Health Care Provider Contacts Research Articles

Vascular Care Delivery during the COVID-19 Pandemic: Impact of Office-Based Laboratory and Ambulatory Surgery Center

Objective: To evaluate how access to an office-based laboratory (OBL) and ambulatory surgery center (ASC) impacted vascular care during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: Vascular procedures performed by our group during the 6-week period before COVID-19 restrictions (group 1) and in the first 6-week period during the COVID-19 restrictions (group 2) were reviewed. The number of procedures performed was categorized as hospital inpatient (HIP), hospital outpatient (HOP), OBL, ASC, and vein center (VC). The procedures were also grouped by type: aneurysm (AAA), carotid (CAR), peripheral arterial disease (PAD), amputation/wound care (AMP), vascular access (VA), deep vein thrombosis (DVT), and venous reflux (CVI). The number of healthcare provider contact points for each patient undergoing care at the HOP, OBL, and ASC were also collected and compared between groups 1 and 2. Differences between groups were determined using the two-way ANOVA. Results: There were no statistically significant differences between groups 1 and 2 for procedure location or type of procedure (p > 0.05). Patient contact with healthcare providers decreased between groups 1 and 2 for ambulatory care. However, projecting the number of contacts for patients in group 2 if they had to have ambulatory care in the HOP setting (913) compared to contacts in the OBL and ASC setting (588) was statistically significant (p < 0.05). No patient or staff member at the OBL or ASC developed COVID-19 infection because of the care received at these venues. Conclusions: The ability to provide essential care for patients in an ambulatory environment was enhanced using our OBL and ASC without compromising safety, efficacy, or transmission of the virus to patients or staff during the height of the COVID-19 pandemic and limited their contact with healthcare workers and therefore reduced the consumption of personal protective equipment by healthcare personnel.

Variation in information needs of patients with interstitial lung disease and their family caregivers according to long-term oxygen therapy: a descriptive study

BackgroundThe information needs of patients and their families regarding interstitial lung disease (ILD) have yet to be studied in detail, and few reports have examined the differences in information needs according to patient status. This study aimed to determine whether there are differences in information needs between outpatients with ILD and their family caregivers and whether these differences depend on long-term oxygen therapy use.MethodsPatients with fibrotic ILDs and their families who visited Kyoto University Hospital between February 2020 and March 2022 were recruited for this descriptive study. Fibrotic ILDs included idiopathic pulmonary fibrosis (IPF), other idiopathic interstitial pneumonias (IIPs) than IPF, connective tissue disease-associated ILD (CTD-ILD), and fibrotic hypersensitivity pneumonia. Data were obtained from electronic patient records and questionnaires. Descriptive data analyses were performed.ResultsSixty-five patients and their family caregivers were analyzed. Twenty-seven (41.5%) patients had IIPs (IPF 9 and other IIPs 18), 34 (52.3%) had CTD-ILD, and 4 (6.2%) had fibrotic hypersensitivity pneumonia. The most common relationship between the patient and their family was a spouse (67.7%), with 80% living together. The primary information needs among patients and their family caregivers were common up to the third rank but differed from the rest. Patients were interested in “when and where to contact health care providers” and “end-of-life care and advanced directives,” while family caregivers were interested in “diet and nutrition” and “care and support at home.” Patients with long-term oxygen therapy had higher needs for “end-of-life care and advanced directives” and “how to manage breathlessness, cough, and fatigue,” while the needs for “drugs for ILD” and “acute exacerbation of ILD” were relatively low. Family caregivers were interested in “diet and nutrition” in the long-term oxygen therapy group and “acute exacerbation of ILD” in the no long-term oxygen therapy group.ConclusionsThis study found that the information needs of patients and their family caregivers were not the same and that the aspect of information needs differed by long-term oxygen therapy status. Healthcare providers should consider the position of the recipient of information, the appropriate time based on the patient’s condition, and the necessary information.

