, and only 3.2% in-person. Conclusion: During COVID-19, there were more follow-up diabetes visits seen compared to initial visits and more no-shows. Most diabetes visits were done by phone during COVID-19. More data is needed to understand how diabetes care delivery has changed as a result of virtual care during COVID-19. Disclosure P.Palcu: None. G.Mukerji: n/a. C.Chu: None. C.Pendrith: None.

Regional Differences in Antibiotic-resistant Enterobacterales Urine Isolates in the United States: 2018-2020

Antimicrobial resistance (AMR) can complicate effective management of urinary tract infections. We conducted a retrospective study of AMR in Enterobacterales urine isolates from ambulatory and hospitalized adult patients from 2018-2020 (BD Insights Research Database) to evaluate regional differences in isolates with an extended-spectrum beta-lactamase-producing phenotype and those not susceptible to beta-lactams, fluoroquinolone (FQ), nitrofurantoin (NFT), trimethoprim/sulfamethoxazole (TMP/SMX), or multiple antibiotic classes (≥ 2 or ≥ 3). Our analyses included 349,741 Enterobacterales urine isolates from 321 inpatient facilities and 980,354 isolates from 338 ambulatory care facilities. In multivariable analyses, the highest rate of resistance was to beta-lactams (60.8% and 55.8% for inpatient and ambulatory settings, respectively), followed by FQ (27.5%), NFT (27.0%), and TMP/SMX (25.4%) for inpatients and by TMP/SMX (22.4%), FQ (21.6%), and NFT (21.6%) for ambulatory patients. Isolates with an extended-spectrum beta-lactamase-producing phenotype (13.2% and 8.6% for inpatient and ambulatory settings, respectively) and multidrug resistance (inpatient and ambulatory rates of 23.4% and 17.7% for ≥ 2 drugs; 9.9% and 6.4% for ≥ 3 drugs) were also prevalent. Statistically significant differences by geographic region (P ≤ 0.005) were observed for AMR classes in both inpatient and ambulatory settings, but the rates remained above the thresholds recommended for empiric urinary tract infection therapy across most regions.

Medicare Coverage Improves Mortality Outcomes in Regions of Poverty in United States

Objectives: Access to care and poverty have been associated with a higher risk of breast cancer, but their impact on breast cancer death has not been fully evaluated. We hypothesized that analysis of data from a large database would further elucidate the association between socioeconomic status and breast cancer mortality. Methods: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify cases of invasive ductal carcinoma diagnosed between 2006-2011, as well as data reflecting the presence or absence of a breast cancer death within five years. Two age groups, 40-64 year old women, and 65+ year old women, were analyzed. From the American Community Survey were acquired annual county level hospital rates, ambulatory care facility rates, nursing/residential care facility rates, rural business rates, population densities, and counts of women in the age groups of interest. Results: With respect to poverty rates, incidence based mortality rates for 40-64 year old women were 13% (99% CI 3%, 25%) higher for counties in the third quartile and 19% (7%, 35%) higher for counties in the fourth quartile (p &lt; 0.01) than for counties in the first quartile; counties in the second quartile did not show higher incidence mortality rates (p &gt; 0.01). Mortality rates for 65+ year old women did not differ among poverty rate quartiles (p &gt; 0.01 for each assessment). A 50% increase in hospitals per 100,000 persons was associated with 8% (5%, 11%) and 5% (1%, 8%) increases in mortality rates for 40-64 y and 65+ y women, respectively, likely reflecting better ascertainment of causes of death at hospitals. Impacts of differences in other rates and population density were not detected (p &gt; 0.01 for each analysis). Conclusion: Counties with higher poverty rates have increased breast cancer mortality rates for 40-64 y women, but not for 65+ y women. Universal coverage associated with Medicare is associated with the absence of an apparent effect of poverty upon breast cancer mortality.

