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Holzinger F, Kümpel L, Resendiz Cantu R, Alberter A, Möckel M, Heintze C. Emergency department visits as a potential opportunity to promote primary care attachment and modify utilization patterns - results of a pilot study in Berlin, Germany. BMC Emerg Med 2024; 24:142. [PMID: 39112973 PMCID: PMC11304799 DOI: 10.1186/s12873-024-01056-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 07/18/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Utilization by low acuity patients contributes to emergency department (ED) crowding. Both knowledge deficits about adequate care levels and access barriers in primary care are important promoters of such presentations. Concurrently, not having a general practitioner (GP) increases the likelihood of low-acuity ED utilization. This pilot study thus investigated feasibility, acceptance, and potential effects of an ED-delivered intervention for low-acuity patients with no regular primary care provider, consisting of an educational leaflet on acute care options and an optional GP appointment scheduling service. METHODS Low-acuity ED consulters not attached to a GP were given an information leaflet about alternative care offers for acute health problems and offered optional personal appointment scheduling at a local GP practice. Patients were surveyed on demographics, medical characteristics, health care utilization, valuation of the intervention, and reasons for not being attached to a GP and visiting the ED. A follow-up survey was conducted after twelve months. Trends in health and health care utilization were evaluated. RESULTS Between December 2020 and April 2022, n = 160 patients were enrolled, n = 114 were followed up. The study population was characterized by young age (mean 30.6 years) and predominantly good general health. Besides good health, personal mobility was a central reason for not being attached to a GP, but general preference for specialists and bad experiences with primary care were also mentioned. Most frequently stated motives for the ED consultation were subjective distress and anxiety, a belief in the superiority of the hospital, and access problems in primary care. The interventional offers were favorably valued, 52.5% (n = 84) accepted the GP appointment scheduling service offer. At follow-up, GP utilization had significantly increased, while there were no significant changes regarding utilization of other providers, including ED. An additional practice survey showed a 63.0% take-up rate for the appointment service. CONCLUSIONS With this pilot study, we were able to show that a personalized appointment scheduling service seems to be a promising approach to promote GP attachment and increase primary care utilization in patients without a regular GP in a highly urbanized setting. Further larger-scale studies are needed to investigate potential quantitative effects on ED visits. TRIAL REGISTRATION German Clinical Trials Register (DRKS00023480); date 2020/11/27.
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Affiliation(s)
- Felix Holzinger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.
| | - Lisa Kümpel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
| | - Rebecca Resendiz Cantu
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Mitte and Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anja Alberter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Mitte and Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Mitte and Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph Heintze
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
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Carey K, Cole MB. Provision of Behavioral Health Services at Community Health Centers and Hospital Emergency Department Visits. Med Care 2024; 62:538-542. [PMID: 38889202 DOI: 10.1097/mlr.0000000000002022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Numerous US patients seek the hospital emergency department (ED) for behavioral health care. Community Health Centers (CHCs) offer a potential channel for redirecting many to a more patient-centered, lower cost setting. OBJECTIVE The aim of this study was to identify unique market areas serviced by CHCs and to examine whether CHCs are effective in offsetting behavioral health ED visits. RESEARCH DESIGN We identified CHC-year specific service areas using patient origin zip codes. We then estimated random effects models applied to 42 federally qualified CHCs operating in New York State during 2013-2020. The dependent variables were numbers of ED mental health (substance use disorder) visits per capita in a CHC's service area, drawn from HCUP State Emergency Department Databases. Key explanatory variables measured CHC number of mental health (substance use disorder) visits, number of unique mental health (substance use disorder) patients, and mental health (substance use disorder) intensity, obtained from the HRSA Uniform Data System. RESULTS Controlling for population, we observed small negative effects of CHC behavioral health integration in explaining ED behavioral health utilization. Measures of mental health utilization in CHCs were associated with 1.3%-9.3% fewer mental health emergency department visits per capita in Community Health Centers' service areas. Measures of substance use disorder utilization in Community Health Centers were associated with 1.3%-3.0% fewer emergency department visits per capita. CONCLUSION Results suggest that behavioral health integration in CHCs may reduce reliance on hospital EDs, but that policymakers explore more avenues for regional coordination strategies that align services between CHCs and local hospitals.
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Affiliation(s)
- Kathleen Carey
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston MA
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Montoro-Pérez N, Montejano-Lozoya R, Escribano S, Richart-Martínez M. Factors associated with non-urgent presentations in the paediatric emergency department using Andersen's behavioural model: A cross-sectional descriptive study. J Clin Nurs 2024; 33:3172-3187. [PMID: 38258512 DOI: 10.1111/jocn.17004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/11/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES To explore the rate of NUPs and associated factors in the PED of the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain) using Andersen's Behavioural Model. METHODS We conducted a descriptive cross-sectional study using Andersen's Behavioural Model in parents visiting the PED with their children at the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain). RESULTS The study involved a total of 530 participants, of whom 419 (79%) had made an NUP. The predisposing factors identified were: (I) paediatric patients brought in by their fathers (OR = 0.460; p = 0.005), (II) lower educational attainment (OR = 3.841; p = 0.000), (III) first-time parenthood (OR = 2.335; p = 0.000) and (IV) higher parental stress (OR = 1.974; p = 0.023). The enabling factors included: (I) responsibility for a significant part of the childcare shared with others (OR = 0.348; p = 0.041) and (II) the perception that PEDs provide better care than primary care (PC) services (OR = 1.628; p = 0.005). The need factors were: (I) existing chronic illness in the child seeking care (OR = 0.343; p = 0.000) and (II) the perceived severity of the urgency (OR = 0.440; p = 0.031). CONCLUSIONS The NUP rates found in this study are similar to those found internationally. In accordance with Andersen's Behavioural Model, we identify predisposing, enabling and need factors to explain the multifactorial nature of NUPs in PEDs. IMPLICATIONS FOR PRACTICE Identifying the factors associated with NUPs enables interventions to be targeted at those groups most likely to engage in NUPs, thereby optimising the functioning of the PED and improving the well-being of children and families. These interventions should focus on improving parental health literacy, providing education on making appropriate decisions about accessing health services and recognising severe symptoms in children, as well as improving access to high-quality PC services. Providing support to parents during the transition to parenthood would also be beneficial. REPORTING METHOD This paper adheres to the STROBE initiative guidelines. CONTRIBUTION FROM PATIENTS OR MEMBERS OF THE PUBLIC Participants, who voluntarily agreed to take part, contributed to the study by completing a paper-based questionnaire containing all the study variables as prepared by the research team.
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Affiliation(s)
- Néstor Montoro-Pérez
- Department of Nursing, Faculty of Health Sciences, Person-Centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
- GREIACC Research Group La Fe Health Research Institute, Valencia, Spain
| | | | - Silvia Escribano
- Department of Nursing, Faculty of Health Sciences, Person-Centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
| | - Miguel Richart-Martínez
- Department of Nursing, Faculty of Health Sciences, Person-Centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
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Dowling-Cullen C, Sakellariou D. Decision-making regarding accessing paediatric unscheduled healthcare during the COVID-19 pandemic: a mixed methods rapid review and thematic synthesis. BMJ Open 2024; 14:e085796. [PMID: 39053956 DOI: 10.1136/bmjopen-2024-085796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE Reductions in paediatric unscheduled healthcare utilisation were seen during the COVID-19 pandemic, with concerns around their impact on children's health. The reasons for these changes are not well described. This review aims to explore the factors reported by parents that influenced their decision-making around accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DESIGN Mixed methods rapid review and thematic synthesis based on the Enhancing Transparency of Reporting the Synthesis of Qualitative research framework. DATA SOURCES MEDLINE, Embase, Web of Science, PsycEXTRA, PsycINFO, Global Health, Global Index Medicus, Dissertations and Theses Global, Google Scholar and OAISter. Studies published from January 2020 to July 2023 were included. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative, quantitative and mixed methods studies that assessed the perspectives of parents on decisions to access or delay or avoid accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DATA EXTRACTION AND SYNTHESIS Nvivo 14.23.0 was used to code results the of the primary studies and develop themes, following a thematic synthesis approach. RESULTS Twelve studies were included, all from high-income settings, mainly in Europe. The studies were conducted across varying times and levels of COVID-19-related restrictions. The principal descriptive themes identified were (i) concerns about COVID-19 infection, (ii) balancing and navigating risks, (iii) perception of healthcare service status and conditions and (iv) perception of information and advice. These were developed into analytic themes to further describe the decision-making process. CONCLUSIONS Parents balanced a range of risks, concerns, advice and responsibilities when considering accessing paediatric unscheduled healthcare during the COVID-19 pandemic. External sources of advice and information were important; misconceptions around public health advice may reflect the multitude of information sources and the rapidly changing circumstances of the pandemic. Public health policy and planning should consider parent perspectives when developing measures to ensure equitable access to appropriate paediatric healthcare services.
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Strehlow M, Alvarez A, Blomkalns AL, Caretta-Wyer H, Gharahbaghian L, Imler D, Khan A, Lee M, Lobo V, Newberry JA, Riberia R, Sebok-Syer S, Shen S, Gisondi MA. Precision emergency medicine. Acad Emerg Med 2024. [PMID: 38940478 DOI: 10.1111/acem.14962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/13/2024] [Accepted: 05/23/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Precision health is a burgeoning scientific discipline that aims to incorporate individual variability in biological, behavioral, and social factors to develop personalized health solutions. To date, emergency medicine has not deeply engaged in the precision health movement. However, rapid advances in health technology, data science, and medical informatics offer new opportunities for emergency medicine to realize the promises of precision health. METHODS In this article, we conceptualize precision emergency medicine as an emerging paradigm and identify key drivers of its implementation into current and future clinical practice. We acknowledge important obstacles to the specialty-wide adoption of precision emergency medicine and offer solutions that conceive a successful path forward. RESULTS Precision emergency medicine is defined as the use of information and technology to deliver acute care effectively, efficiently, and authentically to individual patients and their communities. Key drivers and opportunities include leveraging human data, capitalizing on technology and digital tools, providing deliberate access to care, advancing population health, and reimagining provider education and roles. Overcoming challenges in equity, privacy, and cost is essential for success. We close with a call to action to proactively incorporate precision health into the clinical practice of emergency medicine, the training of future emergency physicians, and the research agenda of the specialty. CONCLUSIONS Precision emergency medicine leverages new technology and data-driven artificial intelligence to advance diagnostic testing, individualize patient care plans and therapeutics, and strategically refine the convergence of the health system and the community.
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Affiliation(s)
- Matthew Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Al'ai Alvarez
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andra L Blomkalns
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Holly Caretta-Wyer
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Laleh Gharahbaghian
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel Imler
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ayesha Khan
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Moon Lee
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Viveta Lobo
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer A Newberry
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ryan Riberia
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Stefanie Sebok-Syer
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sam Shen
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Michael A Gisondi
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
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Bar-Yishay M, Adler L, Bar El A, Boker Faran L, Mizrahi Reuveni M, Sternberg SA, Schejter E, Radomyslsky Z, Segal Y, Azuri J, Yehoshua I. MACCABI-RED, community emergency care at the press of a button: a descriptive study. Fam Pract 2024:cmae032. [PMID: 38870094 DOI: 10.1093/fampra/cmae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Maccabi-RED is a new service developed in Israel that allows primary care staff to direct urgent cases to specialists in the community for evaluation in their local clinics on the same day as an alternative to an emergency department (ED) visit. A primary care physician or a nurse can activate the service, and all nearby specialists receive "a call" and can decide if they are willing to accept it, thus allowing the patient to avoid an unnecessary visit to the ED. AIM To quantify and characterize the medical care provided by this service in a large national healthcare system. DESIGN AND SETTING Multicenter, community-based, retrospective cohort study. METHODS All Maccabi-RED visits recorded between September 2021 and August 2022 were included. Patient characteristics were compared to national demographics. Descriptive statistics were used to present data regarding recorded diagnoses, treating physicians, treatments or referrals provided, and subsequent emergency department admissions or hospitalizations. RESULTS 31831 visits were recorded. Most frequent diagnoses were musculoskeletal pain (12.1%), otitis or otalgia (7.8%), contusions (7.6%), fractures (7.1%), foreign body (6.7%), pregnancy-related symptoms (6.3%), and upper-respiratory or unspecified viral infection (6.3%). The most common treatments reported were foreign body removal (5%) and cast application (3.5%). Only 7.8% of visits resulted in emergency department admission within seven days (any cause). The average time from patient request to physician treatment was 91 min. CONCLUSIONS Maccabi-RED is being widely used by patients nationwide. Additional studies are needed to investigate whether Maccabi-RED reduces emergency department visits and costs.
