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

RESUMO

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


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Agendamento de Consultas , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Cooperação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Prospectivos , Estados Unidos
2.
S Afr Med J ; 109(10): 733-735, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31635567

RESUMO

Every day patients make appointments with doctors in order for both to be able to schedule their time accordingly. All is well unless one of the parties cancels the appointment. In the case of a cancellation that is within 2 hours of a general practitioner visit or 24 hours of a specialist visit, the patient is usually charged for either the full consultation or part thereof. Doctors may also have reasons to cancel and rearrange their appointments with patients, yet there is no penalty placed on the doctor for such behaviour. There appears to be a mismatch between the disincentives for the patient not to cancel v. those of the doctor not to cancel. In this article, the legal and ethical aspects of charging for a missed appointment will be dealt with in order to determine the current situation in South Africa. Furthermore, research into missed appointments will be discussed to ascertain the major causes and provide recommendations to prevent missed appointments from occurring.


Assuntos
Agendamento de Consultas , Pacientes não Comparecentes/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Médicos/estatística & dados numéricos , Humanos , Pacientes não Comparecentes/economia , Visita a Consultório Médico/economia , Médicos/economia , África do Sul
3.
Lakartidningen ; 1162019 Oct 18.
Artigo em Sueco | MEDLINE | ID: mdl-31638708

RESUMO

Since 2016, a number of companies offering primary care services via chats or video calls have entered the Swedish primary care market. This is the first study to investigate whether these services replace other primary care services or if they induce more care and potentially even increase the workload of traditional caregivers. Using administrative care register data from a Swedish region, we find that the use of telemedicine services is associated with higher use of other primary care services (visits and telephone/mail contacts). Further, telemedicine users visit the emergency room at least as often as other residents. We obtain similar results when using various strategies to account for differences between telemedicine users and non-users. However, we cannot completely rule out that an association between transitory health problems and telemedicine use explains the results.


Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Visita a Consultório Médico/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Grupos Étnicos , Feminino , Humanos , Renda , Lactente , Masculino , Pessoa de Meia-Idade , Suécia , Adulto Jovem
4.
BMC Health Serv Res ; 19(1): 697, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615523

RESUMO

BACKGROUND: The reason for doctor visits associated with bad working conditions (and workplace bullying) remains unknown. Therefore, the aim of this study was to examine the association between perceived working conditions as well as workplace bullying and the number of doctor visits as well as the reason for seeing a doctor. METHODS: Data were derived from the German General Social Survey, a representative cross-section of the population in the year 2014. Self-reported doctor visits in the last 3 months were used as outcome measure. Self-rated working conditions (noise, bad air; time/performance pressure; bad working atmosphere; overtime; shifts/night work; hard physical labour) and workplace bullying were assessed. The reason for seeing a doctor was also recorded (acute illness; chronic illness; feeling unwell; requesting advice; visit to the doctor's office without consulting the doctor (e.g., need to get a prescription); preventive medical check-up/vaccination). Regression analysis stratified by sex was conducted. RESULTS: Adjusting for various potential confounders, Poisson regressions showed that workplace bullying was associated with increased doctor visits in men, but not in women. Contrarily, time/performance pressure at work was only associated with increased doctor visits in women, but not in men. Furthermore, the probability of visiting the doctor for reasons of acute illness or feeling unwell increased with workplace bullying in men. The probability of visiting the doctor because of feeling unwell increased with time/performance pressure in women. CONCLUSIONS: Our findings stress the association between adverse working conditions (workplace bullying as well as time/performance pressure at work) and doctor visits, with remarkable gender differences. Longitudinal studies are required to confirm the present findings and to obtain further insights into this relationship.


Assuntos
Bullying/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bullying/estatística & dados numéricos , Doença Crônica , Estudos Transversais , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Percepção , Distribuição por Sexo , Inquéritos e Questionários , Local de Trabalho/psicologia , Local de Trabalho/estatística & dados numéricos , Adulto Jovem
5.
J Drugs Dermatol ; 18(10): 987-990, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584776

