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1.
Fam Pract ; 38(Suppl 1): i3-i8, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34448485

RESUMO

BACKGROUND: Primary care has played a central role in the community response to the coronavirus disease-19 (COVID-19) pandemic. The use of the National Early Warning Score 2 (NEWS2) has been advocated as a tool to guide escalation decisions in the community. The performance of this tool applied in this context is unclear. AIM: To evaluate the process of escalation of care to the hospital within a primary care assessment centre (PCAC) designed to assess patients with suspected COVID-19 in the community. DESIGN AND SETTING: A retrospective service evaluation of all adult patients assessed between 30 March and 22 April 2020 within a COVID-19 primary care assessment centre within Sandwell West Birmingham CCG. METHOD: A database of patient demographics, healthcare interactions and physiological observations was constructed. NEWS2 and CRB65 scores were calculated retrospectively. The proportion of patients escalated was within risk groups defined by NHSE guidelines in place during the evaluation period was determined. RESULTS: A total of 150 patients were identified. Following assessment 13.3% (n = 20) patients were deemed to require escalation. The proportion of patients escalated with a NEWS2 greater than or equal to 3 was 46.9% (95% CI 30.8-63.6%). The proportion of patients escalated to secondary care using NHSE defined risk thresholds was 0% in the green group, 22% (n = 4) in the amber group, and 81.3% (n = 13) in the red group. CONCLUSION: Clinical decisions to escalate care to the hospital did not follow initial guidance written for the COVID-19 outbreak but were demonstrated to be safe.


Assuntos
COVID-19/epidemiologia , Escore de Alerta Precoce , Hospitalização/estatística & dados numéricos , Atenção Primária à Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Inglaterra/epidemiologia , Feminino , Fidelidade a Diretrizes , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Medição de Risco , SARS-CoV-2
2.
Pan Afr Med J ; 38: 414, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381558

RESUMO

Introduction: trauma is the leading cause of mortality in individuals less than 45 years. The principles of Advanced Trauma Life Support (ATLS) which is used around the world in resuscitation of trauma patients have been considered to be safe. However, the outbreak of corona virus disease 2019 (COVID-19) has affected the processes and characteristics of acute trauma patients seen around the world. This study is intended to determine the impact of COVID-19 lockdown on the acute trauma patients seen in a Nigerian trauma centre. Methods: this is a cross-sectional observational study of trauma patients seen in the resuscitation room of the National Hospital trauma centre in Abuja, Nigeria, from 24th February,2020 to 3rd May, 2020. The participants were consecutive acute trauma patients who were grouped into two: five weeks preceding total lockdown and five weeks of total lockdown. Statistical analysis was done using the statistical package for social sciences (SPSS) version 24.0 while results were presented in tables and a figure. Results: a total of 229 patients were recruited into the study with age range 1 to 62 years, mean age of 28 ± 13 and male to female ratio of 3.87. The patient volume reduced by 41.31% during the lockdown. Though motor vehicular crash (MVC) was the predominant mechanism of injury in both groups making up 37.65% and 23.88% respectively, penetrating assault was more during the lockdown period (17.91% versus 6.17%). The lockdown was further associated with more delayed presentation (52.24% versus 48.15%), more referrals (53.73% versus 32.72%), less severe injury score (29.6% versus 56.7%) and no death in the resuscitation room (0% versus 1.85%). Conclusion: despite the reduction in the volume of trauma presentations by 41.31%, patients got the required care with less mortality. Efforts should be directed at sustaining access to acute trauma care in all circumstances to reduce preventable trauma deaths.