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Affiliation(s)
- Mattan Bar-Yishay
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Limor Adler
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- Department of Family Medicine, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Alon Bar El
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Limor Boker Faran
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Miri Mizrahi Reuveni
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | | | - Eduardo Schejter
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Zorian Radomyslsky
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- Faculty of Medicine, Ariel University, Ariel 40700, Israel
| | - Yakov Segal
- Health Division, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Joseph Azuri
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- Department of Family Medicine, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ilan Yehoshua
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
- Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
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Jang SG, Ock M, Kim S. Qualitative Comparison of Perceptions Regarding Patient Engagement for Patient Safety by Physicians, Nurses, and Patients. Patient Prefer Adherence 2024; 18:1065-1075. [PMID: 38854478 PMCID: PMC11162203 DOI: 10.2147/ppa.s456050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/23/2024] [Indexed: 06/11/2024] Open
Abstract
Purpose Patient engagement in ensuring patient safety is widely acknowledged, there is still a need to explore how perceptions of patient engagement vary among different stakeholders within the healthcare system. We aimed to compare the perceptions regarding patient engagement for patient safety among physicians, nurses, and patients by exploring the perspectives. Patients and Methods A qualitative study, comprising three focus group discussions (six to eight people each), was conducted in South Korea. Physicians and nurses who worked at the general hospital level or higher, and patients who had been hospitalized for more than 24 hours, were included. Researchers analyzed the transcripts, and a content analysis was performed to describe influencing elements of patient engagement for patient safety. A word cloud was created through keyword analysis of the transcripts. Results Based on 479 coded data, three categories and eight sub-categories were derived. The first moment of patient engagement was viewed as the choice of medical institutions. Reputation occupied a large part in the hospital selection for all participants, but they did not know about or use the national hospital evaluation data. Participants said that continuous patient engagement, such as the patient's active questioning attitude, guardian's cooperation, sufficient medical personnel, and patient safety education was required during treatment. However, it was said that patient engagement was ignored after patient safety incidents occurred. They mentioned that they were emotional and busy arguing for their own positions, and that it was difficult to use a medical dispute resolution method in practice. In the word cloud by group, fall, explanation, hospital, and patient were common words. Conclusion All three groups agreed on the importance of patient engagement for patient safety but differed in its influencing factors. Efforts should be made to reduce the difference between the three groups on how to involve patients for patient safety.
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Affiliation(s)
| | - Minsu Ock
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, South Korea
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Soyoon Kim
- Department of Medical Law and Ethics, Asian Institute for Bioethics and Health Law, College of Medicine, Yonsei University, Seoul, Republic of Korea
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Stauder SK, Borkar SR, Glasgow AE, Runkle TL, Sherman ME, Spaulding AC, Mohseni MM, DeStephano CC. Emergency Department Visits Before Cancer Diagnosis Among Women at Mayo Clinic. Mayo Clin Proc Innov Qual Outcomes 2024; 8:213-224. [PMID: 38596167 PMCID: PMC11002794 DOI: 10.1016/j.mayocpiqo.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 04/11/2024] Open
Abstract
Objective To determine associations of incident cancer diagnoses in women with recent emergency department (ED) care. Patients and Methods A retrospective cohort study analyzing biological females aged 18 years and older, who were diagnosed with an incident primary cancer (12 cancer types studied) from January 1, 2015, to December 31, 2021, from electronic health records. The primary outcome was a cancer diagnosis within 6 months of a preceding ED visit. Secondary outcomes included patient factors associated with a preceding ED visit. Results Of 25,736 patients (median age of 62 years, range 18-101) diagnosed with an incident primary cancer, 1938 (7.5%) had an ED visit ≤6 months before a diagnosis. The ED-associated cancer cases were highest in lung cancer (n=514, 14.7%) followed by acute lymphoblastic leukemia (n=22, 13.3%). Patient factors increasing the likelihood of ED evaluation before diagnosis included 18-50 years of age (OR=1.32; 95% CI, 1.09-1.61), Elixhauser score (measure of comorbidities) >4 (OR=17.90; 95% CI, 14.21-22.76), use of Medicaid or other government insurance (OR=2.10; 95% CI, 1.63-2.69), residence within the institutional catchment areas (OR=3.18; 95% CI, 2.78-3.66), non-Hispanic Black race/ethnicity (OR=1.41; 95% CI, 1.04-1.88), and established primary care provider at Mayo Clinic (OR=1.45; 95% CI, 1.28-1.65). The ED visits were more likely in those who died within 6 months of diagnosis (n=327, 37.8%) than those who did not die (n=1611, 6.5%). Conclusion Patient characteristics identified in this study offer opportunities to provide cancer risk assessment and health navigation, particularly among individuals with comorbidities and limited health care access.
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Affiliation(s)
| | - Shalmali R. Borkar
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - Amy E. Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Tage L. Runkle
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Mark E. Sherman
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Aaron C. Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
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Johansson T, Chambers RL, Curtis T, Pask S, Greenley S, Brittain M, Bone AE, Laidlaw L, Okamoto I, Barclay S, Higginson IJ, Murtagh FE, Sleeman KE. The effectiveness of out-of-hours palliative care telephone advice lines: A rapid systematic review. Palliat Med 2024; 38:625-643. [PMID: 38708864 PMCID: PMC11158006 DOI: 10.1177/02692163241248544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND People with palliative care needs and their carers often rely on out-of-hours services to remain at home. Policymakers have recommended implementing telephone advice lines to ensure 24/7 access to support. However, the impact of these services on patient and carer outcomes, as well as the health care system, remains poorly understood. AIM To evaluate the clinical- and cost-effectiveness of out-of-hours palliative care telephone advice lines, and to identify service characteristics associated with effectiveness. DESIGN Rapid systematic review (PROSPERO ID: CRD42023400370) with narrative synthesis. DATA SOURCES Three databases (Medline, EMBASE and CINAHL) were searched in February 2023 for studies of any design reporting on telephone advice lines with at least partial out-of-hours availability. Study quality was assessed using the Mixed Methods Appraisal Tool, and quantitative and qualitative data were synthesised narratively. RESULTS Twenty-one studies, published 2000-2022, were included. Most studies were observational, none were experimental. While some evidence suggested that telephone advice lines offer guidance and reassurance, supporting care at home and potentially reducing avoidable emergency care use in the last months of life, variability in reporting and poor methodological quality across studies limit our understanding of patient/carer and health care system outcomes. CONCLUSION Despite their increasing use, evidence for the clinical- and cost-effectiveness of palliative care telephone advice lines remains limited, primarily due to the lack of robust comparative studies. There is a need for more rigorous evaluations incorporating experimental or quasi-experimental methods and longer follow-up, and standardised reporting of telephone advice line models and outcomes, to guide policy and practice.
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Affiliation(s)
- Therese Johansson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Rachel L. Chambers
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Thomas Curtis
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sarah Greenley
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Molly Brittain
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Anna E. Bone
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Lynn Laidlaw
- Cicely Saunders Institute Patient & Public Involvement Group, King’s College London, London, UK
| | - Ikumi Okamoto
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Fliss E.M. Murtagh
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Katherine E. Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
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Charlton K, Rees J, Burrow E. Identifying high cholesterol in the ambulance setting: a mixed-methods cohort study to tackle health inequality. J Public Health (Oxf) 2024; 46:277-285. [PMID: 38291949 DOI: 10.1093/pubmed/fdae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Individuals with low socio-economic status (SES) have disproportionate rates of cardio- vascular disease (CVD) but poorer engagement with preventative health. This study aimed to compare characteristics of individuals with and without hyperlipidaemia and describe their health behaviours. METHODS A mixed-methods study between January and December 2022. Patients aged ≥40 years using the ambulance service with blood pressure of ≥140/90 had their total cholesterol measured using a point of care device. Data including blood pressure, smoking status, National Early Warning Score 2 and clinical frailty scale (CFS) were analysed. RESULTS Of 203 patients (59% female, mean age 65.7 years), 115 (56.7%) had total cholesterol ≥5.1 mmol/L. Thirty patients (14.8%) sought treatment and received either statins (n = 9; 4.4%), dietary modification (n = 7; 3.4%) or no further intervention (n = 14; 6.9%), whilst 85 patients (41.9%) took no further action. Lower CFS (OR 0.53 [0.31-0.93]) and higher total cholesterol (OR 2.07 [1.03-2.76]) predicted seeking further management. SES was not associated with hyperlipidaemia or likelihood of seeking further management, rather this was dictated by competing co-morbidity, poor health literacy and digital divide. CONCLUSIONS Undiagnosed hyperlipidaemia exists in patients using the ambulance service, irrespective of SES. Individual and healthcare system factors prevent engagement in cholesterol lowering behaviours.
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Affiliation(s)
- Karl Charlton
- Research & Development, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne NE15 8NY, UK
| | - Jon Rees
- Helen McArdle Research Institute and Sunderland City Council, School of Psychology, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland SR1 3SD, UK
| | - Emma Burrow
- Research & Development, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne NE15 8NY, UK
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Klein J, Koens S, Scherer M, Strauß A, Härter M, von dem Knesebeck O. Public Beliefs About Accessibility and Quality of Emergency Departments in Germany. West J Emerg Med 2024; 25:389-398. [PMID: 38801046 PMCID: PMC11112668 DOI: 10.5811/westjem.18224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 05/29/2024] Open
Abstract
Background It is well established that emergency department (ED) crowding leads to worse health outcomes. Although various patient surveys provide information about reasons to visit EDs, less is known in terms of beliefs about EDs among the general population. This study examines public beliefs regarding accessibility and quality of EDs and their associations with social characteristics (gender, age, education, immigration background) as well as knowledge about emergency care services and health literacy. Methods We conducted a cross-sectional study based on a random sample of 2,404 adults living in Hamburg, Germany, in winter 2021/2022. We developed eight statements regarding accessibility and quality of EDs leading to two scales (Cronbach's α accessibility = 0.76 and quality of care = 0.75). Descriptive statistics of the eight items are shown and linear regression were conducted to determine associations of the two scales with social characteristics as well as knowledge about emergency care services and health literacy (HLS-EU-Q6). Results Nearly 44% of the respondents agreed that "you can always go to an ED, if you do not get a short-term appointment with a general practitioner or specialist." And 38% agreed with the statement, "If you do not have the time during normal practice hours due to your work, you can always go to an ED." In terms of quality, 38% believed that doctors in EDs are more competent than doctors in general practice, and 25% believed that doctors in EDs are more competent than doctors in specialized practices. In the fully adjusted model, public beliefs about emergency care accessibility and quality of EDs were significantly associated with all social characteristics and knowledge of emergency care options with the strongest associations between knowledge and accessibility (β = -0.17; P < 0.001) and between education and quality (β = -0.23; P < 0.001). Conclusion We found endorsement of public beliefs about accessibility and quality of EDs that can lead to inappropriate utilization. Our results also suggest that knowledge of different emergency services plays an important role. Therefore, after system-related reorganizations of emergency care, information campaigns about such services tailored to socially deprived populations may help alleviate the issue of crowding.
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Affiliation(s)
- Jens Klein
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Hamburg, Germany
| | - Sarah Koens
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Hamburg, Germany
| | - Martin Scherer
- University Medical Center Hamburg-Eppendorf, Department of General Practice and Primary Care Hamburg, Germany
| | - Annette Strauß
- University Medical Center Hamburg-Eppendorf, Department of General Practice and Primary Care Hamburg, Germany
| | - Martin Härter
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Olaf von dem Knesebeck
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Hamburg, Germany
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12
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Snowden A, Young J, Savinc J. Can proactive support prevent unscheduled care? A controlled observational retrospective cohort study in cancer patients in Scotland. BMC Health Serv Res 2024; 24:457. [PMID: 38609990 PMCID: PMC11010331 DOI: 10.1186/s12913-024-10923-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Preventative spend is a global health and social care strategy. Improving Cancer Journeys (ICJ) is a proactive, holistic, multidisciplinary project consistent with this agenda, currently being rolled out across Scotland and parts of UK. ICJ helps people with cancer access whatever support they need to mitigate their most pressing concerns. This study hypothesised that ICJ service users should subsequently use less unscheduled care than matched cohorts not using ICJ. METHODS Retrospective observational cohort study using linked national datasets. N = 1,214 ICJ users in Glasgow were matched for age, sex, deprivation, cancer type, stage, and diagnosis year to two control groups: 1. Cancer patients from Glasgow before ICJ (pre-2014), 2. Cancer patients from rest of Scotland during study period (2014-2018). Cancer registrations were linked for 12-month baseline and study periods to: NHS24 calls, A&E admissions, inpatient hospital admissions, unscheduled care, number & cost of psychotropic prescriptions. Per-person mean service uses were compared between groups. RESULTS There was a significant increase in NHS24 calls in the ICJ group (0.36 per person vs. -0.03 or 0.35), more and longer A&E attendances in ICJ (0.37 per person vs. 0.19 or 0.26; 2.19 h per person vs. 0.81-0.92 h), more and longer hospital admissions in ICJ (4.25 vs. 2.59 or 2.53; 12.05 days vs. 8.37 or 8.64), more care pathways involving more steps in ICJ (0.77 spells vs. 0.39 or 0.57; 1.88 steps vs. 1.56 or 1.21), more psychotropic drug prescriptions and higher costs in ICJ (1.88 prescription vs. 1.56 or 1.21; £9.51 vs. £9.57 or £6.95) in comparison to both control groups. DISCUSSION ICJ users sourced significantly more unscheduled care than matched cohorts. These findings were consistent with much of the comparable literature examining the impact of non-health interventions on subsequent health spend. They also add to the growing evidence showing that ICJ reached its intended target, those with the greatest need. Together these findings raise the possibility that those choosing to use ICJ may also be self-identifying as a cohort of people more likely to use unscheduled care in future. This needs to be tested prospectively, because this understanding would be very helpful for health and social care planners in all countries where proactive holistic services exist.
