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1.
Cochrane Database Syst Rev ; 1: CD011865, 2021 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-33469932

RESUMEN

BACKGROUND: Changes to the method of payment for healthcare providers, including pay-for-performance schemes, are increasingly being used by governments, health insurers, and employers to help align financial incentives with health system goals. In this review we focused on changes to the method and level of payment for all types of healthcare providers in outpatient healthcare settings. Outpatient healthcare settings, broadly defined as 'out of hospital' care including primary care, are important for health systems in reducing the use of more expensive hospital services. OBJECTIVES: To assess the impact of different payment methods for healthcare providers working in outpatient healthcare settings on the quantity and quality of health service provision, patient outcomes, healthcare provider outcomes, cost of service provision, and adverse effects. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase (searched 5 March 2019), and several other databases. In addition, we searched clinical trials platforms, grey literature, screened reference lists of included studies, did a cited reference search for included studies, and contacted study authors to identify additional studies. We screened records from an updated search in August 2020, with any potentially relevant studies categorised as awaiting classification. SELECTION CRITERIA: Randomised trials, non-randomised trials, controlled before-after studies, interrupted time series, and repeated measures studies that compared different payment methods for healthcare providers working in outpatient care settings. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We conducted a structured synthesis. We first categorised the payment methods comparisons and outcomes, and then described the effects of different types of payment methods on different outcome categories. Where feasible, we used meta-analysis to synthesise the effects of payment interventions under the same category. Where it was not possible to perform meta-analysis, we have reported means/medians and full ranges of the available point estimates. We have reported the risk ratio (RR) for dichotomous outcomes and the relative difference (as per cent change or mean difference (MD)) for continuous outcomes. MAIN RESULTS: We included 27 studies in the review: 12 randomised trials, 13 controlled before-and-after studies, one interrupted time series, and one repeated measure study. Most healthcare providers were primary care physicians. Most of the payment methods were implemented by health insurance schemes in high-income countries, with only one study from a low- or middle-income country. The included studies were categorised into four groups based on comparisons of different payment methods. (1) Pay for performance (P4P) plus existing payment methods compared with existing payment methods for healthcare providers working in outpatient healthcare settings P4P incentives probably improve child immunisation status (RR 1.27, 95% confidence interval (CI) 1.19 to 1.36; 3760 patients; moderate-certainty evidence) and may slightly increase the number of patients who are asked more detailed questions on their disease by their pharmacist (MD 1.24, 95% CI 0.93 to 1.54; 454 patients; low-certainty evidence). P4P may slightly improve primary care physicians' prescribing of guideline-recommended antihypertensive medicines compared with an existing payment method (RR 1.07, 95% CI 1.02 to 1.12; 362 patients; low-certainty evidence). We are uncertain about the effects of extra P4P incentives on mean blood pressure reduction for patients and costs for providing services compared with an existing payment method (very low-certainty evidence). Outcomes related to workload or other health professional outcomes were not reported in the included studies. One randomised trial found that compared to the control group, the performance of incentivised professionals was not sustained after the P4P intervention had ended. (2) Fee for service (FFS) compared with existing payment methods for healthcare providers working in outpatient healthcare settings We are uncertain about the effect of FFS on the quantity of health services delivered (outpatient visits and hospitalisations), patient health outcomes, and total drugs cost compared to an existing payment method due to very low-certainty evidence. The quality of service provision and health professional outcomes were not reported in the included studies. One randomised trial reported that physicians paid via FFS may see more well patients than salaried physicians (low-certainty evidence), possibly implying that more unnecessary services were delivered through FFS. (3) FFS mixed with existing payment methods compared with existing payment methods for healthcare providers working in outpatient healthcare settings FFS mixed payment method may increase the quantity of health services provided compared with an existing payment method (RR 1.37, 95% CI 1.07 to 1.76; low-certainty evidence). We are uncertain about the effect of FFS mixed payment on quality of services provided, patient health outcomes, and health professional outcomes compared with an existing payment method due to very low-certainty evidence. Cost outcomes and adverse effects were not reported in the included studies. (4) Enhanced FFS compared with FFS for healthcare providers working in outpatient healthcare settings Enhanced FFS (higher FFS payment) probably increases child immunisation rates (RR 1.25, 95% CI 1.06 to 1.48; moderate-certainty evidence). We are uncertain whether higher FFS payment results in more primary care visits and about the effect of enhanced FFS on the net expenditure per year on covered children with regular FFS (very low-certainty evidence). Quality of service provision, patient outcomes, health professional outcomes, and adverse effects were not reported in the included studies. AUTHORS' CONCLUSIONS: For healthcare providers working in outpatient healthcare settings, P4P or an increase in FFS payment level probably increases the quantity of health service provision (moderate-certainty evidence), and P4P may slightly improve the quality of service provision for targeted conditions (low-certainty evidence). The effects of changes in payment methods on health outcomes is uncertain due to very low-certainty evidence. Information to explore the influence of specific payment method design features, such as the size of incentives and type of performance measures, was insufficient. Furthermore, due to limited and very low-certainty evidence, it is uncertain if changing payment models without including additional funding for professionals would have similar effects. There is a need for further well-conducted research on payment methods for healthcare providers working in outpatient healthcare settings in low- and middle-income countries; more studies comparing the impacts of different designs of the same payment method; and studies that consider the unintended consequences of payment interventions.


