Urban Patient Population Research Articles

Financial toxicity screening in an urban underserved patient population with cancer.

169 Background: Cancer-related financial hardship is associated with treatment delays, non-adherence and adverse survival outcomes. Racial/ethnic minorities and low-income households are disproportionately impacted by financial toxicity. The Comprehensive Score for Financial Toxicity (COST) measure is used to measure financial toxicity in research but has not been validated in low-income, racially diverse cancer patient populations. Methods: We conducted this study at a large urban medical center from January-August 2023. We included cancer patients on systemic therapy for at least 2 months with ECOG performance status 0-2. Participants completed the COST measure, the Functional Assessment of Cancer Therapy: General (FACT-G) and the European Organization for Research and Treatment of Cancer (EORTC) QOL to assess health-related quality of life (HRQOL). Cancer diagnosis/stage, demographic data, and social work/financial counseling interventions were abstracted. Factor analyses were conducted to determine the underlying factor structure of the COST measure responses and bivariate analyses were conducted to identify relationships between COST scores and other data. Results: 100 patients participated in the study; the average age was 65 and both sexes were equally represented. Most patients reported African American (67%) race/ethnicity. 72% of patients held less than a 4-year college degree, 22 % were unemployed and 55% reported a yearly household income of less than $35,000. Lung (46%) and gastrointestinal (38%) cancers were the most represented. 73% were enrolled in a government sponsored insurance program (Medicare, Medicaid). The average COST score among participants was 22 [range 0-44] and mean FACT-G and EORTC scores were 16.5 [range 0-28] and 59.6 [ range 0 – 100] respectively. Fifty-eight patients were referred to social work or financial counseling for financial interventions. Factor analysis revealed three predominant factors among the COST responses (Eigenvalues > 1) including Factor 1: items 3, 7, 8, 9, 10, 11; Factor 2: item 4; Factor 3: item 5. COST was weakly associated with FACT-G and EORTC (Pearson range 0.27 – 0.37). The most highly correlated value was between the COST and EORTC physical wellbeing subscale (Pearson 0.38). The COST score was significantly associated with income, with higher incomes reporting less financial toxicity (p = 0.004). No significant differences in COST scores were noted across gender, race, or level of education. Conclusions: Low levels of financial toxicity were detected using the COST measure in a diverse, low-income cancer patient population despite many patients being referred to social work/financial counseling. Compared to similar studies, we found a weaker correlation between the COST measure and HRQOL. These findings suggest that the COST measure may need to be further adapted for use in underserved populations and patients with government sponsored insurance.

PP01.96 Characterization of DNA damage repair mutations in lung cancer in an underserved urban patient population

PP01.96 Characterization of DNA damage repair mutations in lung cancer in an underserved urban patient population

Validation of a Discharge Risk Calculator for Rural Patients Following Total Joint Arthroplasty

BackgroundAs the volume of total joint arthroplasty in the US continues to grow, new challenges surrounding appropriate discharge surface. Arthroplasty literature has demonstrated discharge disposition to postacute care facilities carries major risks regarding the need for revision surgery, patient comorbidities, and financial burden. To quantify, categorize, and mitigate risks, a decision tool that uses preoperative patient variables has previously been published and validated using an urban patient population. The aim of our investigation was to validate the same predictive model using patients in a rural setting undergoing total knee arthroplasty (TKA) and total hip arthroplasty. MethodsAll TKA and THA procedures that were performed between January 2012 and September 2022 at our institution were collected. A total of 9,477 cases (39.6% TKA, 60.4% THA) were included for the validation analysis. There were 9 preoperative variables that were extracted in an automated fashion from the electronic medical record. Included patients were then run through the predictive model, generating a risk score representing that patient’s differential risk of discharge to a skilled nursing facility versus home. Overall accuracy, sensitivity and specificity were calculated after obtaining risk scores. ResultsScore cutoff equally maximizing sensitivity and specificity was 0.23, and the proportion of correct classifications by the predictive tool in this study population was found to be 0.723, with an area under the curve of 0.788 — both higher than previously published accuracy levels. With the threshold of 0.23, sensitivity and specificity were found to be 0.720 and 0.723, respectively. ConclusionsThe risk calculator showed very good accuracy, sensitivity, and specificity in predicting discharge location for rural patients undergoing TKA and THA, with accuracy even higher than in urban populations. The model provides an easy-to-use interface, with automation representing a viable tool in helping with shared decision-making regarding postoperative discharge plans.

