Caregivers’ Satisfaction toward Under-Five Health Care Services Provided at Primary Health Care Centers in Al Karkh, Baghdad, 2020

Background: Satisfied caregivers are more likely to return for further care and to recommend the primary health care center services to others. Satisfied caregivers usually are compliant with the medical provider advice and the recommended treatment plan. Compliance will eventually lead to better health outcomes. Method: A cross-sectional study with an analytic element was conducted during the period from the beginning of July to the end of September 2020. A convenient sample was collected from six primary health care centers in Al-Karkh side of Baghdad city where caregivers who attend those centers with their children for under-five health care services were interviewed using a structured questionnaire.Objective: To measure the caregivers’ satisfaction toward under-five health care services at primary health care centers in Baghdad Al-Karkh and their association with certain socio-demographic characteristics. Results: A total of 500 caregivers were interviewed during the study period, the overall satisfaction was (64%). Caregivers were satisfied with primary health care centers cleanliness (77.8%), while they were highly dissatisfied with the communication with the nurses (78.8%), with the waiting time for a routine visit (74.6%), with nurses’ antiseptic methods (59.2%), and with the availability and adequacy of their children’s vaccines (65.4%). Conclusions: The level of satisfaction of caregivers with under-five health care services provided at primary health care centers was relatively low. The study revealed that the less educated and older caregivers showed a significant higher level of satisfaction.

Sensitivity and Positive Prediction of Secured Electrocardiograph (ECG) Transmission using Fully Homomorphic Encryption Technique (FHE)

Health connected is a technology that links medical devices, telecommunications and security techniques. It empowers patients to be observed and treated remotely from their homes. Patient’s healthcare records with a connected healthcare system should be stored securely before transmitted for further investigation and interpretation. Electrocardiogram (ECG) is the clinical method utilized to screen heart execution and utilized for the detection of various arrhythmias. For diagnostic purposes, individuals with a background of heart diseases have long records of ECGs, which results in the requirement of a large amount of storage space and labor. Hence, there is a requirement for a system that involves digital signal processing and signal security so that the spared information is made sure about at one spot and an only authentic individual can see and utilize this ECG signal for additional findings. This study presents a set of security solutions that can be deployed in a connected healthcare territory, which includes the fully homomorphic encryption (FHE) techniques used to secure the ECG signals. The study helps the medical provider to record ECG signals confidentially and to prevent mistreatment. The study focuses on Pan and Tompkins algorithm methods for the detection of the ECG Signal. As a result, the output of the Pan and Tompkins algorithm for ECG signal processing with the FHE technique shows a sensitivity of 92.59% and a positive prediction of 90.00%.

Implementing Collaborative Care Management of Behavioral Health for Patients with Inflammatory Bowel Disease

Background Individuals with inflammatory bowel disease (IBD) are up to twice as likely to suffer from anxiety and/or depression. Collaborative care management (CoCM) is an evidenced-based approach to treating behavioral health disorders that has proven effective for a range of conditions in primary care and some specialty settings. This model involves a team-based approach, with care delivered by a care manager (case reviews and behavioral therapy), psychiatrist (case reviews and psychopharmacological recommendations), and medical provider (ongoing care including psychopharmacological prescriptions). We assessed the feasibility and effectiveness of CoCM in reducing anxiety and depressive symptoms in patients with IBD. Methods Patients with psychological distress identified by clinical impression and/or the results of the Patient Health Questionaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were referred to the CoCM program. Data from our 9-month CoCM pilot were collected to assess depression and anxiety response and remission rates. We obtained provider surveys to assess provider acceptability with delivering care in this model. Results Though the coronavirus SARS-CoV2 (COVID-19) pandemic interrupted screening, 39 patients enrolled and 19 active participants completed the program. Overall, 47.4% had either a response or remission in depression, while 36.8% had response or remission in anxiety. The gastroenterologists highly agreed that the program was a beneficial resource for their patients and felt comfortable implementing the recommendations. Discussion CoCM is a potentially feasible and well accepted care delivery model for treatment of depression and anxiety in patients with IBD in a specialty gastroenterology clinic setting

Comfort and Data Sharing With Artificial Companion Robots Among an Online Cohort

Results from a June 2020 survey on comfort with two forms of artificial companion (AC) robots in normal compared with pandemic times will be presented. 1,082 adults age 21-92 (mean 64) completed the online survey for a response rate of 45%. Significantly greater comfort is reported with small AC robots relative to larger human-shaped robots in both normal and pandemic times. In bivariate and adjusted models, younger age and male gender were most commonly associated with greater comfort with AC robots. Most participants (68.7%) did not think an AC robot would make them feel less lonely. About half (52.8 %) of the participants reported that they probably or definitely would want their facial expressions to be read, while a minority (15.0%) were at least somewhat comfortable with AC robots recording their conversations. The most common person participants wanted these data types shared with is themselves, a spouse/partner, and medical provider.

