The impact of the COVID-19 pandemic on the healthcare of patients with type 2 diabetes mellitus in the department of veterans affairs

The novel coronavirus (COVID-19) pandemic and strategies meant to mitigate infections caused disruptions to healthcare services across the globe. To evaluate the impact of the COVID-19 pandemic on the healthcare of patients with type 2 diabetes in the VA healthcare system, this work enumerated a cohort of patients with type 2 diabetes who utilized care in the VA across all months between March 2018 and February 2022 and analyzed service utilization, medication adherence, and diabetes-related short-term outcomes.The first objective was to determine the effect of the pandemic's interruption on the utilization of diabetes-related outpatient encounters. Results showed that the share of patients with diabetes with at least one virtual care visit increased from 3.4% in the pre- COVID year (March 2019 to February 2020) to 16.4% in the first year during COVID (March 2020 to February 2021) while the percent of patients with diabetes with an in- person diabetes-related outpatient visit fell from 89.8% to 72.3%.Second, large changes in oral antidiabetic medication use, adherence (i.e., proportion of days (PDC) covered >=80%), and discontinuation (zero days covered) were discovered during the pandemic among patients with treated type 2 diabetes. The mean percent adherent was 23.4%, 11.6%, and 30.1% during the pre-pandemic (i.e., March 2018-February 2020), pre-vaccine pandemic (i.e., March 2020-December 2020), and post-vaccine pandemic (i.e., January 2021-February 2020) periods, respectively.Finally, this study evaluated changes in average A1C measurement, glycemic control, and preventable diabetes outcomes before and during the COVID-19 pandemic. The percent of eligible patients with A1C measurement decreased by 8.6% when the pandemic began, trending back to pre-pandemic levels by January 2021, at which point it fell by about 1% per month to end of study. The rate of uncontrolled diabetes averaged 400 per 100,000 before the pandemic, but rose to almost 550 per 100,000 patients during the pandemic. Likewise, the rate of short-term complications averaged 30 per 100,000, but rose to 49 per 100,000 at its high during the pandemic.The pandemic's interruptions caused vast differences in the healthcare routines of patients with diabetes, which initially led to more negative outcomes than before the pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The Evolution of the Covid-19 Pandemic in Pediatric Patients with Sickle Cell Disease: From Alpha to Omicron

Background: Approximately two years ago, COVID-19 was declared a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and through genomic surveillance, we have seen the emergence of variants of SARS-CoV-2. In the United States, over 78 million cases and >900,000 deaths attributable to COVID-19 have been reported. SCD was identified as a risk factor for severe COVID-19 disease in adults and pediatric patients. The emergence of novel SARs- CoV-2 variants has led to challenges in diagnosis, treatment, and prediction of long-term sequelae in individuals with SCD and COVID-19. Aim(s): We compare the overall seasonal variation of COVID-19 variants and patterns of healthcare utilization and clinical presentation over time in pediatric patients with SCD and COVID-19 at Children's National Hospital (CNH). Method(s): Our single-center, observational cohort study included 193 pediatric patients with SCD (0-21 years) with PCR-confirmed SARSCoV- 2 infection between March 31, 2020, and January 31, 2022. Per the SECURE SCD Registry definitions, clinical severity was classified as asymptomatic, mild, moderate, and severe. Result(s): A total of 193 unique patients with SCD and positive SARS-CoV-2 PCRs between March 2020-January 2022 were included in our registry. Most patients were female (51.8%), and the mean age was 11.2 years (SD 6.5 years). Most of the cohort resides in Maryland (N=135), and HbSS was the dominant genotype (69.4%). During the alpha dominant variant of the COVID-19 pandemic (March 2020- June 2021) there were 70 cases, followed by 40 cases during the Delta variant (July 2021- December 19, 2021), and 83 cases during the Omicron variant dominance (from December 20, 2021-January 31,2022). There were 149 patients (77%) that presented to the emergency department (ED) or were hospitalized. There were a total of 80 hospitalizations (41.5%), and a relative comparison showed that the percentage of hospitalizations was highest during the delta wave (47.5%) and lowest during the omicron wave (36.1%) (p= 0.407). ED-only utilization was highest in the era of omicron (43.4%, N=36), followed by delta (32.5%, N=13), and then alpha (30%, N=21)(p=0.197). The most common SCD-related complication was vaso-occlusive (VOC) pain (33%, N=64) which accounted for half of all hospital admissions (51%, N=41 of 80). Acute chest syndrome (ACS) was reported in 40% (N=32) of admitted patients and was highest in the alpha era (54.8%, N=17). The use of blood transfusion therapy was highest in the alpha (N=17) and delta (N=14) variants, while Remdesivir use was highest in omicron (N=15). A total of 6 patients received monoclonal antibodies (Delta, N=4;omicron, N=2). Throughout all the variants, there was a significant difference in COVID-19 clinical severity (p>0.005). Of the patients classified as asymptomatic (13%, N=25), seventy-two percent (n=18) were diagnosed during the alpha variant. Mild severity was the most prevalent (69%, N=134), with the omicron variant having the highest cases (51.5%, N=69). Severe cases were observed in all variants (6.7%, N=13) but were most prevalent during the alpha variant (46.2%, N=6). Summary - Conclusion(s): Interestingly, while the relative percentage of hospitalizations was lowest during the omicron wave, it saw the highest percentages of ER utilization. Overall, COVID-19 remains mild in pediatric patients with SCD, and notably, there was higher health care utilization in the omicron era.

