Socioeconomic Barriers Research Articles

Hargobind Khorana - the Legendary Biochemist who cracked the Genetic code

Har Gobind Khorana, the Nobel Prize-winning scientist, would have turned 100 on 9th January, 2022. Many generations of chemists and biologists have been inspired by Gobind's works and intellectual elegance, but high visibility of his success has had a much broader and deeper impact on India. Gobind Khorana is a popular scientific personality in India who represents how edu-cation may assist people to transcend socioeconomic and intellectual barriers. His triumph was fought for, and implausible.

COMMUNITY CENTERED APPROACHES TO INCREASE PARTICIPATION OF AFRICAN AMERICANS IN BRAIN HEALTH AND ADRD RESEARCH

Abstract African Americans/Blacks continue to be underrepresented as participants in Alzheimer’s Disease and related dementia (ADRD) and brain research. Numerous challenges such as lack of information about the Alzheimer’s Disease and related dementia (ADRD), socioeconomic barriers, historical and systemic racism, and distrust of research goals and processes persist in research participation. Research approaches tend to be more recruitment oriented rather than partnership driven that do not address these challenges. As a result, community engagement approaches are increasingly being recognized as a means of building trust and creating new pathways for participation in ADRD studies. This poster focuses on the preliminary work of the Collaborative on Aging Research and Engagement (CARE) --- a community academic partnership comprising the CARE Advisory Team (a community action team of 10 African American leaders), Alzheimer’s Association, the Alzheimer’s Association Greater Indiana Chapter, IU Schools of Nursing, Public Health, and Informatics, Computer Science, and Engineering, and the Indiana Alzheimer’s Disease Research Center. The goal of the partnership is to facilitate active engagement of African Americans aged 45 years and older in research opportunities taking place in in Central and Northwest Indiana. Experiences and perspectives shared at the CARE Advisory Team meetings as well as memos from the researcher staff generated five lessons learned in building relationship oriented, as opposed to recruitment driven, processes. These lessons will be used to develop a community engagement framework focused on the integration of culturally relevant outreach practices in promoting ADRD research opportunities in African American/Black communities.

COGNITIVE TRAINING FOR OLDER CHINESE IMMIGRANTS IN THE US: AN EXPERIENCE-BASED CO-DESIGN APPROACH

Abstract Older Chinese Americans face many socioeconomic barriers including limited English proficiency, low educational levels, and limited access to care. These socioeconomic disadvantages not only contribute to an increased risk of developing dementia but also worsen inequitable access to effective strategies to promote cognitive health. Cognitive training is shown to be beneficial to maintain or enhance cognitive function. However, most prior interventions were tested exclusively in non-Hispanic Whites. To address this gap, we aim to adapt empirically supported cognitive training activities into a culturally and linguistically relevant mHealth cognitive training intervention. The adaptation process of the cognitive training includes focus groups (n=6/group) with older Chinese Americans (3 groups) and adult children (2 groups) to adapt cognitive training components to our target population. We will then organize an experience-based co-design workshop to further refine the intervention. Engaging end-users early will optimize the development of a culturally and linguistically relevant cognitive training intervention.

A Bio-Social Model during the First 1000 Days Optimizes Healthcare for Children with Developmental Disabilities.

