Primary Care Population Research Articles

Factors Informing High-Risk Primary Care Patient Choice around Telehealth Use: a Framework.

While telehealth's presence in post-pandemic primary care appears assured, its exact role remains unknown. Value-based care's expansion has heightened interest in telehealth's potential to improve uptake of preventive and chronic disease care, especially among high-risk primary care populations. Despite this, the pandemic underscored patients' diverse preferences around using telehealth. Understanding the factors underlying this population's preferences can inform future telehealth strategies. To describe the factors informing high-risk primary care patient choice of whether to pursue primary care via telehealth, in-office or to defer care altogether. Qualitative, cross-sectional study utilizing semi-structured telephone interviews of a convenience sample of 29 primary care patients between July 13 and September 30, 2020. Primary care patients at high risk of poor health outcomes and/or acute care utilization who were offered a follow-up primary care visit via audiovisual, audio-only or in-office modalities. Responses were analyzed via grounded theory, using a constant comparison method to refine emerging categories, distinguish codes, and synthesize evolving themes. Of the 29 participants, 16 (55.2%) were female and 19 (65.5%) were Black; the mean age (SD) was 64.6 (11.1). Participants identified four themes influencing their choice of visit type: perceived utility (encapsulating clinical and non-clinical utility), underlying costs (in terms of time, money, effort, and safety), modifiers (e.g., participants' clinical situation, choice availability, decision phenotype), and drivers (inclusive of their background experiences and digital environment). The relationship of these themes is depicted in a novel framework of patient choice around telehealth use. While visit utility and cost considerations are foundational to participants' decisions around whether to pursue care via telehealth, underappreciated modifiers and drivers often magnify or mitigate these considerations. Policymakers, payers, and health systems can leverage these factors to anticipate and enhance equitable high-value telehealth use in primary care settings among high-risk individuals.

Abstract 17939: Predictors of Time in Target Range in a Comprehensive Self-Measured Blood Pressure Program in a Socially and Economically Disadvantaged Primary Care Population

Introduction: The Community Practice Center (CPC) in North Philadelphia serves a community with significant socioeconomic barriers leading to inability to access care necessary for management of hypertension (HTN). Prior studies have shown the efficacy of SMBP programs in improving blood pressure (BP) control. Methods: All sequential patients presenting to the CPC with stage 2 HTN were screened for eligibility. Upon enrollment, patients received a Bluetooth-enabled BP cuff connected to a mobile health app and HTN education. Patients completed validated social and behavioral assessments including social determinants of health (SD)H) assessment via WellRx screen, depression screening (PHQ-9), and self-efficacy screening ( Self-Efficacy to Manage Chronic Disease Scale ). A behavior change plan was created using Brief Problem Solving Therapy based on the aforementioned assessments. Staff continuously monitored usage, BP, and provided individualized interventions. We conducted a cross-sectional quality improvement study using daily BP data from June 2022 - April 2023 to assess the correlation between baseline sociodemographic characteristics and Time in Target Range (TTR) through multivariable linear regression. We calculated TTR, defined as the percentage of time with systolic BP within 100-130 mmHg, through linear interpolation. Results: A total of 133 patients were enrolled in the program. We analyzed data from 78 patients with ≥3 days of readings (average 33; SD 49) and complete baseline characteristics (Table 1). Female sex and non-smoking status were associated with TTR, while diabetes, positive depression screening, positive SDOH screening, and self-efficacy were not (Table 2). Conclusions: In a socioeconomically disadvantaged population participating in a comprehensive SMBP program, depression, SDOH, and self-efficacy screening at time of enrollment did not predict TTR. Participation in a SMBP program may be valuable in these populations.

Using a machine learning model to risk stratify for the presence of significant liver disease in a primary care population

Using a machine learning model to risk stratify for the presence of significant liver disease in a primary care population

Primary Care Physician Supply and Population Health Outcomes in Florida, 2010-2019

Primary Care Physician Supply and Population Health Outcomes in Florida, 2010-2019

Association between psoriasis and cardiometabolic comorbidities in a racially and ethnically diverse low-income primary care population.

