Referral Resources Research Articles

Disparities in Referral Initiation and Completion at an Urban FQHC Look-alike (FQHC-LA) Clinic.

The purpose of this study was to determine referral initiation and completion disparities across primary care encounters at the Hope Family Care Center (HFCC) in Kansas City, MO, by payor type (primary insurance): private insurance, Medicaid, Medicare, and self-pay. Data were collected and analyzed for all encounters (N = 4,235) over a 15-month period, including payor type, referral initiation and completion, and demographics. Referral initiation and completion were calculated by payor type and differences analyzed using Chi-square tests and t-tests. Logistic regression examined payor type association with referral initiation and completion, accounting for demographic variables. Our analysis showed a meaningful difference in rate of referral to specialists by payor type. The Medicaid encounter referral initiation rate was higher than rates for all other payor types (7.4% vs. 5.0%), and self-pay encounters' referral initiation rate was lower than rates for all other payor types (3.8% vs. 6.4%). Using logistic regression, Medicaid encounters had 1.4 greater odds, and self-pay encounters 0.7 greater odds, of initiating a referral compared to private insurance encounters. There was no difference in referral completion by payor type or demographic category. Equal referral completion rates across payor types suggested HFCC may have had well-established referral resources for patients. Higher referral initiation rates for Medicaid and lower for self-pay may suggest that insurance coverage offered financial confidence when seeking specialist care. Higher odds of Medicaid encounters initiating a referral could imply greater health needs among Medicaid patients.

Impact of Policy Change on Access to Medication for Opioid Use Disorder in Primary Care.

The opioid overdose epidemic is escalating. Increasing access to medications for opioid use disorder in primary care is crucial. The impact of the US Department of Health and Human Services' policy change removing the buprenorphine waiver training requirement on primary care buprenorphine prescribing remains unclear. We aimed to investigate the impact of the policy change on primary care providers' likelihood of applying for a waiver and the current attitudes, practices, and barriers to buprenorphine prescribing in primary care. We used a cross-sectional survey with embedded educational resources disseminated to primary care providers in a southern US academic health system. We used descriptive statistics to aggregate survey data, logistic regression models to evaluate whether buprenorphine interest and familiarity correlate with clinical characteristics, and a χ2 test to evaluate the effect of the educational intervention on screening. Of the 54 respondents, 70.4% reported seeing patients with opioid use disorder, but only 11.1% had a waiver to prescribe buprenorphine. Few nonwaivered providers were interested in prescribing, but perceiving buprenorphine to be beneficial to the patient population was associated with interest (adjusted odds ratio 34.7, P < 0.001). Two-thirds of nonwaivered respondents reported the policy change having no impact on their decision to obtain a waiver; however, among interested providers, it increased their likelihood of obtaining a waiver. Barriers to buprenorphine prescribing included lack of clinical experience, clinical capacity, and referral resources. Screening for opioid use disorder did not increase significantly after the survey. Although most primary care providers reported seeing patients with opioid use disorder, interest in prescribing buprenorphine was low and structural barriers remained the dominant obstacles. Providers with a preexisting interest in buprenorphine prescribing reported that removing the training requirement was helpful.

Perspectives on snakebite envenoming care needs across different sociocultural contexts and health systems: A comparative qualitative analysis among US and Brazilian health providers.

