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2.
JAMA Netw Open ; 3(1): e1920010, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995215

RESUMO

Importance: Racial and ethnic disparities in access to health care may result from discrimination. Objectives: To identify differences in the rates at which patients belonging to racial/ethnic minority groups are offered primary care appointments and the number of days they wait for their primary care appointment and to understand the mechanisms by which discrimination occurs. Design, Setting, and Participants: This cross-sectional study used 7 simulated black, Hispanic, and white patient callers to request appointments from 804 randomized primary care offices in 2 urban centers in Texas from November 2017 to February 2018. Data analysis was conducted between February and December 2018. Exposures: Research assistants called randomly assigned offices to schedule an appointment, supplying the same basic information. Race and ethnicity were signaled through callers' names and voices. Main Outcomes and Measures: Appointment offer rates, days to appointment, and questions asked during the call. Results: Of the 7 callers (age range, 18-29 years), 2 (28.6%) self-identified as non-Hispanic black, 3 (42.9%) self-identified as non-Hispanic white, and 2 (28.6%) self-identified as Hispanic. Of the 804 calls they made, 299 (37.2%) were from simulated white callers, 215 (26.7%) were from simulated black callers, and 290 (36.1%) were from simulated Hispanic callers. Overall, 582 callers (72.4%) were offered appointments. In unadjusted models, black and Hispanic callers were more likely to be offered an appointment than white callers (black callers, 32.2 [95% CI, 25.1-39.3] percentage points more likely; P < .001; Hispanic callers, 21.1 [95% CI, 13.7-28.5] percentage points more likely; P < .001). However, after adjusting for whether insurance status was revealed, this statistical significance was lost. In adjusted models, black callers were 44.0 (95% CI, 36.2-51.8) percentage points more likely to be asked about their insurance status than white callers (P < .001), and Hispanic callers were 25.3 (95% CI, 17.1-33.5) percentage points more likely to be asked about their insurance status (P < .001) than white callers. Black and Hispanic callers received appointments further in the future than white callers (black callers: marginal effect estimate, 3.650; 95% CI, 0.579 to 6.721; P = .08; Hispanic callers: marginal effect estimate, 2.644; 95% CI, -0.496 to 5.784; P = .02). Conclusions and Relevance: In this study, black and Hispanic patients were more likely to be offered an appointment, but they were asked more frequently about their insurance status than white callers. Black and Hispanic callers experienced longer wait times than white patients, indicating a barrier to timely access to primary care.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Agendamento de Consultas , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Cooperação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Prospectivos , Estados Unidos
5.
BMC Health Serv Res ; 19(1): 782, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675973

RESUMO

BACKGROUND: In China, a long waiting time for registration is a common occurrence in many tertiary hospitals. This study aimed to analyze the effects of a comprehensive reservation service for non-emergency registration on appointment registration rate, patient waiting time, patient satisfaction and outpatient volume at the Guangzhou Women and Children's Medical Center. METHODS: This was a cross-sectional study. This study investigated the effects of a comprehensive reservation service for non-emergency registration in Guangzhou Women and Children's Medical Center in China starting in October 2015. In total, 2194 patients completed a satisfaction survey administered by the Guangdong Situation Research Center. The content of the questionnaire consisted of six aspects: general impression, service attitude, service quality, hospital environment, price perception and medical ethics. A Likert 5-point rating scale was used in the questionnaire; answers were classified as "very satisfied", "relatively satisfied", "neutral", "unsatisfied" and "very unsatisfied". The method of application was paper-based. T-tests were used to compare the sample means, and chi-square tests were used to compare the rates. A multiple-test procedure was performed to evaluate the differences in the reservation rates during a 12-month period. RESULTS: After the implementation of the comprehensive reservation service for non-emergency registration in our hospital, which has an annual outpatient volume of approximately 4 million, the monthly appointment registration rate increased from (34.95 ± 2.91)% to(89.13 ± 3.12)%,P < 0.01. The patient waiting time was significantly reduced (P < 0.01), and the proportion of patients who believed that the waiting time required improvement was decreased significantly (P < 0.01). Moreover, the third-party evaluation result of outpatient satisfaction significantly improved (P < 0.01). The total hospital outpatient volume decreased(P < 0.01). The outpatient volume of the Department of General Pediatrics decreased. CONCLUSION: The implementation of the comprehensive reservation service for non-emergency registration in the hospital shortened patient waiting time and improved patient satisfaction, and the outpatient volume was effectively controlled. These results indicated that this program obtained the desired results in a Grade 3A hospital in China.


