Phone Contact Research Articles

Need to belong, daily social engagement, and transient loneliness in late life

Social experiences are of great importance in late life, and the need to belong may play a key role in shaping those experiences. A higher need to belong may motivate older adults to maintain a wide variety of social connections (e.g., family ties, friends, acquaintances, group engagement), yet may also lead to higher risks of feeling unsatisfied and lonely. However, little research examines how the need to belong may shape older adults’ social life in the daily context. This study examines the associations between older adults’ need to belong, daily social engagement, and transient loneliness in their everyday life. Older adults ( N = 299) aged 65–89 completed the Need to Belong Scale, measures of their social networks, and ecological momentary assessment (EMA) surveys for five to six days. At each three-hour assessment, they reported in-person and phone contact with a variety of social partners (e.g., family, friends, acquaintances, etc.), whether they engaged in a social group, and rated their feelings of loneliness. In multilevel models, the need to belong did not predict the variety of partners encountered in-person or by phone, but predicted a greater likelihood of engagement with social groups. Older adults with a higher need to belong reported that they felt lonelier at three-hour intervals throughout the day, but this association was attenuated when they had in-person encounters with a greater variety of social partners. Group engagement was associated with feeling less lonely, whereas phone communication was associated with feeling more lonely, regardless of the need to belong. The findings suggest that social engagement with a variety of types of social partners may help satisfy older adults’ need to belong, and highlight the unique benefits that in-person contact (vs. phone contact) and group engagement may confer to mitigate older adults’ loneliness.

Feasibility and acceptability of mobile phone-based triage tool to identify discharged trauma patients in need of further care in Cameroon

BackgroundLack of routine follow-up for trauma patients after hospital discharge likely contributes to high rates of injury-related complications in Cameroon. Mobile phone contact may facilitate timely follow-up and reduce disability...

Preventive interventions to improve older people's health outcomes: systematic review and meta-analysis.

Systematic reviews of preventive, non-disease-specific primary care trials for older people often report effects according to what is thought to be the intervention's active ingredient. To examine the effectiveness of preventive primary care interventions for older people and to identify common components that contribute to intervention success. A systematic review and meta-analysis of 18 randomised controlled trials (RCTs) published in 22 publications from 2009 to 2019. A search was conducted in PubMed, MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, and the Cochrane Library. Inclusion criteria were: sample mainly aged ≥65 years; delivered in primary care; and non-disease-specific interventions. Exclusion criteria were: non-RCTs; primarily pharmacological or psychological interventions; and where outcomes of interest were not reported. Risk of bias was assessed using the original Cochrane tool. Outcomes examined were healthcare use including admissions to hospital and aged residential care (ARC), and patient-reported outcomes including activities of daily living (ADLs) and self-rated health (SRH). Many studies had a mix of patient-, provider-, and practice-focused intervention components (13 of 18 studies). Studies included in the review had low-to-moderate risk of bias. Interventions had no overall benefit to healthcare use (including admissions to hospital and ARC) but higher basic ADL scores were observed (standardised mean difference [SMD] 0.21, 95% confidence interval [CI] = 0.01 to 0.40) and higher odds of reporting positive SRH (odds ratio [OR] 1.17, 95% CI = 1.01 to 1.37). When intervention effects were examined by components, better patient-reported outcomes were observed in studies that changed the care setting (SMD for basic ADLs 0.21, 95% CI = 0.01 to 0.40; OR for positive SRH 1.17, 95% CI = 1.01 to 1.37), included educational components for health professionals (SMD for basic ADLs 0.21, 95% CI = 0.01 to 0.40; OR for positive SRH 1.27, 95% CI = 1.05 to 1.55), and provided patient education (SMD for basic ADLs 0.28, 95% CI = 0.09 to 0.48). Additionally, admissions to hospital in intervention participants were fewer by 23% in studies that changed the care setting (incidence rate ratio [IRR] 0.77, 95% CI = 0.63 to 0.95) and by 26% in studies that provided patient education (IRR 0.74, 95% CI = 0.56 to 0.97). Preventive primary care interventions are beneficial to older people's functional ability and SRH but not other outcomes. To improve primary care for older people, future programmes should consider delivering care in alternative settings, for example, home visits and phone contacts, and providing education to patients and health professionals as these may contribute to positive outcomes.