Long COVID-19 Associated with 5-Fold Increase in Total Medical Costs and Greater Use of Inpatient and Outpatient Services Compared to Non-Long COVID-19: An Analysis of Real-World Data

Objectives: Assess real-world evidence data on the prevalence and impact of long COVID (LC) to establish a baseline for the value of potential therapeutic interventions. Method(s): This study was a retrospective, longitudinal analysis of administrative claims from multiple payer channels spanning 4/1/2020-6/30/2022. Inclusion criteria: 1) ICD-10-CM diagnosis code of COVID-19 (U07.1) on or after 4/1/2020 (COVID-19 diagnosis date=index date), 2) 18+ years of age on index, and 3) at least -365/+30 days of continuous plan enrollment surrounding index. Employing a conservative LC definition, patients were classified as LC if they presented at least 1 claim >= 28 days following the index date which included both a COVID-19 diagnosis and >=1 of 8 LC-related symptoms. LC and non-LC patients were compared on demographics, COVID-19 symptoms, healthcare utilization, and medical costs. Descriptive statistics were presented for outcomes, and bivariate tests of significance were used to assess differences between cohorts. Result(s): Of 4,938,801 medically attended COVID-19 patients meeting inclusion criteria, 386,153 (7.8%) qualified as LC. The LC patients were older (Mean(SD) = 67.0(19.0) vs. 51.0(20.7)), were more likely to be female (65.1% vs. 60.4%), were in poorer health (Deyo-Charlson Comorbidity Index=3.51(3.24) vs. 1.47(2.45)), and presented greater baseline total medical expenditures ($39,769($60,401) vs. $15,275($35,640);p < 0.0001). On index, LC patients had a higher rate of LC-related symptoms, and in the 180-day post-index period, LC patients incurred increased total medical costs ($38,874($54,098) vs. $7,319($18,439);p < 0.001) and greater use of inpatient and outpatient medical services. Conclusion(s): Patients with LC presented elevated rates of symptoms and incurred 5-fold greater medical costs post-index compared to non-LC patients. This study is one of the first to longitudinally quantify the cost and symptom burden of LC in a real-world setting and helps to establish a baseline for the value of potential therapeutic interventions.Copyright © 2023

Beyond Symptoms Alleviation: Population-Level Benefits of COVID-19 Oral Direct-Acting Antiviral (DAA) Treatment and Resulting Decreases in Infectivity and Transmission

Objectives: Efforts to combat COVID-19 have largely focused on vaccination and non-pharmaceutical interventions to decrease hospitalization and death and to reduce transmission. First generation COVID-19 direct-acting antivirals (DAAs) are only authorized for high-risk patients to reduce individual risk of disease progression. However, DAAs can also impact transmission by reducing viral load, thereby shortening the duration of infectivity. Next generation oral DAAs in development may have safety profiles that are amenable to broader eligibility and use. This analysis estimates the economic and clinical impact of increasing the utilization of DAAs to treat COVID-19. Method(s): A susceptible-infected-recovered-susceptible model was developed to estimate COVID-19-related outcomes based on DAA uptake. Cost-savings modeled included reduced healthcare utilization amongst individual patients and, importantly, potential savings attributable to reduced transmission. Cost inputs included treatment acquisition costs, adverse events, healthcare utilization, and productivity losses based on published literature. One million individuals were assessed with clinical and economic outcomes estimated for DAA adoption by risk level. Result(s): The model projects 402,330 new infections per 1 million individuals annually, leading to 6,000 hospitalizations and 107 deaths. By increasing DAA use by 10% in the high-risk population and 20% in the standard-risk population, infections decreased to 312,000, with 1,800 fewer hospitalizations and 34 fewer deaths. Decreases in medical encounters were driven by reduction in transmission (77% of the decrease) and reduction in severity amongst those treated (23% of the decrease). Among deaths averted, 72% were attributable to the reduction in transmission. Overall, costs decrease by 23.5% with increased treatment. Conclusion(s): This study is among the first to model the potential population-level impact of DAAs in reducing infectivity and transmission, a factor currently under-emphasized in the literature. New DAAs under development with potentially improved safety profiles may expand the uptake of treatment and substantially reduce the clinical and economic burden of COVID-19.Copyright © 2023