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Affiliation(s)
- Austyn Snowden
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, Scotland.
| | - Jenny Young
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, Scotland
| | - Jan Savinc
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, Scotland
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13
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Nau LM, Laux G, Altiner A, Szecsenyi J, Leutgeb R. The Use of Medical Services for Low-Acuity Emergency Cases in Germany: Protocol for a Multicenter Observational Pilot Study. JMIR Res Protoc 2024; 13:e54002. [PMID: 38598281 PMCID: PMC11043931 DOI: 10.2196/54002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The increasing number of requests for help for acutely ill patients and their management is a major problem in the health systems of many countries, but especially in Germany. Rescue coordination centers and ambulances in Germany are increasingly overloaded. As a result, rides as a part of rescue operations have been increasing in length for years, yet a relevant proportion of these operations represent low-acuity calls (LACs). The basic objective of this pilot study is the quantitative analysis of the potential misuse of requests to the rescue control center. Indications for alternative treatment options and how to handle these treatment options in nonacute, non-life-threatening health conditions, such as minor injuries or minor infectious diseases, will be assessed. The identification of these LACs is vital in order to prevent health care resources in emergency medical care becoming inadequate. OBJECTIVE The overarching goal of this study is to determine the percentage of unnecessary rescue missions on site and subsequently to obtain an impression of the paramedics' assessment of alternative treatment options or alternative methods of rescue transportation. METHODS This will be an exploratory, noninterventional, cross-sectional study with a quantitative approach. The study is multicentric, with 21 ambulances in 12 different locations. The data for this study were collected via a questionnaire, newly developed for this study, for rescue personnel. Additionally, secondary data from the responsible control center will be linked and processed in an initial descriptive analysis. This descriptive analysis will form the basis for a subsequent variance analysis. RESULTS Data collection started as projected on September 18, 2023, and was ongoing until end of November 2023. We expect the documentation of several thousand rescue operations. We expect the following study results: (1) many unnecessary rescue operations, (2) immediate on-site assessment of correct care and treatment, and (3) patients' reasons for calling a rescue coordination center. CONCLUSIONS To our knowledge, this is the first observational study in which acute rescue operations are recorded on site. The focus of this study is on the trained paramedics' assessment of whether rescue operations are necessary or not. Additionally, alternative treatments, such as out-of-hours care service or primary care service, are shown for each individual case. The study also intends to cover the question of which factors are relevant and statistically significantly connected to the misuse of ambulances. TRIAL REGISTRATION German Register for Clinical Studies (Deutsches Register für Klinische Studien) DRKS00032510; https://drks.de/search/en/trial/DRKS00032510. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54002.
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Affiliation(s)
- Lara Maria Nau
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Rüdiger Leutgeb
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
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Carey K, Cole MB. Mental health care provision in community health centers and hospital emergency department utilization. Health Serv Res 2024; 59:e14283. [PMID: 38243709 PMCID: PMC10915469 DOI: 10.1111/1475-6773.14283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVES To examine whether community health centers (CHCs) are effective in offsetting mental health emergency department (ED) visits. DATA SOURCES AND STUDY SETTING The HRSA Uniform Data System and the HCUP State ED Databases for Florida patients during 2012-2019. STUDY DESIGN We identified CHC-year-specific service areas using patient origin zip codes. We then estimated panel data models for number of ED mental health visits per capita in a CHC's service area. Models measured CHC mental health utilization as number of visits, unique patients, and intensity (visits per patient). PRINCIPAL FINDINGS CHC mental health utilization increased approximately 100% during 2012-2019. Increased CHC mental health provision was associated with small reductions in ED mental health utilization. An annual increase of 1000 CHC mental health care visits (5%) was associated with 0.44% fewer ED mental health care visits (p = 0.153), and an increase of 1000 CHC mental health care patients (15%) with 1.9% fewer ED mental health care visits (p = 0.123). An increase of 1 annual mental health visit per patient was associated with 16% fewer ED mental health care visits (p = 0.011). CONCLUSIONS Results suggest that mental health provision in CHCs may reduce reliance on hospital EDs, albeit minimally. Policies that promote alignment of services between CHCs and local hospitals may accelerate this effect.
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Affiliation(s)
- Kathleen Carey
- Department of Health Law, Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Megan B. Cole
- Department of Health Law, Policy and ManagementBoston University School of Public HealthBostonMassachusettsUSA
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Dai M, Jiang J, Jiang L, Zhou J, Ye L. Health Status of Nonemergency Patients in the Emergency Department Using the EQ-5D. Emerg Med Int 2024; 2024:7880345. [PMID: 38586536 PMCID: PMC10999286 DOI: 10.1155/2024/7880345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/12/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
Background Emergency department (ED) overcrowding is influenced by several factors including the hospital's capacity, staff, patient discharges, and community resources. The number of annual ED visits has increased, with patients' medical needs exceeding emergency capacity, resulting in a widespread concern about emergency room overcrowding. Nonemergency patients tend to use large amounts of emergency medical resources, which is one reason for ED overcrowding. Most patients consider their medical cases urgent, whereas medical professionals consider many cases to be nonemergency. Only a few studies have examined self-rated health among nonemergency patients. Methods This cross-sectional study was conducted in the ED of a tertiary hospital in China using the European Quality of Life Five-Dimensional Questionnaire to investigate the health status of nonemergency patients. Results Among the 545 respondents, 246 (45.14%) self-assessed their health as excellent, 186 (34.13%) as very good, 70 (12.84%) as good, 32 (5.87%) as average, and 11 (2.02%) as poor. Problems related to pain/discomfort were reported by 317 (58.17%) participants, 214 (39.27%) responded that they had problems related to daily activities, 212 (38.90%) responded that they felt anxious or depressed, 211 (38.35%) responded that they had problems related to self-care, and some or extreme problems related to mobility were stated by 193 people (35.41%). Conclusions Nonemergency patients generally reported good health. Pain/discomfort was the most significant factor affecting the health of nonemergency patients, followed by limitation of daily activities. The duration of illness onset and self-rated health status were common factors influencing the health status of nonemergency patients. This trial is registered with ChiCTR1900023578.
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Affiliation(s)
- Min Dai
- Department of Emergency Medicine, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Jingyuan Jiang
- Department of Emergency Medicine, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Lingjun Jiang
- Department of Emergency Medicine, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Jin Zhou
- Department of Emergency Medicine, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Lei Ye
- Nursing Department of West China Hospital, Sichuan University, Chengdu, China
- Department of Emergency and Trauma Nursing, West China Nursing School, Sichuan University, Chengdu, China
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16
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Strandås M, Vizcaya-Moreno MF, Ingstad K, Sepp J, Linnik L, Vaismoradi M. An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective. J Multidiscip Healthc 2024; 17:1385-1400. [PMID: 38560485 PMCID: PMC10981423 DOI: 10.2147/jmdh.s460194] [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: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.
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Affiliation(s)
- Maria Strandås
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Jaana Sepp
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Ljudmila Linnik
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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17
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Asano Y, Takasugi T, Ueno K, Kondo N, Yoshino A, Ojima T. Association between social support and ambulance use among older people in Japan: an empirical cross-sectional study. BMC Emerg Med 2024; 24:37. [PMID: 38438959 PMCID: PMC10913287 DOI: 10.1186/s12873-024-00953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/18/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Ambulance service demand and utilization are increasing worldwide. To address this issue, the factors that affect ambulance use must be identified. Few studies have examined factors that can intervene and thus reduce the frequency of ambulance use. This study aimed to examine the association between social support and ambulance use among older adults in Japan. We hypothesize that social support is associated with reduced ambulance use. METHODS This cross-sectional study was conducted as part of the Japan Gerontological Evaluation Study. In December 2019 and January 2020, we collaborated with individuals aged 65 years or above with no long-term care needs. A total of 24,581 participants were included in the analysis. The objective and explanatory variables were ambulance use and social support, respectively. Binomial regression analysis was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Social support was associated with ambulance use. People who had no one to listen to their complaints or worries were significantly more likely to use ambulance services than those who did (OR [95% CI] = 1.26 [1.03-1.53]). People with no one to take care of them when they were ill were also significantly more likely to use ambulance services than those who had someone to provide care (1.15 [1.01-1.31]). Moreover, the results of binomial logistic regression analysis indicated that individuals who called an ambulance but were not hospitalized had significantly lower social support compared to those who did not call an ambulance. CONCLUSIONS The results suggest that the presence and quality of social support play a significant role in ambulance use among older adults in Japan. Our findings can help policymakers to plan and implement strategies for reducing the burden on emergency medical care.
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Affiliation(s)
- Yotaro Asano
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Tomo Takasugi
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Keiko Ueno
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Atsuto Yoshino
- Department of Medicine Emergency & Disaster Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
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Silva Almodóvar A, Keller MS, Lee J, Mehta HB, Manja V, Nguyen TPP, Pavon JM, Terman SW, Hoyle D, Mixon AS, Linsky AM. Deprescribing medications among patients with multiple prescribers: A socioecological model. J Am Geriatr Soc 2024; 72:660-669. [PMID: 37943070 PMCID: PMC10947820 DOI: 10.1111/jgs.18667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/14/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
Deprescribing is the intentional dose reduction or discontinuation of a medication. The development of deprescribing interventions should take into consideration important organizational, interprofessional, and patient-specific barriers that can be further complicated by the presence of multiple prescribers involved in a patient's care. Patients who receive care from an increasing number of prescribers may experience disruptions in the timely transfer of relevant healthcare information, increasing the risk of exposure to drug-drug interactions and other medication-related problems. Furthermore, the fragmentation of healthcare information across health systems can contribute to the refilling of discontinued medications, reducing the effectiveness of deprescribing interventions. Thus, deprescribing interventions must carefully consider the unique characteristics of patients and their prescribers to ensure interventions are successfully implemented. In this special article, an international working group of physicians, pharmacists, nurses, epidemiologists, and researchers from the United States Deprescribing Research Network (USDeN) developed a socioecological model to understand how multiple prescribers may influence the implementation of a deprescribing intervention at the individual, interpersonal, organizational, and societal level. This manuscript also includes a description of the concept of multiple prescribers and outlines a research agenda for future investigations to consider. The information contained in this manuscript should be used as a framework for future deprescribing interventions to carefully consider how multiple prescribers can influence the successful implementation of the service and ensure the intervention is as effective as possible.
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Affiliation(s)
- Armando Silva Almodóvar
- Institute of Therapeutic Innovations and Outcomes (ITIO), The Ohio State University College of Pharmacy, Columbus, Ohio, USA
| | - Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jiha Lee
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Hemalkumar B Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Veena Manja
- Veterans Affairs Northern California Healthcare System, Mather, California, USA
- University of California Davis, Sacramento, California, USA
| | - Thanh Phuong Pham Nguyen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Juliessa M Pavon
- Division of Geriatrics, Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Samuel W Terman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Hoyle
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Amanda S Mixon
- Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy M Linsky
- General Internal Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Almansour MA, Alhussain MN, Alsarhan MN. Awareness of Urgent Care Services Among Primary Healthcare Center Patients in Al-Ahsa, Saudi Arabia. Cureus 2024; 16:e57099. [PMID: 38681469 PMCID: PMC11053381 DOI: 10.7759/cureus.57099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Background Urgent care clinics (UCCs) provide services for patients without the need to book an appointment in advance to treat acute diseases and injuries that do not need ED service and provide care for chronic conditions. This study aimed to assess the patients's level of awareness regarding UCCs in the Al-Ahsa region and provide information contributing to decision-makers' support about the urgent care services and their patterns of use within primary healthcare. Methods A descriptive cross-sectional study was conducted in the Al-Ahsa region from August 2023 to December 2023. A validated questionnaire was used. Cluster sampling was used to select three primary healthcare centers from four health sectors (southern cluster, middle cluster, northern cluster, and eastern cluster), and then simple random sampling was used to select participants. sample size calculated by Cochran's sample size formula, which estimated 377 participants. However, to accommodate a non-response rate of 10.0% and stronger statistical power and effect size, the final sample size was 469 participants. Data were analyzed by SPSS Statistics version 28 (IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp.). Both descriptive and inferential statistics were used. A p-value ≤0.05 is considered statistically significant. Results Of the 469 participants in the study, more than half (54.8%) were aged between 18 and 38 years old, and more than half (54.8%) were male. More than half (67.4%) reported having no chronic diseases, whereas the most common chronic diseases reported were diabetes mellitus (11.9%) and hypertension (14.3%). Most of the participants (84.9%) weren't aware of UCCs. Among the participants who were aware of UCCs (n=71), 53.5% of them had visited a UCC in the last three months. The most common reasons for their visits were the common cold (40.8%), headaches (5.6%), and abdominal pain (5.6%). More than one-third of participants (38.6%) believed that UCCs provide services like those of the emergency center. According to patients' sex, there was a significant (0.031) difference in the awareness level; the highest was among females at 20.1% vs. 12.6%. Conclusion The study revealed that the majority of the participants were unaware of UCCs. Increasing patients' awareness of UCCs is necessary through different media to improve access to healthcare services and reduce overcrowding in the ED that is caused by non-urgent problems.
