Assessment of community pharmacists’ communication and comfort levels when interacting with Deaf and hard of hearing patients

Background: Deaf and hard of hearing patients who use sign language face considerable communication barriers while accessing pharmacy services. Low comfort-levels between community pharmacists and Deaf and hard of hearing patients result in poor interactions and increase patient safety risks. Objective: 1) To examine the way community pharmacists interact with Deaf and hard of hearing patients in Malaysia, and their level of comfort in such interactions. 2) To examine how comfort-levels vary by the preferred communication methods, resources and employer support. Methods: This cross-sectional study was conducted among registered community pharmacists practicing in Malaysia. Questionnaire items included comfort-levels of community pharmacists when interacting with Deaf and hard of hearing patients, used and preferred communication methods, necessary resources, and perceived employer’s level of support. Based on the list of registered pharmacies, the questionnaire with a pre-paid return envelope was mailed out while pharmacies close to the university were approached in person. This questionnaire was distributed online using Google Form. Comparisons between comfort-levels and study parameters were analyzed using independent t-tests and ANOVA. Results: A total of 297 community pharmacists responded (response rate 29.2%). Higher comfort-levels were reported in those who had received between 1 to 5 prescriptions as compared to those who did not receive prescriptions from Deaf and hard of hearing patients (MD= -0.257, SD=0.104, p=0.042). More than 80% used written information and only 3.4% had used the services of a qualified sign language interpreter throughout their community pharmacist career. Significantly lower comfort-levels (p=0.0004) were reported in community pharmacists who perceived training in sign language as a necessity to interact with Deaf and hard of hearing patients (M=3.6, SD=0.9) versus those who were not interested in sign language training (M=3.8, SD=0.6). Conclusions: The results suggest that community pharmacists were neither extremely comfortable nor averse when interacting with Deaf and hard of hearing patients. The lack of significant findings in terms of comfort-levels may indicate other potential drivers for their choice of communication method when interacting with Deaf and hard of hearing patients.

P005 Rheumatology virtual clinics during COVID-19: are our patients satisfied?

Background/Aims Telemedicine can be broadly defined as the use of telecommunication technologies to provide medical information and services. It can be audio, visual, or text. Its use has increased dramatically during the COVID-19 pandemic to ensure patient and healthcare worker safety. Any healthcare professional can engage with it. It carries benefits like reduced stress and expense of traveling, maintenance of social distancing, and reduced risk of infection. There are some potential drawbacks such as lack of physical examination, liability and technological issues. Methods A questionnaire was sent to 200 patients, selected from different virtual clinics (new and review, doctor and ANP led) run between March and May 2020 in the rheumatology department of University Hospital Waterford. We formulated 14 questions to cover the following aspects: demography, the purpose of the consult, punctuality, feedback, medico-legal concerns, and free text for comments. A self-addressed return envelope was included. Results 83 responses were received. 2 were excluded. The ratio of females to male respondents was 59: 41, with the majority over 60 years old. The main appointment type was review 67 (83%). 80% of patients were called either before or at the time of their scheduled appointment. The vast majority (98.8%) of our patients had confidence in our data protection and trusted our system to maintain their confidentiality. 95% stated that they felt comfortable, were given enough time to explain their health problem and felt free from stress. The respondents who preferred attending the clinic in person (17 in total) compared to the virtual were mostly follow up patients- 12 vs. 5 new. Conclusion Patient satisfaction among those surveyed was high, despite having to introduce the service abruptly during the COVID-19 pandemic. There are many improvements we can adopt to improve our service and even maintain after the pandemic as a way of communicating with our stable patients. As we are covering a large geographical catchment, we can continue to implement the virtual clinic for some appointments. We should prioritize our efforts on identifying the right patient and the type of service we can offer, further training of staff, and increasing awareness of the patients as to how to get the most out of a virtual appointment. Disclosure F.A. Altamimi: None. U. Martin: None. C. Sheehy: None.

Determinants of Rejected Mail Ballots in Georgia’s 2018 General Election

Because of the COVID-19 threat to in-person voting in the November 2020 election, state and local election officials have pivoted to mail-in voting as a potential solution. This method of voting—while safe from a public health standpoint—comes with its own set of problems, as increased use of mail voting risks amplifying existing discrepancies in rejected mail ballots. While some mail ballot rejections are to be expected, a lack of uniformity in whose ballots get rejected among subgroups of voters—whether for mistakes on a ballot return envelope (BRE) or lateness—raise concerns about equal representation. We draw on official statewide voter file and mail-in ballot data from the 2018 midterm election in Georgia, a state that until the pandemic did not have widespread use of mail voting, to test whether some voters are more likely to cast a mail ballot that does not count. Most importantly, we distinguish between ballots rejected for lateness and those rejected for a mistake on the return envelope. We find that newly registered, young, and minority voters have higher rejection rates compared with their counterparts.

