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1.
BMC Health Serv Res ; 21(1): 644, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217265

RESUMO

BACKGROUND: Symptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 18 healthcare systems across the world, with numbers increasing in some cases to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral. This review sought to summarise findings from observational studies conducted in high income countries on PAs' competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care. METHOD: A rapid systematic review of international peer-reviewed literature was performed. Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009-2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. Synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation. RESULTS: From 883 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n = 6) and referrals to specialists (n = 4). Fewer papers reported on consultation processes, such as examinations or history taking (n = 3) Six papers considered PAs' competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis. CONCLUSION: This review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs' roles, including outcomes of the diagnostic process.


Assuntos
Neoplasias , Assistentes Médicos , Médicos , Humanos , Atenção Primária à Saúde , Encaminhamento e Consulta , Especialização
2.
BMC Med Educ ; 21(1): 366, 2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34217282

RESUMO

BACKGROUND: Despite multi-professional collaboration via consultation being increasingly important given the variety of disease diagnoses and treatment, the key elements as consultants remain unclear. The study aimed to identify the skills and attitudes that are important for consultants from the residents' perspective so that they can be targeted as priority goals in subsequent educational interventions. METHODS: We conducted our research in two phases: a preliminary survey (May 1 to 14, 2020) and a main survey (June 1 to 14, 2020). As a preliminary survey, first-year postgraduate residents at St. Luke's International Hospital in Tokyo, Japan, were first asked an open-ended question about the types of skills and attitudes that are important for consultants. After eliminating duplicate answers, there were 19 skills and attitudes in total. In the main survey with residents who completed their residency training at our institute, from 2014 to 2018 and current residents (2019-2020), we first asked them about their demographic characteristics (gender, years of postgraduate education, and type of specialty). Then, they answered how important each skill and attitude are for consultants. All 19 items were scored on a seven-point Likert scale that ranged from 0 (completely disagree) to 6 (totally agree). Cronbach's alpha confirmed the internal consistency of the questionnaire items. Principal component analysis and exploratory factor analysis were performed. RESULTS: The survey included 107 individuals (61.1 %, 175 potential participants). The median postgraduate years of education was four (interquartile range: 2-5), and 64.5 % were men (n = 69). Seven key elements for consultants were identified and termed Willing CONSULT. These included (1) willingness (willingness to accept consultation requests), (2) contact (easy access to consultants), (3) needs (consideration of consulters' needs), (4) suggestions and support (providing clear recommendations and suggestions, following up on the patients, and supporting the consulters continuously), (5) urgency (considering the situation's urgency and responding appropriately), (6) learning opportunities (providing teaching points), and (7) text (writing medical records). CONCLUSIONS: We propose Willing CONSULT, which are important skills and attitudes for consultants.


Assuntos
Consultores , Internato e Residência , Atitude do Pessoal de Saúde , Estudos Transversais , Humanos , Japão , Masculino , Encaminhamento e Consulta , Inquéritos e Questionários , Tóquio
3.
Eur J Gen Pract ; 27(1): 142-151, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34212814

RESUMO

BACKGROUND: The COVID-19 pandemic has resulted in the rapid reorganisation of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks. OBJECTIVES: We explored the type and nature of patient safety incidents in French primary care settings during the COVID-19 first wave to make tentative recommendations for improvement. METHODS: A national patient safety incident reporting survey was distributed to General Practitioners (GPs) in France on 28 April 2020. Reports were coded using a classification system aligned to the WHO International Classification for Patient Safety (incident types, contributing factors, incident outcomes and severity of harm). Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical analysis. Clinicaltrials.gov: NCT04346121. RESULTS: Of 132 incidents, 58 (44%) related to delayed diagnosis, assessments and referrals. Cancellations of appointments, hospitalisations or procedures was reported in 22 (17%) of these incidents. Home confinement-related incidents accounted for 13 (10%) reports and inappropriate medication stopping for five (4%). Patients delayed attending or did not consult their general practitioner or other healthcare providers due to their fear of contracting COVID-19 infection at an in-person visit in 26 (10%) incidents or fear of burdening their GPs in eight (3%) incidents. CONCLUSION: Constraints from the first wave of the COVID-19 pandemic have contributed to patient safety incidents during non-COVID-19 care. Lessons from these incidents pinpoint where primary care services in France can focus resources to design safer systems for patients.


