Gaps In Care Research Articles

BPI24-019: Estimation of Impact of Care Gap on Patient Outcome and Health Care Cost Burden Using Real World Data in Early-Stage NSCLC-An Empirical Study for Delay in Surgery.

BPI24-019: Estimation of Impact of Care Gap on Patient Outcome and Health Care Cost Burden Using Real World Data in Early-Stage NSCLC-An Empirical Study for Delay in Surgery.

Birth Care Gaps in the Childbirth Options, Information, and Person-Centered Explanation (CHOICEs) Measure.

The objective of this study was to revise and improve the intrapartum items of the shared decision-making (SDM) measure, CH ildbirth O ptions, I nformation and person- C entered E xplanation (CHOICEs). Methodological sequential triangulation was used to select a purposive sample of 29 people who gave birth in the United States between August 2019 and June 2021. A qualitative descriptive approach was used to analyze and interpret the data. We used an interview guide with questions related to the nine intrapartum items in CHOICEs to address the question: How did decision-making occur during your most recent birth? Four major themes were identified: provider told me what to do ; communication about interventions during labor and birth ; preferences overlooked ; multiple team members . Under the theme of provider told me what to do , there was one sub-theme of induction of labor . Participants noted lack of shared decision-making, poor communication, and obstetric violence. We found the need for perinatal providers to improve communication with birthing people on topics such as fetal monitoring, induction of labor, and multiple team members who may participate in their care. Revisions of CHOICEs will include seven new items to further address birth preferences, feeling heard, and multiple team members.

Treatment Access for Gastrointestinal Stromal Tumor in Predominantly Low- and Middle-Income Countries

Gastrointestinal stromal tumor (GIST) is a rare cancer treated with the tyrosine kinase inhibitors imatinib mesylate or sunitinib malate. In general, in low- and middle-income countries (LMICs), access to these treatments is limited. To describe the demographic characteristics, treatment duration, and survival of patients with GIST in LMICs treated with imatinib and sunitinib through The Max Foundation programs. This retrospective database cohort analysis included patients in 2 access programs administered by The Max Foundation: the Glivec International Patient Assistance Program (GIPAP), from January 1, 2001, to December 31, 2016, and the Max Access Solutions (MAS) program, January 1, 2017, to October 12, 2020. Sixty-six countries in which The Max Foundation facilitates access to imatinib and sunitinib were included. Participants consisted of patients with approved indications for imatinib, including adjuvant therapy in high-risk GIST by pathologic evaluation of resected tumor or biopsy-proven unresectable or metastatic GIST. All patients were reported to have tumors positive for CD117(c-kit) by treating physicians. A total of 9866 patients received treatment for metastatic and/or unresectable disease; 2100 received adjuvant imatinib; 49 received imatinib from another source and were only included in the sunitinib analysis; and 53 received both imatinib and sunitinib through The Max Foundation programs. Data were analyzed from October 13, 2020, to January 30, 2024. Demographic and clinical information was reported by treating physicians. Kaplan-Meier analysis was used to estimate time to treatment discontinuation (TTD) and overall survival (OS). An imputation-based informed censoring model estimated events for patients lost to follow-up after treatment with adjuvant imatinib. Patients who were lost to follow-up with metastatic or unresectable disease were presumed deceased. A total of 12 015 unique patients were included in the analysis (6890 male [57.6%]; median age, 54 [range, 0-100] years). Of these, 2100 patients were treated with imatinib in the adjuvant setting (median age, 54 [range 8-88] years) and 9866 were treated with imatinib for metastatic or unresectable disease (median age, 55 [range, 0-100] years). Male patients comprised 5867 of 9866 patients (59.5%) with metastatic or unresectable disease and 1023 of 2100 patients (48.7%) receiving adjuvant therapy. The median OS with imatinib for unresectable or metastatic disease was 5.8 (95% CI, 5.6-6.1) years, and the median TTD was 4.2 (95% CI, 4.1-4.4) years. The median OS with sunitinib for patients with metastatic or unresectable GIST was 2.0 (95% CI, 1.5-2.5) years; the median TTD was 1.5 (95% CI, 1.0-2.1) years. The 10-year OS rate in the adjuvant setting was 73.8% (95% CI, 67.2%-81.1%). In this cohort study of patients with GIST who were predominantly from LMICs and received orally administered therapy through the GIPAP or MAS programs, outcomes were similar to those observed in high-resource countries. These findings underscore the feasibility and relevance of administering oral anticancer therapy to a molecularly defined population in LMICs, addressing a critical gap in cancer care.

