Insurance Issues Research Articles

Work-related and non-work-related fatal road accidents: Assessment of psychoactive substance use in commuting.

Commuting road traffic collisions (RTCs) are one of the main causes of occupational death worldwide, including Italy. Among the prominent yet relatively understudied personal risk factors in the subpopulation of workers, there is the use of psychoactive substances. Since the phenomenon of driving under alcohol and drugs effects in the commuter sub-population has so far been poorly studied, we carried out a study by comparing results obtained from the analysis of commuters and non-commuters. The percentage of commuting RTCs victims was 10.4% out of all the RTCs. Commuter victims were mostly men, 51-60 years-old, motorcyclists (32.1%) or car drivers (28.6%), employees, deceased during Fridays and Saturdays, in the afternoon (35.7%) and in the evening (32.1%). It was possible to perform toxicological analyses in 60.7% of commuter cases: approximately 40% tested positive, always and only for ethanol (median Blood Alcohol Concentration, BAC, of about 1.03 g/L). Values above the legal limit were observed in 23.5% of the toxicological samples analyzed from commuter accidents. Our findings contribute to bridging the gap in knowledge in the area of RTCs and commuting and emphasize the importance of carrying out toxicological investigations, with possible repercussions on both insurance issues and public health strategies, which are relevant for analyzing the phenomenon structurally.

Medical Liability, Defensive Medicine, and Introduction to Professional Insurance in the Republic of Kazakhstan

This study aims at verifying relationships between the perception of medico-legal risks involved in the professional activity of Republic of Kazakhstan healthcare professionals (HCPs), defensive medical behavior and their understanding of healthcare professional liability (HCPL) insurance. The current paper also analyzes the experience of some foreign countries based on a study which suggests the ways of improving the medical liability, defensive medicine and introduction to HCPL insurance in the Republic of Kazakhstan. Additionally, the identified advantages to introduction insurance and mediation as an extra-judicial regulation of disputes, the authors point out the identified shortcomings of the matter in the legal acts of the Republic of Kazakhstan. Relevance of the topic is reasoned to the fact that complaints about medical malpractice have increased over time in Kazakhstan, as well as other countries around the world. The costs arising from medical liability lawsuits weigh not only on individual HCPs but also on the budgets of healthcare facilities, many of which in Kazakhstan are supported by public funds. A full understanding of the phenomenon of medical malpractice appears necessary in order to manage this spreading issue and mechanism of HCPL insurance in the Republic of Kazakhstan.

Factors affecting pathways to care for children and adolescents with complex vascular malformations: parental perspectives

BackgroundComplex vascular malformations (VMs) are rare disorders that can cause pain, coagulopathy, disfigurement, asymmetric growth, and disability. Patients with complex VMs experience misdiagnosis, delayed diagnosis, delayed or inappropriate treatments, and worsened health. Given the potential consequences of delaying expert care, we must identify the factors that impede or facilitate this access to care.ResultsWe performed semi-structured interviews with 24 parents (21 mothers; 3 fathers; median age = 42.5 years) of children with complex VMs and overgrowth disorders living in the US, recruited through two patient advocacy groups – CLOVES Syndrome Community, and Klippel-Trenaunay Support Group. We performed thematic analysis to assess parental perspectives on barriers and facilitators to accessing expert care. We identified 11 factors, representing 6 overarching themes, affecting families’ ability to access and maintain effective care for their child: individual characteristics (clinician behaviors and characteristics, parent behaviors and characteristics), health care system (availability of specialist multidisciplinary teams, care coordination and logistics, insurance and financial issues, treatments and services), clinical characteristics (accuracy and timing of diagnosis, features of clinical presentation), social support networks, scientific progress, and luck and privilege. Additionally, access to information about VMs and VM care was a crosscutting theme affecting each of these factors. These factors influenced both the initial access to care and the ongoing maintenance of care for children with VMs.ConclusionParents of children with VMs report multiple factors that facilitate or impede their ability to provide their child with optimal care. These factors represent possible targets for future interventions to improve care delivery for families affected by VMs.

