Traditional Health Care Settings Research Articles

Identifying Community-Based Entrustable Professional Activities for Medical Students Through a Modified Delphi Process.

Recognition of the need for medical education to train physicians who are skilled at supporting population health and work beyond traditional health care settings is growing. Entrustable professional activities (EPAs) for medical students typically have centered around activities taking place in the clinical workplace; however, EPAs that involve working with community members in community contexts have not been clearly established. We used a three-stage online modified-Delphi method to identify community-based EPAs for University of Wisconsin School of Medicine and Public Health medical students. We recruited key stakeholders to participate and asked them, based on their experience, to generate a list of community-based tasks that they believed graduates should be trusted to perform. Subsequently, using a five-point anchored Likert scale (1=strongly disagree to 5=strongly agree), we asked participants to rate their level of agreement with each identified task becoming an EPA. An a priori definition of consensus was established. Twenty-two tasks reached consensus as potential community-based EPAs. The tasks with the highest mean ratings were "addressing trust issues with the medical community amongst the local population" (mean=4.71), "meeting with community members around a health topic" (mean=4.64), "identifying opportunities for disease prevention" (mean=4.64), and "identifying policies that impact community outcomes" (mean=4.57). The identified community-based tasks can support the augmentation of existing community-based curriculum and help identify areas for novel curriculum and assessment development. Lessons learned from this local effort could be helpful to other programs seeking to establish and refine community-based curricula.

Identifying Subgroups of Youth Suicide Decedents Based on Clinical Profiles of Psychiatric and Medical Diagnoses: A Latent Class Analysis

PurposeTo identify risk subgroups of youth suicide decedents using demographic and clinical psychiatric and medical diagnostic profiles to inform tailored youth suicide prevention efforts. MethodsThis study linked Ohio Medicaid and death certificate data for Medicaid enrolled youth aged 8–25 years who died by suicide between January 1, 2010, and December 31, 2020 (N = 511). Latent class analysis was used to identify distinct clinical risk subgroups. ResultsThree latent classes were identified. Internalizing problems were common across all classes, but especially prevalent in class 1, the High Internalizing + Multiple Comorbidities group (n = 152, 30%). A prior history of suicidal behavior was confined to class 1 decedents, who were otherwise characterized by substance misuse, and multiple psychiatric and medical comorbidities. Class 2 decedents, the Internalizing + Externalizing group (n = 176, 34%), were more often younger, male, Black, and unlikely to have a history of substance misuse. Decedents in class 3, the Internalizing + Substance Misuse group (n = 183, 36%), were more often older and likely to have a history of substance misuse, but unlikely to exhibit other externalizing problems. DiscussionInternalizing psychopathology is particularly common among youth who die by suicide, with comorbid externalizing psychopathology, substance misuse, and medical problems contributing to youth suicide risk. Because less than a third of youth who die by suicide have a prior history of recognized suicidal thinking or behavior, universal screening for youth suicide risk should be considered, particularly in younger children, and efforts to integrate suicide prevention in traditional health care settings should be prioritized.

Telerehabilitation: lessons from the COVID-19 pandemic and future perspectives.

The coronavirus disease 2019 (COVID-19) pandemic has had an enormous effect on healthcare, notably rehabilitation for neurological, rheumatological, musculoskeletal, and cognitive diseases. Telerehabilitation provides rehabilitation services via multiple modalities,such as real-time chats, computerized consultations, and distant evaluations, emphasizingassessment, diagnosis, and intervention. While the use of telerehabilitation had restrictions beforeCOVID-19, regulatory changes have accelerated its adoption, broadening therapy provision beyond traditional healthcare settings. Telerehabilitation has been examined for its effectiveness in a variety of health concerns, including stroke, traumatic brain injury, Parkinson's disease, musculoskeletal disorders, and rheumatic diseases. Despite the constraints of the COVID-19 environment, telerehabilitation settings, which include patient and therapist aspects, have emerged to ensure optimal treatment delivery. Key themes include home-based rehabilitation initiatives, wearable gadgets, and the integration of analytics and artificial intelligence. The growing acceptance of telehealth and telerehabilitation is expected to drive further progress in this discipline.