With the advancements in therapeutics and available treatment options, almost all deaths and permanent disabilities from snakebite envenoming (SBE) are preventable. The challenge lies in implementing these evidence-based treatments and practices across different settings and populations. This study aims to compare data on provider perceptions of SBE care across health systems and cultural contexts to inform potential implementation science approaches. We hypothesize different health systems and cultural contexts will influence specific perceived needs to provide adequate snakebite care within central tenets of care delivery (e.g., cost, access, human resources). We previously conducted exploratory descriptive studies in the US and Brazil in order to understand the experience, knowledge, and perceptions of health professionals treating SBE. In the US, in-depth interviews were performed with emergency physicians from January 2020 to March 2020. In BR, focus group discussions were conducted with health professionals from community health centers at the end of June 2021. The focus group discussions (BR) were originally analyzed through an inductive thematic analysis approach. We conducted a secondary qualitative analysis in which this codebook was then applied to the interviews (US) in a deductive content analysis. The analysis concluded in August 2022. Brazil participants were physicians (n=5) or nurses (n=20) from three municipalities in the State of Amazonas with an average of three years of professional experience. US participants were emergency physicians (n=16) with an average of 15 years of professional experience. Four main themes emerged: 1) barriers to adequate care on the patient and/or community side and 2) on the health system side, 3) perceived considerations for how to address SBE, and 4) identified needs for improving care. There were 25 subthemes within the four themes. These subthemes were largely the same across the Brazil and US data, but the rationale and content within each shared subtheme varied significantly. For example, the subtheme "role of health professionals in improving care" extended across Brazil and the US. Brazil emphasized the need for task-shifting and -sharing amongst health care disciplines, whereas the US suggested specialized approaches geared toward increasing access to toxicologists and other referral resources. Despite similar core barriers to adequate snakebite envenoming care and factors to consider when trying to improve care delivery, health professionals in different health systems and sociocultural contexts identified different needs. Accounting for, and understanding, these differences is crucial to the success of initiatives intended to strengthen snakebite envenoming care. Implementation science efforts, with explicit health professional input, should be applied to develop new and/or adapt existing evidence-based treatments and practices for SBE.

Strategies Addressing Barriers to the Implementation of a Pediatric Hand Fracture Care Pathway.

We performed a conventional content analysis of transcripts from four focus groups (parents, emergency/urgent care physicians, plastic surgeons, and hand therapists) to identify relevant concepts (facilitators and barriers). These concepts were mapped to two frameworks. Generic strategies to address the barriers were identified, and further discussions with key stakeholders resulted in tailored strategies for implementation. Five facilitators to implementation of a CKHR-based hand fracture care pathway included established rapport between hand therapists and surgeons, potential for more streamlined care, agreement on identifying another care provider, positive perceptions of hand therapist expertise, and opportunity for patient education. Two individual barriers were concern for poor outcomes and trust. Three systemic barriers were awareness and usability, referral process, and cost and resources. Strategies to address these barriers include pilot-testing of the new care pathway, ensuring closed loop communication, multiple knowledge translation activities, integration of CKHR into the clinical information system, coordinating care and development of parent handouts. Mapping barriers to established implementation frameworks has informed tailored implementation strategies, bringing us one step closer to successfully implementing a new pediatric hand fracture pathway.

Implementation Fidelity of Chatbot Screening for Social Needs: Acceptability, Feasibility, Appropriateness.

Patient and provider-facing screening tools for social determinants of health have been explored in a variety of contexts; however, effective screening and resource referral remain challenging, and less is known about how patients perceive chatbots as potential social needs screening tools. We investigated patient perceptions of a chatbot for social needs screening using three implementation outcome measures: acceptability, feasibility, and appropriateness. We implemented a chatbot for social needs screening at one large public hospital emergency department (ED) and used concurrent triangulation to assess perceptions of the chatbot use for screening. A total of 350 ED visitors completed the social needs screening and rated the chatbot on implementation outcome measures, and 22 participants engaged in follow-up phone interviews. The screened participants ranged in age from 18 to 90 years old and were diverse in race/ethnicity, education, and insurance status. Participants (n = 350) rated the chatbot as an acceptable, feasible, and appropriate way of screening. Through interviews (n = 22), participants explained that the chatbot was a responsive, private, easy to use, efficient, and comfortable channel to report social needs in the ED, but wanted more information on data use and more support in accessing resources. In this study, we deployed a chatbot for social needs screening in a real-world context and found patients perceived the chatbot to be an acceptable, feasible, and appropriate modality for social needs screening. Findings suggest that chatbots are a promising modality for social needs screening and can successfully engage a large, diverse patient population in the ED. This is significant, as it suggests that chatbots could facilitate a screening process that ultimately connects patients to care for social needs, improving health and well-being for members of vulnerable patient populations.

Challenges of methadone maintenance treatment decentralisation from Vietnamese primary care providers' perspectives.

