Health Advice Research Articles

(074) CULTURALLY SENSITIVE ONCOSEXOLOGY TRAINING IN SUB-SAHARAN AFRICA

Abstract Introduction Cancer is highly prevalent in Sub-Saharan Africa. The stigma of cancer leads to late diagnosis and more invasive treatment which result in significant sexual side-effects for affected men and women. Sexual dysfunction is also stigmatized, and oncology providers are not trained to address sexual side-effects in usual care. Patients’ attitudes must be understood in the context cultural traditions and approaches to treatment of sexual dysfunction. Patients may not see sexual problems as the purview of healthcare providers. Additionally, they may reach for traditional remedies before considering medical or psychosocial interventions for sexual problems. During the authors’ academic visit to Kenya, patients and clinicians revealed a deep desire for information and solutions to sexual problems after cancer. Objective We developed an educational sexual health program to begin to meet the needs of multidisciplinary oncology care providers, increasingly incorporating clinical discussions and cultural perspectives. Methods In-person and virtual training programs have been sponsored by the Sexual Medicine Society of North America and the International Society for Sexual Medicine since 2019, initially in Kenya, now for Sub-Saharan Africa. The Kenyan Society of Hematology and Oncology became a partner in 2023. Lectures addressed definitions of sexuality and sexual dysfunction, sexual health assessment, sexual side-effects of cancer and rehabilitation strategies. Local experts were paired with specialists in sexual health and sexual medicine to provide appropriate cultural context. Moderators were frequently cancer survivors whose perspective was considered an important aspect of enhancing a cultural perspective on oncosexuality in the training program. In-person programming was offered in 2019, followed by a virtual symposium in 2021 and a 9-month training program in 2023. Cultural content was increasingly emphasized, based on the inclusion of experts, and learning from evaluations. Participants filled out satisfaction surveys after each of the programs. After the 9-month training program, participants also filled out a survey to inform how they implemented acquired knowledge in their clinical practice. Results Between 140 and 194 participants from multiple disciplines (nursing, urology, oncology, radiation oncology, mental health) attended each of the training programs. The in-person program registered 70 participants, but 140 multidisciplinary clinicians attended, 100 provided an evaluation. One hundred and ninety-four participants worldwide logged into the 2021 program with 50% participating from Kenya, others from African nations, India, UK, US and countries in Asia and Europe. One hundred and twenty-nine participants attended the 2023 training program with 50% attending from Kenya, 11 % from Nigeria and smaller numbers from other parts of Africa and worldwide. Participants evaluated their learning positively. They found the information relevant to their local culture and context. They reported using various implementation strategies, such as individual sexual health evaluations for all patients, starting a sexual health consultation and surveying clinical staff to ascertain their attitudes to a sexual health program. Participants asked for ongoing, hands-on training in the future. Conclusions It is feasible to provide sexual health and sexual medicine education globally if local culture is incorporated as an important aspect of the training. Partnering with local professional societies enhances dissemination of knowledge. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Alex Pastuszak, MD: Contraline - Consultant; Paterna Biosciences - Leadership, Investor; Macro Trials - Advisor; Inherent Biosciences – Advisor.

Informed, but uncertain: managing transmission risk and isolation in the 2022 mpox outbreak among gay and bisexual men in Australia

In 2022, a global outbreak of mpox (formerly ‘monkeypox’) emerged in non-endemic countries, including Australia, predominantly affecting gay, bisexual and other men who have sex with men. Public health advice on transmission and isolation emerged rapidly from different sources, sometimes conflicting and producing uncertainty. Using the concept of ‘counterpublic health’, which acknowledges the incorporation of official science and experiences of affected communities into embodied practice, this paper investigates how people affected by mpox in Australia managed risk of transmission and navigated self-isolation. In-depth interviews were conducted with 16 people: 13 people diagnosed with mpox and three close contacts. All participants were cisgender gay and bisexual men living in Australia. Participants thought critically about public health advice, often finding it restrictive and unresponsive to the needs of people with mpox. Participants’ decisions about reducing mpox risk and isolating often drew on experiences with other infections (i.e. HIV; COVID-19) and were made collaboratively with the people closest to them (e.g. partners, friends, family) to sustain relationships. Future public health responses to infectious disease outbreaks would benefit from identifying more opportunities to formalise and embed mechanisms to obtain feedback from affected communities so as to inform responses.

