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Dermatologia , Pigmentação da Pele , Humanos , Feminino , Dermatologia/estatística & dados numéricos , Masculino , Adulto , Pessoa de Meia-Idade , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Idoso , Adulto Jovem , Adolescente , Dermatopatias/epidemiologia , Dermatopatias/diagnósticoRESUMO
BACKGROUND: The electronic health record (EHR) has been associated with provider burnout, exacerbated by increasing In-Basket burden. OBJECTIVES: We sought to study the impact of implementing a team-based approach to In-Basket management on a series of primary care ambulatory sites. METHODS: We performed a workflow analysis of the transition to the Advanced In-Basket Management (AIM) nurse team triage for six family medicine clinic locations in a large health system. We abstracted and analyzed associated provider workflow metrics from our EHR. We conducted a postintervention provider survey on satisfaction with the AIM project and provider burnout. RESULTS: The AIM project was implemented in six family medicine clinics after provider townhalls and workgroup development. A nurse team curriculum was created using the principles of "maturing the message" before sending it to a provider and "only handle it once" to improve response efficiency. Provider workload metrics abstracted from the EHR demonstrated 12.2 fewer In-Basket messages per provider per day (p < 0.05), 6.3 fewer minutes per provider per day worked outside scheduled hours (p < 0.05), 3.5 fewer minutes spent in the In-Basket per provider per day (p < 0.05), but 13.7 more seconds spent per completed message per provider (p = 0.017), likely attributable to increased message complexity. Sixty-four percent of providers reported no burnout symptoms in a postintervention survey, 56% agreed that the AIM project reduced their burnout, and approximately 70% of providers agreed that the AIM project was acceptable and appropriate for their clinic. CONCLUSION: The AIM project demonstrates team-based nurse In-Basket triage is possible to implement across multiple primary care sites, is an acceptable intervention for providers, can reduce provider workload burden and self-reported provider burnout.
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Esgotamento Profissional , Atenção Primária à Saúde , Autorrelato , Carga de Trabalho , Humanos , Registros Eletrônicos de Saúde , Fluxo de Trabalho , Cefaleia , Pessoal de Saúde/psicologia , Instituições de Assistência AmbulatorialRESUMO
Introduction: falls in the elderly are a neglected health problem in many societies, particularly in the developing world. Many health and social service providers are unprepared to prevent and manage falls and related injuries as they lack sufficient knowledge to identify their predisposing factors. For this reason, this study aims to identify the pattern of falls and its determinants among the elderly in northern Nigeria. Methods: a cross-sectional study was conducted among 300 elderly patients, selected by systematic random sampling. An interviewer-administered questionnaire was used. Data was analyzed using SPSS version 20. Variables were summarised using percentages and measures of central tendency/dispersion. The chi-square test was used in assessing the significance of associations between categorical variables. A p-value of <0.05 was considered statistically significant. Binary logistic regression analysis was conducted to identify determinants of falls. Results: the prevalence of falls and fall injuries was 41.4% and 25.4% respectively. The commonest pattern of fall injuries was swellings and pain (31.1%). Tripping was the commonest 60 (49.2%) cause of fall. Age (p<0.026, AOR=4.424, CI=1.192-16.424), presence of dizziness (p<0.015, AOR=0.334, CI=0.138-0.810), use of shoes with uneven (P<0.021, AOR=0.337, CI=0.133-0.851)/slippery soles (p<0.038, AOR=0.392 CI=0.162-0.948), having slippery mats (P<0.001, AOR=0.086, CI=0.039-0.192), wires/cords exposed (p=0.005, AOR=0.306 CI=0.132-0.705) on the pathways were the determinants. Conclusion: the high prevalence of falls and fall injuries signifies its importance in health care. This implies that physicians should be proactive in asking, assessing, and assisting the elderly to provide targeted interventions to potentially prevent falls.