Decentralising methadone maintenance treatment to primary care improves patients' access to care and their drug and HIV treatment outcomes. However, primary care providers (PCP), especially those working in limited-resource settings, are facing great challenges to provide quality methadone treatment. This study explores the challenges perceived by PCP providing methadone treatment at commune health centres in a mountainous region in Vietnam. We conducted in-depth interviews with 26 PCP who worked as program managers, physicians, counsellors, pharmacists and medication dispensing staff at the methadone programs of eight commune health centres in Dien Bien, Vietnam, in November and December 2019. We used the health-care system framework in developing the interview guides and in summarising data themes. Participants identified major challenges in providing methadone treatment in commune health centres at the individual, clinic and environmental levels. Individual-level challenges included a lack of confidence and motivation in providing methadone treatment. Clinic-level factors included inadequate human resources, lack of institutional support, insufficient technical support, lack of referral resources and additional support for patients. Environment-level factors comprised a lack of reasonable policies on financial support for providers at commune health centres for providing methadone treatment, lack of regulations and mechanisms to ensure providers' safety in case of potential violence by patients and to share responsibility for overdose during treatment. PCP in Vietnam faced multi-level challenges in providing quality methadone treatment. Supportive policies and additional resources are needed to ensure the effectiveness of the decentralisation program.

Social support for patients with penile cancer: A mixed‐method study

AbstractThe research questions were as follows: How much social support do patients with penile cancer (PC) receive after surgical treatment for the condition; which factors are associated with the social support received; and how do patients with PC describe the social support they receive in terms of emotional support, affirmation and concrete aid? The purpose of this study is to describe the amount and type of social support (that is, emotional support, affirmation or concrete aid) received by patients with PC. In addition, it describes the associations between patients' background variables and their perceived social support. Men affected by PC experience a range of unmet support care needs, of which social support has not previously been thoroughly studied. Emotional support consists of caring for another person, respecting and creating a safe atmosphere for them and providing spiritual support. Affirmation is the reinforcement of knowledge and is especially evident in decision‐making processes through advising or counselling. Concrete aid means the provision of assistance in the form of an activity or service that causes the donor to use time or money for the benefit of another person. A partially mixed concurrent dominant status design was used and included semi‐structured interviews with, or letter responses from, 15 patients and a self‐reported social support score survey of 42 patients with PC. The data were analysed using descriptive statistics, a non‐parametric test and a deductive content analysis. Regarding the self‐reported social support score survey, 42 patients reported the social support as good (mean [SD]; range 4.34 [1.06]; 1–6). The most frequent form of social support was affirmation (mean [SD] 4.65 [1.07]), and the least frequent was emotional support (mean [SD] 4.14 [1.16]). Employment status and primary operation were significantly associated with the social support received. Qualitative data imply that family members are the most important emotional supporters. Emotional support from healthcare professionals was felt to be insufficient. Despite their affirmation, patients felt they received incomplete information about the disease. Patients received concrete aid from family members but felt there was a lack of professional help. Although patients deemed the overall social support received to be good, they received insufficient support from healthcare professionals (emotional support) and had unmet informational needs (affirmation) as well as uncertainties regarding income support (concrete aid). Our results can help nurses provide more holistic care to patients with PC. This information can be utilized in the development of nursing interventions for such patients and their family members. In the future, nurses' and other healthcare professionals' counselling skills should be taken into account in their training. They also need to be supported through consultation and referral resources when they reach the limits of their expertise.

Paramedics’ perspectives of the community paramedic role in Ontario

Background: Community paramedicine (CP) expands the paramedic role to emergency call prevention, yet little research has examined paramedics’ perspectives of CP. Aims: This study sought to explore paramedics’ views regarding the CP role and training. Methods: A cross-sectional, web-based survey of Ontario paramedics measured perceptions, support and interest in CP. Descriptive and regression analyses were conducted. Findings Of the 452 participants, 57.5% were male, 43.6% primary care paramedics and 33.0% had a history of being on modified duty. Paramedics perceived CP to include treat-and-release (85.4%), community resource referrals (79.0%), expanded skills (77.9%), community education (75.9%) and follow-up (73.7%). Most were supportive (82.8%) and interested in participating (72.3%). Interest in training was lower in respondents with 20 or more years of service and higher in those with a history of modified duty ( p&lt;0.05). Conclusion: Paramedics are aware the CP role has multiple functions and are supportive and interested in CP. This study has implications for services as CP expands globally.