RESUMO

Introduction: Introduction: Although future atopic dermatitis (AD) clinical research is intended to improve standard-of-care treatment, how patients are currently treated is not well characterized. The purpose of this study was to determine the most frequent medications prescribed in all ages of AD. Methods: The National Ambulatory Medical Care Survey (NAMCS) is a nationally representative survey of United States office-based ambulatory visits and records demographics, diagnoses, and treatments. This is a cross-sectional study using the NAMCS of all AD outpatient office visits from 2006 to 2015. Patient visits with an ICD-9-CM code for AD (691.8) were collected and analyzed. Frequency tables were created for age, race, providers managing AD, and treatment. Results: Patient demographics of AD visits included 51% male (95% Confidence Interval [CI]: 44-58%), 71% white (65-77%), 19% African American (14-25%), and 10% Asian (6-14%). About 31% (24-37%) of visits were to pediatricians and 27% (22-33%) to dermatologists whereas per physician, dermatologists managed more AD visits than pediatricians. Topical corticosteroids (59%; 52-66%) were the most common class of medications prescribed followed by antibiotics (11%; 6-16%) and second generation antihistamines (6%; 3-10%). The most common topical corticosteroid prescribed in AD was triamcinolone (25% of office visits; 18-31%). Hydrocortisone was the most common topical corticosteroid prescribed to children <1 year of age and children aged 8 to 18, whereas triamcinolone was more common in children 2 to 7 years and adults >18 years. Discussion: Topical corticosteroids were the most frequent prescriptions provided at office-based ambulatory visits whereas antibiotics and second-generation antihistamines were the second and third most common prescribed medications, respectively. Although pediatricians manage more AD visits than dermatologists in total visits, dermatologists manage more AD visits than pediatricians per physician. Characterizing how AD patients are currently treated may build a reference for future clinical research investigating novel standard-of-care treatment in AD. J Drugs Dermatol. 2019;18(10):987-990.


Assuntos
Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Padrão de Cuidado/estatística & dados numéricos , Administração Cutânea , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Dermatologistas/estatística & dados numéricos , Feminino , Glucocorticoides/uso terapêutico , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Lactente , Recém-Nascido , Masculino , Visita a Consultório Médico/estatística & dados numéricos , Estados Unidos , Adulto Jovem
6.
BMC Health Serv Res ; 19(1): 678, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533819

RESUMO

BACKGROUND: This study aimed to investigate the relationship between complementary health insurance and frequency of dental visits. METHODS: The present study was performed using the Urban Health Equity Assessment and Response Tool (Urban HEART). A cross-sectional study was conducted in Tehran (Iran) to assess inequalities in health status among different socioeconomic and ethnic groups, genders, geographical areas, and social determinants of health. Out of 20,320 records retrieved from the original study with dental information, 17,252 had both dental insurance and dental visit information. Complementary health insurance as the main independent variable had three categories (i.e., basic insurance, with complementary medical coverage, and with dental coverage). The frequency of dental visits during the last year as a dependent variable had also three categories (i.e., no visit, one, and two, or more dental visits in the last year). In this study, in addition to investigating the relationship between complementary health insurance and frequency of dental visits, potential covariates that may affect the mentioned relationship were evaluated in the regression model. Statistical analyses included simple and multiple multinomial logistic regression considering the sampling method and sampling weights. RESULTS: The meanage of 17,252 participants (Tehran citizens) was 39.36 years; 49.4%were women, 86.0%hadonly basicinsurance, 7.2% had complementary medical insurance, and 6.8% had complementary dental insurance. Of all subjects, 43.8% reported no dental visit, 26.1% reported one, and 30.1% reportedtwoor more dental visits during the lastyear. The frequency of dental visits was lower in people who had basic insurance than others such that that odds ratio (OR) was 0.73 (p-value < 0.001) for one visit and 0.68 (p-value< 0.001) for two or more visits in the last year. The frequency of dental visits was also positively associated with dental brushing, toothpaste use, high educational level, being married, having more than 20 teeth, and having dental pain. CONCLUSION: Having dental insurance increases the frequency of dental visits but the association between dental insurance and dental visits was independently influenced by other predictors.


