Clinic Appointments Research Articles

Assessment of Blood Pressure Control Status Among Hypertensive Patients Attending Rwandan District Hospital NCD Clinics: A Retrospective Follow-Up Study

BackgroundHypertension is a major public health issue and a leading risk factor for cardiovascular disease (CVD). We assessed blood pressure (BP) control among adult hypertensive patients attending non-communicable disease (NCD) clinics in five Rwandan district hospitals.MethodsWe extracted data on hypertensive management from five Rwandan district hospitals from June 2016 to August 2021. BP control was defined as systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg measured within the last four months. We performed statistical analysis using chi-square tests and multivariate regression analyses with 95% confidence intervals (CI).ResultsBlood pressure control was achieved in 41.5% of hypertensive patients (n = 438/1,055). The majority were aged > 60 years (mean age 62; n = 663/1,055; 62.8%), and women, with approximately three-quarters of patients (n = 796/1,055; 75.5%) had a BMI between 18.5 and 24.9 Kg/m2 and the majority (n = 843/1,055; 79.9%) resided in rural districts. More than half (n = 585/1,055; 55.5%) were taking two antihypertensive medications. Factors significantly associated with uncontrolled BP included BMI ≥ 30 kg/m2 (p < 0.001), use of Angiotensin-converting enzyme (ACE) inhibitors (p = 0.01), use of four antihypertensive drugs (p = 0.013), and missing an NCD clinic appointment (p < 0.001).ConclusionsBP control rates among hypertensive patients attending NCD clinics remain low. Strengthening patient counseling, encouraging physical activity, and improving medication adherence are critical. Building the capacity of healthcare staff at both hospital and health centre levels is vital to improving hypertension management in NCD clinics.

The New Frontier of Adult Neurodevelopmental Care: Individual and Caregiver Values.

There are few specialists that serve adults with neurodevelopmental disabilities (NDD), and most adults with NDD receive care from providers without specialty training in NDD. Care for this population is highly variable, and patient and caregiver priorities in this age group are not well known. We aimed to explore individual and caregiver values around adult neurodevelopmental care. In this qualitative study, a qualitative analyst conducted 22 semistructured virtual interviews from September 2021 to February 2022 with randomly selected adults with NDD and/or their caregivers. Each individual with NDD had at least one appointment in the adult NDD clinic, which started in October 2020. Interviews were recorded and professionally transcribed. An inductive codebook was developed and reconciled through an iterative process; transcripts were coded in Atlas.ti with 20% double-coding. Major themes were developed through team discussion. Most interviewees were caregivers of patients with NDD (12); 9 interviews were with patient/caregiver dyads; 1 interview was with a patient alone. Three main themes emerged from the interviews. (1) Value in providers who are curious, engaged, and knowledgeable about NDD-related conditions, which individuals and caregivers referred to as "Unicorn Providers." (2) Value in a connected and coordinated web of care. (3) Value in comfortable and adaptable clinic spaces. They value clinical environments that foster patient success during visits. The need for adult neurodevelopmental care is growing as more individuals with NDD are living into adulthood. Better understanding of patient and caregiver values can help shape this emerging field to meet the needs of this unique, often overlooked and underserved, population.

622 Identifying transportation barriers to attending appointments in a general pediatrics clinic

622 Identifying transportation barriers to attending appointments in a general pediatrics clinic

A retrospective evaluation of patient characteristics and recommendations of a novel multidisciplinary clinic for persons with advanced disability from multiple sclerosis.