Examining knowledge of cancer-related family history in an urban underserved patient population.

e22550 Background: An accurate assessment of family history of cancer is essential in assigning cancer risk, and in decision making regarding the timing and method of cancer screening. However, obtaining a complete and accurate cancer-related family history, including first- and second-degree relatives, is often challenging in underserved communities. Familial dynamics such as single parent households, kinship care, and estrangement may act as barriers to an individual’s knowledge of their family health history. Presently, Electronic Medical Record systems constrain users to a binary documentation of cancer history as either ‘yes’ or ‘no’. However, patients may be unaware or uncertain of their family’s cancer history. These unknowns are not captured, resulting in poor understanding of patient knowledge regarding their family history of cancer. Objective: To assess knowledge of cancer-related family history for first- and second-degree relatives among an urban underserved patient population. Funding source: The American Cancer Society. Methods: University of Illinois Health patients aged 45-75 years without a history of colorectal cancer, who received an order for colorectal cancer screening through fecal immunochemical testing or screening colonoscopy were eligible to participate. A total of 88 respondents completed a 23-item telephone survey assessing knowledge of their family cancer health history using a 5-point Likert scale. Surveys were administered in both English and Spanish languages. Results: Of the 88 survey participants, 50 (57%) were female, 54 (61%) were of black or African American race, and 31 (36%) were of Hispanic or Latino ethnicity. On a single-item question assessing overall knowledge of their cancer-related family history, 35 (39.7%) responded they know it well or very well, versus 13 (14.8%) with little or no knowledge. On knowledge of maternal cancer related history, 8 participants (9.1%) reported little or no knowledge of their mother’s cancer history, and 29 participants (33%) reported little or no knowledge of their maternal relatives’ cancer history. On knowledge of their father’s cancer history, 35 (39.8%) reported little or no knowledge of their father’s cancer history, and 48 participants (54.5%) reported little or no knowledge of their paternal relatives’ cancer history. Conclusions: This original research study addresses the current gap in understanding patient knowledge regarding familial cancer health history. Survey results demonstrate a striking discrepancy between respondent reported overall knowledge of cancer-related family history, and knowledge of their maternal and paternal cancer histories. Moreover, respondents reported increased knowledge of their mother’s versus father’s cancer history p < 0.0001. Improved recognition of unknown family history in first- and second-degree family members may improve cancer-risk assessment.

Hereditary Cancer Screening and Outcomes at an Urban Safety-Net Hospital.

Patients with hereditary cancer syndromes (HCS) have a high lifetime risk of developing cancer. Historically underserved populations have lower rates of genetic evaluation. We sought to characterize demographic factors that are associated with undergoing HCS evaluation in an urban safety-net patient population. All patients who met inclusion criteria for this study from 2016 to 2021 at an urban safety-net hospital were included in this analysis. Inclusion criteria were pathologically confirmed breast, ovarian/fallopian tube, colon, pancreatic, and prostate cancers. Patients also qualified for hereditary breast and ovarian cancers or Lynch syndrome on the basis of National Comprehensive Cancer Network guidelines. Institutional review board approval was obtained. Demographic and oncologic data were collected through retrospective chart review. Univariable and multivariable logistic regression models were constructed. Of the 637 patients included, 40% underwent genetic testing. Variables associated with receiving genetic testing on univariable analysis included patients living at the time of data collection, female sex, Latinx ethnicity, Spanish language, family history of cancer, and referral for genetic testing. Patients identifying as Black, having Medicare, having pancreatic or prostate cancer, having stage IV disease, having Eastern Cooperative Oncology Group (ECOG) prognostic score ≥1, having medium or high Charlson comorbidity index, with current or previous cigarette use, and with previous alcohol use were negatively associated with testing. On multivariable modeling, family history of cancer was positively associated with testing. Patients identifying as Black, having colon or prostate cancer, and having ECOG score of 2 had significantly lower association with genetic testing. Uptake of HCS was lower in patients identifying as Black, those with colon or prostate cancer, and those with an ECOG score of 2. Efforts to increase HCS testing in these patients will be important to advance equitable cancer care.

