Faculty Bibliography

Early in the pandemic, New York City's public hospital system partnered with multiple philanthropic foundations to offer an unconditional cash transfer program for low-income New Yorkers affected by COVID-19. The $1000 cash transfers were designed to help people meet their most immediate health and social needs and were incorporated into healthcare delivery and contact tracing workflows as a response to the public health emergency. To better understand program recipients' experiences, researchers conducted 150 telephone surveys with randomly sampled cash transfer recipients and 20 in-depth qualitative interviews with purposefully sampled survey participants. Survey participants were predominantly Latinx (87%) and women (65%). The most common reported uses of the $1000 were food and rent. Most participants (79%) reported that without the $1000 cash transfer they would have had difficulty paying for basic expenses or making ends meet, with specific positive effects reported related to food, housing, and ability to work. The majority of survey participants reported that receiving the cash assistance somewhat or greatly improved their physical health (83%) and mental health (89%). Qualitative interview results generally supported the survey findings.

Addressing patients' social needs is key to helping patients heal from coronavirus disease 2019 (COVID-19), preventing the spread of the virus, and reducing its disproportionate burden on low-income communities and communities of color. New York City Health + Hospitals (NYC H+H) is the city's single largest healthcare provider to Medicaid and uninsured patients. In response to the COVID-19 pandemic, NYC H+H staff developed and executed a strategy to meet patients' intensified social needs during the COVID-19 pandemic. NYC H+H identified food, housing, and income support as patients' most pressing needs and built programming to quickly connect patients to these resources. While NYC H+H was able to build on its existing foundation of strong social work support of patients, all health systems must prioritize the social needs of patients and their families to mitigate the damage of COVID-19. National and local leaders should accelerate change by developing robust policy approaches to redesign the social and economic system that reinforces structural inequity and exacerbates crises like COVID-19. [Editor's Note: This Fast Track Ahead Of Print article is the accepted version of the manuscript. The final edited version will appear in an upcoming issue of Health Affairs.].

Learning Objective #1: Recognize and manage opioid overdose in a community health center setting Learning Objective #2: Improve linkage to effective treatment for opioid use disorder after overdose CASE: A 54 yo man was found unresponsive at the door of our community health center. Rapid Response was called and the patient was found to be unresponsive to sternal rub, with 6 breaths per minute, and pinpoint pupils. One dose of 4mg of intranasal naloxone was administered, and soon the patient was alert and oriented. He declined transfer to the ED but was amenable to observation, stating that he had just purchased his usual 3 bags and used them outside of his primary care clinic. His PMH was notable for 36 years of IV/intranasal heroin use, prior stroke, GERD, glaucoma, hyperlipidemia, lumbar radiculopathy, and tobacco use. He had one overdose in the 1990s, attempted detox several times and tried self-treating himself with methadone and buprenorphine. He lived with his girlfriend and was unemployed. His medications included cyclobenzaprine and ranitidine. The medical assistant from our addiction medicine clinic engaged the patient, who reported that the overdose scared him, and offered medication treatment which he accepted. The addiction clinic nurse and physician saw the patient that day and gave an initial buprenorphine prescription, instructions and follow-up appointment. He is now stable on buprenorphine 8mg daily. IMPACT/DISCUSSION: The overdose described in this case represents one of three overdoses in the past month at our NYC health center. Urban health centers often serve as community hubs and may be seen as a safer place to use opioids. Overdoses at community health centers represent an important point of patient engagement in treatment for OUD. Treatment with opioid agonist therapy after overdose has been shown to reduce all-cause and opioid-related mortality. However, only a small percentage of patients receive medication therapy after overdose. (Larochelle et al. Annals of Internal Medicine. 2018) Initiation of medication treatment for OUD at the time of ED presentation has also been shown to improve engagement in treatment. (DOnofrio et al. JAMA 2015.) Institutional commitment to training all providers and staff to recognize the signs of opioid overdose and administer intranasal naloxone has direct impact on patient outcomes. Our experience with this case has demonstrated the importance of immediate engagement in care at the time of overdose. Having a team available at the time of overdose that cares for patients with addiction enabled us to quickly engage this patient in care and start medication therapy when he felt most receptive to treatment.
Conclusion(s): Our case demonstrates two crucial steps for improving outcomes in opioid overdose: widespread availability of and training for intranasal naloxone use, along with community health sites equipped to treat patients with opioid use disorder at the time of overdose