Quality of recovery after day care surgery with app-controlled remote monitoring: study protocol for a randomized controlled trial

BackgroundThe majority of surgical interventions are performed in day care and patients are discharged after the first critical postoperative period. At home, patients have limited options to contact healthcare providers in the hospital in case of severe pain and nausea. A smartphone application for patients to self-record pain and nausea when at home after day care surgery might improve patient’s recovery. Currently patient experiences with smartphone applications are promising; however, we do not know whether remote monitoring with such an application also improves the patient’s recovery. This study aims to evaluate the experienced quality of recovery after day care surgery between patients provided with the smartphone application for remote monitoring and patients receiving standard care without remote monitoring.MethodsThis non-blinded randomized controlled trial with mixed methods design will include 310 adult patients scheduled for day care surgery.The intervention group receives the smartphone application with text message function for remote monitoring that enables patients to record pain and nausea. An anaesthesia professional trained in empathetic communication, who will contact the patient in case of severe pain or nausea, performs daily monitoring. The control group receives standard care, with post-discharge verbal and paper instructions.The main study endpoint is the difference in perceived quality of recovery, measured with the QoR-15 questionnaire on the 7th day after day care surgery. Secondary endpoints are the overall score on the Quality of Recovery-15 at day 1, 4 and 7-post discharge, the perceived quality of hospital aftercare and experienced psychological effects of remote monitoring during postoperative recovery from day care surgery.DiscussionThis study will investigate if facilitating patients and healthcare professionals with a tool for accessible and empathetic communication might lead to an improved quality of the postoperative recovery period.Trial registrationThe ‘Quality of recovery after day care surgery with app-controlled remote monitoring: a randomized controlled trial’ is approved and registered on 23 February 2022 by Research Ethics Committees United with registration number R21.076/NL78144.100.21. The protocol NL78144.100.21, ‘Quality of recovery after day care surgery with app-controlled remote monitoring: a randomized controlled trial’, is registered at the ClinicalTrials.gov public website (registration date 16 February 2022; NCT05244772)

Knowledge and practices related to antibiotic use among women in Malang, Indonesia.

Background: Antimicrobial resistance is a public health problem that threatens the efficacy of antibiotics. Incorrect knowledge of antibiotics may lead to their inappropriate use, hinder their effectiveness, and cause antibiotic resistance. Population-based educational campaigns have been found to have either mixed or no effect on improving knowledge and appropriate antibiotic practices, suggesting the need for more targeted approaches in tailoring education for specific subpopulations. Women are the primary caregivers of their families and are more willing to contact healthcare providers. They had greater knowledge of antibiotics and better adherence to the completion of the antibiotic regimen. Therefore, they are suitable for prioritization in a campaign program. Objective: This study examined the knowledge and practices of female visitors to health centers in Malang, Indonesia with respect to antibiotic use. Methods: This cross-sectional study was conducted in Malang, Indonesia, in July and August 2018. Data were collected from 677 women. Multivariate logistic regression was performed to identify the potential factors associated with antibiotic knowledge, self-medication, and completion of antibiotic regimens. Results: Overall, 82.7% of respondents were aware that antibiotics are used against bacteria, while 38.4% reported self-medication with antibiotics and 51.7% reported completing antibiotic regimens. Women with higher education, previous antibiotic use experience, and very easy accessibility to primary doctors were more likely to have high antibiotic knowledge than those with primary education, no antibiotic use in the previous year, and easy/other level of accessibility to primary doctors. Subjects residing in urban areas and with less accessibility to primary doctors were more likely to self-medicate with antibiotics. Additionally, the completion of antibiotic regimens was positively associated with access to a primary care doctor and high antibiotic knowledge. Conclusion: IF Policymakers tend to reduce inappropriate antibiotic use among women. Priority advocates are recommended for urban residents who have experiences of antibiotic use in the previous year. It is therefore important to increase their awareness, particularly regarding diseases against which antibiotics are effective, and activities such as unnecessary use of antibiotics in healthy animals, which may affect their overall effectiveness among humans. More communication channels should be included in the overall scheme to improve the public awareness and accessibility of health professionals.

Knowledge, Attitude and Practice Regarding Kidney Diseases among Primary Care Physicians working in Nepal

Background: Medical officers and resident doctors as primary care physicians (PCPs) are the first contact health care providers to most of the kidney disease patients in Nepal. This study intends to assess knowledge, attitude and practice regarding kidney diseases among these nonnephrology doctors, working in different health institutes all over Nepal. Methods: This was a descriptive, cross sectional, questionnaire based study, conducted over the span of 12 weeks among the primary care physicians. The Ethical Review Board of Nepal Health Research Council had approved our protocol prior to starting the study. An arbitrary scoring system was used to classify knowledge, attitude and practice scores as: 0 to <50% - Poor score, 50% to <75% - Moderate score, ≥ 75% - Good score. Data was entered in Microsoft Excel and analyzed using IBM Statistical Package for the Social Sciences version 25. Results: Out of 239 PCPs enrolled in our study, 41 (17%) obtained good knowledge scores, 124 (51.8%) obtained good attitude scores and 198 (82.8%) obtained good practice scores. None of the study participants had negative attitude towards kidney diseases. The mean scores obtained in our study were 23.03±4.49 for knowledge, 17.64±2.30 for attitude and 6.27±1.24 for practice domains out of total score of 37, 24, and 8 respectively. Conclusions: Our study demonstrated that the majority of PCPs had obtained moderate to poor knowledge scores regarding kidney diseases. However, the majority had a positive attitude and good practice regarding kidney diseases in our study.