Persons with advanced multiple sclerosis (MS) require care beyond the disease modifying treatments offered in conventional MS clinics to address their complex physical and psychosocial needs. In the novel MS Comprehensive and Palliative Care (MSCPC) Program, an MS neurologist, palliative care specialist, and physiatrist collaborate to identify these needs and improve symptom control. To characterize the medical, physical, and psychosocial concerns of persons with advanced disability from MS and describe the recommended interventions of the MSCPC Program. Retrospective chart review of consecutive patients seen in the MSCPC Program from 2019 to 2022. 54 patients were assessed over 74 clinic appointments. Patients' mean age was 59.4 ± 10.8 years (range 37-81) and mean duration of MS was 24.8 ± 11.8 years (range 2-52); 79.7% of patients had secondary progressive MS with median and mode disease severity (EDSS) of 7.5 and 8.5, respectively (range 4-9.5). 70.3% lived at home with a caregiver; the primary caregiver was the spouse for 51.4% of cases. 85.1% of patients received publicly funded in-home assistance for activities of daily living. The most prevalent sequelae of MS were incontinence (89.9%), spasticity (82.6%), and pain (78.3%). ≥1 symptom was addressed at 95.7% of appointments, most often pain (63.8%), spasticity (60.9%), and bowel (59.4%); medication deprescribing was recommended at 29.0% of appointments. Caregiver burnout was identified at 56.5% of appointments. This novel program identified high prevalence of symptoms and made recommendations to improve symptom control at >95% of appointments, suggesting unmet symptom control needs in persons with advanced disability from MS.

Low-volume transanal irrigation (TAI) in the treatment of functional faecal incontinence in children: a cohort study

PurposeFunctional faecal incontinence (FFI) is a stigmatising condition for a child and parents and can be a challenge to treat even in tertiary centres. Transanal irrigation (TAI) is an emerging treatment with great success in refractory cases. We performed TAI with a substantially decreased amount of water used (low-volume TAI), yet no previous evidence exists on this treatment in children. We conducted this study to evaluate the efficacy of low-volume TAI in reducing faecal incontinence (FI) episodes and to provide associated factors for response.MethodsChildren with FFI trained in low-volume TAI in our outpatient incontinence clinic were identified. Baseline characteristics along with rectal ultrasound examination, information on weekly FI episodes and concomitant use of laxatives were noted. The continence status of patients was registered at the first outpatient clinic appointment after the commencement of TAI and after 6 months of treatment. During this period, information about side effects and changes in medication were captured.ResultsWe identified 47 children (mean age 8.06 ± 2.08 years, 27 males) treated with low-volume TAI. Thirty-five (74%) were diagnosed with functional constipation and FI, while 12 (26%) suffered from non-retentive faecal incontinence. Twenty (42%) children gained full faecal continence after 6.75 ± 0.3 months. We found no differences between responders and non-responders in baseline characteristics.ConclusionsLow-volume TAI appears safe and effective in the treatment of FFI refractory to first-line treatment in children. Low-volume TAI could be a valuable tool for the management of these children as the treatment is less invasive, low in cost and well accepted.

P-501. Concerns and Opinions of People Currently or Previously on Oral and Long-Acting Injectable Forms of HIV Preexposure Prophylaxis (PrEP)

Abstract Background Long acting injectable (LAI) preexposure prophylaxis (PrEP) is an effective tool that has the potential to increase PrEP uptake and adherence. However, the majority of studies investigating interest and opinions surrounding LAI PrEP were theoretical, done prior to its approval. It is important to better understand peoples’ opinions about LAI PrEP as uptake increases. Methods We administered a cross-sectional electronic survey to clients at an urban PrEP clinic in the US South. Eligible participants were 18+ years and had previously taken or been prescribed oral or LAI forms of PrEP. Participants were recruited at clinic appointments or through a link sent via the electronic medical record. Participants were asked about their preferences and concerns about oral and LAI PrEP and barriers to access PrEP. Results Between January 10-April 5, 2024, 110 participants completed the survey: 73 during in-person appointments and 37 via online links. Of those, 22 were currently using LAI PrEP, 71 oral PrEP, and 17 were not currently on a form of PrEP. Participants were mostly men (89.1%), and mean age was 38 (range 17-78). 54.5% of respondents were White, 30% Black, and 14.5% Latinx. Most participants preferred an injection versus a daily pill (100% of people already on LAI, 46.5% of people on oral PrEP, and 58.8% of people not currently on PrEP). The most common concerns about PrEP for all groups were side effects, cost of medication, and cost of clinic visits and tests. Of people taking oral PrEP, 59.2% had not switched to injectable either because it was not offered to them, or they were not aware of it. The most common reasons for stopping PrEP amongst people not currently using either form were side effects and no longer needing PrEP. Conclusion LAI PrEP is desired by many, but not all, people who are currently or have previously taken PrEP. Common concerns about PrEP include side effects and cost of medication and/or clinic visits. People on oral PrEP are frequently not offered LAI or do not know it exists. These data demonstrate the importance of improving LAI PrEP accessibility and offering people choice between PrEP methods. Disclosures Mehri McKellar, MD, Gilead: Grant/Research Support

Fact or Myth? Black Patients Do Not Want to Participate in Clinical Trials.