Assuntos
Serviços de Saúde Bucal/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Análise de Dados , Utilização de Instalações e Serviços , Feminino , Nível de Saúde , Humanos , Irã (Geográfico) , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Saúde da População Urbana/estatística & dados numéricos , Adulto Jovem
7.
BMC Health Serv Res ; 19(1): 646, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492128

RESUMO

BACKGROUND: Health care systems are continually being reformed, however care improvement and intervention effectiveness are often assumed, not measured. This paper aimed to review findings from published studies about the appropriateness of eye care delivery, using existing published evidence and/or experts' practice and to describe the methods used to measure appropriateness of eye care. METHODS: A systematic search was conducted using Medline, Embase and CINAHL (2006 to September 2016). Studies reporting the processes of eye care delivery against existing published evidence and/or experts' practice were selected. Data was extracted from published reports and the methodological quality using a modified critical appraisal tool. The primary outcomes were percentage of appropriateness of eye care delivery. This study was registered with PROSPERO, reference CRD42016049974. RESULTS: Fifty-seven studies were included. Most studies assessed glaucoma and diabetic retinopathy and the overall methodological quality for most studies was moderate. The ranges of appropriateness of care delivery were 2-100% for glaucoma, 0-100% for diabetic retinopathy and 0-100% for other miscellaneous conditions. Published studies assessed a single ocular condition, a sample from a single centre or a single domain of care, but no study has attempted to measure the overall appropriateness of eye care delivery. CONCLUSIONS: These findings indicated a wide range of appropriateness of eye care delivery, for glaucoma and diabetic eye care. Future research would benefit from a comprehensive approach where appropriateness of eye care is measured across multiple conditions with a single methodology, to guide priorities within eye care delivery and monitor quality improvement initiatives.


Assuntos
Assistência à Saúde/normas , Oftalmopatias/terapia , Qualidade da Assistência à Saúde , Assistência à Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Visita a Consultório Médico/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde
8.
BMC Res Notes ; 12(1): 610, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547855

RESUMO

OBJECTIVE: This study was aimed to identify factors affecting neonatal mortality in Ethiopia. RESULTS: According to the multilevel multivariable logistic regression analysis, the odds of neonatal mortality was significantly associated with husbands with no education (AOR = 2.30, 95% CI 1.10, 4.83), female birth (AOR = 0.57, 95% CI 0.39, 0.83), twin birth (AOR = 13.62, 95% CI 7.14, 25.99), pre-term birth (AOR = 15.07, 95% CI 7.80, 29.12) and mothers with no antenatal care (ANC) visit during pregnancy (AOR = 1.90 95% CI 1.11, 3.25).


Assuntos
Mortalidade Infantil/tendências , Visita a Consultório Médico/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Estudos Transversais , Escolaridade , Etiópia/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Gravidez de Gêmeos/estatística & dados numéricos , Nascimento Prematuro/etiologia , Fatores de Risco , População Rural , Fatores Sexuais , População Urbana
9.
BMC Res Notes ; 12(1): 618, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547856

RESUMO

OBJECTIVE: Since data related to postpartum hemorrhage in Ethiopia is scarce, this study was aimed to assess the magnitude and associated factors of postpartum hemorrhage among mothers who delivered in Debre Tabor general hospital. RESULTS: In this study, one hundred forty-four mothers' charts were reviewed which made the response rate 100%. This study revealed that the magnitude of postpartum hemorrhage was 7.6% (CI 6.2, 9.8). Chi-square test revealed that there was an association between postpartum hemorrhage and gravidity, parity, having antenatal care visit, and the previous history postpartum hemorrhage. This finding confirmed that uterine atony, retained placenta, and genital tract trauma were the most common leading cause of postpartum hemorrhage.


Assuntos
Hospitais Gerais , Placenta Retida/fisiopatologia , Hemorragia Pós-Parto/diagnóstico , Inércia Uterina/fisiopatologia , Adolescente , Adulto , Estudos Transversais , Parto Obstétrico , Etiópia/epidemiologia , Feminino , Genitália Feminina/lesões , Número de Gestações/fisiologia , Humanos , Visita a Consultório Médico/estatística & dados numéricos , Paridade/fisiologia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/fisiopatologia , Gravidez , Fatores de Risco
10.
Niger Postgrad Med J ; 26(3): 158-163, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441453