Healthcare Utilization Remains Elevated Among People Living with Post-COVID-19 Condition More Than One Year after Acute COVID-19 Illness

Objectives: Healthcare systems require comprehensive data for long-term resource allocation planning to support people living with post-COVID-19 condition (PCC). Limited information is available on long-term PCC-associated healthcare utilization patterns. In this study, we assess healthcare utilization rates six and 12-18 months following acute COVID-19 illness among COVID-19 survivors in British Columbia (BC), Canada by PCC status. Method(s): We used difference-in-difference analysis to assess healthcare utilization by all adult COVID-19 survivors in BC diagnosed with COVID-19 on/before November 18, 2021 during three time periods: (i) 26 weeks after the first 4 weeks of COVID-19 illness, and that exact period (ii) one or two years prior (baseline), and (iii) one year afterwards. PCC/non-PCC patients were matched 1:2 on age, sex, region, comorbidities, vaccination status, and COVID-19 index date +/-14 days. The total number of daily healthcare encounters (medical visit, emergency department visit, hospitalization) per person was calculated. Rate ratios (RR) for PCC-associated healthcare utilization were estimated using weighted Poisson regression. Result(s): The matched cohort (n= 7,092) included 2,364 PCC patients (54.9% female;mean age 39.8 [SD, 13.4] years). Healthcare utilization rates were comparable between the PCC and non-PCC groups at baseline (average: 39.3 vs. 32.7 visits per 1000 patients, respectively), but rose two-fold for the PCC group during the 26-week period post-acute illness (76.1 vs. 33.5). One year later, PCC-associated healthcare utilization rates declined but remained elevated relative to baseline rates (54.6 vs. 34.4). In multivariable Poisson regression models, PCC was associated with a 103% increase in healthcare utilization over 26 weeks post-acute illness (aRR: 2.03, 95% CI 1.71-2.41) and a 24% increase the next year (aRR: 1.24, 95% CI 1.03-1.48). Conclusion(s): The increased healthcare utilization rates noted among PCC patients one year following acute COVID-19 illness highlights the need for adequate planning to provide optimal support for people living with PCC.Copyright © 2023

Real-World effectiveness of voxelotor for the treatment of sickle cell disease

Introduction: Voxelotor is a first-in- class sickle haemoglobin polymerisation inhibitor that targets the pathophysiology of sickle cell disease (SCD). Studies have shown that voxelotor increases haemoglobin and reduces markers of haemolysis. Emerging evidence suggests that voxelotor may improve the clinical symptoms of SCD, lower vaso-occlusive crisis (VOC) rates, and reduce transfusion needs. Objective(s): To examine the real-world impact of voxelotor on transfusion, VOC, and hospitalisation rates among patients with SCD. Method(s): Medical and pharmacy claims data for patients >=4 years with SCD who started voxelotor between November 2019 and March 2022 were obtained from the Symphony Health database. Patients with >=1 year of data before the index date (date of first voxelotor claim) were included. Annualised study outcomes were calculated for patients with >=1 occurrence of the corresponding event in the 3-month preindex period. Outcomes from a 90-day lookback were reported for the total and paediatric (aged 4 to <18 years) populations. Result(s): Of 4023 eligible patients from the Symphony Health database included in the analysis, 596 were <18 years. Compared with the 3-month preindex period, significantly lower annualised rates of transfusions, VOCs, and hospitalizations, and lower annualised mean number of inpatient days, were observed in the total population and paediatric subgroup over the 3-month postindex period. For the total population, the annualised event rates declined by 50.6% for transfusions (n = 248), 23.1% for VOCs (n = 1368), 35.5% for VOC-related hospitalizations (n = 757), and 39.4% for all-cause hospitalizations (n = 928). The annualised mean number of inpatient days declined by 29.6% for VOC-related hospitalizations (n = 757) and by 22.9% for all-cause hospitalizations (n = 928). For paediatric patients, the annualised event rates declined by 79.6% for transfusions (n = 18), 42.4% for VOCs (n = 157), 56.8% for VOC-related hospitalizations (n = 81), and 51.5% for all-cause hospitalizations (n = 106). The annualised mean number of inpatient days declined by 54.1% for VOC-related hospitalizations (n = 81) and by 45.8% for all-cause hospitalizations (n = 106). Conclusion(s): Treatment with voxelotor may provide a clinical benefit to patients with SCD by reducing the frequencies of transfusions, VOCs, and hospitalizations and decreasing inpatient days. Greater reductions were observed in the paediatric subgroup, potentially due to the smaller sample size, historically greater treatment compliance in paediatric patients, or younger patients having accumulated fewer SCD-related complications, enabling a greater clinical response. Limitations include the study's non-randomized design, reliance on claims data, and changes in healthcare use during the COVID-19 pandemic confounding the data.

