scholarly journals Implementing a Data to Care Strategy to Improve Health Outcomes for People With HIV: A Report From the Care and Prevention in the United States Demonstration Project

2018 ◽  
Vol 133 (2_suppl) ◽  
pp. 60S-74S ◽  
Author(s):  
Patricia Sweeney ◽  
Tamika Hoyte ◽  
Mesfin S. Mulatu ◽  
Jacquelyn Bickham ◽  
Antoine D. Brantley ◽  
...  
Keyword(s):  
United States ◽  
Health Outcomes ◽  
Medical Care ◽  
Treatment Adherence ◽  
Viral Suppression ◽  
The United States ◽  
Health Departments ◽  
State Health ◽  
Improve Health

Objectives: The Care and Prevention in the United States Demonstration Project included implementation of a Data to Care strategy using surveillance and other data to (1) identify people with HIV infection in need of HIV medical care or other services and (2) facilitate linkages to those services to improve health outcomes. We present the experiences of 4 state health departments: Illinois, Louisiana, Tennessee, and Virginia. Methods: The 4 state health departments used multiple databases to generate listings of people with diagnosed HIV infection (PWH) who were presumed not to be in HIV medical care or who had difficulty maintaining viral suppression from October 1, 2013, through September 29, 2016. Each health department prioritized the listings (eg, by length of time not in care, by viral load), reviewed them for accuracy, and then disseminated the listings to staff members to link PWH to HIV care and services. Results: Of 16 391 PWH presumed not to be in HIV medical care, 9852 (60.1%) were selected for follow-up; of those, 4164 (42.3%) were contacted, and of those, 1479 (35.5%) were confirmed to be not in care. Of 794 (53.7%) PWH who accepted services, 694 (87.4%) were linked to HIV medical care. The Louisiana Department of Health also identified 1559 PWH as not virally suppressed, 764 (49.0%) of whom were eligible for follow-up. Of the 764 PWH who were eligible for follow-up, 434 (56.8%) were contacted, of whom 269 (62.0%) had treatment adherence issues. Of 153 PWH who received treatment adherence services, 104 (68.0%) showed substantial improvement in viral suppression. Conclusions: The 4 health departments established procedures for using surveillance and other data to improve linkage to HIV medical care and health outcomes for PWH. To be effective, health departments had to enhance coordination among surveillance, care programs, and providers; develop mechanisms to share data; and address limitations in data systems and data quality.

scholarly journals SAT-472 An Atypical Presentation of Severe Hypothyroidism, a Case of Large Posterior Pericardial Effusion Without Hemodynamic Compromise

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Paola Andrea Sanchez Garay ◽  
Daniele Restifo ◽  
Swathi Rao ◽  
Diana Espinoza ◽  
Madalina Liliana Ionescu ◽  
...  
Keyword(s):  
United States ◽  
Pericardial Effusion ◽  
Medical Care ◽  
Chronic Diseases ◽  
Social Services ◽  
Laboratory Data ◽  
The United States ◽  
Healthcare Outcomes ◽  
Large Pericardial Effusion

Abstract BACKGROUND We are reporting a case of a Hispanic female who presented with a pericardial effusion as a complication of hypothyroidism, untreated due to lack of medical care, which demonstrates health disparities in chronic diseases. CLINICAL CASE The patient is a 48 year-old Hispanic female with PMHx of hypothyroidism, non-compliant with medical therapy, who presented to the ED with fatigue and dyspnea. Despite progressively worsening symptoms for the past 4 months, she had refused to be seen by a physician because she was uninsured. Her physical exam was notable for generalized pallor and bradycardia, with otherwise normal cardiopulmonary exam. Her initial laboratory data showed hemoglobin of 5.5 g/dl. CXR demonstrated an enlarged cardiac silhouette, which on CT was found to represent a large pericardial effusion. On admission her laboratory data demonstrated low ferritin, TSH of 94 mIU/L and T4 of 1.4 mcg/dl. m. Cortisol was 9 mcg/dl at 11 am. Repeat hemoglobin post-transfusion was 9 g/dl The patient was started on IV levothyroxine and hydrocortisone. Echocardiogram showed a large posterior wall pericardial effusion without evidence of RV strain. Pericardiocentesis was attempted but was unsuccessful because of difficult access to the fluid location. She was discharged on levothyroxine 88mcg QD and recommended to follow up with endocrinology and cardiology as an outpatient. It is well known that the United States spends a disproportionate amount of money in healthcare in comparison to developing countries (1). Underinvestment in social services and high prices set by pharmaceutical companies are likely contributing factors (1). Unfortunately, the resulting outcomes do not necessarily reflect the spending. Minorities are well known to have a higher morbidity and mortality as well as to present more frequently with dramatic manifestations of chronic diseases. This can often be attributed to a lack of access to medical care and poor follow up. Our patient was diagnosed with pericardial effusion as a complication of untreated hypothyroidism, a condition that is underdiagnosed despite a high incidence (3-37%). This pericardial effusion was initially concerning due to its large volume. The fact that she was hemodynamically stable reflects its chronicity, but it could have led to a fatal complication if she continued without appropriate therapy for a longer period of time. CONCLUSION A case such as this should make us question what more we can do to improve healthcare outcomes for minorities in the USA. REFERENCES (1). Papanicolas, Irene, Liana R. Woskie, and Ashish K. Jha. “Health care spending in the United States and other high-income countries.” Jama 319.10 (2018): 1024-1039.

