Outreach Group Research Articles

Sustaining Ethical ePortfolio Practices: Insights from AAEEBL’s Task Force Year 4

This paper recognises the importance of digital ethics when using ePortfolios and provides information about the development of a comprehensive resource from the Association for Authentic, Experiential and Evidence-based Learning (AAEEBL) Digital Ethics in ePortfolios Task Force’s four-year work. With the public release of ChatGPT addressing ethical challenges in education is critical. Over three years, the global Task Force diligently drafted, refined, and published a suite of digital ethics principles, strategies, scenarios, and resources, which is available as open source. In the fourth year (July 2022-June 2023), the Task Force formed three sub-groups to manage the growing number of objectives. The Development group explored intersections between principles and generative artificial intelligence (GenAI), while evaluating data responsibility. The Outreach group disseminated the work through engaging workshops and publications, which also allowed the wider community feedback opportunities to further enhance the resources. Furthermore, the Research group undertook the ePortfolio Mapping Project to shed light on labour dynamics within ePortfolio practice across North America. The survey instrument was then adapted for data collection in Australia, and New Zealand. The paper highlights the significant achievements of these collective efforts, shares preliminary research findings, and offers valuable insights. It aims to promote ethical ePortfolio usage to enhance teaching, learning and assessment. Practitioner Notes Recognising potential ethical challenges in digital learning is critical. ePortfolios enable integrated learning experiences to meet a range of pedagogical objectives, including the tracking of learning processes as well as end artefacts. Learning how to apply ethical decision-making in using ePortfolios is essential. Comprehensive resources have been developed to assist educators, students, professional staff, and other digital pedagogy stakeholders. Research is underway into current ePortfolio practices which will inform future thinking, advocacy, and awareness.

Evaluation of “Cognitive Behavioral Intervention for Trauma in Schools” (CBITS) in child welfare programs in Germany: study protocol of a randomized controlled trial

BackgroundChildren and adolescents growing up in child welfare institutions have been frequently exposed to traumatic events and psychosocial stress and show elevated rates of mental disorders. Yet, there is a lack of empirically supported treatments to provide adequate mental health care for children in care suffering from trauma-related mental disorders such as posttraumatic stress disorder (PTSD), depression, and anxiety. The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) is an evaluated trauma-focused cognitive-behavioral group intervention, which has proven to be effective in reducing symptoms of PTSD, depression, and anxiety for traumatized children in group settings. The trial will evaluate the effectiveness of the CBITS intervention as an outreach treatment compared with an enhanced treatment-as-usual condition (TAU +) within the German mental health and child welfare system.MethodsIn a randomized controlled trial (RCT) involving N = 90 children and adolescents, we will compare CBITS with TAU + . Participants between 8 and 16 years, reporting at least one traumatic event and moderate posttraumatic stress symptoms (PTSS), will be randomized within their child welfare institution to either one of the conditions using a CATS-2 severity-stratified block randomization. Assessments will take place at baseline, as well as 4 months and 10 months after baseline. The primary outcome is the severity of PTSS after 4 months. Secondary outcomes are depression, anxiety, irritability/anger, quality of life, and global functioning level.DiscussionThe results of our trial will provide evidence regarding effective treatment options for traumatized children in care, which represent an understudied population with limited access to mental health care. Additionally, it could serve as a blueprint for implementing trauma-focused outreach group treatments for children in care and increase the accessibility to appropriate treatment.Trial registrationClinical Trials.gov NCT06038357 D. September 13, 2023.

The effect of mailed outreach on FIT completion among patients aged 45-50 in a safety net healthcare system.

Colorectal cancer screening is recommended starting at age 45, but there has been little research on strategies to promote screening in patients younger than 50. An outreach program quasi-randomly assigned patients aged 45-50 without recent fecal immunochemical test (FIT), colonoscopy or contraindications to screening to two intervention arms: electronic outreach with email and text (electronic outreach only)versus electronic outreach plus mailed outreach with FIT, an instructional letter and a prepaid return envelope (mailed + electronic outreach). In response to known disparities in screening uptake, all Black patients were assigned to receive mailed + electronic outreach. Among patients quasi-randomly assigned to an intervention (non-Black patients), the 180-day FIT completion rate was 18.8% in the electronic outreach only group (n = 1,318) and 25.0% in the mailed + electronic outreach group (n = 1,364) (difference 6.2% [95% CI 3.0, 9.4]). FIT completion was 16.6% among Black patients (n = 469), 8.4% (95% CI 4.1, 12.6) lower than among non-Black patients also assigned to mailed + electronic outreach. Among patients aged 45-50, mailed + electronic outreach had a greater effect on FIT completion than electronic outreach alone. Crossover between intervention groups likely lead to an underestimation of the effect of mailed outreach.

