Barriers To Care Research Articles

Barriers in cancer care for patients with mental illness – a qualitative study

Introduction Patients with mental illness experience a substantial inequity when facing cancer treatment compared to patients without mental illness. They have a higher cancer mortality and are less likely to be referred for treatment following clinical guidelines. The cancer treatment can exacerbate mental symptoms, which may lead to discontinuation of the treatment. Other relevant specialities such as psychiatry and general practice are rarely involved.ObjectivesIn this qualitative case study, the needs, barriers and facilitators of providing high quality, patient-centered care to patients with cancer and pre-existing mental illness were explored. Emphasis was on patients’ experiences of being in the field between oncology, psychiatry, general practice and the municipality.MethodsThe study was anchored at the Department of Oncology, Lillebaelt Hospital, Vejle and data collection took place from January to June 2023. Through purposeful sampling five patients with cancer from adult psychiatric setting were included. Field studies were carried out inspired by the framework of Spradley, and involved following the patients during visits to the department of oncology and in the psychiatric setting. Formal interviews were performed using semi-structured interview guides inspired by Kvale and Brinkmann. Patient files were examined focusing on the awareness of the psychiatric diagnosis and treatment and communication between the departments and sectors.ResultsOur analysis showed one major theme: “Complexity on many levels”, and five subthemes: “The impact of the cancer trajectory on mental illness”, “The structure follows the disease, not the patient”, “Fragmentation of the health care system”, “Patient vulnerability” and “Importance of the patient-professional-relationship”. Barriers included lack of a systematic approach to the patient group in the health care system and sparse collaboration between departments and sectors. The cancer trajectory often led to severe worsening of the psychiatric illness, resulting in psychiatric hospitalisation. Facilitators were specialized coordinators at the hospital or municipality, relatives, patients’ resources and health professionals approaching the patient as a person rather than a disease. Final results will be ready for presentation at the conference.ConclusionsDespite intentions of reducing inequality, the Danish health care system is still not equipped to sufficiently help patients with cancer and pre-existing mental illness through their cancer treatment. This study will highlight relevant target points, paving the way for a new, feasible care model that improves continuity and patient-centered care for patients with cancer and mental illness.Disclosure of InterestNone Declared

Individuals' perceptions and expectations of nutrition care provided by doctors in Australia: A focus group study.

Doctors are well placed to facilitate nutrition care to support dietary improvements due, in part, to their regular contact with their patients. Limited literature exists which explores the perspective of patients regarding thenutrition care provided by medical professionals across the continuum of care. This article explores the perspective of patients regarding perceptions of nutrition advice and care received from doctors and expectations of this care, including key skills and attributes the patients perceive as important. Six online focus groups were conducted with Australian service users (n=32). Framework analysis identified four key themes: perceptions of doctors' role in nutrition care, expectations and experiences; the importance of individualised care; barriers and enablers to nutrition care; and topics, skills and attributes perceived as important in nutrition care. Patients have a desire for individualised and collaborative nutrition care but experienced systemic barriers in practice.

Using the Plan-Do-Study-Act Evaluation Framework to Improve the Recruitment of Women Experiencing Homelessness: Lessons Learned.

Strategic recruitment is necessary to reach recruiting goals when conducting research with vulnerable and transient populations, such as postpartum women experiencing homelessness. The current study evaluated the recruitment process for a qualitative study using the Plan-Do-Study-Act (PDSA) method. In a study conducting semistructured interviews about reproductive interconception care barriers and facilitators for local women who were recently pregnant and homeless in 2022, PDSA cycles were used to improve community organizations' assistance with identifying participants, facilitate screening and interviewing processes, and ensure participants were safeguarded. Iterative PDSA cycles were conducted across a 20-week period. Ultimately, 12 women were interviewed, with increasing participant location and organizational assistance over time. Following 4 key lessons were identified: provide in-person and remote options for conducting data collection; include fair compensation that balances time versus study coercion; weigh feasibility versus importance of sample size with eligibility criteria; and support partnerships with organization connections. The PDSA method served as a parsimonious framework for evaluation. The lessons learned will help facilitate future recruitment efforts for this difficult-to-recruit and vulnerable population.