Characterization of DNA damage repair mutations in lung cancer in an underserved urban patient population.

e20058 Background: DNA-damage repair (DDR) mutations in lung cancer have shown potential for use as therapeutic targets and predictive biomarkers. However, the relationship between DDR mutations and socioeconomic factors remains largely unknown. In this study, we characterize the distribution of DDR gene mutations in lung cancer patients at a single academic medical center serving a unique population consisting of primarily underserved, underinsured patients. Methods: All lung cancer patients seen at the University of Illinois Chicago (UIC) between 11/2/2015 and 9/11/2023 with TEMPUS genetic data available were included in the study (N = 235). DDR mutations of interest were ARID1A, ATM, ATR, ATRX, BAP1, BRCA1, BRCA2, BRIP1, CHEK2, ERCC3, FANCA, FANCC, MLH3, MRE11, MSH6, MUTYH, NBN, PALB2, and RAD50. The population was subdivided into a DDR mutation positive group and a DDR mutation negative group. Each group was compared with respect to lung cancer type, tumor mutational burden (TMB), and socioeconomic factors including sex, race, insurance category, and zip code. Results: The overall frequency of DDR mutations in the population was 28.5% (n = 67). The most common DDR mutations were ARID1A (20.7%), CHEK2 (12.8%), ATM (9.9%), BRCA2 (9.9%), ATRX (7.9%), and MUTYH (7.9%). The histological distribution of the DDR mutation positive group was adenocarcinoma (76.1%), squamous cell carcinoma (4.4%), adenosquamous carcinoma (2.9%), neuroendocrine carcinoma (5.9%), and other (10.4%). The histological distribution of the DDR negative group was adenocarcinoma (60.1%), squamous cell carcinoma (22.0%), adenosquamous carcinoma (1.1%), neuroendocrine carcinoma (4.1%), and other (12.5%). There was a significant effect in TMB, t(55) = 2.97, p = 0.004, with a higher mean TMB in the DDR positive group (M = 14.4, SD = 11.1) compared to the DDR negative group (M = 9.4, SD = 5.1). The most common zip codes in the DDR positive groupwere 60608 (9.0%), 60629 (9.0%), and 60616 (7.5%) compared to 60616 (8.3%), 60609 (5.3%), and 60624 (4.7%) in the DDR negative group. Demographic factors of the two groups are compared below. Conclusions: The frequency and distribution of DDR mutations in lung cancer at UIC appears similar to what has been previously reported in the literature. There is a higher tumor mutational burden in lung cancers with DDR mutations, which may suggest greater susceptibility to immunotherapy. There may be a correlation between the presence of DDR mutations and lung cancer type, insurance category, and patient geographic distribution. Future work will include obtaining further geographic data for the study population such as average income, pollution exposure, and smoking rate by neighborhood. [Table: see text]

Evaluating the Effects of Food Deserts and Food Swamps in an Urban Burn Patient Population.

Poverty is a known risk factor for burn injury and is associated with residency in food deserts and food swamps. Our aim was to determine the prevalence of residency in food deserts and food swamps and to investigate the relationship between food environment, comorbidities, and wound healing in patients with burns. We performed a retrospective chart review of all patients with burns aged ≥ 18 seen in the emergency department or admitted to the burn service at an American Burn Association-verified urban academic center between January 2016 and January 2022. Patient GeoIDs were used to classify residency in food deserts and food swamps, and comorbidities and demographics were recorded. A subset of patients with <20% total body surface area burns who underwent single-operation split-thickness skin grafting was identified for wound healing analysis. A total of 3063 patients were included, with 206 in the heal time analysis. In total, 2490 (81.3%) lived in food swamps and 96 (3.1%) lived in food deserts. Diabetes, hypertension, and tobacco smoking were more prevalent in food swamps than in food deserts or good access areas. While there was no significant effect of the food environment on wound healing, diabetes was associated with longer healing times. Most patients with burns reside in food swamps, which are associated with a higher prevalence of hypertension, diabetes, and smoking. The food environment was not significantly associated with wound healing. Not having diabetes was associated with a shorter time for wound healing.

