scholarly journals Specialty Physician Designation in Referrals from a Vertically Integrated PCMH

2019 ◽  
Vol 6 ◽  
pp. 233339281985038
Author(s):  
Andrew D. Schreiner ◽  
Keri T. Holmes-Maybank ◽  
Jingwen Zhang ◽  
Justin Marsden ◽  
Patrick D. Mauldin ◽  
...  
Keyword(s):  
Medical Home ◽  
Univariate Analysis ◽  
Cross Sectional Study ◽  
Individual Characteristics ◽  
Patient Centered Medical Home ◽  
Patient Centered ◽  
Cross Sectional ◽  
Medical Specialties ◽  
The Individual

Introduction: Primary care referrals to specialty physicians once relied upon the medical skill of the specialist, the quality of past communication, and previous consultative experiences. As health systems vertically integrate, patterns of specialty physician referral designation are not known. Methods: This cross-sectional study from a patient-centered medical home (PCMH) evaluated the proportion of referrals with named specialists. All outpatient specialty referrals from the PCMH between July and December of 2014 were eligible for inclusion, and 410 patients were randomly selected for chart review. The outcome of interest was specialty physician designation. Other variables of interest included PCMH provider experience, the reason for referral, and time to specialty visit. Univariate analysis was performed with Fisher exact tests. Results: Of 410 specialty referrals, 43.7% were made to medical specialties, 41.7% to surgical specialties, and 14.6% to ancillary specialties. Resident physicians placed 224 referrals (54.6%), faculty physicians ordered 155 (37.8%), and advanced practice providers ordered 31 (7.6%). Only 11.2% of the specialty referral orders designated a specific physician. No differences appeared in the reason for referral, the referral destination, the proportion of visits scheduled and attended, or the time to schedule between those referrals with and without specialty physician designation. Faculty physicians identified a specific specialist in 21.4% of referrals compared to residents doing so in 4.9% ( P < .0001). Conclusion: Patient-centered medical home referrals named a specific specialty physician infrequently, suggesting a shift from the historical reliance on the individual characteristics of the specialist in the referral process.

scholarly journals Patient Experience with the Patient-Centered Medical Home in Michigan’s Statewide Multi-Payer Demonstration: A Cross-Sectional Study

2017 ◽  
Vol 32 (11) ◽  
pp. 1202-1209 ◽  
Author(s):  
Issidoros Sarinopoulos ◽  
Diane L. Bechel-Marriott ◽  
Jean M. Malouin ◽  
Shaohui Zhai ◽  
Jason C. Forney ◽  
...  
Keyword(s):  
Patient Experience ◽  
Medical Home ◽  
Cross Sectional Study ◽  
Patient Centered Medical Home ◽  
Sectional Study ◽  
Patient Centered ◽  
Cross Sectional

scholarly journals Efectos ergonómicos inmediatos de un apoyo isquiático en la sedestación. Herramienta preventiva para la información en salud = Immediate ergonomic effects of an ischial support in the sitting position. Preventive tool for health information

2017 ◽  
Vol 8 (2) ◽  
pp. 228
Author(s):  
Luis Ceballos-Laita ◽  
Teresa Mingo-Gómez ◽  
Sandra García-Lázaro ◽  
Sandra Jiménez-del Barrio
Keyword(s):  
Slope Angle ◽  
Cross Sectional Study ◽  
Head Position ◽  
Individual Characteristics ◽  
Sitting Position ◽  
Human Engineering ◽  
Cross Sectional ◽  
Lumbar Flexion ◽  
Upper Cervical ◽  
The Individual