Age-friendly practices during the COVID-19 pandemic: Findings from a scoping review

Abstract Background The COVID-19 pandemic called for innovation and leverage of existing age-friendly practices to promote older people's functional ability and enable them to contribute to their communities and enjoy life. Our aim was to explore the evidence available concerning the development, adaptation, and evaluation of age-friendly practices during the COVID-19 pandemic. Methods A review was conducted in line with the Joanna Briggs Institute scoping review methodology. We considered publications of practices across the 8 domains of the World Health Organization (WHO) age-friendly framework. Our search strategy comprised databases (PubMed, Web of Science, Scopus) and grey literature sources. Results Preliminary findings identified 37 practices by member organizations of the WHO network. The most targeted domains were community support and healthcare services; communication and information; and social participation; while the least targeted were transportation; housing; and outdoor spaces and buildings. Adaptive strategies often relied on remote delivery of information and services through digital or phone contact. Most practices were led by local authorities in collaboration with community organizations, universities, and healthcare practitioners. Opportunities for older people to contribute to the design and implementation of practices varied widely across settings. Enablers for adaptation or development included pre-existing collaborations between stakeholders, availability of contact details of older people in the community, and availability of human and material resources to implement changes. Challenges included limited literacy and access to digital technologies, and participants’ distrust of remote activities. Conclusions Findings emerging from the scoping review provide insights regarding age-friendly practices during COVID-19 and may inform the development of appropriate multi-stakeholder and participatory interventions during future public health crises. Key messages • Age-friendly practices may significantly contribute to meet older people’s material, social and affective needs during public health crises. • Opportunities to leverage age-friendly practices increase with the inclusion of older people’s voices, intergenerational solidarity, multi-stakeholder involvement and strong political will.

University Students’ Techno-Panic: What Learning Support is Available?

The current study sought to identify the level of support provided for first year university students during the novel COVID-19 pandemic online classes with the Moodle learning management system (LMS). The researchers surveyed 1416 first year university students in the second semester of the 2019/2020 academic year, who were all supposed to be part of the web-based courses to logically bring the semester to an end. In an attempt to make students become familiar with the use of the Moodle LMS, the university introduced measures like online orientation, creation of instructional videos, provision of hot phone contact lines as well as IT centre support. Out of these interventions rolled-out by the university, the researchers found that the students did not gain the required benefits as envisaged by the University and for that matter affected the students adversely. From an instructional standpoint, the measures put in place to familiarize students with the Moodle system were laudable. However, the support services provided had issues of implementation. A need exists for a more comprehensive and coordinated support services to adequately equip university students to participate meaningfully in web-based learning.

Long-Term Prognostic Value of Automated Measurements in Nuclear Cardiology: Comparisons with Expert Scoring.

Background and Objectives: Automated methods for the analysis of myocardial perfusion studies have been incorporated into clinical practice, but they are currently used as adjuncts to the visual interpretation. We aimed to investigate the role of automated measurements of summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) as long-term prognostic markers of morbidity and mortality, in comparison to the prognostic value of expert reading. Materials and Methods: The study was conducted at the Nuclear Medicine Laboratory of the University of Thessaly, in Larissa, Greece. A total of 378 consecutive patients with known or suspected coronary artery disease were enrolled in the study. All participants were referred to our laboratory for the performance of stress/rest myocardial perfusion single photon emission computed tomography. Automated measurements of SSS, SRS, and SDS were obtained by Emory Cardiac Toolbox (ECTb (Version 3.0), Emory University, Atlanta, GA, USA), Myovation (MYO, Xeleris version 3.05, GE Healthcare, Chicago, IL, USA), and Quantitative Perfusion SPECT (QPS (Version 4.0), Cedars-Sinai Medical Center, Los Angeles, CA, USA) software packages. Follow-up data were recorded after phone contacts, as well as through review of hospital records. Results: Expert scoring of SSS and SDS had significantly greater prognostic ability in comparison to all software packages (p < 0.001 for all comparisons). Similarly, ECTb-obtained SRS measurements had significantly lower prognostic ability in comparison to expert scoring (p < 0.001), while expert scoring of SRS showed significantly higher prognostic ability compared to MYO (p = 0.018) and QPS (p < 0.001). Conclusions: Despite the useful contribution of automated analyses in the interpretation of myocardial perfusion studies, expert reading should continue to have a crucial role, not only in clinical decision making, but also in the assessment of prognosis.

