BACKGROUND:Familial use of a language other than English (LOE) is associated with worse outcomes among hospitalized children. Professional interpretation improves outcomes but is underused. This pilot study aimed to evaluate the impact of a family-initiated interpretation intervention on use of interpreters. METHODS:We conducted a single-site pilot from April 2023 to January 2024 at a quaternary children's hospital in the midwestern United States. The intervention took place in the pediatric intensive care unit (PICU). Families who used an LOE were encouraged to independently initiate interpretation using hospital-provided tablets. Each patient room had a video interpreter tablet with instructions in the family's primary language. Primary outcomes were the average number and duration of interpreter encounters per patient-day before and after intervention (September 2022-March 2023 vs April 2023-January 2024), analyzed using interrupted time series. Medical team perceptions of intervention feasibility, acceptability, and appropriateness were also measured. RESULTS:There were 158 families in the preintervention group and 271 in the postintervention group. The average duration of interpreter use per patient-day increased from 7.6 to 16.2 minutes (P < .001), and interpreter encounters increased from 0.66 to 1.34 per patient-day (P = .001). Clinician survey responses indicated high acceptability (mean 4.7 ± 0.5), appropriateness (4.7 ± 0.5), and feasibility (4.4 ± 0.7) on a 1 to 5 scale, with 5 indicating "completely agree," with top-box ("completely agree") responses on 73%, 74%, and 46% of items, respectively. CONCLUSIONS:Family-initiated interpretation was associated with increased interpretation. This strategy may improve interpretation in the PICU.

Importance:Sleep-wake disturbances in midlife are common and potentially modifiable contributors to long-term brain health, yet primary care lacks a brief, validated tool that reliably identifies adults with early cognitive vulnerability. Objective:To evaluate associations between commonly used sleep questionnaires and cognitive impairment among midlife primary care patients. Design Setting and Participants:Cross-sectional analysis of baseline data from the MidCog cohort, an observational study of English-speaking adults aged 35 to 64 years receiving primary care at academic practices or federally qualified health centers in the Chicagoland area. Exposures:Five validated sleep questionnaires were used to assess distinct sleep-wake disturbance phenotypes: (A) unsatisfactory sleep (PROMIS Sleep Disturbance T-score >55), (B) short sleep duration (<6 hours; Munich Chronotype Questionnaire), (C) obstructive sleep apnea (OSA) risk (STOP-Bang ≥3), (D) insomnia symptoms (Insomnia Severity Index ≥15), and (E) poor multidimensional sleep health (RU-SATED ≤6). Main Outcomes and Measures:The primary outcome was cognitive impairment defined as an age- and education-adjusted NIH Toolbox Cognition Battery (NIHTB-CB) Fluid Composite T-score <40 (>1 SD below the population mean). Cognitive impairment defined by the Montreal Cognitive Assessment (MoCA) score <23 served as the secondary outcome. Logistic regression estimated adjusted odds ratios (aOR), controlling for age, sex, education, body mass index, hypertension, hypercholesterolemia, diabetes, smoking, depressive symptoms, and recruitment site. Results:Among 646 participants (mean [SD] age, 52.3 [8.1] years; 62.4% female; 38.0% non-Hispanic Black, 38.4% non-Hispanic White, 16.0% Hispanic), cognitive impairment was present in 18.7% by NIHTB-CB and 22.3% by MoCA. Among five sleep-wake disturbance phenotypes evaluated, only poor multidimensional sleep health was consistently associated with cognitive impairment after multivariable adjustment (NIHTB-CB: adjusted OR [95% CI] = 2.03 [1.25-3.26]; MoCA: 1.98 [1.20-3.26]). Conclusions and Relevance:Poor multidimensional sleep health was associated with cognitive impairment in midlife primary care patients. Brief multidimensional sleep health screening may identify individuals with early cognitive vulnerability and represent a potential strategy for targeting sleep-focused interventions to promote long-term brain health. Key Points:Question: Among commonly used brief sleep questionnaires, which measure, if any, best identifies midlife primary care patients at risk of early cognitive vulnerability?Findings: In this cross-sectional study of 646 primary care patients aged 35-64 years, poor multidimensional sleep health assessed using the RU-SATED questionnaire was the only sleep-wake disturbance phenotype consistently associated with cognitive impairment across two cognitive measures (NIH Toolbox Cognitive Battery and Montreal Cognitive Assessment).Meaning: Brief multidimensional sleep health screening may help identify midlife adults with sleep-related early cognitive vulnerability in primary care and may represent a potential target for sleep-focused interventions to promote long-term brain health.