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Acidentes por Quedas , Centros de Atenção Terciária , Humanos , Acidentes por Quedas/estatística & dados numéricos , Estudos Transversais , Feminino , Nigéria/epidemiologia , Masculino , Idoso , Inquéritos e Questionários , Idoso de 80 Anos ou mais , Prevalência , Pessoa de Meia-Idade , Ferimentos e Lesões/epidemiologia , Fatores de Risco , Fatores Etários , Instituições de Assistência Ambulatorial , Tontura/epidemiologiaRESUMO
AIMS OF THE STUDY: This prospective study, conducted with patients from the multidisciplinary post-COVID outpatient clinic at the Pulmonary Division of the Cantonal Hospital Winterthur, aimed to investigate changes in patients' main symptoms, elements that aided in coping with the condition and satisfaction with the consulting and therapeutic interventions. METHODS: After obtaining ethical approval, fifty patients were consecutively included in this longitudinal study, which incorporated three survey times post-consultation: t1 (0-7 days), t2 (4-8 weeks) and t3 (4-6 months). The survey comprised standardised questionnaires, including the Hospital Anxiety and Depression Scale, the Post-COVID-19 Functional Status scale and the Chalder Fatigue scale, along with study-specific questions regarding symptoms and reasons for consulting the post-COVID outpatient clinic. Additionally, ten patients were invited to participate in qualitative individual interviews at t2 and t3. RESULTS: The study was conducted between November 2021 and February 2023. The median age of the 50 participants was 47 years (IQR: 36-55), with 66% (33/50) being female. Most participants (66% or 33/50) reported no pre-existing conditions prior to COVID-19 infection, and only six patients required hospitalisation during the acute phase of their infection. Visits to the multidisciplinary post-COVID clinic occurred approximately eight months post-infection, with referrals primarily made by primary care physicians (82% or 41/50). The majority of patients experienced persistent tiredness, exhaustion and fatigue (94% or 47/50), along with reduced physical performance (82% or 41/50), while pain or breathing difficulties were less frequently mentioned. At t1, around half of the patients were fully or partially unable to work, a proportion that reduced to around a third by t3. Symptoms generally decreased over time, with significant improvements observed between t2 and t3. However, subjectively perceived cognitive limitations worsened or were reported more frequently over time. Most patients (96% or 48/50) felt well cared for throughout their consultations. In qualitative interviews, patients highlighted the medical staff's attentiveness and the time dedicated to consultations, which made them feel that their complaints were taken seriously and that they received appropriate information. CONCLUSIONS: The results confirmed that the multidisciplinary post-COVID outpatient clinic met most respondents' expectations. Patients found that the attentive interprofessional coaching was most helpful in coping with their illness. However, participants also noted long waiting times and expressed a desire for earlier admission to the clinic.
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COVID-19 , SARS-CoV-2 , Humanos , COVID-19/psicologia , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto , Estudos Longitudinais , Instituições de Assistência Ambulatorial , Inquéritos e Questionários , Suíça , Satisfação do Paciente , Fadiga , Depressão , AnsiedadeRESUMO
INTRODUCTION: Disengagement from HIV care during the perinatal period remains a challenge. Improving engagement in HIV care requires monitoring engagement across multiple indicators, including retention in HIV care, visit adherence, clinic transfers, and viral suppression to support improved clinical and programmatic outcomes. METHODS: We enrolled a prospective cohort of pregnant WHIV across a network of five urban clinics in Lilongwe, Malawi from February 2020-February 2021. WHIV were followed from their first antenatal care visit through 9 months postpartum across all study sites using biometric fingerprint scanning. Study visits occurred at enrollment into antenatal care, 6 weeks', 6 months, and 9 months postpartum. In addition, all usual care HIV visits were captured via medical records. Participants who missed a study visit or usual care visit were traced. We evaluated determinants of multiple indicators of engagement in care, including retention in HIV care (attending a scheduled visit or self-reported recent visit when traced), HIV visit adherence (missed scheduled HIV visits and HIV visit coverage), clinic transfers, and viral load suppression (< 1000 copies/mL) using modified Poisson regression and sub-distributional hazard ratios to account for competing events of death and loss-to-follow-up. Associations between clinic transfer and subsequent indicators of engagement in HIV care were evaluated using generalized estimating equations. RESULTS: Among 399 participants, 81% were on ART at baseline. Retention in HIV care was 87% at 6 weeks postpartum, 77% at 6 months postpartum and 89% at 9 months postpartum. At 9 months postpartum, 91% of participants were virally suppressed, 81% had missed a scheduled HIV visit, and 19% had transferred clinics. WHIV who transferred clinics were most likely to miss their subsequent scheduled HIV visit by ≥ 30 days. Transferring clinics was not associated with unsuppressed viral load or non-retention at 9 months postpartum. CONCLUSIONS: In a cohort of WHIV, retention and viral load suppression were high in the perinatal period, but missed HIV visits and clinic transfers were common. Transferring clinics was associated with an increased likelihood of missing a subsequent HIV visit. Clinic transfers may be important indicators of disruptions in clinical care for WHIV in the perinatal period.
