scholarly journals Chronic diseases in the geriatric population: morbidity and use of primary care services according to risk level

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jaime Barrio-Cortes ◽  
Almudena Castaño-Reguillo ◽  
María Teresa Beca-Martínez ◽  
Mariana Bandeira-de Oliveira ◽  
Carmen López-Rodríguez ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Chronic Diseases ◽  
Chronically Ill ◽  
Risk Level ◽  
Geriatric Population ◽  
Factors Associated ◽  
Number Of Patients ◽  
Use Of Services ◽  
The Mean

Abstract Background Geriatric patients have significant morbidity and greater needs for care and assistance. The objective of this study was to describe the characteristics, morbidity, and use of services in primary care (PC) of patients with chronic diseases older than 65 years according to their risk level assigned by the adjusted morbidity groups (AMG) and to analyse the factors associated with the use of PC services. Methods This was a cross-sectional descriptive observational study. Patients older than 65 years from a healthcare service area, classified as chronically ill by the AMG classification system of the PC electronic medical record of the Community of Madrid, were included. Sociodemographic, clinical-care, and PC service utilization variables were collected. Univariate, bivariate and multivariate analyses were done. Results A total of 3292 chronic patients older than 65 years were identified, of whom 1628 (49.5%) were low risk, 1293 (39.3%) were medium risk and 371 (11.3%) were high risk. Their mean age was 78.1 (SD = 8.1) years and 2167 (65.8%) were women. Their mean number of chronic diseases was 3.8 (SD = 2), 89.4% had multimorbidity and 1550 (47.1%) were polymedicated. The mean number of contacts/year with PC was 19.5 (SD = 18.2) [men: 19.4 (SD = 19.8); women: 19.5 (SD = 17.4)]. The mean number of contacts/year in people over 85 years was 25.2 (SD = 19.6); in people 76–85 years old, it was 22.1 (SD = 20.3); and in people 66–75 years old, it was 14.5 (SD = 13.9). The factors associated with greater use of services were age (B coefficient [BC] = 0.3; 95%CI = 0.2–0.4), high risk level (BC = 1.9; 95%CI =0.4–3.2), weight of complexity (BC = 0.7; 95%CI = 0.5–0.8), and ≥ 4 chronic diseases (BC = 0.7; 95%CI = 0.3–1.1). Conclusions In the geriatric population, we found a high number of patients with chronic diseases and there were three levels of risk by AMG with differences in characteristics, morbidity, and use of PC services. The greatest use of services was by patients with older age, high risk level, greater weight of complexity and ≥ 4 chronic diseases. Further research is needed to develop an intervention model more adapted to the reality of the geriatric population based on risk levels by AMG.

scholarly journals Chronic Diseases in the Geriatric Population: Morbidity and use of Primary Care Services According to Risk Level.

2021 ◽  
Author(s):  
Jaime Barrio Cortes ◽  
Almudena Castaño Reguillo ◽  
María Teresa Beca Martínez ◽  
Mariana Bandeira de Oliveira ◽  
María Carmen López Rodríguez ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Chronic Diseases ◽  
Chronically Ill ◽  
Risk Level ◽  
Geriatric Population ◽  
Factors Associated ◽  
Number Of Patients ◽  
Use Of Services ◽  
The Mean

