Retrospective Analysis of a Nationwide Telelactation Program

2021 ◽  
Vol 12 (2) ◽  
pp. 91-100
Author(s):  
Lauren Majors ◽  
Mary Unangst
Keyword(s):  
Health Plan ◽  
Urgent Care ◽  
Health Clinic ◽  
Clinical Workflow ◽  
Breastfeeding Support ◽  
Star Rating ◽  
Retrospective Data Analysis ◽  
Timely Access ◽  
Visit Duration ◽  
Selection Of

BackgroundTelelactation is a modality for delivering remote clinical lactation care using telecommunications technology. Sonder Health, in partnership with Amwell, began offering synchronous video telelactation services to health plans and employer groups in 2016.MethodsWe completed a retrospective data analysis on a randomized selection of 1,087 telelactation visits covered by a health plan or employee-sponsored health plan conducted between 2016–2019. Our aim is to describe a telelactation model and review selected visits for technical modalities utilized, clinical workflow, top self-reported chief conditions, patient satisfaction, visit duration, acuity levels, alternative care options, peak visit time, visits conducted during or after business hours, and days visits took place, and discuss the potential for telelactation to bridge the gaps in timely access to IBCLC-level breastfeeding support.ResultsUsing a 5-star rating system, 95% of patients gave a 5-star rating; 52% of visits occurred outside normal business hours. Top three conditions identified: latching (31%), supply (24%), and nipple/breast pain (15%). Without access to the service, 59% reported they would have accessed an urgent care, emergency department, retail health clinic, or other office appointment; 41% reported they would have sought care “nowhere.”ConclusionsThis telelactation program provided access to skilled, comprehensive clinical lactation care and documents a strong use case for telelactation services.

Pharmacist-Driven Implementation of Outpatient Antibiotic Prescribing Algorithms Improves Guideline Adherence in the Emergency Department

2020 ◽  
pp. 089719002093097
Author(s):  
Kristin Stoll ◽  
Erik Feltz ◽  
Steven Ebert
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Guideline Adherence ◽  
Inappropriate Prescribing ◽  
Community Acquired Pneumonia ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Duration Of Therapy ◽  
Tract Infections ◽  
Selection Of

Background: Inappropriate prescribing of antibiotics has been identified as the most important modifiable risk factor for antimicrobial resistance. Objective: The purpose of this project was to improve guideline adherence and promote optimal use of outpatient antibiotics in the emergency department (ED). Methods: Prescribing algorithms for community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) were developed to integrate clinical practice guideline recommendations with local ED antibiogram data. Outcomes were evaluated through chart review of patients prescribed outpatient antibiotics by ED providers. The primary outcome was adherence to clinical practice guidelines, defined as the selection of an appropriate antibiotic agent, dose, and duration of therapy for each patient discharged. Results: When compared to patients discharged from the ED prior to algorithm implementation (N = 325), the post-implementation group (N = 353) received more antibiotic prescriptions that were completely guideline adherent (61.5% vs 11.7%, P < .00001). Post-implementation discharge orders demonstrated improvement in the selection of an appropriate agent (87.3% vs 45.5%, P < .00001), dose (91.5% vs 77.2%, P < .00001), and duration of therapy (71.1% vs 39.1%, P < .01). Additionally, fluoroquinolone prescribing rates were reduced (2.3% vs 12.3%, P < .00001). A reduction in all-cause 30-day returns to the ED or urgent care was observed (15.3% vs 21.5%, P = .036). Conclusion: Pharmacist-driven implementation of antibiotic prescribing algorithms improved guideline adherence in the outpatient treatment of CAP, SSTI, and UTI.

scholarly journals A Review on Otitis externa: An Approach to a Etiopathogenesis, Epidemiology, Clinical Features and Management Protocol

2021 ◽  
pp. 59-65
Author(s):  
Jatin Gupta ◽  
Sagar Gaurkar ◽  
Sonal Gupta
Keyword(s):  
Otitis Externa ◽  
Operative Procedure ◽  
Outer Wall ◽  
Medical Intervention ◽  
Health Clinic ◽  
Post Surgery ◽  
Operative Care ◽  
Time Period ◽  
Management Protocol ◽  
Selection Of