Challenges faced by human resources for health in Morocco: A scoping review.

Human resources for health (HRH) play a pivotal role in effective health system operation, yet various impediments challenge sustainable development. This scoping review aimed to explore these challenges and potential solutions in aligning the health workforce to meet the evolving healthcare needs of the Moroccan population. We conducted a scoping review searching PubMed, Science Direct, Cairn and Google Scholar for relevant articles published between 2014 and 2023. Additionally, non-peer-reviewed literature sourced from Ministry of Health consultations and allied websites was included. Among the nineteen studies meeting our inclusion criteria, the majority were cross-sectional and predominantly focused on challenges faced by nurses. While some papers delineated multiple HRH challenges (5/19), the rest addressed specific challenges. The identified challenges span organizational and personal levels. Organizationally, the focus was on training, lifelong learning, continuing education, health coverage and shortages, and job satisfaction. At a personal level, HRH in the public health sector encountered challenges such as burnout, stress, and broader occupational health concerns. The reviewed publications underscored a spectrum of challenges necessitating robust policy interventions. Despite promising developments in the Moroccan healthcare system, addressing the unequal urban-rural HRH distribution, augmenting funding, and enhancing HRH quality of life stand as pivotal imperatives.

Security of Telemedicine Platforms for Remote Health Consultation

Security of Telemedicine Platforms for Remote Health Consultation

Can telephone data contribute to a national influenza surveillance system in Australia? A retrospective analysis

Introduction: Data collected from telephone helplines that provide health advice can improve the timeliness and accuracy of disease surveillance, contributing to an appropriate and rapid public health response. We show how these data can forewarn health professionals of increased rates of influenza-like illness (ILI) in the community and discuss implications for COVID-19 syndromic surveillance. Methods: The healthdirect helpline (HH) captures demographic details and characteristics of symptoms from users in 6 Australian states and territories. We compare ILI activity in the HH with ILI activity in emergency department (ED), laboratory, Flutracking and general practice (GP) data using cross-correlation functions. Results: Helpline data correlated strongly with ED data (range in yearly correlations from 0.82-0.99), GP data (0.66 – 0.95) and Flutracking data (0.62-0.89), but yearly correlations with laboratory data varied (0.49-0.95). The highest correlation with laboratory and GP data occurred when HH activity was 1-2 weeks in advance of these data, while correlations with ED and Flutracking data were strongest with no time lag. Discussion: Our analysis demonstrates that the number of ILI-related calls to the HH is a reliable indicator of ILI incidence in Australia. An increase in calls is likely to occur simultaneously with an increase in visits to EDs and prior to an increase in positive laboratory influenza tests and visits to GPs. A surveillance system including these data would assist health practitioners to receive timely and accurate estimates of the level of ILI in the community to better respond to and prepare for seasonal and epidemic influenza.

Abstract PS02-08: The Effect of a Digital Health Coaching Program on Patient Reported Outcomes of Women with Breast Cancer