Survey of lived experiences and challenges in hepatitis B management and treatment

Almost 300 million people are living with chronic hepatitis B infection worldwide and most remain undiagnosed and at risk for liver cancer. In 2015 the World Health Organization (WHO) developed guidelines for the prevention, care, and treatment of persons with chronic hepatitis B and in early 2023 began to work on updating these guidelines. In March 2023, a self-administered, anonymous online survey was launched, aiming to identify patient preferences related to the clinical management of hepatitis B including current management, treatment, and care experiences, preferences regarding engagement with providers, and preferences related to simplifying hepatitis B care access. A sample of 560 individuals living with hepatitis B (self-identified as HBsAg positive) from 76 countries completed the survey. Key findings demonstrated that less than half (49%, N = 268) of participants regularly visited a doctor to check the health of their liver (every 6–12 months), with 37% of participants prescribed antiviral medication by a specialist (82%, N = 167) or general practitioner (13%, N = 26). Participants reported not being actively involved in care decision making with their providers (42%, N = 217), with an overwhelming majority wanting to participate in hepatitis B management and treatment choices (85%, N = 435). Participants provided qualitative and quantitative details using open-ended responses within the survey about challenges with medication affordability and receiving care from a knowledgeable provider. Overall findings demonstrated key gaps in care, management, and treatment access related to hepatitis B: identifying these gaps can be used to identify areas for improvement along the care continuum for viral hepatitis. The survey found a need for the comprehensive simplification of clinical management and health care services related to hepatitis B. A thematic analysis of the open-ended survey responses highlighted major overarching themes including the cost and access burdens associated with hepatitis B management and treatment, and challenges in finding knowledgeable providers. Results from this mixed methods survey were used to inform the WHO hepatitis B guidelines update. Efforts should continue to explore public health approaches to address barriers and facilitators to testing, care, and treatment for people with hepatitis B to improve awareness of hepatitis B and access, care, and treatment among patients and providers.

Barriers and facilitators of readiness for hospital discharge in patients with myocardial infarction: a qualitative study: quality improvement study.

Readiness for hospital discharge (RHD) in patients with myocardial infarction (MI) is a key concept in the discharge process. This study was conducted to explain the barriers and facilitators of preparation for discharge in patients with MI. A qualitative study was conducted using conventional content analysis from April 2021 to 2022. Data collection was done in a targeted manner through semi-structured interviews until the data saturation stage. Nineteen participants (11 patients, 3 family members, and 5 healthcare team) were interviewed. Data analysis was done in eight steps according to the suggested steps of Graneheim and Lundman. MAXQDA18 software was used for coding. From the interviews, 348 primary codes, 11 sub-categories, and 5 categories were extracted. Finally, after continuous analysis and comparison of interviews, codes, and categories, two themes including "supporting platform" and "caring atmosphere" were extracted, which were the result of the participants' experience and understanding of the barriers and facilitators of RHD. The supporting platform included "family support" and "social support" and the caring atmosphere included "care gaps" and "professional healthcare team performance". The results of this study indicate several factors affecting RHD in heart attack patients. According to the results of the study, the participation of the patient, family, healthcare team, and community in creating RHD is recommended. It is also suggested to pay attention to these factors in care and treatment planning to help improve health and control complications and prevent re-hospitalization in these patients.

