Number Of Clinic Visits Research Articles

Prevalence of Herbal Use for Obstetrics Purposes in Al-Madinah Al-Munawwarah, Saudi Arabia

ObjectivesThere are insufficient data on the prevalence of women’s use of herbal medicines in the Almadinah community. The main goal of this study was to determine the prevalence of herbal medicine use during pregnancy, childbirth, and after delivery in Almadinah, Saudi Arabia, and the factors influencing their use. MethodsThis cross-sectional study included pregnant women at Almadinah city primary healthcare centres. Using a five-part short questionnaire, a multistage sampling technique was used to randomly select 170 women. Chi-square and Fisher’s exact tests were used to evaluate the categorical results. Statistical significance was set at P < 0.05. ResultsOf the 170 participants, 41.2%, 30.6%, and 48.2% used herbs during pregnancy, childbirth, and after delivery, respectively. The most popular herbs used during pregnancy, childbirth, and the postpartum period were mint, cinnamon, and fenugreek, respectively. Herbal medicine was primarily used to preserve well-being, stimulate and accelerate childbirth, and disinfect women. Herbal usage during pregnancy was associated with older age, whereas its use during birth was associated with higher educational level, distance from Primary health-care centers (PHCCs), and number of clinic visits. Herbal use was significantly higher during childbirth among homemakers and those with more children. ConclusionsHerbal medications were used by 41% of pregnant women, 44% of them stating that their physicians didn’t mind. The importance of healthcare practitioners’ awareness of the safety and efficacy of herbal medicines should be emphasised in medical education. The current study highlights the purposes of using herbal medications among women in Almadinah Almunawwarrah, Saudi Arabia, as well as the factors that influence it.

Despite Increased Disease Activity, Women who Attended a Dedicated Inflammatory Bowel Disease and Pregnancy Clinic Had Infants With Higher Apgar Scores: A Population-Based Study.

Attendance at a subspecialty pregnancy clinic for women with inflammatory bowel disease (IBD) improves disease-specific pregnancy knowledge. We examined the impact of attendance at a dedicated IBD-pregnancy clinic on IBD and perinatal outcomes. Using linked administrative databases in Alberta, Canada (2012-2019), we identified 1061 pregnant women with IBD who delivered singleton liveborn infants in-hospital who did (n = 314) and did not attend (n = 747) the clinic. Propensity score weighted multivariable log-binomial and multinomial logistic regression models were used to determine the risk of IBD and perinatal outcomes. The median number of clinic visits was 3 (Q1-Q3, 3-5), with 34.7% completing a preconception consultation. A greater proportion of women who attended lived near the clinic, were nulliparous, had a disease flare prior to pregnancy, and were on maintenance IBD medication (P < .05). Women who attended had increased risks of a disease flare during pregnancy (adjusted risk ratio [aRR], 2.02; 95% CI, 1.45-2.82), an IBD-related emergency department visit during pregnancy (aRR, 2.66; 95% CI, 1.92-3.68), and cesarean delivery (aRR, 1.78; 95% CI, 1.23-2.57). Despite this, clinic attendees had a decreased risk of delivering an infant with a low Apgar score at 1 minute (risk ratio [RR], 0.49; 95% CI, 0.32-0.76) and 5 minutes (RR, 0.32; 95% CI, 0.12-0.87). Women who attended a dedicated IBD-pregnancy clinic were more likely to have a disease flare prior to pregnancy, reflecting a more severe disease phenotype, but had similar perinatal outcomes and infants with better Apgar scores at birth. Our study suggests the value of these subspecialty clinics in providing enhanced IBD-specific prenatal care.

Changes in the psychosocial and clinical profiles of anorexia nervosa patients during the pandemic.

