Regular Physician Research Articles

Abstract P149: Ideal Cardiovascular Health is Associated With the Characteristics of and Better Access to Primary Care in a Publicly Funded Healthcare System

Background: Cardiovascular health (CVH) and CVD prevention remains a top public health priority across North America. The health of Canadians is largely accredited to the publicly funded healthcare system, which affords “free” healthcare to all its citizens. However, there is little evidence demonstrating whether the characteristics of and access to primary care by Canadians directly impacts their likelihood of ideal CVH. Objective: To examine the association between ideal CVH and the characteristics of and access to primary care in Canadians. Data and Methods: This study is a cross-sectional design using adult data from the Canadian Community Health Survey (CCHS) 2015-2016 database. The CCHS is a nationwide, nationally representative survey that collects information on the health status, health care access and utilization, and health determinants of the Canadian population. CVH, defined using the AHA CVH Index (CVHI), was determined using self-reported responses in CCHS. Weighted logistic regression was performed to examine the association between ideal CVH and the characteristics of and access to primary care, including having regular care, receiving coordinated care, ER use and access to routine care. Models were also adjusted for individual characteristics known to affect CVH. Results: The majority of the population were females (51%), aged 40-60 (37%), with tertiary education (64%) and of the White race (79%). Overall, 19% of the population had ideal CVH (ideal status in 6-7 CVHI factors), representing approximately 6 million individuals nationwide. Individuals reported having a regular primary healthcare provider (82%), insurance for prescription medication (76%), high coordination in their healthcare between health professionals (10%), difficulties in accessing routine care in the past 12 months (3%). The likelihood of ideal CVH were highest in those who reported having: a regular provider (OR 1.11, 95% CI 1.05-1.17), higher coordination of care (OR 1.10, 95% CI 1.01-1.20) and using the ER less frequently (OR 0.90, 95% CI 0.80-0.95). After controlling for age, sex and race, only having a regular provider (OR 1.11, 95% CI 1.02-1.20) and not reporting difficulties in accessing routine care in the past 12 months (OR 1.02, 95% CI 1.01-1.04) were significantly associated with ideal CVH. Conclusion: Findings from this study suggest that individuals experiencing better primary healthcare, including having a regular primary care physician or having less difficulty accessing care, are more likely to have ideal CVH than those experiencing poor primary healthcare. Further studies should investigate policies that promote better primary healthcare as interventions for preventing CVD and improving CVH.

Abstract OT1-12-01: Exploration of factors associated with imminent risk of late recurrence in hormone receptor positive breast cancer

Abstract Research objectives: To conduct a prospective observational study of patient and tumor-related factors in women with high risk hormone receptor (HR)+/HER2- breast cancer (BC) following at least 5 years of adjuvant hormonal therapy, in order to identify risk factors for imminent recurrence. Rationale: Many of the life-threatening BC recurrences in women with HR+HER2- BC take place more than 5 years post-diagnosis, often after completion of adjuvant hormonal therapy. The identification of a biomarker(s) for late BC recurrence could lead to interventional trials to evaluate preventive therapies. We will evaluate whether the presence of blood-based biomarkers [(i) Circulating Tumor Cells (CTCs), (ii) circulating tumor DNA (ctDNA), (iii) tumor markers (CA 15-3, CEA)] and patient factors may predict BC recurrence. Trial design: A prospective cohort of eligible women with previously treated HR+HER2- BC who have not experienced a distant recurrence will be enrolled; patient and circulating factors will be measured annually until distant recurrence or study completion. Host factors (including BMI, lifestyle, medical illness, surgery, trauma and stress, as well as circulating PlGF, VEGF-1 and inflammatory markers) that may contribute to exit of BC cells from dormancy will also be assessed. The primary outcome is distant BC recurrence. Any BC event, including loco-regional recurrence, new breast or other primary cancer will be evaluated as a secondary endpoint. Outcomes will be ascertained by regular self-report (via annual telephone calls) and/or physician report and confirmed by medical record review. Key eligibility criteria: i) Diagnosis of ER and/or PR positive (either or both 10% positive), HER2 negative invasive BC, ii) predicted >1.5-2% annual risk of recurrence (T2, T3 or T4 with any N+;T1 N2+; T2N0 or T1 N1 cancers with high risk genomic scores), iii) receipt of adjuvant endocrine therapy for at least 4 years, with discontinuation planned in the next 12 months or completion of endocrine therapy within the last 5 years, iv) prior adjuvant chemotherapy, targeted therapy and bone targeted therapies are allowed provided they have been completed. Specific aims: 1) Determine if the presence of (i) CTCs, (ii) ctDNA, (iii) CA15-3 and CEA are associated with imminent risk (within 1-2 years) of distant recurrence in the study population. 2) Identify host factors associated with these blood-based biomarkers, as well as clinical outcomes. Statistical methods: A matched case control design (matching for time since completion of adjuvant hormone therapy, baseline T, N and grade) will be used to investigate associations of key study variables with imminent risk of distant recurrence within the next 1-2 years. Measurements of patients who do versus do not recur will be compared over the 1-2 years prior to relapse. Each variable will be allocated one third of a study-wide type one error of 0.05 (2-sided). ROC analyses and multivariable modelling will be used to optimize sensitivity, specificity, PPV and NPV. Available questionnaire data will be summarized at all time-points to generate descriptive survivorship data. Accrual: Starting in August 2018, we plan to recruit 1,000 patients over 2 years at selected Canadian cancer centres. Citation Format: Jerzak KJ, Cescon DW, Chia SK, Bratman S, Ennis M, Stambolic V, Chang M, Dowling R, Goodwin PJ. Exploration of factors associated with imminent risk of late recurrence in hormone receptor positive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-12-01.