Wezesha Watoto: Implementation of Clinic-Based Developmental Screening in Kenya

Background: The importance of child developmental screening is gaining increased traction within low-resourced settings, but little is known about the implementation of screening programs within clinical systems. This study aimed to evaluate the acceptability, feasibility, fidelity, and sustainability of integrating a child developmental screening tool in a maternal and child health (MCH) clinic in western Kenya.&#x0D; Methods: This implementation study takes place within infrastructure of Academic Model Providing Access to Healthcare (AMPATH). Developmental screening was integrated into MCH care in September 2021 and is ongoing for children ages 18-36 months with perinatal HIV exposure. Feasibility, sustainability, and fidelity are measured with weekly time-motion analysis of clinic flow and daily clinic record review. Acceptability, feasibility, and sustainability were evaluated using semi-structured interviews of caregivers and clinic staff, completed at baseline and 6 months post-implementation. Mixed methods data were analyzed using descriptive statistics, thematic coding, and triangulation.&#x0D; Results: Since onset, 187 children were screened (69.8% of eligible children), with rate of screening consistent over time. Average time to complete screening is 5.4 minutes and decreasing over time. Perceived time of screening was inflated at baseline (≈16min) and 6 months (≈20min). Facilitators to screening included staff teamwork and caregiver cooperation. Lack of time and child’s mood were barriers. Caregivers appreciated others’ concern for their child’s development and noted ease in answering questions. Staff’s remarks were congruent, while emphasizing the need for motivating incentives for children and staff. At 6 months, staff noted screening had become routine. They desired feedback on performance and provided ideas for improvement. Caregivers frequently asked about availability of assistance if potential delays are identified during screening.&#x0D; Conclusion: The integration of developmental screening is aided by positive perceptions from both clinic staff and caregivers. Regular retraining, staff feedback, and referral resources may optimize integration. Research evaluating cost effectiveness is needed.

Social Determinants of Health and Adverse Health Outcomes in an Urban Community Hospital in Northwest Indiana

Background: Social determinants of health (SDOH) are underlying contributing factors ofhealth inequities. Facility-based SDOH screenings inform targeted care, community resource referrals, and actions. St. Mary Medical Center (SMMC), an urban hospital in Northwest Indiana, was first acute care hospital in the state to pilot comprehensive SDOH screenings and referrals using the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences(PRAPARE), a nationally recognized and validated tool. This study is part of a three-phased Community Based Participatory Research (CBPR) partnership between SMMC and IUSM-NWto examine and address SDOH from January 2021-January 2025. This study’s research questions are: What is the distribution of adverse health outcomes by demographics and by SDOH in SMMC’s inpatients?&#x0D; Methods: This descriptive study analyzed a limited dataset generated from EPIC™ by SMMC. It included demographics, behavioral, health outcomes, and SDOH measures for adult inpatient visits from January 2021 to June 2022. Data analysis was conducted in SPSS 28.0 usingdescriptive statistics and tests of association (p&lt;0.05) including One-way ANOVA, Kruskal Wallis H, Chi-square, and Fisher’s Exact. This study was exempted by Indiana UniversityHuman Research Protection Program (IRB #14040).&#x0D; Results: The sample comprised 4370 patients, majority non-Hispanic (90.4%), White (75.7%), older adults (median age 65, IQR = 24), and publicly insured (76.3%). 30-day readmissions accounted for 9.1%. The top three discharge diagnoses were diseases of the circulatory system (20%), digestive system (12.4%), and injury (7.5%). Discharge diagnoses differed significantly (p&lt;.001) by family income, insurance type, stress presence, race, ethnicity, and sex. 30-day readmission was significantly associated with housing risk (p=.036) and insurance type (p&lt;.001).&#x0D; Conclusions: This study underscores the role of SDOH in influencing health outcomes and the importance of continuous SDOH screenings. This study will inform subsequent advanced analysis, the program evaluation, and the translation-to-action phase of the CBPR project.

Creating a community leadership role for non-complex ENT care.