Most children with developmental disabilities (DD) live in resource-limited countries (LMIC) or high-income country medical deserts (HICMD). A social contract between healthcare providers and families advocates for accurate diagnoses and effective interventions to treat diseases and toxic stressors. This bio-social model emphasizes reproductive health of women with trimester-specific maternal and pediatric healthcare interactions. Lifelong neuronal connectivity is more likely established across 80% of brain circuitries during the first 1000 days. Maladaptive gene-environment (G x E) interactions begin before conception later presenting as maternal-placental-fetal (MPF) triad, neonatal, or childhood neurologic disorders. Synergy between obstetrical and pediatric healthcare providers can reduce neurologic morbidities. Partnerships between healthcare providers and families should begin during the first 1000 days to address diseases more effectively to moderate maternal and childhood adverse effects. This bio-social model lowers the incidence and lessens the severity of sequalae such as DD. Access to genetic-metabolomic, neurophysiologic and neuroimaging evaluations enhances clinical decision-making for more effective interventions before full expression of neurologic dysfunction. Diagnostic accuracy facilitates developmental interventions for effective preschool planning. A description of a mother-child pair in a HIC emphasizes the time-sensitive importance for early interventions that influenced brain health throughout childhood. Partnership by her parents with healthcare providers and educators provided effective healthcare and lessened adverse effects. Effective educational interventions were later offered through her high school graduation. Healthcare disparities in LMIC and HICMD require that this bio-social model of care begin before the first 1000 days to effectively treat the most vulnerable women and children. Prioritizing family planning followed by prenatal, neonatal and child healthcare improves wellness and brain health. Familiarity with educational neuroscience for teachers applies neurologic diagnoses for effective individual educational plans. Integrating diversity and inclusion into medical and educational services cross socioeconomic, ethnic, racial, and cultural barriers with life-course benefits. Families require knowledge to recognize risks for their children and motivation to sustain relationships with providers and educators for optimal outcomes. The WHO sustainable development goals promote brain health before conception through the first 1000 days. Improved education, employment, and social engagement for all persons will have intergenerational and transgenerational benefits for communities and nations.

Capacity Building Using Digital Technology for Occupational Therapists and Caregivers in Pakistan: A Participatory Action Research Approach.

This paper describes the development and implementation of a telehealth system in Pakistan to build capacity of healthcare service providers and caregivers of children with developmental disabilities. An asynchronous telehealth system, in the form of a web app, improved therapy-related communication between the therapists and caregivers, thus enabling capacity building through sustained communication among the stakeholders. Participatory Action Research (PAR) identified barriers associated with communication, knowledge transfer, and caregiver learning. Data were collected via observations, interviews, focus groups, and field notes. The experiences of therapists and caregivers were analyzed to design and develop a system that works as a learning mechanism for caregivers in their native languages. The system also addresses socio-economic, geographic, and communication barriers as well as pandemic-imposed obstacles.

Socio-Economic and Cultural Barriers that Affect Women’s Participation in Local Level Governance in the Central Region of Ghana

The study sought to examine the socio-economic and cultural factors that affect women’s participation in local level governance in selected districts in the Central Region of Ghana. The qualitative approach was employed for this study, and an interview guide was used to gather data from 11 women assembly members and two of their husbands, making a total of 13 participants. The participants were sampled using purposive, snowball and convenient sampling techniques. The data was analysed thematically. The study identified lack of self-confidence, limited funds, unsupportive family, abuse and harassment, political affiliations in the Assembly and unsupportive religious organizations as the socio-economic and cultural barriers to women participation in local level governance in Agona West, Gomoa West and Gomoa Central Districts in the Central Region of Ghana. The findings showed that despite the barriers, some of the women were able to surmount such challenges and became successful in the District Assembly elections. The study recommended that special fund should be set up by the government to support Assembly women to perform their roles and responsibilities within their communities regularly. Such funds may help them fulfil their campaign promises, which may encourage them to seek re-election in the District Assemblies. Also, female politicians should mentor potential female politicians. The mentors may support them to build the confidence required to engage in local level politics and to aspire higher positions in political office.