Asunto(s)
Instituciones de Atención Ambulatoria/economía , Personal de Salud/economía , Mecanismo de Reembolso/economía , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Capitación , Estudios Controlados Antes y Después/estadística & datos numéricos , Costos y Análisis de Costo , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/estadística & datos numéricos , Planes de Aranceles por Servicios/economía , Planes de Aranceles por Servicios/normas , Planes de Aranceles por Servicios/estadística & datos numéricos , Humanos , Análisis de Series de Tiempo Interrumpido , Médicos de Atención Primaria/economía , Médicos de Atención Primaria/estadística & datos numéricos , Calidad de la Atención de Salud/economía , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Mecanismo de Reembolso/clasificación , Mecanismo de Reembolso/estadística & datos numéricos , Reembolso de Incentivo/economía , Reembolso de Incentivo/normas , Reembolso de Incentivo/estadística & datos numéricos , Salarios y Beneficios/economía , Resultado del Tratamiento
2.
Curr Opin Allergy Clin Immunol ; 21(1): 38-45, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33369568

RESUMEN

PURPOSE OF REVIEW: The WHO announced the coronavirus disease 2019 (COVID-19) outbreak as a pandemic in February 2020 with over 15 million confirmed cases of COVID-19 globally to date. Otolaryngologists are at a high risk of contracting COVID-19 during this pandemic if there is inadequate and improper personal protective equipment provision, as we are dealing with diseases of the upper-aerodigestive tract and routinely engaged in aerosol-generating procedures. RECENT FINDINGS: This article discusses the background and transmission route for severe acute respiratory syndrome coronavirus 2, its viral load and temporal profile as well as precaution guidelines in outpatient and operative setting in otorhinolaryngology. SUMMARY: As it is evident that COVID-19 can be transmitted at presymptomatic or asymptomatic period of infections, it is essential to practice ear, nose, and throat surgery with high vigilance in a safe and up-to-standard protection level during the pandemic. This article provides a summary for guidelines and recommendations in otorhinolaryngology.


Asunto(s)
/prevención & control , Otolaringología/métodos , Pandemias , Aerosoles , Instituciones de Atención Ambulatoria , Infecciones Asintomáticas , /transmisión , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Nasofaringe/virología , Orofaringe/virología , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Equipo de Protección Personal , Examen Físico , Carga Viral
3.
Support Care Cancer ; 29(1): 231-237, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32342222

RESUMEN

PURPOSE: Adequate adjustment to bodily changes during various phases of cancer treatment is important to patients' emotional well-being. The Body Image Scale (BIS) is a widely used tool for assessment of body image concerns in different cancer types. However, a cut point score indicative of clinically relevant body image concerns has not been established. The purpose of our study was to evaluate whether the previously suggested, but not validated, BIS cut point score of ≥ 10 is an adequate indicator of psychological distress. METHODS: In a prospective cross-sectional study, 590 adult patients were recruited from a psychiatric oncology clinic (November 2017-March 2018). Patient-reported body image concerns, depression, anxiety, and emotional distress were assessed with the BIS, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, and National Comprehensive Cancer Network Distress Thermometer, respectively. RESULTS: Almost half of the patients had a BIS score ≥ 10; these were more likely to be younger, female, Hispanic, and to have breast cancer than patients with a score < 10. BIS scores were positively associated with depression, anxiety, and distress scores. A BIS score ≥ 10 was a significant predictor of moderate depression and anxiety (odds ratios = 3.555 [95% CI 2.478-5.102] and 3.655 [2.493-5.358]; p < 0.001 for both). CONCLUSION: To our knowledge, this is the first study to have assessed the validity of the previously suggested clinically relevant BIS cut point score of ≥ 10 as an indicator of psychological distress. Our results suggest that a BIS score of ≥ 10 or higher should lead to follow-up on body image concerns and/or appropriate referral.


Asunto(s)
Imagen Corporal/psicología , Neoplasias de la Mama/psicología , Distrés Psicológico , Estrés Psicológico/psicología , Adulto , Anciano , Instituciones de Atención Ambulatoria , Ansiedad/psicología , Estudios Transversales , Depresión/psicología , Femenino , Humanos , Persona de Mediana Edad , Apariencia Física/fisiología , Estudios Prospectivos , Encuestas y Cuestionarios
4.
Sports Health ; 13(1): 91-94, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32662740

RESUMEN

BACKGROUND: The preparticipation physical evaluation (PPE) is a requirement for high school sport participation in most states, but its location and role in preventive health care for adolescents is often questioned. HYPOTHESIS: Athletes who had their PPE performed in an office setting, in particular) by their primary care physician (PCP), will have higher human papillomavirus (HPV) immunization rates than those who had their PPE done in a group setting at a mass-participation PPE. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: The PPE forms and immunization records for athletes at a single high school were reviewed to determine the location of PPE, the signing practitioner, and HPV immunization status. RESULTS: A total of 488 athletes (286 males, 202 females) were included; 51% had received at least 1 dose of the HPV vaccine while 39% had completed the series. There was no significant difference in vaccination rates between examination in an office setting versus a group setting. Athletes receiving their PPE at an urgent care facility had significantly lower rates of HPV series completion than all other settings (29% vs 43%; P = 0.004). PPE completion by the athlete's PCP was associated with higher rates of vaccine series completion (46% vs 34%; P = 0.014). CONCLUSION: Athletes who completed their PPE in mass event and office-based settings had similar rates of HPV vaccine series initiation and completion. PPEs done at urgent care facilities were associated with low rates of vaccine series completion, while those done by a PCP were associated with higher rates. CLINICAL RELEVANCE: HPV immunization rates in athletes are low, and the PPE represents a potential opportunity to improve immunization rates.


