The impact of COVID-19 on urology office visits and adoption of telemedicine services

The article examines the content of the current collective agreements of Russian companies. The features of social guarantees of some enterprises are described; the features associated with their activities, location, form of ownership are specified. An analysis of the differences between social guarantees of enterprises operating in the Russian Federation and in developed countries is carried out. Examples of social support for workers in American and German corporations, their features and the result of the impact of social programs on the productivity of these companies are given. The concept of the concept of employee well-being is revealed, the components of this concept are described. The article provides a general analysis of human well-being, refers to the “theory of the hierarchy of needs” by Abraham Maslow, according to which human needs form a hierarchical system, where each need has its own level of significance. As they are satisfied, they give way to other needs. Five key human needs are formulated: human physiological needs; the need for comfort and safety; social needs; the need for respect; the need for self-knowledge. Only by satisfying the last need, a person will be motivated to increase the productivity of his enterprise. An integral part of the concept of well-being for an employee of foreign companies is consultations by experts in various fields of knowledge, trainings for personal and professional growth, programs for a healthy lifestyle and proper nutrition, a free schedule of office visits, and much more. The article provides positive examples from the implementation of this concept in the social programs of foreign enterprises. In the final part of the article, conclusions are drawn and the results of a study on the occupancy rate of collective agreements in Russian companies are presented.

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Abstract P168: Impact of Oral Anticoagulation Choice on Healthcare Utilization for the Primary Treatment of Venous Thromboembolism

Circulation ◽

10.1161/circ.141.suppl_1.p168 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Rob F Walker ◽

Richard F Maclehose ◽

J'Neka Claxton ◽

Terrence Adam ◽

Alvaro Alonso ◽

...

Keyword(s):

Emergency Department ◽

Healthcare Utilization ◽

Oral Anticoagulation ◽

Primary Treatment ◽

Emergency Department Visits ◽

Office Visits ◽

International Classification Of Disease ◽

Hospitalization Rates ◽

The Impact

Introduction: Little is known about the impact of oral anticoagulation (OAC) choice on healthcare encounters during the primary treatment of VTE. Hypothesis: Among anticoagulant-naïve VTE patients we tested the hypotheses that the number of hospitalizations, days hospitalized, emergency department visits, and outpatient office visits would be lower among users of rivaroxaban or apixaban than among users of warfarin. Methods: MarketScan databases for years 2016 and 2017 were used to identify VTE cases and comorbidities using international classification of disease codes, and prescriptions for OACs via outpatient pharmaceutical claims data. Healthcare utilization was identified in the first 6 months after initial VTE diagnoses. Results: The 23,864 individuals with VTE cases were on average (± standard deviation) 55.7 ± 16.1 years old and 50.6% female. Participants had on average 0.2 ± 0.5 hospitalizations, spent 1.3 ± 5.2 days in the hospital, had 5.7 ± 5.1 outpatient encounters, and visited an emergency department 0.4 ± 1.1 times. As compared to warfarin, rivaroxaban and apixaban were associated with fewer hospitalizations, days hospitalized, office visits and emergency department visits, after accounting for age, sex, comorbidities and medications (Table 1). For example, hospitalization rates were 24% lower [IRR: 0.76 (95% CI: 0.69, 0.83)] for patients prescribed rivaroxaban and 22% lower [IRR: 0.78 (95% CI: 0.71, 0.87)] for patients prescribed apixaban, as compared to those prescribed warfarin. When comparing apixaban to rivaroxaban, there were no differences in healthcare utilization. Conclusions: VTE patients prescribed rivaroxaban and apixaban had lower healthcare utilization than did those prescribed warfarin, while there was no difference when comparing apixaban to rivaroxaban. These findings complement existing literature supporting the use of direct OACs over warfarin given their similar effectiveness, slightly better safety profile, and perceived lower patient burden.

