Model Of Care For Patients Research Articles

Assessment of differentiated models of care for stable patients on antiretroviral therapy in a tertiary health facility in Southwestern Nigeria

Objectives: Differentiated care is a patient-centered care designed to improve quality of antiretroviral therapy (ART) service delivery. However, documenting patient experiences on models of differentiated care are critical to understanding and improving the models. This study assessed the preferences of patients on ART for differentiated care models and also explored the experiences of patients with the models. Materials and Methods: An in-depth interview was conducted on 30 patients on differentiated care models. Interviews were audio recorded, later transcribed, and combined with notes taken during the interview. Themes around preference for models, benefits, and challenges associated with models and subthemes were developed from the codes, verified, and analyzed using content analysis. Atlasti version 8 was used to code and develop themes from the data collected. Results: Participants expressed preferences for fast track model which is a facility-based model. They also reported that models yielded key benefits including reduced waiting time and cost of accessing drugs. The major negative impact reported by participants in community-based model was increased status disclosure risk and instability of program in the community pharmacies. Conclusion: Study participants living with human immunodeficiency virus and acquired immunodeficiency syndrome on differentiated care preferred facility-based models. Program instability and increased risk of status disclosure were major challenges associated with community-based model.

Abstract 14644: The Association Between Neighborhood Distress and Outcomes Following Peripheral Vascular Intervention

Introduction: Peripheral arterial disease (PAD) is associated with an elevated risk of mortality. Low socioeconomic status (SES) is associated with increased prevalence and severity of PAD, and low SES has been associated with poor post procedural outcomes in cardiovascular disease. The Distressed Communities Index (DCI) uses seven common proxies of SES, such as educational attainment, housing stability, median income, and employment rate, to generate an aggregate score at a zip code level. Hypothesis: We hypothesized that increased levels of neighborhood distress, as measured by the DCI, is associated with an increased risk of mortality and amputation after PVI. Methods : We queried the Vascular Quality Initiatives (VQI) database, linked with Medicare claims data for patients who had undergone PVI. A total of 16,980 patients with PVI were found and 53 Excluded because ≥ 1 missing data for covariate used in modelling and 381 because DCI Missing. Patient 5-digit zip codes were used to obtain a DCI score (range 1-100, with higher scores indicating greater distress) from the Economic Innovation group. We examined the association between DCI and 2-year mortality and major amputation. Results: At 24 months, 2 964 (17.5%) had died 1 669 (9.9%) and had a major amputation DCI score was positively associated 2-year mortality risk. A 10-point higher DCI score was associated with increased mortality risk (unadjusted HR=1.02; 95%CI [1.01,1.03]) and a higher risk of amputation (unadjusted HR=1.05; 95%CI [1.04,1.07]). Fig. Conclusions: Higher level of community deprivation was associated with increased risk of short-and long-term mortality and amputation outcomes following PVI. PAD care pathways should integrate improved risk assessments and integrated care models for patients from distressed communities to help address health disparities.

The First Neuropalliative Care Unit in Germany-Characteristics of Patients.

We retrospectively analyzed the characteristics of patients treated in our NPC unit between February 2021-February 2022. Data were extracted from medical records and PC assessment including diagnosis, mode of admission and discharge, length of stay, and palliative symptoms. Data are presented as averages with a 95% confidence interval [lower limit; upper limit] or percentage (absolute number). We included 143 patients (52% (75) female, 67.9 years [65.6; 70.2]). Patients were admitted from general wards (48%; 68), their homes (22%; 32), intensive care units (16%; 23) or emergency departments (14%; 20). The main diagnoses were tumors of the nervous system (39%; 56), neurodegenerative diseases (30%; 43), neurologic complications (13%; 19) and cerebrovascular diseases (12%; 17). Complaints most frequently rated as severely to overwhelmingly burdensome were motor- or fatigue-associated problems, problems communicating, dysphagia and pain. The average length of stay was 13.7 days [12.2; 15.2]. Forty-five percent (64) of patients were discharged without further PC, 17% (24) were referred to a hospice and 13% (18) were discharged with outpatient PC. Five percent (7) were referred to neurorehabilitation and 21% (30) of patients died. Our NPC unit is a new model of care for neurological patients with substantial PC needs especially within the structures of a highly specialized and individualized medicine.

