No abstract

Problem Student-run free clinics (SRFCs) provide health and outreach services to underserved populations while offering medical students opportunities for service and education. Many SRFCs were forced to suspend in-person operations in early 2020 due to the COVID-19 pandemic. Before March 2020, JeffHOPE, the SRFC at Sidney Kimmel Medical College at Thomas Jefferson University, operated an evening clinic at 5 locations throughout Philadelphia each week. Approach JeffHOPE’s response to challenges posed by COVID-19 focused on a redesign for a pilot clinic at a shelter site that expressed interest in resuming operations. The student leaders conducted a needs assessment with shelter stakeholders, including administrators and long-term residents, to identify service priorities. They also developed a list of key components for safe patient engagement and care delivery. A hybrid telehealth approach was developed to reduce in-person exposure for patients and volunteers and to involve preclinical medical students remotely. Three iPads were acquired via an internal grant. Outcomes The pilot clinic reopened in September 2020. Over the first 13 weeks of operation, 44 unique patients received care across 98 visits. Of these visits, 21 were in-person only with a clinical student and preceptor, while 77 also used the hybrid telehealth model to connect via iPad with a preclinical student. Patient visit volume was approximately 35%–40% of the pre–COVID-19 level. Of the 58 total volunteers, 11 were preclinical students who participated remotely. Next Steps Three additional JeffHOPE clinic sites have reopened since December 2020 using this hybrid telehealth model. Patient feedback, via surveys and interviews, will determine which components are retained. Other SRFCs should be encouraged to innovate and develop plans for safe resumption of services, with an appropriate approach and organizational support, despite the challenges posed by the pandemic.

No abstract

Lack of recognition and treatment of mental health disorders in the home healthcare (HHC) population has been recognized as a national public health problem. However, there is a gap in understanding the behavioral health needs of HHC patients and caregivers from the perspectives of HHC patients, caregivers, and HHC personnel. These perspectives are critical for informing an acceptable and scalable integrated care model. We conducted semi-structured interviews with HHC patients, caregivers, and HHC personnel to assess the unmet behavioral health needs of HHC patients and their caregivers. Participants were recruited from a Medicare-certified HHC agency that is part of a large health system on the east coast. We completed a total of 31 interviews between January and May 2020. Findings suggest that HHC patients have significant unmet behavioral health and social needs and their caregivers are emotionally and physically drained. Reasons that patients may not be receiving adequate behavioral health services include denial, cost, culture, lack of awareness of available resources, lack of transportation, and homebound status. While most patients discussed the emotional toll of their illness, few were connected to services. HHC personnel offered suggestions on how to meet the behavioral health needs of patients, with the primary focus on providing in-home options. Gaps in meeting the needs of the HHC population necessitate integrated care models that can effectively address the behavioral health and social needs of HHC patients and their families. Future research should develop and test patient and caregiver-directed integrated care models in the HHC setting.

Introduction: Despite its importance in cardiac patients, accurate central venous pressure (CVP) estimation remains a challenge. Noninvasive methods, such as jugular venous pressure measurement, are highly dependent on examiner experience, and the gold-standard invasive methods require procedures that carry risk of complication. Recent studies suggest that pressure measurement directly from a patient’s peripheral intravenous (IV) catheter, termed peripheral venous pressure (PVP), appears promising as an accurate and noninvasive method for CVP estimation. Methods: To be included in the study, patients were either receiving right heart catheterization (RHC) or had an existing pulmonary artery catheter (PAC) in place. CVP was measured using standard technique either during RHC or at bedside from the PAC. The same pressure tubing was then connecting to the patient’s existing IV, regardless of the location or catheter gauge, for measurement of the PVP. Results: Seventeen patients were prospectively enrolled. The majority (70.6%) had their CVP and PVP measured during RHC. In the overall cohort, 35.3% were on mechanical circulatory support, and 29.4% were on inotropes at the time of measurement. CVP and PVP measurements were significantly correlated with one another (Pearson’s r = 0.73, p < 0.001; Figure 1A). Sensitivity analysis was performed to exclude one notable outlier, which strengthened the correlation (Pearson’s r = 0.91, p < 0.001; Figure 1B). Conclusions: This data suggests that PVP is a promising and simple method for the noninvasive estimation of CVP.