Assuntos
COVID-19/epidemiologia , Controle de Infecções/organização & administração , Segurança do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/prevenção & controle , COVID-19/transmissão , Criança , Pré-Escolar , Comunicação , Diagnóstico Tardio/estatística & dados numéricos , Feminino , França , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Inquéritos e Questionários , Adulto Jovem
4.
Acta Derm Venereol ; 101(7): adv00501, 2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34230982

RESUMO

Targeted medications and immunotherapies are being developed to specifically target the pathways involved in tumours. There is limited experience with these new medications and their cutaneous side-effects in the paediatric population. A retrospective study of all paediatric oncological patients treated with targeted therapies and immunotherapies between 1 January 2013 and 1 August 2020 was carried out in 2 haemato-oncological referral centres. A total of 103 children were included in the study. The median (interquartile range) age was 13 years (8.4-16.9), male:female ratio 1.5:1, median (interquartile range) follow-up was 7 months (2-18). Fifty (48%) of the children developed cutaneous adverse events. Treatment was discontinued in only 3 (6%) cases and was altered in only (2%) 1 case due to a cutaneous adverse event. When targeted therapies and immunotherapies for tumours in children are used, there is an increased incidence of cutaneous adverse events. Nevertheless, treatment modification or discontinuation due to cutaneous side-effects is rarely needed.


Assuntos
Terapia de Alvo Molecular , Pele , Criança , Feminino , Humanos , Imunoterapia/efeitos adversos , Lactente , Masculino , Terapia de Alvo Molecular/efeitos adversos , Encaminhamento e Consulta , Estudos Retrospectivos
5.
BMC Health Serv Res ; 21(1): 683, 2021 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-34246276

RESUMO

BACKGROUND: Patients in Alberta, Canada are referred to the United States (US) for proton treatment. The Alberta Ministry of Health pays for the proton treatment and the cost of flights to and from the United States. This study aimed to determine the out-of-pocket expenses incurred by patients or patients' families. METHODS: An electronic survey was sent to 59 patients treated with proton therapy between January 2008 and September 2019. Survey questions asked about expenses related to travel to the US and those incurred while staying in the US, reimbursement of expenses, and whether any time away from work was paid or unpaid leave. RESULTS: Seventeen respondents (response rate, 29%) reported expenses of flights for family members (mean, CAD 1886; range CAD 0-5627), passports/visas and other travel costs (mean, CAD 124; range CAD 0-546), accommodation during travel to the US (mean, CAD 50; range CAD 0-563), food during travel to the US (mean, CAD 89; range CAD 0-338), accommodation in the US (rented home/apartment mean, CAD 7394; range CAD 3075-13,305; hotel mean, CAD 4730; range CAD 3564-5895; other accommodation mean CAD 2660; range CAD 0-13,842), transportation in the US (car mean, CAD 2760; range CAD 0-7649; bus/subway mean, CAD 413; range CAD 246-580), and food in the US (mean, CAD 2443; range 0-6921). Expenses were partially reimbursed or covered by not-for-profit organizations or government agencies for some patients (35%). Patients missed a mean of 59 days of work; accompanying family members missed an average of 34 days. For 29% this time away from work was paid, but unpaid for 71% of respondents. CONCLUSIONS: Multiple factors contributed to the expenses incurred including age of the patient, number of accompanying individuals, available accommodation, mode of transportation within the US, and whether the patient qualified for financial support. Added to this burden is the potential loss of wages for time away from work. The study showed a large variation in indirect costs for each family and supports actively seeking more opportunities for financial support for families with children with cancer.