Abstract Background Understanding the impact of a digital health coaching (DHC) program on patient-reported outcomes in women with breast cancer is imperative as web-based platforms and mobile phone applications to address health care needs flood the marketplace. This study evaluated the effect of a DHC program on patient-reported outcomes, including global health (primary outcome), symptom burden, quality of life, healthcare utilization, and financial toxicity among women undergoing active treatment for breast cancer. Methods English-speaking adult women undergoing active treatment for breast cancer were randomized to receive usual care or a 6-month DHC program, consisting of weekly telephone calls from a Health Advisor, unlimited patient-initiated communication via phone, text, or email, and digital delivery of additional health-behavior content. Patient-reported outcomes (PROs) were collected using validated measures at baseline, and 1, 3, and 6 months. Summary statistics were used to describe participant characteristics. Linear mixed models were used to assess the effect of the intervention on outcomes. Results Participants (n=254, planned enrollment=440) were enrolled from August 2019 to December 2022 and randomized equally to the control and intervention groups (n=127 each). Demographic data are presented in Table 1. Participants had a mean age of 48 (SD =10.15) years; 74% were White; 19.7% were Hispanic. In both groups, several PRO scores changed over time with some improving (quality of life and symptom severity) and others worsening (symptom interference and financial toxicity) compared to baseline (time effects). Of those enrolled in the intervention group 69% were retained in the DHC program, with an overall average of 4.6 months of engagement for all participants. There were no significant group (intervention versus control) effects or group by time interaction effects observed. Trends within and between groups are presented in Table 2. Though not statistically significant, there were fewer ER visits in the intervention group at each timepoint. Conclusions: While differential improvements in the DHC group were not observed, interesting trends in PROs over the 6-month enrollment period were observed in both groups. Participants reported improvements in quality of life and worsening of financial toxicity. Interestingly, slight improvements in symptom severity over time were observed in both groups while symptom interference worsened. Potential reasons for failure to detect a treatment effect for DHC may include ineffectiveness of DHC on the selected outcomes, the intervention not being strong enough as currently delivered to detect a treatment effect, varying uptake of DHC in the intervention group, heterogeneity of the sample, or the study being underpowered due to COVID restrictions affecting enrollment. Table 1. Demographic and clinical characteristics of the study population (n = 254) Table 2. Trends in Patient Reported Outcomes and Healthcare Utilization Citation Format: Meagan Whisenant, Eileen Hacker, Loretta Williams, Joyce Dains, Bryan Fellman, Trinity Isaac, Valerie Shelton, Austin Barr, Carolyn Harty, Mazi Rasulnia, Kelly Brassil. The Effect of a Digital Health Coaching Program on Patient Reported Outcomes of Women with Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS02-08.

Abstract PO2-09-11: Breast Cancer Care Disparities in Sexual Minority Women: An Analysis of the National Institutes of Health All of Us Research Program

Abstract Background. Currently, sexual orientation data is not collected, nor is the language to study sexual orientation data defined by any national cancer database. Due to this limitation, little is known about breast cancer (BC) disparities in sexual minority women (SMW) despite several studies showing increased lifestyle risk factors. Our objective was to study this question in the All of Us database. Methods. We analyzed data from the All of Us research program, a national open enrollment database that registers diverse subjects through associated healthcare electronic medical records and collects survey data. We aimed to compare risk factors, as well as preventative and procedural healthcare utilization differences between SMW and straight women (StW) as they relate to BC care. Results were expressed as odds ratios (OR) with a 95% confidence interval [CI]. Results. Of 229,917 cisgender women who answered the sexual orientation question, 27,302 (11.9%) selected “non-straight orientation, prefer not to answer, or skipped” and thus were defined as SMW. In total, 6,905 (3.0%) women had received a BC diagnosis, including 423 (6.1%) SMW. SMW were less likely to have a BC diagnosis than StW (OR 0.48 [0.43-0.53]). Among all women, there were significant differences in frequency and types of visits and procedures performed. SMW women were less likely to undergo annual history and physical examination (0.79 [0.73-0.85]), mammography (0.61 [0.53-0.69]), and breast biopsy (0.55 [0.41-0.72]), as well as being less likely to undergo breast surgeries (mastectomy 0.53 [0.30-0.93]; lumpectomy 0.53 [0.38-0.74]). Survey data revealed differences in several lifestyle factors that relate to BC risk development. While StW were more likely to answer yes to being an “alcohol participant” (0.79 [0.77-0.82]), SMW reported higher rates of alcohol intake on a daily, weekly, and monthly basis, as well as being more likely to consume 6 or more drinks in one sitting. SMW also showed significantly increased history of smoking/nicotine usage. There were also significant differences in healthcare access and utilization: StW were more likely to receive health advice from a primary care provider (0.65 [0.65-0.69]), while SMW were more likely to utilize urgent and emergency care (1.44 [1.34-1.54]). SMW were also more likely to report being unable to afford care (1.82 [1.72-1.93]), medication (1.69 [1.61-1.76]), specialty care (1.98 [1.89-2.08]), and follow-up care (1.85 [1.75-1.95]), as well as to delay care due to cost concerns about the copay (2.13 [2.02-2.23]), deductible (1.64 [1.56-1.73]), paying out of pocket (1.70 [1.63-1.77]) or because they were nervous (2.80 [2.69-2.91]). SMW reported being more likely to experience healthcare discrimination based on questions about healthcare provider interactions (Table 1). Conclusions.Although likelihood of a breast cancer diagnosis in the All of Us database is significantly higher in StW than SMW, discrimination, lack of access, and underutilization of preventative and screening services by SMW likely creates an underrepresentation of the true number of SMW with BC. Further studies on characteristics at diagnosis, treatments, and survival are needed to address how these disparities affect BC outcomes in SMW. Table 1: Survey answers among sexual minority women (SMW) compared to straight women (StW) reporting on discrimination from healthcare provider interactions in the All of Us database. SMW: sexual minority women; StW: straight women; OR: odds ration; Lower 95 CI: lower 95% confidence interval; Upper 95 CI: upper 95% confidence interval; Sig. *: statistically significant with p < 0.05; OR>1: SMW most likely to answer; OR <1 StW most likely to answer. Citation Format: Lucas Houser, Collin Dougherty, Sean Figy, Jessica Maxwell, Juan Santamaria-Barria. Breast Cancer Care Disparities in Sexual Minority Women: An Analysis of the National Institutes of Health All of Us Research Program [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-09-11.

