Telephone Contact Research Articles

Consultoría telefónica en COT durante la pandemia por COVID-19. ¿Ha venido para quedarse?

Background and aimThe current COVID-19 pandemic scenario has driven surgical departments to a transformation.The worldwide spread of the disease has led to a public health quarantine where health care professionals are at high risk of infection. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. This study aims to demonstrate that a combined framework based on telematics and in-person clinical encounter not only ensures medical care but the safety of healthcare professionals and patients. Material and methodDescriptive observational study on the follow-up of patients during the COVID19 Pandemic, combining telephone and traditional. ResultsA total of 5031 telephone calls were made, differentiating between medical referrals, specialized primary care visits, and outpatient consultation.They were classified as successful, required an in-person visit, or no successful telephone contact. Furthermore, we divided them into 2 groups: resolved and unresolved.53% of all telematic visits were successful. ConclusionsTelematic medical systems are a feasible option in a orthopedics department and an interesting resource to preserve once the pandemic is resolved. Future lines of research should be opened to improve system success, analyze its cost-effectiveness ratio, and correct any legal conflicts that may exist.

Remote Monitoring With Appropriate Reaction to Alerts Was Associated With Improved Outcomes in Chronic Heart Failure: Results From the OptiLink HF Study.

Impedance-based remote monitoring (RM) failed to reduce clinical events in the OptiLink heart failure (HF) trial. However, rates of alert-driven interventions triggered by intrathoracic fluid index threshold crossings (FTC) were low indicating physicians' inappropriate reactions to alerts. We separated appropriate from inappropriate contacts to FTC transmissions in the OptiLink HF trial (Optimization of Heart Failure Management Using OptiVol™ Fluid Status Monitoring and CareLink™). Appropriate contacts had to meet the following criteria: (1) initial telephone contact within 2 working days after FTC transmission, (2) follow-up contacts according to study protocol, and (3) medical intervention initiated after FTC due to cardiac decompensation. We compared time to cardiovascular death or HF hospitalization between RM patients contacted appropriately or inappropriately and patients with usual care. In the RM group, at least one FTC alert was transmitted in 356 patients (70.5%; n=505). Of note, only 55.5% (n=758) of all transmitted FTCs (n=1365) were followed by an appropriate contact. While 113 patients (31.7%; n=356) have been contacted appropriately after every FTC, in 243 patients (68.3%; n=356) at least one FTC was not responded by an appropriate contact. Compared with usual care, RM with appropriate contacts to FTC alerts independently reduced the risk of the primary end point (hazard ratio, 0.61 [95% CI, 0.39-0.95]; P=0.027). RM appropriate reactions to FTC alerts are associated with significantly improved clinical outcomes in patients with advanced HF and implantable cardioverter-defibrillators.

Una sistematización de experiencia psicosocial en: Atención a la familia, psicoeducación familiar, redes de apoyo

La finalidad de esta investigación ha sido comprender el aporte a la sistematización, realizado por el programa de familia con el apoyo del área de psicología y trabajo social, desde las fuerzas militares, en el acompañamiento psicosocial para el manejo de duelo por la pérdida de un ser querido y la nueva funcionalidad del hogar sin su presencia, por lo que es importante tener presente la psicoeducación familiar. Para esto se concedió una participación del equipo interdisciplinario de la institución (psicología, trabajador social, capellán, militar encargado del proceso de bienestar de la unidad militar y la activación de la red de apoyo interinstitucional y familiar).
 Esta experiencia de sistematización se realizó el mes de marzo de 2019, con el fallecimiento de un personal militar en área de orden público crítico en la región del pacífico colombiano, activándose los requerimientos establecidos por las fuerzas militares a través de tres momentos o tiempos de intervención, así: Momento 1. Atención antes y durante las exequias; este momento se estructuró para el acompañamiento, desde el conocimiento de la noticia del fallecimiento en la unidad militar hasta las exequias realizadas. Momento 2. Seguimiento a los familiares del fallecido posterior a las exequias. Momento 3. Seguimiento dividido en dos partes: una inicial donde se tomó contacto telefónico al tercer mes de las exequias, la segunda fue la visita presencial, para sesión única de manejo de duelo.
 La metodología se enmarcó desde un paradigma metodológico cualitativo, siguiendo un enfoque interpretativo y su tipo fue sistematización de experiencias. Los resultados permiten valorar la pertinencia del protocolo de la institución militar para el abordaje de los sucesos desde el fallecimiento del militar y la atención oportuna a los familiares en la atención del duelo y el manejo interdisciplinar que se da en medio del proceso, permitiendo una psicoeducación a la familia, que da muestra de una nueva adaptación a la pérdida del ser querido.