Asunto(s)
Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Examen Físico , Atención Primaria de Salud/estadística & datos numéricos , Deportes , Vacunación/estadística & datos numéricos , Adolescente , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Utilización de Instalaciones y Servicios , Femenino , Humanos , Masculino , Michigan , Estudios Retrospectivos , Instituciones Académicas
5.
Res Social Adm Pharm ; 17(1): 1838-1844, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33317762

RESUMEN

BACKGROUND: The newly emerged coronavirus pandemic (COVID-19) has collapsed the entire global health care system. Due to these settings, a lot of strategic changes are adopted by healthcare facilities to ensure continuity in patient-centered services. OBJECTIVE: This study aims to evaluate the effectiveness of structural and operational changes made in ambulatory care pharmacy services during the COVID-19 pandemic. METHODS: A retrospective comparative study was conducted to evaluate the impact and effectiveness of patient-centered interventions and consequent access to medication management care within Johns Hopkins Aramco Health Care ambulatory care pharmacy services during the COVID-19 pandemic by comparing patient-centered key performance indicators before and during COVID-19 pandemic for a total of 4 months. RESULTS: As a result of the structural and operational changes made in patient-centered ambulatory care pharmacy services during the COVID-19 pandemic, a 48% prescriptions requests and 90% prescriptions fills are increased through online health portal application. A three-fold increase in the pharmacy call center utilization resulted in around 10% abandoned calls. In the number of physical visits to ambulatory care pharmacies, a 37% reduction was also noted. The decrease in staff schedule efficiency and an increase in average prescription waiting time were also noticed. The prescription collection through remote area pick up locations, and medication home delivery services were successful during COVID-19 pandemic as supported by statistical data. CONCLUSION: The access to ambulatory care pharmacy services during COVID-19 pandemic has been successfully maintained via medication home delivery, remote area pickup locations, pharmacy call-center consultations and refill requests, online health portal application services, and other measures, while reducing the number of physical visits to the JHAH hospital/clinic to ensure compliance with infection control and prevention measures.


Asunto(s)
Atención Ambulatoria/organización & administración , Atención Dirigida al Paciente/organización & administración , Servicios Farmacéuticos/organización & administración , Atención Ambulatoria/estadística & datos numéricos , Instituciones de Atención Ambulatoria/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Atención Dirigida al Paciente/estadística & datos numéricos , Servicios Farmacéuticos/estadística & datos numéricos , Estudios Retrospectivos
6.
Nefrología (Madrid) ; 40(6): 579-584, nov.-dic. 2020. graf, mapas
Artículo en Español | IBECS | ID: ibc-194916

RESUMEN

La pandemia de la infección por el coronavirus tipo2 del síndrome respiratorio agudo grave o SARS-CoV-2, causante de la enfermedad por coronavirus de 2019 (COVID-19), ha precisado una transformación drástica de los hospitales y, por consiguiente, de los servicios de Nefrología de España. Desde la Sociedad Española de Nefrología se ha realizado una encuesta a los jefes de servicios de Nefrología de España abordando la reorganización de los servicios de Nefrología y la actividad en la época de mayor afectación por COVID-19. Hemos preguntado por la integración de los nefrólogos en equipos COVID-19, la actividad asistencial de hospitalización de Nefrología (ingresos programados, biopsias renales), la realización de cirugías programadas como los accesos vasculares o la implantación de catéteres peritoneales, la suspensión o no del programa de trasplante renal y la transformación de las consultas externas de Nefrología. En el trabajo actual se detallan la adaptación y la transformación de los servicios de Nefrología en la pandemia COVID-19 en España. Durante dicho periodo se han suspendido los ingresos programados en los servicios de Nefrología, la realización de cirugías/biopsias programadas y ha disminuido en más de un 75% el programa de trasplante renal. Es de interés mencionar que las consultas externas de Nefrología se han realizado mayoritariamente telefónicamente. En conclusión, la pandemia ha impactado claramente en la actividad clínica en los servicios de Nefrología españoles disminuyendo la actividad programada y los trasplantes renales y modificando la actividad en consultas externas. Un plan de transformación asistencial e implementación de telemedicina en Nefrología parece necesario y de gran utilidad en un futuro próximo


The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has required a rapid and drastic transformation of hospitals, and consequently also of Spanish Nephrology Units, to respond to the critical situation. The Spanish Society of Nephrology conducted a survey directed to the Heads of Nephrology Departments in Spain that addressed the reorganisation of Nephrology departments and activity during the peak of COVID-19 pandemic. The survey has been focused on the integration of nephrologists in COVID-19 teams, nephrology inpatient care activities (elective admissions, kidney biopsies), the performance of elective surgeries such as vascular accesses or implantation of peritoneal catheters, the suspension of kidney transplantation programmes and the transformation of nephrology outpatient clinics. This work details the adaptation and transformation of nephrology services during the COVID-19 pandemic in Spain. During this period, elective admissions to Nephrology Services, elective surgeries and biopsies were suspended, and the kidney transplant programme was scaled back by more than 75%. It is worth noting that outpatient nephrology consultations were carried out largely by telephone. In conclusion, the pandemic has clearly impacted clinical activity in Spanish Nephrology departments, reducing elective activity and kidney transplants, and modifying activity in outpatient clinics. A restructuring and implementation plan in Nephrology focused on telemedicine and/or virtual medicine would seem to be both necessary and very useful in the near future


