Follow-up Calls Research Articles

Preventive Home Visits Among Frail Community-Dwelling Older Adults. The Added Value of Follow-Up Telephone Calls

ABSTRACT People in need of care and support do not always find appropriate services. This paper aims to explore the content and added value of monthly follow-up telephone calls after preventive home visits. We used both monitoring data and qualitative semi-structured interviews (with older adults, formal and informal caregivers). Results indicate that a majority of older adults (N = 95) received a regular follow-up of four telephone calls. Social connection and involvement were mentioned by all three groups as positive aspects of the program. Although time-consuming, this paper draws attention to the added value of follow-up telephone calls after preventive home visits.

Benchmarking CRISPR-BP34 for point-of-care melioidosis detection in low-income and middle-income countries: a molecular diagnostics study

Melioidosis is a neglected but often fatal tropical disease. The disease has broad clinical manifestations, which makes diagnosis challenging and time consuming. To improve diagnosis, we aimed to evaluate the performance of the CRISPR-Cas12a system (CRISPR-BP34) to detect Burkholderia pseudomallei DNA across clinical specimens from patients suspected to have melioidosis. We conducted a prospective, observational cohort study of adult patients (aged ≥18 years) with melioidosis at Sunpasitthiprasong Hospital, a tertiary care hospital in Thailand. Participants were eligible for inclusion if they had culture-confirmed B pseudomallei infection from any clinical samples. Data were collected from patient clinical records and follow-up telephone calls. Routine clinical samples (blood, urine, respiratory secretion, pus, and other body fluids) were collected for culture. We documented time taken for diagnosis, and mortality at day 28 of follow-up. We also performed CRISPR-BP34 detection on clinical specimens collected from 330 patients with suspected melioidosis and compared its performance with the current gold-standard culture-based method. Discordant results were validated by three independent qualitative PCR tests. This study is registered with the Thai Clinical Trial Registry, TCTR20190322003. Between Oct 1, 2019, and Dec 31, 2022, 876 patients with culture-confirmed melioidosis were admitted or referred to Sunpasitthiprasong Hospital, 433 of whom were alive at diagnosis and were enrolled in this study. Median time from sample collection to diagnosis by culture was 4·0 days (IQR 3·0-5·0) among all patients with known survival status at day 28, which resulted in delayed treatment. 199 (23%) of 876 patients died before diagnosis and 114 (26%) of 433 patients in follow-up were treated, but died within 28 days of admission. To test the CRISPR-BP34 assay, we enrolled and collected clinical samples from 114 patients with melioidosis and 216patients without melioidosis between May 26 and Dec 31, 2022. Application of CRISPR-BP34 reduced the median sample-to-diagnosis time to 1·1 days (IQR 0·7-1·5) for blood samples, 2·3 h (IQR 2·3-2·4) for urine, and 3·3 h (3·1-3·4) for respiratory secretion, pus, and other body fluids. The overall sensitivity of CRISPR-BP34 was 93·0% (106 of 114 samples [95% CI 86·6-96·9]) compared with 66·7% (76 of 114 samples [57·2-75·2]) for culture. The overall specificity of CRISPR-BP34 was 96·8% (209 of 216 samples [95% CI 93·4-98·7]), compared with 100% (216 of 216 samples [98·3-100·0]) for culture. The sensitivity, specificity, speed, and window of clinical intervention offered by CRISPR-BP34 support its prospective use as a point-of-care diagnostic tool for melioidosis. Future development should be focused on scalability and cost reduction. Chiang Mai University Thailand and Wellcome Trust UK.

Project EPIC (Empowering People to Independence in COPD): Study protocol for a hybrid effectiveness-implementation pilot randomized controlled trial of telephonic, geriatrics-palliative care nurse-coaching in older adults with COPD and their family caregivers

BackgroundEPIC (Empowering People to Independence in COPD) is a geriatric-palliative care telephonic, nurse coach intervention informed by Baltes' Theory of Successful Aging and adapted from the ENABLE (Educate, Nurture, Advise, Before Life Ends) intervention. EPIC, focused on improving independence, mobility, well-being, and COPD symptoms, has undergone formative and summative evaluation for adults with COPD. MethodsThe primary study aim is to assess the refined EPIC intervention's feasibility and acceptability via a pilot hybrid effectiveness-implementation randomized control trial in community-dwelling older adults with moderate to severe COPD and their family caregivers. The secondary aim is to explore the impact of EPIC on patient and caregiver outcomes. Older adults with COPD and their family caregivers (target N = 60 dyads) will be randomized to EPIC (intervention) or usual COPD care (control). EPIC includes six patient and four family caregiver weekly, telephone-based nurse coach sessions using a manualized curriculum (Charting Your Course), plus three monthly follow-up calls. Feasibility will be measured as completion of EPIC intervention and trial components (e.g., recruitment, retention, data collection). Acceptability will be evaluated using satisfaction surveys and post-study feedback interviews. A blinded data collector will assess exploratory outcomes (e.g., Life-Space mobility, quality of life, caregiver burden, emotional symptoms, loneliness, cognitive impairment, functional status, healthcare utilization) at baseline, 12, and 24 weeks. DiscussionThis intervention fills a gap in addressing the geriatrics and palliative care needs and equity for adults with COPD and their family caregivers.Trial registration:ClinicalTrials.gov Identifier: NCT05040386