Assuntos
Terapia com Prótons , Adulto , Alberta/epidemiologia , Criança , Efeitos Psicossociais da Doença , Gastos em Saúde , Humanos , Encaminhamento e Consulta , Inquéritos e Questionários , Estados Unidos
6.
MMWR Morb Mortal Wkly Rep ; 70(27)2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34237048

RESUMO

As of June 30, 2021, 33.5 million persons in the United States had received a diagnosis of COVID-19 (1). Although most patients infected with SARS-CoV-2, the virus that causes COVID-19, recover within a few weeks, some experience post-COVID-19 conditions. These range from new or returning to ongoing health problems that can continue beyond 4 weeks. Persons who were asymptomatic at the time of infection can also experience post-COVID-19 conditions. Data on post-COVID-19 conditions are emerging and information on rehabilitation needs among persons recovering from COVID-19 is limited. Using data acquired during January 2020-March 2021 from Select Medical* outpatient rehabilitation clinics, CDC compared patient-reported measures of health, physical endurance, and health care use between patients who had recovered from COVID-19 (post-COVID-19 patients) and patients needing rehabilitation because of a current or previous diagnosis of a neoplasm (cancer) who had not experienced COVID-19 (control patients). All patients had been referred to outpatient rehabilitation. Compared with control patients, post-COVID-19 patients had higher age- and sex-adjusted odds of reporting worse physical health (adjusted odds ratio [aOR] = 1.8), pain (aOR = 2.3), and difficulty with physical activities (aOR = 1.6). Post-COVID-19 patients also had worse physical endurance, measured by the 6-minute walk test† (6MWT) (p<0.001) compared with control patients. Among patients referred to outpatient rehabilitation, those recovering from COVID-19 had poorer physical health and functional status than those who had cancer, or were recovering from cancer but not COVID-19. Patients recovering from COVID-19 might need additional clinical support, including tailored physical and mental health rehabilitation services.


Assuntos
Instituições de Assistência Ambulatorial , COVID-19/reabilitação , Encaminhamento e Consulta , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Estados Unidos , Adulto Jovem
7.
Urologe A ; 60(7): 847-853, 2021 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-34232324

RESUMO

Testicular cancer occupies a special position in several respects. Although it belongs to the group of rare tumors, which is why extensive experience in treating this tumor can not be guaranteed, interdisciplinary experts collaboration and the consequent implementation of clinical studies have resulted in standardized treatment recommendations. Because testicular cancer is one of the most curable cancers, long-term toxicity and treatment sequelae are of special importance. In the early stages, toxicity could be reduced by minimizing therapy to the extent possible, but without decreasing treatment success. Nevertheless, treatment is still controversially discussed, especially concerning treatment of stage I disease. Finally particular focus should be paid to non-germinal tumors which are even more rare, but partly also more dangerous. Therefore known facts should be made available for the broad medical community. In penile cancer, which is also a very rare tumor entity, organ-sparing surgery and consequent invasive lymph node staging are mandatory.


Assuntos
Neoplasias Embrionárias de Células Germinativas , Neoplasias Penianas , Neoplasias Testiculares , Humanos , Excisão de Linfonodo , Masculino , Estadiamento de Neoplasias , Neoplasias Penianas/patologia , Qualidade de Vida , Encaminhamento e Consulta , Neoplasias Testiculares/patologia
8.
Afr J AIDS Res ; 20(2): 181-188, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34264164

