Effects of Medical Cannabis Certification on Hospital Use by Individuals with Sickle Cell Disease.

Context: Retrospective study of 36 individuals with sickle cell disease (SCD) certified for medical cannabis. Objective: We sought to examine whether medical cannabis certification was associated with a change in utilization of acute care medical services for patients with SCD. Methods: We identified patients with SCD certified for medical cannabis use between July 2014 and December 2021 using the New York State Prescription Monitoring Program (NYS PMP) and cross-matching to our electronic medical record. We estimated the mean incidences of Emergency Department (ED) visits, hospital admissions, inpatient days, and total acute encounters for SCD-related pain per month pre- and post-medical cannabis certification and used paired t-tests to assess the statistical significance of changes in hospital use. We stratified incidence based on whether patients had received a bone marrow transplant (BMT) at any point before or during the research period, since BMT is potentially an important covariate. Recertification rates and patients' reasons for choosing to recertify were qualitatively investigated through retrospective chart review. Results: The incidence of ED visits, hospital admissions, and total acute encounters per month for SCD-related pain decreased pre- to post-certification (p=0.02; p=0.02; p=0.01). These decreases lost statistical significance after stratifying patients based on BMT history. There was no statistically significant change in the number of days per month patients spent hospitalized in either the primary analysis or after stratification by BMT status. Forty-four percent of patients chose to be recertified. Thirty-six percent of patients cited concerns regarding the cost of medical cannabis. Conclusion: Our study did not show a statistically significant relationship between certification for medical cannabis and hospital use after addressing BMT history as a potentially important covariate. However, we were likely underpowered to detect any existing difference after patient data were stratified due to our small sample size. Regardless, 44% of patients chose to be recertified, indicating a perceived benefit and utility in further investigation of medical cannabis for this population with a larger analytic sample. Patient-reported benefits were improvement of pain and other symptoms, decreased opiate requirements, and decreased side effects compared to opiates.

COVID-19 vaccine controversy: A cross-sectional analysis of factors associated with COVID-19 vaccine acceptance amongst emergency department patients in New York City.

Objective: Understanding variables associated with coronavirus disease 2019 (COVID-19) vaccine confidence and hesitancy may inform strategies to improve vaccine uptake in clinical settings such as the emergency department (ED). We aim to identify factors contributing to COVID-19 vaccine acceptance and to assess patient attitudes surrounding offering COVID-19 vaccines in the ED. Methods: We conducted a survey of a convenience sample of patients and patient visitors over the age 18 years, who were native English or Spanish speakers. The survey was conducted from March through August 2021 at 3 EDs in New York City. The survey was administered via an electronic format, and participants provided verbal consent. Results: Our sample size was 377. Individuals with post-graduate degrees viewed vaccines positively (Prevalence Ratio [PR], 1.63; 95% Confidence Interval [CI], 1.07-2.47).  Of the various high-risk medical conditions associated with adverse COVID-19 infection outcomes, diabetes was the only condition associated with more positive views of vaccines (PR, 1.37; CI, 1.17-1.59). Of all participants, 71.21% stated that they believed offering a COVID-19 vaccine in the ED was a good idea. Of unvaccinated participants, 21.80% stated they would get vaccinated if it were offered to them in the ED. Conclusion: EDs can serve as a safety net for vulnerable populations and can act as an access point for vaccination.

Strategies for responding to the COVID-19 pandemic in a rural health system in New York state.

Research and media reports about coronavirus disease 2019 (COVID-19) have largely focused on urban areas due to their high caseloads. However, the COVID-19 pandemic presents distinct and under-recognized challenges to rural areas. This report describes the challenges faced by Bassett Healthcare Network (BHN), a health network in rural upstate New York, and the strategies BHN devised in response. The response to COVID-19 at BHN focused on 4 strategies: (1) Expansion of intensive-care capacity. (2) Redeployment and retraining of workforce. (3) Provision of COVID-19 information, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral testing, and appropriate follow-up for a geographically dispersed population. (4) Coordination of the response to the pandemic across a large, diverse organization. Rural health systems and hospitals can take steps to address the specific challenges posed by the COVID-19 pandemic in their communities. We believe that the strategies BHN employed to adapt to COVID-19 may be useful to other rural health systems. More research is needed to determine which strategies have been most effective in responding to the pandemic in other rural settings.