Insufficient Reimbursement Research Articles

How do you do it?: Gynecologic Brachytherapy Best Practices at High Volume Institutions within the United States and Canada

Definitive treatment including chemoradiation and brachytherapy for patients diagnosed with locally advanced cervical cancer requires significant multidisciplinary coordination. Our goal was to assess and share gynecologic brachytherapy best practices from high volume brachytherapy centers. A survey was sent to 42 centers within the United States and Canada that perform a high volume of complex gynecologic brachytherapy. Responses were collected from 32/42 (76%) institutions. 41% of responding institutions perform > 100 complex brachytherapy procedures per year. Most departments have >1 brachytherapist and 85% of respondents complete 1-2 complex brachytherapy procedures per day. 91% of surveyed departments have support staff specifically devoted to brachytherapy. Approximately 50% of intracavitary/hybrid procedures are performed in departmental brachytherapy suites. Institutions use MRI (35%), CT (24%) or a combination (24%) for treatment planning. 88% of respondents use sedation for tandem based procedures. Respondents cite high complexity of care, insufficient reimbursement, untimely referrals, shared operative and clinical duties, expensive applicator acquisition and complex scheduling as challenging aspects of providing brachytherapy services. Conversely, respondents cite a dedicated team, departmental brachytherapy suite, well organized coordination of procedures and personnel, anesthesia support, a full range of applicators, image-based planning near the department and supportive administration as integral components in providing brachytherapy. Most surveyed institutions have >1 brachytherapist who perform 1-2 procedures per day in a dedicated brachytherapy space with a team that assists with coordination and scheduling efforts. A well supported multidisciplinary team is vital to ensure state of the art brachytherapy which is essential in curing these challenging malignancies.

Perspectives of Physicians in Taipei on the Home Healthcare Programs

<p>目的：高齡社會時代的來臨，居家醫療照護服務需求增加，然而目前醫師參與居家醫療照護比例仍偏低，因此本研究希望能透過問卷調查，協助瞭解台北市醫師對於推動居家照護相關計畫的實務運作與障礙。</p> <p>方法：本研究為無記名結構式問卷調查，於2022年8月至2022年10月之間進行，針對執業登記會籍為臺北市醫師之意見調查，內容包括：基本資料、參加居家醫療照護整合計畫與居家失能個案家庭醫師照護方案現況與障礙誘因等，問卷經專家效度檢視修正後以電子式表單請醫師回答。針對醫師參與居家照護相關計畫（居家醫療照護整合計畫、居家失能個案家庭醫師照護方案）進行單變量分析與多元邏輯斯迴歸分析。</p> <p>結果：本研究共計回收410份，發現到門診數較少的醫師，較願意參與居家醫療照護整合計畫，女性醫師較願意參與居家失能個案家庭醫師照護方案；而越瞭解計畫/方案內容的醫師，越願意參與居家醫療照護整合計畫、居家失能個案家庭醫師照護方案。醫師對於推動居家醫療照護整合計畫之障礙前三名依序為提供24小時電話諮詢服務有困難(76%)、往返案家交通耗時(75%)、給付不足(74%)；而居家失能個案家庭醫師照護方案前三名影響的因素為往返案家交通耗時(71%)、給付不足(69%)、個管師人力不易安排(69%)。</p> <p>結論：對台北市醫師參與居家醫療照護整合計畫、居家失能個案家庭醫師照護方案之政策建議，包括給付需考量向上調整並納入交通成本與提供24小時緊急電話諮詢服務，以及建立更有效率之個案媒合溝通機制。</p> <p> </p><p>Purpose: With the advent of an aging society, the demand for home medical care services in Taiwan has increased. However, the current participation rate of physicians in home medical care remains low. The study accordingly conducted a questionnaire survey to help understand the operational challenges and barriers facing physicians in Taipei regarding the promotion of home healthcare programs. </p> <p> Methods: This study as an anonymous structured questionnaire survey was conducted between August 2022 and October 2022 to solicit the opinions of physicians registered for practice in Taipei City. The questionnaire covers basic information, participation in home medical care integration programs, the current status, and challenges and incentives of home care for disabled cases by family physicians. After expert validity review and revisions, the questionnaire was administered to physicians through in an electronic form. Univariate and linear regression analyses were performed on the results obtained from physicians participating in home healthcare programs (home medical care integration program, home care for disabled cases by family doctors). </p> <p> Results: According to the 410 responses collected, physicians with less clinic sessions are more willing to participate in home medical care integration programs, and female physicians tend to be more willing to participate in home care for disabled cases by family physicians. Physicians equipped with a better understanding of the programs are also more willing to participate. The top three obstacles for physicians to promote home medical care integration programs were respectively difficulty in providing 24-hour telephone consultation services, time-consuming transportation, and insufficient reimbursement. For home care for disabled cases by family physicians, the top three challenges were time-consuming travel to patients at home, insufficient reimbursement, and difficulty in arranging case managers. </p> <p>Conclusion: To promote the participation of Taipei physicians in home medical care integration program and home care for disabled cases by family physicians, the study recommends the following three measures: increasing the reimbursement considering transportation costs, providing 24-hour emergency telephone consultation services, and establishing a more efficient communication mechanism for case matching.</p> <p> </p>

