Virtual planning as a resource for correcting severe facial asymmetry ­ case report / Planejamento virtual como recurso para correção de assimetria facial severa ­ relato de caso

A hiperplasia hemimandibular é responsável por prejuízos estéticos, funcionais, motores e psicossociais. Com etiologia incerta, ocorre frente ao desequilíbrio de fatores regulatórios de crescimento presentes na camada cartilaginosa do côndilo. O relato objetiva descrever a tomada de decisões baseada em exames complementares específicos aliados à adequada intervenção cirúrgica da lesão. Paciente gênero feminino, 33 anos de idade, compareceu à clínica particular com queixa principal de "face assimétrica", foi requerido uma avaliação cintilográfica objetivando e confirmando a interrupção do crescimento condilar, descartando a hipótese de Osteocondroma e condilectomia. Após preparo ortodôntico prévio, os exames tomográficos foram utilizados na criação de um protótipo que foi impresso após a realização dos movimentos ósseos planejados. Mediante à reconstrução, foi concluído que a assimetria presente não seria totalmente corrigida somente através da intervenção ortognática, sendo necessária também uma osteotomia removendo parte da base do corpo e ângulo mandibular, através da confecção de um guia de corte, promovendo à reanatomização sem a necessidade de acesso extra oral submandibular, evitando uma cicatriz em face feminina. Paciente encontra-se em pós-operatório de 60 meses, sem queixas e satisfeita. Portanto, é evidenciado cada vez mais a influência positiva que o planejamento virtual pode trazer aos profissionais na otimização dos resultados cirúrgicos.

Hemimandibular hyperplasia is responsible for aesthetic, functional, motor, and psychosocial impairments. With an uncertain etiology, it occurs due to the imbalance of regulatory growth factors present in the cartilaginous layer of the condyle. The report aims to describe decision-making based on specific complementary exams combined with the appropriate surgical intervention for the condition. A 33-year-old female patient presented at a private clinic with the main complaint of "asymmetric face." A scintigraphic evaluation was requested to objectively confirm the interruption of condylar growth, ruling out the hypothesis of Osteochondroma and condylectomy. After prior orthodontic preparation, tomographic exams were used to create a prototype that was printed after planned bone movements. Through the reconstruction, it was concluded that the existing asymmetry would not be entirely corrected through orthognathic intervention alone, necessitating also an osteotomy to remove part of the base of the body and mandibular angle. This was done through the creation of a cutting guide, allowing for reanatomization without the need for submandibular extraoral access, thus avoiding a scar on the female face. The patient is 60 months postoperative, with no complaints and satisfied. Therefore, the increasingly positive influence of virtual planning on optimizing surgical outcomes for professionals is evident.

The changing shape of English general practice: a retrospective longitudinal study using national datasets describing trends in organisational structure, workforce and recorded appointments.

OBJECTIVE: To describe trends in the organisational structure, workforce and recorded appointments by role in English general practice. DESIGN: Retrospective longitudinal study. SETTING: English general practice. DATA SOURCES AND PARTICIPANTS: NHS England, Office for Health Improvement and Disparities and Care Quality Commission national administrative datasets covering between 5 to 10 years from 2013 to 2023. RESULTS: Between 2013 and 2023, the number of general practices fell by 20% from 8044 to 6419; the average practice list size increase by 40% from 6967 to 9724 patients. The total population covered by providers with over 100 000 registered patients reached 2.3 million in 2023 compared to 0.5 million in 2017. The proportion of practices under individual ownership decreased from 13% to 11% between 2018 and 2023; there was little change in the proportion owned by partnerships, incorporated companies or NHS bodies, which respectively averaged around 80.3%, 6.9% and 0.7%. Between 2015 and 2022, there was a 20% rise in the total full-time equivalent (FTE) general practice workforce, including Primary Care Network staff, from 1.97 to 2.37 per 1000 patients because of an increase in multidisciplinary other 'Direct Patient Care' (DPC) and administrative roles. The number of nurses remained stable, and the number of qualified general practitioners (GPs) decreased by 15%. In September 2022, there were 0.45 FTE qualified GPs per 1000 patients; GPs and other DPC roles, excluding nurses, each represented 19% of the FTE per 1000 patients workforce; administrative roles represented 51%. The general practice workforce is predominantly female. A quarter of GPs qualified overseas. Between 2018 and 2023, there was no clear upward or downward trend in total appointments per 1000 patients with, on average, half provided by GPs. CONCLUSIONS: Since 2013, there has been a shift in general practice towards larger practices with more multidisciplinary teams, alongside a reduction in the number of FTE qualified GPs per 1000 patients. We recommend that the impacts of these changes on access, quality and costs are closely monitored.

