Differences In Completion Rates Research Articles

Feasibility and Acceptability of a Self-Guided Digital Family Skills Management Intervention for Children Newly Diagnosed With Type 1 Diabetes: Pilot Randomized Controlled Trial.

Family dynamics play an important role in determining the glycemic outcomes of type 1 diabetes (T1D) in children. The time interval immediately following T1D diagnosis is particularly stressful for families, and interventions to support families in adjusting their family practices to support adjustment to and management of T1D in the months following diagnosis may improve glycemic outcomes. Self-guided digital interventions offer a sustainable model for interventions to support caregivers in learning evidence-based family management skills for adjustment to and management of T1D. We hypothesized that a self-guided, web-based, family skills management program (addressing caregiver social support as well as family problem-solving, communication, and supportive behavior change strategies) initiated at the time of T1D diagnosis would improve glycemic outcomes in children with T1D. In this study, we report on the feasibility and acceptability of this program. We prospectively evaluated a sample of 37 children newly diagnosed with T1D recruited from a pediatric endocrinology clinic. Parent participants were asked to complete web-based modules addressing social support, family problem-solving, communication, and supportive behavior change strategies. Module completion was analyzed for percentage completion, patterns of completion, and differences in completion rates by coparenting status. Qualitative open-ended feedback was collected at the completion of each module. A total of 31 (84%) of the 37 participants initiated the web-based program. Of those 31 participants, 25 (81%) completed some content and 15 (48%) completed all 5 modules. Completion rates were higher when coparenting partners engaged in the intervention together (P=.04). Of the 18 participants given a choice about the spacing of content delivery, 15 (83%) chose to have all sessions delivered at once and 3 (17%) chose to space sessions out at 2-week intervals. Qualitative feedback supported the acceptability of the program for delivery soon after T1D diagnosis. Families reported on positive benefits, including requesting future access to the program and describing helpful changes in personal or family processes for managing T1D. In this study, we found that a self-guided digital family support intervention initiated at the time of a child's T1D diagnosis was largely feasible and acceptable. Overall, rates of participation and module completion were similar to or higher than other self-guided digital prevention interventions for mental and physical health outcomes. Self-guided digital programs addressing family management skills may help prevent challenges common with T1D management and can decrease cost, increase access, and add flexibility compared to traditional interventions. ClinicalTrials.gov NCT03720912; https://clinicaltrials.gov/study/NCT03720912.

The Management of Depression and Anxiety in Primary Care: Examining Predictors of Adherence to a Psychopharmacological Collaborative Care Management Program for Veterans.

Collaborative care management (CoCM) is an evidenced based approach to psychiatric treatment in primary care, yet literature examining factors associated with program adherence is lacking. This study analyzed predictors of adherence to a CoCM model of psychopharmacological treatment of depression and anxiety in primary care by conducting a retrospective cohort analysis on Veterans referred to a large VA Medical Center's CoCM program over an 18-month period. Baseline characteristics, symptomatic assessments, and covariates of interest were collected. For the primary outcome, the association between covariates and programmatic completion were analyzed. Secondary analyses assessed improvements in psychiatric symptoms. A total of 757 Veterans with depressive or anxiety disorders were included, and 256 completed the CoCM program. Baseline covariates associated with differences in completion rates included the following: age, contact with psychology prior to referral, baseline PHQ-9, baseline GAD-7, and a number of comorbid psychiatric/substance abuse covariates. After controlling for baseline differences, age remained a significant positive predictor of completion (OR 1.019, 95% CI 1.008‒1.030) and cannabis use a significant negative predictor (OR 0.507, 95% CI 0.275‒0.934). Both early improvement in PHQ-9 (OR 1.864, 95% CI 1.210‒2.872) and GAD-7 (OR 1.762, 95% CI 1.154‒2.691) scores were positive predictors. Secondary analyses showed that programmatic completion was associated with greater reductions in psychiatric symptoms. Results identified a number of modifiable parameters associated with differences in completion rates and greater symptomatic reduction for those who complete the program. Additional studies should be conducted examining interventions to optimize CoCM programs by supporting positive predictors while minimizing negative predictors.