The COVID-19 pandemic and related control measures have increased the prevalence of anorexia nervosa (AN), and recent studies demonstrated that approximately 70% of individuals diagnosed with AN experienced deterioration in symptoms. This study aimed to examine the psychosocial and clinical impacts on patients with AN during the COVID-19 pandemic. This cross-sectional study involved 35 female AN adolescents who were being treated at Ege University Child and Adolescent Psychiatry Department. To assess pre-pandemic symptom levels and daily life routines, a retrospective form utilizing the visual analog scale (VAS) was employed. Body mass index (BMI) and Clinical Global Impression (CGI) data were recorded by an interviewer for all 35 patients who gave consent to participate in the study. Fifteen patients completed all the forms [VAS, the Children's Depression Inventory (CDI), the Screen for Child Anxiety Related Disorders Scale (SCARED), the Eating Attitudes Test, the Quality-of-Life Scale (QoLS), the Autism Spectrum Screening Questionnaire, and the Turgay DSM-4 Based Screening and Evaluation Scale for Behavioral Disorders in Children and Adolescents] online in 2022. Clinical diagnosis and progress were assessed retrospectively using The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). The duration of the follow-up period and the number of psychiatric visits were obtained retrospectively from patient files. Retrospective data on pre-pandemic symptom levels and daily life routines were collected using the VAS. The mean age of AN patients was 16.67 ± 1.63 years. Comorbid diseases were present in 73.33% of patients, and major depressive disorder (MDD) was the most common (46.66%). Mean scores indicated moderate levels of anxiety (SCARED score: 37.23 ± 12.67) and depression (CDI score: 17.23 ± 10.85). QoLS scores were negatively correlated with eating attitudes (r = -0.601, p = 0.039). Obsession level, exercise level, and screen time increased during the pandemic, while social activity, quality of education, and perception of learning decreased. BMI increased in all patients. Patients who completed the forms had a higher number of psychiatric visits compared to those who did not complete the forms (p = 0.033). The mean number of clinic visits was 26.27 ± 20.33. The results show that the COVID-19 pandemic had adverse effects on AN patients and disrupted their daily routines. These patients experienced high rates of comorbidities. The patients showed improvement in BMI scores, indicating the positive impact of treatment. These findings emphasize the need for comprehensive psychiatric care and targeted interventions for AN patients during crises such as the COVID-19 pandemic.

Poster 295: Surgical Management and Outcomes of Patellar Instability in Hispanic Adolescents Mirrors the General Adolescent Population

Objectives: Literature has shown that there are differences in care across demographics for sports- related injuries. Delay to physician evaluation, delay to surgery, and decreased surgical management has been documented in common pathology such as ACL tears and Shoulder Instability. Recent research has demonstrated that for Patellar Instability in adolescents, African-American patients had lower odds of having surgical management in addition to their care costing more overall, even when controlled for insurance status. The Hispanic population is a growing minority group who face challenges not just in economic status, but language barriers that may also impart inequitable care for one of the most common diagnoses seen in a Sports clinic. The purpose of this study is to assess for any major differences in care provided to adolescent patients who identify as Hispanic compared to the remainder of the adolescent population. Methods: Patellar Instability patients who underwent MPFL Reconstruction at a single center between September 2008 through December 2015 were collected. Inclusion criteria were age &lt; 19 at time of surgery, preoperative and postoperative data available during chart review, case was performed as the index primary reconstructive procedure, and minimum of 3 month follow-up data available. Charts were reviewed to gather demographic and clinical information including age, sex, race, ethnicity, number of instability episodes, MRI at time of initial evaluation, time from injury to surgery, engagement in postoperative physical therapy, number of postoperative visits attended, Kujala score, and complications. Independent variable t-test was used for analysis of number of clinic visits, therapy sessions, and the Kujala score. The remainder of analysis was completed using χ2 testing. Significance was set at p = 0.05. Results: 95 patients (40 male (42%), 55 female (58%)) met the inclusion criteria. Mean patient age was 15.5. 37 patients identified as Hispanic (38.9%) and 58 (61.1%) of patients identified as non-Hispanic. 58.5% of all patients had an MRI available at their first clinic visit, 69.2% of patients had 2 or more dislocation events prior to surgery, and 37% of patients were formally cleared for return to activity. Hispanic patients more frequently had an MRI prior to surgery compared to non-Hispanic patients (73% vs 50%, p = .039). Otherwise, there was no statistically significant difference in observations between Hispanics patients and non-Hispanic patients, including number of dislocations prior to surgery (p = 0.13), number of clinic visits preoperatively or postoperatively (p = 0.51 and 0.09, respectively), number of therapy sessions attended postoperatively (p = 0.46), or the patient reported outcome as measured by the Kujala score (mean = 91.56 vs 95.25, p = 0.13). Complications in the cohort included 1 infection and 1 case of arthrofibrosis. 2 patients in the Hispanic cohort required revision for recurrent instability compared with 5 patients in the non-Hispanic cohort (p = 0.56). Conclusions: Adolescents with patellar instability who identify as Hispanic had similar outcomes scores and complication rates after operative treatment in the form of MPFL Reconstruction. Hispanic patients more frequently had an MRI at their first clinic visit prior to surgery, but the remainder of the perioperative work-up and care was similar to the non-Hispanic cohort. Though significant deviations in care were not found in this study, reviews to elucidate any variations in care should continue in efforts to ensure equitable treatment of at-risk populations.