Transportation Barriers in Pediatric Orthopaedic Clinic Visits.

OBJECTIVES: To identify what transportation barriers pediatric patients face when traveling to a major metropolitan orthopaedic center, how these barriers affect care, and what changes can be made to address this issue. STUDY DESIGN: A cross-sectional transportation survey was administered to 107 caregivers of patients being seen in the orthopaedic clinic at a tertiary children's hospital in a large metropolitan area. Using logistic regression analysis, we compared socioeconomic characteristics, transportation methods, and scheduling practices among caregivers who reported missing at least one visit in the past and those who reported never missing a visit. RESULTS: 13% (14/108) of caregivers reported missing one or more past visits due to late arrival or transportation issues. Families that traveled more than 45 minutes to clinic (P = 0.04), waited more than one week to schedule a visit (P = 0.002), or reported difficulty scheduling a visit (P = 0.02) were significantly more likely to have a history of nonattendance. In addition, patients who were nonambulatory (P = 0.007), used a mobility device (P = 0.007), or were non-White (P < 0.05) were significantly more likely to have missed a visit. CONCLUSION: Travel time, difficult or delayed scheduling, and patient ambulatory status were all associated with missing orthopaedic clinic visits although other socioeconomic factors were not related. Interventions to improve orthopaedic clinic attendance should focus on promoting accessibility for patients with mobility limitations and encouraging simple and timely scheduling practices.

Uptake and associated factors of six multi-month scripting/appointment spacing differentiated service delivery model of care among stable clients on antiretroviral therapy in Southern Ethiopia.

BACKGROUND: Differentiated service delivery models have been developed to accommodate the rising number of stable antiretroviral therapy clients and to maintain improvements in health outcomes and care retention. Ethiopia adopted the appointment spacing model and has had notable successes in implementing it. However, with the implementation of the six multi-month scripting/appointment spacing model in Ethiopia, little is known about the uptake and its associated factors. Therefore, this study aimed to assess the uptake and associated factors of the six multi-month scripting/appointment spacing differentiated service delivery model of care among stable clients on antiretroviral therapy in Southern Ethiopia. METHODS: A hospital-based cross-sectional study was conducted among 419 stable clients on antiretroviral therapy in southern Ethiopia from June 22 to September 29, 2023. A systematic sampling technique was used to select the study participants. Using a structured questionnaire, socio-demographic, health service delivery, behavioral, and clinical-related data were collected. The collected data were entered into Epi Data version 3.1 and analyzed using Stata version 14. Variables with a P-value <0.05 in the multivariable logistic analysis were considered statistically significant. Multicollinearity and model fitness were checked using the variance inflation factor and the Hosmer and Lemeshow goodness of fit tests, respectively. RESULTS: The uptake of the six multi-month scripting/appointment spacing differentiated service delivery model of care was 63.25% (95% confidence interval (CI): 58.61%, 67.88%). Missed appointment (Adjusted Odds Ratio (AOR): 1.91 (95% CI: 1.13, 3.25)), distance to antiretroviral therapy facility (AOR: 2.90 (95% CI: 1.67, 5.04)), duration on antiretroviral therapy (AOR: 2.21 (95% CI: 1.34, 3.64)), and intermediate social support (AOR: 2.02 (95% CI: 1.29, 3.17)) and strong social support (AOR: 2.71 (95% CI: 1.23, 5.97)) were factors significantly associated with the uptake. CONCLUSION: The uptake of six multi-month scripting/appointment spacing differentiated service delivery models of care was six out of ten clients on antiretroviral therapy. To further improve the uptake, a precise intervention on the identified associated factor is required.