Implementing telehealth support to increase physical activity in girls and women with Rett syndrome—ActivRett: protocol for a waitlist randomised controlled trial

IntroductionIndividuals with Rett syndrome (RTT) experience impaired gross motor skills, limiting their capacity to engage in physical activities and participation in activities. There is limited evidence of the effectiveness of...

Management referral triaging process pilot study: a 'telephone first' approach.

In this Occupational Health Department (OHD), a 'telephone first' approach was introduced to triage management referrals with potential to convert to Telephone Independent Medical Assessment (TIMA). Telephone consultation has been widely used in the UK's NHS in the occupational health setting. To evaluate TIMA effectiveness and efficiency of OHD resources; comparing the outcome of a triage call compared to previous default allocation of next available appointment, percentage of telephone triage calls converted to TIMA and appointment waiting times. To assess use of OHD resources arising from TIMA. To evaluate service user satisfaction following TIMA. To examine service user characteristics. As management referrals were received, service users were given a telephone contact. Data were collected and anonymized regarding service users, who also consented to receive feedback questionnaire. Cross-sectional analysis of this management referral cohort was carried out. Two hundred and sixty-one management referrals were received in the specified period. Eighty per cent had a TIMA carried out (n = 208); 64% of management referrals with TIMA had a report issued (n = 166). Response rate to feedback questionnaire was 38% (n = 70); 94% of survey participants found TIMA acceptable going forward for management referrals (n = 66). Introduction of a 'telephone first' approach resulted in improved efficiency of this OHD, allowing maximum workforce planning, and positive service user feedback.

Telephone- and Text Message-Based Continuing Care After Residential Treatment for Alcohol Use Disorder: A Randomized Clinical Multicenter Study.

Alcohol use disorder (AUD) is characterized by extremely high rates of postresidential treatment relapse, and as such, continuing care to prevent relapse has become an important element in AUD treatment. In this regard, research has yielded heterogeneous evidence on telephone-based (TEL) and text message-based (TEX) continuing care. We aimed to compare the effectiveness of TEL and TEX continuing care provided in different frequencies by psychotherapists for patients from residential treatments in mitigating the occurrence of posttreatment relapse in patients who completed a 12-week abstinence-oriented residential treatment program for AUD. A total of 240 patients from 2 residential treatment programs for AUD were included in the study. Patients were randomly assigned to high- (10 contacts) or low-frequency (3 contacts) TEL, TEX (10 contacts) continuing care, or control group (1 contact) from discharge to 6-month follow-up. The TEL was intended to be supportive and consisted of several cognitive behavioral therapy components, whereas the TEX was based on behavioral self-monitoring techniques and additional calls in case of relapse or as needed. Sociodemographic, clinical, and alcohol-specific variables at residential treatment discharge and at 5-month follow-up were assessed through interviews and questionnaires. Compared with the control group, patients in the high-frequency TEL were significantly more likely to be abstinent at 6-month follow-up and, in case of relapse, showed a tendency toward a longer time to first drink. Moreover, the high-frequency TEL and TEX groups had significantly higher alcohol-related self-efficacy 6months after residential treatment. High-frequency proactive telephone contact by psychotherapists known to the patient may help patients to surmount the vulnerable phase after residential treatment and, in case of relapse, might help patients stay connected to health services, which in turn prevents chronification and facilitates recovery from AUD.