Racial and ethnic minorities in the U.S. experience higher incidence of and greater morbidity from chronic disease. Limited English proficiency (LEP) is a known contributor to these health disparities. The Culturally and Linguistically Appropriate Services (CLAS) standards of the U.S. Department of Health and Human Services promote health equity through the incorporation of professional interpreter services. While such services have been shown to improve quality of care, limited data exist on patient perspectives regarding these services. Better understanding patient experiences with telephone interpreter services (TIS), an increasingly used modality for professional interpretation, could elucidate ways of improving care for this population. This study explored Spanish-speaking patient experiences with TIS at an urban community clinic. Qualitative data collected via focus groups was analyzed using content analysis and grounded theory methods. Our findings suggest that TIS are generally well accepted by Spanish-speaking LEP patients. Limited relationship development with providers and physician attitudes toward TIS were among reported barriers to the use of these services.

Background: Racial and ethnic minorities in the US, a large and growing population, experience higher incidence of and greater morbidity from chronic disease. Limited English proficiency (LEP) is a known contributor to these health disparities. The Culturally & Linguistically Appropriate Services standards promote health equality through the incorporation of interpreter services (IS). IS have shown improved quality of care, but limited data exist on patient perspectives of IS; particularly telephone interpreter services (TIS), an increasingly used form of IS. Better understanding patient experiences with TIS could elucidate ways of enhancing patient-centered care for this patient population; potentially improving health outcomes. Methods: Participants were recruited via flyers, telephone, and face-to-face encounters. They completed a semi-structured questionnaire and participated in a 1-hour, audio-recorded focus group. The focus group facilitator completed field notes after each group. Audio recordings were transcribed then analyzed by content analysis approach and grounded theory. Results: Thirteen individuals participated in 4 focus groups (Group1 n = 4; Group 2 n = 3; Group 3 n = 3; Group 4 n = 3). Participants were female (n=13), ages 33-73 years (mean 55), from Mexico (n=7), Ecuador (n=2), Dominican Republic (n=3), and Columbia (n=1), and had resided in the US for an average of 22 years (range 1-38). 70% reported poor self-rated English language ability (20% fair, 10% not reported). Ten thematic codes in 3 major domains (general attitudes, facilitators, barriers) were identified. Participants reported gratitude for TIS, perceiving TIS increased access to healthcare, and preference for TIS to family members as interpreters. Barriers to the use of TIS were concerns of confidentiality, lack of interpersonal development with physicians, and preference for language-congruent providers. Facilitators to the use of TIS were positive physician attitude toward TIS, physician framing of TIS as a tool in providing quality care, and assurance of accurate communication. Conclusions: Telephone interpreter services (TIS) are generally accepted by Spanish-speaking, LEP patients, and perceived as increasing access to care and assuring accuracy of medical communication. Participants seemed to balance accessing healthcare with concerns of confidentiality when using TIS. Overall, participants fell into two groups; one prioritized access to healthcare, timely and accurate, and the other prioritized relationship building with medical providers. The later was limited in TIS based encounters. Positive physician attitudes toward TIS facilitated their use. This highlights a need for healthcare provider awareness of the impact their attitudes have on patient experiences and acceptance of TIS, and for provider training on relationship building with use of TIS. Lastly, information gathered about patient preferences for language congruent providers speaks to a need for continuing workforce diversification efforts