Effectiveness of mHealth consultation services for preventing postpartum depressive symptoms: a randomized clinical trial

BackgroundAlthough many conventional healthcare services to prevent postpartum depression are provided face-to-face, physical and psychosocial barriers remain. These barriers may be overcome by using mobile health services (mHealth). To examine the effectiveness of mHealth professional consultation services in preventing postpartum depressive symptoms in real-world settings, we conducted this randomized controlled trial in Japan, where universal free face-to-face perinatal care is available.MethodsThis study included 734 pregnant women living in Yokohama city who could communicate in Japanese, recruited at public offices and childcare support facilities. The participants were randomized to the mHealth group (intervention, n = 365), where they could use a free app-based mHealth consultation service with gynecologists/obstetricians, pediatricians, and midwives whenever and as many times as they wanted between 6 p.m. and 10 p.m. on weekdays throughout their pregnancy and postpartum periods (funded by the City of Yokohama government) or the usual care group (control, n = 369). The primary outcome was the risk of elevated postpartum depressive symptoms, defined as Edinburgh Postnatal Depression Scale score ≥ 9. Secondary outcomes were self-efficacy, loneliness, perceived barriers to healthcare access, number of clinic visits, and ambulance usage. All outcomes were collected three months post-delivery. We also conducted subgroup analyses assessing the differences in the treatment effect by sociodemographic status.ResultsMost women completed all questionnaires (n = 639 of 734, response rate: 87%). The mean baseline age was 32.9 ± 4.2 years, and 62% were primipara. Three months post-delivery, women in the mHealth group had a lower risk of elevated postpartum depressive symptoms (47/310 [15.2%]) compared to the usual care group (75/329 [22.8%], risk ratio: 0.67 [95% confidence interval: 0.48–0.93]). Compared with the usual care group, women in the mHealth group had higher self-efficacy, less loneliness, and fewer perceived barriers to healthcare access. No differences were observed in the frequency of clinic visits or ambulance usage. Furthermore, in the subgroup analyses, we did not find differences in the treatment effect by sociodemographic status.ConclusionsLocal government-funded mHealth consultation services have a preventive effect on postpartum depressive symptoms, removing physical and psychological barriers to healthcare access in real-world settings.Trial registrationUMIN-CTR identifier: UMIN000041611. Registered 31 August 2021.

Mainstreamed genetic testing of breast cancer patients: experience from a single surgeon's practice in a large US Academic Center.

This study evaluated the impact of mainstreamed genetic testing (MGT) on the timing and uptake of testing in an academic breast surgeon's practice. Before September 2019 (pre-MGT phase), a breast surgery practice at Massachusetts General Hospital followed a traditional model of a pre-test consultation with a genetic counselor (GC) following a referral. After September 2019 (post-MGT phase), the same practice offered patients genetic testing in a single clinical encounter with a breast surgeon. We evaluated the waiting time between referral and GC visit in the pre-MGT phase and compared the uptake and positivity rates between both phases. In the pre-MGT phase (204 patients), the median waiting time for GC visit was seven days for patients with a newly diagnosed cancer, 211 days for patients with a personal history of cancer, and 224 days for non-cancer patients who had a family history. A total of 105 (51.5%) patients completed a GC appointment. In the post-MGT phase (202 patients), a significantly higher proportion of patients (88.1%, p < 0.001) consented to genetic testing, while the proportion of patients who tested positive was lower (pathogenic variant: 11.9% vs. 20.0%; variant of uncertain significance: 19.9% vs. 28.0%; p = 0.047). Implementing MGT can reduce the number of clinical visits, significantly shorten patients' wait time to test initiation, and increase the completion of genetic testing. Successful integration of this model relied on the genetic expertise of the breast surgeon involved and the support of the GC team.

The Effect of Pharmacist-Led Telemedicine on A1c Reduction During the COVID-19 Pandemic.

