To determine whether there were differences in waiting time for a consultation for a nonurgent cardiology problem among specialists in an academic centre compared with those in community practice.
Cross-sectional telephone survey.
Southwestern Ontario.
Academically affiliated and community-based specialists in cardiology or internal medicine with an interest in cardiology.
Waiting period in weeks for outpatient consultation.
Among community specialists, those with cardiology training had significantly longer waiting times than those without for nonurgent cardiology consultation (median 8.6 versus 3.8 weeks, P=0.0077). Waiting times for consultation were significantly longer for academic specialists than for those in community practice (median 9.1 versus 4.1 weeks, P=0.0013). Significantly longer waiting times exist in communities with a population greater than 100,000 (median 9.1 versus 4.0 weeks, P=0.0005).
Waiting times for consultation for a nonurgent cardiology problem are long. Waiting times are longer for physicians with certification in cardiology, in the academic medical centre and in larger communities.
The objective of the study was to determine the prevalence and comorbidity of persisting attention-deficit hyperactivity disorder (ADHD) in adult psychiatric outpatients. Consecutive patients, first visits excluded, at a general psychiatric outpatient clinic were offered a screening for childhood ADHD with the Wender Utah Rating Scale (WURS). One hundred and forty-one patients out of 398 (35%) completed and returned the scale. Patients above or near cut-off for ADHD (n=57) were offered an extensive clinical evaluation with psychiatric as well as neuropsychological examination. The attrition was analysed regarding age, sex and clinical diagnoses. Out of the screened sample, 40% had scores indicating possible childhood ADHD. These 57 patients were invited to the clinical part of the study, but 10 declined assessment, leaving 47 (37 women and 10 men) who were actually examined. Thirty of these (21 women and nine men) met diagnostic criteria for ADHD at the time of examination. Among the patients with ADHD, affective disorders were the most common psychiatric diagnoses. The rate of alcohol and/or substance abuse, as noted in the medical records, was also high in the ADHD group. In the WURS-screened group, 22% (30 patients assessed as part of this study and one person with ADHD previously clinically diagnosed) were shown to have persisting ADHD. Therefore, it is clearly relevant for psychiatrists working in general adult psychiatry to have ADHD in mind as a diagnostic option, either as the patient's main problem or as a functional impairment predisposing for other psychiatric disorders.
The purpose was to measure the use of psychiatric treatment before and after the start of community psychiatry in a part of Copenhagen. The use was measured during the two years before and after starting for the first 45 patients entering the treatment facility. Number of patients taken in for in-patient treatment, of intakes, of in-patient days, of emergencyroom visits and out-patient attendances were measured. Data about treatment with medicine, committed intakes, suicide attempts and the profession of the case manager were recorded. The number of intakes was reduced from 98 in the two years before community psychiatry to 36 in the period with community psychiatry. In-patient days were reduced by 60%. The number of out-patient contacts was increased six-fold and contacts with psychiatrists two-fold during the period with community psychiatry. Two-thirds of the patients came for day treatment. The treatment contact became more stable. Use of medicine per day was the same, but total use increased because of the more stable contact. No difference in in-patient treatment use was seen according to the case manager's professional education. It is concluded that community psychiatry by increased use of outreach, patient contact, and psychological treatments can increase the stability of the contact and reduce the use of in-patient days.
Notes
Comment In: Ugeskr Laeger. 1993 Oct 18;155(42):33987639837
Since the 1991 Gulf War, more than 10 years and 1 billion dollars of health evaluations and research have been invested in understanding illnesses among Gulf War veterans. We examined the extensive published healthcare utilization data in an effort to summarize what has been learned. Using multiple search techniques, data as of June 2003 from four different national Gulf War health registries and numerous hospitalization and ambulatory care reports were reviewed. Thus far, published reports have not revealed a unique Gulf War syndrome nor identified specific exposures that might explain postwar morbidity. Instead, they have demonstrated that Gulf War veterans have had an increase in multi-symptom condition, injury, and mental health diagnoses. While these diagnoses are similar to those experienced by other comparable military populations, their explanation is not fully understood. New strategies to identify risk factors for, and to reduce, such postdeployment conditions are summarized.
Airborne particulate matter from primarily geologic, non-industrial sources at levels below National Ambient Air Quality Standards is associated with outpatient visits for asthma and quick-relief medication prescriptions among children less than 20 years old enrolled in Medicaid in Anchorage, Alaska.
In Anchorage, Alaska, particulates with aerodynamic diameter or = 34 micro g/m(3). A significant 18.1% increase (RR: 1.181, 95% CI: 1.010-1.381) in the rate of quick-relief medication prescriptions occurred during days with PM(10) of 34-60 micro g/m(3), and a 28.8% increase (RR: 1.288, 95% CI: 1.026-1.619) occurred during days with PM(10) > or = 61 micro g/m(3). Similar results for outpatient asthma visits and quick-relief medication occurred in weekly models. There were no significant associations with PM(2.5) in either daily or weekly models. These subtle but statistically significant associations suggest that non-industrial, geologic sources of PM(10) may have measurable health effects at levels below current national standards.
[All-cause mortality among men of elderly and senile age depending on day of week, a season and changing to daylight saving time for a 13-year period].
To study the all-cause mortality among men of elderly and senile age depending on day of week, month of year, a season, changing to daylight saving time, prospective supervision over 1067 men of 60 years and upward for a 13-year period was conducted. The all-cause mortality depending on transition into daylight saving time was counted for March and October and compared to indicators of April and November accordingly. The all-cause mortality rate had made 1668,5 on 1000. This indicator in January (177.9 per 1000) and August (175.2 per 1000) was higher, than in November (102.4 per 1000; p
To determine the status of ambulatory care training of core internal medicine residents in Canada.