Post-discharge mortality among patients hospitalised with severe acute respiratory infection, Bangladesh, 2012–2019: a prospective observational study

Enhancing outcomes post-hospitalisation requires an understanding of predictive factors for adverse events. This study aimed to estimate post-discharge mortality rates among patients with severe acute respiratory infection (SARI) in Bangladesh, identify associated factors, and document reported causes of death. From January 2012 to December 2019, we conducted follow-up calls to patients or their families 30 days after discharge to assess the status of patients with SARI. Proportions of deaths within 30 days of discharge were estimated, and a comparative analysis of demographics, clinical characteristics, and influenza illness between decedents and survivors was performed using multivariable Cox regression models. Among 23,360 patients with SARI (median age: 20 years, IQR: 1.5-48, 65% male), 351 (1.5%) died during hospitalisation. Of 23,009 patients alive at discharge, 20,044 (87%) were followed, with 633 (3.2%) deaths within 30days of discharge. In children (<18 years), difficulty breathing (adjusted hazard ratio [aHR] 1.8; 95% CI 1.1-3.0), longer hospital stay (aHR 1.1; 95% CI 1.1-1.1), and heart diseases (aHR 8.5; 95% CI 3.2-23.1) were associated with higher post-discharge death risk. Among adults (≥18 years), difficulty breathing (aHR 2.3; 95% CI 1.7-3.0), chronic obstructive pulmonary disease (aHR 1.7; 95% CI 1.4-2.2), and intensive care unit admission (aHR 5.2; 95% CI 1.9-14.0) were linked to elevated post-discharge death risk. Influenza virus was detected in 13% (46/351) of in-hospital SARI deaths and 10% (65/633) of post-discharge SARI deaths. Nearly one in twenty patients with SARI died during hospitalisation or within 1 month of discharge, with two-thirds of deaths occurring post-discharge. Seasonal influenza vaccination is recommended to mitigate influenza-associated mortality. To enhance post-discharge outcomes, hospitals should consider developing safe-discharge algorithms, reinforcing post-discharge care plans, and establishing outpatient monitoring for recently discharged patients. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA [U01GH002259].

Effect of a Co-Located Bridging Recovery Initiative on Hospital Length of Stay Among Patients With Opioid Use Disorder

Co-located bridge clinics aim to facilitate a timely transition to outpatient care for inpatients with opioid use disorder (OUD); however, their effect on hospital length of stay (LOS) and postdischarge outcomes remains unclear. To evaluate the effect of a co-located bridge clinic on hospital LOS among inpatients with OUD. This parallel-group randomized clinical trial recruited 335 adult inpatients with OUD seen by an addiction consultation service and without an existing outpatient clinician to provide medication for OUD (MOUD) between November 25, 2019, and September 28, 2021, at a tertiary care hospital affiliated with a large academic medical center and its bridge clinic. The bridge clinic included enhanced case management before and after hospital discharge, MOUD prescription, and referral to a co-located bridge clinic. Usual care included MOUD prescription and referrals to community health care professionals who provided MOUD. The primary outcome was the index admission LOS. Secondary outcomes, assessed at 16 weeks, were linkage to health care professionals who provided MOUD, MOUD refills, same-center emergency department (ED) and hospital use, recurrent opioid use, quality of life (measured by the Schwartz Outcome Scale-10), overdose, mortality, and cost. Analysis was performed on an intent-to-treat basis. Of 335 participants recruited (167 randomized to the bridge clinic and 168 to usual care), the median age was 38.0 years (IQR, 31.9-45.7 years), and 194 (57.9%) were male. The median LOS did not differ between arms (adjusted odds ratio [AOR], 0.94 [95% CI, 0.65-1.37]; P = .74). At the 16-week follow-up, participants referred to the bridge clinic had fewer hospital-free days (AOR, 0.54 [95% CI, 0.32-0.92]), more readmissions (AOR, 2.17 [95% CI, 1.25-3.76]), and higher care costs (AOR, 2.25 [95% CI, 1.51-3.35]), with no differences in ED visits (AOR, 1.15 [95% CI, 0.68-1.94]) or deaths (AOR, 0.48 [95% CI, 0.08-2.72]) compared with those receiving usual care. Follow-up calls were completed for 88 participants (26.3%). Participants referred to the bridge clinic were more likely to receive linkage to health care professionals who provided MOUD (AOR, 2.37 [95% CI, 1.32-4.26]) and have more MOUD refills (AOR, 6.17 [95% CI, 3.69-10.30]) and less likely to experience an overdose (AOR, 0.11 [95% CI, 0.03-0.41]). This randomized clinical trial found that among inpatients with OUD, bridge clinic referrals did not improve hospital LOS. Referrals may improve outpatient metrics but with higher resource use and expenditure. Bending the cost curve may require broader community and regional partnerships. ClinicalTrials.gov Identifier: NCT04084392.

