The Burden and Autonomy of Women in the IT-BPO Industry in Metropolitan Manila: Under the COVID-19 Pandemic

The purpose of this chapter is to discuss how the COVID-19 pandemic affects the lives and household responsibilities of women in the IT-BPO industry in the Philippines. The growth of the industry has created possibilities for university-educated women in adversity to upgrade their lives, enhance their autonomy, and achieve upward mobility. Through online interviews with female workers/former workers in IT-BPOs in Metropolitan Manila, the author explores their gendered contribution and responsibility in households both prepandemic and during the pandemic, while paying attention to differences in both according to life stage. This study suggests the possibility that young female IT-BPO workers from low-income households, who tend to be economically responsible for their families, are more vulnerable to the pandemic. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.

Resolution Consensus Statement Neutralizing monoclonal antibodies for treatment of COVID-19 - a role in the treatment of vulnerable categories of patients.

In December 2022, the Council of Experts was held. It purpose was to determine the place of virus-neutralizing monoclonal antibodies (NMA) in the ethiotropic treatment of COVID-19 in vulnerable categories of patients. The main issues were identified and their solutions were proposed. At the first visit of pregnant women due to COVID-19, proactive identification of risk factors and early prescription of NMA are recommended, preferably - with published safety data in this category of patients (casirivimab + imdevimab). In patients with oncological and other chronic (rheumatology, pulmonology, gastroenterology) diseases, prophylactic use of NMA is recommended. regardless of the severity of the disease. For patients with chronic pathology regardless of the severity of the disease an early prescription of ethiotropic therapy must be provided, combating the long-term circulation of the virus. To solve the problem of late treatment prescription, it is necessary to: use rapid tests, prescribe NMA if indicated, even if the patient presents late, introduce digital technologies to transfer information about COVID-19 cases between healthcare institutions (HI), create call centers for primary triage of patients, daily hospitals to reduce the burden on the HI. The issue of NMA using related to changes in their activity against new variants of SARS-CoV-2 remains relevant. Among the proposed solutions are: priority of indications over information about the activity of NMA, the diversification of the choice of NMA in HI, taking into account clinical experience, indications for use and prognosis of NMA activity, the use of combined forms of NMA (for example, casirivimab + imdevimab) or a combination of NMA with other means of ethiotropic therapy.Copyright © 2023, Dynasty Publishing House. All rights reserved.

Vaccination against COVID-19 virus for the allergic population in Israel -The experience in a tertiary hospital, Sheba Medical Center in Israel

Background: In December 2020, the vaccination campaign against COVID-19 virus started around the world. The Israel Ministry of Health decided to use vaccines for COVID-19 from Pfizer/Biontech. Early studies with Pfizer COVID-19 vaccines reported that there was a risk of allergic reactions in Britan and several in USA. The patients who had allergic reactions to the vaccine reported prior history of various allergies. Due to these reports Israel Ministry of Health issued warnings cautioning patients with allergies regarding receiving the vaccine. The leading hypothesis was that one of the components of the vaccine, PEG or polyethylene glycol, was the cause of allergic reactions. This substance if found in many other medications.Following these developments, there was a flood of inquiries from the allergic patients in Israel Method: We established a call center in Sheba Medical Center that provided preliminary screening for inquiries from the public. The patients were divided into 3 groups: 1. Patients at low/medium risk level -These patients were vaccinated in the local clinics. Example of patients in this category included patients with allergic rhinitis, well controlled asthma, food allergies, insect venom allergy and mild drug allergy;2. Patients at high risk -These were the patients with more serious drug allergies, not related to PEG. These patients received COVID-19 vaccination under supervision at the Sheba Medical Center;3. Patients at very high risk -These patients had anaphylaxis or severe allergic reactions to IV medications, prior vaccines or PEG. They had a full evaluation at our allergy department including a thorough history and physical and specific allergy testing for PEG and Pfizer COVID-19 vaccine. Result(s): There were 810 patients over the age of 16, who were in high-risk group, and received vaccination in the hospital under supervision of a medical team including allergy physicians and nurses. 217 of these patients were categorized as very high risk and had a full allergy evaluation prior to the vaccination. Out of the patients in the very high risk group, only 5/217 (2.3%) were found to be allergic due to positive skin tests to the vaccine or one of its components. Of all the high risk patients 794/810 (98%) were vaccinated with no immediate response to the vaccine. The 16 patients (2%) had immediate allergic reactions and out of this group 6 (0.7% of total) had an anaphylactic reaction. Conclusion(s): This project describes how an effective algorithm can be established to deal with an urgent need to vaccinate majority of the population.Our data show that the risk of allergic reactions to the Pfizer COVID-19 vaccine is small even within allergic population and that most of the patients can receive the vaccine safely.