Exclusive Breastfeeding in the Bronx-Successes and Shortcomings.

Despite efforts to encourage breastfeeding, exclusive breastfeeding (EBF) rates in the Bronx remain suboptimal. Hospital restrictions and uncertainty surrounding the side effects of coronavirus disease 2019 (COVID-19) greatly impacted the mother-infant dyad during the postpartum hospitalization. Preliminary studies found an initial decrease in EBF, but lasting effects remain unknown. This study aimed to investigate the effect of the COVID-19 pandemic on birth hospitalization EBF rates among a high-risk urban patient population. A retrospective chart review was conducted on all newborns admitted to the newborn nursery at an urban medical center between 2019 and 2021. Patients were separated into prepandemic and pandemic cohorts. Patient demographics, maternal comorbidities, length of stay, feeding method, and newborn characteristics, including status as high risk for hypoglycemia, were collected. EBF was defined as receiving only mother's milk during the birth hospitalization. Descriptive statistics and bivariate analysis were used to examine the data. A total of 630 prepandemic and 643 pandemic newborns were included. The cohorts did not differ in baseline maternal characteristics. Prepandemic newborns were less likely to be high risk (23.3 vs. 29.4%, p = 0.01), more likely to see the hospital lactation consultant (53.2 vs. 24.0%, p < 0.001), and had a longer average length of stay (63.4 vs. 54.5 hours, p < 0.001). Most infants in both cohorts received some breastmilk during the hospitalization (97.6 vs. 94.6%, not significant). There was no difference in EBF between cohorts among all newborns (9.5 vs. 11.4%, p = 0.29) or among nonhigh-risk newborns (12.2 vs. 15.0%, p = 0.22). EBF rates in the Bronx, NY did not change during the pandemic period, despite an increase in high-risk newborns. Further investigation into the effect of lactation consultation, maternal race, ethnicity, and primary language should be further explored to understand the implications of health care disparities on the mother-infant dyad. · The COVID-19 pandemic disrupted many aspects of the mother-infant dyad.. · EBF rates at an urban institution in the Bronx did not change during the COVID-19 pandemic.. · Further investigation is warranted to better understand the barriers to EBF in this population..

MP54-01 ASSOCIATION BETWEEN SOCIAL NEEDS AND PRIMARY TREATMENT CHOICE FOR LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP54-01 ASSOCIATION BETWEEN SOCIAL NEEDS AND PRIMARY TREATMENT CHOICE FOR LOCALIZED PROSTATE CANCER Jay Rollins, Rutul D. Patel, Kevin Labagnara, and Kara L. Watts Jay RollinsJay Rollins More articles by this author , Rutul D. PatelRutul D. Patel More articles by this author , Kevin LabagnaraKevin Labagnara More articles by this author , and Kara L. WattsKara L. Watts More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Social Determinants of Health (SDH)–defined as the conditions where people are born, work, live, and age–impact patients’ access to resources and health outcomes in a variety of ways. Additionally, ethnic differences in primary treatment for prostate cancer have been demonstrated. We assessed the relationship between SDH score and primary treatment choice for localized prostate cancer in a diverse, urban patient population. METHODS: Using our institutional registry, we conducted a retrospective study of men diagnosed with prostate cancer between 2003–2022. Primary treatment choice–defined as either radiation therapy (RT) or radical prostatectomy (RP)–was abstracted with clinical variables. A validated SDH questionnaire, distributed over the past 5 years by our institution’s primary care department, provided self-reported demographics and patients’ concerns regarding specific social risks. Multivariable analyses controlling for age, PSA, and Gleason grade group at diagnosis were performed to analyze the association between SDH variables and primary treatment choice for localized prostate cancer. RESULTS: 217 patients completed the SDH questionnaire and met inclusion criteria; 118 (54%) and 99 (46%) received primary RT and RP, respectively. Median age was 64 years. The cohort was primarily non-Hispanic Black (43%) or Hispanic (41%), English-speaking (80%), and insured through Medicare (65%). Table 1 reports the results of binomial logistic regression models assessing the relationship between the variables of interest and primary treatment selection. Compared to White patients, patients of all other races/ethnicities were more likely to undergo prostatectomy (Non-Hispanic Black OR=9.54, p=0.04; Hispanic OR=9.55, p=0.04; Asian/Other OR=13.87, p=0.03). No specific SDH concern endorsed by patients was significantly associated with treatment choice (p>0.05 for all). CONCLUSIONS: Analysis of our cohort indicates that unmet social needs do not influence primary treatment selection for localized prostate cancer. This suggests the presence of other variables that contribute to racial/ethnic differences in treatment choice. Future studies are needed to investigate the social and cultural factors that influence how patients determine primary treatment for localized prostate cancer. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e753 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jay Rollins More articles by this author Rutul D. Patel More articles by this author Kevin Labagnara More articles by this author Kara L. Watts More articles by this author Expand All Advertisement PDF downloadLoading ...