Health status and missed care among youth in care in British Columbia, Canada: A population study

PurposeYouth in care (YIC) are a marginalized population with high health care needs and barriers to access, resulting in lifelong health disparities. This study examines the health of Canadian YIC and their engagement with the Canadian health care system on a population level. MethodsData were retrieved from the 2018 British Columbia Adolescent Health Survey, a cross-sectional population survey of Grade 7–12 students (ages 12–19 years) in British Columbia, Canada (n = 38,015). Primary outcomes were self-rated general health and mental health, missed medical care, and missed mental health care among YIC. Secondary outcomes included health care access and gender differences. Multivariate analyses adjusted for age, gender, and food insecurity. ResultsYIC represented 1.9 % of the weighted sample population. Compared to non-YIC, YIC accessed health care more frequently from mental health professionals and youth-focused clinics and less frequently from family physicians. YIC reported worse general health (AOR 1.81 [99 % CI 1.40–2.34]) and mental health (AOR 1.81 [99 % CI 1.42–2.32]) than non-YIC. Adjusted for health status, YIC experienced more missed medical care (AOR 1.96 [99 % CI 1.46–2.62]) but comparable missed mental health care to non-YIC. Significant barriers for YIC included negative health care experiences and transportation. Among YIC, female and non-binary genders also had increased risk for worse health and missed care compared to males. ConclusionsYIC in Canada have inequitably unmet health care needs. Many complex factors contribute to this disparity and its correlation with out-of-home care. Further action is needed to reduce health care barriers for YIC.

Unintended consequences of methadone regulation for opioid use disorder treatment among hospitalized patients.

In the United States, there are no federal restrictions on the use of methadone to manage opioid withdrawal symptoms when patients are hospitalized with a medical or surgical condition other than addiction. In contrast, in an outpatient setting, methadone for opioid use disorder(OUD) is highly regulated by federal and state governments and can only be dispensed from an opioid treatment program (OTP). Discrepancies in regulatory requirements across these settings may lead to barriers in care for patients with OUD. Identify how methadone regulation impacts the care of patients with OUD during hospitalization, care transitions, and in the OTP setting. We completed 26 interviews with clinicians and social workers working on hospital-based addiction consultation services across the United States. Study findings are the result of a secondary content analysis of interviews to identifying the word "methadone" and construct themes resulting from the data. We identified three major themes related to "methadone" for OUD treatment, all of which impacted patient care: (1) limited OTP hours leads to tenuous or delayed hospital discharges; (2) inadequate information-sharing between hospitals and OTPs leads to delays in care; and (3) methadone regulations create treatment barriers for the most vulnerable patients. Strict methadone regulations have resulted in unintended consequences for patients with OUD in the hospital setting, during care transitions, and in the OTP setting. Recent and ongoing federal efforts to reform methadone provision may improve some of the reported challenges, but significant hurdles remain in providing safe, equitable care to hospitalized patients with OUD.

Evaluating the role of intern pharmacists in pharmaceutical care in hospitals in Uganda.

In Uganda, there is limited adoption of pharmaceutical care in hospitals due to pharmacist shortages and limited collaboration among healthcare professionals. Intern pharmacists are deployed annually to assist in patient care to address pharmacist shortages. Evaluate intern pharmacist's extent of involvement in pharmaceutical care activities, assess facilitators and barriers, and explore healthcare professionals' perceptions, attitudes, and opinions on implementation of pharmaceutical care. A mixed-method concurrent study was carried out for four months. We conducted an online survey among 107 intern pharmacists from 26 hospitals, including National Referral, Regional Referral, Private Not-For-Profit, and General hospitals; predictors of extent of involvement were identified using linear regression models, using STATA 14. 24 key informants (nurses, prescribers, pharmacists) from five hospitals were interviewed; themes were developed using a deductive thematic analysis approach. Intern pharmacists had a median (Interquartile range[IQR]) age of 25 years (25-27) and 74.7% were male. About half (54.1%) of key informants were female and had a median (IQR) of 10 years (4.0-15.5) of professional experience. Interns focused on patient counseling, lacked documentation, and showed positive attitudes, and knowledge. Key informants supported implementation, but prescribers expressed dissatisfaction with interns' performance. Enhancing pharmacy internship and training through developing policies and guidelines on pharmaceutical care practice, improving working conditions, and mentorship can address gaps impeding pharmaceutical care implementation by intern pharmacists.

Tackling Guideline Non-concordance: Primary Care Barriers to Incorporating Life Expectancy into Lung Cancer Screening Decision-Making-A Qualitative Study.