Purpose: Diabetes remains a prevalent metabolic chronic condition. The pandemic promoted the use of telemedicine for patients with chronic conditions. Telemedicine offers innovative methods to achieve glycemic control for these patients. This study evaluates the effectiveness of telemedicine with pharmacists in reduction of glycated hemoglobin (A1C) for patients with diabetes. Methods: This study (n = 112) was a single-center, retrospective study that evaluated the effectiveness of patients enrolling in pharmacist-led diabetes management utilizing telemedicine during the COVID-19 pandemic. Patients with an A1C >9 mg/dL were contacted for telemedicine with the pharmacy team. The three groups included: patients agreeing to the telemedicine visit (n = 28), patients that declined the telemedicine visit (n = 42), and patients that did not answer the telephone when offered the telemedicine visit (n = 28). Results: Our study revealed a significant change in the primary endpoint A1C (2.6 + 2.4, p = 0.0144) for the patients who accepted telemedicine visits when compared with the other study groups. The secondary endpoints, changes in A1C (when evaluating employment status, number of clinic visits, number of chronic conditions, gender, race) and changes in body mass index, revealed no significant changes. Conclusion: Diabetes management using telemedicine with pharmacists impacts glycemic control in patients with type 2 diabetes. This study demonstrates patients who accepted pharmacist-led telemedicine had a reduction in A1C. Further research may reveal long-term benefits on clinical outcomes after utilizing this service during the COVID-19 pandemic.

Trends in the Cost of Medicines, Consultation Fees and Clinic Visits in Malaysia's Private Primary Healthcare System: Employer Health Insurance Coverage.

To examine trends in the cost of medicines, consultation fees and clinic visits among the employees covered by the employer health insurance in Malaysia's private primary healthcare system in Malaysia. Retrospective cross-sectional study. PMCare claims database from January 2016 to August 2019. A total of 83,556 outpatient clinic visits involving 10,150 IIUM employees of the International Islamic University Malaysia (IIUM) to private general practitioners (GPs). During the study period, IIUM adopts the incentive structure of capping coverage at Ringgit Malaysia (RM) 45/outpatient visit (USD 10.58) to cover for consultation fees and medicine costs. The monthly percentage change in the number of clinic visits, medicine costs, consultation fees and total costs between January 2016 and August 2019. A simple linear regression using Stata v15.1 was also performed to measure the association between the characteristics of the prescribed medicines and medicine charges. The number of clinic visits per patient increased by 17% from January 2016 to August 2019, with consultation fees increasing by 113.9% and total costs by 7.9% per clinic visit per patient. Conversely, the cost of medicines and the number of medicines prescribed per clinic visit per patient decreased by 39.7% and 6.3%, respectively. Within the incentive structure of capping the total amount of coverage per clinic visit, medicine costs were reduced by decreasing the number of medicines prescribed, to offset the increased consultation fees. This may create perverse incentives that affect medicine use with negative consequences for the health system and health insurers.

Trends in Patient's Use of Sexual Health Services During COVID-19 in a Network of STD Clinics, STD Surveillance Network, 2019 to 2021.

The initial years of the COVID-19 pandemic disrupted sexual health care clinic's services. We describe use patterns by patient characteristics, and the use of telehealth (TH) services among a network of sexually transmitted disease (STD) clinics. Data were collected using a survey to assess the impact of COVID-19 from March to December 2020 among 7 jurisdictions who contribute STD visit-level data as part of the STD Surveillance Network. As a complement to the survey, retrospective data from January 2019 to December 2021 from these 7 STD clinics in the same 7 jurisdictions were examined for monthly utilization trends by overall visits, patient characteristics, and TH visits. Survey results indicated 7 clinics prioritized patients for in-person visits and 4 jurisdictions reported urgent care centers were the most common referral location. In April 2020 (relative to April 2019) clinic visits and unique patients decreased by 68.0% and 75.8%, respectively. Telehealth were documented in 4 clinics, beginning in March 2020, peaking in December 2020, and tapering until December 2021. We observed the number of clinic visits (-12.2%) and unique patients presenting for care (-27.2%) in December 2021 had yet to return to levels to that seen in December 2019. Sexually transmitted disease clinics showed fragility and resiliency in their adjustment to the pandemic; allowing for the continuation of services. Overall patient census has been slow to return to prepandemic levels, and many patients may still not be seeking timely care. This could result in missed opportunities to screen and treat STIs and increasing the possibility of harmful sequelae.

"The phone number tells us good things we didn't know before." Use of interactive voice response calling for improving knowledge and uptake of family planning methods among Maasai in Tanzania.