10-year mortality in women after hip fractures

The aim was to study the indexes of short- and long-term mortality in women after hip fractures (HF).Material and methods. In a retrospective study, the data of 146 women with HF aged 50 years and older (mean age (Me [25Q-75Q]): 77.7 [68.1-81.9] years old) hospitalized in 2005-2007 were analyzed. Life outcome data were collected three times (in 2015, 2016 and 2017) by the researchers by telephone contact with patients or their relatives. The analysis was carried out depending on age, type of fracture, the presence of concomitant diseases. The average follow-up period was 144.0 [131.5-152.5] months for surviving patients and 20.2 [6.7-55.0] months for deceased.Results. At the end of investigation 94 women (64.4% among all 146 patients) died, 52 survived. The average age at the time of death for the deceased (84.5 [76.9-91.3] years), did not differ from the indexes of survivors at the end of the study (82.0 [72.9-86.8] years). Hospital mortality rates were 1.6 %, 6-month, 1-, 5- and 10-year mortality, respectively – 12.7 %, 23.0 %, 43.7 % and 54.0%.Conclusions. Survival rates in women did not differ depending on fracture type, and were significantly higher (p < 0.01) in the patients older than 70 years compared with younger patients.

The Effect of Follow-Up Contact on Recovery After Benign Hysterectomy: A Randomized, Single-Blinded, Four-Arm, Controlled Multicenter Trial.

Background: The objective of this trial was to analyze the effect of follow-up programs using standard follow-up protocol and structured coaching on recovery after hysterectomy in an enhanced recovery after surgery setting. Materials and Methods: A randomized, four-armed, single-blinded, controlled multicenter trial comprising 487 women was conducted at five hospitals in the southeast region of Sweden. The women were allocated (1:1:1:1) to Group A: no planned follow-up contact; Group B: a single, planned, structured, broadly kept, follow-up telephone contact with the research nurse the day after discharge; Group C: planned, structured, broadly kept follow-up telephone contact with the research nurse the day after discharge and then once weekly for 6 weeks; and Group D: as Group C, but with planned, structured, coaching telephone contact. Recovery was assessed by the health-related quality of life (HRQoL) questionnaires EuroQoL-5 Dimension with three levels (EQ-5D-3L) and Short-Form-Health Survey with 36 items (SF-36) and duration of sick leave. Results: Neither the recovery of HRQoL as measured by the EQ-5D-3L and the SF-36 nor the duration of sick leave (mean 26.8-28.1 days) differed significantly between the four intervention groups. Irrespective of mode of follow-up contact used, the women had recovered to their baseline EQ-5D-3L health index 4 weeks after surgery. The occurrence of unplanned telephone contact was significantly lower (by nearly 30%) in the women who had structured coaching. Conclusion: Follow-up contact, including coaching, did not seem to expedite the postoperative recovery in HRQoL or reduce the sick leave after hysterectomy, but the coaching seemed to reduce unplanned telephone contact with the health care services. ClinicalTrial.gov (NCT01526668).

Online monitoring of patient self-reported adverse events in early phase clinical trials: Views from patients, clinicians, and trial staff.

Background/aimsNew classes of cancer drugs bring a range of unknown and undesirable adverse events. Adverse event monitoring is essential in phase I trials to assess toxicity and safety. In phase II, the focus is also on efficacy but robust data on adverse events continue to inform the safety and the adverse event profile. Standard, clinician-led monitoring has been shown to underestimate patients’ symptoms. Hence, patient-reported adverse event monitoring has been argued to complement and improve the information on adverse events in early phase clinical trials. With advances in information technology, real-time patient self-reported adverse events in trials are feasible. This study explored the experiences and procedures for reporting adverse events in early phase trials among patients, clinical staff, and trial staff, and their views on using an electronic patient-reported outcome adverse event system in this setting.MethodsQualitative interviews were conducted with patients, purposively sampled across ages, gender, and different phases of trials, and with clinical and trial-related staff involved in early phase trials (e.g. consultants, research nurses, hospital-based trial assistants/data managers, trial unit management staff). Interviews explored patient experiences and views on current adverse event reporting processes and electronic patient-reported outcome adverse event reporting. Framework analysis techniques were used to analyse the data.ResultsInterviewees were from two hospital trusts with early phase portfolios in England and a trial unit, and included sixteen patients, five consultants, four research nurses, five hospital-based trial staff, and two trial unit staff. Interviews identified three key themes (patient experiences, data flow, and views on electronic patient-reported outcome adverse event reporting). Stakeholders emphasised the intensity of trials for patients and the importance of extensive information provision within the uncertainty of early phase trial drugs. Regular face-to-face appointments for patients supplemented by telephone contact aimed to capture any adverse events. Delayed or under-reporting of mild- or low-severity symptoms was evident among patients. Hospital-based staff highlighted the challenges of current data collection including intense timescales, monitoring by trial sponsors, and high workload. Positive views on electronic patient-reported outcome adverse events highlighted that this could provide a more comprehensive and accurate view on the side effects of new drugs. Clinical staff emphasised patient safety and the need for clear responsibilities for monitoring. The need for careful decision-making about data flow and symptom attribution was highlighted; with trial unit staff emphasising the need for clinician review.ConclusionTechnology advances mean it is timely to explore the benefits and challenges of electronic patient-reported outcome adverse event reporting. This is a complex area warranting further consideration within the trial community. We have developed an online patient self-reporting tool and a small pilot with early phase trial patients is underway.