Psoriasis is associated with cardiometabolic comorbidities, including obesity, diabetes, hyperlipidaemia and hypertension. Many studies that established these associations originated from primarily White and/or relatively affluent populations. To evaluate whether there is a differential risk for cardiometabolic comorbidities in racial/ethnic minorities, we performed a cross-sectional analysis comparing cardiometabolic comorbidities between those with and without psoriasis in a racially and ethnically diverse population of 56 987 low-income patients, stratified by race/ethnicity, and assessed whether race/ethnicity acts as an effect modifier for cardiometabolic comorbidities. We found that psoriasis was statistically significantly associated with obesity, diabetes, hyperlipidaemia and hypertension. The association of psoriasis with comorbidities did not differ significantly by race/ethnicity; thus, we did not find evidence of effect modification. However, our diverse, low-income population had an extremely high baseline prevalence of cardiometabolic comorbidities compared with previous populations studied. Our results suggest education and intervention regarding modifiable risk factors are particularly important among vulnerable populations.

A - 16 Performance on the SDMT Predicts Functionality in Older Adults.

The Symbol Digit Modalities Test (SDMT) is a task of processing speed and executive functioning that is widely used to evaluate individuals with Multiple Sclerosis (MS) and has been shown to predict various instrumental activities of daily living. The relationship between SDMT and daily functioning has not been well explored in the aging population. The Activities of Daily Living-Prevention Instrument (ADL-PI) is a self-report measure that assesses changes in functioning and instrumental activities of daily living (IADLs). We evaluate the relationship between SDMT and ADL-PI in older adults with subjective cognitive complaints in an urban, multi-ethnic, primary care population in Bronx, New York. 300 participants (50.7% Hispanic, 43.7% non-Hispanic Black; 37% assessed in Spanish) completed the SDMT and ADL-PI as part of a larger study seeking to improve detection of cognitive impairment in primary care. The mean age of the sample was 71.35 ± 5.76years and participants had a mean 12.26 ± 3.76years of education. Pearson correlations were used to examine the relationship between SDMT and IADLs. SDMT performance was weakly albeit significantly correlated with self-report of functional difficulties on the ADL-PI (r = -0.312, p < 0.001). The relationship between SDMT (Range = 1-51, M = 25.39) and ADL-PI was significant in both English (p < 0.0011) and Spanish (p = 0.004) speaking participants and remained significant when controlling for age, education, and depression (p = 0.002). Consistent with MS literature, the SDMT is a useful tool for predicting self-report of instrumental activities of daily living of older adults with cognitive concerns.

Improving the Reporting of Primary Care Research: Consensus Reporting Items for Studies in Primary Care-the CRISP Statement.

Primary care (PC) is a unique clinical specialty and research discipline with its own perspectives and methods. Research in this field uses varied research methods and study designs to investigate myriad topics. The diversity of PC presents challenges for reporting, and despite the proliferation of reporting guidelines, none focuses specifically on the needs of PC. The Consensus Reporting Items for Studies in Primary Care (CRISP) Checklist guides reporting of PC research to include the information needed by the diverse PC community, including practitioners, patients, and communities. CRISP complements current guidelines to enhance the reporting, dissemination, and application of PC research findings and results. Prior CRISP studies documented opportunities to improve research reporting in this field. Our surveys of the international, interdisciplinary, and interprofessional PC community identified essential items to include in PC research reports. A 2-round Delphi study identified a consensus list of items considered necessary. The CRISP Checklist contains 24 items that describe the research team, patients, study participants, health conditions, clinical encounters, care teams, interventions, study measures, settings of care, and implementation of findings/results in PC. Not every item applies to every study design or topic. The CRISP guidelines inform the design and reporting of (1) studies done by PC researchers, (2) studies done by other investigators in PC populations and settings, and (3) studies intended for application in PC practice. Improved reporting of the context of the clinical services and the process of research is critical to interpreting study findings/results and applying them to diverse populations and varied settings in PC.Annals "Online First" article.

The Commonwealth Fund Survey of Primary Care Physicians Reveals Challenges Experienced by Family Doctors and Emphasizes the Need for Interoperability of Health Information Technologies.

Electronic health information that is easily accessible and shareable among healthcare providers and their patients can provide substantial improvements in Canada's primary care system and population health outcomes. The Commonwealth Fund's (CMWF's) 2022 International Health Policy Survey of Primary Care Physicians (CIHI 2023) highlights the views and experiences of primary care doctors in 10 developed countries, including Canada. The survey covered various topics related to physician workload, the use of information technology and coordination of care. While the COVID-19 pandemic contributed to an increased physician workload that may have impacted the ability to efficiently coordinate care with other healthcare providers, Canadian family doctors did close the gap with other countries as 93% of family doctors are now using electronic medical records (EMRs) in their practices. The CMWF's 2022 survey revealed challenges faced by Canadian family doctors in their practices. However, international comparisons provide opportunities to learn from other countries and build on the implementation of EMRs as part of Canada's shared health priorities.

