Uninsured Participants Research Articles

Healthcare Utilization and Chronic Disease Management for Non-Medicaid-Eligible Patients in a City-Wide Safety-Net Healthcare Access Program.

In 2019, New York City (NYC) launched NYC Care (NYCC), a healthcare access program through NYC Health + Hospitals (H + H) for individuals who are ineligible for federally funded health insurance programs or cannot purchase insurance through the State Marketplace, predominantly undocumented individuals. To examine the sociodemographic characteristics, healthcare use patterns, and chronic disease quality measures for diabetes mellitus (DM) and hypertension among NYCC patients compared with Medicaid patients seen at NYC H + H. Observational study. Adults aged 18years and older enrolled in NYCC (N = 83,003) or Medicaid (N = 512,012) as of January 1, 2022. Patients were included if they had at least one visit between January 1, 2021, and December 31, 2021. Sociodemographic characteristics, healthcare use patterns, and quality measures for DM and hypertension. NYCC patients (n = 83,003) were, on average, older, more likely to be Hispanic with Spanish as their preferred language, had more comorbidities, and had more primary care (adjusted incidence rate ratio 2.75 [95% confidence interval 2.71, 2.80]) and specialty care (2.22 [2.17, 2.26]) visits compared to Medicaid patients (n = 512,012). Rates of emergency department visits were similar between the two groups (1.02 [1.00, 1.04]), but NYCC patients had relatively fewer hospitalizations (0.64 [0.62, 0.67]). NYCC patients with DM or hypertension had higher rates of having a documented hemoglobin A1c or blood pressure in 2022, respectively, and clinically similar rates of chronic disease control (mean difference in hemoglobin A1c - 0.05 [- 0.09, - 0.01] in patients with DM and mean difference in blood pressure - 0.38 [- 0.67, - 0.10]/ - 0.64 [- 0.82, - 0.46]) compared with Medicaid patients. NYCC effectively enrolled a large number of uninsured participants and provided them with healthcare access similar to that of Medicaid patients. Future studies should evaluate the impact of NYCC enrollment on healthcare utilization and disease outcomes.

Abstract P457: Sociodemographic Differences in Cardiac Device Implantation in the Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Progression of cardiac arrhythmia or heart failure often leads to treatment with a cardiovascular implantable electronic device (CIED) such as a pacemaker or pacemaker combined with an implantable cardioverter-defibrillator (ICD). Although small, hospital-based studies suggest that CIED implantation differs by sociodemographic factors, few community-based, cohort studies have prospectively evaluated it by sex, race, age, or health insurance status. Methods: We therefore examined incident CIED implantation in the Atherosclerosis Risk in Communities study (ARIC) among 15,527 eligible participants from four U.S. communities (mean age 54.2 years; 55% female; 27% Black; 90% insured) who self-identified as either Black or white and had a resting, standard twelve-lead electrocardiogram (ECG), but no ECG evidence of a pacemaker or ICD at baseline. We identified incident CIED implantation, defined as the initial device placement per participant, using International Classification of Disease (ICD)-9, ICD-10, and Current Procedural Terminology (CPT) codes during follow-up, right-censored at the time of CIED implantation, death, or end of cohort surveillance (December 31, 2020), whichever came first. We computed follow-up times and person-time denominators, then estimated the corresponding incident implantation rates overall, by sociodemographic factors, and device type. Results: Over a mean [standard deviation] follow-up of 24.0 [9.0] years, we identified 1,068 incident CIED (75% pacemaker; 25% ICD) implantations. Incident CIED implantation rates were higher among male, white, older, and insured participants (38, 30, 38, and 29 per 10,000 person-years) than among female, Black, younger, and uninsured participants (21, 23, 20, and 21 per 10,000 person-years). Relative to their counterparts, CIED incidence rates were lower among female, Black, younger, and uninsured participants: incidence rate ratio (95% confidence interval) = 0.55 (0.49-0.62), 0.77 (0.66-0.89), 0.53 (0.47-0.60), and 0.72 (0.56-0.92), respectively. When analyzed separately, patterns of incident implantation were similar for both pacemakers and ICDs. Conclusion: The sociodemographic patterning of incident CIED implantation is manifest and consistent across device type in this U.S. community-based cohort. Although the clinical, behavioral, and sociocultural reasons for the relative infrequency of implantation among female, Black, younger, and uninsured participants remain unclear, ongoing analyses are examining these differences.