Covid-19 : les transferts internationaux de patients de réanimation, une solution pour les départements frontaliers

La crise sanitaire de la Covid-19 a imposé une adaptabilité jamais réalisée de notre système de santé. Les services de réanimation et les structures de médecine d'urgence ont dû innover et développer des stratégies novatrices pour garantir des soins de qualité à tous les patients relevant de réanimation. La région Grand-Est, et plus particulièrement les départements de Moselle, du Bas-Rhin et du Haut-Rhin, a été particulièrement touchée. Parmi les 349 patients transférés hors de la région, 164 l'ont été vers des pays européens (Allemagne, Autriche, Luxembourg et Suisse) entre le 14 mars et le 4 avril 2020. Ces transferts internationaux, organisés par l'Agence régionale de santé et les Samu-Centre 15, ont essentiellement fait appel à des moyens aériens des hôpitaux, de l'armée et de la protection civile. L'accompagnement des patients, soigneusement sélectionnés, était assuré par un binôme médecin‒ infirmier spécialisés. Le choix de cette stratégie a permis d'éviter la saturation des services de réanimation et d'avoir à faire un choix entre les patients pouvant ou non bénéficier de soins aigus. L'adaptabilité des professionnels de santé et une organisation au plus près du terrain ont permis de réaliser ces transferts dans de bonnes conditions. Cet épisode témoigne de l'importance de laisser la gestion des crises sanitaires aux professionnels de la santé. Cet article présente l'organisation mise en place en région Grand-Est pour préparer et réaliser ces transferts internationaux.Alternate : The COVID-19 health crisis has imposed an unprecedented adaptability of our health system. Intensive care units and emergency departments had to innovate and develop new strategies to guarantee quality care for patients needing intensive care. The "Grand-Est” region and particularly the counties of Moselle, Bas-Rhin and Haut-Rhin, were strongly impacted. Among the 349 patients transferred out of region, 164 were transferred to European countries (Austria, Germany, Luxembourg, and Switzerland) between March 14 and April 4, 2020. These international transfers, organized by the regional health agency and the emergency medical call centers, mainly use flying ambulances belonging to hospitals, army, and civil protection. The support of these patients was provided by a specialized physiciannurse team. The choice of this strategy made it possible to avoid saturation of intensive care units and to make a choice between patients admitted or not in intensive care. Adaptability of health care providers and an organization as close as possible to the field allowed these transfers to be carried out under good conditions. This episode demonstrates the importance of leaving the management of health crisis to health professionals. This article presents the organization set up to prepare and carry out these international transfers.

The use of an online teledermatology platform with patient-submitted history and images for waiting list recovery in dermatology

While teledermatology has been a feature of some dermatology services for some time, the COVID-19 pandemic has led to both a deterioration in waiting lists for routine patients, and the use of distance consultation as a means of providing and improving access for such patients. The majority of teledermatology platforms rely on general practitioner (GP)-submitted information and images, and most data suggest that these systems result in around 50% of patients avoiding hospital attendance through the implementation of management plans suggested by hospital-based consultants (Mehrtens SH, Shall L, Halpern SM. A 14 year review of a UK teledermatology service: experience of over 40,000 teleconsultations. Clin Exp Dermatol 2019;44: 874-81). We now report the use of an online platform (Virtual LucyTM) using patient-provided information via a structured questionnaire, and patient images uploaded following clear online guidance, reinforced by call centre interaction. The data are derived from funded National Health Service (NHS) work: there was no specific funding for its generation. In total, 3500 patients from two hospital trusts with routine waiting list pressures were invited to use the system as an alternative to eventual hospital attendance. After secure registration, they completed dermatology and general health questionnaires based on conventional medical history taking, as well as a Dermatology Life Quality Index and then uploaded one or more images as appropriate. The patient data were reviewed by a consultant and a self-populated report provided to the patient, GP and trust within 72 h. Forty-eight per cent of patients were discharged to their GP with reassurance or a management plan. Patients requiring hospital attendance were signposted to appropriate clinics (e.g. isotretinoin, phototherapy, patch testing) or to surgical clinics for biopsy or excision. Hospital trust-based consultants were able to access the platform to view images prior to any surgery. Of patients directed to hospital clinics, 32% were reclassified as being urgent - waiting list duration was the main determinant of the need for reclassification. Of all images, 0.5% were unsatisfactory, and those patients were contacted through the platform to ask for a replacement image with specific advice. One per cent of patients were contacted by clinical staff by telephone or video to clarify or expand on the information given, and approximately 1% of patients used the platform to ask for additional treatment details. There were no patient complaints, and GP and hospital staff issues related to logistics were increasingly uncommon as iterative development of the system and support processes occurred. Teledermatology using patient-derived information and images gives similar outcomes to those seen in published conventional teledermatology, puts fewer demands on clinical staff, is popular with patients and has a significant benefit to the NHS.