Integrated Care Programme for Older Persons and Community Palliative Care Team Joint Care Model for Patients with Advanced Dementia

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

What Does a Public Health Approach to Mental Health and Illness Look Like?

What Does a Public Health Approach to Mental Health and Illness Look Like?

Models of care for improving health-related quality of life, mental health, or mortality in persons with multimorbidity: A systematic review of randomized controlled trials.

To categorize and examine the effectiveness regarding health-related quality of life (HRQoL), mental health, and mortality of care models for persons with multimorbidity in primary care, community care, and hospitals through a systematic review. We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials up to May 2020. One author screened titles and abstracts, and to validate, a second author screened 5% of the studies. Two authors independently extracted data and assessed risk of bias using the tool by the Cochrane Effective Practice and Organisation of Care group. Study inclusion criteria were (1) participants aged ≥ 18years with multimorbidity; (2) referred to multimorbidity or two or more specific chronic conditions in the title or abstract; (3) randomized controlled design; and (4) HRQoL, mental health, or mortality as primary outcome measures. We used the Foundation Framework to categorize the models and the PRISMA-guideline for reporting. In this study, the first to report effectiveness of care models in patients with multimorbidity in hospital settings, we included 30 studies and 9,777 participants with multimorbidity. 12 studies were located in primary care, 9 in community care, and 9 in hospitals. HRQoL was reported as the primary outcome in 12 studies, mental health in 17 studies, and mortality in three studies-with significant improvements in 5, 14, and 2, respectively. The studies are presented according to settings. Although 20 of the care models reported positive effects, the variations in populations, settings, model elements, and outcome measures made it difficult to conclude on which models and model elements were effective.

229 NEW STROKE EARLY SUPPORTED DISCHARGE SERVICE PROVIDES ALTERNATIVE REHAB PATHWAY AND IMPROVES PATIENT AND ORGANISATIONAL OUTCOMES

Abstract Background Early Supported Discharge (ESD) for stroke is an international model of best care for stroke patients. ESD improves patient outcomes while facilitating a faster hospital discharge through providing stroke specific rehabilitation at home. ESD can be expected to improve disability outcomes and quality of life and reduce length of hospital stay. A pilot ESD service was introduced to this model 3 hospital in 2021 which encompasses a large geographical rural area that historically had an absence of Stroke rehabilitation services. Methods A retrospective review of routine data extracted from 57 patients accepted to the ESD service in 2021 was completed. This initial examination explored the effectiveness of ESD with the population in this rural area. Service Objectives as follows: (1) Improve patient’s functioning as measured by Functional Independence Measure (FIM) and Functional Assessment Measures (FAM); (2) Demonstrate a reduction in disability outcomes as evidenced on the Modified Rankin Scale (MRS); (3) Increase number of early supported discharges directly home for patients; and (4) Reduce length of hospital stay for patients post-stroke. Results Implementation of an ESD service over a 12-month period achieved the following: (1) 8.1% improvement in total FIM/FAM scores indicating positive functional outcomes and enhanced independence when discharged home with ESD; (2) A decrease in the average MRS score indicating improved disability outcomes; (3) 25% of all stroke patients in 2021 were discharged with ESD rehabilitation; (4) An increase of 12% in total number of discharges home post stroke from 2020 to 2021; (5) 244 bed saving days. Conclusion The introduction of an ESD service resulted in patient and organisational benefits. Participation in ESD rehabilitation had a positive impact on reduction of disability scores captured using MRS and improvements in functional outcome measure scores captured using the FIM/FAM.

Virtual Fracture Clinic Model in India: A Technological Innovation.