Patient Recommendations for the Content and Design of Electronic Returns of Genetic Test Results: Interview Study Among Patients Who Accessed Their Genetic Test Results via the Internet.

Genetic test results will be increasingly made available electronically as more patient-facing tools are developed; however, little research has been done that collects data on patient preferences for content and design before creating results templates. This study identifies patient preferences for the electronic return of genetic test results, including what considerations should be prioritized for content and design. Following user-centered design methods, 59 interviews were conducted by using semistructured protocols. The interviews explored the content and design issues of patient portals that facilitated the return of test results to patients. We interviewed patients who received electronic results for specific types of genetics tests (pharmacogenetic tests, hereditary blood disorder tests, and tests for the risk of heritable cancers) or electronically received any type of genetic or nongenetic test results. In general, many of participants felt that there always needed to be some clinician involvement in electronic result returns and that electronic coversheets with simple summaries would be helpful for facilitating this. Coversheet summaries could accompany, but not replace, the more detailed report. Participants had specific suggestions for such results summaries, such as only reporting the information that was the most important for patients to understand, including next steps, and doing so by using clear language that is free of medical jargon. Electronic result returns should also include explicit encouragement for patients to contact health care providers about questions. Finally, many participants preferred to manage their care by using their smartphones, particularly in instances when they needed to access health information on the go. Participants recommended that a patient-friendly front section should accompany the more detailed report and made suggestions for organization, content, and wording. Many used their smartphones regularly to access test results; therefore, health systems and patient portal software vendors should accommodate smartphone app design and web portal design concomitantly when developing platforms for returning results.

Average Time Spent in Referral Process and its Determinants Among Clients of Maternal and Child Health Service in 2 Districts of Jimma Zone, Ethiopia.

Background: The time spent between referring and receiving health facilities is an important determinant of the outcome of the referred patients/clients especially among women in low-income countries due to poor access to early and appropriate referrals. Thus, the aim of this study is to assess the average time spent between referring and service utilization at receiving health facility. Methods: A cross-sectional study was employed by using time and motion approach. Structured questionnaire and observation checklist were used for collecting data. SPSS 21 version was used for data analysis and binary and multivariable logistic regression analysis was carried out to identify a variable that has a significant association on the basis of OR, 95% confidence interval, and a P value of less than .05. Result: A total of 266 women participated in the study with the mean age of the study population is 24.65 (±5.03) years. The majority, (223 (83.8%)) of the participants came for maternal health services and more than half, (143 (53.8%)) of the respondents were self-referrals. Among the referred cases, the main reason for the referral was for further evaluation and management. Women spent a maximum of 540 min on the way to arrive at receiving health facility. Residence and distance were the predictor variables for average time spent. Conclusion: In general, women wait a maximum of one and half hours to contact health care providers for assessment and more than two-fifth of the women wait more than 3 h to get the service at receiving health facility.

The Association of Mobile Health Applications with Self-Management Behaviors among Adults with Chronic Conditions in the United States.

Background: Mobile applications related to health and wellness (mHealth apps) are widely used to self-manage chronic conditions. However, research on whether mHealth apps facilitate self-management behaviors of individuals with chronic conditions is sparse. We aimed to evaluate the association of mHealth apps with different types of self-management behaviors among patients with chronic diseases in the United States. Methods: This is a cross-sectional observational study. We used data from adult participants (unweighted n = 2340) of the Health Information National Trends Survey in 2018 and 2019. We identified three self-management behaviors: (1) resource utilization using electronic personal health records; (2) treatment discussions with healthcare providers; and (3) making healthcare decisions. We analyzed the association of mHealth apps to self-management behaviors with multivariable logistic and ordinal regressions. Results: Overall, 59.8% of adults (unweighted number = 1327) used mHealth apps. Adults using mHealth apps were more likely to use personal health records (AOR = 3.11, 95% CI 2.26–4.28), contact healthcare providers using technology (AOR = 2.70, 95% CI 1.93–3.78), and make decisions on chronic disease management (AOR = 2.59, 95% CI 1.93–3.49). The mHealth apps were associated with higher levels of self-management involvement (AOR = 3.53, 95% CI 2.63–4.72). Conclusion: Among individuals with chronic conditions, having mHealth apps was associated with positive self-management behaviors.

