QOLP-26. ANALYSIS OF REDDIT USERS' PERSPECTIVES OF BRAIN TUMORS

BACKGROUND Reddit, ranking 6th in worldwide Internet site traffic, is a commonly used forum among patients and caregivers affected by brain tumors to discuss diagnoses, treatment, and self-care management. The use of the online forum may suggest patients and caregivers have unmet needs and are seeking further support outside of the clinical setting. We aimed to examine trends from Reddit discussion treads on brain tumors to identify areas of need in patient care. METHODS We used a qualitative, descriptive design to understand patient and caregivers unmet and met needs. We analyzed the top 100 posts and accompanying 271 comments from the ‘braincancer’ subreddit to identify common themes. RESULTS The qualitative content analysis revealed three major topic areas: (1) moving through the grief process; (2) processing diagnostic pathway; and (3) expressing gratitude toward other Reddit users. Most of the authors of the posts were patients with brain tumors (n = 32; 38.5%) who used Reddit as a reflective journaling tool to move through the grief process for themselves or loved ones. About 47% of theses posts discussed the diagnostic process of glioblastoma multiforme (GBM) brain tumors, where users requested an inclusive/welcoming environment in the clinic by their healthcare professionals (HPs). Users also solicited and gave support for other members in the online community. CONCLUSIONS This study highlights the need of implementing social media as a part of HPs’ repertoire for patient outreach/needs. Furthermore, social media outlets like Reddit can help HPs understand the level of support they can give to their patients. Plans of action for physicians seeking to meet the needs of brain tumor patients include monitoring the concerns of patients, becoming verified on the platform/openly identifying themselves online, or conducting ‘Ask Me Anything’ discussions to educate patients.

856. Barriers to PrEP Implementation among Patient-Facing Staff in Three Urban Clinics

Background PrEP implementation has lagged in the US. The role of multidisciplinary staff in PrEP rollout has been neglected. We sought to identify barriers to PrEP implementation among 3 urban federally qualified health centers (FQHCs) in Connecticut that provide HIV and PrEP services in order to inform development of staff training. Methods A link to an anonymous survey was emailed to patient-facing staff members or posted at the end of staff trainings October 2020-April 2021. The survey requested demographics, duration of employment, and using 4 and 5 point Likert scales, ascertained knowledge and beliefs toward PrEP based on established scales, and perceived individual and systemic barriers to PrEP uptake. Results Among 101 respondents, 40% were 36-54yo, 22% were male, 68% were non-prescribing clinicians, and median duration of employment was 6 years (IQR 2-14). Among 32 (31%) prescribers (physicians, PAs, APRNs), 97% felt comfortable discussing sexual risk with patients, though 15% were not familiar with PrEP efficacy and safety data, 28% responded that PrEP use would encourage risky behaviors, 34% were concerned about side effects, 53% responded that educational and behavioral interventions should be attempted prior to prescribing PrEP, and 59% identified lack of provider training as a barrier. Among 69 (68%) non-prescribers, barriers to PrEP uptake included: patients don’t ask for PrEP (43%), lack of insurance (47%), lack of clinic guidelines/protocol (42%), and staff time for counseling (31%). Conclusion Prescribers and non-prescribers identified distinct individual and systemic barriers to PrEP uptake at FQHCs. Among prescribers, uncertainty regarding indications for and safety of PrEP exist, which will be addressed with targeted training. Non-prescribers identified the need for patient outreach, financial assistance, and counseling as the top priorities. The input of clinic multidisciplinary team members is essential to addressing barriers to PrEP implementation. Disclosures Sheela Shenoi, MD, MPH, Merck (Other Financial or Material Support, SS’s spouse worked for Merck pharmaceuticals 1997-2007 and retains company stock in his retirement account. There is no conflict of interest, but it is included in the interest of full disclosure.)

Improving Patient Outreach by Defining Telehealth Suitability in a Tertiary Huntington’s Disease Clinic

Background: The COVID-19 pandemic has increased the need for remote healthcare options among patients with Huntington’s disease (HD). However, since not every HD patient is suitable for telehealth, it is important to differentiate who can be seen virtually from who should remain as in-person. Unfortunately, there are no clinical guidelines on how to evaluate HD patients for telehealth eligibility. Objective: To standardize the teleneurology selection process in HD by implementing a screening tool that accounts for patient-specific factors. Methods: We organized various indications and contraindications to teleneurology into a flowchart. If any indications or contraindications were met, patients were assigned to telehealth or maintained as in-person, respectively. If no indications or contraindications were met, patients were given the option of telehealth or in-person for their upcoming appointments. In two implementation cycles, we tested this screening tool among all HD patients scheduled for clinic visits, aided by chart review and phone interview. Results: In a cohort of 81 patients, telehealth acceptance among eligible patients increased from 45.0%to 83.3%. Frequency of telehealth visits increased from a pre-intervention baseline of 12.8%to 28.2%. Conclusion: Teleneurology utilization among HD patients more than doubled across our study. Our intervention promotes consistency and patient-centeredness in HD clinical care and streamlines the overall telehealth selection process. Future studies can seek to reduce telehealth no-shows and also evaluate the utility of the motor and psychiatric criteria included in our screening tool.