Primary care providers (PCPs) are often the first point of contact for discussing lung cancer screening (LCS) with patients. While guidelines recommend against screening people with limited life expectancy (LLE) who are less likely to benefit, these patients are regularly referred for LCS. We sought to understand barriers PCPs face to incorporating life expectancy into LCS decision-making for patients who otherwise meet eligibility criteria, and how a hypothetical point-of-care tool could support patient selection. Qualitative study based on semi-structured telephone interviews. Thirty-one PCPs who refer patients for LCS, from six Veterans Health Administration facilities. We thematically analyzed interviews to understand how PCPs incorporated life expectancy into LCS decision-making and PCPs' receptivity to a point-of-care tool to support patient selection. Final themes were organized according to the Cabana et al. framework Why Don't Physicians Follow Clinical Practice Guidelines, capturing the influence of clinician knowledge, attitudes, and behavior on LCS appropriateness determinations. PCP referrals to LCS for patients with LLE were influenced by limited knowledge of the life expectancy threshold at which patients are less likely to benefit from LCS, discomfort estimating life expectancy, fear of missing cancer at the point of early detection, and prioritization of factors such as quality of life, patient values, clinician-patient relationship, and family support. PCPs were receptive to a decision support tool to inform and communicate LCS appropriateness decisions if easy to use and integrated into clinical workflows. Our study suggests knowledge gaps and attitudes may drive decisions to offer screening despite LLE, a behavior counter to guideline recommendations. Integrating a LCS decision support tool that incorporates life expectancy within the electronic medical record and existing clinical workflows may be one acceptable solution to improve guideline concordance and increase confidence in selecting high benefit patients for LCS.

Investigating the Impact of Tumor Biology and Social Determinants on Time to Diagnosis and Stage at Presentation of Wilms Tumor.

Delays in diagnosis and time to diagnosis generally are used interchangeably in cancer disparity research, but these terms may have important differences. Although these terms are related, we hypothesize that time to diagnosis is determined by the aggressiveness of the tumor based on intrinsic factors such as tumor biology, whereas delays in diagnosis are caused by extrinsic factors such as socioeconomic status, leading to presentation at higher stage of disease due to barriers of care. We conducted a retrospective study of 306 patients diagnosed with Wilms tumor at Children's Hospital Colorado between 1971 and 2016 identifying patient barriers as extrinsic markers and using unfavorable histology and loss of heterozygosity as markers of aggressive tumor biology. Multivariable logistic regression was performed. Patients with Medicaid were more likely to present greater than 4 days after initial symptoms compared to those with private insurance, and those with housing concerns were more likely to be diagnosed greater than 9 days from initial symptoms. Tumor biology was noted to be associated with higher stage at diagnosis, but patient barriers were not. These findings suggest the interplay between tumor biology, patient barriers, diagnostic timing, and stage at diagnosis is more complex, multifactorial, and in need of further study.

Care Models and Barriers to Long-Term Follow-Up Care Among Childhood Cancer Survivors and Health Care Providers in Asia: A Literature Review.

Most available data evaluating childhood cancer survivorship care focus on the experiences of high-income Western countries, whereas data from Asian countries are limited. To address this knowledge deficit, we aimed to characterize survivorship care models and barriers to participation in long-term follow-up (LTFU) care among childhood cancer survivors (CCSs) and health care providers in Asian countries. Twenty-four studies were identified. Most institutions in China and Turkey adopt the oncology specialist care model, whereas in Japan, India, Singapore, and South Korea, after completion of therapy LTFU programs are available in some institutions. In terms of survivor barriers, findings highlight the need for comprehensive age-appropriate education and support and personalized approaches in addressing individual preferences and challenges during survivorship. Health care professionals need education about potential late effects of cancer treatment, recommended guidance for health surveillance and follow-up care, and their role in facilitating the transition from pediatric to adult-focused care. To optimize the delivery of cancer survivorship care, efforts are needed to increase patient and family awareness about the purpose and potential benefits of LTFU care, improve provider education and training, and promote policy change to ensure that CCSs have access to essential services and resources to optimize quality of survival.

Do people with dementia and carers get what they need? Barriers in social care and carers needs assessments.