Public perceptions and experiences of the minor ailment service in community pharmacy in Scotland

Background: The Minor Ailment Service (MAS) in Scottish community pharmacy allows eligible people to gain improved access to care by providing free treatment for self-limiting conditions. Objective: To determine the perceptions and experiences of individuals using MAS and to quantify the potential impact on usage of other healthcare services. Methods: A cross-sectional survey was conducted of patients accessing MAS across Scotland during June and July 2018. Questionnaire items included reasons for choosing treatment through MAS, which other services they may have accessed had MAS not been available, experiences of consultation, overall satisfaction, and perceived effectiveness of treatment. Those accessing MAS were given a study pack including an information sheet, pre-piloted questionnaire, and pre-paid return envelope. Participants had the option to consent to an optional one-week follow up questionnaire that focused on perceived effectiveness of treatment after seven days and any further access to healthcare services such as general practice, emergency departments or repeat pharmacy visits. Results: There were 1,121 respondents to the initial questionnaire. Most reported ‘convenient Location’ as the main reason for their access to community pharmacy (n=748; 67.1%). If MAS had not been available, 59% (n=655) of participants reported that they would have accessed general practice for treatment of their minor ailment. Experience of consultations was also rated highly with all ten outcome measures scoring ‘Excellent’ overall. Satisfaction was reported positively with most participants reporting full satisfaction with the overall experience (n=960; 87.2%). At one-week follow up, 327 participants responded, over 85% (n=281) did not require further access to care to treat their minor ailment and 99.7% (n=326) said they would use MAS again. Conclusions: Positive perceptions and experiences of those using MAS demonstrate a highly regarded service in terms of satisfaction and experience of consultation. The capacity for MAS to impact on the use of higher-cost healthcare services is evidenced through the number of participants who reported these services as a point of access to care should community pharmacy not be available. This national evaluation demonstrates MAS to be a positively experienced service and outlines the factors determining access for treatment of minor ailments.

Reflextherapy in Healthcare – Reflection on Audit Result and Employment of Therapy

An article was published in 20141 reporting on an audit of the Membership of the Association of Chartered Physiotherapists in Reflextherapy (ACPIRT). This article reflects on the outcome of the audit in the context of a treatment tool in physiotherapy and allied health professions in the United Kingdom and abroad. Background: ACPIRT was established in 1992 by Christine Jones, physiotherapist, and associated colleagues to provide a clinical interest group for physiotherapists and allied health professionals practising reflextherapy (RT), a manual therapy applied to the feet (or hands) similar and akin to reflexology. The audit was carried out in 2009 to establish a professional profile of members and to document their clinical experiences in using RT in healthcare. Methodology: 161 ACPIRT members were sent a postal questionnaire (including a stamped return envelope) regarding their experience using RT treating patients in the NHS and/or in private practice. One hundred (62%) members responded. A pilot study was carried out prior to the main enquiry including 14 ACPIRT committee members. Their results were included in the final audit result. Aims: i) To describe members’ demographics, work environments and opinions of the value of RT in healthcare. ii) To describe the historical background and development of RT to become an accepted therapeutic intervention by the Chartered Society of Physiotherapy. Results: Sixty-eight respondents (68%) considered RT ‘very good’, ‘good’ and ‘as good as’ orthodox physiotherapy. Fifty-eight respondents (58%) thought RT had a 25% placebo effect. No one considered RT to have a 100% placebo effect. Overwhelmingly, 95 respondents (95%) reported ‘relaxation’, ‘reduced stress’ and ‘reduced pain’ as main benefits of the treatment. A few respondents reported ‘increased fertility’, ‘improved bowel function’ and ‘reduced appetite’. Comments were made on the future of RT and recommendation for a Foundation Course. The results showed a mature, highly experienced professional membership with a female gender bias.