Asunto(s)
Humanos , Unidades de Hemodiálisis en Hospital/organización & administración , Diálisis Renal/métodos , Diálisis Renal/normas , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Pandemias , Instituciones de Atención Ambulatoria/organización & administración , Nefrología/organización & administración , Servicios Externos/organización & administración
7.
Medicine (Baltimore) ; 99(52): e23763, 2020 Dec 24.
Artículo en Inglés | MEDLINE | ID: mdl-33350760

RESUMEN

ABSTRACT: Emergency departments receive an increasing amount of musculoskeletal injuries, with the majority referred to a fracture clinic (FCs). A literature review revealed certain orthopaedic injuries can be safely managed away from the FC pathway by general practitioners (GPs) or allied health professionals (AHPs). The present study aims to review all paediatric presentations to FCs at 2 Queensland hospitals, identifying low risk injuries that could potentially be managed by GPs or AHPs. This study is a continuation from Cleary et al in which a primary care pathway (PCP) was proposed for the management of low risk adult orthopaedic injuries. A PCP has the potential to have significant savings to the health system.A retrospective study was conducted looking at paediatric patients (<16 years) referrals to 2 FCs over 8 weeks. Injuries were categorised into those requiring FC care supervised by an orthopaedic surgeon, and those that can be safely managed by GPs or AHPs via a PCP.Four hundred ninety (57.7%) of the 849 patients referred to FC were assessed as suitable for PCP care. The most common upper limb injury deemed suitable was radius and ulna buckle fractures (18.4%), while the most common lower limb injury is ankle sprains (8%). Total failure to attend rate in the PCP group was 6.7%.Adopting the PCP has the potential to significantly reduce FC referrals. With proven success of similar pathways abroad, the PCP may generate significant time and financial savings for both the health care system and patient.


Asunto(s)
Instituciones de Atención Ambulatoria/normas , Servicio de Urgencia en Hospital/normas , Fracturas Óseas/terapia , Atención Primaria de Salud , Niño , Servicios de Salud del Niño/normas , Humanos , Mejoramiento de la Calidad , Queensland , Derivación y Consulta , Estudios Retrospectivos
8.
MMWR Morb Mortal Wkly Rep ; 69(50): 1925-1929, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33332298

RESUMEN

As of December 14, 2020, children and adolescents aged <18 years have accounted for 10.2% of coronavirus disease 2019 (COVID-19) cases reported in the United States.* Mitigation strategies to prevent infection with SARS-CoV-2, the virus that causes COVID-19, among persons of all ages, are important for pandemic control. Characterization of risk factors for SARS-CoV-2 infection among children and adolescents can inform efforts by parents, school and program administrators, and public health officials to reduce SARS-CoV-2 transmission. To assess school, community, and close contact exposures associated with pediatric COVID-19, a case-control study was conducted to compare exposures reported by parents or guardians of children and adolescents aged <18 years with SARS-CoV-2 infection confirmed by reverse transcription-polymerase chain reaction (RT-PCR) testing (case-patients) with exposures reported among those who received negative SARS-CoV-2 RT-PCR test results (control participants). Among 397 children and adolescents investigated, in-person school or child care attendance ≤14 days before the SARS-CoV-2 test was reported for 62% of case-patients and 68% of control participants and was not associated with a positive SARS-CoV-2 test result (adjusted odds ratio [aOR] = 0.8, 95% confidence interval [CI] = 0.5-1.3). Among 236 children aged ≥2 years who attended child care or school during the 2 weeks before SARS-CoV-2 testing, parents of 64% of case-patients and 76% of control participants reported that their child and all staff members wore masks inside the facility (aOR = 0.4, 95% CI = 0.2-0.8). In the 2 weeks preceding SARS-CoV-2 testing, case-patients were more likely to have had close contact with a person with known COVID-19 (aOR = 3.2, 95% CI = 2.0-5.0), have attended gatherings† with persons outside their household, including social functions (aOR = 2.4, 95% CI = 1.1-5.5) or activities with other children (aOR = 3.3, 95% CI = 1.3-8.4), or have had visitors in the home (aOR = 1.9, 95% CI = 1.2-2.9) than were control participants. Close contacts with persons with COVID-19 and gatherings contribute to SARS-CoV-2 infections in children and adolescents. Consistent use of masks, social distancing, isolation of infected persons, and quarantine of those who are exposed to the virus continue to be important to prevent COVID-19 spread.


