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2.
Isr Med Assoc J ; 21(8): 528-531, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474014

RESUMO

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease, which is caused by chronic obstruction of major pulmonary arteries. CTEPH can be cured by pulmonary endarterectomy (PEA). PEA for CTEPH is a challenging procedure, and patient selection and the perioperative management are complex, requiring significant experience. OBJECTIVES: To describe the establishment of a national CTEPH-PEA center in Israel and present results of surgery. METHODS: In this study, we reviewed the outcomes of PEA in a national referral, multi-disciplinary center for CTEPH-PEA. The center was established by collaborating with a high-volume center in Europe. A multidisciplinary team from our hospital (pulmonary hypertension specialist, cardiac surgeon, cardiac anesthesiologist and cardiac surgery intensivist was trained under the guidance of an experienced team from the European center. RESULTS: A total of 38 PEA procedures were performed between 2008 and 2018. We included 28 cases in this analysis for which long-term follow-up data were available. There were two hospital deaths (7%). At follow-up, median New York Heart Association (NYHA) class improved from III to I (P < 0.0001), median systolic pulmonary pressure decreased from 64 mmHg to 26 mmHg (P < 0.0001), and significant improvements were seen in right ventricular function and exercise capacity. CONCLUSIONS: A national center for performance of a rare and complex surgical procedure can be successfully established by collaboration with a high-volume center and by training a dedicated multidisciplinary team.


Assuntos
Endarterectomia/métodos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/cirurgia , Embolia Pulmonar/complicações , Embolia Pulmonar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/cirurgia , Encaminhamento e Consulta , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
3.
Stud Health Technol Inform ; 264: 1795-1796, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438348

RESUMO

Skin cancer incidences have tripled in the Netherlands for the last twenty years and are expected to increase even more in the coming years. Teledermoscopy (TDsc) is implemented in Dutch practice to support and enhance early skin cancer detection by general practitioners (GPs) through remote consultation with dermatologists. This study assesses the effect of TDsc consultation on the quality and efficiency of skin cancer care in the primary setting by analyzing 10,184 TDsc consultations.


Assuntos
Dermatologia , Clínicos Gerais , Neoplasias Cutâneas , Telemedicina , Humanos , Países Baixos , Encaminhamento e Consulta , Neoplasias Cutâneas/terapia
4.
West Afr J Med ; 36(2): 122-128, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385597

RESUMO

BACKGROUND: Oxygen is like any other medication that can cause severe consequences if administered inappropriately. OBJECTIVE: To audit the pattern of acute oxygen therapy on regular hospital wards of a referral centre in Ilorin, Nigeria. METHODS: We reviewed 150 patients that received or had a prescription for acute oxygen therapy in three months and extracted relevant information using a proforma. RESULTS: About one-third of the patients (30%) were >65 years of age and the male to female ratio was 1:1. The commonest indication and medical condition for acute oxygen administration were hypoxemia (70.7%) and pneumonia (26.0%), respectively. Pneumonia accounted for most (41.2 %) of the oxygen therapy in childhood. The majority of patients (88.0%) had written order for oxygen prescription, 40.7% had a prescription to target oxygen saturation and only 31.3% achieved their target saturation. Oxygen prescription was adequate (documentation of delivery device, flow rate of oxygen, and target oxygen saturations) in 40.7% of patients. The assessment, monitoring and titration of oxygen therapy were adequate in 92.7%, 65.3% and 28 % of patients respectively. Overall mortality was 27.3% in patients receiving acute oxygen supplementation. Eleven patients had unstable COPD, and 63.6 %, 54.5 % and 45.6 % of them had adequate oxygen prescription, monitoring and titration respectively. The challenges to oxygen use were faulty delivery devices, emptied oxygen cylinders, inability to routinely do arterial blood gas analysis and lack of hospital oxygen protocol. CONCLUSION: The current practice of acute oxygen therapy is not satisfactory and interventions are advocated to improve the healthcare providers' administration of oxygen.


