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1.
J Am Board Fam Med ; 34(Suppl): S147-S151, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33622830

RESUMO

PURPOSE: Examine use of office resources by primary care patients who were initially evaluated through telehealth, telephone, or in-person encounters. METHODS: Retrospective electronic health record review on patients seen in March 2020 for evaluation of potential COVID-19 symptoms, to assess the total number of interactions with physicians and office staff. RESULTS: Of 202 patients, 89 (44%) had initial telehealth, 55 (27%) telephone, and 52 (26%) in-person encounters. Patients initially evaluated through telehealth, telephone, and in-person encounters had a mean of 6.1 (S.D. = 3.7), 5.2 (S.D. = 3.6), and 4.5 (S.D. = 3.0) total interactions with the office, respectively (P = .03), and 9%, 12.7%, and 19.2%, respectively, had a subsequent in-person or emergency department visit (P = .22). Multivariable analysis showed no differences in number of office interactions based on initial visit type; older patients (95% CI = 0.00-0.07) and those with subjective fevers (95% CI = 1.01-3.01) or shortness of breath (95% CI = 0.23-2.28) had more interactions with the office. CONCLUSION: Primary care providers used virtual visits to care for most patients presenting with potential COVID-19 symptoms, with many patients choosing telephone over telehealth visits. Virtual visits can successfully limit patient exposure to other people, and consideration could be given to increasing its use for patients with potential symptoms of COVID-19.


Assuntos
/diagnóstico , Atenção Primária à Saúde/métodos , Telemedicina/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Pandemias , Estudos Retrospectivos , Telefone/estatística & dados numéricos , Adulto Jovem
2.
J Am Board Fam Med ; 34(Suppl): S162-S169, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33622832

RESUMO

The Coronavirus disease 2019 (COVID 19) pandemic has resulted in a rapid shift to telehealth and many services that need in-person care have been avoided. Yet, as practices and payment policies return to a new normal, there will be many questions about what proportion of visits should be done in-person vs telehealth. Using the 2016 National Ambulatory Medical Survey (NAMCS), we estimated what proportion of visits were amenable to telehealth before COVID-19 as a guide. We divided services into those that needed in-person care and those that could be done via telehealth. Any visit that included at least 1 service where in-person care was needed was counted as an in-person only visit. We then calculated what proportion of reported visits and services in 2016 could have been provided via telehealth, as well as what proportion of in-person only services were done by primary care. We found that 66% of all primary care visits reported in NAMCS in 2016 required an in-person service. 90% of all wellness visits and immunizations were done in primary care offices, as were a quarter of all Papanicolaou smears. As practices reopen, patients will need to catch up on many of the in-person only visits that were postponed such as Papanicolaou smears and wellness visits. At the same time, patients and clinicians now accustomed to telehealth may have reservations about returning to in-person only visits. Our estimates may provide a guide to practices as they navigate how to deliver care in a post-COVID-19 environment.


Assuntos
Visita a Consultório Médico/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Telemedicina/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Humanos , Pandemias , Telemedicina/tendências
3.
CMAJ ; 193(6): E200-E210, 2021 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-33558406

RESUMO

BACKGROUND: Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the initial months of the pandemic in Ontario, Canada. METHODS: This population-based study compared comprehensive, linked primary care physician billing data from Jan. 1 to July 28, 2020, with the same period in 2019. We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period. We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics. We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period. RESULTS: Compared with 2019, total primary care visits between March and July 2020 decreased by 28.0%, from 7.66 to 5.51 per 1000 people/day. The smallest declines were among patients with the highest expected health care use (8.3%), those who could not be attributed to a primary care physician (10.2%), and older adults (19.1%). In contrast, total visits in rural areas increased by 6.4%. Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits. The lowest uptake of virtual care was among children (57.6%), rural residents (60.6%) and physicians with panels of ≥ 2500 patients (66.0%). INTERPRETATION: Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic. Total visits declined least among those with higher health care needs. The determinants and consequences of these major shifts in care require further study.