FC11: Guided low-intensity behavioural activation intervention delivery preferences among people with dementia, informal caregivers, and professional stakeholders: a qualitative study (the INVOLVERA Study)

Background:Despite a need to provide support to people with dementia and informal caregivers to live well with dementia, the availability of psychological interventions to enhance wellbeing and support mental health problems such as depression for people with dementia are limited. A potential solution is behavioural activation, an evidence-based intervention for depression that seeks to target behavioural avoidance. Behavioural activation can be delivered in a written self-help format, with support provided by an informal caregiver, who in turn receives guidance from a healthcare professional. However, it is necessary to develop and tailor self-help interventions to the needs and preferences of specific populations.Objective:To explore the needs and preferences of people with dementia, informal caregivers, and professional stakeholders to ensure cultural appropriateness, relevancy, and acceptability of the intervention.Methods:Participatory action research with co-design principles using semi-structured interviews and focus groups. People with dementia (n=8), informal caregivers (n=19), healthcare professionals (n=18), and community stakeholders (n=7) were provided with draft versions of the behavioral activation written self-help intervention and a proposed intervention delivery model. Open-ended questions explored preferences concerning preferred intervention delivery setting, type of support and guidance provided, perceived relevance of the intervention content and language, and ways to enhance relevancy, cultural appropriateness, and acceptability.Results:Analysis resulted in an overarching theme: Tailoring and flexibility, and three categories: Intervention process, material and context; Support and guidance; and Time. Results informed adaptations to the intervention content and delivery model, including: (1) reducing the amount of material to minimise treatment burden; (2) increasing the relevance of case stories and illustrations to Swedish society and culture; (3) modernising the design and illustrations; (4) including a case story of a person with young onset-dementia; (5) increasing the flexibility of the delivery model (e.g., delivery outside of traditional health care settings); and (6) providing additional guidance to informal caregivers.Conclusion:Stakeholders expressed a need for tailoring and flexibility throughout intervention delivery, and for cultural adaptations to intervention content to improve perceived appropriateness and relevance. A planned feasibility study will examine the feasibility, acceptability, relevancy and cultural appropriateness of the intervention and delivery model.

Development of a self‐help behavioural activation intervention INVOLVERA for people with dementia: a qualitative study

AbstractBackgroundDespite dementia being highly prevalent there is a lack of interventions to support people with dementia, and their informal caregivers, to live well. A guided, self‐help, behavioural activation‐based intervention (INVOLVERA), designed to support people with dementia to re‐engage with pleasurable, routine, and self‐care activities they have stopped doing, may represent a solution (Svedin et al., 2021). An innovative aspect of INVOLVERA is that support to the person with dementia to use INVOLVERA is provided by an informal caregiver, who themselves receives guidance from a healthcare professional. To enhance intervention acceptability and relevance interventions should meet the needs and preferences of the target population. Following Phase I (Development) of the Medical Research Council’s Framework for the development of complex interventions (Skivington et al., 2021), this study explores the needs and preferences of people with dementia, informal caregivers, and professional stakeholders to enhance the acceptability and relevancy of INVOLVERA for people with dementia.MethodsSemi‐structured interviews and focus group discussions were held with people with dementia (n = 8), informal caregivers (n = 19), healthcare professionals (n = 18), and community stakeholders (n = 7). A written draft of INVOLVERA and proposed intervention delivery model were provided to participants. Open‐ended questions explored intervention content, language and intervention delivery preferences. Data were analysed using manifest content analysis.ResultsOne overarching theme: Tailoring and flexibility, and three categories: Intervention process, material and context; Support and guidance; and Time derived from analysis. Results informed the following adaptations: (1) increased flexibility of intervention delivery (e.g., outside of traditional healthcare settings); (2) additional guidance and training to informal caregivers; (3) reduced written material (to minimise treatment burden); (4) modernisation of design and illustrations; (5) improved relevance of case stories and illustrations to the Swedish context; and (6) increased diversity of persons in case stories.ConclusionThis study highlights the importance of developing interventions alongside stakeholders. We anticipate the approach will optimise the acceptability and relevancy of INVOLVERA. Next, we will examine the acceptability and feasibility of INVOLVERA.