RESUMO

Background: An early first dental clinic appointment offers the prospect of prompt preventative care and parental education regarding the oral health of the child. The evidence-based recommendation by dental professionals all over the world is that a child should visit a dentist before or by 1 year of age. Aim: This study aimed to determine the chronological age at and the purpose for a first dental clinic visit amongst children aged 16 years and below attending the Paediatric Dental Clinic at the Lagos University Teaching Hospital (LUTH). Materials and Methods: This was a retrospective study conducted amongst children who attended the Paediatric Dental Clinic at the LUTH between January 2017 and December 2018. Data on age at first dental visit, reasons for attending and other information relevant to the study were collected. Descriptive statistics and Chi-square analysis were conducted, and the level of significance was set at P < 0.05. Results: A total of 1157 children were studied, comprising 580 (50.5%) males and 577 (49.9%) females. Their mean age on their first dental visit was 7.9 ± 3.7 years. Most of the children (31.4%) had their first dental visits at 7 and 9 years, and 0.8% of the children had their first dental visit below the age of 1 year. The most common reason for visiting the dental clinic was dental pain (33.1%). A higher proportion of the children (911 [79.0%]) had their first dental visit for therapeutic purposes, whereas 246 (21.0%) children visited the dental clinic for preventive care. Sex and age at first dental visit were statistically significantly associated with the reason for attendance (P < 0.001). Conclusion: Most children had their first dental visit between the ages of 7 and 9 years, mainly because of pain. It is necessary to create more awareness among parents/caregivers and to establish the concept of dental home.


Assuntos
Assistência Odontológica para Crianças/estatística & dados numéricos , Clínicas Odontológicas/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Saúde Bucal , Pediatria/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Hospitais de Ensino , Humanos , Masculino , Nigéria , Estudos Retrospectivos
11.
Int J Med Inform ; 129: 260-266, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31445265

RESUMO

BACKGROUND: Electronic visits (e-visits) have the potential to expand patients' access to care and reduce healthcare costs. We aimed to describe trends in e-visit adoption among the U.S. office-based physicians and examine physician-and practice-level factors associated with e-visit adoption. METHODS: This was a retrospective observational study of 2011-2015 National Ambulatory Medical Care Survey. We used the Cochran-Armitage tests to evaluate trend changes in e-visit adoption among the U.S. office-based physicians. Multivariable logistic regression was used to calculate the odds of adopting e-visits adjusting for physician and practice characteristics. RESULTS: Our sample included 10,767 respondents, representing 327,836 office-based physicians in the U.S. Our analysis indicated that, in 2015, 15.9% of physicians adopted e-visits, which is a minor increase of 2.2% in total utilization of 13.7% in 2011. The likelihood of adopting e-visits was 2.7 times higher for physicians who have fully implemented electronic health records systems compared (odds ratio, 2.66, [95% CI, 2.16-3.28]) to physicians who have not implemented EHRs. Other predictors of e-visit adoption included primary care rather than specialty care, capitated payment model, and having a secure messaging capability. CONCLUSIONS: Our study demonstrates that overall e-visit adoption is low and has not been implemented as rapidly as other health information technologies. While use of secure information technology could be a facilitator for e-visit implementation, there are other barriers affecting widespread adoption. E-visits are a promising strategy for increasing patients' access to care. Future research is needed to explore implementation barriers that might be impeding e-visit adoption.


Assuntos
Pesquisas sobre Serviços de Saúde , Registros Eletrônicos de Saúde , Humanos , Visita a Consultório Médico/estatística & dados numéricos , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
12.
J Drugs Dermatol ; 18(8): 798-802, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424710

RESUMO

Cutaneous fungal infections account for millions of office visits per year, yet their varied presentations often lead to misdiagnosis. If dermatology clinics are Clinical Laboratory Improvement Amendment (CLIA) certified, direct microscopy with potassium hydroxide or other stains can be used to inexpensively and rapidly diagnose fungal infections. In this survey, we examined dermatologists' perceptions of fungal preparations and CLIA certification to identify barriers that prevent the use of these bedside diagnostics. The response rate was 13% (n=308, based on the number of emails opened). When a cutaneous fungal infection is suspected, 20.94% rarely/never and 19.86% sometimes perform fungal preparations, often because they think clinical diagnosis is adequate or that preparations take too long. 21.32% reported not having CLIA certification, most frequently because the process requires too much work, or they do not know how to apply. Of providers with CLIA certification, over 25% thought it was difficult to obtain. Our results demonstrate that numerous barriers prevent the common use of fungal preparations, including the perception that clinical diagnosis is sufficient and the lack of required CLIA certification. These barriers emphasize the need for additional education about cutaneous fungal infections and use of bedside diagnostics. Additionally, policy-based interventions are necessary to ease the process of CLIA certification.