In Ireland, 68,000 patients are waiting for their first Ear, Nose & Throat (ENT) outpatient (OPD) appointment. One third of referrals pertain to non-complex ENT conditions. Community-based delivery of non-complex ENT care would facilitate access in a timely manner, locally. Despite the creation of a micro-credentialling course, community practitioners have encountered barriers to implementing their newly acquired expertise, including a lack of peer support and subspecialty resourcing. In 2020, funding was secured through the National Doctors Training and Planning Aspire Programme for a fellowship for ENT Skills in the Community, credentialled by the Royal College of Surgeons in Ireland. The fellowship was open to newly qualified GPs with the aim of developing community leadership in ENT, providing an alternative referral resource, providing peer education and creating an advocate for the further development of community-based subspecialists. The fellow started in July 2021 and is based in the Ear Emergency Department at the Royal Victoria Eye and Ear Hospital, Dublin. They have been exposed to non-operative ENT environments, developing diagnostic skills and treating a range of ENT conditions through the utilisation of microscope examination, microsuction and laryngoscopy. Multiplatform educational engagements have provided teaching experience including publications, webinars reaching approximately 200 healthcare workers each and GP-trainee workshops. The fellow has been facilitated in building relationships with key policy stakeholders and is presently working on a bespoke e-referral pathway. Promising early results have secured funding for a second fellowship. Key to the success of the fellowship role will be will be ongoing engagement with hospital and community services.

One Health Initiative: Delusional Parasitosis Needs Assessment, Tennessee 2022

Abstract Delusional parasitosis (DP) is a false, persistent belief that an individual is infested with organisms, especially arthropods, of a parasitic nature. It is a complex and challenging problem that impacts healthcare, the pest management industry, state-led agriculture and health agencies, Extension professionals, and academia because of time burdens and frustration associated with interactions. To address the handling of suspected DP cases, we assembled a University of Tennessee One Health Initiative Working Group with individuals representing diverse disciplines and professions. The Working Group developed and conducted an online needs assessment of pest management, Extension, and health professionals to (i) understand their interactions with suspected DP cases and (ii) determine the educational resources used and needed. Of the pest management professionals and Extension personnel, 72.7% (n = 112) of the respondents indicated they had encountered someone with suspected DP within the last year. Those responding to suspected DP cases spent significantly more time and interactions than what was required for general inquiries. Seventy-three percent of respondents received specimens of which more were human derived (54.4%) than nonhuman derived (41.5%), potentially putting these nonhealthcare professionals at risk of potential contagion. We confirmed a lack of available resources, including protocols, training materials, and resources for expert medical referrals. Additionally, the staff responsible for handling these cases were concerned for their safety. After identifying the most pressing needs, the One Health Working Group members collaborated to produce comprehensive resources to assist professionals in identifying DP cases more quickly and efficiently routing them to essential care.

Abstract P025: Tobacco screening practices and perceived barriers in offering tobacco cessation services in the primary prevention of lung cancer among Texas healthcare centers providing behavioral health treatment