Non-adherence to appointment follow-up and its associated factors among hypertensive patients in follow-up clinics in South Gondar hospitals.

Hypertension is a persistent systemic Blood Pressure reading of 140/90 mm Hg or greater which is a preventable cause of cardiovascular disease morbidity and mortality. To assess non-adherence to appointment follow-up and its associated factors among Hypertensive patients in the follow-up clinics in South Gondar Hospitals 2023. Institutional-based cross-sectional study design was employed in hospitals in South Gondar from January to February to assess missed appointment follow-up and its associated factors among Hypertensive patients in follow-up clinics. There is one comprehensive specialized hospital and 9 primary hospitals in this zone. Using simple random methods four hospitals were selected by lottery method. The sample was calculated by using the single population proportion formula. The collected data was entered into Epi data version 3.1 and exported to Statistical Package for Social Sciences version 26 for analysis. Bivariate and multivariable logistic regression analysis was performed to determine the association factors. A total of 401 hypertensive patients on hypertensive follow-up were involved with a response rate of 95.02%. Age ranged from 25 to 86 years with a median age of 58.47 years. Of the total of participants, 211 (52.6.) were rural residents. Among the total hypertensive patients in the hypertensive follow-up clinic, 39.2% were non-adherent for their appointment follow-up. Living far from follow-up health facility (AOR: 2.53; 95% CI 1.349-4.743), absence of perceived symptoms (AOR: 4.98; 95% CI 2.888-8.590), patient complaints Pill burdens (AOR: 3.50; 95% CI 2.108-5.825), and poor Awareness about complication of hypertension (AOR: 2.62; 95% CI 1.471-4.673) were significantly associated with missing of their appointment follow-up for the most hypertensive patients. The prevalence of non-adherence to medical follow-up in hypertension is high as compared to different national health policy recommendations. Distance from the health facility, absence of perceived symptoms, Pill burdens, and lack of knowledge about complications of hypertension were significantly associated with Missed appointment follow-up in Hypertensive patient.

COVID-19-Related Treatment Cancellations and Oncology Patients' Psychological Health in Nigeria.

Objective: To explore the association between COVID-19-related cancer treatment cancellations and the psychological health of cancer patients in Nigeria.Methods: We analyzed data collected from 15 outpatient cancer clinics, comprising 1,097 patients between April to July 2020. Study outcome was ten psychological impacts, including feeling down, stressed, and unable to access treatment due to COVID-19 (used as continuous and categorical variable (0-3,4-7,8+ events). The independent variable was treatment cancellations due to COVID-19 categorized as 0, 1, and 2+ cancellations. Confounders included religion, ethnicity, income, cancer diagnosis/type, and treatment received. Stata/SE.v.17 was used to perform all analyses. P values of ≤0.05 were deemed statistically significant.Results: Of the 1,097 cancer patients, 65.7% were female, with a mean age (SD) of 49.4 (13.8) years. Most patients (50.3%) reported four to seven psychological health events. Cancer patients who reported two/more treatment cancellations made up only 12.8% of the study sample but accounted for a greater proportion of psychological impacts (23.5%; P<0.001). In the adjusted model, cancer patients with one treatment cancellation (Coef: 0.195, 95%CI: 0.089-0.302) and those with two/more cancellations (Coef: 0.379, 95%CI: 0.255-0.504) had a significantly higher risk of psychological health impacts than those with no treatment cancellations.Conclusion: More than half of our sample of primarily adult female cancer patients reported major psychological health effects due to COVID-19. Cancer patients who experienced at least one treatment cancellation had a higher risk of psychological health consequences than those who did not. The implications of our findings and how to mitigate the impact of COVID-19 on oncology service disruptions are discussed.