RESUMO

Despite global calls for stronger linkages between family planning and HIV, a growing body of evidence in sub-Saharan Africa suggests that the integration of family planning and HIV service delivery is suboptimal in some countries. In this study, we assess the integration and quality of family planning services in health facilities that provide HIV-related services in Nigeria. This study analysed secondary data from the Performance Monitoring and Accountability 2020 cross-sectional survey conducted between May and July 2016 in seven states in Nigeria. Our study sample was restricted to 290 health facilities providing HIV services. We performed descriptive statistics and binary logistic regression analyses. Ninety-five per cent of the health facilities reported offering family planning counselling, provision of family planning methods, and/or referral for family planning methods to clients accessing HIV services. About 84% of these health facilities with integrated family planning and HIV services reported that they discussed the preferred method, dual methods, instructions and side effects of the chosen method, and the reproductive intentions with clients during an HIV consultation. None of the health facilities' characteristics was significantly associated with the integration of family planning services into HIV services. Private health facilities (aOR 0.3, 95% CI 0.07-0.92), urban health facilities (aOR 3.8, 95% CI 1.64-8.76), and provision of postnatal care (aOR 3.9, 95% CI 1.10-13.74) were statistically associated with the quality of family planning services provided to clients accessing HIV services. Family planning services were integrated into HIV services in a majority of the health facilities in our study. However, our findings indicate the need for improvement in the quality of family planning services provided to clients accessing HIV services.


Assuntos
Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Infecções por HIV/terapia , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/métodos , Serviços de Planejamento Familiar/métodos , Infecções por HIV/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Humanos , Nigéria/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Educação Sexual/estatística & dados numéricos
9.
Artigo em Inglês | MEDLINE | ID: mdl-34207403

RESUMO

The aim of the study was to evaluate occlusal parameters in patients with myofascial pain with referral before and after soft tissue mobilization. The study group consisted of 50 people (37 females and 13 males, average age 23.36 ± 2.14 years) diagnosed with myofascial pain with referral. All patients underwent triplicate soft tissue mobilization. Occlusal parameters were evaluated six times, before and after each treatment, using T-scan III. A decreasing tendency of the occlusion time was observed after the first, second, and third therapy. After the third treatment, the mean occlusion time in the entire study group was 0.119 s. The 1st soft tissue mobilization shortened both right and left disclusion times to 0.181 s and 0.185 s, respectively. After the third treatment, these parameters amounted to 0.159 s and 0.165 s, respectively. The Friedman test for the entire study group indicated that soft tissue mobilization altered the occlusion time and both disclusion times (p < 0.05). In conclusion, soft tissue mobilization affects biotensegrity of the masticatory system, thus modifying occlusal parameters. The occlusion time and both disclusion times cannot be considered as cofactors of the existing temporomandibular disorders-myofascial pain with referral.


Assuntos
Síndromes da Dor Miofascial , Transtornos da Articulação Temporomandibular , Adulto , Feminino , Humanos , Masculino , Dor , Encaminhamento e Consulta , Transtornos da Articulação Temporomandibular/terapia , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-34200689

RESUMO

Emergency units have been gradually recognized as important settings for palliative care initiation, but require precise palliative care assessments. Patients with different illness trajectories are found to differ in palliative care referrals outside emergency unit settings. Understanding how illness trajectories associate with patient traits in the emergency department may aid assessment of palliative care needs. This study aims to investigate the timing and acceptance of palliative referral in the emergency department among patients with different end-of-life trajectories. Participants were classified into three end-of-life trajectories (terminal, frailty, organ failure). Timing of referral was determined by the interval between the date of referral and the date of death, and acceptance of palliative care was recorded among participants eligible for palliative care. Terminal patients had the highest acceptance of palliative care (61.4%), followed by those with organ failure (53.4%) and patients with frailty (50.1%) (p = 0.003). Terminal patients were more susceptible to late and very late referrals (47.4% and 27.1%, respectively) than those with frailty (34.0%, 21.2%) and with organ failure (30.1%, 18.8%) (p < 0.001, p = 0.022). In summary, patients with different end-of-life trajectories display different palliative care referral and acceptance patterns. Acknowledgement of these characteristics may improve palliative care practice in the emergency department.