Assuntos
Visita a Consultório Médico/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Pandemias , Atenção Primária à Saúde/tendências , Estudos Retrospectivos , Adulto Jovem
4.
Med Care ; 59(1): 62-66, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33301282

RESUMO

BACKGROUND: Physicians' time with patients is a critical input to care, but is typically measured retrospectively through survey instruments. Data collected through the use of electronic health records (EHRs) offer an alternative way to measure visit length. OBJECTIVE: To measure how much time primary care physicians spend with their patients, during each visit. RESEARCH DESIGN: We used a national source of EHR data for primary care practices, from a large health information technology company. We calculated exam length and schedule deviations based on timestamps recorded by the EHR, after implementing sequential data refinements to account for non-real-time EHR use and clinical multitasking. Observational analyses calculated and plotted the mean, median, and interquartile range of exam length and exam length relative to scheduled visit length. SUBJECTS: A total of 21,010,780 primary care visits in 2017. MEASURES: We identified primary care visits based on physician specialty. For these visits, we extracted timestamps for EHR activity during the exam. We also extracted scheduled visit length from the EHR's practice management functionality. RESULTS: After data refinements, the average primary care exam was 18.0 minutes long (SD=13.5 min). On average, exams ran later than their scheduled duration by 1.2 minutes (SD=13.5 min). Visits scheduled for 10 or 15 minutes were more likely to exceed their allotted time than visits scheduled for 20 or 30 minutes. CONCLUSIONS: Time-stamped EHR data offer researchers and health systems an opportunity to measure exam length and other objects of interest related to time.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde , Feminino , Humanos , Pessoa de Meia-Idade , Médicos de Atenção Primária , Estudos Retrospectivos , Fatores de Tempo
5.
J Am Coll Cardiol ; 76(25): 2911-2922, 2020 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-33334418

RESUMO

BACKGROUND: Determining the reliability and predictive validity of office blood pressure (OBP), ambulatory BP (ABP), and home BP (HBP) can inform which is best for diagnosing hypertension and estimating risk of cardiovascular disease. OBJECTIVES: This study aimed to assess the reliability of OBP, HBP, and ABP and evaluate their associations with left ventricular mass index (LVMI) in untreated persons. METHODS: The Improving the Detection of Hypertension (IDH) study, a community-based observational study, enrolled 408 participants who had OBP assessed at 3 visits, and completed 3 weeks of HBP, 2 24-h ABP recordings, and a 2-dimensional echocardiogram. Mean age was 41.2 ± 13.1 years, 59.5% were women, 25.5% African American, and 64.0% Hispanic. RESULTS: The reliability of 1 week of HBP, 3 office visits with mercury sphygmomanometry, and 24-h ABP were 0.938, 0.894, and 0.846 for systolic and 0.918, 0.847, and 0.843 for diastolic BP, respectively. The correlations among OBP, HBP, and ABP, corrected for regression dilution bias, were 0.74 to 0.89. After multivariable adjustment including OBP and 24-h ABP, 10 mm Hg higher systolic and diastolic HBP were associated with 5.07 (standard error [SE]: 1.48) and 3.92 (SE: 2.14) g/m2 higher LVMI, respectively. After adjustment for HBP, neither systolic or diastolic OBP nor ABP was associated with LVMI. CONCLUSIONS: OBP, HBP, and ABP assess somewhat distinct parameters. Compared with OBP (3 visits) or 24-h ABP, systolic and diastolic HBP (1 week) were more reliable and more strongly associated with LVMI. These data suggest that 1 week of HBP monitoring may be the best approach for diagnosing hypertension.


Assuntos
Determinação da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/métodos , Ventrículos do Coração , Hipertensão , Adulto , Ecocardiografia/métodos , Ecocardiografia/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/etnologia , Hipertensão/fisiopatologia , Masculino , Visita a Consultório Médico/estatística & dados numéricos , Tamanho do Órgão , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
6.
J Prim Care Community Health ; 11: 2150132720969557, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33174495