Maasai living in the Arusha region, Tanzania, face challenges in feeding their children because of decreasing grazing grounds for their cattle. Therefore, they requested birth control methods. Previous studies have shown that lack of knowledge about, and poor access to, family planning (FP) may worsen the situation. We developed an interactive voice response calling (IVRC) platform for Maasai and health care workers (HCW) to create a venue for communication about FP to increase knowledge and access to FP. The objective of this study was to explore the effect of the platform on knowledge, access and use of family planning methods. We applied a participatory action research approach using mixed methods for data collection to develop and pilot-test an mHealth-platform with IVRC using Maa language. We enrolled Maasai-couples and HCW in Monduli District (Esilalei ward), Arusha Region, and followed them for 20 months. A baseline assessment was done to explore knowledge about FP. Furthermore, we abstracted information on FP clinic visits. Based on that, we developed a system called Embiotishu. A toll-free number was provided to interact with the system by calling with their phone. The system offers pre-recorded voice messages with information about FP and reproductive health to educate Maasai. The system recorded the number of calls and the type of information accessed. We measured the outcome by (1) a survey investigating the knowledge of contraceptive methods before and after Embiotishu and (2) counting the number of clinic visits (2018-2020) from medical records and feedback from qualitative data for FP used among Maasai. The acceptability and feasibility were explored through focus group discussions (FGDs) with Maasai and in-depth interviews (IDIs) with HCW. We recruited 76 Maasai couples whom we interviewed during the baseline assessment. The overall knowledge of contraceptives increased significantly (p<0.005) in both men and women. The number of clinic visits rose from 137 in 2018 to 344 in 2019 and 228 in the first six months of 2020. Implants were the most prescribed family planning method, followed by injections and pills, as found in medical records. The number of incoming calls, missed calls, and questions were 24,033 over 20 months. Out of these calls, 14,547 topics were selected. The most selected topics were modern contraceptives (mainly implants, condoms, tubal ligation, and vasectomy). Natural methods of contraception (vaginal fluid observations, calendar, and temperature). Our study has shown that the IVRC system led to an improvement in knowledge about and access to contraceptives. Furthermore, it has potential to increase access to health information as well as improve dialogue between Health workers and Maasai.

Treatment of proximal tibial buckle fractures: removable knee immobilizer versus long leg cast.

The purpose of this study was to compare outcomes and management of patients with buckle fractures of the proximal tibia treated with either a knee immobilizer or a long leg cast (LLC). A retrospective review was performed of pediatric patients with a buckle fracture of the proximal tibia over a 5-year period. Two cohorts were included, those treated with a LLC versus a removable knee immobilizer. Data collected included immobilization type, fracture laterality, length of immobilization, number of clinic visits, fracture displacement, and complications. Differences in complications and management between the cohorts were evaluated. In total, 224 patients met inclusion criteria (58% female, mean age 3.1 years ± 1.7 years). Of these patients, 187 patients (83.5%) were treated with a LLC. No patients in either group were found to have interval fracture displacement during treatment. Seven patients (3.1%) demonstrated skin complications, all in the LLC cohort. Mean length of immobilization was shorter for those treated in a knee immobilizer at 25.9 days versus 27.9 days for the LLC cohort ( P = 0.024). Total number of clinic visits was also less at 2.2 (SD ± 0.4 days) for the knee immobilizer and 2.6 (SD ± 0.7 days) for the LLC ( P = 0.001) cohorts. Pediatric patients with proximal tibial buckle fractures can be safely managed with a knee immobilizer. This treatment method is associated with a shorter duration of immobilization and fewer clinic visits without incidence of fracture displacement. In addition, knee immobilizers can lessen skin issues associated with cast immobilization and cast-related office visits. This is a Level III evidence, retrospective comparative study.

Effectiveness of Screening for Household Gun Ownership in an Urban Primary Care Clinic.

Gun-related suicide and homicide are leading causes of death among children. Little is known about the effectiveness of screening for gun ownership in primary care. We examined positive gun ownership screens over a 2.5-year period in a pediatric primary care clinic. The main outcome was a positive screen for gun ownership. The main predictors included insurance type, neighborhood median income, number of clinic visits, and other social needs. Of 19 163 patients, 474 (2.5%) screened positive for gun ownership. Patients with private insurance and from higher income neighborhoods had 2 to 3 times higher odds of a positive screen. Patients with more visits and with food insecurity had approximately 2 to 4 times the odds of a positive screen for household gun ownership. In conclusion, the rate of positive gun ownership screens was very low and far below known gun ownership rates. Improved screening methods could better identify opportunities for gun safety advocacy.

Comparison of Facial Growth Between Two Nasoalveolar Molding Techniques in Unilateral Complete Cleft Lip Patients: A Randomized, Prospective, Single-blind Trial.

