Chapter 2 Organization of ambulatory services

2011 ◽  
Author(s):  
Bill Horton
Keyword(s):  
Ambulatory Services

scholarly journals Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study

2021 ◽  
Author(s):  
Alex Buoite Stella ◽  
Giovanni Furlanis ◽  
Nicolò Arjuna Frezza ◽  
Romina Valentinotti ◽  
Milos Ajcevic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Orthostatic Intolerance ◽  
Neurological Symptoms ◽  
Postural Tachycardia Syndrome ◽  
Symptom Scale ◽  
Autonomic Symptom ◽  
Postural Tachycardia ◽  
Ambulatory Services

AbstractThe autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51 ± 13 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9–31.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p < 0.01), due to more severe orthostatic intolerance symptoms (p < 0.01), although gastrointestinal (p < 0.01), urinary (p < 0.01), and pupillomotor (p < 0.01) domains were more represented in the non-neurological symptoms group. This study confirms the importance of monitoring ANS symptoms as a possible complication of COVID-19 disease that may persist in the post-acute period.

Access to Ambulatory Care Services for Economically Disadvantaged Children

PEDIATRICS ◽  
1986 ◽  
Vol 78 (5) ◽  
pp. 813-819
Author(s):  
Paul W. Newacheck ◽  
Neal Halfon
Keyword(s):  
Low Income ◽  
Economically Disadvantaged ◽  
War On Poverty ◽  
Disadvantaged Children ◽  
Care Services ◽  
Interview Survey ◽  
Low Income Families ◽  
Using Data ◽  
Ambulatory Services ◽  
Poor Children

Using data from the 1981 Child Health Supplement to the National Health Interview Survey, we examined differences in access to ambulatory services for children of different family incomes. The results indicate that much progress has been made in equalizing access since the War on Poverty was initiated in the mid-1960s. Poor children with superior health status now generally see physicians at the same rates as children in similar health but from higher income families. However, children with substantial health problems from low-income families continue to lag behind their higher income counterparts in similar health. Medicaid was shown to substantially improve access to ambulatory services for economically disadvantaged children in poor health, but less than half of these children are covered by Medicaid. Recent changes in federal and state policies concerning Medicaid are discussed as well as policy options for addressing the needs of children afflicted by both poverty and ill health.

Effect of a Reduced Postpartum Length of Stay Program on Primary Care Services Use by Mothers and Infants

PEDIATRICS ◽  
2000 ◽  
Vol 106 (Supplement_3) ◽  
pp. 937-941
Author(s):  
Kenneth D. Mandl ◽  
Charles J. Homer ◽  
Oren Harary ◽  
Jonathan A. Finkelstein
Keyword(s):  
Primary Care ◽  
Length Of Stay ◽  
Early Discharge ◽  
Urgent Care ◽  
Care Utilization ◽  
Care Services ◽  
Primary Care Services ◽  
Ambulatory Services ◽  
The Impact ◽  
Services Use

Objective. To determine the impact of reduced postpartum length of stay (LOS) on primary care services use. Methods. Design: Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for time trends.Setting: A managed care plan.Intervention: A reduced obstetrical LOS program (ROLOS), offering enhanced education and services.Participants: mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect.Independent Measures: Pre-ROLOS or the post-ROLOS year.Outcome Measures: Telephone calls, visits, and urgent care events during the first 3 weeks postpartum summed as total utilization events. Results. Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) and after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, there were between 2.37 and 2.72 utilization events per dyad; after, there were 4.60. Well-child visits increased slightly to .98 visits per dyad, but urgent visits did not. Conclusion. This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.

REGIONAL VARIATION IN THE UTILISATION OF AMBULATORY SERVICES IN GERMANY

2013 ◽  
Vol 23 (12) ◽  
pp. 1481-1492 ◽  
Author(s):  
Thomas Kopetsch ◽  
Hendrik Schmitz
Keyword(s):  
Regional Variation ◽  
Ambulatory Services

The Ambulatory Services Information System at Graduate Hospital

1990 ◽  
pp. 94-98
Author(s):  
Albert Crawford ◽  
Suzanne Langner ◽  
Nancy Marnell ◽  
Mary Morrison ◽  
Carol Scattergood ◽  
...  
Keyword(s):  
Information System ◽  
Ambulatory Services

scholarly journals Assessing the quality of health care in the management of bronchiolitis in Australian children: a population-based sample survey

