scholarly journals GP services in Australia: presentation profiles during usual practice hours and after-hours periods

2020 ◽  
Vol 26 (2) ◽  
pp. 117
Author(s):  
Jannah Baker ◽  
Helena Britt ◽  
Christopher Harrison
Keyword(s):  
Patient Characteristics ◽  
Service Planning ◽  
Cross Sectional ◽  
Usual Practice ◽  
Management Actions ◽  
Representative Study ◽  
After Hours Care ◽  
Gp Services ◽  
After Hours ◽  
Reasons For Encounter

After-hours general practitioner (GP) services can reduce emergency department demand, which is currently increasing in Australia. Understanding GP after-hours care may assist in service planning. From April 2014 to March 2015, 986 GPs recorded 38275 consultations with start and finish times in the Bettering the Evaluation and Care of Health (BEACH) study, a national, cross-sectional, representative study of GP activity. GP and patient characteristics and the content of encounters in usual-hours and after-hours were compared. Significantly more after-hours than usual-hours encounters were with: GPs aged 60+ years; in metropolitan practices; and practices with 10+ GPs. Patients seen after-hours were more often: male; aged 15–64 years; new to practice; and less likely to hold a Commonwealth Concession Card. They were more likely to be prescribed antibiotics and less likely to: have chronic problems managed; be referred; receive psycholeptic or psychoanaleptic prescription; and undergo a procedure. Throat symptoms, fever and injury were more common reasons for encounter, while infections and injury were more frequently managed problems after-hours. The patient mix, GP characteristics, problems managed and management actions in after-hours care differ from those in usual-hours care in Australia. This greater understanding of after-hours care is the first step to informed resource allocation to improve the delivery of after-hours primary care.

scholarly journals The effects of primary care accessibility and continuity of care on less-urgent emergency department use

2021 ◽  
Author(s):  
◽  
Alexander Fraess-Phillips
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Continuity Of Care ◽  
Interdisciplinary Teams ◽  
Event Analysis ◽  
Cross Sectional ◽  
After Hours Care ◽  
After Hours ◽  
The Impact

Background/Aims. Since the early 2000s, Canada’s primary care system has undergone substantial reforms, including the incorporation of interdisciplinary teams and strategies to optimise accessibility. However, the effects of primary care accessibility and continuity of care on less-urgent emergency department (ED) use are unclear. Three studies were undertaken to investigate the effects of primary care accessibility and continuity of care factors on less-urgent ED use. Methods. Study One employed a cross-sectional analysis of responses to the Canadian Survey of Experiences with Primary Health Care to predict self-reported ED visit avoidability; Study Two employed a longitudinal time-to-event analysis of responses to Ontario’s Health Care Experience Survey linked with subsequent National Ambulatory Care Reporting System data to predict medically assessed less-urgent ED use; and Study Three employed time-series analyses of presentations to two northern British Columbia EDs following changes in walk-in clinic coverage. Results. Study One (n = 2,625) found no significant associations between self-reported ED visit avoidability and all measures of primary care accessibility and continuity of care. However, rural respondents reported greater ED visit avoidability. Conversely, Study Two (n = 34,686) found that all accessibility factors were significantly associated with medically assessed less-urgent ED use, including the presence of a regular PCP, the regular source of care, and the availability of after-hours care through the PCP. However, time with the same PCP was not associated with medically assessed less-urgent ED use. Rurality was also found to moderate the effect of after-hours care accessibility, with only rural respondents reporting a beneficial effect. Finally, Study Three found that changes in walk-in clinic coverage resulted in short-term impacts on less-urgent ED use, with a walk-in clinic closure resulting in an immediate increase in less-urgent presentations and an opening resulting in an immediate decrease. Conclusions. The findings of Studies Two and Three provide evidence that primary care accessibility factors are associated with medically assessed less-urgent ED use; however, the findings of Study One suggest that these factors do not influence self-perceived ED visit avoidability. Future studies should consider this discordance when measuring the impact of primary care accessibility on less-urgent ED use.