Descriptive Report of a Pharmacist-Directed Preconception Care Outreach Program in a Rural Maternity Care Desert.

Preconception care is the prevention and management of biomedical, behavioral, and social risk factors to improve pregnancy outcomes and overall health for reproductive-age patients. A community-based pharmacist-directed preconception care outreach program was developed for women ages 18-45 years living in a rural maternity care desert to help them identify potential health risks and provide them with the needed education, counseling, or referrals to address these risks. Supervised student pharmacists, pharmacy practice residents, and pharmacy faculty from a local University collaborated to provide this program at four community events in conjunction with a mobile health clinic. A summative evaluation was performed after the events concluded, modeled after the RE-AIM framework. One hundred and forty-one women were served by the outreach program. Nearly 98% reported at least one preconception health risk, and 45% reported a barrier preventing them from being able to have an appointment with a physician in the last year. The outreach program was feasible to implement and can be adapted to different settings. Pharmacist-directed outreach programs in rural communities may benefit patients who are not receiving or do not have access to such care in traditional healthcare settings.

‘We Need to Get Paid for Our Value’: Work-Place Experiences and Role Definitions of Peer Recovery Specialists/Community Health Workers

ABSTRACTDespite growing research on peer recovery specialists and community health workers (CHWs) in fields such as substance use disorder (SUD) treatment and recovery support, their workplace experiences are little understood. Through semi-structured interviews with 21 CHWs and peer recovery specialists working within substance use disorder treatment and/or traditional health care settings, we identified six prevalent themes: Benefits/Pleasures of the Role; Reciprocity; Challenges; Duality of Lived Experience; Relationships with Medical Professionals and Supervisors; and Defining Metrics. These themes reveal a complex narrative of system failures, organizational hierarchies, and experiential realities in which shared experiences and personal connections with clients undergird both positive and negative aspects of the role. In the words of one study participant: “We have not taken a vow of poverty, we need to get paid for our value.”

How and where does "care" fit within seminal life-course approaches? A narrative review and critical analysis.

To map the concepts of the caring life-course theory that are used in life-course approaches from different disciplines; establish whether there is a common recognition of, or language used, to describe care in those life-course approaches; and identify the role and contribution of care to the life-course literature. This discursive paper uses a narrative review process to explore points of convergence and divergence between life-course approaches and the caring life-course theory. Categories for analysis were developed deductively and inductively, focusing on the constructs of fundamental care, capacity and capability, care network, care transition, care trajectory and care biography. We identified four disciplinary perspectives: (1) life-course sociology; (2) life-course epidemiology; (3) lifespan developmental psychology; and (4) life-course health development. While six core constructs of the caring life-course theory were described, either explicitly or implicitly, in existing life-course approaches, no single approach fully describes the role and contribution of care across the lifespan. Life-course approaches have largely neglected the contribution and role of care in informing the life-course discourse. This review highlights the significance of care beyond traditional healthcare settings and recognizes it as a fundamental human need for well-being and development, which can contribute to existing life-course literature. There is a need to understand care as a complex system and embrace a whole-system, life-course approach to enable nurses and other healthcare professionals to provide high-quality, patient-centred care. Incorporating care within a life-course approach provides opportunities to integrate and deliver care centred around the person, their life transitions, trajectories and care networks, including informal carers and healthcare professionals. Patients or members of the public were not involved in this study as it is a discursive paper based on the relevant literature.

Remote Patient Monitoring Technologies and Markets

Remote Patient Monitoring (RPM) is a rapidly growing healthcare technology that enables healthcare providers to remotely monitor and manage patients' health outside of traditional healthcare settings. This paper explores the value of RPM, including its potential to improve patient outcomes and reduce healthcare costs, and provides an overview of the RPM market, including market size, growth trends, and business models. The paper also discusses the challenges and opportunities facing the RPM industry, including regulatory and reimbursement issues, privacy and security concerns, and the need for robust evidence of the effectiveness of RPM technologies. The potential for effective RPM has been accelerated as a result of new technologies. We also examine these technologies and their impact to RPM. The paper concludes by highlighting the key drivers of RPM adoption and the future outlook for the RPM market, including the impact of COVID-19 and the growth of digital health more broadly. By providing a comprehensive overview of the RPM market and its business model, this paper will be of interest to healthcare providers, investors, policymakers, and other stakeholders interested in the growth and development of the RPM industry.