Telemedicine and the Utilization of Outpatient Mental Health Services By Patients with Incident Major Depressive Disorder during the COVID-19 Pandemic

Objectives: To examine the role of telemedicine in providing access to outpatient psychotherapy for children and young adults with incident major depressive disorder (MDD) before and during the COVID-19 pandemic, overall and by race and ethnicity. Method(s): Medical claims from a large, national insurer were retrospectively analyzed to identify two cohorts of individuals aged 10-26 years old, based on incident diagnosis ("index") date of MDD (pre-COVID: March-December 2018, COVID: March-December 2020). We tracked health care utilization, utilization by site of care, modality of care, and psychotherapy Results: The majority of patients in the two cohorts (pre-COVID: N=7,758, COVID: N=8,517) were White (78.9% and 78.8%, respectively), followed by Hispanic (11.5% and 10.9%), Black (6.6% and 7.1%), and Asian (3.0% and 3.2%). While pre-index utilization was similar between cohorts, the COVID cohort had 919 psychotherapy visits per 1,000 patients compared to 735 for the pre-COVID cohort in the month post-index. The increase in visits is largely attributable to an increase in telemedicine visits for the COVID cohort. Similarly, psychotherapy visits increased for all racial and ethnic groups in the COVID cohort compared to the pre-COVID cohort in the month post-index: 22.3% for Whites (931 visits per 1,000 patients in COVID cohort vs. 759 in pre-COVID cohort), 45.0% for Asians (951 vs. 656), 20.5% for Blacks (792 vs. 657) and 46.5% for Hispanics (860 vs. 587). Conclusion(s): Telemedicine increased access to mental health services during the pandemic across races and ethnicities, but racial and ethnic disparities persisted. Health systems should capitalize on the telehealth infrastructure developed during the pandemic to sustain this increased access to care while continuing work to reduce disparities.Copyright © 2023

Descriptive Study Investigating Impact of Transition to Universal Health Insurance Coverage on Utilization of Healthcare in Sudan, 2016 - 2021

Objectives: Since 2016, Sudan was transitioning from limited healthcare subsidization to universal health coverage (UHC). Increasing healthcare access was widely considered beneficial, but some worried that UHC would overwhelm clinical services. In 2020 and 2021 UHC faced the challenge of Covid-19. We undertook a review of national healthcare utilization and enrolment data in order to better understand the impact of UHC in Sudan. Method(s): We conducted a descriptive study using National Health Insurance Fund databases. We analyzed annual enrolment, participating facilities, prescription volume and utilization from 2016 to 2021. Enrolment was stratified by employment status (government, informal sector, private sector, pensioner, impoverished). Utilization was assessed by type of care: primary, specialty, chronic disease and other;we calculated the ratio of primary to specialty care visits. We used the Mann-Kendall test for evaluating trends. Result(s): Participating facilities increased from 2,083 in 2016 to 3,549 in 2019, with slight contraction to 3,495 during 2020-21. Annual enrolment increased significantly, from 16.4 million in 2016 to 36.5 million in 2021 (p value < 0.01). The impoverished sector had the largest increase in enrolment (217%);informal sector had the lowest enrolment growth rate (7%). Volume of primary healthcare visits and prescriptions increased every year, except 2020, the first year of Covid-19 in Sudan. Specialty healthcare visits decreased over the same period, from 2,461,424 to 1,249,585 (p < 0.01). The ratio of primary to specialty visits increased from 6.0 in 2016 to 15.7 in 2021 (p < 0.001). Conclusion(s): In Sudan, transition to UHC increased utilization of primary care services, but at a slower rate than enrolment growth. The ratio of primary to specialty visits increased and specialty visits declined, suggesting that more primary care may have prevented specialist-requiring disease states and sequelae. Fears of overwhelming the health system were unfounded indicating that other barriers to healthcare might exist.Copyright © 2023

Special Issue: Recent learnings and development in healthcare financing: A global perspective. (Special Issue: Recent learnings and development in healthcare financing: A global perspective.)

This special issue contains 11 s that discuss recent learnings and developments in healthcare financing from a global perspective. The s cover a range of topics such as the impact of mental illness on poverty and catastrophic health expenditure in India, financing challenges in the American healthcare industry, comparative analysis of health system financing in India and Saudi Arabia, and the contribution of the Ghana National Health Insurance Scheme to inequality in healthcare utilisation. Other s explore the influence of socio-economic status on health financing choices in Jambi Province, households' willingness to pay for community-based health insurance in Bangladesh, and changes in household expenditures during the first wave of COVID-19 in India. The issue also includes discussions on managing the provider-purchaser split in India and reconsidering patient value to create better healthcare.

Changes in health care utilization among Medicare beneficiaries with diabetes two years into the COVID-19 pandemic.

