Is My Cough a Cold or Covid? A Qualitative Study of COVID-19 Symptom Recognition and Attitudes Toward Testing in the UK

Objective: Key to reducing the spread of COVID-19 in the UK is increased use of the NHS Test and Trace (NHSTT) system. This study explored one of the main issues that determine whether people engage with NHSTT, how people understand symptoms that may indicate the presence of COVID-19 and that should trigger a request for a test.Methods: In this qualitative study, a series of semi-structured telephone interviews were conducted with 40 people (21 members of the general population, 19 students). There was nearly an equal split between male and female participants in both samples. Data were collected between 30 November and 11 December 2020 and explored using thematic analysis. There was substantial similarity in responses for both populations so we combined our results and highlighted where differences were present.Results: Participants generally had good knowledge of the main symptoms of COVID-19 (high temperature, new, persistent cough, anosmia) but had low confidence in their ability to differentiate them from symptoms of other illnesses. Attribution of symptoms to COVID-19 was most likely where the symptoms were severe, many symptoms were present, symptoms had lasted for some time and when perceived risk of exposure to infection was high due to previous contact with others. Participants felt encouraged to engage in testing where symptoms were present and had persisted for several days, though, many had concerns about the safety of testing centres and the accuracy of test results. Students had mixed feelings about mass asymptomatic testing, seeing it as a way to access a more normal student experience, but also a potential waste of resources.Conclusions: This study offers novel insights into how people attribute symptoms to COVID-19 and barriers and facilitators to engaging with NHSTT. Participants had positive views of testing, but there is a need to improve not just recognition of each main symptom, but also understanding that even single, mild symptoms may necessitate a test rather than a “wait and see” approach, and to address concerns around test accuracy to increase testing uptake.

The Evolution of AIFA Registries to Support Managed Entry Agreements for Orphan Medicinal Products in Italy

Italy has a well-established prominent system of national registries to support managed entry agreements (MEAs), monitoring innovative medicinal products (MPs) with clinical as well as economic uncertainties to ensure appropriate use and best value for money. The technological architecture of the registries is funded by pharmaceutical companies, but fully governed by the national medicines agency (AIFA). A desktop analysis was undertaken of data over a 15-year timeframe of all AIFA indication-based registries and associated EMA information. The characteristics of registries were evaluated, comparing orphan MPs vs. all MPs exploring cancer and non-cancer indications. OMP (orphan medicinal product) registries’ type vs. AIFA innovation status and EMA approval was reviewed. Of the 283 registries, 182 are appropriateness registries (35.2% relate to OMPs, with an almost equal split of cancer vs. non-cancer for OMPs and MPs), 35 include financial-based agreements [20% OMPs (2 non-cancer, 5 cancer)], and 60 registries are payment by result agreements [23.3% OMPs (4 non-cancer, 10 cancer)]. Most OMPs (53/88) came through the normal regulatory route. With the strengthening of the system for evaluation of innovation, fewer outcomes-based registries have been instigated. AIFA has overcome many of the challenges experienced with MEA through developing an integrated national web-based data collection system: the challenge that remains for AIFA is to move from using the system for individual patient decisions about treatment to reviewing the wealth of data it now holds to optimize healthcare.

Persistent URLs and Citations Offered for Digital Objects by Digital Libraries

As libraries, archives, and museums make unique digital collections openly available via digital library platforms, they expose these resources to users who may wish to cite them. Often several URLs are available for a single digital object, depending on which route a user took to find it, but the chosen citation URL should be the one most likely to persist over time. Catalyzed by recent digital collections migration initiatives at Indiana University Libraries, this study investigates the prevalence of persistent URLs for digital objects at peer institutions and examines the ways their platforms instruct users to cite them. This study reviewed institutional websites from the Digital Library Federation’s (DLF) published list of 195 members and identified representative digital objects from unique digital collections navigable from each institution’s main web page in order to determine persistent URL formats and citation options. Findings indicate an equal split between offering and not offering discernible persistent URLs with four major methods used: Handle, DOI, ARK, and PURL. Significant variation in labeling persistent URLs and inclusion in item-specific citations uncovered areas where the user experience could be improved for more reliable citation of these unique resources.