The Association of Socioeconomic Factors and Well-Differentiated Thyroid Cancer

IntroductionWell-differentiated thyroid cancer (WDTC) is the most common thyroid malignancy, and the worldwide incidence is increasing. Early stage disease is curable with surgery. We hypothesized that patients who live at greater distances from health care institutions or have complicating socioeconomic barriers may present with more advanced diseases and have worse outcomes. MethodsThe National Cancer Database (NCDB) was used to identify patients who were diagnosed with WDTC between 2004 and 2018. Race, ethnicity, insurance status, income status, and distance from residence to health care clinic of diagnosis (great circle distance [GCD]) were analyzed with respect to the severity of disease at presentation (stage) and outcomes. Binary logistic regression and Cox regression were used to determine associations between socioeconomic variables and tumor stage or survival. ResultsThe Hispanic (OR: 1.49, CI: 1.45-1.54, P < 0.001) and Asian (OR: 1.49, CI: 1.43-1.55, P < 0.001) populations had higher odds of developing an advanced disease when compared to the White population separately. Patients without insurance displayed higher odds of developing an advanced disease at diagnosis compared to those with insurance (OR: 1.39, CI: 1.31-1.47, P < 0.001). Adjusted-Cox regression analysis of survival revealed that Black patients had detrimental survival outcomes when compared to White patients (HR: 1.24, P < 0.001), and patients with private insurance had improved survival outcomes when compared to those without insurance (HR: 0.58, P < 0.001). ConclusionsHispanic and Asian patients were found to be more likely to present with an advanced disease but also displayed greater overall survival when compared to the White population. The Black population, patients without insurance, and patients with lower income status exhibited worse survival outcomes.

Systematic Review of Mixed Studies on Malaria in Pregnancy: Individual, Cultural and Socioeconomic Determinants of Its Treatment and Prevention.

Malaria in pregnancy (MiP) is a global public health problem; its research is predominantly quantitative. The objective was to analyze the individual, cultural and socioeconomic determinants of the treatment and prevention of MiP with a systematic review of mixed studies (search had no date restriction). Reproducibility and evaluation of the methodological quality were guaranteed. 21 studies were included (20 from Africa). The quantitative component included 7816 pregnant women and 483 health workers. The qualitative component included 800 subjects (pregnant women, health workers, family members and community leaders). The main topics were the use and acceptability of WHO strategies to prevent MiP, individual determinants related with knowledge, perceptions, attitudes and behaviors on MiP, and cultural and socioeconomic barriers for its treatment and prevention. The main determinants of MiP were long distance to the clinic, lack of economic resources, low-coverage antenatal care, few health workers in the communities, drug shortages, cultural rules that prevent women's participation in health issues, and misconceptions about MiP. MiP has determinants related to economic conditions, the structure and functioning of the health system, symbolic and cultural aspects, as well as knowledge, beliefs, perceptions and behavior of pregnant women, which prevent optimal access and use of preventive strategies. This study evidences the importance of intersectional, intersectoral, and interdisciplinary work to prevent MiP.

Healthcare Disparities

While it holds true that visible minorities often benefit less than average from healthcare systems in North America, there is yet to be consensus on the extent to which racism and other institutionalized issues play a role in leaving them at a serious disadvantage. A 2018 study by Dr. Elizabeth Howell reports that African American women face severe maternal morbidity at rates two-fold that of non-Hispanic white women, which in light of the Black Lives Matter movement, brings to question the integrity of the maternal care system and the professionals who work within it.&#x0D; Many health problems faced by Black, Indigenous, and People of Colour (BIPOC) have not only been a result of racial prejudice, but also disparities beyond the control of individual healthcare providers. In his anthology of essays, Disease, Life, and Man, Rudolf Virchow underscores the origins of disease as rather originating from structural flaws in health states dictated by the democratic polity. Although racism contributes greatly to healthcare inequality, significant disparities also stem from socioeconomic barriers that impede minority access to healthcare. The purpose of this article is to examine the institutional disparities influencing health accessibility for BIPOC women, and analyze its effects on the maternal health of racial minorities with an emphasis on Hamilton, Ontario.

