Discussion: Mitochondrial hepatopathies can range from acute liver failure in the neonatal period to Alpers disease in young adults characterized by hepatomegaly, transaminitis, and cirrhosis. Although incidentally found enhancing liver lesions are generally benign and generally not followed up, the multiple lesions found in this patient in the setting of mitochondrial myopathy may be worth investigating.
aureus (MRSA). The patient was started on broad- spectrum empirical antimicrobial therapy with vancomycin, ceftriaxone, and azithromycin for ventilator-associated pneumonia (VAP), UTI, and MRSA bacteremia. Throughout this hospital stay, the patient also required vasopressor support in the ICU setting for worsening hypotension secondary to septic shock. The patient continued to improve clinically and steadily improved to her baseline before discharge with antibiotics.
PROMOTING RESILIENCE FOR MEDICAID MEMBERS WITH OPIOID USE DISORDER. Elizabeth Holland, BS¹, Hannah Doran, BS¹, Wesley Villavicencio Torres, MD MPH⁹, Karlee Mott, BS¹, Isha Matta, MPH¹, Jennifer Gala True, PhD¹, Lawrence Palinkas, PhD ², Tiffany Ardoin, MD³, Neil Nixdorf, MD⁴, Arthur Johnson, BS⁵, Diana Meyers, RN⁶, Catherine Haywood ⁷, Thad Tatum⁸, Elyse Stevens, MD MPH¹, and Benjamin Springgate, MD, MPH¹; ¹ LSU Health New Orleans, New Orleans, LA, ² University of Southern California, Los Angeles, CA, ³ LSU Health New Orleans, Baton Rouge, LA, ⁴ University of Michigan School of Medicine, Ann Arbor, MI, ⁵ Center for Sustainable Engagement and Development, New Orleans, LA, ⁶ Anna's Place NOLA, New Orleans, LA, ⁷ Louisiana Community Health Outreach Network, New Orleans, LA, ⁸ VOTE, New Orleans, LA, ⁹ Ochsner Health Department of Internal Medicine, New Orleans, LA.
Introduction: From 2020 to 2021, opioid-related overdose deaths in Louisiana rose a disproportionate 56.2% compared to 29.6% nationally. While evidence-based treatment for Opioid Use Disorder (OUD) is highly effective, access to care and retention are critical. Stressors associated with COVID-19 and climate events influence overdose risk among people with OUD in Louisiana. We are conducting a study to describe the impacts of environmental stressors on Louisiana Medicaid members (LMM) with OUD and delivery of clinical services, including Medication for OUD (MOUD). Study: We applied Rapid Assessment Procedures- Informed Community Ethnography to conduct this qualitative study. We employed a community- partnered participatory research framework to co-lead study design and implementation with a diverse Leadership Council. We conducted 42 semi-structured interviews, 17 specifically with LMM with OUD. Interviews were analyzed by summarization of transcripts to classify content within target domains. Patterns were then identified using thematic analysis and the matrix method. Community Leadership Council led data review and developed recommendations for policy interventions. LMM interviewees are 58% female with a mean age of 42.83 years from 7 Louisiana parishes. Identified domains from
interview data for clinical and policy improvement include: supporting emergency disaster plans by patients; improving pre-disaster communications; supporting resilience to environmental stressors; dissemination of successful healthcare adaptations to environmental stressors; expanded use of telehealth; and supporting interventions to address increases in overdose. Although some LMMs reported frequent communication with their providers during periods of environmental stress, others reported communication lapses resulting in medication gaps or relapse. Members identified factors contributing to overdose including fentanyl, scarcity of Narcan, treatment inaccessibility, job loss, displacement, and mental illness as factors complicating care during periods of environmental stress. Conclusion: LMM in treatment for OUD report reduced quality of medical care due to inaccessibility, economic hardship, mental and physical health challenges, and diminished social support related to hurricanes, floods, major storms, and COVID-19 since 2020. Proactive communication mechanisms with providers during times of environmental stressors and the use of telehealth services were perceived as protective against treatment interruption and relapse. Members expressed a need for access to MOUD and harm reduction resources to improve care during severe weather or pandemic events.
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