IntroductionExisting research has linked increased patient participation in oncology care to greater patient satisfaction, enhanced quality of life, and improved healthcare utilization among patients with cancer. Yet, current measures of patient engagement and similar constructs do not reflect the unique experiences of patients with metastatic breast cancer; they also have limitations in terms of modality, cost, and potential for integration into clinical care. To address this, we sought to develop a new measure of participatory care in metastatic breast cancer care, referred to as the Capacity, Opportunity, and Resources in Metastatic Breast Cancer (CORe-MBC) that could be easily used in clinical care.MethodsA comprehensive pool of candidate items for CORe-MBC was created with input from MBC patients, oncologists, and experts in measure development. Items were tested among 130 English-speaking patients with MBC recruited from a large academic oncology center; participants also completed validated measures of health activation, self-efficacy, satisfaction with care, and social support (e.g., emotional, informational, and tangible). Psychometric testing included exploratory factor analyses, using oblique rotations to evaluate factor structure, and parallel analysis to test for dimensionality.ResultsPatients’ ages ranged from 34 to 90 years. The majority (82%) identified as White, one-third (34%) had less than a college degree, and almost all (99%) were female. Candidate items loaded onto three factors (all factor loadings >.5), reflecting the domains of capacity, opportunity, and resources. A total of 10 items were selected for the final measure. Items demonstrated high internal consistency (α = 0.83). Domains of capacity, opportunity, and resources demonstrated moderate to high construct validity with comparable measures of patient activation (r = 0.56, p <.0001) and self-efficacy (r = 0.31–0.40, p < 0.0005), and multiple measures of satisfaction with healthcare (r = 0.42–0.55, p <.0001), and social support (r = 0.52–0.75, p <.0001), respectively.ConclusionThe CORe-MBC measure appears to be psychometrically valid and reliable. Additional studies are ongoing to further validate use of the tool among diverse populations and within a variety of oncology practices, with the goal of providing clinicians with actionable insights to tailor and improve care.

BACKGROUND:Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer important cardiovascular-kidney-metabolic benefits to women with type 2 diabetes (T2D) but are contraindicated during pregnancy. We sought to describe the frequency of GLP-1 RA prescribing among young women with T2D and to examine pregnancy intention, contraceptive use, and receipt of reproductive health counseling in this population. METHODS:A total of 382 English- and Spanish-speaking women with T2D, aged 18-44, were recruited from 38 health centers in Chicago. Patients were enrolled in the usual care arm of an ongoing clinical trial testing a preconception health intervention. GLP-1 RA prescribing was determined via self-report with chart verification. Bilingual research coordinators administered structured surveys measuring pregnancy intention, contraceptive use, and receipt of reproductive health counseling. RESULTS:Participants were sociodemographically diverse; 42.5% had a household income less than $35,000/year, 46% had limited health literacy, and the average age was 36 years. Half (50.8%) were prescribed a GLP-1 RA. Among women prescribed GLP-1 RAs (n = 194), 54.6% intended a future pregnancy; 40.7% used hormonal contraceptives or an intrauterine device. Few reported discussing pregnancy intention (11.9%), contraceptive use (11.4%), or preconception health (13.4%) during their recent visit. Women with limited health literacy were less likely to report discussing preconception health (6.3%, 95% confidence interval [CI]: 1.4-11.2 versus 18.4%, 95% CI: 12.0-24.9, p = 0.01). CONCLUSION:GLP-1 RAs are commonly prescribed to young women with T2D, many of whom intend a future pregnancy, yet reproductive health counseling is scarce. Optimizing preconception care is critical to improve outcomes, particularly for women with limited health literacy.