Patterns of Antibiotic Use, Knowledge, and Perceptions among Jordanian Population: A Cross-sectional Study

Background: Practices concerning antibiotic use have detrimental impacts on body immunity, bacterial resistance, and the overall health of the general population. Misconceptions regarding antibiotic use can lead to improper use and malpractice, posing numerous health threats. Objectives: This study aims to assess the knowledge, practices, and awareness of Jordanian adults about antibiotics. This includes an analysis of their understanding of antibiotic uses and the sources from which they acquire such knowledge. Methods: A representative sample of Jordanian adults was invited to participate in an online survey distributed through social media platforms. Key findings: The results showed that 77.6% of the participants had received an antibiotic at least once in the past 12 months. About two thirds reported no problems with using a different brand name (alternative) for the prescribed antibiotic. The majority of respondents trust the decisions made by pharmacists. Moreover, participants with higher ages, female participants, those with a higher level of education, uninsured participants, and those with a medicine-related degree showed better antibiotic knowledge compared to others (P<0.05 for all). Conclusion: There is a good level of antibiotic-related knowledge amongst Jordanian adults. However, prevalent misconceptions and improper use also exist, indicating the need for focused attention on correcting such practices that might adversely impact the health of the community as a whole.

Use of telemedicine to obtain contraception among young adults: Inequities by health insurance

ObjectivesThe objective of this study was to describe the use of telemedicine for contraception in a sample of young adults and examine differences by health insurance coverage. Study designWe analyzed survey data collected from May 2020 to July 2022 from individuals at risk of pregnancy aged 18 to 29 recruited at 29 community colleges in California and Texas. We used multivariable mixed-effects logistic regression models with random effects for site and individual to compare the use of telemedicine to obtain contraception by insurance status, sociodemographic characteristics, and state. ResultsOur analytic sample included 6465 observations from 1630 individuals. Participants reported using a contraceptive method obtained through telemedicine in just 6% of observations. Uninsured participants were significantly less likely than those privately insured to use contraception obtained through telemedicine (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.31–0.97), as were participants who did not know their insurance status (aOR, 0.54; 95% CI, 0.29–0.99). Texas participants were less likely to use contraception obtained via telemedicine than those in California (aOR, 0.42; CI: 0.25–0.69). ConclusionsFew young people in this study obtained contraception through telemedicine, and insurance was crucial for access in both states. ImplicationsAlthough telemedicine holds promise for increasing contraceptive access, we found that few young adults were using it, particularly among the uninsured. Efforts are needed to improve young adults’ access to telemedicine for contraception and address insurance disparities.

Assessing social needs among patients with cardiovascular and psychiatric comorbidities in free community health clinics.

Community-related health assessments have been shown to improve several outcomes in socioeconomically disadvantaged populations with comorbid chronic health conditions. However, while it is recognized that modifiable social determinant of health (SDH) factors might be responsible for up to 60% of preventable deaths, it is not yet standard of care to routinely screen and address these at preventive health appointments. The objective of this study was to identify the social needs of socioeconomically disadvantaged patients. We performed a retrospective review of the socioeconomic screening questionnaires distributed to under- and uninsured patients seen at a medical student-run free primary care-based community clinic. This study included participants of all ages (0 and up), genders, languages, and ethnicities who filled out the social screening questionnaire. Socioeconomic screening questionnaires assessed the need for critical resources such as food, housing, utilities, finances, transportation, childcare, employment, education, legal support, companionship, health literacy, and community assistance. The primary study outcome was to identify unmet social needs of our medical student-run free clinic patients. We secondarily sought to identify associations between these needs and chronic health conditions. We hypothesized that patients with multiple chronic health problems and financial stressors would have the highest requests for resources. Our retrospective review identified 264 uninsured participants who were evaluated for social needs using a screening questionnaire. Participants who reported unmet social needs had significantly more cardiovascular risk factors than those who did not. Cardiovascular comorbidities and a history of psychiatric illness were the two most common medical problems significantly associated with several unmet social needs. This study provides support for the preemptive identification and appropriate management of physical, mental, and social care to improve disproportionate disparities in long-term health outcomes.

Medication use by insurance coverage in subjects with coronary heart disease in the Southern Cone of Latin America