Assuntos
Dermatomicoses/diagnóstico , Fungos/isolamento & purificação , Indicadores e Reagentes/química , Adulto , Idoso , Dermatologistas/estatística & dados numéricos , Dermatologia/métodos , Dermatologia/estatística & dados numéricos , Dermatomicoses/microbiologia , Dermatomicoses/patologia , Diagnóstico Diferencial , Feminino , Humanos , Hidróxidos/química , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/estatística & dados numéricos , Microscopia , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Compostos de Potássio/química , Padrões de Prática Médica/estatística & dados numéricos , Pele/microbiologia , Pele/patologia , Inquéritos e Questionários/estatística & dados numéricos
13.
Medicina (Kaunas) ; 55(8)2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31405058

RESUMO

BACKGROUND AND OBJECTIVES: This study aims to identify reasons for unscheduled return visits (URVs), and risk factors for diagnostic errors leading to URVs, with comparisons to data from a similar study conducted in the same institution 9 years ago. MATERIALS AND METHODS: This retrospective study included adult patients who attended the emergency department (ED) of a tertiary hospital in Singapore between January 2014 and June 2014, with re-attendance within 72 h for the same or similar complaint. The primary outcome was wrong or delayed diagnoses. Secondary outcomes include admission to the ED observation unit or ward on return visit. Findings were compared with the previous study performed in 2005 to identify trends. RESULTS: Of 67,422 attendances, there were 1298 (1.93%) URVs from 1207 patients (median age 34, interquartile range 24 to 52 years; 59.7% male). The most common presenting complaint was abdominal pain (22.2%). One hundred ninety-one (15.8%) patients received an initial wrong or delayed diagnosis. Factors (adjusted odds ratio; 95% CI) associated with this were: presenting complaints of abdominal pain (2.99; 2.12-4.23), fever (1.60; 1.1-2.33), neurological deficit (4.26; 1.94-9.35), and discharge without follow-up (1.61; 1.1-2.26). Among re-attendances, 459 (38.0%) required admission. Factors (adjusted odds ratio; 95% CI) associated with admission were: male gender (1.88; 1.42 to 2.48); comorbidities of diabetes mellitus (2.07; 1.29-3.31), asthma (5.23; 1.59-17.26), and renal disease (7.48; 2.00-28.05); presenting complaints of abdominal pain (1.83; 1.32-2.55), fever (3.05; 2.10-4.44), and giddiness or vertigo (2.17; 1.26-3.73). There was a reduction in URV rate compared to the previous study in 2005 (1.93% versus 2.19%). Abdominal pain at the index visit remains a significant cause of URVs (22.2% versus 25.1%). CONCLUSIONS: Presenting complaints of neurological deficits, abdominal pain, fever, and discharge without follow-up were associated with wrong or delayed diagnoses among URVs.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Fatores de Risco , Adulto , Serviço Hospitalar de Emergência/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Singapura , Fatores de Tempo
14.
Acta Orthop ; 90(6): 610-613, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31328600

RESUMO

Background and purpose - Unnecessary radiographic and clinical follow-ups are common in treatment of pediatric fractures. We hypothesized that follow-up radiographs are unnecessary to monitor union of physeal fractures of the distal tibia.Patients and methods - All 224 (147 boys) children under 16 years old treated for a physeal fracture of the distal tibia during a 5-year period (2010-14) in Helsinki Children's Hospital were included in this study. Peterson type II fractures comprised 55% and transitional fractures (Tillaux and Triplane) 20% of all injuries. Fracture displacement and alignment was measured. Type and place of treatment was recorded. Number of follow-up radiographs and outpatient visits was calculated and their clinical significance was assessed.Results - 109 children had fractures with < 2 mm displacement and no angulation. The other 115 children's mean fracture displacement was 6 mm (2-28). 54% of all children were treated by casting in situ in the emergency room, 20% with manipulation under anesthesia and 26% with surgery (internal 57, external fixation 2). Median 3 (1-7) follow-up appointments and median 3 (0-6) radiographs were taken. Follow-up radiographs at or before cast removal did not alter treatment in any of the patients. 223 patients' fractures healed within 4-9 weeks in good alignment (≤ 5° angulation).Interpretation - Routine radiographic follow-up is unnecessary to monitor alignment and union of physeal fractures of the distal tibia.