Palliative Care in the Midst of Adversity: Insights from a Low-Income Country.

The integration of palliative care into conventional healthcare services has demonstrated significant benefits in alleviating serious health-related suffering (SHRS), reducing symptom burden, and lowering healthcare expenditure for patients and families. Despite Lebanon's initial steps towards palliative care development, its integration remains inadequate, particularly due to the country's socio-political and economic challenges. This paper examines the current landscape of palliative care services in Lebanon, including their geographical distribution and care models, while addressing the obstacles impeding their progress. Data on palliative care services were gathered from the presentations of stakeholders at the 2023 National Palliative Care Conference. Currently, three nonprofit organizations provide home-based palliative care primarily for end-of-life patients, while seven hospitals offer palliative care through inpatient consultation teams, three of which have specialized palliative care wards and two outpatient clinics. Hospital-based palliative care services are primarily located in the capital city Beirut and operate within private healthcare facilities. Notably, only home-based services are provided free of charge, while hospital-based care is not reimbursed, thus limiting access to palliative care for only those who can afford it. The political and economic instability, inadequate policies and insufficient reimbursement, shortage of trained expertise and essential medicines like morphine, and inconsistent health education are some of the challenges that Lebanon faces in developing palliative care. A multilevel coordinated response and advocacy are crucial to drive policy reforms, enhance education, promote public awareness, and improve clinical practice ensuring quality and equitable palliative care access to all.

B-203 Advancing Equity, Inclusion, and Diversity in Genetic Testing: Disparities in Detection Rates and Access to Carrier Screening Among 8,000 Patients Nationwide

Abstract Background Professional medical societies recommend that carrier screening for 113 different genetic disorders be offered during pregnancy or preconception to all individuals, regardless of ancestry, in order to provide more equitable opportunities for patients to ascertain their reproductive risks. In our clinical laboratory experience, however, the vast majority of healthcare providers continue to order carrier screening for only cystic fibrosis (CF), which is disproportionately common in white individuals of Northern European descent. Our highest volume CF screening test is performed on >10,500 diverse patients per year and utilizes a targeted genotyping array that detects >500 variants in CFTR and >1200 variants in >150 other pertinent genes. Here we report the inequities in diagnostic yield among our first 8,000 patients for whom only limited testing was ordered and examine the barriers to widespread adoption of more inclusive carrier screening. Methods Three carrier screening options (CF, CF+spinal muscular atrophy [SMA], CF+SMA+fragile X syndrome [FXS]+hemoglobinopathies) were ordered clinically and performed on DNA extracted from 8,000 whole blood samples from unique individuals utilizing a custom SNP array (Thermo Fisher GeneTitanTM platform) designed to detect >1700 pathogenic variants in 218 different genes. Data was retrospectively reviewed to determine overall detection rates for carriers of all recommended conditions vs. only the condition(s) included in the originally ordered service. Finally, reproductive health providers at nine different ordering sites across the U.S. were interviewed regarding their current carrier screening practices. Results Patients were referred for testing by 119 different clinical facilities. 98.1% (7847/8000) had CF-only testing ordered, 1.2% (99/8000) had CF+SMA testing ordered, and 0.68% (54/8000) had testing for CF+SMA+FXS+hemoglobinopathies ordered. 7.1% (568/8000) of patients had reportable variants in CFTR. Had CF+SMA testing been ordered on all 8,000 patients, however, the diagnostic yield would have been 8.9%. Of the patients who had CF-only or CF+SMA testing ordered, 11.9% (943/7946) were found to be carriers of hemoglobinopathies. Finally, had all 8000 patients had testing for all currently recommended targets on the panel, the diagnostic yield would have increased to 55% (4396/8000). Ordering providers at 9/50 different contacted sites agreed to interview requests. 100% (9/9) of respondents indicated that their patients experience significant disparities in access to carrier screening, and that the primary cause of these inequities was insufficient insurance reimbursement. 67% (6/9) of respondents indicated that >50% of their patient population identified as non-white and would have “very strongly” benefitted from “testing for other disorders beyond CF.” Conclusions Despite clinical practice guidelines urging for more population-neutral carrier screening, major gaps exist between what is recommended versus ultimately ordered. This significantly limits the clinical utility of testing, especially in patients from underrepresented backgrounds. Improved insurance coverage for more inclusive carrier screening is needed to help reduce such disparities.

