Source Of Payment Research Articles

Defining the Psychiatric and Financial Landscape of Mental and Substance Use Disorders in Head and Neck Cancer Patients

<h3>Purpose/Objective(s)</h3> To evaluate and describe mental and substance use disorders (MSUD) among head and neck cancer patients admitted to the emergency department (ED) in the United States. <h3>Materials/Methods</h3> We analyzed the Nationwide Emergency Database Sample (NEDS) which produces national estimates of ED visits across the United States. Inclusion criteria included patients with a head and neck cancer diagnosis identified through the Clinical Classifications Software. Mental and Substance use disorders were identified using ICD-9 and ICD-10 codes. Variables analyzed include patient demographics, hospital characteristics, expected payment source, and total visit charge. Survey weighted multivariable logistic regression was used to analyze predictors of MSUD. <h3>Results</h3> From 2009-2018, there were 1,398,671 discharges from the ED associated with head and neck cancer, of which 334,056 (23.9%) also presented with a concurrent MSUD. Patients presenting with a MSUD as the primary visit reason (2.3%) were more likely to be younger (58 vs 66 years, p<0.001), male (73.3% vs 70.6%, p<0.001), and less likely to be admitted to the hospital (51.6% vs 53.5%, p<0.001). Among all patients, the 5 most common MSUD disorders were depressive disorders (n=133,377; 9.5%), anxiety disorders (n=122,679; 8.8%), alcohol related disorders (n=80,994; 5.8%), opioid related disorders (n=23,801; 1.7%), and schizophrenia related disorders (n=22,540; 1.6%). Suicidal ideation or attempt was found in 10,228 discharges (3.1%). The total cost of ED admissions related to a primary MSUD was $103,828,679. The cost of ED admission was most expensive for patients with a primary admission diagnosis of alcohol related disorders (34.8%), opioid related disorders (12.5%), and suicidal ideation or attempt (10.9%). On multivariable logistic regression, younger age (OR: 0.98, p<0.001), female gender (OR:1.26, p<0.001), and non-Medicare insurance were associated with the odds of having any diagnosis of MSUD. <h3>Conclusion</h3> There is a high rate of concomitant MSUD in head and neck cancer patients who present to the ED. Our study identifies a subset of younger and female patients who may be at high risk of developing an MSUD. The financial burden of MSUD was high and the head and neck cancer population are particularly vulnerable to depressive, anxiety, and alcohol related disorders. Future studies should design therapeutic or behavioral interventions to mitigate and address mental health disorders in this population.

Investigation of factors from assistive technology professionals that impact timeliness of wheelchair service delivery: a cross-sectional study

Purpose The purpose of this study was to examine factors associated with variability in time from assessment to device delivery (cycle time). Our hypothesis was that device type and type of insurance would be the strongest predictor of cycle time. Materials and methods Data were extracted from the Functional Mobility Assessment/Uniform Dataset (FMA/UDS) Registry that at the time of analysis contained a sample of 2588 people with disabilities (PWD) who were provided with a wheeled mobility device (WMD) between 21 March 2016 and 29 June 2021. To examine the effect of individual factors on the variability in cycle time, a robust linear regression analysis was conducted. Results The average national cycle time was 101.5 (SD = 59.9) d. Geographic area (Capital Metro [p < .001], Great Lakes [p = .016], and Northeast area [p < .001]), higher years since onset of disability (p < .001) and customizable devices (p = .021) were associated with higher cycle time. Non-customizable devices (p = .005), scooters (p < .001), Group 2 power wheelchairs (PWCs; p < .001), and funding source (Medicaid managed care (p < .001) and “other” (p = .028)) were associated with lower cycle time. Conclusions Longer cycle time is likely related to variations in clinical practice, insurance coverage criteria and the level of customizability of the device needed for a particular diagnosis, especially long-term disabilities. Implications for rehabilitation The national average number of days between initial evaluation and device delivery (cycle time) to deliver a wheeled mobility device (WMD) varies based on specific variables such as type of WMD, diagnosis and payer source. Geographic area, years since onset of disability, device type, primary diagnosis and funding source significantly impact cycle times. Increased complexity of the WMD, both manual and power wheelchairs (PWCs), was associated with longer cycle times. As more service delivery models emerge, specific benefits and challenges need to be reported on how they impact cycle time.

