scholarly journals EMS non-conveyance: A safe practice to decrease ED crowding or a threat to patient safety?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jani Paulin ◽  
Jouni Kurola ◽  
Mari Koivisto ◽  
Timo Iirola
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Adverse Outcomes ◽  
Adverse Event Rate ◽  
Secondary Outcome ◽  
Primary Health Care Facility ◽  
Primary Health ◽  
Ed Crowding

Abstract Background The safety of the Emergency Medical Service’s (EMS’s) non-conveyance decision was evaluated by EMS re-contacts, primary health care or emergency department (ED) visits, and hospitalization within 48 h. The secondary outcome was 28-day mortality. Methods This cohort study used prospectively collected data on non-conveyed EMS patients from three different regions in Finland between June 1 and November 30, 2018. The Adjusted International Classification of Primary Care (ICPC2) as the reason for care was compared to hospital discharge diagnoses (ICD10). Multivariable logistic regressions were used to determine factors that were independently associated with adverse outcomes. Results are presented with adjusted odds ratios (aORs) together with 95% confidence intervals (CIs). Data regarding deceased patients were reviewed by the study group. Results Of the non-conveyed EMS patients (n = 11,861), 6.3% re-contacted the EMS, 8.3% attended a primary health care facility, 4.2% went to the ED, 1.6% were hospitalized, and 0.1% died 0–24 h after the EMS mission. The 0–24 h adverse event rate was higher than 24–48 h. After non-conveyance, 32 (0.3%) patients were admitted to an intensive care unit within 24 h. Primary non-urgent EMS mission (aOR 1.49; 95% CI 1.25 to 1.77), EMS arrival at night (aOR 1.82; 95% CI 1.58 to 2.09), ALS unit type vs BLS (aOR 1.43; 95% CI 1.16 to 1.77), rural area (aOR 1.74; 95% CI 1.51 to 1.99), and older patient age (aOR 1.41; 95% CI 1.20 to 1.66) were associated with subsequent primary health care visits (0–24 h). Conclusions Four in five non-conveyed patients did not have any re-contact in follow-up period. EMS non-conveyance seems to be a relatively safe method of focusing ED resources and avoiding ED crowding.

scholarly journals Facility Managers’ Perceptions of Support and Supervision of Ward Based Primary Health Care Outreach Teams in National Health Insurance Pilot Districts in KwaZulu-Natal, South Africa. A Qualitative Study

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1718
Author(s):  
Euphemia Mbali Mhlongo ◽  
Elizabeth Lutge
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Care Facility ◽  
Health Care Facility ◽  
Primary Health Care Facility ◽  
Primary Health ◽  
Kwazulu Natal

Introduction: Evidence from many countries suggests that provision of home and community-based health services, linked to care at fixed primary health care facilities, is critical to good health outcomes. In South Africa, the Ward-Based Primary Health Care Outreach Teams are well placed to provide these services. The teams report to a primary health care facility through their outreach team leader. The facility manager/operational manager provides guidance and support to the outreach team leader. Aim: The aim of the study was to explore and describe the perceptions of facility managers regarding support and supervision of ward-based outreach teams in the National Health Insurance pilot sites in Kwa Zulu-Natal. Setting: The study was carried out in three National Health Insurance pilot districts in KwaZulu- Natal. Methods: An exploratory qualitative design was used to interview 12 primary health care facility managers at a sub-district (municipal) level. The researchers conducted thematic analysis of data. Findings: Some gaps in the supervisory and managerial relationships between ward based primary health care outreach teams and primary health care facility managers were identified. High workload at clinics may undermine the capacity of PHC facility managers to support and supervise the teams. Field supervision seems to take place only rarely and for those teams living far away from the clinic, communication with the clinic manager may be difficult. The study further highlights issues around the training and preparation of the teams. Conclusions: Ward based primary health care outreach teams have a positive impact in preventive and promotive health in rural communities. Furthermore, these teams have also made impact in improving facility indicators. However, their work does not happen without challenges.

scholarly journals Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe’s National Antiretroviral Therapy Programme between 2012 and 2015

2019 ◽  
Author(s):  
Richard Makurumidze ◽  
Tsitsi Mutasa-Apollo ◽  
Tom Decroo ◽  
Regis C. Choto ◽  
Kudakwashe C. Takarinda ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Antiretroviral Therapy ◽  
Cox Regression ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Primary Health Care Facility ◽  
Primary Health

AbstractBackgroundThe last evaluation to assess outcomes for patients receiving antiretroviral therapy (ART) through the Zimbabwe public sector was conducted in 2011, covering the 2007-2010 cohorts. The reported retention at 6, 12, 24 and 36 months were 90.7%, 78.1%, 68.8% and 64.4%, respectively. We report findings of a follow up evaluation for the 2012-2015 cohorts to assess the implementation & impact of recommendations from this prior evaluation.MethodsA nationwide retrospective study was conducted in 2016. Multi-stage proportional sampling was used to select health facilities and study participants records. The data extracted from patient manual records included demographic, baseline clinical characteristics and patient outcomes (active on treatment, died, transferred out, stopped ART and lost to follow-up (LFTU)) at 6, 12, 24 and 36 months. The data were analysed using Stata/IC 14.2. Retention was estimated using survival analysis. The predictors associated with attrition were determined using a multivariate Cox regression model.ResultsA total of 3,810 participants were recruited in the study. The median age in years was 35 (IQR: 28-42). Overall, retention increased to 92.4%, 86.5%, 79.2% and 74.4% at 6, 12, 24 and 36 months respectively. LFTU accounted for 98% of attrition. Being an adolescent or a young adult (aHR 1.41; 95%CI:1.14-1.74), receiving care at primary health care facility (aHR 1.23; 95%CI:1.01-1.49), having initiated ART between 2014-2015 (aHR 1.45; 95%CI:1.24-1.69), having WHO Stage 4 (aHR 2.06; 95%CI:1.51-2.81) and impaired functional status (aHR 1.24; 95%CI:1.04-1.49) predicted attrition.ConclusionThe overall retention was higher in comparison to the previous 2007–-2010 evaluation. Further studies to understand why attrition was found to be higher at primary health care facilities are warranted. Implementation of strategies for managing patients with advanced HIV disease, differentiated care for adolescents and young adults and tracking of LFTU should be prioritised to further improve retention.

Respiratory Viruses in a Primary Health Care Facility in Amsterdam, the Netherlands

2018 ◽  
Vol 26 (4) ◽  
pp. 211-215 ◽  
Author(s):  
Andrea H.L. Bruning ◽  
Wilhelmina B. de Kruijf ◽  
Henk C.P.M. van Weert ◽  
Anja Vrakking ◽  
Menno D. de Jong ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
The Netherlands ◽  
Care Facility ◽  
Health Care Facility ◽  
Respiratory Viruses ◽  
Primary Health Care Facility ◽  
Primary Health
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