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Infecções por HIV , Complicações Infecciosas na Gravidez , Humanos , Feminino , Malaui , Infecções por HIV/terapia , Gravidez , Adulto , Estudos Prospectivos , Complicações Infecciosas na Gravidez/terapia , Carga Viral , Assistência Perinatal/estatística & dados numéricos , Assistência Perinatal/métodos , Transferência de Pacientes/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Retenção nos Cuidados/estatística & dados numéricos , Adulto Jovem , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Instituições de Assistência Ambulatorial/estatística & dados numéricosRESUMO
OBJECTIVE: To describe family physicians who primarily practise in a walk-in clinic setting and compare them with family physicians who provide longitudinal care. DESIGN: A cross-sectional study that linked results from a 2019 physician survey to provincial administrative health care data in Ontario. The characteristics, practice patterns, and patients of physicians primarily working in a walk-in clinic setting were compared with those of family physicians providing longitudinal care. SETTING: Ontario. PARTICIPANTS: Physicians who primarily worked in a walk-in clinic setting in 2019, as indicated by an annual physician survey. MAIN OUTCOME MEASURES: Physician demographic and practice characteristics, as well as their patients' demographic and health care utilization characteristics, were reported according to whether the physician was a walk-in clinic physician or a family physician who provided longitudinal care. RESULTS: Compared with the 9137 family physicians providing longitudinal care, the 597 physicians who self-identified as practising primarily in walk-in clinics were more frequently male (67% vs 49%) and more likely to speak a language other than English or French (43% vs 32%). Walk-in clinic physicians tended to have more encounters with patients who were younger (mean 37 vs 47 years), who had lower levels of prior health care utilization (15% vs 19% in highest band), who resided in large urban areas (87% vs 77%), and who lived in highly ethnically diverse neighbourhoods (45% vs 35%). Walk-in clinic physicians tended to have more encounters with unattached patients (33% vs 17%) and with patients attached to another physician outside their group (54% vs 18%). CONCLUSION: Physicians who primarily work in walk-in clinics saw many patients from historically underserved groups and many patients who were attached to another family physician.
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Médicos de Família , Humanos , Ontário , Estudos Transversais , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Médicos de Família/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Medicina de Família e Comunidade/estatística & dados numéricos , Inquéritos e Questionários , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricosAssuntos
Instituições de Assistência Ambulatorial , COVID-19 , Infecções por HIV , SARS-CoV-2 , Carga Viral , Humanos , COVID-19/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Angola/epidemiologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Fármacos Anti-HIV/uso terapêutico , Pandemias , Contagem de Linfócito CD4RESUMO
This quality improvement project implemented a standardized chemotherapy class for newly diagnosed patients receiving oncology care at an urban ambulatory oncology center. Results showed high scores on patient satisfaction qu.