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Klein J, Koens S, Scherer M, Strauß A, Härter M, von dem Knesebeck O. Variations in the intended utilization of emergency care in case of gastrointestinal diseases. Health Policy 2024; 140:104970. [PMID: 38194836 DOI: 10.1016/j.healthpol.2023.104970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/22/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
Frequent utilization of emergency care and overcrowded emergency departments (EDs) are highly relevant topics due to their harmful consequences for patients and staff. The present study examines variations of intended health care use in urgent and non-urgent cases among the general population. In a cross-sectional telephone survey, a sample of N = 1,204 adults residing in Hamburg, Germany, was randomly drawn. At the beginning of the survey, one of 24 different vignettes (case stories) describing symptoms of inflammatory gastrointestinal diseases were presented to the participants. The vignettes varied in sex (male/female), age (15, 49, 72 years), daytime (Tuesday morning, Tuesday evening), and urgency (low, high). Participants were asked in an open-ended question about their primal intended utilization if they or their children would be affected by such symptoms. Overall, about 14 % chose emergency facilities (ED, ambulance, emergency practice) despite presentation of non-urgent conditions (n = 602). Intended emergency care use varied considerably even if the degree of urgency was comparable. Adolescence, male sex, and symptoms occurring in the evening were associated with increased ED and ambulance use. Inappropriate utilization of ED and ambulance (analyses regarding utilization due to non-urgent problems) was more often observed among male respondents and those with a migration background (1st generation). Information campaigns focused on emergency care use and reorganisation of emergency care wards are possible interventions.
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Affiliation(s)
- Jens Klein
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Sarah Koens
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annette Strauß
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Denham A, Hill EL, Raven M, Mendoza M, Raz M, Veazie PJ. Is the emergency department used as a substitute or a complement to primary care in Medicaid? HEALTH ECONOMICS, POLICY, AND LAW 2024; 19:73-91. [PMID: 37870129 DOI: 10.1017/s1744133123000270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Policies to decrease low-acuity emergency department (ED) use have traditionally assumed that EDs are a substitute for unavailable primary care (PC). However, such policies can exacerbate ED overcrowding, rather than ameliorate it, if patients use EDs to complement, rather than substitute, their PC use. We tested whether Medicaid managed care enrolees visit the ED for nonemergent and PC treatable conditions to substitute for or to complement PC. Based on consumer choice theory, we modelled county-level monthly ED visit rate as a function of PC supply and used 2012-2015 New York Statewide Planning and Research Cooperative System (SPARCS) outpatient data and non-linear least squares method to test substitution vs complementarity. In the post-Medicaid expansion period (2014-2015), ED and PC are substitutes state-wide, but are complements in highly urban and poorer counties during nights and weekends. There is no evidence of complementarity before the expansion (2012-2013). Analyses by PC provider demonstrate that the relationship between ED and PC differs depending on whether PC is provided by physicians or advanced practice providers. Policies to reduce low-acuity ED use via improved PC access in Medicaid are likely to be most effective if they focus on increasing actual appointment availability, ideally by physicians, in areas with low PC provider supply. Different aspects of PC access may be differently related to low-acuity ED use.
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Affiliation(s)
- Alina Denham
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA
| | - Elaine L Hill
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, USA
| | - Maria Raven
- Department of Emergency Medicine, School of Medicine, University of California, San Francisco, USA
| | - Michael Mendoza
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, USA
- Department of Family Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, USA
| | - Mical Raz
- Department of History, University of Rochester, Rochester, USA
- Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, USA
| | - Peter J Veazie
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, USA
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22
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Dormont B, Dottin A. Does the opening of an emergency department influence hospital admissions? Evidence from French private hospitals. Soc Sci Med 2024; 340:116380. [PMID: 38007967 DOI: 10.1016/j.socscimed.2023.116380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/28/2023]
Abstract
Although operating an emergency department (ED) can influence general admission activity of hospitals, most articles that analyze hospital care ignore the potential spillover of emergency activity. In this paper, we examine the consequences of a French reform that encouraged the creation of EDs within private-for-profit (PFP) hospitals in order to decrease congestion in EDs. We use administrative panel data on 365 French PFP hospitals observed between 2002 and 2012. Specifications including hospital fixed-effects are estimated to examine the impact of an ED opening on private hospitals' admission activity, namely inpatient and day-care admissions (ED visits are excluded, but patients admitted following an ED visit are included). We control for shocks that can impact demand for care in hospitals, and we estimate yearly changes before and after the opening. We find that an ED opening is followed by an increase in the number and proportion of inpatient admissions, and by an increase in the length of inpatient stays. A transitory increase in the bed occupancy rate is also observed. In many countries, public and private hospitals compete to some extent. The former provide a public service, while the latter are profit-maximizers that are allowed to specialize in profitable activities. They generally focus on day-care admissions. We provide empirical evidence that private hospitals experience a significant change in the composition of their admissions when they start providing emergency care. Opening an ED creates a new non-selective entryway to private hospitals, resulting in admissions of inpatients with health problems that are more severe. Hence, involving PFP hospitals in the provision of emergency care is likely to make the structure of admissions of private hospitals closer to that of public hospitals.
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Affiliation(s)
- Brigitte Dormont
- Université Paris Dauphine, PSL Research University, LEDa, 75016, Paris, France.
| | - Alexis Dottin
- Université Paris Panthéon Assas, 75006, Paris, France.
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Koens S, Klein J, Scherer M, Strauß A, Härter M, Schäfer I, Lüdecke D, von dem Knesebeck O. Perceived treatment urgency of common mental disorders in the German population. Sci Rep 2023; 13:22711. [PMID: 38123622 PMCID: PMC10733386 DOI: 10.1038/s41598-023-49969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Perceived treatment urgency of mental disorders are important as they determine utilization of health care. The aim was to analyze variations in perceived treatment urgency in cases of psychosis (adolescents), alcoholism (adults), and depression (older adults) with two levels of severity each by characteristics of the case and the respondents. A telephone survey (N = 1200) with vignettes describing cases of psychosis, alcoholism, and depression was conducted in Hamburg, Germany. Vignettes varied by symptom severity and sex. Perceived treatment urgency was assessed by three items. A sum scale was calculated. Linear regression models were computed to analyze differences in perceived urgency by characteristics of the case (severity, sex) and the respondents (sex, age, education, migration background, illness recognition, personal affliction). Perceived treatment urgency was significantly higher in severe cases and varied by education. Additionally, regarding psychosis, estimated urgency varied significantly by correct illness recognition. With regard to depression, perceived urgency differed significantly by age and correct illness recognition. Interaction effects between case severity and sociodemographic characteristics of the respondents, personal affliction, and correct recognition of the disorder were found. The identified differences should be considered in the development of interventions on mental health literacy with regard to adequate urgency assessment.
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Affiliation(s)
- Sarah Koens
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jens Klein
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Annette Strauß
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Jones A, Watt JA, Maclagan LC, Swayze S, Jaakkimainen L, Schull MJ, Bronskill SE. Factors associated with recurrent emergency department visits among people living with dementia: A retrospective cohort study. J Am Geriatr Soc 2023; 71:3731-3743. [PMID: 37314108 DOI: 10.1111/jgs.18457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/12/2023] [Accepted: 05/14/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Research on factors associated with recurrent emergency department (ED) visits and their implications for improving dementia care is lacking. The objective of this study was to examine associations between the individual characteristics of older adults living with dementia and recurrent ED visits. METHODS We used health administrative databases to conduct a population-based retrospective cohort study among older adults with dementia in Ontario, Canada. We included community-dwelling adults 66 years and older who visited the ED between April 1, 2010, and March 31, 2019 and were discharged home. We recorded all ED visits within one year after the baseline visit. We used recurrent event Cox regression to examine associations between repeat ED visits and individual clinical, demographic, and health service use characteristics. We fit conditional inference trees to identify the most important factors and define subgroups of varying risk. RESULTS Our cohort included 175,863 older adults with dementia. ED use in the year prior to baseline had the strongest association with recurrent visits (3+ vs.0 adjusted hazard ratio (aHR): 1.92 (1.89, 1.94), 2vs.0 aHR: 1.45 (1.43, 1.47), 1vs.0 aHR: 1.23 (1.21, 1.24)). The conditional inference tree utilized history of ED visits and comorbidity count to define 12 subgroups with ED revisit rates ranging from 0.79 to 7.27 per year. Older adults in higher risk groups were more likely to live in rural and low-income areas and had higher use of anticonvulsants, antipsychotics, and benzodiazepines. CONCLUSIONS History of ED visits may be a useful measure to identify older adults with dementia who would benefit from additional interventions and supports. A substantial proportion of older adults with dementia have a pattern of recurrent visits and may benefit from dementia-friendly and geriatric-focused EDs. Collaborative medication review in the ED and closer follow-up and engagement with community supports could improve patient care and experience.
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Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Jennifer A Watt
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Liisa Jaakkimainen
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Schull
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Timothée CH, Samuel V, Thibaud M. The assignment-dial-a-ride-problem. Health Care Manag Sci 2023; 26:770-784. [PMID: 37864124 DOI: 10.1007/s10729-023-09655-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 09/06/2023] [Indexed: 10/22/2023]
Abstract
In this paper, we present the first Assignment-Dial-A-Ride problem motivated by a real-life problem faced by medico-social institutions in France. Every day, disabled people use ride-sharing services to go to an appropriate institution where they receive personal care. These institutions have to manage their staff to meet the demands of the people they receive. They have to solve three interconnected problems: the routing for the ride-sharing services; the assignment of disabled people to institutions; and the staff size in the institutions. We formulate a general Assignment-Dial-A-Ride problem to solve all three at the same time. We first present a matheuristic that iteratively generates routes using a large neighborhood search in which these routes are selected with a mixed integer linear program. After being validated on two special cases in the literature, the matheuristic is applied to real instances in three different areas in France. Several managerial results are derived. In particular, it is found that the amount of cost reduction induced by the people assignment is equivalent to the amount of cost reduction induced by the sharing of vehicles between institutions.
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Affiliation(s)
- Chane-Haï Timothée
- Univ Lyon, INSA Lyon, Université Claude Bernard Lyon 1, Univ Lyon 2, DISP-UR4570, 21 avenue Jean Capelle, Villeurbanne, 69621, Auvergne Rhone-Alpes, France
| | - Vercraene Samuel
- Univ Lyon, INSA Lyon, Université Claude Bernard Lyon 1, Univ Lyon 2, DISP-UR4570, 21 avenue Jean Capelle, Villeurbanne, 69621, Auvergne Rhone-Alpes, France
| | - Monteiro Thibaud
- Univ Lyon, INSA Lyon, Université Claude Bernard Lyon 1, Univ Lyon 2, DISP-UR4570, 21 avenue Jean Capelle, Villeurbanne, 69621, Auvergne Rhone-Alpes, France.
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26
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Dröge P, Ruhnke T, Fischer-Rosinsky A, Henschke C, Keil T, Möckel M, Günster C, Slagman A. Patients pathways before and after treatments in emergency departments: A retrospective analysis of secondary data in Germany. Health Policy 2023; 138:104944. [PMID: 38016261 DOI: 10.1016/j.healthpol.2023.104944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/30/2023]
Abstract
Increasing emergency department (ED) utilization induces considerable pressure on ED staff and organization in Germany. Reasons for certain ED attendances are seen partly in insufficient continuity of care outside of hospitals. To explore the health care patterns before and after an ED attendance in Germany, we used claims data from nine statutory health insurance funds, covering around 25 % of statutory health insurees (1). We descriptively analyzed ED attendances for adult patients in 2016 according to their sociodemographic characteristics and diagnoses (2). Based on the ED attendance as initial event, we investigated health care provider utilization 180 days before and after the respective ED treatment and are presented by means of Sankey diagrams. In total, 4,757,536 ED cases of 3,164,343 insured individuals were analyzed. Back pain was the most frequent diagnosis in outpatient ED cases (5.0 %), and 80.2 % of the patients visited primary care physicians or specialists 180 days before and 78.8 % 180 days after ED treatment. Among inpatient cases, heart failure (4.6 %) was the leading diagnosis and 74.6 % used primary care physicians or specialists 180 days before and 65.1 % 180 days after ED treatment. The ED re-attendance slightly increased for back pain (4.9 % to 7.9 %) and decreased for heart failure (13.4 % to 12.6 %).