Analysis of the Potential and Performance of the Tourism Sector towards the Community (Study on Pasir Kencana Beach Tourism Area in Pekalongan City)

Purpose: Tourism has become a major growth engine in Indonesia and has helped the local economy and government. One of Indonesia's emerging economic sectors is tourism. Pekalongan is one of the most central cities in Java and has many natural and man-made tourist spots. To increase the attractiveness and sustain tourism, Pasir Kencana tourism in Pekalongan city should be properly managed. The objective of this investigation is to determine the extent to which community-based tourism (CBT) is being used, how it is implemented, and what obstacles are encountered in implementing CBT in tourism. Method: Data were collected through observations, interviews, and documentation. Data analysis was conducted through the use of the descriptive narrative method. Result: These results show that although the community has participated in tourism management, it has not reached the desired level. Pasir Kencana Beach is a good example of community-based tourism, evidenced by the activities of a good tourism outreach group (Pokdarwis). Constraints of community-based tourism management development strategies include promoting tourism, adding qualified human resources based on the field of education, using information technology to introduce and promote tourism to a wider audience; it is also possible to attract investors to help improve tourism-related infrastructure and develop tourism destinations by making the best use of available space and leveraging local uniqueness and culture to generate more revenue from visitors. Contribution: This research contributes to developing scientific concepts about community participation in developing tourist destinations.

Assessment of embedded versus remote pharmacist versus remote student pharmacist outreach on statin prescribing

BackgroundThe Statin Use in Persons with Diabetes (SUPD) measure is a Star measure by the Center for Medicare & Medicaid Services. The Duke Population Health Management Office has a team of pharmacists and pharmacy students who conduct targeted outreach to patients at risk of failing statin quality measures. Pharmacy services are embedded in select primary care clinics and other clinics are supported remotely. ObjectivesThe primary objective of this review is to compare the initiation rates of recommended statin prescriptions between embedded pharmacist versus remote pharmacist versus remote student pharmacist outreach groups, all of which have different levels of autonomy within pharmacy practice. The secondary objectives are to identify the barriers to the implementation of statin therapy and to assess the statin drugs and intensity of the statins prescribed. MethodsA single-center, retrospective chart review was performed for SUPD patients with Medicare insurance. SUPD patients included patients between 40 and 75 years of age, diagnosed with type 2 diabetes, and were not dispensed at least 1 statin medication of any intensity during the 6-month measurement period. The primary outcome was the initiation of recommended statin medications prescribed, or pended for the primary care provider to prescribe, for qualifying patients by embedded, remote, and remote student pharmacists. Secondary outcomes included the reasons for the nonimplementation of statin recommendations, reasons statin therapy was not prescribed to patients contributing to the SUPD measure gap, and statin drug and dose prescribed for appropriateness. ResultsA total of 189 patients were included in the evaluation. In this study, 34.9% of the patients filled the prescribed or pended statin prescription and 83.3% of patients filled the prescribed or pended statin prescription at the recommended intensity according to the American College of Cardiology/American Hospital Association guidelines, effectively closing the SUPD measure gap. The initiation rates of recommended statin prescriptions between the embedded pharmacist, remote pharmacist, and remote student pharmacist outreach were numerically different at 36.7%, 28.2%, and 36.7%, respectively, even though not statistically different (P = 0.61). ConclusionRemote student pharmacists’ performance was equal to that of the embedded pharmacists when comparing the initiation rates of statin medications prescribed or pending the primary care provider’s approval. The most common reason for nonimplementation of statin therapy is that the statin was refused by the patient. Atorvastatin and rosuvastatin were the two most commonly prescribed statins.