Assuntos
Hospitais para Doentes Terminais , Cuidados Paliativos , Serviço Hospitalar de Emergência , Humanos , Encaminhamento e Consulta , Estudos Retrospectivos
11.
Bone Joint J ; 103-B(7 Supple B): 98-102, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192903

RESUMO

AIMS: The purpose of this study was to determine the access to and ability to use telemedicine technology in adult patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), and to determine associations with the socioeconomic characteristics of the patients, including age, sex, race, and education. We also sought to understand the patients' perceived benefits, risks, and preferences when dealing with telemedicine. METHODS: We performed a cross-sectional survey involving patients awaiting primary THA and TKA by one of six surgeons at a single academic institution. Patients were included and called for a telephone-administered survey if their surgery was scheduled to be between 23 March and 2 June 2020, and were aged > 18 years. RESULTS: The response rate was 52% (189 of 363 patients). A total of 170 patients (90.4%) reported using the internet, 177 (94.1%) reported owning a device capable of videoconferencing, and 143 (76.1%) had participated in a video call in the past year. When asked for their preferred method for a consultation, 155 (82.8%) and 26 (13.9%) ranked in-person and a videoconference as their first choice, respectively. The perceived benefits of telemedicine consultations included reduced travel to appointments (165 (88.2%) agreed) and reduced cost of attending appointments (123 (65.8%) agreed). However, patients were concerned that they would not establish the same patient-physician connection (100 (53.8%) agreed), and would not receive the same level of care (52 (33.2%) agreed) using telemedicine consultations compared with in-person consultations. CONCLUSION: Most patients undergoing arthroplasty have access to and are capable of using the technology required for telemedicine consultations. However, they still prefer in-person consultations due to concerns that they will not establish the same patient-physician connection and will not receive the same level of care, despite the benefits of reducing the time spent in travelling and the cost of attending appointments, and the appointments being easier to attend. Cite this article: Bone Joint J 2021;103-B(7 Supple B):98-102.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Acesso aos Serviços de Saúde , Encaminhamento e Consulta , Telemedicina , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários
12.
Emerg Med Clin North Am ; 39(3): 589-603, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215404

RESUMO

Emergency medicine clinicians are mandated reporters, legally, which obligates clinicians to report any behavior suspicious for child maltreatment to local authorities. Pediatric patients often present to the emergency department with concern for physical injury and other pervasive complaints. In some cases, these injuries are nonaccidental. To appropriately advocate and protect children from further physical and emotional trauma, it is important for clinicians to recognize the signs and symptoms of child maltreatment and sexual abuse.


Assuntos
Maus-Tratos Infantis/diagnóstico , Cuidadores , Criança , Desenvolvimento Infantil , Serviços de Proteção Infantil , Diagnóstico Diferencial , Diagnóstico por Imagem , Medicina Legal , Humanos , Notificação de Abuso , Anamnese , Síndrome de Munchausen Causada por Terceiro/diagnóstico , Exame Físico , Profilaxia Pós-Exposição , Encaminhamento e Consulta , Doenças Sexualmente Transmissíveis/prevenção & controle , Tempo para o Tratamento
13.
Rev Soc Bras Med Trop ; 54: e00762021, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34231771

RESUMO

INTRODUCTION: Leptospirosis and brucellosis cause immunosuppression that worsens the clinical condition of people living with HIV/AIDS (PLWHA). We investigated the serological profile and risk factors of PLWHA. METHODS: Serum samples (n=238) were researched for Brucella spp. antibodies using Rose Bengal and tube agglutination tests and Leptospira spp. antibodies using the microscopic agglutination test. RESULTS: All samples were negative for Brucella spp. For leptospirosis, four samples (1.69%) were positive, and Andamana was the prevalent serovar. CONCLUSIONS: Low or no detection of these zoonoses does not reduce their importance in PLWHA. Vigilant, educational, and preventive measures should be adopted.


