226 Diabetes and Access to Care Among Mexican Immigrants in a Safety Net Emergency Department

Abstract Background Use of antibiotics without a prescription (non-prescription use) contributes to antimicrobial resistance. Non-prescription use includes obtaining and taking antibiotics without a prescription, taking another person’s antibiotics, or taking one’s own stored antibiotics. We conducted a quantitative survey focusing on the factors that impact patients’ decisions to use non-prescription antibiotics. Methods We surveyed patients visiting public safety net primary care clinics and private emergency departments in a racially/ethnically diverse urban area. Surveys were read aloud to patients in Spanish and English. Survey domains included patients’ perspectives on which syndromes require antibiotic treatment, their perceptions of health care, and their access to antibiotics without a prescription. Results We interviewed 190 patients, 122 from emergency departments (64%), and 68 from primary care clinics (36%). Overall, 44% reported non-prescription antibiotic use within the past 12 months. Non-prescription use was higher among primary care clinic patients (63%) than the emergency department patients (39%, p = 0.002). The majority felt that antibiotics would be needed for bronchitis (78%) while few felt antibiotics would be needed for diarrhea (30%) (Figure 1). The most common situation identified “in which respondents would consider taking antibiotics without contacting a healthcare provider was “got better by taking this antibiotic before” (Figure 2). Primary care patients were more likely to obtain antibiotics without prescription from another country than emergency department patients (27% vs. 13%, P=0.03). Also, primary care patients were more likely to report obstacles to seeking a doctor’s care, such as the inability to take time off from work or transportation difficulties, but these comparisons were not statistically significant. Figure 1. Patients’ agreement that antibiotics would be needed varied by symptom/syndrome. Figure 2. Situations that lead to non-prescription antibiotic use impacted the two clinical populations differently Conclusion Non-prescription antibiotic use is a widespread problem in the two very different healthcare systems we included in this study, although factors underlying this practice differ by patient population. Better understanding of the factors driving non-prescription antibiotic use is essential to designing patient-focused interventions to decrease this unsafe practice. Disclosures All Authors: No reported disclosures

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EMDOC (Emergency Department Overcrowding) Internet-Based Safety Net Research

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2007.03.022 ◽

2008 ◽

Vol 35 (1) ◽

pp. 101-107 ◽

Cited By ~ 18

Author(s):

Robert Steele ◽

Attilla Kiss

Keyword(s):

Emergency Department ◽

Safety Net ◽

Emergency Department Overcrowding

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973-P: Unmet Social Needs and Emergency Department Visits and Hospitalization among U.S. Safety-Net Health Center Patients with Both Diabetes and Hypertension

Diabetes ◽

10.2337/db21-973-p ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 973-P

Author(s):

ALICE YAN ◽

MUKOSO N. OZIEH ◽

ZUMIN SHI

Keyword(s):

Emergency Department ◽

Health Center ◽

Safety Net ◽

Emergency Department Visits ◽

Social Needs

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Access to care, nativity and disease management among Latinos with diabetes in a safety-net healthcare setting

AIMS Public Health ◽

10.3934/publichealth.2019.4.488 ◽

2019 ◽

Vol 6 (4) ◽

pp. 488-501 ◽

Cited By ~ 1

Author(s):

Elizabeth Burner ◽

◽

Sophie Terp ◽

Chun Nok Lam ◽

Emily Neill ◽

...

Keyword(s):

Disease Management ◽

Access To Care ◽

Healthcare Setting ◽

Safety Net

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Prior Frequent Emergency Department Use as a Predictor of Emergency Department Visits After a New Cancer Diagnosis

JCO Oncology Practice ◽

10.1200/op.20.00889 ◽

2021 ◽

pp. OP.20.00889

Author(s):

Arthur S. Hong ◽

Danh Q. Nguyen ◽

Simon Craddock Lee ◽

D. Mark Courtney ◽

John W. Sweetenham ◽

...