Asunto(s)
Instituciones de Atención Ambulatoria/estadística & datos numéricos , /diagnóstico , Servicio de Urgencia en Hospital/estadística & datos numéricos , Adolescente , /transmisión , Niño , Preescolar , Femenino , Humanos , Masculino , Mississippi/epidemiología , Factores de Riesgo
10.
Medicine (Baltimore) ; 99(52): e23942, 2020 Dec 24.
Artículo en Inglés | MEDLINE | ID: mdl-33350799

RESUMEN

ABSTRACT: The levels of indoor air pollutants are increasing. However, the indoor air quality of only operating rooms, intensive care units, and radiology departments is usually monitored in hospitals. Hence, we aimed to evaluate the indoor air quality of an otorhinolaryngology outpatient clinic and compare air quality indices among different areas in a hospital.We prospectively measured indoor air quality using air quality sensors in different areas of a hospital from February 1, 2019 to January 31, 2020. Carbon dioxide (CO2), total volatile organic compounds (VOCs), particulate matter with diameter of <2.5 µm (PM2.5), and nitrogen dioxide concentrations were measured in the otorhinolaryngology clinic, orthopedic clinic, and reception area. The intervention efficacy was compared between otorhinolaryngology clinics employing and not employing air-cleaners.The overall concentrations of CO2, VOCs, and PM2.5 in the otorhinolaryngology clinic were significantly higher than those in the orthopedic clinic or reception area. The indoor air quality was the worst in winter. The intervention effect was observed only in PM2.5 concentrations in otorhinolaryngology clinics employing an air-cleaner.Medical practitioners and patients are frequently exposed to ambient indoor air pollution in otorhinolaryngology clinics. Hence, health-related strategies to protect against ambient indoor air pollution in otorhinolaryngology clinics are warranted.


Asunto(s)
Contaminación del Aire Interior/análisis , Contaminación del Aire/análisis , Instituciones de Atención Ambulatoria , Dióxido de Carbono/análisis , Hospitales , Dióxido de Nitrógeno/análisis , Otolaringología , Compuestos Orgánicos Volátiles/análisis , Contaminantes Atmosféricos , Instituciones de Atención Ambulatoria/normas , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Monitoreo del Ambiente/métodos , Hospitales/normas , Hospitales/estadística & datos numéricos , Humanos , Evaluación de Necesidades , Estaciones del Año
11.
Epilepsy Behav ; 112: 107483, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33181898

RESUMEN

INTRODUCTION: When the SARS-CoV-2 pandemic reached Europe in 2020, a German governmental order forced clinics to immediately suspend elective care, causing a problem for patients with chronic illnesses such as epilepsy. Here, we report the experience of one clinic that converted its outpatient care from personal appointments to telemedicine services. METHODS: Documentations of telephone contacts and telemedicine consultations at the Epilepsy Center Frankfurt Rhine-Main were recorded in detail between March and May 2020 and analyzed for acceptance, feasibility, and satisfaction of the conversion from personal to telemedicine appointments from both patients' and medical professionals' perspectives. RESULTS: Telephone contacts for 272 patients (mean age: 38.7 years, range: 17-79 years, 55.5% female) were analyzed. Patient-rated medical needs were either very urgent (6.6%, n = 18), urgent (23.5%, n = 64), less urgent (29.8%, n = 81), or nonurgent (39.3%, n = 107). Outpatient service cancelations resulted in a lack of understanding (9.6%, n = 26) or anger and aggression (2.9%, n = 8) in a minority of patients, while 88.6% (n = 241) reacted with understanding, or relief (3.3%, n = 9). Telemedicine consultations rather than a postponed face-to-face visit were requested by 109 patients (40.1%), and these requests were significantly associated with subjective threat by SARS-CoV-2 (p = 0.004), urgent or very urgent medical needs (p = 0.004), and female gender (p = 0.024). Telemedicine satisfaction by patients and physicians was high. Overall, 9.2% (n = 10) of patients reported general supply problems due to SARS-CoV-2, and 28.4% (n = 31) reported epilepsy-specific problems, most frequently related to prescriptions, or supply problems for antiseizure drugs (ASDs; 22.9%, n = 25). CONCLUSION: Understanding and acceptance of elective ambulatory visit cancelations and the conversion to telemedicine consultations was high during the coronavirus disease 2019 (COVID-19) lockdown. Patients who engaged in telemedicine consultations were highly satisfied, supporting the feasibility and potential of telemedicine during the COVID-19 pandemic and beyond.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Atención Ambulatoria/organización & administración , Infecciones por Coronavirus/prevención & control , Epilepsia/terapia , Control de Infecciones/organización & administración , Pandemias/prevención & control , Neumonía Viral/prevención & control , Telemedicina/organización & administración , Adolescente , Adulto , Anciano , Atención Ambulatoria/métodos , Citas y Horarios , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Derivación y Consulta , Teléfono , Adulto Joven
12.
MMWR Morb Mortal Wkly Rep ; 69(44): 1648-1653, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33151918