Assuntos
Agendamento de Consultas , Pacientes Ambulatoriais/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Centros de Atenção Terciária/organização & administração , Listas de Espera , China , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Inquéritos e Questionários , Fatores de Tempo
7.
Rev Saude Publica ; 53: 92, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644723

RESUMO

OBJECTIVE: To estimate the use of the first dose of antibiotics in the health care unit in children from the 2015 Pelotas Birth Cohort at 24 months. METHODS: A total of 4,014 children were monitored. We used descriptive statistics and Poisson regression to analyze the association between socioeconomic and demographic variables, participation in daycare units, in the activities of the Pastoral da Criança and in the Primeira Infância Melhor program, low birth weight, hospitalization between 12 and 24 months, place of medical appointment, prevalence of medical appointment in the last 30 days, prescription of antibiotics, and administration of the first dose in the health care unit. RESULTS: A total of 1,044 children had medical appointments in the last 30 days, of which 45% were prescribed antibiotics and only 10.5% were administered the first dose of this medication in the health care unit. Children with brown, yellow or indigenous skin color were administered 2.5 times more antibiotics than white children. Children whose mothers had 12 years or more of education were administered 83.0% fewer antibiotics than those whose mothers had up to 4 years of education. Among those who were hospitalized for 12 to 24 months, the use of antibiotics was almost four times higher than among those who were not. Among the children served by the Brazilian Unified Health System (SUS), only 15.3% were administered the first dose of antibiotic in the health care unit. When compared with children served by private health care or health plan, administration of the first dose in the SUS was 76.0% higher. CONCLUSIONS: Despite the efforts related to the Pastoral da Criança campaign "Antibiotic: first dose immediately," adherence to the provision of antibiotics in the health care unit is still low. Strategies are necessary and urgent so children have access to the first dose of antibiotics in the health care unit.


Assuntos
Antibacterianos/administração & dosagem , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Adulto , Agendamento de Consultas , Brasil/epidemiologia , Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Estudos de Coortes , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Mães , Programas Nacionais de Saúde , Prevalência , Fatores Socioeconômicos , Fatores de Tempo , Adulto Jovem
9.
J Shoulder Elbow Surg ; 28(11): 2079-2083, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31521525

RESUMO

BACKGROUND: The purpose of this study was to assess the effect of individual state Medicaid expansion status on access to care for shoulder instability. METHODS: Four pairs of Medicaid expanded (Louisiana, Kentucky, Iowa, and Nevada) and unexpanded (Alabama, Virginia, Wisconsin, and Utah) states in similar geographic locations were chosen for the study. Twelve practices from each state were randomly selected from the American Orthopedic Society for Sports Medicine directory, resulting in a sample size of 96 independent sports medicine offices. Each office was called twice to request an appointment for a fictitious 16-year-old first-time shoulder dislocator with either in-state Medicaid insurance or Blue Cross Blue Shield (BCBS) private insurance. RESULTS: A total of 91 physician offices in 8 states were contacted by telephone. An appointment was obtained at 36 (39.6%) offices when calling with Medicaid and at 74 (81.3%) offices when calling with BCBS (P < .001). Thirty-five (38.5%) offices were able to make appointments for both types of insurance, 39 (42.9%) for only BCBS, 1 (1.1%) for only Medicaid, and 16 (17.5%) for neither. For Medicaid patients, an appointment was booked in 13 (27.7%) clinics from Medicaid expanded states and in 23 (52.3%) clinics from unexpanded states (P = .016). CONCLUSION: For a first-time shoulder dislocator, access to care is more difficult with Medicaid insurance compared with private insurance. Within Medicaid insurance, access to care is more difficult in Medicaid expanded states compared with unexpanded states. Medicaid patients in unexpanded states are twice as likely as those in expanded states to obtain an appointment.