Housing cost burden, homeownership, and self-rated health among migrant workers in Chinese cities: The confounding effect of residence duration

Housing is a critical social determinant of health. Research on the impact of housing on health among migrants is more complex than that of the general population because of migrants' health decline over time: while migrants exhibit a health advantage upon arrival, they gradually lose it as they stay longer in the host city. Existing studies on migrants' housing and health have paid little attention to the confounding effect of residence duration and are thus prone to misleading results. Using data from the 2017 China Migrants Dynamic Survey (CMDS), this study fills in the gap by examining how the incorporation of residence duration alters the relationship of housing cost burden and homeownership with migrant self-rated health (SRH). The study shows that migrant workers with higher housing cost burden and longer residence duration tend to have worse SRH. Incorporating residence duration attenuates the crude association between homeownership and worse SRH. The results imply that the health decline among migrants can be attributed to the discriminatory hukou system—a system that limits migrants' access to social welfare and puts them in a socioeconomically disadvantaged position. The study thus emphasizes the removal of structural and socio-economic barriers faced by the migrant population.

Participatory multi-criteria evaluation of landscape values to inform wildfire management

Climate change is expected to increase the number of days with meteorological conditions conducive to uncontrollable wildfires. Thus, it is necessary to strengthen the capacity of wildfire-prone regions to minimize the adverse impacts of these wildfires by creating resilient landscapes. In this paper we develop a participatory multi-criteria evaluation to identify and map landscape values and prioritize areas according to these values in the Montseny Biophere Reserve (Catalonia, NE Spain). Then, we draft a wildfire management strategy to protect the areas that have been prioritized through selected fuel reduction sectors that would reduce wildfire intensity. Finally, we emphasize the added value of a participatory multi-criteria evaluation in the adaptation to and management of expected megafires. We find that the integration of landscape values through participatory multi-criteria evaluation has the potential to alter wildfire management strategies by adding fuel reduction sectors and changing their implementation order. However, the implementation of the planned fuel reduction treatments faces socioeconomic and institutional barriers that call for a deeper engagement with transdisciplinary project design and transformative science.

Integrating crop redistribution and improved management towards meeting China's food demand with lower environmental costs.

China feeds 19.1% of the world's population with 8.6% of the arable land. Here we propose an integrated approach combining crop redistribution and improved management to meet China's food demand in 2030. We simulated the food demand, estimated the national crop production through the productivity of the top 10% of producers in each county, and optimized the spatial distribution of 11 groups of crop types among counties using the data of the top producers. Integrating crop redistribution and improved management increased crop production and can meet the food demand in 2030, while the agricultural inputs (N and P fertilizers and irrigation water) and environmental impacts (reactive N loss and greenhouse gas emissions) were reduced. Although there are significant socio-economic and cultural barriers to implementing such redistribution, these results suggest that integrated measures can achieve food security and decrease negative environmental impacts. County-specific policies and advisory support will be needed to achieve the promises of combining optimization strategies.

Smoking cessation interventions for Hispanic/Latino(a) adults in the USA: protocol for a systematic review and planned meta-analysis

IntroductionHispanic smokers face multiple cultural and socioeconomic barriers to cessation that lead to prominent health disparities, including a lack of language-appropriate, culturally relevant, evidence-based smoking cessation interventions. This systematic review...

Clinician Perceptions of the Negative Impact of Telehealth Services in the Management of Drug-Induced Movement Disorders and Opportunities for Quality Improvement: A 2021 Internet-Based Survey.

Tardive dyskinesia (TD) is a drug-induced movement disorder (DIMD) seen in patients taking dopamine-receptor blocking agents (DRBAs). Clinicians should regularly monitor patients with or at risk of developing DIMDs; however, telehealth visits during the COVID-19 pandemic presented several significant challenges related to screening and care of these patients. In this observational survey study, respondents compared in-person with video/telephone visits to determine the impact on the evaluation, diagnosis, and monitoring of patients with DIMDs. The online survey was conducted (May 14-June 21, 2021) with qualified clinicians who prescribed a vesicular monoamine transporter 2 inhibitor or benztropine for DIMDs in the past 6 months, spent ≤70% of their professional time in the clinic, and conducted telehealth visits with ≥15% of their patients between December 2020 and January 2021. The questionnaire probed clinicians about their ability to evaluate, diagnose and monitor (hereinafter referred to as manage) patients with DIMDs via telehealth. Survey respondents included 277 clinicians from psychiatry (n = 168) and neurology (n = 109) practices. Certain signs and symptoms (visual cues) used for diagnosis of DIMDs were not observable through telehealth and evaluation was comparatively more difficult with phone visits than video visits. Patients without caregivers and lower-functioning patients were at higher risk of missed diagnosis of DIMDs and were also difficult to monitor via telehealth. Limited access to computers or telephones and patients living alone were among the top socioeconomic barriers limiting clinicians' ability to diagnose DIMDs. Patients without a regular caregiver were also more difficult for clinicians to evaluate and monitor adequately. Further, most clinicians received no training related to evaluation of DIMDs via telehealth or engaging caregivers as health care partners. Our study highlights specific limitations and challenges and provides considerations to help clinicians better manage DIMDs in the context of telehealth services.

