Background: Chlamydia is the most reported bacterial sexually transmitted infection (STI). The rates of chlamydia rose by 19% between 2011 and 2018. The STI National Strategic Plan (2021-2025, encourages coordinated solutions to address STIs and reduce disparities in disadvantaged populations.
Background: Chlamydia is the most frequently reported sexually transmitted infection. COVID-19 exacerbated the challenges in treating and preventing new Chlamydia trachomatis (CT) infections. This study examined the impact of COVID-19 on treating CT-positive patients discharged from a safety-net women's emergency unit.Methods: This was a preretrospective and postretrospective cohort study.Chlamydia trachomatis-positive female patients seen in the women's emergency unit were evaluated. Patients discharged in 2019, the "pre-COVID-19" group, and those discharged in 2020, the "COVID-19" group, were compared. The primary outcome was CT treatment within 30 days, and secondary outcomes included prescription dispensation, repeat tests taken, and expedited partner treatment. A subgroup of patients discharged before treatment who entered a nurse-led follow-up program was also evaluated.Results: Of the 1357 cases included, there were no differences in successful 30-day treatment (709 of 789 [89.9%] vs. 568 of 511 [89.9%], P = 0.969) or repeat positive CT test (74 of 333 [22.2%] vs. 46 of 211 [21.8%]), P = 0.36) between pre-COVID-19 and COVID-19. However, the patients who picked up their prescription (196 of 249 [78.7%] vs. 180 of 206 [87.4%], P = 0.021) and those who were prescribed expedited partner therapy (156 of 674 [23.1%] vs. 292 of 460 [63.5%], P < 0.001) increased. Findings in the subgroup of patients who entered the follow-up program were consistent with those in the full cohort. Conclusions:The COVID-19 pandemic did not change treatment patterns of CT-positive patients in this safety-net women's emergency unit. However, patients were more likely to pick up their medications during COVID-19. Despite the perseverance of these programs through the pandemic, most patients are discharged before positive results, and a fair amount remain untreated.
Background: During the opioid epidemic, misuse of acetaminophen-opioid products resulted in supratherapeutic acetaminophen ingestions and cases of hepatotoxicity. In 2014, the US Food and Drug Administration (FDA) limited the amount of acetaminophen in combination products to 325 mg, and the US Drug Enforcement Administration (DEA) changed hydrocodone/acetaminophen from schedule III to schedule II. This study assessed whether these federal mandates were associated with changes in acetaminophen-opioid supratherapeutic ingestions. Methods: We identified emergency department encounters at our institution of patients with a detectable acetaminophen concentration and manually reviewed these charts. Results: We found a decline in acetaminophen-opioid supratherapeutic ingestions after 2014. A downtrend in hydrocodone/acetaminophen ingestions accompanied a relative increase in codeine/acetaminophen ingestions from 2015 onwards. Conclusion: This experience at one large safety net hospital suggests a beneficial impact of the FDA ruling in reducing likely unintentional acetaminophen supratherapeutic ingestions, carrying a risk of hepatotoxicity, in the setting of intentional opioid ingestions.