Do bond market participants care about directors’ and officers’ liability insurance?——Empirical evidence based on the pricing of corporate bonds

ABSTRACT Based on the risk hedging perspective, this paper examines the impact of directors’ and officers’ liability insurance (hereafter referred to as D&O liability insurance) on the pricing of corporate bonds. We find that the purchase of D&O liability insurance can effectively reduce corporate bond insurance pricing. The path test shows that the purchase of D&O liability insurance can reduce the bond insurance pricing by improving the quality of company’s internal control. Furthermore, the paper finds that when management power is greater, investor protection is poor or financial risk is high,the impact of the D&O liability insurance is stronger. After purchasing D&O liability insurance, creditors will reduce the use of corporate governance contractual terms, but will set more investments and financing as well as option contractual terms. In addition, companies that purchase D&O liability insurance issue bonds with higher credit ratings and longer bond maturities.

Smjernice u postlisabonskom europskom međunarodnom privatnom pravu

Smjernice u postlisabonskom europskom međunarodnom privatnom pravu

A quality assessment of online patient information regarding tonsillitis using the EQIP tool

BackgroundTonsillitis is a common paediatric condition. The decision to seek medical attention and consent to treatment is usually made by parents or guardians. With increased accessibility of the internet, online medical information plays an increasingly significant role in the decision-making process. Little is known regarding the quality of online patient information on tonsillitis, as this has not been previously studied. ObjectiveThe aim of our study was to identify the quality of information regarding tonsillitis on websites intended for the public. MethodsWe conducted a systematic review of online information on tonsillitis using the following search terms: “Tonsillectomy”, “Tonsillitis”, “Adenotonsillectomy” and “Tonsil”. The first three pages of returned websites were captured and each website was examined using the validated Ensuring Quality Information for Patients (EQIP) tool (score 0–36). ResultsA total of 92 websites met the inclusion criteria for analysis. The overall median EQIP score was 19 with an interquartile range of 17–22 and a maximum of 32. More than half of all websites originated from the USA (61%) and hospitals were the most common source of information (29%). Most websites failed to describe the quantitative benefits or address the medical intervention costs and insurance issues. Half of the websites included both tonsillectomy and antibiotics as treatments for tonsillitis. Only 68% included complications of tonsillitis or tonsillectomy. ConclusionsThe assessment of the quality of online patient information websites regarding tonsillitis by the EQIP tool indicates that most websites were of poor credibility, with minimal information regarding treatment choices and complications. To improve awareness of tonsillitis, there is a need for more informative and patient-centred websites that are compatible with the international quality standard for patient information.

COMPARATIVE ANALYSIS OF THE DYNAMICS OF DEVELOPMENT OF INSURANCE IN THE SPHERE OF WATER TRANSPORT: UKRAINIAN PRACTICE AND FOREIGN EXPERIENCE

COMPARATIVE ANALYSIS OF THE DYNAMICS OF DEVELOPMENT OF INSURANCE IN THE SPHERE OF WATER TRANSPORT: UKRAINIAN PRACTICE AND FOREIGN EXPERIENCE

DISASTER RISK FINANCING AND INSURANCE: HOW FAR HAVE WE KNOWN?

Natural catastrophes have resulted in massive losses for Indonesia. The government lacks the capacity to pay all damages caused by the disasters. The purpose of this research is to map the literature on catastrophe risk finance and insurance, particularly in terms of financial instruments that can be deployed. The scoping review approach was used in this study to locate and map relevant material. The findings of this study revealed that there are still significant research gaps on the issue of catastrophe risk finance and insurance, beginning with the research aim, financial instruments mentioned, and research methodologies and procedures applied. This study is planned to serve as the foundation for future research on the subject of catastrophe insurance in developing nations.