Gaping gaps in rural mental health care: understanding causes and prioritizing solutions

IntroductionMental health is crucial and is the backbone of all dimensions of health; physical, social and spiritual. Mental health has multiple interfaces and it is important to bring mental health to the center stage as it is the key regulator of all human activities. Unfortunately, there are alarming gaps in mental health care especially in rural areas which require attention of mental health professionals and policy makers.The study aims to understand the causes of these gaps and suggest possible and practical solutions to bridge them.ObjectivesTo study the spectrum of mental health gaps present in rural areas of Haryana, a state in the northern part of India and find culturally sensitive and relevant solutions keeping in view the socio economic realities and prevalent legal framework.Methods Any factor having bearing on mental health but is operative sub-optimally would be considered as mental health gap for the current investigation. Rural camps were organized in 10 villages to assess the service gap at three different levels: overt (measurable), covert (including attitudinal) and ancillary (including those embedded in the psychiatry evaluation and treatment). The camps were organized by following these three basic steps: 1) Evaluating the geographic and demographic details of the villages selected. This was done by meeting the key stakeholders of the villages and the official health and service statistics available on the government website 2) Camp by multidisciplinary team in the villages with an advance intimation. The team members evaluated the mental health care awareness and the felt needs by interviewing all the villagers attending the camp on that particular day. 3) Post camp review by the team to analyze the service gaps and steps to address and narrow the gaps.ResultsApart from inadequate availability of professional and infrastructural resources, there were many attitudinal and ancillary gaps serving as obstacles to treatment seeking. Trust gaps leading to poor acceptance and legislation not congruent with the socio cultural needs were key impediments. Rural people had more faith in Spiritual leaders and faith healers for their mental health issues and medical help was sought only when they have signs of physical illness. Mental health and illnesses were not on priority. Availability, accessibility and affordability of health services were important factors needing immediate attention.Conclusions Rural services need to be augmented by de professionalization and task shifting is the key to address and cover the yawning gaps in the services. Massive, coordinated, multidisciplinary and sustainable efforts are needed to bridge the multitude of gaps keeping in view poverty and illiteracy as compounding factors.Disclosure of InterestNone Declared

Hospitalist Recognition and Treatment of Obesity in Inpatients: A Quality Improvement Cohort Study

Background: Obesity is primarily managed in the outpatient setting, however its impact on the frequency and course of hospitalizations is well-established. Considering the rising prevalence of obesity and the broad implications on population health when untreated, hospitalizations may represent an untapped opportunity to address obesity management. Methods: We performed a retrospective cohort study comparing the frequency of inpatient obesity documentation to initiation of obesity-targeted therapy, including weight management clinic referral and weight management medication prescription on discharge from hospitalization by hospitalists for patients with class 2 and 3 obesity. We also queried the frequency of weight management clinic referrals and weight management medication prescriptions prior to hospitalization for these cohorts. Results: The cohorts included 1531 patients with class 2 (49.2%) or class 3 (50.8%) obesity. During hospitalization, obesity was frequently documented as a medical problem in patients with both class 2 (48.4%) and class 3 (75%) obesity. Patients with class 3 obesity were more likely to be referred on discharge to a weight management clinic and initiated on weight management medications, however the overall absolute number of referrals and prescriptions were low. Conclusions: We observed that hospitalists documented the presence of obesity in over 60% of patients, yet rarely implemented targeted treatment on discharge. Our results suggest a gap exists between awareness of obesity and subsequent intervention. This highlights an opportunity to generate an inpatient workflow to bridge a gap in care for patients with obesity.

Iron Deficiency, Anemia, and Iron Supplementation in Patients With Heart Failure: A Population-Level Study.