1529. Factors Associated With HIV-positive Test Results in People Who Inject Drugs

Abstract Background Syringe Services Programs (SSP) are essential for harm reduction among persons who inject drugs (PWID). The Kentucky Income Reinvestment Program (KIRP), a statewide program funded through the Ryan White HIV/AIDS Program, provides comprehensive early intervention services targeting those at highest risk for HIV infection. As KIRP provides testing at SSPs and at other venues serving PWID, we sought to compare factors associated with a positive HIV test result between SSP sites and community testing sites. Methods We conducted a cross-sectional study across the state of Kentucky from January 2022 to March 2023. We compared the demographic characteristics of PWID tested across 54 SSPs versus PWID tested at KIRP outreach events (substance abuse treatment centers, correctional facilities, shelters, etc.); and factors associated with an HIV-positive test result. Study data were collected and managed using a REDCap database. The statistical analyses, including logistic regression, were performed with Stata 17 (College Station, TX: Stata Corp LLC). Results In the study period, 20,397 PWID were tested for HIV, 10,058 in the outreach events, and 10,339 at SSPs. The median age was 39 (IQR 32 – 46) years; 11,075 (54.3%) were male, 18,905 (92.7%) were white, and 550 (6.7%) reported MSM behavior. Outreach events were superior in reaching racial and ethnic minority groups. (Table 1). The HIV-positive rate was higher in the outreach group (0.37% vs. 0.15%; p=0.003). In a multivariate model, PWID not engaged with an SSP were significantly associated with higher HIV incidence when adjusted by gender, race, and sexual risk factors for HIV acquisition.Table 1.Demographic characteristics of the PWID tested for HIV by test location.Table 2.Factors associated with an HIV-positive test in PWID. Conclusion SSPs provide comprehensive harm reduction services, and, in our study, reduced HIV incidence amongst participants. We were able to reach more underrepresented populations with testing at outreach sites, which also serve PWID. To end the HIV epidemic, and increase prevention services, enrollment of underrepresented populations into SSP services is paramount. Disclosures All Authors: No reported disclosures

Evaluation of the COVID-19 Vaccination Campaign ¡Ándale! ¿Qué Esperas? in Latinx Communities in California, June 2021-May 2022.

The 12-month vaccination campaign ¡Ándale! ¿Qué Esperas? was launched to increase COVID-19 vaccination rates in Latinx populations in California by expanding community outreach. The objectives of this evaluation were to (1) determine predictors of vaccination rates and (2) identify barriers to vaccination and potential solutions. Five community partners in California serving Latinx populations with high social vulnerability participated in the ¡Ándale! ¿Qué Esperas? campaign. Community health workers were hired to deliver outreach (virtual, one-on-one, group based, and information dissemination), vaccinations, and supportive services. We collected data on outreach strategy used (method and location), number of vaccinations provided and reasons for delay, and number of times that supportive services were provided. We used regression models to assess significant predictors of vaccinations and supportive services. Community health workers (N = 146) hired from June 1, 2021, through May 31, 2022, performed outreach engagements (n = 6297) and supportive services (n = 313 796), resulting in 130 413 vaccinations and 28 660 vaccine appointments. The number of vaccinations administered was significantly higher at events in which supportive services were provided versus not provided (coefficient = 34.02; 95% CI, 3.34-64.68; P = .03). The odds ratio of supportive services was 3.67 (95% CI, 1.76-7.55) during virtual outreach and 2.95 (95% CI, 2.37-3.69) during one-on-one outreach (P < .001 for both) as compared with information dissemination encounters. Vaccination concerns were reported among 55.0% of vaccinated survey respondents (67.7%, vaccine confidence; 51.7%, access). Supportive services facilitate vaccinations, ease transportation and time barriers, and instill confidence among working-class racial and ethnic minority populations.

