Patient Mistrust Research Articles

Factors of mental health patients’ uptake in social prescribing: a mixed methods study in Portugal

Abstract Successfully addressing mental health challenges demands comprehensive, community-driven solutions. Social prescribing (SP) emerges as an innovative approach, fostering integrated care by connecting healthcare patients to community resources. Research in this topic proved effects of SP in mental health and well-being promotion, but factors influencing patients’ uptake remain underexplored. This study examined the factors associated with the uptake in patients with mental health needs in SP project in Portugal. This mixed methods study examined registries data of 403 patients referred to SP for mental health needs. A logistic regression was used to analyse sociodemographic characteristics and referral details associated with SP uptake. Semi-structured interviews were conducted with stakeholders to explore challenges and facilitators of users uptake. Most users were female (71.7%) and elder (average age 64.4 years, SD ± 20.0). Mental health needs included social isolation, loneliness, anxiety, and depression. 43.7% of referred patients had diagnosed mental illnesses and 55.8% attended at least one SP appointment. SP uptake was more likely among patients referred for social and financial support (OR 2.02; 95%CI 1.32-3.07; p = 0.001) and referred during the Covid-19 period (OR 1.64; 95%CI 1.08-2.49; p = 0.020). increased the probability of SP uptake. In contrast, SP uptake was less likely among those having diabetes (OR 0.49; 95%CI 0.28-0.88; p = 0.016). Health professionals’ proactive engagement with patients facilitated uptake in SP, yet challenges arose from users’ complex needs, low awareness, motivation, and acceptance of non-traditional responses such as community-based activities, along with mistrust of their effectiveness. SP has the potential to foster mental health and well-being through person-centred holistic care, yet challenges in uptake related to health and psychosocial factors must be addressed to optimize the SP positive impacts. Key messages • Factors influencing the uptake of patients with mental health needs in SP initiative in Portugal involved need of social and financial support, pandemic period and health professionals’ attitudes. • Despite SP potential, for effective implementation it is key to address challenges, like complexity of patients’ needs, awareness gaps and patient mistrust, to maximize its positive outcomes.

Epistemic Shortcuts and Unjust Diagnostic Practices

ABSTRACT When diagnosing psychological disorders, doctors are expected to take the mental anguish of patients and offer fast and accurate explanations. The pressure that comes with this often leaves doctors in need of epistemic shortcuts for faster diagnoses. One such epistemic shortcut is to lean on statistical data when offering a diagnosis. When used justly, doctors consider a patient’s testimony, exhibited symptoms and statistical data relating to the general features of the patient such as age, weight and sex to determine if a patient has a given disorder or illness. Practices such as this have the capacity to yield good results at a quick pace, however, such practices may also be abused. With a focus on gender statistics and psychological diagnoses, I argue that systematic practices of epistemic injustice may occur when the statistical data becomes over-valued and the epistemic privilege of patients to be able to assert their own bodily and mental experiences is ignored. This places patients at risk of misdiagnosis, long-term damage and pain, or even death. It also produces patient mistrust both of themselves and of the medical community, which can carry further repercussions for public health.

A cross-sectional survey of clinical trials knowledge, participation, and perspectives in an underserved community of Washington, DC.

The inclusion of participants from underrepresented and underserved groups is lagging in dermatology clinical trials. Through dissemination of a pilot survey at a community skin health fair, knowledge, participation, and perspectives of clinical trials were evaluated in an urban, medically underserved community in Washington, DC. Clinical trial-related questions were derived from the Health Information National Trends Survey 5 Cycle 4. This cross-sectional survey analyzed responses from 39/55 attendees (71% response rate). Most respondents were female (23/37 [62.2%]), between the ages of 25 and 54 (19/38, [50.0%]), and self-identified as non-white (35/39 [89.7%]) with a majority self-identifying as Black (16/31 [41%]). Most respondents self-reported knowing "little" to "nothing" about clinical trials (26/35 [74.3%]), and even more were unaware of the federal resource clinicaltrials.gov (30/37 [81.1%]). Few respondents discussed clinical trials as a treatment option with their healthcare provider (8/35 [22.9%]), yet having a discussion was significantly correlated with clinical trial participation (p = 0.0302). Self-reported level of knowledge was not significantly associated with participation in a clinical trial (p = 0.3035). Healthcare providers were the preferred first source of clinical trial information, followed by an internet search. Respondents rarely cited mistrust or skepticism as a barrier to participation (2/34 [5.9%]). Subjective positive healthcare experiences were significantly correlated to positive expectations with clinical trial participation (p = 0.0242). The findings of this study suggest the essential role healthcare providers, including dermatologists, play in clinical trial education and recruitment of underrepresented populations, and that patient mistrust may be present but is a rarely cited barrier to clinical trial participation.