Estimate of the incidence of PANDAS and PANS in 3 primary care populations.

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection (PANDAS) and Pediatric Acute-Onset Neuropsychiatric syndrome (PANS) are presumed autoimmune complications of infection or other instigating events. To determine the incidence of these disorders, we performed a retrospective review for the years 2017-2019 at three academic medical centers. We identified the population of children receiving well-child care at each institution. Potential cases of PANS and PANDAS were identified by including children age 3-12 years at the time they received one of five new diagnoses: avoidant/restrictive food intake disorder, other specified eating disorder, separation anxiety disorder of childhood, obsessive-compulsive disorder, or other specified disorders involving an immune mechanism, not elsewhere classified. Tic disorders was not used as a diagnostic code to identify cases. Data were abstracted; cases were classified as PANDAS or PANS if standard definitions were met. The combined study population consisted of 95,498 individuals. The majority were non-Hispanic Caucasian (85%), 48% were female and the mean age was 7.1 (SD 3.1) years. Of 357 potential cases, there were 13 actual cases [mean age was 6.0 (SD 1.8) years, 46% female and 100% non-Hispanic Caucasian]. The estimated annual incidence of PANDAS/PANS was 1/11,765 for children between 3 and 12 years with some variation between different geographic areas. Our results indicate that PANDAS/PANS is a rare disorder with substantial heterogeneity across geography and time. A prospective investigation of the same question is warranted.

Performance of Single-Lead Handheld Electrocardiograms for Atrial Fibrillation Screening in Primary Care: The VITAL-AF Trial

BackgroundHandheld single-lead electrocardiographic (1L ECG) devices are increasingly used for atrial fibrillation (AF) screening, but their real-world performance is not well understood. ObjectivesThe purpose of this study was to quantify the diagnostic test characteristics of 1L ECG automated interpretations for prospective AF screening. MethodsWe calculated the diagnostic test characteristics of the AliveCor KardiaMobile 1L ECG (AliveCor, US) algorithm using unblinded cardiologist overread as the gold standard using single 30s tracings administered by medical assistants among individuals aged ≥65 years participating in the VITAL-AF trial (NCT03515057) of population-based AF screening embedded within routine primary care. ResultsA total of 14,230 individuals (mean age 74 ± 7 years, 60% women, 82% White) had 31,376 tracings reviewed by 13 cardiologists. A total of 24,906 (79.6%) tracings had an AliveCor interpretation of normal, 5,046 (16.1%) were unclassified, 797 (2.5%) were possible AF, and 573 (1.8%) were no analysis. Cardiologists read 808 (2.6%) tracings as AF. AliveCor possible AF had a PPV of 51.7% (95% CI: 47.8%-55.6%). AliveCor normal had an NPV of 99.8% (95% CI: 99.7%-99.8%). The AliveCor algorithm had an overall sensitivity of 51.0% (95% CI: 47.1%-54.9%) and a specificity of 98.7% (95% CI: 98.6%-98.9%). AliveCor tracings interpreted as unclassified (PPV 5.9%, 95% CI: 5.1%-6.7%) and no analysis (PPV 6.5%, 95% CI: 4.6%-8.9%) had low predictive values for AF and were increasingly prevalent at older ages (13.7% for age 65-69 years to 28.1% for age ≥85 years, P < 0.01). ConclusionsIn an older primary care population undergoing AF screening with handheld 1L ECGs, automated algorithm interpretations were sufficiently accurate to exclude the presence of AF but not to establish an AF diagnosis.

A prospective study on the prevalence of MASLD in people with type-2 diabetes in the community. Cost effectiveness of screening strategies.