IMPORTANCE: The coronavirus 2019 (COVID-19) pandemic abruptly impacted health care service delivery and utilization. However, the impact on older adults with diabetes in the United States is unclear. OBJECTIVE: To estimate changes in health care utilization among older adults with diabetes during the initial 2 years of the COVID-19 pandemic compared to the 2 years before, and to examine the variation in utilization changes by demographic and socioeconomic characteristics. DESIGN SETTING AND PARTICIPANTS: In this study, we analyzed changes in utilization, measured by the average use of health care services per 1,000 persons with diabetes, using medical claims for Medicare fee-for-service beneficiaries aged 67 years and above. Utilization changes by setting (acute inpatient, emergency room [ER], hospital outpatient, physician office, and ambulatory surgery center [ASC]) and by media (telehealth and in-person) were examined for 22 months of the pandemic (03/2020-12/2021) compared with pre-pandemic period (03/2018-12/2019). We also estimated utilization changes by beneficiaries' age group, sex, race/ethnicity, and residential urbanicity. RESULTS: The study sample consisted of approximately 6 million beneficiaries with diabetes each month. In the first 2 years of the pandemic, the average use of health care services by setting was 5-17% lower than the pre-pandemic level for all types of services. Phase 1 (03/2020-05/2020) had the largest decrease in utilization: physician office visits changed by -51.2% (95% CI, -55.0% to -47.5%), ASC procedures by -45.1% (95% CI, -49.8% to -40.4%), ER visits by -36.9% (95% CI, -39.0% to -34.7%), acute inpatient stays by -31.5% (95% CI, -33.6% to -29.3%), and hospital outpatient visits by -27% (95% CI, -29.3% to -24.8%). The reduction in utilization varied by sociodemographic subgroup. During the pandemic, the use of telehealth visits increased by 511.1% (95% CI, 502.2% to 520.0%) compared to the pre-pandemic period. The increase was smaller among rural residents. CONCLUSIONS AND RELEVANCE: Medicare beneficiaries with diabetes experienced a reduction in the use of health care services during the COVID-19 pandemic, some of which persisted through two years into the pandemic. Telehealth visits increased, but not enough to overcome decreases in in-person visits. Understanding these patterns may help to optimize the use of health care resources for diabetes management in the post-pandemic era and during future emergencies.

Mode of Hospital Rheumatology Appointments in People with Rheumatoid Arthritis: The Impact of the Pandemic in England

Background/Aims During the COVID-19 pandemic rheumatology services were advised to limit face to face contact, with remote telemedicine used instead. Although suitable for some people, issues have been highlighted with telemedicine. The frequency and proportion of remote appointments during the pandemic has not been described, or the socio-demographic characteristics of those accessing remote or in-person rheumatology care. This study aims to describe rheumatology healthcare utilisation and mode of appointment (remote/in-person) in people with rheumatoid arthritis (RA), prior to, and during the pandemic in England. Methods A retrospective prevalent cohort study of people with RA, identified using a validated algorithm, as of 1st April 2019 using electronic health record data (OpenSAFELY). Outpatient rheumatology appointments between 1st April 2019 and 31st March 2022 were identified. For each year, the number of outpatient appointments, mode of appointment (remote/in-person) and patient socio-demographic characteristics were described. Results 130,884 people with RA were identified. Since the start of the pandemic, the proportion of people without any appointments in a 12-month period increased from 28.5% in 2019/20 to 33.3% in 2020/ 21 and has not recovered. Older people were most frequently not seen (51% of people >80 years in 2020/21 and 2021/22). Of appointments where mode was known, 54.4% of people with appointments in the year from April 2020 were only seen remotely, reducing to 35.1% in the year from April 2021 (Table 1). The proportion with all remote appointments increased with increasing age, comprising 62% of people >80 years in 2020. This age gradient persisted in 2021, though proportions of those >80 years with all-remote appointments was lower (44%). Compared to urban dwellers, a higher proportion of those living in rural areas had all remote appointments in 2020 (58% vs 53%) and 2021 (38% vs 34%). Conclusion During the pandemic, one third of people with RA were not seen at all over a 12-month period and these were more frequently older people. Over half of people were only seen remotely in 2020, decreasing to one-third in 2021. Given the limitations of remote appointments it is unknown whether this increased frequency of remote appointments will impact long-term outcomes.

