The impacts of unmet health-related social needs, such as homelessness, inconsistent access to food, and exposure to violence on health and health care utilization, are well-established. Growing evidence indicates that addressing these and other needs can help reverse their damaging health effects, but screening for social needs is not yet standard clinical practice. In many communities, the absence of established pathways and infrastructure and perceptions of inadequate time to make community referrals are barriers that seem to often keep clinicians and their staff from broaching the topic. The Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities Model, tested by the Center for Medicare and Medicaid Innovation, addresses this critical gap between clinical care and community services in the current health care delivery system by testing whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries impacts their total health care costs and improves health. DISCUSSION PAPER Perspectives | Expert Voices in Health & Health Care With input from a panel of national experts and after review of existing screening instruments, CMS developed a 10-item screening tool to identify patient needs in 5 different domains that can be addressed through community services (housing instability, food insecurity, transportation difficulties, utility assistance needs, and interpersonal safety). Clinicians and their staff can use this short tool across a spectrum of ages, backgrounds, and settings, and it is streamlined enough to be incorporated into busy clinical workflows. Just like with clinical assessment tools, results from this screening tool can be used to inform a patient's treatment plan as well as make referrals to community services.

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A941for the management of rheumatoid arthritis (RA). Several studies have demonstrated efficacy and tolerability of conventional DMARDs, resulting in control of disease activity and improvement of functional disability. The aim of this study was to describe the effectiveness of leflunomide and methotrexate in patients with RA in a real-life cohort in Colombia. Methods: A descriptive cross-sectional study was performed. We included patients receiving leflunomide or methotrexate as monotherapy or in combination. Clinical follow-up was designed by the authors according to DAS28; therapy had to be adjusted with DAS28 > 3.2 unless patient´s conditions don't permit it. We divided patients in two groups: remission-low disease activity (Rem/LDA) patients and moderate-severe disease activity (MDA/SDA). Descriptive epidemiology was done, percentages and averages were calculated; the mean of each variable was analyzed using t-Student and the level of disease activity was analyzed using Pearson´s statistics. Results: We included 3949 patients were 56% were receiving methotrexate in monotherapy, 21% received leflunomide in monotherapy and 23% received combined therapy. Mean age was 59 years ± 12 years old, 83% were female and 17% male. In the group of patients receiving only methotrexate 55% achieved remission and 18% LDA. In the group receiving only leflunomide 45% achieved remission and 20% LDA. Finally in the group receiving combined therapy 44% achieved remission and 19% LDA. There was statistical significance between disease activity and therapy. ConClusions: Leflunomide and/or methotrexate are effective for treatment of RA. In settings and countries like Colombia were there are limited resources the accurate use of this medications are a cost-effective option for disease management.

48% had less than a year, 16% between two and three years, 18% more than three years, 13% more than four years, and 5% were temporarily caregivers. In our study, 85% of caregivers were a family member, while 15% a nurse or a non-related person. Regarding the compensation, 97% did not receive any salary or payment for being caregiver, the remaining 3% received between 265 and 530 USD per month. Conclusions: Our study demonstrated that the care for patients with MD is mainly assumed by family members. Our results agree with other studies in chronic conditions where only a small proportion of caregivers is paid. Caregivers should be considered for the health system.

Objectives: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and tumor necrosis factor (TNF) blocking agents have been widely used in the treatment of SpA. Recent evidence has shown anti-TNF therapies may induce hepatic injury. Interleukin inhibitors, a newer drug class with potentially lower side effects, have recently been approved for use. We aim to assess the risk of treatment-related liver injury among patients with SpA utilizing real-world data. Methods: A retrospective, claims-based observational study was conducted in a multi-state health system from 2010 to 2017. SpA patients were identified by diagnosis codes and proposed treatment agents, including NSAIDs, anti-TNF agents, and interleukin inhibitors. The primary outcome was 12-month incidence of liver injury after each treatment. Liver injury was evaluated as abnormal liver function test lab values. Results: The majority of patients (98.9%, n=16,348) received NSAIDs only for first-line treatment. Of those, 1.6% (n=259) changed from NSAIDs to second-line monotherapy treatment with anti-TNF agents (n=249) or interleukin inhibitors (n=6), or polytherapy with at least 2 anti-TNFs 6 NSAIDs or anti-TNF + interleukin 6 NSAIDs (n=4). Before the second-line treatment, liver injury rate at first-line was 8.5% (22/259),serving as a benchmark. Patients receiving anti-TNF agents as second-line treatment had a similar incidence of liver injury compared to the benchmark (9.2% vs 8.5%, p=0.768). Patients receiving interleukin inhibitors as second-line treatment did not have any liver injuries incidence, however no statistical significance was found due to the small sample size (0% vs 8.5%, p=1.000). Additionally, patients receiving a polytherapy had a higher incidence of liver injury (50.0% vs 8.5%, p=0.043), and the incidence remained high (33.3%) in clinical perspective after excluding those pre-existing liver injuries at firstline. Conclusions: Treatment with a polytherapy of TNFs and/or interleukin inhibitors might increase the risk of liver injury. Further studies with larger sample sizes are needed to validate these findings.