Widespread Third-Party Tracking On Hospital Websites Poses Privacy Risks For Patients And Legal Liability For Hospitals.

Computer code that transfers data to third parties (third-party tracking) is common across the web and is subject to few federal privacy regulations. We determined the presence of potentially privacy-compromising data transfers to third parties on a census of US nonfederal acute care hospital websites, and we used descriptive statistics and regression analyses to determine the hospital characteristics associated with a greater number of third-party data transfers. We found that third-party tracking is present on 98.6percent of hospital websites, including transfers to large technology companies, social media companies, advertising firms, and data brokers. Hospitals in health systems, hospitals with a medical school affiliation, and hospitals serving more urban patient populations all exposed visitors to higher levels of tracking in adjusted analyses. By including third-party tracking code on their websites, hospitals are facilitating the profiling of their patients by third parties. These practices can lead to dignitary harms, which occur when third parties gain access to sensitive health information that a person would not wish to share. These practices may also lead to increased health-related advertising that targets patients, as well as to legal liability for hospitals.

Abstract P577: Demographic Disparities in the Distribution and Severity of Coronary Artery Disease- An Urban-Suburban Comparative Study

Background: Some small powered studies have suggested a paradoxical finding of less severe coronary artery obstruction in African American (AA) males as compared to Caucasian male patients despite a higher prevalence of CVD mortality in AAs. We performed a retrospective study to further identify the difference in the extent of coronary artery obstruction and the prevalence of multivessel disease between an urban hospital and a suburban hospital. Methods: A chart review of cardiac catheterization reports was performed on 3,579 patients from 2 different hospitals (1 urban and 1 suburban center). Statistical analysis was done using R and Stata. Results: Analyzing the main characteristics of the patient population we found that the suburban patient population (SPP) was 7 years older than the urban patient population (UPP) (P-valve= &lt;0.001), 78.4% of the suburban population were Caucasian while 79.7% of the urban center patient population were African Americans (P value= &lt;0.001). 96% of the patient population at the suburban center were insured while 85% of patients at the urban center were insured (P= &lt;0.001). Comorbidity burden was overall higher in the SPP ( P-Value= &lt; 0.001). SPPs were found to have a higher prevalence of severe CAD than UPP (Table 1). However, no significant difference was noted when comparing the prevalence of multivessel disease (Table 2). Conclusion: SPPs are more likely to have severe CAD than UPPs but with a similar level of CAD distribution.

COVID-19 and Changes in Reported Social Risk Factors at a Primary Care Practice in the South Bronx.