scholarly journals Emergency medicine and "acute" general practice: comparing apples with 0ranges

2000 ◽  
Vol 23 (2) ◽  
pp. 152 ◽  
Author(s):  
Sue Ieraci ◽  
Paul Cunningham ◽  
Janet Talbot-Stern
Keyword(s):  
Emergency Medicine ◽  
General Practice ◽  
Cost Effectiveness ◽  
Service Provision ◽  
Patient Population ◽  
Waiting Times ◽  
Service Planning ◽  
Precise Analysis ◽  
Gp Services ◽  
After Hours

Emergency Departments (EDs) operate at the interface between the inpatient and ambulatory sectorsof health care. Because of shared funding between the Commonwealth and States for ambulatory care,there has been intense focus on the ED patient population, and the potential to shift the locus of carefor non-inpatients.One of the frequently cited models for the provision of after-hours GP services is the Balmain GeneralPractice Casualty (GPC). This paper analyses the GPC model, looking in detail at casemix, clinicalquality, waiting times and cost-effectiveness. It is argued that the services provided and the casemix ofthe patient population of GPC and EDs are distinctly different. Cost-effectiveness for GPC has notbeen objectively established.Health service planning should recognise the distinct but complementary roles of general practice andemergency medicine. Evaluation of alternative models of service provision should critically examine theavailable evidence, and comparisons should be based on a precise analysis of equivalent services.

Accessing Primary Health Care: A Community Survey of Issues regarding General Practice and Emergency Department Services in an Outer Metropolitan Area

2006 ◽  
Vol 12 (3) ◽  
pp. 78 ◽  
Author(s):  
AJ McGaw ◽  
P Jayasuriya ◽  
C Bulsara ◽  
S C Thompson
Keyword(s):  
General Practice ◽  
After Hours Care ◽  
Gp Services ◽  
After Hours ◽  
Appointment Availability ◽  
Gp Visits ◽  
Quota Sampling ◽  
Respiratory Conditions ◽  
Financial Issues ◽  
Specific Health

This survey aimed to identify views of residents of an outer metropolitan location towards general practice (GP) services, after-hours care and their use of emergency departments (ED). Four hundred respondents were selected randomly using quota sampling and interviewed by telephone. Respondents wanted a GP who was "easy to talk to", who listened and was interested in them, competent, straightforward and thorough. Of those who were dissatisfied, the main concerns were GPs' unwillingness to listen to the patient and rushing the consultation. GP visits occurred for specific health problems - most commonly fever, tiredness and respiratory conditions. Preventive advice regarding health and lifestyle issues was not mentioned as a reason for attending GPs. Appointment availability and financial issues impeded access to GPs. Most people who used an ED did so because of the unavailability of GP services, showing that access block starts in general practice, with the severity of their illness/injury being the second major reason.

Perceived Experiences of Community Violence Among Adolescents: A School Survey From Rio de Janeiro, Brazil

2021 ◽  
pp. 088626052110051
Author(s):  
Claudia L. de Moraes ◽  
Érika B. dos Santos ◽  
Michael E. Reichenheim ◽  
Stella R. Taquette ◽  
Luciane Stochero ◽  
...  
Keyword(s):  
Public Schools ◽  
Community Violence ◽  
Rio De Janeiro ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Global Public Health ◽  
Cross Sectional ◽  
Interpersonal Aggression ◽  
Adolescent Students ◽  
Management Actions