Weekly Vitamin D Supplementation to Prevent Acute Respiratory Infections in Young Children at Different Latitudes: A Randomized Controlled Trial

To evaluate the effectiveness of weekly vitamin D supplementation in reducing the number of acute respiratory infections (ARI) in preschool children. Randomized, double-blind, placebo-controlled trial in 303 children aged 1.5-3.5years from 2014 to 2105 in 3 Chilean cities at different latitudes: Santiago (33°S, n=101), Talcahuano (37°S, n=103), and Punta Arenas (53°S, n=99). Participants were allocated (1:1:1) to receive placebo, cholecalciferol (vitamin D3 (VD3)) 5600 IU/week (low-dose), or 11 200 IU/week (high-dose) for 6months. Primary outcome was parent-reported number of ARI; secondary outcomes included number of ARI hospitalizations, change of serum 25-hydroxyvitamin D (25(OH)D) and LL-37/cathelicidin levels, and adverse events. The mean age of participants was 26±6months; 45% were female. Baseline 25(OH)D was 24.9±6.1ng/ml, with 23% having 25(OH)D<20ng/ml. No significant baseline clinical or laboratory differences were observed among groups. Overall, 64% (n=194) completed study participation, without baseline differences between subjects lost to follow-up vs those completing participation or differences in completion rates across groups. After 6months, a dose-dependent increase in serum 25(OH)D was observed from the VD3 intervention (P<.001), with a higher proportion of subjects ending the trial with 25(OH)D<20ng/ml in the placebo group (30.8%) vs the low-dose (7.4%) and high-dose groups (5.1%). However, no group differences were observed in number of ARI (P=.85), ARI hospitalizations (P=.20), LL-37/cathelicidin change (P=.30), or adverse events (P=.41). While weekly VD3 supplementation, in doses equivalent to 800 IU and 1600 IU daily, was associated with improved 25(OH)D levels in preschoolers, we did not find a reduced number of ARI in this sample.

Comparing in Person to Telehealth Delivery of a Family Violence Intervention.

There is increasing evidence that therapy and intervention services delivered by telehealth are effective at reducing a variety of mental health symptoms. Limited studies have indicated online services can reduce intimate partner violence (IPV), but none have tested in-person compared to telehealth-delivered interventions for men who have used IPV. Clinical outcome data from 311 parents (192 fathers and 119 linked coparent mothers) engaged in the Fathers for Change (F4C) intervention following referral by child protective services for IPV were examined to determine if in-person delivery of the intervention differed in terms of client treatment engagement and retention or outcomes. Parents who enrolled during a 1-year period prior to the COVID pandemic received their F4C therapy in person, while those who enrolled during the pandemic received their intake and most of their sessions via telehealth delivery. Parents reported significantly greater symptoms of depression, anxiety, and stress prior to treatment if they enrolled prior to COVID than if they enrolled during the pandemic. There were few differences in completion rates or outcomes based on in-person compared to telehealth delivery. Fathers were slightly more likely to complete treatment and attended a significantly higher percentage of their sessions when it was delivered by telehealth during COVID. Fathers reported significantly lower stress scores posttreatment when they received COVID telehealth delivery compared to prior to COVID in-person delivery of F4C. These findings suggest that telehealth may be an appropriate and viable option for the delivery of IPV interventions for families.

Data-driven collaborative QUality improvement in Cardiac Rehabilitation (QUICR) to increase program completion: protocol for a cluster randomized controlled trial

BackgroundCoronary heart disease (CHD) is the leading cause of deaths and disability worldwide. Cardiac rehabilitation (CR) effectively reduces the risk of future cardiac events and is strongly recommended in international clinical guidelines. However, CR program quality is highly variable with divergent data systems, which, when combined, potentially contribute to persistently low completion rates. The QUality Improvement in Cardiac Rehabilitation (QUICR) trial aims to determine whether a data-driven collaborative quality improvement intervention delivered at the program level over 12 months: (1) increases CR program completion in eligible patients with CHD (primary outcome), (2) reduces hospital admissions, emergency department presentations and deaths, and costs, (3) improves the proportion of patients receiving guideline-indicated CR according to national and international benchmarks, and (4) is feasible and sustainable for CR staff to implement routinely.MethodsQUICR is a multi-centre, type-2, hybrid effectiveness-implementation cluster-randomized controlled trial (cRCT) with 12-month follow-up. Eligible CR programs (n = 40) and the individual patient data within them (n ~ 2,000) recruited from two Australian states (New South Wales and Victoria) are randomized 1:1 to the intervention (collaborative quality improvement intervention that uses data to identify and manage gaps in care) or control (usual care with data collection only). This sample size is required to achieve 80% power to detect a difference in completion rate of 22%. Outcomes will be assessed using intention-to-treat principles. Mixed-effects linear and logistic regression models accounting for clusters within allocated groupings will be applied to analyse primary and secondary outcomes.DiscussionAddressing poor participation in CR by patients with CHD has been a longstanding challenge that needs innovative strategies to change the status-quo. This trial will harness the collaborative power of CR programs working simultaneously on common problem areas and using local data to drive performance. The use of data linkage for collection of outcomes offers an efficient way to evaluate this intervention and support the improvement of health service delivery.EthicsPrimary ethical approval was obtained from the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH01093), along with site-specific governance approvals.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001239651 (30/11/2023) (https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386540&isReview=true).

