scholarly journals Effects of introducing a walk-in clinic on ambulatory care sensitive hospitalisations among asylum seekers in Germany: a single-centre pre–post intervention study using medical records

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e027945
Author(s):  
Celina Lichtl ◽  
Kayvan Bozorgmehr
Keyword(s):  
Ambulatory Care ◽  
Incidence Rate ◽  
Asylum Seekers ◽  
Time Trends ◽  
Intervention Study ◽  
Post Intervention ◽  
Rate Ratios ◽  
The Impact ◽  
Reception Centre ◽  
Ambulatory Care Sensitive

ObjectiveMeasuring the effect of introducing a walk-in clinic on ambulatory care sensitive (ACS) hospitalisations among asylum seekers in a large state reception- and registration centre.Design and settingPre–post intervention study using anonymous account data from a university hospital functioning as referral facility for a state reception- and registration centre in the third largest German federal state.ParticipantsWe included all asylum seekers residing in the reception centre and admitted to the referral hospital between 2015 to 2017.InterventionsEstablishment of an interdisciplinary walk-in clinic in the reception centre (02/2016).Main outcome measuresInternational lists for ACS conditions for both adults and children were adapted and used to calculate the prevalence of ACS conditions among the population (primary outcome measure). The impact of the intervention on the outcome was analysed using a segmented Poisson regression to calculate incidence-rate ratios with respective 95% CIs, adjusted for age, sex and admission.ResultsThe prevalence of ACS hospitalisations changed over time, as did the effect of age, sex and quarter of admission. Introducing the walk-in clinic reduced the prevalence of ACS hospitalisations among asylum seekers compared with the period before establishment of the clinic (incidence-rate ratios (IRR)=0.80 (0.65 to 1.00), p=0.054), but the effect was attenuated after adjustment for time trends. The average difference in prevalence of ACS hospitalisations compared with the period before establishment of the clinic, corrected for pre-existing time trends, age and sex of asylum seekers was IRR=1.03 ((0.69 to 1.55), p=0.876).ConclusionsA walk-in clinic in reception centres may be effective to reduce ACS hospitalisations, but our study could not prove evidence for a measurable effect after full adjustment for time trends. Further research, ideally with parallel control groups, is required to establish evidence for the effectiveness of walk-in clinics in reception centres on reducing ACS hospitalisations.

scholarly journals Emergency department use in people who experience imprisonment in Ontario, Canada

CJEM ◽  
2019 ◽  
Vol 22 (2) ◽  
pp. 232-240
Author(s):  
John Tuinema ◽  
Aaron M. Orkin ◽  
Stephanie Y. Cheng ◽  
Kinwah Fung ◽  
Fiona G. Kouyoumdjian
Keyword(s):  
Emergency Department ◽  
General Population ◽  
Ambulatory Care ◽  
Ambulatory Care Sensitive Conditions ◽  
Higher Ed ◽  
High Urgency ◽  
Women In Prison ◽  
Rate Ratios ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

ABSTRACTObjectivesThe aims of this study were to describe emergency department (ED) utilization by people in provincial prison and on release, and to compare with ED utilization for the general population.MethodsWe linked correctional and health administrative data for people released from provincial prison in Ontario in 2010. We matched each person by age and sex with four people in the general population. We compared ED utilization rates using generalized estimating equations, by sex and for high urgency and ambulatory care sensitive conditions.ResultsPeople who experienced imprisonment (N = 48,861) had higher ED utilization rates compared with the general population (N = 195,444), with rate ratios of 3.2 (95% CI 3.0–4.4) for men and 6.5 (95% CI 5.6–7.5) for women in prison and a range of rate ratios between 3.1 and 7.7 for men and 4.2 and 8.8 for women over the 2 years after release. Most ED visits were high urgency, and between 1.0% and 5.1% of visits were for ambulatory care sensitive conditions. ED utilization rates increased on release from prison.ConclusionsPeople experiencing imprisonment in Ontario have higher ED utilization compared with matched people in the general population, primarily for urgent issues, and particularly in women and in the week after release. Providing high-quality ED care and implementing prison- and ED-based interventions could improve health for this population and prevent the need for ED use.