Body Knowledge, Reproductive Anxiety, and "Paying the Rent" in Octavia E. Butler's "Bloodchild"

In this article, we read Octavia E. Butler's "Bloodchild" as a "paying the rent" story in which reproduction functions as the source of payment made by the Terrans to the Tlic. We use Jenkins's distinctions between "hierarchical body knowledge" and "intelligent body knowledge," which derive from Butler's conception of "body knowledge," to argue that the Tlic's reproduction anxiety results from a legacy of "hierarchical body knowledge" that persists in their approaches to and valuation of their Terran trade partners. The problem with hierarchical body knowledge, as Butler suggests in "Bloodchild," is that it fosters social stratification at the expense of survival and could lead both groups to one-up themselves to death. To avoid such a fate, the story suggests that both groups need to develop a symbiotic love for each other, a love rooted in one of the foundational tenets of intelligent body knowledge—that a body's survival value is more important than its social value.

The Proposal of Corporate Payout Decisions’ Modelling

Decisions on a company’s profit sharing are the most important financial decisions for both the shareholders as a source of additional income and the company as the source of cash outflow. The net profit can be transferred to the shareholders in the form of dividends or stock repurchases. Due to the fact that for both, dividends and share repurchase, the source of payments is the net profit (either last year profit, or retained profit), it can be assumed that decisions regarding dividend payments and share repurchases are interdependent. Therefore, a very important and so far without an unequivocal solution is the problem of measuring the relationship between decisions on dividend payments and share repurchases (whether to pay out a company’s profit in one of the forms, in both forms or at all). Taking into consideration the possibility of interdependence of both forms of corporate payout policy as well as the fact that data describing payout policy are of panel nature and the relationships between the decisions and the determinants may be non-linear, two simultaneous equations second order panel binomial choice model with random specific effects, the parameters of which are estimated in the same way as in the two stage least squares, was suggested for modelling the payout policy. The modelling procedure was verified by the estimation of the model on a balanced panel of 153 companies listed on the Warsaw Stock Exchange over the period 2008–2016 (1,377 observations). The study results show that the proposed procedure enables the selection of appropriate factors determining the decisions on dividends and share repurchases and the assessment of the relationship between them. It takes into the consideration the panel nature of the data and the possibility of heterogeneity and removes the phenomenon of endogeneity in the model, thereby, filling an existing gap in the literature on corporate payout decisions.

Associations between Place of Birth, Type of Attendant, and Small for Gestational Age Births among Pregnant non-Hispanic Black Medicaid Recipients.

Although non-Hispanic Black women have increased risks of adverse birth outcomes compared with non-Hispanic white women in the United States, there is a lack of research specifically focusing on non-Hispanic Black women. Thus, this study's purpose was to evaluate whether place of birth and type of attendant used during labor is associated with having a newborn born small for gestational age (SGA) among non-Hispanic Black Medicaid recipients. This study used 2017 Natality data from the National Vital Statistics System for non-Hispanic Black women who used Medicaid as a source of payment (N = 322,604). Type of attendant (ie, the medical professional who assisted during childbirth), place of birth (ie, setting where the woman gave birth), maternal factors, and SGA were obtained from birth certificates. We used multivariate logistic regression to investigate the association between place of birth, type of birth attendant, and newborns born SGA. After adjustment, women who used a certified nurse-midwife or other midwife as an attendant during labor had statistically significant decreased odds of having a neonate born SGA compared with those who had a physician as an attendant (odds ratio [OR], 0.69; 95% CI, 0.66-0.71 and OR, 0.68; 95% CI, 0.55-0.85, respectively). Those who gave birth in a birthing center or had planned home births also had statistically significant decreased odds of having a neonate born SGA (OR, 0.52; 95% CI, 0.38-0.69 and OR, 0.37; 95% CI, 0.21-0.66, respectively). However, those who had an unplanned home birth had twice the odds of having a neonate born SGA compared with those who gave birth at a hospital or clinic (OR, 2.00; 95% CI, 1.50-2.64). Given the racial disparity in adverse birth outcomes for non-Hispanic Black women, the observed associations provide justification for future research to determine whether birthing location and birth attendant are related to SGA.

