Clinical characteristics, attendance outcomes and deaths of homeless persons in the emergency department: implications for primary health care and community prevention programmes

Abstract Background: Home based physiotherapy is offered by Primary Care Physiotherapy Services to adults and older patients in Norway, however there is limited knowledge regarding the patient characteristics and outcome. The aim of this study was to describe the variation in demographics, clinical characteristics and outcomes of patients receiving three different working models of home based physiotherapy, and whether outcomes were related to goal attainment. Methods: Patients referred to home based physiotherapy in a municipality in Norway were invited to participate in this observational study. The respective physiotherapy service is organized in three working models according to the patients’ function, degree of independence, and the individual need for home based physiotherapy; early intervention, reablement or regular physiotherapy. Patients’ demographics, clinical characteristics, physical function (Patient-specific functional scale, PSFS), physical performance (Short Physical Performance Battery, SPPB), health-related quality of life (EQ-5D), and goal attainment were registered at baseline and follow-up (maximum six months after baseline). We used logistic regression to analyse whether changes in PSFS, SPPB, and EQ-5D were associated with goal attainment. Results: In total, 689 and 402 patients completed baseline and follow-up assessments, respectively. At baseline, patients receiving early intervention had better SPPB and EQ-5D scores than patients receiving reablement and regular physiotherapy. The two latter groups had similar SPPB scores, but the regular physiotherapy group had poorer EQ-5D scores than the reablement group. At follow-up, all patient groups had improved PSFS scores, and patients receiving reablement and regular physiotherapy also showed improved SPPB and EQ-5D scores. Among the 375 patients with goal attainment assessed at follow-up, 165 (44%) achieved the treatment goal. Goal attainment was associated with improved PSFS and EQ-5D scores. Conclusions: This study describes a broad spectrum of patient characteristics receiving different working models of home based physiotherapy in primary health care in Norway. The early intervention group is a new target group for prevention of functional decline in older adults, contributing with new knowledge to decision makers in primary health care.

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Implementing the Regulation of the Minister of Health by Polish Emergency Departments In 2020

Emergency Medical Service ◽

10.36740/emems202103104 ◽

2021 ◽

Vol 8 (3) ◽

pp. 144-149

Author(s):

Jan Stachurski ◽

Anna Kaczyńska ◽

Zofia Czaplińska-Paszek

Keyword(s):

Health Care ◽

Emergency Department ◽

Primary Health Care ◽

Emergency Departments ◽

Data Retrieval ◽

Medical Centers ◽

Primary Health ◽

After Hours

Aim: The inadequate system of triage in Emergency Departments leads to the situation in which the personnel is not always able to provide care on time. A regulation determining the conditions of performing triage in Emergency Departments (paragraph 1, section 2) was issued on 27 June 2019. In order to present the level of the fulfilment of rules from the regulation and to determine the level of organization in the Polish health care, the percentage of Emergency Departments which provided the required information on their websites, was examined. Material and methods: The study was conducted in April 2020. 236 websites of hospitals with Emergency Departments were analyzed. The criteria of data retrieval were as follows: 1. The presence of the information concerning the rules of redirecting patients to Primary Health Care/After Hours Medical Centers. 2. The presence of information concerning the time an Emergency Department doctor has to inform the patient about the admission or about refusal to admit a patient. The collected data were statistically analyzed. Each Emergency Department was given the following statuses: “yes”, “no”, or “incomplete”. Results: Information concerning the 1st criterion were available in case of 59 hospitals (25%), while no such information was on the website in Opole and West Pomeranian Provinces. Information concerning the 2nd criterion was placed by 51 hospitals. In 28 cases the information was described as ”complete” and in 23 as “incomplete”. Conclusions: The majority of hospitals failed to observe the obligation to provide the information included in the Regulation.

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