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Affiliation(s)
| | | | - Antje Fischer-Rosinsky
- Charité - Universitätsmedizin Berlin, Emergency and Acute Medicine (CVK, CCM), Berlin, Germany
| | - Cornelia Henschke
- Dept. Health Care Management, Berlin University of Technology, Berlin, Germany
| | - Thomas Keil
- Charité - Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, Emergency and Acute Medicine (CVK, CCM), Berlin, Germany
| | | | - Anna Slagman
- Charité - Universitätsmedizin Berlin, Emergency and Acute Medicine (CVK, CCM), Berlin, Germany
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27
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Solakoglu GA, Baspinar A, Aciksari K, Oguz S, Adak NA. Motives behind low-acuity geriatric emergency medicine attenders: a picture from free healthcare system. Ir J Med Sci 2023; 192:3091-3099. [PMID: 37069379 DOI: 10.1007/s11845-023-03359-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Current evidence about the low-acuity ED visits of old patients has been generated in various healthcare systems; however, this is not a well-researched area in middle-income countries by patients' perspectives. METHODS A study of 231 patients attending the ED of a tertiary public hospital was conducted using a structured questionnaire from June to August 2021. Eligible patients were community-dwelling, aged > 65 years, who presented with lower clinical urgency. The questionnaire tool was developed using questions from available studies on health service utilization. Additional commentary was obtained from the patients regarding on the reasons for attending the ED and was administered on weekdays between 8:00 am and 5:30 pm. RESULTS The study included 221 patients over 65 years of age, with a mean age of 72.21 ± 4.2. A total of 58.4% of the patients thought that they should be examined urgently, 15.4% had symptoms that had lasted more than one month, and 59% requested emergency imaging. Patients preferred the ED via treatment, imaging, transportation opportunities of emergency department, past negative experiences, and access problems with family medicines or appointment problems with specialist outpatient clinics with expectations of continuity of care. CONCLUSION Old individuals have unique healthcare needs, and the motives behind this group of patients with low-acuity problems to apply to the ED is complex. As one of the key objectives of healthcare policies is to make sure that patients are assessed at proper time and place, studies that consider patient perspectives might lead to accurate conclusions for this aim.
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Affiliation(s)
- Görkem Alper Solakoglu
- Emergency Medicine Department, Istanbul Medeniyet University, Üsküdar, Istanbul, Turkey.
| | - Adem Baspinar
- Sociology Department, Kırklareli University, Merkez, Kırklareli, Turkey
| | - Kurtulus Aciksari
- Emergency Medicine Department, Istanbul Medeniyet University, Üsküdar, Istanbul, Turkey
| | - Seda Oguz
- Emergency Medicine Department, Istanbul Medeniyet University, Üsküdar, Istanbul, Turkey
| | - Nur Aleyna Adak
- Emergency Medicine Department, Istanbul Medeniyet University, Üsküdar, Istanbul, Turkey
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Horvath S, Visekruna S, Kilpatrick K, McCallum M, Carter N. Models of care with advanced practice nurses in the emergency department: A scoping review. Int J Nurs Stud 2023; 148:104608. [PMID: 37801938 DOI: 10.1016/j.ijnurstu.2023.104608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/31/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Emergency departments play a critical role in healthcare systems internationally. Visits for emergency care continue to increase, related to poor access to primary care, the COVID-19 pandemic, and health human resource issues. International literature shows similar stressors in the emergency department. Extended wait times to see health providers lead to poor outcomes, and innovative models of care are needed to address emergency department overcrowding and to meet the needs of patients. Advanced practice nurses have the expertise and scope of practice to optimize and address primary and acute care needs and could be further integrated into the emergency healthcare systems. It is unclear what and how advanced practice nurses are functioning in emergency departments to improve patient and organization outcomes. METHODS This scoping review was a comprehensive search of MEDLINE, EMCARE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and gray literature. Authors developed inclusion and exclusion criteria, performed title and abstract screening, and full text screening using review software. Data about models of care with advanced practice nurses were extracted and organized to understand patient, provider, and organizational outcomes. We also extracted information about the development and implementation of roles. RESULTS Of the 6780 records identified, 76 met inclusion criteria. Emergency department models of care, mainly using nurse practitioners, include fast-track, generalized emergency, minor injury, orthopedics, pediatrics, geriatrics, specific populations, and triage. Reported patient outcomes include improvement in key metrics specific to emergency departments, such as total length of stay, wait times to be seen by a provider, left without being seen rates, treatment for pain, costs, and resource use. When comparing nurse practitioners to other providers, outcomes were similar or better for patient and organizational outcomes. DISCUSSION Various models of care utilizing advanced practice nurses in emergency departments are present internationally and information about how they are developed, integrated, and utilized provides practical information to support and sustain new roles. There is an opportunity to expand the use of these roles into emergency departments as the nurse practitioner scope of practice grows. Given the current crisis across healthcare systems, there is need for innovation, and improving delivery of emergency services with these advanced practice nursing models of care can help to address important health policy priorities in Canada and other countries. TWEETABLE ABSTRACT Advanced Practice Nurse models of care in emergency - Improved outcomes for patients and organizations - A review of the literature. @SamanthaH_RN.
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Affiliation(s)
- Samantha Horvath
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.
| | - Sanja Visekruna
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | | | - Nancy Carter
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.
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Huang Z, Natarajan K, Lim HC, Weng Y, Tan HY, Seow E, Peng LL, Ow JT, Kuan WS, Chow A. Applying Andersen's healthcare utilization model to assess factors influencing patients' expectations for diagnostic tests at emergency department visits during the COVID-19 pandemic. Front Public Health 2023; 11:1250658. [PMID: 38074705 PMCID: PMC10701756 DOI: 10.3389/fpubh.2023.1250658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
Background The uncertainties surrounding the COVID-19 pandemic led to a surge in non-urgent emergency department (ED) attendance among people presenting with upper respiratory tract infection (URTI) symptoms. These non-urgent visits, often manageable in primary care, exacerbated ED overcrowding, which could compromise the quality of ED services. Understanding patients' expectations and the reasons for these ED visits is imperative to mitigate the problem of ED overcrowding. Hence, we assessed the factors influencing patients' expectations for diagnostic tests during their ED visits for uncomplicated URTI during different phases of the pandemic. Methods We conducted a cross-sectional study on adults with URTI symptoms seeking care at four public EDs in Singapore between March 2021 and March 2022. We segmented the study period into three COVID-19 pandemic phases-containment, transition, and mitigation. The outcome variables are whether patients expected (1) a COVID-19-specific diagnostic test, (2) a non-COVID-19-specific diagnostic test, (3) both COVID-19-specific and non-COVID-19-specific diagnostic tests, or (4) no diagnostic test. We built a multinomial regression model with backward stepwise selection and classified the findings according to Andersen's healthcare utilization model. Results The mean age of participants was 34.5 (12.7) years. Factors (adjusted odds ratio [95% confidence interval]) influencing expectations for a COVID-19-specific diagnostic test in the ED include younger age {21-40 years: (2.98 [1.04-8.55])}, no prior clinical consultation (2.10 [1.13-3.89]), adherence to employer's health policy (3.70 [1.79-7.67]), perceived non-severity of illness (2.50 [1.39-4.55]), being worried about contracting COVID-19 (2.29 [1.11-4.69]), and during the transition phase of the pandemic (2.29 [1.15-4.56]). Being non-employed influenced the expectation for non-COVID-19-specific diagnostic tests (3.83 [1.26-11.66]). Factors influencing expectations for both COVID-19-specific and non-COVID-19-specific tests include younger age {21-40 years: (3.61 [1.26-10.38]); 41-60 years: (4.49 [1.43-14.13])}, adherence to employer's health policy (2.94 [1.41-6.14]), being worried about contracting COVID-19 (2.95 [1.45- 5.99]), and during the transition (2.03 [1.02-4.06]) and mitigation (2.02 [1.03-3.97]) phases of the pandemic. Conclusion Patients' expectations for diagnostic tests during ED visits for uncomplicated URTI were dynamic across the COVID-19 pandemic phases. Expectations for COVID-19-specific diagnostic tests for ED visits for uncomplicated URTI were higher among younger individuals and those worried about contracting COVID-19 during the COVID-19 pandemic. Future studies are required to enhance public communications on the availability of diagnostic services in primary care and public education on self-management of emerging infectious diseases such as COVID-19.
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Affiliation(s)
- Zhilian Huang
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore, Singapore
| | - Karthiga Natarajan
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore, Singapore
| | - Hoon Chin Lim
- Department of Accident and Emergency, Changi General Hospital, Singapore, Singapore
| | - Yanyi Weng
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hann Yee Tan
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Eillyne Seow
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Li Lee Peng
- Department of Emergency Medicine, National University Hospital, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jing Teng Ow
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore, Singapore
| | - Win Sen Kuan
- Department of Emergency Medicine, National University Hospital, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Angela Chow
- Infectious Diseases Research and Training Office, National Centre for Infectious Diseases, Singapore, Singapore
- Department of Preventive and Population Medicine, Office of Clinical Epidemiology, Analytics, and Knowledge [OCEAN], Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Hughes AM, Arredondo K, Lester HF, Oswald FL, Pham TND, Jiang C, Hysong SJ. What can we learn from COVID-19?: examining the resilience of primary care teams. Front Psychol 2023; 14:1265529. [PMID: 38078279 PMCID: PMC10703302 DOI: 10.3389/fpsyg.2023.1265529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/06/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction The COVID-19 pandemic continues to place an unprecedented strain on the US healthcare system, and primary care is no exception. Primary care services have shifted toward a team-based approach for delivering care in the last decade. COVID-19 placed extraordinary stress on primary care teams at the forefront of the pandemic response efforts. The current work applies the science of effective teams to examine the impact of COVID-19-a crisis or adverse event-on primary care team resilience. Methods Little empirical research has been done testing the theory of team resilience during an extremely adverse crisis event in an applied team setting. Therefore, we conducted an archival study by using large-scale national data from the Veterans Health Administration to understand the characteristics and performance of 7,023 Patient Aligned Care Teams (PACTs) during COVID-19. Results Our study found that primary care teams maintained performance in the presence of adversity, indicating possible team resilience. Further, team coordination positively predicted team performance (B = 0.53) regardless of the level of adversity a team was experiencing. Discussion These findings in turn attest to the need to preserve team coordination in the presence of adversity. Results carry implications for creating opportunities for teams to learn and adjust to an adverse event to maintain performance and optimize team-member well-being. Teamwork can act as a protective factor against high levels of workload, burnout, and turnover, and should be studied further for its role in promoting team resilience.
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Affiliation(s)
- Ashley M. Hughes
- Department of Biostatistics and Epidemiology, University of Illinois at Chicago, Chicago, IL, United States
- Center of VHA Innovation for Complex, Chronic Healthcare, Edward Hines JR VA Hospital, Hines, IL, United States
| | - Kelley Arredondo
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Veterans’ Health Administration Office of Rural Health’s Veterans Center, White River Junction, VT, United States
- VA South Central Mental Illness Research, Education and Clinical Center (SC MIRECC), a Virtual Center, Houston, TX, United States
| | - Houston F. Lester
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Department of Management, University of Mississippi, Oxford, MS, United States
| | - Frederick L. Oswald
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Trang N. D. Pham
- Department of Biostatistics and Epidemiology, University of Illinois at Chicago, Chicago, IL, United States
| | - Cheng Jiang
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Sylvia J. Hysong
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
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Dhodapkar MM, Gouzoulis MJ, Halperin SJ, Radford ZJ, Rubin LE, Grauer JN. Urgent Care Visits Sought After Primary Total Hip Arthroplasty: A Potentially Overlooked Resource. J Arthroplasty 2023; 38:2361-2365. [PMID: 37196730 DOI: 10.1016/j.arth.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Following total hip arthroplasty (THA), readmissions and emergency department (ED) visits have been studied. Urgent care utilization is not well-characterized and may represent an overlooked avenue to facilitate lesser acuity patient needs. METHODS Primary THAs performed for osteoarthritis indications were identified from 2010 to April of 2021 from a large national database. The incidence and timing of 90-day postoperative ED and urgent care visits were determined. Univariable and multivariable analyses assessed factors associated with urgent care relative to ED utilization. Reasons and acuity of diagnoses for these visits were determined. For 213,189 THA patients, 90-day ED visits were identified for 37,692 (17.7%) and urgent care visits for 2,083 (1.0%). The greatest incidence of both ED and urgent care visits were in the first two postoperative weeks. RESULTS Independent predictors of urgent care utilization relative to ED utilization were: procedures being performed in the Northeast or South, insurance plan being Commercial, women, and lesser comorbidity burden (P < .0001). Reason for visits to the ED was directly related to the surgical site for 25.6% but for urgent care were just 4.8% (P < .0001). Reasons for visits to the ED were classified as low-acuity for 57.4% and for urgent care 96.9% (P < .0001). CONCLUSION Following THA, patients may need urgent evaluation. While many issues can be addressed through the office, urgent care visits may represent a viable and underused resource relative to the ED for a large percentage of patients who have lower acuity diagnoses.