Winter cancellations of elective surgical procedures in the UK: a questionnaire survey of patients on the economic and psychological impact

ObjectivesTo quantify the economic and psychological impact of the cancellation of operations due to winter pressures on patients, their families and the economy.DesignThis questionnaire study was designed with the help of patient groups. Data were collected on the economic and financial burden of cancellations. Emotions were also quantified on a 5-point Likert scale.SettingFive NHS Hospital Trusts in the East Midlands region of England.ParticipantsWe identified 796 participants who had their elective operations cancelled between 1 November 2017 and 31 March 2018 and received responses from 339 (43%) participants.InterventionsParticipants were posted a modified version of a validated quality of life questionnaire with a prepaid return envelope.Main outcome measuresThe primary outcome measures were the financial and psychological impact of the cancellation of elective surgery on patients and their families.ResultsOf the 339 respondents, 163 (48%) were aged <65 years, with 111 (68%) being in employment. Sixty-six (19%) participants had their operations cancelled on the day. Only 69 (62%) of working adults were able to return to work during the time scheduled for their operation, with a mean loss of 5 working days (SD 10). Additional working days were lost subsequently by 60 (54%) participants (mean 7 days (SD 10)). Family members of 111 (33%) participants required additional time off work (mean 5 days (SD 7)). Over 30% of participants reported extreme levels of sadness, disappointment, anger, frustration and stress. At least moderate concern about continued symptoms was reported by 234 (70%) participants, and 193 (59%) participants reported at least moderate concern about their deteriorating condition.ConclusionsThe cancellation of elective surgery during the winter had an adverse impact on patients and the economy, including days of work lost and health-related anxiety. We recommend better planning, and provision of more notice and better support to patients.

Follow-up in patients with a burn-related emergency department visit: a feasibility study

Background Data on epidemiology, costs, and outcomes of burn-related injuries presenting at emergency departments (EDs) are scarce. To obtain such information, a questionnaire study with an adequate response rate is imperative. There is evidence that optimized strategies can increase patient participation. However, it is unclear whether this applies to burn patients in an ED setting. The objective of this feasibility study was to optimize and evaluate patient recruitment strategy and follow-up methods in patients with burn injuries presenting at EDs. Methods In a prospective cohort study with a 6-month follow-up, patients with burn-related injuries attending two large EDs during a 3-month study period were included. Eligible patients were quasi-randomly allocated to a standard or optimized recruitment strategy by week of the ED visit. The standard recruitment strategy consisted of an invitation letter to participate, an informed consent form, a questionnaire, and a franked return envelope. The optimized recruitment strategy was complemented by a stamped returned envelope, monetary incentive, sending a second copy of the questionnaire, and a reminder by telephone in non-responders. Response rates were calculated, and questionnaires were used to assess treatment, costs, and health-related quality of life. Results A total of 87 patients were included of which 85 were eligible for the follow-up study. There was a higher response rate at 2 months in the optimized versus the standard recruitment strategy (43.6% vs. 20.0%; OR = 3.1 (95% CI 1.1–8.8)), although overall response is low. Non-response analyses showed no significant differences in patient, burn injury or treatment characteristics between responders versus non-responders. Conclusions This study demonstrated that response rates can be increased with an optimized, but more labor-intensive recruitment strategy, although further optimization of recruitment and follow-up is needed. It is feasible to assess epidemiology, treatment, and costs after burn-related ED contacts.

2300

OBJECTIVES/SPECIFIC AIMS: To study the rate of recruitment to the Pulmonary Research Registry (PRR) at the University of Chicago using HealtheRx recruitment Versus usual practice. METHODS/STUDY POPULATION: CommunityRx is a health information technology, integrated with electronic medical record (EMR) platforms, that generates personalized referrals (“HealtheRxs”) for community-based programs and services that address basic and other health-related self-care needs. The target population included people ages 18 and older, English speaking, living in 1 of 16 ZIP codes on Chicago’s south and west sides (106 mi2) who received care at ≥1 of 28 CommunityRx partner sites and had a diagnosis of asthma or COPD. Between December 2015 and December 2016, information about pulmonary research participation opportunities was included on the HealtheRxs of eligible patients contemporaneously with usual registry recruitment methods. Usual methods, used since 2010 by the PRR group, included public advertisements requiring the patient to call the research team for more information and education of eligible patients identified during routine clinical care with a Pulmonary/Critical Care clinician or when enrolling in a pulmonary clinical trial. We hypothesized that, compared with usual recruitment practices, the HealtheRx recruitment strategy would increase the rate and decrease the per subject cost of patient recruitment to a prospective registry. Total annual recruitment costs for each method were calculated and divided by the number of consented PRR enrollees per method. RESULTS/ANTICIPATED RESULTS: Between December 22, 2015 and December 15, 2016 13,437 HealtheRxs (8762 for asthma, 3842 for COPD, and 833 for both asthma and COPD) were generated with the recruitment advertisement. In total, 41 patients responded to the ad and participated in the phone survey. In which 15 (36.5%) participants self-reported a diagnosis of asthma only (65% of all HealtheRxs with advertisement were for asthma only), 9 (22%) reported a diagnosis of COPD only (28.5% of all HealtheRxs with advertisement were for COPD only), and 17 (41.5%) reported diagnoses of both asthma and COPD (6.2% of all HealtheRxs with advertisement were for asthma and COPD). Most participants were female (n=28), non-Hispanic black (n=37), and not employed (n=39). The median age was 57. The majority (n=31) had never participated in health or medical research and was not aware of current opportunities to participate in research (n=25). All 41 participants expressed interest in joining PRR and were mailed a blank PRR consent form and a prepaid return envelope with their incentive check for the telephone survey. To date, 5 participants returned a signed consent form via mail and were enrolled in PRR. During the same period, 4 patients enrolled in PRR via usual recruitment methods. The cost per subject to enroll in PRR was $364.40 using the HealtheRx recruitment and $4590 using usual practice. DISCUSSION/SIGNIFICANCE OF IMPACT: NIH has called for innovation in research recruitment methodologies to increase enrollment especially of people who are under-represented in clinical trials research. This study demonstrates the feasibility and efficiency of using an EMR-integrated recruitment method to enroll people of under-represented minority groups to a research registry.