Introduction: The external ear is the part of our ears which is seen from outside. It is made up of the auricles (pinna) and external auditory canal; and, includes the outer wall of the middle ear, i.e. the eardrum. Otitis externa is a regular presentation when on call for ENT or at the emergency ENT health clinic or centre. Infective and reaction groups of otitis externa are classified. Methodology: The articles reviewed in this narrative review article have been traced from a variety of links and sources over the internet like PubMed, NCBI, ScienceDirect, NHSINFORM, Uptodate, WebmedCentral, American family physician, ClevelandClinic, StatPearls, and many more. References from high yielding sources were taken and the articles were properly assessed. Results: Paying attention to the scientific elements while performing an operative procedure can  give a physician extended results. Which operative modality to be chosen depends on the patient. The patient’s choices are also important in the decision making of the operation. Discussion: External otitis is possibly spotted in almost every peer category. Approximately ten percent (10%) of humans may face this condition during their lifetime. Most of the time, the infection is mixed. Medical intervention of the ear can prove painful for most cases, therefore, post-surgery analgesics must be utilized for a time period which the treating physician prescribes. The aim of curing the patient is to free him/her from the symptoms and getting rid-off any pathogen causing a specific infection. Conclusion: The efficacy of operative modalities of extremes of otitis externa will rely on complete patient examination, history and lab results. Selection of the correct intervention, proper knowlege of the regional anatomy, paying attention to scientific elements and good post-operative care is necessary. It is never easy  to avoid otitis externa, but we can make an effort to decrease the risk of developing this problem.

scholarly journals 2066. Development and Implementation of Prescribing Algorithms for Antibiotics on Discharge from the Emergency Department

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S696-S696 ◽  
Author(s):  
Kristin Stoll ◽  
Erik Feltz ◽  
Steven C Ebert
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Guideline Adherence ◽  
Community Acquired Pneumonia ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Duration Of Therapy ◽  
Tract Infections ◽  
Algorithm Implementation ◽  
Selection Of

Abstract Background In the emergency department (ED), rapid decision-making and frequent distractions are often challenging to implementing effective antimicrobial stewardship. The purpose of this project is to improve guideline adherence and promote optimal use of outpatient antibiotic therapy for community-acquired infections. Methods Prescribing algorithms were developed to integrate clinical practice guideline recommendations with emergency department-specific antibiogram data. Algorithms for treating community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), and urinary tract infections (UTI) were made available throughout the ED. Outcomes were evaluated through a chart review of patients prescribed empiric outpatient antibiotics for CAP, SSTI, or UTI by ED providers. Patients were excluded if they were <18 years old, pregnant, or taking antibiotics prior to arrival. The primary outcome was rate of adherence to clinical practice guidelines, defined as the selection of an appropriate antibiotic agent, dose, and duration of therapy for each patient discharged. Secondary outcomes included the rate of fluoroquinolone use, as well as all-cause 30-day returns to the ED or urgent care. Results When compared with patients discharged from the ED prior to algorithm implementation (N = 325), the post-implementation group (N = 172) received more antibiotic prescriptions that were completely guideline adherent (57.0% vs. 11.7%, P < 0.01). Post-implementation discharge orders demonstrated improvement in the selection of an appropriate agent (86.6% vs. 45.5%, P < 0.01), dose (89.0% vs. 77.2%, P < 0.01), and duration of therapy (63.4% vs. 39.1%, P < 0.01). Additionally, fluoroquinolone prescribing rates in this population were reduced (2.9% vs. 12.3%, P < 0.01). In the post-implementation patients who presented at least 30 days prior to analysis (N = 124), a reduction in all-cause 30-day returns to the ED or urgent care was observed (12.9% vs. 21.5%, P < 0.05). Conclusion Implementation of antibiotic prescribing algorithms improved guideline adherence in the outpatient treatment of CAP, SSTI, and UTI. By developing prescribing algorithms, pharmacists may reduce the unnecessary use of broad-spectrum antibiotics and prevent patient returns to the ED. Disclosures All authors: No reported disclosures.

scholarly journals Two Medicaid health plans’ models and motivations for improving colorectal cancer screening rates