State of the union: A review of state‐based laws and regulations supporting pharmacist payment for clinical services

AbstractIntegrating pharmacists into interdisciplinary care models is essential for achieving the Quintuple Aim in health care, which emphasizes improving patient outcomes, enhancing patient and provider experiences, reducing costs, and advancing health equity. Despite expanded scopes of practice that facilitate collaborative models, pharmacists often face significant barriers due to inconsistent and insufficient reimbursement for their clinical services. This review seeks to address these challenges by focusing on state‐based legislation and regulations that establish payment parity or create pathways for reimbursing pharmacist clinical services. Through a narrative review, this article systematically compares different states' approaches to pharmacist reimbursement by examining affected payers, billable services, and other pertinent details. The ultimate goal is to propose model characteristics for states considering the enhancement or development of legislation and regulations to ensure equitable payment mechanisms for pharmacist services. By providing a comprehensive overview of existing models and identifying effective legislative characteristics, this review aims to inform and empower pharmacists and their advocates with a better understanding of reimbursement regulations and to inspire community‐driven advocacy for equitable compensation, thus supporting the integration of pharmacists as essential health care providers.

Why and How to Integrate Early Palliative Care Into Cutting-Edge Personalized Cancer Care.

Early palliative care, palliative care integrated with oncology care early in the course of illness, has myriad benefits for patients and their caregivers, including improved quality of life, reduced physical and psychological symptom burden, enhanced prognostic awareness, and reduced health care utilization at the end of life. Although ASCO and others recommend early palliative care for all patients with advanced cancer, widespread implementation of early palliative care has not been realized because of barriers such as insufficient reimbursement and a palliative care workforce shortage. Investigators have recently tested several implementation strategies to overcome these barriers, including triggers for palliative care consultations, telehealth delivery, navigator-delivered interventions, and primary palliative care interventions. More research is needed to identify mechanisms to distribute palliative care optimally and equitably. Simultaneously, the transformation of the oncology treatment landscape has led to shifts in the supportive care needs of patients and caregivers, who may experience longer, uncertain trajectories of cancer. Now, palliative care also plays a clear role in the care of patients with hematologic malignancies and may be beneficial for patients undergoing phase I clinical trials and their caregivers. Further research and clinical guidance regarding how to balance the risks and benefits of opioid therapy and safely manage cancer-related pain across this wide range of settings are urgently needed. The strengths of early palliative care in supporting patients' and caregivers' coping and centering decisions on their goals and values remain valuable in the care of patients receiving cutting-edge personalized cancer care.

You Cannot Function in "Overwhelm": Helping Primary Care Navigate the Slow End of the Pandemic.