Le repas thérapeutique en hôpital de jour de pédopsychiatrie à l’épreuve des contraintes sanitaires : thérapie institutionnelle et Covid-19

In the context of the COVID-19 pandemic, the Pordegui children's hospital – a day psychiatric centre at Montauban hospital – first closed its doors in March 2019, like many ambulatory care facilities. As a result, the first confinement had a strong impact on the accessibility to care for particularly vulnerable patients. While the lockdown has been eased after a few weeks, the respect of hygiene rules and barrier gestures still impacts the therapeutic framework of the institution. This article aims to document reflections on the effects that the current arrangements, inherent to the pandemic health situation, seem to produce over the organization of care in psychiatric children's hospitals, using the example of therapeutic meals. The latter should not be taken for granted, even though the minimal conditions for this caring time have been reinstated. Such conditions include a repetitive, structuring and reassuring framework with schedules, collective arrangements characterized by the regular presence pattern of the caregivers and their availability, as well as feedback sessions in the form of institutional meetings. After the reopening of the center, specific phenomena that were not so identifiable during the other care times were noticed during the meals of individual and group of patients. A situational analysis was led, based on observations, experience with patients and cross-examination (institutional psychotherapy and phenomenology) in order to understand these movements and highlight what seems to be irreducible for a meal to be therapeutic.

Improving Coordination During Care Transition between Ambulatory and Inpatient Care Facilities: Evaluating the Utilization and Scope of Ehr Facilitated Longitudinal Plan of Care

Gaps in generation and timely transfer of relevant information during care transitions remain a greatchallenge to care coordination. Electronic Health Record (EHR) based information transfer tools are notefficiently used by most providers. The objective of this project was to understand the current process of caretransition between ambulatory and inpatient care setting and to explore the utilization and scope of an EHRbased Longitudinal Plan of Care in improving coordination during care transition. The Longitudinal Planof Care when compared with transition of care practices recommended by Transitions of Care ConsensusConference and National Transitions of Care Coalition work group showed that it lacked some informationpertinent to care coordination. The survey performed indicated that most commonly used Electronic HealthRecord tool for care transition were notes and chart reviews (97.4%, 93.4%). Only 12% of the participantsexpressed high satisfaction with the currently used tool. Among the participants who used the LongitudinalPlan of Care, only 8.8% reported it as a sufficient tool for information transfer. Majority (93.5%) wereunaware that such a tool existed and had never explored its functionality. Improving the functionality ofLongitudinal Plan of Care and training health care providers can greatly facilitate information transferduring care transition.

Continued Growth and Advances in Ambulatory Anesthesiology

Article| February 2021 Continued Growth and Advances in Ambulatory Anesthesiology Catlin Nalley Catlin Nalley Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor February 2021, Vol. 85, 27. https://doi.org/10.1097/01.ASM.0000733860.08295.6c Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Catlin Nalley; Continued Growth and Advances in Ambulatory Anesthesiology. ASA Monitor 2021; 85:27 doi: https://doi.org/10.1097/01.ASM.0000733860.08295.6c Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: ambulatory care facilities, anesthesia, ambulatory, pain management, surgical procedures, operative Decades ago, sending a patient home the same day he or she underwent surgery was unheard of. However, ongoing advancements in surgical practices as well as improvements in postoperative care have made this the norm. Since it was first proposed in the mid-19th century, ambulatory anesthesia has become an integral component of the surgical experience. The discovery of more effective short-acting anesthetic drugs as well as a tailored approach to care has made it possible for the specialty to support a growing demand for safe and efficient ambulatory procedures. During an interview with the ASA Monitor, Tong Joo (TJ) Gan, MD, MHS, FRCA, MBA, Professor and Distinguished Endowed Chair, Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, shared his perspective on the growth of ambulatory anesthesiology and what the future may hold. ASA Monitor: How has the field of ambulatory anesthesiology evolved? Dr. Gan: Ambulatory anesthesia... You do not currently have access to this content.

