549. Monoclonal Antibody Therapy for COVID-19 Infection in Michigan: The Flint Experience

Background Bamlanivimab (BAM), a neutralizing IgG1 monoclonal antibody (mAb), received emergency use authorization (EUA) by the U.S. Food and Drug Administration (FDA) for treatment of mild to moderate COVID-19 infection in patients 12 years of age and older weighing at least 40 kg at high risk for progressive and severe disease on Nov 10, 2020. The purpose of this study is to describe our experience with this treatment modality. Methods Hurley Medical Center (HMC), is a 443-bed inner city teaching hospital in Flint, MI. HMC administered its first BAM infusion on Nov 19, 2020. Through April 30, 2021, 407 patients with confirmed SARS-CoV-2 infection, received a mAb infusion. 62/407 patients received the combination mAb therapy of BAM + Etesevimab, as the EUA for BAM monotherapy was revoked on 04/16/21. We retrospectively collected basic demographic data and hospitalization to our facility within 14 days of receiving mAb therapy on these patients. Results During the 5.5 month study period, patients receiving mAb therapy at HMC had a mean age of 56 years (yrs) (± standard deviation) (± 15.4) and a mean Body Mass Index (BMI) of 34 kg/m² (± 8.5) (Tables 1,2). African Americans (AA) comprised 48% (194/407) (Table 3) and females comprised 54% (220/407) of the cohort. 6% (25/407) of the patients required hospitalization within 14 days of mAb infusion, had a mean age of 58 yrs (± 17) (p-value 0.62) and a mean BMI of 32 kg/m² (± 9) (p-value 0.33). Females and AA comprised 56% (14/25) and 48% (12/25) of this subgroup respectively (p-value 1.0). No deaths were reported within 30 days of infusion in this cohort. Conclusion Previously published reports cite a hospitalization rate in untreated high-risk COVID-19 infected patients of 9-15%. During the period of study, the county hospitalization rate and county mortality rate for all comers with COVID-19 was 6.6% and 2.7% respectively while our high risk cohort had a hospitalization rate of 6% and with no deaths reported. Our cohort had much lower rates of hospitalization and death than would be expected especially in a group which comprised of 48% AA in an underserved area. mAb therapy seems to have a protective effect with significant reduction in the hospitalization and mortality rate among high-risk patients with COVID-19 infection and should be prioritized for administration. Disclosures All Authors: No reported disclosures

Development of Medical Drone for Blood Product Delivery: A Technical Assessment

Drone is the well-known technology in military and amateur application. Recently, the drone was used to deliver goods and parcels. There is an increasing need for urgent delivery of medical supplies in low resource setting due to traffic congestion and terrain obstacles. The delivery of blood in emergency cases such as postpartum hemorrhaging is challenging and can be delayed due to geographical condition in underserved area. Postpartum hemorrhaging needs an immediate blood transfusion with proper blood product to save the life of mother and baby. To address to this need, a drone that can deliver blood supply to the desired location may be a good option. Therefore, research has been conducted to identify the baseline of drone specifications for blood delivery. A Hexacopter with the ArduPilot firmware and a Lithium-Polymer battery of 16,000 mAh were used to study the applicability of blood products delivery using drone. Using several tests to assess drone limitations, experimental data was obtained and analyzed using distinctive methods. The results indicated that the thrust-to-weight ratio of the drone play a paramount role for the drone performance and flight time. The GPS guidance performance showed a reliable and stable flight with only a slight deviation of ±6 meters during the tests. Finally, a test flight was conducted to simulate the actual test location from Queen Elizabeth Hospital and Hospital Wanita dan Kanak-Kanak, Likas, Sabah. The developed drone reached a flight time of 25 minutes covering 8.38 km with 4.3 kg take-off weight.

Challenges and Lessons Learned From a Telehealth Community Paramedicine Program for the Prevention of Hypoglycemia: Pre-Post Pilot Feasibility Study

Background Prevention through Intervention is a community paramedicine program developed by Birmingham Fire and Rescue Services in Alabama. This program aims to reduce dependency on emergency medical services (EMS) for nonemergency-related events through education and to lower the frequency of emergency calls in underserved populations. A telehealth intervention with an emphasis on hypoglycemia was implemented to (1) tailor the intervention to meet the educational needs of participants and (2) facilitate follow-ups. A pre-post pilot feasibility evaluation of the telehealth intervention was conducted. Objective This paper describes the results of the feasibility evaluation, implementation challenges, and the lessons learned about the deployment of a hypoglycemia prevention program in an underserved area and its evaluation. Methods This single-arm pretest-posttest intervention included (1) an initial in-person visit (week 1), (2) 3 weekly telecoaching calls (weeks 2-4), (3) 1 biweekly call (week 6), and (4) a final in-person visit (week 8) for collecting posttest data from individuals who called EMS due to hypoglycemic events. In-person visits included educational sessions conducted by EMS personnel. Participants’ education included tailored content related to hypoglycemia. Weekly telecoaching calls focused on hypoglycemia symptom monitoring and education reinforcement via a telehealth dashboard. The primary measures focused on feasibility measures, and exploratory measures focused on the fear of hypoglycemia, self-efficacy, and a knowledge of diabetes. Results A total of 40 participants participated in the intervention. However, the study was marred with high attrition. The various factors behind the low retention rate were discussed. There was a decreasing trend in all three subdomains of the fear of hypoglycemia from pretest to posttest. There was also a significant increase in participants’ self-efficacy in hypoglycemia self-management (P=.03). Conclusions This study shows preliminary and promising results for a community-based intervention specifically for hypoglycemia. However, the socioeconomic setting in which the intervention was delivered may have resulted in high dropout rates and low attendance during the intervention, which are considerations for future telehealth studies. Trial Registration ClinicalTrials.gov NCT03665870; https://clinicaltrials.gov/ct2/show/NCT03665870