Parents' perception and willingness to maintain provider care continuity for their children under universal health coverage.

BackgroundProvider continuity of care (COC) is closely related to patient outcome in pediatrics. However, no study has investigated how parents perceive the importance of COC and whether their perceptions affect their willingness to make effort to maintain good provider COC for their children under universal health coverage.MethodsA cross-sectional survey was conducted between August 2017 and February 2018 across 6 different practices: 2 medical centers, 2 regional hospitals, 1 district hospital, and 1 clinic (n = 825). Parents' and caregivers' perceptions and perceived value of COC were evaluated using 7 items. The contingent valuation method was used to estimate willingness to pay and spend time.ResultsOf all respondents, only 47% (n = 394) were willing to spend >30 minutes to have their children see the regular physician if the regular physician relocated. Approximately 38% (n = 302) respondents were willing to pay more than New Taiwan Dollar (NT$) 300 per month to maintain provider COC. The perception that high COC is important was associated with willingness to spend more time for maintaining high provider COC.ConclusionParents' perception of COC does not affect their willingness to pay for maintaining high provider COC for their children but affects their willingness to spend more time to maintain COC.

Physicians' awareness and practice toward influenza and pneumococcal vaccines for high-risk patients.

Objectives:The aim of the study is to assess the awareness of family medicine residents about influenza and pneumococcal vaccination for high-risk patients and to verify the most significant variables that might affect residents’ knowledge and the tools needed to enhance their practice.Materials and Methods:This cross-sectional study was conducted at four major hospitals in Riyadh, Saudi Arabia, during the period, October through December 2017. A pretested self-administered questionnaire was handed to 180 family residents. Descriptive statistics were used to analyze the study data. The Chi-square test was used to compare categorical variables data. The One-way ANOVA test was used to detect the significant difference.Results:The overall knowledge of physicians about influenza and pneumococcal vaccines was inadequate and was more toward pneumococcal vaccine, in spite their respectable knowledge about the target population. The main reasons for non- prescribing of vaccines were forgetfulness (59.4%), the availability of vaccines (33.9%), and the patients’ refusal (23.3%). The tools that might help for prescribing were the need for the presence of electronic reminder (69.4%) and the patients should follow a regular family physician (47.2%).Conclusion:Knowledge and practice of influenza and pneumococcal vaccination are inadequate. This is mainly because of forgetfulness owing to minimal guideline awareness, lack of vaccine availability, and patients’ refusal. The important recommendations to enhance vaccination practice among physicians are the implementation of electronic reminders, regular follow-up with the same physician in addition to educational programs during residency, and patient education about the importance of vaccinations as a means of disease prevention.

SELF CARE AGENCY OF OBESE INDIVIDUALS

Aim: The aim of the study is to determine the self-care agency of with obese individuals and the factors affecting them. Methods: The study having a defining characteristic was held between the dates of January 2017 and June 2017 at an obesity clinic of the department of endocrinology and metabolic diseases of a training hospital. Within the scope of the sample 257 people that applied to the hospital between these dates, and accorded with the boundedness of the study were taken. The data of the study were gathered through face-to-face interview method by using personal information form and self-care agency scale.The data were analyzed using percentages, numbers, Student's t-test, Mann Whitney U test and Kruskall Wallis test analysis. Results: Findings: Of the individuals included in the study 81.7% were female, 30.7% of them are in the 51-60 age group. It was found that 78.2% of individuals had chronic disease and 56.4% of them were first degree obese. The overall average of self-care power of the individuals was determined as 100.13± 18.44. No significant difference was found when the overall average of self-care power was compared according to BMI. In the study, it was determined that gender, age group, marital status, income status, regular physician control, physical activity and education have a significant effect on self-care.Conclusion: As a result of this study, it was found that the average self-care agency score of the obese individuals included in the study was moderate.