Historically, Black and Hispanic patient populations in the Bronx Borough of New York City have experienced the highest rates of social risk factors, and associated poor health outcomes, in New York State. During the pandemic, Bronx communities disproportionately experienced high rates of COVID-19 illness and death. To date, little is known regarding the COVID-19 pandemic's impact on social risk factors in urban, at-risk communities. This study aimed to determine how social risk factors changed during the pandemic in a Bronx-based patient population. Study participants were adult patients seen at a Federally Qualified Health Center in the South Bronx. Using a paired longitudinal study design, 300 participants were randomly selected for telephonic outreach during the pandemic from a sample of 865 participants who had been offered a social risk factor screener in the year prior to the pandemic. The outreach survey used included the social risk factor screener and questions regarding COVID-19 illness burden and prior engagement in social services. The McNemar test was used to analyze trends in reported social risks. Housing quality needs, food insecurity, and legal care needs significantly increased during the pandemic. Participants who reported COVID-19 illness burden were 1.47 times more likely to report a social risk factor (P = .02). No significant relationship was found between prior enrollment in clinic-based social services and degree of reported social risk (P = .06). Housing quality needs, food insecurity, and legal care needs increased during the COVID-19 pandemic in a predominantly Black and Hispanic identifying urban patient population. Urgently addressing this increase is imperative to achieving health equity in ongoing COVID-19 mitigation efforts.

Diabetic Foot Complications: A Retrospective Cohort Study.

Diabetes mellitus is a highly prevalent disease globally and contributes to significant morbidity and mortality. As a consequence of multiple pathophysiologic changes which are associated with diabetes, these patients frequently suffer from foot-related disorders: infections, ulcerations, and gangrene. Approximately half of all amputations occur in diabetic individuals, usually as a complication of diabetic foot ulcers. In this retrospective study, we analyzed and characterized a cohort of 69 patients and their diabetes-related foot complications. The main characteristics of our cohort were as follows: older age at diagnosis (mean age 66); higher incidence of diabetes in males; predominantly urban patient population. The most frequent complications of the lower extremity were ulcerations and gangrene. Moreover, in our study, 35% of patients required surgical reintervention, and 27% suffered from complications, while 13% required ICU admission. However, diabetic foot lesions are preventable via simple interventions which pointedly reduce foot amputations. Early identification and the appropriate medical and surgical treatment of the complications associated with diabetic foot disease are important because they still remain common, complex and costly.

ERAS implementation in an urban patient population undergoing gynecologic surgery.

Enhanced recovery after surgery (ERAS) protocols improve outcomes. We investigated ERAS implementation in a population with comorbid conditions, inadequate insurance, and barriers to healthcare undergoing gynecologic surgery. To investigate ERAS implementation in publicly insured/uninsured patients undergoing gynecologic surgery on hospital length of stay (LOS), 30-day hospital readmission rates, opioid administration, and pain scores. Data were obtained pre- and post-ERAS implementation. Patients undergoing gynecologic surgery with private insurance, public insurance, and uninsured were included (N=589). LOS, readmission <30 days, opioid administration, and pain scores were assessed. Implementation of ERAS led to shorter LOS 1.75 vs. 1.49 days (p=0.008). Average pain scores decreased from 3.07 pre-ERAS vs. 2.47 post-ERAS (p=<0.001). Opioid use decreased for ERAS patients (67.22 vs. 33.18, p=<0.001). Hospital readmission rates were unchanged from 8.2% pre-ERAS vs. 10.3% post-ERAS (p=0.392). ERAS decreased pain scores and opioid use without increasing LOS or readmissions.

Comparison of weight loss outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy in a racially mixed urban patient population.

National data show a trend favoring laparoscopic sleeve gastrectomy (SG) over Roux-en-Y gastric bypass (RYGB). Published data demonstrating the differences in weight loss between the two procedures are mixed. In this retrospective study using clinical data from 2010 to 2020, we compared the clinical and demographic characteristics of patients undergoing either SG or RYGB to evaluate their long-term weight loss outcomes. University hospital in the United States. A total of 3329 patients were identified in our institutional Metabolic and Bariatric Surgery Accreditation and Quality Improvement database using Current Procedural Terminology codes for either RYGB or SG. A general linear model was used for baseline characteristics. Logistic regression was used for factors favoring RYGB versus SG. A multivariable linear mixed model was used for weight-trajectory analysis. Cox regression was used for a cumulative hazard ratio of 10% weight regained from nadir. Factors favoring RYGB were diagnoses of type 2 diabetes and gastroesophageal reflux disease, Hispanic ethnicity, and surgeon's preference. SG was favored among Black patients and smokers. RYGB was associated with more weight loss at all time points. The risk of weight regain was significantly higher after SG versus RYGB. The bariatric procedure choice is significantly influenced by race, medical history, and surgeon's experience. RYGB results in a significantly more durable weight loss compared with SG regardless of race or other stratification factors.