Ethical choreography in China’s Human Gene Editing controversy

ABSTRACT He Jiankui announced to the world in November 2018 that his team had genetically edited twin human embryos that were then brought to term. Recruiting participants through an HIV outreach group and using CRISPR/Cas9 technology, He targeted the CCR5 genes claiming this would make the children immune to HIV. One way to understand He’s case is through Charis Thompson’s concept of ethical choreography, which shows how scientists ‘invent around’ potential ethical objections to their work. In particular, such a focus on ethical choreography traces how individual scientists can exploit ambiguity in institutional boundaries to recombine different logics to advance their vision of good, innovative, and ethical science. He’s actions can be seen to been the result of his traversal of blurred boundaries that demarcate science/market and science/medicine in order to recombine academic, market, medical, and cultural logics. This combination of logics is seen in ethical justifications that He put forth for his experiment, which provoked much criticism and controversy, but should nonetheless be taken seriously and placed in context. While He’s vision of good science was rejected, examples of ethical choreography can be found in other instances of biomedical innovation and there remains the potential for other scientists to pick up where He left off. Following the ethical choreography of scientists also allows for more specificity in discussions about what and when boundaries should be strengthened or relaxed in order to advance a more equitable vision of science and technology.

Establishment of a Fellowship in Street Medicine.

The American Medical Association recognizes street homelessness as a significant barrier to the provision of high-quality care.1 Traditional medical training provides inadequate preparation for physicians to manage persons experiencing unsheltered homelessness (PEUH). Street medicine is the direct provision of health care and social support to PEUH,2 who experience high barriers to needed care and tend to use acute hospital-based care at high rates.3We established a street medicine fellowship to enable physicians to acquire the requisite clinical and organizational skills to become leaders in improving outcomes in this vulnerable population.The UPMC Mercy Street Medicine Fellowship is the first of its kind. This one-year, one fellow per year program was initiated in 2019 by UPMC Mercy, Pennsylvania. The fellowship accepts applications from physicians who have completed a residency in internal medicine, family medicine, emergency medicine, or psychiatry, and who seek to develop expertise in caring for PEUH while also participating in multidisciplinary care to enable them to serve as future leaders in this field. At the end of the fellowship training a survey is sent to learners.Fellows are instructed in comprehensive management of PEUH. The program uses the “go-to people” approach to health care as promoted by the Street Medicine Institute. Fellows are challenged to set aside the mindset of the “office approach,” which often does not embrace unique social determinants of health, and round 3 to 4 times per week on the streets, on the riverbanks, and in homeless encampments, including general rounds, targeted case management rounds, and specialty rounds (eg, psychiatric, harm reduction, intimate partner violence, etc). They participate in additional outpatient clinics, 3 half days per week, which have been established for PEUH and for those who have transitioned from street homelessness into housing. Fellows maintain this continuity group of patients throughout the fellowship year. Home visits are also conducted for newly placed patients.Fellows apply the concept of “community united” so that changes initiated in one community are spread to others. They utilize multidisciplinary mentors and engage in productive communication with experts in street medicine. They conduct a formal comparative analysis of 2 communities in which street medicine is practiced to further develop insight into improvement opportunities as well as attend the annual International Street Medicine Symposium as a learning activity and for academic presentation as applicable.Fellows are assessed monthly according to the Accreditation Council for Graduate Medical Education's Core Competencies. Fellows also complete a monthly evaluation of their assigned experience. Lastly, fellows are surveyed at the completion of the year (Figure).Our first fellow now carries a university faculty position in another city. She teaches in the outpatient setting and has integrated clinical street work with community initiatives, a street medicine interest group, and a peer outreach group. Our second fellow is practicing emergency medicine in another city and incorporating her skills to improve care in that setting for PEUH.Although our program is young, our graduates have affirmed that formal fellowship training in street medicine is a viable yet heretofore unexplored avenue toward more effectively addressing society's responsibility toward PEUH.

Effectiveness and costs of a low-threshold hearing screening programme (HörGeist) for individuals with intellectual disabilities: protocol for a screening study

IntroductionIndividuals with intellectual disabilities (ID) often suffer from hearing loss, in most cases undiagnosed or inappropriately treated. The implementation of a programme of systematic hearing screening, diagnostics, therapy initiation or...

Raising impact of particle physics outreach through gamification

The International Masterclass - Hands on Particle Physics is an outreach event proposed by the International Particle Physics Outreach Group since 2004. Its traditional format had a worldwide success during the last years, reaching thousands of high school students and introducing them to the world of particle physics. During the last two years, the COVID-19 pandemics forced all the groups proposing the activity to find an online alternative to preserve the spirit of the initiative. The local committee of University of Trento proposed an online event, divided into several short events carried out over two weeks. The introduction of an analysis challenge among the students has made it possible to obtain a very good response and to achieve, with less than 20 students, enough statistics to discuss physical results of the analysis. The contribution describes the details of the organization, results, and feedback from the students, with some proposals to improve the experience for the next years.