Background Texas has one of the highest rates of uninsured patients in the US and is one of the few states that has not expanded Medicaid (Fig 1). We sought to examine if there were differences by age, race, and ethnicity in the risk COVID-19 outcomes among those with Medicaid coverage vs. the uninsured population. Figure 1Medicaid Expansion States. Blue are the states which expanded Medicaid. Yellow are the states which did not. Texas is one of the largest non-Medicaid expansion states. Methods We conducted a retrospective analysis of all patients hospitalized in 81 hospitals in Dallas-Fort Worth area. All inpatients with COVID-19 from 3/1/2020 to 9/30/2021 were included in the analysis. We examined the following COVID-19 outcomes: ICU care, pneumonia, and respiratory failure stratified (separate logistic models for each outcome) by race, ethnicity, and age adjusted for a multitude of sociodemographic, clinical, and co-morbid characteristics (Fig 2). Figure 2Graphic Methods Results 71,778 individuals diagnosed with COVID-19 were hospitalized: 12.9% had Medicaid and 23% were uninsured. For all COVID-19 study outcomes (ICU care, pneumonia, and respiratory failure), White Medicaid patients had lower odds ratios vs. their White uninsured counterparts indicating worse outcomes compared to Black Medicaid patients vs. Black uninsured counterparts (Table 1). Similarly, for all outcomes, Hispanic Medicaid patients had lower (worse) odds ratios vs. Hispanic uninsured counterparts compared to the same model with non-Hispanic patients. Finally, for all three outcomes, the youngest Medicaid age cohort (18-44 years) were less likely to require ICU care, have pneumonia or respiratory failure vs. the youngest uninsured patients; while conversely there was trend (not always statistically significant) that middle aged or older Medicaid cohorts were more likely compared to their same age uninsured counterparts to experience these outcomes. Table 1 Adjusted odds ratio of COVID-19 outcomes by insurance status stratified by race, ethnicity, and age group. Conclusion We found that age modified the risk for ICU care with younger Medicaid recipients at lower odds vs. uninsured than older cohorts. For race and Hispanic ethnicity, all Medicaid groups had lower likelihood of poor COVID-19 outcomes compared to their uninsured counterparts. However, the effect was more pronounced among Whites vs. Blacks and Hispanics vs. non-Hispanics (Fig 3). Providing health insurance such as Medicaid to uninsured younger patients could significantly improve health outcomes, especially among Whites, Hispanics, and younger patients. Figure 3Graphic Conclusion Disclosures Mamta K. Jain, MD, MPH, Gilead Sciences: Grant/Research Support|GSK/ViiV: Grant/Research Support|Janssen: Grant/Research Support|Merck: Grant/Research Support|Regeneron: Grant/Research Support Mae Thamer, PhD, Gilead: Grant/Research Support Kavita Bhavan, MD, MPH, Gilead: Grant/Research Support.
Background Texas has one of the highest rates of uninsured populations in the US (Fig1). We hypothesized that those without insurance were more likely to be hospitalized for COVID-19 but were at higher risk for severe disease and mortality due to uncontrolled medical illness prior to hospitalization. Methods We conducted a retrospective analysis of patients hospitalized in 81 hospitals in Dallas- Ft. Worth (DFW) area. All inpatients and outpatients with COVID-19 from 3/1/2020 to 4/1/2021 were included to examine risk for hospitalization. Subset analysis included those hospitalized with COVID-19. Data presented is comparison between Medicaid and uninsured population as they were similar in age distribution (Fig 2). Results 198, 174 COVID-19 unique individuals were identified; 7.5% had Medicaid and 25.1% were uninsured. Among Medicaid, 29.6% were hospitalized vs. 25.8% of Medicaid vs. uninsured (adjusted odds ratio (aOR) 1.26 (1.20, 1.33). Among the 71,778 (∼36%) hospitalized for COVID-19, comparing Medicaid vs. uninsured: 44.9 vs. 56.3% had ICU care; 51.4% vs. 80.2% had pneumonia, 41.1% vs. 67.5% had respiratory failure with higher odds of developing these outcomes in uninsured (see Table 1). Median duration of hospital stay was longer in uninsured than Medicaid ( see Table 2a) and mortality in the hospital was 7.4% vs. 7.9% among Medicaid vs. uninsured (p< 0.0001). Thirty-day readmission rates were lower for Medicaid vs. uninsured (Table 3). In the year prior to the COVID-19 hospitalizations, use of health care among the uninsured was lower compared to Medicaid patients for outpatient, inpatient, and ER visits (p< 0.0001 for all comparisons; see Table 2b). Conclusion Uninsured in North Texas had lower odds of hospitalization vs. Medicaid patients, likely due to younger age, but once hospitalized had higher risk for COVID pneumonia, ICU care, and respiratory failure. Median number of days was higher among uninsured but in-hospital mortality was higher among Medicaid population. Prior contact with healthcare system was lower among uninsured and 30-day readmissions were also lower, suggesting barriers accessing health care. Poorer outcomes among uninsured once hospitalized may be due to untreated co-morbidities (Fig 3). Expansion of Medicaid has the potential of ameliorating these disparities. Figure 3Conclusion graphic Disclosures Mamta K. Jain, MD, MPH, Gilead Sciences: Grant/Research Support|GSK/ViiV: Grant/Research Support|Janssen: Grant/Research Support|Merck: Grant/Research Support|Regeneron: Grant/Research Support Mae Thamer, PhD, Gilead: Grant/Research Support Kavita Bhavan, MD, MPH, Gilead: Grant/Research Support.
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