Assuntos
COVID-19 , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Tempo , Centros de Traumatologia , Índices de Gravidade do Trauma , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia , Adulto Jovem
3.
Malawi Med J ; 33(1): 15-20, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34422229

RESUMO

Purpose: To evaluate the clinical and socio-demographic profile of patients living with glaucoma and receiving care in a tertiary eye center in Zimbabwe. Method: A hospital-based retrospective study of clinical records of glaucoma patients from January 2014 to December 2018. The study involved collating demographic information of patients, visual acuities, (VA) intraocular pressure, (IOP), cup-to-disc ratios, (CDRs), average retinal nerve fibers thickness, (RNFL), cup volume, cup-to-disc area, vertical cup-to-disc ratio, (VCDR), rim area, disc area, glaucoma hemifield test, visual field indices and the management of glaucoma. Results: Nine thousand one hundred and eighty-five (9,185) folders were retrieved. Out of these, 432 (4.7%) qualified for the study and were analyzed. There were 267 (61.8%) males and 165 (38.2%) females. The mean age (± Standard deviation, SD) of the patients was 62.66 ± 15.94 years, (range 10 - 110 years). The means visual acuity (VA): OD =1.30 ± 1.06 Logarithm of the Minimum Angle of Resolution, (logMAR), OS = 1.33 ± 1.06 logMAR; IOP: OD = 29.51 ± 12.89 mmHg, OS: 29.17 ± 12.59 mmHg; CDRs: OD = 0.91 ± 0.14 D, OS = 0.92 ± 0.14 D; and the average RNFL thickness was 72.76 ± 18.26 µm and 71.24 ± 23.17 µm in the right and left eye respectively. The mainstay of treatment was medication only. Conclusion: There were more males than females receiving glaucoma care at the tertiary level. Glaucoma cases included juveniles but the mean age was mostly the elderly. It was characterized by high IOPs, large CDRs, and thin RNFL suggestive of late presentation.


Assuntos
Glaucoma/diagnóstico , Glaucoma/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Glaucoma/terapia , Glaucoma de Ângulo Aberto/epidemiologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/patologia , Retina/anatomia & histologia , Estudos Retrospectivos , Fatores Socioeconômicos , Campos Visuais/fisiologia , Adulto Jovem , Zimbábue/epidemiologia
4.
Clin Pediatr (Phila) ; 60(9-10): 418-426, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34342242

RESUMO

Pediatrician Screening, Brief Intervention, and Referral to Treatment (SBIRT) practices vary widely, though little is known about the correlates of SBIRT implementation. Using data from a national sample of US pediatricians who treat adolescents (n = 250), we characterized self-reported utilization rates of SBIRT among US pediatricians and identified provider- and practice-level characteristics and barriers associated with SBIRT utilization. All participants completed an electronic survey querying the demographics, practice patterns, and perceived barriers related to SBIRT practices. Our results showed that 88% of respondents reported screening for substance use annually, but only 26% used structured/validated screening instruments. Furthermore, 40% of respondents provided evidence-based brief interventions, and only 11% implemented all core SBIRT practices. Common barriers (eg, confidentiality and insufficient time) and unique provider- and setting-specific barriers to implementation were identified. These findings indicate that although most pediatricians deliver some SBIRT components in their practice, few implement the full SBIRT model, and barriers persist.


Assuntos
Intervenção na Crise/métodos , Programas de Rastreamento/métodos , Pediatras/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Comportamento do Adolescente , Confidencialidade , Intervenção na Crise/estatística & dados numéricos , Humanos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Tempo , Estados Unidos
5.
Pan Afr Med J ; 39: 24, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34394815

RESUMO

Introduction: palliative care offers a care and support system to people living with Human Immunodeficiency Virus (HIV) infection/Acquired Immunodeficiency Syndrome (AIDS). In Nigeria, the palliative care (PC) practice generally is new and still developing. While most studies on HIV/AIDS assess drug treatment and adherence for people living with HIV/AIDS (PLWHA), there is paucity of data on PC services available for them. We therefore assessed the PC services offered and referral services available to PLWHA in health facilities. Methods: we conducted a cross-sectional study across all public secondary and tertiary health facilities offering HIV care services in Abuja, Nigeria between February and May 2017. We used an interviewer-administered semi-structure questionnaire to collect information from the heads of health facilities. The questionnaire assessed palliative care and referral services for PLWHA. Frequencies and proportions were calculated using Microsoft-Excel. Results: of the 17 health facilities assessed, only 6 (35.3%) have constituted a palliative care team but only 3 (17.6%) had some sources of fund for PC. Twelve (70.6%) provided nutritional support for PLWHA, 6 (35.3%) provided spiritual and 8 (47.1%) offered bereavement support for families of PLWHA. Sixteen (94.1%) had well-established referral services for PLWHA. Conclusion: palliative care services for PLWHA were generally poor in all the health facilities. There exists a well-established referral services for PLWHA in most of the health facilities. We recommend that the PC structure for PLWHA should be improved by increasing and ensuring compliance to guidelines and the established referral network should continue to be strengthened.