Retour d'expérience sur la régulation au Samu de Paris pendant la crise de Covid-19

L'épidémie de Covid-19 représente une crise dont l'ampleur n'avait jusque-là jamais été imaginée. Des modifications des pratiques pour y faire face ne pouvaient reposer uniquement sur des doctrines ou des intuitions, mais nécessitaient adaptabilité, innovation et réactivité. Un renforcement en moyens techniques et humains a été débuté dès la fin du mois de février. L'organisation de la régulation médicale du Samu de Paris a été modifiée, renforcée en fonction des flux de patients à traiter et adaptée à la spécificité de la crise de Covid. L'ensemble des mesures avait comme objectif d'apporter la réponse la plus adaptée aux patients atteints de la Covid-19 et de préserver la réponse aux appels urgents du 15. Une collaboration fructueuse s'est rapidement établie entre tous les acteurs de la santé, hospitaliers et libéraux favorisant un maintien à domicile d'un certain nombre de patients et empêchant ainsi une saturation précoce des services d'urgence. Le développement et l'intégration de nouveaux outils informatiques ont facilité et diversifié les réponses apportées. Il est, dès à présent, indispensable de pérenniser et de renforcer ces acquis afin de développer le service d'accès aux soins (SAS) nécessaire pour apporter à la population une qualité de soins optimisée.Alternate abstract: COVID-19 represents a crisis the scale of which had never been imagined before. Changes in practices to coping with them could not be based solely on doctrines or intuitions, but require adaptability, responsiveness, and innovation. A reinforcement of technical and human resources was introduced at the end of February. The organization of the medical regulation of the Samu (Emergency Medical Service) in Paris has been modified, reinforced according to the flow of patients to be treated and adapted to the Covid evolution. All the measures were aimed at providing the most appropriate response to patients with COVID-19 and preserving the answer of the emergency calls received on the 15. A fruitful collaboration was quickly established between all the actors of health, particularly with in-hospital and liberal practitioners favoring a home maintenance of a lot of patients and thus avoiding the saturation of emergency medical services. The development and integration of new IT tools have facilitated and diversified the provided solutions. It is now essential to perpetuate and strengthen these achievements to develop the service to access to care (French acronym SAS).

Using telehealth to support community health workers in Uganda during COVID-19: a mixed-method study.

BACKGROUND: At the onset of the COVID-19 pandemic, a local consortium in Uganda set up a telehealth approach that aimed to educate 3,500 Community Health Workers (CHW) in rural areas about COVID-19, help them identify, refer and care for potential COVID-19 cases, and support them in continuing their regular community health work. The aim of this study was to assess the functioning of the telehealth approach that was set up to support CHWs during the COVID-19 pandemic. METHODS: For this mixed-method study, we combined analysis of routine consultation data from the call-center, 24 interviews with key-informants and two surveys of 150 CHWs. Data were analyzed using constant comparative method of analysis. RESULTS: Between March 2020 and June 2021, a total of 35,553 consultations took place via the call center. While the CHWs made extensive use of the call center, they rarely asked for support for potential Covid-19 cases. According to the CHWs, there were no signs that people in their communities were suffering from severe health problems due to COVID-19. People compared the lack of visible symptoms to diseases such as Ebola and were skeptical about the danger of COVID-19. At the same time, people in rural areas were afraid to report relevant symptoms and get tested for fear of being quarantined and stigmatized. The telehealth approach did prove useful for other purposes, such as supporting CHWs with their regular tasks and coordinating the supply of essential products. The health professionals at the call center supported CHWs in diagnosing, referring and treating patients and adhering to infection prevention and control practices. The CHWs felt more informed and less isolated, saying the support from the call center helped them to provide better care and improved the supply of medicine and other essential health products. CONCLUSIONS: The telehealth approach, launched at the start of the COVID-19 pandemic, provided useful support to thousands of CHWs in rural communities in Uganda. The telehealth approach could be quickly set up and scaled up and offers a low cost strategy for providing useful and flexible support to CHWs in rural communities.

