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Magnusson C, Ryge H, Scott F, Herlitz J, Axelsson C. Limited need for hospital resources among patients brought to hospital by the emergency medical services. BMC Emerg Med 2021; 21:156. [PMID: 34911447 PMCID: PMC8672622 DOI: 10.1186/s12873-021-00549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background In Sweden, the majority of patients who are transported to hospital by the emergency medical services (EMS) are relatively old and the majority suffer from comorbidity. About half these patients are admitted to a hospital ward and will stay in hospital. However, the other half will only make a visit to the emergency department (ED). The burden on the ED is extensive and many elderly patients have to stay for many hours in the ED. Aim To describe the patients who are brought to hospital by the EMS, with particular emphasis on those that were discharged from the ED, and to assess the proportion of these patients who did not require hospital resources, which could mean that they were candidates for primary care (PC). Methods An observational analysis of a cohort of patients who were transported to hospital by the EMS in 2016 in the Municipality of Gothenburg. Results In all, 5,326 patients were transported to hospital by the EMS of which 52% were discharged directly from the ED. These patients included 37% assessed as not requiring hospital resources. The three most common causes of contact with the EMS in this subset were abdominal pain (15%), back pain (8%) and non-specified disease (7%). Of these patients, 77% had contact with a physician in the ED, whereas 6% had contact with a nurse and 17% left the ED without any contact. Twenty-six per cent were given advice on follow-up in PC. Conclusions Among patients who were brought to hospital by the EMS, more than half were discharged directly from the ED. Among these patients, 37% were assessed as not requiring hospital resources. These patients comprised 15% of the overall study cohort and may be candidates for primary care.
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Affiliation(s)
- Carl Magnusson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Helena Ryge
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Filip Scott
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Christer Axelsson
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Kelley AT, Smid MC, Baylis JD, Charron E, Binns-Calvey AE, Archer S, Weiner SJ, Begaye LJ, Cochran G. Development of an unannounced standardized patient protocol to evaluate opioid use disorder treatment in pregnancy for American Indian and rural communities. Addict Sci Clin Pract 2021; 16:40. [PMID: 34172081 PMCID: PMC8229269 DOI: 10.1186/s13722-021-00246-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Opioid use disorder (OUD) disproportionately impacts rural and American Indian communities and has quadrupled among pregnant individuals nationwide in the past two decades. Yet, limited data are available about access and quality of care available to pregnant individuals in rural areas, particularly among American Indians (AIs). Unannounced standardized patients (USPs), or "secret shoppers" with standardized characteristics, have been used to assess healthcare access and quality when outcomes cannot be measured by conventional methods or when differences may exist between actual versus reported care. While the USP approach has shown benefit in evaluating primary care and select specialties, its use to date for OUD and pregnancy is very limited. METHODS We used literature review, current practice guidelines for perinatal OUD management, and stakeholder engagement to design a novel USP protocol to assess healthcare access and quality for OUD in pregnancy. We developed two USP profiles-one white and one AI-to reflect our target study area consisting of three rural, predominantly white and AI US counties. We partnered with a local community health center network providing care to a large AI population to define six priority outcomes for evaluation: (1) OUD treatment knowledge among clinical staff answering telephones; (2) primary care clinic facilitation and provision of prenatal care and buprenorphine treatment; (3) appropriate completion of evidence-based screening, symptom assessment, and initial steps in management; (4) appropriate completion of risk factor screening/probing about individual circumstances that may affect care; (5) patient-directed tone, stigma, and professionalism by clinic staff; and (6) disparities in care between whites and American Indians. DISCUSSION The development of this USP protocol tailored to a specific environment and high-risk patient population establishes an innovative approach to evaluate healthcare access and quality for pregnant individuals with OUD. It is intended to serve as a roadmap for our own study and for future related work within the context of substance use disorders and pregnancy.
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Affiliation(s)
- A Taylor Kelley
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, 500 Foothill Drive, Building 2, Salt Lake City, UT, 84148, USA.
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA.
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA.
