Community Practice Settings Research Articles

Comparison of prone and upright, stereotactic, and tomosynthesis-guided biopsies with secondary analysis of ultrasound-occult architectural distortions.

Compare prone and upright, stereotactic, and tomosynthesis-guided vacuum-assisted breast biopsies (prone DM-VABB, prone DBT-VABB, upright DM-VABB, and upright DBT-VABB) in a community-practice setting and review outcomes of ultrasound-occult architectural distortions (AD). Consecutive biopsies performed at two community-based breast centers from 2016 to 2019 were retrospectively reviewed. Technical details of each procedure and patient outcomes were recorded. Separate analyses were performed for ultrasound-occult ADs. Two sample t-tests and Fisher's exact test facilitated comparisons. A total of 1133 patients underwent 369 prone DM-VABB, 324 prone DBT-VABB, 437 upright DM-VABB, and 123 upright DBT-VABB with 99.2%, 100%, 99.3%, and 99.2% success, respectively (p-values > 0.25). Mean lesion targeting times were greater for prone biopsy (minutes: 6.94 prone DM-VABB, 8.54 prone DBT-VABB, 5.52 upright DM-VABB, and 5.51 upright DBT-VABB; p-values < 0.001), yielding longer total prone procedure times for prone biopsy (p < 0.001). Compared to DM-VABB, DBT-VABB used fewer exposures (p < 0.001) and more commonly targeted AD, asymmetries, or masses (p < 0.001). Malignancy rates were similar between procedures: prone DM-VABB 22.4%, prone DBT-VABB 21.9%, upright DM-VABB 22.8%, and upright DBT-VABB 17.2% (p-values > 0.19). One hundred forty of the 1133 patients underwent 145 biopsies for ultrasound-occult AD (143 DBT-VABB and 2 DM-VABB). Biopsy yielded 27 malignancies and 47 high-risk lesions (74 of 145, 51%). Malignancy rate was 20.7% after surgical upgrade of one benign-discordant and two high-risk lesions. All biopsy procedure types were extremely successful. The 20.7% malignancy rate for ultrasound-occult AD confirms a management recommendation for tissue diagnosis. Upright biopsy was faster than prone biopsy, and DBT-VABB used fewer exposures than DM-VABB. Our results highlight important differences between prone DM-VABB, prone DBT-VABB, upright DM-VABB, and upright DBT-VABB. Moreover, the high likelihood of malignancy for ultrasound-occult AD will provide confidence in recommending tissue diagnosis in lieu of observation or clinical follow-up. • Upright and prone stereotactic and tomosynthesis-guided breast biopsies were safe and effective in the community-practice setting. • The malignancy rate for ultrasound-occult architectural distortion of 20.7% confirms the management recommendation for biopsy. • Upright procedures were faster than prone procedures, and tomosynthesis-guided biopsy used fewer exposures than stereotactic biopsy.

Delegation of insulin administration to non-registered healthcare workers in community nursing teams: A qualitative study.

To explore stakeholder perspectives on the benefits and/or disadvantages of the delegation of insulin injections to healthcare support workers in community nursing services. Qualitative case study. Interviews with stakeholders purposively sampled from three case sites in England. Data collection took place between October 2020 and July 2021. A reflexive thematic approach to analysis was adopted. A total of 34 interviews were completed: patients and relatives (n = 7), healthcare support workers (n = 8), registered nurses (n = 10) and senior managers/clinicians (n = 9). Analysis resulted in three themes: (i) Acceptance and confidence, (ii) benefits and (iii) concerns and coping strategies. Delegation was accepted by stakeholders on condition that appropriate training, supervision and governance was in place. Continuing contact between patients and registered nurses, and regular contact between registered nurses and healthcare support workers was deemed essential for clinical safety. Services were reliant on the contribution of healthcare support workers providing insulin injections, particularly during the COVID-19 pandemic. Benefits for service and registered nurses included: flexible team working, increased service capacity and care continuity. Job satisfaction and career development was reported for healthcare support workers. Patients benefit from timely administration, and enhanced relationships with the nursing team. Concerns raised by all stakeholders included potential missed care, remuneration and task shifting. Delegation of insulin injections is acceptable to stakeholders and has many benefits when managed effectively. Demand for community nursing is increasing. Findings of this study suggest that delegation of insulin administration contributes to improving service capacity. Findings highlight the essential role played by key factors such as appropriate training, competency assessment and teamwork, in developing confidence in delegation among stakeholders. Understanding and supporting these factors can help ensure that practice develops in an acceptable, safe and beneficial way, and informs future development of delegation practice in community settings. A service user group was consulted during the design phase prior to grant application and provided comments on draft findings. Two people with diabetes were members of the project advisory group and contributed to the study design, development of interview questions, monitoring study progress and provided feedback on study findings.