Race and socioeconomic determinants of opioid use and disposal following pediatric surgery.

Opioids are a mainstay in treating acute post-surgical pain although there are limited data on post-discharge use. To assess post-operative opioid usage in children undergoing outpatient pediatric surgical procedures and provider variability in the number of doses prescribed by procedure. This cohort study included parents of children who were prescribed opioids following outpatient pediatric surgical procedures at Texas Children's Hospital from July 2019 to July 2020. Subjects participated in an opioid takeback program with an accompanying telephone survey to determine opioid utilization. Reported opioid usage included the following: none (0 percent), some (>0 percent but <100 percent), and all (100 percent). Provider prescribing patterns were stratified by doses and surgical intervention. Parents of 423 patients received follow-up calls, of which 350 (82.7 percent) reported use of some to all opioids and 73 (17.3 percent) reported using none. In the group reporting use of all opioids (n = 140 [33.1 percent]), parents were more likely to be single, have Medicaid, and report lower education levels when compared with parents reporting some or no opioid use. The number of opioids prescribed was not associated with the amount used (p = 0.51). The number of doses varied widely within each surgical procedure: The median number of doses prescribed ranged from 6 to 15 with some patients prescribed more than twice the median given the same procedure. This study suggests that opioids are indicated for acute post-surgical pain in children although select patient and parental factors are associated with the extent of usage. This study also highlights significant variability in prescribed doses for similar procedures and may indicate both overprescribing and underprescribing by physicians.

Abstract TP48: Rebuilding Sustainable Stroke Support Group: Strategies and Impact

Background: Comprehensive Stroke Program identified decreased monthly Stroke Support Group [SSG] participants [P] months after pandemic, when safe to meet. November 2022, the Neuroscience Nurse Navigator [NNN] took responsibility to rebuild the SSG by enhancing communication [EC], value [V], &amp; consistency [C] for stroke survivors &amp; caregivers [SS/CG]. Purpose: Evaluate strategies to rebuild a sustainable SSG &amp; impact of EC, V, &amp; C. Methods: NNN EC by coordinating with [w/] marketing to post events &amp; SS stories, &amp; updating the SSG brochure with “Life After Stroke” [LAS] verbiage &amp; an RSVP QR code. SS/CG received emails 1-week before SSG &amp; 1 day after w/information shared. NNN added SSG to discharge [DC] instructions &amp; encouraged attendance during inpatient rounding &amp; post DC follow-up calls. The annual Stroke Reunion, October 2023, highlighted SSG. NNN added V by making SS/CG feel heard &amp; understood, while reminding SS of LAS purpose. SS/CG feedback was used to develop a recovery topic calendar w/speakers &amp; healthy snacks. Evidence-based AHA/ASA resources were used to facilitate discussion. SS/CG engagement was encouraged to share experiences &amp; SS were recognized &amp; celebrated during their stroke anniversary month. NNN ensured C by holding SSG monthly regardless of RSVPs &amp; arranged to cover the event when unavailable. Number of SSG-P &amp; new P were monitored w/surveys completed in June &amp; July. Results: SSG-P increased in February [220%] &amp; April [320%] from October. SSG-P decreased during Spring Break &amp; summer vacations. New P began attending in November w/highest number in April [9]. Surveys showed 95% found the topic helpful &amp; likely to make LC. All SSG-P reported SSG helped LAS adjustment, planned to attend monthly &amp; would encourage others to attend. Conclusion: Key strategies, EC, V, &amp; C, helped build a sustainable SSG and improved SS/CG satisfaction. The NNN was able to streamline processes, build meaningful connections, attract new P &amp; improved SS/CG participation.

Underuse of Antiviral Drugs to Prevent Progression to Severe COVID-19 - Veterans Health Administration, March-September 2022.

Antiviral drugs reduce the rate of progression to severe COVID-19 when given to patients with mild-to-moderate disease within 5 days of symptom onset. Despite being recommended for patients at high risk for progression to severe COVID-19 because of age or chronic conditions, reported antiviral use among the general adult population has been ≤35%. To ascertain reasons for underuse of antiviral medications to prevent severe COVID-19 and propose interventions accordingly, a detailed review was conducted of 110 Veterans Health Administration patients with mild-to-moderate infection at high risk for progression because of underlying conditions (organ transplantation or hematologic malignancies) who did not receive an antiviral drug. Among these 110 patients, all of whom had received COVID-19 vaccine, 22 (20.0%) were offered treatment but declined, and 88 (80.0%) were not offered treatment. Among the 88 patients not offered treatment, provider reasons included symptom duration of >5 days (22.7%), concern about possible drug interactions (5.7%), or absence of symptoms (22.7%); however, among nearly one half (43 of 88; 48.9%) of these patients, no reason other than mild symptoms was given. Among 24 (55.8%) of those 43 patients, follow-up was limited to telephone calls to report test results and inquire about symptom evolution, with no documentation of treatment being offered. These findings suggest that education of patients, providers, and medical personnel tasked with follow-up calls, combined with advance planning in the event of a positive test result, might improve the rate of recommended antiviral medication use to prevent severe COVID-19-associated illness, including death.