Virtual Fracture Clinics (VFCs) are an alternative to the conventional model of fracture and minor injuries care. It is a new, evolving service designed to speed up patient access to orthopaedic care introduced in the United Kingdom in 2011 and has been increasingly used in the management of certain musculoskeletal injuries. This observational, pilot study evaluates the possibility of combining telemedicine technology and a virtual fracture clinical assessment pathway to remotely assess patients supported by radiology imaging in India. Piloting and developing a virtual fracture clinical assessment pathway model in India is faced with many challenges including regulations, internet, and data connectivity issues, and concerns of medico-legal implications. Recent studies have reported Virtual Fracture Clinics (VFCs) to be able to provide a safe, cost-effective model of patient care in a subset of musculoskeletal injuries. Limitations and shortcomings of Virtual Fracture Clinics (VFCs) in India can be mitigated with effective communication, enhanced documentation, appropriate training, and information governance. This pathway is not a replacement for conventional 'face-to-face' evaluation but a credible option to complement the delivery of trauma and orthopaedic care in the future in India.

Management of Malignant Bowel Obstruction: An Innovative Proactive Outpatient Nurse-Led Model of Care for Patients With Advanced Gynecologic Cancer.

Malignant bowel obstruction (MBO) in patients with advanced gynecologic cancer (GyCa) can negatively impact clinical outcomes and quality of life. Oncology nurses can support these patients with adequate tools/processes. Patients with GyCa with/at risk of MBO endure frequent emergency or hospital admissions, impacting patient care. Optimizing oncology nurses' role to improve care for patients with GyCa with/at risk of MBO, the gynecology oncology interprofessional team collaborated to develop a proactive outpatient nurse-led MBO model of care (MOC). The MBO MOC involves a risk-based algorithm engaging interdisciplinary care, utilizing standardized tools, risk-based assessment, management, and education for patients and nurses. The MOC has improved patient-reported confidence level of bowel self-management and decreased hospitalization. Following education, nurses demonstrated increased knowledge in MBO management. An outpatient nurse-led MBO MOC can improve patient care and may be extended to other cancer centers, fostering collaboration and best practice.

Experiences, perspectives, and practice patterns of pulmonary embolism follow-up in Denmark. A mixed method study informing the development of A sTrucTurEd INtegrateD post PE care model

Abstract Background Practice patterns of follow-up after pulmonary embolism (PE) varies both within and between countries, and high-quality evidence to provide clinical guidance is lacking [1,2]. This study is part of the trial – A sTrucTurEd INtegrateD post Pulmonary Embolism care model (Attend-PE) aimed at developing and testing the effectiveness of a structured, integrated and patient-centered follow-up care model for patients with PE. Purpose To explore experiences, perspectives, and practice patterns of PE follow-up. Ultimately identifying and describing the opportunity space for a structured integrated post PE care model. Methods We performed a convergent mixed method study based on data from patient journey mapping including surveys, observations, and semi-structured patient interviews across all main hospitals treating PE in Denmark. An integrated mixed methods interpretation was conducted using joint displays. Results Main results are presented in joint displays in Figure 1 and 2. Observations and surveys were conducted at 18 hospitals including 12 in-depth patient-interviews. The structure of care varied greatly. Patients expressed a need for early follow up and specialist care but at 18% of the sites first follow-up visit was not until 3–6 months after PE and 24% of the sites only had in-person contact with patients when follow-up echocardiography was needed. At some sites it was also highlighted that not all patients were referred to the post PE follow-up. anticoagulation clinics. Further, transition of care to the general practitioner was identified as a particular challenge. All sites considered Non-vitamin K antagonist oral anticoagulants the preferred anticoagulant treatment with low-molecular-weight heparins/Vitamin K antagonists as second choice. The possible need for extended treatment and reduced dose favored Rivaroxaban and Apixaban. The decision on treatment duration was most often taken at the 3–6-month follow-up visit, and patients described the decision on extended treatment as positive and reassuring. Patient information (oral and written) varied greatly and was most often focused on anticoagulant treatment, while knowledge on PE in general, symptom management, and activity was scarce. Two sites offered structured group-based patient education, but unstructured patient education at the individual follow-up visits was most common. Help and guidance on managing post-PE symptoms and returning to everyday life was perceived essential by patients, as it affected them both physically and mentally. However, none of the sites routinely offered or referred patients to rehabilitation. Involvement of relatives was considered important but 33% of the hospital sites did not systematically encourage relatives to attend follow-up. Conclusion The considerable variation in structure of PE follow-up care demonstrated in this mixed method study highlights the need for a structured integrated post pulmonary embolism care model. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Danish Heart AssociationThe Novo Nordisk Foundation

A novel PA-led urgent care model for medical oncology patients at a large academic cancer center.