To assess strategies for optimizing participation of underserved minorities in a blood-based early CRC detection test study (PREEMPT CRC; NCT04369053) at a hospital serving primarily Black patients. Culturally sensitive, racially congruent research staff approached patients undergoing average-risk screening colonoscopy. Consent/study procedures were synchronized with clinical appointments. Enrolled and not-enrolled patient characteristics were compared. Recruitment was compared with other study sites. 247/509 eligible participants enrolled; most identified as Black (88.7%). No baseline characteristics were associated with participation. Recruitment was high compared to other sites (11th centile). Recruitment barriers for Black individuals can be overcome when easy, culturally sensitive access is facilitated.

Outcomes of functional tics in adolescents: a single-centre tertiary study

ObjectiveTo investigate the prognosis and co-occurring disorders, including functional neurological symptoms, in adolescents diagnosed with functional tic-like behaviour (FTLB).DesignThis was a single-centre tertiary study in the UK. A structured clinical...

P-1462. Utilization of a Point-of-Care Hepatitis C Test to Treat in People Experiencing Homelessness with Street Medicine Outreach

Abstract Background Persons experiencing homelessness (PEH) have disproportionately higher rates of untreated chronic hepatitis C virus (HCV) than the public. Improved community funding and resources are needed to expand HCV rapid point-of-care (POC), confirmatory testing, treatment and follow-up. Given that PEH face competing priorities (unstable housing, food access, addiction, other infections), it is our role as clinicians to reduce barriers to HCV treatment, understand hesitancies for deferring treatment, and design programs to improve accessibility. This is the pilot project of a Street Medicine (SM) based initiative to use POC testing for HCV amongst PEH with linkage of care to a federally qualified health clinic (FQHC). Hepatitis C Screening and Treatment Protocol HCV- Hepatitis C Virus POC- Point of Care CHASS- Community Health and Social Services HbsAg- Hepatitis B Surface Antigen CBC- Complete Blood Count CMP- Complete Metabolic Panel Methods SM provides medical care to PEH outside of a hospital setting. Medical students and residents were recruited to form a HCV outreach team at Henry Ford Hospital and trained in HCV testing via OraQuick rapid antibody (Ab) test. During SM outreach, PEH were provided education on HCV and offered POC testing with a $10.00 grocery gift card. If a patient was identified as HCV Ab positive they were provided free transportation to a FQHC for confirmatory testing. If diagnosis was confirmed, they were evaluated for eligibility for simplified HCV treatment, check-ins to assess adherence and sustained virologic response (Figure 1). Results From February-April 2024, 103 PEH were tested using POC HCV testing on SM runs, with 4 positive results. 3 of 4 patients were confirmed for CHASS clinic appointments. 1 patient presented to clinic follow-up but deferred confirmatory testing bloodwork, demonstrating challenges in arranging for HCV clinic follow-up care. Conclusion Previous studies have shown that lack of insurance, prior authorization and referral process, active injection drug use or alcohol use, lack of knowledge of HCV treatment, and limited healthcare workforce and infrastructure have all contributed to the low treatment rate in the homeless. Using trusted community organizations with SM, this initiative aims to reduce testing and transportation barriers in order to eliminate HCV in PEH. Larger numbers of positive patients are needed to best assess the feasibility of the program, and if providing all testing and treatment at the point of care is needed to improve compliance. Disclosures Marcus Zervos, MD, Johnson and johnson: Grant/Research Support|Moderna: Grant/Research Support Seema Joshi, MD, AbbVie: Grant/Research Support

P-1321. The Infectious Disease Needs of Adult Ukrainian Refugees in a Tertiary Centre in the West of Ireland

