The Respectful & Equitable Access to Comprehensive Healthcare (REACH) program receives funding from the Robin Hood Foundation and the New York State Department of Health AIDS Institute. Weiss receives grant support from Gilead Sciences and has served as a consultant for AbbVie and Gilead Sciences. Vu reports speaker fees from Peer View Institute. All other authors report no conflict of interest. Study design and concept were contributed by Chasan, Sigel, Vu, and Weiss. Riazi, Ciprian, Giardina, and Gibbs collected the data, which were interpreted by Toribio, Amory, Chasan, and Sigel. The manuscript was written by Vu and Weiss and revised by Parrella, Cambe, Camacho, and Vu. Research from this study was presented as an abstract poster on November 14, 2016, at the AASLD Liver Meeting in Boston, Massachusetts.

Background: As a harm reduction-focused primary care clinic for people who use drugs, the Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program faced multiple barriers due to the COVID-19 pandemic. We describe and evaluate how the telemedicine-driven adaptations REACH made allowed the program to engage its patients. Methods: REACH expanded its telemedicine capabilities by transitioning its in-person clinic and methods of connecting with referrals to telemedicine. The program provided patients with phones to increase access to needed technology. Results: Throughout 2020, patient visits continuously shifted from being entirely in-person, to entirely telemedicine, to a hybrid model. Clinic show rates averaged 71% with this hybrid model, compared with 57% pre-COVID-19. Phones were distributed to 88 patients, 77% of which engaged in at least one telemedicine visit. Conclusions: Telemedicine allowed REACH to provide uninterrupted care during the pandemic. The program is now refining its hybrid model of telemedicine and in-person care to more equitably serve all patients.

The aim of this work was to engage with, empower and support junior doctors to drive quality improvement (QI) and innovation. Methods 12 junior doctors were competitively appointed as Wrexham Innovation Fellows by the Site Innovation Lead. They were provided with formal QI and innovation training, mentoring and guidance to drive change. They communicate via whataspp when possible and work together as a group to bring issues to the Site Innovation Lead. This helps to identify barriers, signpost to key players in the organisation, open doors and helps develop a robust PDSA cycle. Results The Innovation Fellows work as a team and have registered over 20 QI projects to date. 100% (12/12) of Innovation fellows feel that trainee involvement in QI and innovation is a good thing and 92% (11/12) feel that their training has been complimented through their work and support as an Innovation Fellow. Since becoming an Innovation Fellow, 75% (9/12) feel more supported by the organisation to undertake QI and Innovation and 92% (11/12) feel more engaged to undertake QI and innovation since undertaking the programme. The scheme is now expanding to include advanced nurse practitioners, pharmacists and physicians associates. Conclusions Junior doctors are in unique position to influence innovation, quality improvement (QI) and leadership across NHS organisations. Providing them with bespoke leadership and QI training can help them feel supported, drive innovation, enhance trainee satisfaction, enhance their training and deliver quality improvement and innovation that can help drive change. Other organisations should consider utilising junior doctors and allied healthcare professionals as Innovation Fellows within a structured framework to drive innovation and change.