Recomendaciones para el manejo de la enfermedad pulmonar post tuberculosis / Recommendations for the Management of Post Tuberculosis Lung Disease

Introducción: Los esfuerzos de la lucha contra la tuberculosis (TB) se centran habitualmente en un diagnóstico precoz y un tratamiento eficaz y oportuno para romper la cadena de transmisión de Mycobacterium tuberculosis. Sin embargo, en los últimos años, coincidiendo con la asociación sindémica TB/COVID-19, han aparecido cada vez más evidencias sobre las graves secuelas clínicas, funcionales y psicosociales que puede ocasionar la TB, condición que se ha definido como enfermedad pulmonar post-tuberculosis (PTLD). Aproximadamente, un tercio de los pacientes que sobreviven a la TB se enfrentan a esto, incluyendo síntomas respiratorios persistentes con exacerbaciones episódicas, insuficiencia respiratoria crónica, trastornos emocionales y desafíos psico-sociales que impactan negativamente en la calidad de vida y enfrentan un alto costo catastrófico. Objetivo: Proporcionar un modelo compartido, orientador y científicamente válido para diagnosticar, evaluar y tratar en forma oportuna a los pacientes con PTLD (prevención, diagnóstico, tratamiento y posible rehabilitación). Metodología: Es una investigación documental que incluye revisiones sistemáticas, meta-análisis, estudios observacionales y de las directrices existentes en los últimos años al respecto, sumado a una evaluación por expertos en el tema, con el propósito de adaptarlas a las condiciones locales de cada país latinoamericano. Conclusiones: Considerando la carga mundial, particularmente, latinoamericana de TB, y la carga estimada de la PTLD, se considera urgente el desarrollo de un consenso sobre este tema. Creemos que las recomendaciones de ALAT proporcionarán la base para la formulación y adopción de directrices nacionales para el manejo del PTLD en Amé- rica Latina.

Introduction: Efforts to combat tuberculosis (TB) usually focus on early, rapid diagnosis and effective treatment to break the chain of transmission of Mycobacterium tuberculosis. However, in the last few years, coinciding with the syndemic TB/COVID-19 association, more and more evidence has proved the serious clinical, functional and psycho-social sequelae that TB can cause. This condition has been defined as Post-Pulmonary Disease Tuberculosis (PTLD) and it affects approximately one-third of the patients who survive TB, facing persistent respiratory symptoms with episodic exacerbations, chronic respiratory failure, emotional disorders and psychosocial challenges that negatively impact their life quality, meaning a high catastrophic cost. Objective: Provide a shared, guiding and scientifically valid model to promptly diagnose, evaluate and treat patients with PTLD (prevention, diagnosis, treatment and possible rehabilitation). Methodology: It is documentary research that includes systematic reviews, meta-analysis, observational studies and the guidelines that have existed in recent years in this regard, added to an evaluation by experts, with the purpose of adapting them to local conditions of each Latin American country. Conclusions: Considering the global and, particularly, the Latin American burden of TB, and the estimated burden of PTLD, the development of a consensus document on this topic is urgent. Therefore, we think ALAT recommendations will provide the basis for the formulation and adoption of national specific guidelines for the management of PTLD in Latin America.

Total cost of care of Medicare Advantage beneficiaries participating in an appointment-based model in a national pharmacy chain.

BACKGROUND: The appointment-based model (ABM) is a pharmacy service to improve medication-related health outcomes. ABM involves medication synchronization and medication review, plus other services such as medication reconciliation, medication therapy management, vaccine administration, and multimedication packaging. ABM can improve medication adherence, but the economic impact is unknown. OBJECTIVE: To assess the effect of a national pharmacy chain's ABM program for Medicare Advantage beneficiaries on total cost of care (TCOC). METHODS: This study analyzed administrative claims data from April 7, 2017, through February 29, 2020, for Medicare Advantage beneficiaries with Part D using a propensity score-matched cohort design. The national pharmacy chain provided a list of ABM participants. Eligibility criteria for the ABM and control (non-ABM) groups included age 65 years or older on the index date (initial participation, ABM; random fill date, control) and continuous enrollment from at least 6 months pre-index (baseline) date through at least 6 months post-index (follow-up) date. Medical inflation-adjusted (2020) TCOC was calculated as the sum of all health care spending from Medicare Advantage beneficiaries with Part D plan and patient paid amounts, standardized to per patient per month (PPPM), during the follow-up period. Secondary outcomes included medication adherence calculated across prevalent maintenance therapeutic classes using proportion of days covered (PDC). RESULTS: Each group contained 5,225 patients with balanced characteristics after matching: 64% female, 73% White, mean age 75 years, mean Quan-Charlson comorbidity index score 0.9, and hypertension and dyslipidemia, each >65%. Median baseline all-cause PPPM health care costs in the ABM and control groups, respectively, were $517 and $548 ($221 and $234 medical, $135 and $164 pharmacy). Baseline PDC of at least 80% was 83% in the ABM group and, similarly, 84% in the control group. The mean (SD) follow-up was 604 (155) days for the ABM group and 598 (151) days for the control group. During the follow-up period, the median PPPM TCOC for the ABM group was $656 and was $723 for the control group (P = 0.011). Median pharmacy costs were also significantly less in the ABM group ($161 vs $193, P < 0.001), whereas median medical costs were $328 in the ABM group and $358 among controls (P = 0.254). More patients in the ABM group were adherent during follow-up, with 84% achieving PDC of at least 80% vs 82% among controls (P = 0.009). CONCLUSIONS: The ABM program was associated with significantly lower follow-up median total costs (medical and pharmacy), driven primarily by pharmacy costs. More patients were adherent in the ABM program. Payers and pharmacies can use this evidence to assess ABM programs for their members.