Abstract Background: Geriatric patients have significant morbidity and greater needs for care and assistance. The objective of this study was to describe the characteristics, morbidity, and use of services in primary care (PC) of patients with chronic diseases older than 65 years according to their risk level assigned by the adjusted morbidity groups (AMG) and to analyse the factors associated with the use of PC services.Methods: This was a cross-sectional descriptive observational study. Patients older than 65 years from a basic health area, classified as chronically ill by the AMG classification system of the PC electronic medical record of the Community of Madrid, were included. Sociodemographic, clinical-care, and PC service utilization variables were collected. Univariate, bivariate and multivariate analyses were done.Results: A total of 3,292 chronic patients older than 65 years were identified, of whom 1,628 (49.5%) were low risk, 1,293 (39.3%) were medium risk and 371 (11.3%) were high risk. Their mean age was 78.1 (SD=8.1) years and 2,167 (65.8%) were women. Their mean number of chronic diseases was 3.8 (SD=2), 89.4% had multimorbidity and 1,550 (47.1%) were polymedicated. The mean number of contacts/year with PC was 19.5 (SD=18.2) [men: 19.4 (SD=19.8); women: 19.5 (SD=17.4)]. The mean number of contacts/year in people over 85 years was 25.2 (SD=19.6); in people 76-85 years old, it was 22.1 (SD= 20.3); and in people 66-75 years old, it was 14.5 (SD=13.9). The factors associated with greater use of services were age (B coefficient [BC]= 0.3; 95%CI= 0.2 – 0.4), high risk level (BC=1.9; 95%CI =0.4 – 3.2), weight of complexity (BC=0.7; 95%CI=0.5 – 0.8), and ≥ 4 chronic diseases (BC=0.7; 95%CI=0.3 – 1.1).Conclusions: In the geriatric population, we found a high number of patients with chronic diseases and there were three levels of risk by AMG with differences in characteristics, morbidity, and use of PC services. The greatest use of services was by patients with older age, high risk level, greater weight of complexity and ≥ 4 chronic diseases. Further research is needed to develop an intervention model more adapted to the reality of the geriatric population based on risk levels by AMG.

scholarly journals Use of primary and hospital care health services by chronic patients according to risk level by adjusted morbidity groups

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jaime Barrio-Cortes ◽  
María Soria-Ruiz-Ogarrio ◽  
María Martínez-Cuevas ◽  
Almudena Castaño-Reguillo ◽  
Mariana Bandeira-de Oliveira ◽  
...  
Keyword(s):  
Palliative Care ◽  
High Risk ◽  
Health Services ◽  
Chronic Diseases ◽  
Service Utilization ◽  
Hospital Care ◽  
Chronically Ill ◽  
Predisposing Factors ◽  
Risk Level ◽  
Chronic Patients

Abstract Background Patients with chronic diseases have increased needs for assistance and care. The objective of this study was to describe the characteristics and use of primary care (PC) and hospital care (HC) health services by chronic patients according to risk level based on adjusted morbidity groups (AMG) and to analyze the associated factors. Methods Cross-sectional descriptive observational study. Patients from a basic health area classified as chronically ill by the AMG classification system of the Madrid PC electronic medical record were included. Sociodemographic, clinical-care characteristics (classified as predisposing factors or need factors) and service utilization variables were collected. Univariate, bivariate and simple linear regression analyses were performed. Results The sample consisted of 9866 chronic patients and 8332 (84.4%) used health services. Of these service users, 63% were women, mean age was 55.7 (SD = 20.8), 439 (5.3%) were high risk, 1746 (21.2%) were medium risk, and 6041(73.4%) were low risk. A total of 8226 (98.7%) were PC users, and 4284 (51.4%) were HC users. The average number of annual contacts with PC was 13.9 (SD = 15); the average number of contacts with HC was 4.8 (SD = 6.2). Predisposing factors associated with services utilization at both care levels were: age (B coefficient [BC] = 0.03 and 0.018, 95% CI = 0.017–0.052 and 0.008–0.028, respectively, for PC and HC) and Spanish origin (BC = 0.962 and 3.396, 95% CI = 0.198–1.726 and 2.722–4.070); need factors included: palliative care (BC = 10,492 and 5047; 95% CI = 6457–14,526 and 3098-6995), high risk (BC = 4631 and 2730, 95% CI = 3022–6241 and 1.949–3.512), number of chronic diseases (BC = 1.291 and 0.222, 95% CI = 1.068–1.51 and 0.103–0.341) and neoplasms (BC = 2.989 and 4.309, 95% CI = 1.659–4.319 and 3.629–4.989). Conclusions The characteristics and PC and HC service utilization of chronic patients were different and varied according to their AMG risk level. There was greater use of PC services than HC services, although utilization of both levels of care was high. Service use was related to predisposing factors such as age and country of origin and, above all, to need factors such as immobility, high risk, and number and type of chronic diseases that require follow-up and palliative care.