Assuntos
Hipóxia/terapia , Auditoria Médica/estatística & dados numéricos , Oxigenoterapia/estatística & dados numéricos , Pneumonia/terapia , Centros de Atenção Terciária/normas , Idoso , Criança , Feminino , Humanos , Masculino , Nigéria , Oxigênio , Oxigenoterapia/métodos , Encaminhamento e Consulta
5.
Stud Health Technol Inform ; 264: 674-678, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438009

RESUMO

Electronic Health Records (EHRs) can be used for research but this raises the problem of data quality. OBJECTIVE: To evaluate the quality of the information recorded in an EHR by a general practitioner (GP) during a regular office consultation. METHOD: 191 dialogs between the GP and patient were recorded and translated into the International Classification of Primary Care Second edition (ICPC-2) codes. Written information of the corresponding EHR was extracted and coded for comparison. RESULTS: The primary reason for the consultation was recorded in the EHR in 41.2% of the cases and the diagnosis in 44.1% of the cases. Diagnoses noted in the EHR were less often communicated to the patients than the primary reasons (p<0.0001). CONCLUSION: There is a loss of information between the dialog during a consultation and what is reported in the EHR. Consequences in terms of continuity and safety of care can be expected.


Assuntos
Registros Eletrônicos de Saúde , Clínicos Gerais , Humanos , Encaminhamento e Consulta
6.
Einstein (Sao Paulo) ; 17(4): eAO4696, 2019 Aug 22.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31460617

RESUMO

OBJECTIVE: To determine the frequency of drug therapy problem in the treatment of patients with tuberculosis and HIV/AIDS. METHODS: Data were obtained through a cross-sectional study conducted between September 2015 and December 2016 at a reference hospital in infectious diseases in Belo Horizonte (MG), Brazil. Sociodemographic, clinical, behavioral and pharmacotherapeutic variables were evaluated through a semi-structured questionnaire. Drug-related problems of pharmaceutical care were classified using the Pharmacotherapy Workup method. Factors associated with indication, effectiveness, safety and compliance drug therapy problem were assessed through multiple logistic regression. RESULTS: We evaluated 81 patients, and 80% presented at least one drug therapy problem, with indication and adherence drug therapy problem being the most frequent. The factors associated with drug therapy problem were age, marital status, new case, ethnicity, time of HIV diagnosis and time to treat tuberculosis. CONCLUSION: The frequency of drug therapy problem in coinfected patients was high and the identification of the main drug therapy problem and associated factors may lead the multiprofessional health team to ensure the use of the most indicated, effective, safe and convenient medicines for the patients clinical condition. Tuberculosis and HIV/AIDS coinfected individuals aged over 40 years are more likely to have drug therapy problems during treatment; in that, the most frequente are those that signal toward need of medication for an untreated health condition and non-compliance to treatment. Thus, older patients, unmarried or married, who have treated tuberculosis before, with a shorter time to tuberculosis treatment and longer time to diagnose HIV/AIDS, should receive special attention and be better followed by a multiprofessional health team because they indicate a higher chance of presenting Problems related to the use of non-adherent drugs.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antituberculosos/administração & dosagem , Cooperação do Paciente/estatística & dados numéricos , Medicamentos sob Prescrição/normas , Tuberculose/tratamento farmacológico , Adulto , Antituberculosos/efeitos adversos , Estudos Transversais , Feminino , Humanos , Masculino , Encaminhamento e Consulta , Fatores Socioeconômicos
7.
J Laryngol Otol ; 133(8): 704-712, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31370911

RESUMO

OBJECTIVES: The National Institute for Health and Care Excellence referral guidelines prompting urgent two-week referrals were updated in 2015. Additional symptoms with a lower threshold of 3 per cent positive predictive values were integrated. This study aimed to examine whether current pan-London urgent referral guidelines for suspected head and neck cancer lead to efficient and accurate referrals by assessing frequency of presenting symptoms and risk factors, and examining their correlation with positive cancer diagnoses. METHODS: The risk factors and symptoms of 984 consecutive patients (over a six-month period in 2016) were collected retrospectively from urgent referral letters to University College London Hospital for suspected head and neck cancer. RESULTS: Only 37 referrals (3.76 per cent) resulted in a head and neck cancer diagnosis. Four of the 23 recommended symptoms demonstrated statistically significant results. Nine of the 23 symptoms had a positive predictive value of over 3 per cent. CONCLUSION: The findings indicate that the current referral guidelines are not effective at detecting patients with cancer. Detection rates have decreased from 10-15 per cent to 3.76 per cent. A review of the current head and neck cancer referral guidelines is recommended, along with further data collection for comparison.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias de Cabeça e Pescoço/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Adulto Jovem
8.
Stud Health Technol Inform ; 264: 586-590, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437991

RESUMO

Telemedicine is an increasingly used strategy for providing care to patients. The prevention and treatment of Upper Respiratory Tract Infections (URTIs) during outbreaks still require new management approaches. We aimed to describe patients' characteristics and the care process after the creation and implementation of a virtual care program for patients with URTI during the epidemiological outbreak. We studied all consultations that took place between May, 21st, and September, 14th 2018 at Hospital Italiano de Buenos Aires (HIBA). After applying exclusion criteria 218 consultations were left for the analysis. Most patients did not need a referral to a care center for a face-to-face assessment. The consultation rate to the Emergency Department (ED) within 7 days was 11.92% (26/218) with a 95% CI of 7.94-16.99%. This new approach in patient care has a great potential for relieving the overcrowding in EDs, decreasing waiting times and preventing the infection spread in waiting rooms.