Background Poor medication adherence among older adults with multiple chronic conditions and polypharmacy is a public health concern stemming from distinct challenges. Prior interventions have largely used a one-size-fits-all approach or resource-intensive approaches inappropriate for busy primary care clinics. Objective To address this, Phenotyping Adherence Through Technology-Enabled Reports and Navigation (PATTERN) was adapted from prior work. PATTERN is a portal-based intervention for monitoring self-reported medication adherence challenges among older adults in primary care. This study sought to implement and evaluate PATTERN’s feasibility and acceptability. Methods We conducted a patient randomized study with a posttest design. Primary care physicians at the participating health center were informed of the study, and approval was obtained to contact their patients. Patient eligibility included being aged 60 years or older, having prescription medications for ≥8 chronic conditions, and an upcoming visit with a physician who had provided approval. Potentially eligible patients were identified using an electronic health record query, and a research coordinator phoned them to confirm eligibility, assess interest, obtain consent, and conduct enrollment. Randomization occurred following enrollment. Those randomized to PATTERN received a medication adherence assessment in their patient portal accounts several days ahead of their visit. The assessment identified whether a patient was experiencing a medication adherence challenge, and if so, the type (cognitive, psychological, medical, regimen-related, social, or economic). Identified challenges were sent to the patient’s primary care physician. Assessment delivery several days ahead of a visit was thought to offer sufficient time for patients to complete it and clinicians to review any challenges. Approximately 2 weeks after visits, the coordinator recontacted participants to conduct posttest interviews. This ensured clinicians had sufficient time to respond to challenges during or after visits. Posttest interviews measured the self-reported use of the portal, demographic and health characteristics, and for those randomized to PATTERN, intervention satisfaction. Self-reported data were captured in REDCap and analyzed descriptively. Electronic health record data were also analyzed descriptively to objectively identify feasibility, that is, whether intervention arm participants completed the PATTERN assessment. Results We enrolled 64 participants (32 received usual care, and 32 received intervention). Most were female (66%, 42/64), not Hispanic or Latino (94%, 60/64), and identified as White (58%, 37/64). The average (SD) age was 75 (6.8) years. Most participants (80%) self-reported using the patient portal ≥12 times per year. However, electronic health record data revealed that less than half of all participants randomized to PATTERN (47%, 15/32) completed the medication adherence assessment. Of those who remembered completing it, 60% (3/5) were very satisfied with the experience and 20% (1/5) were a little satisfied. Conclusions PATTERN has the potential for use with older primary care patients experiencing multiple chronic conditions and polypharmacy. Yet, further adaptation is needed to ensure recipients access their patient portal accounts and complete assessments.

Older people with HIV (OPWH) have an increased risk of type 2 diabetes mellitus (T2DM). Understanding this is important to screen and initiate treatments. This study explored awareness of T2DM, perceived risk, and willingness to receive T2DM preventive education. OPWH were recruited from an academic health center in Chicago, Illinois between November 2022 and January 2023. Staff used interview guides for qualitative data collection and administered a sociodemographic survey. Qualitative data was analyzed using the Framework Method; survey data was analyzed descriptively. A total of 19 participants were enrolled; the mean age was 59 years, and 37% were female. Thematic analysis revealed: (1) although participants were familiar with T2DM, they were largely unaware of the increased risk among individuals with HIV; (2) participants had divergent views regarding their own T2DM risk perception; (3) health maintenance was a motivator for T2DM prevention, yet participants noted lifestyle improvements may be difficult to implement; (4) participants were open to receiving diabetes prevention materials via the patient portal. Despite a general lack of awareness of T2DM risk among older adults with HIV, participants were willing to receive T2DM prevention information. Future research should develop plain language materials for OPWH and determine appropriate delivery procedures.

Approximately one in five HIV infections in the United States occurs among cisgender women, those whose gender identity matches their sex assigned at birth. Pre-exposure prophylaxis (PrEP) is a highly effective preventive option for all genders, yet lack of awareness and stigma have hindered uptake. To address this gap, we sought to develop and pilot test an electronic health record-based strategy among cisgender women in primary care. Our strategy, informed by prior work, identified cisgender women in primary care who might benefit from PrEP, provided them with person-centered PrEP educational materials via the patient portal, and offered an opportunity to electronically request a dedicated PrEP visit with a PrEP champion – a female primary care physician – if desired. We conducted two sequential patient-randomized pilot studies to test: (1) the efficacy of the materials compared to usual care, and (2) the preliminary effectiveness of our strategy compared to usual care. The primary outcomes for the efficacy study included PrEP knowledge and PrEP stigma, while the primary outcome for the preliminary effectiveness study was PrEP uptake over a three-month period. In total, we enrolled 200 women. The efficacy study (n = 100, n = 50 per arm) revealed our PrEP educational materials significantly increased PrEP knowledge scores among women who were directly shown the materials, compared to those who were not (9.4 (standard deviation (SD) 0.9) vs. 5.8 (SD 1.8) out of 10, p-value < 0.01, respectively). However, the preliminary effectiveness study (n = 100, n = 50 per arm) resulted in no significant differences, other than PrEP awareness, between women randomized to our strategy and those randomized to usual care. PrEP educational materials have the potential to increase PrEP knowledge among cisgender women. For the patient portal to be an effective delivery channel, additional support efforts should be considered. The study was registered at ClinicalTrials.Gov, Clinical Trial number NCT05709860 registered on 2023-01-17.