Associations between adverse childhood experiences and trust in health and other information from public services, professionals and wider sources: national cross sectional survey

IntroductionTrust in health and other systems can affect uptake of public health advice and engagement with health services. Individuals who had adverse childhood experiences (ACEs) are more likely to experience...

Factors Associated with Acute Telemental Health Consultations in Older Veterans.

The United States Veterans Health Administration is a leader in the use of telemental health (TMH) to enhance access to mental healthcare amidst a nationwide shortage of mental health professionals. The Tennessee Valley Veterans Affairs (VA) Health System piloted TMH in its emergency department (ED) and urgent care clinic (UCC) in 2019, with full 24/7 availability beginning March 1, 2020. Following implementation, preliminary data demonstrated that veterans ≥65years old were less likely to receive TMH than younger patients. We sought to examine factors associated with older veterans receiving TMH consultations in acute, unscheduled, outpatient settings to identify limitations in the current process. This was a retrospective cohort study conducted within the Tennessee Valley VA Health System. We included veterans ≥55years who received a mental health consultation in the ED or UCC from April 1, 2020-September 30, 2022. Telemental health was administered by a mental health clinician (attending physician, resident physician, nurse practitioner, or physician assistant) via iPad, whereas in-person evaluations were performed in the ED. We examined the influence of patient demographics, visit timing, chief complaint, and psychiatric history on TMH, using multivariable logistic regression. Of the 254 patients included in this analysis, 177 (69.7%) received TMH. Veterans with high-risk chief complaints (suicidal ideation, homicidal ideation, or agitation) were less likely to receive TMH consultation (adjusted odds ratio [AOR]: 0.47, 95% confidence interval [CI] 0.24-0.95). Compared to attending physicians, nurse practitioners and physician assistants were associated with increased TMH use (AOR 4.81, 95% CI 2.04-11.36), whereas consultation by resident physicians was associated with decreased TMH use (AOR 0.04, 95% CI 0.00-0.59). The UCC used TMH for all but one encounter. Patient characteristics including their visit timing, gender, additional medical complaints, comorbidity burden, and number of psychoactive medications did not influence use of TMH. High-risk chief complaints, location, and type of mental health clinician may be key determinants of telemental health use in older adults. This may help expand mental healthcare access to areas with a shortage of mental health professionals and prevent potentially avoidable transfers in low-acuity situations. Further studies and interventions may optimize TMH for older patients to ensure safe, equitable mental health care.

