Willingness to travel for CAR-T: A choice-based conjoint analysis.

e18503 Background: Chimeric antigen receptor T-cell therapy (CAR-T) is a novel therapy only available at specialized centers. Because patients prefer treatment close to home and provider continuity, preferences may result in unequal access. Sharing follow-up (f/u) with a local provider could increase willingness to travel, but its appeal to patients is unknown. Methods: We conducted a choice-based conjoint analysis to determine the clinical and care delivery factors that patients with diffuse-large B cell lymphoma (DLBCL) value when deciding whether to travel for CAR-T. We recruited from 13 sites within an integrated health system and asked participants to make choices between 12 pairs of treatment options that varied on 5 attributes: travel time, oncologist continuity, whether shared f/u was offered, two-year overall survival (OS), and intensive care unit (ICU) admission rate. Preferences for specific attributes were determined using a generalized estimating equation model with treatment choice as the outcome and the attributes as the variables. Each attribute’s coefficient (importance weight [IW]) represented its value to participants: higher IWs indicated greater value; negative IWs indicated undesirable attributes. Results: We invited 489 patients and 303 (62%) responded. IWs ranged from -0.56 to 1.15 (total cohort) and -2.83 to 2.50 (when modeled by race). Treatments at cancer centers ≥60 minutes away were valued less than those 30 minutes away without collaborative f/u; but were desirable if shared f/u care was offered (Table). Black respondents valued treatments ≥60 minutes away less despite shared f/u care. Participants also valued oncologist continuity (IW 1.15 [0.99, 1.32]), greater OS (IW 0.71 [0.63, 0.79] per 5 percentage point increase), and lower ICU admission rates (IW -0.21 [-0.25, -0.17] per 5 percentage point increase). Oncologist continuity was more highly valued by Black than by White respondents (IW 2.50 [1.74, 3.27] vs 1.09 [0.92, 1.25]). Conclusions: Patients with DLBCL are more likely to select CAR-T therapy at distant cancer centers if f/u care is shared locally. This could represent a strategy to expand access to CAR-T. Travel remains a barrier for Black patients despite shared f/u, suggesting the need to investigate targeted strategies that promote equitable access to CAR-T. [Table: see text]

Patient and Worker Perceptions of Satisfaction of Quality of Health Services Provided in Kabil, Afghanistan

Background: Many patients prefer treatment abroad in Afghanistan. The quality of treatment services is low and they cover the treatment of themselves. This causes both the loss of the national wealth of Afghanistan and poor satisfaction of the workers and patients. The aim of this study was to evaluate the satisfaction of health service providers and beneficiaries in the capital city of Kabil, Afghanistan on the quality of tertiary health services. Methods: Tertiary health facilities chosen from sixteen in Kabil according to their worker and patient capacity, randomly. Health professionals and service recipients recruited using face-to-face questionnaire method. Findings: The level of hospital services are above average for both employees and inpatients in Kabil whereas more hospital workers thinks that health services are weak (p=0.024). Workers spend more money for treatments made in abroad (p=0.043). Conclusions/Application to Practice: Quality of health services is a shared responsibility between hospital management, staff and patients. New governmental regulations should be found for tertiary hospitals and promotive changes should be made for hospital workers in order to increase total quality management.

Treatment of Warts in Children With Focus on Recalcitrant Warts: A Narrative Review

Context: Warts are benign cutaneous and mucosal growths caused by human papillomavirus. Warts are the most common skin diseases seen by pediatric dermatologists. Warts are often self-limited, especially in children, but some lesions are not resolved despite repeated treatments and referred to as recalcitrant warts. Evidence acquisition: Electronic databases such as Google Scholar, PubMed, and Scopus were searched during 2000-2018 and a review was conducted for articles published in English on pediatric warts by focusing on recalcitrant warts. Results: If warts are asymptomatic and being in a location that causes no cosmetic or other problems, observation is the ideal management course. Most parents and children prefer treatment for their warts. There are three modalities of treatment: medical, surgical, and immunotherapy. Conclusions: Treatment of warts is a therapeutic challenge that depends on the patient’s age and the type of warts. Despite treatment according to evidence-based guidelines, a significant proportion of warts are failed to respond. This condition is an unsolved problem in practice. The management for treating these lesions has remained unclear and a wide range of the second line of treatments has been developed.

Antimalarial Drugs in Ghana: A Case Study on Personal Preferences

Malaria is a serious infection affecting millions of people in Africa. Our study investigated the personal preferences and applications of antimalarial medicines in Ghana. Based on over 1000 questionnaires distributed in Ghana from January to May 2019, we noticed that although Western medications to fight this disease are widely available, most patients in Ghana prefer treatment with locally produced herbal remedies. This preference appears to be due to a combination of traditional venues for obtaining medicines “on the street” rather than in licensed pharmacies, trust in local and “green” products, extensive advertisement of such local products, and an inherent distrust of imported and synthetic or orthodox medicines. Going local and natural is a trend also observed in other countries across the globe and adds to the acceptance or rejection of drugs regardless of their activity or toxicity. In fact, adverse side effects associated with herbal remedies, such as general weakness, swelling and sore mouth, do not seem to deter the respondents of this study in Ghana. We propose a combination of (a) increasing public awareness of the benefits of modern medicine and (b) an improvement and control of the quality of herbal remedies to raise the standard for the treatment of malaria in countries such as Ghana.