37 Background: Oncology patients are high users of the emergency department (ED), which often results in hospital admissions for management of cancer symptoms or cancer treatment toxicities. Interventions such as urgent care (UC) models can decrease such visits, and help improve patient management, health care utilization, and patient experience. Sunnybrook Health Sciences Centre, a large tertiary care hospital in Toronto, Canada has a high volume of medical oncology ED visits (average 4 per day) with about 50% admitted for management. Methods: A novel physician-assistant (PA) led and physician supervised UC model was developed to assist in medical oncology patient phone triage, assessment, and management of cancer or treatment related issues that would otherwise have been sent to the ED by the oncology team. There were two phases: 1) due to COVID, the patients were managed in a dedicated stream primarily using space and nursing in the ED, 2) a dedicated UC clinic with nursing support was opened for these patients. Results: In phase 1, there were 424 referrals over 24 months; 84% would have otherwise been sent through the usual ED process. 26% of patients were managed with PA navigation outside the UC program in other hospital settings. Of the 204 patients formally treated in the UC stream, 67.7% were discharged home. At 48 hours, 89% of discharged patients were stable or improved; this was 80% at 14 days, and 17.3% came back to the ED or were admitted within 14 days of the UC visit. In phase 2, there have so far been 214 referrals over 5 months; 83.6% would have otherwise been sent to the ED. Of the patients who were assessed, 77.9% were discharged home. Outcomes of these patients are being collected. The top 3 patient issues managed during both phases were: fever, pain, and dyspnea. Fifteen patient telephone surveys were completed, and 93.3% were either satisfied or highly satisfied with their UC experience. Conclusions: A novel PA-led triage and management model for urgent medical oncology patient issues was found in initial phase to be feasible and effective with streamlined care through the ED. Once a dedicated UC clinic was opened, referral volumes increased, and a high rate of ED diversion, patient discharge, and effective care was continued. Patients were also highly satisfied. Several ongoing process and outcome measures are being evaluated to help expand the scope and impact of this resource.

S1453 Weight Loss in Bariatric Surgery Patients Treated at a Novel Clinic Incorporating Obesity Medicine for Treatment of Nonalcoholic Fatty Liver Disease

