ImportanceMinoritized groups are less likely to receive COVID-19 therapeutics, but few studies have identified potential methods to reduce disparities.ObjectiveTo determine whether screening plus outreach, when compared with referral alone, increases identification of vulnerable pediatric patients at high risk for severe disease eligible for COVID-19 therapeutics from low-resourced communities.Design, Setting, and ParticipantsA retrospective cohort study of COVID-19 medication allocation between January 1, 2022, and February 15, 2022, at Lurie Children’s Hospital, a quaternary care children’s hospital, in Chicago, Illinois. The cohorts were pediatric patients referred for COVID-19 therapeutics or with a positive SARS-CoV-2 polymerase chain reaction within the hospital system followed by outreach. Screening involved daily review of positive cases of SARS-CoV-2, followed by medical record review for high-risk conditions, and communication with clinicians and/or patients and families to offer therapy.ExposuresDiagnosis of COVID-19.Main Outcomes and MeasuresThe primary measure was difference in child opportunity index (COI) scores between the 2 cohorts. Secondary measures included presence and duration of symptoms at diagnosis, medication uptake, race and ethnicity, insurance type, qualifying medical condition, sex, primary language, and age.ResultsOf 145 total patients, the median (IQR) age was 15 (13-17) years, and most were male (87 participants [60.0%]), enrolled in public insurance (83 participants [57.2%]), and members of minoritized racial and ethnic groups (103 participants [71.0%]). The most common qualifying conditions were asthma and/or obesity (71 participants [49.0%]). From 9869 SARS-CoV-2 tests performed, 94 eligible patients were identified via screening for COVID-19 therapeutics. Fifty-one patients were identified via referral. Thirty-two patients received medication, of whom 8 (25%) were identified by screening plus outreach alone. Compared with referred patients, patients in the screening plus outreach group were more likely to have moderate, low, or very low COI composite scores (70 patients [74.5%] vs 27 patients [52.9%]); public insurance (65 patients [69.1%] vs 18 patients [35.3%]); and asthma or obesity (60 patients [63.8%] vs 11 patients [21.6%]). Patients in the referral group were more likely to be non-Hispanic White (23 patients [45.1%] vs 19 patients [20.2%]) and receive medication (24 patients [47.1%] vs 8 patients [8.5%]).Conclusions and RelevanceCompared with referral patients, screening plus outreach patients for COVID-19 medications were more socially vulnerable, with lower COI scores, and more likely to have asthma or obesity. Future studies should investigate communication strategies to improve uptake of these medications after outreach.
Highlights Infection with Entamoeba histolytica is uncommon in pediatric patients outside of endemic regions. Diagnosis with plasma next-generation sequencing is feasible and may avoid invasive procedures. Current diagnostic modalities for amebic liver abscess have significant limitations.
Background Scarcity of therapeutics to treat Coronavirus Disease 2019 (COVID-19) during the surge in cases caused by the Omicron variant raised concerns that structural inequities would decrease access to these medications for racial minorities and patients with lower socioeconomic status. We hypothesized that screening plus outreach would increase identification of eligible patients in these vulnerable patient populations when compared to referrals alone. Methods A retrospective cohort study of COVID medication allocation was performed at a quaternary pediatric medical care facility between 1/1/22–2/15/22. The two cohorts were patients referred for COVID therapy and patients identified via screening followed by outreach. Screening plus outreach included daily review of laboratory reports for new positive cases of SARS-CoV-2, followed by chart review for high-risk conditions, and communication with providers or directly with eligible patients to offer therapy. Demographic characteristics, chronic medical conditions, socioeconomic parameters, and medication receipt were compared between the two groups. Results Overall, 51 and 94 patients were identified via referral and screening plus outreach, respectively. Thirty-two patients received medication of which eight (25%) were identified by screening plus outreach alone. Compared to referred patients, patients in the screen plus outreach group were more likely to have moderate, low, or very low childhood opportunity index (COI) scores (74.5% vs 52.9%%, p = 0.009); public health insurance (69.1% vs 37.5%, p < 0.001); asthma/obesity (63.8% vs 21.6%, p < 0.001), and race/ethnicity other than White, Non-Hispanic (79.8% vs 54.9%, p = 0.002). Patients in the referral group were more likely to receive medication (47.1% vs. 8.5%, p < 0.001). Conclusion Compared to referral, screening plus outreach for COVID medications can increase identification of patients who are racial minorities, have asthma/obesity, and have lower socioeconomic status. Future studies should investigate communication strategies to improve uptake of these medications after outreach. Disclosures All Authors: No reported disclosures.
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