Resumen: Introducción: La información sobre la correcta ergonomía se ha incrementado para disminuir la prevalencia de síntomas lumbares y/o cervicales en la población. Sin embargo, el acondicionamiento y el mobiliario de las instituciones universitarias no se adecuan a las características individuales de los sujetos, lo cual dificulta el proceso. Objetivo: analizar los cambios en la postura, al incorporar un apoyo isquiático en sujetos jóvenes. Material: Estudio transversal comparativo sobre 76 sujetos universitarios voluntarios (24 varones y 52 mujeres, edad media de 20,7; DT ± 2,64). Se registró la postura mediante fotogrametría sagital con un software 2D, en posición de sedestación y en sedestación corregida mediante la colocación de un apoyo isquiático de 5 centímetros de altura. Posteriormente se analizaron los ángulos cráneo-vertebral (CV), cervical superior (CS), cervical inferior (CI), lumbar (AL). Resultados: Se encontraron diferencias estadísticamente significativas entre la posición sedente y la sedente corregida en todos los ángulos analizados (p<0,01). Consiguiendo la disminución de la flexión lumbar y de la posición de cabeza adelantada. Conclusión: La utilización de un apoyo isquiático de 5 centímetros de altura en la posición de sedestación, disminuye la flexión lumbar y la posición de cabeza adelantada en comparación con una sedestación sin apoyo en sujetos jóvenes.Palabras clave: postura, columna, comunicación, ingeniería humana, educación para la salud.Abstract: Introduction: Information about correct ergonomics is increasing in order to avoid cervical and lumbar symptoms. However, the furniture of the colleges does not fit the individual characteristics, which make difficult the process. Objective: Analyse the posture change, when an ischial support is incorporated in young population. Methods: Cross sectional study. 76 volunteers students were included (24 men and 53 women, average age 20,7 SD ± 2,64). Posture was registered with sagittal photogrammetry and analysed by 2D software, in sitting position and corrected sitting position by 5-centimeters-isquial-support. Then, Neck Slope angle (NS), Upper Cervical angle (UP) Lower cervical angle (LC) and lumbar spine angle (LS) were analysed. Results: Statistical differences were found between the sitting position and corrected sitting position in all analysed angles (p<0,01). This means less lumbar flexion and forward head position. Conclusion: A 5-centimeter-isquial-support decrease lumbar flexion and forward head position compared to sitting position without ischial support in young adults.Keywords: posture, spine, communication, human engineering, health education.

scholarly journals First-Year Antibiotics Exposure in Relation to Childhood Asthma, Allergies, and Airway Illnesses

2020 ◽  
Vol 17 (16) ◽  
pp. 5700
Author(s):  
Zhijun Zou ◽  
Wei Liu ◽  
Chen Huang ◽  
Chanjuan Sun ◽  
Jialing Zhang
Keyword(s):  
Childhood Asthma ◽  
Cross Sectional Study ◽  
Individual Characteristics ◽  
First Year ◽  
Cross Sectional ◽  
Childhood Health ◽  
History Of ◽  
Household Environment ◽  
One Year ◽  
The Individual

Background: Associations of early antibiotics exposures with childhood asthma, allergies, and airway illnesses are debated. Objectives: We aimed to investigate associations of first-year antibiotics exposure with childhood asthma, allergies, and airway illnesses. Methods: A cross-sectional study was conducted among preschoolers in Shanghai, China during 2011–2012. A questionnaire regarding household environment and lifestyles and childhood health outcomes was reported by the child’s parents. Results: In total, 13,335 questionnaires (response rate: 85.3%) were analyzed and 3049 (24.1%) children had first-year antibiotics exposure. In the multivariate logistic regression analyses, first-year antibiotics exposure had significant associations with the higher odds of lifetime-ever pneumonia (adjusted OR, 95% CI: 2.15, 1.95–2.37), croup (1.46, 1.24–1.73), wheeze (1.44, 1.30–1.60), asthma (1.38, 1.19–1.61), food allergy (1.29, 1.13–1.46), and allergic rhinitis (1.23, 1.07–1.41), and as well as current (one year before the survey) common cold (≥3 times) (1.38, 1.25–1.52), dry cough (1.27, 1.13–1.42), atopic dermatitis (1.25, 1.09–1.43), wheeze (1.23, 1.10–1.38), and rhinitis symptoms (1.15, 1.04–1.26). These associations were different in children with different individual characteristics (age, sex, family history of atopy, and district) and other early exposures (breastfeeding, home decoration, pet-keeping, and environmental tobacco smoke). Conclusions: Our results indicate that first-year antibiotics exposure could be a strong risk factor for childhood pneumonia, asthma, allergies, and their related symptoms. The individual characteristics and other early exposures may modify effects of early antibiotic exposure on childhood allergies and airway illnesses.