Mail survey.
All 16 program directors of internal medicine residency training programs in Canada.
The nature and amount of ambulatory care training experienced by residents, information about the faculty tutors, and the sources and types of patients seen by the residents. As well, the program directors were asked for their opinions on the ideal ambulatory care program and the kinds of teaching skills required of tutors.
All of the directors responded. Fifteen stated that the ambulatory care program is mandatory, and the other stated that it is an elective. Block rotations are more common than continuity-of-care assignments. In 12 of the programs 10% or less of the overall training time is spent in ambulatory care. In 11 the faculty tutors comprise a mixture of generalists and subspecialists. The tutors simultaneously care for patients and teach residents in the ambulatory care setting in 14 of the schools. Most are paid through fee-for-service billing. The respondents felt that the ideal program should contain a mix of general and subspecialty ambulatory care training. There was no consensus on whether it should be a block or continuity-of-care experience, but the directors felt that consultation and communication skills should be emphasized regardless of which type of experience prevails.
Although there is a widespread commitment to provide core internal medicine residents with experience in ambulatory care, there is little uniformity in how this is achieved in Canadian training programs.
Notes
Cites: CMAJ. 1990 Feb 15;142(4):386-72302637
Cites: Acad Med. 1989 May;64(5):259-612496699
Cites: J Gen Intern Med. 1989 Mar-Apr;4(2):136-82709172
Cites: JAMA. 1987 Sep 18;258(11):1491-53625948
Cites: Ann Intern Med. 1987 Sep;107(3):392-83619225
Cites: J Gen Intern Med. 1990 Jan-Feb;5(1 Suppl):S3-142303929
Cites: J Med Educ. 1986 Apr;61(4):293-3023959047
Cites: N Engl J Med. 1986 Jan 2;314(1):27-313940313
Cites: Ann Intern Med. 1979 Mar;90(3):412-17426411
To examine patterns of ambulatory physician visits for musculoskeletal disorders (MSD) in Canada.
Physician claims data from 7 provinces were analyzed for ambulatory visits made by adults age >or= 15 years to primary care physicians and specialists (all medical specialists, rheumatologists, internists, all surgical specialists, orthopedic surgeons) for MSD (arthritis and related conditions, bone disorders, back disorders, ill defined symptoms) during fiscal year 1998-99. Person-visit rates and total and mean number of visits to all physicians for MSD were calculated by condition group. The percentages of patients with MSD seeing physicians of different specialties were also calculated. Provincial data were combined to calculate national estimates.
Over 15.5 million physician visits were made for MSD during 1998-99. About 24% of Canadians made at least one physician visit for MSD: 16% for arthritis and related conditions, 2% for bone disorders, 7% for back disorders, and 6% for ill defined symptoms. Person-visit rates for MSD varied by province, were highest among older Canadians, and were greater for women than men. Primary care physicians were commonly seen, particularly for back disorders. Consultation with surgical and medical specialists was less common and varied by province and by condition.
MSD place a significant burden on Canada's ambulatory healthcare system. As the population ages, there will be an escalating demand for care. Careful planning will be required to ensure that those affected have access to the care they require. A limitation in using administrative data to examine health service utilization is that MSD diagnostic codes require validation.
[An outpatient study by stress echocardiography with dobutamine of myocardial function in patients with congestive heart failure (the first trial in Russia of the use of the dobutamine-echocardiography test)].
Dobutamin stress-echocardiography has been tried outpatiently in the diagnostic center for feasible use in functional assessment of the myocardium in patients with congestive heart failure class 3-4 by classification of New York Heart Association. Eleven outpatients (a mean age 56 +/- 8 years) with left ventricular dilatation and a reduction in the ejection fraction received an increasing dose of dobutamin (5-40 micrograms) min/kg in intravenous infusion in the course of which central hemodynamics and left ventricular segmental contractility were measured with two-dimensional and Doppler echocardiography. By the hemodynamic response to dobutamin infusion reflecting difference in the myocardial reserve, two groups of patients were identified. The authors suggest dobutamin Doppler echocardiography for use in outpatient setting as a safe and effective procedure for assessing contractile myocardial reserve and prognosis of congestive heart failure.
Evaluation of the consumption of antimicrobial drugs is an important component of antibiotic policy and provides a picture of rationality of treatment. In the present paper, the authors analyzed the consumption of antibacterial agents of the ATC group J01 for systemic use in out-patient practice in Slovakia in 1999-2001. The data were taken from materials of all Slovak insurance companies provided by the Ministry of Health of the Slovak Republic. The paper evaluated the total out-patient consumption of antimicrobial agents and the financial costs of antibiotic therapy, analyzed the consumption of the individual groups of antibiotics and the consumption of individual agents, and compared the found out-patient consumption with that of Finland. The DDD values in the period under study gave evidence of a high but stable consumption of antibiotics. The analysis according to the groups of antibiotics revealed the dominance of penicillins with wider spectra, penicillins sensitive to beta-lactamases, and macrolides. The evaluation of individual antimicrobial agents showed a positive tendency of the growth of amoxicillin consumption, compensated by a decrease in the consumption of less advantageous ampicillin. The comparison of the Slovak and Finnish consumptions of macrolide antibiotics showed a prevailing consumption of roxitromycin and klaritromycin in Slovakia, and azitromycin in Finland. As far as cephalosporins are concerned, the preparations of the first generation dominated in Finland, and those of the second generation in Slovakia.