Outcomes and Experiences of Patients and Their Caregivers After Severe Stroke Requiring Tube Feeding in Peru

ObjectivesEvaluate clinical outcomes of stroke survivors in Peru discharged with artificial nutrition via a feeding tube (FT), and explore perspectives and experiences of these patients and their caregivers. MethodsRetrospective chart review to describe the prevalence of FT placement and characteristics of patients admitted with stroke to the Instituto Nacional de Ciencias Neurológicas in Lima, Peru between January 2019 and 2021. Follow-up calls to stroke survivors discharged home with FTs or their caregivers included quantitative and qualitative questions to assess long-term outcome and explore perspectives around poststroke care and FT management. We analyzed quantitative data descriptively and applied thematic analysis to qualitative data using a consensus-driven codebook. ResultsOf 812 hospitalized patients with stroke, 146 (18%) were discharged home with FT, all with nasogastric tubes (NGTs). Follow-up calls were performed a median of 18 months after stroke with 96 caregivers and three patients. Twenty-five patients (25%) had died, and 82% of survivors (n = 61) remained dependent for some care. Four themes emerged from interviews: (1) perceived suffering (physical, emotional, existential) associated with the NGT and stroke-related disability, often exacerbated by lack of preparedness or prognostic awareness; (2) concerns around compromised personhood and value-discordant care; (3) coping with their loved-one's illness and the caregiving role; and (4) barriers to NGT care and skill acquisition. ConclusionWe identified a high burden of palliative and supportive needs among severe stroke survivors with NGTs and their caregivers suggesting opportunities to improve poststroke care through education, communication, and support.

Developing, implementing, and evaluating the visiting Neighbors' program in rural Appalachia: A quality improvement protocol.

Older adults living alone in rural areas frequently experience health declines, social isolation, and limited access to services. To address these challenges, our medical academic university supported a quality improvement project for developing and evaluating the Visiting Neighbors program in two rural Appalachian counties. Our Visiting Neighbors program trained local volunteers to visit and guide rural older adults in healthy activities. These age-appropriate activities (Mingle, Manage, and Move- 3M's) were designed to improve the functional health of older adults. The program includes four in-home visits and four follow-up telephone calls across three months. The purpose of this paper was to describe the 3M's Visiting Neighbors protocol steps guiding the quality improvement procedures relating to program development, implementation, and evaluation. This Visiting Neighbors study used a single-group exploratory quality improvement design. This program was tested using quality improvement standards, including collecting participant questionnaires and visit observations. Older adults (> 65 years) living alone (N = 30) participants were female (79%) with a mean age of 82.96 (SD = 7.87) years. Volunteer visitor participants (N = 10) were older adult females. Two volunteer visitors implemented each visit, guided by the 3M's activities manual. All visits were verified as being consistently delivered (fidelity). Enrollment and retention data found the program was feasible to conduct. The older adult participants' total program helpfulness ratings (1 to 5) were high (M = 51.27, SD = 3.77). All volunteer visitor's program helpfulness ratings were also high (M = 51.78, SD = 3.73). The Visiting Neighbors program consistently engaged older Appalachian adults living alone in the 3M's activities. The feasibility and fidelity of the 3M's home visits were verified. The quality improvement processes included engaging the expert advisory committee and rural county stakeholders to ensure the quality of the program development, implementation, and evaluation.

Effectiveness of a home-based music-paced physical activity programme on exercise-related outcomes after cardiac rehabilitation: a randomized controlled trial.

A randomized controlled trial was conducted to examine the effects of a home-based music-paced physical activity programme guided by Information-Motivation-Strategy (IMS) model and Self-determination theory on exercise-related outcomes for patients with coronary heart disease (CHD) after cardiac rehabilitation (CR). A total of 130 patients with CHD from a regional CR centre in Hong Kong were recruited and randomly allocated into intervention (n = 65) or control groups (n = 65). The intervention group received theory-guided practical sessions on performing prescribed home-based physical activity with individualized synchronized music, and follow-up telephone calls. The primary outcome was exercise capacity. Secondary outcomes included exercise self-efficacy, physical activity level, and exercise self-determination. Data were collected at baseline, 3 months, and 6 months after study entry. The generalized estimating equations model was used to assess the intervention effects. Patients with CHD in the intervention group demonstrated significantly greater improvements in exercise capacity at 3 months [β = 35.68, 95% confidence interval (CI) 2.69-68.68, P = 0.034] and significantly improved exercise self-efficacy at 6 months (β = 3.72, 95% CI 0.11-7.32, P = 0.043) when compared with the control group. However, no significant group differences were found in physical activity level and exercise self-determination. The study findings provide evidence on an innovation on improving the exercise capacity and exercise self-efficacy of patients with CHD. The music-paced physical activity guided by the IMS model and Self-determination theory requires further investigation on its long-term effects in future studies. ChiCTR-IOR-17011015.