This study was developed to explicate underlying organizational factors contributing to the deterioration of primary care clinicians' mental health during the COVID-19 pandemic. Using data from the Larry A. Green Center for the Advancement of Primary Health Care for the Public Good's national survey of primary care clinicians from March 2020 to March 2022, a multidisciplinary team analyzed more than 11,150 open-ended comments. Phase 1 of the analysis happened in real-time as surveys were returned, using deductive and inductive coding. Phase 2 used grounded theory to identify emergent themes. Qualitative findings were triangulated with the survey's quantitative data. The clinicians shifted from feelings of anxiety and uncertainty at the start of the pandemic to isolation, lack of fulfillment, moral injury, and plans to leave the profession. The frequency with which they spoke of depression, burnout, and moral injury was striking. The contributors to this distress included crushing workloads, worsening staff shortages, and insufficient reimbursement. Consequences, both felt and anticipated, included fatigue and demoralization from the inability to manage escalating workloads. Survey findings identified responses that could alleviate the mental health crisis, namely: (1) measuring and customizing workloads based on work capacity; (2) quantifying resources needed to return to sufficient staffing levels; (3) promoting state and federal support for sustainable practice infrastructures with less administrative burden; and (4) creating patient visits of different lengths to rebuild relationships and trust and facilitate more accurate diagnoses. Attention to clinicians' mental health should be rapidly directed to on-demand, confidential mental health support so they can receive the care they need and not worry about any stigma or loss of license for accepting that help. Interventions that address work-life balance, workload, and resources can improve care, support retention of the critically important primary care workforce, and attract more trainees to primary care careers.

Therapy deserts: A call to action to address inequitable access to therapy services among pediatric orthopaedic patients

Background"Food deserts" are areas with limited access to affordable and healthy foods, disproportionately affecting low-income and ethnic minority communities in the United States. Analogous disparities exist in other disciplines. Our interprofessional team observed "therapy deserts” in orthopaedic and rehabilitation settings, wherein pediatric patients (particularly those with Medicaid-type insurance) appeared to lack equal access to physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services. Inadequate access to therapy services places patients at risk for worse outcomes. MethodsWe conducted a quality improvement project to assess pediatric patients’ access to therapy care in our region. We surveyed all local PT, OT, and SLP clinics identified from a comprehensive listserv maintained by pediatric therapy teams in our institution. Using a scripted questionnaire, we contacted 113 PT, 38 OT, and 82 SLP clinics external to our institution, collecting data on accepted conditions, appointment waitlist periods, and accepted insurance types. Our primary objective was to determine the percentage of clinics that accepted patients with Medicaid-type insurance. We supplemented our survey with an examination of the Area Deprivation Index (ADI) for each clinic location. Results59 PT clinics (52%), 15 OT clinics (39%), and 36 SLP clinics (44%) completed the survey. Clinics often had limited capacity to care for medically complex conditions. Waitlist times varied, with a median wait of 1 week for PT services, 1 month for OT services, and immediate availability for SLP services. Only 14% of responding PT clinics, 53% of OT clinics, and 22% of SLP clinics accepted patients with Medicaid-type insurance. Insufficient reimbursement rates were frequently cited as the reason for not accepting Medicaid-type insurance. Waitlist times were longer for PT and SLP clinics that accepted Medicaid-type insurance compared to those that did not. Moreover, clinics that accepted Medicaid-type insurance were, on average, in more disadvantaged locations. ConclusionsOur findings suggest the existence of “therapy deserts,” where limited access to therapy services is influenced by insurance type and patient complexity. These restrictions likely exacerbate existing health disparities and illustrate a systemic problem rooted in complex social drivers of health. Addressing "therapy deserts" requires collaborative efforts from multidisciplinary teams. Level of EvidenceLevel III

Examining the use of psychiatric collaborative care and behavioral health integration codes at federally qualified health centers: A mixed-methods study.