Facilitated telemedicine for hepatitis C virus: Addressing challenges for improving health and life for people with opioid use disorder.

People who use drugs (PWUD) frequently delay or avoid obtaining medical care in traditional healthcare settings. Through a randomized controlled trial, we investigated facilitated telemedicine for hepatitis C virus (HCV) integrated into opioid treatment programmes. We sought to understand the experiences and meanings of facilitated telemedicine and an HCV cure among PWUD. We utilized purposive sampling to interview 25 participants, 6-40 months after achieving an HCV cure. We interpreted and explicated common meanings of participants' experiences of an HCV cure obtained through facilitated telemedicine. Participants embraced facilitated telemedicine integrated into opioid treatment programmes as patient-centred care delivered in 'safe spaces' (Theme 1). Participants elucidated their experiences of substance use and HCV while committing to treatment for both entities. Facilitated telemedicine integrated into opioid treatment programmes enabled participants to avoid stigma encountered in conventional healthcare settings (Theme 2). Participants conveyed facing negative perceptions of HCV and substance use disorder. Improved self-awareness, acquired through HCV and substance use treatment, enabled participants to develop strategies to address shame and stigma (Theme 3). An HCV cure, considered by PWUD as a victory over a lethal infectious disease, promotes self-confidence, enabling participants to improve their health and lives (Theme 4). Integrating facilitated telemedicine into opioid treatment programmes addresses several healthcare barriers for PWUD. Similarly, obtaining an HCV cure increases their self-confidence, permissive to positive lifestyle changes and mitigating the negative consequences of substance use. In this study of patient involvement, we interviewed patient-participants to understand the meaning of an HCV cure through facilitated telemedicine. Participants from a facilitated telemedicine pilot study provided essential input on the design and outcomes of a randomized controlled trial. Pilot study participants endorsed facilitated telemedicine in a testimonial video. They attended site initiation meetings to guide trial implementation. A Patient Advisory Committee (PAC) ensured that patient participants were active members of the research team.The PAC represented patients' voices through feedback on study procedures. ASustainability Committee supported public involvement in the research process, including educational opportunities, feedback on implementation, and future sustainability considerations.

Competing allegiance in an unclear role: Peer and non-peer understanding of peer support in Massachusetts, United States

Lack of role clarity is a central challenge to the growth and retention of the peer workforce as peer support specialists (PSS) increasingly work alongside non-peer providers in traditional mental healthcare settings. This study examined role clarity among peer and non-peer workers and identifies areas of consensus and disagreement in understanding the peer role. Qualitative interviews were conducted with PSS (N = 18), non-peer direct care staff (N = 15), and non-peer clinical staff (N = 6) employed at two behavioral health organizations in the Northeast. Thematic analysis was conducted. Most non-peer staff have generally positive attitudes towards the inclusion of PSS in behavioral healthcare organizations, and task overlap was not indicated as problematic. Non-peer staff report and demonstrate a wide range of understanding but little clarity about the peer role, and peer staff themselves describe diverging descriptions of their own role. A consensus emerged regarding peer roles related to individual and group support, facilitating community integration, and relationship building. Key areas of disagreement include peer inclusion on clinical teams and role in service engagement. Competing peer and organizational ethos were identified as a central challenge of workplace integration. In sum, while peer tasks, roles, and responsibilities are perceived as valuable and non-overlapping with non-peer tasks, they remain ill-defined. Existing role tension is not based on task overlap but rather emerges from competing peer and organizational ethos and allegiances. Education and cultural humility among non-peer staff are critical to reducing interprofessional tension. Simultaneously, peer teams must develop cohesive peer ethos and role identity to ensure internal role clarity.

Patient-Reported Outcomes from a Pilot Plant-Based Lifestyle Medicine Program in a Safety-Net Setting.