Experiences of health services among patients with chronic conditions

Introduction : Patients with chronic illnesses often have complex health care needs and use multiple social and health care services. This study examined experiences about health care use among persons with chronic conditions and whether these experiences were associated with sociodemographic factors, health care needs and use of health care services. Methods : The data were from a randomly sampled population survey concerning health care experiences n=2626, response rate 46%. In this study we used a subgroup of persons with a chronic illness n=1282. The outcome measures were experiences about: access to care, respectful treatment, participation to care and coordination of care during the last 12 months. The explanatory factors were sociodemographic factors, need for care functional limitation, depression, use of health services ambulatory care and hospitalization and having a continuous therapeutic relationship regular physician. Multivariate logistic regression was used to analyze the relationships between the explanatory and outcome variables. Results : In fully adjusted models, more negative experience of care on all dimensions were reported by those with sever functional limitations ORs 0.35-0.49 and frequent visit to ambulatory care ORs 0.43-0.59, while continuous therapeutic relationship was related better experiences on all dimensions ORs 1.50-1.91. Depression was related to more negative experiences in respectful treatment OR= 0.54 and poorer coordination of care OR=0.61. Those who had been hospitalized during the past year reported more problems in respectful treatment OR=0.57 and coordination of care OR=0.41. Compared to those using public health centers as the main site of ambulatory care, better access to care was reported by those using private clinic OR=2.24, occupational health care OR=1.91 or hospital outpatient clinic OR=2.45. Participation to care was more often reported by those using hospital outpatient clinic as main site of care compared to other groups. Discussion : In conclusion, these results indicate poor responsiveness of the health care system among those with complex health care needs and frequent use of health care. The lesson learned from the study is that many of the common problems of the Finnish health care system, such as poor and inequitable access to care and problems in integration, are reflected also in experiences of those with higher health care needs. Frequent attenders 10% of health care users are estimated to cause a substantial proportion of all health care costs. Thus, organizations and responsiveness of health care should be monitored from the point of view of these vulnerable users. The limitation of the study is that we were not able to examine experiences in terms of specific illnesses. Future studies should focus on condition specific health care needs and experiences.

Is Immigrant Status Associated With Cervical Cancer Screening Among Women in Canada? Results From a Cross-Sectional Study.

Cervical cancer accounts for the highest mortality rate from cancer in women worldwide. Despite widespread availability of cervical cancer screening programs in Canada, immigrant women are largely underscreened. The most recently published Canadian-wide study evaluated screening uptake from 2001 to 2002. The objectives included identifying the prevalence of underscreened women in Canada, determining the risk of underscreening for cervical cancer among immigrant women, and providing an update on Canadian screening practices. This study included women aged 20 to 69 who completed the Canadian Community Health Survey 2012. The prevalence of underscreening among Canadian-born and immigrant women was estimated. A log-binomial model was fit to estimate the relative risk (RR) of underscreening for immigrant women while controlling for age, income level, visible minority status, smoking status, and access to a regular physician. A secondary analysis compared immigrants residing in Canada for greater or less than 10 years to Canadian-born women. Of the 17854 women eligible for this study, 18.6% of Canadian-born women and 28.9% of immigrant women were underscreened (P<0.05). Immigrant women were at significantly higher risk of being underscreened compared with Canadian-born women (RR 1.32; 95% CI 1.20-1.45). The relative risk did not change when stratifying by length of time since immigration (RRrecent immigrant 1.32; 95% CI 1.16-1.50; and RRlong-term immigrant 1.32; 95% CI 1.19-1.47). Immigrant status continues to be associated with a significantly higher risk of underscreening, irrespective of time in Canada. Social and educational programs targeted towards immigrants are needed to mitigate the disparity in cervical cancer screening.