Frequency and Predictors of Emergency Department Visits Following Colonoscopy: An Assessment of Procedure Safety

Introduction: Colonoscopy is the most commonly performed colorectal cancer screening test in the US, and is associated with known adverse events (AE), including gastrointestinal bleeding (GIB), bowel perforation, abdominal pain, and others. Despite this, post-colonoscopy AEs are rarely monitored by current colonoscopy quality programs. This study investigated the frequency of ED visits in the two weeks following an outpatient colonoscopy at a multi-site academic center. Method(s): We conducted a retrospective cohort study including all adults aged >= 40 who underwent an outpatient colonoscopy at a single academic center between 2016-2019. Data from 2020 were excluded given unpredicTable effects of the COVID-19 pandemic on healthcare utilization. Patients were identified using procedural codes and administrative claims records were used to identify persons who had a subsequent ED visit up to 14 days after their procedure date. For those with ED visits, patient charts were reviewed to data including details of ED presentation. Descriptive statistics were used to characterize the sample. Result(s): There were 187 patients who had an ED visit within two weeks of their colonoscopy, among 34,222 total colonoscopies during the same 4 year time period (0.44%). 46.1% of the ED visits reviewed were either definitely or possibly related to post-colonoscopy AEs. The mean age of the population sample was 61 years. The most common presenting symptoms to the ED post-colonoscopy included abdominal pain (47%), GI bleeding (27.7%), and nausea/vomiting (20.6%). The most common ED diagnosis included GI bleed (26.2%), dehydration (6.4%), and obstruction (3.6%). Nearly half of patients presenting to the ED were admitted (47.2%). In terms of clinical details of the colonoscopies of those who presented to the ED, polypectomy was performed in 67.4% of patients and polypectomy of a large (>=10mm) polyp was performed in 22.7% of patients. Hot snare/biopsy was used in 36.9% of patients and periprocedural use of anti-thrombotics occurred in 36.9% of patients. (Table) Conclusion(s): ED visits occurred in roughly 4 out of 1000 patients within two weeks of a colonoscopy at our center, and nearly half of these patients were admitted. A high proportion of ED visits were for GI symptoms. Furthermore, over 1/3rd of patients with ED visits following a colonoscopy had polyps removed with electrosurgical techniques. These data suggest that regular monitoring of post-colonoscopy ED visits may be valuable for quality improvement purposes.

The first year of the COVID-19 pandemic in humanitarian settings: epidemiology, health service utilization, and health care seeking behavior in Bangui and surrounding areas, Central African Republic.

BACKGROUND: Despite increasing evidence on COVID-19, few studies have been conducted in humanitarian settings and none have investigated the direct and indirect effects of the pandemic in the Central African Republic. We studied the COVID-19 epidemiology, health service utilization, and health care seeking behavior in the first year of the pandemic in Bangui and surrounding areas. METHODS: This mixed-methods study encompasses four components: descriptive epidemiological analysis of reported COVID-19 cases data; interrupted time series analysis of health service utilization using routine health service data; qualitative analysis of health care workers' perceptions of how health services were affected; and health care seeking behavior of community members with a household survey and focus group discussions. RESULTS: The COVID-19 epidemiology in CAR aligns with that of most other countries with males representing most of the tested people and positive cases. Testing capacity was mainly concentrated in Bangui and skewed towards symptomatic cases, travelers, and certain professions. Test positivity was high, and many cases went undiagnosed. Decreases in outpatient department consultations, consultations for respiratory tract infections, and antenatal care were found in most study districts. Cumulative differences in districts ranged from - 46,000 outpatient department consultations in Begoua to + 7000 in Bangui 3; - 9337 respiratory tract infections consultations in Begoua to + 301 in Bangui 1; and from - 2895 antenatal care consultations in Bimbo to + 702 in Bangui 2. Consultations for suspected malaria showed mixed results while delivery of BCG vaccine doses increased. Fewer community members reported seeking care at the beginning of the pandemic compared to summer 2021, especially in urban areas. The fear of testing positive and complying with related restrictions were the main obstacles to seeking care. CONCLUSIONS: A large underestimation of infections and decreased health care utilization characterized the first year of the COVID-19 pandemic in Bangui and surrounding area. Improved decentralized testing capacity and enhanced efforts to maintain health service utilization will be crucial for future epidemics. A better understanding of health care access is needed, which will require strengthening the national health information system to ensure reliable and complete data. Further research on how public health measures interact with security constraints is needed.

Patients' satisfaction with teleconsultations during the COVID-19 pandemic in the Kingdom of Bahrain

Background: The SARS-CoV-2 pandemic led to the restructuring of traditional clinical activity;hence, globally, 58% of countries implemented the use of telemedicine to meet their healthcare needs. Background: To examine patients' satisfaction with telemedicine medical service and experience at the level of primary care in the Kingdom of Bahrain. Methods: A retrospective cross-sectional study was conducted on 335 patients who used teleconsultations in January 2022 in primary care. A validated questionnaire was modified to assess patients' satisfaction with teleconsultation medical services and experience during the COVID-19 pandemic. Results: A total of 315 responses were included in the final analysis (response rate 94%). Almost all expressed extreme satisfaction with the medical service as they were able to easily explain their medical problem over the phone and fully understood their illness after the consultation. They were also satisfied with the ability of the doctor to understand their problem, explain their treatment, and provide appropriate management over the phone. Over 90% were satisfied with the consultation time that it does not require transportation and would like to use it in the future. Sharing private or personal information over the phone received the lowest satisfaction rate (77.5%). Conclusion: The overall satisfaction expressed by respondents of this survey with the teleconsultation medical service and experience is very high. Such a result confirms that patients have a positive attitude towards telemedicine services in primary care and are willing to use it again and, therefore, must be adopted as a proactive strategy to ensure long-term sustainability.