| | - Marcela C Smid
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E 2B300, Salt Lake City, UT, 84132, USA
| | - Jacob D Baylis
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA
| | - Elizabeth Charron
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA
| | - Amy E Binns-Calvey
- Jesse Brown VA Medical Center, Medical Services, 820 S Damen Ave, Chicago, IL, 60612, USA
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois At Chicago, 840 South Wood Street, CSN 440, Chicago, IL, 60612, USA
- Edward Hines VA Hospital, Center of Innovation for Complex Chronic Healthcare, 5000 5th Avenue, Hines, IL, USA
| | - Shayla Archer
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, 500 Foothill Drive, Building 2, Salt Lake City, UT, 84148, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA
| | - Saul J Weiner
- Jesse Brown VA Medical Center, Medical Services, 820 S Damen Ave, Chicago, IL, 60612, USA
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois At Chicago, 840 South Wood Street, CSN 440, Chicago, IL, 60612, USA
| | - Lori Jo Begaye
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA
| | - Gerald Cochran
- Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E 5R341, Salt Lake City, UT, 84132, USA
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Craswell A, Dwyer T. Reasons for choosing or refusing care from a nurse practitioner: Results from a national population-based survey. J Adv Nurs 2019; 75:3668-3676. [PMID: 31441094 DOI: 10.1111/jan.14176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/12/2019] [Accepted: 08/06/2019] [Indexed: 02/06/2023]
Abstract
AIM To understand the public's willingness or lack thereof, to be seen and treated by a nurse practitioner (NP) as the first point of contact when accessing healthcare services. DESIGN This cross-sectional, population-based survey study used computer assisted telephone interviewing to elicit public opinions on the topic. METHODS Data were collected in July and August 2015 from calls randomly placed to Australian households. Survey questions were developed from previous surveys and pilot tested. Summative content analysis was used to analyse open-ended responses. RESULTS Most respondents were always, or in some situations, willing to receive care from a nurse practitioner. The main themes identified from those willing to be seen by a nurse practitioner in any situation were, (a) appropriately qualified nurse practitioners, (b) the knowledge and experience to refer on if necessary. Description of situations from those unwilling to be seen by a nurse practitioner related to concern about appropriate care in a life-threatening condition. CONCLUSION Respondents unwilling to consider any care from a nurse practitioner or care in an emergency situation, reveal a lack of understanding of their role in the wider healthcare team. As the number of nurse practitioners increase, professional groups and community awareness programmes should be focused on explaining and promoting their essential role. IMPACT This study addresses the increasing healthcare requirements of ageing populations through understanding acceptance by society to the provision of care from health professionals other than medical practitioners. Most respondents were willing to be seen by a nurse practitioner for all or most of their healthcare needs. Lack of understanding of their scope of practice and role in the wider healthcare team, particularly in emergency situations, was reflected in responses. Those who would refuse care from a NP were in the minority. Appropriateness and acceptability of the roles of health professionals to provide quality care collaboration need consideration by policy makers.
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Affiliation(s)
- Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Qld, Australia
| | - Trudy Dwyer
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Qld, Australia
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Tinkler SE, Sharma RL, Susu-Mago RRH, Pal S, Stano M. Access to US primary care physicians for new patients concerned about smoking or weight. Prev Med 2018; 113:51-56. [PMID: 29719220 PMCID: PMC6310034 DOI: 10.1016/j.ypmed.2018.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/13/2018] [Accepted: 04/28/2018] [Indexed: 11/22/2022]
Abstract
Tobacco smoking and obesity are leading causes of preventable morbidity and mortality in the US, and primary care physicians are the main source of preventive care. However, it is not known whether access for new patients is affected by an expression of interest in preventive care. In a 2015 audit, we called US primary care physicians' offices to request appointment information regarding new patient physicals for simulated patients. Simulated patients were differentiated by smoking concerns (N = 907), weight concerns (N = 867), or no health concerns ("healthy" patients; N = 3561). Additionally, patient profiles varied by race/ethnicity, sex, and insurance type. We also examined whether access differed in states that expanded Medicaid under the Affordable Care Act. We found that physicians' offices were no more likely to offer appointments to patients with smoking concerns than to healthy patients (54% vs. 55%; p-value = 0.56), and patients with smoking concerns were offered fewer appointments than patients with weight concerns (54% vs. 62%, p-value < 0.01). In analyses adjusted for covariates, smoking concerns did not improve appointment offers for any patient group, and reduced Medicare patients' offers in Medicaid expansion states by 9 percentage points relative to healthy patients (95% CI: -16, -2). Health concerns did not statistically significantly affect waits-to-appointment. Our results suggest that patients with smoking concerns are no more likely to be offered new patient appointments than those with no health concerns. The greater likelihood of appointment offers for some patients with weight concerns is encouraging for obesity prevention and management.
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Affiliation(s)
- Sarah E Tinkler
- Department of Economics, Portland State University, Portland, OR, United States
| | - Rajiv L Sharma
- Department of Economics, Portland State University, Portland, OR, United States.
| | - Raven R H Susu-Mago
- Department of Economics, Portland State University, Portland, OR, United States
| | - Sudeshna Pal
- Department of Economics, Portland State University, Portland, OR, United States
| | - Miron Stano
- Department of Economics, Oakland University, Rochester, MI, United States
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Sharma R, Tinkler S, Mitra A, Pal S, Susu-Mago R, Stano M. State Medicaid fees and access to primary care physicians. HEALTH ECONOMICS 2018; 27:629-636. [PMID: 28944526 DOI: 10.1002/hec.3591] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 07/01/2017] [Accepted: 08/08/2017] [Indexed: 05/27/2023]
Abstract
Medicaid and uninsured patients are disadvantaged in access to care and are disproportionately Black and Hispanic. Using a national audit of primary care physicians, we examine the relationship between state Medicaid fees for primary care services and access for Medicaid, Medicare, uninsured, and privately insured patients who differ by race/ethnicity and sex. We found that states with higher Medicaid fees had higher probabilities of appointment offers and shorter wait times for Medicaid patients, and lower probabilities of appointment offers and longer wait times for uninsured patients. Appointment offers and wait times for Medicare and privately insured patients were unaffected by Medicaid fees. At mean state Medicaid fees, our analysis predicts a 27-percentage-point disadvantage for Medicaid versus Medicare in appointment offers. This decreases to 6 percentage points when Medicaid and Medicare fees are equal, suggesting that permanent fee parity with Medicare could eliminate most of the disparity in appointment offers for Medicaid patients. The predicted decrease in the disparity is smaller for Black and Hispanic patients than for White patients. Our research highlights the importance of considering the effects of policy on nontarget patient groups, and the consequences of seemingly race-neutral policies on racial/ethnic and sex-based disparities.
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Affiliation(s)
| | | | - Arnab Mitra
- Portland State University, Portland, OR, USA
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