RESUMEN

Since March 2020, large-scale efforts to reduce transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), have continued. Mitigation measures to reduce workplace exposures have included work site policies to support flexible work site options, including telework, whereby employees work remotely without commuting to a central place of work.* Opportunities to telework have varied across industries among U.S. jobs where telework options are feasible (1). However, little is known about the impact of telework on risk for SARS-CoV-2 infection. A case-control investigation was conducted to compare telework between eligible symptomatic persons who received positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test results (case-patients, 153) and symptomatic persons with negative test results (control-participants, 161). Eligible participants were identified in outpatient health care facilities during July 2020. Among employed participants who reported on their telework status during the 2 weeks preceding illness onset (248), the percentage who were able to telework on a full- or part-time basis was lower among case-patients (35%; 42 of 120) than among control-participants (53%; 68 of 128) (p<0.01). Case-patients were more likely than were control-participants to have reported going exclusively to an office or school setting (adjusted odds ratio [aOR] = 1.8; 95% confidence interval [CI] = 1.2-2.7) in the 2 weeks before illness onset. The association was also observed when further restricting to the 175 participants who reported working in a profession outside the critical infrastructure† (aOR = 2.1; 95% CI = 1.3-3.6). Providing the option to work from home or telework when possible, is an important consideration for reducing the risk for SARS-CoV-2 infection. In industries where telework options are not available, worker safety measures should continue to be scaled up to reduce possible worksite exposures.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Evaluación de Síntomas , Telecomunicaciones/estadística & datos numéricos , Trabajo/estadística & datos numéricos , Adolescente , Adulto , Instituciones de Atención Ambulatoria , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estados Unidos/epidemiología , Adulto Joven
13.
Int J Pediatr Otorhinolaryngol ; 138: 110383, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33152974

RESUMEN

INTRODUCTION: Virtual outpatient clinics (VOPC) have been integrated into both paediatric and based adult outpatient services due to a multitude of factors, including increased demand for services, technological advances and rising morbidity secondary to ageing populations. The novel coronavirus disease (COVID-19) has accentuated pressures on the National Health Service (NHS) infrastructure, particularly elective services, whilst radically altering patterns of practice. AIM: To evaluate the impact of the COVID-19 pandemic on paediatric otolaryngology outpatient services whilst collating patient feedback to elicit long-term sustainability post COVID-19. METHOD: A retrospective analysis of VOPCs was undertaken at a tertiary paediatric referral centre over a 3-month capture period during the COVID-19 pandemic. Demographic, generic clinic (presenting complaint, new vs. follow-up, consultation type), as well as outcome data (medical or surgical intervention, discharge vs. ongoing review, onward referral, investigations, and conversion to face-to-face) was collated. Additionally a modified 15-point patient satisfaction survey was created. The Paediatric Otolaryngology Telemedicine Satisfaction survey (POTSS), was an adaptation of 4 validated patient satisfaction tools including the General Medical Council (GMC) patient questionnaire, the telehealth satisfaction scale (TESS), the telehealth usability questionnaire (TUQ), and the telemedicine satisfaction and usefulness questionnaire (TSUQ). RESULTS: Of 514 patients reviewed virtually over a 3-month period, 225 (45%) were randomly selected to participate, of which 200 met our inclusion criteria. The most common mode of consultation was telephony (92.5%, n = 185). Non-attendance rates were reduced when compared to face-to-face clinics during an equivalent period prior to the COVID-19 pandemic. A significant proportion of patients (29% compared to 26% pre-VOPC) were discharged to primary care. Nine percent were listed for surgery compared to 19% pre-VOPC. A subsequent face-to-face appointment was required in 10% of participants. Overall, the satisfaction when assessing the doctor-patient relationship, privacy & trust, as well as consultation domains was high, with the overwhelming majority of parents' content with the future integration and participation in VOPCs. CONCLUSION: An evolving worldwide pandemic has accelerated the need for healthcare services to reform in order to maintain a steady flow of patients within an elective outpatient setting without compromising patient care. Solutions must be sustainable long-term to account for future disruptions, whilst accounting for evolving patient demographics. Our novel survey has demonstrated the vast potential that the integration of VOPCs can offer paediatric otolaryngology services within a carefully selected cohort of patients.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Infecciones por Coronavirus , Pandemias , Satisfacción del Paciente , Pediatría/estadística & datos numéricos , Neumonía Viral , Telemedicina , Adolescente , Atención Ambulatoria/métodos , Instituciones de Atención Ambulatoria/organización & administración , Betacoronavirus , Niño , Preescolar , Femenino , Encuestas de Atención de la Salud , Humanos , Lactante , Masculino , Pediatría/métodos , Relaciones Médico-Paciente , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Medicina Estatal , Telemedicina/métodos , Telemedicina/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Reino Unido
14.
BMC Health Serv Res ; 20(1): 996, 2020 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-33129317

RESUMEN

BACKGROUND: Intimate partner violence (IPV) is highly prevalent in the United States and impacts the physical and mental health and social well-being of those who experience it. Healthcare settings are important intervention points for IPV screening and referral, yet there is a wide range of implementation of IPV protocols in healthcare settings in the U.S., and the evidence of the usefulness of IPV screening is mixed. This process evaluation investigates the facilitators and barriers to implementing Coordinated Care for IPV Survivors through the M Health Community Network ("M Health Network"), an intervention that aimed to standardize IPV screening and referral in a multi-specialty clinic and surgery center (CSC). Two validated IPV screens were introduced and mandated to be done by rooming staff at least once every 3 months with all clinic patients regardless of gender; the Humiliation Afraid Rape Kick (HARK) for presence of IPV and the shortened Danger Assessment (DA-5) for lethality of IPV. Upon a positive screen, the patient was offered immediate informational resources and, if willing, was referred to a social worker for care coordination with a community organization. METHODS: Semi-structured, individual and group process interviews with clinic managers and clinic staff at 8 CSC clinics (N = 24) were undertaken at 3,12, and 27 months after intervention start. Semi-structured interviews were undertaken with the research team (N = 3) post-implementation. A Consolidated Framework for Implementation Research (CFIR) codebook was used to code data in two rounds. After each round, thick description was used to write detailed and contextual descriptions of each code. Facilitators and barriers to implementation were identified during the second round of thick description. RESULTS: Facilitators to implementation were clinic staff support, dedication, and flexibility and research team engagement. Barriers were lack of prioritization, loss of intervention champions, lack of knowledge about intervention protocol and resources, staff and patient discomfort discussing IPV, and operational issues with screen technology. CONCLUSIONS: The IPV protocol was implemented, but faced common barriers. CFIR is a complex, but comprehensive, tool to guide process evaluation for IPV screening and referral interventions in health systems in the U.S.