As screening for the liver disease and risk-stratification pathways are not established in patients with type-2 diabetes mellitus (T2DM), we evaluated the diagnostic performance and the cost-utility of different screening strategies for MASLD in the community. Consecutive patients with T2DM from primary care underwent screening for liver diseases, ultrasound, ELF score and transient elastography (TE). Five strategies were compared to the standard of care: ultrasound plus abnormal liver function tests (LFTs), Fibrosis score-4 (FIB-4), NAFLD fibrosis score, Enhanced liver fibrosis test (ELF) and TE. Standard of care was defined as abnormal LFTs prompting referral to hospital. A Markov model was built based on the fibrosis stage, defined by TE. We generated the cost per quality-adjusted life year (QALY) gained and calculated the incremental cost-effectiveness ratio (ICER) over a lifetime horizon. Of 300 patients, 287 were included: 64% (186) had MASLD and 10% (28) had other causes of liver disease. Patients with significant fibrosis, advanced fibrosis, and cirrhosis due to MASLD were 17% (50/287), 11% (31/287) and 3% (8/287), respectively. Among those with significant fibrosis classified by LSM≥8.1 kPa, false negatives were 54% from ELF and 38% from FIB-4. On multivariate analysis, waist circumference, BMI, AST levels and education rank were independent predictors of significant and advanced fibrosis. All the screening strategies were associated with QALY gains, with TE (148.73 years) having the most substantial gains, followed by FIB-4 (134.07 years), ELF (131.68 years) and NAFLD fibrosis score (121.25 years). In the cost-utility analysis, ICER was £2480/QALY for TE, £2541.24/QALY for ELF and £2059.98/QALY for FIB-4. Screening for MASLD in the diabetic population in primary care is cost-effective and should become part of a holistic assessment. However, traditional screening strategies, including FIB-4 and ELF, underestimate the presence of significant liver disease in this setting.

Clinical Validation of a Primary Antibody Deficiency Screening Algorithm for Primary Care

PurposeThe diagnostic delay of primary antibody deficiencies (PADs) is associated with increased morbidity, mortality, and healthcare costs. Therefore, a screening algorithm was previously developed for the early detection of patients at risk of PAD in primary care. We aimed to clinically validate and optimize the PAD screening algorithm by applying it to a primary care database in the Netherlands.MethodsThe algorithm was applied to a data set of 61,172 electronic health records (EHRs). Four hundred high-scoring EHRs were screened for exclusion criteria, and remaining patients were invited for serum immunoglobulin analysis and referred if clinically necessary.ResultsOf the 104 patients eligible for inclusion, 16 were referred by their general practitioner for suspected PAD, of whom 10 had a PAD diagnosis. In patients selected by the screening algorithm and included for laboratory analysis, prevalence of PAD was ~ 1:10 versus 1:1700–1:25,000 in the general population. To optimize efficiency of the screening process, we refitted the algorithm with the subset of high-risk patients, which improved the area under the curve–receiver operating characteristics curve value to 0.80 (95% confidence interval 0.63–0.97). We propose a two-step screening process, first applying the original algorithm to distinguish high-risk from low-risk patients, then applying the optimized algorithm to select high-risk patients for serum immunoglobulin analysis.ConclusionUsing the screening algorithm, we were able to identify 10 new PAD patients from a primary care population, thus reducing diagnostic delay. Future studies should address further validation in other populations and full cost-effectiveness analyses.RegistrationClinicaltrials.gov record number NCT05310604, first submitted 25 March 2022

Prevalence and healthcare utilization in managing herpes zoster in primary care: a retrospective study in an Asian urban population.

Herpes zoster (HZ) causes significant morbidity, particularly in older adults. With the advent of a recombinant zoster vaccine, HZ is potentially preventable. However, data on HZ burden and healthcare utilization in primary care populations remains scarce. This study described the prevalence and healthcare utilization in managing HZ in a developed community. A retrospective database review was conducted across a cluster of 8 public primary care clinics in urban Singapore. Data of multi-ethnic Asian patients with a diagnosis code of "herpes zoster" from 2018 to 2020 was extracted from their electronic medical records. Socio-demographic, clinical, visitation, medical leave, prescription, and referral data were analyzed. A total of 2,987 out of 737,868 individuals were diagnosed with HZ over 3 years. The mean age was 59.9 (SD + 15.5) years; 49.2% were male; 78.5% Chinese, 12.2% Malay, and 4.1% Indian. The prevalence was 221, 224, 203 per 100,000 persons in 2018, 2019, and 2020, respectively. The 70 to 79-year age group had the highest prevalence (829/100,000) across 3 years. Oral acyclovir (median daily dose 4,000 mg; median duration 7 days) and topical acyclovir were prescribed in 71.6 and 47.6%, respectively. Analgesia prescribed were gabapentin (41.0%), paracetamol combinations (30.1%), oral NSAIDs (23.7%), opioids (6.0%), and tricyclic antidepressants (1.9%). Most individuals consulted only once (84.3%); 32.7% of them required medical leave and 5.6% had more than 7 days of absenteeism. HZ-related referrals to the hospital were required in 8.9% (4.9% emergency, 2.8% ophthalmology). The findings of this study suggest a need for HZ vaccination among older age groups. Visitation and referral rates were low. The use of topical acyclovir was uncovered, and further research should evaluate the underlying reasons, benefits, and harms of such practice. The use of analgesia combinations may be explored further.

