Establishing an Office-Based Framework for Resuming Otolaryngology Care in Academic Practice During the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 health crisis abruptly disrupted the practice of otolaryngology. This article aims to define the changes needed to operate an academic otolaryngology practice safely and efficiently from within the epicenter of the pandemic. We define the areas of normal patient workflow that have been affected by COVID-19, and we offer mitigation strategies with attention paid to the specific needs of subspecialties. DATA SOURCES: The article includes data specific to the office practice metrics of the Weill Cornell Medicine Department of Otolaryngology-Head and Neck Surgery, as well as publically available data from New York Presbyterian Hospital system and the New York Times. REVIEW METHODS: Expert opinion. CONCLUSIONS: Through careful planning and execution, it is possible to reestablish safe otolaryngologic patient care during the COVID-19 pandemic. It will require a significant change from prior practice models for successful implementation. Additionally, telemedicine can be positively integrated into the treatment of otolaryngology diseases for new and established patients. IMPLICATIONS FOR PRACTICE: The information conveyed in this review can be used as a guide by large and small otolaryngology groups to identify aspects of the patient visit that are "at risk" due to COVID-19, and it suggests sensible responses that can be made without a significant disruption to normal practice. The methods used to identify vulnerabilities with the patient visit process can be applied to future unforeseen crises, such as a resurgence of COVID-19 or a novel pandemic.

Recommendations for Dermatology Office Reopening in the Era of COVID-19.

The COVID-19 pandemic, originating in Wuhan, China, has become a major public health and economic challenge for countries around the world. As of May 08, 2020, there are over 3 million COVID-19 cases, and 250,000 COVID-19- associated deaths in 215 countries. As more data is collected, updated infection control measures are continuously released and published by government, public health authorities, and physician specialty associations. Across the globe, dermatological practices have had to limit their operations to varying degrees to facilitate disease control, but as the pandemic subsides, they will broaden their operations. In light of the uncertainty surrounding safe and effective practice of medical and aesthetic dermatology in the era of COVID-19, fourteen international experts in the field contributed to recommendations for effective infection control protocols and practice management modifications. While guidance from the World Health Organization and local public health officials comes first, these recommendations are crafted as a starting point for dermatologists worldwide to commence either reopening their doors to patients or expanding available service offerings. This can help ensure that patients receive needed care in the short term and improve long term practice viability. J Drugs Dermatol. 2020;19(7):e-1-e-9. doi:10.36849/JDD.2020.5293.

Review of emergency preparedness in the office setting: How best to prepare based on your practice and patient demographic characteristics.

OBJECTIVE: To outline an approach to assessing the risk of emergencies in one's medical practice and determining the equipment and medications required for emergencies and the necessary staff training to meet this important facet of patient care. SOURCES OF INFORMATION: The emergency preparedness recommendations presented in this article are based on data collected from family physicians' current preparedness plans, formal physician evaluation and informal feedback provided after 2 large group presentations, and the authors' expertise in areas including family medicine, emergency medicine, prehospital care, and pharmacology. MAIN MESSAGE: Delineating risk based on practice profile, location, and demographic characteristics will inform the development of an appropriate plan to meet both public expectations and professional obligations. Reviewing the plan or having a practice drill of the plan once developed will improve the process in the event of an emergency. It is also essential to have medication and equipment checked periodically for expiry dates and proper functioning. CONCLUSION: Physicians will encounter office emergencies at some time in their practice. Appropriate risk assessment, planning, and preparedness will allow the provision of high-quality care, safety for staff members, the best patient outcomes, and the reward of having managed a time-sensitive problem in an efficient and effective manner.

Embodied disruption: "Sorting out" gender and nonconformity in the doctor's office.

Among LGBTQ people, those who are gender nonconforming (GNC) may be at heightened risk of both discrimination and underutilization of healthcare-yet little is known about what happens during healthcare encounters to compel GNC individuals to continue or avoid seeking future care. This study qualitatively examines the healthcare experiences of a racially diverse sample of 34 adult LGBTQ cis women, transgender men, and nonbinary individuals in a metropolitan area of the United States who do not conform to dominant biomedical schemas of sex and gender. GNC individuals experience embodied disruption in medical settings when patients are mis/recognized; providers respond to disruption in ways that further distress patients. Broadly, participants report similar experiences across racial and gender identities, but patients manage disruption somewhat differently depending on their embodied positions to gender norms. This study contributes to literature of stress, stigma, and sex, gender, and sexuality within medicine by illuminating how stigmatizing healthcare interactions deter LGBTQ individuals from seeking healthcare. Findings point to the importance of considering both structural factors and embodied visibility in future research addressing how stigma and discrimination manifest within health settings to disadvantage LGBTQ groups.