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) grant number HHSN268200900029C. Background Clinical guidelines recommend cardioprotective medication use in coronary heart disease (CHD) patients. Underuse of these drugs is common among patients of low resources, which may be explained by insufficient access in the public sector. Aim We aim to assess medication use and barriers to care by insurance coverage in subjects with CHD in the Southern Cone of Latin America. Methods We analysed cross-sectional data from 593 participants with CHD residing in Argentina, Chile and Uruguay, within the CESCAS community-based cohort study. Participants were categorized as covered by public insurance only or having additional coverage (social security or private insurance). We calculated the prevalence of recommended medications use, mean number of medications, use of ≥ 1 and ≥ 2 drugs, and reported barriers to needed care in insured and uninsured participants. Differences between coverage groups were assessed with univariable and multivariable analysis (logistic and Poisson regression) adjusted by age, sex, previous revascularization, educational level and barriers. Results Medication use ranged from 39.8% (lipid-lowering) to 84.1% (antihypertensives). Mean number of medications was 1.8 (SE 0.1), 95.4% used ≥ 1 drugs, and 59.8% used ≥ 2 drugs. There were no significant differences by coverage in medication use, except for higher ACE-inhibitor and nitrate use among participants in the public sector (35.8% vs. 53.2%, p=0.001; and 1.5% vs. 5.2%, p=0.047 respectively). In the multivariable analysis, having public coverage only was not significantly associated with medication use, but it was with reporting barriers to care (OR 2.06, 95% CI 1.21-3.52). Conclusion Insurance coverage was not associated with the use of most medications in CHD patients in the Southern Cone of Latin America, possibly due to public health programs providing them free of charge. Uninsured participants more often face barriers to access medical care, and future studies should address these healthcare inequalities.

Multidimensional financial hardship among uninsured and insured young adult patients with metastatic breast cancer.

Little is known about the heterogeneous nature of financial hardship in younger patients with metastatic disease and the extent to which insurance protects against it. We examine the association between insurance status and multidimensional indicators of financial hardship in a national sample of women with metastatic breast cancer. We conducted a national, retrospective online survey in partnership with the Metastatic Breast Cancer Network. Eligible participants were ≥18 years, diagnosed with metastatic breast cancer, and able to respond in English. We estimated multivariate generalized linear models predicting two distinct dimensions of financial hardship-financial insecurity (the ability to afford care and living costs) and financial distress (the extent of emotional/psychological distress experienced due to costs)-as a function of insurance status. Participants responded from 41 states (N = 1054; median age: 44 years). Overall, 30% were uninsured. Financial insecurity was more frequently reported by uninsured respondents. In adjusted analyses, uninsured participants were more likely than insured participants to report contact by debt collectors (adjusted risk ratio [aRR]: 2.38 [2.06, 2.76]) and being unable to meet monthly expenses (aRR: 2.11 [1.68, 2.66]). Financial distress was reported more frequently by insured participants. For example, insured participants were more likely to worry about future financial problems due to cancer and distress about lack of cost transparency. After adjustment, uninsured participants remained about half as likely as insured participants to report financial distress. Young adult women with metastatic cancer reported a high burden of financial toxicity. Importantly, insurance does not protect against financial distress; however, the uninsured are the most materially vulnerable.

The Impact of Social Determinants of Health on Vision Loss From Cataracts and Cataract Surgery Utilization in the United States—A National Health Interview Survey Analysis

To investigate the association of social determinants of health (SDOH) factors and cataract-related outcomes disparities. Cross-sectional, with a nationally representative sample. We used publicly available data from the 2008, 2016, and 2017 National Health Interview Survey data sets. Outcome measures included self-reported prevalence for ever been diagnosed with cataract, vision loss secondary to cataracts, and the likelihood of undergoing cataract surgery. Survey-weighted, multivariable logistic regression models, adjusted for age, race and ethnicity, and other relevant covariates, were used to examine the association between SDOH factors and cataract-related outcomes. A total of 81,551 participants were included, who were predominantly between 18 and 44 years of age (49.6%), female (51.7%), and White (74.8%). Multivariable regression models with age as a covariate showed that individuals who were not working were more likely to report having cataracts than those who were working (P < .001). Those who needed but could not afford medical care in the past year were more likely to report vision loss secondary to cataracts than their counterparts (P < .001). Uninsured participants were less likely to report undergoing cataract surgery than those with private insurance (P=.03). Individuals with higher income (poverty-income ratio: 1.00-2.99 vs <1.00) were more likely to report undergoing cataract surgery (P=.04). Several SDOH factors were associated with disparities in rates of cataract-related outcomes. These findings highlight the importance of ophthalmologists screening for social risks in patients with cataract, as these social factors are important barriers for access to care.