Commentary on “Basivertevbral nerve ablation for the treatment of chronic low back pain with modic changes in a community practice setting: 6 months follow-up”

Commentary on “Basivertevbral nerve ablation for the treatment of chronic low back pain with modic changes in a community practice setting: 6 months follow-up”

Feasibility of Point-of-Care Genomic Profiling in the Diagnosis and Treatment of Cancer of Unknown Primary.

Cancer of unknown primary remains a challenging clinical entity. Despite receiving empiric chemotherapy, median overall survival is approximately 6-12 months. Site-specific therapy based on molecular characterization has been shown to improve outcomes; however, feasibility outside of clinical trials, especially in community centers, is lacking. This study explores the application of rapid next-generation sequencing in defining cancer of unknown primary and to identify therapeutic biomarkers. A retrospective chart review was performed by identifying pathological samples designated cancer of unknown primary. Next-generation sequencing testing was based on an automated workflow utilizing the Genexus integrated sequencer, validated for clinical use. Genomic profiling was further integrated within a routine immunohistochemistry service, with results reported directly by anatomic pathologists. Between October 2020 and October 2021, 578 solid tumor samples underwent genomic profiling. Among this cohort, 40 were selected based on an initial diagnosis of cancer of unknown primary. The median (range) age at diagnosis was 70 (42-85) and 23 (57%) were female. Genomic data were used to support a site-specific diagnosis in 6 patients (15%). Median turnaround time was 3 business days (IQR: 1-5). Most common alterations identified were KRAS (35%), CDKN2A (15%), TP53 (15%), and ERBB2 (12%). Actionable molecular targeted therapies were identified in 23 (57%) patients, including alterations in BRAF, CDKN2A, ERBB2, FGFR2, IDH1, and KRAS. Immunotherapy-sensitizing mismatch repair deficiency was identified in 1 patient. This study supports the adoption of rapid next-generation sequencing among patients with cancer of unknown primary. We also demonstrate the feasibility of integration of genomic profiling with diagnostic histopathology and immunohistochemistry in a community practice setting. Diagnostic algorithms incorporating genomic profiling to better define cancer of unknown primary should be considered for future study.

Impact of a Community-Based Weight Management Program in a North Carolina Health Care System.

Current strategies for obesity management in primary care leave many patients inadequately treated or unable to access treatment entirely. We aimed to evaluate a comprehensive, primary care clinic-based weight management program's clinical effectiveness in a community practice setting. Methods: This was an18-month pre/postintervention study. We collected demographic and anthropometric data on patients enrolled in a primary care-based weight management program.The primary outcomes were percent weight loss postintervention and the proportion of patients who achieved a clinically significant total body weight loss (TBWL) of 5% or greater. Results: Our program served 550 patients over 1,952 visits from March 2019 through October 2020.A total of 209 patients had adequate program exposure, defined as four or more completed visits. Among these, all received targeted lifestyle counseling and 78% received antiobesitymedication.Patients who attended at least four visits had an average TBWL of 5.7% compared to an average gain of 1.5% total body weight for those with only one visit. Fifty-three percent of patients (n=111)achieved greater than 5% TBWL, and 20%(n=43)achieved greater than 10% TBWL. We demonstrated that a community-based weight management program delivered by obesity medicine-trained primary care providers effectively produces clinically significant weight loss. Future work will include wider implementation of this model to increase patient access to evidence-based obesity treatments in their communities.