Assuntos
Infecções Respiratórias , Telemedicina , Surtos de Doenças , Humanos , Encaminhamento e Consulta , América do Sul
9.
Rech Soins Infirm ; 137(2): 49-61, 2019 06.
Artigo em Francês | MEDLINE | ID: mdl-31453671

RESUMO

Introduction and objective : In the activity of wound and scar nurses (Infirmières spécialisées en plaies et cicatrisation ; ISPC), the "second-line" nursing consultation is also an opportunity to offer applicants the opportunity for training. This study is part of an exploratory perspective, with the objective of questioning the didactic dimension of this type of consultation. To address the issue, attention is focused on the analysis of the ISPC's activity.Material and method : Two simple self-confrontation interviews of an ISPC are analyzed on the basis of video consultations.Results and discussion : Although the results identified remain incomplete since the interviews were based on a single individual, this article shows how the ISPC, after the interviews, is able to formulate future adjustments to their practice. The first avenue is to highlight a necessary transformation of the discourse of the ISPC during consultations. The second is to question the modality of the post-consultation follow-up.


Assuntos
Cicatriz/enfermagem , Encaminhamento e Consulta , Ferimentos e Lesões/enfermagem , Humanos
10.
Artigo em Alemão | MEDLINE | ID: mdl-31428831

RESUMO

BACKGROUND: The number of patients in emergency rooms without a medical emergency is increasing. Outpatient services for mutual support and relief between the in-patient and out-patient sector are not yet fully established. AIM OF THE WORK: The aim was to determine the extent to which patients in emergency rooms have real medical emergencies by comparing patients with at least two and those with a maximum of one chronic illness. An additional aim was to identify factors influencing the previous use of outpatient structures. MATERIAL AND METHODS: The study participants included emergency room patients from the cross-sectional study "PiNo-Nord." All persons in five emergency rooms in northern Germany between October 2015 and July 2016 who were not treated as "immediate" or "very urgent" were interviewed. An exploratory data analysis and multivariate logistic regression were performed. RESULTS: The 293 patients with ≥2 chronic diseases were just as often a medical emergency compared to the 847 patients with a maximum of 1 chronic disease. The most frequent occasions for consultation were musculoskeletal trauma (33%, n = 293 vs. 42%, n = 847) or trauma of the skin (11%, n = 293 vs. 13%, n = 847). In both groups, the general practitioner or specialist caregiver, as well as diagnostic or treatment options, rarely played a role in visiting the emergency department. The strongest predictors of previous outpatient treatment were the duration of the appeal in the last six months, a high subjective treatment urgency, the presence of at least two chronic conditions, and a consultation event concerning the musculoskeletal injuries. CONCLUSIONS: In both patient groups, no evidence of unnecessary visits to the emergency room was found. For the most part, outpatient structures are used in advance and the emergency department is only visited in the event of an actual medical emergency.


Assuntos
Doença Crônica/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Alta do Paciente , Doença Crônica/epidemiologia , Estudos Transversais , Alemanha , Humanos , Encaminhamento e Consulta
12.
Stud Health Technol Inform ; 264: 1199-1203, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438115

RESUMO

Due to several factors including time and budget constraints, General Practitioners (GPs) are often under-trained on the communication needs of patients with learning disabilities (LDs). As such, they may find it difficult to extract accurate information from these patients. Digital technologies have the potential to alleviate communication barriers, yet their use in this context remains vastly unexplored. Hence, we conducted 2 focus groups with 12 experts in LDs to investigate how tablet applications may be used to promote the information exchange process between GPs and patients with mild LDs. The experts identified an initial set of design criteria for the future implementation of these technologies and were enthusiastic about the potential impact they may have on primary care. In addition, they also discussed a potential model for extracting medical information from this population, which focused on breaking the overall consultation down into smaller, less cognitively challenging segments.