820 Transgender Patients with Assault by Burn

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S249-S249
Author(s):  
Uriel J Sanchez ◽  
Clifford C Sheckter ◽  
Yvonne L Karanas
Keyword(s):  
United States ◽  
Medical Care ◽  
Partner Violence ◽  
Public Awareness ◽  
Total Body Surface Area ◽  
The United States ◽  
Care Providers ◽  
Burn Care ◽  
Major Burn

Abstract Introduction The transgender population is estimated at 25 million worldwide and 1 million in the United States. Transgender individuals or those experiencing gender dysphoria are at a higher risk of intimate partner violence and assault (60%) as well as suicide (40%), with reports of 18 transgender individuals killed this year alone in the United States. Trauma and burn care providers need to be aware of this population’s unique medical and surgical needs. To our knowledge, we describe the first reports of burn injuries in transgender patients. Methods We performed a retrospective review of all transgender or gender dysphoric patients admitted to a regional burn center from 2010 to 2019 with a major burn diagnosis (>20% total body surface area). Patients were identified by International Classification of Disease codes in addition to self-identification at time of admission. We describe the mechanism of injury, circumstances surrounding the incident, hospital course, disposition at discharge, and outcomes in clinic follow up. Results The cohort consisted of two patients who were transgender females (i.e. born biologic male and identified as female), aged 31 and 36. Both patients were homeless and had histories of substance abuse and mental health issues. The burn sizes were 20% and 80% and both were flame injuries. One was injured by her domestic partner. The other was injured in a tent fire from a camping stove. The 20% TBSA patient underwent 3 surgeries and was discharged to medical respite on PBD #55. The 80% TBSA patient underwent 9 surgeries and was discharged to inpatient rehabilitation on PBD #75. Regarding their transgender medical care, neither patient was actively being treated by a medical professional although they both reported taking estrogens. Neither patient had undergone transgender surgery. Hormone therapy was not continued during their hospital stay due to lack of information surrounding prior use and limited knowledge regarding the safety of hormonal therapy during burn treatment. Both patients were initially lost to follow up but subsequently reentered our health care system. Both patients have since been referred to our county transgender clinic and are now actively followed by a transgender provider. Conclusions Transgender patients are at high risk for violence and assault, which includes burn. These patients are more difficult to identify and may have inadequate transgender medical care. Burn providers of all levels should be aware of the unique needs of this population and involve transgender medical providers in the acute and rehabilitative care when feasible. Applicability of Research to Practice Raise public awareness regarding assault by burn in the transgender population.

scholarly journals Post-disaster Surveillance among State Health Departments in the United States

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Erin Simms ◽  
Amy Wolkin ◽  
Ekta Choudhary ◽  
Robert Mathes ◽  
Michael Heumann ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Health Departments ◽  
State Health ◽  
Post Disaster

Resurgence of Acute Rheumatic Fever

PEDIATRICS ◽  
1989 ◽  
Vol 84 (3) ◽  
pp. 585-586
Author(s):  
RAE-ELLEN W. KAVEY ◽  
EDWARD L. KAPLAN
Keyword(s):  
United States ◽  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
The United States ◽  
Health Departments ◽  
State Health ◽  
The Past ◽  
Medical Centers ◽  
Military Populations

Between February 1987 and September 1988, there were eight published reports of outbreaks or increases of acute rheumatic fever cases in civilian as well as in military populations in the United States. This is a change from the past decade. Because rheumatic fever is no longer a reportable disease to local or state health departments, we thought it important to attempt to ascertain the extent of this middle 1980s resurgence. We contacted 56 physicians by telephone, all of them pediatric cardiologists. Essentially, all practice in large referral medical centers.

scholarly journals Sexual risk behaviour and viral suppression among HIV-infected adults receiving medical care in the United States

AIDS ◽  
2014 ◽  
Vol 28 (8) ◽  
pp. 1203-1211 ◽  
Author(s):  
Christine L. Mattson ◽  
Mark Freedman ◽  
Jennifer L. Fagan ◽  
Emma L. Frazier ◽  
Linda Beer ◽  
...  
Keyword(s):  
United States ◽  
Medical Care ◽  
Sexual Risk ◽  
Viral Suppression ◽  
Risk Behaviour ◽  
The United States ◽  
Sexual Risk Behaviour
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