Studies have shown an association between iron deficiency (ID) and clinical outcomes in patients with heart failure (HF), irrespective of the presence of ID anemia (IDA). The current study used population-level data from a large, single-payer health care system in Canada to investigate the epidemiology of ID and IDA in patients with acute HF and those with chronic HF, and the iron supplementation practices in these settings. All adult patients with HF in Alberta between 2012 and 2019 were identified and categorized as acute or chronic HF. HF subtypes were determined through echocardiography data, and ID (serum ferritin concentration <100 μg/L, or ferritin concentration between 100 and 300 μg/L along with transferrin saturation <20%), and IDA through laboratory data. Broad eligibility for 3 clinical trials (AFFIRM-AHF [Study to Compare Ferric Carboxymaltose With Placebo in Patients With Acute HF and ID], IRONMAN [Intravenous Iron Treatment in Patients With Heart Failure and Iron Deficiency], and HEART-FID [Randomized Placebocontrolled Trial of Ferric Carboxymaltose as Treatment for HF With ID]) was determined. Among the 17 463 patients with acute HF, 38.5% had iron studies tested within 30 days post-index-HF episode (and 34.2% of the 11 320 patients with chronic HF). Among tested patients, 72.6% of the acute HF and 73.9% of the chronic HF were iron-deficient, and 51.4% and 49.0% had IDA, respectively. Iron therapy was provided to 41.8% and 40.5% of patients with IDA and acute or chronic HF, respectively. Of ID patients without anemia, 19.9% and 21.7% were prescribed iron therapy. The most common type of iron therapy was oral (28.1% of patients). Approximately half of the cohort was eligible for each of the AFFIRM-AHF, intravenous iron treatment in patients with HF and ID, and HEART-FID trials. Current practices for investigating and treating ID in patients with HF do not align with existing guideline recommendations. Considering the gap in care, innovative strategies to optimize iron therapy in patients with HF are required.

44 Trends in Management of Chronic Kidney Disease among Adults with Diabetes, NHANES 1988-2020

OBJECTIVES/GOALS: Chronic kidney disease (CKD) affects nearly 40% of adults with diabetes. Our objective is to assess trends in risk factor control and use of 2022 ADA and KDIGO guideline-recommended medications. METHODS/STUDY POPULATION: Using data from 1988 to 2020 from the National Health and Nutrition Examination Survey, we will examine trends in sociodemographic risk factors and glycemic, blood pressure, and lipid control among adults with CKD and diabetes. Glycemic control will be defined as a hemoglobin A1c (HbA1c)&lt;7%, blood pressure control will be examined at cutoffs of 130/80 and 120/80 mmHg, and lipid control will be defined as a fasting triglyceride level ≥150 mg/dL, a low-density lipoprotein (LDL) &lt;100 mg/dL without atherosclerotic cardiovascular disease (ASCVD), or LDL&lt;70 mg/dL if they have ASCVD. We will assess changes in the use of commonly used antidiabetic, antihypertensive, and lipid-lowering medications. RESULTS/ANTICIPATED RESULTS: We hypothesize that from 1988-2020, blood pressure control has improved while glycemic and lipid control has not improved among adults with diabetes and CKD. We expect decreases in sulfonylurea use and increases in DPP-4 inhibitor, metformin, ACE inhibitor, angiotensin receptor blocker, statin, and insulin use over time among those with diabetes and CKD. In addition, there is likely a significant gap between those who are eligible to use newer medications like SGLT2 inhibitors or GLP-1 receptor agonists and who are currently using them within this subpopulation. DISCUSSION/SIGNIFICANCE: This study will examine adherence to guideline-recommended management and identify gaps in care for adults with CKD and diabetes, which may inform how best to optimize medication use for cardiorenal protection in this high-risk patient population.

Integrating Mental Health In Perinatal Care: Perspectives Of Interprofessional Clinicians.

Despite the prevalence of perinatal mental health issues in the United States, gaps in care persist. To address this, perinatal health care settings are asked to focus on patients' mental health by administering standardized screening and, increasingly, by integrating mental health teams in their clinics. Using in-depth interviews and ethnographic observations, I investigated these emerging practices, exploring the experiences of certified nurse-midwives, obstetricians, and mental health clinicians. I found that certified nurse-midwives and obstetricians lack time, resources, and expertise, restricting their ability to address patients' mental health. Integrated mental health clinicians are constrained by the stratified organization of health care and structural deprioritization of mental health. Redesigning perinatal health care and de-siloing mental health training are necessary to increase clinicians' effectiveness and to improve perinatal health outcomes.

Experiences and resultant care gaps among women with HIV in Canada: concept mapping the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) findings

ObjectivesThe community-based, longitudinal, Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) explored the experiences of women with HIV in Canada over the past decade. CHIWOS’ high-impact publications document...