Abstract 5965: The effectiveness of health care professional training on the legal issues impacting individuals diagnosed with cancer to improve patient quality of life

Abstract A cancer diagnosis may carry with it a variety of legal issues, including navigating insurance, government benefits, employment, and consumer rights. These legal issues can cause people unnecessary worry, confusion, and stress, and can be overwhelming. The Insurance and Finance Intensive provides health care professionals tools to proactively identify the presence of cancer-related legal, insurance, and financial issues facing their patients. Additionally, the training helps health care professionals to offer referrals to appropriate legal and related resources, once those issues are identified. Oncology health care professionals participated in an eight-hour comprehensive training. Attendees were provided with substantive information about cancer-related legal issues, such as identifying health insurance options, navigating taking time off work and accessing disability insurance, and managing finances. A follow-up survey was sent to past 2020 and 2021 Intensive attendees (n=126), to measure the effectiveness of the training and to address additional questions and difficult case studies. Ninety-four percent of survey respondents indicated that they changed their behavior or practice based on what they learned at the training. Ninety-four percent of survey respondents strongly agreed or agreed that the information provided by the training helped reduce the financial burden that their patients and families experience after a cancer diagnosis. Ninety-seven percent of respondents strongly agreed or agreed that the information provided by the training improved the quality of life of their patients and families. The Insurance & Finance Intensive successfully provided health care professionals with valuable information on the practical and legal issues that impact individuals diagnosed with cancer. It is recommended that more health care professionals participate in this training to mitigate the financial burden of a diagnosis and improve the quality of life of their patients. Citation Format: Madison McMahon Ward, Joanna Fawzy Morales, Monica Fawzy Bryant. The effectiveness of health care professional training on the legal issues impacting individuals diagnosed with cancer to improve patient quality of life [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5965.

A Third Employment Category for Platform Workers in China: A Tough Start

Abstract In China, labour providers can be classified as employees or as independent contractors. Although platform workers have a certain freedom to decide when and where to work, they are nonetheless subordinate to their employers to a greater degree than independent contractors. However, because they are generally classified as independent contractors rather than employees, they cannot obtain any of the rights accorded to employees. Since platform workers are also unlike employees and have their own distinct characteristics, the mere extension of the labour rights an employee owes to the platform worker cannot solve this problem. A third employment category—an intermediate one between the employee and the independent contractor—may be a viable option that provides platform workers with partial labour rights. The Chinese government has been reluctant to create such a category but changed its stance on 16 July 2021, when it issued the Guiding Opinions on Protecting Workers in the New Form of Employment. This regulation creates a third employment category for workers ‘who do not meet the employee status standard but are subject to some degree of control from the company’. This regulation also grants the group many, but not all, employee rights, such as minimum wage. Given the particular needs of third category workers, occupational injury insurance and other issues should be redesigned to meet these needs.

Levering internet-based discussion data from gynecological cancer survivors to inform survivorship care: A mixed methods thematic analysis approach.

e24143 Background: Internet and social media platforms offer insight into the experience of survivorship, but the volume of narrative data is often cumbersome for thorough thematic analysis. We present a semi-automated mixed methods approach to analyze web-based discussions and demonstrate its utility on American Cancer Society (ACS) Discussion Board posts from gynecologic cancer survivors. Methods: Posts from the ACS Ovarian Cancer, Uterine Cancer, and Other Gynecological Cancer Discussion Boards were analyzed for psychosocial themes described in the Cancer Survivorship Care Framework. Quantitative analysis was facilitated by verified keywords created for each theme of interest and was completed via custom Python scripts and R packages. Qualitative analysis was expedited by theme keywords and completed on a subset of posts. Results: A total of 125,498 posts made by 6,436 gynecological cancer survivors and caregivers between July 2000 and February 2020 were evaluated. Of all posts, 23,458 were related to psychosocial aspects of survivorship and were analyzed. Quantitative analysis revealed that survivors frequently discussed the role of friends and family in care, fatigue, health insurance issues, and the effect of cancer on loved ones. The most frequently used psychosocial-related words were “family,” “hope,” and “help.” Qualitative analysis demonstrated that survivors frequently discussed coping and caregiver relationships, where survivors sought advice on topics including spousal emotional adjustment, financial toxicity, and confronting mortality. Conclusions: Online platforms offer great opportunity to learn about patient experiences of survivorship care. Candid conversations between survivors may be leveraged to inform survivorship practices and improve future survivorship initiatives. Our novel methodology expedites thematic analysis of such robust narrative data and its translation into survivorship settings.