RESUMO

OBJECTIVE: In this brief report, we characterize pediatric primary care service utilization in metropolitan Chicago over the first 24 weeks of the COVID-19 pandemic response in relation to the comparable time period in 2019. METHODS: We examined retrospective visit and billing data, regardless of payer, from 16 independent pediatric practices that utilize a common electronic medical record platform within an Accountable Care Organization of 252 pediatricians in 71 offices throughout metropolitan Chicago. We categorized visits as Well-Child and Immunization-Only (WC-IO) or Other types and identified visits with a telemedicine billing modifier. Diagnoses for Other visits were tallied and categorized using the Agency for Healthcare Research and Quality Clinical Classification System. We summarized counts of visits and the proportion of visits with a telemedicine billing modifier in one-week epochs for 2020 compared with 2019. RESULTS: There were 102 942 total visits (72 030 WC-IO; 30 912 Other) in 2020 and 144 672 visits (80 578 WC-IO; 64 094 Other) in 2019. WC-IO visits in 2020 were half of 2019 visits at the start of the Illinois Stay-at-Home Order and returned greater than 90% of 2019 visits in 8 weeks. Other visit types have remained below 70% of 2019 visits. A telemedicine billing modifier peaked in mid-April (21% of all visits) and declined to <10% of all visits in June (Phase 2 reopening). The top 10 most common diagnoses differed between years. CONCLUSIONS: Recovery of well child and immunization visits suggests that practice-level efforts and policy change can ensure children receive recommended care as the pandemic evolves.


Assuntos
Assistência Ambulatorial , Saúde da Criança , Infecções por Coronavirus , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Pneumonia Viral , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Betacoronavirus , Chicago/epidemiologia , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Registros Eletrônicos de Saúde , Humanos , Imunização , Lactente , Visita a Consultório Médico/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Estudos Retrospectivos , Isolamento Social , Telemedicina
9.
JAMA Netw Open ; 3(10): e2021476, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33006622

RESUMO

Importance: Little is known about the association between the coronavirus disease 2019 (COVID-19) pandemic and the level and content of primary care delivery in the US. Objective: To quantify national changes in the volume, type, and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based vs telemedicine encounters. Design, Setting, and Participants: Analysis of serial cross-sectional data from the IQVIA National Disease and Therapeutic Index, a 2-stage, stratified nationally representative audit of outpatient care in the US from the first calendar quarter (Q1) of 2018 to the second calendar quarter (Q2) of 2020. Main Outcomes and Measures: Visit type (office-based or telemedicine), overall and stratified by patient population and geographic region; assessment of blood pressure or cholesterol measurement; and initiation or continuation of prescription medications. Results: In the 8 calendar quarters between January 1, 2018, and December 31, 2019, between 122.4 million (95% CI, 117.3-127.5 million) and 130.3 million (95% CI, 124.7-135.9 million) quarterly primary care visits occurred in the US (mean, 125.8 million; 95% CI, 121.7-129.9 million), most of which were office-based (92.9%). In 2020, the total number of encounters decreased to 117.9 million (95% CI, 112.6-123.2 million) in Q1 and 99.3 million (95% CI, 94.9-103.8 million) in Q2, a decrease of 21.4% (27.0 million visits) from the average of Q2 levels during 2018 and 2019. Office-based visits decreased 50.2% (59.1 million visits) in Q2 of 2020 compared with Q2 2018-2019, while telemedicine visits increased from 1.1% of total Q2 2018-2019 visits (1.4 million quarterly visits) to 4.1% in Q1 of 2020 (4.8 million visits) and 35.3% in Q2 of 2020 (35.0 million visits). Decreases occurred in blood pressure level assessment (50.1% decrease, 44.4 million visits) and cholesterol level assessment (36.9% decrease, 10.2 million visits) in Q2 of 2020 compared with Q2 2018-2019 levels, and assessment was less common during telemedicine than during office-based visits (9.6% vs 69.7% for blood pressure; P < .001; 13.5% vs 21.6% for cholesterol; P < .001). New medication visits in Q2 of 2020 decreased by 26.0% (14.1 million visits) from Q2 2018-2019 levels. Telemedicine adoption occurred at similar rates among White individuals and Black individuals (19.3% vs 20.5% of patient visits, respectively, in Q1/Q2 of 2020), varied by region (low of 15.1% of visits [East North Central region], high of 26.8% of visits [Pacific region]), and was not correlated with regional COVID-19 burden. Conclusions and Relevance: The COVID-19 pandemic has been associated with changes in the structure of primary care delivery, with the content of telemedicine visits differing from that of office-based encounters.


Assuntos
Visita a Consultório Médico/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Afro-Americanos , Idoso , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
10.
Tex Med ; 116(9): 47, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33023282

RESUMO

Regardless of whether education takes place virtually or in-person, Texas school vaccination rules remain in effect for the 2020-21 school year, according to the Texas Department of State Health Services. All Texas public schools (and most private schools) and colleges require students to have certain shots before they can attend classes at the beginning of a school year.