Poor sleep health has been associated with worse cognitive and health outcomes in older adults. Less is known about this relationship in midlife. Thus, we aimed to investigate the relationship between self-reported sleep health, cognitive function, and performance on common health tasks among middle-aged adults, as sleep may be a modifiable target to address later life risk of cognitive decline. English-speaking adults aged 35-64 were recruited from an academic general internal medicine practice and federally qualified health centers in the greater Chicagoland area. Multidimensional sleep health (regularity, satisfaction, alertness, timing, efficiency, and duration) was measured by the RU-SATED questionnaire. Global cognitive function was measured using the Montreal Cognitive Assessment (MoCA); age- and education-adjusted Z-scores were calculated. Cognitive impairment was defined as MoCA Z-score lower than one standard deviation below population mean. Performance on common health tasks (e.g. comprehension of print health material, recall of spoken instructions, dosing medications, recall of multimedia education) were assessed using the Comprehensive Health Activities Scale (CHAS). We examined the association between sleep health, cognitive impairment, and health task performance using univariate and multivariable logistic regression. Covariates, selected a priori , included age, sex, number of chronic conditions, and depressive symptoms. A total of 310 participants (mean age 51.2 ± 8.1; 66% female; 39% non-Hispanic Black, 32% non-Hispanic White, 21% Hispanic; 54% with 2+ chronic conditions) were included in analyses. The median sleep health score was 8 (interquartile range: 6-10) and cognitive impairment was found in 11.3%. Poorer sleep health was significantly associated with cognitive impairment after adjusting for a priori covariates (adjusted odds ratio, 0.98; 95% CI, 0.96-0.99; P = 0.007). Both poorer sleep health (ß, 1.11; 95% CI, 0.22-1.99; P = 0.014) and cognitive impairment (ß, -27.7; CI, (-34.3)-(-21.1); P<0.001) were independently associated with poorer performance on health tasks, after adjusting for a priori covariates. Poorer self-reported sleep health in midlife was associated with a greater likelihood of cognitive impairment, whereas both poorer sleep health and cognitive impairment were associated with lower self-management abilities to navigate healthcare. Future studies should examine whether sleep-targeted intervention in midlife can mitigate cognitive later-life decline and poorer health outcomes.

Background:The COVID-19 pandemic has had a widespread impact on sleep quality, yet little is known about the prevalence of sleep disturbance and its impact on self-management of chronic conditions during the ongoing pandemic. Objective: To evaluate trajectories of sleep disturbance, and their associations with one’s capacity to self-manage chronic conditions. Design: A longitudinal cohort study linked to 3 active clinical trials and 2 cohort studies with 5 time points of sleep data collection (July 15, 2020 – May 23, 2022). Participants: Adults living with chronic conditions who completed sleep questionnaires for two or more time points. Exposure: Trajectories of self-reported sleep disturbance across 5 time points. Main Outcomes: 3 self-reported measures of self-management capacity, including subjective cognitive decline, medication adherence, and self-efficacy for managing chronic disease. Results: 549 adults aged 23 to 91 years were included in the analysis. Two thirds had 3 or more chronic conditions; 42.4% of participants followed a trajectory of moderate or high likelihood of persistent sleep disturbance across the study period. Moderate or high likelihood of sleep disturbance was associated with older age (RR 1.57, 95% CI 1.09, 2.26, P<.05), persistent stress (RR 1.54, 95% CI 1.16, 2.06, P=.003), poorer physical function (RR 1.57, 95% CI 1.17, 2.13, P=.003), greater anxiety (RR 1.40, 95% CI 1.04, 1.87, P=.03) and depression (RR 1.63, 95% CI 1.20, 2.22, P=.002). Moderate or high likelihood of sleep disturbance was also independently associated with subjective cognitive decline, poorer medication adherence, and worse self-efficacy for managing chronic diseases (all P<.001). Conclusions: Persistent sleep disturbance during the pandemic may be an important risk factor for inadequate chronic disease self-management and potentially poor health outcomes in adults living with chronic conditions. Public health and health system strategies might consider monitoring sleep quality in adults with chronic conditions to optimize health outcomes.