Voices From the Field: Amplifying Clinicians' Perspectives for Black Maternal Equity [ID 2683631

INTRODUCTION: Nationally, Black birthing individuals face a disproportionate burden of maternal mortality and severe maternal morbidity. Although there is growing research interest in tackling these inequities, a significant gap exists in incorporating the insights and perspectives of interprofessional front-line clinicians. This study sought to learn the experiences and viewpoints of physicians, certified nurse-midwives (CNMs), and registered nurses (RNs) to identify strategies for addressing maternal care inequities. METHODS: In collaboration with our community advisory board, we constructed semistructured questions to conduct interviews and focus groups with obstetrical clinicians. Transcripts were coded using NVIVO, utilizing inductive and deductive approaches, and content and narrative analysis to identify themes. Participant consent and IRB exemption status were obtained. RESULTS: We interviewed 20 clinicians: 6 ob-gyn physician interviews, 3 CNMs, and 14 RNs across two focus groups between January and July 2023. Key themes emerged regarding systemic challenges and opportunities. Identified challenges include 1) clinician bias and poor communication, 2) unequal care, 3) patient mistrust, and 4) lack of administrative data. Opportunities for future directions include 1) implementation of clinician training and simulation with an equity lens, 2) standardization of maternal care with safety bundles, 3) incorporation of group prenatal care and expansion of postpartum wraparound services, and 4) disaggregation of clinical operations data by race. CONCLUSION: This study identifies key challenges and opportunities to address the Black maternal health crisis. Our findings inform priorities to guide ACOG's collective action and commitment to eliminating racial inequities that lead to disparate health outcomes.

Disregarding Uncertainty, Marginalizing Patients

What does it mean to “trust the science”? The phrase is often used to suggest that scientific knowledge is static and that the public can treat current recommendations as eternal verities. The medical community is not omniscient, however. Indeed, some illnesses are characterized by uncertainty: it is not clear with what frequency the associated symptoms occur or whether they are a manifestation of a psychological disorder or a physiological disease. The medical field is no stranger to such challenges, labeling such illnesses as “contested.” The communication of uncertainty surrounding these illnesses, however, presents a troubling dynamic. Rather than engaging in constructive dialogue that moves scientific understanding forward, viewpoints become entrenched, points of disagreement are obscured, and professionals retaliate against one another. In the best case scenario, patients are merely left to sort through dense medical concepts on their own; in the worst case, they are targeted by predatory providers. Patients suffer, trust in science declines.
 Drawing on insights from the economics literature, this Article presents a theoretical framework for approaching the uncertainty inherent in contested illnesses. The framework discusses the pattern of evidence accumulation that accompanies an uncertain illness, distinct from that of a disease where uncertainty is substantially resolved. Applying these insights to the communication of uncertainty surrounding contested illnesses, the Article notes that null results in the presence of well-designed studies should be weighed differently than null results in the presence of case studies or small sample studies. If an illness is truly uncertain, the framework highlights the potential benefits of additional caution in approaching irreversible actions, such as prematurely communicating the resolution of uncertainty (which can lead to the development of patient mistrust). This careful communication of uncertainty is vital to prevent patient marginalization and to clarify the often-inscrutable information landscape in these contexts. Current regulations for medical providers and public figures are insufficient, however, to incentivize such careful communication. This Article proposes a government-coordinated informational digest that weighs existing evidence based on the rigor of study design and imputes null results to missing results of completed studies. The agency coordinating the digest will provide incentives for studies that fill gaps in the literature and which incorporate input from patient advocate groups into the design. In doing so, it will enable the medical community to both better handle existing uncertainty and to take important steps toward resolving it. More importantly, however, this transparent process educates the public about how scientific beliefs should evolve and prevents the irreversible harm of patient marginalization.