S11-2 Co-production of a physical activity referral scheme in the German health care system

Abstract Purpose Physical activity referral schemes (PARS) have the potential to promote physical activity (PA) among the mostly inactive primary care population with non-communicable diseases (NCD). Despite significant expansion throughout Europe, a national scheme has not yet been established in Germany. Thus, the ongoing research project BewegtVersorgt aims to develop, implement, and evaluate a PARS to promote PA for persons with NCD within the German healthcare system. Methods The PARS was developed using a co-production approach which integrated twelve organizations from different sectors within the healthcare system (health insurances, physicians, exercise professionals, patients’ representatives) and was guided by the research team. Initially, stakeholders’ ideas of a PARS were collected in individual interviews. These were followed by three co-production meetings where individual ideas and current evidence were combined, and different PARS models for the German setting were elaborated. Finally, all stakeholders agreed on one PARS for implementation as a regional model project. Results The co-produced PARS starts with the primary care physician, as the gatekeeper in the German healthcare system, who offers 10 min PA advice to the patients who would benefit from PA participation. Afterward, the patients are referred to an exercise professional through a referral form. The exercise professional delivers the remaining central components of the intervention - initial assessment, six 1-hour individual PA counseling sessions spread throughout 12 weeks, final assessment, a progress report to the general practitioner, and one follow-up visit at six months. The intervention uses a patient-centered approach and motivational interviewing. The end goal is an adaptation of an active lifestyle and transfer to local physical activity opportunities. Conclusions By using a co-production approach, the expertise of different stakeholders within the healthcare system as well as scientific findings could be integrated into the development process of the PARS. To which extent this participatory approach leads to greater acceptance of the new healthcare service among the implementing actors and positively influences their cooperation within the PARS will be evaluated during the implementation phase. Support/Funding Source The study is funded by the Federal Ministry of Health based on a resolution of the German ‘Bundestag’ by the federal government.

Severe hypertriglyceridemia prevalence at a primary care setting in Catalonia, Spain

Hypertriglyceridemia (HTG) increases the risk of cardiovascular disease and pancreatitis, and its prevalence varies across populations. To determine the prevalence of moderate-to-severe hypertriglyceridemia (msHTG, 500-879mg/dl) and severe hypertriglyceridemia (sHTG, ≥ 880mg/dl) in a primary care population in Catalonia, Spain, and to categorize them according to presence/absence of factors potentially causing HTG. Retrospective analysis of clinical and laboratory data in SIDIAP (Information System for the Development of Primary Care Research) from 2010, 2013, 2016, and 2019. We considered medications with hypolipidemic effects and those potentially increasing TG levels. We developed logistic regression models adjusted by age and sex to calculate the probability of having ms/sHTG according to covariates of interest. In the study years, 36.2‒42.0% of the >3.5 million active primary care users had ≥1 TG determination. Prevalence for msHTG was 0.7% and for sHTG 0.2% among those with recorded TG. In 2019, 54.7% were female; median (IQR) age was 62.5 (49.4‒73.7) years. Prevalence was higher in 36‒50-year-old persons (1.3% msHTG, 0.4% sHTG) and men (1.1% msHTG, 0.3% sHTG). Most cases were associated with secondary and <20% with non-secondary causes, the latter being most prevalent in young patients. The secondary causes more strongly associated with msHTG/sHTG were obesity, uncontrolled diabetes mellitus (DM) and gamma-glutamyl transferase >100U/L. The prevalence of msHTG was 0.7% and that of sHTG was 0.2% between 2010 and 2019 among individuals with recorded TG. msHTG/sHTG most often affected men around their fifties and people with obesity and uncontrolled DM. Most msHTG and sHTG cases were associated with the presence of secondary causes.