Saúde de mulheres de dois grupos de atividade física: estudo de acompanhamento durante a COVID-19

O objetivo foi monitorar indicadores de saúde mental e a prática de exercícios de respiração e alongamento no contexto doméstico durante dois meses da pandemia COVID-19 entre mulheres participantes de dois grupos de atividade física de Unidades Básicas de Saúde. A amostra foi composta por 17 mulheres, que participaram de quatro contatos telefônicos. As variáveis foram a autopercepção de saúde, da ansiedade, da qualidade do sono e da concentração, além de dificuldades econômicas (falta do básico em casa no período) e a prática de exercícios de respiração e alongamento no domicílio, bem como as dificuldades para a realização destas. O teste de Friedman foi utilizado para verificar diferenças nas variáveis nos quatro momentos. Diferenças significativas na autopercepção da qualidade do sono (com piores resultados em T4) e na prática de exercícios (piores resultados em T1) foram observadas. Em três dos quatro momentos do monitoramento, pelo menos uma mulher referiu que havia faltado o básico para a sobrevivência. Onze mulheres citaram barreira(s) em pelo menos um dos momentos do estudo para a realização dos exercícios, sendo a mais citada: não saber realizar o exercício ou se sentir insegura realizando sozinha. Conclui-se que, considerando a necessidade de adequação dos serviços de saúde em função da pandemia, ações de monitoramento, combinadas com estratégias de escuta e aconselhamento, podem ser uma boa alternativa para o acompanhamento da saúde dos participantes dos grupos de atividade física.

Using Hybrid Telepractice for Supporting Parents of Children with ASD during the COVID-19 Lockdown: A Feasibility Study in Iran.

During the three-month closure of clinics and day centers in Iran due to the coronavirus disease 2019 (COVID-19) lockdown, parents of children with Autism Spectrum Disorder (ASD) became solely responsible for their care and education. Although centers maintained telephone contact, it quickly became evident that parents needed more detailed advice and guidance. Staff from 30 daycare centers volunteered to take part in a two-month online support and training course for 336 caregivers of children with ASD of different ages. In addition to the provision of visual and written information, synchronous video sessions were used to coach parents on the learning goals devised for the children. Both qualitative and quantitative data were collected to understand the acceptability of using telepractice and the outcomes achieved. A low dropout rate and positive feedback from parents indicated that they perceived telepractice sessions to be useful. The factors contributing to parents’ satisfaction were identified. Although the use of telepractice would be a good alternative for caregivers in any future lockdowns, it could also be used in conjunction with daycare center services to encourage greater parental participation, or with families living in areas with no day centers. Further studies are needed to compare telepractice to usual daycare face-to-face interventions, and to document its impact and cost-effectiveness for parents and children.

Abstract 15035: Managing Covid-19 Amongst Pediatric Heart Transplant Recipients in Sao Paulo, Brazil

Introduction: Heart transplant recipients are considered high risk for poor outcomes following Covid-19 infection. However, there is minimal literature on the effects of Covid-19 on this cohort. We provide our centres experience, as a developing nation with limited resources, in the prevention and management of Covid-19 amongst pediatric heart transplant recipients. Methods: 141 pediatric heart transplant recipients are currently followed-up at our centre - Heart Institute (InCor), Sao Paulo Medical School. We monitored this cohort using telephone contact, by which we postponed appointments and gave recommendations to stay home and maintain hygiene. Since March 2020, for any potential organ donations, a screening was conducted of the donor by taking a history, a RT-PCR-Covid 19 swab and performing a chest CT scan. Results: Five pediatric heart transplant recipients were suspected to have Covid-19 disease and two were tested positive for Covid-19. The first patient was a 14-year-old girl who underwent heart re-transplantation for coronary artery vasculopathy on March 5th, 2020. She developed significant haemodynamic compromise on post-operative day 45 and was transferred to ICU. Her chest CT showed extensive lung opacities (Figure 1). While attempting to wean her from mechanical ventilation, she had a sudden death. The second patient was a 6-year-old male. He presented to the hospital with vomiting, pyrexia, abdominal pain and nasal congestion. His chest CT scan demonstrated small nodule opacification of the lungs. He was appropriately commenced on fluids, antibiotics and antiviral medications. With improvements in his clinical state, he was discharged after 8-days. Conclusions: We provided telehealth to reduce the spread of Covid-19 amongst our cohort. However, we still had two Covid-19 positive cases at our centre. Our observations suggest that pediatric heart transplant recipients are at risk of deleterious outcomes from COVID-19 infection.