Abstract Cigarette smoking is the leading cause of preventable death and illness globally and accounts for over 80% of all lung cancer diagnoses in the U.S. Patients with behavioral health (e.g., mental health and/or substance use) needs have elevated levels of smoking relative to the general population and are thus disparately impacted by tobacco-related cancers. Tobacco screenings, a precursor to providing evidence-based interventions for smoking cessation, play a critical role in the primary prevention of lung cancer. However, their use in behavioral health treatment centers has historically been inconsistent. The aim of this study was to analyze barriers and facilitators to tobacco screening in settings where Texans receive behavioral health care to contextualize current screening trends and, in turn, provide recommendations for improvement. This study assessed the prevalence of mandated tobacco screenings in 80 centers providing healthcare to Texans with behavioral health needs. We examined key factors that could enhance screening conduct (i.e., provision of a tobacco use assessment template, hard stop in the electronic health record [EHR] for patient tobacco use status, and the availability of tobacco screening training), assessed associations between center practices and mandated tobacco screenings, and delineated providers’ perceived barriers to tobacco use intervention provision. Results indicated that 80% of surveyed centers mandated tobacco use screenings; those that did were significantly more likely than those that did not to have a hard stop for tobacco use status in the EHR (p&amp;lt;0.008) and to make training on tobacco screening available to providers (p=0.016). The most widespread barriers to tobacco use disorder care provision, endorsed by at least 50% of all respondents at &amp;gt;1 type of healthcare center (e.g. federally qualified health centers, global local mental health authorities, substance use treatment centers in local mental health authorities, and stand-alone substance use treatment centers), were relative perceived importance of competing diagnoses, lack of community resources for referral, perceived lack of time, lack of provider knowledge or confidence, and belief that patients do not comply with cessation treatment. Overall, there are opportunities for centers providing care to Texans with behavioral health needs to bolster their tobacco screening and intervention capacity to prevent cancer-related disparities in this group. Healthcare centers can support their providers to intervene upon tobacco use by mandating screenings, streamlining clinical workflow with hard stops in patient records, and by educating providers about patient’s interest in quitting along with the importance of treating tobacco with brief evidence-based intervention strategies. Future work should focus on how these healthcare centers can facilitate providers’ ability to link tobacco screenings with smoking cessation services and lung cancer eligibility screening to increase the early detection of lung cancers and prevent tobacco-related cancer disparities. Citation Format: Ammar D. Siddiqi, Maggie Britton, Tzuan A. Chen, Brian J. Carter, Carol Wang, Isabel Martinez Leal, Anastasia Rogova, Bryce Kyburz, Teresa Williams, Mayuri Patel, Lorraine R. Reitzel. Tobacco screening practices and perceived barriers in offering tobacco cessation services in the primary prevention of lung cancer among Texas healthcare centers providing behavioral health treatment. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P025.

Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care

Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care

Operationalizing Depression Screening in Ambulatory Palliative Care: A Quality Improvement Project.

Depression is common in the palliative care setting and impacts outcomes. Operationalized screening is unusual in palliative care. Lack of operationalized depression screening at two ambulatory palliative care sites. A fellow-driven quality improvement initiative to implement operationalized depression screening using the patient health questionnaire-2 (PHQ-2). The primary measure was rate of EMR-documented depression screening. Secondary measures were clinician perspectives on the feasibility and acceptability of implementing the PHQ-2. The intervention is a clinic-wide implementation of PHQ-2 screening supported by note templates, brief clinician training, referral resources for clinicians, and opportunities for indirect psychiatric consultation. Operationalized depression screening rates increased from 2% to 38%. All clinicians felt incorporation of depression screening was useful and feasible. Operationalized depression screening is feasible in ambulatory palliative care workflow, though optimization through having screening be completed prior to clinician visit might improve uptake.

Addressing health equity through a telehealth maternal–newborn home visit for nurse practitioner students

This educational innovation describes the implementation and evaluation of a telehealth maternal-newborn home visit clinical experience for nurse practitioner students at an urban, private research university in the Midwest. The visits were conducted using the Family Connects evidence-based universal support program for families with newborns to evaluate each family's unique risks and to align their needs with available community resources. Students were prepared for the clinical experience through advanced practice didactic modules and simulation and then participated in the visits over a 2-week period. After the clinical opportunity, both students and community health nurse collaborators completed a survey about their experiences. The students reported feeling prepared to participate in the visits, that they were able to meet clinical objectives using telehealth, and learned about the community resources available for families with newborns. The nurses reported feeling prepared to collaborate with nurse practitioner students and that they benefitted from having a student participate in the visits. The experience prepared the students to meet the needs of a diverse patient population during the early postpartum/newborn period by providing newborn care advice, addressing access to health, assessing social determinants of health, and considering community resource referrals to reduce disparities and improve health equity. This article describes how a telehealth clinical experience addresses the American Association of Colleges of Nursing Essentials for advanced-level nursing students and provides recommendations for incorporating and evaluating telehealth clinical experiences in pediatric advanced practice education.

Mpox Case Reports in an Urban Homeless Population and a Proof of Concept for a Street-Based Mobile Mpox Vaccination Clinic.