Association between the prevalence of obstructive lung disease and the use of aspirin in a diabetic population

Many diabetic patients take a daily low-dose of aspirin because they are two to three times more likely to suffer from heart attacks and strokes, but its role in obstructive lung diseases is less clear.A total of 1,003 subjects in community practice settings were interviewed at home. Patients self-reported their personal and clinical characteristics, including any history of obstructive lung disease (including COPD or asthma). Current medications were obtained by the direct observation of medication containers. We performed a cross-sectional analysis of the interviewed subjects to assess for a possible association between obstructive lung disease history and the use of aspirin.In a multivariate logistic regression model, a history of obstructive lung disease was significantly associated with the use of aspirin even after correcting for potential confounders, including gender, low income (<USD 30,000/year), number of comorbidities, number of medications, cigarette smoking, and alcohol problems (adjusted odds ratio = 0.67, P = 0.03, 95% confidence interval = 0.47, 0.97). The opposite was found with aspirin and that for diabetic individuals that use insulin. A secondary analysis discovered a significant interaction between aspirin use and insulin: aspirin was associated with lower rates of lung disease except among those taking both drugs where the prevalence is significantly higher.These data suggest a negative correlation between the use of aspirin and obstructive lung disease prevalence in patients with diabetes but not for those that use insulin. Further studies are required to determine if this association is causal.

Potential enhanced association between obstructive lung disease and history of depression in patients with diabetes

Depression is one of the most common comorbidities of chronic diseases including diabetes and obstructive lung diseases (emphysema, chronic bronchitis, and asthma). Obstructive lung diseases and depression have few symptoms in common. However, they are both common in adults and associated with chronic inflammation. It is not clear if their coappearance in diabetic patients is coincidental or associated beyond that expected by chance.A total of 1,003 adults with diabetes in community practice settings were interviewed at home at the time of their enrolment into the Vermont Diabetes Information System, a clinical decision support program. Patients self-reported their personal and clinical characteristics, including any obstructive lung disease. Laboratory data were obtained directly from the clinical laboratory, and current medications were obtained by direct observation of medication containers. We performed a cross-sectional analysis of the interviewed subjects to assess a possible association between the prevalence of obstructive lung disease and depression.In a multivariate logistic regression model, obstructive lung disease was significantly associated with depression even after correcting for gender, obesity (≥30 kg/m2), high comorbidities (>2), low annual income (<$30,000/ year), cigarette smoking, alcohol problems, and education level (odds ratio=1.83; 95% confidence interval 1.27, 2.62; P <0.01).These data suggest a potential enhanced association between obstructive lung disease and depression in patients with diabetes. Future studies are needed to identify if inflammation is implicated in this association as a common denominator.

Proposed Implementation of a Patient-Centered Self-Assessment Tool for Patients with Neuroendocrine Tumors among Academic and Community Practice Sites: The City of Hope Model.

Neuroendocrine tumors are a rare type of cancer found in hormone-producing cells throughout the body. Research on disease-specific patient education assessments in this population is lacking. We previously demonstrated the feasibility and validity of NET VITALS, a patient-centered self-assessment designed to improve patients' knowledge of their neuroendocrine tumor diagnosis/treatment and facilitate communication with their physician. In this report, we provide a brief overview of patient assessments that have been used for patients with neuroendocrine tumors. We summarize NET VITALS and present a proposed infrastructure for its implementation into standard clinical care in both academic and community practice settings at City of Hope. Incorporating NET VITALS into standard of care treatment for patients with neuroendocrine tumors may improve patients' overall clinical care experience.

Investigating disparities in hepatocellular carcinoma and their effect on patterns of systemic care.

