Difficulty accessing supervised consumption services during the COVID-19 pandemic among people who use drugs in Vancouver, Canada.

BACKGROUND: The overdose crisis in Canada has worsened since the emergence of the COVID-19 pandemic. Although this trend is thought to be driven in part by closures or reduced capacity of supervised consumption services (SCS), little is known about the factors that may impede access to such services during the COVID-19 pandemic among people who use drugs. This study sought to characterize the prevalence and correlates of having difficulty accessing SCS during the COVID-19 pandemic among people who use drugs in Vancouver, Canada. METHODS: Cross-sectional data from two open prospective cohorts of people who use drugs were collected via phone or videoconferencing interviews conducted between July 2020 and November 2020. Multivariable logistic regression analyses were used to examine factors associated with experiencing difficulty accessing SCS. RESULTS: Among the 428 people who use drugs who participated in the study, 223 (54.7%) self-identified as men and the median age was 51 years (1st to 3rd quartile: 42-58). A total of 58 (13.6%) participants reported experiencing difficulty accessing SCS. In a multivariable analysis, factors positively associated with difficulty accessing SCS included daily crystal methamphetamine use (Adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI] 1.28-5.30), active injection drug use (AOR = 4.06; 95% CI 1.38-11.90), recent non-fatal overdose (AOR = 2.45; 95% CI 1.24-4.85), and unstable housing (AOR = 2.14; 95% CI 1.08-4.23). Age was inversely associated with the outcome (AOR = 0.96; 95% CI 0.93-0.99) in multivariable analyses. The most commonly reported reasons for experiencing difficulty accessing SCS were: COVID-19-related site closure or shortened hours (42.9%) and having to wait too long to use a site (39.3%). CONCLUSIONS: We found that people who use drugs with markers of structural vulnerability and drug-related risk were more likely to experience difficulty accessing SCS during the COVID-19 pandemic. These findings point to the need for strategies to support access to such services as part of pandemic response efforts.

A Multidisciplinary Consensus Recommendation on a Synoptic Radiation Treatment Summary: A Commission on Cancer Workgroup Report.

PURPOSE: The radiation treatment summary provides a clinical and technical overview of a patient's full course of radiation therapy. Despite its importance to multiple stakeholders, there is no widely followed radiation treatment summary template. METHODS AND MATERIALS: The Commission on Cancer convened a multistakeholder workgroup to develop a synoptic radiation treatment summary template. The workgroup included individuals with expertise in radiation, medical and surgical oncology, medical physics, oncology informatics, cancer registry, electronic medical record systems, treatment planning systems, and registry information systems. The workgroup iterated a template until consensus was achieved. RESULTS: The consensus radiation treatment summary template is divided into 3 sections that allows for a mix of structured and free text. The first section, "Radiation Course Summary," is meant to provide information that is of broad interest and in a manner that is potentially accessible to patients, their families, and nononcology-trained care team members. The second section, "Anatomic Target Summary," provides information that is potentially useful to oncology-trained care team members who will be primarily interested in which anatomies were irradiated, by what modality, and to what cumulative dose. The third section, "Delivered Prescriptions," summarizes technical information that is primarily of interest and accessible to radiation oncology-trained clinicians, registrars, and researchers. CONCLUSIONS: We have proposed a consensus template with 3 sections to meet the needs of a diverse set of consumers. We recommend that providers, professional societies, and accreditation bodies with interest in the radiation treatment summary continue collaborative efforts to test, iterate, and drive adoption of a synoptic template.

Collaborative clinical quality improvement for pressure ulcers in nursing homes.

The National Nursing Home Improvement Collaborative aimed to reduce pressure ulcer (PU) incidence and prevalence. Guided by subject matter and process experts, 29 quality improvement organizations and six multistate long-term care corporations recruited 52 nursing homes in 39 states to implement recommended practices using quality improvement methods. Facilities monitored monthly PU incidence and prevalence, healing, and adoption of key care processes. In residents at 35 regularly reporting facilities, the total number of new nosocomial Stage III to IV PUs declined 69%. The facility median incidence of Stage III to IV lesions declined from 0.3 per 100 occupied beds per month to 0.0 (P<.001) and the incidence of Stage II to IV lesions declined from 3.2 to 2.3 per 100 occupied beds per month (P=.03). Prevalence of Stage III to IV lesions trended down (from 1.3 to 1.1 residents affected per 100 occupied beds (P=.12). The incidence and prevalence of Stage II lesions and the healing time of Stage II to IV lesions remained unchanged. Improvement teams reported that Stage II lesions usually healed quickly and that new PUs corresponded with hospital transfer, admission, scars, obesity, and immobility and with noncompliant, younger, or newly declining residents. The publicly reported quality measure, prevalence of Stage I to IV lesions, did not improve. Participants documented disseminating methods and tools to more than 5,359 contacts in other facilities. Results suggest that facilities can reduce incidence of Stage III to IV lesions, that the incidence of Stage II lesions may not correlate with the incidence of Stage III to IV lesions, and that the publicly reported quality measure is insensitive to substantial improvement. The project demonstrated multiple opportunities in collaborative quality improvement, including improving the measurement of quality and identifying research priorities, as well as improving care.