Abstract Background Since February 2022 6.5 million have fled Ukraine; 104’ 870 to Ireland (2% of Irish population) [1, 2] The surge in those seeking temporary protection, coupled with infectious disease epidemiology in Ukraine; high prevalence of blood borne viruses and TB has placed strain on host countries' health services. [3, 4] 18 ‘840 (18% of National total, 0.37% of Irish population) are accommodated within our catchment area. The objective of this study was to evaluate case complexity, barriers to access and impact on service by this population. HIV, HCV and HBV prevalence, control and management Methods We performed a retrospective chart review using our electronic patient record, compiled data on a protected spreadsheet and results were collated. Tuberculosis prevalence, susceptibility, site and management Results 123 adult Ukrainian refugees have newly attended our service since February 2022 - April 2024, 2.03 new patients weekly; 63/123 (51.2%) are female. The mean age is 44.7 years (18 - 79). 76 (61.8%) have HIV (PLWH); 68 (89.5%) known diagnoses; 39 (57.3%) of whom were virally suppressed on ART and 27 (40%) were viraemic as a result of treatment interruption, 2 (2.9%) had no blood testing with us. 7 (5.7%) were newly diagnosed following arrival to Ireland; 4 (57%) with advanced disease (mean CD4 Count 285 IU/mL [28 - 753]). Thirty two (42%) PLWH are co-infected with HCV, 4 (5.3%) with HBV. 37 (30%) attended with HCV mono-infection, 9 (7.3%) with HBV mono-infection. 17 PLWH (22.4%) report previously treated TB. We have seen 4 (3.25%) cases of active TB; three of MDR pulmonary disease and results are pending for the fourth case. 4, 10.5% of women living with HIV in this cohort have had pregnancies; 2 (5.3% of WLH) are currently pregnant (both live in Donegal; average 165.6 miles from clinic). The average distance traveled to our clinic is 64.6 miles (Range 0.62 - 189); based on current geographic distribution of the group 50.4% (62/123) can access public transport that would allow them to reach our clinic within 2 hours. There was no significant association between access to public transport and missed clinic appointments (p = 0.64). 115/123 (93.5%) have a need for an interpreter. Since February 2022 26 (21%) have required hospital admission with an average length of stay of 22.9 days and a total of 597 bed days used. Conclusion We have identified significant case complexity and ongoing high ID service need for this cohort. Cohort Demographics Disclosures All Authors: No reported disclosures

P-1420. Tracking Shadows: Loss to Follow-up in Persons Living with HIV

Abstract Background During the year 2020, HIV viral suppression was 89.4% in clients throughout the United States who receive care through the Ryan White HIV/AIDS program (RYHAP). This was a significant increase compared to 69.5% in 2010. Likewise, Wayne State University (WSU) Tolan Park Infectious Disease Clinic, which is also funded by RYHAP noted a 5% increase in the rate of viral suppression in 2020 compared to the previous year. Eighty-six percent of Tolan Park clients across all Ryan White programs were virally suppressed, eighty-seven percent of women and youth were virally suppressed. However, there was a decline in the overall patient pool in 2019. The goal of this study was to locate those lost-to-care as part of the WSU Tolan Park clinic. Methods Clinicians reviewed a list of clients who were lost-to-care during 2019. These clients were individually called by nurse practitioners, patient advocates or early intervention staff (EIS) to re-engage in medical care. The quality improvement team then discussed feedback from staff and clients regarding barriers to medical care. Results We contacted a total of 310 clients. Out of these, 40 (13%) were lost-to-care. Among the remaining clients, 95 (31%) were deceased, 64 (21%) were in-care at other clinics, 63 (20%) were currently in-care at Tolan park clinic, 41 (13%) had confirmed clinic appointments and 7 (2%) were out-of-state or incarcerated. Of the 40 clients returned to care at the Tolan Park clinic, route cause analysis revealed the main barriers to care including poor mental health, lack of transportation, schedule conflicts, relocation, poor financial resources, inadequate medication adherence and clinic fatigue. Conclusion We report a significant number of patients who were lost-to-care at the WSU Tolan Park clinic. Our patients continue to experience poor mental health, poor medication adherence and several socioeconomic barriers that limit their access to continuity of care. Our results highlight the need for better tracking services and strategies to minimize the loss to follow-up in HIV clinics. Disclosures All Authors: No reported disclosures

Adherence, perceptions and knowledge of an HIV PMTCT programme: A mother-baby pair study