A case for genomic medicine in South African paediatric patients with neuromuscular disease.

Paediatric neuromuscular diseases are under-recognised and under-diagnosed in Africa, especially those of genetic origin. This may be attributable to various factors, inclusive of socioeconomic barriers, high burden of communicable and non-communicable diseases, resource constraints, lack of expertise in specialised fields and paucity of genetic testing facilities and biobanks in the African population, making access to and interpretation of results more challenging. As new treatments become available that are effective for specific sub-phenotypes, it is even more important to confirm a genetic diagnosis for affected children to be eligible for drug trials and potential treatments. This perspective article aims to create awareness of the major neuromuscular diseases clinically diagnosed in the South African paediatric populations, as well as the current challenges and possible solutions. With this in mind, we introduce a multi-centred research platform (ICGNMD), which aims to address the limited knowledge on NMD aetiology and to improve genetic diagnostic capacities in South African and other African populations.

Abstract PR001: Socioeconomic analysis and disparities in germline genetic testing for pancreatic cancer

Abstract Introduction: Germline genetic testing is now recommended for patients with pancreatic ductal adenocarcinoma (PDAC). We explored whether attributes of testing, such as uptake fraction and rate, were associated with various clinical features. Here we identified barriers to germline testing and explored a relationship between lag of germline diagnosis and patient social profiles, including median income, race, and ethnicity from New York’s largest healthcare system. Methods: Patients with PDAC were identified using billing records across our institution with an IRB-approved protocol. Germline mutation data were assessed through chart review. Median income was annotated using zip codes and www.census.gov. Date of diagnosis (DOD) was recorded as the date of biopsy or, if no biopsy was performed, the date of earliest lesion-found CT scan. Lag of testing was calculated as the difference between DOD and the date of germline sample collection. Results: Between Mar 2016 and Feb 2022, 305 patients with PDAC were identified, with 103 (36.3%) having reports found (F), and 202 (63.7%) not having reports found (NF). Availability of germline testing did not vary by median income (F: 95954 dollars vs NF: 94368 dollars, t=0.414, p=0.68). There was no significant difference in the geographic distribution (gender, race, and ethnicity) of patients between F and NF: gender (F: Male 41%, Female 59%; NF: Male 43%, Female 57%; p=0.92), race (F: Asian 8%, African American 13%, White 55%, Others 5%, Not Reported 19%; NF: Asian 9%, African American 16%, White 54%, Others 6%, Not Reported 15%; p=0.92), ethnicity (F: Non-Hispanic 81%, Hispanic 11%, Others 5%; NF: Non-Hispanic 83%, Hispanic 4%, Others 12%; p=0.16). Pearson analysis between median income (x) and lag of testing (y) showed a negative correlation (y=-0.0027x+315.6, R=-0.241, p=0.014). Level of income (cutoff: 100k) also affected the mean days in lag of testing (below 100k: 111.8d, above 100k: -44.0d, t=2.190, p=0.031). African American (AA) patients` had a significant lag of testing compared to White (W) patients (AA: 194.4d, W: -20.9d, t=2.123, p=0.037) and insignificant lag compared to Asian (A) patients (AA: 194.4d, A: -7.33d, t=1.924, p=0.068). In addition, no African American patients had germline genetic testing performed before the diagnosis of pancreatic cancer, whereas 1 Asian patient (11.1%) and 11 White patients (18.6%) had testing performed before the diagnosis. Finally, Hispanic (H) patients had a statistically insignificant lag of testing compared to non-Hispanic (NH) patients (H: 193.9d, NH: 27.76d, t=1.419, p=0.160). Conclusion: Analysis of germline and clinical data from our 305-patient cohort identified a striking and concerning negative correlation between patient median income and lag between DOD and germline testing. In addition, patient race and ethnicity also significantly contributed to delays in germline testing. These results compel further investigation into the operational processes and socioeconomic barriers that will prompt germline testing at our institution. Citation Format: Xianghui Zou, Baho Sidiqi, Sunita Patruni, Christopher Hollweg, Noah Kauff, Daniel King. Socioeconomic analysis and disparities in germline genetic testing for pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr PR001.