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Neoplasias , Educação de Pacientes como Assunto , Satisfação do Paciente , Humanos , Educação de Pacientes como Assunto/normas , Neoplasias/tratamento farmacológico , Melhoria de Qualidade , Antineoplásicos/uso terapêutico , Feminino , Masculino , Pessoa de Meia-Idade , Enfermagem Oncológica/normas , Enfermagem Oncológica/educação , Assistência Ambulatorial/normas , Adulto , Instituições de Assistência Ambulatorial/normasRESUMO
BACKGROUND: Improving geographic access can aid in managing tuberculosis (TB) by enabling early diagnosis and treatment initiation. Although geospatial techniques have been used to map the transmission patterns of drug-resistant TB in South Africa, fewer studies have investigated the accessibility of TB diagnostic services. This study evaluated the accessibility of TB diagnostic services and disease distribution in the eThekwini district of South Africa. METHODS: In this cross-sectional study, population data for 2021 were disaggregated into smaller analysis units and then re-aggregated through the dasymetric mapping technique. Data on notified TB patients, including Global Positioning System coordinates of clinics, were obtained from the District of Health Information System, exported to ArcGIS 10.8.2 and used to calculate distances to the nearest clinics and hospitals. RESULTS: 92% of the population (3 730 494 people) in eThekwini could access TB diagnostic services within 5 km. Patients travelled an average distance of 4.7 km (range: 0.1-26.9 km). TB diagnostic services were highly accessible in the Northern and Central regions and moderately accessible in the predominately rural Western and Southern regions. The smallest population of eThekwini resides in rural areas; however, 40.7% of its residents live >5 km from a diagnosing facility, with patients in the South having to travel up to 44.5 km. TB incidence was higher in the predominately rural West and South regions compared with the Central and North regions which are mainly comprised of urban and suburban areas. Our findings also showed that 98.4% of the clinics in eThekwini were located within 30 km of a hospital at an average distance of 9.6 km within the district. However, the distribution of these hospitals does not demonstrate equitable access as the majority are located within the Central region, and fewer are found in the other three regions of eThekwini. CONCLUSIONS: Addressing the disparities in access to TB diagnostic services is required in the eThekwini district. Leveraging the existing mobile health clinics can assist with this, particularly, in rural areas with inadequate access. Additionally, active-case finding should be intensified in these regions since they had a higher TB burden per population. Prioritising interventions in these areas is crucial for reducing the impact of the disease on affected communities.
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Acessibilidade aos Serviços de Saúde , Atenção Primária à Saúde , Tuberculose , Humanos , África do Sul/epidemiologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Estudos Transversais , Feminino , Adulto , Masculino , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adolescente , Pessoa de Meia-Idade , Análise Espacial , Sistemas de Informação Geográfica , Adulto Jovem , Criança , Pré-Escolar , Lactente , Serviços de Diagnóstico/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricosRESUMO
BACKGROUND: Lowering LDL-cholesterol is a fundamental goal for both primary and secondary prevention of atherosclerotic cardiovascular diseases. Our study aims to analyse potential sex disparities regarding the tolerability and effectiveness of lipid-lowering therapy in patients with and without reported statin intolerance who are being treated at a lipid-outpatient clinic. METHODS: From 2017 to 2022, n = 1062 patients (n = 612 men, n = 450 women) at high-risk were referred to our lipid-outpatient clinic because of difficulties in lipid control by primary healthcare providers. The main therapeutic objective was to optimize lipid-lowering therapy according to current treatment guidelines. RESULTS: Patients presented with high LDL-C baseline levels (4.97 ± 1.81 mmol/l (192 ± 70 mg/dL) in men and 5.46 ± 2.04 mmol/l (211 ± 79 mg/dL) in women). Intolerance towards statins was reported more frequently by women (48.2%) than by men (38.9%, p = 0.004). LDL-C continuously decreased with individual treatment adjustments across follow-up visits. In total, treatment goals (LDL < 1.4 mmol/l (< 55 mg/dl) or < 1.8 mmol/l (< 70 mg/dl)) were accomplished in 75.8% of men and 55.5% of women after the last follow-up visit (p < 0.0001). In men, these data are almost identical in subjects with statin intolerance. In contrast, treatment goals were reached less frequently in women with statin intolerance compared to women tolerant to statin therapy. CONCLUSION: Even if treated in a specialized lipid clinic, women are less likely to reach their target LDL-C than men, particularly when statin intolerant. Nevertheless, many patients with statin intolerance can be successfully treated using oral combination and PCSK9 inhibitor therapy. However, ongoing follow-up care to monitor progress and to adjust treatment plans is necessary to reach this goal.
