scholarly journals Transmission of SARS-CoV-2 in inpatient and outpatient settings in a Veterans Affairs healthcare system

2021 ◽  
Author(s):  
Chetan Jinadatha ◽  
Lucas D Jones ◽  
Hosoon Choi ◽  
Piyali Chatterjee ◽  
Munok Hwang ◽  
...  
Keyword(s):  
At Risk ◽  
Healthcare System ◽  
Veterans Affairs ◽  
Outpatient Clinics ◽  
Nosocomial Transmission ◽  
Contact Tracing ◽  
Healthcare Personnel ◽  
Sequencing Analysis ◽  
Ancillary Care ◽  
Outpatient Settings

Abstract Background Healthcare personnel and patients are at risk to acquire severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in healthcare settings, including in outpatient clinics and ancillary care areas. Methods Between May 1, 2020 and January 31, 2021, we identified clusters of 3 or more COVID-19 cases in which nosocomial transmission was suspected in a Veterans Affairs healthcare system. Asymptomatic employees and patients were tested for SARS-CoV-2 if they were identified as being at risk through contact tracing investigations; for 7 clusters all personnel and/or patients in a shared work area were tested regardless of exposure history. Whole genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples from the clusters and from control employees and patients. Results Of 14 clusters investigated, 7 occurred in community-based outpatient clinics, 1 in the emergency department, 3 in ancillary care areas, and 3 on hospital medical/surgical wards that did not provide care for patients with known COVID-19 infection. Eighty-one of 82 (99%) symptomatic COVID-19 cases and 31 of 35 (89%) asymptomatic cases occurred in healthcare personnel. Sequencing analysis provided support for several transmission events between co-workers and in 2 cases supported transmission from healthcare personnel to patients. There were no documented transmissions from patients to personnel. Conclusions Clusters of COVID-19 with nosocomial transmission predominantly involved healthcare personnel and often occurred in outpatient clinics and ancillary care areas. There is a need for improved measures to prevent transmission of SARS-CoV-2 by healthcare personnel in inpatient and outpatient settings.

scholarly journals Encountering suicide in primary healthcare rehabilitation: the experiences of physiotherapists

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Åse Lundin ◽  
Anna Bergenheim
Keyword(s):  
At Risk ◽  
Healthcare System ◽  
Primary Healthcare ◽  
Qualitative Content Analysis ◽  
Western Hemisphere ◽  
Mental Wellbeing ◽  
Healthcare Personnel ◽  
Public Health Issue ◽  
Structured Interviews ◽  
Patients At Risk

Abstract Background Suicide is a serious public health issue and one of the most common causes of death globally. Suicide has long-lasting impact on personal, relational, community and societal levels. Research has shown that patients often seek help in the primary healthcare system preceding a suicide. Studies exploring the experiences of encountering patients at risk for suicide have been performed among various categories of healthcare personnel, such as nurses and psychiatry residents as well as emergency room staff. There is a lack of research regarding primary healthcare rehabilitation staff, despite the fact that physiotherapists are the third largest health profession in the Western hemisphere and often work with patients experiencing mental health symptoms. The aim of this study was to explore the experiences of encountering patients at risk for suicide among physiotherapists working in a primary healthcare rehabilitation setting. Methods Semi-structured interviews were conducted with 13 physiotherapists working in primary healthcare rehabilitation clinics in the Gothenburg area, Sweden. The interviews were recorded on audio and transcribed into written text. A qualitative content analysis was performed on the material collected. Results The analysis of the material revealed an overarching theme, Through barriers and taboos – the physiotherapist finds a way, with five main categories: possibilities for identification, obstacles in meeting suicide, workplace environment matters, where does the patient belong? and education and experience are keys. Conclusions The present study indicates that physiotherapists in the primary healthcare system encounter patients experiencing suicidality, and they expressed a strong desire to care for both the physical and mental wellbeing of the patients. Despite reporting many barriers, the physiotherapists often found a way to form a meaningful therapeutic alliance with the patient and to ask about possible suicidality in their clinical practice. The result suggests that physiotherapists could play a larger role in working with patients experiencing suicidality in a primary healthcare setting and that they could be viewed as possible gatekeepers in identification as well as referral of these patients into other parts of the healthcare system.