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Affiliation(s)
- Meera M Dhodapkar
- Yale Department of Orthopaedics and Rehabilitation, New Haven, Connecticut
| | | | - Scott J Halperin
- Yale Department of Orthopaedics and Rehabilitation, New Haven, Connecticut
| | - Zachary J Radford
- Yale Department of Orthopaedics and Rehabilitation, New Haven, Connecticut
| | - Lee E Rubin
- Yale Department of Orthopaedics and Rehabilitation, New Haven, Connecticut
| | - Jonathan N Grauer
- Yale Department of Orthopaedics and Rehabilitation, New Haven, Connecticut
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Tatlıparmak AC, Alpar S, Yilmaz S. Factors influencing recurrent emergency department visits for mild acute respiratory tract infections caused by the influenza virus. PeerJ 2023; 11:e16198. [PMID: 37818329 PMCID: PMC10561640 DOI: 10.7717/peerj.16198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
Background Seasonal viral outbreaks, exemplified by influenza A and B viruses, lead to spikes in emergency department (ED) visits, straining healthcare facilities. Addressing ED overcrowding has become paramount due to its implications for patient care and healthcare operations. Recurrent visits among influenza patients remain an underexplored aspect, necessitating investigation into factors influencing such revisits. Methods Conducted within a tertiary care university hospital, this study adopts an observational retrospective cohort design. The study included adult patients with acute respiratory symptoms diagnosed with influenza using rapid antigen testing. The cohort was divided into single and recurrent ED visitors based on revisits within 10 days of initial discharge. A comparative analysis was performed, evaluating demographics, laboratory parameters, and clinical process data between recurrent visitors and single visitors. Results Among 218 patients, 36.2% (n = 139) experienced recurrent ED visits. Age and gender disparities were not significant. Antibiotics were prescribed for 55.5% (n = 121) and antivirals for 92.7% (n = 202) of patients, with no notable influence on recurrence. Recurrent visitors exhibited lower monocyte counts, hemoglobin levels, higher PDW and P-LCR percentages, and increased anemia prevalence (p = 0.036, p = 0.01, p = 0.004, p = 0.029, p = 0.017, respectively). C-reactive protein (CRP) levels did not significantly affect recurrence. Conclusion This study highlights the pressing concern of recurrent ED visits among mild influenza patients, magnifying the challenges of ED overcrowding. The observed notable prescription rates of antibiotics and antivirals underscore the intricate landscape of influenza management. Diminished monocyte counts, hemoglobin levels, and altered platelet parameters signify potential markers for identifying patients at risk of recurrent visits.
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Affiliation(s)
| | - Suleyman Alpar
- Department of Emergency Medicine, Beykent University, İstanbul, Turkey
| | - Sarper Yilmaz
- Deparment of Emergency Medicine, Kartal Dr. Lutfi Kirdar City Hospital, İstanbul, Turkey
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Poterala JE, Stanley E, Narayan AK, Guevara AE, Naeger DM, Miles RC. Mammography Screening Outreach Through Non-Primary Care-Based Services. J Am Coll Radiol 2023; 20:1014-1021. [PMID: 37423346 DOI: 10.1016/j.jacr.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/25/2023] [Accepted: 04/06/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE To estimate the proportion of patients visiting urgent care centers or emergency departments or being hospitalized who were not up to date with recommended mammography screening to assess the potential impact of non-primary care-based cancer screening interventions. METHODS Adult participants from the 2019 National Health Interview Survey were included. Among participants not up to date with breast cancer screening guidelines based on ACR recommendations, the proportion of patients reporting an urgent care, emergency department visit, or hospitalization within the last year was estimated accounting for complex survey sampling design features. Multiple variable logistic regression analyses were then conducted to evaluate the association between sociodemographic characteristics and mammography screening adherence. RESULTS The study included 9,139 women between the ages of 40 and 74 years without history of breast cancer. Of these respondents, 44.9% did not report mammography screening within the last year. Among participants who did not report mammography screening, 29.2% reported visiting an urgent care center, 21.8% reported visiting an emergency room, and 9.6% reported being hospitalized within the last year. The majority of patients receiving non-primary care-based services, who were not up to date with mammography screening, were from historically underserved groups including Black and Hispanic patients. CONCLUSION Nearly 10% to 30% of participants who have not obtained recommended breast cancer screening have visited non-primary care-based services including urgent care centers or emergency rooms or have been hospitalized within the last year.
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Affiliation(s)
- Johanna E Poterala
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Edward Stanley
- School of Medicine, American University of the Caribbean, Pembroke Pines, Florida
| | - Anand K Narayan
- Vice Chair of Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - David M Naeger
- Director of Radiology; Vice Chair, Department of Radiology, Denver Health Medical Center, University of Colorado, Denver, Colorado
| | - Randy C Miles
- Chief of Breast Imaging; Associate Director of Radiology for Research, Denver Health Medical Center, Denver, Colorado.
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Dhodapkar MM, Gouzoulis MJ, Halperin SJ, Modrak M, Yoo BJ, Grauer JN. Urgent Care Versus Emergency Department Utilization for Foot and Ankle Fractures. J Am Acad Orthop Surg 2023; 31:984-989. [PMID: 37253245 DOI: 10.5435/jaaos-d-22-01097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/22/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Foot and ankle fractures are common injuries for which patients may need urgent evaluation and care. Many such injuries are managed in emergency departments (EDs), but urgent care facilities may sometimes be an appropriate setting. Understanding which foot and ankle fractures are managed at which facility might help define care algorithms, improve patient experience, and suggest directions for containing costs. METHODS This retrospective cohort study used the 2010 to 2020 M151 PearlDiver administrative database. Adult patients less than 65 years old presenting to EDs and urgent care facilities for foot and ankle fractures were identified using ICD-9 and ICD-10 diagnosis codes, excluding polytrauma, and Medicare patients. Patient/injury variables associated with urgent care utilization relative to ED utilization and utilization trends of urgent care relative to ED were assessed with univariable and multivariable analyses. RESULTS From 2010 to 2020, 1,120,422 patients with isolated foot and ankle fractures presented to EDs and urgent care facilities. Urgent care visits evolved from 2.2% in 2010 to 4.4% in 2020 (P , 0.0001). Independent predictors of urgent care relative to ED utilization were defined. In decreasing odds ratios (ORs), these were insurance (relative to Medicaid, commercial OR 8.03), geographic region (relative to Midwest, Northeast OR 3.55, South OR 1.74, West OR 1.06), anatomic location of fracture (relative to ankle, forefoot OR 3.45, midfoot 2.20, hindfoot 1.63), closed fracture (OR 2.20), female sex (OR 1.29), lower ECI (OR 1.11 per unit decrease), and younger age (OR 1.08 per decade decrease) (P , 0.0001 for all). DISCUSSION A small but increasing minority of patients with foot and ankle fractures are managed in urgent care facilities relative to EDs. While patients with certain injury types were associated with increased odds of urgent care relative to ED utilization, the greatest predictors were nonclinical, such as geographic regions and insurance type, suggesting areas for optimizing access to certain care pathways. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Meera M Dhodapkar
- From the Yale Department of Orthopaedics and Rehabilitation, New Haven, CT
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Burns SK, Krishnamurti T, Doan TT, Kahn JM, Ray KN. Parent Care-Seeking Decisions for Pediatric Acute Respiratory Tract Infections in the United States: A Mental Models Approach. Acad Pediatr 2023; 23:1326-1336. [PMID: 36871609 PMCID: PMC10475487 DOI: 10.1016/j.acap.2023.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/14/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE To understand US parent health care-seeking decisions in the context of multiple in-person and telehealth care options. As the health care landscape evolves, new research is needed to explain how parents now decide when and where to seek acute pediatric health care. METHODS We applied a mental models approach, focusing on the archetypal example of care-seeking for pediatric acute respiratory tract infections (ARTIs), by first reviewing pediatric ARTI guidelines with 16 health care professionals to inform 40 subsequent semi-structured interviews with parents of young children in 2021. Interviews were qualitatively coded using thematic analysis, with code frequency and co-occurrence informing the final influence model of parent health care-seeking decisions. RESULTS Parent interviewees identified 33 decisional factors which were synthesized into seven dimensions influencing care-seeking decisions: perceived illness severity, perceived child susceptibility, parental self-efficacy, expected accessibility of care, expected affordability of care, expected quality of clinician, and expected quality of site. The first three dimensions (perceived severity, perceived susceptibility, parental self-efficacy) influenced an initial decision about whether to seek care, while all seven factors influenced a subsequent decision about where to seek care (eg, in-person primary care, primary care-based telehealth, urgent care, direct-to-consumer telehealth). Uncertainty was present within many dimensions (eg, severity, access, quality) indicating potential targets to support parent decision-making processes and optimize care-seeking behaviors. CONCLUSIONS A mental models approach identified dimensions influencing parent choice to seek care and choice of care site for children with ARTIs, suggesting targets to advance family-centered practice and policy.
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Affiliation(s)
- Sarah K Burns
- Department of Pediatrics (SK Burns, TT Doan, and KN Ray), University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, PA.
| | - Tamar Krishnamurti
- Department of Medicine (T Krishnamurti), University of Pittsburgh School of Medicine, PA.
| | - Tran T Doan
- Department of Pediatrics (SK Burns, TT Doan, and KN Ray), University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, PA.
| | - Jeremy M Kahn
- Department of Health Policy & Management (JM Kahn), University of Pittsburgh Graduate School of Public Health, PA; Department of Critical Care Medicine (JM Kahn), University of Pittsburgh School of Medicine, PA.
| | - Kristin N Ray
- Department of Pediatrics (SK Burns, TT Doan, and KN Ray), University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, PA.
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Montoro-Pérez N, Montejano-Lozoya R, Escribano S, Richart-Martínez M. Factors associated with frequent users in hospital paediatric emergency departments: A single centre study in Spain. Int Emerg Nurs 2023; 70:101344. [PMID: 37714055 DOI: 10.1016/j.ienj.2023.101344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/03/2023] [Accepted: 08/12/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Over the last decade, the demand for hospital paediatric emergency departments (PEDs) has been on the rise. Studies have been carried out in adults, but in paediatrics, and in Spain, they are few and far between. In order to develop interventions to alleviate this problem, it is necessary to understand the factors that predispose people to use these services. OBJECTIVE The main objective of this study was to identify the factors associated with frequent users of PEDs in Spain. METHODS A descriptive, cross-sectional study conducted between September 2021 and December 2022 in the PED of a referral hospital in Spain. RESULTS There were 530 participants, 12.07% of whom were frequent users. There was an indirect association between frequent use and having a secondary level of education (OR = 0.282, p = 0.002). The factors which were directly associated included: perceived urgency (OR = 10.209, p = 0.002) and the perception that PEDs provide better care than primary care (PC) (OR = 2.664, p = 0.044). CONCLUSIONS The percentage of frequent users is comparable with international levels. As a strategy to reduce the frequency of visits, health interventions are needed to ensure that parents know how to correctly interpret their children's symptoms and are well informed about the recommended flow of care.
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Affiliation(s)
- Néstor Montoro-Pérez
- Department of Nursing, Faculty of Health Sciences, Person-centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain; GREIACC research group, La Fe Health Research Institute, Valencia, Spain
| | | | - Silvia Escribano
- Department of Nursing, Faculty of Health Sciences, Person-centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
| | - Miguel Richart-Martínez
- Department of Nursing, Faculty of Health Sciences, Person-centred Care and Health Outcomes Innovation Group, University of Alicante, San Vicente del Raspeig, Spain
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Nguyen OT, Katoju S, Pons EE, Motwani K, Daniels GM, Reed AC, Alfred J, Feller DB, Hong YR. Predictors of intent to utilize the emergency department among a free clinic's patients. Am J Emerg Med 2023; 71:25-30. [PMID: 37327708 PMCID: PMC10527010 DOI: 10.1016/j.ajem.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/26/2023] [Accepted: 06/04/2023] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVE Primary care use helps reduce utilization of more expensive modes of care, such as the emergency department (ED). Although most studies have investigated this association among patients with insurance, few have done so for patients without insurance. We used data from a free clinic network to assess the association between free clinic use and intent to use the ED. METHODS Data were collected from a free clinic network's electronic health records on adult patients from January 2015 to February 2020. Our outcome was whether patients reported themselves as 'very likely' to visit the ED if the free clinics were unavailable. The independent variable was frequency of free clinic use. Using a multivariable logistic regression model, we controlled for other factors, such as patient demographic factors, social determinants of health, health status, and year effect. RESULTS Our sample included 5008 visits. When controlling for other factors, higher odds of expressing ED interest were observed for patients who are non-Hispanic Black, older, not married, lived with others, had lower education, were homeless, had personal transportation, lived in rural areas, and had a higher comorbidity burden. In sensitivity analyses, higher odds were observed for dental, gastrointestinal, genitourinary, musculoskeletal, or respiratory conditions. CONCLUSIONS In the free clinic space, several patient demographic, social determinants of health and medical conditions were independently associated with greater odds of reporting intent on visiting the ED. Additional interventions that improve access and use of free clinics (e.g., dental) may keep patients without insurance from the ED.