Effect of community-based health insurance on catastrophic health expenditure among chronic disease patients in Asella referral hospital, Southeast Ethiopia: a comparative cross-sectional study

BackgroundChronic disease-related catastrophic health spending is frequent in Ethiopia affecting several households, particularly the poorest ones. A community-based health insurance (CBHI) scheme has been in place in Ethiopia since 2011. The scheme aims to provide financial protection against health expenditure but there is little evidence of how well it protects chronic patients financially.ObjectiveThe objective of the study was to evaluate the effect of community-based health insurance in reducing the incidence of catastrophic health expenditure among patients attending chronic disease follow-up departments in Asella referral hospital, Southeast Ethiopia.MethodA health facility-based comparative cross-sectional study was conducted in Asella referral hospital from March 2022 to May 2022. Systematic random sampling was used to select 325 chronic patients. Data were collected using an open data kit (ODK) collect app and then imported to STATA version 16 for analysis. Propensity score matching was used to evaluate the effect of community-based health insurance on catastrophic health expenditure.ResultThe study enrolled a total of 325 chronic patients (157 insurance members and 168 nonmembers). More than 30% of the study participants incurred health spending that could be catastrophic based on the 15% nonfood threshold. Catastrophic health expenditure was found in 31% of insured and 47% of uninsured participants. Overshoot and mean positive overshoot were 10% and 33% for insured members, respectively and the corresponding figures were 18% and 39% for nonmembers. Community-based health insurance contributes to a 19% ((ATT = -0.19, t = -2.97)) reduction in the incidence of catastrophic health expenditure among chronic patients. This result is found to be consistent for alternative measurements of the outcome variable and the use of alternative matching algorithms.ConclusionChronic patients, particularly those in uninsured households, had a high incidence and intensity of catastrophic health expenditure. Hence, it is relevant to expand community-based health insurance to provide financial protection for people suffering from chronic conditions.

Abstract A120: Disparities in cervical cancer screening rates and electronic health record completeness among All of Us Research Program participants

Abstract With the introduction of the Papanicolaou and HPV tests, cervical cancer rates have been reduced by up to 70% in the United States since the 1950s. In 2018, overall incidence was 8.0/100,000 and mortality was 2.0/100,000. But despite the overall decline in rates, the burden of cervical cancer still impacts different populations unevenly. For example, Black women in Louisiana had a cervical cancer death rate more than twice the national average at 4.6/100,000, which can in part be attributed to disparities in cervical cancer screening rates. The All of Us Research Program (AoU) is a nationwide longitudinal study that seeks to accelerate health research and medical breakthroughs by engaging people and communities who have historically been left out of medical research. The AoU dataset was used to determine if cervical cancer screening rates among participants reflect national rates, both overall and for specific demographics. We also aimed to identify and quantify disparities in electronic health record (EHR) completeness among AoU participants. Participants who were assigned female at birth, between the ages of 21 and 65, and with an intact cervix were considered eligible for screening. From the eligible population, those that had any EHR were identified using body height, heart rate, and body weight as proxies. Univariate and multivariate logistic regression were used to determine the likelihood of having record of up-to-date screening and the likelihood of having any EHR with the following covariates: age, race/ethnicity, gender identity, sexual orientation, income level, educational attainment, insurance status, geography, region, disability status, HIV status, and EHR site. A total of 144,541 participants were found to be eligible for screening. Of these, 118,576 had any EHR and 20,332 showed a history of screening. Sixty-seven percent of participants with screening history were up to date according to the U.S. Preventative Services Task Force guidelines. Age, race/ethnicity, region, insurance status, and HIV status were associated with up-to-date screening records. Black and Hispanic participants (0.65, p&amp;lt;0.001 and 0.85, p =0.002 respectively), Midwestern participants (0.45, p&amp;lt;0.001), uninsured participants (0.79, p=0.007), and participants living with HIV (0.44, p&amp;lt;0.001) were less likely to have up-to-date screening compared to White participants, Northeastern participants, insured participants, and participants without HIV. Participants were less likely to have up-to-date screening as age increased, where participants ages 60-65 were least likely (0.21, p&amp;lt;0.001) to have up-to-date screening compared to ages 21-29. Educational attainment, income level, sexual orientation, gender identity, disability status, and geography were not associated with up-to-date screening records. There is a high rate of data missingness for cervical cancer screening in the AoU dataset. However, overall trends in screening rates among AoU participants likely reflect true health disparities. Some observed trends may be due to AoU’s unique population. Citation Format: Samantha Tesfaye, Tamara Litwin, Sheri Schully. Disparities in cervical cancer screening rates and electronic health record completeness among All of Us Research Program participants [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A120.