Assuntos
Brucelose , Infecções por HIV , Leptospira , Leptospirose , Testes de Aglutinação , Animais , Anticorpos Antibacterianos , Brasil/epidemiologia , Brucelose/complicações , Brucelose/epidemiologia , HIV , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Hospitais , Humanos , Leptospirose/complicações , Leptospirose/epidemiologia , Encaminhamento e Consulta , Fatores de Risco
14.
Artigo em Inglês | MEDLINE | ID: mdl-34281079

RESUMO

The study aimed to evaluate hospitalizations in a COVID-dedicated facility during the "spring wave" of the epidemic in 2020 in Poland and analyze changes in access to hospital treatment in the country in the early phase of the pandemic. We investigated all referrals and admissions to the Ministry of Interior and Administration hospital in Bialystok from 14 April to 14 August 2020. A total of 238 patients were referred to the hospital (with a median age of 64.5 years; IQR, 44-78), most commonly with fever (n = 151; 63.5%). Only 135 (56.7%) were admitted (5.5% of the number hospitalized in the same period in 2019). SARS-CoV-2 was confirmed in 42 (17.7%) cases. Older people with concomitant diseases and disabilities dominated. Seventeen patients (12.6%) required ICU treatment, and 19 (14%) died. Based on the National Health Fund data, we also examined changes in the rate of hospitalizations in Poland and in selected Polish COVID/ and non-COVID hospitals between February and August 2019 and 2020. The number of hospitalizations in Poland decreased dramatically in comparison to 2019. A very low hospitalization rate, significantly lower than in structurally similar non-COVID hospitals, was observed in transformed hospitals. Better use of hospital resources was observed when the hospital was semi-transformed and had the flexibility to adapt to epidemiological needs. The study seems to confirm that the system of transformed COVID hospitals resulted in unused healthcare resources and limited patient access to medical services in the early period of the epidemic. As a consequence, systemic modifications allowing the maximization and adequate use of the Polish healthcare system's limited resources have been implemented.


Assuntos
COVID-19 , Adulto , Idoso , Estudos Transversais , Hospitalização , Hospitais , Humanos , Pessoa de Meia-Idade , Pandemias , Polônia/epidemiologia , Encaminhamento e Consulta , Estudos Retrospectivos , SARS-CoV-2
15.
BMC Health Serv Res ; 21(1): 713, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34284786

RESUMO

BACKGROUND: Many patients with mental disorders are treated by their general practitioner (GP). Innovative technology-based integrated care models (e.g., mental health specialist video consultations) have been proposed to facilitate access to specialist services in primary care settings. While perspectives of patients and providers have been examined, there is little insight into the perspectives of health policy experts on such models. The purpose of this study was to examine the perspectives of health policy experts on (1) current challenges for continuity of care, (2) anticipated benefits and barriers for implementation of mental health specialist video consultations along with (3) practical and regulative preconditions for sustained implementation in primary care. METHODS: In a cross-sectional qualitative study, we conducted 15 semi-structured interviews with health policy experts representing various stakeholders in the German health care system: health insurances, governmental bodies, clinicians' professional associations, and patient representatives. Following a critical realism approach, we applied a qualitative inductive content analysis to derive key themes from the material. RESULTS: Health policy experts saw long waiting times for patients and a lack of collaboration between in- and outpatient mental health services as well as mental health specialists and GPs as main barriers for current continuity of care. Health policy experts also felt that video consultations bear great potential to foster coordinated care between GPs and specialists and ensure timely referral for severely burdened patients. Increased workload for the general practice staff to facilitate video consultations and difficulties in establishing reliable therapeutic alliances between patients and specialists via remote treatment were considered as major barriers. Health policy experts varied significantly in their level of knowledge concerning legal frameworks and regulations pertaining to video consultations. However, the implementation of appropriate reimbursement schemes and sufficient data protection were regarded as the major regulative challenges. CONCLUSIONS: Health policy experts mostly consider mental health specialist video consultations as a promising way to overcome current challenges for the management of patients with mental disorders at the interface between primary and specialist care. To ensure sustained implementation, a multi-stakeholder approach accounting for the perspective of health policy experts, patients, and providers should be followed. TRIAL REGISTRATION: German Clinical Trials Register DRKS00012487.