Assuntos
Continuidade da Assistência ao Paciente , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/terapia , Procedimentos Desnecessários , Adolescente , Moldes Cirúrgicos , Criança , Pré-Escolar , Diáfises/diagnóstico por imagem , Diáfises/lesões , Diáfises/cirurgia , Epífises/diagnóstico por imagem , Epífises/lesões , Epífises/cirurgia , Feminino , Finlândia , Fixação de Fratura , Consolidação da Fratura , Humanos , Lactente , Masculino , Manipulação Ortopédica , Visita a Consultório Médico/estatística & dados numéricos , Radiografia , Fraturas da Tíbia/classificação
15.
Plast Reconstr Surg ; 144(2): 276-286, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348326

RESUMO

BACKGROUND: The numerous office visits required to complete expansion in implant-based breast reconstruction impact patient satisfaction, office resources, and time to complete reconstruction. This study aimed to determine whether prepectoral compared to subpectoral immediate implant-based breast reconstruction offers expedited tissue expansion without affecting complication rates. METHODS: Consecutive patients who underwent immediate implant-based breast reconstruction with tissue expanders from January of 2016 to July of 2017 by a single surgeon were grouped into subpectoral (partial submuscular/partial acellular dermal matrix) or prepectoral (complete acellular dermal matrix coverage), and reviewed. The primary outcomes were total days and number of visits to complete expansion. Groups were compared by univariate analysis with significance set at p < 0.05. RESULTS: In total, 101 patients (subpectoral, n = 69; prepectoral, n = 32) underwent 184 immediate implant-based breast reconstructions (subpectoral, n = 124; prepectoral, n = 60). There was no difference in age, body mass index, smoking, or diabetes between the groups (all p > 0.05). Follow-up was similar between groups (179.3 ± 98.2 days versus 218.3 ± 119.8 days; p = 0.115). Prepectoral patients took fewer days to complete expansion (40.4 ± 37.8 days versus 62.5 ± 50.2 days; p < 0.001) and fewer office visits to complete expansion (2.3 ± 1 .7 versus 3.9 ± 1.8; p < 0.001), and were expanded to greater final volumes than subpectoral patients (543.7 ± 122.9 ml versus 477.5 ± 159.6 ml; p = 0.017). Between prepectoral and subpectoral reconstructions, there were similar rates of minor complications (25 percent versus 18.5 percent; p = 0.311), readmissions (5 percent versus 2.4 percent; p = 0.393), seromas (8.3 percent versus 5.6 percent; p = 0.489), reoperations for hematoma (3.3 percent versus 1.6 percent; p = 0.597), and explantations (5 percent versus 2.4 percent; p = 0.393). CONCLUSION: This novel analysis demonstrates that prepectoral immediate implant-based breast reconstruction can facilitate expansion to higher total volumes in nearly half the office visits compared to subpectoral placement in similar populations without increasing complication rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Derme Acelular , Implante Mamário/métodos , Implantes de Mama , Neoplasias da Mama/cirurgia , Expansão de Tecido/métodos , Implante Mamário/instrumentação , Feminino , Humanos , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Expansão de Tecido/instrumentação , Dispositivos para Expansão de Tecidos
16.
Geriatr Gerontol Int ; 19(8): 705-710, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237101

RESUMO

AIM: The purpose of this study was to investigate whether transpersonal trust (TPT) moderates the relationship between chronic conditions and general practitioner (GP) visits among the oldest old in Germany. METHODS: The multicenter prospective cohort Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients (85+) (AgeQualiDe) was carried out. Individuals were recruited through GP offices at six study centers in Germany (follow-up wave 7). Primary care patients were aged ≥85 years (n = 861, mean age 89.0 years; range 85-100 years). The self-reported number of outpatient visits to the GP was used as the outcome measure. To explore religious and spiritual beliefs, the short form of the Transpersonal Trust scale was used. The presence or absence of 36 chronic conditions was recorded by the GP. RESULTS: Multiple Poisson regressions showed that GP visits were positively associated with the number of chronic conditions (incidence rate ratio 1.03, P < 0.05). TPT moderated the relationship between chronic conditions and GP visits (incidence rate ratio 1.01, P < 0.05). The association between chronic conditions and GP visits was significantly more pronounced when TPT was high. CONCLUSION: Our findings highlight the importance of TPT in the relationship between chronic conditions and GP visits. Future longitudinal studies are required to clarify this subject further. Geriatr Gerontol Int 2019; 19: 705-710.