Gestational diabetes screening and management: the issues of GDM risk factors and phone number documentations

Background: Gestational diabetes mellitus (GDM) if unmanaged can complicate pregnancy outcomes. Selective screening of GDM is a common policy hence, the need for complete medical records of patients. The extent and pattern that documentation of patients’ records can impact GDM screening-by-telehealth requires elucidation. The aim was to describe the effectiveness of phone contacts on medical records and GDM risk factors among a hospital-based antenatal clinic setting Methods: This was an observational study in which previously reported antenatal records of patients screened for GDM were reviewed for effectiveness of phone contacts to do telehealth, and this was with simultaneous GDM risk assessment. Data were analysed by descriptive frequency counting. Results: On effectiveness of phone details on medical records, 41/98 cases were reached, of which 31.7% have three or more GDM risk factors to fulfil selection criteria for laboratory screening of GDM. Prevalence of risk factors in initial routine data collection (24.9%), previous history assessment (21.3%) and at antenatal monitoring phase (37.8%), Among the 57/98 phone contacts that were unreached, 59.6% are switched off. Conclusions: The observations highlight the need of concerted focus on policy and education, for both staff and patients, to improve documentation of correct and valid telephone details in medical records.

Medical experience as an influencing parameter in emergency medical care for psychiatric emergencies: retrospective analysis of a multicenter survey

BackgroundPrehospital care of psychiatric patients often relies on the medical experience of prehospital emergency physicians (PHEPs). The psychiatrists (PSs) involved in the further treatment of psychiatric patients also often rely on their experience. Furthermore, the interaction between PHEPs and PSs is characterized by interaction problems and different approaches in the prehospital care of the psychiatric emergency.ObjectivesTo analyze the phenomenon of “medical experience” as a cause of possible interaction-related problems and assess its impact on the prehospital decision-making process between prehospital emergency physicians and psychiatrists.MethodsThe retrospective data analysis was conducted between November 2022 and March 2023. Medical experience was defined as follows, based on the demographic information collected in the questionnaires: For PHEPs, the period since obtaining the additional qualification in emergency medicine was defined as a surrogate marker of medical experience: (i) inexperienced: < 1 year, (ii) experienced: 1–5 years, (iii) very experienced: > 5 years. For PSs, age in years was used as a surrogate parameter of medical experience: (i) inexperienced: 25–35 years, (ii) experienced: 35–45 years, (iii) very experienced: > 45 years.ResultsInexperienced PSs most frequently expressed anxiety about the psychiatric emergency referred by a PHEP (27.9%). Experienced PHEPs most frequently reported a lack of qualifications in handling the care of psychiatric emergencies (p = 0.002). Very experienced PHEPs were significantly more likely to have a referral refused by the acute psychiatric hospital if an inexperienced PS was on duty (p = 0.01). Experienced PHEPs apply an intravenous hypnotic significantly more often (almost 15%) than PSs of all experience levels (p = 0.001). In addition, very experienced PHEPs sought prehospital phone contact with acute psychiatry significantly more often (p = 0.01).ConclusionPHEPs should be aware that the PS on duty may be inexperienced and that treating emergency patients may cause him/her anxiety. On the other hand, PHEPs should be receptive to feedback from PS who have identified a qualification deficiency in them. Jointly developed, individualized emergency plans could lead to better prehospital care for psychiatric emergency patients. Further training in the prehospital management of psychiatric disorders is needed to minimize the existing skills gap among PHEPs in the management of psychiatric disorders.

