Evaluating a Tobacco Treatment Program's Transition to Telehealth Using a Social Determinants of Health Lens.

INTRODUCTION: While strong associations exist between social determinants of health (SDOH), socioeconomic status, and smoking, these factors are not routinely assessed in tobacco treatment programs (TTP). This study addresses this gap by evaluating a composite metric of SDOH and a measure of access to care to determine program reach before and after the implementation of telehealth tobacco treatment delivery. AIMS AND METHODS: We examined inpatient data from a large TTP during two comparable time periods from April 1, 2019 to September 30, 2019 (pre-telehealth) and from April 1, 2020 to September 30, 2020 (telehealth). The populations were compared using point-of-care data, including 5-digit zip codes mapped to the CDC's Social Vulnerability Index (SVI) and driving distance (in 60-min increments) to the study hospital. Chi-square tests for homogeneity were performed for SVI and driving distance comparisons. RESULTS: While distance distributions were significantly different between the pre-telehealth and telehealth populations (χ 2 = 13.5 (df = 3, N = 3234), p = .004, no significant differences existed in the proportion of SVI categories between the two populations (χ 2 = 5.8 (df = 3, N = 3234), p = .12). In the telehealth population, patients with the highest SVI vulnerability had the greatest proportions living >1 h from the hospital. CONCLUSIONS: This study offers a novel evaluation of tobacco treatment in relation to an SDOH metric (SVI) and care access (distance to the hospital) for inpatient populations. Patient reach, including to those with high vulnerabilities, remained consistent in a transition to telehealth. These methods can inform future reach and engagement of patients who use tobacco products, including patients with high vulnerability or who reside at greater distances from treatment programs. IMPLICATIONS: This study provides the first analysis of inpatient tobacco use treatment (TUT) transition to telehealth delivery of care during the COVID-19 pandemic using the CDC's SVI metric and patient distance to the hospital. The transition resulted in consistent reach to patients at the highest vulnerability. These findings can inform efforts to evaluate SDOH measures and improve reach, engagement, and research on telehealth delivery of inpatient TUT.

An Analysis of Inpatient Tobacco Use Treatment Transition to Telehealth.

INTRODUCTION: During the COVID-19 pandemic, many tobacco users increased their tobacco use, and calls to quitlines decreased. Among inpatients, the pandemic also necessitated a rapid transition of intensive tobacco use counseling to telehealth counseling. No data exist comparing the outcomes of telehealth inpatient counseling with in-person (pre-telehealth) counseling. AIMS AND METHODS: We examined inpatient data from a large tobacco treatment program (TTP) during two comparable time periods 04/01/2019-09/30/2019 (pre-telehealth) and 04/01/2020-09/30/2020 (telehealth). The pre-telehealth and telehealth populations were compared using Pearson's chi-square test for homogeneity on each populations' patient, visit, and medication acceptance characteristics. Reach to "current tobacco users" was analyzed using TTP flowsheet and electronic health record (EHR) data in relation to aggregate EHR data in the data warehouse. RESULTS: Mean monthly tobacco treatment inpatient counseling and outreach visits increased 38.9% in the telehealth period (M = 376, SD = 36.7) compared with the pre-telehealth period (M = 271, SD = 50.0) (t(10) = 3.8, p = .004). Reach significantly increased from 32.8% to 65.9% among all "current tobacco users" admitted, including 31.8% to 66.6% in races at higher risk for COVID-19 severe disease. Pearson's chi-square tests for homogeneity showed significant differences in the pre-telehealth and telehealth population distributions for age, visit type, ethnicity, and medication acceptance. CONCLUSIONS: This study offers the first understanding of characteristics of patients, visits, and medication acceptances in pre-telehealth and telehealth tobacco use treatment for inpatient populations. Larger reach and counseling were identified in the telehealth population. This study's findings on inpatient tobacco use treatment can inform future reach and engagement of large numbers of patients who use tobacco products. IMPLICATIONS: This study provides the first analysis of inpatient tobacco use treatment transition to telehealth delivery of care during the COVID-19 pandemic. The transition resulted in increases in reach and cessation counseling. These findings can inform efforts to improve reach, engagement, and research on telehealth delivery of inpatient tobacco use treatment.

Oyster-related tenosynovitis: a rare case of Mycobacterium szulgai in the immunocompromised.

A 66-year-old man with a history of renal transplant on chronic immunosuppression presented to his primary care physician with a swollen right index finger. On examination, mild swelling was present. Conservative management failed and initial plain films were negative. Corticosteroid injection was performed by orthopaedics, but symptoms recurred several months later and an MRI showed flexor digitorum tenosynovitis and abscesses of the superficialis and profundus tendons. A flexor tenolysis was performed with cultures positive for Mycobacterium szulgai, a rare, non-tuberculous mycobacterial infection. Treatment was initiated with moxifloxacin, ethambutol and azithromycin daily for nearly 4 months. Repeat MRI 3 months after completion of antibiotics showed near resolution of the tenosynovitis.