Development of a home visit solution with a route- and appointment planning tool for patients with severe spasticity: A participatory design study.

Objectives: This article describes how a home visit solution was developed in a co-design process between patients in treatment for severe spasticity, their caregivers and hospital nurses. The solution was developed using a participatory design approach and was based on the identified needs of the participants. Methods: We developed a home visit solution through an iterative process and a collective 'reflection-in-action' approach with patients, caregivers and healthcare professionals. Results: The study revealed the complexities of establishing new routines around home visits. The solution included a new workflow for the nurses and a new route and appointment planning tool. Conclusion: Through a participatory design approach, the users developed a home visit solution that minimised disruption to patients' daily lives and facilitated a dialogue between the nurses and the caregivers about the treatment and the patients' spasticity, which helped to adjust the treatment in line with the patient´s needs.

Mapping evidence on the factors contributing to long waiting times and interventions to reduce waiting times within primary health care facilities in South Africa: A scoping review.

BACKGROUND: Globally, reduction of patient waiting time has been identified as one of the major characteristics of a functional health system. In South Africa, 83% of the general population visiting primary healthcare (PHC) facilities must contend with long waiting times, overcrowding, staff shortages, poor quality of care, an ineffective appointment booking system, and a lack of medication. These experiences may, in turn, affect how patients view service quality. METHODS: This scoping review was guided by Arksey and O'Malley methodological framework. The primary literature search of peer-reviewed and review articles was achieved through PubMed/MEDLINE, Google Scholar, Science Direct, and World Health Organization (WHO) library databases, using waiting times, outpatient departments, factors, interventions, and primary healthcare facilities as keywords. Two independent reviewers screened abstracts and full articles, using the set inclusion and exclusion criteria. We used NVIVO® version 10 software to facilitate thematic analysis of the results from included studies. RESULTS: From the initial 250 records screened, nine studies were eligible for inclusion in this scoping review. Seven papers identified the factors contributing to waiting time, and five papers mentioned effective interventions implemented to reduce waiting times within PHC facilities. Our analysis produced three (patient factors, staff factors, and administrative systems) and two (manual-based waiting time reduction systems and electronic-based waiting time reduction systems) main themes pertaining to factors contributing to long waiting times and interventions to reduce waiting times, respectively. CONCLUSION: Our results revealed that the patients, staff, and administrative systems all contribute to long waiting times within the PHC facilities. Patient waiting times recorded a wider and more evenly spread patient arrival pattern after the identified interventions in our study were implemented. There is a need to constantly strategize on measures such as implementing the use of an electronic appointment scheduling system and database, improving staff training on efficient patient flow management, and regularly assessing and optimizing administrative processes. By continuously monitoring and adapting these strategies, PHC facility managers can create a more efficient and patient-centered healthcare experience.

Predicting Patient No-Shows: Situated Machine Learning with Imperfect Data.