People with dementia and unpaid carers need to go through a social care or carers needs assessment to access and receive subsidised or fully-funded social care. With no previous evidence, this qualitative study aimed to provide insights into the access to, experiences of receiving and conducting social care or carers needs assessments, and access to social care. Unpaid carers of people with dementia and professionals conducting social care or carers needs assessment living or working in England were interviewed remotely about their experiences between April and August 2023. Topic guides were co-produced with two unpaid carers, and both were supported to code anonymised transcripts. Thematic analysis was used to analyse the data. Twenty-seven unpaid carers (n = 21) and professionals (n = 6) participated. Four themes were generated: (1) Issues with accessing needs assessments, not the process; (2) Knowledge of needs assessments and the health and social care system; (3) Expectations of unpaid carers; and (4) Post-assessment unmet needs. The most prominent barriers unpaid carers and their relatives with dementia encountered were awareness of and access to needs assessment. Unpaid carers were mostly unaware of the existence and entitlement to a needs assessment, and sometimes realised they had participated in one without their knowledge. Professionals described the pressures on their time and the lack of financial resources within services. To facilitate improved access to dementia care and support for carers, the pathway to accessing needs assessments needs to be clearer, with better integration and communication between health and social care.

Clinician Needs for Electronic Health Record Pediatric and Adolescent Weight Management Tools: A Mixed-Methods Study.

Clinicians play an important role in addressing pediatric and adolescent obesity, but their effectiveness is restricted by time constraints, competing clinical demands, and the lack of effective electronic health record (EHR) tools. EHR tools are rarely developed with provider input. We conducted a mixed method study of clinicians who provide weight management care to children and adolescents to determine current barriers for effective care and explore the role of EHR weight management tools to overcome these barriers. In this mixed-methods study, we conducted three 1-hour long virtual focus groups at one medium-sized academic health center in Missouri and analyzed the focus group scripts using thematic analysis. We sequentially conducted a descriptive statistical analysis of a survey emailed to pediatric and family medicine primary care clinicians (n = 52) at two private and two academic health centers in Missouri. Surveyed clinicians reported that they effectively provided health behavior lifestyle counseling at well-child visits (mean of 60 on a scale of 1-100) and child obesity visits (63); however, most felt the current health care system (27) and EHR tools (41) do not adequately support pediatric weight management. Major themes from the clinician focus groups were that EHR weight management tools should display data in a way that (1) improves clinical efficiency, (2) supports patient-centered communication, (3) improves patient continuity between visits, and (4) reduces documentation burdens. An additional theme was (5) clinicians trust patient data entered in real time over patient recalled data. Study participants report that the health care system status quo and currently available EHR tools do not sufficiently support clinicians working to manage pediatric or adolescent obesity and provide health behavior counseling. Clinician input in the development and testing of EHR weight management tools provides opportunities to address barriers, inform content, and improve efficiencies of EHR use.

Usability of technological tools to overcome language barriers in health care: a scoping review protocol

IntroductionIn many healthcare contexts globally, where the languages of care providers and patients do not match, miscommunication or non-communication can lead to inaccurate diagnoses and subpar treatment outcomes. In order...

Facilitators of and barriers to gastric cancer and precursor diagnosis among South Texas residents: Social determinants of health.

Latinos/Hispanics are at higher risk for developing gastric cancer (GC) compared with non-Hispanic whites, and social determinants of health (SDoH) are thought to contribute. This study addressed SDoH and their interactions contributing to disparities in the testing and treatment of Helicobacter pylori (HP) infection and diagnosis of GC and its known precursors, among Latinos/Hispanics relative to non-Latinos at two affiliated but independent health systems in San Antonio, Texas, using a mixed methods approach. Secondary data abstraction and analysis showed that GCs represented 2.6% (n = 600) of our population. Men and older individuals were at higher GC risk. Individuals with military insurance were 2.7 times as likely to be diagnosed as private insurance. Latinos/Hispanics had significantly (24%) higher GC risk than Whites. Poverty and lack of insurance contributed to GC risk among the minorities classified as other (Asians, Native Americans, Multiracial; all p < 0.01). All SDoH were associated with H. pylori infection (p < 0.001). Qualitative analysis of patient and provider interviews showed providers reporting insurance as a major care barrier; patients reported appointment delays, and lack of clinic staff. Providers universally agreed treatment of H. pylori was necessary, but disagreed on its prevalence. Patients did not report discussing H. pylori or its cancer risk with providers. These data indicate the importance of considering SDoH in diagnosis and treatment of GC and its precursors, and educating providers and patients on H. pylori risks for GC.