Preventing Homelessness Through the National Call Center for Homeless Veterans: Analysis of Calls and Service Referrals.

OBJECTIVE: This study was the first to examine the characteristics and referral outcomes for veterans calling the National Call Center for Homeless Veterans (NCCHV). METHODS: The authors analyzed data from NCCHV and U.S. Department of Veterans Affairs (VA) health care records. RESULTS: Between December 2018 and October 2020, the NCCHV received 266,100 messages, with no major increase in the first 6 months of the COVID-19 pandemic. Of 110,197 veterans who contacted NCCHV, 69.6% were at risk for homelessness, and 20.1% were homeless. Most contacts (90.2%) resulted in a referral or transfer to a local resource. About 59.5% of NCCHV veterans had a medical record in the Veterans Health Administration; their use of homeless programs increased from 25.9% to 81.3%. Uses of mental health services, substance use treatment, and medical services showed small-to-moderate increases after NCCHV contacts. CONCLUSION: NCCHV is important for linking veterans to health and social care. Additional work is needed to assess veterans' outcomes after an NCCHV contact.

[Feedback from the establishment of a psychiatric regulation line at SAMU 62 in the context of Covid-19]. / Retour d'expérience de la mise en place d'une ligne de régulation psychiatrique au SAMU 62 dans le contexte Covid-19.

The epidemic context of Covid-19 and the containment measures, put in place since 16 March 2020, has significantly increased the number of emergencies calls in call center (SAMU). In the department of Pas-de-Calais, one step of the crisis measures was setting up a psychiatric regulation line, which aims to manage calls with strong emotional valence (in connexion with containment, anxiety related to the epidemic context, or break in psychiatric cares for people suffering of mental disorders). This psychiatric hotline was provided from 20 March 2020 to 15 May 2020 by fifteen psychiatric careers (psychiatrists, psychologists and psychiatric nurses) from the network of the medical-psychological emergency unit (unit of the emergency call center which aims to manage people involved in psychotraumatic events). In total, 556 calls were answered, i.e. an average of 9,8 calls per day. The typology of calls was in a quarter of the cases anxiety related to the fear of being infected, in the second quarter, adjustment disorders related to containment, and for about half of the calls, psychiatrics symptoms whether it was preexisting and increased by the discontinuation of care, or context-induced. The benefits identified by this device were as follows: -the discharge of time-consuming calls for the medical dispatcher assistant, -the expertise of a mental health professional, knowing the mental health network, to make the decision more fluid. Last but not least, it is interesting to note that the presence of the psychiatric regulator in the regulation room allowed a transfer of calls and a reciprocal acculturation. In view of the relevance of the establishment of a psychiatric regulation line in the epidemic context of Covid-19, it seems interesting to consider the sustainability of this system, which is part of a global context of evolution of the provision of emergency care.

A comprehensive call center supporting safe, efficient operations during a pandemic

Research has shown that a comprehensive call center can support a safe, efficient, and quality experience for patients and their families. When a patient receives a cancer diagnosis, the stakes are already high. Add a pandemic to an immunocompromised patient population and fear escalates. In order to accommodate the ever-changing information and ease patients' anxieties surrounding their cancer diagnoses, it is necessary that an institution be available 24/7 to inform, help navigate systems, and manage symptoms because the emergency room, and many times the clinics, have too many inherent risks. MD Anderson expanded the hours of operation for askMDAnderson, a comprehensive call center staffed by operators, health information specialists, registered nurses, and advance practice providers, to cater to all the needs, and to support safe and efficient operations during the pandemic. This highly skilled team serves as a critical information link to patients and their loved ones for all transitions in care needs, such as guidance on food delivery, parking, medication renewals and side effect management. The askMDAnderson staff educates our stakeholders about MD Anderson services, programs, treatments and clinical trials during and after the pandemic until we return to the "new normal." Our employees are available for all levels of "hand holding” and provide a constant flow of timely, factual information. In this case study, you will learn how MD Anderson expanded this newly evolving system and how our team's efforts led to a safer, more efficient, less expensive, and more satisfying care experiences for patients and their families. © The Author(s), 2020.