Lumbopelvic Pain in Pregnancy in a Diverse Urban Patient Population: Prevalence and Risk Factors.

Objective: Pregnancy lumbopelvic pain (PLPP) is a common ailment during pregnancy with physical, psychosocial, and economic consequences. Prior literature has focused on majority Caucasian patient populations; none have focused on Hispanic populations, especially in the United States. The purpose of this study was to determine the proportion of pregnant people who experience PLPP in mostly Hispanic population. Materials and Methods: Cross-sectional survey Setting: Academic medical center Patients: All pregnant people attending a prenatal visit in obstetrical offices from July 2018 through March 2020 were asked to complete a questionnaire compiling demographic, socioeconomic information as well as describe any pain symptoms. Furthermore, the Pregnancy Mobility Index (PMI), Pelvic Girdle Pain Questionnaire (PGQ), and the Questionnaire for Urinary Incontinence Diagnosis (QUID) were included. Results: In a cohort (n = 851) that was 62% Hispanic, we found a 63% point-prevalence rate for PLPP. Pregnant people who reported PLPP were further along in their pregnancy, did have significantly higher scores for the PMI and PGQ, indicating a greater level of disability, and reported issues with incontinence (QUID). Results of the logistic regression found that a higher PMI score and financial instability were factors influencing PLPP. Conclusions: In a cohort of majority Hispanic people, we found that 63% of respondents had PLPP. Our study found that a higher PMI score and financial instability were factors influencing PLPP. Clinicians should be alert to pregnant people who express their difficulties with activities of daily living as they may be at risk of PLPP, and could benefit from further evaluation and treatment.

Evaluating perceptions and usage of natural remedies, herbal medicine, and dietary supplements for kidney stones among a diverse, international, urban patient population.

Our goal was to assess the use and perceptions of complementary and alternative medicine (CAM) for kidney stones among a diverse, urban population. This was a cross-sectional study of patients treated for kidney stones in the Bronx, NY. We assessed demographic information, personal history of kidney stones, as well as knowledge and use of CAM for kidney stones. Patient demographics and responses were analyzed using chi-squared, t tests, and binomial logistic regression. 113 patients were surveyed. 90% identified as non-white, of whom 58% indicated Hispanic, 46% Latinx, and 23% Black. 56% of patients were born outside the United States. 56% of patients had heard of CAM for kidney stones and 44% had used CAM for kidney stones. The most common CAM were fruits (N = 42, 84%). Recurrent stone formers were more likely than first-time stone formers to have heard of CAM (68 vs 44% p = 0.013) and to have used CAM (56 vs 30%, p = 0.008). Those identifying as Hispanic were more likely to have both heard of and tried CAM for kidney stones (p = 0.036 and 0.022, respectively) compared to non-Hispanic patients. CAM are commonly used among our diverse, urban patient population. While some remedies are high in citrate and alkali (i.e., lemon, cranberry), others are high in oxalate (i.e., beets) and could potentially contribute to stone formation. These findings underpin the importance that medical providers educate themselves on the CAM used in their specific patient populations and discussing use with patients. Providers should aim to identify and reconcile therapeutics that oppose goals of treatment.

Utilizing primary care to engage patients on opioids in a psychological intervention for chronic pain.