496 Background: Hepatocellular carcinoma (HCC) disproportionately affects minorities, particularly Black and Hispanic patients, and patients of lower socioeconomic status. These patients are more likely to be diagnosed with advanced disease, less likely to receive curative therapies, and have higher mortality rates. Data on the impact of disparities on patterns of systemic treatment (STx) in these disadvantaged groups are limited. This retrospective observational study used a large real-world database to explore differences in patient characteristics and patterns of STx based on race/ethnicity (R/E) and insurance status. Methods: 1283 patients diagnosed with HCC from 2011 to 2021 with known race, insurance, documented metastatic disease (mHCC), and without prior transplant from the nationwide de-identified Flatiron Health EHR-derived database were selected and analyzed. Chi-squared tests, T-tests, and log-rank tests were used to assess how R/E and insurance (Medicaid vs non-Medicaid) were related to HCC risk factors, number of lines of systemic therapy (LOT), and time from metastatic diagnosis (mDx) to start of STx. Results: Of 1283 patients evaluated, there were 750 white (W), 175 Black (B), 122 Hispanic (H), 69 Asian (A), and 167 patients with other race. B and H patients had the highest rates of known HCV (B 74.3%, H 48.4%, W 41.2%, A 23.2%; p &lt; 0.001) and A patients were most likely to have known HBV (53.6%). More B and H patients had Medicaid (W 10.9%, A 14.3%, B 18.9%, H 28.5%, p &lt; 0.001) and had the lowest rates of Medicare with commercial insurance (W 25.9%, A 21.7%, B 12.6%, H 14.6%, p &lt; 0.001). H patients had the lowest rates of commercial insurance (H 39.3%, W 41.3%, A 44.9%, B 44.6%, p &lt; 0.001). There was no significant difference in likelihood of receiving approved STx after mDx based on R/E. A patients had the highest rates of receiving multiple LOT (A 37.5%, W 18.5%, B 18.9%, H 20.5%; p = 0.285). 30-40% of patients with mHCC did not receive any STx and only 18-27% received more than 1 LOT. Most patients received STx for mHCC within 2 months without a significant difference based on R/E. There was no difference in unadjusted time to treatment based on insurance. Conclusions: This large-scale analysis did not reveal significant differences in the likelihood of receiving STx after mDx based on R/E or insurance. This analysis has limited data from safety net hospitals, which may impact our ability to fully elucidate disparities in the medical management of advanced HCC. 30-40% of patients with mHCC did not receive any STx and only 18-27% received more than 1 LOT, indicating that a significant portion of patients with HCC may be undertreated even in academic and community practice settings. Large scale real-world database analysis is a critical way to better understand treatment and survival outcomes in this population, which is expected to have the highest rates of HCC over the next 10 years and has been underrepresented in HCC trials.

Basivertebral Nerve Ablation for the Treatment of Chronic Low Back Pain with Modic Changes in a Community Practice Setting: 12 Month Follow-Up

Basivertebral Nerve Ablation for the Treatment of Chronic Low Back Pain with Modic Changes in a Community Practice Setting: 12 Month Follow-Up

The Influence of Radiologist Practice Setting on Identification of Vascular Compression from Magnetic Resonance Imaging in Trigeminal Neuralgia

Preoperative magnetic resonance imaging (MRI) studies are routinely ordered for trigeminal neuralgia (TN), though with contested reliability in contemporary literature. A potential reason for this disagreement is inconsistency in MRI reading methodologies. Here, we compare the rate of reported neurovascular compression on preoperative MRI by radiologists employed in community or private practice settings and academic neuroradiologists. A retrospective review was conducted on patients who underwent endoscopic microvascular decompression for TN with intraoperatively visualized neurovascular compression and primary read by a non-academic or community radiologist. Patient imaging was then re-read by a board-certified neuroradiologist practicing in an academic setting, who was blinded to the initial read and the side of TN symptoms. Non-academic radiologists reported vascular compression in 26.0% (20/77) of all patients, and mention was rarely made of the non-pathological side (sensitivity= 26.0%). On academic neuroradiologist re-reads, vascular compression was noted in 87.0% (67/77) of patients on the pathological side and in 57.1% (44/77) on the non-pathological side (sensitivity= 87.0%, specificity= 42.9%). Isotropic/near isotropic 3-dimensional steady state or heavily T2-weighted sequences were read with 92.3% sensitivity and 36.9% specificity, compared to 58.3% sensitivity and 66.7% specificity using routine T2 weighted sequences. The frequency of vascular compression reported by non-academic radiologists is much lower than what is reported by academic neuroradiologists reading the same MRI scans. These results highlight the effect of practice setting on the predictive power of neuroimaging. Future studies are indicated to further investigate these relationships, as well as to trial newer imaging modalities.