Impact of Health Education on Mothers' Knowledge of Preventive Health Practices

1997 ◽  
Vol 27 (4) ◽  
pp. 199-202 ◽  
Author(s):  
Mubina Agboatwalla ◽  
Dure Samin Akram
Keyword(s):  
Health Education ◽  
Breast Feeding ◽  
Intervention Study ◽  
Intervention Group ◽  
Preventive Health ◽  
Slum Area ◽  
Post Intervention ◽  
Community Based ◽  
Significant Difference ◽  
The Impact

A prospective community-based intervention study was conducted in a slum area of Karachi, Pakistan, with the objective of evaluating the impact of health education on the knowledge of mothers. One hundred and fifty households were studied in the intervention and the same in the non-intervention group. The post intervention knowledge scores of the mothers showed a significant difference of P < 0.05. Nearly 50.7% mothers in the intervention group knew of at least four diseases against which vaccination is given as compared to the non-intervention group ( P < 0.05). Similarly, mothers in the intervention group were more aware about the advantages of breast feeding, signs of dehydration, measures for prevention of measles and tuberculosis as compared to the non-intervention group ( P < 0.05). Finally, a comparison was made between the pre- and post-intervention scores between the two groups. The score in the non-intervention group changed from 11.5 to 16.1 ( P > 0.05) as compared to the intervention group in which it changed from 10.2 to 32.2 ( P < 0.05).

scholarly journals Impact of Electronic Prescription on Prescribing Errors

2021 ◽  
pp. 212-220
Author(s):  
Ameen M. Almohammadi ◽  
Huda M. Al-Dhahri ◽  
Shroug H. Al-Harbi
Keyword(s):  
Study Design ◽  
Intervention Study ◽  
Dosage Forms ◽  
Electronic Prescribing ◽  
Prescribing Errors ◽  
Post Intervention ◽  
Electronic Prescription ◽  
Prescription Errors ◽  
Trade Names ◽  
The Impact

Aims: There are series of medical errors that can be prevented by taking precautions.             Therefore, the study evaluates the impact of the electronic prescribing system on prescription errors. Study Design:  A pre-post study design was conducted. Place and Duration of Study: The study was conducted at outpatient pharmacy services of a teaching hospital in Jeddah city. Methodology: Prescriptions were evaluated for the presence of the essential prescription elements such as patient information, drug name, dose, frequency, strength, and other prescription completeness parameters. Results: In the pre-intervention study, 1182 handwritten prescriptions were evaluated, and 6627 errors were detected from these prescriptions. The length of the pre-and post-intervention period was two weeks each. The most prevalent prescribing errors were that of medications written without defined dosage forms were recorded 1653 (55.90%) time followed by prescriptions written by trade names 1493 (22.5%), without route of administration 1266 (19.1%), and without specified duration 1009 (15.2%). However, 1512 prescriptions were evaluated in the post-intervention study, among which 339 errors were detected. The errors included prescriptions written without diagnosis (5.09%), or without doctor’s name or stamp (1.52%), written by trade names (4.49%), without defined dosage forms (4.29%), and without specified duration (2.84%). Conclusion: The study concluded that E-prescribing eliminated prescription errors that resulted from handwritten prescriptions.

scholarly journals Machine learning application to the reduction of ambulatory care sensitive admissions (ACSA)

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
T Ngo ◽  
V Georgescu ◽  
C Gervet ◽  
A Laurent ◽  
T Libourel ◽  
...  
Keyword(s):  
Machine Learning ◽  
Primary Care ◽  
Health Care ◽  
Ambulatory Care ◽  
Support Vector ◽  
Care Services ◽  
Health Authorities ◽  
Primary Care Workforce ◽  
The Impact ◽  
Ambulatory Care Sensitive