The Effects of Call Center Counsrlors' Job Stress on Health Percption and Resilience (In the COVID19 Pnademic)

The purpose of this descriptive survey research is to find the effects of call center counselors' job stress on their health perception and resilience, and the relations between these three variables. The study subjects were 201 counselors working at K call center in S city. For data analysis, SPSS WIN 23.0 program was used to conduct t-test, ANOVA, Pearson's correlation coefficient, and Multiple Regression. According to the research, their work department positively and significantly affected health perception (β=.093. p=.007), whereas their working period negatively and significantly influence job stress (β=-.057, p=.008) and health perception (β=-.068, p=.005). With regard to correlations between variables, job stress had negative correlations with health perception(r=-.259, p=<.001) and resilience(r=-.264, p=<.001), and health perception had a positive correlation with resilience(r=.398, p=<.001). Based on the results, this study proposes the strategy to increase job proficiency levels, tointroduce shift work system, and improve resilience through health perception in order toreduce job stress. © 2022,Journal for ReAttach Therapy and Developmental Diversities. All Rights Reserved.

Future directions regarding the implementation of pharmaceutical services in Romania: Legislative changes and activities performed during the COVID-19 pandemic

Introduction: In the last years, the pharmacist has performed a new range of activities, from traditional medicines dispensing to patient-centred services. In many countries, the implementation of pharmaceutical services has showed significant benefits for public health systems. During the COVID19 pandemic, pharmacists had assumed additional responsibilities and adapted their activities. Nevertheless, in Romania the legal framework and definition of pharmaceutical services have been recently established. Objective(s): The aim was to identify recent legislative changes contributing to the implementation of Romanian pharmaceutical services. Moreover, the author has highlighted some new activities performed by pharmacists throughout the COVID19 pandemic. Method(s): Data was collected by searching national authorities' databases (Ministry of Health, the College of Pharmacists from Romania, National Institute of Public Health). Electronic databases (mainly PubMed and Google Scholar) were searched to identify new responsibilities of pharmacists after March 2020. Then, information was extracted, analysed and discussed. Result(s): In November 2020, an official definition of the pharmaceutical services was introduced due to the completion of the Romanian Pharmacy Law no. 266/2008. Another important event for the future of the profession was the approval of the list of pharmaceutical services (Ministry of Health Order No. 2382, November 4, 2021), divided into essential and advanced services. The legal framework could be correlated with a positive change regarding the pharmacy residency training (three year duration) and the number of specialist pharmacists. In 2019, there were reintroduced two specialties, like Pharmaceutical Industry and cosmetology and General Pharmacy, in addition to Clinical Pharmacy and Clinical Laboratory. Consequently, the number of places increased with 32% in 2019 comparing with 2018, respectively 63% in 2020, as a measure of the authorities to increase the health personnel due to the pandemic. During the national state of alert, more than 9% of the pharmacy residents had to fullfil a new professional role and to provide assistance to public health departments concerning COVID-19 public support. Through the order of the head of the department for emergency situations, they were sent to airports, ambulance service, COVID19 call-centres or other administrative departments in the period January 2021-March 2022. In addition to activities carried out usually, such as dispensing, counseling, measuring biological parameters (high blood pressure, blood sugar), community pharmacists were allowed to perform rapid antigen tests for COVID-19 after May 10, 2021. Until the 1st January 2022, there were 137 temporary authorised community pharmacies in Romania. Conclusion(s): The approval of the Romanian official list of pharmaceutical services represented the first step for expanding the role of the pharmacist and his contribution to the healthcare system. As drug professionals, pharmacists are a valuable resource. During the pandemic, pharmacists were in the first line and had an active role in helping patients, proving the ability to adjust and offer new services. Therefore, in the future, regulators should consider integrating pharmacists in medical multidisciplinary teams, with benefits for patient care and health systems.

Caring for the caregiver during COVID-19 suspended visitation

During the 4th surge of COVID-19, August to November 2021, visitation was suspended in a hospital system in North Georgia. The Compassionate Connections Call Center (CCCC) was created to alleviate staff stress and to manage calls and communication. The goal of the initiative was to reduce interruptions to patient care caused by the increased number of calls to the clinical units by patients, families, loved ones and personal caregivers. The CCCC managed all incoming calls and communicated with the patient’s primary nurse through a coordinated process which limited interruptions. By caring for the caregiver, the aim was to improve the workplace experience of the nurses. Ninety-seven volunteers from over 13 departments across the organization worked in the CCCC and managed 3200 calls. With an average call time of roughly three minutes, the center freed up approximately 160 hours daily for nurses who might otherwise have paused patient care to answer calls. In addition, a family liaison role was created to proactively provide updates to families. This team of forty-six Registered Nurses worked a total of 2925 hours proactively updating families and facilitating virtual visits. © The Author(s), 2022.