Assuntos
Síndrome de Imunodeficiência Adquirida/terapia , Infecções por HIV/terapia , Instalações de Saúde/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Estudos Transversais , Humanos , Nigéria , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários
7.
HIV Res Clin Pract ; 22(3): 63-70, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34308800

RESUMO

BACKGROUND: Background: The COVID-19 pandemic and associated containment measures dramatically affected the health care systems including the screening of human immunodeficiency virus and the management people living with HIV around the world by making the access to preventive care services and specific medical monitoring more difficult. OBJECTIVE: Objective: To study the impact of the COVID-19 pandemic on the holistic care of people living with HIV in Liège (Belgium). METHODS: Methods: In this retrospective observational study conducted in Liège University Hospital, we compared the out-patient follow-up of HIV-infected individuals as well as the number of new HIV diagnoses between 2019 and 2020 and between the different waves of the COVID-19 pandemic in 2020. RESULTS: Results: In 2020, when compared to 2019, we observed a significant decrease in the number of new HIV diagnoses, especially during the first wave of the pandemic, and in the number of consultations undertaken by sexual health services, psychologists and specialists in infectious diseases at our HIV clinic. We also observed a decrease in the number of viral load assays and blood CD4 + T-cells count analyses performed, although we found less patients with HIV plasma viral load above 400 copies per mL in 2020. Finally, we noted a significant reduction in terms of screening of our HIV-infected patients for hepatitis C, syphilis, colorectal and anal cancers and hypercholesterolemia. CONCLUSIONS: Conclusions: Our experience exhibits the deleterious impact of the COVID-19 pandemic on the HIV care and the need to implement new strategies to guarantee its continuum.


Assuntos
COVID-19/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Assistência Ambulatorial/estatística & dados numéricos , Bélgica/epidemiologia , Contagem de Linfócito CD4/estatística & dados numéricos , COVID-19/prevenção & controle , Coinfecção/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Sobreviventes de Longo Prazo ao HIV/psicologia , Sobreviventes de Longo Prazo ao HIV/estatística & dados numéricos , Humanos , Programas de Rastreamento/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2 , Tempo para o Tratamento/estatística & dados numéricos , Carga Viral/estatística & dados numéricos
8.
J Ambul Care Manage ; 44(4): 293-303, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34319924

RESUMO

COVID-19 necessitated significant care redesign, including new ambulatory workflows to handle surge volumes, protect patients and staff, and ensure timely reliable care. Opportunities also exist to harvest lessons from workflow innovations to benefit routine care. We describe a dedicated COVID-19 ambulatory unit for closing testing and follow-up loops characterized by standardized workflows and electronic communication, documentation, and order placement. More than 85% of follow-ups were completed within 24 hours, with no observed staff, nor patient infections associated with unit operations. Identified issues include role confusion, staffing and gatekeeping bottlenecks, and patient reluctance to visit in person or discuss concerns with phone screeners.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , COVID-19/terapia , Continuidade da Assistência ao Paciente/organização & administração , Pneumonia Viral/terapia , Unidades de Cuidados Respiratórios/organização & administração , Adulto , Idoso , Boston/epidemiologia , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Encaminhamento e Consulta/estatística & dados numéricos , SARS-CoV-2 , Análise de Sistemas , Fluxo de Trabalho
9.
Am J Manag Care ; 27(7): e215-e217, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34314120

