The after-hours encounter is an important aspect of primary care. This study examined the pattern of patient behavior after hours in a rural Ontario setting serving a mixed white and native population. Of the 83 telephone calls and 59 visits over a six-week period, approximately 60 percent were from females (52 percent of the clinic population), and 70 percnet were for new problems, with acute infection accounting for nearly one third of the contacts. Forty-seven percent of the calls were rated as highly necessary; 56 percent of the calls received visits. The following factors related to the preceding call increased the likelihood of a visit: (1) an early evening call; (2) a high necessity rating; (3) a classification of trauma: (4) caller at the limit of tolerance of symptoms: (5) white caller. The significance of the results and their implications are discussed.
Specialized, multidisciplinary clinics improve service provision and reduce morbidity for patients with congestive heart failure (CHF). Although sex-related differences in access to cardiac health services have been reported, it remains unclear whether there are sex-related differences in the use of these specialized services.
To evaluate possible sex-related differences in severity at entry into specialized, multidisciplinary clinics, and compare prescription patterns between male and female patients at these clinics.
Data were obtained from the electronic clinical files of 765 CHF patients newly admitted to any of three main CHF clinics in Montreal, Quebec. Univariate and multivariate models were used to compare differences between sexes.
Only 27.1% of patients were female. The mean age (+/- SD) of the women in the present study was similar to that of the men (64+/-16 years versus 65+/-13 years, respectively). Left ventricular ejection fraction at entry for patients with reduced systolic function was comparable between sexes. The New York Heart Association functional class at entry was similar among men and women with systolic dysfunction. However, among patients with preserved systolic function, women were more symptomatic, with a higher functional class at entry (adjusted OR 2.52, 95% CI 1.18 to 5.38). Prescription profiles were similar for men and women.
Entry into a clinic may be delayed for women with preserved systolic function CHF. However, clinic referral patterns and disease management appeared to be similar among both men and women with systolic dysfunction CHF.
Cites: Eur Heart J. 2000 May;21(9):699-70010739720
To describe the incidence, reasons for, and characteristics of health center visits by campers at a Canadian provincial Scout jamboree.
A retrospective observational design utilized a medical record review process. The study sample was 804 campers present for 4,816 camper days (CDs).
There were 172 visits to the camp health center for an incidence rate of 36 per 1,000 CDs. The median length of stay was 30 minutes. Patients with illnesses were seen 1.7 times more frequently than those with injuries. One in five visits was for follow-up. More than 97% of visits occurred during the scheduled health center hours of operation. The rate of adverse events (AEs) was 3.32 per 1,000 CDs, accounting for 9.3% of all visits.
The incidence of health center visits and AEs are consistent with studies conducted with other resident camps. Camp administrators, organizers, and healthcare personnel must be prepared to provide care for a wide range of illnesses and injuries at camp. Understanding the trends associated with camp health center usage allows adequate personnel and physical resources to be prepared and identifies increased usage levels. Nurses can use this information to advocate for nurses to be employed at camps to aid in health prevention services as well as to manage illnesses and injuries.
To review the services provided by an early pregnancy assessment clinic (EPAC) in Vancouver, British Columbia, and to assess the characteristics of the women accessing their services and their satisfaction with the care provided.
The EPAC at BC Women's Hospital and Health Centre was opened in September 2007 to offer assessment of early pregnancy complications and management of early pregnancy loss. We conducted a review of the records of all patients who accessed the clinic in its first year of operation to review the origin of referrals, patient assessments, diagnoses, treatment, complications, and follow-up. Additionally, we distributed satisfaction surveys to patients.
A total of 411 patients were referred to the EPAC in its first year of operation. Most referrals were from family physicians (38%), and the primary reason for referral was most commonly cramping and/or spotting (57%). The mean wait time for patients to be seen was 2.02 working days, and the majority of women (91%) were given a diagnosis at their first clinic visit. After assessment, 48% of women had manual vacuum aspiration or dilatation and curettage arranged, 21% had expectant management, and 17% required no treatment, because of complete miscarriage. While 94% of patients with non-viable pregnancies were treated at EPAC, 6% were referred to other health care agencies. In the satisfaction surveys completed, comments about the EPAC were largely positive and primarily focused on the emotional support and level of care received.