Abstract A112: Approaches to addressing cancer mortality disparities in U.S. health organizations: Identifying key themes in collaborative grant projects

Abstract Background Black men and women facing cancer diagnoses are more likely than White men and women to die from their disease despite similar or lower cancer incidence rates (American Cancer Society Cancer Facts & Figures for African American/Black People 2022-2024). The American Cancer Society (ACS), in partnership with Pfizer Global Medical Grants (Pfizer), provided grant funding and engagement support to 16 projects based in 12 U.S. states and the District of Columbia examining prostate or multi-site cancer disparities along the cancer care continuum. Post hoc interviews by ACS team members were conducted with researchers to identify main themes discovered during their project period. These findings were key takeaways to be utilized in future work related to cancer mortality disparity efforts. Methods From April through June 2023, 16 grant-funded project leads were invited to participate in 30-45 minute qualitative virtual interviews. These semi-structured interviews included questions related to how projects addressed racial disparities in their communities, partnerships with stakeholder groups, and resources and educational materials created. The open-ended questions were adopted to allow for project leads to share their unique perspective and project details they deemed important to address in the cancer disparities research area. Interviews were audio recorded and transcribed for accuracy. Three independent coders read and extracted important quotes to identify common themes. Results A total of 15 out of the 16 grant-funded project teams were interviewed, with one interview postponed to outside the study period. Various themes were identified among the project interviews, with most centered around interventions addressing health system on the patient- and provider- levels. The most common interventions and themes identified as ways to bridge the cancer mortality gap in Black and White people include: creating relatable and culturally adaptive educational materials, assistance with transportation and communication barriers, prioritizing patient social needs, utilizing patient navigators to supplement patient support, addressing providers’ unconscious bias and patient mistrust, incorporating artificial intelligence to streamline patient care, and organizing community partnerships to expand the reach of potential patients and encourage visitation for cancer screenings. Conclusion These post hoc interviews among grant funded projects highlighted important areas along the cancer care continuum that can be addressed and further studied as ways to decrease the cancer mortality gap between Black and White people. The public-private grants partnership between ACS and Pfizer provided a unique opportunity to explore novel interventions in the field of cancer disparities. This meaningful work can be similarly extended to other health organizations to continue the work in communities across the U.S. in an effort to eliminate racial disparities in cancer outcomes. Citation Format: Emily C. Marlow, Kristen A. Wehling, Karla L. Wysocki, Dewayne Brumlow. Approaches to addressing cancer mortality disparities in U.S. health organizations: Identifying key themes in collaborative grant projects [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A112.

Words matter: How clinical encounters can be unknowingly stigmatizing to some patient communities.

356 Background: Lack of patient engagement around the content and approach to care conversations related to social determinants of health (SDOH) can negatively impact healthcare experiences and exacerbate disparities in outcomes. Lived environment, financial/logistical challenges, general access barriers and patient mistrust must be addressed on a systemic and individual level. Assumptions based on socioeconomic status, age, race, gender, and medical conditions can undermine communication and/or invalidate a patient's feelings and lived experiences. Accelerating the requirement of SDOH screenings without addressing the patient-centeredness of these conversations will likely contribute to health inequities and yield substandard patient experiences and outcomes. Methods: To better understand patient perspectives about language commonly used in SDOH screenings, we gathered views on terminology used towards patients through surveys, focus groups, and virtual workshops. Participants were recruited from a diverse pool of insured patients served by Patient Advocate Foundation representing various medical diagnoses, were lower income (<$48,000), racially/ethnically reflective of the US, and experienced healthcare access and/or affordability challenges. Results: Patients had both positive and negative perspectives on SDOH screening in clinical settings, specifically focused on communication, bias, and privacy. Survey/focus group results revealed the discomfort of financial and non-medical information (SDOH) being included in their electronic medical record (EMR). “It’s important to find words that are less stigmatizing because it affects how we see ourselves and others.” Only 21% reported being extremely comfortable with SDOH information being recorded in their EMR and subsequently being available to multiple members of their healthcare team. Judgement, embarrassment, shame, and lack of action (i.e., linkage to resources) were often cited as reasons for not wanting to have uncomfortable conversations. Patients also felt that disclosing this information could (or would) influence the treatment options offered, creating bias solely regarding their perceived ability to manage their medical and non-medical financial obligations. Conclusions: We uncovered how, without patient engagement, language and processes the healthcare system uses can feel biased and stigmatizing to those it is designed to help. Stigmatizing conversations can perpetuate discriminatory attitudes, influence clinicians' decision-making when treating a patient, and affect patient trust and disclosure within care settings. This cycle impacts quality of care and contributes to health disparities. By listening to patient perspectives, researchers and health care professionals can become more culturally aware and reduce stigmatizing language, while making care more patient-centric and inclusive.

