Psychiatry NCHD referrals to the local emergency department in the context of an in-house primary care service

2020 ◽  
pp. 1-5
Author(s):  
C. Carey ◽  
E. Doody ◽  
R. McCafferty ◽  
M. Madden ◽  
N. Clendennen ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Service ◽  
Inpatient Admission ◽  
Primary Care Service ◽  
University Hospital ◽  
Similar Proportion ◽  
Care Services ◽  
Increased Risk ◽  
Local Emergency Department

Objectives. Patients with psychiatric illness are at increased risk of developing non-psychiatric medical illnesses. There have been positive reports regarding the integration of primary care services into mental health facilities. Here, we evaluate the appropriateness of psychiatry non-consultant hospital doctors (NCHD) transfers to the local emergency department (ED) in the context of an in-house primary care service. Methods. We reviewed the inpatient transfers from St Patrick’s University Hospital (SPUH) to the local ED at St James’ Hospital (SJH) from 1 January 2016 to 31 December 2017. We used inpatient admission to SJH as our primary marker of an appropriate transfer. Results. 246 inpatients were transferred from SPUH to the SJH ED for medical review in the years 2016 and 2017. 27 (11%) of these were referred to the ED by the primary care service. 51% of those referred were admitted with similar rates of admission for both general practitioner (n = 27, 54% admitted) and NCHD initiated referrals (n = 219, 51% admitted). Acute neurological illness, concern regarding a cardiac illness, and deliberate self-harm were the most common reasons for referral. Conclusion. Our primary finding is that, of those transferred to ED by either primary care or a psychiatry NCHD, a similar proportion was judged to be in need of inpatient admission. This indicates that as a group, psychiatry NCHD assessment of acuity and need for transfer was similar to that of their colleagues in primary care.

Role of out of hours primary care service in limiting inappropriate access to emergency department

2017 ◽  
Vol 13 (4) ◽  
pp. 549-555 ◽  
Author(s):  
Andrea Posocco ◽  
Maria Paola Scapinello ◽  
Irene De Ronch ◽  
Francesco Castrogiovanni ◽  
Gianluca Lollo ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Service ◽  
Primary Care Service ◽  
Out Of Hours

scholarly journals Primary Care Service Areas: A New Tool for the Evaluation of Primary Care Services

2003 ◽  
Vol 38 (1p1) ◽  
pp. 287-309 ◽  
Author(s):  
David C. Goodman ◽  
Stephen S. Mick ◽  
David Bott ◽  
Therese Stukel ◽  
Chiang-hua Chang ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Service ◽  
Primary Care Service ◽  
Care Services ◽  
Primary Care Services ◽  
Service Areas

EXPECTATION OF CLIENTS TOWARDS PRIMARY CARE SERVICE AT COMMUNE HEALTH CENTERS

2017 ◽  
pp. 70-77
Author(s):  
Thi Hoa Nguyen ◽  
Thi Thao Nguyen ◽  
Minh Tam Nguyen
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Primary Care Patient ◽  
Care Service ◽  
Care Patient ◽  
Care Quality ◽  
Health Centers ◽  
Primary Care Service ◽  
Cross Sectional ◽  
Care Services

Background: Patients’ expectations are considered to influence their satisfaction with the service provided. This can be used to provide a deeper understanding and better approach to improve health care delivery. Objectives: This study was to identify patients' expectations forhealth care services at commune health centers in Huong Thuy Town, Thua Thien Hue province. Methods: A cross-sectional study with data collected from 423 people in Huong Thuy, using the 38-item standardized questionnaire to measure patients' expectations of primary care. A five score Likert scale from strongly disagree to strongly agree was used to report people’s expectation towards primary care services at commune health centers. Results: Among five important features of primary care, patient expectations for aspects of the medical care were the highest ranking. Aspects that achieved the lowest expectations were the availability and accessibility. The items such as “Facilities should be well equipped and modern”, “Doctor should guide patient in taking medicines correctly” and “Doctor should make patient feel free and comformtable to talk about health issues” received the highest scores. Conclusions: The study provides evidence on what patients expect for primary care service, thus helps to improve primary care quality, especially on the aspects that patients rate highest priorities. Key words: primary care, patient’s expectation, commune health center

scholarly journals Course of Uncomplicated Acute Gastroenteritis in Children Presenting to Out-of-hours Primary Care