1032-P: Improving CGM Uptake in Minority Youth and Youth with Poorly Controlled T1D

Background: Continuous glucose monitoring (CGM) improves glycemic control for youth with type 1 diabetes (T1D) . Despite these benefits, less than half of youth with T1D use CGM. Objective: To determine if trial CGM use (10-days) increases CGM uptake and is associated with improved glycemic control among minority youth and youth with poorly controlled T1D. We also examined barriers to CGM use. Methods: This prospective study was conducted at an academic Pediatric Diabetes Center. Youth with T1D for more than 3 months, with no previous CGM usage, or no CGM usage in the last year were enrolled. Diabetes staff placed CGM at the point of care (POC) and provided CGM education. Barriers to prior CGM use, hemoglobin A1c (HbA1c) , and demographic information were recorded. Participants received 5 and 10-day follow up calls from the diabetes team to review glycemic trends. At 3 months, participants' use of CGM and HbA1c were recorded. Results: Youth with T1D (n=22) were enrolled (13 first time CGM users, 9 past users) , mean age 14.1years (SD 3.1) , 41% non-Hispanic black, 68% female, mean diabetes duration 6.3 ± 4.4years, and baseline mean HbA1c of 10.8%. Patient-cited barriers to prior CGM use included technical difficulties (n=5) , unawareness of CGM (n=4) , difficulty obtaining CGM (n=4) , general apprehension (n=3) , not wanting devices (n=3) , and pain, fear of needles, and new diabetes diagnosis (n=1 each) . Of participants, 20 completed some follow-up, and 18/20 (90%) cited wanting to use CGM long-term. Of 13 participants who completed 3 and/or 6-month follow-up visits, only 9 were actively using CGM. Further barriers to use included insurance issues (n=2) and CGM falling off (n=1) . There was no change in mean HbA1c from baseline to follow-up (10.8 ±2.4% vs. 10.3 ±2.3%, p=0.46) . Conclusion: There are many barriers to CGM uptake in youth. Providing a trial use of CGM at the POC may increase uptake of CGM use in at-risk diabetes populations, but further investigation of additional barriers that impact long-term adherence to CGM is needed. Disclosure T.L.Lin: None. J.A.Manfredo: None. N.Illesca: None. K.Abiola: None. N.Hwang: None. M.Seel: None. E.A.Brown: None. R.M.Wolf: Consultant; NEMA Research, Research Support; Dexcom, Inc. Funding Johns Hopkins Children's Center Innovation Award, and Dexcom

Insurance Issues as Secondary Stressors Following Flooding in Rural Australia-A Mixed Methods Study.

Flood events can be dramatic and traumatic. People exposed to floods are liable to suffer from a variety of adverse mental health outcomes. The adverse effects of stressors during the recovery process (secondary stressors) can sometimes be just as severe as the initial trauma. Six months after extensive flooding in rural Australia, a survey of 2530 locals was conducted focusing on their flood experiences and mental health status. This mixed methods study analysed (a) quantitative data from 521 respondents (21% of total survey respondents) who had insurance coverage and whose household was inundated, 96 (18%) of whom reported an insurance dispute or denial; and (b) qualitative data on insurance-related topics in the survey’s open comments sections. The mental health outcomes were all significantly associated with the degree of flood inundation. The association was strong for probable PTSD and ongoing distress (Adjusted Odds Ratios (AORs) with 95% confidence intervals 2.67 (1.8–4.0) and 2.30 (1.6–3.3), respectively). The associations were less strong but still significant for anxiety and depression (AORs 1.79 (1.2–2.7) and 1.84 (1.2–2.9)). The secondary stressor of insurance dispute had stronger associations with ongoing distress and depression than the initial flood exposure (AORs 2.43 (1.5–3.9) and 2.34 (1.4–3.9), respectively). Insurance was frequently mentioned in the open comment sections of the survey. Most comments (78% of comments from all survey respondents) were negative, with common adverse trends including dispute/denial, large premium increases after a claim, inconsistencies in companies’ responses and delayed assessments preventing timely remediation.

Perceptions of Genetic Testing: A Mixed-Methods Study of Patients with Pulmonary Fibrosis and Their First-Degree Relatives.