Impression of Primary Care Follow-Up After a PICU Admission: A Pilot Survey of Primary Care Pediatricians.

The majority of PICU general follow-up occurs with primary care providers. Our objective was to investigate primary care pediatricians': 1) comfort with and barriers to caring for children after a PICU admission, 2) knowledge of and screening for post-intensive care syndrome in pediatrics (PICS-P), and 3) resource needs. Pilot cross-sectional survey study. Metropolitan Detroit, Michigan from September 2022 to March 2023. Primary care pediatricians. The survey included 15 questions on provider demographics, comfort with and barriers to caring for children after a PICU admission, knowledge of and screening practices for PICS-P, and resource needs. The median values for continuous data and frequencies for categorical data were calculated. The survey response rate was 17% (26/152). The median age was 38.5 years (interquartile range 34-52 yr) and 19 of 26 (73%) were female. In case studies, 26 of 26 (100%) were "very comfortable" resuming care for a patient with a straightforward bronchiolitis PICU admission while 8 of 26 participants (31%) were "somewhat uncomfortable" and 1 of 26 (4%) was "not at all comfortable" with caring for a patient after a complex acute respiratory distress syndrome PICU admission. Seven of 26 participants (27%) were familiar with the term "post-intensive care syndrome in pediatrics." Over 50% screened for four of five PICS-P domains. Key barriers were care coordination with specialists, discomfort or difficulties with managing new home equipment, and inadequate or missing documentation. In this pilot study, approximately one-third of primary care pediatricians had knowledge of PICS-P. Participants experienced numerous care barriers. Our findings suggest future research could engage improved study methods and designs, and focus on interventions to support primary care-provided PICU follow-up.

Operationalizing the Women-Centred HIV Care Model for trans women and persons with transfeminine experience living with and affected by HIV: a qualitative study

Background The Women-Centered HIV Care (WCHC) Model and associated toolkits were created to address the health care barriers and disparities that women and gender diverse people living with HIV experience. Since trans women and transfeminine people experience disproportionately high rates of HIV acquisition (in comparison to their cisgender peers) amidst biologic, social, political, and historical factors that affect their general care experiences negatively, more research is needed. Aim We aimed to obtain feedback on the WCHC Model regarding the acceptability, applicability, usability, gaps, and potential adaptations needed to meet the needs of trans women and gender diverse people with transfeminine experience. Methods Our study was grounded in community-based research principles and intersectionality frameworks. We conducted semi-structured interviews with 17 trans women and transfeminine people residing in Ontario, Canada. We analyzed the data using a descriptive qualitative content analysis approach. Results Participants were largely satisfied with the WCHC Model. However, participants were concerned with the model’s implementation due to a lack of knowledge among healthcare providers regarding trans women’s experiences within broader social contexts. Simultaneously, participants affirmed the need for care providers to offer person-centered care – a central component of the WCHC Model. Lastly, participants spoke to the healthcare system limitations and failures that disproportionately affected trans women and posed significant barriers to WCHC access and engagement. Discussion Our findings demonstrate that trans women perceive successful healthcare delivery as combining holistic care frameworks – like the WCHC Model – with healthcare providers’ understanding of individual and community needs. There is a need for policy reform to improve the healthcare system. We offer reflections and recommendations for improving healthcare for trans women.

Hepatitis B Virus Infection in Eastern Libya: Current Efforts for Overcoming Regional Barriers for Its Elimination.

Approximately 2.2% of Libyans have chronic hepatitis B (CHB) and are at the highest risk of developing end-stage disease complications. Several resource-limited countries, including Libya, may be far from achieving the WHO goal of hepatitis B elimination by 2030 as a result of several testing and linkage to care (LTC) barriers. In Libya, data about the current HBV infection situation is scarce. Therefore, our study aimed to evaluate the trends of HBV in eastern Libya, Tobruk region, and try to identify the region-specific gaps and barriers that could potentially delay the WHO goal of HBV elimination. An eighteen-year retrospective review of records of the main district medical center in the region was done to estimate the trends of HBV infection and qualitative interviews with the clinical staff of the CHB registry in the region were conducted to investigate the current status of HBV management. Out of 392,952 records, 371 (0.09%) HBV-positive were recorded and declining trends of the infection were noticed over the study period. Until late 2019, there was no linkage to care or follow-up for people with HBV infection. However, a CHB registry was established in late 2019 to manage HBV infections in the region, yet there are several barriers such as the lack of diagnostic infrastructure for liver function assessment and antiviral treatment. Despite the significant decline observed in the occurrence of HBV infection and introduction of important HBV management steps such as establishment of the CHB registry, there are still several barriers that could delay the elimination of the infection.