Assuntos
Serviços de Saúde Comunitária/legislação & jurisprudência , Educação de Pacientes como Assunto , Instituições Acadêmicas , Vacinação/legislação & jurisprudência , Vacinação/estatística & dados numéricos , Doenças Preveníveis por Vacina/prevenção & controle , Vacinas , Criança , Infecções por Coronavirus , Humanos , Visita a Consultório Médico/estatística & dados numéricos , Pandemias , Pneumonia Viral , Texas
11.
Cad Saude Publica ; 36Suppl 3(Suppl 3): e00181920, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33053060

RESUMO

The continent of the Americas has the greatest number of people infected and deaths associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the world. Brazil occupies the 2nd position in numbers of infected cases and deaths, preceded only by the United States. Older adults and those with pre-existing chronic illnesses are more vulnerable to the consequences of the virus. The SARS-CoV-2 epidemic has serious consequences for health services. Therefore, an assessment of the pandemic's effect on the older Brazilian population is urgently needed. The study examines the prevalence of COVID-19 related symptoms, care-seeking, and cancellation of surgery or other scheduled medical care among a nationally representative sample of Brazilians aged 50 and over derived from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) and a telephone follow-up survey (the ELSI-COVID-19 initiative) between late May and early June 2020. About 10.4% of older adults reported any fever, dry cough or difficulty breathing in the 30 days prior to the interview, with the highest prevalence in the North region (50%). Among individuals with symptoms, only 33.6% sought care. Individuals living in the South or Southeast regions were significantly less likely to seek care for COVID-19 related symptoms. Nearly one in six participants had to cancel scheduled surgery or other medical care; this proportion was higher among women, those with more education, and people with multiple chronic conditions. This paper is among the first to investigate the effect of COVID-19 on health care use in Brazil among older adults. Results highlight the need to adapt health care delivery (such as through telemedicine) to ensure the continuity of care as well as the urgent need for wide dissemination of information to guide the population on disease prevention measures and how to obtain healthcare when needed.


Assuntos
Infecções por Coronavirus/psicologia , Visita a Consultório Médico/estatística & dados numéricos , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral/psicologia , Idoso , Betacoronavirus , Brasil , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Visita a Consultório Médico/tendências , Pneumonia Viral/epidemiologia , Fatores Socioeconômicos
12.
Graefes Arch Clin Exp Ophthalmol ; 258(12): 2655-2660, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32960319

RESUMO

PURPOSE: To quantify the shrinking in outpatient and intravitreal injections' volumes in a tertiary referral retina unit secondary to virus causing coronavirus disease 2019 (COVID-19). METHODS: In this retrospective cross-sectional study, we reviewed the charts of all patients who had a visit at a medical retina referral center during the Italian quarantine (from 9th of March 2020 to 3rd of May 2020). Number and characteristics of these data were compared with data from the same period in 2019 (from 9th of March 2019 to 3rd of May 2019). RESULTS: In the 2019 study period, there were 303 patients attending clinic (150 males, 153 females). In the 2020 study period, patients decreased to 75 (48 males, 27 females; P = 0.022 comparing gender prevalence between the two periods) with an overall reduction of 75.2%. Mean ± SD age was 71.4 ± 14.3 years (range 25-93 years) in the 2019 study period and 66.7 ± 13.1 years (range 32-91 years) in the 2020 study period (P = 0.005). The largest drop in outpatient volume was recorded in AMD patients (- 79.9%). Regarding the intravitreal treatments, there were 1252 injections in the 2019 period and 583 injections in the 2020 period (- 53.6% in injections). The drop in intravitreal treatments was larger in patients with posterior uveitis, retinal vein occlusion, and diabetes (- 85.7%, - 61.9%, and - 59.6%, respectively). CONCLUSION: The volume of outpatient visits and intravitreal injections declined during the COVID-19 quarantine. The short- and long-term impacts are that routine in-person visits and intravitreal injections are expected to increase after the quarantine and, even more, after the pandemic.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Visita a Consultório Médico/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Doenças Retinianas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Injeções Intravítreas , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Quarentena , Encaminhamento e Consulta/estatística & dados numéricos , Doenças Retinianas/diagnóstico , Doenças Retinianas/fisiopatologia , Estudos Retrospectivos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia
13.
Rev. psiquiatr. infanto-juv ; 37(3): 8-19, jul.-sept. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-197398