Some key aspects of telemedicine development to support human illness: a systematic review

The aim of this research is to describe the use of telemedicine applied to patients characterised by a particular state of illness, which often drives them toward a frail and chronic status, in a systematic manner. This work employed the Tranfield approach to carry out a systematic literature review (SLR), in order to provide an efficient and high-quality method for identifying and evaluating extensive studies. The methodology was pursued step by step, analysing keywords, topics, journal quality to arrive at a set of relevant open access papers that was analysed in detail. The same papers were compared to each other and then, they were categorised according to significant metrics, also evaluating technologies and methods employed. Through our systematic review we found that most of the patients involved in telemedicine programs agreed with this service model and the clinical results appeared encouraging. Findings suggested that telemedicine services were appreciated by patients, they increased the access to care and could be a better way to face emergencies and pandemics, lowering overall costs and promoting social inclusion.Copyright © 2022 Inderscience Enterprises Ltd.

Adopting a Telemedicine Model of Asthma Care during the Covid-19 Pandemic

Purpose of study The IMPACT DC Asthma Clinic is an intervention program designed to transition children who are heavily dependent on the emergency department for episodic care to more effective longitudinal asthma care in their primary medical homes. We sought to study the implementation of a telemedicine model for IMPACT DC during the COVID-19 pandemic in order to address barriers to care. Methods used A telemedicine model of IMPACT DC was implemented using rapid-cycle improvements and process mapping. Measures for adoption of services including visit completion, show rates, primary language, and patient satisfaction were collected for six months. Healthcare utilization data for the six months prior to the IMPACT DC clinical intervention was collected. This data was compared to in- person clinic visits over the same six-month period the previous year. Summary of results 360 patients successfully completed a telemedicine visit between April 2020 and September 2020 with an average visit show rate of 52%. Primary language was English in 89%. These patients were most frequently classified as having mild-persistent asthma and were assessed as well-controlled. Satisfaction survey response rate was 33%;overall average satisfaction was high. In the comparison group, 701 patients successfully completed an in-person clinic visit between April 2019 and September 2019 with a visit show rate of 39%. Primary language was English in 84%. These patients were most frequently classified as having mild-persistent asthma, not well-controlled. Healthcare utilization data for both groups six months prior to their visit are displayed Conclusions The use of telemedicine provides IMPACT DC a feasible and adoptable model to continue caring for children with asthma, with overall high patient satisfaction. This model addresses access barriers during the pandemic, and promises to be an adjunctive tool for reaching families with low show rates and high healthcare utilization. (Table Presented).

Pulmonary sarcoidosis

The lung is the most common organ affected by sarcoidosis. Multiple tools are available to assist clinicians in assessing lung disease activity and in excluding alternative causes of respiratory symptoms. Improving outcomes in pulmonary sarcoidosis should focus on preventing disease progression and disability, and preserving quality of life, in addition to timely identification and management of complications like fibrotic pulmonary sarcoidosis. While steroids continue to be first-line therapy, other therapies with fewer long-term side-effects are available and should be considered in certain circumstances. Knowledge of common clinical features of pulmonary sarcoidosis and specific pulmonary sarcoidosis phenotypes is important for identifying patients who are more likely to benefit from treatment.Copyright © ERS 2022.

Health Disparities in Children with Covid-19 Early in the Pandemic: Socioeconomic Disadvantages Contributing to Severe Disease