Living Alone During COVID-19: Social Contact and Emotional Well-being Among Older Adults.

ObjectiveThe COVID-19 outbreak and associated physical distancing measures altered the social world for most older adults, but people who live alone may have been disproportionately affected. The current study examined how living alone was associated with daily social contact and emotional well-being among older adults during the pandemic.MethodAdults (N = 226) aged 69+ completed a brief survey assessing their living situation, social contact with different social partners (in person, by phone, electronically), and emotions during the morning, afternoon, and evening the prior day.ResultsOlder adults who live alone were less likely to see others in person or to receive or provide help. Living alone was associated with more positive emotions concurrent with in-person contact. In contrast, phone contact was associated with higher levels of negative affect among those living alone, but not among those who live with others. Older adults who live alone were more likely to have contact with friends (rather than family).DiscussionFindings suggest older adults who live alone may be more reactive to social contact during the COVID-19 outbreak than older adults who reside with others. In-person contact may confer distinct benefits not available via telephone contact, suggesting that possible interventions during the pandemic may work best with safe forms of in-person contact, possibly with nonfamily members.

Telerehabilitation After Stroke Using Readily Available Technology: A Randomized Controlled Trial

Background The number of people living with stroke has increased demand for rehabilitation. A potential solution is telerehabilitation for health care delivery to promote self-management. One such approach is the Augmented Community Telerehabilitation Intervention (ACTIV). This structured 6-month program uses limited face-to-face sessions, telephone contact, and text messages to augment stroke rehabilitation. Objective To investigate whether ACTIV improved physical function compared with usual care. Methods This 2-arm, parallel randomized controlled trial was conducted in 4 New Zealand centers. Inclusion criteria were patients with first-ever stroke, age >20 years, and discharged home. A blinded assessor completed outcome measurement in participants’ homes at baseline, postintervention, and 6 months postintervention. Stratified block randomization occurred after baseline assessment, with participants allocated to ACTIV or usual care control. Results A total of 95 people were recruited (ACTIV: n = 47; control: n = 48). Postintervention intention-to-treat analysis found a nonsignificant difference between the groups in scores (4·51; P = .07) for physical function (measured by the physical subcomponent of the Stroke Impact Scale). The planned per-protocol analysis (ACTIV: n = 43; control: n = 48) found a significant difference in physical function between the groups (5·28; P = .04). Improvements in physical function were not maintained at the 12-month follow-up. Conclusions ACTIV was not effective in improving physical function in the ACTIV group compared with the usual care group. The per-protocol analysis raises the possibility that for those who receive more than 50% of the intervention, ACTIV may be effective in preventing deterioration or even improving physical function in people with stroke, in the period immediately following discharge from hospital.

Comparison Outcomes of Anesthesia and Hospitalization of Endovascular Treatment versus Open Surgery for Infra Renal Abdominal Aortic Aneurysm at Sina Hospital from 2011 to 2019