‘You go away happier in your heart’: The generativity of a women’s community learning jewellery-making group

Within the growing body of research on creative arts practices in community settings and mental health and well-being, the craft of jewellery-making has not featured strongly, and understanding from contextual, critical sociological perspectives has not been widely developed. This article reports on ethnographic research undertaken with an older women’s adult community learning (ACL) jewellery-making group, using theories of ecological and relational agency and insights from feminist theorizing to help elucidate its social, creative, educational and mental health and well-being-related generative processes. Findings are presented along two main, interrelated themes: creative agency and shared learning, and the social generativity of the group. The focus is on the transgressive, resistive and expansive aspects of the group’s interactions within the wider socio-economic, sociopolitical and cultural context of the women’s lives. Implications for enacting the mental health and well-being agenda in ACL are discussed.

Improving cancer care for underserved populations in an academic and community practice setting: protocol for a community health worker pilot navigation programme

IntroductionDelaying cancer treatment following diagnosis impacts health outcomes, including increasing patient distress and odds of mortality. Interventions to promote timely healthcare engagement may decrease patient-reported stress and improve quality of...

Real-World Treatment Experience of Venetoclax in Combination with Hypomethylating Agents in Patients with Newly Diagnosed Acute Myeloid Leukemia: Updated Experience from a Predominately Community Setting in the US

Introduction: Venetoclax (Ven) in combination with hypomethylating agents (HMAs) is approved to treat patients (pts) with newly diagnosed (ND) acute myeloid leukemia (AML) who are ineligible for intensive chemotherapy, based on the results from phase 1b (NCT02203773) and phase 3 (VIALE-A; NCT02993523) studies. This study aims to better understand pre- and post-VIALE-A real-world (rw) treatment (Tx) experience of Ven+HMA in routine clinical care. Methods: This retrospective cohort study used the Flatiron Health electronic health record-derived, nationwide, de-identified database. Pts with ND AML, aged ≥18 years, who initiated Ven+HMA Tx ≤1 month from AML diagnosis between June 1, 2018, and March 31, 2021 (excluding HMA Tx prior to AML diagnosis) were included. The study cohort was stratified into pre- (before July 1, 2020) vs post-VIALE-A (July 1, 2020 onwards). Timing of bone marrow (BM) biopsy, rw complete response/complete response with partial hematologic recovery (rwCR/CRh; <5% BM blasts with a platelet count >50×109/L and absolute neutrophil count [ANC] >0.5×109/L), and rwCR/complete response with incomplete hematologic recovery (rwCR/CRi; <5% BM blasts with either ANC <1000×109/L or platelet <100×109/L) were measured. Tx schedule modifications were documented. Kaplan-Meier analyses summarized time to last administration, time to first BM biopsy, time to first response (<5% BM blasts), time to death, or censoring at the end of follow-up on January 31, 2022. Cox regression analyses with a time varying covariate (Tx schedule modification) were conducted to examine the association between Ven Tx schedule modifications and overall survival (OS). Results: In total, 498 pts treated with Ven+HMA met the study criteria; most pts were treated in community practice (80%) vs academic settings (20%). Overall, 66% (330/498) of pts were pre-VIALE-A and 34% (168/498) were post-VIALE-A (median age was 76 and 75 years, secondary-AML was 33% and 27%, respectively). European LeukemiaNet 2017 classification: adverse, 42% vs 46%; intermediate, 22% vs 28%; favorable, 13% vs 9% for pre- vs post-VIALE-A cohorts, respectively. The median time from diagnosis to Ven Tx initiation was 12 days for the pre-VIALE-A cohort and 14 days for the post-VIALE-A cohort. Median time to last administration was 4.34 months for the pre-VIALE-A cohort (median follow-up: 8.98 months) and 4.67 months for the post-VIALE-A cohort (median follow-up: 8.52 months). Fewer pts in the post- vs pre-VIALE-A cohort (13% [22/168] vs 19% [63/330]) discontinued ≤60 days after Tx initiation (p=0.10). Overall, 65% (323/498) of pts with evaluable BM blast clearance were documented during follow-up and had low early mortality (death ≤60 days; <2% [<5/323]) vs 35% (175/498) of pts without an evaluable BM blast clearance who had higher early mortality (23% [40/175]). Amongst pts with BM blast clearance data available, more pts in the post- (61% [77/126]) vs pre-VIALE-A cohort (45% [101/225]) had their first biopsy by 28 ± 14 days after Tx initiation (proxy for Tx cycle 1). Earlier time to BM assessment after Ven Tx initiation in the post- vs pre-VIALE-A cohorts was associated with an earlier median time to first response (2.34 vs 5.14 months, respectively). More post- vs pre-VIALE-A pts with rwCR/CRi (n=45 vs n=93, respectively) had Ven schedule modifications after remission (days 0-30: 60% vs 39%; days 31-60: 36% vs 29%; anytime: 89% vs 74%). Most common reasons for Ven schedule modifications after remission, as documented in available physician notes (122 pre- vs 79 post-VIALE-A) were: toxic effect of Tx (88% vs 90%) and other reasons e.g. non-cancer related medical issues and cancer-related Tx (49% vs 51%; Table 1). Time-varying survival analysis showed that Ven Tx schedule modifications after remission were associated with longer median OS (Table 2). Conclusions: This study observed an evolution of earlier BM biopsy and an improvement in Ven Tx schedule modification in pts with ND AML who received Ven+HMA from pre- to post-VIALE-A, in a predominantly community setting in the US. Cytopenia was noted as a common reason for Ven Tx schedule modifications. Ven Tx schedule modifications after remission were associated with better median OS. Opportunities remain to further improve the number of pts with earlier BM assessment to determine Ven Tx schedule modifications and provide the best chance for optimal Tx outcomes for pts. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A Culturally Competent Vaccine Hesitancy Educational Model for Community Pharmacists to Increase Vaccine Uptake, Louisiana, 2021-2022.

