Distance from the endocrinology clinic and diabetes control in a rural pediatric population

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Ana K. LePage ◽  
J. Benjamin Wise ◽  
Jennifer J. Bell ◽  
Dmitry Tumin ◽  
Aimee W. Smith
Keyword(s):  
Pediatric Population ◽  
Geographic Distance ◽  
Clinic Visit ◽  
Diabetes Control ◽  
Final Visit ◽  
Pediatric Endocrinology ◽  
Visit Adherence ◽  
Review Period ◽  
The Impact ◽  
Endocrinology Clinic

AbstractObjectiveWe analyzed the impact of geographic distance from the clinic on adherence to recommended clinic visits and diabetes control among patients with type 1 diabetes (T1D) seen in a pediatric endocrinology clinic serving a rural region in eastern North Carolina.MethodsWe retrospectively included patients with T1D age ≤20 years seen in our clinic during 2017. Outcomes were tracked until June 2018. Distance from the clinic was determined according to the zone improvement plan (ZIP) code of patient address. Visit adherence was defined based on the number of attended visits during the study period, aiming for 1 every 3 months. Glycated hemoglobin (HbA1c) was measured at the first and last visits during the review periodResultsThe analysis included 368 patients, of whom 218 (59%) completed at least 1 visit every 3 months. The median HbA1c was 9.1 (interquartile range [IQR]: 8.0, 10.3) at the initial visit, and 9.3 (IQR: 8.0, 11.1) at the final visit. Median distance from the clinic was 56 km (IQR: 35, 86). On multivariable logistic regression, greater distance from the clinic was associated with lower odds of visit adherence (odds ratio per 10 km: 0.93; 95% confidence interval: 0.87, 0.99; p=0.030). Neither distance to the clinic nor clinic visit adherence were associated with HbA1c.ConclusionsPatients living further away from the clinic were less likely to adhere to the recommended visit schedule, but distance was not correlated with HbA1c levels. Further work is needed to assist families living far from the clinic with adhering to recommended visits.

Influence of the Basal Metabolic Profile on the Evolution of the Pediatric Patient with Obesity

2021 ◽  
Author(s):  
Belén Fernández ◽  
Ainhoa Sarasua Miranda ◽  
Isabel Lorente Blázquez ◽  
Ignacio Diez López
Keyword(s):  
Body Composition ◽  
Childhood Obesity ◽  
Pediatric Population ◽  
Tertiary Hospital ◽  
The Body ◽  
Basal Metabolism ◽  
Pediatric Endocrinology ◽  
Simple Method ◽  
Endocrinology Clinic

Childhood obesity is a problem of growing importance globally. It is associated with significant health problems. Knowing how to treat it effectively would improve the quality of life of these children. The aim of this chapter is to study how basal metabolism influences the somatometric evolution of the child and adolescent population with obesity in a pediatric endocrinology clinic. Study childhood obesity in a tertiary hospital by means of a multichannel impedanceometry study. All the patients had a basal metabolism lower than the calculated theoretical ideal. In overall terms, weight reduction is not achieved in this pediatric population. However, it is observed a decrease in fat content in the medium term (1-3 years). Bioelectrical impedanceometry measurement is a simple method in clinical practice to evaluate the energy consumption and the body composition. Knowing the body composition of these children would help to intervene more effectively to help control obesity and its health consequences.

Community-Based Accompaniment and the Impact of Distance for HIV Patients Newly Initiated on Antiretroviral Therapy: Early Outcomes and Clinic Visit Adherence in Rural Rwanda

2016 ◽  
Vol 22 (1) ◽  
pp. 77-85 ◽  
Author(s):  
Fabien Munyaneza ◽  
Joseph Ntaganira ◽  
Laetitia Nyirazinyoye ◽  
Ermyas Birru ◽  
Marie Paul Nisingizwe ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Clinic Visit ◽  
Community Based ◽  
Hiv Patients ◽  
Visit Adherence ◽  
The Impact

scholarly journals No-Show Rates in Employed Otolaryngology Practice

2019 ◽  
pp. 014556131989315 ◽  
Author(s):  
Brett T. Comer ◽  
Lauren E. Harris ◽  
Caitlin E. Fiorillo ◽  
Thomas J. Gal ◽  
Allyson Hughes
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Clinic Visit ◽  
Insurance Type ◽  
Visit Adherence ◽  
Key Factor ◽  
Potential Improvement ◽  
The Impact ◽  
Clinic Visits