Study Shows Declining Trend in Psychotherapy by Psychiatrists

Study Shows Declining Trend in Psychotherapy by Psychiatrists

Repeal of state laws permitting denial of health claims resulting from alcohol impairment: Impact on treatment utilization.

Many states in the U.S. still have Alcohol Exclusion Laws (AELs), which allow insurance companies to deny health claims resulting from alcohol impairment. There are concerns that this form of structural stigmatization affects alcohol treatment-seeking behaviors. We examined the effects of AEL repeal on treatment admissions for alcohol use disorder (AUD). Data on alcohol treatment admissions from 1992 to 2017 were obtained from the Treatment Episode Data Set. The state-level aggregate number of treatment admissions was derived, including healthcare professional referrals only, self-referrals only, and both self-referral and healthcare professional referrals. The number of treatment admissions by health insurance status (private, public, and uninsured) was also calculated. The study used a difference-in-differences (DID) quasi-experimental design. The DID analysis showed that the number of admissions for alcohol treatment from healthcare professional referrals increased 16% in the AEL repeal states compared to states with AELs or that never had AELs (IRR=1.16, 95% CI=1.07, 1.25). These results were consistent for analysis by payment sources. In particular, treatment admissions from healthcare professional referrals for patients covered by private insurance increased about 38% in states with AEL repeal (IRR=1.38, 95% CI=1.17, 1.64) compared to states without AEL repeal. However, the findings were no longer significant when the state-specific time trends were taken into account. This study documented that AEL repeal may have had a significant impact on the number of treatment admissions for AUD. These findings suggest that AELs function as a barrier to treatment-seeking behavior.

"Falling between the cracks": Experiences of Black dementia caregivers navigating U.S. health systems.

In addition to numerous care responsibilities, family caregivers are expected to navigate health systems and engage in healthcare management tasks on behalf of their persons living with dementia (PLWD). These challenging tasks pose additional difficulties for Black dementia caregivers. Due to the centuries-old, disadvantaged social history of Black Americans, several unique stressors, vulnerabilities, and resources have emerged which inform and affect Black dementia caregivers' experiences and well-being. Focus groups were held with Black caregivers (N=19) from the United States to explore the unique experiences and perspectives of this population navigating the U.S. health system on behalf of their PLWD. Five overarching themes were constructed during thematic analysis: Forced Advocacy, Poor Provider Interaction, Payor Source Dictates Care, Discrimination, and Broken Health System. Black dementia caregivers unanimously concurred that the health system that they experience in America is "broken." Gaps in the health system can lead to people [as one caregiver passionately expressed] "falling between the cracks," in terms of care, services, and resources needed. Caregivers agreed that class, sex, utilizing public health insurance, and being a "person of color" contribute to their difficulties navigating the health system. Caregivers perceived being dismissed by providers, forcing them to advocate for both themselves and their PLWD. Healthcare providers and researchers can utilize these findings to improve the experiences and healthcare outcomes of Black persons living with dementia and their caregivers. Additionally, these findings can lead to the development of culturally tailored caregiver education programs.

Length of stay and trauma center finances: A disparity of payer source at a Level I trauma center.

In an effort to reduce costs, hospitals focus efforts on reducing length of stay (LOS) and often benchmark LOS against the geometric LOS (GMLOS) as predicted by the assigned diagnosis-related group (DRG) used by the Centers for Medicare and Medicaid Services. The objective of this cross-sectional study was to evaluate the impact of exceeding GMLOS on hospital profit/loss with respect to payer source. Contribution margin for each insured patient admitted to a Level I trauma center between July 1, 2016, and June 30, 2019, was determined. Age, ethnicity, race, DRG weight, DRG version, injury severity, intensive care unit admission status, mechanical ventilation, payer, exceeding GMLOS, and the interaction between payer and exceeding the GMLOS were regressed on contribution margin to determine significant predictors of positive contribution margin. Among 2,449 insured trauma patients, the distribution of payers was Medicaid (54.6%), Medicare (24.0%), and commercial (21.4%). Thirty-five percent (n = 867) of patient LOS exceeded GMLOS. Exceeding GMLOS by 10 or more days was significantly more likely for Medicaid and Medicare patients in stepwise fashion (commercial, 2.7%; Medicaid, 4.5%; Medicare, 6.0%; p = 0.030). Median contribution margin was positive for commercially insured patients ($16,913) and negative for Medicaid (-$8,979) and Medicare (-$2,145) patients. Adjusted multivariate modeling demonstrated that when exceeding GMLOS, Medicare and Medicaid cases were less likely than commercial payers to have a positive contribution margin (p < 0.001 and p < 0.001). Government-insured patients, despite having a payer source, are a financial burden to a trauma center. Excess LOS among government insured patients, but not the commercially insured, exacerbates financial loss. A shift toward a greater proportion of government insured patients may result in a significant fiscal liability for a trauma center. Economic and Value-Based Evaluation, Level III.