56 A Novel Transitional Care Strategy Improving Health Care Utilization in Diabetes Patients

Diabetes is a common chronic disease requiring regular primary care physician (PCP) clinic visits to prevent diabetes-associated complications. Noncompliance of PCP follow-up occurs frequently among chronic diabetic patients. A novel transitional care plan was established in a hospital urgent care center (UCC) adjacent to an emergency department (ED) with the goal of increasing PCP compliance. We aim to investigate the quality improvement role of implementing this novel transitional care strategy. All patients with new-onset diabetes or history of diabetes were enrolled from April 6, 2015 through October 1, 2017. Enrolled patients followed the transitional care protocol; upon disposition, a follow-up PCP clinic appointment was scheduled and given to the patient before discharge. Each patient was also advised to return to diabetic transitional care (within the UCC), if they were unable to keep their PCP appointment. The number of PCP clinic visits, diabetic transitional care visits and ED visits were compared before and after the intervention. The association between PCP clinic/ED visits and such intervention were investigated in a linear multivariate regression model. The number of PCP clinic visits before and after the intervention was compared using paired student t-test. A total of 12,226 patient encounters were included. The average number of PCP clinic visits per patient within 12 months before the intervention was 1.75, in comparison to 2.58 post-intervention PCP clinic visits, after adjusting for the same follow-up duration (p<0.001). The number of PCP visits increased (point estimate=0.015, 95% CI0.006-0.024) and the number of ED visits decreased (point estimate= -0.012, 95% CI -0.018 to -0.007), with the increased number of transitional care visits in a multivariate regression analysis. Additionally, 68% of patients kept their PCP appointment after the transitional care visit. However, this percentage decreased with increased intervals between the initial transitional care and subsequent PCP clinic appointments. A novel diabetic transitional care strategy increased patient compliance for PCP follow-up visits and decreased the number of ED visits. However, patient PCP follow-up compliance decreased with an increased interval between transitional care and subsequent PCP clinic appointments.

Predictors of hospital readmissions in internal medicine patients: Application of Andersen's Model.

This study aimed to identify predictors of internal medicine patients' readmission to hospital, using Andersen's behavioral model. This prospective cohort study included 2622 patients aged ≥18years, who were admitted to internal medicine wards at a university hospital between 1 February 2015 and 31 January 2016. Independent variables were divided into four groups (predisposing, enabling, need, and utilization), based on Andersen's model, and included in stepwise logistic regression analysis. Younger age, male sex, a main diagnosis of neoplasm, longer length of stay, higher comorbidity scores, and weaker coping ability predicted all readmission. Predictors of unplanned readmission included having someone to help at home following discharge, comorbidity scores, and length of stay. Predictors of unplanned, related, and preventable readmissions included having someone to help at home following discharge, having a regular physician, and the main diagnosis at discharge. The most powerful predictors influencing readmission were need-related variables. Although some predictors of readmission were unalterable, they could be used to identify high-risk patients. Innovative approaches targeting discharge planning and postdischarge care for patients with high comorbidity scores and long length of stay could reduce internal medicine patients' unplanned readmission.

Association between patient attachment to a regular doctor and self-perceived unmet health care needs in Canada: A population-based analysis of the 2013 to 2014 Canadian community health surveys.

Although Canada operates a universal health care insurance system, equitable access to required health care services when needed still poses a challenge for some. The aim of this study was to examine the relationship between patient attachment to a family physician and self-perceived unmet health care needs (UHN) in Canada, after adjusting for predisposing, enabling, and need factors of the behavioral model of health services use. This cross-sectional study used data from the Canadian Community Health Surveys, cycle 2013 to 2014. A sample of 58462 individuals aged 12years and over was analyzed. Logistic regression models were used to examine the relationship between patient attachment and self-perceived UHN. An estimated 10.41% of the Canadian population 12years and older reported having UHN in the previous year. Among people with self-perceived UHN, there was significantly greater likelihood of unattachment to a family physician-no regular doctor or having a regular site of care, being younger, being female, being divorced, separated or widowed, having higher education, having lower income, having poorer perceived physical or mental health, having a weak sense of community belonging, having at least one chronic condition, and having greater activity limitations. Ongoing public discourses on improving primary health care performance and reducing the burden of UHN in Canada should prioritize efforts that promote and facilitate the use of a regular family physician.

Soins médicaux généraux en unité hospitalière spécialement aménagée : une enquête nationale