RESUMO

INTRODUCCIÓN: La hiperfrecuentación en los servicios de urgencias impacta en la calidad asistencial y el consumo de recursos. Los datos disponibles en relación al colectivo infanto-juvenil hiperfrecuentador en urgencias de psiquiatría son escasos, a pesar del aumento de visitas en los últimos años. OBJETIVO: Caracterizar la hiperfrecuentación infanto-juvenil de urgencias de psiquiatría de un hospital terciario durante el año 2017. MÉTODOS: Estudio observacional retrospectivo, diseño caso-control. Se seleccionaron todos los usuarios menores de edad visitados en nuestras urgencias de psiquiatría y de nuestro sector durante el 2017. Se obtuvieron datos sociodemográficos y clínicos mediante explotación de datos asistenciales y revisión de historias clínicas. La hiperfrecuentación se estableció como ≥5 visitas/año. Se realizó un análisis descriptivo univariado y uno comparativo bivariado entre personas hiperfrecuentadoras y no hiperfrecuentadoras. RESULTADOS: La muestra incluyó 550 personas menores de edad, siendo hiperfrecuentadoras un 3,8% (n=21). Las hiperfrecuentadoras fueron de nacionalidad extranjera en mayor proporción (28,6% vs 13,1%, p = 0,04), sin otras diferencias significativas. Entre el colectivo hiperfrecuentador, el trastorno de conducta fue el diagnóstico principal más prevalente (33,3%), recibía tratamiento psicofarmacológico habitual el 100% (antipsicóticos un 95,2%) y existían factores de vulnerabilidad social en una elevada proporción (distocia sociofamiliar 61,8%, institucionalización 48%). CONCLUSIONES: La hiperfrecuentación infanto-juvenil en urgencias de psiquiatría es una realidad. Se trata de una población socialmente vulnerable, altamente medicada y en la que destaca la problemática conductual. Este colectivo requiere de una atención compleja y multidisciplinar, donde los recursos de soporte social juegan un papel clave


INTRODUCTION: Frequent attenders to the emergency department affect quality of care and imply resource overuse. Data regarding child and adolescent psychiatric frequent attendance to the emergency department is scarce, although their number of visits is growing. OBJECTIVE: To characterize child and adolescent frequent attenders in the psychiatric emergency department of Hospital Clínic de Barcelona during the year 2017. METHODS: Retrospective observational study, case-control design. We selected all minors who attended our psychiatric emergency department in 2017 that belonged to our catchment area. We collected sociodemographic and clinical data through automatic extraction and manual review of electronic medical records. Frequent attendance was established as ≥5 visits/year. We performed a descriptive analysis of frequent attenders and a bivariate analysis comparing frequent attenders versus non-frequent attenders. RESULTS: Our sample included 550 children and adolescents, of which 3.8% (n=21) were frequent attenders. There were significantly more foreigners among frequent attenders (28.6% vs 13.1%, p = 0.04), without other differences between groups. Among frequent attenders, conduct disorders were the most prevalent main diagnoses (33.3%), all had at least one psychotropic medication prescribed (antipsychotics in 95.2%) and social vulnerability factors were present for most of them (family conflict in 61.8%, 48% living in residential care institutions). CONCLUSIONS: Child and adolescent frequent attendance to the psychiatric emergency department is a reality. They are a socially vulnerable and highly medicated subgroup, with a preponderance of conduct problems. They are in need of a comprehensive and multidisciplinary approach, were social services are a key feature


Assuntos
Humanos , Feminino , Adolescente , Serviços de Emergência Psiquiátrica/métodos , Vulnerabilidade Social , Readmissão do Paciente/normas , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Estudos de Casos e Controles , Transtorno da Conduta/psicologia , Visita a Consultório Médico/estatística & dados numéricos , Fatores de Tempo , Readmissão do Paciente/estatística & dados numéricos
15.
Am J Gastroenterol ; 115(10): 1698-1706, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32701731