190 Enhancing Research Ethics, Equity and Protections for Uninsured Study Participants

OBJECTIVES/GOALS: To increase diversity in clinical and translational research (CTR), to strengthen protections for uninsured and under-insured study participants from vulnerable groups by addressing their medical, ancillary care and psycho-social needs and to develop a systematic ethically sound approach to addressing such needs in the study protocol and budget. METHODS/STUDY POPULATION: We conducted) ethical analyses of: (1) the regulatory and ethics scholarship concerning protections and duty of care to research participants from vulnerable groups, and 2) arguments concerning the nature and scope of ancillary care obligations of researchers, as well as 3) a review of the applicable local, federal, and international regulations and practices concerning the duty of care to CTR participants and potential participants who are uninsured, under-insured and/or undocumented members of vulnerable groups. RESULTS/ANTICIPATED RESULTS: Uninsured and underinsured study participants pose major ethical challenges for CTR as medical needs arising during a study are usually covered by the participants own insurance. Lack of health insurance increases vulnerability and creates (1) a barrier to research participation for members of socially disenfranchised groups, (2) risk of discriminatory exclusion of such participants from clinical studies, and (3) inter-institutional inconsistencies in meeting their medical needs; thus limiting diversity in CTR. To address the challenges, we propose an inclusive, systematic, ethically sound approach, which deliberately plans for and provides resources within a study protocol to address the medical and psycho-social needs of uninsured participants during and beyond the study. DISCUSSION/SIGNIFICANCE: Including diverse participants in CTR ensures data quality and social justice. PIs and IRBs should adopt an inclusive approach to the medical needs of vulnerable uninsured participants, plan for their medical and ancillary care needs in the protocol and budget, list community resources, provide follow-up support and note assistance in their files.

Abstract PO-108: Predictors of retention rates in the Active Living After Cancer program at MD Anderson Cancer Center: A comparison of classes during and before COVID-19

Background: As an overlooked aspect of cancer, survivorship often begs the question of “what's next?” once treatment is complete. Physical activity following treatment has been shown to improve quality of life and decrease rates of recurrence. The MD Anderson Active Living After Cancer Program (ALAC) has recruited over 900 cancer survivors and caregivers since its establishment in 2013. This study seeks to examine how retention rates have changed since the transition to virtual classes due to the COVID-19 pandemic, and whether variables associated with retention differ between in person and virtual classes. Methods: A retrospective study of baseline surveys completed by participants (N=860) through Redcap was conducted, excluding those currently enrolled in ongoing ALAC classes. A chi-square test was performed to determine whether completion rates were significantly different between in person and virtual classes. A bivariate regression model was used to determine whether participant demographics varied between virtual and in person classes, based on insurance status and education level. A logistic regression was performed to investigate whether these factors were predictors of retention in either class. Results: Retention rates significantly differed between virtual (87.91%) and in person classes (77.20%); participants of virtual classes were two times as likely to complete the program compared to their in-person counterparts (P=0.00). Compared to in person classes, uninsured participants comprised a larger proportion of virtual classes, while privately and publicly insured participants comprised a smaller proportion (P=0.014). In both classes, participants who never received a high school diploma or GED constituted the most common education level. Having insurance and completion of some higher education were only weakly associated with retention. Conclusion: Given the success of ALAC since its creation, we are interested in expanding enrollment beyond MD Anderson Cancer Center. This study provides understanding of the benefits and limitations of virtual classes since the rise of COVID-19. Overall, greater retention rates demonstrate the utility of virtual classes. Maintaining a virtual aspect of future ALAC classes, such as a hybrid program, may help improve survivor outreach by identifying potentially overlooked groups. Citation Format: Kendahl Servino, Stacy Mitchell, Che Young Lee, Yue Liao, Karen Basen-Engquist. Predictors of retention rates in the Active Living After Cancer program at MD Anderson Cancer Center: A comparison of classes during and before COVID-19 [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-108.

Comparing community-driven COVID-19 vaccine distribution methods: Faith-based organizations vs. outpatient clinics.

Minority and low socioeconomic communities may face practical barriers to vaccination, including decreased access to health care and less trust in healthcare organizations; however, few studies have focused on these barriers as the cause of differential vaccine uptake. We worked with community partners to implement and evaluate two community-driven approaches to COVID-19 vaccination distribution-through faith-based organizations (FBOs) and outpatient clinics-with a focus on understanding the differences between the populations who accessed each distribution method. Participants who came to the vaccination locations were approached and asked to complete a survey during their 15 min post-vaccination observation period. Differences between distribution locations were examined using Chi-square tests. The survey rendered 1,476 valid responses, with a total of 927 participants recruited at clinical locations and 519 at FBOs during vaccination events. There were significant differences by race/ethnicity, with distribution methods at FBOs reaching a higher proportion of Hispanic/Latino and Marshallese participants. The proportion of uninsured participants who had lower health literacy and had lower educational attainment was higher with the FBO distribution method. FBO participants were more likely to report "completely" trusting the COVID-19 vaccine. There was no significant difference between FBO and clinic participants with regard to the level of vaccine hesitancy. There were no statistically significant differences with regard to access. A higher proportion of Hispanic/Latino and Marshallese participants utilized FBOs for vaccination, suggesting collaborations with FBOs can potentially increase vaccination uptake among minority communities and help mitigate vaccination disparities.