Background: Two methods of repair are currently available for an abdominal aortic aneurysm (AAA), open aneurysm surgery, and endovascular aneurysm repair (EVAR). The purpose of this article is to investigate and compare the outcomes of all cases of open surgery versus EVAR conducted from2011 to 2019 at Sina Medical Research and Training Hospital, the first EVAR was conducted at Sina Hospital in 2011. Methods: This research is a retrospective cross-sectional study. The study population consisted of all abdominal aortic aneurysm patients who were treated at Sina Hospital in Tehran from September 2011 to December 2019. All patients who met the inclusion criteria participated in the study. A checklist of required data was prepared and used to extract data from patients' medical case files. Patients' information was completed via telephone contact with patients or their families. Analyses were performed using SPSS software with a 5-percent error rate. Results: The sample consisted of 194 patients who were divided into two groups. 73 patients (37.6%) underwent open surgery and 121 patients (62.4%) underwent EVAR. All patients (100%) who underwent open surgery received general anesthesia, while only 15 patients (12.8%) who underwent EVAR received general anesthesia, and 102 patients (87.2%) who underwent EVAR received spinal anesthesia. Rates of blood loss and blood transfusion, length of stay in the intensive care unit (ICU), the total length of postoperative hospitalization for patients who underwent open surgery were significantly higher than for those who underwent EVAR (P-value <0.001). The mortality probability of patients with a history of CVA and smoking was3.47 and 2.66 times higher than those with a negative history of these cases, respectively. Although average EF was higher in living patients compared to deceased ones, this difference was not statistically significant (P-value= 0.161). Conclusion: Surgery duration, length of stay in ICU, length of hospital stay, and rate of blood transfusion of patients undergoing EVAR was reduced in comparison with those undergoing open surgery.

Dietary Approaches to Stop Hypertension Dietary Intervention Improves Blood Pressure and Vascular Health in Youth With Elevated Blood Pressure.

This randomized control trial assessed the post-intervention and 18-month follow-up effects of a 6-month dietary approaches to stop hypertension (DASH)-focused behavioral nutrition intervention, initiated in clinic with subsequent telephone and mail contact, on blood pressure (BP) and endothelial function in adolescents with elevated BP. Adolescents (n=159) 11 to 18 years of age with newly diagnosed elevated BP or stage 1 hypertension treated at a hospital-based clinic were randomized. DASH participants received a take-home manual plus 2 face-to-face counseling sessions at baseline and 3 months with a dietitian regarding the DASH diet, 6 monthly mailings, and 8 weekly and then 7 biweekly telephone calls focused on behavioral strategies to promote DASH adherence. Routine care participants received nutrition counseling with a dietitian consistent with pediatric guidelines established by the National High Blood Pressure Education Program. Outcomes, measured pre- and post-intervention and at 18-months follow-up, included change in BP, change in brachial artery flow-mediated dilation, and change in DASH score based on 3-day diet recalls. Adolescents in DASH versus routine care had a greater improvement in systolic BP (-2.7 mm Hg, P= 0.03, -0.3 z-score, P=0.03), flow-mediated dilation (2.5%, P=0.05), and DASH score (13.3 points, P<0.0001) from baseline to post-treatment and a greater improvement in flow-mediated dilation (3.1%, P=0.03) and DASH score (7.4 points, P=0.01) to 18 months. The DASH intervention proved more effective than routine care in initial systolic BP improvement and longer term improvement in endothelial function and diet quality in adolescents with elevated BP and hypertension. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00585832.

Adherence to the treatment of pa-tients in the long-term supervision period after myocardial infarction (according to the REGATA register)

Aim To study long-term compliance with treatment in patients included into the REGistry of pATients after myocArdial infarction (REGATA).Material and methods In 2012-2013, the study included 481 patients with a history of myocardial infarction (MI) who visited the district outpatient clinic. Median age was 72 [62;78] years; men, 51.4 % (n=247); median time from the last MI to the date of inclusion into the registry was 5 [2;9] years. Compliance with treatment was determined with the Morisky-Green questionnaire during telephone contacts with patients at 36 and 48 months (n=230) after the inclusion. Patients scored 4 were considered compliant; patients scored 3 were low-compliant; and patients scored 0-2 were non-compliant. Statistical significance of differences in compliance at 36 and 48 months was assessed with the McNemar test.Results There were no significant differences between the proportions of compliant, low-compliant and non-compliant patients for the analyzed period. However, at 48 months after the inclusion, the number of patients who had difficulties in answering the questionnaire questions significantly increased from 15.5 % to 21.6 % (p=0.04). Analysis of changes in compliance with the treatment for only compliant patients showed that at 36 months from the inclusion, 87 patients remained highly compliant (37.8 %) while at 48 months, only 32 (36.8 %) patients remained compliant with the treatment. Proportion of compliant patients did not significantly differ for men and women, patients younger and older than 60 years, patients with primary MI and reinfarction, prone and not prone to self-management, and for those who used or not the medicine assistance.Conclusion The data obtained as a part of the REGATA registry indicate insufficient long-term compliance with the treatment of after-MI patients with both primary MI and reinfarction, an increasing proportion of patients who are unable to assess their degree of compliance, and decreasing compliance among highly compliant patients during the period between 36 and 48 months of observation. On the whole, there were no significant changes in the compliance with the treatment for 12 months between the first and the second interviews. The proportion of patients compliant with the prescribed drug therapy was significantly lower in the presence of predisposition to self-management.