Context: Chronic pain, one of the most prevalent issues encountered in primary care, is often treated with opioid prescriptions. Overuse of these medications can cause overdose and death, creating a dire need for alternative treatment methods. Psychological interventions are effective for improving pain and distress, yet are underutilized. Physicians report difficulty engaging patients already on opioids in these interventions; it is possible that offering this intervention in a primary care setting may alleviate this barrier. Objective: Determine whether opioid prescriptions are related to patients engaging in a brief psychological intervention for chronic pain management in primary care. Study Design: Secondary analysis of a pilot randomized clinical trial of a 5-session psychological intervention for chronic pain. Setting: Primary care clinic in an urban setting Patient Population: Patients with chronic pain (N= 220) were approached to enroll in a pilot randomized clinical trial (RCT) for a brief, psychological intervention for pain in primary care. Of these, 60 participated and 160 declined. Instruments: Electronic health records were reviewed to determine whether patients were prescribed opioids or pain medications at the time they were approached about the RCT. Main outcome: Comparing opioid prescriptions in enrollees versus non-enrollees. Results: There was not a significant difference between enrollees and non-enrollees in the rate of opioid prescriptions (18.3% vs. 20%, p= .78), the morphine milligram equivalent dose of opioids (M= 17.64, SD= 22.91 vs. M= 18.07, SD= 18.19; p= .95), or the rate of non-opioid pain prescriptions (33.3% vs. 40%, p = .37). When examining for gender differences, among women, there were similar rates between enrollees and non-enrollees in the rate of opioid prescriptions (23.4% vs. 17%, p = .36). However, no males with an opioid prescription enrolled, whereas 25% of men who did not enroll had an opioid prescription. Conclusions: Among all patients, opioid prescriptions were not related to enrollment in the RCT. This suggests that engaging patients who are on opioids in a psychological treatment for chronic pain, specifically in a primary care setting, may increase utilization. However, this may be true for women, but not men. Further work needs to be done to identify methods to increase psychological intervention engagement among all patients receiving opioids, but especially men.

COVID-19 testing trends: pre-radiation and throughout cancer care

Abstract Introduction: Patients presenting for radiation therapy (RT) at a single institution were analysed regarding treatment delays and disparities during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study was conducted at an urban multidisciplinary cancer centre. In April 2020, the institution’s radiation oncology department implemented universal COVID-19 screening protocols prior to RT initiation. COVID-19 testing information on cancer patients planned for RT from 04/2020 to 01/2021 was reviewed. Trends of other lifetime COVID-19 testing and overall care delays were also studied. Results: Two hundred and fifty-four consecutive cancer patients received RT. Median age was 63 years (range 24–94) and 57·9% (n = 147) were Black. Most (n = 107, 42·1%) patients were insured through Medicare. 42·9% (n = 109) presented with stage IV disease. One (0·4%) asymptomatic patient tested positive for COVID-19 pre-RT. The cohort received 975 lifetime COVID-19 tests (median 3 per patient, range 1–18) resulting in 29 positive test results across 21 patients. Sixteen patients had RT delays. Identifying as Hispanic/Latino was associated with testing positive for COVID-19 (p = 0·015) and RT delay (p = 0·029). Conclusion: Most patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, increased testing burden, delays in diagnostic workup and testing positive for COVID-19 may intensify disparities affecting this urban patient population.

Primary care gap: factors associated with persistent lack of primary care after hospitalisation.

IntroductionAccess to primary care in the USA is associated with decreased acute care utilisation and better health outcomes, yet millions of Americans lack a primary care provider (PCP). In our study, we report the risk factors for having no assigned PCP for hospitalised patients both at the time of discharge and over the course of the following year.MethodsWe conducted a retrospective cohort study of 12 663 adult patients discharged from the medicine service at our academic inpatient hospital from 2017 to 2018. We compared the characteristics of patients with and without a PCP listed in the electronic health record at time of discharge. In a second analysis, for those patients without a PCP, we used subsequent encounters with our health system to compare characteristics of those who had a PCP assigned within 1 year after discharge with those who did not.ResultsAt time of discharge, patients without a PCP were more likely to be younger, male, non-Asian and non-Black, to have Medicaid insurance or to be self-pay, to be experiencing homelessness and to have a substance use disorder diagnosis. During the year after discharge, the most significant risk factors for persistently lacking a PCP were non-private insurance status (Medicaid, Medicare, self-pay), experiencing homelessness and having a substance use disorder diagnosis.DiscussionOur study demonstrates important risk factors for persistently lacking an assigned PCP in our urban patient population, including health insurance status, homelessness and substance use disorders. Targeted interventions are indicated to connect these high-risk individuals to primary care.