Despite evidence to support the integration of behavioral health and physical health care, the adoption of Integrated Behavioral Health (IBH) has been stymied by a lack of reliable and sustainable financing mechanisms. This study aimed to provide information on the use of Psychiatric Collaborative Care Model (CoCM) and behavioral health integration (BHI) codes and the implementation of IBH in federally qualified health centers (FQHCs). This cross-sectional, mixed-methods study involved an electronic survey of administrators and follow-up qualitative interviews from a subset of survey respondents. Quantitative data were analyzed using descriptive analysis and thematic coding was used to analyze qualitative data to identify salient themes. Administrators (N = 52) from 11 states completed the survey. Use of CoCM (13%) or BHI codes (17.4%) was low. Most administrators were not aware that CoCM (72%) or BHI codes (70%) existed. Qualitative interviews (n = 9) described barriers that further complicate IBH and code use like workforce shortages and insufficient reimbursement for the cost to deliver CoCM services. Although FQHCs are working to meet the needs of the communities they serve, a lack of billing clarity and awareness and workforce issues hinder the adoption of the CoCM. FQHCs face many demands to provide care to safety net populations, yet are not fully equipped with the resources, workflows, staffing, and payment structures to support CoCM/BHI billing. Increased financial and logistical support to build practice infrastructure is needed to reduce the administrative complexity and inadequate reimbursement mechanisms that currently hinder the implementation of the CoCM and integrated care delivery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Substance Use Disorder Treatment Programs during a Health Crisis: Response to the COVID-19 Pandemic and Future Implications

Background: The COVID-19 pandemic rapidly changed how substance use disorder (SUD) treatment services are delivered. In this qualitative study, we examined what changes SUD treatment programs in Arkansas implemented in response to the pandemic, what factors influenced their ability to implement these changes, and their reflections, outlook, and future recommendations. Methods: Between May and August 2020, we conducted semi-structured phone interviews with 29 leaders at 21 SUD programs throughout Arkansas. Interview questions focused on what changes programs implemented in response to the pandemic, barriers and facilitators to implementation, and future outlook. Interviews were thematically analyzed. Results: Programs implemented similar infection control practices, including COVID-19 screening at entry, masks, hand hygiene, and social distancing. Residential programs discontinued outside visitations and capped admissions, and outpatient programs implemented telehealth services. Clients generally responded well to the changes, however many experienced difficulties (e.g., anxiety, lack of access to telehealth). While programs welcomed additional financial support (e.g., CARES act) and looser regulatory restrictions (e.g., telehealth use), many struggled economically due to lower demand and insufficient reimbursement. Programs varied in leadership and staff responses to the pandemic, and in their capacity to implement the changes (e.g., facilities, staffing). Finally, interviewees acknowledged they were unprepared for the pandemic and were uncertain about the future. Conclusions: The insights from the COVID-19 pandemic and SUD programs’ responses helps researchers, policymakers and practitioners understand what has happened during the pandemic, how to prepare for future crises, and how to build more resilient SUD and public health systems.

Role of Sehat Insaf Card in access to healthcare services

Introduction: The Sehat Insaf Card (SIC) scheme has the potential to improve access to healthcare services for low-income families in Pakistan, there are several challenges that healthcare professionals may face during its implementation. Objectives: This study aims to assess the workload, reimbursement rates, quality of care, and job satisfaction and burnout levels of healthcare professionals in private hospitals providing services under the Sehat Insaf Card scheme. The study's findings will provide insights into the effectiveness of the scheme and inform policymakers about healthcare workforce well-being. Methodology: The study utilized a cross-sectional survey design to collect data from private hospitals in Lahore, using a one-day survey and questionnaires to achieve a snapshot of the research problem at a societal level. A sample size of 200 was calculated and data were analyzed using SPSS. Regression analysis was done to calculate value significance of the analysis. Results: The study assessed the impact of Sehat Insaf Card on healthcare professionals in private hospitals. Results showed a significant impact on increased work and demand (mean score: 76.09, p-value: 0.0071), due to administrative requirements (mean score: 65.09, p-value: 0.0082), and insufficient reimbursement rates (mean score: 56.98, p-value: 0.0032).

Why Are Family Doctors Still Not Addressing Oral Health?

Oral health dramatically affects overall health and vice versa. Oral health is a key health indicator for Healthy People 2030. Yet family physicians are not addressing this important health issue at the same level they address other essential health problems. Studies show that family medicine training and clinical activities are lacking in the area of oral health. The reasons are multi-factorial including insufficient reimbursement, lack of accreditation emphasis, and poor medical-dental communication. There is hope. Robust oral health curricula for family doctors exist and efforts are being made to create primary care oral health education champions. The tide is turning on accountable care organizations adding oral health services, access, and outcomes to their systems. Like behavioral health, oral health can be fully integrated into the care family physicians offer.

A snapshot of teleradiology practice in Turkey: the results of a survey among radiologists.