Assessment of the effect of telephonic follow-up on readmissions and mortality rate of the patients with acute coronary syndrome and acute heart failure in Rashid hospital

Abstract: Background Acute Coronary Syndrome (ACS) and Acute Heart Failure (AHF) are severe medical conditions that are closely associated with higher rates of readmissions and mortality in hospitals. These conditions pose an exponential challenge to the health care system and increase patient burden. Objectives This study aims to identify the effect of Telephonic follow-up on readmission and mortality rates in Rashid Hospital due to ACS and AHF. Methods In 2022, we conducted a prospective study. We divided 805 patients admitted with ACS and AHF in Rashid Hospital into two groups and compared the readmission and mortality rates of patients who were followed up with those who were not. The data collection tool included a demographic questionnaire, which was then analyzed by statistical tests and SPSS software. Results There are patients in the follow-up call group versus patients in the no follow-up call group. The patients with follow-up calls had a higher survival rate (98.3%) when compared with the ones who had not been called (93.4%) (p=0.003). Readmission rates for follow-up patients were (7.7%) versus (5.9%) for those without follow-up calls (p=0.429). The study analyzed and investigated the individuals on various other factors but with no statistically significant difference between the two groups. Conclusion The study provides insight into the various factors and their association with patients&amp;apos; outcomes. Even though the association of readmission rate to follow-up was unremarkable, the mortality rate of patients with follow-up was significantly lower.

Using Care Navigation to Improve Patient-Reported Outcomes Among Older Adult Patients: Preliminary Results From a Pilot Study.

Navigating health and social care in the United States can be difficult for people of all ages, but older adults often have multiple health problems, chronic illnesses, and disabilities that can increase the complexities of their care. To assist older adult patients and/or their caregivers with coordinating care, and providing information, advocacy, and resources, Henry Ford Health (HFH) implemented a Senior Care Navigation Program (SCNP). Older HFH patients or their caregivers were referred to the SCNP either by a provider or another member of their care team. A senior navigator (SN) then reached out to the patient/caregiver by telephone to discuss the SCNP and their support/care needs. The SN scheduled follow-up calls as needed. Patients/caregivers enrolled in Phase 1 of this pilot program were given the option to join the evaluation group. These patients were interviewed by an independent research interviewer at baseline, 3-, 6-, and 9-month post initial contact to complete 5 patient-reported outcomes measures. Our Phase 1 pilot has demonstrated significant improvements in the EQ5D (health-related quality of life) and two patient-reported outcomes measurement information system (PROMIS) measures (depression and anxiety) suggesting that the SCNP program at HFH is having a positive impact on older adult patients' health and well-being. In Phase 2, we will further evaluate the impact of the SCNP on healthcare utilization.

First pill hardest to swallow: An evaluation study of cardiovascular nurse-led follow-up phone calls

IntroductionScreening for cardiovascular disease (CVD) followed by preventive medication is expected to reduce CVD (2,3,5). However, insufficient medication adherence may affect screening effectiveness (11-12). It remains uncertain which interventions are suitable to support citizens in their decision-making about taking CVD preventive medication. ObjectiveWe evaluated if and how three nurse-led telephone follow-up (TFU) calls supported citizens in making informed decisions regarding CVD preventive medication and thereby potentially strengthened their medication adherence. MethodsEmploying a theory-based evaluation design inspired by Dahler-Larsen (39-41), we developed and tested a programme theory describing if and how the TFU calls supported medical decision-making and potentially improved medication adherence. Data were collected via telephone. FindingsWe analysed 61 TFU calls collected between May 2017 and April 2019 and found that TFU calls supported participants’ reflections on preventive medication. TFU calls supported informed decision-making regarding initiating medication, allowing participants to consider personal preferences and values, including both opting for and abstaining from medication. The content of the TFU calls revolved around four crucial themes: I) understanding the purpose of taking the medicine; II) meaningfulness and joint reflection support the decision; III) relation to healthcare professionals; and IV) taking medication for the first time. ConclusionTFU calls effectively supported citizens' understanding and addressed their needs. Trusted healthcare professionals' recommendations were preferred for decisional support. Initiating CVD preventive medication was particularly challenging for citizens who had not previously taken such medication. We recommend scheduling TFU calls early: the first after one week, the second after one month and the third after six months.