Impact of a Dyadic Intervention on Family Supporter Involvement in Helping Adults Manage Type 2 Diabetes.

BackgroundFamily support for adults’ diabetes care is associated with improved self-management and outcomes, but healthcare providers lack structured ways to engage those supporters.ObjectiveAssess the impact of a patient-supporter diabetes management intervention on supporters’ engagement in patients’ diabetes care, support techniques, and caregiving experience.DesignMultivariate regression models examined between-group differences in support-related measures observed as part of a larger trial randomizing participants to a dyadic intervention versus usual care.ParticipantsA total of 239 adults with type 2 diabetes and either A1c >8% or systolic blood pressure >160mmHg enrolled with a family supporter.InterventionHealth coaches provided training on positive support techniques and facilitated self-management information sharing and goal-setting.Main MeasuresPatient and supporter reports at baseline and 12 months of supporter roles in diabetes care and caregiving experience.ResultsAt 12 months, intervention-assigned patients had higher odds of reporting increased supporter involvement in remembering medical appointments (AOR 2.74, 95% CI 1.44, 5.21), performing home testing (AOR 2.40, 95% CI 1.29, 4.46), accessing online portals (AOR 2.34, 95% CI 1.29, 4.30), deciding when to contact healthcare providers (AOR 2.12, 95% CI 1.15, 3.91), and refilling medications (AOR 2.10, 95% CI 1.14, 3.89), but not with attending medical appointments or with healthy eating and exercise. Intervention-assigned patients reported increased supporter use of autonomy supportive communication (+0.27 points on a 7-point scale, p=0.02) and goal-setting techniques (+0.30 points on a 5-point scale, p=0.01). There were no differences at 12 months in change scores measuring supporter distress about patients’ diabetes or caregiving burden. Intervention-assigned supporters had significantly larger increases in satisfaction with health system support for their role (+0.88 points on a 10-point scale, p=0.01).ConclusionsA dyadic patient-supporter intervention led to increased family supporter involvement in diabetes self-management and increased use of positive support techniques, without increasing caregiver stress.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06946-8.

Client satisfaction and experience of telemedicine and home use of mifepristone and misoprostol for abortion up to 10 weeks’ gestation at British Pregnancy Advisory Service: A cross-sectional evaluation

ObjectiveEvaluate satisfaction and experience with telemedicine consultation and home use of mifepristone and misoprostol for abortion to 10 weeks’ gestation. Study DesignCross-sectional evaluation of British Pregnancy Advisory Service (BPAS) clients who used mifepristone and misoprostol at home from 11 May to 10 July 2020. We sent a text message with a link to a web-survey 2 to 3 weeks postabortion. Questions assessed satisfaction and experiences with a service model including telephone consultation and provision of medicines by mail or collection from the clinic. We used bivariate and multivariate regression to explore associations between client characteristics and outcomes. Our primary outcomes were overall satisfaction (5-point Likert scale) and reported contact with a health care provider. ResultsA total of 1,333 clients participated. Respondents described home use of medications as “straightforward” (75.8%) and most were “very satisfied” (78.3%) or “satisfied” (18.6%) overall. Being “very satisfied” was associated with parity (aOR 1.53, 95% CI 1.09−2.14) and pain control satisfaction (aOR 2.22, 95% CI 1.44−3.44). Health care provider contact was reported by 14.7%; mainly to BPAS’ telephone aftercare service (76.8%). Dissatisfaction with pain control (aOR 3.62, 95% CI 1.79−7.29) and waiting >1 week to use mifepristone (aOR3.71, 95% CI 1.48−9.28) were associated with health care provider contact. If needed in the future, most would prefer consultation by phone (74.3%) and home use of mifepristone and misoprostol (77.8%). ConclusionsSatisfaction with telemedicine and home use of mifepristone and misoprostol is high. Most clients do not need health care provider support when administering medicines at home or post abortion.

Health professional's exposure, attitude, and acceptance of drug promotion by industry representatives: A cross-sectional study in Ethiopia.