Assuntos
Telefone Celular , Clínicos Gerais , Transtornos de Aprendizagem , Grupos Focais , Humanos , Encaminhamento e Consulta
13.
Stud Health Technol Inform ; 264: 1403-1407, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438157

RESUMO

Clinical data, such as laboratory test results, is increasingly being made available to patients through patient portals. However, patients often have difficulties understanding and acting upon the clinical data presented in portals. As such, many turn to online resources to fill their knowledge gaps and obtain actionable advice. In this work, we present a content analysis of the questions posted in a major social Q&A site to characterize lay people's general information needs concerning laboratory test results and to inform the design of patient portals for supporting patients' understanding of clinical data. We identified 15 information needs related to laboratory test results, and clustered them under four themes: understanding the results of lab test, interpreting doctor's diagnosis, learning about lab tests, and consulting the next steps. We draw on our findings to discuss design opportunities for supporting the understanding of laboratory results.


Assuntos
Serviços de Laboratório Clínico , Portais do Paciente , Humanos , Internet , Encaminhamento e Consulta
14.
Stud Health Technol Inform ; 264: 1179-1183, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438111

RESUMO

The continuity of care is the relationship between a physician and a patient that extends throughout different episodes of illness. This care includes that in some opportunities the patient must consult a medical specialist. In this qualitative study, we set out to explore and describe the different requests for referral authorization to a specialist by patients affiliated with private health insurance, in order to understand the different patterns of interaction between general practitioners (GP) and their patients. The conversation analysis let us identify categories (structural and functional) after a critical reading of messages between GPs and their patients through an Electronic Health Records (EHR) messaging system. This work allowed us to know more in depth the process of continuity of care. In most cases, the doctor answered affirmatively to the request for a new referral to a specialist.


Assuntos
Clínicos Gerais , Registros Eletrônicos de Saúde , Humanos , Pesquisa Qualitativa , Encaminhamento e Consulta , Especialização
15.
Medicine (Baltimore) ; 98(33): e16808, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415394

RESUMO

Evidence-based studies have revealed outcomes in patients with chronic kidney disease that differed depending on the design of care delivery. This study compared the effects of 3 types of nephrology care: multidisciplinary care (MDC), nephrology care, and non-nephrology care. We studied their effects on the risks of requiring dialysis and the differences between these methods had on long-term medical resource utilization and costs.We conducted a retrospective cohort study involving patients with an estimated glomerular filtration rate of (eGFR) ≤45 mL/min/1.73 m from 2005 to 2007. Patients were divided into MDC, non-MDC, and non-nephrology referral groups. Between-group differences with regard to the risk of requiring dialysis and annual medical utilization and costs were evaluated using a 5-year follow-up period.In total, 661 patients were included. After other covariates and the competing risk of death were taken into account, we observed a significant (56%) reduction in the incidence of dialysis in both the MDC and non-MDC groups relative to the non-nephrology referral group. Costs were markedly lower in the MDC group relative to the other groups (average savings: US$ 830 per year; 95% confidence interval: 367-1295; P < .001).For patients without nephrology referrals, MDC can substantially reduce their risk of developing end-stage renal disease and lower their medical costs. We therefore strongly advocate that all patients with an eGFR of ≤45 mL/min/1.73 m should be referred to a nephrologist and receive MDC.


Assuntos
Assistência à Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Nefrologia/economia , Diálise Renal/economia , Insuficiência Renal Crônica/economia , Idoso , Assistência à Saúde/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nefrologia/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Equipe de Assistência ao Paciente/economia , Encaminhamento e Consulta/economia , Estudos Retrospectivos
16.
Rev. Hosp. El Cruce ; (24): 1-7, 18/07/2019.
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1006642

