Prior activation of social work team process by pre-admission one-click automatic referral system

Abstract Background Coronary artery disease (CAD) is the leading global cause of mortality. Coronary angiography (CAG) is often performed for CAD patients, and the mean length of stay (LoS) is 4 d. Requests to the social work team (SWT) are often delayed until just before discharge, causing unnecessarily prolonged LoS and reduced chances of obtaining financial support. If the SWT’s support system is activated beforehand for scheduled CAGs, the LoS would be shorter and patients would be relieved of emotional and financial burdens. Methods Collaborating with the cardiology and medical informatics departments, a one-click automatic referral system (OARS) was set up (January-May 2021). When cardiologists scheduled a CAG in the outpatient department, an OARS cue popped automatically for the medical aid recipients. The cardiologists could also activate the pre-admission OARS for other patients when necessary. Subsequently, the SWT responded on that day to discuss initiating the financial support process with the candidates. The rate of cardiologists’ pre-admission referral to SWT, decision-making time on financial support provision, and proportion of patients receiving financial support were compared before and after initiating OARS. Results After initiating pre-admission OARS, the rate of cardiologists’ pre-admission referral to SWT increased from 17.8% (18/101: mean age, 64.6±12.0 y; 32 females; January-December 2020) to 59.1% (55/93: mean age, 64.0±11.8 y; 29 females; June-December 2021) (p < 0.001). Although the decision-making time to provide financial support did not change significantly (8.4±11.1 vs. 4.7±11.6 d; p = 0.96), the proportion of patients receiving financial support increased (45.5% [46/101] vs. 60.2% [56/93]; p = 0.045). Conclusions By enhancing the cardiologists’ pre-admission referral to SWT and success rate of receiving financial support, the proactive strategy of pre-admission OARS benefits CAD patients scheduled for CAG. Key messages • By building a proactive referral strategy of pre-admission OARS, more CAD patients scheduled for CAG could obtain timely financial support and be relieved both emotionally and financially by the SWT. • This pre-admission OARS might be incorporated for more disease entities for patients in need.


Background:
The COVID-19 pandemic caused severe disruptions in healthcare systems and societies and exacerbated existing inequalities for women and girls across every sphere.Our study explores health systems responses to gender equality goals during the COVID-19 pandemic and which role these goals play in pandemic recovery policies.

Methods:
We apply a qualitative comparative approach.Country case studies (expert information, secondary sources) were collected in March/April 2022.The sample comprised Australia, Brazil, Germany, United Kingdom and USA, reflecting conditions of high to upper-middle income countries with established public health systems, democratic political institutions and gender equality policies.Selected topics: maternity care/reproductive services, violence against women, and gender equality/female leadership.

Results:
All countries tried to keep essential maternity and reproductive services open, but strong limitations applied especially for prevention and counselling services; at the same time, digitalisation/telemedicine supported service expansion.Violence against women and children strongly increased during the pandemic.Routine services were partly kept open and new helplines occasionally established, but no action was taken to scale-up mental health support and respond to new demand.A push-back of gender equality was observed across countries in all areas of health and social care, often coupled with strong increase in intersecting social inequalities; participation of women in decision-making bodies was generally weak and not monitored.

Conclusions:
Across countries, gender equality policies cracked under the pressure of the COVID-19 pandemic; this is true for countries with male and female political leaders, and for different areas of SDG5 and health.There is an urgent need for more effective intersectional gender equality policies and improved participation of women in global health and in health system recovery plans.

Background:
Estimates suggest that numerous people live without health insurance in Germany.Existing evidence on uninsured patients' health and care use is scarce, specifically in Germany.The present study involves citizens' engagement to identify community perceptions of factors associated with health and medical care and to generate community-driven policy recommendations.Methods: Representatives of civil society, affected patients and citizens ('co-researchers') participate in a participatory health research project (MoveCitizenS) located in Bonn, Germany, using Photovoice and Community-based Mapping.The study is composed of five work packages over a 24-month period: (1) Photovoice workshops for co-researchers to produce, select and analyse photographs; (2) a series of workshops to conduct community-based mapping to identify barriers and facilitators of health care utilization; (3) workshops to co-design a crosssectional survey of uninsured patients (n = 300); (4) project evaluation by co-researchers; (5) a dissemination strategy (e.g.advocacy event, exhibition) will be developed.

Results:
Procedures to facilitate the active engagement of citizens and patients are discussed.Preliminary results on community perceptions of uninsured patients' health and medical care and factors influencing health outcomes and care utilization are presented at the conference.Conclusions: This is the first citizen science study which facilitates the understanding of barriers and enabling factors of good health and access to medical care for patients who lack health insurance coverage in Germany.This case study of a participatory project can be adapted to a range of settings to integrate local perspectives to improve population health for all.Key messages: Numerous patients in Germany are uninsured but evidence on their health and medical care is lacking.
Using participatory methods to address these key questions is an important approach to generate suitable policy recommendations to meet the needs of the community and improve population health.

Background:
The impact of racism on health and the quality of health care services for racialized patients have been the object of prior research.The experiences of racialized medical students and physicians, who operate in a field of tension between natural sciences and practical application and between a 'medical habitus' and exclusionary discrimination, have hardly been examined to date.The education of (future) physicians is an especially fruitful research area in the context of the study of institutional racism in the health care system, as informal everyday experiences come together with formal knowledge and normative learning.

Methods:
Based on expert consultations and preliminary interviews with civic stakeholders, teaching and learning materials in German medical studies were randomly sampled and used as a starting point for qualitative guided interviews with physicians and medical students in Germany who are themselves affected by racism.The first steps of the thematic analysis of these interviews are reflected upon and further developed in focus group discussions with the interviewees.

Results:
The study is particularly concerned with the question of how certain dimensions of racism in the health care sector are related, and how racist normativity appears in this context.This is concretized in the relationship between formal and informal medical curricula as well as in the interweaving of everyday experiences and teaching materials.

Conclusions:
There are different dimensions of relation between a hegemonic normativity in the medical curriculum and the everyday experiences of racialized medical students and physicians in Germany.Politics, faculties, publishers, and civic society may be the target of several recommendations for action regarding those diverse dimensions, e.g. the line between omission and stereotyping of several patient groups.
Coronary artery disease (CAD) is the leading global cause of mortality.Coronary angiography (CAG) is often performed for CAD patients, and the mean length of stay (LoS) is 4 d.Requests to the social work team (SWT) are often delayed until just before discharge, causing unnecessarily prolonged LoS and reduced chances of obtaining financial support.If the SWT's support system is activated beforehand for scheduled CAGs, the LoS would be shorter and patients would be relieved of emotional and financial burdens.May 2021).When cardiologists scheduled a CAG in the outpatient department, an OARS cue popped automatically for the medical aid recipients.The cardiologists could also activate the pre-admission OARS for other patients when necessary.Subsequently, the SWT responded on that day to discuss initiating the financial support process with the candidates.The rate of cardiologists' pre-admission referral to SWT, decision-making time on financial support provision, and proportion of patients receiving financial support were compared before and after initiating OARS.
Institutional distrust has shaped this population's interpretation of the pandemic response and enabled vaccine misinformation and conspiracy theories to take hold.We found complex information networks and preference for Francophone, African and social media.Limited English proficiency and preference for the oral tradition restricted engagement with official public health messaging.Suspicion of government motives, low knowledge, and culturally specific perceptions about vaccination contributed to belief that breakthrough infections and need for COVID-19 boosters imply the vaccine is not effective.The population felt coerced 15th European Public Health Conference 2022