Condiciones de trabajo en consultorios adyacentes a farmacias privadas en Ciudad de México: perspectiva del personal médico / Working conditions in outpatient clinics adjacent to private pharmacies in Mexico City: perspective of physicians

Objetivo: Analizar, desde la perspectiva del personal médico, las condiciones laborales de los consultorios adyacentes a farmacias privadas (CAF), así como sus elementos organizativos. Método: Estudio cualitativo exploratorio consistente en entrevistas semiestructuradas a 32 médicos/as de los CAF en Ciudad de México. Se utilizó la técnica de análisis de contenido dirigido basado en códigos previamente construidos y emergentes, relacionados con la experiencia vivida de los sujetos en su campo laboral. Resultados: El personal médico percibió que trabajar en los CAF no cumple con sus expectativas profesionales por la baja remuneración, la informalidad en la contratación y la ausencia de garantías laborales establecidas en la ley. Esto les impide disfrutar de los beneficios asociados con el empleo formal y sustenta el deseo de laborar en los CAF solo de manera temporal. Consideraron que los incentivos económicos por número de consultas, procedimientos y ventas alcanzadas por la farmacia les permiten aumentar su ingreso sin influir en su conducta prescriptiva. Señalaron que los sistemas de supervisión y presión en los CAF buscan afectar su autonomía para activar la venta de medicamentos en la farmacia. Conclusiones: El personal médico que labora en CAF enfrenta una difícil situación laboral. Los elementos gerenciales usados para inducir la prescripción y activar las ventas de las farmacias conforman un entorno laboral que genera retos en materia de regulación, y subraya la necesidad de monitorear la calidad de los servicios brindados en estos consultorios y los posibles riesgos a los usuarios (AU)

Objective: To analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. Methods: We carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis technique was used based on previously built and emerging codes which were related to the experience of the subjects in their work. Results: Respondents perceive that work in CAFs does not meet professional expectations due to low pay, informality in the recruitment process and the absence of minimum labour guarantees. This prevents them from enjoying the benefits associated with formal employment, and sustains their desire to work in CAF only temporarily. They believe that economic incentives related to number of consultations, procedures and sales attained by the pharmacy allow them to increase their income without influencing their prescriptive behaviour. They express that the monitoring systems and pressure exerted on CAFs seek to affect their autonomy, pushing them to enhance the sales of medicines in the pharmacy. Conclusions: Physicians working in CAFs face a difficult employment situation. The managerial elements used to induce prescription and enhance pharmacy sales create a work environment that generates challenges for regulation and underlines the need to monitor the services provided at these clinics and the possible risk for users (AU)

Influence of Office Systems on Pediatric Vaccination Rates.

This study seeks to better understand the impact of practice-level factors on up-to-date (UTD) rates in children. We compared practice-level vaccination rates for 54 practices to survey data regarding office practices for staffing, vaccine delivery, reminder-recall, and quality improvement. Vaccination rates at 24 and 35 months were analyzed using t tests, analysis of variance, and linear regression. Private practices and those using standing orders had higher UTD rates at 24 months ( P = .01; P = .03), but not at 35 months. Having a pediatrician in the office was associated with higher UTD rates at both 24 and 35 months ( P < .01). Participating in a network and taking walk-in patients were associated with lower UTD rates ( P = .03; P = .03). As the percentage of publicly insured patients decreases, the UTD rate rises at 24 and 35 months ( r = -0.43, P = .001; r = -0.037, P = .007). Reported use of reminder recall-systems, night/evening hours, and taking walk-in patients were not associated with increased UTD rates.

REGAIN LOST LUSTER WITH MODERN MEDICINE IDEAS.

The role of the moderns physician is evolving. To find the right place amid the changing landscape, it's time to put some old thinking behind. Here are six ways to do that.