Both limited health literacy (HL) and elevated blood pressure variability (BPV) in later life have been associated with the risk of dementia and cognitive impairment. However, little is known about the relationship between HL, BPV, and domain-specific cognitive decline. We aimed to examine this relationship among primary care older adults. English-speaking adults aged 55-74 were recruited from an academic general internal medicine practice and federally qualified health centers in Chicago between 8/2008 and 6/2010. HL was measured by the Newest Vital Sign. BPV was assessed by variation independent of mean systolic blood pressure calculated from all blood pressure measures obtained during routine ambulatory visits that occurred in calendar years 2008 – 2012. Five cognitive domains (processing speed, inductive reasoning, and working, long-term, and prospective memories) were assessed through 15 tests at baseline, which were repeated three additional times at a 2.5-year interval. Changes in Z-scores were calculated from baseline (T1) to the last available assessment (T4 or T3) for each of the five cognitive domains. We examined associations between BPV and domain-specific cognitive changes with univariate and multivariable regression, adjusting for a priori covariates including baseline age, sex, race, hypertension, number of chronic conditions excluding hypertension, cognitive function, HL, and interval between cognitive assessments. A total of 299 participants (age 63.3 ± 5.3; 73% female; 26% non-Hispanic Black, 67% non-Hispanic White; 1.8 ± 1.3 chronic conditions; 51.8% with hypertension at baseline) were included in analyses (Table 1). Median interval between cognitive assessments was 8.4 years (IQR 8.2-8.7). Baseline hypertension (β, 1.00; 95% confidence interval (CI), 0.28-1.71; p = 0.006) and limited HL (β, 1.42; CI, 0.65-2.20; p<0.001) were significant predictors of 5-year BPV (Table 2). Greater 5-year BPV was significantly associated with decline in long-term memory (β, -0.035; CI, (-0.064)-(-0.007); p = 0.016), but not with changes in other cognitive domains, after adjusting for a priori covariates (Table 3). Limited health literacy in later life is associated with greater variability of systolic blood pressure over five years, which was, in turn, associated with greater decline in long-term memory over a median follow-up of eight years.

In a large academic medical center, processes for ordering and receiving biomarker testing to inform cancer treatment in nonsmall cell lung cancer varied by whether tests were conducted internally or externally. Lack of standardization in biomarker testing processes, despite the availability of electronic health record solutions, contributes to clinician burden and may increase risk of delays in receipt of testing results; therefore, efforts to streamline ordering processes may benefit health systems.

Background Older adults with HIV are at increased risk of developing certain chronic health conditions including type 2 diabetes mellitus (T2DM). As the number and complexity of conditions increases, so do treatment and health care needs. We explored patient and clinician preferences for HIV+T2DM care and perceived solutions to improving care. Methods We conducted an exploratory qualitative study comprised of individual in-depth interviews. Participants included English-speaking patients aged 50 and older living with HIV and T2DM and infectious disease (ID) and primary care (PC) clinicians from a large academic health center in Chicago. Thematic analysis drew from the Framework Method. Results A total of 19 patient and 10 clinician participants were interviewed. Many patients reported seeking HIV and T2DM care from the same clinician; they valued rapport and a ‘one-stop-shop’. Others reported having separate clinicians; they valued perceived expertise and specialty care. Nearly all clinicians reported comfort screening for T2DM and initiating first line oral therapy; ID clinicians reported placing referrals for newer, complex therapies. Patients would like educational support for T2DM management; clinicians would like to learn more about newer therapies and easier referral processes. Conclusions Patient-centered care includes managing T2DM from a variety of clinical settings for individuals with HIV, yet strategies are needed to better support clinicians. Future research should examine how best to implement these strategies.