Asunto(s)
Asistencia Médica , Evaluación de Procesos, Atención de Salud , Instituciones de Atención Ambulatoria , Femenino , Programas de Gobierno , Humanos , Violencia de Pareja/prevención & control , Masculino , Tamizaje Masivo/métodos , Derivación y Consulta , Parejas Sexuales , Sobrevivientes , Estados Unidos
15.
Georgian Med News ; (306): 122-132, 2020 Sep.
Artículo en Ruso | MEDLINE | ID: mdl-33130659

RESUMEN

World Health Organization has declared coronavirus disease (COVID-19, SARS-CoV-2) a pandemic. There is little evidence regarding the negative impact of COVID-19 infection on women's reproductive health. Previous coronavirus outbreaks that occurred in previous years are known to include severe acute respiratory syndrome (SARS) in 2002-2003 and Middle East respiratory syndrome (MERS), which was first reported in 2012. So far, there is no evidence that pregnant women are more susceptible to COVID-19 than the general population. This short review provides a review of the scientific literature, which highlights the classification of respiratory viruses, transmission routes, transmission factors, virus-related diseases, case determination of COVID-19, clinical symptoms of COVID-19, laboratory diagnostics of COVID-19, algorithm the doctor's actions to examine patients, the impact on pregnancy, the treatment of pregnant women, women in childbirth and puerperas, as well as tactics of managing newborns in a pandemic, measures to prevent spread in a medical institution are highlighted.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Instituciones de Atención Ambulatoria , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Femenino , Humanos , Recién Nacido , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Neumonía Viral/transmisión , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología
16.
Femina ; 48(11): 646-653, 20201130. graf, tab
Artículo en Portugués | LILACS | ID: biblio-1140180

RESUMEN

Objetivo: O objetivo do estudo foi verificar a existência da objeção de consciência na atenção integral à saúde das vítimas de violência sexual, bem como conhecer a estrutura de atendimento das instituições credenciadas na rede de atenção à vítima de violência sexual no Estado de Minas Gerais. Métodos: Trata-se de um estudo de campo de caráter quantitativo, transversal, descritivo e analítico, com proposta de coleta de dados das instituições credenciadas ao atendimento às vítimas de violência sexual no estado. O instrumento foi entregue aos(às) coordenadores(a) desses serviços. Resultados: Verificou-se que 11% dos serviços não possuem médicos e 31% não fornecem treinamento para esse tipo de atendimento. Foi revelado que 85% dessas instituições já encontraram pacientes que desejam fazer o aborto legal, mas 83% delas não tiveram seu pedido atendido. Houve 60% da presença de objeção de consciência por parte de toda a equipe médica, sendo o principal motivo religioso (57%). Conclusão: O sistema de assistência no Estado não está preparado para o atendimento integral às vítimas de violência sexual, principalmente no quesito resolução do aborto legal, sendo a objeção de consciência o maior obstáculo. Faz-se necessária uma rede de referência e contrarreferência funcionante para amenizar esse problema tão sério e evidente. Espera-se que o resultado da pesquisa crie espaços de diálogo dentro do Estado que favoreçam ações adequadas sobre o aborto legal e respeitem o profissional médico se houver objeção de consciência.(AU)


Objective: The aim of this study was to verify the existence of conscientious objection to comprehensive health care for the victim of sexual violence, as well as to understand the service structure of institutions authorized in the health care system for victims of sexual violence in the state of Minas Gerais. Methods: This is a quantitative, cross-sectional, descriptive, and analytical field study aiming to collect data from institutions authorized to assist victims of sexual violence in the state. The instrument was handed in to the coordinators of these services. Results: It was found that 11% have no physician in service and that 31% had no training for this type of care. It was revealed that 85% of these institutions have already encountered patients wishing to have a legal abortion, but 83% of them have not had their request granted. There was a 60% presence of conscientious objection by the entire medical team, the main reason being religious (57%). Conclusion: The assistance system is not prepared for comprehensive care for victims of sexual violence, especially in terms of legal abortions, with conscientious objection being the main obstacle. A functional referral and counter-referral system is needed to alleviate such a serious and evident problem. It is hoped that the research results will promote dialogues in the state that favor appropriate actions on legal abortion, and respect the medical professional, in case of conscientious objection.(AU)


Asunto(s)
Humanos , Femenino , Embarazo , Bioética , Aborto Inducido/legislación & jurisprudencia , Aborto Inducido/ética , Aborto Legal/legislación & jurisprudencia , Aborto Legal/ética , Instituciones de Atención Ambulatoria/ética , Brasil , Estudios Transversales , Negativa del Paciente al Tratamiento , Violencia contra la Mujer
17.
Afr J Prim Health Care Fam Med ; 12(1): e1-e4, 2020 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-33054267