276 Full Spectrum Town Hall Meetings - Advancing Clinician-Patient-Researcher Engagement for Hidradenitis Suppurativa (HS)

OBJECTIVES/GOALS: Full Spectrum Town Halls (FSTH) were organized to bring together patients, scientists, clinicians, advocates and others interested in Hidradenitis Suppurative (HS) – stakeholders across the spectrum of translational research – to infuse patient experiences and voices into designing HS research METHODS/STUDY POPULATION: The Rockefeller University (RU), Clinical Directors Network (CDN), and the HS Foundation organized three hybrid in-person/online HS FSTHs (2018-2023). The 2018 event focused on patients, describing the current state of HS knowledge and new research into HS biology (T2, T3). Patients shared lived experiences in testimonials and a panel discussion. Advocates described community and mental health resources (T4). The 2021 event returned research results (T2, T3) to the community and updates about treatments in the pipeline (T4). The 2023 FSTH targeted clinicians (T4) addressing a critical translational gap in HS care and presenting best practices in diagnosis, surgical, and medical treatments. RESULTS/ANTICIPATED RESULTS: Impact on science: FSTH attendees joined a Community Engagement Studio providing feedback used to refine study variables/procedures. Attendees joined research studies that advanced understanding HS mechanisms of disease, clinical course and treatment.Impact on patient experience: Participants appreciated having a forum to hear/share experiences of shame, mistrust, misdiagnosis and hope. Feedback improved practices for privacy, consenting, and returning study results. Impact on clinical practice and care: FSTH raised awareness of stigma, need for respect and empathy, and advanced learning about in disease mechanisms, effective biologics, importance of epithelial tunnels and surgical care. DISCUSSION/SIGNIFICANCE: HS is a stigmatizing, poorly understood disease. FSTHs fostered bidirectional learning among scientists, clinicians, patients and other stakeholders. Patients engaged with researchers to improve research design and participate in mechanistic and therapeutic clinical research, advancing the field.

Implementation of perinatal quality collaborative statewide initiative improves obstetrical opioid use disorder care and outcomes

BackgroundMaternal deaths resulting from opioid use disorder (OUD) have been rising across the United States​. OUD among pregnant persons is associated with adverse pregnancy outcomes including preterm birth along with racial disparities in optimal OUD care. ObjectiveWe aimed to evaluate whether the Illinois Perinatal Quality Collaborative’s (ILPQC) implementation of the Mothers and Newborns affected by Opioids – Obstetric quality improvement initiative was associated with improvement of OUD identification, provision of optimal OUD care for birthing patients, and reduction in racial gaps of optimal OUD care. Study DesignUsing a prospective cohort design, hospitals reported monthly key measures for all patients with OUD at delivery between July 2018 – December 2020. ILPQC facilitated collaborative learning opportunities, rapid-response data, and quality improvement (QI) support. Generalized linear mixed effects regression models were used to​ evaluate improvement in optimal OUD care including increases in linkages to medication assisted treatment, recovery treatment services and naloxone counseling across time​; and to determine whether optimal OUD care was associated with positive outcomes such as lower odds of preterm birth. ResultsNinety- one hospitals submitted data on 2,095 pregnant persons with OUD. For the primary outcomes, the rates of patients receiving Medication Assisted Treatment (MAT) and recovery treatment services improved across the initiative from 41 to 78% and 48 to 67% respectively. For the secondary outcomes, the receipt of recovery treatment services and both recovery treatment services / MAT provided prenatally before delivery admission was associated with lower odds of preterm birth (aOR (95% CI) 0.67 (0.50, 0.91) and 0.49 (0.31, 0.75), respectively). During the first quarter of the initiative, Black patients with OUD were less likely to be linked to MAT (23% vs. 48%); however, an increase in MAT rates across the initiative occurred for all patients, with the greatest improvement for Black patients with an associated reduction in this disparity gap with greater than 70% of both Black and White patients linked to MAT. ConclusionThe MNO-OB initiative is associated with improvements in optimal OUD care for pregnant patients across Illinois hospitals, while racial disparity in OUD care was reduced across the MNO OB initiative. The findings further implicate how optimal OUD care can improve pregnancy outcomes and close persistent racial gaps in pregnant individuals with OUD.