Revisiting the Recommended Duration of Interviews Conducted by Mobile Phone in Low- and Middle-income Countries: A Randomized Trial in Malawi

Guidelines for conducting surveys by mobile phone calls in low- and middle-income countries suggest keeping interviews short (&lt;20 minutes). The evidence supporting this recommendation is scant, even though limiting interview duration might reduce the amount of data generated by such surveys. We recruited nearly 2,500 mobile phone users in Malawi and randomly allocated them to 10-, 20-, or 30-minute phone interviews, all ending with questions on parental survival. Cooperation was high in all groups, and differences in completion rates were minimal. The extent of item nonresponse, age heaping, and temporal displacement of deaths in data on parental survival generally did not vary between study groups, but reports of maternal age at death were more reliable in longer interviews. Recommendations about the duration of mobile phone interviews might be too restrictive. They should not preclude additional modules, including ones on mortality, in mobile phone surveys conducted in LMICs.

Playing for cognition: investigating the feasibility and user experience of a virtual reality serious game for cognitive assessment in children with congenital heart disease

BackgroundIn order to facilitate the development and implementation of innovative technology in clinical practice, it is important to understand the user experience of end-users. Virtual Reality (VR) offers the possibility to assess cognitive functioning in a dynamic environment that simulates real-world situations. The purpose of this cross-sectional study was to investigate the feasibility of a VR Serious Game for cognitive assessment in school-aged children with congenital heart disease (CHD). The sub-aims were two-fold: (1) to objectively evaluate the feasibility of the VR Serious Game in children with CHD in comparison to typically developing (TD) children and (2) to explore the user experience of both groups following their interaction with the VR Serious Game.ResultsA total of 101 children participated in this study; 98 children were included in the final analysis (CHD: n = 54; TD: n = 47). The VR Serious Game appeared feasible for both children with CHD and TD children, with 88% children completing the innovative VR assessment without encountering any issues. There were no discernible differences in completion rates between groups. Children with CHD reported significantly lower scores than TD children on three user experience scales: Engagement, Flow and Presence. Nonetheless, the scores for Engagement and Flow were still considered "moderate to good". Both groups reported minimal adverse physiological reactions.ConclusionsThe findings suggested that the VR Serious Game was feasible for children with CHD and that the user experience was positive. Future research should investigate the effectiveness of the VR Serious Game compared with a conventional or digital neuropsychological assessment, prioritising the development of novel outcome measures that can better estimate and explain the impact of cognitive impairment on daily functioning.

Automating Patient-reported Data Collection: Does it Work?

There are several electronic patient-reported outcomes (ePROs) vendors that are being used at institutions to automate data collection. However, there is little known about their success in collecting patient-reported outcomes (PROs) and it is unknown which patients are more likely to complete these surveys. In this study, we assessed rates of PRO completion, as well as determined factors that contributed to the completion of baseline and follow-up surveys. We queried our ePRO platform to assess rates of completion for baseline and follow-up surveys for patients from October 2019 to June 2022. All baseline surveys were administered before pediatric orthopaedic procedures, and follow-up surveys were sent at 3 months, 6 months, 1 year, and 2 years after surgery to patients with baseline data. Descriptive statistics were used to summarize the data. Univariate and multivariate analyses were performed to assess differences in patients who did and did not complete surveys. This study included 1313 patients during the study period. Baseline surveys were completed by 66% of the cohort (n = 873 patients). There was a significant difference in race/ethnicity and language spoken in the patients who did and did not complete baseline surveys ( P < 0.01) with lower rates of completion in African American, Hispanic, and Spanish-speaking patients. At least one follow-up was obtained for 68% of patients with baseline surveys (n = 597 patients). There were significant differences in completion rates based on race/ethnicity ( P = 0.03) and language spoken ( P = 0.01). There were lower rates of baseline completion for patients with government insurance in our multivariate analysis (odds ratio: 0.6, P < 0.01). Baseline and follow-up PRO data can be obtained from the majority of patients using automated ePRO platforms. However, additional focus is needed on collecting data from traditionally underrepresented patient groups to better understand outcomes in these patient populations. Level III-retrospective cohort study.

Neurocognitive and psychosocial outcomes in survivors of childhood leukemia with Down syndrome.