Nasoalveolar molding (NAM) has become standard treatment in our Craniofacial Center. Two types of pre-surgical NAM, Grayson technique and Figueroa technique, co-exist. We previously found no differences in number of clinic visits, cost and 6 months post-operative outcome between the two techniques. Since Figueroa's method involves passive, whilst Grayson's method involves active, alveolar molding, we extended the previous study to evaluate facial growth between these two groups. This randomized, prospective, single-blind study, conducted between May 2010 and March 2013, recruited 30 patients with unilateral complete cleft lip and palate patients and randomized them for Grayson or Figueroa pre-surgical NAM. Their standard lateral cephalometric measurements at 5 years were used to determine facial growth. Twenty-nine patients completed 5 years of follow-up. There were no statistical differences in facial cephalometric measurements between the two groups. Pre-surgical NAM using either passive or active NAM technique produced similar facial growth patterns after unilateral cleft lip and palate repair.

Outcomes for Standardized Home and Hospital-Based Infusions of Infliximab for Children With Inflammatory Bowel Disease.

Pediatric inflammatory bowel disease (IBD) is commonly treated with infliximab in a hospital setting. Utilization of home infusions (HI) is increasing due to insurance mandates, travel time savings, and convenience. We evaluated adverse outcomes (AOs) of infliximab infusions in children with IBD receiving HI compared to hospital-based infusions. Children receiving HI between September 2016 and September 2018 were retrospectively matched based on age, race, ethnicity, sex, and disease type to a cohort receiving infliximab at a hospital-based center. A survival analysis evaluated the hazard ratio for AOs in HI relative to hospital-infused children over 2 years. AOs were defined as discontinuation of therapy for clinically relevant reasons, IBD-related hospitalizations, and emergency department visits. We included 102 children (51 pairs) (63% male, 91% White, 92% Crohn disease). Disease location, behavior, growth status, and disease severity were similar between the 2 cohorts. Quiescent disease increased from 3% to 93% after 2 years without cohort differences. At baseline, 94% of HI patients and 88% of controls were on 5 mg/kg every 8 weeks as standard maintenance therapy. Within 2 years, only 19% remained on 5 mg/kg and the remainder required increased dosing or decreased interval. The HI cohort had fewer labs obtained ( P < 0.001), though laboratory values, number of clinic visits, and frequency of AOs were similar. Drug durability, AOs, and laboratory values were similar between HI and hospital-based infusions. These findings suggest HI may be as effective as hospital-based infusions, provided a standardized care approach is utilized.

Use of Cellular-Enabled Remote Patient Monitoring Device for Hypertension Management in Pregnant Women: A Feasibility Study

IntroductionHypertension affects 5–10% of pregnancies in the United States. Chronic hypertension during pregnancy can have a significant impact on maternal and neonatal outcomes, especially in rural populations. Pregnancies complicated by hypertension are currently managed through frequent clinic visits or extended hospital stays. Cellular-enabled remote patient monitoring devices provide an alternative treatment method for women in rural areas.Research AimThis study aimed to measure the feasibility of and patient satisfaction with using an integrated model of cellular-enabled remote patient monitoring devices for blood pressure supported by a 24/7 nurse call center.MethodsIn a mixed methods pilot study, twelve women with chronic hypertension during pregnancy were given cellular-enabled BodyTrace™ blood pressure cuffs and weight scales. Participants’ blood pressures were continuously monitored by a nurse call center. Participants completed a survey and a brief semi-structured interview after two weeks.ResultsParticipants scored low on stress and anxiety with mean scores of 5.45 (SD = 3.56) and 8.09 (SD 3.62), respectively. Participants scored high on behavioral intention, system usability, and perceived benefits with mean scores of 8.73 (SD = 2.53), 75.91 (SD = 23.70), and 19.64 (SD = 5.92), respectively. Participants perceived benefits to using the device, including increased monitoring by health professionals, increased self-awareness, decreased number of clinic visits, and convenience of use. Perceived disadvantages included higher readings when compared to clinical readings.DiscussionCellular-enabled remote patient monitoring devices for blood pressure are a valuable tool for managing treatment of pregnancies complicated by hypertension.

Five-year Weight Loss Maintenance With Obesity Pharmacotherapy.

Long-term treatment of obesity with lifestyle changes alone is unsustainable for most individuals because of several factors including adherence and metabolic adaptation. Medical management of obesity has proven efficacy for up to 3 years in randomized controlled trials. However, there is a dearth of information regarding real-world outcomes beyond 3 years. This work aimed to assess long-term weight loss outcomes over a 2.5- to 5.5-year period with US Food and Drug Administration (FDA)-approved and off-label antiobesity medications (AOMs). A cohort of 428 patients with overweight or obesity were treated with AOMs at an academic weight management center with an initial visit between April 1, 2014, and April 1, 2016. Intervention included FDA-approved and off-label AOMs. The primary outcome was percentage weight loss from initial to final visit. Key secondary outcomes included weight reduction targets as well as demographic and clinical predictors of long-term weight loss. The average weight loss was 10.4% at a mean follow-up duration of 4.4 years. The proportions of patients who met the weight reduction targets of 5% or greater, 10% or greater, 15% or greater, and 20% or greater were 70.8%, 48.1%, 29.9%, and 17.1%, respectively. On average, 51% of maximum weight loss was regained, while 40.2% of patients maintained their weight loss. In a multivariable regression analysis, a higher number of clinic visits was associated with more weight loss. Metformin, topiramate, and bupropion were associated with increased odds of maintaining 10% or greater weight loss. Clinically significant long-term weight loss of 10% or more beyond 4 years is achievable in clinical practice settings with obesity pharmacotherapy.