Identifying key roles of the pharmacy technician in primary care settings

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose As the pharmacist’s role expands, particularly in primary care practice settings, there is an opportunity for expansion of pharmacy technician duties to aid in administrative and clinical tasks that do not require the pharmacist’s professional judgment. Identifying, defining, and expanding the roles of pharmacy technicians has been deemed a key part of the pharmacy practice model. These roles have been shown to enhance pharmacist efficiency and patient outreach; however, examples of the various innovative activities performed by technicians in the primary care setting are lacking in the literature. Methods The duties of primary care pharmacist technicians were compiled and defined in 2 different healthcare systems. The role of the technician was separately implemented at each institution, and study designs and protocols were individually created and executed. One institution utilized a 4-round consensus-building process to systematically refine and codify tasks for a dictionary of duties. The second institution utilized a free-text survey, task documentation data in the electronic medical record, and a telephone discussion with the technicians. Results Despite a lack of methods- and data-sharing between the 2 institutions, similar tasks were identified, including conducting patient outreach, assisting with medication affordability and access, providing patient education, managing referrals, and scheduling appointments. Differences in technician involvement were noted in areas such as prior authorization, care coordination meetings, and quality improvement projects. Conclusion Pharmacy technicians are a helpful, yet underutilized, resource in the primary care setting. Further exploration of technician roles is needed to determine the financial and clinical impact of expanding these roles.

Vulnerable Patient Outreach Program (VPOP)

The COVID-19 pandemic has significantly disrupted many traditional patient care delivery models. To help meet patient needs, the Penn State Health Department of Family and Community Medicine started a medical student-run Vulnerable Patient Outreach Program (VPOP). This program pairs medical students with providers to address healthcare needs for the most vulnerable patients. At the program outset, a total of 125 patients were identified and 64 agreed to participate. All patients were over the age of 65 and had multiple medical comorbidities. This study reviews the impact of VPOP on the care of 34 participants. Each participant completed pre-structured satisfaction surveys over the phone. The results indicate a high degree (94%) of patient satisfaction. Patients were particularly comfortable communicating their health needs to medical students and specifically highlighted medical student professionalism. Medical students also found this program to be beneficial, citing an ability to help during pandemic times in a clinically meaningful way. The highly positive reactions from both patients and medical students suggest that outreach programs, like this one, are one way to meet the needs of vulnerable patients. These findings also suggest that, as a longitudinal experience beyond COVID-19, medical students may benefit from participation in vulnerable patient outreach programs.

A Cloud-Based Solution to Support Patient Outreach and Engagement for Chronic Disease and Preventative Care-A Retrospective Study (Preprint)

BACKGROUND Patients more actively engaged in their care have better clinical outcomes. OBJECTIVE To examine the performance of a widely adopted cloud-based patient engagement system for management of diabetes, hypertension, and preventative screenings at two large healthcare systems. METHODS We included patients with diabetes, hypertension, and those due for breast cancer screenings and/or bi-annual wellness visits and at Loudon Medical Group (LMG) in Virginia, and Basset Medical Group (BMG) in New York between 2019-2021. We examined outreach outcomes including successful contact rate (SCR), patient response rate (PRR), and adherent response rate (ARR). Associations between demographic characteristics and outcome measures were explored with Chi-square or Fisher’s exact tests. RESULTS Attempted contacts with patients with diabetes (N=2567) at LMG resulted in SCR of 87.1%, PRR of 47.2%, and ARR of 38.4%. At BMG, attempted contacts with patients with diabetes (N=3621), hypertension (N=10881), patients for breast cancer screening (N=2441), and wellness visits (N=9070) resulted in SCR values of 91.0%, 93.2%, 90.1%, and 92.1%; PRR of 57.0%, 59.8%, 50.8%, and 52.0%; and ARR of 45.2%, 39.8%, 6.8%, and 11.5% respectively. Outreach outcomes measures were significantly higher in patients with hypertension, and those carrying commercial or Medicare insurance vs. those who were self-insured or on Medicaid plans (SCR P<.0001, PRR P<.0001, and ARR P=.0013). Among diabetic patients, only SCR (P=.0008) was significantly associated with commercial or Medicare insurance. In general, rate of contact (SCR) had more favorable results as compared to the rate of follow-up visits (PRR, ARR), with higher PRR significantly associated with female sex (P<.0001), and a higher SCR seen among patients contacted by text (P<.0001). Age-stratified analysis showed that 60-69 years old diabetic patients had the highest SCR and ARR. Hypertensive patients between the ages of 70-79 had the highest SCR, PRR, and ARR. CONCLUSIONS This cloud-based patient outreach system demonstrated high rates of contact in patients with hypertension, diabetes and/or eligible for preventative screenings. Overall response rates were over 50%, with moderate adherence rates for diabetes and hypertension, but low adherence for preventative screenings. Older patients had higher adherence rates. Additional strategies are needed to translate successful patient contact into response and adherence. CLINICALTRIAL NA