Network-based Analysis of Prescription Opioids Dispensing Using Exponential Random Graph Models (ERGMs).

The United States has been experiencing an unprecedented level of opioid overdose-related mortality due in part to excessive use of prescription opioids. Peer-driven network interventions may be beneficial. A key assumption of social network interventions is that of some members of the network act as key players and can influence the behavior of others in the network. We used opioid prescription records to create a social network of patients who use prescription opioid in the state of Rhode Island. The study population was restricted to patients on stable opioid regimens who used one source of payment and received the same opioid medication from ≥ 3 prescribers and pharmacies. An exponential random graph model (ERGM) was employed to examine the relationship between patient attributes and the likelihood of tie formation and modularity was used to assess for homophily (the tendency of individuals to associate with similar people). We used multivariable logistic regression to assess predictors of high betweenness centrality, a measure of influence within the network. 372 patients were included in the analysis; average age was 51 years; 53% were female; 57% were prescribed oxycodone, 34% were prescribed hydrocodone and 9% were prescribed buprenorphine/naloxone. After controlling for the main effects in the ERGM model, homophily was associated with age group, method of payment, number and type of opioid prescriptions filled, mean daily dose, and number of providers seen. Type of opioid and number of prescribers were identified as significant predictors of high betweenness centrality. We conclude that patients who use multiple prescribers or have a diagnosis of opioid use disorder may help promote positive health behaviors or disrupt harmful behaviors in an opioid prescription network.

Determinants of e-payment system perception and satisfaction: Journey from India to Canada

Canada is the country, most embracing cashless technology hardly surprising since there are over 2 credit cards for every person living there as claimed by a recent study of forex bonuses 2017. In 2016 this position was attained by Sweden, where barely 1% of the value of all payments was paid in coins or notes. Is India still on the verge of being known as “yet to become a cashless economy”? If yes, then how much time does India expect to become a cashless economy. It is commonly believed that good security gains public trust, and the perceptions of good security and trust ultimately increase the use of electronic payment system. In this paper, we examine the relationship between the security measures offered by the e-payment channel and the ultimate perception of the consumers of the security, trust and usefulness of the e-payment system this study proposes an empirical model that delineates the factors of consumers’ perceived security and perceived trust, with the effects of perceived security and perceived trust on the use of e-payment systems. Primary data has been collected through questionnaires and hypothesis testing is done. Our results show that transaction procedure significantly impacts the perception of the customers which can be employed by the service providers to make e payment sources more efficient and increase its usage.

Buprenorphine Utilization, Concomitant Benzodiazepines and Opioid Analgesics, and Payment Source: Trends from 2015 to 2019

Buprenorphine Utilization, Concomitant Benzodiazepines and Opioid Analgesics, and Payment Source: Trends from 2015 to 2019

Tobacco Cessation Counseling and Medications Provided by Physicians to Tobacco Users During Primary Care Visits.

Introduction:The established guidelines for treating tobacco use and dependency is brief provider intervention to assist those willing to quit by providing access to medication and/or behavioral counseling. The purpose of the study is to determine the extent of cessation treatment offered by providers during primary care visits by patients who are current tobacco users, and to examine associations between patient factors and treatment received.Methods:Using data from the 2015 to 2018 National Ambulatory Medical Care Survey (NAMCS), we examined tobacco cessation counseling and medications from 4590 visits by patients with current tobacco use. Separate multivariate logistic regressions were used to assess whether the odds of receiving tobacco cessation treatment varied by age, gender, race/ethnicity, and payment source.Results:Of visits by current tobacco users, 18.4% included cessation counseling, 5.5% included cessation medication, and 22.1% included at least 1 type of treatment. Visits by patients with Medicare had 44% greater odds of including counseling (CI = 1%-205%) and treatment (OR = 1.44; 95% CI = 1.01-2.06). Visits classified as “other payment type” had 73% greater odds of including counseling (OR = 1.73; 95% CI = 1.05-2.84). Visits by women had 86% greater odds of including medication (CI = 17%-294%).Conclusions:Tobacco cessation treatment is underutilized by providers during primary care visits. Further research is necessary to understand and address barriers to providing routine cessation assistance.

