Evaluation of Care Processes and Health Care Utilization in Newly Implemented Medical Homes in Italy: A Population-Based Cross-sectional Study

2019 ◽  
Vol 35 (3) ◽  
pp. 265-273
Author(s):  
Matthew Alcusky ◽  
David Singer ◽  
Scott W. Keith ◽  
Sarah E. Hegarty ◽  
Marco Lombardi ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Home ◽  
Population Based ◽  
Care Physician ◽  
Care Utilization ◽  
Local Health Authority ◽  
Local Health ◽  
Process Of Care ◽  
Cross Sectional ◽  
Medical Homes

In the Local Health Authority (LHA) of Parma, Emilia Romagna, Italy, 16 medical homes were established between 2011 and 2014. The authors implemented a 1-year (January 1, 2015, to December 31, 2015) cross-sectional population-based design to compare utilization and processes of care between medical homes and comparison practices using the Parma LHA administrative health care database. Residents (n = 372 396) attributed to a primary care physician practicing in a medical home as of January 1, 2015, were considered exposed to medical homes. Adjusted rates of emergency department (ED) use (incidence rate ratio [IRR] = 0.86; 95% CI = 0.82-0.90), potentially avoidable ED use (IRR = 0.78; 95% CI = 0.72-0.84), and hospitalization for chronic ambulatory care sensitive conditions (ACSCs; IRR = 0.87, 95% CI = 0.78-0.97) were lower among patients in medical homes. Performance on process of care measures favored the medical home group; however, associations were generally weak. Receipt of care in medical homes in Parma LHA was associated with lower rates of avoidable ED visits and hospitalizations for chronic ACSCs.

scholarly journals General practitioner attitudes and confidence to deprescribing for elderly patients

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Pier Riccardo Rossi ◽  
Sarah E. Hegarty ◽  
Vittorio Maio ◽  
Marco Lombardi ◽  
Andrea Pizzini ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Real Life ◽  
Care Physician ◽  
Local Health Authority ◽  
Local Health ◽  
Cross Sectional Survey ◽  
Patient Centered ◽  
Cross Sectional ◽  
Factors Affecting

Deprescribing is a patient-centered process of medication withdrawal intended to achieve improved health outcomes through discontinuation of one or more medications that are either potentially harmful or no longer required. The objective of this study was to assess the perceptions of primary care physicians on deprescribing and potential barriers to deprescribing in the Local Health Authority (LHA) of Turin, Piedmont, Italy. Secondary objective was to evaluate educational needs of primary care physician. Cross sectional survey of primary care physicians working in the LHA of Turin, Piedmont, Italy. 439 GPs (71.3% of the total number of primary care physicians) attended an educational session related to deprescribing and were asked to anonymously answer a paper survey. Participants were asked to complete a previously published questionnaire about deprescribing and potential factors affecting the deprescribing process. A correlation coefficient was calculated to assess the association between physicians’ confidence in deprescribing and attitudes or barriers associated with deprescribing. Many GPs (71%) reported general confidence in their ability to deprescribe. Most respondents (83%) reported they were comfortable deprescribing preventive medications, however almost half expressed doubts regarding deprescribing when medication was initially prescribed by a colleague (45%) or when patient and/or caregiver supported the opportunity to continue the assumption (49%). Around a third of doctors maintain that the absence of strong evidence supporting deprescribing prevents them from considering it (38%), that they do not have the necessary time to effectively go through the process of deprescribing (29%), and that fear of possible effects due on withdrawal prevents them from deprescribing (31%). There was no strong correlation between physicians’ confidence and attitudes or barriers associated with deprescribing. The present study confirms that general practitioners sense the importance of deprescribing and feel prepared to face it managing communication with patients and caregivers, but find barriers when enacting the practice in a real-life context.

Primary care and suicidality among psychiatric outpatients: The patient-doctor relationship matters

2020 ◽  
pp. 009121742097799
Author(s):  
Krista Schultz ◽  
Sharan Sandhu ◽  
David Kealy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Primary Care Physician ◽  
Population Based ◽  
Borderline Personality ◽  
Care Physician ◽  
Cross Sectional

Objective The purpose of the current study is to examine the relationship between the quality of the Patient-Doctor Relationship and suicidality among patients seeking mental health care; specifically, whether patients who perceive having a more positive relationship with primary care physician will have lower levels of suicidality. Method Cross-sectional population-based study in Greater Vancouver, Canada. One-hundred ninety-seven participants were recruited from three Mental Health Clinics who reported having a primary care physician. Participants completed a survey containing questions regarding items assessing quality of Patient-Doctor Relationship, general psychiatric distress (K10), borderline personality disorder, and suicidality (Suicidal Behaviours Questionnaire-Revised-SBQ-R). Zero-order correlations were computed to evaluate relationships between study variables. Hierarchical regression analysis was used to control for confounding variables. Results The quality of the patient doctor relationship was significantly negatively associated with suicidality. The association between the quality of the patient-doctor relationship and suicidality remained significant even after controlling for the effects of psychiatric symptom distress and borderline personality disorder features. Conclusions The degree to which patients’ perceive their primary care physician as understanding, reliable, and dedicated, is associated with a reduction in suicidal behaviors. Further research is needed to better explicate the mechanisms of this relationship over time.