We investigated patients at high cardiovascular risk who were referred to our specialized lipid outpatient clinic because of elevated lipid levels and difficulties in lipid-lowering treatment in the primary care setting. The primary goal of such a clinic is to help patients to achieve optimal lipid levels through personalized treatment plans. We focused on prescription behavior and differences in treatment tolerability and effectiveness between men and women.A large proportion of patients (more frequently women (48.2%) than men (38.9%)) reported intolerance towards statins and most patients' LDL-cholesterol levels were far away from treatment goals. However, when treated at a specialized lipid clinic providing ongoing follow-up care to monitor progress and to adjust treatment plans if necessary, many of those patients were able to tolerate lipid lowering medication to achieve better lipid control and to maintain their lipid levels within target ranges.However, women were less likely to reach LDL-cholesterol treatment targets compared to men, especially if they reported intolerance towards statins. Ongoing follow-up care to monitor progress and to adjust treatment plans is necessary to reach treatment goals.
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LDL-Colesterol , Inibidores de Hidroximetilglutaril-CoA Redutases , Caracteres Sexuais , Humanos , Masculino , Feminino , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Pessoa de Meia-Idade , Idoso , LDL-Colesterol/sangue , Instituições de Assistência AmbulatorialRESUMO
BACKGROUND: Families of children with medical complexity (CMC) may face challenges related to Social Determinants of Health (SDoH). Although standardized SDoH screening has been implemented in numerous medical settings, there has been limited study of screening among CMC. Our global aim is to improve access to institutional and community resources for families of CMC with identified needs. Here, we aimed to establish SDoH screening for families in our outpatient Complex Care Center and attain a screening rate of 80%. METHODS: A multidisciplinary team in our clinic used quality improvement methods to implement and study an expanded SDoH screen, which included 3 questions specific to the needs of CMC (ie, emergency planning, social support, and medical equipment concerns). Interventions, informed and refined by 5 key drivers, were tested over a 12-month period. A statistical process control chart tracked key outcome and process measures over time. RESULTS: SDoH screening sustained a mean of 80% after implementation during the study period. Incorporating registration staff in screen distribution was our most impactful intervention. At least 1 SDoH concern was identified on 56% of screens; concerns specific to CMC and mental health were most frequently reported. A total of 309 responses to positive screens were reported in total. CONCLUSIONS: Successful implementation of an expanded, tailored SDoH screen revealed a multitude of social needs specific to families of CMC that otherwise may not have been recognized. Our team continues to develop and distribute resources to address identified needs.