The primary aim of this study was to assess the feasibility of a developmentally tailored neurocognitive assessment in survivors of childhood acute leukemia with Down syndrome (DS-leukemia). A secondary aim was to compare outcomes in the DS-leukemia group to a historical comparison group of individuals with DS and no history of childhood cancer. Survivors of DS-leukemia (n = 43; 56% male, mean [SD] age at diagnosis = 4.3 [4.5] years; age at evaluation = 15 [7.9] years) completed a neurocognitive assessment battery that included direct measures of attention, executive function, and processing speed, and proxy ratings of attention problems and executive dysfunction. Direct assessment outcomes were compared to a historical comparison cohort of individuals with DS and no history of childhood cancer (DS-control; n = 117; 56% male, mean [SD] age at evaluation = 12.7 [3.4] years). Rates of valid task completion ranged from 54% to 95%, suggesting feasibility for most direct assessment measures. Compared to the DS-control group, the DS-leukemia group had significantly lower completion rates on measures of executive function (p = 0.008) and processing speed (p = 0.018) compared to the DS-control group. There were no other significant group differences in completion rates. Compared to the DS-control group, the DS-leukemia group had significantly more accurate performance on two measures of executive function (p = 0.032; p = 0.005). Compared to the DS-control group, the DS-leukemia group had significantly more problems with executive function as identified on proxy ratings (6.5% vs. 32.6%, p = <0.001). Children with Down syndrome (DS) are at increased risk for developing acute leukemia compared to the general population but are systematically excluded from neurocognitive outcome studies among leukemia survivors. This study demonstrated the feasibility of evaluating neurocognitive late effects in leukemia survivors with DS using novel measures appropriate for populations with intellectual developmental disorder.

Breast Cancer Screening and BI-RADS Scoring Trends Before and During the COVID-19 Pandemic in an Academic Safety-Net Hospital.

Little is known about how the COVID-19 pandemic affected screening mammography rates and Breast Imaging Reporting and Data Systems (BI-RADS) categorizations within populations facing social and economic inequities. Our study seeks to compare trends in breast cancer screening and BI-RADS assessments in an academic safety-net patient population before and during the COVID-19 pandemic. Our single-center retrospective study evaluated women ≥ 18 years old with no known breast cancer diagnosis who received breast cancer screening from March 2019-September 2020. The screening BI-RADS score, completion of recommended diagnostic imaging, and diagnostic BI-RADS scores were compared between the pre-COVID-19 era (from 1 March 2019 to 19 March 2020) and COVID-19 era (from 20 March 2020 to 30 September 2020). Among the 11,798 patients identified, screened patients were younger (median age 57 versus 59 years, p < 0.001) and more likely covered by private insurance (35.9% versus 32.3%, p < 0.001) during the COVID-19 era compared with the pre-COVID-19 era. During the pandemic, there was an increase in screening mammograms categorized as BI-RADS 0 compared with the pre-COVID-19 era (20% versus 14.5%, p < 0.0001). There was no statistically significant difference in rates of completion of diagnostic imaging (81.6% versus 85.4%, p = 0.764) or assignment of suspicious BI-RADS scores (BI-RADS 4-5; 79.9% versus 80.8%, p = 0.762) between the two eras. Although more patients were recommended to undergo diagnostic imaging during the pandemic, there were no significant differences in race, completion of diagnostic imaging, or proportions of mammograms categorized as suspicious between the two time periods. These findings likely reflect efforts to maintain equitable care among diverse racial groups served by our safety-net hospital.

Implementation of a smartphone application for precision brain health assessment in a rural low socioeconomic setting: The Bogalusa Heart Study