The status of patient portal use among Emergency Department patients experiencing houselessness: A large-scale single-center observational study

ObjectivePatient portal (PP) use has rapidly increased in recent years. However, the PP use status among houseless patients is largely unknown. We aim to determine 1) the PP use status among Emergency Department (ED) patients experiencing houselessness, and 2) whether PP use is linked to the increase in patient clinic visits. MethodsThis is a single-center retrospective observational study. From March 1, 2019, to February 28, 2021, houseless patients who presented at ED were included. Their PP use status, including passive PP use (log-on only PP) and effective PP use (use PP of functions) was compared between houseless and non-houseless patients. The number of clinic visits was also compared between these two groups. Lastly, a multivariate logistic regression was analyzed to determine the association between houseless status and PP use. ResultsWe included a total of 236,684 patients, 13% of whom (30,956) were houseless at time of their encounter. Fewer houseless patients had effective PP use in comparison to non-houseless patients (7.3% versus 11.6%, p < 0.001). In addition, a higher number of clinic visits were found among houseless patients who had effective PP use than those without (18 versus 3, p < 0.001). The adjusted odds ratio of houseless status associated with PP use was 0.48 (95% CI 0.46–0.49, p < 0.001). ConclusionsHouselessness is a potential risk factor preventing patient portal use. In addition, using patient portals could potentially increase clinic visits among the houseless patient population.

ENGAGING PATIENTS IN INFLAMMATORY BOWEL DISEASE CARE — WHAT DETERMINES ACTIVE PARTICIPATION?

Abstract BACKGROUND Patient-provider co-production of care is integral to managing inflammatory bowel diseases (IBD), chronic and incurable conditions that affect patients’ quality of life. Patients in the IBD Qorus Learning Health System self-report symptoms and treatment goals prior to clinic visits via electronic surveys, which helps their providers develop patient-centered treatment plans. This study examines factors that predict patients’ active participation in the program to inform future strategies to promote programmatic engagement and continuity of care. METHODS A retrospective cohort study was performed using electronic health records and survey results from a private community gastrointestinal practice engaged with Qorus between 2016 and 2021. Patients with IBD who consented to participate in Qorus were followed for two years after they submitted the first pre-clinic visit survey. The primary outcome was the ratio of eligible surveys (submitted within two weeks prior to clinic visits) to the number of clinic visits, with a ratio &amp;lt;0.5 representing inactive participation and ≥0.5 representing active participation. The first survey and its associated clinic visit were excluded from participation score calculation because it does not reflect patients’ longitudinal involvement. Multivariable logistics regression was performed with patient demographics, mental health status, prior healthcare utilization, and disease severity as covariates. RESULTS Among 244 patients who met the inclusion criteria, 122 were inactive participants and 122 were active participants. Inactive participants completed a median of 0 (IQR 0-1) surveys and 3 (IQR 1-5) clinic visits, while active participants completed a median of 2 (IQR 1-3) surveys and 2 (IQR 2-4) clinic visits (Table 1). Multivariable logistics regression shows that older age, history of anxiety or depression, and higher number of clinic visits were associated with inactive participation. Compared to the age group 18-24 years old, patients ≥35 were less likely to participate actively: 35-44 (OR 0.32 [95% CI 0.11-0.90]), 45-54 (OR 0.24 [95% CI 0.07-0.72]), ≥55 (OR 0.34 [95% CI 0.12-0.94]). Patients with a history of anxiety or depression showed less active participation than those without (OR 0.44 [95% CI 0.25-0.77]). Higher number of clinic visits was also associated with less active participation (OR 0.88 [95% CI 0.78-0.99]) (Table 2). CONCLUSION Age ≥35, history of anxiety or depression, and frequent clinic visits were associated with less active participation in an IBD Learning Health System. Lack of familiarity with digital health resources, concomitant mental health disorders, or participation fatigue may potentially explain these findings. Further research is needed to investigate the causes of inactive participation to design interventions that address these causes.