Race, ethnicity, and immune tolerance induction in hemophilia A in the United States

BackgroundIn racially diverse communities, treatment of chronic diseases can vary across racial and ethnic groups. ObjectivesTo examine healthcare disparities in hemophilia care in the United States by evaluating receipt of immune tolerance induction (ITI) among different racial and ethnic groups. MethodsIn this cross-sectional study, people with severe hemophilia A with an inhibitor who entered the Center for Disease Control and Prevention Community Counts registry between 2013 and 2017, were aged ≥5 years at study entry, and had a history of an inhibitor (n = 614) were included. The proportion of participants receiving ITI was examined according to race and ethnicity in bivariable analysis and multivariable analysis adjusting for demographic and clinical covariates. Unadjusted and adjusted prevalence ratios and corresponding 95% CIs were computed. ResultsAmong 614 participants included in the study, 56.4% were non-Hispanic (NH) White, 19.7% were NH Black, 18.4% were Hispanic, and 4.9% were Asian. ITI was received by 85.2% of participants. On bivariable analysis, ITI treatment did not vary by race or ethnicity. On multivariable analysis, NH Black and Hispanic participants were significantly less likely to receive ITI compared to NH White participants (adjusted prevalence ratio, 0.91 [95% CI, 0.84-0.99] and 0.84 [95% CI, 0.75-0.93], respectively). ConclusionAlthough the role of ITI may evolve with growing use of emicizumab and the introduction of new hemophilia treatment products, understanding characteristics that influence care, particularly race and ethnicity, where physician bias and patient mistrust can occur, will remain relevant and applicable to other complex therapies, including gene therapy.

Patient and healthcare professional perspectives on implementing patient-reported outcome measures in gender-affirming care: a qualitative study

ObjectivesPatient and healthcare professional perspectives are needed to develop a gender-affirming care patient-reported outcome measure (PROM) implementation plan. We aimed to identify top considerations relevant to gender-affirming care PROM implementation...

Experiences and Perceptions of Healthcare Stakeholders in Disclosing Errors and Adverse Events to Historically Marginalized Patients.

We sought to assess the experiences and perceptions of healthcare stakeholders involved in the response to historically marginalized patients who have been harmed in healthcare. We investigated the challenges in disclosing errors and adverse events and the types of tools and resources that would better address the needs of historically marginalized patient populations. We conducted separate focus groups with two healthcare stakeholder groups: (1) frontline clinicians directly involved in the clinical care of historically marginalized patients and (2) risk and patient safety professionals involved in the hospital response to care breakdowns. We conducted an inductive analysis of the qualitative data to identify thematic clusters. We interviewed 7 clinicians and 5 risk safety professionals, with a total sample size of 12 participants. Participants shared multilevel challenges in responding to historically marginalized patients after harm (system-, organizational-, and patient-level), such as fragmentation of care, lack of standardized protocols, and patient mistrust. Participants also identified their desired tools and resources for disclosure to meet the needs of historically marginalized patients, which included culturally appropriate toolkits, disclosure training, and the inclusion of multidisciplinary healthcare team members in the disclosure process. Our results suggest that multiple interventions will be needed to achieve the goal of prompt disclosure of errors and adverse events across all populations engaged in health care. Future studies should investigate the perspectives of historically marginalized patients and their family members on how error and adverse event disclosure conversations should unfold.