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Insights on Otolaryngology Residency Training during the COVID-19 Pandemic

Otolaryngology ◽

10.1177/0194599820922502 ◽

2020 ◽

Vol 163 (1) ◽

pp. 38-41 ◽

Cited By ~ 14

Author(s):

Dana L. Crosby ◽

Arun Sharma

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Learning Strategies ◽

Residency Training ◽

Resident Education ◽

Training Programs ◽

Well Being ◽

Office Visits ◽

Key Indicator ◽

Medical Crisis ◽

The Impact

Otolaryngology residency training programs are facing a novel challenge due to severe acute respiratory syndrome coronavirus 2. The widespread impact and chronicity of this pandemic makes it unique from any crisis faced by our training programs to date. This international medical crisis has the potential to significantly alter the course of training for our current resident cohort. The decrease in clinical opportunities due to the limitations on elective surgical cases and office visits as well as potential resident redeployment could lead to a decline in overall experience as well as key indicator cases. It is important that we closely monitor the impact of this pandemic on resident education and ensure the implementation of alternative learning strategies while maintaining an emphasis on safety and well-being.

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Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain

Pain Medicine ◽

10.1093/pm/pnaa014 ◽

2020 ◽

Vol 21 (12) ◽

pp. 3567-3573 ◽

Cited By ~ 3

Author(s):

James M Whedon ◽

Andrew W J Toler ◽

Louis A Kazal ◽

Serena Bezdjian ◽

Justin M Goehl ◽

...

Keyword(s):

Primary Care ◽

Spinal Pain ◽

Chiropractic Care ◽

Care Physician ◽

Health Claims ◽

Prescription Opioids ◽

Office Visits ◽

Opioid Prescription ◽

Health Claims Data ◽

The Impact

Abstract Objective Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain. Design and Setting We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012–2017. Subjects We included adults aged 18–84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. We identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care. Methods We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as: acute (first chiropractic encounter within 30 days of diagnosis) and nonacute (all other patients). Results The total number of subjects was 101,221. Overall, between 1.55 and 2.03 times more nonrecipients filled an opioid prescription, as compared with recipients (in Connecticut: hazard ratio [HR] = 1.55, 95% confidence interval [CI] = 1.11–2.17, P = 0.010; in New Hampshire: HR = 2.03, 95% CI = 1.92–2.14, P < 0.0001). Similar differences were observed for the acute groups. Conclusions Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase.

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The Impact of Broadband Access on Social and Economic Integration: Results from the RefugeeMobile Pilot

Journal of Refugee Studies ◽

10.1093/jrs/fez067 ◽

2019 ◽

Author(s):

William N Evans ◽

Brendan Perry ◽

Rachel Factor

Keyword(s):

United States ◽

Research Question ◽

Risk Groups ◽

The United States ◽

Control Group ◽

Broadband Access ◽

Office Visits ◽

Group Members ◽

One Year ◽

The Impact

Abstract The Internet is a ubiquitous feature of everyday life and an important research question is whether improving broadband access for at-risk groups such as refugees enhances social and economic outcomes. The article reports the results of the RefugeeMobile pilot where a sample of refugees to the United States were randomly assigned a smartphone (n = 82) with eight months of free service and pre-loaded apps designed to help them adjust to life in the United States, or not (n = 74). At a one-year follow-up, results indicate that assignment to treatment generates statistically significant increases in smartphone ownership and Internet access, and some measures of social integration. Results for employment and earnings were positive but statistically insignificant. Treatment-group members had fewer interactions with their case worker, a smaller fraction of in-office visits and hence a larger fraction of interactions by phone than control-group members, suggesting the pilot may have increased programme efficiency.