ObjectivesThe UHSA (UHSA) are French psychiatric units for inmates which admit detainees suffering from a psychiatric disorder requiring full-time hospital care. Non-psychiatric pathologies are overrepresented in patients with psychiatric disorders but also in detainees. As a result, patients hospitalized in UHSA are largely exposed to non-psychiatric conditions, and exploring the organization of general medical care for these patients appears very relevant. The aim of this study is to review the general medical care in all French UHSA. MethodsA descriptive study was carried out through a survey of the nine facilities. ResultsAll UHSA benefit from the intervention of a general practitioner. The physical clinical examination, the biological assessment and the electrocardiogram are systematically performed at the patient's admission in 7, 5 and 9 establishments, respectively. However, the offer of general medical care in UHSA seems disparate and sometimes insufficient. Specialized consultations are regularly requested during hospitalizations, but no establishment benefits from a telemedicine system or specialized consultations on site. The extraction of the patient to the general hospital is therefore systematic when such a consultation is needed. But the number of penitentiary escorts per day is limited. In 6 UHSA, medical extractions are thus regularly canceled by the penitentiary administration, sometimes without a medical opinion. Finally, the patient's regular physician is only contacted in 3 UHSA during hospitalizations. ConclusionBased on these results, ways of improving the organization of general medical care in UHSA are proposed through four main axes: the structure and general organization; the general medical care; the link with the healthcare partners and the articulation with the penitentiary administration.

Using Mobile Health to Enhance Outcomes of Noncommunicable Diseases Care in Rural Settings and Refugee Camps: Randomized Controlled Trial.

BackgroundRural areas and refugee camps are characterized by poor access of patients to needed noncommunicable disease (NCD)–related health services, including diabetes and hypertension. Employing low-cost innovative eHealth interventions, such as mobile health (mHealth), may help improve NCDs prevention and control among disadvantaged populations.ObjectiveThe aim of this study was to assess the effect of employing low-cost mHealth tools on the accessibility to health services and improvement of health indicators of individuals with NCDs in rural areas and refugee camps in Lebanon.MethodsThis is a randomized controlled trial study in which centers were allocated randomly into control and intervention sites. The effect of an employed mHealth intervention is assessed through selected quality indicators examined in both control and intervention groups. Sixteen primary health care centers (eight controls, eight interventions) located in rural areas and Palestinian refugee camps across Lebanon were included in this study. Data on diabetic and hypertensive patients—1433 in the intervention group and 926 in the control group—was extracted from patient files in the pre and postintervention periods. The intervention entailed weekly short message service messages, including medical information, importance of compliance, and reminders of appointments or regular physician follow-up. Internationally established care indicators were utilized in this study. Descriptive analysis of baseline characteristics of participants, bivariate analysis, logistic and linear regression were conducted using SPSS (IBM Corp).ResultsBivariate analysis of quality indicators indicated that the intervention group had a significant increase in blood pressure control (P=.03), as well as a significant decrease in the mean systolic blood pressure (P=.02), mean glycated hemoglobin (HbA1c; P<.01), and in the proportion of HbA1c poor control (P=.02). Separate regression models controlling for age, gender, and setting showed a 28% increase in the odds of blood pressure control (P=.05) and a 38% decrease in the odds of HbA1c poor control (P=.04) among the intervention group in the posttest period. Females were at lower odds of HbA1c poor control (P=.01), and age was statistically associated with annual HbA1c testing (P<.01). Regression models for mean systolic blood pressure, mean diastolic blood pressure, and mean HbA1c showed that a mean decrease in HbA1c of 0.87% (P<.01) pretest to posttest period was observed among the intervention group. Patients in rural areas belonging to the intervention group had a lower HbA1c score as compared with those in refugee camps (P<.01).ConclusionsThis study underlines the importance of employing integrative approaches of diseases prevention and control in which existing NCD programs in underserved communities (ie, rural and refugee camps settings) are coupled with innovative, low-cost approaches such as mHealth to provide an effective and amplified effect of traditional NCD-targeted care that can be reflected by improved NCD-related health indicators among the population.Trial RegistrationClinicalTrials.gov NCT03580330; https://clinicaltrials.gov/ct2/show/NCT03580330 (Archived by WebCite at http://www.webcitation.org/70mhVEUwQ)

Abstract C24: Determinants of delays in care-seeking for ovarian cancer symptoms in African American women