Interactions between pharmaceutical companies and health care providers have long been an area of interest from ethical as well as scientific grounds. The information provided by those companies must be scientifically accurate and fair. The current study aimed to investigate the exposure, attitude, and training background of medical doctors and pharmacy professionals regarding drug promotional activities, and assess their acceptance of promotional gifts provided by pharmaceutical sales representatives. A cross-sectional study was conducted on medical doctors and pharmacy professionals working at Bahir Dar and Gondar cities, Amhara regional state, Ethiopia. Data were collected using a self-administered structured questionnaire and Statistical Package for Social Science (SPSS) version 26 was used for analysis. A Chi-square test was computed to investigate the presence of an association between the dependent and independent variables. A p-value of less than 0.05 was considered to declare significance at a 95% Confidence Interval (CI). A total of 105 health professionals, 81 pharmacy professionals, and 24 medical doctors have participated in the study. Above two-thirds of the respondents (69.5%) agreed that most talks sponsored by drug companies were helpful and educational. On the other hand, 39% of the respondents agreed and 47.6% disagreed that receiving gifts from pharmaceutical representatives will increase the chance that they will eventually sell or recommend the drug company's products. The majority of the study participants (81%) preferred drug samples and stationery as appropriate gifts by pharmaceutical sales representatives. Significant gaps were found regarding the training of health professionals about the ethics of drug marketing and how to deal with pharmaceutical representatives. Policies aiming at restricting health care provider's contacts with pharmaceutical companies during residency training along with incorporating gift restriction policies could bring significant improvements.

Environmental Sars-Cov-2 Surface Testing: Low Incidence of Virus Positivity in Outpatient and Inpatient Hematology/Oncology Settings

Introduction: Current evidence suggests that the COVID-19 related mortality and morbidity is higher in cancer patients due to increased visits to healthcare facilities (e.g., doctor's visits, phlebotomy, imaging, social work, financial consultations, therapy administration, etc) and inherent or therapy-induced immunosuppression. Patients with hematologic malignancies harboring SARS-CoV-2 have the highest mortality compared with other cancer patients. Although COVID-19 is knowingly transmitted person to person via respiratory droplets, there is potential for infection from contact with surfaces (e.g. plastic, metal, cardboard, etc) polluted with fomites that have been shown to have viable virus up to 72 hours in laboratory settings (Van Doremalen et al. NEJM 2020). The risk of nosocomial infections is hypothesized to be due to environmental contact and contamination, but there are no real-world analyses that exist that demonstrate the impact of recently established infection control policies (e.g., strict use of personal protective equipment (PPE), social distancing, hand hygiene, disinfectant protocols, etc) in hematology/oncology patient settings. This study evaluated the frequency of SARS-CoV-2 on a multitude of environmental surfaces in outpatient and inpatient settings in a large tertiary COVID-19 referral cancer center in New Jersey.Methods: IRB approval was obtained to conduct the study in a COVID-19 referral center in 2 large, freestanding outpatient clinics (i.e., malignant hematology and medical oncology) and co-localized infusion suites as well as two physically separated inpatient units (i.e., a leukemia/lymphoma/CART unit and an active COVID-19 floor, the latter housing cancer patients actively infected with SARS-CoV-2 and persons under investigation (PUI) for infection). Surface testing for viral RNA in the outpatient infusions suites included spaces where several patients with recent SARS-CoV-2 infection were receiving cancer treatment in the outpatient setting. High-impact areas were selected based on frequency of use, patient and healthcare provider contact, and risk of contamination from COVID-19 positive subjects (COVID-19+) and PUIs due to virus transmissibility. Surfaces were sampled on Mondays, Wednesdays and Fridays from 6/17/20 through 6/29/20 prior to scheduled cleaning and disinfection services, but after patient or staff use, following WHO protocols for COVID-19 surface sampling. Specimens were analyzed with real-time reverse transcriptase PCR analysis.Results: Overall, 204 total environmental samples were collected over the study period. Testing sites were categorized as 1) Public areas (waiting rooms, infusion areas, bathrooms, floors, elevator banks, doors, and exam rooms included designated isolation rooms for known COVID-19+/PUIs); 2) Staff areas (computer equipment, pneumatic tubing stations, pharmacy bench, and medication rooms); and 3) Medical equipment (IV poles, chemotherapy bags, vitals monitor, telemetry stations, and linen carts).Among the 130 surfaces examined from the two outpatient hematology-oncology clinics and 36 tests from the inpatient leukemia/lymphoma/CART cell unit, all 166 surfaces were negative for SARS-CoV-2 viral RNA (see Table). Among the inpatient COVID-19+ and PUI units, one of 38 samples were positive (2.6%). The one positive sample was taken from the floor of an elderly patient with multiple medical comorbidities being treated with remdesevir, dexamethasone, and apixaban for SARS-CoV-2 pneumonia. Altogether, the positive test rate for SARS-CoV-2 RNA across all surfaces in the combined outpatient and inpatient hematology/oncology units was 0.5% (1/204).Discussion: This systematic investigation of ‘real world’ environmental surfaces performed in outpatient and inpatient hematology-oncology units revealed overall negligible detection of active SARS-CoV-2 RNA. It highlights the efficacy of current, detailed infection control policies (e.g., screening, nursing-directed triage for PUIs/COVID-19+ patients, visitor restriction, telehealth, social distancing, and disinfection protocols) and should also mitigate concerns of healthcare providers and patients, particularly those in the healthcare setting with blood disorders. Additionally, the one positive sample from a COVID-19 unit emphasizes the need for physical separation of patients with SARS-CoV-2.DisclosuresEvens:Research To Practice: Honoraria, Speakers Bureau; Merck: Consultancy, Honoraria, Research Funding; Pharmacyclics: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; MorphoSys: Consultancy, Honoraria; Abbvie: Consultancy, Honoraria; Seattle Genetics: Consultancy, Honoraria, Research Funding; Epizyme: Consultancy, Honoraria, Research Funding; Mylteni: Consultancy, Honoraria.