scholarly journals Association of the Implementation of the Patient-Centered Medical Home with Quality of Life in Patients with Multimorbidity

2019 ◽  
Vol 35 (1) ◽  
pp. 119-125 ◽  
Author(s):  
Linnaea Schuttner ◽  
Ashok Reddy ◽  
Ann-Marie Rosland ◽  
Karin Nelson ◽  
Edwin S. Wong
Keyword(s):  
Quality Of Life ◽  
Medical Home ◽  
Patient Centered Medical Home ◽  
Patient Centered

Establishing the Role of the Pharmacist in the Patient-Centered Medical Home… The Opportunity is Now

2009 ◽  
Vol 25 (5) ◽  
pp. 287-291 ◽  
Author(s):  
Richard W Dettloff ◽  
Patricia Glosner ◽  
Susannah Motl Moroney
Keyword(s):  
Medical Home ◽  
Medical Setting ◽  
Patient Centered Medical Home ◽  
Coordinated Care ◽  
Patient Centered ◽  
Medication Therapy ◽  
Quality Of Patient Care ◽  
The Us ◽  
Care Coordinators

The patient-centered medical home (PCMH) is an approach to delivering comprehensive, continuous, coordinated care across all life stages and has been hypothesized to be one potential solution to the discrepancy between the high cost but low quality of health care in the US. Although a plethora of literature exists on how pharmacy interventions can improve the quality of patient care through medication therapy management programs, there is a paucity of data supporting pharmacists' involvement in PCMHs. Pharmacists are uniquely trained and positioned to make important contributions to PCMHs as medication care coordinators. The opportunity is now for pharmacists to establish their role within this medical setting.

scholarly journals Quality of Life in Keratoconus: Evaluation With Keratoconus Outcomes Specific Questionnaire (KORQ)

2021 ◽  
Author(s):  
roberto damian pacheco pinto ◽  
Ricardo Yuji Abe ◽  
Flavia Cid Gomes ◽  
Paulo Rodolfo Tagliari Barbisan ◽  
Alexandre Fattah Martini ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Univariate Analysis ◽  
Cross Sectional Study ◽  
Wilcoxon Test ◽  
Cross Sectional ◽  
Specific Questionnaire ◽  
Functional Scores ◽  
History Of ◽  
Assess Quality

Abstract Purpose: To assess quality of life in keratoconus patients using the Keratoconus Outcomes Research Questionnaire (KORQ) translated and validated to Portuguese language. KORQ is the only validated keratoconus specific questionnaire and has high rating for psychometric properties.Methods: In this cross-sectional study enrolled 100 patients with keratoconus from a tertiary referral eye hospital, from April 2018 to June 2019. Associations between age, gender, allergic conjunctivitis, keratoconus stage, best-corrected visual acuity (BCVA), maximum simulated keratometry (Kmax), steep keratometry (K2), pachymetry, treatments performed, hydrops and KORQ scores were evaluated with univariate (Wilcoxon test and the Kruskal Wallis test) and multivariate linear regression with stepwise backward modeling. Lower scores of KORQ are associated with better quality of life, as well as higher scores are associated with greater impairment of functional activities and symptoms.Results: Out of the 100 patients, mild, moderate and severe keratoconus, was observed in 15%, 46% and 39% of participants, respectively. Univariate analysis showed lower values for function scores with male gender (p<0.05) and both functional and symptoms scores statistically associated with BCVA<0.3 (LogMAR) (p<0.05). Multivariate analysis indicated significantly lower functional scores in individuals with BCVA<0.3 (p<0.001) and those with history of crosslinking treatment (p=0.022), while symptom scores were only statistically associated with BCVA<0.3 (p<0.001).Conclusions: In patients with keratoconus, BCVA in the better eye and history of crosslinkig are factors were associated with better quality of life scores using KORQ.