Characterizing Supportive Services Use by Caregiving Relationship Status

Informal caregivers of aging older adults experience a high degree of burden and strain. These emotional experiences often stem from stressful tasks associated with caregiving. Caregiving supportive services that target the provision of support for stressful tasks are instrumental in alleviating caregiving burden and strain. Research is limited on what types of caregiving supportive services caregivers are accessing by relationship status and their source of information. We sought to characterize caregiving supportive services use by caregiving relationship status. We analyzed cross-sectional data from the 2015 National Study of Caregiving limited to caregivers of older adults □65 years. Caregiver relationship status (i.e., spouse, child, other relative/non-relative) was the independent variable. Bivariate analyses were performed to examine the association with caregiver relationship status and 1) any use of supportive services, 2) type of supportive service used among users, and 3) source of information about supportive services. Our sample consisted of 1,871 informal caregivers, 30.7% reported using supportive services. By caregiver relationship status, children had the greatest use of supportive services compared to spouses and other relatives/non-relatives (33.3% vs. 22.5% vs. 22.1%, p=.02, respectively). Among users of services, there were no differences in type of services used. Spouses primarily received their information about services from a medical provider or social worker (73.8%, p=.004). Our findings highlight the need to ensure that other caregiving groups such as spouses have access to important supportive services such as financial support. Medical providers and/or social workers should be better leveraged and equipped to provide this information.

Responsive Medical Providers and Recent HIV Medical Services Engagement Among Transgender Women and Cisgender Men Who Have Sex With Men in the Philippines

Transgender women and cisgender men who have sex with men (trans-WSM and cis-MSM) comprise the majority of new HIV infections in the Philippines. There is limited research in the Philippines on the relationship between having a provider responsive to the needs of these populations and recent engagement in HIV medical services such as HIV testing and treatment. We used multivariate logistic regression to examine the relationship between having a responsive medical provider and engagement in HIV medical services in the past 12 months among an online sample of 318 trans-WSM and cis-MSM in the Philippines. Participants without a responsive medical provider had lower adjusted odds of recent HIV medical service engagement than those who did (aOR = 0.32, 95% CI [0.16, 0.62], p = .00). In stratified analyses, this relationship was significant for trans-WSM but not cis-MSM. Increasing access to responsive providers in the Philippines could bolster recent engagement with HIV medical services.

742. Evaluation of Chagas Disease Diagnostic Testing Practices in Four Hospital Systems in California and Texas

Background Chagas disease (CD) is a neglected parasitic disease that affects >6 million people in the Americas, including >200,000 people in the United States (US). Medical provider knowledge of CD is key to decreasing morbidity and transmission; however, few studies have assessed diagnostic practices in US health systems serving at-risk patients. Our study aimed to describe existing provider approaches to diagnosing CD in California and Texas. Methods Site-based research teams at four hospital systems (the University of California [UC] San Francisco [UCSF], San Diego [UCSD], Irvine [UCI], and the Harris Health System [HHS] in Houston, TX) retrospectively identified patients ≥18 years old tested for CD between 2016-2019 and systematically extracted electronic medical record data using complementary electronic data entry forms. Specifically, eligible patients were identified using laboratory orders at UCSF and UCI, while the remaining sites employed SlicerDicer (Epic Systems). This study was approved by institutional review boards at each site. Results We identified 333 patients tested for CD, including 109 from UCSF, 88 from UCSD, 25 from UCI, and 111 from HHS. These patients had 125, 99, 31, and 181 tests sent to commercial laboratories, respectively. Test reactivity varied by system with the greatest percent reactivity among tests ordered at UCI (23%) followed by UCSD (16%), HHS (15%), and UCSF (10%). Among patients who screened positive for CD by commercial assays, confirmatory testing through the Centers for Disease Control and Prevention was sought for 100% at UCI; 59% at HHS, 55% at UCSF, and 40% at UCSD. The medical specialty that most often ordered CD testing was Cardiology at all UC sites (UCSF, 50%; UCSF, 55%; UCI, 35%) and Internal Medicine at HHS (46%; Cardiology ordered 13%). Only one recorded CD test was ordered by an Obstetrics/Gynecology service at any site. Conclusion These early results report positivity rates between our healthcare systems and demonstrate inconsistency in attaining recommended confirmatory testing, as well as a paucity of CD testing ordered through Obstetrics/Gynecology despite risk of congenital transmission. These findings suggest areas of opportunity to improve provider awareness and lay a foundation for standardizing CD diagnostic practices in the US. Disclosures Caryn Bern, MD, MPH, UpToDate (Wolters Kluwer) (Other Financial or Material Support, Author Royalties)