Assuntos
Clínicos Gerais , Múltiplas Afecções Crônicas , Visita a Consultório Médico/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Qualidade de Vida , Espiritualidade , Confiança , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Clínicos Gerais/psicologia , Clínicos Gerais/estatística & dados numéricos , Alemanha , Serviços de Saúde para Idosos/estatística & dados numéricos , Humanos , Masculino , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/psicologia , Múltiplas Afecções Crônicas/terapia , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
17.
Reprod Health ; 16(1): 73, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151402

RESUMO

BACKGROUND: Antenatal care (ANC) is special care for pregnant women with the aim of preventing, detecting and treating health problems in both the fetus and mother. Early ANC attendance promotes early detection and treatment of complications which result in proper management during delivery and puerperium. However, the majority of pregnant women in Ethiopia initiate their ANC late. Therefore, this study aimed to assess the prevalence of late initiation of ANC and its associated factors among attendants in Addis Zemen primary hospital. METHOD: An institution-based cross-sectional study was conducted at Addis Zemen primary hospital from February 7 to June 122,018. The systematic random sampling technique was employed to select 369 pregnant women who attended ANC in the hospital. Data cleaning and analysis was done using SPSS version 25 statistical software. Descriptive statics and bi variable and multivariable logistic regression models were employed to assess the magnitude and factors associated with late initiation of ANC defined as making the first visit after 12 weeks of gestation. RESULT: This study indicated that 52.5% of the attendants initiated ANC late. The multivariable logistic regression analysis showed that being housewife (Adjusted odds ratio (AOR) = 2.85, 95% CI: 1.36, 5.96), self-employment (AOR = 2.38, 95% CI: 1.12, 5.04), travel expenses (AOR = 1.72, 95% CI: 1.05, 2.81), poor knowledge about ANC (AOR = 2.98, 95% CI: 1.78, 5.01) and unplanned pregnancy (AOR = 2.31, 95% CI: 1.28, 4.16) were significantly associated with late ANC initiation. CONCLUSION: The prevalence of late ANC initiation remains a major public health issue in Ethiopia. The major factors for being late were found to be poor knowledge, being housewife, and self-employment, travel expenses and unintended pregnancy. District and zonal health offices should work to create awareness about the importance of early initiation of ANC, make the service closer to the community and increase contraceptive utilization.


Assuntos
Instalações de Saúde/normas , Serviços de Saúde Materna/normas , Visita a Consultório Médico/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/métodos , Adulto , Estudos Transversais , Etiópia , Feminino , Promoção da Saúde , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gravidez , Gestantes , Adulto Jovem
18.
Econ Hum Biol ; 34: 286-295, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31097347

RESUMO

The seasonal influenza virus afflicts millions of people in the U.S. population each year, imposing significant costs on those who fall ill, their families, employers, and the health care system. The flu is transmitted via droplet spread or close contact, and certain environments, such as schools or offices, promote transmission. In this paper, we examine whether increases in employment are associated with increased incidence of the flu. We use state-level data on the prevalence of the flu from the Centers for Disease Control and Prevention. In our preferred specification, we find that a one percentage point increase in the employment rate increases the number of influenza related outpatient health care visits by 19%, and these effects are highly pronounced in the retail sector and healthcare sector, the sectors with the highest levels of interpersonal contact.


Assuntos
Emprego/estatística & dados numéricos , Influenza Humana/epidemiologia , Visita a Consultório Médico/estatística & dados numéricos , Humanos , Estações do Ano , Estados Unidos
20.
Obstet Gynecol Clin North Am ; 46(2): 339-351, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056135

RESUMO

Patient safety is inseparable from quality and is a top priority for the United States health care system. This article explores factors that contribute to errors and patient harm in office practice, discusses key ways in which errors in the outpatient setting compare with those occurring in the inpatient setting, and describes strategies for supporting and improving patient safety in office practice.


Assuntos
Assistência Ambulatorial , Segurança do Paciente , Qualidade da Assistência à Saúde , Assistência Ambulatorial/estatística & dados numéricos , Procedimentos Cirúrgicos Ambulatórios , Erros de Diagnóstico , Feminino , Ginecologia/métodos , Humanos , Erros Médicos/prevenção & controle , Erros Médicos/estatística & dados numéricos , Obstetrícia/métodos , Visita a Consultório Médico/estatística & dados numéricos , Gravidez , Garantia da Qualidade dos Cuidados de Saúde
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