Abstract P332: Asynchronous Management Of Hypertension: The Effectiveness Of Remote Patient Monitoring In Mixed Populations

Background: This study evaluated the effectiveness of a remote patient monitoring (RPM) program for hypertension (HTN) management in cardiology (CV) and primary care (PC) populations. Methods: Patients were provided cellular-enabled blood pressure (BP) cuffs that transmitted data to a practice-integrated portal. Patients who uploaded ≥ 30 BP readings for ≥ 90 days (n=2,761) were included. Clinical staff trained patients to take BP measurements, and patients received calls to discuss medication adherence and care plans. If readings were outside the predetermined range, alerts were sent to practice providers for medical management. Results: The study included 2,761 patients, with an average transmission index of 67% for CV (60.7 times per 90 days) and 63% (56.7 times per 90 days) for PC. At enrollment, uncontrolled HTN was prevalent in 65.4% (1345/2057) of CV and 68% (479/704) of PC patients. Post-intervention, there was a significant decrease in uncontrolled HTN to 49.3% (1014/2057) and 60.0% (422/704), respectively (p &lt; 0.001). Both systolic and diastolic HTN improved with reductions of 11.4 mmHg and 8.6 mmHg in SBP and DBP, respectively, in CV patients, and 8.0 mmHg and 4.6 mmHg in PC patients (p &lt; 0.0001). The most significant improvements were observed in patients with stage 2 HTN, achieving SBP and DBP reductions of 20.81 mmHg and 13.9 mmHg in CV patients and 15.9 mmHg and 10.0 mmHg in PC patients (p &lt; 0.0001), respectively. The treatment was also effective in patients with high pulse pressure (PP), with PC patients experiencing an average PP reduction of 6.2 mmHg and a reduction of 5.8 mmHg among CV patients (p &lt; 0.0001). Conclusion: RPM can be an effective adjunct therapy to improve HTN management in both primary care and specialty care populations.

Identifying Children in Foster Care and Improving Foster Care Documentation in Primary Care.

Children and youth in foster care (CYFC) are a population with special healthcare needs, and the American Academy of Pediatrics has healthcare standards to care for this population, but implementation challenges include identifying clinic patients in foster care (FC). Documentation of FC status in the Electronic Health Record (EHR) can support the identification of CYFC to tailor care delivery. Therefore, we aimed to improve the percentage of CYFC with problem list (PL) documentation of FC status from 20% to 60% within 12 months. This study used a five-cycle plan-do-study-act quality improvement model in two co-located primary care teaching clinics. The primary outcome was the weekly percentage of patients with FC status on EHR PL. Ishikawa cause and effect analysis and resident survey identified barriers and informed interventions: education, patient list distribution, documentation training, email reminders, and clinic champion. We constructed statistical process control charts of the primary outcome to assess for improvement. Mean weekly percentage of patients with FC status on PL improved from 19.8% to 60.2%. The most extensive improvements occurred after designating a clinic champion and providing email reminders with enhanced patient lists. The sustainability of PL documentation (mean = 71.7%) was demonstrated 3-4 years after the completion of plan-do-study-act cycle interventions. Educating providers, collaborating with child welfare to provide patient lists to providers, standardizing documentation, and designating clinic champions are promising methods of improving EHR documentation of FC status. Identifying and documenting FC status are important initial steps to optimizing care for this vulnerable population in primary care.

A Systematic Approach to Assessing and Addressing Palliative Care Needs in an Outpatient Population.

Developing systems to routinely and equitably identify and meet the palliative care (PC) needs of seriously ill populations is a critical frontier for palliative medicine. An automated screen identified Medicare primary care patients who had serious illness based on diagnosis codes and utilization patterns. A stepped-wedge design was used to evaluate a 6-month intervention through which a healthcare navigator assessed these seriously ill patients and their care partners for PC needs in the domains of 1) physical symptoms, 2) emotional distress, 3) practical concerns, and 4) advance care planning (ACP) via telephone surveys. Identified needs were addressed with tailored PC interventions. 292/2175 (13.4%) patients screened positive for serious illness. 145 completed an intervention phase; 83 completed a control phase. Severe physical symptoms were identified in 27.6%, emotional distress in 57.2%, practical concerns in 37.2%, and ACP needs in 56.6%. Twenty-five intervention patients (17.2%) were referred to specialty PC compared to six control patients (7.2%). Prevalence of ACP notes increased 45.5% to 71.7% (p=0.001) during the intervention and remained stable during the control phase. Quality of life remained stable during the intervention and declined 7.4/10 to 6.5/10 (p=0.04) during the control phase. Through an innovative program, patients with serious illness were identified from a primary care population, assessed for PC needs, and offered specific services to meet those needs. While some patients were appropriate for specialty PC, even more needs were addressed without specialty PC. The program resulted in increased ACP and preserved quality of life.