RESUMO

OBJETIVO: Este trabajo presenta el inicio de un proyecto de largo término que analiza la dinámica local de circulación de pacientes y colaboración profesional entre el conjunto de efectores localizados en los partidos de Florencio Varela, Berazategui, Alte. Brown y Quilmes, denominado la Red del Sudeste Bonaerense. Ésta articula efectores de primer, segundo y tercer nivel de atención (169 en total), asiste a 2 millones de personas anualmente en una de las áreas con mayor población del país y con altos niveles de necesidades básicas insatisfechas. METODOLOGÍA: La metodología se plantea desde los métodos mixtos que articulan técnicas cualitativas y cuantitativas para la recolección, procesamiento y análisis de la información de los efectores de la Red, a partir de: registros de pacientes pediátricos, datos epidemiológicos y trabajo de campo etnográfico. Complementariamente, se articulan tres líneas multi-disciplinarias: Análisis de sistemas y servicios de salud en red; Análisis espacial entre centros de salud; Análisis de redes sociales (identifica estructuras y dinámicas de flujo y colaboración). RESULTADOS: Los resultados sugieren: a) la estructura de derivaciones la HEC tiene una forma de "estrella", b) mayor cantidad de derivaciones desde los distritos de la Red del Sudeste que de otros efectores, c) Coeficiente de Jaccard es bajo, d) dificultades en el mecanismo de contra-referencia, e) la estructura de colaboración entre 25 especialidades es un modelo "centro/periferia", f) emergen subgrupos de acuerdo a las patologías derivadas. CONCLUSIÓN: Se concluye con una discusión sobre la importancia de la interacción estructural entre las especialidades para la atención compleja de patologías pediátricas. Finalmente, la centralidad del HEC en la dinámica de derivaciones pediátricas se corresponde con su condición de único efector de tercer nivel de la región, su robusta comunicación con los efectores en el territorio así como por su posicionamiento como referente nacional de derivación por patologías específicas.


OBJECTIVE: This paper presents the beginning of a long-term project that analyses local dynamics of patient transfers and professional collaboration among a formal assistance network of health providers called the "Southeastern Network" localized in four districts in the Metropolitan Area of Buenos Aires: F. Varela, Berazategui, Alte. Brown y Quilmes. This network connects primary, secondary and tertiary care levels (169 in total) and assists over 2 million people annually in the region, one of the most populated and deprived areas in Argentina. METHODS: Methodological strategies point toward a mixed methods approach, which articulates qualitative and quantitative methods for collecting, processing and analyzing the information from the network care providers: patients institutional registers, epidemiological data and ethnographic field work.Additionally, we follow three multi-disciplinary lines: health systems and services analysis, special analysis regarding care providers, Social Network Analysis (identifying structures and dynamics of patients flow and professional collaboration). RESULTS: Suggest: a) the structure of patients' referral is "star" model b) there are more referrals from the Network's districts than from other areas c) Jaccard Coefficient is low, d) there are some difficulties in counter-referral mechanisms e) professional collaboration structure among 25 medical specialties is a "center/periphery" model f) some subgroups emerge from assisting certain pathologies. CONCLUSIONS: We conclude with a discussion on the importance of structural interaction among medical specialties for complex pediatric care. Finally, the centrality of El Cruce Hospital within pediatric referrals in this area correspond to the fact that it is the only tertiary care provider, it maintains robust communications with other care providers and it is positioned as national reference for specific pathologies referral.


Assuntos
Encaminhamento e Consulta , Níveis de Atenção à Saúde , Pesquisa Qualitativa , Atenção à Saúde , Sistemas Nacionais de Saúde , Hospitais Pediátricos
17.
Rev. argent. salud publica ; 39(9): 35-37, Julio 2019.
Artigo em Espanhol | LILACS, BINACIS, ARGMSAL | ID: biblio-1007208

RESUMO

INTRODUCCIÓN: El Hospital Posadas organiza anualmente desde 2007 la atención, el seguimiento y la referencia de niños y niñas de 0 a 6 años con infecciones respiratorias agudas bajas (IRAB) a fin de afrontar la epidemia pediátrica y disminuir la morbimortalidad infantil por esta patología. OBJETIVO: mejorar la transversalidad de la estrategia de atención integral en red para el cuidado de los pacientes con IRAB en los diferentes niveles de atención del sistema público de salud de las regiones sanitarias V, VII y XII de la Provincia de Buenos Aires, a fin de contribuir a la disminución de la morbimortalidad infantil, fortalecer las redes asistenciales de salud y garantizar el acceso de la población al nivel de complejidad que requiera, según el riesgo de su situación sociosanitaria. MÉTODOS: diseño descriptivo vinculado al relato de la experiencia de intervención en salud sobre las IRAB y con un enfoque retrospectivo como base para la exposición de la estrategia y la evaluación de resultados. RESULTADOS: Considerando el ingreso de usuarios por guardia, neonatología, consultorio de seguimiento e internación, se registraron 1838 eventos totales (710 en internación y 1128 en ambulatorio) de los cuales 1560 fueron referenciados. El tiempo promedio de demora en la referencia del equipo del hospital a los territorios fue inferior a un día (19 horas) y menor que el de pacientes ambulatorios. DISCUSIÓN: la intervención permitió aumentar la cantidad de usuarios incluidos en la estrategia, favoreció el trabajo conjunto y la integración de los equipos de salud interhospitalarios.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Pediatria , Encaminhamento e Consulta , Infecções Respiratórias , Cultura Organizacional
18.
Am J Orthod Dentofacial Orthop ; 156(1): 61-66, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256840