The efficacy of memantine in the treatment of civilian posttraumatic stress disorder: an open-label trial

ABSTRACT Background: Currently, there is a paucity of pharmacological treatment options for posttraumatic stress disorder (PTSD), and the development of a novel pharmacotherapeutic approach has become a matter of great interest. Objective: We conducted a 12-week open-label clinical trial to examine the efficacy and safety of memantine, an N-methyl-D-aspartate receptor antagonist, in the treatment of civilian PTSD. Method: Thirteen adult patients with DSM-IV PTSD, all civilian women, were enrolled. They were monitored at an ambulatory care facility every week until 4 weeks and then every 4 weeks until 12 weeks. Memantine was added to each patient’s current medication, with the initial dosage of 5 mg/day and then titrated. Concomitant medications were essentially kept unchanged during the trial. The primary outcome was PTSD diagnosis and severity assessed with the Posttraumatic Diagnostic Scale (PDS). Results: Of the 13 cases, one dropped out and two were discarded due to the protocol deviation, and the analysis was done for the remaining 10. Mean PDS total scores decreased from 32.3 ± 9.7 at baseline to 12.2 ± 7.9 at endpoint, which was statistically significant with a large effect (paired t-test: p = .002, d = 1.35); intrusion, avoidance, hyperarousal symptoms were all significantly improved from baseline to endpoint. Six patients no longer fulfilled the diagnostic criteria of PTSD at endpoint. Some adverse, but not serious, effects possibly related to memantine were observed, including sleep problems, sleepiness, sedation, weight change and hypotension. Conclusions: Memantine significantly reduced PTSD symptoms in civilian female PTSD patients and the drug was well tolerated. Future randomized controlled trials are necessary to verify the efficacy and safety of memantine in the treatment of PTSD.

18. Durations of Antibiotic Therapy and Factors Associated with Longer Than Recommended Durations for Common Ambulatory Infections in an Integrated Healthcare System

BackgroundDuration of antibiotic therapy is an important focus for antibiotic stewardship, but the extent and drivers of excessive durations are not well understood. This project aimed to describe durations of therapy prescribed for common infections across the ambulatory care settings of an integrated healthcare system and identify factors associated with longer than recommended durations.MethodsThis was a retrospective, cross-sectional evaluation conducted from July 1, 2018 to June 30, 2019. We identified antibiotic prescriptions for adults age 18 years or older presenting to a Denver Health ambulatory care facility (urgent care, emergency department, family medicine clinic, or internal medicine clinic) for an infection with a recommended duration of therapy of 5 days or less based on institutional guidance. Infections included purulent and non-purulent cellulitis, uncomplicated subcutaneous abscess, acute bacterial sinusitis (ABS), acute otitis media (AOM), community acquired pneumonia, cystitis, and pyelonephritis treated with an indicated fluoroquinolone. Prescriptions for more than 5 days were classified as longer than recommended. We evaluated whether the following factors were associated with longer than recommended prescriptions: location of visit, type of infection, patients’ age, race/ethnicity, sex, infection type, and prescribing provider typeResults5331 prescriptions met inclusion criteria. Of those, the duration of therapy was longer than recommended for 2095 (39%) (Table 1). Durations varied significantly across locations (p< 0.0001). In the sub-group analysis family medicine clinics had the highest proportion of longer than recommended durations (46%). Durations also varied significantly by type of infection. For cellulitis, ABS, and AOM, the duration was longer than recommended in 50%, 54%, and 75% of cases, respectively. Other factors associated with longer than recommended durations included male sex (p< 0.0001) and prescriptions by advanced practice providers (p = 0.0008).Table 1: Antibiotic Duration of Therapy for Common Outpatient InfectionsConclusionCare locations, infection types, and both patient and prescriber factors were associated with longer than recommended prescriptions suggesting specific opportunities to prevent excessive durations of therapy. Disclosures All Authors: No reported disclosures