Налоговые способы поддержки бизнеса в России в период коронавируса

The current events caused by the COVID-19 pandemic concern all spheres of life of every citizen and every enterprise (organization). Forced changes pose a lot of urgent issues to the leadership of the state, regions, municipalities, and individual economic entities. Among such issues, the most important ones are the retention of income and sources of salary payments, the possibility of obtaining tax breaks, the search for attracting additional resources to the turnover of enterprises when revenues from current activities are reduced, possible sanctions for non-fulfillment or improper fulfillment of obligations. A significant tool during the pandemic is the state tax policy. In the context of the coronavirus pandemic, there have been changes in the system of business and economic relations around the world. The first introduction of quarantine immediately showed how much businesses, especially small and medium-sized ones, were not ready for such situations, how difficult it was for them to survive and save jobs. In order to provide anti-crisis support to enterprises, the state introduces tax incentives and relief, since it is in these conditions that state support is extremely important for economic entities. If in stable economic conditions tax instruments for supporting and stimulating business are benefits, especially in terms of innovative developments and investments, in crisis economic conditions these are, as a rule, deferrals and installments of payments for taxes and fees. The tax burden on Russian business is quite heavy in any situation due to the economic nature of tax payments, but in crisis circumstances, including those caused by the coronavirus pandemic, the tax burden becomes unbearable for many business entities that naturally expect effective measures of support from the state. At the same time, it is necessary to achieve a balance of interests of business and the state in matters of taxation in order to protect against threats and challenges of the external environment. The article discusses state measures of tax support for Russian business during the coronavirus pandemic, the so-called “quarantine assistance”. This is exemption from taxes and fees for the reporting tax periods, as well as postponement of tax payments, reduction of insurance premiums, and other measures of state support for entrepreneurs. An effective state tax policy in difficult epidemiological conditions, which necessitates a partial or complete shutdown of some industries, will contribute to a successful way out of the crisis and strengthen the economic security of the state. The article also suggests possible tax measures so that taxpayers do not feel the pressure of an excessive tax burden where it is not required, both during the pandemic and on the way out of the crisis situation. Contribution of the authors: the authors contributed equally to this article. The authors declare no conflicts of interests.

Financial, Military, and Logistic Aspects of the Preparation for the English Invasion of France in 1415

This article considers the organisational component of the preparation of the English invasion of France in 1415. The army of Henry V was one of the largest during the entire Hundred Years War. The development of raising whole armies, rather than merely minor, “non-royal”, expeditions, by contracting for indentured retinues should be seen as primarily an evolutionary consequence of the need to plan and manage the increased scale and duration of continental wars. The three central points to mobilisation are the recognised and necessary authority of the king, the strategic planning role of the council, and the function of the chancery in communicating administrative instructions. Both modern researchers and chroniclers are forced to determine the purpose of the invasion relying on the subsequent actions of the king and his army; until the last moment, the king kept even the place of the upcoming landing secret. The paper analyses the principles of acquisition of the expeditionary military contingent: the influence of the king’s personal participation on the composition, organisational structure, and recruiting of troops (a combination of direct recruitment and indentured retinues). It is emphasised that almost all the highest nobility of the kingdom was involved in the royal army. A significant number of military retinues (and captains) are noted as a distinctive feature of the army in 1415. The article also analyses the financing of the campaign and the sources of payment for military service (direct and indirect taxes, loans, and pleading of the crown jewels). The author examines the organisation of the supply and logistic aspects of the upcoming military expedition to the continent, i.e. the preparation and provision of weapons (including siege equipment), horses and vehicles, provisions and fodder, the principles of collecting ships and their number, payment for ships and crews, the place / mooring of the fleet, and features of landing.

Associated factors of neonatal near miss among newborns of adolescent mothers in Brazil.