Pakikipagpalagayang- loob: Exploring Mutual Trust between Programme Managers and Children in a Philippine Residential Care Facility

This study examines the trust relationship between the programme managers and residents in a house for girls in need of protection in the Philippines which advocates child participation. The research employs interviews with the programme managers and residents (10) using Sikolohiyang Pilipino (Filipino psychology) methods of pagtatanong-tanong (asking questions) and pakikipagkuwentuhan (exchanging stories). The first research question explores how the management demonstrates trust towards the children, revealing cognitive and affective trust, along with the manifestation of palagay ang loob, ease within the inner selves of both parties. The second question unveils reciprocal trust, where the initial trust of the managers is mirrored by the children in their benevolence, ability, and integrity. Notably, the study introduces the concept of pakikipagpalagayang-loob, highlighting mutual trust rooted in the acceptance and understanding of holistic selves. The study contributes to local literature by addressing a research gap in understanding residential care within the Philippine context. Moreover, it enhances the body of knowledge on Filipino Psychology by analyzing trust through the lenses of loob and kapwa in Sikolohiyang Pilipino.

It’s About Time! Timing in Epilepsy Evaluation and Treatment

The 2023 American Epilepsy Society Annual Course “It’s About Time” addressed timing in epilepsy evaluation and treatment with respect to health disparity and vulnerable populations and diagnostic, clinical, and epilepsy surgery evaluation. This comprehensive course included topics on gaps in epilepsy care and optimization of behavioral health for patients with epilepsy. The summary details current knowledge in areas of seizure forecasting and epileptogenesis. Intricacies and controversies over timing were discussed for treatment of nonconvulsive seizures and ictal-interictal patterns, acute symptomatic seizures, neuromodulation versus surgery, and epilepsy surgery in status epilepticus. Timing regarding clinical care in autoimmune-associated epilepsy, developmental and epileptic encephalopathy, and dietary therapy were examined. Additionally, salient topics on using novel biomarkers and collaboration with neuropsychological outcomes were also tackled in this all-encompassing lecture series.

Outpatient hospitalist-run procedure service bridges the gap in oncology care

Hospitalist-run procedure teams enable expedited care in the inpatient setting. However, wait times for outpatient interventional radiology (IR) are long at our institution. Our study thus aims to compare the safety and wait times between procedural teams and IR placement of outpatient temporary hemodialysis catheters (THDC) for patients undergoing Chimeric antigen receptor T-cell (CAR-T) therapy apheresis. A retrospective chart review was conducted on all patients receiving outpatient THDC for CAR-T therapy from August 2019 until November 2022. During our study period, only 7 of the central lines were placed by IR, while 75 were placed by the procedure service. The average wait time from CAR-T consenting to procedure was 8.9 days for the procedure service and 14.7 days for IR. The 30 day minor complication rate was low – 2.7% in the procedure group, and 0% in the IR group. No major complications were noted in either group

Rheumatic Diseases Amidst Conflict in Northwest Syria: Unveiling Health Challenges and Implications

Abstract Background The ongoing conflict in Syria has significantly affected the health care system, particularly in the realm of rheumatology. The purpose of this study is to assess the current state of rheumatic diseases in the northwestern region of Syria, where the health care infrastructure has been severely impacted. Methods This was a retrospective study reviewing all patients with rheumatologic conditions seen in internal medicine clinics in northwest Syria between September 2019 and February 2022. Baseline demographic data and diagnoses were collected retrospectively, without any data duplication, from outpatient clinic records. The study also reviewed the availability of investigations and drugs in the northwestern region of Syria. Results We analyzed data from 488 patients (average age: 37.4; 63% female) diagnosed with rheumatic diseases. The most prevalent condition was connective tissue disorders (25.6%), with osteoarthritis (12.1%) and rheumatoid arthritis (8.2%) following. The ongoing conflict has led to a significant shortage of rheumatologists, with only three serving a population of 5.5 million. Furthermore, the conflict has disrupted the provision and quality of rheumatology diagnostic tests, reducing patient accessibility. The dearth of medications and increased costs have compounded the complexity of health care for those with rheumatic diseases. Conclusions This study highlights the urgent need for improved health care services and proposes solutions to address gaps in rheumatic care in northwest Syria.