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Programas de Rastreamento , Melhoria de Qualidade , Determinantes Sociais da Saúde , Humanos , Criança , Programas de Rastreamento/métodos , Instituições de Assistência Ambulatorial , Feminino , Masculino , Pré-Escolar , Equipe de Assistência ao PacienteRESUMO
Regulating patients' no-show behavior is critical from the standpoints of sustainable medical services and operational efficiencies. The purpose of this study was to evaluate the patients' intention to make partial up-front payments at outpatient clinics. This was a cross-sectional study design introducing a self-administered questionnaire to 221 outpatients at a private health facility. The questionnaire measured the patient's demographic characteristics, perceived usefulness (PU), trust in the health facility, and intention to make upfront partial payments. Out of the total respondents, 57.4% were female. There were 34.8% Malays, 40.6% Chinese and 24.6% Indians. The majority (66.5%) of the respondents attained tertiary education. Nearly a third of the respondents (30.5%) reported an income between 3000 and 5000 Malaysian Ringgit (RM). Regarding payment mode, just more than half (51.1%) made self-payment, and 21.8% by guaranteed letter. A quarter (24.9%) waited more than 3 h for consultation and 59.6% visited the health facility more than 2 times in a year. Initial analysis showed that PU, trust, age, education, number of visits, and hours of waiting were significantly associated with the intention to make a partial payment. Multiple linear regression showed that perceived usefulness (B = 0.517, p < 0.001); trust in hospital management (B = 0.288, p < 0.001) and number of visits (B = 0.216, p < 0.001) were associated with the intention to make partial payment. Intention to make partial up-front payments is associated with higher perceived usefulness in making such payments and hospital trust. Visiting the health facility frequently was associated with a higher intention to make upfront partial payment. The result may guide further studies on potential remedies to no-show.
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Instituições de Assistência Ambulatorial , Intenção , Humanos , Feminino , Masculino , Malásia , Adulto , Pessoa de Meia-Idade , Estudos Transversais , Instituições de Assistência Ambulatorial/economia , Inquéritos e Questionários , Pacientes não Comparecentes/estatística & dados numéricos , Pacientes não Comparecentes/psicologia , Confiança , Pacientes Ambulatoriais/psicologia , Adulto Jovem , IdosoRESUMO
BACKGROUND: Outpatient Clinics (OCs) are under pressure because of increasing patient volumes and provider shortages. At the same time, many patients with chronic diseases receive routine follow-up consultations that are not always necessary. These patients block access to care for patients that are in actual need for care. Pre-assessing patient charts has shown to reduce unnecessary outpatient visits. However, the resulting late cancellations due to the pre-assessment, challenge efficient alignment of capacity with actual patient demand, leading to either empty slots or overtime. This study aims to develop a method to analyse the effect of pre-assessing patients before inviting them to the OC. This involves 1) to select who should come and 2) to optimize the impact of pre-assessment on the schedule and efficient use of OC staff. METHODS: This prospective mixed-methods evaluation study consists of 1) an expert meeting to determine a pre-assessment strategy; 2) a retrospective cohort study to review the impact of this strategy (12 months of a Dutch nephrology OC); 3) mathematical optimization to develop an optimal criteria-based scheduling strategy; and 4) a computer simulation to evaluate the developed strategy. Primary outcomes are the staff idle time and staff overtime. Secondary outcomes evaluate the number of weekly offered appointments. RESULTS: The expert group reached consensus about the pre-assessment criteria. 875 (18%) of the realized appointments in 2022 did not meet the OC visit pre-assessment criteria. In the best performing scheduling strategy, 94 slots (87% of the available capacity) should be scheduled on a weekly basis. For this schedule, 26.8% of the OC weeks will experience idle time ( µ =2.51, σ =1.44 appointment slots), and 21% of the OC weeks will experience overtime ( µ =2.26, σ =1.65 appointment slots) due to the variation in patient appointment requests. Using the pre-assessment strategy combined with the best performing scheduling strategy under full capacity (108 slots), up to 20% increase in patient demand can be handled with equal operational performance. CONCLUSIONS: This evaluation study allows OC managers to virtually test operational impact of pre-assessment strategies on the capacity of their OC, and shows the potential of increasing efficient use of scarce healthcare capacity. TRIAL REGISTRATION: Not applicable.