A Survey of Ski Patrols in the United States Comparing Medical Direction, Patroller Training, and Patient Care.

Ski patrols are tasked with substantial challenges: distance from definitive care, complex extrications, and winter environments. Rules for US ski patrols stipulate that ≥1 persons be trained in basic first aid, but no further regulations regarding the specifics of provided medical care exist. This project investigated patroller training, patient care, and medical direction of US ski patrols through a survey of ski patrol directors and medical directors. Participants were contacted via email, phone, and personal contacts. After consultation with known ski patrol directors and medical directors for question guidance, 2 separate institutional review board-approved surveys were designed: 1 for ski patrol directors and 1 for ski patrol medical directors, containing 28 and 15 qualitative questions, respectively. The surveys were distributed with a link to the encrypted Qualtrics survey platform. After 2 reminders and 4 mo, results were downloaded from Qualtrics into an Excel spreadsheet. Twenty-two responses from patrol directors and 15 from medical directors were received. The response rate is unknown. Outdoor emergency care certification was the minimum medical training required by 77% of the study participants. Twenty-seven percent of surveyed patrols belonged to an emergency medical service agency. Fifty percent of 11 surveyed ski patrols had a medical director, 6 of whom were board certified in emergency medicine. All surveyed medical directors stated that they assisted with patroller education, and 93% assisted with protocol development. The surveys demonstrated variability in patroller training, protocols, and medical directorship. The authors questioned whether ski patrols would benefit from increased standardization of care and training, quality improvement programs, and medical directorship.

The impact of a self-management program on exercise adherence among patients discharged after coronary artery bypass grafts: A quasi-experimental study in Thailand.

Exercise adherence is essential for maintaining the physical and mental health of patients after coronary artery bypass grafts (CABG). However, adherence is often poor, particularly in the early weeks after hospital discharge, leading to adverse health outcomes. Therefore, implementing self-management programs is crucial to promote and sustain long-term exercise adherence among these patients. This study aimed to examine the impact of self-management programs on exercise adherence in post-CABG patients. A quasi-experimental posttest-only control group study was conducted from April to November 2022 at Surat Thani Hospital in Thailand. Forty post-CABG patients were gender and age-matched and randomly assigned to either the control group (n = 20) or the experimental group (n = 20). The experimental group participated in a six-week self-management program for exercise adherence, utilizing telephone and LINE applications, while the control group received standard care. Data were collected using validated exercise adherence rating scales and a self-management questionnaire. Descriptive statistics and independent t-tests were employed for data analysis. The mean exercise adherence score in the control group was 9.30 (SD = 4.91), whereas it was 21.30 (SD = 3.20) in the experimental group. The experimental group, which received the self-management program, exhibited significantly higher exercise adherence scores compared to the control group (t = 9.16, df = 32.65, p <0.001). This study demonstrates the effectiveness of a post-CABG self-management program in improving exercise adherence. Nurses play a crucial role in promoting and enhancing self-management during the pre-and post-discharge phases, and regular phone or LINE application contacts can have a positive impact on post-CABG patients. Policymakers should consider implementing self-management programs to encourage patients to maintain their exercise routines, leading to improved physical and mental well-being.

Pregnant women with mild COVID-19 followed in community setting by telemedicine, and factors associated with unfavorable outcome.