EFFECTS OF ACTIVE PATIENT PARTICIPATION IN AN INFLAMMATORY BOWEL DISEASE QUALITY IMPROVEMENT PROGRAM ON HEALTHCARE UTILIZATION OUTCOMES

Abstract BACKGROUND Although previous studies have shown that participating in a structured national quality improvement program improves healthcare utilization for patients with inflammatory bowel disease (IBD), it is not known whether the extent of active participation influences health outcomes. Patients in the IBD Qorus Learning Health System self-report symptoms and treatment goals prior to clinic visits via electronic surveys, which facilitates disease surveillance and patient-provider co-production of care. This study assesses the relationship between active patient participation and IBD-related healthcare utilization outcomes. METHODS We reviewed electronic health records and surveys of patients with IBD from a private community gastrointestinal practice participating in Qorus for two years after they submitted the first pre-clinic survey. The study period was from 2016 to 2021. Primary outcomes were times from the first survey to an IBD-related ED visit/hospitalization, urgent message*, and CT-scan use. Participation score was calculated as a ratio of eligible surveys (submitted within two weeks prior to clinic visits) to the number of clinic visits, with a ratio &amp;lt;0.5 representing inactive participation and ≥0.5 representing active participation. Cox proportional hazards regression was performed to determine the relationship between active participation and healthcare utilization, controlling for potential confounders such as IBD subtype, baseline clinical disease activity, steroid use, and six-months-prior IBD-related ED visit/hospitalization and CT scan use. The “survival time” was defined as the time from the first survey to IBD-related healthcare utilization events, loss of follow-up in the electronic health records, or two years, whichever occurred earliest. RESULTS Out of 244 patients, 122 were inactive participants and 122 were active participants. Among inactive participants, 23.8% experienced an IBD-related ED visit/hospitalization, 27.9% sent an urgent message, and 12.3% received a CT scan. Among active participants, 18.9 % experienced an IBD-related ED visit/hospitalization, 21.3% sent an urgent message, and 12.3% received a CT scan (Table 1). Active and inactive (reference) Qorus participants were not statistically different in their healthcare utilization: ED visit/hospitalization (HR 0.61[95% CI 0.34-1.09]), sending an urgent message (HR 0.68 [95% CI 0.40-1.15]), and CT scan use (HR 1.00 [95% CI 0.47-2.13]), after adjusting for confounders (Table 2). CONCLUSION Although active participants show numerically less frequent ED visit/hospitalization and urgent message than inactive participants, there was not a statistically significant association between participation and healthcare utilization. A greater sample size is needed to draw further conclusions to inform future strategies to engage patients and optimize health outcomes.

A mixed-methods study of autistic adults’ healthcare independence over time

BackgroundHealthcare independence refers to an individual’s ability to participate in and manage their healthcare by using specific skills like communicating with providers and scheduling appointments. Understanding healthcare independence among autistic young adults is important to designing healthcare systems that provide equitable support for autistic people throughout their lives. ObjectiveTo quantify changes in autistic adults’ healthcare independence over time and understand factors associated with change in healthcare independence. MethodsWe administered a measure of healthcare skills, the Transition Readiness Assessment Questionnaire (TRAQ), to n = 27 autistic young adults who provided a self-report, and n = 21 autistic young adults who participated via proxy-report by supporters, at one autism-specialized primary care clinic. Participants completed the TRAQ at baseline, six months, and 12 months. We used repeated measures generalized linear mixed models to quantify changes in healthcare independence over time, controlling for demographic factors, executive functioning, restrictive and repetitive behaviors, and number of clinic visits. To understand factors associated with change in healthcare independence, we completed follow-up semi-structured interviews with n = 6 autistic young adults and n = 5 supporters of autistic young adults. ResultsAutistic young adults who participated via self-report showed statistically significantly increases in healthcare independence between baseline and 12 months and between six months and 12 months, and significant increases on most TRAQ subdomains over time (e.g., appointment keeping, managing medications). Autistic young adults who participated via proxy-report showed no significant changes in healthcare independence over time, and significant improvement on the management of activities subdomain between baseline and 12 months. Changes in healthcare independence were associated with interactions with providers, individual health changes, consistent support needs, and community resources. ConclusionsAt one autism-specialized primary care clinic, some autistic young adults may demonstrate improvements in healthcare independence, but other autistic young adults may require additional support strategies to increase healthcare independence. Future studies among larger samples are needed to obtain generalizable understanding of healthcare independence for autistic adults.