scholarly journals Outpatient Antibiotic Use for Common Infectious Diagnoses: Patterns in Telehealth During the Emergence of COVID-19

2021 ◽  
Vol 1 (S1) ◽  
pp. s35-s36
Author(s):  
Brigid Wilson ◽  
Taissa Bej ◽  
Sunah Song ◽  
Janet M Briggs ◽  
Richard Banks ◽  
...  
Keyword(s):  
Primary Care ◽  
Healthcare System ◽  
Acute Respiratory Infection ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Outpatient Clinics ◽  
Administrative Databases ◽  
Community Based ◽  
Outpatient Visits ◽  
Outpatient Settings

Background: The influence of increased use of telehealth during the emergence of COVID-19 on antibiotic prescriptions in outpatient settings is unknown. The VA Northeast Ohio Healthcare System has 13 community-based outpatient clinics (CBOCs) that provide primary and preventive care. We assessed changes in antibiotic prescriptions that occurred as care shifted from in-person to telehealth visits. Methods: Using VHA administrative databases, we identified all primary care CBOC visits between January 1, 2019, and December 31, 2020, that included a diagnosis for an acute respiratory infection (ARI), a urinary tract infection (UTI), or a skin or soft-tissue infection (SSTI), excluding visits with >1 of these diagnoses or with additional infectious diagnoses (eg, pneumonia, influenza). We summarized the proportion of telehealth visits and the proportion of patients prescribed antibiotics at quarterly intervals. We specifically assessed outpatient visits from April to December 2019 compared to the same months in 2020 to account for seasonality while analyzing diagnosis and antibiotic trends in the emergence of the COVID-19 pandemic. Results: The patients receiving care in April–December 2019 compared to April–December 2020 were similar (Table 1). From April through December 2019, 90% of CBOC primary care visits with a diagnosis for ARI, UTI, or SSTI were in-person, and antibiotics were prescribed at 63%, 46%, and 65% of visits in either modality, respectively (Figure 1). From April through December 2020, only 33% of CBOC primary care visits for ARI, UTI, and SSTI were in person, and antibiotics were prescribed at 46%, 38%, and 47% of visits in either modality, respectively. Comparing April–December in 2019 and 2020, the number of CBOC visits for ARI fell by 76% (2,152 visits to 509 visits), with a more modest decline of 20% and 35% observed for UTI and SSTI visits. In-person visits for ARIs and SSTIs were more likely than telehealth visits to result in an antibiotic prescription (Figure 2). Conclusions: Among the CBOCs at our healthcare system, an increase in the proportion of telehealth visits and a reduction in ARI diagnoses occurred after the emergence of COVID-19. In this setting, we observed a reduction in the proportion of visits for ARIs, UTIs, and SSTIs that included an antibiotic prescription.Funding: MerckDisclosures: None

scholarly journals Legionella in the veterans healthcare system: report of an eight-year survey

2003 ◽  
Vol 131 (2) ◽  
pp. 835-839 ◽  
Author(s):  
A. A. KELLY ◽  
L. H. DANKO ◽  
S. M. KRALOVIC ◽  
L. A. SIMBARTL ◽  
G. A. ROSELLE
Keyword(s):  
Healthcare System ◽  
Positive Outcome ◽  
The United States ◽  
Veterans Affairs ◽  
Outpatient Clinics ◽  
Fiscal Year ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Healthcare Associated

The Veterans Health Administration (VHA) of the Department of Veterans Affairs tracks legionella disease in the system of 172 medical centres and additional outpatient clinics using an annual census for reporting. In fiscal year 1999, 3·62 million persons were served by the VHA. From fiscal year 1989–1999, multiple intense interventions were carried out to decrease the number of cases and case rates for legionella disease. From fiscal year 1992–1999, the number of community-acquired and healthcare-associated cases decreased in the VHA by 77 and 95·5% respectively (P=0·005 and 0·01). Case rates also decreased significantly for community and healthcare-associated cases (P=0·02 and 0·001, respectively), with the VHA healthcare-associated case rates decreasing at a greater rate than VHA community-acquired case rates (P=0·02). Over the time of the review, the VHA case rates demonstrated a greater decrease compared to the case rates for the United States as a whole (P=0·02). Continued surveillance, centrally defined strategies, and local implementation can have a positive outcome for prevention of disease in a large, decentralized healthcare system.