07. Recombinant Zoster Vaccine (RZV) Second-Dose Completion in Adults Age 50‒64 Years in the United States

Background In 2018, CDC recommended a highly efficacious adjuvanted recombinant zoster vaccine (RZV, Shingrix) as a 2-dose series for prevention of herpes zoster (HZ) for immunocompetent persons age ≥50 years, with the 2nd dose recommended 2–6 months after the 1st dose. Among Medicare beneficiaries, 2-dose series completion 6 months and 12 months post initiation was 78% and 86%, respectively. Here we estimate the proportion of adults age 50–64 years who completed the 2-dose RZV series within 6 or 12 months after receiving their 1st dose, by using two administrative claims databases. Methods We used medical and pharmaceutical claims data from October 2017‒March 2020 IQVIA® PharMetrics Plus and October 2017‒October 2020 IBM® MarketScan® databases. RZV vaccination was defined using Current Procedural Terminology and National Drug Codes. We allowed for sufficient follow-up time by examining 1st doses given at least 6 or 12 months prior to the end of the study period in both databases. Place of administration was available in IQVIA data. Results Among persons age 50‒64 years, in IQVIA and MarketScan, 70% and 68% received their 2nd RZV dose within 6 months, respectively, and 79% and 81% received their 2nd dose within 12 months, respectively. The median age of 1st dose of RZV vaccination was 60 years and ~60% were female [Table 1]. When the 2nd dose was administered within 12 months, the median interval between 1st and 2nd doses was 104 and 98 days in the IQVIA and MarketScan databases, respectively. Characteristics by age, sex, or region were similar in persons who received 1 RZV dose vs. 2 RZV doses [Table 1]. Among those who received only 1 RZV dose with at least 12 months of follow-up time, 55% of vaccinations occurred at ambulatory medical provider offices and 40% at pharmacies; among 2 doses recipients, 33% of vaccinations occurred at provider offices and 62% at pharmacies. Conclusion Among 50‒64-year-olds, 2-dose RZV series completion was ~70% within 6 months and 80% within 12 months of initiation. The findings were similar across two administrative claims databases. Availability of RZV at pharmacies has potentially helped to increase RZV 2nd dose completion rates. Disclosures All Authors: No reported disclosures

The influence of COVID-19 on healthcare seeking behaviors among students attending a minority-serving institution: A cross-sectional study (Preprint)

BACKGROUND COVID-19 may influence healthcare seeking behaviors among university students due to their beliefs about the virus, disruptions in access to care, or both. This has not been studied among university students, particularly those attending a minority-serving institution (MSI). OBJECTIVE To examine the effects of COVID-19 on healthcare seeking behaviors among students attending an MSI. METHODS An online survey was sent to all registered students at a public MSI between February and March 2021. Frequency of in-person and virtual contacts with a healthcare professional across a sample of months in 2019 and 2020 were compared using Wilcoxon Signed Rank Tests. RESULTS Approximately 52.5% reported no in-person visits during the pandemic compared to 47.8% pre-pandemic (Z = -1.800, P = .07). Approximately 47.7% reported no virtual contact during the pandemic compared to 77.5% reporting no virtual contact with a medical provider pre-pandemic (Z = 11.011, P < .001). When in-person and virtual contacts were combined, 43.5% of respondents reported no virtual or in-person contact with medical providers pre-pandemic compared with 34.1% during the pandemic (Z = 3.918, P <.001). CONCLUSIONS Among university students attending a public MSI, in-person visits and contact with their respective healthcare providers decreased during the current COVID-19 pandemic. These results are of particular importance given the relationship between seeking healthcare and the maintenance of health behaviors.