Antiretroviral Therapy (ART)-related Knowledge Seeking among People Living with HIV (PLHIV) in China: Role of Information & Communication Technology (ICT)

Abstract This paper investigated the use of information communication technology (ICT) to seek antiretroviral therapy (ART)-related knowledge among people living with HIV (PLHIV) taking antiretroviral treatment in Guangxi, China. A total 1902 participants who undertook ART and had used ICT were recruited from 12 sites with the highest cumulative HIV incidence. A questionnaire survey was used to collect data on the participants’ sociodemographic characteristics, clinical outcomes, infections in the family and comorbidity, access to healthcare resources, ICT using behavior in HIV management, and ART-related knowledge. The results showed that 15% of the participants had searched HIV-related information online, fewer participants had contacted healthcare providers via computer (1.6%) or text messaging (11.9%), and only 7.7% of the participants had contacted other PLHIV using ICT. Education had a positive impact on the knowledge level of all three categories of ART-related knowledge. Participants with better medication and mechanisms knowledge were more likely to search HIV-related information online and less likely to contact healthcare providers using text messages. Findings of this study suggested that ICT was used as an effective approach to acquire some type of ART-related knowledge. ICT was underutilized in health communication among the PLHIV in this study due to low education level and insufficient eHealth literacy. Future intervention programs should address the customization of the communication tools and focus on improving the education level and eHealth literacy of the PLHIV to better promote ICT as an efficient platform for ART-related knowledge seeking.

Preliminary Assessment of a Telehealth Approach to Evaluating, Treating, and Discharging Low-Acuity Patients With Suspected COVID-19.

BackgroundTelemedicine is uniquely positioned to address challenges posed to emergency departments (EDs) by the Coronavirus Disease 2019 (COVID-19) pandemic. By reducing in-person contact, it should decrease provider risk of infection and preserve personal protective equipment (PPE).ObjectivesTo describe and assess the early results of a novel telehealth workflow in which remote providers collaborate with in-person nursing to evaluate and discharge well-appearing, low-risk ED patients with suspected COVID-19 infection.MethodsRetrospective chart review was completed 3 weeks after implementation. Metrics include the number of patients evaluated, number of patients discharged without in-person contact, telehealth wait time and duration, collection of testing, ED length of stay (ED-LOS), 72-h return, number of in-person health care provider contacts, and associated PPE use.ResultsAmong 302 patients evaluated by telehealth, 153 patients were evaluated and discharged by a telehealth provider with reductions in ED-LOS, PPE use, and close contact with health care personnel. These patients had a 62.5% shorter ED-LOS compared with other Emergency Severity Index level 4 patients seen over the same time period. Telehealth use for these 153 patients saved 413 sets of PPE. We observed a 3.9% 72-h revisit rate. One patient discharged after telehealth evaluation was hospitalized on a return visit 9 days later.ConclusionTelehealth can be safely and efficiently used to evaluate, treat, test, and discharge ED patients suspected to have COVID-19. This workflow reduces infection risks to health care providers, PPE use, and ED-LOS. Additionally, it allows quarantined but otherwise well clinicians to continue working.