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Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA; Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA.
| | - SriVarsha Katoju
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA
| | - Erick E Pons
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA; College of Medicine, Ohio State University, Columbus, OH, USA
| | - Kartik Motwani
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA
| | - Gabriel M Daniels
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA; Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Austin C Reed
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA; Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Joanne Alfred
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA; Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David B Feller
- Department of Community Health & Family Medicine, University of Florida, Gainesville, FL, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, Gainesville, FL, USA
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Koh VTJ, Ong RHS, Chow WL, Tiah L, Oh HC, Yow WQ, Sharma S, Huat Yap JC. Understanding patients' health-seeking behaviour for non-emergency conditions: a qualitative study. Singapore Med J 2023:384043. [PMID: 37675670 DOI: 10.4103/singaporemedj.smj-2020-494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
| | | | - Wai Leng Chow
- Epidemiology and Disease Control, Ministry of Health, Singapore
| | - Ling Tiah
- Accident and Emergency Department, Changi General Hospital, Singapore
| | - Hong Choon Oh
- Health Services Research, Changi General Hospital, Singapore
| | - Wei Quin Yow
- Humanities Arts and Social Sciences, Singapore University of Technology and Design, Singapore
| | - Shrutivandana Sharma
- Engineering Systems and Design, Singapore University of Technology and Design, Singapore
| | - Jason Chin Huat Yap
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Jermini-Gianinazzi I, Blum M, Trachsel M, Trippolini MA, Tochtermann N, Rimensberger C, Liechti FD, Wertli MM. Management of acute non-specific low back pain in the emergency department: do emergency physicians follow the guidelines? Results of a cross-sectional survey. BMJ Open 2023; 13:e071893. [PMID: 37541755 PMCID: PMC10407374 DOI: 10.1136/bmjopen-2023-071893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVES Clinical guidelines for acute non-specific low back pain (LBP) recommend avoiding imaging studies or invasive treatments and to advise patients to stay active. The aim of this study was to evaluate the management of acute non-specific LBP in the emergency departments (ED). SETTING We invited all department chiefs of Swiss EDs and their physician staff to participate in a web-based survey using two clinical case vignettes of patients with acute non-specific LBP presenting to an ED. In both cases, no neurological deficits or red flags were present. Guideline adherence and low-value care was defined based on current guideline recommendations. RESULTS In total, 263 ED physicians completed at least one vignette, while 212 completed both vignettes (43% residents, 32% senior/attending physicians and 24% chief physicians). MRI was considered in 31% in vignette 1 and 65% in vignette 2. For pain management, non-steroidal anti-inflammatory drugs, paracetamol and metamizole were mostly used. A substantial proportion of ED physicians considered treatments with questionable benefit and/or increased risk for adverse events such as oral steroids (vignette 1, 12% and vignette 2, 19%), muscle relaxants (33% and 38%), long-acting strong opioids (25% and 33%) and spinal injections (22% and 43%). Although guidelines recommend staying active, 72% and 67% of ED physicians recommended activity restrictions. CONCLUSION Management of acute non-specific LBP in the ED was not in agreement with current guideline recommendations in a substantial proportion of ED physicians. Overuse of imaging studies, the use of long-acting opioids and muscle relaxants, as well as recommendations for activity and work restrictions were prevalent and may potentially be harmful.
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Affiliation(s)
- Ilaria Jermini-Gianinazzi
- Emergency Department, Ospedale Regionale di Bellinzona e Valli Bellinzona, Bellinzona, Ticino, Switzerland
| | - Manuel Blum
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria Trachsel
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maurizio Alen Trippolini
- School of Health Professions, Berne University of Applied Sciences, Bern, Switzerland
- Evidence-based Insurance Medicine (EbIM), Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Nicole Tochtermann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Caroline Rimensberger
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Dominik Liechti
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria M Wertli
- Department of General Internal Medicine, Kantonsspital Baden AG, Baden, Aargau, Switzerland
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Shaw V, Yu A, Parsons M, Olsen T, Walker C. Acute assessment services for patient flow assistance in hospital emergency departments. Cochrane Database Syst Rev 2023; 7:CD014553. [PMID: 37439227 PMCID: PMC10334694 DOI: 10.1002/14651858.cd014553.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND Emergency departments (EDs) are facing serious and significant issues in the delivery of effective and efficient care to patients. Acute assessment services have been implemented at many hospitals internationally to assist in maintaining patient flow for identified groups of patients attending the ED. Identifying the risks and benefits, and optimal configurations of these services may be beneficial to those wishing to utilise an acute assessment service to improve patient flow. OBJECTIVES To assess the effects of acute assessment services on patient flow following attendance at a hospital ED. SEARCH METHODS We searched MEDLINE, CENTRAL, Embase and two trials registers on 24 September 2022 to identify studies. No restrictions were imposed on publication year, publication type, or publication language. SELECTION CRITERIA Studies eligible for inclusion were randomised trials and cluster-randomised trials with at least two intervention and two control sites. Participants were adults (as defined by study authors) receiving care either in the ED or the acute assessment service, where both were based in the hospital setting. The comparison was hospital-based acute assessment services with usual, ED-only care. The outcomes of this review were mortality at time point closest to 30 days, length of stay in the service (in minutes), and waiting time to see a doctor (in minutes). DATA COLLECTION AND ANALYSIS We followed the standard procedures of Cochrane Effective Practice and Organisation of Care for this review (https://epoc.cochrane.org/resources). MAIN RESULTS We identified a total of 5754 records in the search. Following assessment of 3609 de-duplicated records, none were found to be eligible for inclusion in this review. AUTHORS' CONCLUSIONS At present there are no randomised controlled trials exploring the effects of acute assessment services on patient flow in hospital-based emergency departments compared to usual, ED-only care.
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Affiliation(s)
- Victoria Shaw
- Department of Nursing, Toi Ohomai Institute of Technology, Rotorua, New Zealand
| | - An Yu
- Infrastructure and investment, Te Whatu Ora, Wellington, New Zealand
| | - Matthew Parsons
- Faculty of Health, The University of Waikato, Hamilton, New Zealand
| | - Tava Olsen
- Melbourne Business School, The University of Melbourne, Melbourne, Australia
| | - Cameron Walker
- Engineering Science, The University of Auckland, Auckland, New Zealand
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Menyah E, Garcia SM, McCormack A, Taiwo B, Aly M, Kamel W, Dhinsa BS. Assessing Referrals to a Trauma and Orthopaedic Department: Evaluation of a Traffic Light System for Virtual Fracture Clinic in the Emergency Department and Urgent Care. Cureus 2023; 15:e41316. [PMID: 37539403 PMCID: PMC10395551 DOI: 10.7759/cureus.41316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Background The Trauma and Orthopaedic (T&O) on-call service receives referrals from the emergency department (ED), general practice (GP) and urgent treatment centres (UTCs) and requests for inpatient reviews. The virtual fracture clinic (VFC) pathway allows ED and UTC clinicians to assess, discharge and refer when necessary. For VFC, the on-call orthopaedic consultant reviews the cases the next working day and makes an appropriate plan. This pathway consists of a traffic light system, in which practitioners can either safely discharge with written advice (green), refer to the VFC (yellow) or refer to the on-call team (red). Method The aim of this study was to assess how the VFC pathway was being utilised. All referrals to the T&O on-call team over three weeks were evaluated retrospectively. The following referrals were excluded: fractured femur, head injury, trauma calls and back pain pathway. The following data were collected: patient details, diagnosis, referral source, reason for referral, plan, double booking with VFC and appropriateness. Results A total of 191 referrals were analysed. Most referrals are from the ED (51%) and UTC (23%). Of the referrals, 39% were deemed to be inappropriate. Of the inappropriate referrals, 35% should have been referred directly to the VFC rather than the on-call team. A significant minority (7%) of inappropriate referrals were referred to the on-call team and VFC. Conclusion Education and collaboration are required with the ED and UTC to ensure the proper use of the VFC pathway. Immediate radiograph reporting may also be beneficial.
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Affiliation(s)
- Effie Menyah
- Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR
| | - Sean M Garcia
- Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR
| | - Ann McCormack
- Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR
| | - Babajide Taiwo
- Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR
| | - Mohamed Aly
- Orthopaedics, Alexandria University, Alexandria, EGY
- Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR
| | - Walid Kamel
- Trauma and Orthopaedics, William Harvey Hospital, Ashford, GBR
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Davis E, Fagnano M, Halterman JS, Frey SM. Utilization of the emergency department as a routine source of care among children with asthma. J Asthma 2023; 60:1377-1385. [PMID: 36399630 PMCID: PMC10192056 DOI: 10.1080/02770903.2022.2149409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
Objective: To describe characteristics of children with persistent asthma in the ED who receive most of their healthcare in emergency settings; and determine whether recent asthma experiences or historic patterns of care are associated with identifying the ED as a typical location for care.Methods: We conducted a sub-analysis of baseline data from Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED), an RCT of children (3-12 years) presenting to the ED with persistent asthma (2016-2020). Caregivers identified reasons for seeking emergency care, including if their child received most overall healthcare in the ED ('ED Care'; primary outcome) or not ('Other Care'). Independent variables included demographics, recent symptoms and quality of life (QOL), and historic preventive care and healthcare use. We compared responses between ED Care and Other Care groups using bivariate and multivariate analyses.Results: We analyzed data for 355 children (31% ED Care, 69% Other Care). Compared with Other Care, ED Care respondents were more likely to identify the ED as the closest source of healthcare; report fewer symptom nights but a poorer quality of life; and describe the ED as a usual place for sick care, despite most having a PCP.Conclusions: Many children with asthma use the ED as a typical source of healthcare, and are distinguished by need for proximity, poorer caregiver QOL, and historic patterns of care-seeking. Efforts to improve timely access to outpatient care and reinforce the role of PCP-directed asthma management, such as through telemedicine, may reduce preventable morbidity including ED visits.
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Affiliation(s)
- Erin Davis
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Maria Fagnano
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jill S. Halterman
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sean M. Frey
- University of Rochester School of Medicine and Dentistry, Rochester, NY
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Slagman A, Fischer-Rosinský A, Legg D, Schmieder K, Möckel M. Identification of low-acuity attendances in routine clinical information documented in German Emergency Departments. BMC Emerg Med 2023; 23:64. [PMID: 37280527 DOI: 10.1186/s12873-023-00838-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION It has not yet been possible to ascertain the exact proportion, characterization or impact of low-acuity emergency department (ED) attendances on the German Health Care System since valid and robust definitions to be applied in German ED routine data are missing. METHODS Internationally used methods and parameters to identify low-acuity ED attendances were identified, analyzed and then applied to routine ED data from two EDs of the tertiary care hospitals Charité-Universitätsmedizin Berlin, Campus Mitte (CCM) and Campus Virchow (CVK). RESULTS Based on the three routinely available parameters `disposition´, `transport to the ED´ and `triage´ 33.2% (n = 30 676) out of 92 477 presentations to the two EDs of Charité-Universitätsmedizin Berlin (CVK, CCM) in 2016 could be classified as low-acuity presentations. CONCLUSION This study provides a reliable and replicable means of retrospective identification and quantification of low-acuity attendances in German ED routine data. This enables both intra-national and international comparisons of figures across future studies and health care monitoring.