To identify the associated factors of neonatal near miss among newborns of Brazilian adolescents and to compare their occurrence in young women aged 12 to 16 years and 17 to 19 years. Cross-sectional, hospital-based study, using data from the study Nascer no Brasil ("Birth in Brazil") on puerperal adolescents and their newborns in all regions of Brazil. Multiple and univariate logistic regression were employed to identify the associated factors of neonatal near miss. The following factors were found to be associated to neonatal near miss among newborns of adolescent mothers: public source of payment (OR = 4.57, 95% CI = 2.02-10.32), having to seek help in different maternity hospitals (OR = 1.52; 95% CI = 1.05-2.20), and maternal near miss (OR = 5.92; 95% CI = 1.94-18.05), in addition to a record of low weight in a previous pregnancy (OR = 3.12; 95% CI = 1.61-6.04) and twin pregnancy (OR = 7.49; 95% CI = 3.28-16.82). Neonatal near miss affected newborns of adolescent mothers in both age groups equally. Also, the determinant factors of neonatal near miss can be mostly reduced with qualified prenatal, labor, and birth care.

Poverty and Risk of Cleft Lip and Palate: An Analysis of United States Birth Data.

The relationship between poverty and incidence of cleft lip and cleft palate remains unclear. The authors investigated the association between socioeconomic status and cleft lip with or without cleft palate and cleft palate only in the United States after controlling for demographic and environmental risk factors. The U.S. 2016 and 2017 natality data were utilized. Proxies for socioeconomic status included maternal education, use of the Special Supplemental Nutrition Program for Women, Infants, and Children, and payment source for delivery. Multiple logistic regression controlled for household demographics, prenatal care, maternal health, and infant characteristics. Of 6,251,308 live births included, 2984 (0.05 percent) had cleft lip with or without cleft palate and 1180 (0.02 percent) had cleft palate only. Maternal education of bachelor's degree or higher was protective against, and delayed prenatal care associated with, cleft lip with or without cleft palate (adjusted ORs = 0.73 and 1.14 to 1.23, respectively; p < 0.02). Receiving assistance under the Special Supplemental Nutrition Program for Women, Infants, and Children was associated with cleft palate only (adjusted OR = 1.25; p = 0.003). Male sex, first-trimester tobacco smoking, and maternal gestational diabetes were also associated with cleft lip with or without cleft palate (adjusted ORs = 1.60, 1.01, and 1.19, respectively; p < 0.05). Female sex, prepregnancy tobacco smoking, and maternal infections during pregnancy were associated with cleft palate only (adjusted ORs = 0.74, 1.02, and 1.60, respectively; p < 0.05). Increased incidence of orofacial clefts was associated with indicators of lower socioeconomic status, with different indicators associated with different cleft phenotypes. Notably, early prenatal care was protective against the development of cleft lip with or without cleft palate. Risk, III.

Adult Day Service Use among Ethnic Minority Older Adults: An Updated Integrative Review

Adult day services (ADS) are a preferred care option for racial and ethnic minorities compared to other types of long-term care services in the United States. However, there is limited knowledge on minority ADS users. Focusing on minority older adults, this study aims to (a) identify facilitator and barriers of ADS use, and (b) examine ADS’s effect on health and wellbeing. Using Whittemore and Knafl’s methodology of integrative reviews, we searched relevant studies published between 2010 to 2020 in Ageline, PubMed, PsycINFO, CINAHL, Web of Science and Google Scholar and included 8 articles in this review after extensive screening and critical appraisal. Crowe Critical Appraisal Tool (CCAT) was used to assess methodological rigor of the studies included in this review. This review showed that individual factors of ADS use among minority older adult included functional impairment, diabetes, race, gender, and degree of loneliness. Organizational characteristics, such as availability of transportation services, bilingual nurses, peer support, and cultural activities, and structural factors including for-profit status and source of payment were also related to ADS use among minority older adults. Positive outcomes associated with ADS use were improved quality of life and sense of fulfillment. Better understanding of minority older adults’ experience with ADS will help tailor the services to better fit their cultural preferences and needs. Future research should move beyond individual-level factors to identify and address organizational and structural factors such as institutional structure, organization culture and practice impact on disparities and discrimination in services access and quality.