"Youth as accessories": Stakeholder Perspectives on Youth Participation in Mental Health Policymaking [Part II

To elicit stakeholder perspectives on the findings from our scoping review on youth participation in mental health policymaking, we conducted a global consultation with young people and adults directly involved in mental health policymaking. Forty-four stakeholders from 16 countries, including 15 young people, 9 policymakers and 20 facilitators of youth participation, took part in individual interviews and/or focus groups. They were asked about how the review findings contrasted with their own experiences in mental health policymaking. The transcribed data were thematically analyzed. All participants viewed lived experience as valuable in identifying policy gaps. Youth pointed out that children and youth with disabilities, diverse sexual orientations, and/or gender identities were often excluded, and spoke about feelings of being an "accessory", illustrating a lack of power-sharing in a tokenized policymaking process. Adult participants' accounts highlighted the challenges inherent in policymaking such as the need for political knowledge and institutional time constraints. A range of cultural, socio-economic, and political barriers to youth participation, that were often context-specific, were identified. The diverse perspectives of stakeholders extended the review results. Based on our findings, we recommend that adults and institutions: (1) recognize lived experience as expertise in shaping mental health policies; (2) include diverse groups; (3) reduce tokenistic relationships through the creation of safer spaces, adult feedback, co-production, and social accountability; and (4) adopt an intersectional approach to address cultural, socio-economic, and political barriers to participation. Methodologically, our work demonstrates why stakeholder consultations are an essential component of scoping reviews.

Rediscovering life after being diagnosed with HIV: A qualitative analysis of lived experiences of youth living with HIV in rural Rwanda.

In sub-Saharan Africa, youth living with HIV, especially those who have lost one or both parents, face economic, socially and psychological challenges that hinder adherence to ART, ultimately leading to poor health outcomes. Partners In Health/Inshuti Mu Buzima implemented an Adolescent Support Group (ASG) to support HIV-positive youth aged 15-25 years. During the evaluation of the ASG program, we sought to better understand youths' lived experiences to improve our delivery of HIV care. We conducted qualitative in-depth, semi-structured individual interviews with youth enrolled in the ASG program. All interviews were conducted in-person or by telephone. Thematic analysis applying the framework approach with parallel inductive coding in Kinyarwanda and English was used. We interviewed 35 youth who ranged in age from 16 to 29 years. The main themes related to the lived experiences of youth were (a) Experiences living with HIV, including disclosure, stigma, interactions with the health care system, and medication adherence; (b) external challenges, defined as challenges that were not related to the implementation of the ASG program; and (c) personal vision. Almost all youth reported acquiring HIV from their mothers and disclosure of HIV status occurred around the age of 10. Disclosure was often unintentional and followed by internalized and enacted stigma. Many reported poor past medication adherence which improved following enhanced counselling. External challenges were overwhelmingly economic in nature, and orphanhood was a root cause of other challenges such as difficulty accessing education, lack of transport to health facility, and lack of insurance fees. Despite these challenges, youth have an optimistic view of the future with dreams of health, economic attainment, marriage, and children. Healthcare providers should empower caregivers to support HIV disclosure. Supporting youth as they face many economic challenges could help address socio-economic barriers to good health and promote holistic well-being.