scholarly journals Health Care Utilization and Symptom Severity in Ghanaian Children – a Cross-Sectional Study

PLoS ONE ◽  
2013 ◽  
Vol 8 (11) ◽  
pp. e80598 ◽  
Author(s):  
Ralf Krumkamp ◽  
Nimako Sarpong ◽  
Benno Kreuels ◽  
Lutz Ehlkes ◽  
Wibke Loag ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Symptom Severity ◽  
Cross Sectional Study ◽  
Care Utilization ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals PREVALENCE OF PARACOCCIDIOIDOMYCOSIS INFECTION BY INTRADERMAL REACTION IN RURAL AREAS IN ALFENAS, MINAS GERAIS, BRAZIL

2014 ◽  
Vol 56 (4) ◽  
pp. 281-285 ◽  
Author(s):  
Evandro Monteiro de Sá Magalhães ◽  
Carla de Fátima Ribeiro ◽  
Carla Silva Dâmaso ◽  
Luiz Felipe Leomil Coelho ◽  
Roberta Ribeiro Silva ◽  
...  
Keyword(s):  
Rural Areas ◽  
Alcohol Intake ◽  
Paracoccidioides Brasiliensis ◽  
Statistical Significance ◽  
Epidemiological Data ◽  
Population Based ◽  
Minas Gerais ◽  
Delayed Type Hypersensitivity ◽  
Local Health ◽  
Cross Sectional

This study aimed to estimate the prevalence of paracoccidioidal infection by intradermal reaction (Delayed-Type Hypersensitivity, DTH) to Paracoccidioides brasiliensis in rural areas in Alfenas, Southern Minas Gerais (MG) State, Brazil, and to assess risk factors (gender, occupation, age, alcohol intake and smoking) associated with infection. We conducted a population-based cross-sectional study using intradermal tests with gp 43 paracoccidioidin in 542 participants, who were previously contacted by local health agents and so spontaneously attended the test. Participants underwent an interview by filling out a registration form with epidemiological data and were tested with an intradermal administration of 0.1 mL of paracoccidioidin in the left forearm. The test was read 48 hours after injection and was considered positive if induration was greater than or equal to 5 mm. Out of 542 participants, 46.67% were positive to the skin test. Prevalence increased in accordance with an increase of age. There was statistical significance only for males. Occupation, alcohol intake and smoking habits were not significantly associated with the risk of paracoccidioidomycosis infection. There is relevance of paracoccidioidomycosis infection in such rural areas, which suggests that further epidemiological and clinical studies on this mycosis should be done in the southern part of Minas Gerais State.

scholarly journals Emergency department revisits and rehospitalizations among infants and toddlers for acute allergic reactions

2021 ◽  
Vol 42 (3) ◽  
pp. 247-256
Author(s):  
Lacey B. Robinson ◽  
Anna Chen Arroyo ◽  
Rebecca E. Cash ◽  
Susan A. Rudders ◽  
Carlos A. Camargo
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
New York ◽  
Health Care Utilization ◽  
Population Based ◽  
Care Utilization ◽  
Allergic Reactions ◽  
Infants And Toddlers ◽  
Ed Visits ◽  
Total Charges

Background and Objective: Allergic reactions, including anaphylaxis, are rising among children. Little is known about health care utilization among infants and toddlers. Our objective was to characterize health care utilization and charges for acute allergic reactions (AAR). Methods: We conducted a retrospective cohort study of trends in emergency department (ED) visits and revisits, hospitalizations and rehospitalizations, and charges among infants and toddlers (ages < 3 years), with an index ED visit or hospitalization for AAR (including anaphylaxis). We used data from population-based multipayer data: State Emergency Department Databases and State Inpatient Databases from New York and Nebraska. Multivariable logistic regression was used to identify factors associated with ED revisits and rehospitalizations. Results: Between 2006 and 2015, infant and toddler ED visits for AAR increased from 27.8 per 10,000 population to 35.2 (Ptrend < 0.001), whereas hospitalizations for AAR remained stable (Ptrend = 0.11). In the one year after an index AAR visit, 5.1% of these patients had at least one AAR ED revisit and 5.9% had at least one AAR rehospitalization. Factors most strongly associated with AAR ED revisits included an index visit hospitalization and receipt of epinephrine. Total charges for AAR ED visits (2009‐2015) and hospitalizations (2011‐2015) were more than $29 million and $11 million, respectively. Total charges increased more than fourfold for both AAR ED revisits for AAR rehospitalizations during the study period. Conclusion: Infants and toddlers who presented with an AAR were at risk for ED revisits and rehospitalizations for AAR within the following year. The charges associated with these revisits were substantial and seemed to be increasing.

Associations of androgens with health care utilization and costs in women—Perspectives of a population-based cohort study

Maturitas ◽  
2016 ◽  
Vol 89 ◽  
pp. 5-8
Author(s):  
Robin Haring ◽  
Henri Wallaschofski ◽  
Henry Völzke ◽  
Steffen Flessa ◽  
Brian G. Keevil ◽  
...  
Keyword(s):  
Health Care ◽  
Cohort Study ◽  
Health Care Utilization ◽  
Population Based ◽  
Care Utilization
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