scholarly journals Stereoacuity after Successful Occlusion Therapy in Children with Anisometropic Amblyopia

2021 ◽  
Vol 62 (11) ◽  
pp. 1539-1546
Author(s):  
Sang Wook Lee ◽  
Eun Hye Jung
Keyword(s):  
Patient Characteristics ◽  
Visual Development ◽  
Post Treatment ◽  
Control Group ◽  
Normal Children ◽  
Factors Affecting ◽  
Anisometropic Amblyopia ◽  
Factors Associated ◽  
Number Of Patients ◽  
The Mean

Purpose: To compare the stereoacuity between patients with anisometropic amblyopia who were treated and achieved normal visual acuity (VA) and normal children and evaluate the factors associated with stereoacuity.Methods: We retrospectively reviewed the records of 37 pediatric patients with anisometropic amblyopia who recovered to normal VA with glasses and occlusion treatment (amblyopia group) and 34 normal children (control group). The Worth 4-dot test, Lang II test, Titmus test, and TNO test were performed to measure stereoacuity. Clinical characteristics were compared between the two groups, and factors affecting stereoacuity outcomes were also analyzed in the amblyopic group.Results: The mean age at diagnosis of amblyopia was 5.3 ± 1.4 years, and the mean VAs at diagnosis were 0.41 ± 0.24 and 0.06 ± 0.07 in amblyopic and fellow eyes, respectively. The mean duration of occlusion was 19.00 ± 9.44 months, and VA of amblyopic eyes improved to 0.04 ± 0.04 after occlusion treatment. The patient characteristics did not differ significantly between the two groups, except for the final VA of the amblyopic eye. The final mean logarithm of minimal angle of resolution VA of the amblyopic eye in the amblyopia group was significantly worse than that in the control group. The number of patients with normal stereoacuity was significantly lower in the amblyopia group than in the control group on Lang II, Titmus, and TNO tests. Factors associated with poor stereoacuity were severe amblyopia in the Lang II test and poor post-treatment VA of the amblyopic eye in the Titmus test.Conclusions: Stereoacuity was worse in the amblyopia group than in the control group, despite normal visual development. The depth of amblyopia and post-treatment VA were associated with stereoacuity outcomes. Thus, VA improvement should be closely monitored in the amblyopic eye to obtain good stereoacuity.

scholarly journals The utility of the records medical: factors associated with the medication errors in chronic disease

2017 ◽  
Vol 25 (0) ◽  
Author(s):  
Hellen Lilliane da Cruz ◽  
Flávia Karla da Cruz Mota ◽  
Lorena Ulhôa Araújo ◽  
Emerson Cotta Bodevan ◽  
Sérgio Ricardo Stuckert Seixas ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Medication Errors ◽  
Medical Records ◽  
Secondary Data ◽  
Diabetic Patients ◽  
Medication History ◽  
Factors Associated ◽  
Compromise Patient Safety ◽  
History Of ◽  
The Mean

ABSTRACT Objective: This study describes the development of the medication history of the medical records to measure factors associated with medication errors among chronic diseases patients in Diamantina, Minas Gerais. Methods: retrospective, descriptive observational study of secondary data, through the review of medical records of hypertensive and diabetic patients, from March to October 2016. Results: The patients the mean age of patient was 62.1 ± 14.3 years. The number of basic nursing care (95.5%) prevailed and physician consultations were 82.6%. Polypharmacy was recorded in 54% of sample, and review of the medication lists by a pharmacist revealed that 67.0% drug included at least one risk. The most common risks were: drug-drug interaction (57.8%), renal risk (29.8%), risk of falling (12.9%) and duplicate therapies (11.9%). Factors associated with medications errors history were chronic diseases and polypharmacy, that persisted in multivariate analysis, with adjusted RP chronic diseases, diabetes RP 1.55 (95%IC 1.04-1.94), diabetes/hypertension RP 1.6 (95%CI 1.09-1.23) and polypharmacy RP 1.61 (95%IC 1.41-1.85), respectively. Conclusion: Medication errors are known to compromise patient safety. This has led to the suggestion that medication reconciliation an entry point into the systems health, ongoing care coordination and a person focused approach for people and their families.