Improving Efficacy of Telemedicine in Outpatient Pediatrics

Purpose/Objectives: As the epidemiology of COVID19 and its impact on pediatrics evolved, we abruptly converted acute visits to virtual encounters in our pediatric teaching clinic. Initially providers engaged virtually with each caregiver and triaged the need to upgrade to in-person encounters. Provider and caregiver time was inappropriately utilized through repeat visits for the same complaint when a virtual visit was converted to inperson (sometimes with a different provider) and when caregivers were unavailable to answer their phones. In addition, providers were not consistent with approach to information gathering and documentation of care provided. Our objective was to optimize physician availability and minimize time wasted for all and standardize approach to virtual visits within the teaching environment. Design/Methods: Our plan was to task shift administrative roles to the call center (CC) appointment clerks and triage nurses. We used the Plan-Do-Study-Act model for quality improvement to implement sequential cycles of change. The intervention began with a baseline survey and interviews of residents and attending providers to determine the impact on resident education and which complaints would be best completed in a virtual vs. in-person setting. We then developed a CC triage algorithm to guide virtual or in-person appointment assignment (Figure 1) and a provider guide to standardize virtual visits (Figure 2). The CC gave caregivers a specified time to expect a call back and instructions to transmit relevant images to the provider in advance. Results: The baseline survey revealed provider calls were often not answered by caregivers, providers had difficulty perceiving patients' complaints, and providers were unclear how to document virtual visits. The impact to resident education included decreased opportunities to practice physical exam and decreased protected educational time, as attending providers spent most of their time on phone calls. Educational benefits included having more autonomy in developing the assessment and plan on the phone rather than first confirming with a preceptor. After the triage algorithm was implemented and provider guide was distributed, provider feedback included less time wasted with call attempts, patients were less inappropriately appointed for virtual encounters when requiring in-person appointments, caregiver complaints decreased with respect to callback time, protected educational time was reinstated, and preceptor availability during clinical time improved. Conclusion/Discussion: Learners noted this transition to telemedicine improved their communication skills as military pediatricians communicating with their patients and with sub-specialists. In addition they learned how to triage which patients need to come in to clinic when resources are limited. Our next steps include completing a chart review to show number of virtual visits which resulted in a repeat in-person visit over time to determine further changes to the algorithm. We intend virtual encounters and utilization of these tools to be an enduring process beyond the pandemic.

INTERDISCIPLINARY STUDENT LEAD CALL CENTER TO SUPPORT SOCIAL NEEDS OF PATIENTS DIAGNOSED WITH COVID19

STATEMENT OF PROBLEM/QUESTION: Social risk factors (SRF), such as food insecurity, represent adverse social circumstances associated with poor health outcomes. The COVID-19 pandemic impacted impoverished communities by exacerbating existing SRF. Students and faculty at Boston University Medical Center (BUMC), an academic safety net hospital, and Boston University School of Social Work (BUSSW) partnered to develop an outreach call center (CC) to explore SRF of patients with COVID-19 and connect them with available social need resources. In this , the development and operations of the CC and descriptive data on the volume and type of outreach efforts will be presented. DESCRIPTION OF PROGRAM/INTERVENTION: Call Center (CC) Operation: An ambulatory RN performed SRF screening in patients diagnosed with COVID-19 and sent referrals to the CC. Then, students called patients and screened for SRF using the THRIVE screening tool, and used the THRIVE Directory, an online repository of resources, to provide information about organizations to support their social needs. Two weeks later, students called the patients to assess whether they received help and provided additional support as needed. MEASURES OF SUCCESS: Volume of outreach calls and type of outreach efforts were evaluated. Number of patients reached through the CC were tracked using Epic reports. Types of referrals were tracked using automated reports from the THRIVE Directory database. Finally, students completed surveys to reflect on their experiences and to evaluate the impact on skills to address social needs. FINDINGS TO DATE: Between 10/2020 and 03/2021, the CC served 312 patients and 478 referrals were made, with a mean of 1.53 referrals per patient. Patients were most often referred to the City of Boston Food Delivery (148 referrals). Patients were most often referred to Government programs (188), followed by BMC programs (133) and Local Non-Profits (70). The most common primary support area was Food. Preliminary results from students' surveys showed a positive impact in their skills to collaboratively address social needs. KEY LESSONS FOR DISSEMINATION: It was feasible to develop and implement an interdisciplinary social needs outreach workforce to support patients with COVID-19. Food was the most important driver of social need among BUMC patients. Our partnership with the City of Boston was key to effective assistance with food delivery, showing the importance of collaborative partnerships when developing outreach efforts to support patients with social needs. Finally, interdisciplinary outreach opportunities like the CC can be used to teach health professional students about the different scopes of practice and how to effectively collaborate with other disciplines when addressing patient health related social needs.