Background: Prevention of mother-to-child transmission (PMTCT) programmes are designed to prevent HIV transmission to infants and children. Despite efforts to achieve this goal, several factors continue to pose challenges.Objectives: To investigate the level of adherence, perceptions, knowledge, and factors associated with adherence to the PMTCT programme in primary healthcare facilities.Method: A descriptive cross-sectional study design and quantitative research approach was used, and clinical records were reviewed to determine the prevalence of seroconverted babies of mothers enrolled in a PMTCT programme for the past 2 years in the community healthcare centres. Bivariate and multivariate logistic regression analyses were performed.Results: A total of 341 mother-baby pairs were recruited and took part in the study. Most women (263; 77%), perceived that a pregnant woman living with HIV can transmit the virus to her unborn baby. The following factors were independently associated with non-adherence: being unmarried, the period of maternal HIV diagnosis and initiation on antiretroviral therapy, unsuppressed viral load results, missed clinic appointments, side effects, and getting tired of taking HIV medication.Conclusion: This study investigated adherence to and perceptions of all components of the PMTCT programme by pregnant and breastfeeding women in primary healthcare facilities. Despite the significant progress made, maternal and paediatric HIV pandemic pose a challenge to the PMTCT services. There is a need for follow-up research to monitor the ongoing adherence to the PMTCT programme and its long-term impact in reducing the rate of transmission of HIV in mothers.

Screening Young Adult Cancer Patients for Vocational Rehabilitation Services: A Vocational Rehabilitation Readiness Screening Tool.

We aimed to develop an online vocational rehabilitation (VR) readiness screening (VRRS) tool for young adults diagnosed with cancer. VR readiness was defined as being physically and cognitively ready to enter or return to work or school. We developed an initial VRRS tool informed by previous studies, a scoping review to determine such a tool had not already been developed, and consultation with subject matter experts. We iteratively refined the tool on the basis of four rounds of interviews with young adults with cancer. The refined VRRS was then administered online to patients before they attended scheduled clinic appointments. We evaluated the VRRS completion rate; the ability of the online VRRS tool to assess patients' readiness for VR; and the concordance between clinical interview and that of the online VRRS tool, which was determined by using Cohen's κ or a fitting alternative; κ ≥ .61 suggested clinical utility. The proportion of study participants completing the VRRS was 72.3% (136/188, 95% CI [65.4%, 78.6%]) and 69.2% (81/117, 95% CI [60.0%, 77.4%]) of participants who completed a clinical interview also completed the online VRRS tool. All clinical interview determinations and 93.8% (76/81) of online VRRS tool indicated participants' VR readiness.The VRRS-clinical interview agreement rate was 93.8% (95% CI [86.2%, 98.0%]). The prevalence index, bias index, and prevalence- and bias-adjusted κ statistic with 95% CIs were 0.938 [- 0.991, - 0.886], 0.062 [0.009, 0.114], and 0.877 [0.724, 0.959], respectively. The VRRS tool is thus both feasible and effective in this sample of young adults with cancer.

Evaluation of occlusal contacts in antagonist teeth using traditional occlusiography with photographic documentation in patients with periodontitis and TMJ dysfunction during clinical dental appointments

Relevance. Selective grinding is incorporated into the comprehensive treatment of periodontitis and TMJ (temporomandibular joint) dysfunction due to the presence of occlusal discrepancies, which can exacerbate or initiate these conditions. The evaluation of occlusal contacts, their distribution, and contact areas is crucial for diagnosing occlusal disturbances and selecting treatment approaches. Traditionally, occlusal contacts have been assessed using occlusograms obtained with articulating paper. However, the advent of digital technologies has made the interpretation of these parameters more challenging for practicing clinicians. This study aimed to evaluate occlusal contact parameters in patients with periodontitis and TMJ dysfunction (without pain symptoms) using traditional occlusiography with photographic documentation and articulating paper during clinical dental appointments.Material and methods. The study included 68 patients aged 18 to 44 years, of whom 41 were divided into four groups: 11 patients without signs of periodontitis or TMJ dysfunction, 11 with TMJ dysfunction but no periodontal pathology, 8 with both periodontitis and TMJ dysfunction, and 11 with periodontitis but no TMJ dysfunction. Occlusal contacts and their surface areas were assessed using occlusiography with photographic documentation.Results. The study revealed an increase in the number of occlusal contacts in cases of periodontitis and TMJ dysfunction. In patients with periodontitis and combined pathology (periodontitis and TMJ dysfunction), a significant rise in the frequency of pathological tooth wear was observed. The occlusal contact area varied significantly across all groups.Conclusion. An analysis of the literature and the obtained data identified consistent trends in changes in the number and area of occlusal contacts associated with these clinical conditions. The "occlusal contact area" parameter exhibited considerable variability and warrants further research to establish reference values. No conclusive data supporting selective grinding in patients with periodontitis and TMJ dysfunction were obtained.