Patients who do not show up for scheduled appointments are a considerable cost and concern in healthcare. In this study, we predict patient no-shows for outpatient surgery at the endoscopy ward of a hospital in Denmark. The predictions are made by training machine leaning (ML) models on available data, which have been recorded for purposes other than ML, and by doing situated work in the hospital setting to understand local data practices and fine-tune the models. The best performing model (XGBoost with oversampling) predicts no-shows at sensitivity = 0.97, specificity = 0.66, and accuracy = 0.95. Importantly, the situated work engaged local hospital staff in the design process and led to substantial quantitative improvements in the performance of the models. We consider the results promising but acknowledge that they are from a single ward. To transfer the no-show models to other wards and hospitals, the situated work must be redone.

How to Tell Whether Patients Engage and Use a Patient Portal - An Analysis of Five Functions.

BACKGROUND: The road to a more sustainable healthcare system includes creating a digital interface to the healthcare system that patients can use to engage in their health problems while outside the consultation room. The aim of the study was to evaluate trends in the use of functions in a patient portal and assess which functions were most likely to contribute to sustainable healthcare. STUDY DESIGN: Open, uncontrolled retrospective analysis of citizens' use of the patient portal. METHODS: Extraction and statistical analysis of log data. RESULTS: Log analysis revealed that patients engaged with the patient portal to make appointments, fill out and submit questionnaires, send messages to their care provider, inspect their laboratory results, and view notes about themselves. The functions that displayed a significantly increasing trend were the number of appointments made, the number of messages sent, and the number of checked test results. DISCUSSION: While portal engagement can reduce patient dependency on healthcare services, external factors also influence this outcome. Further research is needed to investigate which functions support healthcare sustainability and enhance patient empowerment, possibly through other study designs.

Prevalence of financial hardship and health-related social needs among patients with missed radiology appointments.

PURPOSE: We aimed to evaluate the prevalence of financial hardship and Health-Related Social Needs (HRSN) among patients who missed their radiology appointment. METHODS: English-speaking adult patients, with a missed outpatient imaging appointment at any of a tertiary care imaging centers between 11/2022 and 05/2023 were eligible. We measured self-reported general financial worry using Comprehensive Score for Financial Toxicity (COST), imaging hardship (worry that the current imaging is a financial hardship to patient and their family), material hardship (e.g., medical debt), cost-related care nonadherence, and HRSNs including housing instability, food insecurity, transportation problems, and utility help needs. RESULTS: 282 patients were included (mean age 54.7 ± 15.0 years; 70.7 % female). Majority were non-Hispanic White (52.4 %), followed by Asian (23.0 %) and Hispanic (16.0 %) racial/ethnic background. Most missed appointments were patient-initiated (74.8 %); 13.5 % due to cost or insurance coverage and 6.4 % due to transportation and parking. Mean COST score was 26.8 with 44.4 % and 28.8 % reporting their illness and imaging as a source of financial hardship. 18.3 % and 35.2 % endorsed cost-related care nonadherence and material hardship. 32.7 % had at least one HRSNs with food insecurity the most common (25.4 %). Only 12.5 % were previously screened for financial hardship or HRSNs. Having comorbidity and living in more disadvantaged neighborhoods was associated with higher report of financial hardship and HRSNs. CONCLUSION: Financial hardship and HRSNs are common among those who miss radiology appointments. There needs to be more rigorous screening for financial hardship and HRSNs at every health encounter and interventions should be implemented to address these.

Wait times for scheduling appointments with hospital affiliated dermatologists in New York City.