HIV patient access to healthcare services in post-austerity era in Greece

Purpose The ten-year economic crisis and the ensuing fiscal adjustment that Greece experienced between 2009 and 2018 has had a major impact on patient access to health-care services and resulted in an increase in unmet population health needs. The present study aims to assess the impact of economic crisis and ensuing austerity on HIV patient access to health-care services. Design/methodology/approach A cross-sectional study was carried out between February and April 2019 to assess barriers in access to HIV care faced by people living with HIV. A total of 329 HIV positive individuals participated in the study. An online, self-reporting questionnaire was developed and adapted to the specific clinical and societal characteristics of HIV. Findings A total of 94.2% of respondents were male and 67.80% lived in Athens. Most of them were diagnosed with HIV-1 10 years ago. Out of the total respondents, 37.40% reported obstacles in accessing HIV care over the past year. A total of 24.30% reported they were not tested for viral load in the past six months and received a result. Individuals, who self-evaluate their financial status as very bad or bad, were more likely to be unaware of their viral load (55.60%) than those with better financial status (33.5%) (P &lt; 0.01). Only 33.3% of uninsured participants were aware of their viral load, and this figure rose to 63.30% (P &lt;0.01) amongst insured participants. Originality/value The ten-year economic crisis that Greece experienced in the period 2009–2018 had significant effects on the quality of services of the National Health System. This study attempts to fill the research gap regarding the impact of one of the severest economic crises during the past century with complex social extensions, in one of the most vulnerable patient groups. In this context, the study assesses barriers to access to optimal care of people living with HIV in Greece after a decade of austerity and the variables that impact on such access.

Health insurance status and type associated with varying levels of glycemic control in the US: The multi-ethnic study of atherosclerosis (MESA)

AimsTo investigate associations of health insurance with measures of glucose metabolism, and whether associations vary by diabetes status or insurance type. MethodsCross-sectional analysis of baseline data from the Multi-Ethnic Study of Atherosclerosis. Cohort a priori stratified by age <65 (N = 3,665) and ≥65 years (N = 2,924). Multivariable linear and logistic regression assessed associations between insurance and fasting glucose, HOMA-IR, and prevalent diabetes, controlling for relevant confounders, including age, sex, race/ethnicity, income, and education. ResultsIn participants <65, compared to uninsured, having any insurance was associated with lower fasting glucose in participants with diabetes (Mean Difference = −20.4 mg/dL, P = 0.01), but not in participants without diabetes. Compared to Private insurance, uninsured participants had higher fasting glucose (Mean Difference = 3.8 mg/dL, P = 0.03), while participants with Medicaid had higher HOMA-IR (Mean Difference = 3.5 mg/dL, P < 0.01). In participants ≥65, compared to Private insurance, uninsured participants (Mean Difference = 7.5 mg/dL, P = 0.02), and participants with Medicaid only (Mean Difference = 19.9 mg/dL, P < 0.01) or Medicare + Medicaid (Mean Difference = 5.2 mg/dL, P = 0.03) had higher fasting glucose. ConclusionsIn this large multiethnic cohort, having any insurance was associated with significantly lower fasting glucose for individuals with diabetes. Levels of fasting glucose and insulin resistance varied across different insurance types.

Satisfaction among the Insured and the Uninsured Patients visiting for OPD services in various health facilities of Kaski

Health insurance is the process of financial protection against health-related poverty and catastrophic health care cost. Satisfaction of the patients is the perception towards services they get from the health institution. This study aims to assess the satisfaction level and factors associated with it among the insured and the uninsured patients visiting the OPD services in the health facilities of Kaski.&#x0D; Cross-sectional analytical study was conducted using purposive sampling technique. Data was collected through Face-to-face interview among 258 participants (107 Insured and 151 Uninsured) while EPI DATA and SPSS were used for the data entry and analysis respectively. Ethical approval was obtained from the institutional review committee of Pokhara University and respective health facilities and consent from each participant was taken.&#x0D; Insured and uninsured participants were 41.5% and 58.5% respectively. 52.3% of insured and 49% of uninsured patients were female. Among the 107 insured participants, 74.8% participants visited for the first time and 18.7% for follow up. Educational status and SHI premium affordability were associated with satisfaction of the insured. Waiting time was associated with satisfaction among the uninsured participants. Waiting time, time provided doctors related availability of medicines related to lower level of satisfaction in both participants. Majority of the insured (83.2%) and uninsured (84.8%) participants were satisfied.&#x0D; The study shows overall satisfaction to be good in both insured and uninsured participants; however, it is suggested to improve the health service-related factors like waiting time; time provided by the doctors and the awareness on policy among the patients for further improvement of the program in Nepalese context.