Dissecting the journey to breast cancer diagnosis in sub-Saharan Africa: Findings from the multicountry ABC-DO cohort study.

Most breast cancer patients in sub‐Saharan Africa are diagnosed at advanced stages after prolonged symptomatic periods. In the multicountry African Breast Cancer‐Disparities in Outcomes cohort, we dissected the diagnostic journey to inform downstaging interventions. At hospital presentation for breast cancer, women recalled their diagnostic journey, including dates of first noticing symptoms and health‐care provider (HCP) visits. Negative binomial regression models were used to identify correlates of the length of the diagnostic journey. Among 1429 women, the median (inter‐quartile range) length (months) of the diagnostic journey ranged from 11.3 (5.7‐21.2) in Ugandan, 8.2 (3.4‐16.4) in Zambian, 6.5 (2.4‐15.7) in Namibian‐black to 5.6 (2.3‐13.1) in Nigerian and 2.4 (0.6‐5.5) in Namibian‐non‐black women. Time from first HCP contact to diagnosis represented, on average, 58% to 79% of the diagnostic journey in each setting except Nigeria where most women presented directly to the diagnostic hospital with advanced disease. The median number of HCPs visited was 1 to 4 per woman, but time intervals between visits were long. Women who attributed their initial symptoms to cancer had a 4.1 months (absolute) reduced diagnostic journey than those who did not, while less‐educated (none/primary) women had a 3.6 months longer journey than more educated women. In most settings the long journey to breast cancer diagnosis was not primarily due to late first presentation but to prolonged delays after first presentation to diagnosis. Promotion of breast cancer awareness and implementation of accelerated referral pathways for women with suspicious symptoms are vital to downstaging the disease in the region.

Med Check: Centanafadine; Dayvigo; Digital Health Devices; Pimavanserin; Meloxicam/Rizatriptan

Med Check: Centanafadine; Dayvigo; Digital Health Devices; Pimavanserin; Meloxicam/Rizatriptan

Internet and Health Information Technology Use and Psychological Distress Among Older Adults With Self-Reported Vision Impairment: Case-Control Study.

BackgroundThe number of older adults with vision impairment (VI) is growing. As health care services increasingly call for patients to use technology, it is important to examine internet/health information technology (HIT) use among older adults with VI.ObjectiveThis study aimed to examine (1) the rates of internet/HIT use among older adults with VI compared with a matched sample of their peers without VI, (2) associations of VI with internet/HIT use, and (3) association of HIT use with psychological distress, assessed with the Kessler-6 screen.MethodsData were obtained from the 2013 to 2018 US National Health Interview Survey. Older adults (aged ≥65 years) with self-reported VI were matched with older adults without VI, in a 1:1 ratio, based on age, sex, number of chronic medical conditions, and functional limitations (N=2866). Descriptive statistics and multivariable logistic regression models, with sociodemographic factors, health conditions, health insurance type, and health care service use as covariates, were used to examine the research questions.ResultsIn total, 3.28% of older adults (compared with 0.84% of those aged 18-64 years) reported VI, and 25.7% of them were aged ≥85 years. Those with VI were significantly more socioeconomically disadvantaged than those without VI and less likely to use the internet (adjusted odds ratio [aOR] 0.64, 95% CI0.49-0.83) and HIT (aOR 0.74, 95% CI 0.56-0.97). However, among internet users, VI was not associated with HIT use. HIT use was associated with lower odds of mild/moderate or serious psychological distress (aOR 0.62, 95% CI 0.43-0.90), whereas VI was associated with greater odds of mild/moderate or serious distress (aOR 1.84, 95% CI 1.36-2.49). Health care provider contacts were also associated with higher odds of internet or HIT use.ConclusionsCompared with their matched age peers without VI, older adults with VI are less likely to use HIT because they are less likely to use the internet. Socioeconomically disadvantaged older adults experiencing a digital divide need help to access information and communication technologies through a fee waiver or subsidy to cover internet equipment and subscription and ensure continuous connectivity. Older adults with VI who do not know how to use the internet/HIT but want to learn should be provided instruction, with special attention to accessibility features and adaptive devices. Older adults with a low income also need better access to preventive eye care and treatment of VI as well as other health care services.