Assuntos
Saúde Mental , Telemedicina , Estudos Transversais , Política de Saúde , Humanos , Atenção Primária à Saúde , Pesquisa Qualitativa , Encaminhamento e Consulta , Especialização
17.
Int J Qual Health Care ; 33(3)2021 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-34270723

RESUMO

BACKGROUND: Patients and primary care providers (PCPs) can experience frustration about poor access to specialist care. The Champlain Building Access to Specialists through eConsultation (BASETM) is a secure online platform that allows PCPs to ask a clinical question to 142 different specialty groups. The specialist is expected to respond within 7 days. METHODS: This is a retrospective review of the Champlain BASETM respirology eConsults from January 2017 to December 2018. The eConsults were categorized by types of questions asked by the referring provider and by the clinical content of the referral. Specialists' response time and time spent answering the clinical question were analyzed. Referring providers' close-out surveys were reviewed to assess the impact of the respirology eConsult service on traditional referral rates and clinical course of action. RESULTS: Of the 26 679 cases submitted to the Champlain BASE TM eConsult service, 268 were respirology cases (1%). 91% were sent by family physicians and 9% by nurse practitioners. The median time to respond by specialists was 0.8 days, and the median time billed by specialists was 20 min. The most common topics were pulmonary nodules and masses (16.4%), cough (10.4%), infective problems (8.6%), chronic obstructive pulmonary disease (8.6%) and dyspnea Not Yet Diagnosed (NYD) (7.8%). The most common types of questions asked by PCP were related to investigations warranted (43.1% of cases), general management (17.5%), monitoring (12.6%), need for a respirology referral (12.3%) and drug of choice (6.3%). In 23% of cases, the PCP indicated they were planning to refer the patient for an in-person consultation but no longer needed to after receiving the eConsult advice (avoided referrals). On the other hand, in 13% of cases, the PCP was not going to refer but did after the eConsult (prompted referrals). The eConsult led to a new or additional clinical course of action by the PCP in 49% of cases. In 51% of cases, the PCP suggested the clinical topic would be well suited to a CME event. CONCLUSIONS: Participation in eConsult services can improve timely access to respirologists while potentially avoiding clinic visits and significantly impacting referring PCPs clinical course of action. Using the most common clinical topics and types of questions for CME planning should be considered. Future research may include a cost analysis and provider perspectives on the role of eConsult in respirology care.


Assuntos
Acesso aos Serviços de Saúde , Atenção Primária à Saúde , Estudos Transversais , Humanos , Encaminhamento e Consulta , Estudos Retrospectivos
18.
J Cataract Refract Surg ; 47(8): 1096, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34292894

RESUMO

A 56-year-old man with an ocular history of strabismus surgery at age 3 years, anatomically narrow angles, and patent laser peripheral iridotomies in both eyes underwent refractive lens exchange in which a SA60AT (Alcon Laboratories, Inc.) 38 diopter (D) intraocular lens (IOL) was implanted in the right eye and a SA60AT 36 D IOL was implanted in the left eye. He presented with symptoms consistent with negative dysphotopsia (ND) in both eyes immediately after surgery, describing temporal dark arcs that were constantly present and did not improve over the past 2 years. Of note, the patient was most symptomatic in the left eye. On examination, the manifest refractions and corrected distance visual acuities were -0.50 +1.50 × 20 and 20/20 in the right eye and +0.75 -1.25 × 158 and 20/20 in the left eye; visual fields, extraocular motility, and pupils were normal. Intraocular pressures were normal as measured by applanation tonometry at 10 mm Hg in both eyes. Slitlamp examination revealed trace meibomian gland disease in both eyes, normal tear lake and cornea, and patent peripheral laser iridotomies at the 11 o'clock position in the right eye and the 1 o'clock position in the left eye. The anterior chamber was slightly shallow temporally but deep centrally and quiet in both eyes. The lens examination revealed 4.0 mm anterior fibrotic capsule openings with well-positioned SA60AT posterior chamber IOLs in the bag with haptics at 1 and 7 o'clock in both eyes (Figure 1JOURNAL/jcrs/04.03/02158034-202108000-00021/figure1/v/2021-07-22T111213Z/r/image-tiff). The posterior capsule was intact with trace posterior capsule opacification in both eyes and striae in the posterior capsules. Dilated fundus examination was unremarkable with a cup-to-disc ratio of 0.4 in the right eye and 0.3 in the left eye and normal pink neuroretinal rims. What strategies would you offer this patient to treat the ND and what specific testing and counseling do you provide for patients with this condition?