Community violence (CV) is a global public health problem due to its high frequency and severe consequences. Although CV is one of the leading causes of death among adolescents, little is known about the everyday CV situations that do not lead to death. This study aimed to estimate the frequency of exposure to and involvement in CV situations among adolescent students from public and private schools in the city of Rio de Janeiro, Brazil. This was a cross-sectional study of 693 individuals in their second year of high school selected through stratified multistage random sampling. Information about their exposure to and involvement in CV was collected through a self-completed multidimensional questionnaire in the classrooms. For approximately 30% of the adolescents, someone close to them had been murdered, and 40% had already seen the corpse of a victim of homicide. Seventeen percent reported having been directly involved in CV situations. Approximately 38%, 13%, and 25% had been victims of robberies, interpersonal aggression, and death threats to either themselves or their relatives, respectively. Many of these situations occurred more than once. In general, CV was more frequently reported by boys and by those who did not live with both parents. Adolescents from higher economic classes experienced more interpersonal aggression and felt a greater need to carry a gun. Those who belonged to the lower economic classes and studied in public schools were more exposed to lethal violence than other students. The results call attention to the very high percentage of adolescent students that are involved in CV situations as well as to the differences in violence rates among population subgroups. Such findings should be considered when planning CV prevention and management actions in schools and other socialization spaces for adolescents.

scholarly journals A cross-sectional study reporting concussion exposure, assessment and management in Western Australian general practice

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Elizabeth Thomas ◽  
HuiJun Chih ◽  
Belinda Gabbe ◽  
Melinda Fitzgerald ◽  
Gill Cowen
Keyword(s):  
General Practice ◽  
Cross Sectional Study ◽  
Limited Information ◽  
Sectional Study ◽  
Cross Sectional ◽  
Usual Practice ◽  
Exact Test ◽  
Concussion Management ◽  
Practice Knowledge ◽  
Western Australian

Abstract Background General Practitioners (GPs) may be called upon to assess patients who have sustained a concussion despite limited information being available at this assessment. Information relating to how concussion is actually being assessed and managed in General Practice is scarce. This study aimed to identify characteristics of current Western Australian (WA) GP exposure to patients with concussion, factors associated with GPs’ knowledge of concussion, confidence of GPs in diagnosing and managing patients with concussion, typical referral practices and familiarity of GPs with guidelines. Methods In this cross-sectional study, GPs in WA were recruited via the RACGP WA newsletter and shareGP and the consented GPs completed an electronic survey. Associations were performed using Chi-squared tests or Fisher’s Exact test. Results Sixty-six GPs in WA responded to the survey (response rate = 1.7%). Demographics, usual practice, knowledge, confidence, identification of prolonged recovery as well as guideline and resource awareness of GPs who practised in regional and metropolitan areas were comparable (p > 0.05). Characteristics of GPs were similar between those who identified all symptoms of concussion and distractors correctly and those who did not (p > 0.05). However, 84% of the respondents who had never heard of concussion guidelines were less likely to answer all symptoms and distractors correctly (p = 0.039). Whilst 78% of the GPs who were confident in their diagnoses had heard of guidelines (p = 0.029), confidence in managing concussion was not significantly associated with GPs exposure to guidelines. It should be noted that none of the respondents correctly identified signs of concussion and excluded the distractors. Conclusions Knowledge surrounding concussion guidelines, diagnosis and management varied across GPs in WA. Promotion of available concussion guidelines may assist GPs who lack confidence in making a diagnosis. The lack of association between GPs exposure to guidelines and confidence managing concussion highlights that concussion management may be an area where GPs could benefit from additional education and support.

Inappropriate outpatient antibiotic use in children insured by Kentucky Medicaid

2021 ◽  
pp. 1-7
Author(s):  
Bethany A. Wattles ◽  
Kahir S. Jawad ◽  
Yana Feygin ◽  
Maiying Kong ◽  
Navjyot K. Vidwan ◽  
...  
Keyword(s):  
Claims Data ◽  
Inappropriate Prescribing ◽  
Patient Characteristics ◽  
Antibiotic Use ◽  
Population Based ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Pharmacy Claims ◽  
Medicaid Children