Assuntos
Acesso aos Serviços de Saúde , Cobertura do Seguro , Seguro Saúde , Medicaid , Luxação do Ombro/cirurgia , Adolescente , Agendamento de Consultas , Humanos , Patient Protection and Affordable Care Act , Estados Unidos
10.
Br J Gen Pract ; 69(687): 488, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31558516
11.
Artigo em Inglês | MEDLINE | ID: mdl-31510102

RESUMO

High costs are an important reason patients postpone dental visits, which can lead to serious medical consequences. However, little is known about the determinants of postponing visits due to financial constraints longitudinally. Thus, the purpose of this study was to examine the determinants of postponing dental visits due to costs in older adults in Germany longitudinally. Data from wave 5 and 6 of the Survey of Health, Ageing, and Retirement in Europe was used. The occurrence of postponed dental visits due to costs in the last 12 months served as the outcome measure. Socioeconomic and health-related explanatory variables were included. Conditional fixed effects logistic regression models were used (n = 362). Regressions showed that the likelihood of postponing dental visits due to costs increased with lower age, less chronic disease, and lower income. The outcome measure was neither associated with marital status nor self-rated health. Identifying the factors associated with postponed dental visits due to costs might help to mitigate this challenge. In the long term, this might help to maintain the well-being of older individuals.


Assuntos
Serviços de Saúde Bucal/economia , Cooperação e Adesão ao Tratamento , Idoso , Idoso de 80 Anos ou mais , Agendamento de Consultas , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Aposentadoria , Fatores Socioeconômicos , Inquéritos e Questionários
12.
N C Med J ; 80(5): 261-268, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471505

RESUMO

BACKGROUND Successful diabetes care requires patient engagement and health self-management. Diabetes shared medical appointments (SMAs) are an evidence-based approach that enables peer support, diabetes group education, and medication management to improve outcomes. The purpose of this study is to learn how diabetes SMAs are being delivered in North Carolina, including the characteristics of diabetes SMAs across the state.METHOD Twelve health systems in the state of North Carolina were contacted to explore clinical workflow and intervention characteristics with a member of the SMA care delivery team. Surveys were used to assess intervention characteristics and delivery.RESULTS Diabetes SMAs were offered in 10 clinics in 5 of the 12 health systems contacted with considerable heterogeneity across sites. The majority of SMAs were open cohorts (80%), offered monthly (60%) for 1.5 hours (60%). SMAs included a mean of 7.5 ± 3.4 patients with a maximum of 11.2 ± 2.7 patients. Survey data revealed barriers (cost-sharing and provider buy-in) to, and facilitators (leadership support and clinical champions) of, clinical adoption and sustained implementation.LIMITATIONS External validity is limited due to the small sample size and geographic clustering.CONCLUSION There is significant heterogeneity in the delivery and characteristics of diabetes SMAs in North Carolina with only modest uptake across the health systems. Further research to determine best practices and effectiveness in diverse, real-world clinical settings is required to inform implementation and dissemination efforts.