Back Pain in the Era of Opioid Restriction and Implications for Neurosurgeons Based on Qualitative Findings From a Rural State.

Historically, back pain has been an inciting complaint for the initiation of opioids. Aggressive marketing of opioids to treat back pain coupled with the initiation of pain being treated as "the fifth vital sign" contributed to the emerging opioid crisis in the USA. West Virginia (WV) has long been considered the epicenter of the crisis. In 2018, the WV legislature passed a bill that placed prescribing limits on opioids. Our group set out to investigate the impacts of opioid prescribing restrictions through a sequential, mixed methods study evaluating prescription trends and stakeholder experiences. These stakeholder experiences generated emergent themes regarding the evolution of the opioid crisis up to and beyond the implementation of the bill, which is of relevance to neurosurgeons and back pain treatment. This study explores those findings for a neurosurgical audience. This study consisted of open-ended, semi-structured interviews with a purposive sample of 50 physicians, pharmacists, and patients in WV. Interviews were recorded and transcribed verbatim. Content analysis was utilized as the methodological orientation. Five theoretical domains relevant to the treatment of back pain emerged, describing the prevalence of opioid use, barriers to access care, the importance of opioids for function in resource-poor rural areas,disconnected and siloed care, and patient views on the impacts of pain care gaps and solutions. Spinal pain care in rural WV is complex due to identified challenges. Care siloing factors in suboptimal spinal pain care. Future work should define, implement, and assess the real-world effectiveness of treatment paradigms for the full spectrum of surgical and non-surgical back pain complaints. Neurosurgeons should be present in this arena.

An obesity medicine curriculum increases the obesity care self-efficacy of internal medicine residents in the primary care setting.

Primary care physicians (PCPs) report insufficient knowledge and training gaps in obesity care. Internal Medicine (IM) residency offers an opportunity to address this educational gap for future PCPs. We designed an innovative, multicomponent curriculum on obesity medicine (OM) in the primary care setting for IM residents. We then conducted a prospective, 6-month, two-arm study within two residency programs in Maryland evaluating feasibility (use, appropriateness for IM training, and satisfaction) of the curriculum as well as changes in self-efficacy within seven obesity care domains, assessed on 4-point scales (1-not at all confident to 4-very confident). One residency program received the curriculum and the other served as the control group. We recruited 35 IM residents to participate (17 intervention, 18 control). Among intervention residents, 42% used all curricular components; appropriateness and satisfaction with the curriculum were high. Compared with controls, intervention residents had statistically significant increases in five obesity care self-efficacy domains: nutrition (intervention 0.8 vs. control 0.2, p = .02), behaviour change (1.2 vs. 0.4, p < .01), weight-gain-promoting medications (0.8 vs. 0.1, p = .01), anti-obesity medications (1.2 vs. 0.5, p = .03), and bariatric surgical counselling (0.9 vs. 0.4, p = .03). There were no significant changes in physical activity or post-bariatric surgical care domains. Our OM curriculum is feasible with IM residents and increases residents' obesity care self-efficacy beyond what is achieved with usual IM training.

Clinicians Speak: We Need to Redesign Postpartum Care.

Research indicates gaps in postpartum care that negatively impact maternal and infant health. Prior research exploring clinicians' perspectives on these gaps is limited to those of maternal providers. We explored the views and experiences of maternal and infant health-care providers on the care of mothers and infants in the postpartum period. Qualitative analysis revealed three themes: Gaps in Infant Care Education and Preparation for Parenting, Gaps in Maternal Pregnancy and Postpartum Care and Expectations and Knowledge, and Ideas for Integrating Care, Education, and Support in the postpartum period. Results suggest a need for care models that offer improved prenatal education and expectation setting, methods to help mothers prepare their social support networks, and integrated and convenient access to postpartum care.