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Instituições de Assistência Ambulatorial , Agendamento de Consultas , Nefrologia , Humanos , Estudos Prospectivos , Instituições de Assistência Ambulatorial/organização & administração , Países Baixos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Eficiência OrganizacionalRESUMO
. The organisation of outpatient medical and nursing clinics for the follow-up of patients after hospitalization for a myocardial infarction or heart failure. INTRODUCTION: Guidelines suggest careful monitoring of patients after acute heart failure (AHF) or acute myocardial infarction (AMI). OBJECTIVE: To describe the implementation of the 'accompanied discharge' (DIMACC) pathway for patients admitted for AHF or AMI in the Cardiology Department of the Pio XI hospital in Desio, and to evaluate its feasibility. METHODS: The DIMACC pathway was built following the recommendations of international guidelines and with the involvement of all the actors. RESULTS: At discharge, the health objectives to be achieved are defined, and outpatient visits during the first year after hospitalization in the District outpatient clinics with the cardiology doctor and family nurses are booked. The patient stays in the outpatient clinic about 1.5 hours to complete at first, in half an hour, questionnaires on measures, symptoms, adherence, quality of life; then, to receive the nursing visit lasting half an hour for the assessment of the questionnaires, measurement of clinical parameters and counseling; and finally, to be visited by the cardiologist. During the pilot phase (6 months of recruitment and 1 year of follow-up) 168 patients (129 AMI and 39 AHF) followed the pathway: 4 (2.4%) patients died during the follow-up, 14 (8.3%) abandoned the pathway and 150 (89.3%) completed it. CONCLUSIONS: The implementation of the DIMACC pathway required an investment of time (about a year) and resources but the follow-up is feasible. The next phase will be the evaluation of the patient outcomes.
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Insuficiência Cardíaca , Hospitalização , Infarto do Miocárdio , Humanos , Insuficiência Cardíaca/enfermagem , Insuficiência Cardíaca/terapia , Infarto do Miocárdio/enfermagem , Infarto do Miocárdio/terapia , Seguimentos , Feminino , Masculino , Idoso , Estudos de Viabilidade , Alta do Paciente , Pessoa de Meia-Idade , Instituições de Assistência Ambulatorial/organização & administração , Itália , Assistência Ambulatorial , Assistência ao ConvalescenteRESUMO
INTRODUCTION AND OBJECTIVES: La Clínica Latina is a free clinic that strives to meet the healthcare needs of the Spanish-speaking population of Franklin County, Ohio, including metropolitan Columbus. As a student-run free clinic, care is provided each week by volunteer medical students and resident physicians under the administrative leadership of the medical student board and clinical supervision of licensed physicians. Patients served by the clinic have a multitude of chronic health conditions, which are managed by clinic volunteers through the delivery of over 1500 appointments per year. In order to better serve the rapidly growing patient population, this study describes the delivery and results of an assessment aimed at understanding the needs that are being met sufficiently at the clinic and what pitfalls still exist in the clinic's provision of care. METHODS: By delivering a survey inquiring about the experiences of patients at La Clínica Latina, clinic workflow can be optimized for the provision of patient-centered care. RESULTS: Insights collected from a convenience sample of 30 patients demonstrate mobile phone use as the primary mode of communication with clinic volunteers, previously under-appreciated musculoskeletal health concerns, longer than desired wait times after check-in, and variable experiences of health literacy by patient gender. CONCLUSION: By addressing each of these insights in updates to clinic workflow, La Clínica Latina may prove to become an even more useful resource to the region's growing Hispanic population.