Assuntos
Agendamento de Consultas , Diabetes Mellitus/terapia , Pesquisas sobre Serviços de Saúde , Humanos , North Carolina
13.
Neuron ; 103(4): 559-562, 2019 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437452
14.
Stud Health Technol Inform ; 264: 512-515, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437976

RESUMO

Medicine has evolved considerably in recent decades in part thanks to information and communication technologies in health (ICTs). However, face-to-face consultations continue to be the predominant model, since alternatives such as telemedicine are still the subject of debate. On the other hand, in some very specific specialties, centralization is relevant, mainly due to the low frequency and prevalence of diseases, as well as the need to have highly specialized professionals, causing problems in terms of accessibility and costs for the health system. In this study we have analyzed the first consultations to an orthopedics oncology service at a tertiary institution and performed an analysis of economic costs was carried out between 2 possible scenarios: face-to-face consultations versus telemedicine. Analyzing the 2 scenarios, there would be a cost-benefit in the use of telemedicine leading to a decrease in healthcare cost between 12.2% and 72%.


Assuntos
Agendamento de Consultas , Telemedicina , Comunicação , Análise Custo-Benefício , Ortopedia
15.
Stud Health Technol Inform ; 264: 1682-1683, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438291

RESUMO

The health industry will see increased implementations of value-based models. This study validates a predictive model for determining emergency room utilization. Data from 2991 records are used for the analysis. To validate the model we used Poisson and random forest models. The results indicate that patients with one of six chronic conditions, who missed scheduled appointments or had higher body mass indexes were more likely to utilize the emergency department.


Assuntos
Agendamento de Consultas , Doença Crônica , Serviço Hospitalar de Emergência , Humanos
16.
Stud Health Technol Inform ; 264: 1686-1687, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438293

RESUMO

The Hospital Authority of Hong Kong ("HA") launched an interactive mobile application "BookHA" intending to use innovative technology to support healthcare delivery. "BookHA" provides an 'easy and convenient' alternative for patients to book specialist clinics along with the current methods - in-person or via fascmile. Patients, clinical staff, and the corporates benefit from this initiative as evidenced by the utilization figures, and the findings from patients surveys and staff surveys.


Assuntos
Agendamento de Consultas , Assistência à Saúde , Hong Kong , Humanos , Aplicativos Móveis
17.
Br Dent J ; 227(4): 291-297, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31444446

RESUMO

Introduction Children and young people's (CYP) missed healthcare appointments may be an indicator of neglect. Healthcare providers are encouraged to consider the child as 'was not brought' (WNB) and to assess the need for early multidisciplinary information sharing to safeguard and promote welfare.Method A new WNB-CYP pathway (flowchart, template patient notes, template letters) for missed appointments was developed. After piloting at one community dental service (CDS) clinic for eight months, a service evaluation was conducted via retrospective review of records and semi-structured interviews with staff.Results Of 1,238 appointments for CYP, 134 were missed (WNB rate 10.8%) by 91 children. The WNB-CYP pathway was followed consistently 113 times (84.3%) and, when used, three quarters of WNBs were rebooked after communication with parents within three weeks. Written information was shared in 25 cases with general medical practitioners and other health and social care professionals. Staff reported high levels of engagement and pathway acceptability; it relieved uncertainty and supported decision-making, teamwork and inter-professional communication without increasing daily workload. Following minor amendments, the pathway was rolled out service-wide with similar success.Conclusion A new WNB-CYP pathway facilitated early and consistent sharing of safeguarding information with other professionals about missed CDS dental appointments and improved dental team confidence.


Assuntos
Agendamento de Consultas , Pais , Adolescente , Atitude do Pessoal de Saúde , Criança , Pessoal de Saúde , Humanos , Estudos Retrospectivos
18.
Int J Med Inform ; 129: 37-42, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31445279