Antimalarial Drugs in Ghana: A Case Study on Personal Preferences

Malaria is a serious infection affecting millions of people in Africa. Our study investigated the personal preferences and applications of antimalarial medicines in Ghana. Based on over 1000 questionnaires distributed in Ghana from January to May 2019, we noticed that although Western medications to fight this disease are widely available, most patients in Ghana prefer treatment with locally produced herbal remedies. This preference appears to be due to a combination of traditional venues for obtaining medicines “on the street” rather than in licensed pharmacies, trust in local and “green” products, extensive advertisement of such local products, and an inherent distrust of imported and synthetic or unnatural medicines. Going local and natural is a trend also observed in other countries across the globe, and adds to the acceptance or rejection of drugs regardless of their activity or toxicity. In fact, adverse side effects associated with herbal remedies, such as general weakness and swollen, sore mouth, do not seem to deter the respondents of this study in Ghana. We propose a combination of (a) increasing public awareness of the benefits of modern medicine and (b) an improvement and control of the quality of herbal remedies to raise the standard of malaria treatment in countries such as Ghana.

Antimalarial Drugs in Ghana: A Case Study on Personal Preferences

Malaria is a serious infection affecting millions of people in Africa. Our study investigated the personal preferences and applications of antimalarial medicines in Ghana. Based on over 1000 questionnaires distributed in Ghana from January to May 2019, we noticed that although Western medications to fight this disease are widely available, most patients in Ghana prefer treatment with locally produced herbal remedies. This preference appears to be due to a combination of traditional venues for obtaining medicines “on the street” rather than in licensed pharmacies, trust in local and “green” products, extensive advertisement of such local products, and an inherent distrust of imported and synthetic or unnatural medicines. Going local and natural is a trend also observed in other countries across the globe, and adds to the acceptance or rejection of drugs regardless of their activity or toxicity. In fact, adverse side effects associated with herbal remedies, such as general weakness and swollen, sore mouth, do not seem to deter the respondents of this study in Ghana. We propose a combination of (a) increasing public awareness of the benefits of modern medicine and (b) an improvement and control of the quality of herbal remedies to raise the standard of malaria treatment in countries such as Ghana.

Socio-Cultural Change of Society Against Health in the Village of Panciro, Gowa Regency

This study aims to determine the social and cultural changes of the community towards health in the Village of Panciro, Gowa Regency. This research method uses a qualitative approach and descriptive type. Data sources of this research are interviews and documentation. Activities in data analysis include data reduction, data display, and conclusion drawing. The results showed that traditional treatments or modern treatments can be a comparison in society, but all returned with that choice, in which both have the same goal of treating illness and healing albeit in different ways between the two. There are community norms that are strongly held by the Gowa community where men should not be shaking hands with a woman who is not his mahram (not related by blood), so a woman must be treated by a doctor of the same sex. The Government of Gowa Regency pays attention to the health sector by cutting the administration process to hasten the queue so that this can be a trigger for people to prefer treatment at the hospital rather than traditional medicine.

Progress in home-based treatment

Home-based treatment has been promoted as an alternative to hospital admission over the last 30 years, with the system in England being particularly well developed. There is less stigma, patients and families appear to prefer treatment at home, and there has been a significant reduction in the number of acute beds. In more recent years, there have been criticisms of the lack of effect on reducing hospital admissions and concerns have also been raised about patient safety. Home-based treatment is being further developed on the island of Ireland, and this will hopefully be influenced by current and future local research.

Possibility of potential herbal-drug interactions in elderly population

Medicines are variable in composition and quality, which may have an impact on their interaction profile still as a result of the reliability of reports regarding them. As such, the potential for herb-drug interactions increases in elderly population. For this instance we conducted a survey based study in which 208 patients were surveyed belonging to different areas of Karachi. These people were of different age groups ranging from 40-60 years old. They were asked to answer a face to face questionnaire based on the concurrent use of the conventional medicine and herbal drugs and their possible interaction based side effects. Our results sho ws that out of 208, 124(59.6%) volunteers prefer treatment with herbal and allopathic medicines, 138 (66.3%) use medications on daily basis while 70 (33.7%) don’t use on daily basis. And 56 volunteers were at high risk of potential herb-drug interaction, among them 32.7% have dynamic interactions and 21.2% have kinetic interactions in their medication regime. Out of 208 volunteers 89% were experiencing adverse effects (self reported). Since a significant number of herb-drug interactions were detected in elderly patients, it is suggested that health care professionals and consumers should be aware of the potential herb-drug interactions and health care professionals should question and advice their patients on their use of herbal medicines.

Telepsychiatry - When Resources are Short

“Telepsychiatry” refers to video conferencing (interactive audio-video link in real-time where patient and doctor can both see and hear each other at the same time). Limited access to clinicians that have similar cultural and ethnic background decrease speed and accuracy of diagnosis and treatment (especially psychotherapeutic intervention). One solution to this problem is to give refugees, migrants and asylum seekers access to ethnic specialists by using Telepsychiatry.4 stations have been established in Denmark during pilot project in periode 2005-2007. The equipment has been installed in two hospitals, one asylum seekers centre and one social rehabilitation institution.Participants were mentally ill refugees, migrants and asylum seekers. 61 participants were involved in the assessment and/or treatment through 318 telepsychiatry provided remote consultations. They received mental health care by video-conferencing from providers who spoke participants ‘own language, i.e. without the assistance of interpreters.All participants were asked to fulfil 10-items satisfaction questionnaire after the end of Telepsychiatry contact. The most of participants would prefer treatment via Telepsychiatry than via interpreter.Aside from cross cultural patient population, Telepsychiatry can be used in order to provide mental health care towards domestic population in rural and remote areas with resource shortage.