Impact of the COVID19 Pandemic on Admissions and Emergency Department Visits of Adults with Sickle Cell Disease

Background: The most common complication of sickle cell disease (SCD) in adults is vaso-occlusive crisis that is characterized by severe pain. These events can often be managed at home with oral analgesics, but if the pain is not controlled or the patient develops other associated problems, they seek care in an emergency department (ED). In the ED, they receive initial treatment with pain medications and are assessed for other complications such as infection and acute chest syndrome. If an individual's pain is not controlled in a short period of time, the majority of these patients are admitted to the hospital for inpatient management or placed in an observation unit (OBs) for 6-47 hours. The COVID-19 pandemic affected the Greater Newark community starting in mid March with the majority of all inpatient admissions (Ads) being COVID related through the end of May. It has been observed both at our medical center and nationally that during this time period and even afterwards, the number of ED visits and Ads had significantly fallen. The reasons for this finding may include fear of contracting COVID infection at the hospital, regular telemedicine (TM) calls to facilitate outpatient management, and an increase in the number of prescriptions of home pain medications. The purpose of this analysis was to examine patterns of ED visits, Ads, outpatient visits, prescription renewals and nurse (RN) and social worker (MSW) calls in order to determine the impact of COVID-19 infection on the local SCD community.Methodology: A retrospective review was undertaken of billing data and the EMR of all patients with SCD treated at Newark Beth Israel Medical Center (a 450 bed community-based academic tertiary care medical center) between January 2020 and June 2020. Data collected included the number of and reason for ED and OBs, Ads, the number of TM and outpatient visits, and MSW and RN telephone contacts. All patients 18 years of age and older were included. Overall, 100 adults with SCD received care between January and June.Results: Peak hospital COVID Ads, ED and OBs for all patients (SCD and non-SCD) occurred during the weeks between March 25 and May 24, 2020 with a daily inpatient census over 200 between April 7 and 24. SCD Ads at peak COVID (April-May) were significantly lower at 26±2/month compared to 64±11/month pre-COVID (January-February) (p= 0.04). ED and OBs were unchanged. During the peak of COVID, 10/93 (11%) SCD Ads (1 death) were COVID related with 80/96 (86%) for uncomplicated pain crises. MSW and RN called all patients proactively to offer support at onset of COVID pandemic. During this same time period, the number of MSW telephone contacts increased from 138±37/month pre-COVID to 372±21/month during COVID (p=0.02). RN contacts with SCD patients were stable and mostly were for pain prescription renewals. TM was initiated in March 2020 and an increase in these visits correlated with a fall in face to face physician visits: 83.5±11/month pre-COVID to 39.5±8/month peak COVID (p= 0.04), and TM 0/month pre-COVID and 31±4/month peak COVID (0.01).Conclusion: The outbreak of COVID-19 in the community reduced the number of Ads for patients with SCD without an increase in ED and OBs visits. MD face-to-face encounters were reduced but outpatient care continued with the initiation of TM, regular RN contact with maintenance of pain medication prescriptions and a greater numbers of MSW calls for psychosocial support. Further investigation and understanding of the use of Ads for SCD care, and the reduction during COVID, may have implications for current SCD management.DisclosuresCohen:GBT: Speakers Bureau.