In February 2022, an educational model was launched to train Louisiana pharmacists to become positive influencers of vaccination decisions via targeted, culturally competent interventions, with the objective of improving COVID-19 vaccine uptake in communities. A total of 47 pharmacists completed the course, and more than 90% noted that the education would help them optimize vaccine acceptance in their community practice settings. The pharmacists will participate in vaccine surveillance to assess the success of the educational model intervention and predictors of vaccine uptake. (Am J Public Health. 2022;112(S9):S900-S903. https://doi.org/10.2105/AJPH.2022.307070).

Community pharmacist-provided opioid intervention frequencies and barriers

BackgroundCommunity pharmacists are well-positioned to engage in opioid-related harm reduction activities (i.e., opioid interventions). However, several barriers to providing these interventions have been identified. Comparing the frequencies of opioid interventions and identifying which barriers are perceived to have the highest impact in providing interventions will yield valuable information for increasing opioid use disorder (OUD) care access within pharmacies. ObjectivesTo (1) characterize the frequency of 9 opioid interventions in community practice settings and (2) assess community pharmacists’ perceptions of what impact 15 key barriers have on providing opioid interventions. MethodsThis was a multi-state, cross-sectional, and descriptive survey study. Opioid interventions evaluated included prevention (e.g., OUD screening) and treatment (e.g., OUD resource referral); barriers encompassed confidence and knowledge, work environment, provider interactions, and patient interactions. Respondents were recruited from 3 community pharmacy practice-based research networks in the Midwest and South regions of the US. Recruitment and telephone survey administration occurred between December 2021 and March 2022. Descriptive statistics were computed and open-ended items were reviewed to identify common themes. ResultsSixty-nine of 559 pharmacists contacted (12.3%) completed the survey. All opioid interventions were reported to be provided less frequently than indicated in practice. Screening and referral interventions were provided least frequently, at 1.2 and 1.6 times on average, respectively, to the last 10 patients for which respondents felt each intervention was needed. Patient refusal, minimal or no reimbursement, inadequate staffing and time, and negative patient reactions were identified as the highest-impact barriers to providing opioid interventions. Approximately 26% of respondents agreed or strongly agreed that pharmacy school adequately prepared them to provide opioid interventions in practice. ConclusionPrioritizing the resolution of pharmacy work environment barriers will support pharmacists in routinely providing opioid interventions. Changes in Doctor of Pharmacy curricula and continuing education are also indicated to further prepare pharmacists to engage in opioid-related harm reduction.