This study featured a survey that offers a snapshot of various teleradiology practices in Turkey, a Group of Twenty country that has undertaken a major transformation of its health care system during the last two decades and is currently the world leader in terms of the combined number of per capita magnetic resonance imaging and computed tomography examinations performed (which represent the bulk of teleradiology services worldwide). The study data was collected from 4736 Turkish Society of Radiology (TSR) members via an electronic platform in the web environment through a questionnaire consisting of 24 questions. The survey was conducted in a 3-month time window (March-May 2021). Statistical tools were used for the analysis of the quantitative data. Responses from 156 members of the TSR comprised the study data, revealing that teleradiology is used for various applications in Turkey. Almost half of the participants (49%) performed teleradiology only in the private sector. Half of the respondents (51%) stated that they reported images at home for multiple centers. Moreover, 38% of the participants had been reporting more than 50 examinations per day, and 74% of the respondents earned less than 0.50 Euro per examination they reported. The overall satisfaction with teleradiology among the teleradiologists was, on average, 4.7 out of 10 points. The results are both promising for the future (i.e., concerning the propensity for adopting new technology) and alarming for the current state of affairs (i.e., insufficient radiologist reimbursement and lack of licensing and accreditation of teleradiology service providers). Periodic surveys performed in countries with different health care systems concerning financial, technical, and medicolegal aspects might reveal an up-to-date landscape of teleradiology practices worldwide and help guide local and regional decision-makers.

Resource and Reimbursement Barriers to Comprehensive Cancer Care Delivery: An Analysis of Association of Community Cancer Centers Survey Data.

Comprehensive cancer care (CCC) delivery is recommended in guidelines and considered essential for high-quality cancer management. Barriers, such as insufficient reimbursement, prevent consistent access to and delivery of CCC. Association of Community Cancer Centers conducted a national survey to elucidate capacity and barriers to CCC delivery to inform policy and value-based payment reform. Survey methodology included item generation with expert review, iterative piloting, and cognitive validity testing. In the final instrument, 27 supportive oncology services were assessed for availability, reasons not offered, and coverage/reimbursement. 204 of 704 member programs completed survey questions. Despite most services being reported as offered, a minority were funded through insurance reimbursement. The services least likely to obtain reimbursement were those that address practical and family/childcare needs (0.7%), caregiver support (1.5%), advanced care directives (1.7%), spiritual services (1.8%), and navigation (2.7%). These findings did not vary by region or practice type. There is a lack of sufficient reimbursement, staffing, and budget to provide CCC across the United States. Care models and reimbursement policies must include CCC services to optimize delivery of cancer care.

Last Resort Antibiotics Costs and Reimbursement Analysis of Real-Life ICU Patients with Pneumonia Caused by Multidrug-Resistant Gram-Negative Bacteria in Germany.

Multidrug-resistant Gram-negative bacteria (MDR-GNB) cause serious infections and aggravate disease progression. Last resort antibiotics are effective against MDR-GNB and are reimbursed by flat rates based on German diagnosis-related groups (G-DRG). From a hospital management perspective, this analysis compared hospital reimbursement for last resort antibiotics with their acquisition costs to outline potential funding gaps. Retrospective analyses based on medical charts and real-life reimbursement data included patients with pneumonia due to MDR-GNB treated in intensive care units (ICU) of a German tertiary care hospital (University Hospital Cologne) between January 2017 and December 2020. Drug-associated hospital reimbursement of G-DRG was compared with drug acquisition costs based on preliminarily approved last resort antibiotics (cefiderocol, ceftazidime-avibactam, ceftolozane-tazobactam, and imipenem-cilastatin-relebactam) according to label. Funding gaps were determined for the treatment of Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, and mixed infections, respectively. Most of the 31 patients were infected with Enterobacterales (n = 15; 48.4%) and P. aeruginosa (n = 13; 41.9%). Drug-associated G-DRG reimbursement varied from 44.50 EUR (mixed infection of P. aeruginosa and Enterobacterales) to 2265.27 EUR (P. aeruginosa; mixed infection of P. aeruginosa and Enterobacterales). Drug acquisition costs ranged from 3284.40 EUR in ceftazidime-avibactam (minimum duration) to 15,827.01 EUR for imipenem-cilastatin-relebactam (maximum duration). Underfunding was found for all MDR-GNB, reaching from 1019.13 EUR (P. aeruginosa; mixed infection of P. aeruginosa and Enterobacterales) to 14,591.24 EUR (Enterobacterales). This analysis revealed the underfunding of last resort antibiotics in German hospital treatment. Insufficient reimbursement implies less research in this field, leading to a more frequent use of inappropriate antibiotics. The cycle closes as this contributes to the development of multi-drug resistant bacteria.