Non-Medical Use of Cognitive Enhancing Prescription Medications Among Occupational Therapy and Speech Language Pathology Health Care Students: A Pilot Study

Purpose: This research was designed to serve as a pilot study to generate baseline data on non-medical use of prescription drugs (NMUPD) for cognitive/academic enhancement purposes among students representing two healthcare professions, Occupational Therapy (OT) and Speech Language Pathology (SLP) and to assess students’ opinions regarding whether use of these medications constitutes academic “cheating.” Introduction: NMUPD, such as Adderall ® or Ritalin ®, to reduce fatigue, improve memory, and increase concentration to ultimately improve grades has increased among college students in recent years, with estimated use put as high as 35% on some campuses. These drugs appear to be readily available to those not prescribed them, with primary sources including family, friends, and classmates. Aside from health concerns stemming from ingesting non-prescribed medications is the ethical concern whether use of such cognitive enhancers is “cheating.” Methods: Following IRB approval, 150 OT and 150 SLP students, randomly selected from membership in their respective national associations, were mailed survey packets containing a cover letter, questionnaire, and return envelope. Results: A total of 51 completed surveys, including 25 OT and 26 SLP students, were returned and included in analyses. Of these, five (9.8%) reported using cognitive enhancing prescription medications. Four of these reported having a legal prescription, including one who admitted faking symptoms of ADHD to access the prescription. The fifth student had no prescription. Motives included recreational enjoyment, to improve attention/concentration, reduce hyperactivity/impulsivity, and to obtain higher grades. Four out of ten students indicated abuse of prescription medications was a problem at their institutions, with three out of ten believing it was easy to obtain such drugs. Students were visibly divided as to whether use of these medications was academic cheating. Conclusions: The percent of these healthcare profession students reporting to have used non-prescribed medications for academic enhancement purposes mirrors that of studies on the general college student population and reflects the division as to whether use constitutes cheating. As the survey is a self-report, the numbers using the prescription medications may be higher. Results indicate future research on NMUPD among healthcare students is warranted, along with a need to educate students on the risks of use of these medications for non-prescribed purposes.

Decision-making criteria in tactical make-or-buy issues: an empirical analysis

Purpose – The purpose of this paper is to seek to contribute to the assessment of the impact of a number of decision-making criteria in resolving tactical make-or-buy issues in enterprises operating in Greece. Moreover, it sheds light on the relationship between the impact of each criterion and a number of independent variables. Design/methodology/approach – Initially, depth interviews were made with purchasing managers in ten industrial firms operating in Greece. The findings of these interviews and the review of the pertinent literature provided the basis for the questionnaire design. Then, a copy of the questionnaire and a prepaid self-addressed return envelope were mailed to a stratified sample of 300 industrial firms operating in Greece. By the end of this process, 85 questionnaires were received, representing a 28.3 percent response rate. Findings – Cost and quality appear to be the criteria with the most impact, which indicates that companies usually resolve tactical make-or-buy issues in order to achieve short-term cost savings or operational advantage. The emphasis placed upon the other criteria tends to vary with the situation under which the particular make-or-buy issue is resolved. Originality/value – It develops a more precise assessment of the impact of each make-or-buy decision-making criterion and investigates the relationship between this impact and a number of independent variables.