CLL-449 Patterns of Treatment and Prognostic Testing Among Black Patients With Chronic Lymphocytic Leukemia (CLL): Results From informCLL, a Prospective, Observational Registry

To evaluate real-world treatment patterns and prognostic biomarker testing in Black patients with CLL enrolled in informCLL. informCLL, a US-based, prospective, observation registry, enrolled patients who initiated FDA-approved treatment for CLL/SLL (October 2015 - June 2019). Baseline characteristics, FISH testing rates, and patterns of treatment were summarized by lines of therapy (LOT). Of 1462 enrolled patients, 106 (7%) were Black. Black patients were predominantly enrolled in the South (69%) and from community-based practices (87%). Compared with the overall registry population, Black patients were younger (median age 66 years vs 71 years), had higher proportions with ECOG status ≥1 (65% vs 53%) and Rai stage III-IV (64% vs 51%), and similar time from diagnosis to treatment on registry (median 40 months vs 41 months) but shorter time from diagnosis to first-line treatment (median 7 months vs 19 months). FISH testing rates were similar (25% vs 28%). In a multivariate analysis (performed in overall registry population), baseline factors associated with FISH testing were shorter time from diagnosis to treatment, better ECOG status, earlier LOT (first-line), community practice setting, and a prior malignancy (p<0.05 for all); race was not a predictive factor. As observed in the overall population, ibrutinib was the most frequent treatment among Black patients in first-line (50%) and R/R (67%) settings, followed by chemoimmunotherapy (first-line, 43%; R/R, 15%). In the first-line cohort, ibrutinib use generally increased over time (2016, 31%; 2017, 57%; 2018, 63%; 2019, 55%) while chemoimmunotherapy use persisted (56%, 36%, 38%, and 36%, respectively). In R/R patients, ibrutinib use decreased over time while chemoimmunotherapy remained consistent. In informCLL, Black patients with CLL tended to be younger, with worse ECOG status, more advanced disease, and shorter time to first-line therapy than the overall registry population. Black patients may need close monitoring of disease status as they will tend to require initial CLL therapy more rapidly than other patients. Although ibrutinib was the most common treatment in Black patients, chemoimmunotherapy use remained persistent. Prognostic testing rates were suboptimal in Black patients, similar to the overall population. ©2022 American Society of Clinical Oncology, Inc. Reused with permission. This abstract was accepted and previously presented at the 2022 ASCO Annual Meeting. All rights reserved.

A thematic analysis of broker consultation in a TF-CBT community based learning collaborative.

Consultation is an important implementation strategy to increase competence, knowledge, and fidelity to evidence-based practice in community settings. However, the literature has primarily focused on consultation for clinical providers, and less is known about consultation for "broker" professionals, or those who identify and refer children to mental health services. Given their critical role in connecting youth to evidence-based treatment, investigating broker knowledge and use of evidence-based screening and referral are needed. To address this gap, the current study examines the content of consultation provided to broker professionals.

PROMs in the Community Practice Setting: An Institutional Experience.

PROMs in the Community Practice Setting: An Institutional Experience.

Strategies to Ensure Continuity of Care Using Telemedicine with Older Adults during COVID-19: A Qualitative Study of Physicians in Primary Care and Geriatrics.

Objectives: Our objective was to interview primary care physicians (PCPs) and geriatricians on their experiences using telemedicine during the COVID-19 pandemic to examine strategies used to maintain continuity of care with their patients, ages 65 and older. Methods: Using purposive sampling, we selected physicians based on community size (metro/suburban/rural) and practice setting (academic/community) and conducted semi-structured interviews via Zoom (mean: 30 minutes). Interviews were recorded, transcribed, coded, and analyzed using framework analysis. Results: We enrolled 33 physicians (15 PCPs and 18 geriatricians) from July to November 2020. Findings indicate that many physicians successfully bridged the digital divide by: assessing patients’ technological readiness in advance, being flexible with telehealth modes, using available home or facility-based staff, educating patients on telehealth privacy and usefulness, making accommodations for disabilities, and involving caregivers. Discussion: These findings can inform future policy and practice and assist physicians in resolving addressable barriers to telehealth use among older patients.