97 Evaluation and Diagnosis of Pulmonary Tuberculosis Among Emergency Department Patients at a Large Urban Safety-Net Hospital in Los Angeles

Abstract Im/migrants are a vulnerable population who face numerous social barriers. These barriers likely contribute to unmet social needs, which may increase avoidable health care utilization such as emergency department (ED) visits. Within an im/migrant cohort at a large urban safety-net hospital (N = 1405 patients), we describe types and levels of unmet social needs, and estimate the relationship between level of unmet social needs and ED visit rates. Food insecurity was the most prevalent reported social need (30%), followed by educational needs (29%); employment needs (19%); barriers to paying for medications (18%); lack of transportation (17%); and housing insecurity (10%). After adjusting for sociodemographic factors, having ≥ 4 unmet social needs was associated with an additional 249.47 visits/1000 im/migrant patients/year (95% CI 15.95-482.99, p-value = 0.036), relative to those with no reported needs. Our findings emphasize the importance of rigorously assessing and addressing social needs within im/migrant populations, which may narrow disparities in ED use.

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COVID-19 Pandemic and the Cholecystitis Experience at a Major Urban Safety-Net Hospital

Journal of Surgical Research ◽

10.1016/j.jss.2021.02.037 ◽

2021 ◽

Vol 264 ◽

pp. 117-123

Author(s):

Katherine F Vallès ◽

Miriam Y Neufeld ◽

Elisa Caron ◽

Sabrina E Sanchez ◽

Tejal S Brahmbhatt

Keyword(s):

Safety Net ◽

Safety Net Hospital ◽

Urban Safety

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140. Symptoms and Situations Predispose Patients to Use Antibiotics Without Medical Advice

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.450 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S200-S200

Author(s):

Michael Hansen ◽

Barbara Trautner ◽

Roger Zoorob ◽

George Germanos ◽

Osvaldo Alquicira ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Emergency Departments ◽

Primary Care Clinic ◽

Antibiotic Use ◽

Safety Net ◽

Care Clinic ◽

Primary Care Clinics ◽

Primary Care Patients ◽

Emergency Department Patients

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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Abstract 090: Armenian Ethnicity: An Independent Risk Factor for Positive Exercise Treadmill Tests

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.090 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Ara H Rostomian ◽

Daniel Sanchez ◽

Jonathan Soverow

Keyword(s):

Risk Factors ◽

Los Angeles ◽

Multivariate Logistic Regression Analysis ◽

Safety Net ◽

The United States ◽

World Health ◽

Limited Information ◽

Safety Net Hospital ◽

Exercise Treadmill ◽

History Of

Background: Several studies have examined the risk of cardiovascular disease (CVD) among larger racial and ethnic groups such as Hispanics and African-Americans in the United States, but limited information is available on smaller subgroups such as Armenians. According to the World Health Organization, Armenia ranks eighth in CVD rates among all countries however it is unclear if Armenian immigrants living in the US have the same high rates of disease. This study examined whether being of Armenian descent increased the risk of having a positive exercise treadmill test (ETT) among patients treated at a safety net hospital in Los Angeles County. Methods: Data on patients who received an ETT from 2008-2011 were used to conduct a retrospective analysis of the relationship between Armenian ethnicity and ETT result as a surrogate measure for CVD. A multivariate logistic regression analysis was used to estimate the odds ratios (OR) for having a positive ETT among Armenians relative to non-Armenians, adjusting for the following pre-specified covariates: gender, age, diabetes, hypertension, hyperlipidemia, smoking, family history of coronary artery disease (CAD), and patient history of CAD. Results: A total of 5,297 patients, ages 18 to 89, were included. Of these, 13% were Armenian and 46% were male, with an average age of 53 years. Armenians had higher odds of having a positive ETT than non-Armenians (Crude OR=1.30, p=0.037, CI:1.02,1.66). After adjusting for CV risk factors, Armenians were still significantly more likely to have a positive ETT than non-Armenians (OR=1.33, p=0.029, CI:1.03,1.71). CAD (OR 2.02, p<0.001, CI:1.38,2.96), and hyperlipidemia (OR=1.31, p=0.008, CI:1.07,1.60) were also significantly associated with a positive ETT. Conclusion: Armenians have a higher likelihood of having a positive ETT than non-Armenians. This relationship appears to be independent of traditional CV risk factors and suggests a role for cultural and/or genetic influences.

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