The study and application of brain tumors classification based on artificial intelligence

The application of AI in the medical field has been increasingly popular due to its ability to enhance the accuracy and efficiency of diagnoses. A plurality of individuals employs diverse techniques and refine existing methods in order to achieve greater precision. This paper provides an overview of the methodology utilized in early research papers for brain tumors classification. This includes the input of datasets, preprocessing, model building, training and testing, evaluation, and application. In addition, this paper presents four models used in early research, including the Artificial neural network (ANN) which mimics the organization and operation of neural networks in living organisms by processing information through interconnected nodes or neurons. Another model is k-Nearest Neighbor (KNN), an instance-based learning algorithm that labels new data points by comparing them to the K closest labeled data points in the training dataset. The third model is Visual Geometry Group-16 (VGG-16), a 16-layer Convolutional Neural Network (CNN) that is highly regarded for its simplicity and effectiveness and is one of the top-performing CNN models used by VGG. Lastly, GN-AlexNet is a hybrid learning mode that combines the GoogleNet structure with the AlexNet model. The remainder of the article explains the utilization of this AI in three application scenarios, namely as an assistant for doctors, patients, and insurance companies. Moreover, the paper highlights potential challenges that may arise in both the present and future, such as patient mistrust and the emergence of new models like Vision Transformer (ViT) that could potentially outperform CNNs.

PS03 Dermatologist perspectives on topical steroid withdrawal: distrust, disinformation and distance?

Abstract Topical steroid withdrawal (TSW) has become a polarizing phenomenon. The TSW has been described as ‘intense erythema and burning…more prolonged than can be explained by the rebound vasodilation that occurs after discontinuing topical steroids’ (Cotter C, Burton T, Proctor A et al. Topical steroid withdrawal syndrome: time to bridge the gap. Br J Dermatol 2022; 187:780–1). However, TSW acceptance and consensus around diagnosis have proven elusive among dermatologists. This contrasts with a growing patient movement online, with > 572 million views of #topicalsteroidwithdrawal on TikTok. Disparities between patient and clinician acceptance have care implications, relating to psychological wellbeing and engagement with services (Scott S, Deary I, Pelosi AJ. General practitioners’ attitudes to patients with a self diagnosis of myalgic encephalomyelitis. BMJ 1995; 310:508). Self-reported diagnosis of previous emergent, ‘unexplained’ conditions like myalgic encephalomyelitis led to negative clinician attitudes regarding patient concordance, potentially leading to worse outcomes and psychological burden. This study aimed to clarify dermatologist perspectives regarding TSW and assess attitudes toward self-diagnosis. A two-part online questionnaire was developed and disseminated to UK-based dermatology consultants, registrars and fellows via social media and email. Section one presented a TSW clinical scenario and randomized respondents into two groups, one mentioning self-diagnosis of TSW and an otherwise identical control without self-diagnosis. Questions focused on attitudes regarding patient predicted behaviours. Section two asked perspectives on TSW as an entity and management experiences. Comparative data were analysed via SPSS (IBM, Armonk, NY, USA) using statistical tests. In total, 103 responses were received, including those from 51 consultants and 38 registrars. Thirty-four per cent of respondents considered TSW to be a distinct clinical entity, 17.5% did not and 48.5% were unsure. The cohort had seen at least 599 patients presenting with a self-diagnosis of TSW but made the diagnosis itself 157 times. Eighty-two per cent linked the diagnosis to social media and 96.1% most associated TSW with eczema. Eighteen per cent felt their patients with TSW were receiving adequate care. There were statistically significant differences whereby respondents felt patients self-diagnosing with TSW were less likely to comply with treatment (P = 0.003), were more likely to take up one’s time (P = 0.001), would pose difficult management problems (P ≤ 0.001) and would be less desirable on clinic lists compared with controls not mentioning TSW (P ≤ 0.001). Qualitative themes included inappropriate topical steroid use, patient mistrust and desire for further research. Many dermatologists encounter patients presenting with TSW self-diagnoses, but uncertainty regarding its validity is common. Clinicians see this phenomenon as strongly linked to eczema and as being driven by social media. Patients self-diagnosing with TSW were more likely to be viewed negatively in terms of treatment concordance and difficulty with management. A minority of dermatologists believe their patients with TSW are receiving adequate care. Further research is essential to achieve consensus and support patients.