scholarly journals P145 A review of vitamin D testing in primary care: significant savings to be made

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Emily Riding ◽  
Elizabeth MacPhie
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
High Risk ◽  
British Society ◽  
Repeated Testing ◽  
North West ◽  
The North ◽  
Number Of Patients ◽  
Vitamin D Levels ◽  
Lower Limb Pain

Abstract Background Vitamin D deficiency is common in the UK due to a lack of sunlight over the winter months. Risk factors include darker skin and reduced exposure to sunlight (e.g. housebound/institutionalised patients or those who cover skin for religious reasons). As part of the Choosing Wisely campaign, the British Society for Rheumatology recommend that vitamin D testing should be reserved for people at high risk of deficiency and avoided as part of routine investigation of widespread pain alone. They also recommend that repeat testing isn’t usually necessary in patients who are taking vitamin D supplements. The aim of this project was to review the testing of Vitamin D in a Primary Care setting. Methods An EMIS search was conducted for patients who had their vitamin D levels tested in September and October 2017. The following information was collected for each patient: indication for testing, vitamin D level, whether vitamin D had been tested previously or subsequently, treatment offered and the patient’s residence. Results 96 patients had their vitamin D levels checked. Of these, 8 were excluded as they had been tested on the advice of secondary care. Of the remaining 88 patients, 6 (6%) were vitamin D deficient and 34 (38%) had insufficient vitamin D levels. The most common indication for testing was tiredness in 26 patients (30%) followed by generalised aching/lower limb pain 19 (22%). 8 (9%) patients were tested due to pain at specific sites including a single joint or abdominal pain, 5 (6%) due to neurological symptoms, 4 (5%) due to a diagnosis of CKD and 3 (3%) due to skin and hair problems. There was no clearly documented indication for testing levels in the remaining 3 (3%) patients. 35 (40%) patients had previously had their vitamin D levels tested and 19 (22%) patients had subsequent testing. Of the patients with abnormal vitamin D levels, 22 (25%) were prescribed treatment, 16 (18%) advised to buy over the counter and no advice was documented in 16 (18%) patients. None of the patients lived in residential or nursing homes. Conclusion This project identified a range of indications for vitamin D testing and a large number of patients who had repeated testing. This highlights a potential area for education in primary care surrounding the value in both initial and repeated testing of vitamin D levels. The findings show a need for an improvement in documentation as some patients had no clear linked reason for testing and no evidence that abnormal levels were actioned. However, there were limitations to determining whether BSR guidelines were followed as some factors that would lead to patients being at high risk of deficiency (such as skin colour) could not be collected from EMIS. Disclosures E. Riding None. E. MacPhie Other; EM is the secretary of the North West Rheumatology Club; meetings are supported by an unrestricted educational grant from UCB.

Outcomes of Radiosurgery for Brainstem Arteriovenous Malformations

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Tomoyuki Koga ◽  
Masahiro Shin ◽  
Atsuro Terahara ◽  
Nobuhito Saito
Keyword(s):  
Arteriovenous Malformations ◽  
Additional Treatment ◽  
Surgical Morbidity ◽  
Factors Associated ◽  
Obliteration Rate ◽  
Early Results ◽  
Number Of Patients ◽  
The Mean ◽  
Risk Of Hemorrhage

Abstract BACKGROUND: Arteriovenous malformations (AVMs) in the brainstem yield a high risk of hemorrhage. Although stereotactic radiosurgery (SRS) is accepted, because of high surgical morbidity and mortality, outcomes are still unclear. OBJECTIVE: We previously reported the early results of SRS for brainstem AVMs. Here, we obtained data from a longer follow-up for a larger number of patients and present precise outcomes based on the latest follow-up data. METHODS: Forty-four patients with brainstem AVMs were treated by SRS. Outcomes such as the rates of obliteration, hemorrhage after treatment, and adverse effects were retrospectively analyzed. RESULTS: The annual hemorrhage rate before SRS was 17.5%. The mean follow-up period after SRS was 71 months (range, 2-168 months). The actuarial obliteration rate confirmed by angiography was 52% at 5 years. Factors associated with higher obliteration rate were previous hemorrhage (P = .048) and higher margin dose (P = .048). For patients treated with a margin dose of ≥ 18 Gy, the obliteration rate was 71% at 5 years. Persistent worsening of neurological symptoms was observed in 5%. The annual hemorrhage rate after SRS was 2.4%. Four patients died of rebleeding, and disease-specific survival rate was 86% at 10 years after treatment. CONCLUSION: Nidus obliteration must be achieved for brainstem AVMs because they possibly cause lethal hemorrhage even after SRS. Treatment with a high margin dose is desirable to obtain favorable outcomes for these lesions. Additional treatment should be considered for an incompletely obliterated nidus.