Few is known on pregnant women with mild COVID-19 managed in a community setting with a telemedicine solution, including their outcomes. The objective of this study is to evaluate the adverse fetal outcomes and hospitalization rates of pregnant COVID-19 outpatients who were monitored with the Covidom© telemedicine solution. A nested study was conducted on pregnant outpatients with confirmed COVID-19, who were managed with Covidom© between March and November 2020. The patients were required to complete a standard medical questionnaire on co-morbidities and symptoms at inclusion, and were then monitored daily for 30 days after symptom onset. Adverse fetal outcome was defined as a composite of preterm birth, low birthweight, or stillbirth, and was collected retrospectively through phone contact with a standardized questionnaire. The study included 714 pregnant women, with a median age of 32.0 [29.0-35.0] and a median BMI of 23.8 [21.3-27.0]. The main comorbidities observed were smoking (53%), hypertension (19%). The most common symptoms were asthenia (45.6%), cough (40.3%) and headache (25.7%), as well as anosmia (28.4%) and agueusia (32.3%). Adverse fetal outcomes occurred in 64 (9%) cases, including 38 (5%) preterm births, 33 (5%) low birthweights, and 6 (1%) stillbirths. Hospitalization occurred in 102 (14%) cases and was associated with adverse fetal outcomes (OR 2.4, 95% CI 1.3-4.4). Our study suggests that adverse fetal outcomes are rare in pregnant women with mild COVID-19 who are monitored at home with telemedicine. However, hospitalization for COVID-19 and pregnancy-induced hypertension are associated with a higher risk of adverse fetal outcome.

Smoking and COPD Knowledge in the General Spanish Population: A CONOCEPOC Study

Background: The objective of this analysis is to evaluate tobacco use and the level of chronic obstructive pulmonary disease (COPD) knowledge among the general adult population in Spain and to compare these results to those obtained in the 2011 survey. Methods: A cross-sectional, observational, epidemiological study was conducted by telephone interviews and stratified by sex, age, and setting. The study design was identical to that of the study conducted in 2011. Results: Of a total of 89,601 phone contacts, there were 6534 respondents. The average age was 61.5 years. With respect to smoking, 30.9% reported being former smokers and 14.7% were current smokers, 63.6% of whom reported having attempted to quit. Among the current smokers, 19.7% claimed to use electronic cigarettes, although 88% believe these pose a health risk. No significant differences were found in smoking prevalence or frequency of attempts to quit according to residential setting (rural/urban). The highest prevalence of current smoking in men was recorded in the 55–64 years age range (31.6%), while in women it was from 45 to 54 years (34.6%). Smoking has decreased with respect to 2011, from 21.1% to 16.1% in men and from 17.9% to 13.2% in women, with a clear variability according to region. Of the population surveyed, 32.5% had spontaneous knowledge about COPD, with significant geographic variability. The most frequent sources of information about the disease were social media and the Internet (39.6%), followed by the media (35.2%). Conclusions: The prevalence of tobacco use in adults has considerably decreased and there is greater knowledge about COPD in Spain, although there is significant variability according to region, which could explain the geographic variability in the prevalence of COPD. Strategies are needed to increase COPD education and awareness and to reinforce smoking prevention measures among women.

A qualitative study of factors influencing ePHR adoption by caregivers and care providers of Alzheimer's patients: An extension of the unified theory of acceptance and use of technology model