Perceptions and use of complementary and integrative health practices among rehabilitation professionals: A survey

Despite increasing use of complementary and integrative health (CIH) by rehabilitation providers, information on rehabilitation professionals’ perceptions and utilization of CIH is limited. The purpose of this study was to investigate rehabilitation professionals’ perceptions, utilization, barriers and research of CIH in the United States. A cross-sectional online survey was conducted on the perceptions, utilization, barriers and research regarding CIH. Survey invitations were posted on community boards of rehabilitation associations and sent to rehabilitation institutions listserv in 2020. Of 405 respondents, the majority of respondents were physical therapists (PTs) (34%), then, occupational therapists (OTs) (20%), and physicians (16.8%). Most respondents (68%) worked in settings offering integrative health. Forty three percent of respondents were trained and 22% were certified in CIH practice. Breathing exercises, meditation, massage, and yoga were the most commonly utilized practices for self-care and patient care. Physicians and PTs were more likely than OTs to initiate discussion about CIH with patients ( p =.001 and p =.046 respectively), and senior practitioners were more likely to initiate these discussions than junior practitioners ( p =.037 and p <.001, respectively). Peer-reviewed publications, clinical experience, and personal experience with CIH were the most selected factors affecting respondents’ attitudes toward CIH practices. Rehabilitation clinicians reported that insufficient provider reimbursement and insufficient skills were the primary obstacles to CIH practice. Rehabilitation researchers reported that insufficient funding as the primary obstacle to conducting CIH research. Rehabilitation professionals commonly utilize CIH in practices for self-care and patient care, and they perceive insufficient training, clinical reimbursement and research funding as the main barriers to advancing CIH.

Access and quality of biomarker testing for precision oncology in Europe

BackgroundPredictive biomarkers are essential for selecting the best therapeutic strategy in patients with cancer. The International Quality Network for Pathology, the European Cancer Patient Coalition and the European Federation of Pharmaceuticals Industries and Associations evaluated the access to and quality of biomarker testing across Europe. MethodsData sources included surveys of 141 laboratory managers and 1.665 patients, and 58 in-depth interviews with laboratory managers, physicians and payers. Four access metrics (laboratory access, test availability, test reimbursement, test order rate) and three quality metrics (quality scheme participation, laboratory accreditation, test turnaround time) were applied to rank the results. ResultsThe access to precision medicines is higher in countries with public national reimbursement processes in place. Lack of diagnostic laboratory infrastructure, inefficient organization and/or insufficient public reimbursement narrow the access to single biomarker tests in many European countries. In countries with limited public reimbursement, pharma and patients’ out of pocket were the primary funding sources for testing. Uptake of multi-biomarker next generation sequencing (NGS) is highly varied, ranging from 0% to >50%. Financial constraints, a lack of NGS testing capabilities and the failure to include NGS testing in the guidelines represent the main barriers to NGS implementation. The quality of biomarker testing is highest in Western and Northern Europe, with more than 90% of laboratories participating in quality assurance schemes. ConclusionsOur data clearly indicate the need for a call to action to ensure the clinical implementation of precision medicine in Europe.

Pilot testing a tool to determine the costs and time associated with community pharmacy-based administration of injectable naltrexone.