2021 ◽  
Author(s):  
Anouk AH Weghorst ◽  
Irma J Bonvanie ◽  
Gea A Holtman ◽  
Michiel R de Boer ◽  
Marjolein Y Berger
Keyword(s):  
Primary Care ◽  
Acute Gastroenteritis ◽  
Care Service ◽  
Primary Care Service ◽  
Symptom Duration ◽  
Out Of Hours ◽  
Typical Symptom ◽  
Follow Up Study ◽  
Increased Risk

Abstract Background: The aim of this article is to describe the courses of vomiting, diarrhea, fever, and clinical deterioration, in children with uncomplicated gastroenteritis at presentation. This study was performed as a 7-day prospective follow-up study in an out-of-hours primary care service. The course of vomiting, diarrhea, and fever was analyzed by generalized linear mixed modeling. Because young children (≤12 months) and children with severe vomiting are at increased risk of dehydration, the potentially more complicated courses of these groups are described separately. The day(s) most frequently associated with deterioration and the symptoms present in children who deteriorated during follow-up were also described.Results: In total, 359 children presented with uncomplicated acute gastroenteritis to the out-of-hours primary care service. Of these, 31 (8.6%) developed a complicated illness and needed referral or hospitalization. All symptoms decreased within 5 days in most children (>90%). Vomiting and fever decreased rapidly, but diarrhea decreased at a somewhat slower pace, especially among children aged 6–12 months. Children who deteriorated during follow-up had a higher frequency of vomiting at presentation and higher frequencies of vomiting and fever during follow-up.Conclusions: The frequency of vomiting, not its duration, appears to be the more important predictor of deterioration. When advising parents, it is important to explain the typical symptom duration and to focus on alarm symptoms. Clinicians should be vigilant for children with higher vomiting frequencies at presentation and during follow-up because these children are more likely to deteriorate.

scholarly journals Enhanced Primary Care improves GP service regularity in older patients without impacting on service frequency

2012 ◽  
Vol 18 (4) ◽  
pp. 295 ◽  
Author(s):  
David A. J. Gibson ◽  
Rachael E. Moorin ◽  
David Preen ◽  
Jon Emery ◽  
C. D'Arcy J. Holman
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Multinomial Logistic Regression ◽  
Care Service ◽  
Primary Care Service ◽  
Service Utilisation ◽  
Relative Likelihood ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

The objective of this study was to assess the impact of Enhanced Primary Care service utilisation on subsequent GP service regularity and frequency. The study involved a retrospective population-based longitudinal cohort using linked administrative health records of hospital and primary care services for people over the age of 65 years. Multinomial logistic regression modelling was used to evaluate changes in the relative likelihood of increased primary care service regularity and frequency in exposed and unexposed individuals adjusting for age, sex and recent chronic disease hospitalisation history. Enhanced Primary Care services significantly and substantially increased the relative likelihood of increased regularity with no corresponding higher likelihood of increased frequency of GP contact. Increased regularity was more likely with increasing age except for the oldest age group (90+ years). Some chronic disease histories (e.g. diabetes) showed a higher likelihood of improved regularity while others were less likely to produce an increased regularity (e.g. hypertension). The study suggests a capacity for modification of physician and patient behaviour using incentivised services within the current fee-for-service system in Australia.

scholarly journals A national evaluation of the Irish public health counselling in primary care service– examination of initial effectiveness data

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charles Brand ◽  
Fiona Ward ◽  
Niamh MacDonagh ◽  
Sharon Cunningham ◽  
Ladislav Timulak
Keyword(s):  
Primary Care ◽  
Large Scale ◽  
Care Service ◽  
Outcome Data ◽  
Primary Care Service ◽  
Observational Research ◽  
Research Approach ◽  
Growth Curve Analysis ◽  
Republic Of Ireland ◽  
Post Therapy