IMPROVED OUTPATIENT COVID-19 SURVIVAL BY 60% IN THE ELDERLY POPULATION: LESSONS FROM CANO HEALTH'S (CANO) BROAD-REACHING STRATEGIES AND TACTICS FOR GENERAL MEDICINE PRACTICES

BACKGROUND: In 2020, no consensus or guidance existed for managing COVID-19. Many PCP offices were forced to close. CANO kept clinics fully staffed and open, and published two articles on best practices for treating COVID-19 (5,6). CANO is a PCP network caring for underserved Medicare Advantage (MA). Growing from a single clinic (1) to ∼130 centers in < 6Y, CANO focused on 'treatable' gaps in: chronic disease management, HEDIS measures, and clinical inertia. CANO results have been extraordinary (2-6). Here we describe initiatives and strategies to navigate care delivery through the pandemic. METHODS: Tracking COVID-19 Cases-Bracing for Surges. A dedicated CANO COVID Task Force (CTF) collected data on 38,193 patients. Detection of 'surges' reliably predicted need to restock COVID-19 medicines, allocate staff, and communicate updates to staff and patients. The CTF collected data on COVID-19 infections, admissions, ER visits, patient deaths, etc. RESULTS: Staff Retention. The CTF performed much of COVID-related care and research, PCPs provided routine care with little interruption. Development of Published COVID-19 Treatment Algorithm. Data came directly from CANO EMR (5) and literature review (6). Application of the treatment algorithm led to a 60% lower outpatient COVID-19 mortality vs national average (P < .05) (7). At-Home COVID Care. Televisits;in home visits including testing, vaccination, treatment;home delivery of pulse oximeters, prescriptions and oxygen. Vaccination Program. A telephone campaign resulted in a vaccination rate of 83.8% vs. Florida average 74.9% as of Dec 31, 2021(7). Resumption of In-Person Clinic Visits. Dedicated Retention Team drove the return to in-clinic visits from 6% in April, 2020 to >90% by December, 2021. Impact of Real time monitoring. The collection and monitoring of data by the CTF through CANO's proprietary population health platform, Cano Panorama (R), facilated strategic planning and allocation of resources. Repurposing of staff. Associates were repurposed due to reduced in office visits to various teams. These teams included dedicated CTF call center, retention team, CANO at Home staff. CONCLUSIONS: Key Lessons for Dissemination: CANO platforms have served well during the crisis presented by the pandemic as in routine care. CANO has quickly put into systems and platforms that place highly effective and reproducible strategies to reduce the burden of COVID-19, improve disease course and survival, and, renormalize care.

COVID-19 Fear, Health Behaviors, and Subjective Health Status of Call Center Workers.

BACKGROUND: Fear may be critical in explaining individual and social behaviors. This study investigates the association between COVID-19 fear and health behavior and subjective health status changes of call center workers in the COVID-19 era. METHODS: This cross-sectional study uses an online survey with 339 call center workers. We measured COVID-19 fear, health behaviors, and subjective health, and analyzed with the Macnemar or paired t-test, ANOVA or χ2 test, Scheffe's test, and multiple linear regression. RESULTS: COVID-19 fear was associated with poor stress management, shorter sleep hours, and binge eating. Moreover, COVID-19 fear and time pressure at work were negatively associated with subjective health status. CONCLUSION: Strengthening the support system for call center workers to manage the COVID-19 fear might be essential. Moreover, there is a need to improve dense environments and reduce time pressure by ensuring adequate rest time and increasing physical activity.