Driving a Hard Bargain is a Balancing Act: How social preferences constrain the negotiation process

We investigate the haggling process in bargaining. Using an experimental bargaining game, we find that a first offer has a significant impact on the bargaining outcome even if it is costless to reject. First offers convey information on the player’s reservation value induced by his social preferences. They are most often accepted when they are not above the equal split. However, offers which request much more than the equal split induce punishing counteroffers. The bargaining outcome is therefore critically influenced by the balance of toughness and kindness signaled through the offers made in the haggling phase.

Is my cough a cold or covid? A qualitative study of COVID-19 symptom recognition and attitudes towards testing in the UK

Objective Key to reducing the spread of COVID-19 in the UK is increased use of the NHS Test and Trace (NHSTT) system. This study explored one of the main issues that determine whether people engage with NHSTT, how people understand symptoms that may indicate the presence of COVID-19 and that should trigger a request for a test. Methods In this qualitative study, a series of semi-structured telephone interviews were conducted with 40 people (21 members of the general population, 19 students). There was nearly an equal split between male and female participants in both populations. Data were collected between 30 November and 11 December 2020 and explored using thematic analysis. There was substantial similarity in responses for both populations so we combined our results and highlighted where differences were present. Results Participants generally had good knowledge of the main symptoms of COVID-19 (high temperature, new, persistent cough, anosmia) but had low confidence in their ability to differentiate them from symptoms of other illnesses. Attribution of symptoms to COVID-19 was most likely where the symptoms were severe, many symptoms were present, symptoms had lasted for some time and when perceived risk of exposure to infection was high due to previous contact with others. Participants felt encouraged to engage in testing where symptoms were present and had persisted for several days, though many had concerns about the safety of testing centres and the accuracy of test results. Students had mixed feelings about mass asymptomatic testing, seeing it as a way to access a more normal student experience, but also a potential waste of resources. Conclusions This study offers novel insights into how people attribute symptoms to COVID-19 and barriers and facilitators to engaging with testing. Participants had positive views of testing, but there is a need to improve not just recognition of each main symptom, but also understanding that even single, mild symptoms may necessitate a test rather than a wait and see approach, and to address concerns around test accuracy to increase testing uptake.

A92 PREVIOUS VIRTUAL CONSULTATION EXPERIENCE IS RELATED TO PRECEPTOR’S WILLINGNESS TO INVOLVE TRAINEES IN VIRTUAL CARE DURING THE COVID-19 PANDEMIC

Background The COVID-19 pandemic has accelerated the need for healthcare service reform in order to reduce the risk of transmission of SARS-CoV-2 infection between patients, healthcare providers and medical trainees. Gastroenterologists have been challenged to adopt to virtual consultations and accommodate medical trainees in their virtual clinics. Aims To assess the impact of virtual care on medical education during the COVID-19 pandemic Methods A REDCap survey was disseminated among gastroenterology providers via email. The subsection of the survey on medical education consisted of 4 questions pertaining to inclusion of trainees in virtual clinics, type of virtual clinic, observation method and an open-ended question for additional comments. Quantitative data was analyzed using IBM SPSS Statistics 27 and qualitative theme analysis was applied for short answer responses. Results Of the 24 respondents that completed the survey, only 6 (25%) had trainees involved in their clinics (Table 1). The type of clinic consultations conducted were telephone only (50%), a combination of telephone, video and hospital-base telehealth (33.3%) and hospital-based telehealth only (16.7%). There was an equal split between direct and indirect observations. Preceptors that had previous experience with virtual consultation prior to the pandemic, were more likely to include trainees in their virtual clinics (66.6% vs 33.4%; Fisher’s exact test, p=0.033). For preceptors who included trainees in their virtual clinics, their overall satisfaction averaged 0.51 points lower (95% CI: 0.19–0.84, p=0.004). Concerns identified were lack of trainee engagement, adequate remuneration for healthcare providers, and lack of training for trainee and preceptors on how to navigate virtual platforms. Conclusions This survey demonstrates that gastroenterologists with previous experience with virtual clinics are more likely to accommodate trainees in their virtual clinics. However, involving trainees seem to reduce preceptor’s satisfaction with virtual clinic. Our findings suggest that there is a need to provide telemedicine training for both educators and trainees, in order to alleviate concerns and promote its adoption as organizations seek to continue to provide high-quality medical education while providing virtual care. Funding Agencies None