Patients' experience accessing dermatologic care is understudied. The purpose of this cross-sectional study was to examine current wait times for new patients to receive dermatological care in NYC. Websites at 58 accredited private and public hospitals in the five boroughs of NYC were reviewed to identify dermatology practices. Office telephone numbers listed on each website were called to collect information pertaining to whether the physician was accepting new patients, type of insurance accepted (public, private, both, or none), and the number of days until a new patient could be seen for an appointment. Data pertaining to the time kept on hold and availability of web-based booking were also collected. Mean waiting time for an appointment was 50 days [standard deviation, SD 66] - nearly 2 months, but the distribution was considerably skewed. The median waiting time was 19.5 days [Interquartile range, IQR 4-60]. The time kept on hold to make the appointment was negligible at about 1 min (63 s, SD = 77) but could take up to ~ 7 min. Two-thirds of dermatologists accepted private, Medicare, and Medicaid insurance (n = 228, 66%); a small number accepted only private insurance (n = 12, 4%) or no insurance at all (n = 16, 5%). The median waiting time for an appointment for the 228 providers that accepted Medicaid was 30.5 days (IQR = 5.0-73.25) while for providers who did not accept Medicaid (n = 116) the median wait time for an appointment was 13.0 days (IQR = 3.0-38.0). Just over half (56%) of the dermatologists allowed for appointments to be booked on their website (n = 193). This research highlights the necessity of incorporating new strategies into routine dermatology appointments in order to increase treatment availability and decrease healthcare inequality.

How An Academic Direct Primary Care Clinic Served Patients from Vulnerable Communities.

PURPOSE: Direct primary care (DPC) critics are concerned that the periodic fee precludes participation from vulnerable populations. The purpose is to describe the demographics and appointments of a, now closed, academic DPC clinic and determine whether there are differences in vulnerability between census tracts with and without any clinic patients. METHODS: We linked geocoded data from the DPC's electronic health record with the social vulnerability index (SVI). To characterize users, we described their age, sex, language, membership, diagnoses, and appointments. Descriptive statistics included frequencies, proportions or medians, and interquartile ranges. To determine differences in SVI, we calculated a localized SVI percentile within Harris County. A t test assuming equal variances and Mann-Whitney U Tests were used to assess differences in SVI and all other census variables, respectively, between those tracts with and without any clinic patients. RESULTS: We included 322 patients and 772 appointments. Patients were seen an average of 2.4 times and were predominantly female (58.4%). More than a third (37.3%) spoke Spanish. There was a mean of 3.68 ICD-10 codes per patient. Census tracts in which DPC patients lived had significantly higher SVI scores (ie, more vulnerable) than tracts where no DPC clinic patients resided (median, 0.60 vs 0.47, p-value < 0.05). CONCLUSION: This academic DPC clinic cared for individuals living in vulnerable census tracts relative to those tracts without any clinic patients. The clinic, unfortunately, closed due to multiple obstacles. Nevertheless, this finding counters the perception that DPC clinics primarily draw from affluent neighborhoods.

Selective centralized booking as a low-cost alternative to centralized referral.

SummaryCentralized referral systems have been successfully implemented to shorten and equalize surgical wait times; however, ongoing expenses make sustaining these projects challenging. We trialed a low-cost centralized booking project for hernia surgery in a community hospital from July to November 2019. Eligible patients (i.e., those with visible or palpable inguinal or umbilical hernias who were agreeable to an open mesh repair) were booked with the first available surgeon after initial consultation. Centrally booked patients with either inguinal or umbilical hernias waited a mean of 82 (standard deviation [SD] 32) and 80 (SD 66) days, respectively, while those who did not use the centralized system waited 137 (SD 89) and 181 (SD 92) days, respectively. Centralized booking increased operating room utilization as a larger pool of patients was available to call when last-minute cancellation occurred; centralized booking also effectively equalized wait-lists among 6 surgeons. Selective centralized booking is a promising concept that led to more efficient utilization of available operating room time with a significant decrease in wait times; this system could potentially improve access for all patients awaiting general surgery without requiring additional funding.

Patient Selection Is the Key for Successful Video Appointments: Lessons Learned from the COVID-19 Pandemic.

The use of video appointments (VAs) increased significantly during the COVID-19 pandemic. This study investigated the evolution of VA utilisation in Finland using data from two surveys conducted in 2021 (40 responses) and 2023 (30 responses). Our primary aim was to identify patient groups best suited for VAs. Respondents were either neurologists or neurologists-in-training. Our findings suggest that patients with epilepsy or headaches are most suitable for VAs. VAs were primarily used for follow-up visits during both survey periods, but their application for first visits decreased from 68.20% in 2021 to 27.80% in 2023. Healthcare professionals' concerns about data protection have diminished over time, but there is still need for enhanced training in the use of remote applications. Future research should focus on validating the cost-effectiveness, data security and timeliness of VAs.