Job Satisfaction and Self-Perceptions Among Ecuadorian Medical Doctors During Their Compulsory Rural Community Social Service: A Countrywide Cross-Sectional Analysis.

Job satisfaction has been shown to have important effects at the organizational level. In various corners of the world, physicians are obliged to perform a period of social service, generally at the first level of care in rural or remote areas. To describe the level of job satisfaction and perceptions of Ecuadorian rural physicians regarding compulsory social service. A descriptive, cross-sectional study was conducted based on a self-administered online questionnaire from February to March 2022, in Ecuadorian rural physicians who were performing their compulsory social service. Participants were invited through official outreach groups. A total of 247 surveys were included in this study. We assessed job satisfaction by means of the S20/23 job satisfaction questionnaire and compared these results with sociodemographic variables and job characteristics of the participants. We performed the reliability test (Cronbach's alpha) to find the validity of the S20/23 questionnaire in physicians performing compulsory social service. The majority of participants were women (61.0%), and overall job satisfaction was 4.1/7.0 pts. "indifferent." The only satisfaction factor in which a predominance of dissatisfaction was found related to benefits/remuneration (43.3%). Participants' perceptions of wrong academic guidance during training, insufficient induction, and negative experiences during work were related to higher levels of dissatisfaction (P < .05). The level of job satisfaction of Ecuadorian rural physicians during their compulsory social service was low and graduates indicated a neutral attitude toward job satisfaction in general. Negative perceptions with respect to training and expectation formation prior to and during the mandatory social service generated greater dissatisfaction. The Ministry of Health of Ecuador, as an organizational entity, should implement improvements to increase the job satisfaction of recently graduated physicians, given the implications that this experience may have for their professional future.

Sociodemographic Comparison of Children With High-risk Medical Conditions Referred vs Identified Through Screening Plus Outreach for COVID-19 Therapeutics

Minoritized groups are less likely to receive COVID-19 therapeutics, but few studies have identified potential methods to reduce disparities. To determine whether screening plus outreach, when compared with referral alone, increases identification of vulnerable pediatric patients at high risk for severe disease eligible for COVID-19 therapeutics from low-resourced communities. A retrospective cohort study of COVID-19 medication allocation between January 1, 2022, and February 15, 2022, at Lurie Children's Hospital, a quaternary care children's hospital, in Chicago, Illinois. The cohorts were pediatric patients referred for COVID-19 therapeutics or with a positive SARS-CoV-2 polymerase chain reaction within the hospital system followed by outreach. Screening involved daily review of positive cases of SARS-CoV-2, followed by medical record review for high-risk conditions, and communication with clinicians and/or patients and families to offer therapy. Diagnosis of COVID-19. The primary measure was difference in child opportunity index (COI) scores between the 2 cohorts. Secondary measures included presence and duration of symptoms at diagnosis, medication uptake, race and ethnicity, insurance type, qualifying medical condition, sex, primary language, and age. Of 145 total patients, the median (IQR) age was 15 (13-17) years, and most were male (87 participants [60.0%]), enrolled in public insurance (83 participants [57.2%]), and members of minoritized racial and ethnic groups (103 participants [71.0%]). The most common qualifying conditions were asthma and/or obesity (71 participants [49.0%]). From 9869 SARS-CoV-2 tests performed, 94 eligible patients were identified via screening for COVID-19 therapeutics. Fifty-one patients were identified via referral. Thirty-two patients received medication, of whom 8 (25%) were identified by screening plus outreach alone. Compared with referred patients, patients in the screening plus outreach group were more likely to have moderate, low, or very low COI composite scores (70 patients [74.5%] vs 27 patients [52.9%]); public insurance (65 patients [69.1%] vs 18 patients [35.3%]); and asthma or obesity (60 patients [63.8%] vs 11 patients [21.6%]). Patients in the referral group were more likely to be non-Hispanic White (23 patients [45.1%] vs 19 patients [20.2%]) and receive medication (24 patients [47.1%] vs 8 patients [8.5%]). Compared with referral patients, screening plus outreach patients for COVID-19 medications were more socially vulnerable, with lower COI scores, and more likely to have asthma or obesity. Future studies should investigate communication strategies to improve uptake of these medications after outreach.