Medications for opioid use disorder (MOUD), including injectable naltrexone (IN), are part of evidence-based OUD treatments. MOUD access often is limited, especially in rural communities. When authorized to administer non-vaccination injections, pharmacists can increase IN accessibility. However, inadequate reimbursement for pharmacist-administered IN can hinder widespread adoption. To pilot test a process to obtain a preliminary estimate of the total costs and time associated with community-pharmacist administered IN. A purposively-selected sample of key informants at community pharmacies administering IN were surveyed about time and cost for best practice IN activities. Respondents estimated the time to perform activities and average pharmacist/pharmacy technician hourly salary, which were used to calculate administration costs. The approach to estimate time and costs was feasible. Administrative costs (mean=$93, range: $48-$164) and time (mean=123min., range: 63-220min.) to administer IN varied widely. Pharmacists'/pharmacy technicians' roles varied by pharmacy. Pharmacists allocate significant time and resources to administer IN. Insufficient reimbursement may disincentivize pharmacy-involved OUD treatment and ultimately slow needed expansion of MOUD services. Increasing IN services requires engaging pharmacies to expand their practice through educational campaigns, along with a commitment to reimburse the cost of medications and related administration activities.

604. Impact of COVID-19 Pandemic on Telehealth Practices in Pediatric Infectious Diseases

BackgroundThe COVID-19 pandemic has led to changes in clinical practice, including a significant increase in the use of telehealth (TH). We sought to assess the impact of the pandemic on the use and perceptions of TH by pediatric infectious diseases (PID) clinicians.Figure 1. Modalities Figure 2. Comfort MethodsThe PIDS* Telehealth Working Group developed a 26-question online survey to assess telehealth practices among PID clinicians. The survey was available via Survey Monkey® from 12/6/2020-2/26/2021 to members of PIDS, PICNIC*, AAMI and AAP*. Clinicians in active practice in North America were included in the analysis.Figure 3. Platforms Figure 4. Barriers ResultsThe response rate was 10% (n=253) of 2,550 PID clinicians. Physicians accounted for 98.4% of the cohort. The remaining 1.6% were allied health professionals. 81 survey respondents (32%) were in 4 US states (CA, TX, OH and NY) and the province of Quebec. 62.8% of respondents were women, 37% of respondents were 36-45 years old, with 42.7% devoting about 50-99% of their time to direct patient care. TH usage increased during the pandemic with the most gain in provider-patient communications with 65.6% increase for synchronous and 22.1% for asynchronous TH (Figure 1). Gains in provider-provider TH were less than 20%. Respondents reported a 6-fold gain in comfort with TH usage versus pre-pandemic level (Figure 2). Most respondents report being satisfied with their current platform and modality. Once the COVID-19 waivers expire, 70% of respondents plan to continue using TH. The most common TH modality used was an EMR-integrated TH platform (Figure 3). The main perceived barriers to TH adoption were lack of complete physical examination (73.7%), dealing with new technology (21.5%), and insufficient reimbursement (20.8%) (Figure 4).ConclusionThe COVID-19 pandemic has resulted in a significant increase in the use of TH by PID specialists versus pre-pandemic usage. Respondents gained comfort with use of different telehealth modalities during the pandemic. This data can help clinicians and organizations in planning and resource allocation for telehealth programs in a post-pandemic environment.Disclosures All Authors: No reported disclosures

TELEDENTISTRY DURING THE COVID-19 PANDEMIC: A REVIEW OF LITERATURE

Dentistry is one of the fields that are hugely affected by the COVID-19 pandemic due to high concentrations of contaminated aerosols which can be transmitted while undergoing dental procedures and can potentially lead to the nosocomial spread of the COVID-19 virus. Teledentistry, a subunit of telehealth, is an alternative that is widely chosen to diminish in-clinic appointments and to support social distancing. The four main methods of teledentistry are live or synchronous video, store-and-forward (asynchronous), remote patient monitoring (RPM), and mobile health (mHealth). Teledentistry can be applied to all specialities including oral medicine, oral and maxillofacial surgery, endodontics, orthodontics, prosthodontics, periodontics, pediatric and preventive dentistry with high accuracy and reliability. The process of teledentistry consists of subunits including teleconsultation, telediagnosis, teletriage, and telemonitoring. Focusing on its advantages, regarding the affordability and convenience of teledentistry, it originated a paradigm shift for the prevention and promotion of oral health. COVID-19 patients can still receive dental care with the use of teledentistry. Moreover, it aids patients from rural areas where access to dental specialities is limited. However, solutions to address concerns about the image quality, digital literacy of both healthcare providers and patients, insufficient financial reimbursement of dentists, security and technical issues are required to enhance the effectiveness of teledentistry. Hopefully, this review paper can be helpful for giving information regarding teledentistry.