Objective: To report baseline no-show rates in the hospital-employed otolaryngology practice setting and to identify factors that may affect clinic show rates that are targets for potential improvement. Study Design: Retrospective chart review. Methods: Electronic medical records from October 2012 through July 2014 of a hospital-employed otolaryngology practice were reviewed. Patients were classified by insurance type: commercial, Medicare, Medicaid, and self-pay. Clinic visits were classified as new patient, follow-up, or postoperative. No-show rates were tabulated for each type of clinic visit and compared. Factors to improve no-show rates are discussed. Results: There was an overall no-show rate of 8.3% for 5817 scheduled clinic visits. Among visit types, follow-up visits had the highest no-show rates. Among insurance types, Medicaid had the highest no-show rates. New patient Medicaid patients, follow-up Medicaid patients, and follow-up commercial insurance patients had the highest rate of no-shows among visit/insurance type combinations. Persistent reminders are a key factor in improving rate of clinic visit adherence. Conclusion: A previously unreported baseline no-show rate was established for hospital-employed otolaryngology clinics. The utilization of repeated, live-person reminders to mitigate the impact of clinic no-show rates needs to be further investigated.

scholarly journals Using Telemedicine as a method for providing physician coverage: A pilot experience in a pediatric endocrinology clinic

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Yafi
Keyword(s):  
Medical Condition ◽  
Clinic Visit ◽  
Small Sample ◽  
Hormone Deficiency ◽  
Height Velocity ◽  
Pediatric Endocrinology ◽  
Anthropometric Measures ◽  
Physician Visits ◽  
Medical Visits ◽  
Endocrinology Clinic

Abstract Background Telemedicine (TM) has been a rapidly growing method of providing health. Using technology to provide healthcare at a distance can be helpful in improving access and providing immediate medical care when needed. We evaluated families' choice and acceptance of TM visit in a pediatric endocrinology clinic as an alternative to rescheduling appointments. Based on these experiences potential and limitations will be discussed. Methods The families of our patients were informed about the TM visits and given the option to participate. The TM visits were designed for follow-up patients, only. Scope of TM visits was to review the medical condition, laboratory results, anthropometric measures, calculate height velocity, review, and develop medical management plans without performing physical examinations remotely. Satisfaction was obtained at the end of the TM visit. Results 14 families were offered a TM visit when their physician was not available to conduct the visit. Six families (42%) agreed to participate in the TM visits, of which 2 dropped out. Patients seen were diagnosed with short stature or growth hormone deficiency. All of the participating families (100%) expressed satisfaction and would participate in TM visits in the future. Families who declined the TM visit chose to reschedule for traditional physician visits later. Conclusions Telemedicine can offer a practical solution to provide coverage for general and specialized physicians, suddenly unavailable, or to increase access to medical visits in underserved areas. Patients should be informed about TM visits and related details of the process, expectations, privacy, and outcomes prior to starting any TM clinic visit. Although a small sample, our pilot indicates a high hesitancy to participate. Efforts to increase acceptance of TN visits in a highly developed health system cannot be underestimated.

scholarly journals Impact of Telephone Follow-Up on Patient Satisfaction in a Pediatric Neurosurgery Clinic

2020 ◽  
Vol 7 (6) ◽  
pp. 1255-1259
Author(s):  
Erica Blanco ◽  
Shenae Samuels ◽  
Rebekah Kimball ◽  
Daxa Patel ◽  
Sandra Citty ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Pediatric Population ◽  
Adult Population ◽  
Pediatric Neurosurgery ◽  
Clinic Visit ◽  
Patient Satisfaction Scores ◽  
Physician Rating ◽  
Satisfaction Measures ◽  
The Impact

Patient satisfaction is a key metric used to measure quality in health care. However, patient satisfaction measures in the pediatric population are less studied and understood than in the adult population. The purpose of this study was to evaluate the impact of telephone follow-up on patient satisfaction in an outpatient pediatric neurosurgery clinic. A standardized telephone follow-up call was performed within 1 week of a child’s clinic visit. Pearson’s χ2 or Fisher’s exact tests were used to assess changes in patient satisfaction measures after implementation of the telephone follow-up call initiative. The proportion of overall “top-box” physician rating significantly increased from 85.5% in 2017 to 95.6% in 2018 ( P = .04). There was also a nonsignificant upward trend in the proportion of respondents noting that they would recommend this provider, as well as in all measures of physician communication quality and office staff quality. A simple telephone call to new patients after an outpatient pediatric neurosurgery clinic visit resulted in statistically significant and clinically meaningful changes in patient satisfaction scores.