Abstract C128: Barriers identified by healthcare professionals concerning the participation of people living with HIV in HPV-related cancer clinical trials in Puerto Rico

Abstract OBJECTIVES: Effectively recruiting and retaining participants in clinical trials (CTs) has proven to be a challenge. Identifying and addressing barriers to CTs participation will allow more CTs to reach enrollment targets and generalize results. We aimed to identify the main barriers that healthcare professionals caring for people living with HIV (PLWH) and potential participants have encountered for promotion and participation in ULACNet-101, respectively, in Puerto Rico (PR). METHODS: We analyzed data from two follow-up phone surveys (2 months and 4 months) with healthcare professionals from HIV healthcare organizations in PR that participated in a training activity focused on CTs and patient navigation. The training activity was part of the efforts implemented at PR to enhance the recruitment strategies in ULACNet-101, a CT aimed at preventing HPV-related cancers among PLWH under the California-Mexico-Puerto Rico (CAMPO) Consortium. Healthcare professionals were questioned about the challenges they face while recommending potential participants to ULACNet-101. Additionally, they identified barriers to participation in the study reported by patients. RESULTS: Eighty-two healthcare professionals participated in the training activity (mean age 45±12 years and 72% female). Following the session, 58 (79.5% response rate) and 43 (64.2% response rate) healthcare professionals completed the first and second follow-up call, respectively. Most of the participants from both follow-up calls worked at community-based organizations (74.1% and 72.1%, respectively). In both calls, the most common barriers that healthcare professionals reported to refer patients to ULACNet-101 were that patients did not show interest (32.8% and 44.2%) and they had not found the best time to talk to patients (24.1% and 18.6%). However, a significant number of healthcare professionals (25.9% and 30.3%) stated that there were no impediments to referring patients to ULACNet-101. Regarding barriers reported by patients to participate, most healthcare professionals informed that the CT site is far from where they live (55.2% and 55.8%) and that they have no one to take them to appointments (55.2% and 53.5%). Additional common barriers reported to participation in ULACNet-101 cited by patients included a lack of awareness about CTs (46.6%, first follow-up call) and fear of the procedures (55.8%, second follow-up call). To overcome barriers to participation in ULACNet-101, healthcare professionals provided educational material about CAMPO (93.1% and 94.4%), coordinated an appointment with a physician to clarify doubts (24.1% and 27.8%), and provided CAMPO’ staff contact information (89.7% and 94.4%). CONCLUSION: The reported barriers by healthcare professionals are crucial to understand and enhance the recruitment of PLWH into cancer-related CTs. We anticipate that by addressing these, we will be able to increase the number of participants in ULACNet-101. As a result, this information will be used to guide the implementation of other cancer related CTs for PLWH in PR. Citation Format: Veronica C. Rodriguez. Barriers identified by healthcare professionals concerning the participation of people living with HIV in HPV-related cancer clinical trials in Puerto Rico [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C128.

Abstract A050: Faith-based messaging and materials for colorectal cancer screening in the African Methodist Episcopal church

Abstract Introduction: Religion plays a significant role in Black and African American communities, yet little is known about ways to incorporate faith into colorectal cancer (CRC) screening messages and how to distribute such messages to the congregation and community. Brief description of pertinent experimental procedures: We collaborated with members of the African Methodist Episcopal (AME) church in Atlanta, Georgia to create culturally appropriate and locally relevant faith-based CRC screening messages and materials. We used a modified boot camp translation (BCT) approach to obtain input from AME congregants to 1) develop faith-based CRC screening messages that resonate with the AME community and 2) identify the role of the church in bringing CRC information to the AME community. Messages were developed using market-tested CRC screening messaging from the National Colorectal Cancer Roundtable (NCCRT) as a starting point. Eligible participants were members from six churches within the AME Atlanta East District, ages 45 to 75 years, and willing to participate in one 5-hour in-person meeting and two follow-up video-conferencing calls. The in-person session consisted of expert presentations by a national leader on CRC and screening, a local leader well-versed in barriers to screening and community resources, and a prominent figure within the church clergy. Interactive small group sessions were also part of the in-person meeting and focused on developing CRC screening messages and identifying dissemination channels. Follow-up virtual sessions (one-hour each) were conducted to solicit feedback from participants on the materials created (e.g., fact sheets, pamphlets, message cards). Summary of new, unpublished data: A total of twenty-seven adults participated in the in-person session (17 women and 10 men) and 12-13 of these individuals attended the virtual follow-up sessions. Based on input obtained, the research team developed CRC screening messages that 1) incorporated faith-based concepts into health messaging, 2) sought to raise CRC awareness and knowledge through personal connections, or 3) empowered individuals to take control of their colorectal health through the strength of their community. Messages included: “Faith over fear! Get screened for colorectal cancer today;” “Honor God by taking care of your body.” “Share your cancer story. It can save lives.” “You are not alone. We are in this together.” Participants identified the following preferred dissemination methods/channels: print materials (e.g., flyers, pamphlets, message cards) and digital materials (e.g., videos) shown during Sunday service. Additional channels included cancer awareness events and social media platforms. Conclusion: Churches serve as key partners in delivering health information as they are among the most trusted institutions within the Black and African American community. Using BCT, we incorporated participant feedback to create faith-based CRC screening messages and identified channels for sharing information within the AME church community. Citation Format: Jamie Thompson, Jennifer Rivelli, Priyanka Gautom, Cheryl Johnson, Megan Burns, Dani Schenk, Caleb Levell, Nikki Hayes, Gloria Coronado. Faith-based messaging and materials for colorectal cancer screening in the African Methodist Episcopal church [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A050.