Health and lifestyle advice in community pharmacy for musculoskeletal conditions: a focused ethnography

Abstract Introduction Musculoskeletal health conditions are common, painful, and disabling, and often occur alongside other long-term conditions. Around a third of the UK population live with a musculoskeletal condition placing a huge burden on health and social care resources, accounting for 1 in 7 general practitioner consultations.[1] Primary care often focuses on using safe but less effective pharmacological approaches (e.g., paracetamol) despite evidence-based recommendations for self-management and lifestyle support being more effective, particularly in the context of pain management. However, access to such support is not always available or adequate. Community pharmacy is recognised for its important and well positioned setting for the delivery of public health promotion, supporting people to improve their health and live well through the Healthy Living Pharmacy Framework. Despite policy recommendations for an extended role in supporting people to self-manage long-term conditions and to adopt healthier behaviours, we currently do not know how community pharmacy manages and supports lifestyle advice in practice, particularly in relation to musculoskeletal health. Aim To gain an in-depth insight into community pharmacy daily practice in relation to the delivery of health and lifestyle advice, in order to examine community pharmacy’s current and future potential for supporting musculoskeletal health conditions. Methods An in-depth multi-site ethnographic approach was used across four community pharmacies differing in geographical and socioeconomic areas in England (April 2023 – October 2023). Data included 92 hours of observations within community pharmacies observing everyday practice and customer interactions, and 19 in-person semi-structured interviews (participants included counter assistants, dispensers, technicians and pharmacists). Results were analysed iteratively using analytic induction.[2] Results The provision of lifestyle advice was seen as awkward by staff members and problematic in consultations where advice was deemed unsolicited by customers, particularly in relation to sensitive topics such as weight or alcohol use. Pharmacists were generally more confident including lifestyle advice within appointments in the consultation room, and embedding behaviour change messages within an overall health check. Nevertheless, they lacked knowledge and training with regards to support and lifestyle advice specific for musculoskeletal health conditions. Observed over-the-counter interactions with customers were often complicated in terms of opportunities for staff to offer lifestyle advice, with encounters concerning pain relief medication at times resulting in tense and arduous consultations. Staff often found the experience of trying to offer lifestyle advice uncomfortable and challenging, leaving many feeling demotivated and lacking in confidence and as a result avoid introducing lifestyle advice into conversations. Conclusion Community pharmacy staff recognised the importance of the provision of lifestyle advice but experienced many barriers to its delivery. Increasing demands on community pharmacy with new services have implications with regards to capacity, time and skills development to effectively imbed lifestyle advice into everyday practice. Pharmacy staff may benefit from enhanced support and training to increase confidence and motivation in providing lifestyle advice, particularly relating to understanding musculoskeletal health and effective self-management strategies.

Mixed methods assessment of the influence of demographics on medical advice of ChatGPT.

To evaluate demographic biases in diagnostic accuracy and health advice between generative artificial intelligence (AI) (ChatGPT GPT-4) and traditional symptom checkers like WebMD. Combination symptom and demographic vignettes were developed for 27 most common symptom complaints. Standardized prompts, written from a patient perspective, with varying demographic permutations of age, sex, and race/ethnicity were entered into ChatGPT (GPT-4) between July and August 2023. In total, 3 runs of 540 ChatGPT prompts were compared to the corresponding WebMD Symptom Checker output using a mixed-methods approach. In addition to diagnostic correctness, the associated text generated by ChatGPT was analyzed for readability (using Flesch-Kincaid Grade Level) and qualitative aspects like disclaimers and demographic tailoring. ChatGPT matched WebMD in 91% of diagnoses, with a 24% top diagnosis match rate. Diagnostic accuracy was not significantly different across demographic groups, including age, race/ethnicity, and sex. ChatGPT's urgent care recommendations and demographic tailoring were presented significantly more to 75-year-olds versus 25-year-olds (P < .01) but were not statistically different among race/ethnicity and sex groups. The GPT text was suitable for college students, with no significant demographic variability. The use of non-health-tailored generative AI, like ChatGPT, for simple symptom-checking functions provides comparable diagnostic accuracy to commercially available symptom checkers and does not demonstrate significant demographic bias in this setting. The text accompanying differential diagnoses, however, suggests demographic tailoring that could potentially introduce bias. These results highlight the need for continued rigorous evaluation of AI-driven medical platforms, focusing on demographic biases to ensure equitable care.