Falling Between the Cracks: Experiences of Black Dementia Caregivers Navigating U.S. Health Systems

In addition to numerous care responsibilities, family caregivers are expected to navigate health systems and engage in healthcare management tasks on behalf of their persons living with dementia (PLWD). These challenging tasks pose additional difficulties for Black dementia caregivers. Due to the centuries-old, disadvantaged social history of Black Americans, several unique stressors, vulnerabilities, and resources have emerged which inform and affect Black dementia caregivers’ experiences and well-being. Focus groups were held with Black caregivers (N = 19) from the United States (U.S.) to explore the unique experiences and perspectives of this population navigating the U.S. health system on behalf of their PLWD. Five overarching themes were developed during thematic analysis: Forced Advocacy, Poor Provider Interaction, Payor Source Dictates Care, Discrimination, and Broken Health System. Black dementia caregivers unanimously concurred that the health system that they experience in America is “broken.” Gaps in the health system can lead to people [as one caregiver passionately expressed] “falling between the cracks,” in terms of care, services, and resources needed. Caregivers agreed that class, sex, utilizing public health insurance, and being a “person of color” contribute to their difficulties navigating the health system. Caregivers perceived being dismissed by providers, forcing them to advocate for both themselves and their PLWD. Healthcare providers and researchers can utilize these findings to improve the experiences and healthcare outcomes of Black patients with dementia and their caregivers. Additionally, these findings can lead to the development of culturally tailored caregiver education programs.

887. Implementation of Long-acting Injectable Cabotegravir/Rilpivirine for HIV-1 Treatment at a Ryan White-funded Clinic in the U.S. South

BackgroundIn January 2021, the first ever long-acting injectable (LAI) antiretroviral therapy (ART), cabotegravir/rilpivirine (CAB/RPV), was approved for maintenance HIV-1 treatment in select patients with virologic suppression. LAI-ART has the potential to improve ART adherence, reduce HIV stigma, and promote equity in care outcomes, however, implementation in real-world settings has yet to be evaluated.MethodsWe launched a pilot LAI-ART program at the largest Ryan White-funded HIV clinic in the Southeast. From 4/14/21 to 5/14/21, providers referred patients interested and willing to switch to LAI-CAB/RPV who met screening criteria. Our interdisciplinary LAI team (Clinician-Pharmacy-Nursing) verified clinical eligibility (HIV-1 < 200 c/ml ≥6 months and no history of virologic failure, resistance to either drug, or chronic HBV infection) and pursued medication access for 28-day oral lead-in and monthly injectable CAB/RPV. We describe demographic and clinical variables of referred PWH and early outcomes in accessing LAI-ART. ResultsAmong 42 referrals, median age was 40.5 (Q1-Q3, 32-52) years, 83% were men, and 76% Black. Payor source distribution was 26% Private, 19% Medicare, 10% Medicaid, and 45% ADAP. At the time of referral, median CD4 count was 583 (Q1-Q3, 422-742) cells/mm3 and median sustained HIV-1 RNA < 200 c/ml was 1427 (Q1-Q3, 961-2534) days. A total of 35 patients (74%) met clinical eligibility for LAI-CAB/RPV, including 4 patients who required a transition off proton pump inhibitor therapy to accommodate oral RPV. Ineligible PWH were excluded due to evidence of RPV resistance (n=5), possible RPV hypersensitivity (n=1), and HIV non-suppression (n=1). The table summarizes the process of pursuing LAI-ART access for the initial 10 enrollees by insurance status. ConclusionOur experience implementing LAI-ART at a Ryan White-funded HIV clinic in the Southern U.S. has been challenged by substantial human resource capital to attain drug, delayed therapy initiation due to insurance denials, and patient ineligibility primarily due to concern for potential RPV resistance. These barriers may perpetuate disparities in ART access and virologic suppression among PWH and need to be urgently addressed so that LAI-ART can be offered equitably.Disclosures Lauren F. Collins, MD, MSc, Nothing to disclose Bradley L. Smith, Pharm.D., AAHIVP, Gilead Sciences, Inc (Advisor or Review Panel member) Wendy Armstrong, MD, Nothing to disclose Jonathan Colasanti, MD, Integritas CME (Consultant, develop and deliver CME content around Rapid Entry/Rapid ART)