AbstractBackground and AimsAs the nowadays provision of many healthcare services relies on technology, a better understanding of the factors contributing to the acceptance and use of technology in health care is essential. For Alzheimer's patients, an electronic personal health record (ePHR) is one such technology. Stakeholders should understand the factors affecting the adoption of this technology for its smooth implementation, adoption, and sustainable use. So far, these factors have not fully been understood for Alzheimer's disease (AD)‐specific ePHR. Therefore, the present study aimed to understand these factors in ePHR adoption based on the perceptions and views of care providers and caregivers involved in AD care.MethodsThis qualitative study was conducted from February 2020 to August 2021 in Kerman, Iran. Seven neurologists and 13 caregivers involved in AD care were interviewed using semi‐structured and in‐depth interviews. All interviews were conducted through phone contacts amid Covid‐19 imposed restrictions, recorded, and transcribed verbatim. The transcripts were coded using thematic analysis based on the unified theory of acceptance and use of technology (UTAUT) model. ATLAS.ti8 was used for data analysis.ResultsThe factors affecting ePHR adoption in our study comprised subthemes under the five main themes of performance expectancy, effort expectancy, social influence, facilitating conditions of the UTAUT model, and the participants' sociodemographic factors. From the 37 facilitating factors and 13 barriers identified for ePHR adoption, in general, the participants had positive attitudes toward the ease of use of this system. The stated obstacles were dependent on the participants' sociodemographic factors (such as age and level of education) and social influence (including concern about confidentiality and privacy). In general, the participants considered ePHRs efficient and useful in increasing neurologists' information about their patients and managing their symptoms in order to provide better and timely treatment.ConclusionThe present study gives a comprehensive insight into the acceptance of ePHR for AD in a developing setting. The results of this study can be utilized for similar healthcare settings with regard to technical, legal, or cultural characteristics. To develop a useful and user‐friendly system, ePHR developers should involve users in the design process to take into account the functions and features that match their skills, requirements, and preferences.

Intergenerational solidarity with digital communication and psychological well-being among older parents during the COVID-19 pandemic.

We aimed to identify intergenerational solidarity (emotional closeness, in-person contact, phone contact, geographic proximity, consensus, and conflict) with digital communication (texting, video call, and social media interaction) with adult children among older parents during the COVID-19 pandemic. In addition, we aimed to investigate whether intergenerational solidarity with digital communication latent classes were associated with older parents' psychological well-being. We used the 2022 survey of the Longitudinal Study of Generations (LSOG). The sample consisted of 519 older parents who reported about 1245 adult children. Two-level latent class analysis identified six classes at the child level (Level 1: distant but digitally connected, tight-knit and digitally connected, tight-knit traditional, detached, intimate but distant, and sociable). In addition, the analysis identified three classes at the parent level (Level 2: digitally connected, mixed, and intimate but distant). Results of multivariate regression showed that older parents in the digitally connected latent class had better psychological well-being than those in the mixed latent class. Consequently, our finding indicates that digital solidarity with adult children can be beneficial for older parents' psychological well-being during the COVID-19 pandemic.

A Cross-National Study of Nomophobia Among Brazilian, Chinese, French, and U.S. Young People: The Role of Materialism

Why do young people from Generation Z (born between 1995 and the mid-2000s) become nomophobic consumers of smartphones? This research aims for a better understanding of nomophobia, the fear of being without mobile phone contact, and this from a cross-national perspective. Data collected from 1,326 young people (aged 16-24) from Brazil, China, France, and the United States demonstrate that nomophobia is positively related to materialism, the value that consumers place on the acquisition of material objects. A structural equation model shows that the different dimensions of materialism do not affect nomophobia uniformly across national identity. Nomophobia is positively related to the happiness dimension (possessions needed for happiness) in Brazil, to the success dimension (possessions as indicators of success) in China, and to the centrality dimension (possessions as central for the self) in France and the United States. These findings have notable implications for practitioners and researchers.