AbstractBackgroundSmartphone apps for digital health with decentralized data collection enable more frequent and precise brain‐health monitoring via the abundance of embedded sensors. Such methods may improve the sensitivity of traditional metrics and representation among diverse populations impacted by health disparities, especially in ADRD studies. Here, we describe a framework for implementing a smartphone‐based digital platform for precision brain health assessment in a longitudinal cohort of Black and White men and women.MethodsParticipants are being recruited as part of a multi‐site study from the Bogalusa Heart Study (BHS), a community‐based cohort in rural Louisiana that began in 1973. The digital platform consists of a smartphone application that is used remotely every three months for two weeks. It includes tasks that assess cognition, speech, gait and balance, and questionnaires that ensure instructions are appropriately followed and to monitor usage experiences. The BHS study personnel handle the initial screening, enrollment, and application setup. To overcome internet connection and time/availability issues, remote phone calls from BHS staff and text messages from a local area code using RingCentral software were implemented. Messages included short reminders, a link to step‐by‐step instructions to complete the application setup, and examples of smartphone tasks. (Figure 1.) Participants could schedule a call to receive phone instructions to complete the process.ResultsA total of 94 participants [age 56 ± 4.5, women n = 60 (69%), Black n = 16 (19%)] have been enrolled in the study thus far. Of those, 77 (82%) registered and set up the application (69 at the study site and 8 remotely via text/phone), and 62 (81%) completed at least one set of tasks. There was no significant difference in completion rates between race [White n = 52 (84%) and Black n = 10 (77%); p = 0.54] and sex groups [women n = 45 (82%) and men n = 17 (85%); p = 0.75].ConclusionResults showed that individuals from a rural community‐based cohort are willing to use digital technologies for brain health assessments. These findings highlight the importance of utilizing low‐cost, scalable platforms and adapting research protocols to meet the requirements of specific populations, particularly those from low socioeconomic and underrepresented backgrounds.

Rural origin student representation in health courses at the University of Tasmania: 2011-2020.

To describe longitudinal trends in the admission and completion of domestic Tasmanian rural origin students in health courses at the University of Tasmania (UTAS). A retrospective audit of records for all domestic Tasmanian students admitted to, or who completed a health course offered by UTAS between 2011 and 2020 was conducted. Data extracted from student records included gender, age, Indigenous background, rural origin (based on residential address outside of Launceston or Hobart at the time of application), health discipline, year of admission and/or completion. Data were analysed in STATA. Between 2011 and 2020, 7516 domestic Tasmanian students were admitted to health courses at UTAS, of which 22.6% were rural origin (vs. a rural population of 36.7%). Students admitted were mostly female (77.0%) and studying nursing (51.1%). Rural origin students were more likely to study at the regional campus in Launceston than in Hobart, the capital city (OR, 3.79 [3.4-4.3, p < 0.00]). Over this same period, 5086 students completed a health course. There was little difference in completion rates among regional vs. rural origin students (OR, 1.04 [1.0-1.1, p < 0.00]); however, completion rates decreased with increasing remoteness. Indigenous and male students were less likely to complete than non-Indigenous (OR, 0.73 [0.7-0.8, p < 0.05]) and female students (OR, 0.97 [1.0-1.0, p < 0.05]) respectively. Tasmanian rural origin students are admitted to a range of health courses at UTAS and many complete. However, additional measures are needed to attract a greater number of local rural origin students to study health courses and to support them through to course completion.

HSD16 Impact of Provider Nudges on Herpes Zoster Vaccine Series Completion during the COVID-19 Pandemic in the United States

To determine the impact of a pharmacy-based, clinical decision support (CDS) tool on herpes zoster (HZ) vaccine series completion during the initial months of the COVID-19 pandemic across the US. In partnership with Kroger Health, a pharmacy CDS tool alerted staff of patients due for their second HZ vaccine dose, which had been accompanied previously by a timed text message. Once operations changed due to COVID-19, the system limited outreach to only patients visiting the pharmacy. Primary outcomes included the proportion of patients receiving both doses within a Kroger-owned pharmacy (n=2,293) and the number of days between doses, both within and across two 32-week periods before and after the pandemic hit the US. Generalized estimating equation-based (GEE) logistic and linear regression models determined differences in completion rates and time to completion. During the observation period, 38,937 adults received at least one HZ vaccine dose, with 77.2% receiving both doses. Patients engaged by the CDS tool achieved 80.5% dose completion, versus 65.4% of those not intervened (p<0.0001), which was lower than in the period immediately before the pandemic (85.8%, p<0.0001). The dosing window averaged 119.4 days (SD: 26.91), which was the longest timeframe between doses since the HZ vaccine was launched and nearly one month longer than before the pandemic (93.0 days [SD: 28.02], p<0.0001). The odds of dose completion increased in areas of higher health literacy (OR: 1.01; 95% CI: 1.007-1.014), but decreased in areas of higher poverty (OR: 0.992; 95% CI: 0.988-0.995). Time to completion was slightly shorter (B=-0.04, p<0.05) in areas of higher health literacy. Despite changes in clinical processes, a nationwide community pharmacy was successful in completing HZ vaccine dose series for adults during the pandemic, suggesting that processes in community pharmacies can protect staff while remaining committed to providing preventive health services during public health crises.