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Functional Endoscopic Sinus Surgery in Patients with Chronic Sinusitis and Asthma

Otolaryngology ◽

10.1177/019459989411000604 ◽

1994 ◽

Vol 110 (6) ◽

pp. 494-500 ◽

Cited By ~ 38

Author(s):

Gary J. Nishoka ◽

Paul R. Cook ◽

William E. Davis ◽

Joel P. McKinsey

Keyword(s):

Endoscopic Sinus Surgery ◽

Hospital Admissions ◽

Chronic Sinusitis ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Office Visits ◽

Sinus Disease ◽

Physician Office ◽

Steroid Dependent ◽

The Impact

Twenty asthma patients who underwent functional endoscopic sinus surgery for chronic sinusitis were studied. Medical records and questionnaire data for these 20 patients were studied regarding the Impact of sinus disease and functional endoscopic sinus surgery on their asthma. We found that 95% reported that their asthma was worsened by their sinus disease (95% confidence interval, 0.74 to 0.99+), and 85% reported that functional endoscopic sinus surgery improved their asthma (0.60 to 0.97). Of the 13 patients who used both inhalers and systemic medication, 53.8% were able to eliminate some of their medication (0.21 to 0.79). Furthermore, 61.5% of these patients had a concomitant reduction in their inhaler use (0.28 to 0.85). All patients (six) who used only inhalers experienced a reduction in their inhaler use (0.54 to 1.00), and two patients were able to eliminate their inhalers completely. One of two patients who were steroid dependent was able to discontinue steroids after surgery. Of patients who used steroids intermittently (13), 53.8% were able to eliminate the use of steroids after surgery (0.21 to 0.79). Patients who required preoperative hospital admissions (4) and emergency room or urgent physician office visits (18) had a 75.0% and 81.3% ( p < 0.001) reduction in visits, respectively, after surgery. Because 43% of the cost of asthma is the result of hospitalizations and emergency department/urgent physician office visits, a significant Impact on health care costs can be realized with functional endoscopic sinus surgery in this patient population.

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Sources of variation in follow-up expenditure after radical cystectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.335 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 335-335

Author(s):

Goutham Vemana ◽

Joel Vetter ◽

Ling Chen ◽

Gurdarshan Singh Sandhu ◽

Seth A. Strope

Keyword(s):

Radical Cystectomy ◽

Practice Patterns ◽

Care Delivery ◽

Total Variance ◽

Office Visits ◽

Recommended Care ◽

Patient Level ◽

Follow Up Care ◽

The Impact

335 Background: Follow-up care after radical cystectomy is poorly defined with extensive variation in practice patterns. We sought to determine sources of these variations in care as well as examine the economic impact of standardization of care to guideline recommended care. Methods: Using linked SEER-Medicare data from 1992 to 2007, we determined follow-up care expenditures (time and geography standardized) for 24 months after surgery. Accounted costs included office visits, imaging studies, urine tests and blood work. A multilevel model was implemented to determine the impact of region, surgeon, and patient factors on care delivery. We then compared the actual expenditures on care in the Medicare system (interquartile range) to the expenditures if patients received care recommended by current clinical guidelines. Results: Expenditures over 24 months of follow-up were calculated per month and per patient. The mean and median monthly expenditures were $33 and $21 respectively (minimum $0, maximum $429, 25th to 75th percentile $9 to $43). The total variance of expenditure situated at the surgeon-level and SEER region-level was 9.9% and 4.0% respectively. After accounting for the region, the total variance of expenditure situated at the patient-level and surgeon-level was 14.95% and 7.81% respectively. The assessed cost of guideline follow-up recommendations varied from 0.78-9.05 times the calculated Medicare costs. The guideline recommended cost of follow-up was higher than actual Medicare expenditures in all but one category. Conclusions: While some regional and surgeon-level variations in care were found, most variation in expenditure on follow-up care was at the patient-level, largely based on comorbidity, node positivity, chemotherapy status, readmission rates, and final cancer stage. Standardization of care to current established guidelines would create larger expenditures for the Medicare system than current practice patterns.

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Assessment of health care resource utilization (HRU) in patients with castration-resistant prostate cancer (CRPC).

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.89 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 89-89

Author(s):

Sophia Li ◽

Zhijie Ding ◽

Jennifer H Lin ◽

Chris Pericone ◽

Ajay S. Behl ◽

...