Outcome of patients older than 85 years hospitalized in a neurology unit

BackgroundAdvanced age is a major determinant of mortality and poor outcome at any level. In hospitalized patients, advanced age is a major issue in terms of prognosis, resource use, and therapeutic choices.AimsWe aimed at assessing the 1 year outcome of elderly patients admitted to a neurology unit for various acute conditions.MethodsConsecutive patients admitted to a neurology unit were enrolled and followed-up at 3, 6, and 12 months with structured phone interviews gathering information about mortality, disability, hospital readmissions, and place of residency. Inclusion criteria were age ≥ 85 years, availability of written consent and phone contact; no exclusion criteria were applied.ResultsOver a period of 16 months, 131 patients (88.8 ± 3.3, 92 females, 39 males) were admitted. The pre-hospitalization modified Rankin Scale (mRS) median (IQR) score, obtainable in 125 patients, was 2 (0, 3) and > 3 in 28/125 (22.4%) patients. Fifty-eight (46.8%) patients had pre-existing dementia (this information was missing for one patient). Eleven patients died during hospitalization. Of the 120 discharged patients, 60 (50%) were alive at 12 months, 41 died during follow-up (34.2%), and 19 (15.8%) were lost. At 12 months, out of the 60 alive patients, 29 (48.3%) had a mRS > 3. We did not detect predictors of 12-month survival. Predictors of 12-month worsening of functional status were pre-hospitalization mRS, pre-existing cognitive impairment, and male sex.ConclusionsOne-year mortality of elderly patients admitted to a neurology unit is extremely high. After one year, less than one fourth of elderly patients hospitalised for an acute neurological disease are left with only no-to-moderate disability.

The Association of Long-Term Opioid Use With Health Care and Home Care Service Use Among Aged Home Care Clients.

To compare health care and home care service utilization, mortality, and long-term care admissions between long-term opioid users and nonusers among aged home care clients. A retrospective cohort study based on the Resident Assessment Instrument-Home Care (RAI-HC) assessments and electronic medical records. The study sample included all regular home care clients aged ≥65years (n= 2475), of whom 220 were long-term opioid users, in one city in Finland (population base 222,000 inhabitants). Health care utilization, mortality, and long-term care admissions over a 1-year follow-up were recorded from electronic medical records, and home care service use from the RAI-HC. Negative binomial and multivariable logistic regression, adjusted for several socioeconomic and health characteristics, were used to analyze the associations between opioid use and health and home care service use. Compared with nonusers, long-term opioid users had more outpatient consultations (incidence rate ratio 1.26; 95% CI 1.08-1.48), home visits (1.23; 1.01-1.49), phone contacts (1.38; 1.13-1.68), and consultations without a patient attending a practice (1.22; 1.04-1.43) after adjustments. A greater proportion of long-term opioid users than nonusers had at least 1 hospitalization (49% vs 41%) but the number of inpatient days did not differ after adjustments. The home care nurses' median work hours per week were 4.3 (Q1-Q3 1.5-7.7) among opioid users and 2.8 (1.0-6.1) among nonusers. Mortality and long-term care admissions were not associated with opioid use. Long-term opioid use in home care clients is associated with increased health care utilization regardless of the severity of pain and other sociodemographic and health characteristics. This may indicate the inability of health care organizations to produce alternative treatment strategies for pain management when opioids do not meet patients' needs. The exact reasons for opioid users' greater health care utilization should be examined in future.

Characteristics of untreated cancer patients admitted to an acute supportive/palliative care unit.

To assess the characteristics of patients who had never received anticancer treatments at admission of an acute supportive palliative care unit (ASPCU). From a consecutive sample of 422 advanced cancer patients, 62 patients with no previous anticancer therapy were selected and compared with a random sample of patients who had received anticancer treatments. Patients without previous anticancer therapy (14.7%) were mainly admitted to ASPCU for a low KPS and high symptom burden, often waiting for or needing a histological diagnosis to make a decision for the next therapeutic steps. This group of patients were older (P<0.0005), more frequently males (P=0.007), and had more comorbidities (P<0.0005) in comparison with treated patients. Twenty-four per cent of these patients started chemotherapy subsequently. Treatment-naive patients had a higher level of symptom burden, which was less responsive to a comprehensive palliative and more frequently died within three months in comparison with treated patients. Treatment-naive patients showed a higher level of symptom burden, which was less responsive to a comprehensive palliative treatment. In addition they more frequently died within three months in comparison with treated patients.