Rationale: Genetic testing is an emerging tool in interstitial lung disease (ILD) as several ILD subtypes have potential genetic causes or predispositions with resultant clinical implications. There is a need to understand the perceptions of patients and their first-degree relatives of genetic testing for ILD. Objectives: The objective of this study was to investigate patients with ILD and their first-degree family members' understanding of the genetic risks associated with ILD and their interest and/or concerns about genetic testing. Methods: This mixed-methods study included patients with ILD and their first-degree relatives. Data were obtained from an online survey and three focus groups. Categorical data were reported with descriptive frequencies. Chi-square analyses were used to measure associations. Focus group discussions were transcribed, coded, and analyzed according to the grounded theory principle. Results: A total of 188 respondents completed the survey; 119 patients, 52 first-degree relatives, and 17 who were both patients and who also reported being a first-degree relative to someone with ILD. Most (79%) patients had idiopathic pulmonary fibrosis. The majority of patients and first-degree relatives were unsure if there was a genetic cause, whereas 71% of those who were both patient and first-degree relative thought there could be a genetic cause to their ILD. Fifty-nine percent of respondents worried their family members could be affected, and 72% of respondents were interested in genetic testing. Interest in genetic testing was associated with sex (P = 0.03), post-secondary education (P = 0.047), and having a family member with ILD (P = 0.02). The primary motivators were understanding risk to family members and contributing to research. First-degree relatives were concerned about insurance issues (60%) and personal stress (60%) more often than patients (40% and 28%, respectively); 29% of first-degree relatives anticipated changing their health behavior based on results. Focus group themes included disease knowledge, understanding the role of genetics in ILD, testing concerns, and how to use genetic testing information. Conclusions: This study provides insight into the perceptions of patients and first-degree relatives of ILD-related genetic testing. These findings inform the need for additional patient resources, yet a better understanding of the clinical applications of ILD genetic testing and how testing may impact diagnostics, therapeutics, and prognostication.

IoT: For Maintaining a Health Care Record

This Research fundamentally a Qualitative move toward which manage words and accentuate on nontactical devices and procedures for information examination. In the ongoing time, there is a need for a structure with related devices, individuals, time, spots, and associations, which is completely participated in what the future held for Things (IoT). Web of Things has transformed into authoritative construction blocks in the improvement of the clinical consideration noticing system. The place of a powerful IoT clinical consideration structure is to give progressing remote seeing of patient sickness, to thwart the essential patient conditions, and to deal with the individual fulfillment through adroit IoT natural components. New hardships have been given IoT for the security of systems and cycles and with the insurance issues of a person's clinical data. Information security using IoT is outstandingly tangled and irksome; since overall accessibility and transparency are the focal issues associated with IoT. Security and assurance by design ought to be fundamental for any IoT use case, adventure, or association. Key Words: 1. Radio Frequency Identification (RFID) 2. Network Model 3. Cloud Computing

Abstract #1178966: A Rare Case of Idiopathic Osteoporosis with COL10A1 and COL27A1 Genetic Mutations in a Premenopausal Woman