atient-centered care was most recently defined by the National Academy of Sciences in 2001 as "providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions." 1 Notably, this care approach counters a unidirectional, clinician-driven model where the clinician's voice and expertise is paramount.The introduction of the Patient Protection and Affordable Care Act in 2010 also heralded a major reform of the US health care delivery system, with an increased focus on patient-centered care delivery and research. 2,33][4][5] Most recently, the US Department of Health and Human Services, in collaboration with the National Cancer Institute, released the National Cancer Plan roadmap, which is focused on 8 essential goals to improve the lives of people diagnosed with cancer, including delivery of evidence-based, patient-centered care. 6ornerstone to patient-centered care is a highly functional patient-clinician relationship that is based on a collaborative partnership that promotes bidirectional communication, empathy, respect, comfort, and perspective-sharing. [7][8][9] This partnership allows clinicians to better understand their patients as individuals with unique experiences, values, preferences, and care needs, and helps patients to better grasp their condition and evidence-based care options. 9Further supporting a patient's early involvement in their health care, including identification of their care goals and treatment preferences, or the extent they wish to be involved in decisions (eg, shared or delegated to family or clinicians) is essential. 10etastatic breast cancer (mBC), an advanced and incurable form of breast cancer, 11 offers the opportunity to consider how a patient-centered approach can be operationalized in today's oncology care environment.Given the complex nature of an mBC diagnosis, care teams often comprise multiple specialists, and treatment choices require weighing risks and benefits.Prioritizing the patient-clinician relationship is essential for guiding clinical decisions and delivering high-quality care that aims to improve outcomes. 12In 2022, a multidisciplinary working group comprising expert key partners in breast oncology, health services research, decision sciences, health literacy, and patient advocacy convened to form the Innovative Patient-Centered Decision-Making Consortium (I-PCDMC).Across 2 separate in-person meetings (July and October), the I-PCDMC discussed the current state of treatment decision-making in mBC care, including the key components of patient-centered decision-making (PCDM), best practices for implementation, and measurement of PCDM.This commentary provides an expert-guided synthesis of the hypotheses, findings, components, and research gaps of PCDM for mBC care delivery, with the intent to optimally support the practice and measurement of PCDM over the long term.We propose

ImportanceWhile continuous glucose monitoring (CGM) has been found to improve diabetes care processes and outcomes, adoption remains low.ObjectiveTo examine the association between CGM prescriptions and individual characteristics among patients with type 1 or 2 diabetes (T1D and T2D, respectively).Design, Setting, and ParticipantsRetrospective cross-sectional study using electronic health record data for patients with T1D or T1D from 275 clinic sites nationwide between January 2014 and February 2021. All participating clinics were federally qualified health centers (FQHCs), the largest US system of primary care for vulnerable populations. Data were analyzed from September 2022 to August 2024.Main Outcomes and MeasuresSociodemographic factors, clinical characteristics, and CGM prescription orders.ResultsA total of 1168 patients with T1D (mean [SD] age, 41.8 [16.0] years; 600 [51.4%] male; 372 [31.9%] Black; 262 [22.4%] Hispanic, and 750 [64.2%] White patients) and 35 216 patients with T2D (mean [SD] age, 58.4 [13.1] years; 19 772 [56.1%] female; 12 030 [34.2%] Black; 12 979 [36.9%] Hispanic, and 20 413 [58.0] White patients) were included. Overall, CGM prescriptions were infrequent (129 [11.0%] for patients with T1D and 362 [1.0%] for those with T2D) but increased throughout the study period. Among patients with T1D, those who reported Hispanic ethnicity (odds ratio [OR], 0.30; 95% CI, 0.16-0.57), Black race (OR, 0.61; 95% CI, 0.38-0.99), or were uninsured (OR, 0.42; 95% CI, 0.23-0.74) had lower multivariable odds of receiving a CGM prescription than White or insured adults, respectively. Similar findings were observed among patients with T2D reporting Hispanic ethnicity (OR, 0.43; 95% CI, 0.32-0.57), Black race (OR, 0.76; 95% CI, 0.59-0.98), or being uninsured (OR, 0.42; 95% CI, 0.31-0.58), relative to their counterparts. Among patients with T2D, hemoglobin A1c values higher than 9.0% (OR, 3.17; 95% CI, 2.37-4.21) and a greater burden of diabetes complications were associated with higher odds of CGM prescription.Conclusions and RelevanceIn this cross-sectional study of electronic health record data, rates of CGM prescription orders were low among FQHC patients with T1D and T2D. Disparities in CGM orders were observed among patients reporting Hispanic ethnicity, Black race, and those who lacked health insurance. Future research is needed to understand the causes of infrequent CGM orders in FQHCs and drivers of observed disparities in this vulnerable patient population.