Cholesterol mediates the effects of single and multiple environmental phenols in urine on obesity

BackgroundOverweight and obesity are among the leading chronic diseases worldwide. Environmental phenols have been renowned as endocrine disruptors that contribute to weight changes; however, the effects of exposure to mixed phenols on obesity are not well established.MethodsUsing data from adults in National Health and Nutrition Examination Survey, this study examined the individual and combined effects of four phenols on obesity. A combination of traditional logistic regression and two mixed models (weighted quantile sum (WQS) regression and Bayesian kernel-machine regression (BKMR)) were used together to assess the role of phenols in the development of obesity. The potential mediation of cholesterol on these effects was analyzed through a parallel mediation model.ResultsThe results demonstrated that solitary phenols except triclosan were inversely associated with obesity (P-value < 0.05). The WQS index was also negatively correlated with general obesity (β: 0.770, 95% CI: 0.644–0.919, P-value = 0.004) and abdominal obesity (β: 0.781, 95% CI: 0.658–0.928, P-value = 0.004). Consistently, the BKMR model demonstrated the significant joint negative effects of phenols on obesity. The parallel mediation analysis revealed that high-density lipoprotein mediated the effects of all four single phenols on obesity, whereas low-density lipoprotein only mediated the association between benzophenol-3 and obesity. Moreover, Cholesterol acts as a mediator of the association between mixed phenols and obesity. Exposure to single and mixed phenols significantly and negatively correlated with obesity. Cholesterol mediated the association of single and mixed environmental phenols with obesity.ConclusionsAssessing the potential public health risks of mixed phenols helps to incorporate this information into practical health advice and guidance.

Superior medical resources or geographic proximity? The joint effects of regional medical resource disparity, geographic distance, and cultural differences on online medical consultation

Online medical consultation platforms enable patients to seek health advice from physicians across geographic regions. In this study, we analyze patterns of online consultation between patients and physicians. We examine the joint effects of regional medical resource disparity, geographic distance, and cultural differences between patients and physicians on patients' decisions about which physicians they consult online. Using a unique dataset of city-to-city tuples based on 813,684 online consultation records and combining it with region-level data from multiple external sources, we find that while regional medical resource disparity drives patients from medically disadvantaged regions to seek online consultations with physicians from medically advantaged regions, geographic distance and cultural differences tend to constrain these consultations. We also find that cultural differences can amplify the impact of regional medical resource disparity, whereas geographic distance may lessen this effect. Further, we discover that the constraining effect of geographic distance is partly due to the online-to-offline nature of online medical consultations. Moreover, additional analyses suggest that physicians' online reputation and information about physicians’ participation on the platform can help alleviate the negative effects of geographic distance and cultural differences. These findings hold significant implications for the allocation of medical resources and the formulation of healthcare policies.

Cultural Intelligence: A critical capability for health and safety professionals in building interpersonal trust?

This literature review was conducted as part of the authors submission in attaining a Master’s In Advanced Leadership Practices through Massey University (2018 – 2019). The literature review was supported with research which included focus groups, the aim of which was to explore the theories and beliefs of senior executives from the New Zealand business community about the impact of building trust where their health and safety advisor has cultural intelligence capability. It is intended that the results of the focus groups will be published in future issues of this publication.

Remote Health Consultation with Doctors powered by GPT

Remote Health Consultation with Doctors powered by GPT

Evaluating ChatGPT's Utility in Medicine Guidelines Through Web Search Analysis.