Mpox is a new public health outbreak that particularly threatens the homeless population. Street Medicine Phoenix (SMP) is a student-led interprofessional volunteer organization that provides medical care and other essential services to individuals experiencing homelessness in Phoenix, Arizona. In addition to core services such as wound care; health screenings (blood pressure and blood glucose.); vision screenings; HIV testing; naloxone education and distribution; flu, COVID-19, and Hepatitis A vaccinations; and community resource referrals, SMP began offering mpox education and vaccination at outreach events. During an outreach event shortly after the onset of the mpox outbreak, SMP identified 2 suspected mpox cases. Accordingly, SMP has partnered with the Maricopa County Public Health Department to set up mobile mpox vaccination clinics on the streets outside of Phoenix Arizona's largest homeless shelter. We share the details of these 2 cases along with our early efforts vaccinating individuals experiencing homelessness for mpox via our mobile vaccination clinic. Our experiences demonstrate the importance of community agencies providing direct outreach to underserved populations where they are at, particularly the homeless population, to address public health concerns such as emerging disease outbreaks like mpox. In addition, these cases highlight the potential significant impact that street medicine programs can have on their respective homeless communities in the context of infectious disease mitigation and emphasize the importance of partnerships with local health departments.

DETERMINING FEASIBILITY FOR USE OF GERIATRIC COGNITIVE SCREENINGS BY MEDICAL CASE MANAGERS SERVING OLDER (50+) PLWH

Abstract Cognitive impairment (CI) is a significant age-related risk exacerbated by HIV. However, AIDS Service Organizations (ASO) have not implemented effective screening tools for detection of CI in older adults living w/HIV (OALH). This study examined feasibility for use of those tools by medical case managers (MCM) serving OALH. MCMs from nine Colorado ASOs self-administered a questionnaire measuring baseline knowledge of warning signs and risk factors (WS/RF) of CI in OALH, evaluating familiarity with screening of/response to WS/RF of CI within this population. Data from 24 MCMs showed OALH comprised 47% of all clients, and 68% of respondents reported no related training. Similarly, 67% reported not feeling confident identifying WS/RF. 100% of respondents reported not screening for CI, and many endorsed limited awareness/availability of screening tools (87%), referral resources (87%), and training (83%). This identified a need and desire for use/implementation of cognitive screening tools to improve ASO care for OALH.

Midwives' knowledge and perceived barriers to screening alcohol use among pregnant women in a southwestern US state.

Alcohol consumption during pregnancy can produce multiple damaging outcomes to the foetus, commonly referred to as fetal alcohol spectrum disorders (FASD). FASD represents the leading non-genetic cause of preventable birth defects in the United States where alcohol guidelines recommend pregnant woman abstain from alcohol use. This study examined: (i) midwives' knowledge, attitude and intent to screen for prenatal alcohol use; and (ii) assessed perceived barriers to communicating alcohol-related information. Using an online questionnaire, data were obtained from midwives (n=61) in a southwestern US state between March and May 2018. Descriptive statistics were used to describe midwives' knowledge, attitude, intent and perceived barriers. Several midwives considered one alcoholic beverage per occasion to be safe for the foetus (20.3%), some thought alcohol was safe during the 3rd trimester (14.8%) only and few thought it was safe in all trimesters. Many midwives (63.3%) were unaware that the TWEAK and T-ACE were validated alcohol screening tools for pregnant women. Furthermore, most midwives (>50%) agreed that limited time with patients, a need for additional training and lack of information on referral resources interfered with their sharing of alcohol abstinence guidelines. Midwives reported highly favourable attitudes and intentions toward sharing alcohol abstinence messages with their pregnant patients. More in-depth research and larger samples are needed to explore barriers (knowledge gaps, limited time with patients, need for additional training) that hinder midwives' dissemination of abstinence messages to pregnant women and limit the uptake of validated alcohol screening tools.

Feasibility of video-based joint hypermobility assessment in individuals with suspected Ehlers-Danlos syndromes/generalised hypermobility spectrum disorders: a single-site observational study protocol

IntroductionEhlers-Danlos syndromes (EDS)/generalised hypermobility spectrum disorders (G-HSD) affect the connective tissue of the body and present with a heterogeneous set of symptoms that pose a challenge for diagnosis. One of...