Assuntos
Cápsula do Cristalino , Lentes Intraoculares , Pré-Escolar , Humanos , Implante de Lente Intraocular , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Encaminhamento e Consulta
19.
Zhonghua Shao Shang Za Zhi ; 37(7): 666-667, 2021 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-34304407

RESUMO

According to a document issued by the General Office of National Health Commission, "one person, one diagnosis, and one room" is required in the process of outpatient consultation. However, the patient will need to go to another room for dressing change after the doctor checks the wound if sticking to the conventional layout of current wound repair specialist outpatient clinic in hospitals and following the regulation of "separation of diagnosis and treatment". To allow a patient walking back and forth with the exposed wounds to different clinics or going to another clinic for dressing change with the original dressing reapplied to the wound is against the regulation of nosocomial infection control and the principle of sterility. To ensure that the layout of the outpatient clinic in the wound repair outpatient department not only conforms to the principle of "one person, one diagnosis, and one room", but also meets the characteristics of the diagnosis and treatment process of chronic wounds, this paper proposes the layout of "large space and small partition" in the wound repair clinic.


Assuntos
Instituições de Assistência Ambulatorial , Bandagens , Humanos , Encaminhamento e Consulta , Infecção da Ferida Cirúrgica
20.
BMC Health Serv Res ; 21(1): 728, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34301242

RESUMO

BACKGROUND: An estimated nine out of ten persons in sub-Saharan Africa (SSA) are unable to access timely, safe and affordable surgery. District hospitals (DHs) which are strategically located to provide basic (non-specialist) surgical care for rural populations have in many instances been compromised by resource inadequacies, resulting in unduly frequent patient referrals to specialist hospitals. This study aimed to quantify the financial burdens of surgical ambulance referrals on DHs and explore the coping strategies employed by these facilities in navigating the challenges. METHODS: We employed a multi-methods descriptive case study approach, across a total of 14 purposively selected DHs; seven, three, and four in Tanzania, Malawi and Zambia, respectively. Three recurrent cost elements were identified: fuel, ambulance maintenance and staff allowances. Qualitative data related to coping mechanisms were obtained through in-depth interviews of hospital managers while quantitative data related to costs of surgical referrals were obtained from existing records (such as referral registers, ward registers, annual financial reports, and other administrative records) and expert estimates. Interview notes were analysed by manual thematic coding while referral statistics and finance data were processed and analysed using Microsoft Office Excel 2016. RESULTS: At all but one of the hospitals, respondents reported inadequacies in numbers and functional states of the ambulances: four centres indicated employing non-ambulance vehicles to convey patients occassionally. No statistically significant correlation was found between referral trip distances and total annual numbers of referral trips, but hospital managers reported considering costs in referral practices. For instance, ten of the study hospitals reported combining patients to minimize trip frequencies. The total cost of ambulance use for patient transportation ranged from I$2 k to I$58 k per year. Between 34% and 79% of all patient referrals were surgical, with total costs ranging from I$1 k to I$32 k per year. CONCLUSION: Cost considerations strongly influence referral decisions and practices, indicating a need for increases in budgetary allocations for referral services. High volumes of potentially avoidable surgical referrals provide an economic case - besides equitable access to healthcare - for scaling up surgery capacity at the district level as savings from decreased referrals could be reinvested in referral systems strengthening.


Assuntos
Ambulâncias , Hospitais de Distrito , Adaptação Psicológica , Humanos , Malaui , Encaminhamento e Consulta , Tanzânia , Zâmbia
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