scholarly journals Knowledge, attitude and perceptions about Crimean Congo Haemorrhagic Fever (CCHF) among occupationally high-risk healthcare professionals of Pakistan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ali Ahmed ◽  
Muhammad Saqlain ◽  
Maria Tanveer ◽  
Azhar Hussain Tahir ◽  
Fakhar Ud-Din ◽  
...  
Keyword(s):  
At Risk ◽  
Health Care Professionals ◽  
Work Experience ◽  
Tertiary Care ◽  
Nosocomial Transmission ◽  
Haemorrhagic Fever ◽  
Sources Of Information ◽  
Validated Questionnaire ◽  
Low Middle Income Countries ◽  
Crimean Congo Haemorrhagic Fever

Abstract Background Crimean Congo Haemorrhagic Fever (CCHF), a tropically neglected infectious disease caused by Nairovirus, is endemic in low middle-income countries like Pakistan. Emergency health care professionals (HCPs) are at risk of contracting nosocomial transmission of CCHF. We, therefore, aim to analyze the knowledge, attitudes, and perceptions (KAP) of at-risk physicians, nurses, and pharmacists in Pakistan and the factors associated with good KAP. Method A validated questionnaire (Cronbach’s alpha 0.71) was used to collect data from HCPs in two CCHF endemic metropolitan cities of Pakistan by employing a cross-sectional study design. For data analysis percentages, chi-square test and Spearman correlation were applied by using SPSS version 22. Results Of the 478 participants, 56% (n = 268) were physicians, 37.4% (n = 179) were nurses, and 6.5% (n = 31) were pharmacists. The proportion of HCPs with good knowledge, attitude, and perception scores was 54.3%, 81, and 69%, respectively. Being a physician, having more work experience, having a higher age, working in tertiary care settings, were key factors for higher knowledge (p < 0.001). The correlation coefficient showed significant positive correlation between attitude- perception (r = 0.560, p < 0.001). Conclusion We have observed average knowledge of HCPs. Therefore, we recommend time to time education campaigns and workshops in highly endemic CCHF regions to be launched by health ministries and HCPs, in particular nurses, encouraged to follow authentic academic sources of information to prevent nosocomial transmission.

scholarly journals Need to Intervene: An Exploratory Study of Nurses’ Experiences With Patienthood

2021 ◽  
Vol 8 ◽  
pp. 237437352199884
Author(s):  
Marian A O Cohen ◽  
Jim McQuaid ◽  
Ruth Remington
Keyword(s):  
Patient Satisfaction ◽  
Quality Of Care ◽  
Healthcare System ◽  
Family Caregiver ◽  
Exploratory Study ◽  
Medical Personnel ◽  
Healthcare Personnel ◽  
Coordination Of Care ◽  
Professional Perspective

Much has been written about the patient experience, but there is little information about experiences of providers as patients. Since lay patients and providers have differing perspectives and expectations, it is important to identify those elements shared by those in each group and those that diverge. This study identified experiences of nurses as being a patient or a family caregiver of a patient as well as identified assessments of the healthcare system by nurses. An exploratory study using a self-administered electronic questionnaire with a group of registered nurses was conducted. Assessments of the system by responders were positive when addressing quality of care, interactions among healthcare personnel, and interactions with patients. However, when discussing their experiences as patient, nurses reported they encountered problems with coordination of care, responses of medical personnel, attention to details of care, and responses to their attempts to become more involved. Results confirm issues raised by patients who are not medical experts in patient satisfaction studies. Adding a professional perspective highlights where problems with the healthcare system lie.

Identifying the Nutritionally “At-Risk” Outpatients at Veterans Affairs Hospital

2013 ◽  
Vol 113 (9) ◽  
pp. A71
Author(s):  
C. Eastburn ◽  
D.J. Handu ◽  
A. Bergmann ◽  
C. O'Rourke
Keyword(s):  
At Risk ◽  
Veterans Affairs
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