Abstract Introduction: Ovarian cancer is the most deadly gynecologic cancer, and the mortality burden is disproportionately higher among African American women. Women diagnosed with stage IV disease have less than a 30% 5-year survival rate, compared to 90% 5-year survival in stage I disease, which highlights the importance of early diagnosis. Lack of financial means and limited access to care may contribute to delays in symptomatic women seeking treatment, with consequent later stage at diagnosis. However, several studies, performed in samples predominantly comprised of White women, suggest insurance and income do not sufficiently reflect access to care. Here, we examine whether delay in care-seeking (captured through duration of symptoms prior to diagnosis) among African American women is more strongly influenced by socioeconomic status, access to care, or social access barriers (discrimination and trust in physicians). Methods: This analysis includes data from 550 African American women with ovarian cancer enrolled in the African American Cancer Epidemiology Study (AACES). AACES is a case-control study spanning 11 geographic regions in the United States: North Carolina, South Carolina, Georgia, Alabama, Tennessee, Louisiana, Texas, New Jersey, Ohio, Chicago, and Detroit. Included in the phone-administered AACES survey were questions about symptoms associated with ovarian cancer such as abdominal lumps, changes in bowel habits, and abnormal vaginal bleeding, in the year prior to ovarian cancer diagnosis. If a woman indicated she had a symptom, duration of the symptom was recorded in months. Logistic regression was used to estimate the odds ratios between predictors of accessing care and the outcome of treatment delay. The outcome was defined as having any of the 10 symptoms for at least eight months prior to diagnosis (i.e., those exceeding the seven-month mean symptom duration in this population). Models were adjusted for region, age at diagnosis, histotype, first-degree family history of breast or ovarian cancer, marital status, body mass index, Charlson comorbidity score, pelvic-inflammatory disease history, education, and income. Access to care variables included regular source of health care, insurance, regular physician relationship, and experiencing a barrier to accessing health care. Perceived discrimination was evaluated using the mean response score for questions from Williams' Everyday Discrimination Scale. Trust in physicians was modeled using the mean response score from the Anderson Dedrick Trust in Physicians Scale. Results: 41% (n=227) of women reported having at least one symptom for eight months prior to diagnosis. After adjustment for confounders, trust in physicians was inversely associated with longer duration of symptoms. A one-unit increase in the mean trust score was associated with 0.73 times the odds of women reporting undiagnosed symptoms in the previous 8 months (OR 0.73 CI 0.55-0.96). Conversely, a one-unit increase in frequency of mean everyday discrimination score was associated with 1.56 times the odds of 8 months of undiagnosed symptoms (OR 1.56 CI 1.14-2.15), after adjustment for confounders. Access to care measures and socioeconomic variables were not associated with longer symptom length in this study population. Conclusions: Various studies have considered access to care mainly in terms of availability of health insurance. Our results suggest perceived discrimination and lack of trust in physicians are important barriers to African American women seeking treatment for their ovarian cancer symptoms, even after controlling for socioeconomic status, insurance, and source of care. Citation Format: Megan Mullins, Michele L. Cote, Sarah Abbott, Anthony J. Alberg, Elisa V. Bandera, Jill Barnholtz-Sloan, Melissa Bondy, Fabian Camacho, Ellen Funkhouser, Patricia G. Moorman, Lauren C. Peres, Ann G. Schwartz, Paul D. Terry, Frances Wang, Joellen M. Schildkraut, Edward S. Peters. Determinants of delays in care-seeking for ovarian cancer symptoms in African American women [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C24.

Abstract C59: HBV screening and vaccination among first-generation African immigrants: A pilot study

Abstract Background: African Americans disproportionately bear a large burden of hepatitis B virus (HBV)-related liver disease in the U.S. Foreign-born African immigrants have high HBV prevalence rates. However, data on the African immigrant community are sparse. Information about HBV screening, vaccination, and awareness of this vulnerable population has been less well characterized. The purpose of this study was to provide the basis for a better understanding of HBV burden in this population and identify risk factors for implementation of future preventive and treatment programs. Methods: We conducted a cross-sectional survey among 71 first-generation African Americans in New York City. Survey questions were asked regarding participants' HBV infection status, screening and vaccination history, practice of infection monitoring and treatment, knowledge of HBV transmission, and perceived barriers to screening and proper monitoring. Descriptive analyses and bivariate chi-square tests were conducted to describe the study sample and identify predictors of HBV screening and vaccination. Results: The study sample consists of 47 men and 23 women, with an average age of 33. Among the sample, 87.7% are immigrants from sub-Sahara Africa, and over 85.4% lived in the U.S. more than 15 years. About half of the participants never had HBV screening (43.6%) and never received vaccination (50%). We found a low level of HBV-related knowledge. Only about half of the participants had a correct understanding of the ways in which HBV is transmitted. Bivariate analyses showed that four factors were significantly associated with HBV screening and vaccination. Specifically, having health insurance (p &amp;lt; .01), a regular physician (p &amp;lt; .01), and college or higher degree (p &amp;lt; .01) are significantly associated with having HBV screening. In addition, having health insurance (p &amp;lt; .001) and a regular physician (p &amp;lt; .001) are significantly associated with having HBV screening. Furthermore, “do not have any problems/symptoms” is the most cited reason (26.75%) for not having had HBV screening. Conclusion: First-generation African immigrants in the study sample had very limited knowledge regarding HBV transmission, disease etiology, and severity, which should be the focus of future intervention to promote HBV screening and vaccination. Furthermore, we identified several predictors of HBV screening and vaccination among first-generation African immigrants. Specifically, low education, lack of health insurance, and access to a regular physician served as barriers to HBV screening and vaccination. Public health campaigns and policies need to address these social barriers. Citation Format: Grace X. Ma, Adeodat Ilboudo, Omar Dibba, Lin Zhu, Yin Tan, Olorunseun O. Ogunwobi. HBV screening and vaccination among first-generation African immigrants: A pilot study [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C59.

