1274. The PrEP Care Continuum Among an Uninsured Patient Population

Background Despite the clear preventive benefits of HIV Pre-Exposure Prophylaxis (PrEP), uptake among populations at highest risk of HIV acquisition has been limited by lack of health insurance and access to care. In March 2018 we opened a free PrEP clinic for those without insurance. We provide HIV prevention services, following the CDC guidelines, with PrEP case manager navigation, medical management, and medication for at-risk individuals free of charge. Methods Half-day clinics were organized on a twice-monthly basis with supervision provided by two infectious disease specialists and several other licensed providers/fellows, with supporting case managers and medical assistants. Medical students were enlisted to help organize and manage patient visits. All patient visits were preceded by discussion with case managers to document insurance status, followed by a sexual history and general physical examination by medical students and supervisory licensed providers. We performed all laboratory testing, diagnostics, and follow-up visits per CDC guidelines. Results From March 2018 to 2019, 193 self-identified at-risk patients scheduled an appointment; 157 unique patients were seen and all deemed eligible for PrEP per CDC guidelines. Of those eligible for PrEP, 140 (89%) received a prescription and started emtricitabine/tenofovir and 115 (73%) remain in care with ≥2 visits completed. Of the 25 no longer in care at our clinic, 6 have insurance or Medicaid (2 continue to be seen in our insured PrEP Clinic), 1 reports no HIV risk factors, and 1 is over-income for pharmacy patient assistance. Patients enrolled in clinic are largely male (145, 92%); 74% age ≤ 34, a disproportionate fraction belonging to a minority racial/ethnic group (67, 43%), with a majority Latinx (60, 38%). A total of 48 STI cases were identified, mostly rectal chlamydia, rectal and pharyngeal gonorrhea 39 (81%), and 9 (19%) cases of syphilis, and no new HIV or HCV infections. At the first visit, 17% of our patients have an STI and at subsequent visits 22% have a new STI. Conclusion Implementation of a free PrEP clinic for uninsured patients is a feasible and effective strategy to reach key populations at risk for HIV. STI rates are high in our population and increased after starting PrEP. Disclosures All authors: No reported disclosures.

Barriers to Colonoscopy in an Uninsured Patient Population—A Quality Improvement Project

Colorectal cancer remains common, with the “80 per cent by 2018” initiative proposed by the National Colorectal Cancer Roundtable. This study was designed to examine obstacles for patients who did not receive their scheduled colonoscopy, focusing on the impact of insurance status. Retrospective chart review was carried out on patients who did not complete their colonoscopy as scheduled from January 2013 to June 2017. The control group consisted of patients who completed their scheduled colonoscopy. One hundred and seventy five patients missed 200 colonoscopies. The most common reasons for cancellation were patient illness (16%), no-show (14%), no prep carried out (13%), inadequate prep (10%), and no transportation (11%). The canceled patients were significantly more likely to have the combination of no insurance and no Primary Care Provider (PCP) (13% vs 4%, P = 0.008), personal history of cancer (22% vs 12%, P = 0.02), and higher rates of prior GI issues (78% vs 50%, P < 0.001). The canceled group had a significantly lower history of colon polyps (37% vs 53%, P = 0.006). Difficulty with the bowel prep in addition to lack of insurance and poverty likely does create a barrier, even in a system that has a safety net, atop other issues such as transportation and inability to miss work playing a role.

Provision of Telemedicine Services by Community Health Centers: An Analysis of the Readiness for HIT Survey Results

The objective of this study was to assess the use of telemedicine services at community health centers. A national survey was distributed to all federally qualified health centers to gather data on their use of health information technology, including telemedicine services. Over a third of responding health centers (37%) provided some type of telemedicine service while 63% provided no telemedicine services. A further analysis that employed ANOVA and chi-square tests to assess differences by the provision of telemedicine services (provided no telemedicine services, provided one telemedicine service, and provided two or more telemedicine services) found that the groups differed by Meaningful Use compliance, location, percentage of elderly patients, mid-level provider, medical, and mental health staffing ratios, the percentage of patients with diabetes with good control, and state and local funds per patient and per uninsured patient. This article presents the first national estimate of the use of telemedicine services at community health centers. Further study is needed to determine how to address factors, such as reimbursement and provider shortages, that may serve as obstacles to further expansion of telemedicine services use by community health centers.

(P2-82) Developing and Implementing an Emergency Preparedness and Trauma Research Program in a New Level One Trauma Center

Our level one trauma center with a service area covering a population of approximately four-million people treats approximately 80,000 patients per year. In 2010, we anticipate more than 23,000 patients admitted, and to experience more than 850,000 patient encounters within the network. Trauma research is an important component to any level one trauma center, as well as a requirement of the American College of Surgeons/Committee on Trauma (ACS/COT). Our trauma center has recently gained level one designation and began an emergency preparedness research and trauma research (EPR/TR) program in earnest. We are fortunate to have support from executive administrators. Stewardship is a necessary element of our planning, in part because we are a county hospital serving a large uninsured patient population. The following are a few of the necessary steps we took to build an (EPR/TR) department from the beginning, to the point of submitting abstracts, manuscripts, funding grants, and presentations to regional, national, and international conferences, journals, and agencies. Structure the Emergency Preparedness Office to be a component of Trauma Services, allowing a unique opportunity for real-time disaster and mass casualty research. Secure a commitment from senior executives. Secure an experienced researcher, capable of research administration. Ensure the (EPR/TR) director, trauma medical director, trauma services director, and emergency preparedness coordinator can be a cohesive team with complimentary skills. Encourage trauma surgeons to perform research with assistance from the (EPR/TR) Office. Seek federal and foundation funding. Seek alliances with appropriate consortiums and associations. Develop a research relationship with pre-hospital emergency services. The above steps represent only some of the components used to build our (EPR/TR) department. We anticipate the planned expansion of the above steps will take our EPR/TR to the next level and increase extramural funding.