Lifestyle medicine interventions that emphasize healthy behavior changes are growing in popularity in U.S. health systems. Safety-net healthcare settings that serve low-income and uninsured populations most at risk for lifestyle-related disease are ideal venues for lifestyle medicine interventions. Patient-reported outcomes are important indicators of the efficacy of lifestyle medicine interventions. Past research on patient-reported outcomes of lifestyle medicine interventions has occurred outside of traditional healthcare care settings. In this study, we aimed to assess patient-reported outcomes on nutrition knowledge, barriers to adopting a plant-based diet, food and beverage consumption, lifestyle behaviors, self-rated health, and quality-of-life of participants in a pilot plant-based lifestyle medicine program in an urban safety-net healthcare system. We surveyed participants at three time points (baseline, 3 months, 6 months) to measure change over time. After 6 months of participation in the program, nutrition knowledge increased by 7.2 percentage points, participants reported an average of 2.4 fewer barriers to adopting a plant-based diet, the score on a modified healthful plant-based diet index increased by 5.3 points, physical activity increased by 0.7 days per week while hours of media consumption declined by 0.7 h per day, and the percentage of participants who reported that their quality of sleep was "good" or "very good" increased by 12.2 percentage points. Our findings demonstrate that a lifestyle medicine intervention in a safety-net healthcare setting can achieve significant improvements in patient-reported outcomes. Key lessons for other lifestyle medicine interventions include using a multidisciplinary team; addressing all pillars of lifestyle medicine; and the ability for patients to improve knowledge, barriers, skills, and behaviors with adequate support.

The integration of harm reduction services in the Veterans Health Administration (VHA): a qualitative analysis of barriers and facilitators

Background Substance use is common among U.S. military veterans and veterans are at high risk for negative consequences associated with substance use, such as injection-related infections and overdose. Although harm reduction services (HRS) are highly evidence-based, implementation in traditional healthcare settings has been limited. This formative, qualitative study sought to identify barriers and facilitators to the integration of HRS and identify appropriate implementation strategies to support the optimized integration of a comprehensive bundle of HRS in the Veterans Health Administration (VHA). Methods Semi-structured interviews explored how harm reduction is currently understood by VHA providers and elicited input on perceived facilitators and barriers to implementation. Data were analyzed using a directed content analysis and the Practical, Robust Implementation and Sustainability Model (PRISM) implementation framework was used to organize findings. Results were then mapped to relevant implementation strategies using the Consolidated Framework for Implementation Research - Expert Recommendations for Implementing Change (CFIR – ERIC) tool. Results 15 interviews with VHA providers were conducted across 5 sites. Respondents reported that current HRS are fragmented and dependent on the knowledge, time, and comfort level of individual providers. Stigma around substance use at the patient, provider, and institutional levels was noted to be a key barrier to HRS adoption. Based on identified barriers and facilitators, strategies that may be effective for increasing adoption of HRS include engagement of champions, communication and educational strategies, and adaptation of existing infrastructure. Conclusions Many of the barriers identified in this formative study may be addressed using evidence-based implementation strategies. Additional research is needed to identify implementation strategies that are effective for addressing stigma, which is perceived to be a persistent challenge to the provision of integrated harm reduction services.

Change in cardiometabolic risk factors in a pilot safety-net plant-based lifestyle medicine program.

Interventions emphasizing healthful lifestyle behaviors are proliferating in traditional health care settings, yet there is a paucity of published clinical outcomes, outside of pay-out-of-pocket or employee health programs. We assessed weight, hemoglobin A1c (HbA1c), blood pressure, and cholesterol for 173 patients of the Plant-Based Lifestyle Medicine Program piloted in a New York City safety-net hospital. We used Wilcoxon signed-rank tests to assess changes in means, from baseline to six-months, for the full sample and within baseline diagnoses (i.e., overweight or obesity, type 2 diabetes, prediabetes, hypertension, hyperlipidemia). We calculated the percentage of patients with clinically meaningful changes in outcomes for the full sample and within diagnoses. The full sample had statistically significant improvements in weight, HbA1c, and diastolic blood pressure. Patients with prediabetes or overweight or obesity experienced significant improvements in weight and those with type 2 diabetes had significant improvements in weight and HbA1c. Patients with hypertension had significant reductions in diastolic blood pressure and weight. Data did not show differences in non-high-density lipoprotein cholesterol (non-HDL-C), but differences in low-density lipoprotein cholesterol (LDL-C) were approaching significance for the full sample and those with hyperlipidemia. The majority of patients achieved clinically meaningful improvements on all outcomes besides systolic blood pressure. Our study demonstrates that a lifestyle medicine intervention within a traditional, safety-net clinical setting improved biomarkers of cardiometabolic disease. Our findings are limited by small sample sizes. Additional large-scale, rigorous studies are needed to further establish the effectiveness of lifestyle medicine interventions in similar settings.