The association between bone mineral density (BMD) and fracture differs in premenopausal women when compared to the postmenopausal women. Irrespective of the BMD, any fragility fracture in those aged 20-50 requires evaluation for secondary causes of osteoporosis. In the absence of secondary causes, idiopathic osteoporosis (IOP) is considered. We present a case of a premenopausal woman with IOP whose mutational analysis revealed variants in COL10A1 and COL27A1. These genetic mutations are found in Schmid-type metaphyseal chondrodysplasia (SMCD) and Steel syndrome, respectively. To our knowledge, this is the first case report establishing a linkage between these specific mutations and IOP. A 36-year-old Hispanic woman with a history of fragility fracture of the lumbar spine at age 23 was referred to Endocrinology for further evaluation. Dual-energy x-ray absorptiometry (DEXA) reported a Z-score of -3.0 in L1-L4, consistent with osteoporosis of the lumbar spine. A careful history, physical examination, and laboratory evaluation ruled out secondary causes of osteoporosis. In the interim, the patient presented a recurrent fragility fracture of the left proximal humerus requiring surgical intervention where bone marrow (BM) was obtained for cytology. BM cytology was found normocellular without increase in blasts or lymphocytes. Notably, the mutational analysis revealed heterozygous variants of uncertain significance (VUS) in COL10A1 [variant c682 c >T (p.Pro228Ser)] and COL27A1 [variant c.1814 c >T (p.Thr 6605 Met)]. Whole exome sequencing was not able to be performed due to insurance issues. The most common secondary causes of premenopausal bone loss include estrogen deficiency as seen in hypogonadism, drug exposure such as glucocorticoids, malabsorption disorders like celiac disease, hyperthyroidism, hypercalciuria, hyperparathyroidism, and disturbances in calcium and vitamin D metabolism. Osteoporosis with no known secondary causes is known as IOP. IOP is a disorder with multiple proposed mechanisms including impairment in growth hormone and insulin like growth factor axis, osteoblast dysfunction, and genetic mutations. Mutational analysis in selected IOP cases, have shown pathogenic variants and VUS in LRP5, LRP6, COL1A1, COL1A2, PLS3, WNT1, DKK1, FKBP10, HGD, SLC34A3. Our patient was found with heterozygous VUS in COL10A1 and COL27A1. These genetic mutations are found in (SMCD) and Steel syndrome, respectively. These rare osteochondrodysplasias, more commonly found in childhood, are associated with skeletal abnormalities including scoliosis, congenital hip dislocations, short stature, and characteristic facial features. More importantly, COL10A1 encodes the alpha 1 chain of collagen type X which is involved in growth plate function, and COL27A1 gene encodes a member of the fibrillar collagen family involved in the calcification of cartilage and the transition of cartilage to bone. To our knowledge, COL10A1 and COL27A1 mutations have not been yet associated as primary causes of IOP. We report this case aiming for further research to identify additional genetic etiologies of IOP.

Contributions of nurse specialists in the allergy and immunology service and patient care.

Specialist nurses have a crucial role within the allergy and immunology specialty that reflects their competence in an increasingly complex area of work and ability to use advanced diagnostic testing and therapeutic modalities. A specialist nurse in Qatar follows the local Hamad Medical Cooperation (HMC) guidelines and the competency published by the British Society for Allergy and Clinical Immunology (BSACI).Specialist Allergy NursesLearning domain: Learn and review the written standard operating procedure (SOP) and protocols for all diagnostic and therapeutic allergy procedures, including skin prick testing (inhaled, food, and others), intradermal testing, skin patch testing, penicillin testing, food and drug challenges, different desensitization protocols, and biologics and other medication administration. In addition, learn the protocol for immunotherapy administration and maintain an updated knowledge of trends and developments in the field by reading relevant articles, journals, and related material and attending seminars and conferences, as needed.Maintain a safe work environment: Perform all the above procedures and medication administration with a high grade of competency under physician supervision. Apply quality measures to ensure safety. Furthermore, perform stocktaking by regularly checking procedure requirements, availability of items and consumables, date of expiry of items, and medications. Monitor the patients closely during drug and food allergy challenge procedures and record and report patients’ vitals and reactions to treating physicians. Ensure that a patient stays the required observation time after injection(s).General care: Assess patient needs and suggest solutions to patient care problems. Provide education and resources for the patient and family support as needed. React appropriately and on time during patient reaction situations to mitigate early adverse reactions. Maintain patient, employee, and clinic confidentiality.Specialist Immunology Nurses• Develop specialist knowledge and experience in immunology.• Develop nurse-led clinics for administering immunoglobulin replacement therapy safely and effectively based on patients’ preferences (IV vs. SC and in-hospital vs. home programs).• Coordinate communication between members of the multidisciplinary team to facilitate the appropriate delivery of care.• Provide education and resources for the patient and family support (insurance issues, resources for vaccination recommendations, concerns regarding traveling and vacations, pregnancy, and any other lifecycle changes).

Relationship of primary care clinician characteristics with continuous glucose monitoring use and confidence.