With the rise of machine learning applications in health care, shifts in medical fields that rely on precise prognostic models and pattern detection tools are anticipated in the near future. Chat Generative Pretrained Transformer (ChatGPT) is a recent machine learning innovation known for producing text that mimics human conversation. To gauge ChatGPT's capability in addressing patient inquiries, the authors set out to juxtapose it with Google Search, America's predominant search engine. Their comparison focused on: 1) the top questions related to clinical practice guidelines from the American Academy of Family Physicians by category and subject; 2) responses to these prevalent questions; and 3) the top questions that elicited a numerical reply. Utilizing a freshly installed Google Chrome browser (version 109.0.5414.119), the authors conducted a Google web search (www.google.com) on March 4, 2023, ensuring minimal influence from personalized search algorithms. Search phrases were derived from the clinical guidelines of the American Academy of Family Physicians. The authors prompted ChatGPT with: "Search Google using the term '(refer to search terms)' and document the top four questions linked to the term." The same 25 search terms were employed. The authors cataloged the primary 4 questions and their answers for each term, resulting in 100 questions and answers. Of the 100 questions, 42% (42 questions) were consistent across all search terms. ChatGPT predominantly sourced from academic (38% vs 15%, p = 0.0002) and government (50% vs 39%, p = 0.12) domains, whereas Google web searches leaned toward commercial sources (32% vs 11%, p = 0.0002). Thirty-nine percent (39 questions) of the questions yielded divergent answers between the 2 platforms. Notably, 16 of the 39 distinct answers from ChatGPT lacked a numerical reply, instead advising a consultation with a medical professional for health guidance. Google Search and ChatGPT present varied questions and answers for both broad and specific queries. Both patients and doctors should exercise prudence when considering ChatGPT as a digital health adviser. It's essential for medical professionals to assist patients in accurately communicating their online discoveries and ensuing inquiries for a comprehensive discussion.

P004 Empowering the reproductive choices of patients with rheumatic disease: using the BSR 2022 pregnancy guidelines audit tool to evaluate pre-conception medication advice

Abstract Background/Aims For ideal pregnancy outcomes, patients with inflammatory rheumatic disease require targeted disease control with pregnancy compatible medications. A proactive approach is required given that people often won’t disclose plans for a pregnancy with healthcare professionals unless directly asked, and 45% of UK pregnancies are unplanned. The BSR 2022 guidelines on prescribing drugs in pregnancy and breastfeeding makes various recommendations on pre-pregnancy counselling for people with rheumatic disease with referral to specialists with relevant expertise as appropriate. Therefore, we used the linked BSR audit tool to evaluate documentation of pre-pregnancy counselling in rheumatology clinics lacking obstetric input at our hospital. Methods Inclusion criteria were all females, aged 15-45 years, attending a doctor-led Rheumatology clinic without obstetric input between 24/4/23 - 30/4/23 at University College London Hospital. Exclusion criteria were infertility and those seen as one-off clinic appointments and not commenced on medications. Clinic notes from all Rheumatology reviews over the preceding one year were assessed using the audit tool in the 2022 BSR pregnancy guidelines. People currently pregnant were audited for the year prior to the date of conception of their pregnancy. Results Among 50 clinics reviewed, 42 female subjects were eligible across 19 clinics, 64% of whom were aged 36-45 years and 36% were aged 21-35 years. Six subjects were pregnant. Diagnoses included: 24% systemic lupus erythematosus; 19.5% rheumatoid arthritis; 17% seronegative axial spondyloarthropathy; and the remaining 39% consisted of fibromyalgia, hypermobility, and other inflammatory arthritidies. 70% of people were screened for antibodies that could adversely impact pregnancy (i.e. anti-Ro or anti-phospholipid). Only 26% of subjects had documentation of being asked if they wished to conceive. In subjects who did not express a wish to conceive, only 21% were asked if they were using contraception. A total of 17% of the 42 subjects were referred to a specialist Obstetric-Rheumatology clinic for pre-pregnancy counselling during the study period. Of 35 subjects taking medications, only 22.8% had documentation of appropriate pre-pregnancy drug counselling within the last year. Of patients without documented pre-pregnancy advice, 46% were taking medications considered unsafe in pregnancy. Furthermore, no patients were signposted to sources of further information on drug therapy and/or rheumatic disease in pregnancy. Conclusion This audit highlights a lack of regular documented discussions around family planning and medication counselling in female subjects of childbearing age attending rheumatology clinics lacking obstetric input. Regular discussions are important for those who do and don’t wish to conceive, to appropriately counsel regarding pre-pregnancy measures or contraception. This audit using the BSR audit tool will be used as the baseline for a quality improvement project to support colleagues in providing regular, accurate reproductive health advice, supported by trusted online resources and referral to a specialist obstetric-rheumatology service as required. Disclosure A. Shirazi: None. B. Goulden: Grants/research support; Undertaking a PhD supported by Versus Arthritis (ref. 22975). I. Giles: Grants/research support; IG has received an unrestricted research grant, travel and speaker fees from UCB Pharma.