In its first year of operation, the EPAC was well used and provided efficient and compassionate care. Patients reported high satisfaction with the quality of care received from staff, and showed particular appreciation for the emotional care received.
This study sought to quantify and characterize complementary and alternative medicine (CAM) use among patients presenting to a pediatric otolaryngology clinic with the aim of increasing CAM use awareness for the practicing pediatric otolaryngologist.
Four hundred thirty-four caregivers of patients presenting to a pediatric otolaryngology clinic were surveyed regarding their child's use of CAMs. Demographic information, perceived benefits, and sources of information regarding CAM was collected. Spearman correlation coefficient was used to assess strength of associations.
Three-hundred and sixty-four caregivers completed the survey (83.9% response rate). The children of 69% of respondents had utilized CAM, and 46% were using CAM at the time of the survey. Higher income and chronic illness in the child were significant predictors of CAM use. The children of older and married parents were more likely to have utilized CAM (non-significant). The most common agents were multivitamins (43%) and vitamin D (32%). Parents whose children used more CAMs were more likely to perceive a benefit.
A significant proportion of pediatric otolaryngology patients utilized CAM in our study population. The most commonly used agents are mostly benign, but others may have more unknown consequences. It is crucial that otolaryngologists ask specifically about these agents, as they potentially interact with prescription medications and some may lead to surgical complications.
To explore what nursing home resident demographic, clinical, functional, and health services utilization characteristics influence a "do not hospitalize" designation.
Historical cohort study.
Extended care residents in 2 hospital-based and 4 free-standing nursing homes who died between 2001 and 2007.
The designation of "do not hospitalize" on a resident's chart.
Continuity of family physician care from admission to death (adjusted hazard ratio [AHR] 2.16, 95% confidence interval [CI] 1.33 to 3.49), a sudden and unexpected death (AHR 0.43, 95% CI 0.25 to 0.73), and age (AHR 1.02, 95% CI 1.01 to 1.02) were independently associated with a "do not hospitalize" designation.
The greater than 2-fold positive association of continuity of family physician care with a "do not hospitalize" designation is an interesting addition to the literature on how continuity of physician care matters.
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Cites: Ann Fam Med. 2003 Sep-Oct;1(3):149-5515043376
Continuity of care is one of the components of the medical care utilization process. This process includes a number of components. Here two of these other components are considered so that variations in the continuity of care may be studied: the volume of utilization and the regularity of utilization. Volume of utilization is the number of visits to physicians in a period of time, while regularity of utilization is the extent to which an individual visits physicians at regular intervals. When data on utilization from an administrative data file were used, analysis showed that continuity varied with the volume and regularity of use. Sex, a diagnosis of chronic illness, visits to specialists and age were introduced as predictors of continuity, given the levels of both volume and regularity of utilization. Sex did not have any effect on continuity. Age had an effect only for individuals with a low volume of utilization. Continuity scores varied for chronic illness only if use of medical care was regular, while it varied for physician specialty only for those with few visits. An interaction effect of chronic illness with the specialty of the physician was also identified.
To assess the effects of obtaining a blood culture on the subsequent diagnostic and therapeutic management of young febrile children without an evident focus of bacterial infection, we carried out a randomized controlled clinical trial of this procedure in 146 children 3 to 24 months of age who presented to our emergency department with an unexplained temperature of 39.0 degrees C or higher. Random assignment to either have (67 children) or not have (79) a blood sample taken for culture resulted in groups equivalent in age, sex, weight, socioeconomic status, temperature at enrolment and laboratory test results. No differences were detected in the rates of subsequent hospital admission, outpatient visits, determination of complete blood count or other blood tests, urinalysis or urine culture, chest or other roentgenography, or administration of antibiotics or other medications. Knowledge of the absence of such differences should be helpful in evaluating the relative benefits and costs of blood culture for young febrile children.
Cites: N Engl J Med. 1973 Jun 21;288(25):1309-124145198