Keyword(s):

Mixed Model ◽

Linear Mixed Model ◽

Office Visit ◽

Fold Increase ◽

Data Availability ◽

Castration Resistant Prostate Cancer ◽

Castration Resistance ◽

Office Visits ◽

Observation Unit ◽

The Impact

89 Background: Although patients with CRPC frequently develop metastasis within 3 years following castration resistance, the impact of metastasis on HRU in these patients is not well understood. Methods: The Optum de-identified electronic health record database (1/1/2007 – 4/30/2016) was used in this single cohort observational study comparing HRU after metastasis with HRU before metastasis. The cohort included only non-metastatic CRPC (nmCRPC) patients who later developed metastasis. The pre-metastasis period spanned from nmCRPC identification to development of metastasis; the post-metastasis period spanned from metastasis until death or end of data availability. Per-patient per-month (PPPM) HRU was estimated during both pre- and post-metastasis periods by a generalized linear mixed model adjusted for log-transformed baseline PSA, age, testosterone levels, and Charlson Comorbidity Index. Results: With a mean time of 11 and 17 months of pre- and post-metastasis periods, respectively, 540 CRPC men were included, with a mean age at nmCRPC identification of 75 years. Higher HRU was seen across all service types during the post-metastasis period. There was a 2.5-fold increase in inpatient admissions and a 6.4-fold increase in inpatient length-of-stay in the post-metastasis period compared to the pre-metastasis period (p < 0.01). For emergency department (ED) visits, there was a 2.0-fold increase from the pre- to post-metastasis periods (p < 0.01). For observation unit visits, a 2.7-fold increase was seen in the post-metastasis period (p < 0.01). Finally, patients were 40% more likely to have an office visit after developing metastasis (p < 0.01). The PPPM use of intensive care unit, hospice or skilled nursing facility were too low for meaningful comparison between the pre- and post-metastasis periods. Conclusions: Shorter time to metastasis was observed in this cohort vs. other nmCRPC studies, likely due to delayed disease identification. CRPC patients incurred substantially higher HRU after developing metastasis, attributable to inpatient, ED, observation unit as well as office visits, suggesting that delaying metastasis may reduce or delay the increased HRU in patients with nmCRPC.

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The Impact of Web 2.0 on the Doctor-Patient Relationship

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2010.00462.x ◽

2010 ◽

Vol 38 (1) ◽

pp. 17-26 ◽

Cited By ~ 35

Author(s):

Bernard Lo ◽

Lindsay Parham

Keyword(s):

Health Information ◽

Electronic Medical Records ◽

Medical Records ◽

Digital Health ◽

The Internet ◽

Office Visits ◽

Internet Users ◽

The Impact ◽

E Mail ◽

Stimulus Package

The hypothetical case of Mr. Jenkins illustrates innovations in digital health information technology that may profoundly change medical care and the doctorpatient relationship. The Internet contains enormous amounts of health information, and about threequarters of Internet users look online for health information. 1 Sometimes patients bring information they found on the Internet to their physicians. Physicians and patients can also now communicate by e-mail rather than by telephone or office visits, although these e-mail communications may not be integrated into the patient’s medical record. Furthermore, electronic medical records are slowly being adopted, particularly in hospitals and large integrated health systems. Funding to promote the adoption of electronic medical records (EMRs) has been included in the 2009 federal stimulus package under the Obama Administration.

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The Impact of Vaccine Refusal on Physician Office Visits During the Subsequent 12 Months

Military Medicine ◽

10.7205/milmed-d-16-00442 ◽

2017 ◽

Vol 182 (9) ◽

pp. e1810-e1815

Author(s):

Milissa U. Jones ◽

Cassandra G. Carter ◽

Kenneth L. Cameron ◽

Tyler K. Smith

Keyword(s):

Office Visits ◽

Vaccine Refusal ◽

Physician Office ◽

The Impact

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