Introduction: The Yale Fatty Liver Disease Program (YFLDP) is a patient care model incorporating weight management with standard hepatology care for targeted treatment of nonalcoholic fatty liver disease (NAFLD). Weight management is the mainstay treatment for NAFLD, with 10% total body weight loss (TBWL) leading to disease improvement. Bariatric surgery is an effective treatment for obesity and associated metabolic diseases, though only an estimated 1% of eligible patients receive referral nationwide. We studied YFLDP patient referral rates to bariatric surgery, clinical and surgical characteristics, and weight loss outcomes. Methods: We retrospectively extracted demographic, surgical, and weight loss outcome data of adult YFLDP patients from 10/2015 to 5/2022. Standard eligibility criteria included body mass index (BMI) >40 kg/m2 or >35 kg/m2 with an obesity-associated comorbidity. Actual 1-year weight loss outcomes were compared to predicted weight-loss outcomes calculated using the MBSAQIP Bariatric Surgical Risk/Benefit Calculator and assessed with a 2-tailed t-test. Results: There were 1,166 patients, of whom 596 (51.1%) were eligible for bariatric surgery (Table). Of these, 150 (25.3%) received referral, 32 patients (21.3%) underwent surgery (22 received sleeve gastrectomy (SG) and 10 had a Roux-en-Y gastric bypass [RYGB]). Patients who received surgery were more likely female and upper class compared to those who continued with lifestyle/medication management. Patients receiving SG and RYGB had mean TBWL 21.5% and 20.0%, respectively, while patients who continued medication/lifestyle management had TBWL of 3%. There was no significant difference comparing actual vs predicted final BMI (P=0.12), actual vs predicted weight loss (P=0.13), and actual vs predicted TBWL (P=0.13) post-bariatric surgery for all procedures (Figure). Conclusion: Integration of weight management with hepatology medical care is an effective model for NAFLD weight loss treatment. Patients receive referral for bariatric surgical evaluation at a rate 25 times greater than the national average, and those that receive surgery have comparable weight loss to that predicted in all patients receiving these surgeries, and on average exceeded the treatment threshold expected to treat NAFLD. Further study to identify patients who would most benefit from bariatric surgery would help to inform better patient selection and proactive referral efforts.Figure 1.: Predicted vs actual bariatric surgical outcomes in patients referred for surgery. (A) Actual vs Predicted Final Body Mass Index (BMI) post Bariatric Surgery: Comparison between YFLDP (Yale Fatty Liver Disease Program) patients’ actual BMI post bariatric surgery vs predicted BMI post bariatric surgery using the MBSAQIP Bariatric Surgical Risk/Benefit Calculator. There was no statistically significant difference between actual and predicted BMI (P=0.12). (B) Total Body Weight Loss (TBWL) in Patients given Bariatric Surgery Referral: Comparison between YFDLP patients’ total body weight % reduction in patients given a bariatric surgery referral who either underwent a gastric bypass or sleeve gastrectomy or did not have surgery and continued with lifestyle/medication management. Patients who underwent surgery had a statistically significant percent reduction in TBWL compared to patients managed with only lifestyle/medications. Error bars represent standard error. ***P< 0.001 Table 1. - Demographic and surgical characteristics of Yale Fatty Liver Disease Program patients who were referred for bariatric surgery Patient Characteristics Referred, Underwent Bariatric Surgery (+)(n=32) Referred, Did Not Undergo Bariatric Surgery (-)(n=118) P Sex n (%) Male 6 (19) 35 (30) 0.22 Female 26 (81) 83 (70) Age years (SD) 49 (10.3) 51 (12.98) 0.60 Medicare Qualifying n (%) 2 (6) 19 (12.98) 0.15 Race n (%) White 22 (69) 86 (73) 0.29 Black 4 (13) 15 (13) Asian 1 (3) 0 (0) Other/Declined 5 (15) 17 (14) Ethnicity n (%) Hispanic 6 (19) 27 (23) 0.62 Non-Hispanic 26 (81) 91 (77) Insurance Status n (%) Uninsured 0 (0) 0 (0) 0.045 Medicaid 14 (44) 31 (26) Medicare 2 (6) 27 (23) Private 16 (50) 60 (51) Median House Income by Zip Code n (%) < $50k 7 (22) 29 (25) 0.48 $50k-100k 19 (59) 75 (63) >$100k 6 (19) 14 (12) Anti-Obesity Medications n (%) Lifetime 16 (47) 38 (32) 0.78 Since YFLDP 10 (31) 29 (25) BMI Reduction mean (SD) RYGB (n=10) 8.3 (5.4) Predicted 1.3 (3.9) < 0.001 SG (n=22) 9.4 (6.1) < 0.001 TBWL % (SE) RYGB (n=10) 20.5 (3.5) Predicted 3 (0.8) < 0.001 SG (n=22) 21 (2.73) < 0.001 (+) Surgery denotes patients who underwent bariatric surgery after referral. (-) Surgery denotes patients who did not undergo bariatric surgery after referral. Patients who underwent bariatric surgery had statistically significant greater reduction in mean BMI compared to patients who did not have surgery. SD is standard deviation, SE is standard error, BMI is body mass index (kg/m2), RYGB is Roux-en-Y gastric bypass, SG is sleeve gastrectomy, TBWL is total body weight loss.

138 The Effect of Changes in Physician Shift Times and Physical Patient Coverage Areas on Resident Sign-out Burden in an Academic Emergency Department

Emergency department (ED) staffing and patient assignments contribute to the clinical training environment during residency. Excessive patient hand offs (eg, sign-outs) at change of shift is associated with medical error and excess cognitive load, and may negatively impact resident education and wellness. We aimed to characterize subjective resident experience and objectively measure resident sign-out burden before and after implementing a physician staffing model change and a non-geographically localized patient care model in an urban academic ED.

The ASA Classification System as a Predictive Factor to Stay at the Virtual Hybrid Care Hotel.