Evidence for feasibility of implementing online brief cognitive‐behavioral therapy for eating disorder pathology in the workplace

CBT-T is a brief (10-week) cognitive-behavioral therapy for non-underweight eating disorders. This report describes the findings from a single center, single group, feasibility trial of online CBT-T in the workplace as an alternative to health service settings. This trial was approved by the Biomedical and Scientific Research Ethics committee, University of Warwick, UK (reference 125/20-21) and was registered with ISRCTN (reference number: ISRCTN45943700). Recruitment was based on self-reported eating and weight concerns rather than diagnosis, potentially enabling access to treatment for employees who have not previously sought help and for those with sub-threshold eating disorder symptoms. Assessments took place at baseline, mid-treatment (week 4), post-treatment (week 10), and follow-up (1 and 3 months post-treatment). Participant experiences following treatment were assessed using quantitative and qualitative approaches. For the primary outcomes, pre-determined benchmarks of high feasibility and acceptability were met, based on recruiting >40 participants (N = 47), low attrition (38%), and a high attendance rate (98%) over the course of the therapy. Participant experiences revealed low previous help-seeking for eating disorder concerns (21%). Qualitative findings indicated a wide range of positive impacts of the therapy and the workplace as the therapeutic setting. Analysis of secondary outcomes for participants with clinical and sub-threshold eating disorder symptoms showed strong effect sizes for eating pathology, anxiety and depression, and moderate effect sizes for work outcomes. These pilot findings provide a strong rationale for a fully powered randomized controlled trial to determine the effectiveness of CBT-T in the workplace. This study demonstrates the feasibility of implementing an eating disorders intervention (online CBT-T) in the workplace as an alternative to traditional healthcare settings. Recruitment was based on self-reported eating and weight concerns rather than diagnosis, potentially enabling access to treatment for employees who had not previously sought help. The data also provide insights into recruitment, acceptability, effectiveness, and future viability of CBT-T in the workplace.

Increasing capacity in acute day care settings: patients' experiences of a pop-up day care unit

The unit operated fortnightly between December 2020 and March 2021. Family feedback on the service was collated via an online survey. 72 respondents found NHB acceptable; 70 (97%) would be happy to return; 63 (90.3%) preferred the NHB to attending Bristol Royal Hospital for Children or had no preference for their appointments. Positive comments focused on service organisation and clinical environment. Families valued the availability of the close, free parking. The minimal negative comments related to travel directions, lack of catering facilities and the small number of toilets. The pop-up service model was highly acceptable to families. This highlights the need for appropriate hospital services to explore similar initiatives beyond traditional healthcare settings in order to ensure that the provision of equitable health care is in line with the NHS Long Term Plan.