IMPACT OF THE COVID-19 PANDEMIC ON THE ACTIVATION OF EMERGENCY MEDICAL SERVICES FOR STROKE IN ADALUSIA SPAIN

Background and aims: The purpose of this study was to analyze the influence of the Covid-19 pandemic on the incidence of stroke in the months of lockdown in Andalusia. According to the Spanish Society of Neurology, in March 2020 there were 28% fewer activations of emergency medical services for stroke in Andalusia (Spain) than in the same period of 2019. A study carried out by the Barcelona emergency services detected a decrease of 18% in the same period. A study published in Portugal by the journal Neurology reported a 34% reduction. Methods: The periods of March and April of the years 2019, 2020 and 2021 were studied. The study variables were: Number of activations of emergency medical services for stroke, number of stroke patients diagnosed, age, gender . Results: 298 patients were diagnosed with stroke in 2019 and 2020. The percentage of activation of the emergency medical services was 66.7% and 55.2% in 2019 and 2020 respectively. The number of stroke diagnoses in 2021 was 353 cases and the activation percentage 56.2%. The median age of stroke patients decreases progressively each year. The percentage of men was 60% and remains stable during the three year period. Conclusions: The decrease in the activation of the emergency medical services for stroke that was reported in the bibliography was not detected in Andalusia. In a pandemic situation, call centers must be prepared to respond to the increasing volume of calls and to ensure call centers remain accessible.

Developing a drug-device combination for patients with Parkinson's disease during the COVID19 pandemic

Objective: To describe the challenges of developing a drug-device combination for patients with Parkinson's disease (PD) during the COVID19 pandemic. Background: ND0612 is a continuous, subcutaneous levodopa/ carbidopa delivery system in development for patients with PD experiencing motor fluctuations. In this population, trials of drug-device combinations typically require extensive face-to-face support and monitoring. Methods: A COVID19-Taskforce was established to rapidly adapt study execution strategies and tactics, balancing patient safety with good study practice under the extraordinary conditions imposed by the pandemic. Results: A risk assessment led to a temporary protocol addendum;almost 70% of planned onsite study visits were given the option to be conducted virtually (with clear guidance), the rest (including screening) were deemed critical to continue in-person. Specific local tactics addressed the difficulties in conducting virtual visits in countries with limited network infrastructures. Nurse-educator support visits at patient homes were partially replaced by virtual visits, and the nurse call center was extended to provide 24/7 patient support. Study supplies (including investigational product) were sent directly to patient's homes. In addition, personal protection equipment was provided where needed, and COVID19 testing was available for study monitors. Conclusion: The changes implemented were well-accepted by the investigators and patients and ensured patient safety while maintaining the integrity of this clinical trial. We found that clear and frequent communication, with a balanced 'hybrid' mix of virtual and in-person approaches, successfully enabled the safe continuation of pivotal clinical trials with this drug-device combination in patients with PD.

Action Taken in the Kingdom of Bahrain for People with Diabetes (Preparedness and Response)

Background: Since the beginning of the virus spread globally the government of Kingdom of Bahrain has taken responsibility for maintain the Health and Safety of all segments of society, citizen and resident. And the Kingdom has raised the Alert level for the virus. It is worth noting that Bahrain has taken proactive precautionary measures to mitigate the spread of the virus. People with diabetes are more likely to have more severe symptoms and complication when infected with any virus, and the risk of getting very sick from covid-19 is likely to be lower if diabetes is well managed. From our data collected and accumulative on 25/8/2021the percentage of the number of Diabetes Mellitus from the total positive cases as one of the NCD was 4.9%. An Activation plan was triggered as soon as out break was reported in China late 2019, through lunch of wide range of resolutions, protocols and precautionary measures, which including;- Establish a task force to combating the Corona Virus (Covid-19). - Set up a War Room to coordinate activities. - Ensure availability of Hospitals and ICU beds, isolation, quarantine and treatment centers. - Ensure the safe return of Our citizens from Across the globe. - The laboratory testing and tracing capacity. - Creation an official Bahraini application (a conscious community application). - Establish a call center 444 (respond to the inquiries of all citizen and resident. - Mobile unit for testing& vaccination (for citizen and resident) to serve the elderly, with disability and infirm. - The plan for immunization. - Drug delivery services for patients as part of strengthening precautionary efforts to reduce the spread of covid-19, the hospital and health centers developed a patient drug delivery services to home, with the aim of ensuring the health, safety and comfort of patients. - Telemedicine service: to provide the best health services to all citizens and residents taking into account the health and safety of the community, this medical service started since April 2020, including services provided for video technology consultation.