RESUMO

INTRODUCTION: Biologic agents including infliximab are effective but costly therapies in the management of inflammatory bowel disease (IBD). Home infliximab infusions are increasingly payer-mandated to minimize infusion-related costs. This study aimed to compare biologic medication use, health outcomes, and overall cost of care for adult and pediatric patients with IBD receiving home vs office- vs hospital-based infliximab infusions. METHODS: Longitudinal patient data were obtained from the Optum Clinformatics Data Mart. The analysis considered all patients with IBD who received infliximab from 2003 to 2016. Primary outcomes included nonadherence (≥2 infliximab infusions over 10 weeks apart in 1 year) and discontinuation of infliximab. Secondary outcomes included outpatient corticosteroid use, follow-up visits, emergency room visits, hospitalizations, surgeries, and cost outcomes (out-of-pocket costs and annual overall cost of care). RESULTS: There were 27,396 patients with IBD (1,839 pediatric patients). Overall, 5.7% of patients used home infliximab infusions. These patients were more likely to be nonadherent compared with both office-based (22.2% vs 19.8%; P = .044) and hospital-based infusions (22.2% vs 21.2%; P < .001). They were also more likely to discontinue infliximab compared with office-based (44.7% vs 33.7%; P < .001) or hospital-based (44.7% vs 33.4%; P < .001) infusions. On Kaplan-Meier analysis, the probabilities of remaining on infliximab by day 200 of therapy were 64.4%, 74.2%, and 79.3% for home-, hospital-, and office-based infusions, respectively (P < .001). Home infliximab patients had the highest corticosteroid use (cumulative corticosteroid days after IBD diagnosis: home based, 238.2; office based, 189.7; and hospital based, 208.5; P < .001) and the fewest follow-up visits. Home infusions did not decrease overall annual care costs compared with office infusions ($49,149 vs $43,466, P < .001). DISCUSSION: In this analysis, home infliximab infusions for patients with IBD were associated with suboptimal outcomes including higher rates of nonadherence and discontinuation of infliximab. Home infusions did not result in significant cost savings compared with office infusions.


Assuntos
Assistência Ambulatorial/métodos , Terapia por Infusões no Domicílio/métodos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Infliximab/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Assistência Ambulatorial/economia , Criança , Estudos de Coortes , Colite Ulcerativa/tratamento farmacológico , Redução de Custos , Doença de Crohn/tratamento farmacológico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde , Gastos em Saúde , Terapia por Infusões no Domicílio/economia , Hospitalização/estatística & dados numéricos , Humanos , Infusões Intravenosas , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Consultórios Médicos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
Urology ; 144: 46-51, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32619595

RESUMO

OBJECTIVE: To evaluate whether video visits were being used as substitutes to clinic visits prior to COVID-19 at our institution's outpatient urology centers. METHODS: We reviewed 600 established patient video visits completed by 13 urology providers at a tertiary academic center in southeast Michigan. We compared these visits to a random, stratified sample of established patient clinic visits. We assessed baseline demographics and visit characteristics for both groups. We defined our primary outcome ("revisit rate") as the proportion of additional healthcare evaluation (ie, office, emergency room, hospitalization) by a urology provider within 30 days of the initial encounter. RESULTS: Patients seen by video visit tended to be younger (51 vs 61 years, P <.001), would have to travel further for a clinic appointment (82 vs 68 miles, P <.001), and were more likely to be female (36 vs 28%, P = .001). The most common diagnostic groups evaluated through video visits were nephrolithiasis (40%), oncology (18%) and andrology (14.3%). While the 30-day revisit rates were higher for clinic visits (4.3% vs 7.5%, P = .01) primarily due to previously scheduled appointments, revisits due to medical concerns were similar across both groups (0.5% vs 0.67%; P = .60). CONCLUSIONS: Video visits can be used to deliver care across a broad range of urologic diagnoses and can serve as a substitute for clinic visits.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Telemedicina , Urologia , Comunicação por Videoconferência , Adulto , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Estudos Retrospectivos
17.
J Am Acad Dermatol ; 83(5): 1538-1539, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32682892
18.
Am J Otolaryngol ; 41(6): 102569, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32683188