Facilitating primary care provider use in a patient-centered medical home intervention study for chronic hemodialysis patients.

Patients with chronic kidney disease have a high disease burand may benefit from primary care services and care coord A medical home model with direct access to primary care services is one approach that may address this need, yet has not been examined. As a substudy of the Patient-Centered Outcomes Research Institute (PCORI) patient-centered medical home for kidney disease (PCMH-KD) health system intervention study, we examined the uptake of free primary care physician (PCP) services. The PCORI PCMH-KD study was an initial step toward integrating PCPs, a nurse coordinator, a pharmacist, and community health workers (CHWs) within the health care delivery team. Adult chronic hemodialysis (CHD) at two urban dialysis centers were enrolled in the intervention. We examined trends and factors associated with the use of the PCMH-KD PCP among two groups of patients based on their report of having a regular physician for at least six months (established-PCP) or not (no-PCP). Of the 173 enrolled patients, 91 (53%) patients had at least one visit with the PCMH-KD PCP. The rate of visits was higher in those in the no-PCP group compared with those in the established-PCP group (62% vs. 41%, respectively). Having more visits with the CHW was positively associated with having a visit with the PCMH-KD PCPs for both groups. Embedded CHWs within the care team played a role in facilithe uptake of PCMH-KD PCP. Lessons from this health system intervention can inform future approaches on the integration of PCPs and care coordination for CHD patients.

An Exploration of the Content and Usability of Web-Based Resources Used by Individuals to Find and Access Family Physicians.

Background:The most commonly recommended strategy in Canada for patients wishing to find a regular family physician (FP) is through the use of websites with FP listings. We aimed to explore the content and usability of these websites.Methods:We identified publicly available websites with FP listings in Western Canada, analyzing them thematically through open coding for website content and conducting framework analysis for website usability.Results:Twelve unique websites were identified and grouped into three categories: (1) Physician regulatory authorities (“Colleges”); (2) Governmental; and (3) Miscellaneous. College websites provided the greatest detail about the FPs and enabled searching, though had low readability. Governmental websites listed basic contact information and were credible but contained less detail than College websites. Miscellaneous websites were narrower in focus and therefore easier to navigate but lacked updated and accurate information.Conclusion:Many websites help patients find FPs. Their content and usability are variable, suggesting a need for guidance in the development of these resources.

Recruitment Techniques and Strategies in a Community-Based Colorectal Cancer Screening Study of Men and Women of African Ancestry.

Recruiting ethnically diverse Black participants to an innovative, community-based research study to reduce colorectal cancer screening disparities requires multipronged recruitment techniques. This article describes active, passive, and snowball recruitment techniques, and challenges and lessons learned in recruiting a diverse sample of Black participants. For each of the three recruitment techniques, data were collected on strategies, enrollment efficiency (participants enrolled/participants evaluated), and reasons for ineligibility. Five hundred sixty individuals were evaluated, and 330 individuals were enrolled. Active recruitment yielded the highest number of enrolled participants, followed by passive and snowball. Snowball recruitment was the most efficient technique, with enrollment efficiency of 72.4%, followed by passive (58.1%) and active (55.7%) techniques. There were significant differences in gender, education, country of origin, health insurance, and having a regular physician by recruitment technique (p < .05). Multipronged recruitment techniques should be employed to increase reach, diversity, and study participation rates among Blacks. Although each recruitment technique had a variable enrollment efficiency, the use of multipronged recruitment techniques can lead to successful enrollment of diverse Blacks into cancer prevention and control interventions.