RESUMO

OBJECTIVE: The objectives of this research were to investigate and compare general and pediatric dentists' subjective judgments of orthodontic case complexity and to determine how their perceptions of case complexity influence their decisions to refer the patient to an orthodontist. METHODS: Twenty pediatric dentists and 21 general dentists participated in the study. Pretreatment orthodontic records of 20 patients with a variety of malocclusions and a range of American Board of Orthodontics Discrepancy Index (DI) scores were used. Respondents were asked about their background and training in orthodontics. They were also asked to identify the subjective complexity of each case with the use of a 100-point visual analog scale (VAS) and whether they would refer the patient to an orthodontic specialist. A mixed-model multivariate data analysis was used to evaluate the subjective case complexity with the use of fixed factors such as DI score, type of panel member, experience, annual continuing education rate, and gender. Generalized linear mixed models were used to investigate the referral patterns of the general dentists and pediatric dentists. Level of significance was set at P < 0.05 for all statistical analyses. RESULTS: General dentists appeared to provide more overall orthodontic treatment than pediatric dentists; many general dentists provide limited orthodontic treatment and clear aligner therapy (P < 0.05). The perceived complexity score for cases was not significantly different between the 2 groups (P = 0.82). The association between DI score and perceived complexity was similar in both groups (P = 0.183) and there was a high correlation between DI and VAS score in the sample (r = 0.71; 95% Cl 0.38-0.87). Pediatric dentists had higher referral rates for cases with DI scores both below and above 20. Significant differences were noted between the pediatric and general dentists in the individual case referral decision as evaluated by the DI (P < 0.037) and VAS (P < 0.042) scores. CONCLUSIONS: General dentists provided more orthodontic care than the pediatric dentists. Both groups identified case complexity similarly, with only minor differences, but pediatric dentists had higher referral rates to orthodontic specialists regardless of the initial case complexity.


Assuntos
Tomada de Decisões , Odontólogos , Clínicos Gerais , Índice de Necessidade de Tratamento Ortodôntico , Ortodontistas , Encaminhamento e Consulta/normas , Atitude do Pessoal de Saúde , Odontólogos/educação , Clínicos Gerais/educação , Humanos , Julgamento , Má Oclusão/terapia , Análise Multivariada , Ortodontia Corretiva , Seleção de Pacientes , Projetos de Pesquisa , Inquéritos e Questionários
19.
Pan Afr Med J ; 33: 4, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31303949

RESUMO

Introduction: Self-referrals to inappropriate levels of care result in an increased patient waiting time, overburdening of higher levels of care, reduced primary healthcare utilisation rate and increasing healthcare costs. Furthermore, self-referral places an additional encumbrance on various levels of care as allocation of resources and infrastructure cannot be accurately planned, based on the facility catchment population. The aim of this study was to determine the prevalence and determinants of patient self-referral at the out-patient department of Stanger Hospital, KwaZulu-Natal between January and June 2017. Methods: A cross-sectional study was conducted at the out-patient department in Stanger Hospital, using interviewer administered questionnaires to collect information from 385 patients, through convenience sampling, between January and June 2017. Multivariable regression analysis was used to test for factors associated with self-referral. Results: of the 385 patients interviewed 36% (n = 138) were self-referrals. Most of the self-referrals were male (51.5%) and of the African race (57.2%). Five institutional factors namely: care received from healthcare workers (91.3%); waiting times (88.4%); help offered (87%); treatment and attitude of healthcare workers (63%) and availability of medication (55.8%) were considered as the main drivers of self-referral. Multivariable regression analysis established a significant positive association between patient self-referral and age (40 years and below), attitude of healthcare workers, quality of care received form healthcare workers, waiting times and the availability of diagnostic tests. Conclusion: This study indicates that most patients attending Stanger Hospital do comply with the prescribed referral pathway, however a significant proportion still bypass the referral system.


Assuntos
Hospitais de Distrito/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Listas de Espera , Adulto , Fatores Etários , Estudos Transversais , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Regressão , África do Sul , Inquéritos e Questionários , Fatores de Tempo
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