BHSeP37 Is routine clinic follow-up post-incisional hernia repair still needed, or should we transition to Patient Initiated Follow-Up ‘PIFU’?

Abstract Introduction Patient Initiated Follow-Up (PIFU) pathway allows patients to control their follow-up care, enabling them to be seen quickly when necessary and avoiding the inconvenience of low clinical value appointments. This study reviews the outcomes of operatively managed incisional hernia cases and evaluates the first outpatient clinic outcomes to assess the suitability of PIFU for these cases. Method Retrospective data analysis was conducted for patients who underwent elective incisional hernia repair and were followed up as outpatients from January 2021 to May 2024. Data were collected on the type of surgical repair, postoperative complications and the outcome of the clinic review. Results 49 cases were analysed (38 ventral hernias, 6 loin hernias post-nephrectomy, 2 parastomal hernias, and 3 combined ventral and parastomal hernias). The results showed that only 5 cases (10.2%) had a change in the management plan during the first outpatient clinic review (3 out of the 5 cases were the combined ventral and parastomal repairs). Management changes included arranging further follow-up, requesting a scan, or planning for another surgery. The median waiting time for the outpatient clinic review was 8 weeks. Additionally, 6 cases (12.2%) attended the emergency department with presentations such as pain, seroma, hematoma, and wound complications. Conclusion Considering that only 10.2% of the cases included in the study required change in the management plan during the first outpatient clinic appointment, PIFU pathway can be safely and effectively applied for these cases which will free up considerable capacity in outpatient service to reduce the care backlog.

The Influence of Structural Factors and Telemedicine on Missed Appointments Among Medicaid-Insured Patients.

Missed clinic appointments disproportionately affect Medicaid-insured patients and residents of socioeconomically deprived neighborhoods. The role of the recent telemedicine expansion in reducing these disparities is unclear. We analyzed the relationship between census tract (CT) poverty level, residential segregation, missed appointments, and the role of telemedicine. This retrospective cohort study used electronic health records (EHR) data merged with population datasets and restricted to adult patients (≥ 18years) with completed or missed internal or family medicine outpatient clinic visits (03/2020-12/2022). Using generalized estimating equations, we analyzed the association between missed appointments, CT poverty level, CT residential segregation (operationalized using the isolation index), and appointment modality. Sample size was 125,229 appointments for 68,471 unique patients (Hispanic [46.6%], White [9.4%], Black [18.7%], Asian [2.6%], Native American [1.9%], and "other race/ethnicity" [0.8%]; 18-39years [38.2%], 40-64years [56.4%], and > = 65years [5.36]). There was an increased likelihood of missed appointments with increasing Hispanic isolation index (OR 1.12; 95% CI 1.03, 1.23) and decreased likelihood with increasing Black isolation index (OR 0.71; 95% CI 0.61, 0.83). The protective effect of telemedicine on missed appointments decreased with increasing Black and Hispanic isolation index. Our results suggest that further studies are needed to understand the potential impact of telemedicine on healthcare use inequities among residents of residentially segregated areas. Targeted interventions that aim to identify and address structural factors that could limit the benefits of telemedicine use are also needed.

A Next Available Appointment (NAA) Tool to Better Manage Patient Delay Risk and Patient Scheduling Expectations in Specialist Clinics.