Abstract B113: Colorectal cancer screening completion rates and barriers to colorectal cancer screening 6 months following participation in CRC screening intervention

Abstract Background: Though colorectal cancer (CRC) screening rates have increased significantly over the past two decades, screening disparities persist among Latinos. To increase CRC screening rates among Latinos, a promotor-led intervention was implemented to provide educational workshops and link community members to screenings through a partnered Federally Qualified Health Center (FQHC). Aims: To assess screening completion at 6-months follow-up. To identify barriers influencing adherence to CRC screening among participants who participated in a promotor-led intervention. Methods: The Juntos Contra el Cáncer/Together Against Cancer (JUNTOS) program was a promotor-led cancer prevention study that provided CRC prevention workshops to adults ages 50 to 75 in a primarily Latino community in San Diego, CA. Based on the Social Ecological Framework, the intervention targeted knowledge of CRC, screening attitudes, social support, screening barriers, and linked participants to community resources. Promotors assisted participants in scheduling appointments, which is the first step in CRC screening at the partnering FQHC. From December 2016 to July 2018, a total of 66 participants who were not up to date with CRC screening attended a 2.5-hour workshop, received follow-up calls from promotors, and completed a 6-month assessment. Demographics, health conditions, CRC knowledge, and attitudes changes towards screening were compared between participants who completed a CRC screening (adherent) and those who did not at 6 months (nonadherent). Chi-squared and t-tests were conducted to assess significant differences among adherent and nonadherent participants. For nonadherent participants, barriers to scheduling an appointment were evaluated. Results: The sample included 66 Latinos ages 50 to 75 (women=70%). Results from the 6-month follow-up show that 59% participants reported completing CRC screening. Findings show a statistically significant decrease in negative attitudes towards CRC screening from baseline to follow-up (M1=2.88 [SD=.81], M2=2.53 [SD=.85], p&amp;lt;.001). Differences in demographics, health conditions, attitudes towards screening, CRC knowledge, and health behaviors were not statistically significant at baseline between adherent and nonadherent participants at follow-up. The most frequently reported barriers for nonadherent participants to schedule an appointment with their medical provider were being too busy (48%) and not having health insurance (41%). Conclusions: Preliminary findings suggest that the delivery of the promotor-led intervention improved attitudes of CRC screening and led to increases in self-reported screening rates among nonadherent adults. For uninsured participants, waiving the appointment or providing additional support to navigate the health system may help them complete CRC screening. Overall, these findings build the evidence on the preliminary efficacy of group-based CRC education and linkages to care for nonadherent adults. Citation Format: Carolina López de la Torre, Jill N. JoaDumbauld, Jessica Haughton, Anthony Barrios, Dalia Rojas, Mirna Díaz, José López, Maria Milla, Samir Gupta, Jesse Nodora, Christian Ramers, Felipe Garcia-Bigley, Jessica Marquez, Balambal Baharti, Elva M. Arredondo. Colorectal cancer screening completion rates and barriers to colorectal cancer screening 6 months following participation in CRC screening intervention [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B113.

PDB94 WILLINGNESS-TO-PAY FOR PHARMACOGENETIC TESTING AMONG PATIENTS WITH DIABETES MELLITUS

The growing recognition that Pharmacogenetics (PGx) testing has the potential to boost patients' confidence in the safety and efficacy of their medications, raises the question of who will pay for these tests. This study assesses the willingness of patients with diabetes to undertake and pay for PGx testing and to explore important factors that influence decision-making. A survey invitation link was posted on a Facebook page dedicated to diabetes. A contingent valuation was performed to evaluate the monetary value of benefits that might be offered by testing. Participants’ willingness to pay (WTP) for PGx testing was gauged in three hypothetical scenarios, scenario1: PGx testing is currently available to improve the selection and dosage of your medications; scenario2: in addition to scenario1, PGx testing might reveal your susceptibility to future diseases; scenario3: in addition to scenario1and 2, PGx may reveal that you may not respond, or respond negatively, to the only drugs available. Logistic regression and OLS models were implemented to assess the relationship between demographics characteristics and WTP amount One hundred and thirty participants (40% males, 60% females) completed the survey. Almost 73%, 85%, 90% were interested in PGx testing in scenario 1, 2, and 3, respectively. Average WTP was $61.5, $78.4, $73.2 for scenario 1, 2, and 3, respectively. Older participants, participants with higher incomes, and those with low education attainment reported higher WTP in all scenarios. Further, male and uninsured participants were prepared to pay more for PGx testing only in scenario 2 and 3. Attitudes towards PGx testing was significantly (p<0.05) associated with WTP in scenario 1 and 2 Diabetic patients were willing to undergo and pay for PGx testing, suggesting that not all medications exhibit desirable therapeutic effects. The encouraging findings reveal that some patients find valuable clinical utility in PGx testing.