Abstract Objective: To describe risk factors associated with inappropriate antibiotic prescribing to children. Design: Cross-sectional, retrospective analysis of antibiotic prescribing to children, using Kentucky Medicaid medical and pharmacy claims data, 2017. Participants: Population-based sample of pediatric Medicaid patients and providers. Methods: Antibiotic prescriptions were identified from pharmacy claims and used to describe patient and provider characteristics. Associated medical claims were identified and linked to assign diagnoses. An existing classification scheme was applied to determine appropriateness of antibiotic prescriptions. Results: Overall, 10,787 providers wrote 779,813 antibiotic prescriptions for 328,515 children insured by Kentucky Medicaid in 2017. Moreover, 154,546 (19.8%) of these antibiotic prescriptions were appropriate, 358,026 (45.9%) were potentially appropriate, 163,654 (21.0%) were inappropriate, and 103,587 (13.3%) were not associated with a diagnosis. Half of all providers wrote 12 prescriptions or less to Medicaid children. The following child characteristics were associated with inappropriate antibiotic prescribing: residence in a rural area (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07–1.1), having a visit with an inappropriate prescriber (OR, 4.15; 95% CI, 4.1–4.2), age 0–2 years (OR, 1.39; 95% CI, 1.37–1.41), and presence of a chronic condition (OR, 1.31; 95% CI, 1.28–1.33). Conclusions: Inappropriate antibiotic prescribing to Kentucky Medicaid children is common. Provider and patient characteristics associated with inappropriate prescribing differ from those associated with higher volume. Claims data are useful to describe inappropriate use and could be a valuable metric for provider feedback reports. Policies are needed to support analysis and dissemination of antibiotic prescribing reports and should include all provider types and geographic areas.

scholarly journals Hospital Processes and the Nurse-Patient Interaction in Breast Cancer Care. Findings from a Cross-Sectional Study

2021 ◽  
Vol 18 (15) ◽  
pp. 8224
Author(s):  
Johanna Sophie Lubasch ◽  
Susan Lee ◽  
Christoph Kowalski ◽  
Marina Beckmann ◽  
Holger Pfaff ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Social Support ◽  
Cancer Patients ◽  
Perceived Social Support ◽  
Patient Characteristics ◽  
Patient Survey ◽  
Breast Cancer Patients ◽  
Cross Sectional ◽  
Patient Interaction ◽  
Hospital Structures

(1) Background: Evidence suggests that organizational processes of hospitals have an impact on patient-professional interactions. Within the nurse-patient interaction, nurses play a key role providing social support. Factors influencing the nurse-patient interaction have seldomly been researched. We aimed to examine whether the process organization in hospitals is associated with breast cancer patients’ perceived social support from nurses.; (2) Methods: Data analysis based on a cross-sectional patient survey (2979 breast cancer patients, 83 German hospitals) and information on hospital structures. Associations between process organization and perceived social support were analyzed with logistic hierarchical regression models adjusted for patient characteristics and hospital structures.; (3) Results: Most patients were 40–69 years old and classified with UICC stage II or III. Native language, age and hospital ownership status showed significant associations to the perception of social support. Patients treated in hospitals with better process organization at admission (OR 3.61; 95%-CI 1.67, 7.78) and during the hospital stay (OR 2.11; 95%-CI 1.04; 4.29) perceived significantly more social support from nurses.; (4) Conclusions: Designing a supportive nursing work environment and improving process organization in hospitals may create conditions conducive for a supportive patient-nurse interaction. More research is needed to better understand mechanisms behind the associations found.

Diverging trends in US male-female condom use by STI risk factors: a nationally representative study

2020 ◽  
pp. sextrans-2020-054642
Author(s):  
Casey E Copen ◽  
Patricia J Dittus ◽  
Jami S Leichliter ◽  
Sagar Kumar ◽  
Sevgi O Aral
Keyword(s):  
Risk Factors ◽  
Condom Use ◽  
Illicit Drugs ◽  
Female Condom ◽  
Cross Sectional ◽  
The Past ◽  
Representative Study ◽  
The Usa ◽  
Over Time ◽  
Sex Partner