RESUMEN

The COVID-19 pandemic has affected nearly every country worldwide and all African countries. The issue of healthcare workers (HCWs) contracting the disease is a growing concern in Ghana, because of the risk of spreading infections amongst themselves and to vulnerable patients in their care. This article illustrates how 14 staff at the Korle Bu Polyclinic/Family Medicine Department were incidentally found to be Covid-19 positive with most of them being asymptomatic. This observation led to a modification of the personal protective equipment (PPE) used by clinical staff when attending to patients. Furthermore, this finding suggests that a different criteria or guideline may be needed for testing of HCWs during a pandemic where a significant proportion of infected people are asymptomatic. We conclude that in the primary care setting HCWs must be ready to see all the following cases safely: routine patients, asymptomatic COVID-19 patients and suspected COVID-19 patients.


Asunto(s)
Instituciones de Atención Ambulatoria , Infecciones por Coronavirus , Transmisión de Enfermedad Infecciosa , Personal de Salud , Hallazgos Incidentales , Pandemias , Neumonía Viral , Atención Primaria de Salud , Adulto , Infecciones Asintomáticas , Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Ghana/epidemiología , Hospitales , Humanos , Incidencia , Control de Infecciones , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Equipo de Protección Personal , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Neumonía Viral/virología , Adulto Joven
18.
PLoS One ; 15(10): e0241017, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33104705

RESUMEN

BACKGROUND: Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world's most affected countries, and its health system was already experiencing the aftermath of the 2015 recession. METHODS: Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings. RESULTS: We found the concept of 'health sector crisis' to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible-if insecure-working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhão. CONCLUSIONS: The 'plates' of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.


Asunto(s)
Personal Administrativo/psicología , Betacoronavirus , Infecciones por Coronavirus , Recesión Económica , Sector de Atención de Salud/economía , Administradores de Instituciones de Salud/psicología , Personal de Salud/psicología , Pandemias , Neumonía Viral , Sector Privado/economía , Sector Público/economía , Instituciones de Atención Ambulatoria/economía , Actitud del Personal de Salud , Brasil , Servicios de Salud Comunitaria/economía , Países en Desarrollo , Humanos , Reembolso de Seguro de Salud , Entrevistas como Asunto , Médicos/psicología , Investigación Cualitativa , Telemedicina , Desempleo
19.
Nephrol Nurs J ; 47(5): 401-411, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33107712

RESUMEN

Cardiac arrest is the leading cause of death among patients receiving hemodialysis, and major deficiencies exist in hemodialysis staff-provided cardiopulmonary resuscitation (CPR). Our study aimed to identify factors influencing CPR delivery in the outpatient hemodialysis clinic. Through content analysis of in-depth interviews with 10 staff members of a hemodialysis clinic, we identified three broad themes regarding barriers and facilitators to performing CPR in the hemodialysis clinic: 1) physical and environmental challenges regarding the layout of the clinic; 2) uncertainty about optimal in-clinic CPR procedures, particularly concerning patient positioning and dealing with the hemodialysis machine; and 3) benefit of continuous improvement programs, including hemodialysis-specific protocols, hands-on training, and pre-defined team roles. Our findings call for further investigation of optimal in-clinic resuscitation procedures to inform hemodialysis clinic CPR protocols and hemodialysis staff training.


Asunto(s)
Instituciones de Atención Ambulatoria , Reanimación Cardiopulmonar , Accesibilidad a los Servicios de Salud , Diálisis Renal , Humanos , Investigación Cualitativa
20.
BMJ Open ; 10(10): e041514, 2020 10 23.
Artículo en Inglés | MEDLINE | ID: mdl-33099501

RESUMEN

OBJECTIVE: The COVID-19 pandemic is having major implications for stroke care with a documented significant fall in hospital acute stroke admissions. We investigated whether COVID-19 has resulted in a decreased number of referrals to the transient ischaemic attack (TIA) clinics across the North West London region. SETTING AND DESIGN: All the TIA clinical leads of the North West London region received an invitation by email to participate in an online survey in May 2020. The survey questionnaire aimed to assess the number of patients with suspected TIA consecutively referred to each of the TIA clinics of the North West London region between 1 March and 30 April 2020, the COVID-19 period, and between 1 March and 30 April 2019. RESULTS: We had a response rate of 100%. During the COVID-19 period, the TIA clinics of the North West London region received 440 referrals compared with 616 referrals received between 1 March and 30 April 2019 with a fall in the number of the referrals by 28.6%. In April 2020 compared with April 2019, the number of the referrals declined by 40.1%. CONCLUSIONS: This multicentre analysis documented a significant reduction in the number of patients referred with suspected TIA to the specialised rapid access outpatient clinics in the North West London region during the COVID-19 pandemic. Future studies are needed to confirm our findings and to better characterise the incidence of cerebrovascular disease during the COVID-19 pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Ataque Isquémico Transitorio , Neumonía Viral/epidemiología , Derivación y Consulta/estadística & datos numéricos , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Betacoronavirus , Estudios Transversales , Hospitalización , Humanos , Incidencia , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/epidemiología , Londres/epidemiología , Pandemias , Servicios Preventivos de Salud/métodos , Servicios Preventivos de Salud/estadística & datos numéricos , Calidad de la Atención de Salud
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