Abstract Background Reducing Ambulatory Care Sensitive Admissions (ACSA) not only enhances patients’ quality of life but could also save substantial costs. ACSA are avoidable admissions for chronic conditions that are associated with socio-economic status, health status, utilization and readiness of primary care service as well as environmental factors. Undoubtedly, health authorities are highly interested in enhancing the health care services in order to reduce the number of ACSA. The objective is to identify the geographic areas where the primary care workforce should be increased in order to maximize the decrease in ACSA. Methods Using ambulatory care and inpatient claims data as well as contextual variables, we apply support vector machine regression (SVR) to select the geographic areas (fr. Bassins de vie - BVs) and the number of to-be-added primary care nurses that maximize the ACSA reduction. We also take into account the constraints related to budget and the equality of health care access. Particularly, there are three possible constraints: (1) the total number of nurses can be added in the whole region; (2) the maximum number of the nurses can be added at each area; (3) the maximum density of nurses (numbers of the nurses per 10,000 habitants) can be reached at each area. The results are visualized using spatial maps. Preliminary results In 2014, 27,000 ACSA occurred in the Occitanie, France region. For a specific set of constraints values, the model identified 16 BVs (out of 201) where the addition of 30 nurses could lead to the maximum ACSA reduction in number which is 17. Conclusions In the French Occitanie region, our SVR model was able to target a small number of geographic areas to maximize the impact of increased primary care workforce on ACSA. Our approach is applied to a single region, and it can be applied to other regions or extended at the national level as well as to other countries. Key messages A decision support tool to help health authorities in locating primary health care resources for the maximum reduction of ambulatory care sensitive admissions. An application of machine learning in primary care services.

scholarly journals Impact of the herpes zoster vaccination programme on hospitalised and general practice consulted herpes zoster in the 5 years after its introduction in England: a population-based study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037458
Author(s):  
Nick Andrews ◽  
Julia Stowe ◽  
Galena Kuyumdzhieva ◽  
Bersabeh Sile ◽  
Ivelina Yonova ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Incidence Rate ◽  
Vaccination Programme ◽  
Vaccine Coverage ◽  
Ecological Impact ◽  
Population Based ◽  
Age Cohorts ◽  
Catch Up ◽  
Rate Ratios ◽  
The Impact

ObjectivesTo assess the impact of herpes zoster vaccination in the 5 years after introduction for 70- to 79-year-olds in England in September 2013.DesignPopulation based ecological impact assessment.SettingHospitals covering the whole English population for the period 2008 to 2018 and 293 general practices (GP) for the period 2005 to 2018, in England.ParticipantsOver the period the population contributed 117·5 million person-years for hospitalisation events and 6.96 million person-years for GP events in individuals aged 60 to 89.InterventionsLive attenuated herpes zoster vaccination (Zostavax), first used on 1st September 2013, in 70- and 79-year-olds with continued use in new 70 year-olds and with a staged catch-up of those aged 71 to 78 years in 2013.Outcome measuresHerpes zoster and postherpetic neuralgia (PHN) consultation and hospitalisation rates in age-cohorts according to vaccine eligibility. Incidence rate ratios in age-cohorts eligible for vaccination compared with those non-eligible were calculated by Poisson regression. This was used to estimate prevented cases and, along with vaccine coverage, to estimate vaccine effectiveness.ResultsLarge and prolonged reductions in herpes zoster and PHN consultations and hospitalisations were observed in the 5 years post-implementation. For example, in 79 year-olds first eligible in 2013, the incidence rate ratio for consultations 5 years later was 0·65 (95% CI: 0·52 to 0·81). Over the whole period an estimated 40 500 fewer zoster consultations and 1840 fewer zoster hospitalisations occurred because of the vaccination programme. These reductions were consistent with effectiveness in the routine cohorts (vaccinated aged 70) of between 37% (for hospitalised zoster) and 75% (for PHN consultations) and, in catch up cohorts (vaccinated aged 78 to 79) of between 49% (for hospitalised PHN) and 66% (for PHN consultations).ConclusionGiven the clear and sustained impact of herpes zoster vaccination over the 5-year period since introduction, optimising vaccination coverage is important to attain maximum benefit.

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