Why to purchase health knowledge on online platforms? A two-phased SEM-ANN approach

ABSTRACT Previous research on online health knowledge payment has mainly focused on the health consultation context and knowledge contributors-related characteristics. However, less attention has been given to the roles of health knowledge itself and the underlying platforms. Based on the perceived value theory and S-O-R framework, this study investigated how health knowledge and platform characteristics influence consumers’ purchase intention. Through a survey of 432 Chinese respondents, we employed a multi-analytical approach, combining structural equation modelling (SEM) with artificial neural network (ANN) techniques. SEM results indicate that knowledge personalisation, platform information quality, and platform service quality positively influence both utilitarian and hedonic values, subsequently affecting purchase intention. Furthermore, our findings support the partial mediation role of perceived value. ANN results highlight platform information quality as the most influential stimulus factor. Our study broadens the research scope of online health knowledge payment and offers theoretical and practical insights for its further advancement.

Teleconsulting in wound care: Connecting the primary care to the wound specialist reduces unnecessary referrals.

In the Netherlands the primary care (General Practitioner or homecare nurse) encounter a variety of wounds ranging from traumatic to diabetic foot ulcers. According to a recent study 82.4% of the patients with a wound can be treated in a primary setting with the GP as medical supervisor. The remaining 17.6% of patients need more extensive care including advice by a specialised doctor, diagnosis and treatment. Prompt analyses and treatment of underlying causes by specialised doctors in a multidisciplinary setting is necessary for treating patients with complicated wound. This article describes the impact of Electronic Health Consultation on all wounds treated in the primary care. And describes the effect on the duration until referral to the hospital and the influence on the amount of unnecessary referrals to the hospital. All data was collected prospectively from June 2020 until October 2021. The study involved a process where primary care could seek advice from a Wound Physician at the Alrijne Wound Centre through a specialised Electronic Health Consultation. A total of 118 patients were analysed. 41/118 (34.7%) patients required a physical consultation with analysis and treatment in the hospital, after teleconsultation. The remaining 77/118 (65.3%) could be treated in primary care after Electronic Health Consultation. The mean duration of wound existence until Electronic Health Consultation was 39.3 days (range 5-271, SD: 38.5). 3/41 (7.3%) of the referrals were unnecessary. Electronic Health Consultation serves as a valuable and efficient tool for enhancing wound care, ultimately contributing to improved patient management and resource allocation within the healthcare system. This article describes the impact of Electronic Health Consultation on all wounds treated in the primary care and the influence on the duration until referral to the hospital and the influence on the amount of unnecessary referrals to the hospital.

A Longitudinal Investigation of Lower-Risk Gambling Limits in the Canadian National Study.

Recent years have seen increased attention given to identifying and describing the levels of gambling participation that confer a risk of harm in order to generate public health advice regarding lower-risk gambling. However, most of the existing literature has failed to explicitly assess these limits in a prospective manner. The purpose of this study is to employ a methodology consistent with prior investigations to evaluate the level of gambling participation associated with an increased risk of future gambling-related harm. Using data from the Alberta Gambling Research Institute's National Project Online Panel Survey, risk ratios and Receiver Operating Characteristic (ROC) analyses were used to determine the relative risk of gambling-related harm associated with participating in a greater number of gambling formats, gambling more days per month, and spending a greater proportion of income gambling. Prospective lower-risk limits were largely consistent with those identified in previous cross-sectional analyses (e.g., no more than two gambling formats, no more than once a week), with the exception that higher limits were found for the percent of household income spent gambling (3.4-6.4% vs. 1%). We advise that future research on lower-risk gambling limits consider the use of more granular assessment instruments and prospective methods to more closely evaluate the association between gambling participation and gambling harm.