Preparedness of outpatient health facilities for ambulatory treatment with all-oral short DR-TB treatment regimens in Zhytomyr, Ukraine: a cross-sectional study

BackgroundUkraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder, are common co-morbidities. One in five DR-TB patients has human immunodeficiency virus (HIV). As part of health reform, the country is moving from inpatient care to ambulatory primary care for tuberculosis (TB). In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting care for DR-TB patients on all-oral short DR-TB regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine, to provide good quality ambulatory care.MethodsThis is a retrospective analysis of routinely collected programme data. Before discharge of every patient from the hospital, MSF teams assess services available at outpatient facilities using a standardised questionnaire. The assessment evaluates access, human resources, availability of medicines, infection control measures, laboratory and diagnostic services, and psychosocial support.ResultsWe visited 68 outpatient facilities in 22 districts between June 2018 and September 2019. Twenty-seven health posts, 24 TB-units, 13 ambulatories, two family doctors and one polyclinic, serving 30% of DR-TB patients in the oblast by September 2019, were included. All facilities provided directly observed treatment, but only seven (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and mostly limited to TB-doctors. TB-treatment and adequate storage space were available in all facilities, but only five (8%) had ancillary medicines. HIV-positive patients had to visit a separate facility to access HIV-care. Personal protective equipment was unavailable in 32 (55%) facilities. Basic laboratory services were available in TB-units, but only four (17%) performed audiometry. Only ten (42%) TB-units had psychosocial support available, and nine (38%) offered psychiatric support.ConclusionOutpatient facilities in Zhytomyr oblast are not yet prepared to provide comprehensive care for DR-TB patients. Capacity of all facilities needs strengthening with trainings, infection control measures and infrastructure. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential for successful decentralisation. The health reform is an opportunity to establish quality, patient-centred care.

Preparedness of outpatient health facilities for ambulatory treatment with all–oral short DR–TB treatment regimens in Zhytomyr, Ukraine: a cross–sectional study

Abstract Introduction Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder (AUD), are common comorbidities. As part of health reform, the country is moving from inpatient-care to ambulatory primary care for tuberculosis (TB). This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine. Methods This is a cross-sectional study in which routine program data was collected during June 2018 and February 2020. Before discharge of every patient from the hospital, MSF teams assess outpatient facilities available using a standardized checklist. The assessment evaluates access, human-resources, availability of medicines, infection control, laboratory and diagnostic services, and psychosocial support. Results We visited 90 outpatient facilities in 23 districts and 1 city between June 2018 and February 2020. Forty health posts, 27 TB-units, 23 ambulatories including two family doctors and one polyclinic were included. All facilities provided DOT, but only nine (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and limited to TB-doctors. TB-medicines and storage space were available in all facilities, but only twenty two (24%) stored ancillary medicines. HIV-patients had to visit a separate facility to access HIV-care. Personal protective equipment for infection control was unavailable in 41 (46%) facilities. Basic laboratory services were available in TB-units, but only 3 (11%) performed audiometry. Only twenty (22%) TB-units had psychosocial support available, and 1 (4%) psychiatric support. Conclusions Outpatient facilities in Zhytomyr oblast are not yet fully prepared to provide comprehensive care for DR-TB patients. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential to establish high quality, patient-centered care.

COVID-19: A Lever for the Recognition of Obesity as a Disease? The French Experience.

Despite repeated efforts by the international scientific community, academic societies and the combined actions of patient associations, public authorities have difficulties in admitting that obesity is not just a risk factor but a disease. Could our current experience with the COVID-19 pandemic be a lever to advance the cause of people with obesity? In this crisis, it seems pertinent to report on the French experience with the actions of stakeholders that were able to challenge the status quo in this field.

How New York City Health + Hospitals System-Wide Special Pathogens Program Responded to COVID-19.

How New York City Health + Hospitals System-Wide Special Pathogens Program Responded to COVID-19.