740-P: Effect of Family Support Intervention on Support Roles and Impact of Support on HbA1c among Adults with Type 2 DM

Many adults with DM have a family supporter (FS) involved in their care. Informal support has been linked with better DM management and outcomes. We evaluated the effect of a patient and FS engagement intervention on FS roles in DM care, and the impact of those roles on HbA1c. Two-hundred and thirty-nine adult Veterans with type 2 DM and a FS were randomized to intervention vs. usual care for 12 months. Intervention dyads received one coaching session, biweekly automated calls to prompt action planning on new DM concerns, coaching calls to prepare for clinic visits, and summaries of primary care visits and DM complication risk. All models were controlled for baseline HbA1c, age, sex, insulin use, and FS cohabitation with patient. Over 12 months, participants in the intervention group were more likely to have increased involvement in several FS roles, including: deciding when to contact healthcare providers about concerns (AOR 2.080, 95% CI 1.137,3.804), remembering to go to appointments (AOR 2.852, 95% CI 1.503, 5.412), take (1.853, 95% CI 1.001, 3.428) and refill (AOR 2.193, 1.196, 4.019) medications, and perform (AOR 2.615, 95% CI 1.405, 4.867) and review (AOR 2.822, 95% CI 1.506, 5.290) home testing. Changes in help navigating the healthcare system, and encouraging healthy eating and exercise were not different by intervention arm. Help remembering to take medications at baseline was associated with 0.457% increase in HbA1c over 12 months (95% CI 0.107, 0.807, p=0.011), and no support roles were significantly associated with HbA1c decrease. In conclusion, this intervention increased FS involvement in diabetes-specific self-management, with less impact on general lifestyle support. Patients with support for taking medication prior to the intervention had significant subsequent increases in HbA1c. This may indicate family are recognizing which patients have challenges with medication taking, but need more training to effectively help improve subsequent patient outcomes. Disclosure M. Zupa: None. M. Heisler: None. J. Piette: None. R.B. Trivedi: None. S.C. Stoll: None. D. Obrosky: None. E.Z. Lovelace: None. M.K. Mor: None. A. Rosland: None. Funding VA Health Services Research and Development (IIR 14–074-1); Michigan Center for Diabetes Translational Research (5P60-DK09292); Michigan Claude D. Pepper Older Americans Independence Center (AG-024824); VA Ann Arbor Center for Clinical Management Research; University of Pittsburgh (5T32DK007052-45)

A Pilot Study of the Feasibility and Accuracy of Inpatient Continuous Glucose Monitoring

There are minimal data assessing the accuracy or use of continuous glucose monitoring (CGM) in hospitalized patients. Our group was interested in its use in the perioperative period, since we suspect we would identify more extremes and thus more dangerous blood glucose levels than seen with traditional bedside blood glucose monitoring. Given the lack of data for CGM use in hospitalized patients, and the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we felt this is a critical time to share our data. Use of CGM could potentially reduce the number of health care provider contacts and use of personal protective equipment. Eligible patients were adults (age ≥18 years) with diabetes who used intermittent home blood glucose monitoring and who were scheduled to undergo an elective general surgery at University of Washington Medical Center. The study protocol was approved by the University of Washington Institutional Review Board. The study was also registered as a clinical trial. Continuous intravenous insulin infusion was used per hospital algorithm (target blood glucose 100 mg/dL [5.6 mmol/L] to 180 mg/dL [10.0 mmol/L]) until oral consumption was resumed, at which time subcutaneous insulin was initiated. This …

Perceived Barrier in Accessing Emergency Medical Services of Ethnic Groups in the Highlands of Chiang Rai Province, Thailand

Objective: To explore the barriers of accessing emergency medical services among several ethnic groups, including the Hmong, Lisu, Lahu and Akha people. Material and Methods: The qualitative study was conducted to interview 43 participants, including the Akha, Lahu, Lisu and Hmong people. Purposive sampling was used to select participants for in-depth interviews, from February to March, 2019. The data were analyzed using content analysis. Results: The results show that the barriers of using emergency medical service (EMS) can be divided into the following five categories: the barrier to effectively communication, response to the symptoms of emergency illnesses, transportation facilities to support patients with emergency illnesses, fear to contact healthcare providers and the individual’s perception of emergency medical symptoms. Conclusion: The barriers of using EMS among different cultures, ethnicities and languages are a concern and obstacles to the increase appropriate pre-hospital management and reducing pre-hospital delay. A community collaboration partnership should be the goal of improving pre-hospital care among ethnic people.