Is the digital divide between older adults and other age groups closing? Impact of telemedicine and adherence with remote symptom monitoring in older adults compared to middle age and AYA patients with cancer.

e13689 Background: The wide adoption of telehealth during the pandemic brought the concern of widening technology disparity especially between AYAs 15-39y, mid-age 40-64y, older adults 65y+. Also, patient-reported outcomes (PRO)-based remote monitoring of patients (pts) with cancer between clinic visits improves quality of life and overall survival but is also often app-based. Since telehealth’s impact on other tech-related health behaviors such as adherence w remote symptom monitoring is not fully understood, we investigated PRO completion patterns in routine cancer care, pre- and mid pandemic. Methods: We queried a prospectively maintained registry of all remotely delivered PROs through the electronic health record (EHR) at our institution across two consecutive time periods: ‘prepandemic’ 9/1/17-3/31/20; ‘midpandemic’ 4/1/20-1/31/23. We captured pt demographics, cancer characteristics, and PRO adherence outcomes; we summarized descriptive statistics and compared (t-test, ANOVA) between time and age cohorts, PRO adherence and independent variables. Results: In total, 182,850 unique patients receiving routine cancer care were sent 1+ remote PROs outside of a clinic visit. Patient adherence w PROs overall increased, from 34% prepandemic (12548 of 37377 pts responding) to 62% mid-pandemic (89,634 of 145,473 patients responding; p &lt;0.00001). We then analyzed completion patterns of one global health PRO used widely across different oncologic settings to understand patient-level response behaviors. Of 4996 pts sent PROs prepandemic (1/1/18-3/31/20), 2517 (50%) responded; of 13543 pts sent PROs midpandemic (4/1/20-12/31/22), 10171 (75%) responded, an increase of 25%, p&lt;0.001). Prepandemic, 77% of pts responded only after a reminder from the clinical team, while midpandemic, only 2% needed these reminders, with 98% responding without a nudge (p&lt;0.001). Prepandemic, only 42% of seniors responded vs 54% mid-age &amp; 64% AYA (p&lt;0.01); midpandemic response rates increased across age cohorts (seniors increasing to 72%; mid-age to 77%; AYA to 77%) to where now, the difference in completion rates across age cohorts was no longer significant (p0.42). Furthermore, virtual visits accounted for the improvements seen in PRO adherence across age cohorts – with response rate among those with virtual visits being 99.9% in seniors, 99.7% in mid-age, and 100% in AYA during year 2022 while PRO response rates midpandemic in pts with in-person visits decreased across all age cohorts to AYA 29%, mid-age 33%, senior 32%. Conclusions: Telehealth was associated with significantly increased adherence with remote symptom monitoring with older adults accounting for the largest increases in this technology’s uptake to where the previously observed divide in EHR-based PRO adherence between older adults and mid-age &amp; AYA patients was closed.

Effect of combining motivational interviewing with cognitive remediation on personal recovery in patients with schizophrenia.

We have been practising the Neuropsychological and Educational Approach to Remediation (NEAR) as cognitive remediation (CR) in a psychiatric hospital and have implemented it in combination with regular interviews based on Motivational Interviewing (MI) approximately 2years after launching NEAR. In this study, we investigated whether combining MI with CR affected completion of the programme, cognitive functions, global functioning, and personal recovery of patients with schizophrenia by analysing medical records. In this retrospective observational study, 14 participants were assigned to the NEAR group and 12 participants were assigned to the NEAR + MI group. Fifteen participants in the NEAR group (n = 6) and NEAR + MI group (n = 9) completed the programme. First, the difference in the completion rate between the groups was examined using the chi-squared test. Second, measures of cognitive functions, global functioning, and personal recovery pre-and post-intervention were examined using the Wilcoxon signed-rank tests for those in each group who completed the programme. Third, therapeutic responses for each group were compared using the Mann-Whitney U tests. There were no statistically significant differences in completion rates between the groups. In the NEAR group, verbal memory and overall cognition improved after the intervention. On the other hand, not only cognitive functions but also global functioning and personal recovery improved in the NEAR + MI group. Moreover, changes in global functioning and personal recovery were significantly higher in the NEAR + MI group. Study findings indicated that combining MI with CR improves cognitive functions, global functioning, and personal recovery in patients with schizophrenia.

Risk Factor Assessment in Virtual Cardiac Rehabilitation Amid the Covid-19 Pandemic.

Risk Factor Assessment in Virtual Cardiac Rehabilitation Amid the Covid-19 Pandemic.