RESUMO

As the number of inpatients with advanced age and chronic conditions rises, so too does the need for inpatient palliative care (PC). Despite the strong evidence base for PC, less than 50% of all inpatient PC needs are met by inpatient consults. Over the past several months in epicenters of the COVID-19 pandemic, PC providers have responded to the increased need for PC services through innovative digital programs including telepalliative care programs. In this article, we explore how PC innovations during COVID-19 could transform the PC consult to address workforce shortages and expand access to PC services during and beyond the pandemic. We propose a 3-pronged strategy of bolstering inpatient telepalliative care services, expanding electronic consults, and increasing training and educational tools for providers to help meet the increased need for PC services in the future.


Assuntos
COVID-19/terapia , Cuidados Paliativos/métodos , Equipe de Assistência ao Paciente/organização & administração , Telemedicina/métodos , COVID-19/epidemiologia , Humanos , Pacientes Internados/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos
10.
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
11.
Arch Pediatr ; 28(6): 441-450, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34140219

RESUMO

BACKGROUND: At the beginning of March 2020, Cameroon experienced its first cases of infection with the new coronavirus (SARS-COV-2). Very quickly, there was a drop in the rate of hospital attendance. The purpose of this study was to observe the variations in the uptake of pediatric consultations and vaccinations in a pediatric hospital. METHODS: A descriptive and retrospective cross-sectional study was carried out using consultation and vaccination statistics from a pediatric hospital in the city of Yaoundé, political capital of Cameroon, from January 2016 to May 2020. Data were entered in Microsoft Excel and exported to R software (Version 3.3.3) for statistical analysis. First, time series raw data (before and after COVID-19) were plotted and the trend estimated by locally weighted scatterplot smoothing (LOWESS) methods. Then a classic seasonal decomposition was performed to distinguish between seasonal trends and irregular components using moving averages. The Webel-Ollech overall seasonality test (WO test) was also run to formally check for seasonality. The results of the study are presented as narrative tables and graphs. RESULTS: Following the partial confinement recommended by the government of Cameroon, the number of pediatric consultations decreased by 52% in April and by 34% in May 2020 compared with rates during the same periods in 2019 (P=0.00001). For antenatal visits, the rates dropped by 45% and 34%, respectively, in April and May 2020 compared with 2019. The demand for immunization services also declined. As a result, the demand for BCG vaccines, third-dose tracer vaccines (diphtheria, tetanus, pertussis), polio, and MMR in children as well as tetanus vaccines in childbearing women dropped significantly. CONCLUSION: The start of the COVID-19 pandemic was accompanied by a significant drop in consultation and vaccination activities. If no action is taken to correct this phenomenon, the ensuing months could be marked by a considerable increase in patients, sometimes suffering from vaccine-preventable diseases. The death rate could increase considerably in the pediatric population.


Assuntos
COVID-19 , Pandemias , Encaminhamento e Consulta/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Camarões , Criança , Estudos Transversais , Hospitais Pediátricos , Humanos , Estudos Retrospectivos
12.
Ann R Coll Surg Engl ; 103(7): 487-492, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192487

RESUMO

INTRODUCTION: In response to the COVID-19 pandemic, our emergency general surgery (EGS) service underwent significant restructuring, including establishing an enhanced ambulatory service and undertaking nonoperative management of selected pathologies. The aim of this study was to compare the activity of our EGS service before and after these changes. METHODS: Patients referred by the emergency department were identified prospectively over a 4-week period beginning from the date our EGS service was reconfigured (COVID) and compared with patients identified retrospectively from the same period the previous year (Pre-COVID), and followed up for 30 days. Data were extracted from handover documents and electronic care records. The primary outcomes were the rate of admission, ambulation and discharge. RESULTS: There were 281 and 283 patients during the Pre-COVID and COVID periods respectively. Admission rate decreased from 78.7% to 41.7%, while there were increased rates of ambulation from 7.1% to 17.3% and discharge from 6% to 22.6% (all p<0.001). For inpatients, mean duration of admission decreased (6.9 to 4.8 days), and there were fewer operative or endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39) and telephone reviews (0 to 39), while early computed tomography scan was increasingly used to facilitate discharge (5% vs 34.7%). There were no differences in 30-day readmission or mortality. CONCLUSIONS: Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, achieving a decrease of 952 inpatient bed days in this critical period, while maintaining patient safety.