Principios generales de la interconsulta médica en enfermos hospitalizados / General principles of medical interconsultation for hospitalised patients

La interconsulta médica en pacientes hospitalizados constituye una actividad habitual entre los especialistas en medicina interna. Sin embargo, a pesar de su impacto e importancia crecientes, no se ha establecido un modelo que defina sus características, sus objetivos o la información que debe contener. En este trabajo, desde el Grupo de Asistencia Compartida e Interconsultas de la Sociedad Española de Medicina Interna, se proponen unas recomendaciones generales respecto a la forma de solicitar y de responder una interconsulta médica hospitalaria, así como un formato para la misma (AU)

Medical interconsultation for hospitalised patients is a regular activity among internal medicine specialists. However, despite its growing impact and importance, a model that defines its characteristics, objectives and information has not been established. This study, conducted by the Shared Care and Interconsultations Group of the Spanish Society of Internal Medicine, proposes a number of general recommendations concerning the method for requesting and responding to hospital medical interconsultations, as well as a format for these interconsultations (AU)

El consultorio psiquiátrico penitenciario / No disponible

La elevada prevalencia de trastornos mentales en internos que cumplen condena en centros penitenciarios ordinarios españoles es un problema grave y de calado. Son varias las publicaciones en nuestro país que objetivan este hecho y varias las hipótesis que pueden explicar este fenómeno. Así mismo, la asistencia especializada no es homogénea. Destaca la convivencia de 3 modelos asistenciales, el catalán y vasco (con las transferencias en materia sanitaria en estas comunidades autónomas) y el modelo general de las prisiones dependientes del Ministerio del Interior, en las que tampoco existe una estrategia común respecto a los especialistas en psiquiatría que llevan a cabo la labor consultora. En aras de abordar esta situación se creó el Programa de atención integral al enfermo mental en prisión (PAIEM), y se expondrán sus principales características. Así mismo se tomará como ejemplo el convenio entre el CHP Castellón y los dos CP de la provincia de Castellón (AU)

No disponible

[Factors associated with investment in an office medicine project by general practice residents]. / Déterminants du projet d'installation en ambulatoire des internes de médecine générale.

OBJECTIVE: To identify thefactors associated with investment in an office medicine project by French general practice (GP) residents. METHODS: We conducted a national survey using a web-based self-administered questionnaire and analyzed the data collected by multiple logistic regressions. The dependent variable was "an office medicine project" The explanatory variables were both individual (socio-demographic and linked to training trajectories) and contextual (related to the available training programmes and the regional medical demography). RESULTS: The response rate was 48.5%. Out of the 1,695 residents of the study sample, 315 (18.6%) already had a project to setup an office practice during their third cycle ofmedical studies. The main factors associated with this project were (p < 0.05): to receive strong academic support, to live in a rural or semi-rural area, to work as a GP locum, to perform residency training in the same city as the medical training and to perform residency training in a region with a high percentage of GPs 55years and older. CONCLUSIONS: This study showed that a project to setup an office practice was influenced by both individual and contextualfactors. Special attention should be paid to the means and content of training to ensure better supportfor residents, which could make office general practice more attractive.

[Stepwise outpatient care]. / Abgestufte ambulante psychiatrische Behandlung.

OBJECTIVE: To assess possible differences in clinical, social, care, and satisfaction profile of patients treated by outpatient clinics or office based psychiatrists. METHOD: The study sample consists of 100 patients of a psychiatric outpatient clinic and 100 patients treated by office based psychiatrists in the same catchment area. Patients were examined using standardized assessment instruments for severity of illness (HoNOS, CGI), general (GAF) and specific functional impairment (PSP), and satisfaction with psychiatric services (ZUF-8). Chi-square tests, univariate ANOVAs and stepwise multivariate logistic regression models were applied. RESULTS: Compared with patients treated by office based psychiatrists, patients treated by the outpatient clinic showed higher HoNOS and CGI scores, lower GAF and PSP scores, and had more often a disability pension, a legal guardianship, a schizophrenia diagnosis, suicide attempts, hospitalizations, and therapeutic contacts. However, there were no significant differences regarding care satisfaction. CONCLUSION: The assessed outpatient clinic met the German statutory criteria for its legitimation. However, care needs have to be specified in a better way, and the different care intensity as well as concrete interventions between both settings have to be specified more accurately.

Closely consider finances, staffing when expanding office hours.

As primary care practices consider transforming to the Patient Centered Medical Home framework, one of the key concepts is increasing practice availability to patients. Adding nontraditional hours is worth exploring to meet patient needs and increase profitability.