Every year there are approximately 3 million new outpatient specialist clinic appointments at local hospital networks in Victoria, Australia. Growing daily demand for these services leads to high-volume waiting lists and therefore long appointment delays for patients. This phenomenon emphasises the importance of providing analytics and tools to assist with waiting list management in outpatient specialist clinics. In this paper, we developed a novel Next Available Appointment (NAA) tool, to assist clinicians to manage delayed-appointment risk and improve the patient experience by aligning the expected and actual day of the appointment. The NAA uses simulation to determine the earliest available week for a patient appointment on or after the timeframe requested by the clinician, considering the current waiting list and future planned clinician availability. It was validated using 3years of historical waiting list information across several scenarios chosen to capture operational diversity. As a practical example, a scenario chosen for implementation within the clinic's operational setting achieved a simulated reduction in overdue appointments from 41% to 25% (i.e., a reduction of 47,000 overdue appointments over 3years). We also provided early details on the implementation of the tool currently underway.

Looking under the hood of a hybrid two-way texting intervention to improve early retention on antiretroviral therapy in Malawi: an implementation fidelity evaluation

BackgroundWhile key to interpreting findings and assessing generalizability, implementation fidelity is underreported in mobile health (mHealth) literature. We evaluated implementation fidelity of an opt-in, hybrid, two-way texting (2wT) intervention previously demonstrated to improve 12-month retention on antiretroviral therapy (ART) among people living with HIV (PLHIV) in a quasi-experimental study in Lilongwe, Malawi.MethodsShort message service (SMS) data and ART refill visit records were used to evaluate adherence to 2wT content, frequency and duration through the lens of the Conceptual Framework for Implementation Fidelity. Message delivery and 2wT participant interactions were considered across four core 2wT components: 1) weekly motivational SMS messages; 2) proactive SMS appointment reminders; 3) SMS reminders after missed appointments; and 4) interactive messaging with 2wT staff about transfers and appointment rescheduling. Using mixed-effects logistic regression models adjusted for participant demographics, we examined the effect of core 2wT component fidelity on a) on-time appointment attendance and b) timely return to care after a missed appointment, presenting adjusted odds ratios (aORs) and 95% confidence intervals (CIs).ResultsThe 468 2wT participants had a median of 52 study weeks (interquartile range [IQR] 34 – 52) with 6 ART appointments (IQR 4—7) of which 2 (IQR 1 – 3) were missed. On average, participants received a motivation message for 75% (IQR 56%—83%) of enrolled weeks, a reminder before 83% (IQR 67%—100%) of appointments, and after 67% (IQR 0%—100%) of missed appointments. Participants reported 9 transfers and rescheduled 46 appointments through 2wT prompts; 196 appointments were changed via unprompted interaction. Participants with 10% higher expected motivation message delivery were more likely to attend clinic appointments on time (aOR: 1.08; 95%CI: 1.01 – 1.16, p = 0.03). Receiving and responding to an appointment reminder in any way were also associated with increased on-time appointment attendance (aOR: 1.35; 95%CI: 1.03 – 1.79, p = 0.03 and aOR: 1.47, 95%CI: 1.16 – 1.87, p = 0.001, respectively). No associations were found for 2wT messages and timely return to care following a missed appointment.ConclusionGreater 2wT implementation fidelity was associated with improved care outcomes. Although implementation fidelity monitoring of mHealth interventions is complex, it should be integrated into study design.

P0391 The impact of point of care ultrasound on time to initiating advanced therapy in IBD (GUIDE-IBD): A randomised controlled trial