MP36: Can one emergency physician improve department flow? A proof-of-concept trial of a physician float role

Introduction: Emergency departments (EDs) are overcrowded and patient acuity and volumes are ever-increasing. While changes to the flow of ED patient input and output are outside the control of frontline ED teams, the efficiency of ED throughput can be optimized. One widely studied intervention is the implementation of a physician liaison role to assist in managing overall ED flow. The Physician Float (PF) acts as a triage liaison, second physician for resuscitations, ED procedural sedation physician, and fields ED referral calls. This is a first-iteration proof-of-concept trial to plan, implement and evaluate if the PF role could decrease ED length of stay (LOS) by a goal of 30 minutes, over a four-week period, without adverse changes to left without being seen (LWBS) and bounce-back rates. Methods: The PF role was implemented as a scheduled emergency physician shift in the fall of 2017. Ongoing iterations of this role implementation are being reviewed for re-implementation. The primary outcome measure was ED LOS; secondary outcomes included time-to-physician initial assessment (PIA), EMS offload rates, and LWBS and 72-hour bounce-back rates. Qualitative data including patient concerns and physician feedback were also collected. Data were collected after the trial from a centralized, de-identified ED information system database with time-stamp quantifiers and compared to the following four-week time period where the shift is a regular ED physician shift at the same time. The ED physician and nursing team planned and implemented the PF role, then results were evaluated and shared with the wider ED staff in departmental grand rounds and quality council presentation formats, and recommendations were gathered from to adjust and strengthen future iterations of PF role implementation. Results: Descriptive statistics and Mann-Whitney and Median tests were calculated. On average there were 185 daily ED visits in the trial and comparison periods. Median ED LOS decreased by 12 minutes in the PF trial period (p&lt;0.05). Furthermore, there was a 12 minute decreased ED LOS for all discharged patients (p&lt;0.05). PIA time decreased by 13 minutes for patients that were admitted. The average percentage of EMS offloads within 60 min improved from 75% to 80.7% for admitted patients. LWBS and 72-hour bounce-back rates were unchanged. No additional patient concerns arose related to or during the trial. Physician feedback on the PF role was mainly positive. Conclusion: The defined role of a PF in an ED can decrease ED LOS, albeit not achieving the desired 30-minute reduction on the first iteration, this trial supported proof-of-concept for implementation of a PF role in a tertiary care centre ED. Further iterations are needed to evaluate the scalability and sustainability of this role.

PHS70 - Factors Associated with Non-Persistent Surveillance after Diagnosis of Oral Potentially Malignant Disorders

Individuals diagnosed with oral potentially malignant disorders (OPMDs) are recommended to receive regular surveillance in addition to oral screening once every two years through the National Oral Screening Program in Taiwan. However, their adherence to regular surveillance after the OPMD diagnosis is poor, and some of them are diagnosed with oral cavity cancer at an advanced stage nonetheless. This study, therefore, aimed to examine factors associated with non-persistent surveillance. Individuals who were diagnosed with OPMDs through the oral screening program were identified from the oral screening database. Patterns of surveillance after the diagnosis of OPMDs and use of health services were retrieved from their National Health Insurance claims database. Persistence of surveillance was defined as regular follow-up physician visits or oral screening without a gap longer than seven months. Cox proportional hazards regression model was adopted to identify factors associated with the risk of non-persistent surveillance. Of 11,341 subjects identified in this study, the mean age was 53 years old, and 93% of them were male. Female, poverty, Charlson Comorbidity Index < 2, living in city area, betel nut chewing, cigarette smoking, and no dental attendance in one year prior to the OPMD diagnosis were associated with a higher risk of non-persistence surveillance. This study identified factors associated with the risk of non-persistent surveillance after the diagnosis of OPMDs. The information is of importance for planning interventions to improve persistent surveillance in order to detect development of oral cavity cancer at an earlier stage.

A comprehensive framework identifying readmission risk factors using the CHAID algorithm: a prospective cohort study.

To identify frequency of readmission after discharge from internal-medicine wards, readmission risk factors, and reasons and costs of readmission. Prospective cohort study. A tertiary-care hospital in Turkey. 2622 adult patients discharged from internal-medicine wards of the hospital between 1 February 2015 and 31 January 2016. Thirty day all-cause readmission rates, reasons and costs of readmission. To identify readmission risk factors Chi-square Automatic Interaction Detector (CHAID) analysis was conducted. The same hospital readmission rate was 17.9%, while the same hospital or different-hospital readmission rate was 21.3%. Receiver operating characteristic (ROC) curve analysis showed that the predictive performance of the CHAID algorithm was high. According to the CHAID algorithm, the most significant readmission risk factor was the main diagnosis of neoplasm at the index admission. In other diagnosis groups, higher Charlson comorbidity score, higher level of education, having a regular physician, and three dimensions of Readiness for Hospital Discharge Scale were significant risk factors for readmission. The most frequent reason for readmission was neoplasm, and the total cost of readmissions was ~$900 000. The CHAID algorithm for readmissions had a high predictive strength and provided details that aid physicians in decision-making. Measures must be taken from initial diagnosis to post-discharge follow-up, to minimize readmissions, especially in patients with neoplasm.