Keyword(s):

Emergency Department ◽

Cancer Diagnosis ◽

Negative Binomial ◽

Academic Medical Center ◽

Safety Net ◽

Emergency Department Visits ◽

Patients With Cancer ◽

Safety Net Hospital ◽

Ed Visits ◽

After Cancer

PURPOSE: To determine whether emergency department (ED) visit history prior to cancer diagnosis is associated with ED visit volume after cancer diagnosis. METHODS: This was a retrospective cohort study of adults (≥ 18 years) with an incident cancer diagnosis (excluding nonmelanoma skin cancers or leukemia) at an academic medical center between 2008 and 2018 and a safety-net hospital between 2012 and 2016. Our primary outcome was the number of ED visits in the first 6 months after cancer diagnosis, modeled using a multivariable negative binomial regression accounting for ED visit history in the 6-12 months preceding cancer diagnosis, electronic health record proxy social determinants of health, and clinical cancer-related characteristics. RESULTS: Among 35,090 patients with cancer (49% female and 50% non-White), 57% had ≥ 1 ED visit in the 6 months immediately following cancer diagnosis and 20% had ≥ 1 ED visit in the 6-12 months prior to cancer diagnosis. The strongest predictor of postdiagnosis ED visits was frequent (≥ 4) prediagnosis ED visits (adjusted incidence rate ratio [aIRR]: 3.68; 95% CI, 3.36 to 4.02). Other covariates associated with greater postdiagnosis ED use included having 1-3 prediagnosis ED visits (aIRR: 1.32; 95% CI, 1.28 to 1.36), Hispanic (aIRR: 1.12; 95% CI, 1.07 to 1.17) and Black (aIRR: 1.21; 95% CI, 1.17 to 1.25) race, homelessness (aIRR: 1.95; 95% CI, 1.73 to 2.20), advanced-stage cancer (aIRR: 1.30; 95% CI, 1.26 to 1.35), and treatment regimens including chemotherapy (aIRR: 1.44; 95% CI, 1.40 to 1.48). CONCLUSION: The strongest independent predictor for ED use after a new cancer diagnosis was frequent ED visits before cancer diagnosis. Efforts to reduce potentially avoidable ED visits among patients with cancer should consider educational initiatives that target heavy prior ED users and offer them alternative ways to seek urgent medical care.

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Reduced rate of postpartum readmissions among homeless compared with non-homeless women in New York: a population-based study using serial, cross-sectional data

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-012898 ◽

2021 ◽

pp. bmjqs-2020-012898

Author(s):

Rie Sakai-Bizmark ◽

Hiraku Kumamaru ◽

Dennys Estevez ◽

Sophia Neman ◽

Lauren E M Bedel ◽

...

Keyword(s):

Emergency Department ◽

New York ◽

Random Effect ◽

Safety Net ◽

Homeless Women ◽

Homeless Population ◽

Secondary Outcome ◽

Cross Sectional ◽

Ed Visits ◽

Income Quartile

ObjectiveTo assess differences in rates of postpartum hospitalisations among homeless women compared with non-homeless women.DesignCross-sectional secondary analysis of readmissions and emergency department (ED) utilisation among postpartum women using hierarchical regression models adjusted for age, race/ethnicity, insurance type during delivery, delivery length of stay, maternal comorbidity index score, other pregnancy complications, neonatal complications, caesarean delivery, year fixed effect and a birth hospital random effect.SettingNew York statewide inpatient and emergency department databases (2009–2014).Participants82 820 and 1 026 965 postpartum homeless and non-homeless women, respectively.Main outcome measuresPostpartum readmissions (primary outcome) and postpartum ED visits (secondary outcome) within 6 weeks after discharge date from delivery hospitalisation.ResultsHomeless women had lower rates of both postpartum readmissions (risk-adjusted rates: 1.4% vs 1.6%; adjusted OR (aOR) 0.87, 95% CI 0.75 to 1.00, p=0.048) and ED visits than non-homeless women (risk-adjusted rates: 8.1% vs 9.5%; aOR 0.83, 95% CI 0.77 to 0.90, p<0.001). A sensitivity analysis stratifying the non-homeless population by income quartile revealed significantly lower hospitalisation rates of homeless women compared with housed women in the lowest income quartile. These results were surprising due to the trend of postpartum hospitalisation rates increasing as income levels decreased.ConclusionsTwo factors likely led to lower rates of hospital readmissions among homeless women. First, barriers including lack of transportation, payment or childcare could have impeded access to postpartum inpatient and emergency care. Second, given New York State’s extensive safety net, discharge planning such as respite and sober living housing may have provided access to outpatient care and quality of life, preventing adverse health events. Additional research using outpatient data and patient perspectives is needed to recognise how the factors affect postpartum health among homeless women. These findings could aid in lowering readmissions of the housed postpartum population.

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