Accuracy of venous thromboembolism assessment and compliance to prophylaxis in a tertiary care center

2016 ◽  
Vol 31 (8) ◽  
pp. 541-545 ◽  
Author(s):  
Pamela S Kim ◽  
Antonios P Gasparis ◽  
Kristan Probeck ◽  
Doreen Elitharp ◽  
Apostolos Tassiopoulos ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Risk Level ◽  
Tertiary Care Center ◽  
Potential Harm ◽  
Number Of Patients ◽  
Quality Programs ◽  
The Mean

Background Proper assessment of venous thromboembolism (VTE) risk level in hospitalized patients is vital to providing adequate prophylaxis. Clinical decision support (CDS) tools with electronic medical record (EMR) have been used by institutions to improve assessment and prophylaxis. As such, this study was conducted after implementing such a system to compare admitting service (AS) assessment of VTE risk level to the VTE consult service (CS) assessment. In addition, compliance of ordered prophylaxis based on AS assessment was evaluated. Methods At a tertiary care center, we performed a review of randomly selected patients assessed within 18 h of admission for VTE risk over a five-month period. A total of 104 patients were evaluated, four of which were excluded because of VTE presence on admission. Patients were assessed for VTE risk independently, first by the AS, followed by the VTE CS. Prophylaxis orders were then reviewed based on AS assessment compliance to CDS recommendations for prophylaxis based on ACCP guidelines. Results All 100 patients underwent VTE risk assessment within 18 h from admission. The mean age was 63 years. Comparing AS to CS assessment, 13 patients had incorrect assessments ( p < .001). Of these, six patients were under-assessed ( p = .029), and seven patients were over-assessed ( p = .014). Based on AS assessment there were eight patients who had incorrect prophylaxis ordered. Unnecessary exposure to complications due to inappropriate prophylaxis occurred in five patients. Conclusion Despite the use of EMR CDS tools, there continues to be a significant number of patients that are being under-assessed and under-prophylaxed for VTE resulting in exposing patients to potential harm. Quality programs need to be instituted to further improve VTE assessment and prophylaxis.

scholarly journals Socio-demographic and clinical pattern of patients attending a neuropsychiatric hospital in Nigeria: A five-year retrospective study

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Shehu Sale
Keyword(s):  
Risk Factors ◽  
Psychiatric Disorders ◽  
Formal Education ◽  
Simple Random Sampling ◽  
Descriptive Study ◽  
Clinical Pattern ◽  
Factors Associated ◽  
Number Of Patients ◽  
History Of ◽  
The Mean

Psychiatric disorders contribute significantly to disability worldwide. The various risk factors associated with their prevalence and outcomes are also influenced by the region individuals live in. This study was carried out to assess the sociodemographic and clinical pattern of patients attending a neuropsychiatric hospital. It was a retrospective descriptive study of patients managed for psychiatric disorders at the hospital. Medical case notes of 246 patients were selected by simple random sampling. A sociodemographic and clinical variables questionnaire was designed to collate the data. The mean age of patients was 29.1 years and consisted mostly of young adults. There was approximately an equal number of patients of both genders. Approximately 66.3% of the patients were married, and 98.4% had no formal education. More than half were unemployed and a great number (37.4%) was being managed for epilepsy. The report of a family history of mental illness was relatively low compared to other studies. The sociodemographic and clinical pattern of mental disorders are embedded in the regional and cultural settings patients find themselves and this may lead to unique or differing risk factors across study settings.

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