The impact of fluorescein-guided technique in the surgical removal of CNS tumors in a pediatric population: results from a multicentric observational study

2020 ◽  
Vol 63 (6) ◽  
Author(s):  
Camilla de Laurentis ◽  
Julius Höhne ◽  
Claudio Cavallo ◽  
Francesco Restelli ◽  
Jacopo Falco ◽  
...  
Keyword(s):  
Observational Study ◽  
Pediatric Population ◽  
Cns Tumors ◽  
Surgical Removal ◽  
The Impact

scholarly journals The Impact of a Produce Prescription Programme on Healthy Food Purchasing and Diabetes-Related Health Outcomes

2021 ◽  
pp. 1-24
Author(s):  
Julian Xie ◽  
Ashley Price ◽  
Neal Curran ◽  
Truls Østbye
Keyword(s):  
Health Outcomes ◽  
Fruits And Vegetables ◽  
Healthy Food ◽  
Grocery Store ◽  
Diabetes Control ◽  
Food Purchasing ◽  
Significant Relationships ◽  
Expenditure Share ◽  
The Impact

Abstract Objective: To evaluate a Produce Prescription Programme’s utilisation, and its effects on healthy food purchasing and diabetes control among participants with type 2 diabetes. Design: Prospective cohort study using participants’ electronic health records (EHR) and food transaction data. Participants were categorized as “Frequent Spenders” and “Sometimes Spenders” based on utilisation frequency. Multivariate regressions assessed utilisation predictors; and programme effects on fruit/vegetable purchasing (spending, expenditure share, variety) and on diabetes-related outcomes (HbA1c, BMI, blood pressure). Setting: Patients enrolled by clinics in Durham, North Carolina, USA. Participants received $40 monthly for fruits and vegetables at a grocery store chain. Subjects: 699 food-insecure participants (353 with diabetes). Results: Being female and older was associated with higher programme utilisation; hospitalisations were negatively associated with programme utilisation. Frequent Spender status was associated with $8.77 more in fruit/vegetable spending (p < 0.001), 3.3% increase in expenditure share (p = 0.007), and variety increase of 2.52 fruits and vegetables (p < 0.001). For $10 of Produce Prescription Dollars spent, there was an $8.00 increase in fruit/vegetable spending (p < 0.001), 4.1% increase in expenditure share, and variety increase of 2.3 fruits/vegetables (p < 0.001). For the 353 participants with diabetes, there were no statistically significant relationships between programme utilisation and diabetes control. Conclusions: Programme utilisation was associated with healthier food purchasing, but the relatively short study period and modest intervention prevent making conclusions about health outcomes. Produce Prescription Programmes can increase healthy food purchasing among food-insecure people, which may improve chronic disease care.

scholarly journals 1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S684-S684
Author(s):  
Victoria Konold ◽  
Palak Bhagat ◽  
Jennifer Pisano ◽  
Natasha N Pettit ◽  
Anish Choksi ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Intervention Group ◽  
Post Intervention ◽  
Days Of Therapy ◽  
New Antibiotics ◽  
Core Elements ◽  
Quasi Experimental ◽  
Empirical Antibiotics ◽  
The Impact

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

scholarly journals Pediatric Endocrinology in the Time of COVID-19: Considerations for the Rapid Implementation of Telemedicine and Management of Pediatric Endocrine Conditions

2020 ◽  
Vol 93 (6) ◽  
pp. 343-350
Author(s):  
Molly O. Regelmann ◽  
Rushika Conroy ◽  
Evgenia Gourgari ◽  
Anshu Gupta ◽  
Ines Guttmann-Bauman ◽  
...  
Keyword(s):  
Patient Care ◽  
Care Patient ◽  
The Novel ◽  
Patient Privacy ◽  
Pediatric Endocrinology ◽  
Quality Of Patient Care ◽  
Care Outcomes ◽  
Novel Coronavirus ◽  
The Impact

<b><i>Background:</i></b> Pediatric endocrine practices had to rapidly transition to telemedicine care at the onset of the novel coronavirus disease 2019 (COVID-19) pandemic. For many, it was an abrupt introduction to providing virtual healthcare, with concerns related to quality of patient care, patient privacy, productivity, and compensation, as workflows had to change. <b><i>Summary:</i></b> The review summarizes the common adaptations for telemedicine during the pandemic with respect to the practice of pediatric endocrinology and discusses the benefits and potential barriers to telemedicine. <b><i>Key Messages:</i></b> With adjustments to practice, telemedicine has allowed providers to deliver care to their patients during the COVID-19 pandemic. The broader implementation of telemedicine in pediatric endocrinology practice has the potential for expanding patient access. Research assessing the impact of telemedicine on patient care outcomes in those with pediatric endocrinology conditions will be necessary to justify its continued use beyond the COVID-19 pandemic.

scholarly journals Telemedicine experiences at a pediatric endocrinology clinic during the COVID-19 pandemic

2021 ◽  
Author(s):  
Yasemin Denkboy Ongen ◽  
Erdal Eren ◽  
Kadriye Cansu Sahin ◽  
Meltem Buhur Pirimoglu ◽  
Halil Saglam ◽  
...  
Keyword(s):  
Pediatric Endocrinology ◽  
Endocrinology Clinic
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