1575. Screening Plus Outreach Versus Referrals to Identify Patients for Outpatient COVID Medications

Abstract Background Scarcity of therapeutics to treat Coronavirus Disease 2019 (COVID-19) during the surge in cases caused by the Omicron variant raised concerns that structural inequities would decrease access to these medications for racial minorities and patients with lower socioeconomic status. We hypothesized that screening plus outreach would increase identification of eligible patients in these vulnerable patient populations when compared to referrals alone. Methods A retrospective cohort study of COVID medication allocation was performed at a quaternary pediatric medical care facility between 1/1/22–2/15/22. The two cohorts were patients referred for COVID therapy and patients identified via screening followed by outreach. Screening plus outreach included daily review of laboratory reports for new positive cases of SARS-CoV-2, followed by chart review for high-risk conditions, and communication with providers or directly with eligible patients to offer therapy. Demographic characteristics, chronic medical conditions, socioeconomic parameters, and medication receipt were compared between the two groups. Results Overall, 51 and 94 patients were identified via referral and screening plus outreach, respectively. Thirty-two patients received medication of which eight (25%) were identified by screening plus outreach alone. Compared to referred patients, patients in the screen plus outreach group were more likely to have moderate, low, or very low childhood opportunity index (COI) scores (74.5% vs 52.9%%, p = 0.009); public health insurance (69.1% vs 37.5%, p &amp;lt; 0.001); asthma/obesity (63.8% vs 21.6%, p &amp;lt; 0.001), and race/ethnicity other than White, Non-Hispanic (79.8% vs 54.9%, p = 0.002). Patients in the referral group were more likely to receive medication (47.1% vs. 8.5%, p &amp;lt; 0.001). Conclusion Compared to referral, screening plus outreach for COVID medications can increase identification of patients who are racial minorities, have asthma/obesity, and have lower socioeconomic status. Future studies should investigate communication strategies to improve uptake of these medications after outreach. Disclosures All Authors: No reported disclosures.

Does Street Outreach Engage Its Intended Target Population? Clinical Experience in the Veteran's Health Administration Homeless Service Programs.

Clinical street outreach programs serve people experiencing unsheltered homelessness, who have been shown to have greater medical and psychiatric comorbidities, and increased social and financial challenges. However, outreach programs may struggle in practice to engage the most vulnerable of these individuals. Data from the Veterans Health Administration's (VHA's) Homeless Operations Management System (HOMES) from 2018 to 2019 (N = 101,998) were used to compare sociodemographic, clinical, and financial characteristics of literally homeless veterans contacted through street outreach to those who were self-referred or clinic-referred. Veterans engaged through street outreach reported substantially more days of unsheltered homelessness in the past month (mean (M) = 11.18 days, s.d.=13.8) than the clinic-referred group (M = 6.75 days, s.d.=11.1), and were more likely to have spent the past 30 days unsheltered (RR = 2.23). There were notably few other differences between the groups. Despite epidemiologic evidence in the literature showing higher medical, psychiatric, and social and financial vulnerabilities among unsheltered homeless individuals, our street outreach group was not found to be any worse off on such variables than the clinic-referred or self-referred groups, other than increased time unsheltered. Outreach workers seem to engage more unsheltered individuals, but do not necessarily engage those with such severe vulnerabilities. Dedicated outreach program funding, training, and support are needed to support street outreach to those with the most severe problems.

S951 Bridging Healthcare Disparities in Inflammatory Bowel Disease (IBD) Through a Telehealth Hybrid Clinic Model