Purpose of Study: Ethnic disparities are associated with increased risk for severe disease in pediatric patients with COVID-19. Identifying the underlying social determinants of health are necessary to lead to improved health care utilization and mitigation strategies. Methods Used: This is an observational cohort study of children with COVID-19 in Colorado (the CCC study) from March 15 2020-October 31 2020. Pediatric patients between 2-20 years of age with positive SARS-CoV-2 PCR were included. Multivariable logistical regression models were fitted to identify demographic, socioeconomic, and comorbid health conditions as predictors of severe COVID-19 disease, as defined by hospital admission and need for respiratory support. Summary of Results: We identified 1572 pediatric patients with COVID-19 (45% Hispanic, 54% Medicaid or uninsured, 16% non-English language, and 20% obese). In univariable analyses, Hispanic ethnicity was associated with severe outcomes, including hospital admission (OR 2.4, CI: 1.57, 3.80, p<0.01) and respiratory support (OR 2.4, CI: 1.38, 4.14, p<0.01). Patients who identified as Hispanic or Latino had significantly increased rates of obesity (28% vs. 14%, p<0.01), preferred non-English language (31% vs. 3%, p<0.01), and had Medicaid or no insurance (79% vs. 33%, p<0.01) when compared to non-Hispanic or Latino children. After adjusting for covariables, ethnicity was no longer associated with hospital admission (OR 0.9, CI: 0.53, 1.63, p=0.79) or respiratory support (OR 0.6, CI: 0.29, 1.21, p=0.15). Obesity (OR 1.9, CI: 1.15, 3.08, p=0.01), non-English language (OR 2.4, CI: 1.35, 4.23, p<0.01), and Medicaid insurance (OR 2.0, CI: 1.10, 3.71, p=0.02) were identified as independent risk factors for severe disease. Conclusion(s): Severe COVID-19 disease observed in Hispanic or Latino patients early in the pandemic appears to be secondary to underlying comorbid conditions, such as obesity, and socioeconomic disadvantages that may have influenced access to care, such as language and insurance status. Pediatric healthcare providers and public health officials should use this knowledge to tailor resource allocation to better target this underserved patient population.

Basic needs of the first batch of medical staff in the fever clinic of Peking union medical college hospital during Coronavirus disease 2019 outbreak: A qualitative study.

Objective The objective of this study was to investigate the basic needs of medical staff during the coronavirus disease 2019 pandemic in a fever clinic, so as to provide a reference for the global epidemic medical teams. Methods A semi-structured qualitative interview outline was designed, including: (1) work level: Working hours, working intensity, and safety guarantee in a fever clinic;(2)life level: Diet, sleep, and physical comfort;(3)psychological level: Emotion, pressure, coping style, and interpersonal resources. The basic needs of the first batch of the fever clinic in Peking Union Medical College Hospital was studied by open telephone interviews. Results A total of 37 medical staff were interviewed, including 8 males (21.6%) and 29 females (78.4%). Among them, there were 16 doctors (43.2%), 19 nurses (51.4%), and 2 medical technicians (5.4%). In terms of work settings, the ideal continuous working time was 4-6 hours per shift. There should be pro re nata positions during extremely high workload, and sufficient personal protective equipment was the key to safety. In terms of living conditions, providing meals according to different shifts was important for dietary needs, and sleeping pills were temporarily needed for sleep. In terms of psychological reactions, nervousness and worrying were relatively common. Family and colleagues were important resources of support. Sport could help relieve physical and psychological stress, and psychological support from psychologists was helpful in reducing their negative emotions. Conclusions The basic needs of medical staff should be respected so as to keep the efficacy of their work. We suggest that medical staff can rest after each 4-6 h working shift. Personal protective equipment should be sufficient. Psychological support should be noted in all of them and provided when necessary.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

Ambulatory visits, active component, U.S. Armed Forces, 2021

The aggregate numbers and rates of ambulatory care visits by active component service members in 2021 were the highest of the previous ten years. Most disease and injury categories experienced slight increases in both rates and numbers. From 19% of ambulatory care visits in 2020 to less than 15% in 2021, telehealth contacts were used less frequently. The statistics for 2021 demonstrate a return to pre-pandemic levels, notwithstanding the possibility that the response to the COVID-19 pandemic in 2020 was related with declines in the incidence of disease and injury diagnoses in the community of service members seeking ambulatory care. Additionally, the proportions of telehealth-delivered medical encounters have similarly decreased to the lower levels seen before the pandemic. Lessons learned may direct future actions to lower the frequency of disease and harm in the post-pandemic era. This study details the ambulatory health care visits made by active component members of the U.S. Army, Navy, Air Force, and Marine Corps in 2020 in terms of frequency, rates, trends, and other factors. U.S. service members' ambulatory visits to fixed military and nonmilitary medical treatment facilities (reimbursed through the Military Health System [MHS]) are recorded in standardized, computerized records. The Defense Medical Surveillance System (DMSS), the data source for this report, routinely archives these records for health surveillance purposes. This research excludes ambulatory visits that are not frequently and fully recorded using standardized electronic records (for example, during deployments, field training exercises, or at sea). As in previous MSMR reports, the primary (first-listed) diagnostic position of the visit records was used to categorize all records of ambulatory visits of active component service members according to the first four characters of the ICD-10 codes. In this research, a specific query of the DMSS records was carried out to identify ambulatory visits that were completed via "telehealth" encounters rather than in-person meetings (e.g., via telephone or video conferencing). Most data summaries included both types of encounters and did not make a distinction between them, however due to the rise in telehealth encounter usage during the coronavirus 2019 (COVID-19) pandemic, changes in the proportions of telehealth encounters were examined.