scholarly journals Attitudes of medical students in Pakistan toward the doctor-patient relationship

2014 ◽  
Author(s):  
Waqas Ahmad ◽  
Edward Krupat ◽  
Yumna Asmaa ◽  
Noor-E- Fatima ◽  
Rayan Attique ◽  
...  
Keyword(s):  
Medical Students ◽  
Patient Centered Care ◽  
Cross Sectional Study ◽  
Individual Characteristics ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Patient Centered ◽  
Cross Sectional ◽  
Centered Care ◽  
Academic Year

Background. We initiated this study with the aim to assess the leaning of medical students towards either a doctor-centered or a patient-centered care and explore the effects of personal attributes on it like gender, academic year etc. of the students. Methods. A cross-sectional study was conducted between July-Sep 2013. The study population consisted of 1274 medical students in years 1-5 from two medical colleges. English version of PPOS was used to assess attitudes of medical students towards doctor-patient relationship. The relationship between PPOS scores and individual characteristics like gender, academic year etc. were examined by using Independent t-test and one way ANOVA. Results. A total of 792 students formed the final sample. Characteristics associated with most patient-centered attitudes were being in 4th academic year, married, being a foreigner and belonging to a Private college (p<0.05). Characteristics associated with most doctor-centered attitudes were being in 2nd academic year, divorced, having a local origin and belonging to a Govt. college (p<0.05). Gender and having doctor parents had no bearing, statistically, on the attitudes. Conclusion. Despite ongoing debate and emphasis on a patient-centered curriculum, our study suggests that current curriculum and its teachings are not producing the results they are designed to achieve. Students should be adequately exposed to the patients from the beginning of their medical education in clinical settings which are more sympathetic to a patient-centered care.

scholarly journals Acromegaly Disease Activity According to ACRODAT®, in Spain: ACROVAL Study

2021 ◽  
Author(s):  
Monica Marazuela ◽  
Concepción Blanco ◽  
Ignacio Bernabeu ◽  
Edelmiro Menendez ◽  
Rocío Villar ◽  
...  
Keyword(s):  
Disease Activity ◽  
Clinical Evaluation ◽  
Cross Sectional Study ◽  
Patient Centered ◽  
Cross Sectional ◽  
Mild Disease ◽  
Clinical Action ◽  
The Relationship

Abstract Objectives: To evaluate disease activity status using the Acromegaly Disease Activity Tool (ACRODAT®) in a cohort of Spanish acromegaly patients, to assess the relationship between the level of disease activity according to both ACRODAT® and the physicians’ clinical evaluation, and to study the potential discrepancies in the perception of symptoms between physicians and patients.Design: Multicenter, observational, descriptive and cross-sectional study. Methods: Disease activity was assessed in adult patients with acromegaly under pharmacological treatment during at least 6 months using ACRODAT®.Results: According to ACRODAT®, 48.2%, 31.8% and 20.0% of a total of 111 patients were classified as having a stable disease (S), mild disease activity (M-DA) and significant disease activity (S-DA) respectively. ACRODAT® classification of disease activity significantly correlated with physicians’ opinion, with a moderate inter-rater agreement and a specificity of 92.45% (PPV=86.21%). No correlation was found between IGF-1 levels and severity of symptoms or quality of life (QoL). A decision to take clinical action was significantly more frequent in S-DA and M-DA patients than S patients but no action was taken on 5 (22.7%) and 27 (77.1%) S-DA and M-DA patients, respectivelyConclusions: ACRODAT® detected disease activity in 51.8% of patients. Interestingly, although M-DA and S-DA patients were likely to be in the process of being controlled, action was not always taken on these patients. ACRODAT® is a validated and highly specific tool that may be useful to routinely monitor acromegaly and to identify patients with non-obvious disease activity by incorporating “patient-centered” parameters like symptoms and QoL to the clinical evaluation of acromegaly.

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