Abstract Background Intestinal ultrasound is an accurate tool for assessing inflammatory bowel disease activity1. Previous studies showed point-of-care ultrasound (POCUS) can impact treatment decisions in 48% of appointments2. Early diagnosis and treatment improves outcomes in Crohn’s disease (CD). We aimed to investigate if POCUS in the IBD clinic led to earlier initiation of advanced therapies using a randomised controlled trial. Methods Patients attending an IBD clinic at a UK tertiary referral centre with known or suspected IBD (with a high likelihood) were eligible. During the primary clinic appointment clinicians’ investigation and treatment decisions were recorded. Immediately following this they were randomised 1:1 to POCUS or standard of care (SOC). The POCUS group then had further review with an option to alter treatment decisions. The primary end-point was time to initiating definitive therapy (in days) (new/changed immunomodulator, advanced therapy or surgery only). Secondary end-points included clinical score (HBI, SCCAI), calprotectin and patient tolerability. Patients were followed for 12 months. Results 122 patients were enrolled between 1st June and 1st November 2023. Median age was 25 years (16-79) and 50% male with a final diagnosis of 87 CD, 23 UC, 4 IBD-U and 8 non IBD (new referrals). 63 had POCUS and 59 SOC. POCUS was performed by one of two sonographers (one gastroenterologist and one radiologist). 65 (53%) were on advanced therapy or immunomodulators at baseline. 99 (81%) had advanced therapy, immunomodulators or surgery during the study period. Mean time to definitive treatment decision was 43 days with POCUS compared to 92 days in SOC (p&amp;lt;0.01). 65 (53%) patients had a change of, or started a new therapy and mean time to treatment initiation was also significantly shorter in the POCUS group, 75 days, compared to SOC, 131 days (p=0.033). In a sub-group of 20 new referrals, 12 were diagnosed with IBD. Mean time to treatment initiation was shorter with POCUS (82 vs 151 days). Steroid prescriptions at the baseline appointment were significantly higher in the POCUS group, 11/63 vs 2/59 (p = 0.012). Any change to treatment in the POCUS group occurred in 29/63 (46%) patients. Scans took an average of 7.5 minutes with 100% patient acceptability. Conclusion POCUS leads to earlier IBD-related decision making which translates into earlier initiation of effective therapy. This should, in turn, lead to improved care with shorter time to remission and reduced complications. Pathways to incorporate POCUS into routine clinical practice to optimise its effectiveness need further evaluation. This will require collaborative training and working across multiple specialties to effectively deliver this service. References (1)Taylor SA, Mallett S, Bhatnagar G, et al. Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn’s disease (METRIC): a multicentre trial. Lancet Gastroenterol Hepatol. 2018;3(8):548-558. doi:10.1016/S2468-1253(18)30161-4 (2)Bots S, De Voogd F, De Jong M, et al. Point-of-care Intestinal Ultrasound in IBD Patients: Disease Management and Diagnostic Yield in a Real-world Cohort and Proposal of a Point-of-care Algorithm. J Crohns Colitis. 2022;16(4):606-615. doi:10.1093/ecco-jcc/jjab175

P1304 High prevalence of HLA DRB1*01:03 in Australian Inflammatory Bowel Disease patients without prediction of refractory disease

Abstract Background Crohn’s disease (CD) and ulcerative colitis (UC) have been associated with the major histocompatibility complex in genome wide association studies (1) and subsequently this area is the most widely studied genetic region. HLA-DRB1*01:03 has been associated with susceptibility to both CD and UC (2), and with severe ulcerative colitis (3). However, the frequency of this allele is known to vary by ethnicity. We aimed to determine the frequency of HLA DRB1*01:03 in a multi-ethnic Australian population and determine its association with refractory disease. Methods At a single centre, tertiary Inflammatory Bowel Disease (IBD) service patients with either CD or UC underwent blood collection at the time of clinic appointment, endoscopy or medication infusion and their HLA DRB1 genotype was determined. Demographic and clinic data was retrospectively collected from the electronic medical record (EMR). Refractory disease was determined by failure of 1 or more advanced therapies including biologics and small molecules, as well as the use of steroids within the last 12 months. Descriptive statistics were used and a Chi Square test (IBM SPSS Version 29) used to assess the relationship between HLA DRB1*01:03 and refractory disease. Results 123 patients were enrolled and HLA DRB1 genotypes identified. 10 patients were excluded from further analysis due to an absence of clinical data or a diagnosis of IBD-U. 113 patients were included for final analysis of which 57.5% were male, the mean age was 40.2 (+/- 16.3). 39.8% had UC and 60.2% had CD, and of those 45.5% had fistulising disease. 35.4% had previously undergone surgery and 77% of the cohort were prescribed an advanced therapy. 11.5% of patients had either heterogenous or homogenous HLA DRB1*01:03. There was no significant association between HLA DRB1*01:03 and failure of advanced therapy (P=0.88) or steroid use (P=0.88). Conclusion We identified a high proportion of IBD patients with HLA DRB1*01:03 compared with previous reports (4). High rates of advanced therapy use, and previous surgery indicate that the cohort has a high proportion of severe disease that could account for this finding. However, no association was found between HLA DRB1*01:03 and our measures of refractory disease possibly due to inadequate numbers in our cohort at present. Further investigation of the utility of HLA DRB1*01:03 is warranted in multi-ethnic populations.