'Healthcare Providers’ Experience Using Telehealth During The COVID-19 Pandemic' (Preprint)

BACKGROUND Although telemedicine has been around for the last four decades, many healthcare providers (HCPs) are not familiar with its use. The rise of COVID-19 pandemic has thrusted HCPs to adopt telemedicine instead of the conventional office visit in order to provide ongoing care for their patients. Many HCPs were tested on their technological literacy and conformability. This was further compounded by not only the technological literacy of patients, but their internet accessibility as 1 in 4 Kentucky households do not have access to broadband internet. OBJECTIVE Our study aimed not only to assess HCPs’ experience with using telemedicine during COVID-19, but also to identify its potential benefits for our highly morbid underserved patients. METHODS We conducted an online electronic survey for The Medical Center at Bowling Green HCPs. The survey questionnaire was developed using Qualitrics©, following Dillman’s (2009) Tailored Design Method for internet surveys,12and was optimized for smart phone browsers. The survey was launched on July 20th, 2020 via a bulk invitation email with a direct link to the online questionnaire sent to all 176 HCPs affiliated with the Medical Center Physician’s Group. RESULTS A total of 70 HCPs began the survey. The two most common specialties of respondents were primary care (28%) and cardiologists (12.5%), while the two most common primary practice types were private practice and academic hospital (37.5% each). The majority (81.2%) of HCPs indicated that they had used telehealth during the COVID-19 pandemic. Of HCPs that did not use telemedicine, 31.2% cited that telemedicine was inappropriate for their field, 25% cited they had concerns for privacy issues, and 18.7% cited concerns about not being able to provide appropriate medical care. The majority (82.3%) of HCPs that used telemedicine during the pandemic indicated that they had never used it previously. Similarly, HCPs that used telemedicine indicated that technological issues due to poor internet connectivity (86.2%) and concerns about privacy issues (45.2%) were either a “big” or “somewhat” of a disadvantage to telemedicine. However, approximately 61% of HCPs said they will consider using telemedicine after COVID-19 restrictions are lifted, and 33.3% will consider it in certain situations. Most HCPs (58.8%) generally agreed with the idea that telehealth visits are more time efficient, but approximately half indicated they would feel either “uncomfortable” or “extremely uncomfortable” with patient management using telehealth alone. Overall, HCPs rated their experience with telehealth a 3.90 on a scale of 1 to 5. When compared, there was no statistically significant difference between the cardiologist and non-cardiologist group. CONCLUSIONS Telemedicine was a quickly forced transition on HCPs and a large majority of them did not have much previous experience with it. However, the data we collected seems to indicate that HCPs largely had an above average experience with telemedicine and 94% indicated that they would consider using it in their practice after COVID-19 ended. Broadband connection remains elusive to many Kentucky households. In addition, the average time a patient must travel to-and-fro a doctor’s office in our rural underserved area is approximately 1 hour and 20 minutes. Therefore, telemedicine will be a reasonable option for follow up visits, laboratory results review and/or prescription refills. This will likely increase patient’s compliance and lead to resource conservation such as gas and travel time.

Facilitating health promoting ideas and actions: Participatory research in an underserved Swedish residential area

Background For an intervention to contribute to decreased health gaps, people living in underserved areas must participate in the research-to-action process during the development of the intervention. The purpose of this study was to collaborate with residents living in a Swedish underserved area to generate health and wellness priorities and actions with specific interests in dental health and nutrition. Methods We applied Group Level Assessment (GLA) together with people living in a Swedish neighborhood where obesity, dental caries and other illnesses are prevalent. GLA is a qualitative, participatory methodology that is designed for a large group to generate and evaluate relevant needs and priorities within a lens of action for positive social change. Residents were recruited by posters, postcards and snowball sampling. In total, 47 residents participated. Eight GLA sessions were held over a five-month time period. Results The GLA sessions resulted in reflections, proposals and actions for change by the residents. Adolescent and parent need for support, improved communication and more meeting places were highlighted as priorities for promoting health and well-being. The results were presented for stakeholders in a report and an exhibition and some of the participants started a language café. Conclusions GLA helped residents identify what they thought valuable and relevant concerning health issues and supported them in taking actions to achieve change.