Introduction: Missed visits have been estimated to cost the U.S. healthcare system $50 billion annually and have been linked to healthcare inefficiency, higher rates of emergency department visits, and worse outcomes. COVID-19 disrupted existing outpatient healthcare utilization patterns. In our study, we sought to examine the frequency of missed outpatient visits over the course of the COVID-19 pandemic and to examine patient-level characteristics associated with non-attendance. Methods: This study utilized data from a longitudinal cohort study (the Chicago COVID-19 Comorbidities (C3) study). C3 participants were enrollees in 1 of 4 active, “parent” studies; they were rapidly enrolled in C3 at the onset of the pandemic. Multiple waves of telephone-based interviews were conducted to collect experiences with the pandemic, as well as socio-demographic and health characteristics, health literacy, patient activation, and depressive and anxiety symptoms. For the current analysis, data from waves 3 to 8 (05/01/20-05/19/22) were analyzed. Participants included 845 English or Spanish-speaking adults with 1 or more chronic conditions. Results: The percentage of participants reporting missed visits due to COVID-19 across study waves ranged from 3.1 to 22.4%. Overall, there was a decline in missed visits over time. No participant sociodemographic or health characteristic was consistently associated with missed visits across the study waves. In bivariate and multivariate analysis, only patient-reported anxiety was significantly associated with missed visits across all study waves. Conclusion: Findings reveal that anxiety was consistently associated with missed visits during the COVID-19 pandemic, but not sociodemographic or health characteristics. Results can inform future public health initiatives to reduce absenteeism by considering patients’ emotional state during times of uncertainty.

BackgroundOlder adults with multiple chronic conditions (MCC) and polypharmacy often face challenges with medication adherence. Nonadherence can lead to suboptimal treatment outcomes, adverse drug events, and poor quality of life. ObjectiveTo facilitate medication adherence among older adults with MCC and polypharmacy in primary care, we are adapting a technology-enabled intervention previously implemented in a specialty clinic. The objective of this study was to obtain multilevel feedback to inform the adaptation of the proposed intervention (Phenotyping Adherence Through Technology-Enabled Reports and Navigation [PATTERN]). MethodsWe conducted a formative qualitative study among patients, clinicians, and clinic administrators affiliated with a large academic health center in Chicago, Illinois. Patient eligibility included being aged 65 years or older, living with MCC, and contending with polypharmacy. Eligibility criteria for clinicians and administrators included being employed by any primary care clinic affiliated with the participating health center. Individual semistructured interviews were conducted remotely by a trained member of the study team using interview guides informed by the Exploration, Preparation, Implementation, and Sustainment Framework. Thematic analysis of interview audio recordings drew from the Rapid Identification of Themes from Audio Recordings procedures. ResultsIn total, we conducted 25 interviews, including 12 with clinicians and administrators, and 13 with patients. Thematic analysis revealed participants largely found the idea of technology-based medication adherence monitoring to be acceptable and appropriate for the target population in primary care, although several concerns were raised; we discuss these in detail. ConclusionsOur medication adherence monitoring intervention, adapted from specialty care, will be implemented in primary care. Formative interviews, informed by the Exploration, Preparation, Implementation, and Sustainment Framework and conducted among patients, clinicians, and administrators, have identified intervention adaptation needs. Results from this study could inform other interventions using the patient portal with older adults.