Online ACT Matrix Parent Training for Japanese-Speaking Mothers with Distress in the United States.

Cultural stigma, shame, self-concealment, and language and socio-economic barriers often keep Asian immigrant parents and children away from mental and behavioral services in the United States. Research shows that increased levels of parent distress suggest a negative impact on parenting practices and correlate child-maltreatment. Therefore, this study aimed to test one functionally contextual strategy to address such issues. The current study evaluated the effects of an online Acceptance and Commitment Training (ACT) Matrix for Japanese-speaking mothers living the United States. A nonconcurrent multiple baseline single-subject design across four mothers was used to assess the effect of ACT Matrix on value-driven behaviors, parental engagement (session attendance and daily assignment completion), parental distress, and psychological flexibility. The study consisted of a baseline, treatment (three ACT Matrix treatment sessions adapted from the six-step protocol), maintenance, and follow-up phases. A visual analysis reporting level, trend, variability, immediacy of change and overlap was used to identify a functional relation between the treatment and observable overt behaviors of value-driven behaviors and daily assignment completion. In addition, a non-overlap of all pairs was used to measure effect sizes for these behaviors. For psychological flexibility and parental distress, we used the reliable change index to assess whether clinically significant improvement occurred or not. The results revealed that the online ACT Matrix parent training program was effective in improving all four dependent variables. Mothers reported that the training was culturally sensitive, effective, and acceptable. The details of findings and the implications for future research as preventive science are discussed.

LBSUN208 Patient Education And Addressal Of Social Determinants Of Health: Key To Improvement In Diabetes Care

Abstract As per American Diabetes Association, diabetes is a 'complex chronic illness requiring continuous medical care with multifactorial risk reduction strategies beyond glycemic control'. In 2018, the prevalence of diabetes mellitus in the US population was 10.5% (34.2 million people). It is the seventh leading cause of death in the United States. The average healthcare expenditure is 2.3 times higher for diabetics than non-diabetics. The goal of diabetes care as per the American Diabetes Association and the American College of Cardiology is HbA1c less than 7%, blood pressure less than 140/90mmHg, and LDL cholesterol less than 100mg/dl. Only 19.2% of diabetic population meet all these criteria. At the Guthrie-Robert Packer Hospital, we use the 'Diabetic Bundle' as a quality metric for the standard of care for diabetic patients. It is a metric with diabetic patients seen in the past 2 years who have an active Guthrie PCP, with A1C less than 8 in the past 6 months, LDL less than 70 mg/dl (or currently prescribed a moderate or high dose statin) in the past year and age 40-75, and medical attention for nephropathy (a microalbumin test in the past year, or a nephrology visit, or are on an ACE/ARB, or have ESRD/CKD Stage 4) as a system numerator and total diabetes patients seen in the last 2 years who have an active Guthrie PCP as a system denominator. For the past few years, the resident's clinic has had lower compliance with the diabetic bundle. Multiple factors were responsible. Lack of awareness about the quality metric, discontinuity of care, failure to educate patients, poor patient involvement in diabetes care, socio-economic barriers like lack of insurance, poor family and social support, lack of transportation, poor patient compliance, and low health literacy were some of the identified factors. We conducted the prospective study to improve diabetes care by assessing 'diabetic bundle' compliance. Key interventions were focused on creating a multidisciplinary care team of the clinic director, care coordinator, informatics, nurse, resident, and faculty. Resident education regarding the diabetic bundle, patient education and involvement in diabetes care, outreach calls and mails to the non-compliant, involving the care coordinator in addressing social needs, and regular updating of the diabetes registry were some of the main interventions done during the study period. All these interventions contributed to improvement in the diabetic bundle but we believe that the most important factor in improving diabetes care was educating the patients, involving them in their diabetes care, and addressing their social determinants of health. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.