Assuntos
COVID-19/prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Tratamento de Emergência/estatística & dados numéricos , Cirurgia Geral/organização & administração , Centro Cirúrgico Hospitalar/organização & administração , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/transmissão , Tratamento Conservador/estatística & dados numéricos , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/métodos , Tratamento de Emergência/normas , Feminino , Seguimentos , Cirurgia Geral/normas , Cirurgia Geral/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Readmissão do Paciente/estatística & dados numéricos , Segurança do Paciente/normas , Estudos Prospectivos , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Centro Cirúrgico Hospitalar/normas , Centro Cirúrgico Hospitalar/estatística & dados numéricos
13.
Rev Esp Salud Publica ; 952021 Jun 23.
Artigo em Espanhol | MEDLINE | ID: mdl-34159951

RESUMO

OBJECTIVE: In recent years, it has been seen that, despite the existence of emergency services in Primary Care, some users attend emergency services of their referral hospital on their own initiative. The objective of this study was to explore the causes of the increase in the Northern Health Management Area of Huelva (Spain) population's own initiative to attend hospital emergency services, to the detriment of the provision of emergency services by Primary Care. METHODS: A qualitative study based on the Grounded Theory by Glasser and Strauss was carried out on a sample of nineteen patients and sixteen physicians from the Northern Health Management Area of Huelva (Spain), divided into four focus groups. This method has four phases: data collection, data organisation, data analysis, and theory development. RESULTS: The qualitative analysis process of the four focus groups resulted in 104 codes or minimum units of information. The main causes of the increase in this own initiative were related to delays in medical appointments and complementary tests, mistrust in Primary Care physicians and greater trust in hospital specialists, ignorance regarding the offer of services, proximity to the hospital, and the closure of the Riotinto (Huelva) emergency point. CONCLUSIONS: Lack of accessibility to specialised care, geographic dispersion, mistrust due to deterioration of the physician-patient relationship, lack of health education among the population, and the culture of immediacy are the main causes of the increase in attending hospital emergency services on their own initiative identified in this population.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Serviços Médicos de Emergência/organização & administração , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Pesquisa Qualitativa , Espanha
14.
Isr J Health Policy Res ; 10(1): 34, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074319

RESUMO

BACKGROUND: Telemedicine has become an integral part of health care delivery in recent years. One of the leading applications for this use is WhatsApp - a free smartphone application that allows instant messaging with pictures and videos. This study analyzed the emerging role of WhatsApp on reducing the need for referrals to medical specialists and to compare the views of physicians regarding WhatsApp consultations. METHODS: A cross-sectional study based on an anonymous web-survey was conducted among PCPs and medical specialists working in the Israel Defense Forces Medical-Corps during September and October, 2019. RESULTS: Of 201 participants, 153 were PCPs and 48 were medical specialists. 86.9 % of PCPs and 86.5 % of specialists used WhatsApp every day in professional settings. Added workload, potential breaching of patient confidentiality and lack of full documentation of consultations were the main concerns among physicians using the application. 60.7 % of PCPs and 95.7 % of specialists stated that these consultations have reduced the need for in-person appointments at least once a week. CONCLUSIONS: In times of COVID-19 that require social distancing, WhatsApp provides a simple, readily available platform for consultations between healthcare providers, even to the extent of rendering some in-person appointments unnecessary. Healthcare organizations should address the matters troubling healthcare providers, mainly patient confidentiality and lack of documentation in patients' medical records, while providing adequate compensation for those providing the service during and after work hours.