Abstract P325: Early Insights From A Self-measured Blood Pressure Program In A Socially And Economically Disadvantaged Primary Care Population

Background: Meta-analyses have shown the success of SMBP in BP control. We aim to describe an SMBP QI program at our primary care clinic and assess its impact on BP. The Einstein CPC is a safety net practice that serves a socially and economically disadvantaged population facing many HTN management barriers. Methods: This program utilized a QI approach for BP control and patient-provider connection. Patient demographics, clinical features, and SDOH were assessed at baseline. Patients with uncontrolled HTN (SBP &gt;140 mmHg) were asked to participate. To date, 111 patients enrolled. Patients were given a Bluetooth-enabled BP monitor connected to a mobile health app, HTN education, DASH diet recommendations, and orientation to SMBP protocols. Those reporting social needs or depression were referred to behavioral resources. Health staff continuously telemonitored patient usage, BP, and individualized interventions. We evaluated the difference in BP from baseline BP and estimated the change in time using a linear multilevel model with random intercept and random slope for each patient. We also calculated time in target range defined as time in SBP 100-130 and DBP 70-80 in mmHg. Results: Patient characteristics (Table 1). Those with at least 3 d of BP readings - 93% (103/111) were included in the BP analysis (Figure 1); mean follow-up 69±67 d and BP readings 42±52. Over 90 d, SBP, and DBP decreased by 11 (95% CI: 4-17) and 5 (95% CI: 3-8) mmHg, respectively. Conclusions: A QI-based SMBP program with robust telemonitoring and individualized interventions may effectively promote short-term adherence to remote BP monitoring and BP control in a socially and economically disadvantaged population.

Prevalence of Cannabis Use Disorder and Reasons for Use Among Adults in a US State Where Recreational Cannabis Use Is Legal.

Medical and nonmedical cannabis use and cannabis use disorders (CUD) have increased with increasing cannabis legalization. However, the prevalence of CUD among primary care patients who use cannabis for medical or nonmedical reasons is unknown for patients in states with legal recreational use. To estimate the prevalence and severity of CUD among patients who report medical use only, nonmedical use only, and both reasons for cannabis use in a state with legal recreational use. This cross-sectional survey study took place at an integrated health system in Washington State. Among 108 950 adult patients who completed routine cannabis screening from March 2019 to September 2019, 5000 were selected for a confidential cannabis survey using stratified random sampling for frequency of past-year cannabis use and race and ethnicity. Among 1688 respondents, 1463 reporting past 30-day cannabis use were included in the study. Patient survey-reported reason for cannabis use in the past 30 days: medical use only, nonmedical use only, and both reasons. Patient responses to the Composite International Diagnostic Interview-Substance Abuse Module for CUD, corresponding to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition CUD severity (0-11 symptoms) were categorized as any CUD (≥2 symptoms) and moderate to severe CUD (≥4 symptoms). Adjusted analyses were weighted for survey stratification and nonresponse for primary care population estimates and compared prevalence of CUD across reasons for cannabis use. Of 1463 included primary care patients (weighted mean [SD] age, 47.4 [16.8] years; 748 [weighted proportion, 61.9%] female) who used cannabis, 42.4% (95% CI, 31.2%-54.3%) reported medical use only, 25.1% (95% CI, 17.8%-34.2%) nonmedical use only, and 32.5% (95% CI, 25.3%-40.8%) both reasons for use. The prevalence of CUD was 21.3% (95% CI, 15.4%-28.6%) and did not vary across groups. The prevalence of moderate to severe CUD was 6.5% (95% CI, 5.0%-8.6%) and differed across groups: 1.3% (95% CI, 0.0%-2.8%) for medical use, 7.2% (95% CI, 3.9%-10.4%) for nonmedical use, and 7.5% (95% CI, 5.7%-9.4%) for both reasons for use (P = .01). In this cross-sectional study of primary care patients in a state with legal recreational cannabis use, CUD was common among patients who used cannabis. Moderate to severe CUD was more prevalent among patients who reported any nonmedical use. These results underscore the importance of assessing patient cannabis use and CUD symptoms in medical settings.