Abstract 9854: Socioeconomic Status: A Key Determinant of Cardiac Rehab Participation Among Medicare Beneficiaries

Introduction: Participation in cardiac rehabilitation (CR) is poor, with disparities across patient demographic and clinical subgroups. Lower CR participation and completion rates may be associated with patients residing in socioeconomically distressed communities. Hypothesis: Patients undergoing surgical and percutaneous coronary revascularization living in distressed communities have lower rates of CR participation and completion. Methods: Medicare beneficiaries undergoing coronary revascularization (July 2016-December 2018) were identified using 100% Medicare claims data. The primary exposure was the quintile of distressed community index (DCI), with 1st and 5th quintiles representing the least and most distressed communities, respectively. CR participation and completion were defined as attending ≥1 session and attending 36 sessions within 1 year of discharge based on CPT codes in outpatient files. Multivariable logistic regression was used to evaluate the relationship between beneficiary DCI quintile and CR participation and completion. Results: Among 414,730 beneficiaries, 23.4% lived in the 1st DCI quintile and 16.4% lived in the 5th quintile. Patients in the 5th DCI quintile tended to be younger, non-white, dual eligible for Medicare/Medicaid, and more comorbid. Overall, 155,872 (37.6%) patients participated in ≥1 CR session, and 45,591 (29.3%) of those patients completed all 36 sessions. CR participation decreased as DCI quintile increased, with participation 12.0 percentage-points lower in the 5th vs 1st DCI quintile (Table). There were no significant differences in completion of 36 sessions across DCI quintiles. Conclusions: CR participation was significantly lower in more socioeconomically distressed communities, but there were no differences in completion rates. Strategies to reduce disparities in CR participation in distressed communities should focus on barriers to initial enrollment after qualifying events.

Patient-reported outcomes: Completion, access, and equity.

141 Background: Patient Reported Outcomes CTCAE (PROM) completion has demonstrated improvements in survival for patients with advanced cancer. Little is known about completion rates by race and gender for questionnaires assigned to all patients receiving IV infusions. Methods: Beginning in 2019 all patients who had a visit associated with an IV infusion were assigned a PROM PRO-CTCAE questionnaire through the EHR portal 72 hours prior to the visit and again using an in- clinic tablet if not completed upon check-in. The PROMs questionnaires are available in 6 languages via both electronic platforms. At registration, all patients self- identify as White, Black/African American, Asian or other (multiple, do not prefer to answer) by race. We collected 2021 data on all eligible patients who were assigned a questionnaire and cross referenced that by completion and self-assigned race and gender at registration. Data from breast, thoracic and GI clinics are presented. Results: 1715 patients were eligible and self-identified as White, Black or Asian for a PROM CTCAE questionnaire across the three clinics (519 breast clinic, 390 thoracic, 806 GI). 3872 questionnaires were completed (average 2.26 questionnaires per eligible patient). 2875 (73%) were completed by EHR portal and 1027 (27%) were completed in clinic on the tablet. White patients completed questionnaires 67% when assigned, Asian 68% and Black/African American 52% of the time. 81% of breast clinic patients completed questionnaires, 62% of thoracic patients and 54% of GI patients. Overall, in thoracic and GI clinics White women completed questionnaires 58%, Black women 41% and Asian women 70% compared to White men 59%, Asian men 56% and Black men 57%. All patients who completed questionnaires in breast clinic identified as women. Conclusions: We assigned PROM CTCAE questionnaires to all eligible patients who had an IV infusion encounter associated with their visits in the breast, thoracic and GI clinics by both the electronic chart portal and again in clinic by tablet, if not completed prior to the in person visit. PROM questionnaires are available in 6 languages through both methods. We identified differences in completion rates by race with fewer African American/Black patient completion rates compared to White or Asian self-identification, (52% vs 67.5%). The largest differences were between White or Asian women, 58% and 70% completion rates compared to Black women 41%. Differences in gender may explain differences across disease groups as all breast clinic patients were self-identified as female, 81% completion rate compared to 62% thoracic and 54% GI.

Effect of Minocycline on Depressive Symptoms in Patients With Treatment-Resistant Depression