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Hispânico ou Latino , Avaliação das Necessidades , Clínica Dirigida por Estudantes , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Instituições de Assistência Ambulatorial , Letramento em Saúde , Idioma , Ohio , Assistência Centrada no Paciente , Clínica Dirigida por Estudantes/organização & administraçãoRESUMO
BACKGROUND: Hypertension affects approximately 1 in 2 adults in the US. Home blood pressure (BP) monitoring programs are effective in the diagnosis and management of hypertension. Free clinics serve as an integral safety net for millions of uninsured and economically disadvantaged patients in the US. The feasibility and effects of a free home BP monitoring and follow-up program in a free clinic setting is not well characterized. METHODS: This was a prospective study of the implementation of a pilot BP monitoring and follow-up program between March 2021 and August 2023 at 2 free clinics in the San Francisco Bay Area. A total of 78 hypertensive patients were enrolled in the program and given a free BP monitor. We surveyed via telephone the change in systolic and diastolic BPs and BP monitor use and comfort at 3 weeks. Volunteers in clinic roles involved in the BP monitoring program were surveyed to assess their time spent and perceptions of the program. RESULTS: Of the 78 patients, 37 provided responses to the 3-week survey. A total of 36 of 37 (97%) patients reported using their BP monitor. A total of 35 patients reported using it at least once a week (95%), with the majority reporting at least four uses a week (68%). A total of 36 patients (97%) planned on continuing to use their BP monitor. At 3 weeks, the mean systolic and diastolic BP changed by -6.40 mmHg (95% CI, -10.8 to -2.01 mmHg; P = .00577) and -2.72 mmHg (95% CI, -5.62 to 0.188 mmHg; P = .0657), respectively. The time commitment for this program ranged from 130 ± 51 min for program leaders to 16 ± 14 min per week for patient-facing roles. All volunteer roles (patient-facing, phone follow-up, program leaders) expressed that they had a clear understanding of their responsibilities in the program (median 4 on Likert scale, IQR 3-5). CONCLUSION: Home BP monitoring and follow-up is feasible to implement in free clinics, resulting in high rates of patient engagement among respondents. Our findings suggest that home BP monitoring and follow-up programs may be beneficial in vulnerable patient populations.
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Monitorização Ambulatorial da Pressão Arterial , Estudos de Viabilidade , Hipertensão , Humanos , Feminino , Masculino , Estudos Prospectivos , Projetos Piloto , Pessoa de Meia-Idade , Monitorização Ambulatorial da Pressão Arterial/métodos , São Francisco , Idoso , Adulto , Instituições de Assistência Ambulatorial , SeguimentosRESUMO
BACKGROUND: Previous research has highlighted inequalities in access to Swedish youth clinics (YCs). These inequalities exist not only between non-migrant and young migrant populations but also within various migrant groups. OBJECTIVES: To assess awareness and utilization of Swedish YCs among migrants enrolled in Swedish language programmes and explore associated factors. METHODS: This cross-sectional study involved 1,112 migrants aged 15-65. The analytical sample included 642 (57%) participants who answered the main outcome question about awareness of YCs. Descriptive statistics, bivariate, and multivariate log-binomial regression analyses using a Bayesian approach were applied to summarize the data and identify factors associated with awareness and utilization of YCs among migrants. RESULTS: The results revealed that 30% of all participants and 40% of the participants aged 15-25 years had heard of YCs. Additionally, 23% of the target group (15-25 years) had ever visited one. During descriptive and bivariate analyses, socio-demographic variations were evident in YCs' awareness and utilization. However, in multivariate analyses, only the associations between awareness and year of arrival, and YCs' utilization and year of arrival and type of residence permit, remained statistically significant. CONCLUSION: This study highlights the level of awareness of YCs among migrants attending Swedish language programmes and their utilization by those aged 15-25 years, potentially impacting their access to crucial services and resources. Targeted interventions and sustainable strategies beyond one-time interventions are essential to address the specific needs of different socio-demographic groups and ensure equitable access to YCs' information and services.
Main findings: This study highlights the level of awareness and utilization of youth clinics among migrants attending Swedish language programmes, revealing socio-demographic disparities across different groups.Added knowledge: Migrant men and unaccompanied minors are more likely to be aware of and use youth clinics than migrant women and those with legal guardians, while recent migrants and those with temporary residence permits are at an increased risk of being unaware of or not utilizing these services.Global health impact for policy and action: Targeted interventions and sustainable strategies, beyond one-time efforts, are essential to address the specific needs of different migrant subgroups and ensure equitable and universal access to crucial information and services related to sexual and reproductive health and rights.