Assuntos
COVID-19 , Aplicativos Móveis , Médicos/estatística & dados numéricos , Telemedicina/métodos , Adulto , Estudos Transversais , Atenção à Saúde/métodos , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Smartphone , Inquéritos e Questionários
15.
Rev Bras Enferm ; 74Suppl 4(Suppl 4): e20200090, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34105641

RESUMO

OBJECTIVE: To report the results of a dissertation developed with nurses who perform childcare consultations in Family Health Units in a Health District of João Pessoa, Paraíba, Brazil. METHODS: Experience report of the presentation and interpretation of the research results, in 2018, with 42 nurses, using the conversation strategy with two focus groups. RESULTS: The nurses showed disappointment with the negative results evidenced in the study's feedback, but they highlighted the importance of this moment for discussion and reflection of their practices, thus arousing the interest in qualifying the child's health care. FINAL CONSIDERATIONS: This study achieved the objective of promoting the dissemination of the findings of a research, coupled with the social and ethical commitment to return to the nurses and participating services with the feedback of the research results to improve the reality in which they work.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Cuidados de Enfermagem , Atenção Primária à Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Brasil , Criança , Retroalimentação , Humanos , Pediatria
16.
Medicine (Baltimore) ; 100(22): e26252, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087914

RESUMO

ABSTRACT: Suicide is an increasingly serious public health care concern worldwide. The impact of decreased in-house psychiatric resources on emergency care for suicidal patients has not been thoroughly examined. We evaluated the effects of closing an in-hospital psychiatric ward on the prehospital and emergency ward length of stay (LOS) and disposition location in patients who attempted suicide.This was a retrospective before-and-after study at a community emergency department (ED) in Japan. On March 31, 2014, the hospital closed its 50 psychiatric ward beds and outpatient consultation days were decreased from 5 to 2 days per week. Electronic health record data of suicidal patients who were brought to the ED were collected for 5 years before the decrease in in-hospital psychiatric services (April 1, 2009-March 31, 2014) and 5 years after the decrease (April 1, 2014-March 31, 2019). One-to-one propensity score matching was performed to compare prehospital and emergency ward LOS, and discharge location between the 2 groups.Of the 1083 eligible patients, 449 (41.5%) were brought to the ED after the closure of the psychiatric ward. Patients with older age, burns, and higher comorbidity index values, and those requiring endotracheal intubation, surgery, and emergency ward admission, were more likely to receive ED care after the psychiatric ward closure. In the propensity matched analysis with 418 pairs, the after-closure group showed a significant increase in median prehospital LOS (44.0 minutes vs 51.0 minutes, P < .001) and emergency ward LOS (3.0 days vs 4.0 days, P = .014) compared with the before-closure group. The rate of direct home return was significantly lower in the after-closure group compared with the before-closure group (87.1% vs 81.6%, odds ratio: 0.66; 95% confidence interval: 0.45-0.96).The prehospital and emergency ward LOS for patients who attempted suicide in the study site increased significantly after a decrease in hospital-based mental health services. Conversely, there was significant reduction in direct home discharge after the decrease in in-house psychiatric care. These results have important implications for future policy to address the increasing care needs of patients who attempt suicide.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Fechamento de Instituições de Saúde/estatística & dados numéricos , Hospitais Comunitários/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Desinstitucionalização/estatística & dados numéricos , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Fechamento de Instituições de Saúde/legislação & jurisprudência , Hospitalização/estatística & dados numéricos , Humanos , Japão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/legislação & jurisprudência , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/economia , Unidade Hospitalar de Psiquiatria/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Tentativa de Suicídio/estatística & dados numéricos
17.
J Cancer Res Ther ; 17(2): 547-550, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34121706