Abstract A044: Creating culturally relevant colorectal cancer screening messages and materials for tribal communities in the Great Plains

Abstract Introductory sentences indicating the purposes of the study: We applied a modified version of boot camp translation (BCT), a validated community participatory approach, to engage tribal community members in the Great Plains to develop culturally and locally relevant colorectal cancer (CRC) screening messages and materials. Brief description of pertinent experimental procedures: CRC is one of the leading causes of cancer death in the United States and disproportionally affects American Indian adults, especially American Indians living in the Great Plains. Routine CRC screening leads to earlier diagnosis and prolonged survival from the disease. However, American Indian adults are less likely to be up to date on CRC screening than White adults, highlighting the need to increase CRC screening within this community. In partnership with the Great Plains Tribal Leaders Health Board and the National Association of Chronic Disease Directors, we used a modified BCT approach to elicit feedback from tribal community members to create messages and materials that motivate tribal members to get screened for CRC. To make the BCT process more meaningful for our partner communities, we reframed the BCT sessions by referring to them as listening sessions. Eligible tribal community members recruited were between the ages of 45-75 and agreed to participate in all three listening sessions over a two-month period. The sessions consist of one five-hour in-person gathering in Rapid City, South Dakota, and two one-hour follow-up video-conferencing calls. The in-person session included a cultural presentation of Lakota teachings by a local hoop dancer, CRC education by an expert in CRC research, a presentation by local leaders on interventions to increase community access to CRC screening, and discussions on CRC knowledge, beliefs, barriers to screening, and messages/materials to help increase screening. The follow-up sessions, scheduled to occur in the summer of 2023, will gather feedback on draft materials and messages. Summary of the new unpublished data: A total of 38 adults participated in the first listening session. The key themes emphasized the importance of: 1) including Lakota words in the messages/materials as language is tied to cultural identity, 2) creating messaging/materials that are relatable, address local barriers, and include resources and cultural imagery, 3) applying a multigenerational approach to screening education in the messages and materials, 4) including cultural details about healing traditions, and 5) using visuals for colon health education and screening education. The participants suggested using videos in clinics, radio ads, visual stories, brochures, and text messages as the primary channels to disseminate the messages/materials. Statement of conclusions: We successfully used a modified BCT approach to incorporate participant feedback to develop CRC screening messages and materials and identified preferred dissemination channels for the Great Plains tribal communities. Final materials will be showcased. Citation Format: Priyanka Gautom, Jamie H. Thompson, Jennifer S. Rivelli, Senait R. Tadesse, Richard Mousseau, LaToya Brave Heart, Kelley LeBeaux, Derrick Molash, Lorrie Graaf, Dawn Wiatrek, Gloria D. Coronado. Creating culturally relevant colorectal cancer screening messages and materials for tribal communities in the Great Plains [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A044.

Multidisciplinary Care May Help to Reduce Disparities Associated With Race in Youth With Psychogenic Nonepileptic Seizures

BackgroundPsychogenic nonepileptic seizures (PNES) are a common type of functional neurological disorder in which patients experience seizurelike episodes. Health disparities based on race and socioeconomics, documented in children with epilepsy and adults with PNES, have not been reported in children and adolescents with PNES. We hypothesize that disparities exist in this population, which impact overall care and therefore influence outcomes. MethodsWe retrospectively analyzed youth referred to our multidisciplinary clinic from 2018 to 2020. All patient charts were screened by social work before the visit to identify potential barriers to care, and a nurse conducted follow-up calls. Patients' race was identified from the electronic health record and compared with several variables. Outcomes were collected via phone follow-up. Descriptive statistics were produced, and comparisons between white patients and patients of other races were completed using Fisher exact tests and multivariable logistic regressions. ResultsDuring the study period, 237 patients were eligible for the analysis. Sixty-eight patients (29%) identified as a race other than white. Only 60%, 56%, and 40% of the cohort were reached for follow-up at one, three, and 12 months, respectively. In general, outcomes were similar between racial groups; however, we found that patients of nonwhite race were more likely to receive support from social work due to barriers identified in screening (P = 0.045). ConclusionsHealth disparities based on race may exist in youth with PNES. A multidisciplinary clinic including social work may help mitigate barriers leading to more equitable care and similar outcomes for white and nonwhite youth with PNES.