RESUMO

OBJECTIVE: This study aims to estimate the association between health information technology (HIT) use and influenza vaccine uptake among US adults. MATERIALS AND METHODS: Data analysis was conducted using 2011-2015 National Health Interview Survey (NHIS) adult data (n = 169,912). HIT use was defined as having used computers (past 12 months) to seek health information, fill prescriptions, schedule appointments, communicate with health providers via email, and/or use online health chat groups. Crude and multivariable logistic regression models were used to estimate the odds of influenza vaccine uptake among HIT users versus non-users. Interactions were tested and stratified results were reported. RESULTS: Among US adults, 39.8% received an influenza vaccine in the past 12 months, while 48.6% reported any HIT use. After adjusting for covariates, any HIT users had 1.23 times greater odds (95% CI = 1.19, 1.27) of influenza vaccine uptake relative to non-HIT users. HIT use for looking up health information on the internet (OR = 1.19, 95% CI = 1.15, 1.23), filling prescriptions (OR = 1.56; 95% CI = 1.50, 1.66), scheduling appointments (OR = 1.56; 95% CI = 1.50, 1.66), and communicating with providers via email (OR = 1.51; 95% CI = 1.44, 1.59) were significantly associated with influenza vaccine uptake. DISCUSSION: HIT use is positively associated with influenza vaccine uptake. Each category of HIT use was independently associated with influenza vaccine uptake. To our knowledge, no other studies have evaluated the relationship between HIT use and influenza vaccine uptake. Our results are exploratory and represent an association, not a causal relationship. Longitudinal, confirmatory studies are also needed to verify our cross-sectional findings.


Assuntos
Vacinas contra Influenza , Informática Médica , Adolescente , Adulto , Idoso , Agendamento de Consultas , Estudos Transversais , Correio Eletrônico , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
Rev Esp Salud Publica ; 932019 Jul 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31346155

RESUMO

OBJECTIVE: Non-scheduled consultation is very frequent among patients with cancer, creating alterations and delays in programmed visits. We describe the incidence of non-scheduled consultations in patients with digestive cancer in our hospital. METHODS: Descriptive, prospective, non-interventional study. In a six-month period (May-December 2017), non-scheduled visits were chronologically recorded in the medical oncology consultation of digestive tumours of Hospital Juan Ramón Jiménez de Huelva. We performed a descriptive analysis of the variables collected through the statistical program G-STAT v.2.0. RESULTS: Patients with colon or rectal cancer generated most consultations (68.63%). followed by pancreatic (9.15%) and gastric (5.23%). Most patients had metastatic or advanced stage cancer (59.87%) and were under palliative or symptomatic treatment (58.82%). The most frequent reason for consultation was clinical symptoms (47.05%). followed by information demand (18.30 %). CONCLUSIONS: Non-scheduled consultations in cancer patients are frequent; they cause interference in scheduled consultations and not always resolved satisfactorily. We propose several measures to reduce the number of non-scheduled consultation in oncology.


Assuntos
Agendamento de Consultas , Neoplasias do Sistema Digestório/terapia , Utilização de Instalações e Serviços/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Neoplasias do Sistema Digestório/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha
20.
Stud Health Technol Inform ; 262: 75-78, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349269

RESUMO

Surgery cancellation is a well-recognized quality problem within hospitals. The e-Team Surgery project addressed the problem of elective surgery cancellation at a Norwegian hospital and explored the potential to reduce surgery cancellation by providing a tool for secure online communication between the hospital and the patient. This communication would occur before surgery while the patient was still at home. The causes of elective surgery cancellation are divided into two major categories: hospital- and patient-related reasons. As part of the e-Team Surgery project, this study addressed patient reasons for cancelling surgery through qualitative interviews with 11 patients who fit these criteria. The study found that most patients called the hospital to reschedule, not to cancel, their upcoming surgery. The patient interviews had significant implications for the e-Team Surgery project. They affected the overall understanding of the surgery cancellation problem and made more clear the data and information needed when developing sustainable systems to reduce elective surgery cancellation.


Assuntos
Agendamento de Consultas , Procedimentos Cirúrgicos Eletivos , Medidas de Resultados Relatados pelo Paciente , Hospitais , Humanos , Noruega
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