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Affiliation(s)
- Anna Slagman
- Emergency and Acute Medicine (CVK, CCM), Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Antje Fischer-Rosinský
- Emergency and Acute Medicine (CVK, CCM), Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - David Legg
- Emergency and Acute Medicine (CVK, CCM), Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kristin Schmieder
- Emergency and Acute Medicine (CVK, CCM), Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Martin Möckel
- Emergency and Acute Medicine (CVK, CCM), Health Services Research in Emergency and Acute Medicine, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Rehbock C, Krafft T, Sommer A, Beumer C, Beckers SK, Thate S, Kaminski J, Ziemann A. Systems thinking methods: a worked example of supporting emergency medical services decision-makers to prioritize and contextually analyse potential interventions and their implementation. Health Res Policy Syst 2023; 21:42. [PMID: 37277868 DOI: 10.1186/s12961-023-00982-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/07/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Systems thinking can be used as a participatory data collection and analysis tool to understand complex implementation contexts and their dynamics with interventions, and it can support the selection of tailored and effective implementation actions. A few previous studies have applied systems thinking methods, mainly causal loop diagrams, to prioritize interventions and to illustrate the respective implementation context. The present study aimed to explore how systems thinking methods can help decision-makers (1) understand locally specific causes and effects of a key issue and how they are interlinked, (2) identify the most relevant interventions and best fit in the system, and (3) prioritize potential interventions and contextually analyse the system and potential interventions. METHODS A case study approach was adopted in a regional emergency medical services (EMS) system in Germany. We applied systems thinking methods following three steps: (1) a causal loop diagram (CLD) with causes and effects (variables) of the key issue "rising EMS demand" was developed together with local decision-makers; (2) targeted interventions addressing the key issue were determined, and impacts and delays were used to identify best intervention variables to determine the system's best fit for implementation; (3) based on steps 1 and 2, interventions were prioritized and, based on a pathway analysis related to a sample intervention, contextually analysed. RESULTS Thirty-seven variables were identified in the CLD. All of them, except for the key issue, relate to one of five interlinked subsystems. Five variables were identified as best fit for implementing three potential interventions. Based on predicted implementation difficulty and effect, as well as delays and best intervention variables, interventions were prioritized. The pathway analysis on the example of implementing a standardized structured triage tool highlighted certain contextual factors (e.g. relevant stakeholders, organizations), delays and related feedback loops (e.g. staff resource finiteness) that help decision-makers to tailor the implementation. CONCLUSIONS Systems thinking methods can be used by local decision-makers to understand their local implementation context and assess its influence and dynamic connections to the implementation of a particular intervention, allowing them to develop tailored implementation and monitoring strategies.
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Affiliation(s)
- Cassandra Rehbock
- Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229 ER, The Netherlands
- Aachen Institute for Rescue Management and Public Safety, University Hospital RWTH Aachen and City of Aachen, 52068, Aachen, Germany
| | - Thomas Krafft
- Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229 ER, The Netherlands.
| | - Anja Sommer
- Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229 ER, The Netherlands
- Aachen Institute for Rescue Management and Public Safety, University Hospital RWTH Aachen and City of Aachen, 52068, Aachen, Germany
| | - Carijn Beumer
- Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229 ER, The Netherlands
| | - Stefan K Beckers
- Aachen Institute for Rescue Management and Public Safety, University Hospital RWTH Aachen and City of Aachen, 52068, Aachen, Germany
| | - Stefan Thate
- City of Oldenburg - Fire Department, 26127, Oldenburg, Germany
- Oldenburg Research Network Emergency and Intensive Care Medicine (OFNI), Carl Von Ossietzky University, 26129, Oldenburg, Germany
- University Institute of Medical Informatics, University Hospital RWTH Aachen, 52057, Aachen, Germany
| | - Jörn Kaminski
- Rettungsdienst Landkreis Oldenburg, 27793, Wildeshausen, Germany
| | - Alexandra Ziemann
- Department of Health, Ethics and Society, Care And Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229 ER, The Netherlands
- Department of Social and Policy Sciences, University of Bath, Bath, BA2 7AY, United Kingdom
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Pergeline J, Rivière S, Rey S, Fresson J, Rachas A, Tuppin P. Social deprivation and the use of healthcare services over one year by children less than 18 years of age in 2018: A French nationwide observational study. PLoS One 2023; 18:e0285467. [PMID: 37224152 DOI: 10.1371/journal.pone.0285467] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 03/07/2023] [Indexed: 05/26/2023] Open
Abstract
This study aimed to describe the health status of children and how social deprivation affects their use of healthcare services and mortality. Children living in mainland France were selected from the national health data system (SNDS) on their date of birth or birthday in 2018 (< 18 years) and followed for one year. Information included data on healthcare reimbursements, long-term chronic diseases (LTDs) eligible for 100% reimbursement, geographic deprivation index (FDep) by quintile (Q5 most disadvantaged), and individual complementary universal insurance (CMUc) status, granted to households with an annual income below the French poverty level. The number of children who had at least one annual visit or hospital admission was compared using the ratio of geographic deprivation (rQ5/Q1) and CMUc (rCMUc/Not) after gender and age-standardization. Over 13 million children were included; 17.5% had CMUc, with an increase across quintiles (rQ5/Q1 = 3.5) and 4.0% a LTD (rQ5/Q1 = 1.44). The 10 most frequent LTDs (6 psychiatric) were more common as the deprivation increased. Visits to general practitioners (GPs) were similar (≈84%) for each FDep quintile and the density of GPs similar. The density decreased with increasing deprivation for specialists and visits: paediatricians (rQ5/Q1 = 0.46) and psychiatrists (rQ5/Q1 = 0.26). Dentist visits also decreased (rQ5/Q1 = 0.86) and deprived children were more often hospitalised for dental caries (rQ5/Q1 = 2.17, 2.1% vs 0.7%). Emergency department (ED) visits increased with deprivation (rCMUc/Not = 1.35, 30% vs 22%) but 50% of CMUc children lived in a municipality with an ED vs. 25% without. Approximately 9% of children were admitted for a short stay and 4.5% for a stay > 1 night (rQ5/Q1 = 1.44). Psychiatric hospitalization was more frequent for children with CMUc (rCMUc/Not = 3.5, 0.7% vs 0.2%). Higher mortality was observed for deprived children < 18 years (rQ5/Q1 = 1.59). Our results show a lower use of pediatricians, other specialists, and dentists among deprived children that may be due, in part, to an insufficient supply of care in their area of residence. These results have been used to recommend optimization and specifically adapted individual or area-wide policies on the use of healthcare services, their density, and activities.
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Affiliation(s)
- Jeanne Pergeline
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
| | - Sébastien Rivière
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
| | - Sylvie Rey
- Direction de la Recherche, des études, de l'évaluation et des Statistiques (Drees), Paris, France
| | - Jeanne Fresson
- Direction de la Recherche, des études, de l'évaluation et des Statistiques (Drees), Paris, France
| | - Antoine Rachas
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
| | - Philippe Tuppin
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
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Spek M, van Charldorp TC, Vinck VV, Venekamp RP, Rutten FH, Zwart DL, de Groot E. Displaying concerns within telephone triage conversations of callers with chest discomfort in out-of-hours primary care: A conversation analytic study. PATIENT EDUCATION AND COUNSELING 2023; 113:107770. [PMID: 37150153 DOI: 10.1016/j.pec.2023.107770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/30/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVES In primary care out of hours service (OHS-PC), triage nurses ask questions to assign urgency level for medical assessment. A semi-automatic decision tool (the Netherlands Triage Standard, NTS) facilitates triage nurses with key questions, but does not leave much room for paying attention to callers' concerns. We wanted to understand how callers with chest pain formulate their concerns and are helped further during telephone triage. METHODS We conducted a conversation analytic study of 68 triage calls from callers with chest discomfort who contacted OHS-PC of which we selected 35 transcripts in which concerns were raised. We analyzed expressions of concerns and the corresponding triage nurse response. RESULTS Due to the task-oriented nature of the NTS, callers' concerns were overlooked. For callers, however, discussing concerns was relevant, stressed by the finding that the majority of callers with chest discomfort expressed concerns. CONCLUSIONS Interactional difficulties in concern-related discussions arised directly after expressed concerns if not handled adequately, or during the switch to the counseling phase. PRACTICE IMPLICATIONS When callers display concerns during telephone triage, we recommend triage nurses to explore them briefly and then return to the sequence of tasks described in the NTS-assisted triage process.
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Affiliation(s)
- Michelle Spek
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Tessa C van Charldorp
- Department of Languages, Literature and Communication, Faculty of Humanities, Utrecht University, Utrecht, the Netherlands
| | - Vera V Vinck
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Roderick P Venekamp
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Frans H Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dorien L Zwart
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Esther de Groot
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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McIntyre A, Janzen S, Shepherd L, Kerr M, Booth R. An integrative review of adult patient-reported reasons for non-urgent use of the emergency department. BMC Nurs 2023; 22:85. [PMID: 36991388 DOI: 10.1186/s12912-023-01251-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE To conduct an integrative review of the scientific literature to explore adult patient-reported reasons for using the emergency department (ED) non-urgently. METHOD A literature search of CINAHL, Cochrane, Embase, PsycINFO, and MEDLINE was conducted with filters for humans, published January 1, 1990-September 1, 2021, and English language. Methodological quality was assessed using Critical Appraisal Skills Programme Qualitative Checklist for qualitative and National Institutes Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies for quantitative studies. Data was abstracted on study and sample characteristics, and themes/reasons for ED use. Cited reasons were coded using thematic analysis. RESULTS Ninety-three studies met inclusion criteria. Seven themes were found: need to be risk averse with respect to the health issue; knowledge and awareness of alternative sources of care; dissatisfaction with primary care provider; satisfaction with ED; ED accessibility and convenience resulting in low access burden; referred to the ED by others; and relationships between patients and health care providers. DISCUSSION This integrative review examined patient-reported reasons for attending the ED on a non-urgent basis. The results suggest that ED patients are heterogenous and many factors influence their decision-making. Considering the complexity with which patients live, treating them as a single entity may be problematic. Limiting excessive non-urgent visits likely requires a multi-pronged approach. CONCLUSION For many ED patients, they have a very clear problem which needed to be addressed. Future studies should explore psychosocial factors driving decision-making (e.g., health literacy, health-related personal beliefs, stress and coping ability).
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Affiliation(s)
- Amanda McIntyre
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada.
- Department of Emergency Medicine, University Hospital, London Health Sciences Centre, London, Canada.
| | | | - Lisa Shepherd
- Department of Emergency Medicine, University Hospital, London Health Sciences Centre, London, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Mickey Kerr
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, Canada
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Mayhew M, Denton A, Kenney A, Fairclough J, Ojha A, Bhoite P, Hey MT, Seetharamaiah R, Shaffiey S, Schneider GW. Social deprivation, the Area Deprivation Index, and emergency department utilization within a community-based primary and preventive care program at a Florida medical school. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01871-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
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Benjamin P, Bryce R, Oyedokun T, Stempien J. Strength in the gap: A rapid review of principles and practices for urgent care centres. Healthc Manage Forum 2023; 36:101-106. [PMID: 36519425 PMCID: PMC9976643 DOI: 10.1177/08404704221143300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Responding to a provincial government decision to develop two Urgent Care Centres (UCCs) in Saskatchewan, we undertook a rapid review of published literature with the objective of determining best practices for their creation and functioning. Two English-limited PubMed database searches combining "after-hours care," "ambulatory care," "emergency medicine," "urgent care," "minor emergency," "walk-in," and "Canada" over the past 10 years were the sources of articles for our review. Articles were independently reviewed by two authors and synthesized collaboratively. From 833 articles, 44 were utilized in the review. Six considerations in the following areas were subsequently outlined: expected impact, preferred location, healthcare services collaboration, available services, staffing priorities, and community partnerships. These principles were considered against the backdrop of currently successful Canadian UCCs. This review indicates that general principles for the successful development of UCCs exist; these may guide the establishment and functioning of UCCs both in Saskatchewan and elsewhere.
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Affiliation(s)
- Ponn Benjamin
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rhonda Bryce
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Rhonda Bryce, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. E-mail:
| | | | - James Stempien
- Royal University Hospital, Saskatoon, Saskatchewan, Canada
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Cardozo Ocampo A, García Pareja MA, Serrano Rojas CA, Grajales Osorio N. Seguridad en urgencias sobre la referencia de pacientes no urgentes a centros de atención primaria. REPERTORIO DE MEDICINA Y CIRUGÍA 2023. [DOI: 10.31260/repertmedcir.01217372.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Objetivos: determinar la seguridad al referir pacientes triage 4 y 5 desde un servicio de urgencias a centros de atención primaria, conociendo su disposición final y las posibles complicaciones por esta estrategia. Métodos: estudio observacional retrospectivo de 333 pacientes clasificados como triage 4 y 5 que fueron referidos desde el servicio de urgencias a un centro de atención primaria en febrero 2019. A través de la aseguradora se obtuvo la información sobre si asistieron o no a dicha cita programada y la conclusión final de la consulta. Resultados: 52 pacientes (15,6%) no asistieron a la cita programada sin que esto causara alguna complicación para su salud. De los 281 que sí asistieron, 1,4% fueron referidos a valoración especializada urgente sin que requirieran ingreso hospitalario y 98,6% fueron atendidos y manejados en forma ambulatoria por el médico de atención primaria. Se encontraron diferencias entre los no asistentes a la atención primaria en los subgrupos de edad entre 3 a 17 (p=0,009) y 18 a 37 años (p=0,04). Conclusiones: la estrategia de referencia de pacientes clasificados en 4 o 5 desde un servicio de urgencias a centros de atención primaria es segura, incluso si estos no asisten a la cita programada.
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