Handling of remote monitoring alerts according to the weekday of transmission: results from the OptiLink HF study

Abstract Background Remote monitoring of patients suffering from heart failure (HF) did not result in improved clinical outcomes in the OptiLink-HF trial. However, initiation of medical intervention after transmission of telemedicine alerts triggered by fluid index threshold crossings (FTCs) was low. The relation between weekday of transmission of FTC and subsequent patient contact is unknown. Methods Patients enrolled in the intervention arm of the OptiLink HF trial (n=505, age 66.1±10.1, male 77.2, EF 26.7±6.1%) were analyzed according to the weekday of transmission of FTC. Transmissions of FTC on Mondays to Thursdays were categorized as TD1, Fridays to Sundays as well as bank holidays as TD2. Primary endpoint was time between transmission and telephone contact; secondary endpoints were subsequent medical intervention and hospitalizations. Results During a follow-up of 18 months, 1364 FTC (866 (63.5%) categorized to TD1, 498 (36.5%) to TD2) alerts occurred in 356 patients. In 46.2% of FTC same day telephone contact was performed in group TD1 compared to 18.3% in group TD2 (p&amp;lt;0.001). Accordingly, the median time to contact was significantly longer in TD2 compared to TD1 (2 (1–3) vs. 0 (0–1); p&amp;lt;0.001). Rates of no telephone contact were not different between the groups (12.1% vs. 12.4%; p=0.866). Although, signs of worsening HF were prevalent in 32.4% in TD1 vs. 32.1% in TD2 (p=0.996), initiation of a pharmacological intervention was more likely in TD1 compared to TD2 (27.9% vs. 22.9%; p=0.041). No differences existed concerning hospitalization for HF within 30 days after FTC (3.9% vs. 3.4%; p=0.636). Conclusion Transmission of FTC alerts during weekends and on bank holidays were less likely associated with timely patient contacts and initiation of pharmacological intervention than during the week. Telemedical centers providing 24/7 remote monitoring service might help to optimize patient care. Funding Acknowledgement Type of funding source: None

Factors related to perceived continuity of care in hospitalized cardiac patients

Abstract Background Since healthcare systems are increasingly complex and often fragmented, continuity of care after hospitalization is a priority to increase patient safety and satisfaction. Aim Describe factors related to continuity of care in patients hospitalized due to cardiac conditions. Methods This cross-sectional multicenter study enrolled patients 6 weeks after hospitalization due to cardiac conditions. A total of 993 patients were included (mean age 72.2 (SD 10.4), males 66%) with AMI (35%), AF (25%), angina (21%) and HF (17.3%). Patients completed the Patient Continuity of Care Questionnaire, a questionnaire based on the definition that continuity of care is “the extent to which a series of health care services is experienced as connected and coherent and is consistent with a patient's health needs and personal circumstances”. The total score of the questionnaire ranges from 6 to 30, higher score indicating higher continuity and a score &amp;lt;24 indicating insufficient continuity. Cronbach's alpha on the total PCCQ was 0.94. Correlations between PCCQ and quality of life, depression, anxiety, perceived control and health care utilization were estimated using spearman rang correlation. Results Insufficient continuity of care ranged between 47% to 59% in the different diagnosis groups, which the highest continuity in the AMI group and lowest in patients with atrial fibrillation. In patients hospitalized due to AMI (n=355, mean age 71 (± 11), 70% men), continuity of care was related to higher perceived control, higher quality of life, a good financial situation, being a man, no symptoms of anxiety or depression (ᚹ range 0.17–0.26 p≤0.002). A low score on the PCCQ were associated with follow-up visit to a nurse in primary care after hospitalization (ᚹ −0.12 p=0.033). In patients hospitalized due to angina (n=210, mean age 73 (± 9), 74% men), continuity of care was related to higher perceived control, higher quality of life and no depressive symptoms (ᚹ range between 0.20 and 0.26 p=0.005). In patients with AF, (n=255, mean age 71 (± 10.), 58% men), continuity of care was related to having had contact by telephone with a nurse-led AF clinic, higher perceived control, higher quality of life and not being depressed (ᚹ range between 0.14–0.25 p=0.03). In patients with HF, (n=173, mean age 77 (±8) 59% men), continuity was related to male ender, younger age, follow-up in a nurse-led HF clinic and not being anxious (ᚹ range between 0.16 and 0.22 p=0.004–0.047). Low total score on PCCQ correlated to having had telephone contact with nurse in primary care (ᚹ −0.24 p=0.002). Conclusion Almost half of all patient reported insufficient continuity of care. Perceived control, quality of life, and symptoms of depression were related to higher continuity of care in all diagnose groups except heart failure. Further, there was a correlation between continuity and follow-up visits or contact by telephone with nurse-led clinics in all diagnose groups except angina. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Medical Research Council of Southeast Sweden, Centre for Clinical Research Sörmland