ObjectiveCondom use behaviours are proximal to recent STI increases in the USA, yet it remains unclear whether the use of condoms has changed over time among unmarried, non-cohabiting young men who have sex with women (MSW) and how this variability is influenced by STI risk factors.MethodsTo examine condom use over time among MSW aged 15–29, we used three cross-sectional surveys from the 2002, 2006–2010 and 2011–2017 National Survey of Family Growth. We estimated weighted percentages, adjusted prevalence ratios (APRs) and 95% confidence intervals (CI) to assess changes in condom use, stratified by whether MSW reported any STI risk factors in the past 12 months (ie, perceived partner non-monogamy, male-to-male sex, sex in exchange for money or drugs, sex partner who injects illicit drugs, or an HIV-positive sex partner).ResultsWe observed a divergence in trends in condom use at last sex between men aged 15 –29 with STI risk factors in the past 12 months and those without such history. We saw significant declines in condom use from 2002 to 2011–2017 among men with STI risk factors (APR=0.80, 95% CI 0.68 to 0.95), specifically among those aged 15–19 (APR=0.73, 95% CI 0.57 to 0.94) or non-Hispanic white (APR=0.71, 95% CI 0.54 to 0.93). In contrast, trends in condom use among men with no STI factors remained stable or increased. Across all time periods, the most prevalent STI risk factor reported was perception of a non-monogamous female partner (23.0%–26.9%). Post-hoc analyses examined whether condom use trends changed once this variable was removed from analyses, but no different patterns were observed.ConclusionsWhile STIs have been increasing, men aged 15–29 with STI risk factors reported a decline in condom use. Rising STI rates may be sensitive to behavioural shifts in condom use among young MSW with STI risk factors.

Acetabular Chondral Lesions in Hip Arthroscopy: Relationships Between Grade, Topography, and Demographics

2017 ◽  
Vol 45 (11) ◽  
pp. 2501-2506 ◽  
Author(s):  
Carlos Suarez-Ahedo ◽  
Chengcheng Gui ◽  
Stephanie M. Rabe ◽  
Sivashankar Chandrasekaran ◽  
Parth Lodhia ◽  
...  
Keyword(s):  
Traumatic Injury ◽  
Demographic Factors ◽  
Patient Characteristics ◽  
Cross Sectional Study ◽  
Chondral Lesion ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Chondral Lesions ◽  
Chondral Damage ◽  
Male Sex

Background: Hip pain remains a challenge given the multiple factors that can cause damage to the articular cartilage, such as traumatic injury, metabolic damage, and morphologic variations such as femoroacetabular impingement (FAI) and that can contribute to progression of osteoarthritis. However, a direct relationship between patient characteristics, the extent of acetabular chondral damage, and topologic characteristics of chondral lesions has not been established. Purpose: To compare the grade of acetabular chondral damage, measured in terms of acetabular labrum articular disruption (ALAD) classification, to the size and position of the chondral lesions, matching patients’ demographic factors such as age and body mass index (BMI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included all hip arthroscopies performed by the corresponding author from August 7, 2008, to November 19, 2014, in which acetabular chondral lesions were intraoperatively identified and measured in terms of ALAD grade, clockface location, and size. Bivariate analyses and multiple logistic regression were used to identify the demographic factors, characteristics of the acetabular chondral lesion, and other anatomic characteristics that were related to the ALAD grade of the acetabular chondral lesion. Results: Acetabular chondral lesions were measured in 1502 patients during the study period. Multivariate analysis showed that higher ALAD grade of acetabular chondral damage was significantly related to male sex, more advanced age, the area of the acetabular chondral lesion, anterior extension of the acetabular chondral lesion within the anterosuperior quadrant, labral detachment from the acetabular cartilage, and posterior extension of the labral tear. Conclusion: Higher grades of acetabular chondral damage were related to male sex, increased age, height, weight, BMI, and the size of the lesion. Chondral lesions were generally found in the anterosuperior region of the acetabulum, consistent with labral lesions and the weightbearing area of the acetabulum.

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