2019 ◽  
Vol 28 (10) ◽  
pp. 817-825
Author(s):  
Nusrat Homaira ◽  
Louise K Wiles ◽  
Claire Gardner ◽  
Charlotte J Molloy ◽  
Gaston Arnolda ◽  
...  
Keyword(s):  
Medical Record ◽  
Guideline Adherence ◽  
Healthcare Setting ◽  
Population Based ◽  
Sample Survey ◽  
Hospital Inpatient ◽  
History Taking ◽  
Ambulatory Services ◽  
Record Review

BackgroundBronchiolitis is the most common cause of respiratory hospitalisation in children aged <2 years. Clinical practice guidelines (CPGs) suggest only supportive management of bronchiolitis. However, the availability of CPGs do not guarantee that they are used appropriately and marked variation in the clinical management exists. We conducted an assessment of guideline adherence in the management of bronchiolitis in children at a subnationally representative level including inpatient and ambulatory services in Australia.MethodsWe searched for national and international CPGs relating to management of bronchiolitis in children and identified 16 recommendations which were formatted into 40 medical record audit indicator questions. A retrospective medical record review assessing compliance with the CPGs was conducted across three types of healthcare setting: hospital inpatient admissions, emergency department (ED) presentations and general practice (GP) consultations in three Australian states for children aged <2 years receiving care in 2012 and 2013.ResultsPurpose-trained surveyors conducted 13 979 eligible indicator assessments across 796 visits for bronchiolitis at 119 sites. Guideline adherence for management of bronchiolitis was 77.3% (95% CI 72.6 to 81.5) for children attending EDs, 81.6% (95% CI 78.0 to 84.9) for inpatients and 52.3% (95% CI 44.8 to 59.7) for children attending GP consultations. While adherence to some individual indicators was high, overall adherence to documentation of 10 indicators relating to history taking and examination was poorest and estimated at 2.7% (95% CI 1.5 to 4.4).ConclusionsThe study is the first to assess guideline-adherence in both hospital (ED and inpatient) and GP settings. Our study demonstrated that while the quality of care for bronchiolitis was generally adherent to CPG indicators, specific aspects of management were deficient, especially documentation of history taking.

Effects of Medicaid Managed Care on Health Care Use: Infant Emergency Department and Ambulatory Services

PEDIATRICS ◽  
2001 ◽  
Vol 108 (1) ◽  
pp. 103-110 ◽  
Author(s):  
E. A. Alessandrini ◽  
K. N. Shaw ◽  
W. B. Bilker ◽  
K. A. Perry ◽  
M. D. Baker ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Managed Care ◽  
Health Care Use ◽  
Medicaid Managed Care ◽  
Ambulatory Services

Psychiatric management of drug overdose: Risk factors, diagnosis and treatment

2011 ◽  
Vol 26 (S2) ◽  
pp. 1612-1612
Author(s):  
D. de la Vega Sánchez ◽  
P. Sánchez Páez ◽  
M.R. Gómez Soler ◽  
P. Artieda Urrutia ◽  
J. Gómez Arnau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Personality Disorder ◽  
Suicide Attempt ◽  
Emergency Services ◽  
List Type ◽  
Toxic Substances ◽  
Common Diagnosis ◽  
Psychiatric Units ◽  
Ambulatory Services ◽  
Substance Related Disorders

IntroductionSuicidal behaviours are commonly found at increased rates among individuals with psychiatric disorders.ObjectivesTo identify risk factors of suicide among the population attended in our area, describe the characteristics of the attempt and the management.MethodsReview of the drug overdosings attended in our Hospital from July to December of 2009.ResultsWe identified 112 drug overdosings. 80′4% of the patients had psychiatric history: Mood-Anxiety disorders 60′7%, Substance-Related Disorders 41′1%, Personality disorder 30′4% and Psychotic disorder 10′7. Previous attempts were found in 43′8% of the patients. The most common drug used were benzodiacepines (73% of the cases), followed by antypsychotics (17′9%). Up to 32′1% of the patients used non psychiatric drugs. 64′3% of the patients consumed alcohol and 13′4% cocaine. Moreover, 15′2% of the patients took other toxic substances such us bleach, soap and other chemical products.We did not find significant differences when studying triggers (family, partnership, economical or others)The most common diagnosis was suicide attempt (41′1%), followed by parasuicide attempt. 41′4% of the drug overdosings were not considered as self injurious behavior. 64% were referred to ambulatory services, 22′5% needed hospitalization in psychiatric units, and 5′4 were hospitalized in medical services. Although those diagnosed of personality disorder were more often diagnosed of parasuicide (50% Vs 32′1%), they needed more hospitalizations (41% Vs 21%)Conclusions-Self-injurious behavior is one of the most common causes of consulting in the emergency services.-Patients diagnosed of personality disorder are more commonly hospitalized after making a suicide attempt.

Sign in / Sign up

Export Citation Format

Share Document