The Care Hotel is a virtual hybrid care model for postoperative patients after low-risk procedures which allow recovery in an outpatient environment. This study aimed to analyze if the American Society of Anesthesiologists Physical Status (ASA PS) Classification System can be used as a predictive factor for staying at Mayo Clinic's Care Hotel. This retrospective cohort study was conducted between July 23, 2020, and June 4, 2021, at Mayo Clinic in Florida, a 306-bed community academic hospital. ASA PS Class and post-procedure care setting (Care Hotel vs inpatient ward) were collected. Patients were classified into two ASA PS groups (ASA PS Classes 1-2 and 3-4). Pearson's Chi-square test was used to determine if the ASA PS Class and having stayed or not at the Care Hotel were independent and an Odds Ratio (OR) calculated. Out of 392 surgical and procedural patients, 272 (69.39%) chose the Care Hotel and 120 (30.61%) chose the inpatient ward. There was a statistically significant association between ASA PS Class and staying at the Care Hotel, P < .01. The OR of preferring to stay at the Care Hotel in patients with ASA PS Class 1-2 vs ASA PC Class 3-4 was 1.91 (P = .0041, 95% CI: 1.229-2.982). Patients with ASA PS Classes 1-2 are almost twice as likely to elect to stay at the Care Hotel compared to those with ASA PS Classes 3-4. This finding may help care teams focus their Care hotel recruitment efforts.

COVID-19 in patients with gastrointestinal stromal tumors: Recommendations for management and vaccination.

The coronavirus disease 2019 (COVID-19) pandemic profoundly affected the management and treatment of patients with malignancies. Based on the progress reported in the literature, we reviewed the recommendations for treatment and vaccination in patients with gastrointestinal stromal tumor (GIST) during COVID-19. We focus on whether there is a risk and what could be the possible effects of vaccinating patients with GIST/cancer. Since the situation is quickly changing, and the health services have been severely disrupted, the diagnosis, treatment and recommendations for vaccination of these patients against COVID-19 are still not updated. The approval of vaccines in the pandemic gave hope that we would soon be able to return to a more normal life. However, the oncology community needs to adapt and provide the most effective treatment and care models for patients with rare cancer, such as GIST. Collecting data on the impact of vaccination in patients with GIST/cancer also will be beneficial in expanding knowledge about the future planning of treatment strategies and optimizing care in the event of a subsequent pandemic.

Adherence to secondary prevention measures after acute coronary syndrome in patients associated exclusively with the public and private healthcare systems in Brazil

Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.

Discussion on the Application of Human-centered Care Model for Dementia Patients in Geriatric Department

Discussion on the Application of Human-centered Care Model for Dementia Patients in Geriatric Department

Managing COVID-19 through collaboration: applying a novel patient care model in a rural Indian community

Background Rural communities in India are vulnerable to the global pandemic of severe acute respiratory coronavirus 2 (SARS-CoV-2) due to a lack of resources and delayed access to information. To address the challenges faced by Primary Health Centers, the Karuna Trust-Lopamudra Medical Center COVID-19 High Dependency Unit (KLCHDU), a collaboration between a local hospital, a non-governmental organization, infectious disease physicians from an academic medical center in the United States, and a local citizens council, was established in May 2021. This collaboration implemented diagnostic and management COVID-19 protocols recommended by the Infectious Diseases Society of America, the National Institute of Health, and the U.S. Centers for Disease Control and provided basic training on recommended practices to Primary Health Center and other local healthcare workers. Methods All local patients between 1 May 2021 through 31 July 2021 who tested positive for SARS-CoV-2 with a rapid antigen test or polymerase chain reaction test were admitted to the KLCHDU and were included in this study. Patient demographics, medical history, hospital course, and laboratory findings were evaluated to determine the outcomes of patients treated within this unique healthcare model. Results Eighty-three patients (54% male) qualified for inclusion during the study period. Common comorbidities included hypertension (52%), diabetes mellitus (48%), and coronary heart disease (10%). Nearly one-third of patients had received at least one dose of SARS-CoV-2 vaccine. The most frequently administered hospital medications were dexamethasone (65%), low molecular weight heparin (54%), and remdesivir (53%). The average absolute leukocyte count was 1534 cells/µL, average blood glucose was 182 mg/dL, average D-dimer was 849 ng/mL, and average NEW-2 score on admission and discharge was 4.4 and 3.2. The average duration of hospital stay was five days. Eleven (13%) patients were prescribed supplemental oxygen at discharge and one patient died from infection complications. Conclusions Our data show a duration of inpatient hospitalization and mortality rate on the lower end of most published data. The results of our study encourage allocation of resources based on recommended protocols and the use of telehealth for collaboration and resource sharing.