Efficacy and safety of a vitamin-mineral intervention for symptoms of anxiety and depression in adults: A randomised placebo-controlled trial “NoMAD”

BackgroundAnxiety and depression are increasingly burdening society. We investigated whether micronutrients (vitamins and minerals), improve anxiety and depression symptoms in an adult community setting. MethodsParticipants (n = 150) describing functionally-impairing symptoms of anxiety/depression randomly received micronutrients or placebo for 10 weeks. Primary outcome measures were Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder Scale-7 (GAD-7), and Clinical Global Impression-Improvement scale (CGII). They were monitored online with regular phone contact with a clinical psychologist. ResultsLinear mixed-effects modelling showed significant improvements in both groups, with the micronutrient group improving significantly more quickly on both the PHQ-9 (t = −2.17, p = 0.03) and the GAD-7 (t = −2.23, p = 0.03). Subsequent models with covariates showed that participant characteristics moderated time-by-group interactions; micronutrients provided fastest improvement relative to placebo for younger participants, those from lower socioeconomic groups and those who had previously tried psychiatric medication. On the CGII, there were no group differences at end-point ((F1,148) = 1.36, p = 0.25, d = 0.19, 95 % CI [−0.13 to 0.51]), with 49 % of the micronutrient and 44 % of the placebo groups being identified responders. Participants on micronutrients had significantly increased bowel motions compared with placebo. There was no increased suicidal ideation, no serious adverse events and the blind was adequately maintained. Drop out was low at 8.7 %. LimitationsThe improvement under placebo and lack of formal diagnoses limit generalizability. ConclusionsDespite limited clinician contact, all participants improved significantly, though improvements were faster with micronutrients. Participants in some subgroups demonstrated a lower response to placebo, identifying where micronutrients may offer greatest potential as an intervention.

0336 Tele-Self CBTi: Results of a Randomized Controlled Trial of a Nurse-Supported Self-Management Intervention for Insomnia Disorder

Abstract Introduction Approximately half of all Veterans meet diagnostic criteria for Insomnia Disorder. Cognitive Behavioral Therapy for Insomnia (CBTi) is recommended as first-line treatment but access is limited. Self-help CBTi could increase patient access and is more effective with provider support. Self-help CBTi has not been evaluated in those with significant mental health morbidity or Veterans; a population having greater medical and mental health morbidity and more severe sleep difficulties than non-Veterans. Methods Treatment-seeking Veterans were randomly assigned to 6 sessions of Tele-Self CBTi or Health Education Control (HEC). Nurses without sleep medicine experience were trained to deliver Tele-Self CBTi; the combination of provider support plus professionally designed patient and provider CBTi treatment manuals developed through an iterative process integrating expert and patient feedback. Both arms received nurse phone contacts (≤20 minutes). Outcomes including insomnia severity, subjective and objective sleep parameters, fatigue and mood were assessed at baseline, post-treatment (8 weeks), and 6 months. Results Study participants (N=178) were 55 years of age (SD=13), mostly male (72%), with a mental health condition (83%), and about half African American (43%) and half Caucasian (49%). At post-treatment, Veterans randomized to Tele-Self CBTi realized greater reductions in insomnia severity (ISI estimated mean improvement 5.7 vs 2.0, p&amp;lt;.001) and greater improvements in fatigue and depression symptoms (ps&amp;lt;.04). At 6 months, ISI findings were sustained (5.3 vs. 2.4, p&amp;lt;.001) and more Tele-Self CBTi than HEC participants (32% vs 10%) scored below the cutoff suggestive of insomnia disorder (ISI&amp;lt; 11) (p=.001). Preliminary findings also suggest better post-treatment outcomes for Tele-Self CBTi on sleep diary SOL (25 vs 45 minutes) and WASO (34 vs 55 minutes). Conclusion A self-management CBTi requiring minimal provider resources was effective in reducing insomnia severity in veterans with considerable mental health co-morbidity. Tele-Self CBTi can help bridge the gap between unavailable resources and high demand for services and can serve as the entry level in stepped-care treatment for insomnia disorder. Future research is needed to identify characteristics of patients most likely to benefit from Tele-Self CBTi. Support (if any) Funding was provided by Veterans Affairs Office of Research and Development (CIN 13-410 and IIR 16-281).