Overcoming language barriers in pediatric care: a multilingual, AI-driven curriculum for global healthcare education.

Online medical education often faces challenges related to communication and comprehension barriers, particularly when the instructional language differs from the healthcare providers' and caregivers' native languages. Our study addresses these challenges within pediatric healthcare by employing generative language models to produce a linguistically tailored, multilingual curriculum that covers the topics of team training, surgical procedures, perioperative care, patient journeys, and educational resources for healthcare providers and caregivers. An interdisciplinary group formulated a video curriculum in English, addressing the nuanced challenges of pediatric healthcare. Subsequently, it was translated into Spanish, primarily emphasizing Latin American demographics, utilizing OpenAI's GPT-4. Videos were enriched with synthetic voice profiles of native speakers to uphold the consistency of the narrative. We created a collection of 45 multilingual video modules, each ranging from 3 to 8 min in length and covering essential topics such as teamwork, how to improve interpersonal communication, "How I Do It" surgical procedures, as well as focused topics in anesthesia, intensive care unit care, ward nursing, and transitions from hospital to home. Through AI-driven translation, this comprehensive collection ensures global accessibility and offers healthcare professionals and caregivers a linguistically inclusive resource for elevating standards of pediatric care worldwide. This development of multilingual educational content marks a progressive step toward global standardization of pediatric care. By utilizing advanced language models for translation, we ensure that the curriculum is inclusive and accessible. This initiative aligns well with the World Health Organization's Digital Health Guidelines, advocating for digitally enabled healthcare education.

Optimizing Care Delivery in Patients with Chronic Kidney Disease in the United States: Proceedings of a Multidisciplinary Roundtable Discussion and Literature Review.

Approximately 37 million individuals in the United States (US) have chronic kidney disease (CKD). Patients with CKD have a substantial morbidity and mortality, which contributes to a huge economic burden to the healthcare system. A limited number of clinical pathways or defined workflows exist for CKD care delivery in the US, primarily due to a lower prioritization of CKD care within health systems compared with other areas (e.g., cardiovascular disease [CVD], cancer screening). CKD is a public health crisis and by the year 2040, CKD will become the fifth leading cause of years of life lost. It is therefore critical to address these challenges to improve outcomes in patients with CKD. The CKD Leaders Network conducted a virtual, 3 h, multidisciplinary roundtable discussion with eight subject-matter experts to better understand key factors impacting CKD care delivery and barriers across the US. A premeeting survey identified topics for discussion covering the screening, diagnosis, risk stratification, and management of CKD across the care continuum. Findings from this roundtable are summarized and presented herein. Universal challenges exist across health systems, including a lack of awareness amongst providers and patients, constrained care team bandwidth, inadequate financial incentives for early CKD identification, non-standardized diagnostic classification and triage processes, and non-centralized patient information. Proposed solutions include highlighting immediate and long-term financial implications linked with failure to identify and address at-risk individuals, identifying and managing early-stage CKD, enhancing efforts to support guideline-based education for providers and patients, and capitalizing on next-generation solutions. Payers and other industry stakeholders have opportunities to contribute to optimal CKD care delivery. Beyond addressing the inadequacies that currently exist, actionable tactics can be implemented into clinical practice to improve clinical outcomes in patients at risk for or diagnosed with CKD in the US.

Birth cohort-specific consideration in an Emergency Department Hepatitis C Testing Programme: A description of age-related characteristics and outcomes.