Trajectories of adherence to ACEI/ARB medications following a motivational interviewing intervention among Medicare Advantage beneficiaries in Texas

ObjectivesTo assess the impact of student telephone motivational interviewing intervention on angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEI/ARBs) adherence trajectories and identify predictors of each trajectory. MethodsThe intervention group included continuously enrolled Medicare Advantage Plan patients non-adherent to ACEI/ARBs vs the control group (1:2 ratio). The intervention was tailored by pre-intervention trajectories and included an initial and five follow-up calls. Adherence was measured 6 months after initial calls using the proportion of days covered (PDC). Monthly PDCs were integrated into a group-based trajectory model and categorized patients into 4-groups. A multinomial logistic regression model was used to evaluate trajectory predictors. ResultsThe study comprised 240 intervention patients and 480 controls with four trajectories: adherent trajectory 44.2%, gradual improvement in adherence 13.4%, slow decline in adherence 24.1%, and discontinuation 18.3%. Patients with the intervention were less likely to experience a slow decline in adherence than controls (OR: 0.627 [0.401–0.981]). Patients with specialty prescribers’ visits, ≥ 1 previous hospitalization, rapid decline in adherence as pre-intervention trajectory, and higher CMS risk score were associated with discontinuation trajectory. ConclusionIntervention patients vs controls had a lower likelihood of following a slow decline in adherence pattern. Practice implicationsThis study underscores the importance of individualized interventions and the association between past adherence patterns and post-intervention trajectories.

A Randomized Controlled Trial of a Financial Navigation Program for Patients with Multiple Myeloma

Introduction Advances in multiple myeloma (MM) treatment improve survival but expose patients (pts) to significant financial toxicity (FT) due to lifelong administration of costly therapies. Financial support services (FSS) like nurse navigators (NN), financial advocates (FA), and social workers (SW) can offset healthcare costs by accessing patient assistance programs. However, these services are underused due to ad hoc referrals and reluctance to discuss financial issues. We developed a financial navigation program (FNP) that proactively identifies pts at risk of FT, comprehensively assesses their needs, systematically connects pts to resources, and follows-up to ensure needs are met. In a randomized controlled trial (RCT), we assessed whether this FNP reduces FT compared to usual care. Methods We recruited adult pts with MM receiving systemic treatment at the University of Pennsylvania at their follow-up appointments. Consenting pts completed the COmprehensive Score for financial Toxicity (COST) questionnaire; those at risk of FT (score&amp;lt;26) were randomized 1:1 to the intervention (FNP) or usual care. We aimed to randomize 82 participants to achieve 80% power based on prior studies (expected improvement in COST by 5 in intervention, 2 in usual care). Pts completed a baseline survey to assess socioeconomic and demographic factors, cost-coping behaviors, quality of life (QoL), and satisfaction. After 4 months, pts completed a similar, final survey. In the FNP, the NN assessed financial and transportation barriers to care by telephone, performed proactive outreach to FA and SW, and coordinated resources, followed by monthly follow-up calls. We measured patient-reported outcomes as change from baseline to study completion; the primary outcome was change in COST score. Secondary outcomes were changes in cost-coping behaviors, QoL, and satisfaction. We performed an intention-to-treat, bivariate analysis (t-test or χ 2 test) of each outcome and conducted rapid thematic analysis of free-text responses. We also observed consenting pts whose baseline COST≥26, and - in post-hoc analysis - assessed for differential change in COST score at follow-up among this cohort vs the randomized/at-risk population. Results We assessed 315 pts from Feb-Dec 2022 ( Figure): 193 consented, 106 randomized, and 83 were included in analysis (41 in intervention, 42 in usual care). Randomized pts were an average of 65 years, 53% female, 39% nonwhite, 78% college-educated, and 51% earned ≤$60,000/year. This contrasted with 8% non-white pts among the non-randomized (high baseline COST) group (p&amp;lt;0.001). Despite all randomized pts being insured, 55% reported that MM treatment costs posed a significant financial burden. Many (46%) were on lenalidomide containing regimens. The mean, baseline COST score was 14.4 (SD 7.5) in the intervention versus 16.0 (SD 6.5) in usual care (p=0.3). Most pts had baseline FSS use, with a higher proportion in usual care (76%) than intervention (51%), p=0.03. During a median follow-up of 4.9 months, 17% in usual care received FSS. In the intervention arm, 95% participated in the FNP, with 68% completing ≥3 follow-up calls within 4 months. Randomized (at risk) pts showed an average improvement in COST of 4.6 (SD 8.9), significantly different from the non-randomized (low risk) group's mean worsening of -15.8 (SD 7.2) at follow-up; p&amp;lt;0.001. The intervention arm had a greater but non-significant improvement in COST score (mean 5.7 [SD 8.8]) compared to usual care (mean 3.5 [SD 8.9]); p=0.3. There were no significant changes in cost coping behaviors, QoL, or satisfaction between the two randomized arms. There was a significantly higher number of financial assistance applications submitted among pts randomized to the FNP (34%) vs usual care (12%); p=0.02. Patient feedback indicated the FNP improved understanding of FSS and reduced stress. Conclusions In this study, we confirmed that most pts with MM experience financial hardship and are at-risk of FT, despite being insured. We observed significant racial disparities in this risk. Our RCT showed that by screening pts with the COST tool and proactively coordinating FSS for at-risk pts, we can potentially reduce financial hardship. We attribute the non-significant improvement in FT to an under-powered analysis from higher-than-expected improvement in COST among usual care pts. Our program is efficient and scalable and demonstrated high retention.