A CLINICAL-COMMUNITY PARTNERSHIP TO ADDRESS OLDER ADULTS’ SOCIAL DETERMINANTS OF HEALTH NEEDS

Abstract Social determinants of health (SDH) are non-medical social needs key to reducing health disparities and improving health outcomes. Adequately identifying patients’ unmet SDH needs in primary care (PC) is a critical first step in addressing them, yet many questions remain regarding feasibility and implementation of screenings and how to effectively meet patients’ needs and improve their outcomes. With formative and process evaluation analyses, we report on the development and implementation of a community-based pilot study to proactively target high-risk, low-income, older patients with SDH needs. Over a six-month planning period, leadership from a PC clinic and a community based aging services organization (CBO) collaboratively created a shared infrastructure for in-office SDH screening by clinicians with direct referral to CBO for SDH support. The research team addressed challenges of workflow and barriers to sharing/accessing electronic health records. The pilot program will cover a 2-year period (12-month enrollment; 12-month follow-up) in which patients are screened at annual visits and followed-up in the community. In the first 6 months, 286 patients were screened, from which 34 (12%) CBO referrals were made, and nine patients were receptive to receiving more information, suggesting a need to explore patient barriers and receptiveness to services/supports. We report on lessons learned, adaptations to the pilot, efforts to increase identification of eligible patients, and strategies to enhance uptake of services beyond the traditional health care setting. Investment in health and aging services partnerships is a viable pathway to reducing health care use and spending, especially for older adult populations

P067Understanding the family planning decision-making choices of people who inject drugs

<h3>Objectives</h3> Limited data exist surrounding family planning decision making of people who inject drugs (PWID). This study explored the contraceptive practices and needs of PWID for the purpose of implementing values-based contraceptive resources at a syringe exchange program (SEP). <h3>Methods</h3> Using a mixed-methods design, we collected 68 quantitative surveys and 16 qualitative, semi-structured interviews with female-identifying, English-speaking clients of a SEP in Rochester, New York. Quantitative data was analyzed with descriptive statistics and qualitative data was coded and analyzed using grounded theory until thematic saturation was reached. <h3>Results</h3> 63.2% of survey respondents did not desire pregnancy in the next year, and 52.2% have experienced unintended pregnancy in the past. Of the 51.5% of respondents not using contraception, 54.3% were interested in initiating it. When deciding contraceptive methods, participants valued ease of access (37.5%), effectiveness (34.4%), and limited required follow up (21.9%). Qualitative interviewees described their "ideal pregnancy" as including increased financial and relationship stability, a decrease in drug use, and the ability to provide their children with opportunities to thrive. Provider stigma often prevented PWID from obtaining contraception through traditional healthcare settings, but SEPs were trusted resources in the community. Both survey and qualitative participants felt contraceptive services through an SEP would be convenient and comfortable, with 54.6% of total survey respondents interested in these services. <h3>Conclusions</h3> PWID identify key values in contraceptive choices and future pregnancies and view SEPs as trusted service providers. Although decision-making is complex and individualized, understanding the experiences of PWID is an important step in making family planning services equitable.

Rapid Syphilis Testing

&#x0D; This Horizon Scan summarizes available information regarding rapid point-of-care testing for the detection of Treponema pallidum, the bacteria that causes syphilis.&#x0D; Rapid point-of-care testing to screen people for a possible case of syphilis allows health care providers to screen people where they are, rather than relying on people’s access to traditional health care settings. The rapid provision of test results can also help to guide treatment in the moment, rather than requiring additional appointments that could increase the number of people with active syphilis infections lost to follow-up.&#x0D; There are currently no point-of-care syphilis tests licensed for use by Health Canada; however, at least 1 multiplex syphilis and HIV-1/HIV-2 detection test could be licensed for use in Canada by the end of 2022.&#x0D; Based on the evidence reviewed, rapid tests for the detection of syphilis appear to be adequately sensitive and specific for screening. The use of point-of-care testing, at-home self-testing, at-home sample collection methods, and telemedicine and virtual care options may be interventions to consider as health care systems move forward and work to catch up on the screening backlog and missed tests related to the COVID-19 pandemic, and also find ways to connect with people who have previously been harder to reach.&#x0D;

TALKING TO EACH OTHER: OPPORTUNITIES AND CHALLENGES OF CARE COORDINATION BETWEEN HOSPITALS, CLINICS, AND SCHOOLS

In medicine, safe handoffs between care teams are mandatory, reduce errors, and save lives. Youth who return to school after a mental health crisis or hospitalization often need intentional and individualized care coordination and reentry planning. Bridging care across schools and traditional healthcare settings is difficult for many reasons, including time, interdisciplinary access, and privacy laws. Mental illness can be “invisible” and intimidating to address as educators. Academic illness (ie, school failure) is vastly inaccessible to traditional treatment and often perceived to be beyond the scope of practice for healthcare providers.