RESUMO

OBJECTIVES: To evaluate the impact of the novel coronavirus pandemic on practice patterns, clinical behavior, personal health, and emotional/psychological concerns of rhinologists. METHODS: A 15-question survey was sent out to the American Rhinologic Society's (ARS) membership to determine the impact of COVID-19 during the crisis. Demographic factors and practice patterns were collected and evaluated. RESULTS: There were 224 total respondents out of 835 ARS members queried (26.8% response rate). Study queries were sent in April 2020. Notably, 17.8% reported illness in themselves or their staff and 74.4% noted a psychological/emotional impact. A plurality of rhinologists noted their practice volume and in-office procedure volume has become 20.0% and 0.0% of their prior volumes, respectively. In addition, 96.2% were noted to be using telemedicine in our subspecialty. CONCLUSION: In addition to severely impacting volume and the perception of future decreases in patients and revenue, the COVID-19 pandemic has had a physical and emotional impact on rhinologists in ways that need to be further studied. These data include significantly novel and objective information. The COVID-19 crisis also reveals the important role of telemedicine in rhinology. Guidelines regarding personal protective equipment for in-office visits, nasal endoscopy, and other in-office and operating room procedures would be particularly helpful as future waves are expected.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus/epidemiologia , Otorrinolaringologistas , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Betacoronavirus , Endoscopia/estatística & dados numéricos , Humanos , Visita a Consultório Médico/estatística & dados numéricos , Otorrinolaringologistas/psicologia , Pandemias , Equipamento de Proteção Individual/estatística & dados numéricos , Inquéritos e Questionários , Telemedicina/estatística & dados numéricos , Estados Unidos/epidemiologia
20.
BMC Public Health ; 20(1): 1131, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32690064

RESUMO

BACKGROUND: Previous studies have suggested that there is an association between air pollutants and circulatory and respiratory diseases; however, relatively few have analyzed the association between air pollutants and outpatient visits based on the mortality, hospitalization rates, etc., especially in areas with relatively good air quality. Therefore, we conducted this study to research the association between air pollutants and outpatient visits in Fuzhou, China. METHODS: We used a generalized linear Poisson model to study the association between air pollution and outpatient visits for respiratory and circulatory diseases from 2016 to 2018 in Fuzhou, China. RESULTS: In the single pollutant model, nitrogen dioxide (NO2) had a significant effect. For lag day 0 to lag day 5, the effect decreased with every 10 µg/L increase in NO2. The daily maximum 8-h mean ozone (O3-8h) and upper respiratory outpatient visits were positively associated during the cold period [lag2, excess risk (ER) (95% confidence interval (CI)): 1.68% (0.44-2.94%)], while O3-8h and respiratory disease were positively associated during the warm period [lag5, ER (95% CI): 1.10% (0.11-2.10%) and lag4, ER (95% CI): 1.02% (0.032-2.02%)]. Similarly, particulate matter (PM) with an average aerodynamic diameter of less than 10 µm (PM10) and lower respiratory diseases were positively associated during the warm period [lag0, ER (95% CI): 1.68% (0.44-2.94%)]. When the concentration of O3-8h was higher than 100 µg/L, there was a positive effect on circulatory [lag5, ER (95% CI): 2.83% (0.65-5.06%)], respiratory [lag5, ER (95% CI): 2.47% (0.85-4.11%)] and upper respiratory [lag5, ER (95% CI): 3.06% (1.38-4.77%)] outpatient visits. The variation in O3-8h changed slightly when we adjusted for other air pollutants, and after adjusting for O3-8h, the ERs of the other air pollutants changed slightly. After adjusting for PM with an average aerodynamic diameter of less than 2.5 µm (PM2.5), the ERs of the other air pollutants increased, and after adjusting for NO2, the ER of PM decreased. CONCLUSION: Exposure to ambient NO2, O3, PM2.5 and PM10 was associated with an increase in respiratory and circulatory system-related outpatient visits in Fuzhou, China.


Assuntos
Poluentes Atmosféricos/análise , Doenças Cardiovasculares/epidemiologia , Visita a Consultório Médico/estatística & dados numéricos , Pacientes Ambulatoriais , Doenças Respiratórias/epidemiologia , Doenças Cardiovasculares/mortalidade , China/epidemiologia , Humanos , Doenças Respiratórias/mortalidade , Estações do Ano , Análise Espaço-Temporal
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