Insufficient treatment response and resulting chronicity constitute a major problem in depressive disorders. Remission rates range as low as 15% to 40% and treatment-resistant depression (TRD) is associated with low-grade inflammation, suggesting anti-inflammatory interventions as a rational treatment strategy. Minocycline, which inhibits microglial activation, represents a promising repurposing candidate in the treatment of TRD. To determine whether 6 weeks of minocycline as add-on to antidepressant treatment as usual can significantly reduce depressive symptoms in patients with TRD. The study was conducted in Germany and designed as a multicenter double-blind randomized clinical trial (RCT) of 200 mg/d minocycline treatment over a course of 6 weeks with a 6-month follow-up. Participants were recruited from January 2016 to August 2020 at 9 university hospitals that served as study sites. Key inclusion criteria were a diagnosis of major depressive disorder (according to Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition] criteria), severity of depressive symptoms on the Hamilton Depression Rating Scale (HAMD-17) greater than or equal to 16 points, aged 18 to 75 years, body mass index 18 to 40, Clinical Global Impression Scale (CGI-S) greater than or equal to 4, failure to adequately respond to an initial antidepressant standard medication as per Massachusetts General Hospital Antidepressant Treatment History Questionnaire, and stable medication for at least 2 weeks. A total of 258 patients were screened, of whom 173 were randomized and 168 were included into the intention-to-treat population. Statistical analysis was performed from April to November 2020. Participants were randomized (1:1) to receive adjunct minocycline (200 mg/d) or placebo for 6 weeks. Primary outcome measure was the change in Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to week 6 analyzed by intention-to-treat mixed model repeated measures. Secondary outcome measures were response, remission, and various other clinical rating scales. Of 173 eligible and randomized participants (84 randomized to minocycline and 89 randomized to placebo), 168 formed the intention-to-treat sample (79 [47.0%] were women, 89 [53.0%] were men, 159 [94.6%] were White, 9 [6.4%] were of other race and ethnicity, including Asian and unknown ethnicity), with 81 in the minocycline group and 87 in the placebo group. The mean (SD) age was 46.1 (13.1) years, and the mean (SD) MADRS score at baseline was 26.5 (5.0). There was no difference in rates of completion between the minocycline (83.3% [70 of 81]) and the placebo group (83.1% [74 of 87]). Minocycline treatment did not alter the course of depression severity compared with placebo as assessed by a decrease in MADRS scores over 6 weeks of treatment (1.46 [-1.04 to 3.96], P = .25). Minocycline treatment also exhibited no statistically significant effect on secondary outcomes. In this large randomized clinical trial with minocycline at a dose of 200 mg/d added to antidepressant treatment as usual for 6 weeks, minocycline was well tolerated but not superior to placebo in reducing depressive symptoms in patients with TRD. The results of this RCT emphasize the unmet need for therapeutic approaches and predictive biomarkers in TRD. EU Clinical Trials Register Number: EudraCT 2015-001456-29.

Use of quality-of-life instruments for people living with HIV: a global systematic review and meta-analysis.

IntroductionDue to the effectiveness of combined antiretroviral therapy and its growing availability worldwide, most people living with HIV (PLHIV) have a near‐normal life expectancy. However, PLHIV continue to face various health and social challenges that severely impact their health‐related quality‐of‐life (HRQoL). The UNAIDS Global AIDS Strategy discusses the need to optimize quality‐of‐life, but no guidance was given regarding which instruments were appropriate measures of HRQoL. This study aimed to review and assess the use of HRQoL instruments for PLHIV.MethodsWe conducted a global systematic review and meta‐analysis, searching five databases for studies published between January 2010 and February 2021 that assessed HRQoL among PLHIV aged 16 years and over. Multivariable regression analyses were performed to identify factors associated with the choice of HRQoL instruments. We examined the domains covered by each instrument. Random‐effects meta‐analysis was conducted to explore the average completion rates of HRQoL instruments.Results and discussionFrom 714 publications, we identified 65 different HRQoL instruments. The most commonly used instruments were the World Health Organization Quality‐of‐Life‐ HIV Bref (WHOQOL‐HIV BREF)—19%, Medical Outcome Survey‐HIV (MOS‐HIV)—17%, Short Form‐36 (SF‐36)—12%, European Quality‐of‐Life Instrument‐5 Dimension (EQ‐5D)—10%, World Health Organization Quality‐of‐Life Bref (WHOQOL BREF)—8%, Short Form‐12 (SF‐12)—7% and HIV/AIDS Targeted Quality‐of‐Life (HAT‐QOL)—6%. There were greater odds of using HIV‐specific instruments for middle‐ and low‐income countries (than high‐income countries), studies in the Americas and Europe (than Africa) and target population of PLHIV only (than both PLHIV and people without HIV). Domains unique to the HIV‐specific instruments were worries about death, stigma and HIV disclosure. There were no significant differences in completion rates between different HRQoL instruments. The overall pooled completion rate was 95.9% (95% CI: 94.7−97.0, I 2 = 99.2%, p < 0.01); some heterogeneity was explained by country‐income level and study type.ConclusionsA wide range of instruments have been used to assess HRQoL in PLHIV, and the choice of instrument might be based on their different characteristics and reason for application. Although completion rates were high, future studies should explore the feasibility of implementing these instruments and the appropriateness of domains covered by each instrument.