Obstetric experiences of young black mothers: An intersectional perspective

BackgroundIn Chicago, maternal morbidity and mortality is six times more likely among Black birthing people than white, despite policy initiatives to promote maternal health equity. Disparities in maternal morbidity and mortality reflect experiences of structural inequities – including limited quality obstetric care, implicit bias, and racism resulting patient mistrust in the health care system, inadequate social support, and financial insecurity. Although there is published literature on Black women's experiences with obstetric care, including experiences with individual and structural racism, little is known about the intersection of age and race and experiences with health care. The purpose of this study was to explore the maternal health and pregnancy experiences of young Black women utilizing an intersectional theoretical lens. MethodsIn this study, we conducted two focus groups in a sample of 11 young Black pregnant people. We conducted a thematic analysis to identify codes, themes, and subthemes of the data. ResultsWe developed two overarching themes: obstetric racism and obstetric resistance. To elucidate how obstetric racism framed our participants’ healthcare experiences, we identified sub-themes: intersectional identities as young Black women, medical mistrust, and pregnancy trauma. The second major theme describes ways in which participants protected themselves against obstetric racism to engender positive health experiences. These methods of resistance included identifying advocates and relying on trusted providers. ConclusionsThe current standard of obstetric care in the US is suboptimal due to individual and structural racism. This study provides unique data on the experiences with health care for young, Black pregnant individuals and delivers valuable insight into how individual and structural racism impacts obstetric care for young Black women.

Inequitable Care Delivery for COVID-19 Positive People of Color and People With Disabilities

<h3>Research Objectives</h3> To explore provider observations of inequitable care delivery towards COVID-19 positive patients who are Black, Indigenous, and People of Color (BIPOC) and/or have disabilities and to identify ways health providers may be contributing to and compounding inequitable care. <h3>Design</h3> Qualitative research design using thematic analysis of data collected via individual semi-structured interviews between April and November 2021. <h3>Setting</h3> Hospitalized and ambulatory care. <h3>Participants</h3> A total of 19 pandemic frontline health care providers including nine physicians, five nurses, three rehabilitation professionals, and two nurse practitioners from Washington, Florida, Illinois, and New York were recruited through convenience and snowball sampling. The majority of participants were female (n=12) and White (n=11). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> A semi-structured interview guide included questions regarding equity in treatments among COVID-19 patients who are BIPOC or have disabilities and perceptions around stigma related to COVID-19. <h3>Results</h3> Discriminatory treatment included decreased care (i.e., less explanation due to communication barriers, less interaction with health care providers, no access to telehealth follow-ups), delayed care, and fewer options for care. Health care providers' bias and stigma (racism, ableism, and ageism), patient mistrust and provider-patient disconnect, lack of resources (e.g., staff, interpreter services, funding, or collaboration across health systems), fear of transmission, and burnout were mentioned as drivers for discriminatory treatment. COVID-19 related health system policies such as visitor restrictions and telehealth follow-ups also inadvertently resulted in discriminatory practices towards BIPOC patients and patients with disabilities. <h3>Conclusions</h3> BIPOC patients and patients with disabilities may experience lower quality of healthcare related to COVID-19 due to factors such as providers' biases, fear, burnout, and lack of needed resources in their work settings. In addition, COVID-19-related restrictions and policies compounded existing inequitable care for these populations. <h3>Author(s) Disclosures</h3> Authors do not have conflicts to disclose.