Introduction: Due to increased prevalence of IBD and lack of access to specialized care, Henry Ford Health is offering a hybrid clinic model in rural areas, that offers patients the opportunity to physically present to a clinic near their homes where a nurse performs an intake, and an IBD specialist is available through telemedicine. This study was designed to identify barriers to IBD care, and the impact it has on healthcare cost and quality of life. Methods: This is a retrospective chart review conducted at a large tertiary care center. Data were collected between July 2021 and March 2022. We included all adult patients with the diagnosis of Crohn’s Disease and Ulcerative Colitis living in Michigan. The control group consisted of in person clinical encounters at the Henry Ford IBD center in Novi, Michigan. The intervention group consisted of hybrid clinic visits at the Saginaw Outreach clinic. We gathered data on IBD flares, hospitalization, medication compliance, need for surgery within the past year, and emergency department (ED) visits at both sites. Results: There was a total of 68 patients in the outreach group compared to 134 patients in the control group. The analysis showed that 16.7% of the outreach group had presented to the ED within a year of their clinic visit compared to 18.3% in the control group (p=0.782). While 24.2% of the outreach group were hospitalized compared to 19.7% in the control group (p= 0.459). Finally, 37.9% of the patients in the outreach group had IBD complications necessitating surgical interventions within a year of their clinic visit compared to only 16.1% in the control group (p=0.001). Conclusion: Providing cost-effective care that is available for patients with IBD was the main driving factor of our hybrid telehealth model. According to the system based and multinational review that we conducted this hybrid telehealth clinic is the first of its kind across the country. Financial challenges are a more prevalent barrier in accessing office-based care in rural areas. Our study supports the previously published results as patients at our outreach clinic had a higher rate of surgeries within a year before their initial telehealth visit, as they were twice more likely to have undergone surgery within the past year. This is attributed to the lower socioeconomic status and lack of access to specialized care. In conclusion, this is a longitudinal study to assess if the telemedicine clinic can aid patients in attaining clinical remission and improving quality of life.

Community Health Workers as Trust Builders and Healers: A Cohort Study in Primary Care.

Improving patients' self-care for chronic disease is often elusive in the context of social deprivation. We evaluated whether a practice-integrated community health worker (CHW) intervention could encourage effective long-term self-management of type 2 diabetes mellitus (T2DM). This cohort study, in a safety-net primary care practice, enrolled patients with uncontrolled T2DM and psychosocial risk factors. Patients were identified through a practice diabetes registry or by clinicians' referrals. The CHWs engaged patients in trust building and sensemaking to understand their social context, identify goals, navigate health care, and connect to community resources. Primary outcome was progress through 3 prospectively defined stages of self-care: outreach (meeting face-to-face); stabilization (collaborating to address patients' life circumstances); and self-care generativity (achieving self-care competencies). Secondary outcomes were change in hemoglobin A1c (HbA1c) and need for urgent care, emergency department, or hospital visits. Of 986 participating patients, 27% remained in outreach, 41% progressed to stabilization, and 33% achieved self-care generativity. Repeated measures ANOVA demonstrates an overall decline in HbA1c, without group differences, through the 4th HbA1c measurement (mean follow-up 703 days). Beginning at the 5th HbA1c measurement (mean 859 days), the self-care generativity group achieved greater declines in HbA1c, which widened through the 10th measurement (mean 1,365 days) to an average of 8.5% compared with an average of 8.8% in the outreach group and 9.0% in the stabilization group (P = .003). Rates of emergency department and hospital visits were lower in the self-care generativity group. Practice-linked CHWs can sustainably engage vulnerable patients, helping them advance self-management goals in the context of formidable social disadvantage.

Effect of Electronic and Mail Outreach From Primary Care Physicians for COVID-19 Vaccination of Black and Latino Older Adults