RESUMO

Purpose: Health emergency due to COVID-19 started in Uruguay on March 13, 2020; our mastology unit tried to ensure adequate oncological care, and protect patients from the virus infection and complications. Objective: To assess the health care activities in the "peak" of the pandemic during 3 months. Materials and Methods: we collected data from the electronic health record. Results: There were a total of 293 medical appointments from 131 patients (221 face-to-face), that decreased by 16.7% compared to the same period in 2019 (352 appointments). The medical appointments were scheduled to evaluate the continuity of systemic treatment or modifications (95 patients; 72.5%), follow-up (17; 12.9%), first-time consultation (12; 9.1%), and assess paraclinical studies (7; 5.3%). The patients were on hormone therapy (81 patients; 74%), chemotherapy (CT) (21; 19%), and anti-HER2 therapies (9; 8%). New twenty treatments were initiated. Of the 14 patients that were on adjuvant/neoadjuvant CT, 9 (64.3%) continued with the same regimen with the addition of prophylactic granulocyte-colony-stimulating factors (G-CSF), and 5 (35.7%), who were receiving weekly paclitaxel, continued the treatment with no changes. Of the seven patients that were on palliative CT, 2 (28.5%) continued the treatment with the addition of G-CSF, 3 (42.8%) continued with weekly capecitabine or paclitaxel with no treatment changes, and 2 (28.5%) changed their treatment regimen (a less myelosuppressive regimen was selected for one and due to progression of the disease in the other patient). The ninety patients who were receiving adjuvant, neoadjuvant, or palliative criteria hormone therapy and/or anti-HER2 therapies, continued the treatment with no changes. Conclusions: The evidence suggests that, although medical appointments decreased by approximately 17%, we could maintain healthcare activities, continued most of the treatments while the most modified was CT with G-CSF to avoid myelosuppression.


Assuntos
Neoplasias da Mama/tratamento farmacológico , COVID-19/epidemiologia , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Oncologia/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Medula Óssea/efeitos dos fármacos , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/imunologia , COVID-19/imunologia , COVID-19/prevenção & controle , COVID-19/transmissão , Controle de Doenças Transmissíveis/normas , Continuidade da Assistência ao Paciente/organização & administração , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Hematopoese/efeitos dos fármacos , Hematopoese/imunologia , Humanos , Oncologia/organização & administração , Oncologia/normas , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Telemedicina/organização & administração , Telemedicina/normas , Telemedicina/estatística & dados numéricos , Triagem/organização & administração , Triagem/normas , Uruguai/epidemiologia
18.
J Occup Health ; 63(1): e12231, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33974321

RESUMO

OBJECTIVES: Prevention of and early treatment for noncommunicable diseases such as hypertension, hyperglycemia, and dyslipidemia are important, as these diseases are asymptomatic in early stages but can lead to critical conditions such as macro- and microvascular disorders later on. While screening is conducted worldwide, low rates of hospital visits after screening is a common issue. We aimed to investigate the effect of reminder letters on the consultation behavior of screened participants. METHODS: We used administrative claims data from a database managed by JMDC Inc for participants of health checkups in 2014, 2015, 2016, and 2017, who belonged to a health insurance society. Reminder letters were sent regularly 6 months after checkups to improve participant consultation behavior. Participants who screened positive for hypertension, hyperglycemia, and dyslipidemia, and who were not taking medication for any of these diseases at the time of health checkups, were included in the analyses. RESULTS: A total of 1739 participants in 2014, 1693 in 2015, 2002 in 2016, and 2144 in 2017 were included in the analysis for hypertension. The cumulative proportion of hospital visits gradually increased over the course of 12 months after checkups in all years. After 2015, spikes, albeit very small ones, were observed at 6 months after checkups in accordance with the timing of reminder letters. Similar trends were observed for hyperglycemia and dyslipidemia. CONCLUSIONS: Sending reminder letters is a potentially effective approach to increase hospital visits, but further improvements (ie, multiple reminders) may be necessary to affect enhancements in participant consultation behavior.


Assuntos
Programas de Rastreamento/estatística & dados numéricos , Serviços de Saúde do Trabalhador/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Sistemas de Alerta/estatística & dados numéricos , Adulto , Bases de Dados Factuais , Dislipidemias/diagnóstico , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Hiperglicemia/diagnóstico , Hipertensão/diagnóstico , Seguro Saúde/estatística & dados numéricos , Japão , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Estudos Retrospectivos
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