Context: Continuous glucose monitoring (CGM) provides clearer readings of blood glucose levels than traditional finger-stick glucose tests and is associated with improved diabetes outcomes such as reduced HbA1c. CGM can inform insulin dosing and diet decisions, and alert patients to hypoglycemia. A lack of endocrinologists in the majority of U.S. counties, particularly rural areas, and long wait times in many endocrinologists' offices create disparities in CGM access for patients with diabetes. Expanding use of CGM in primary care can improve care and patient diabetes outcomes. Objective: Understand primary care clinicians' experience with CGM to determine feasibility and resources needed to prescribe CGM. Study Design: Quantitative phase of explanatory sequential mixed methods study using cross-sectional online survey. Setting: Primary care. Population studied: Primary care physicians and advanced practice providers across the U.S. Outcome Measures: Past CGM prescribing behaviors, future likelihood to prescribe, resources needed to prescribe. Results: 632 respondents. Role: 72% attending physicians. Organization: Federally Qualified Health-Center (or similar) (27%), hospital-owned (27%), private practice (22%). Half (47%) had seen patients with CGM but never prescribed; two-fifths (39%) had prescribed CGM. Three-fifths (62%) moderately or very likely to prescribe CGM in the future. Likelihood to have prescribed CGM: Post-training physicians more likely than residents (OR=0.303, CI=.160-.575) or PA/NPs (OR=0.356, CI=.165-.766), part-time practice less likely than full-time (OR=0.546, CI=.305-.978), <75% time delivering primary care less likely than 75%+ (OR=0.595, CI=.371-.955), and location greater than 40 miles from an endocrinologist more likely than endocrinologist within 10 miles (OR=1.941, CI=1.17-3.21). Likelihood to prescribe with access to various resources greatest for consultation on insurance issues (72% moderately/very likely) and CGM education/training (72% moderately/very likely). Conclusions: Primary care clinicians have interest in prescribing CGM for patients with diabetes. Clinician type, percentage of time spent practicing, portion of time delivering primary care, and distance from endocrinologist are related to likelihood to prescribe CGM. Previous experience prescribing CGM may improve confidence and likelihood of future prescribing. Consultation, education and training on CGM for primary care clinicians may increase access to CGM.

Association of Race/Ethnicity, Inactivation on Waitlist for Socioeconomic Reasons, and Outcomes in Heart-Transplantation (HT)

<h3>Purpose</h3> Transient waitlist inactivation (WI) can be due to medical, logistical (program or patient related), or for socioeconomic reasons (SER) like medical non-compliance, inappropriate substance use or insurance issues. We evaluated the association of race/ethnicity with WI for SER, subsequent reactivation and outcomes after HT. <h3>Methods</h3> Of 48,213 adult candidates for single organ HT meeting study criteria in UNOS, between June 2006 and February 2021, we identified n=2,812 HT candidates who had WI at least once for SERs (SER WI cohort), n=16,411 with WI for non-SERs and n=28,990 with no WI. The cohorts were compared for race/ethnicity, WI, and post-HT outcomes. We also evaluated this relationship across UNOS regions. Race/ethnicity was categorized as non Hispanic White (nH-W), non Hispanic Black (nH-B), Hispanic (H) and Asian/others. <h3>Results</h3> Compared to others, rate of HT was lower in SER-WI cohort (40.7% SER-WI, 46.1% non-SER WI and 83.3% no-WI, p<0.01). While nH-B constituted similar proportion in overall and non-SER WI cohorts (∼23%), they constituted disproportionately higher proportion of SER-WI cohort (33.3%). Overall, nH-B were more likely to be inactivated than nH-W for SERs, OR=1.70(1.55-1.86), p<0.01 using logistic regression, adjusted for candidate age, gender, height, BMI, ischemic etiology, blood group, LVAD, inotropes, education, projected insurance and listing status (Fig1A). Further, once inactivated for SERs, compared to nH-W, nH-B were less likely to be re-activated on the waitlist and receive HT or improve clinically to not needing HT; OR=0.56(0.45-0.71), p<0.01 adjusted for baseline differences (Fig1B). This pattern was consistent across UNOS regions. Finally, nH-B candidates in the SER-WI cohort who received HT, had a trend towards worse post-HT survival. <h3>Conclusion</h3> These results raise concerns for possible provider and HT center bias in evaluating socioeconomic risks (considered to be relative contraindications to HT) in nH-B candidates.

Perspective and Legal Issues of Individual Earthquake Insurance

Perspective and Legal Issues of Individual Earthquake Insurance