Endoscopy COVID-19 Testing Requirements Disproportionately Affect Communities That Are Medically Underserved and May Worsen Health Care Disparities

Inequities in health care outcomes among communities that are medically underserved are prevalent in the field of gastroenterology, especially related to cancer prevention and cancer-related morbidity and mortality. Uptake and completion of colorectal cancer (CRC) screening is impacted by patient-, provider-, and system-level factors, such as patient mistrust or fear, financial barriers, and lack of access to specialists and colonoscopy, as well as other barriers (Figure 1).1 Black patients are less likely to be screened for CRC, are more likely to present with late-stage CRC, and have a lower 5-year survival rate.

Tackling the global impact of substandard and falsified and unregistered/unlicensed anti-tuberculosis medicines

Substandard and falsified (SF) medicines are a global health challenge with the World Health Organization (WHO) estimating that 1 in 10 of medicines in low- and middle-income countries (LMICs) are SF. Antimicrobials (i.e. antimalarials, antibiotics) are the most commonly reported SF medicines. SF medicines contribute significantly to the global burden of infectious diseases and antimicrobial resistance (AMR). This article discusses the challenges associated with the global impact of SF and unregistered/unlicensed antimicrobials with a focus on anti-TB medicines. Tuberculosis (TB) is the 13th leading cause of death worldwide, and is currently the second leading cause of death from a single infectious agent, ranking after COVID-19 and above HIV/AIDS. Specifically in the case of TB, poor quality of anti-TB medicines is among the drivers of the emergence of drug-resistant TB pathogens. In this article, we highlight and discuss challenges including the emergence of SF associated AMR, patient mistrust and lack of relevant data. We also present study reports to inform meaningful change. Recommended solutions involve the adaptation of interventions from high-income countries (HICs) to LMICS, the need for improvement in the uptake of medication authentication tools in LMICs, increased stewardship, and the need for global and regional multidisciplinary legal and policy cooperation, resulting in improved legal sanctions.

Abstract 11231: Rethinking the Disconnect in Patient Outreach: Key Considerations in Addressing Racial Disparities in Hypertension

Background: Disparities in hypertension and cardiovascular outcomes among Black men in the US are influenced by social determinants of health (SDOH) and systemic inequity. Self-measured blood pressure (SMBP) monitoring programs may be an efficacious strategy to combat these disparities in the community setting. Leveraging the advantages of SMBP, however, requires improved understanding of barriers to engagement in this population. Methods: A total of 258 Black male patients of a Federally Qualified Health Center, with severe hypertension ( &gt; 160mm Hg systolic or &gt; 100mm Hg diastolic) were eligible. Patients were called using the phone number(s) in the electronic health record (EHR), and callers documented brief summaries of the call. At least 3 attempts were made to offer a free BP cuff, and provide longitudinal SMBP education and heart-healthy lifestyle counseling. NVivo was used for coding and content analysis, employing mixed inductive and deductive approaches to identify barriers to engagement. Coding structure included ‘communication’ and ‘engagement’, stratified by positive and negative attributes. Results: Analysis of initial outreach data (n=172) highlighted themes of unfavorable engagement to include excessive burden from competing health priorities and socioeconomic stress, and communication themes included unreliable phone numbers in the EHR hindering contact, and skepticism/mistrust of the caller by those patients reached. (Table). Conclusion: Optimizing engagement in SMBP programs to address hypertension disparities remains challenging, however improved SDOH screening and resource connection, system practices in EHR integrity, and understanding of patient mistrust of the health system may be key considerations. Ongoing thematic analyses on sustained SMBP skill-building and patient trust in care navigation may provide further insight on strategies to improve racial disparities in cardiovascular health outcomes.