SUN-180 SOCIO-DEMOGRAPHIC CHARACTERISTICS AND OUTCOMES AT 18 MONTHS OF A COHORT OF ESKD PATIENTS STARTING HEMODIALYSIS IN INDIA

Hemodialysis (HD) is the dominant renal replacement therapy (RRT) in India. A national free dialysis programme was introduced in 2016, but the determinants of outcomes in dialysis in India have received limited attention. The Dialysis Outcomes in India study followed a cohort of incident dialysis patients to evaluate the impact of socio-demographic and economic factors on clinical outcomes. Here we describe the baseline socio-demographic and clinical characteristics associated with 18-month survival on hemodialysis. 1000 participants were recruited at 16 dialysis facilities across nine states in India. Demographic, clinical information, socioeconomic and quality of life parameters were collected in a web-based secure data collection platform. We examined the association of survival with age, gender, years of education, monthly household income, source of payment for dialysis, type of insurance coverage, vascular access, haemoglobin and intradialytic weight gain. Chi-square and Fishers exact T tests were used to test for associations and a p value of <0.05 was deemed significant. The median age (IQR) of the subjects was 59 (19) years, and 30% were female. 20% of the participants had education beyond primary school. One quarter 26% of the participants were graduates. 80% of the female participants worked within the home, while 44% of the male participants were either retired or not working. Of those who had a job, 9% had to change their occupation due to treatment. Median monthly family income was reported as US$ 500 (586). A history of hypertension was reported in 80% of participants [duration 5 (7) years], and diabetes in 54% [duration 10 (10) years]. Median distance traveled to the dialysis unit was 10 (16) kms. 60% of the participants funded dialysis out of pocket (OoP), 25% had government or an employer-based, while 10% had private insurance. The median monthly OoP expenditure was US$ 390±180 for uninsured participants and US$ 160±140 for insured participants. The dialysis outcomes at 18 months are described in Table 1. Survivors had shorter travel distance to dialysis center, higher household income and hemoglobin and lower interdialytic weight gain.Table 1Dialysis Outcomes at 18 MonthsOutcomes at 18 monthsTotal (n=1000)Continuing Dialysis368 (36.8%)Kidney Transplant111 (11.1%)Peritoneal Dialysis29 (2.9%)Conservative Therapy50 (5%)Withdrew Dialysis144 (14.4%)Death256 (25.6%)Lost to Follow-up42 (4.2%) Open table in a new tab In this national cohort of patients on HD, 37% continued on RRT at 18 months. Availing dialysis closer to home, adequate financial risk protection in terms of regular household income was associated with continuing on dialysis. Monitoring clinical and socio-economic outcomes in dialysis provides an opportunity to identify modifiable factors to improve quality of dialysis and inform policy around the national dialysis programme. Collection of outcomes data as part of the care workflow improves quality of data collection; we envisage institutionalization of the dialysis outcomes study towards establishment of a national dialysis registry in India.

Inequalities Between Migrants and Non-Migrants in Accessing and Using Health Services in Greece During an Era of Economic Hardship.

A cross-sectional study was conducted from April 2013 until March 2014 to explore the existence of inequalities in access to and utilization of health services by migrants compared to non-migrants in Greece and to test the influence of various factors on these disparities. Also, we investigated the influence of several socioeconomic and demographic characteristics. Study population included 1,152 migrants and 702 non-migrants. Migrants, participants suffering from a chronic disease, those without health insurance, and patients who assessed their health status as not at all good/a little good/moderate were statistically more likely to report unmet needs in getting their medication. Uninsured participants, females, those unemployed or without a permanent occupational status, and those who assessed their health status as not at all good/a little good/moderate were statistically more likely to report unmet needs in access to health services during the last year. Regarding the use of health services, those with health coverage, non-migrants, and females were statistically more likely to go for a blood test as a hospital outpatient. Greece, despite administrative delays and barriers, provided full coverage to the uninsured, asylum seekers, and migrants, even many groups of undocumented migrants.