Objective: Describe baseline patient characteristics, needs, and stress of new to insulin at hospital discharge. Methods: Single site RCT to evaluate a DM Discharge Toolkit on mean 30-day glucose is ongoing among English speaking patients (pts), 21 - 80 years, with expected survival > 90 days, new to insulin at discharge. Results: Among 97 eligible, 67 approached, and 40 enrolled (consent rate 60%). Mean age was 51.9 years +11.4; 55% were male; 35% had public insurance; 52% identified as black, 30% white, and >22% Hispanic/Latino, with 23 (58%) prior DM. Mean glucose was 374 +213 and median HbA1C 11.4 [9.6, 13.3]. Nearly 30% had limited literacy (Single Item Literacy Screener, >2), though > 90% had home internet and reported its use for health information. Acceptability of research continuous glucose meter (CGM) at discharge was high (48%). Stress was also high, over 60% reported elevated perceived stress (Perceived Stress Scale >14), 35% with prior DM reported elevated DM distress (Diabetes Distress Score > 2.0). A majority (60%) had > 1 health-related social need (HRSN), 12.5% had > 3; food insecurity (22.5%), transportation (15%) and medication affordability (12.5%) were highest. Conclusion: Our medically/socially complex cohort of DM patients consented to RCT, including many of minority race/ethnicity. These patients have high levels of disease and non-disease specific stress and multiple HRSN that could affect safe insulin delivery. Interestingly, most accessed and used technology/internet, and were open to DM technology (CGM). Achieving better glycemic control in our sickest patients demands comprehensive, multi-modal interventions which can leverage DM technology to enhance care delivery. Disclosure K. Lee: None. C.M. Smyrniotis: None. C.A. Clingan: None. K.M.V. Carthy: None. C. Coventry: None. K. Davis: None. S.J. Freeman: None. J.J. Lee: None. J. Song: None. J.L. Holl: None. S. Bailey: Consultant; Gilead Sciences, Inc. Research Support; Gilead Sciences, Inc., Pfizer Inc., Merck Sharp & Dohme Corp., Lundbeck. Consultant; Lundbeck. A. Wallia: Research Support; UnitedHealth Group, Novo Nordisk. Funding R18 HS026143, NIH/AHRQ

Frequent use of pain relief medications among patients with migraine can result in disease worsening and medication-overuse headache (MOH), a painful and debilitating condition. We sought to conduct a cross-sectional survey among adult patients diagnosed with migraine to determine: 1) their awareness of MOH, and 2) their knowledge of the condition and its prevention, and 3) the association of these factors with actual use of pain relief medications. We recruited and interviewed 200 English-speaking adults with migraine who had a clinic visit with a neurologist or primary care provider within the past month. Patients were identified via an electronic health record query. Almost 40% of participants had never heard of the term 'medication-overuse headache.' In bivariate analyses, participants who were Black or Hispanic and those with limited health literacy were less likely to have heard of MOH. Participants scored an average of 2.1 (range: 0-3) on a MOH knowledge measure; older participants, those with limited health literacy, lower education, and little or no migraine-related disability demonstrated less knowledge. Almost a third (31.5%) of patients reported overusing pain relief medication and were at risk for MOH. Overuse was not significantly associated with MOH awareness, knowledge, or sociodemographic factors, but was related to greater migraine-related disability. Our findings suggest that patient awareness and knowledge of MOH is suboptimal, particularly among older adults, racial and ethnic minority groups, and those with limited health literacy. Interventions are needed to prevent MOH and better inform patients about risks associated with frequent use of pain relief medications.

Objectives:Medication overuse headache (MOH) is a common, debilitating condition occurring when migraine patients overuse pain relief medications. We conducted a convergent mixed methods study examining patient-provider communication on MOH.Methods:Migraine patients were identified from one academic health center via electronic health records. Research staff recruited patients and administered a remote survey on MOH awareness, knowledge, and communication; descriptive and bivariate analyses were conducted. Neurologists from the same health center were invited to participate in qualitative interviews; analysis drew from the Rapid Identification of Themes from Audio Recordings procedures. A side-by-side comparison of results followed.Results:Participants included 200 patients and 13 neurologists. More than one third of patients (39.5 %) had never heard of 'medication overuse headache.' Among those who had, 38.4 % learned about MOH ≥ 5 years after their migraine diagnosis. Neurologists similarly reported limited patient awareness of MOH and suggested communication was provider-initiated, reactive to patient-reported symptoms and behaviors. Participants agreed MOH was described as a 'consequence' of frequent medication taking, though specific terminology varied with neurologists suggesting they choose terms they perceive to be easier to understand and less stigmatizing to patients. Neurologists felt they lacked effective patient education resources.Conclusions:Findings reveal delayed opportunities to inform patients about MOH. Standardized education supporting early preventive communication is needed, perhaps in primary care where many patients seek initial care for migraine symptoms.