Implementation and Evaluation of a 10-Week Health Equity Curriculum for Pharmacy Students

Objective To describe a health equity curriculum created for pharmacy students and evaluate students' perceptions and structural competency after completion of the curriculum.Methods A health equity curriculum based on transformative learning and structural competency frameworks was implemented as a 10-week mandatory component of the pass-no pass neuropsychiatric theme for second year pharmacy students. Each week, students reviewed materials around a neuropsychiatric-related health equity topic and responded to discussion prompts through asynchronous forums or synchronous online video discussions. The effectiveness of the health equity curriculum was evaluated through assessment of structural competency through a validated instrument, an objective structured clinical examination (OSCE), and a questionnaire.Results All enrolled second year pharmacy students (n=124) participated in the health equity curriculum. Of the 75 students who completed the structural competency instrument, 46 (61%) were able to identify structural determinants of health, explain how structures contribute to health disparities, or design structural interventions. Ninety-six of the 124 students (77%) were able to address their OSCE standardized patient's mistrust in the health care system. Thematic analysis of student comments elucidated three themes: allyship, peer connection, and self-awareness. Students rated asynchronous discussion forums as significantly less effective than online video discussions and patient cases for achieving curricular objectives.Conclusion A mandatory curriculum delivered remotely throughout the didactic pharmacy curriculum using a blended learning approach was an effective way to incorporate health equity content and conversations into existing courses. Implementation of this or similar curriculums could be an important step in training pharmacy students to be advocates for social justice.

Race, ethnicity, and emergency department post-overdose care

BackgroundEmergency department (ED) visits for opioid-related overdoses continue to rise across the United States, particularly among Black, Latinx, and American Indian/Alaskan Native communities. A minority of people with opioid use disorder (OUD) engages in formal addiction treatment and there are racial disparities in treatment access. ED visits for opioid overdose are crucial opportunities to link individuals with OUD to harm reduction and treatment services. However, we know little about whether racial inequities exist in ED treatment after opioid overdose. MethodsThis observational, cross-sectional study examined differences in services provided to overdose patients who were discharged after an ED visit for opioid overdose by patient race-ethnicity. Primary outcomes included provision of take-home naloxone, ED-based behavioral counseling, and linkage to treatment. Race-ethnicity differences in post-overdose ED services were evaluated using chi-square analyses, and multivariable logistic regression analyses were conducted to examine associations of race-ethnicity with receiving post-overdose services, controlling for other institutional-, provider-, and patient-level factors. ResultsFrom September 2017 to February 2020, 734 patients were discharged from the ED for an opioid-related overdose. Most patients were White non-Latinx (70.0%), 8.9% were Black non-Latinx, 3.3% were Other race non-Latinx, and 18.0% were Latinx. Take-home naloxone was the most frequent intervention provided to patients while behavioral counseling was the lowest across all race-ethnicity categories. There were no statistically significant differences in provision of take-home naloxone and treatment referral based on patient race-ethnicity. However, a lower proportion of discharged Black non-Latinx patients received behavioral counseling compared to patients of other race-ethnicities, and the odds of receiving behavioral counseling was significantly higher for White non-Latinx (OR: 1.75; 95% CI: 1.00, 3.06); Latinx (OR: 2.06; 95% CI: 1.05, 4.06); and Other race non-Latinx (OR: 3.29; 95% CI: 1.18, 9.15) patients compared to Black non-Latinx patients. ConclusionBlack non-Latinx patients discharged from the ED for an opioid-related overdose were less likely to receive behavioral counseling compared to non-Black patients. Possible reasons for this decreased provision of behavioral counseling include provider bias, patient mistrust of the medical and behavioral health care systems, and limited provider training in addiction medicine and motivational interviewing. These inequities add to the known racial disparities in ED patient care. Further research should elucidate barriers to behavioral counseling within ED settings and factors contributing to racial inequities in post-overdose emergency care.

Colorectal cancer disparities and African Americans: is it time to narrow the gap?

Colorectal cancer is the second most common cause of cancer death in both men and women. Although the overall incidence and mortality rates of colorectal cancer are declining, African Americans have significantly higher rates of colorectal cancer than Caucasians, and they have worse 5-year survival rates. This article reviews some of the contributing factors that lead to this racial disparity in colorectal cancer between these groups. The increase in poor health outcomes among African Americans is due to low socioeconomic standing, poor compliance, psychosocial barriers, and patient mistrust of healthcare providers and the healthcare system. Research on interventions to improve health outcomes is important to reduce the causes of these disparities.&#x0D; Keywords: colorectal cancer; screening; African Americans; Blacks; health disparities; interventions; public health