P5.07: Impact of the Liver Transplant Pharmacy (LTP) At the Center For Liver Transplant and Hepatobiliary Surgery (CLTHPS) in Educating Our Transplanted Patients in Costa Rica. A Comparison of Benefits to a Traditional Model Pharmacy

Introduction: The social security in Costa Rica has institutional pharmacies with traditional models supporting transplant programs (not fully dedicated to this matter). The LTP at the CLTHPS represents a unique and innovative model of care for transplant patients. The LTP has specialized workers who dedicate all their time to attend the liver transplanted population, those who are in the waiting list and also, the patients who have had any hepatobiliary surgery, encompassing a comprehensive attention from the admission until hospital discharge, as well as outpatients. Part of our success has been an active education program and a personalized pharmacy for the particular needs of each patient. The LTP guarantees an open and permanent communication between the patient and the pharmacist, who has a permanent position in the LTP, allowing her to know globally every patient, their medications, lifestyles, nutritional issues, etc. In this way, the pharmacist identifies the needs of each patient, and works hand in hand with each patient in a multi-step approach of education, including: medicament education and dispensations, resolution of doubts about dosage, interactions and side effects and informative material, etc. Methods: We want to compare the impact of our educational program at the LTP with the counterpart made in a traditional model pharmacy (TMP) for a whole year. We have our monthly indicators in which we register all the production we made, including the educational part, as well as the amount of medication refunded by non-withdrawal. All institutional pharmacies measure the monthly production and that data is accessible, for further comparative analyze of information between our LTP and a TMP. The closer TMP to the LTP is the Hospital Mexico´s Pharmacy, so we’ll work with its yearly production. Results: What we expect to find is that the LTP has a stronger impact in educative benefit for our patients, according to the quantity of attended patients, based in the quantity of non-withdrawal prescriptions and reduction of misinformation using the prescribed medication. Conclusions: Our LTP, with a define attention program, not only helps our patients with a personalized education to have a better comprehension of their medication, but also makes the non-withdrawal prescriptions to maintain in low rates.

Models of acute care for injured older patients—Australia and New Zealand practice

IntroductionThe epidemiology of injured patients has changed, with an increasing predominance of severe injury and deaths in older (65 years and above) patients after low falls. There is little evidence of the models of care that optimise outcomes for injured older patients. This study aims to describe clinician perspectives of existing models of acute care for injured older patients in Australia and New Zealand. MethodsThis cross-sectional online survey of healthcare professionals (HCP) managing injured older patients in Australia or New Zealand hospitals was conducted between November 2nd and December 12th, 2020. Recruitment was via survey link and snowball sampling to professional organisations and special interest groups via email and social media. HCP were asked, using a Likert scale, how likely four typical case vignettes were to be admitted to one of twelve options for ongoing care. Additional questions explored usual care components. ResultsParticipants (n=157) were predominantly Australian medical professionals in a major trauma service (MTS) or metropolitan hospital. The most common age defining “geriatric” was aged 65 years and older (43%). HCP described variability in the models and components of acute care for older injured patients in Australia and New Zealand. As a component of care, cognitive, delirium and frailty screening are occurring (60%, 61%, 46%) with HCP from non-major trauma services (non-MTS) reporting frailty and cognitive impairment screening more likely to occur in the emergency department (ED). Access to an acute pain service was more likely in a MTS. Participants described poor likelihood of a geriatrician (highest 16%) or physician (highest 12%) review in ED ConclusionDespite a low response rate, HCP in Australia and New Zealand describe variability in acute care pathways for injured older patients. Given the change in epidemiology of injury towards older patients with low force mechanisms, models of acute injury care should be evaluated to define a cost-effective model and components of care that optimise patient-centred outcomes relevant to injured older patients. HCP described some factors they perceive to determine care, and outcomes of variability, offering guidance for future research and resource allocation in the Australia and New Zealand trauma system.