The emergency department (ED) has increasingly become an important public health partner in non-targeted hepatitis C virus (HCV) testing and referral to care efforts. HCV has traditionally been an infection associated with the Baby Boomer generation; however, recent exacerbation of the opioid epidemic has resulted in a growing number of younger cohorts, namely Millennials, also impacted by HCV. Examination of this age-related demographic shift, including subsequent linkage success and linkage barriers, from the perspective of an ED-based testing and linkage programme may have implications for future population and health systems interventions. A retrospective descriptive chart review was performed, inclusive of data from August 2015 through December 2020. We compared the quantity of positive HCV screening antibody (Ab) and confirmatory (RNA) tests and further considered linkage rates and correlative demographics (e.g. gender, race). Patient barriers to HCV care linkage (e.g. substance misuse, lack of health insurance, homelessness) were also evaluated. The data set was disaggregated by birth cohort to include Silent Generation (SG) (1928-45), Baby Boomer (BB) (1946-64), Generation X (Gen X) (1965-80), Millennial (1981-96) and Generation Z (1997-2012). Descriptive statistics and chi-square analysis were performed. Overall, 83,817 patients were tested for HCV (50.6% of eligible); 6187 (7.4%) were HCV Ab positive, and 2665 were HCV RNA positive (3.2%). RNA-positive individuals were more likely to be white (70.4%) and male (67.7%); generational distribution was similar (BB 33.3%, Gen X 32.0% and Millennials 32.7%). Amongst Ab-positive patients, white (45.5%), male (47.2%) and Millennial (49.7%) individuals were most likely to be RNA-positive. Overall, 28.1% of the RNA-positive cohort successfully linked to care; linkage to care rates were significantly higher in older generations (38.1% in BB vs. 17.8% in Millennials) (p < .00001). Over 90% were identified as having at least one linkage to care barrier. Younger generations (Gen X and Millennials) were disproportionately impacted by linkage barriers, including incarceration, lack of health insurance, history of mental health and substance use disorders, as well as history of or active injection drug use (IDU) (p < .00001). Older generations (SG and BB) were more likely to be impacted by competing medical comorbidities (p < .00001). The ED population represents a particularly vulnerable, at-risk cohort with a high prevalence of HCV and linkage to care barriers. While past HCV-specific recommendations and interventions have focused on Baby Boomers, this data suggests that younger generations, including Gen X and Millennials, are increasingly affected by HCV and face disparate social risk and social need factors which impede definitive care linkage and treatment.

Unmet Social Needs and Breast Cancer Screening Utilization and Stage at Presentation

Unmet social needs in local populations may hinder the development of targeted cancer control interventions aimed at improving screening utilization and early-stage breast cancer diagnosis to ultimately improve breast cancer survival disparities. To evaluate if (1) city-funded screening mammography is associated with utilization of screening mammography, (2) unmet social needs are associated with utilization of screening mammography, and (3) unmet social needs are associated with later-stage disease at diagnosis. This cohort study included patients with stages I-IV invasive ductal or lobular carcinoma treated at an academic medical center (including both an underserved safety-net hospital [SNH] and a National Cancer Institute-designated academic cancer center [ACC]) from 2020 to 2023. Eligible patients were aged 18 years or older and able to consent. Data were analyzed between July 2023 and September 2023. The Health Leads Social Needs Screening Toolkit, a screening tool that gathers information on the most common social need domains affecting patient health. Univariable and multivariable logistic regression was utilized to evaluate the following primary outcomes: (1) routine screening mammography and (2) American Joint Committee on Cancer 8th edition clinical stage at presentation. Of the 322 women who completed the Health Leads Social Needs Screening Toolkit, 201 (62%) self-identified as Hispanic, 63 (19%) as non-Hispanic Black, and 63 (19%) as non-Hispanic White. Two hundred fifty-five (76%) patients with access to city-funded screening mammography completed a screening mammogram. Patients who presented to the SNH were more likely to present with late-stage disease compared with early-stage disease (15 of 48 [31%] vs 50 of 274 [18%]; P = .04). On multivariable logistic regression, not completing a screening mammography was associated with having an increasing number of unmet social needs (OR, 0.74; 95% CI, 0.55-0.99; P = .047) and an increasing age at diagnosis (OR, 0.92; 95% CI, 0.89-0.96; P < .001). Moreover, increasing unmet social needs was significantly associated with late-stage diagnosis above and beyond screening mammography (OR, 1.38; 95% CI, 1.01-1.89; P = .04). In this cohort study, access to screening mammography did not translate to utilization of screening mammography, increasing unmet social needs were significantly associated with lower rates of screening mammography, and those with increasing unmet social needs were more likely to present with late-stage disease. This association transcended recruitment site (SNH vs ACC), indicating that patients in either hospital setting may benefit from unmet social needs screening to overcome access to care barriers associated with late-stage disease at diagnosis.