COVID-19 morbidity is highest in Black and Latino older adults. These racial and ethnic groups initially had lower vaccination uptake than others, and rates in Black adults continue to lag. To evaluate the effect of outreach via electronic secure messages and mailings from primary care physicians (PCPs) on COVID-19 vaccination uptake among Black and Latino older adults and to compare the effects of culturally tailored and standard PCP messages. This randomized clinical trial was conducted from March 29 to May 20, 2021, with follow-up surveys through July 31, 2021. Latino and Black individuals aged 65 years and older from 4 Kaiser Permanente Northern California (KPNC) service areas were included. Data were analyzed from May 27, 2021, to September 28, 2021. Individuals who had not received COVID-19 vaccination after previous outreach were randomized to electronic secure message and/or mail outreach from their PCP, similar outreach with additional culturally tailored content, or usual care. Outreach groups were sent a secure message or letter in their PCP's name, followed by a postcard to those still unvaccinated after 4 weeks. The primary outcome was time to receipt of COVID-19 vaccination during the 8 weeks after initial study outreach. KPNC data were supplemented with state data from external sources. Intervention effects were evaluated via proportional hazards regression. Of 8287 included individuals (mean [SD] age, 72.6 [7.0] years; 4665 [56.3%] women), 2434 (29.4%) were Black, 3782 (45.6%) were Latino and preferred English-language communications, and 2071 (25.0%) were Latino and preferred Spanish-language communications; 2847 participants (34.4%) had a neighborhood deprivation index at the 75th percentile or higher. A total of 2767 participants were randomized to culturally tailored PCP outreach, 2747 participants were randomized to standard PCP outreach, and 2773 participants were randomized to usual care. Culturally tailored PCP outreach led to higher COVID-19 vaccination rates during follow-up compared with usual care (664 participants [24.0%] vs 603 participants [21.7%]; adjusted hazard ratio (aHR), 1.22; 95% CI, 1.09-1.37), as did standard PCP outreach (635 participants [23.1%]; aHR, 1.17; 95% CI, 1.04-1.31). Individuals who were Black (aHR, 1.19; 95% CI, 1.06-1.33), had high neighborhood deprivation (aHR, 1.17; 95% CI, 1.03-1.33), and had medium to high comorbidity scores (aHR, 1.19; 95% CI, 1.09-1.31) were more likely to be vaccinated during follow-up. This randomized clinical trial found that PCP outreach using electronic and mailed messages increased COVID-19 vaccination rates among Black and Latino older adults. ClinicalTrials.gov Identifier: NCT05096026.

Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini.

IntroductionUniversal access to antiretroviral therapy (ART) is a cornerstone of Eswatini’s national HIV strategy, and the number of people on ART in the country more than tripled between 2010 and 2019. Building on these achievements, the Ministry of Health (MOH) is scaling up differentiated service delivery, including less-intensive differentiated ART (DART) models for people doing well on treatment. We conducted a mixed-methods study to explore client and health care worker (HCW) perceptions of DART in Eswatini.MethodsThe study included structured site assessments at 39 purposively selected health facilities (HF), key informant interviews with 20 HCW, a provider satisfaction survey with 172 HCW and a client satisfaction survey with 270 adults.ResultsAll clients had been on ART for more than a year; 69% were on ART for ≥ 5 years. The most common DART models were Fast-Track (44%), Outreach (26%) and Community ART Groups (20%). HCW and clients appreciated DART, noting that the models often decrease provider workload and client wait time. Clients also reported that DART models helped them to adhere to ART, 96% said they were “very satisfied” with their current model, and 90% said they would recommend their model to others, highlighting convenience, efficiency and cost savings. The majority of HCW (52%) noted that implementation of DART reduced their workload, although some models, such as Outreach, were more labor-intensive. Each model had advantages and disadvantages; for example, clients concerned about stigma and inadvertent disclosure of HIV status were less interested in group models.ConclusionsClients in DART models were very satisfied with their care. HCW were also supportive of the new approach to HIV treatment delivery, noting its advantages to HF, HCW and to clients. Given the heterogeneous needs of people living with HIV, no single DART model will suit every client; a diverse portfolio of DART models is likely the best strategy.

Building resilience through informal networks and community knowledge sharing: post-disaster health service delivery after Hurricane Maria

ABSTRACT In September of 2017, Hurricane Maria made landfall in Puerto Rico, bringing widespread damage to public systems across the island, which included particularly devastating impacts to local hospitals and medical facilities. Health care organisations operating on the ground played an essential role in hurricane response efforts as they attempted to address the medical needs of vulnerable populations. However, minimal research has discussed how the provision of post-disaster healthcare rested on the knowledge and participation of local communities. This study aims to fill these gaps by exploring the ways in which health care workers relied on their relationships with informal community networks to navigate the post-disaster landscape and provide adequate health services. This study uses post-disaster response data collected in Puerto Rico, which includes interviews with private, non-profit, and university-affiliated health organisations, as well as community health centers and emergent health outreach groups. Findings from this study highlight the critical role informal networks, community outreach, and relationship building play in response work as organisations attempt to overcome the specific complexities and challenges of operating in the post-disaster context. Furthermore, our research illustrates how deficient government support and systematic failings shift the burden of resilience building onto community members and organisations.