Abstract Background The Counselling in Primary Care service (CIPC) is the first and only nationally available public counselling service in the Republic of Ireland. This study provides initial data for the effectiveness of short-term psychotherapy delivered in a primary care setting in Ireland for the first time. Method A practice-based observational research approach was employed to examine outcome data from 2806 clients receiving therapy from 130 therapists spread over 150 primary care locations throughout Ireland. Pre-post outcomes were assessed using the CORE-OM and reliable and clinically significant change proportions. Binary logistic regression examined the effect of pre therapy symptom severity on the log odds of recovering. Six and 12 month follow up data from a subsample of 276 clients were also analysed using growth curve analysis. Results Of 14,156 referred clients, 5356 presented for assessment and 52.3% (N = 2806) consented to participate. Between assessment and post-therapy a large reduction in severity of symptoms was observed- Cohen’s d = 0.98. Furthermore, 47% of clients achieved recovery,a further 15.5% reliably improved, 2.7% reliably deteriorated and34.7% showed no reliable improvement. Higher initial severity was associated with less chance of recovering at post-therapy. Significant gains were maintained between assessment and12 months after therapy- Cohen’s d = 0.50. Conclusions Outcomes for clients in the CIPC service compared favourably with large scale counselling and psychotherapy services in jurisdictions in the U.K., the U.S.A., Norway and Sweden. This study expands the international primary care psychotherapy research base to include the entire Republic of Ireland jurisdiction.

Impact of cancer on emergency department outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18618-e18618
Author(s):  
Alexander S. Qian ◽  
Edmund M. Qiao ◽  
Vinit Nalawade ◽  
Rohith S. Voora ◽  
Nikhil V. Kotha ◽  
...  
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Cancer Patients ◽  
Metastatic Cancer ◽  
Inpatient Admission ◽  
Cancer Site ◽  
Patients With Cancer ◽  
Increased Risk

e18618 Background: Cancer patients frequently utilize the Emergency Department (ED) for a variety of diagnoses, both related and unrelated to their cancer. Patients with cancer have unique risks related to their cancer and treatment which could influence ED-related outcomes. A better understanding of these risks could help improve risk-stratification for these patients and help inform future interventions. This study sought to define the increased risks cancer patients face for inpatient admission and hospital mortality among cancer patients presenting to the ED. Methods: From the National Emergency Department Sample (NEDS) we identified patients with and without a diagnosis of cancer presenting to the ED between 2016 and 2018. We used International Classification of Diseases, version 10 (ICD10-CM) codes to identify patients with cancer, and to identify patient’s presenting diagnosis. Multivariable mixed-effects logistic regression models assessed the influence of cancer diagnoses on two endpoints: hospital admission from the ED, and inpatient hospital mortality. Results: There were 340 million weighted ED visits, of which 8.3 million (2.3%) occurred in patients with a cancer diagnosis. Compared to non-cancer patients, patients with cancer had an increased risk of inpatient admission (64.7% vs. 14.8%; p < 0.0001) and hospital mortality (4.6% vs. 0.5%; p < 0.0001). Factors associated with both an increased risk of hospitalization and death included older age, male gender, lower income level, discharge quarter, and receipt of care in a teaching hospital. We identified the top 15 most common presenting diagnoses among cancer patients, and among each of these diagnoses, cancer patients had increased risks of hospitalization (odds ratio [OR] range 2.0-13.2; all p < 0.05) and death (OR range 2.1-14.4; all p < 0.05) compared to non-cancer patients with the same diagnosis. Within the cancer patient cohort, cancer site was the most robust individual predictor associated with risk of hospitalization or death, with highest risk among patients with metastatic cancer, liver and lung cancers compared to the reference group of prostate cancer patients. Conclusions: Cancer patients presenting to the ED have high risks for hospital admission and death when compared to patients without cancer. Cancer patients represent a distinct population and may benefit from cancer-specific risk stratification or focused interventions tailored to improve outcomes in the ED setting.

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