2018 ◽  
Vol 10 (1) ◽  
pp. 68-77 ◽  
Author(s):  
Jennifer K Coury ◽  
Jennifer L Schneider ◽  
Beverly B Green ◽  
Laura-Mae Baldwin ◽  
Amanda F Petrik ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Plan ◽  
Organizational Context ◽  
Qualitative Interviews ◽  
Health Clinic ◽  
Health Plans ◽  
Implementation Challenges ◽  
Crc Screening ◽  
Health Clinics ◽  
Implementation Models

Abstract Screening rates for colorectal cancer (CRC) remain low, especially among certain populations. Mailed fecal immunochemical testing (FIT) outreach initiated by U.S. health plans could reach underserved individuals, while solving CRC screening data and implementation challenges faced by health clinics. We report the models and motivations of two health insurance plans implementing a mailed FIT program for age-eligible U.S. Medicaid and Medicare populations. One health plan operates in a single state with ~220,000 enrollees; the other operates in multiple states with ~2 million enrollees. We conducted in-depth qualitative interviews with key stakeholders and observed leadership and clinic staff planning during program development and implementation. Interviews were transcribed and coded using a content analysis approach; coded interview reports and meeting minutes were iteratively reviewed and summarized for themes. Between June and September 2016, nine participants were identified, and all agreed to the interview. Interviews revealed that organizational context was important to both organizations and helped shape program design. Both organizations were hoping this program would address barriers to their prior CRC screening improvement efforts and saw CRC screening as a priority. Despite similar motivations to participate in a mailed FIT intervention, contextual features of the health plans led them to develop distinct implementation models: a collaborative model using some health clinic staffing versus a centralized model operationalizing outreach primarily at the health plan. Data are not yet available on the models’ effectiveness. Our findings might help inform the design of programs to deliver mailed FIT outreach.

scholarly journals Urgent Care Center and Retail Health Clinic Utilization Among Adults: United States, 2019

2021 ◽  
Author(s):  
Lindsey Black ◽  
Dzifa Adjaye-Gbewonyo
Keyword(s):  
United States ◽  
Care Center ◽  
Urgent Care ◽  
Health Clinic ◽  
Urgent Care Center ◽  
The Past ◽  
Clinic Visits

This report examines urgent care center or retail health clinic visits among adults in the past 12 months by sex and selected characteristics.

scholarly journals Potemkin Protections: Assessing Provider Directory Accuracy and Timely Access for Four Specialties in California

2021 ◽  
Author(s):  
Abigail Burman ◽  
Simon F. Haeder
Keyword(s):  
Primary Care ◽  
Managed Care ◽  
Primary Care Providers ◽  
Urgent Care ◽  
Regulatory Regime ◽  
Care Providers ◽  
California Department ◽  
Care Plans ◽  
Consumer Access ◽  
Timely Access

Abstract Context: Accurate provider directories and whether consumers can schedule timely appointments are crucial determinants of health access and outcomes. We assessed whether consumers can rely on provider directories to find in-network primary care providers, cardiologists, endocrinologists, and gastroenterologists for 2018 and 2019 for all managed care plans in California and whether they can access these providers in a timely manner. Method: We used large, random, and representative surveys of provider directories for all managed care plans in California for four specialties obtained from the California Department of Managed Health Care with a total of 657,012 observations (290,711 for 2018 and 475,524 for 2019). Findings: Surveys were able to verify provider directory entries for the four specialties for 59% to 76% of listings or 78% to 88% of providers reached. Moreover, we found that consumers were able to schedule urgent care appointments for 28% to 54% of listings or 44% to 72% of appropriately listed providers. For general care appointments, the percentages ranged from 35% to 64% of listed providers or 51% to 87% of appropriately listed providers. Differences across markets were generally small related to accuracy. Medi-Cal plans outperformed other markets with regards to timely access. Primary care consistently outperformed all other specialties. Timely access rates were higher for general appointments than for urgent care appointments. Conclusions: Despite the fact that California is one of the most active and well-resourced regulators in the nation, we found concerning results for consumers when it comes to locating in-network providers and gaining timely access. This raises questions about the regulatory regime as well as consumer access and health outcomes.

Preferences for rapid point-of-care HIV testing in Nova Scotia, Canada

Sexual Health ◽  
2013 ◽  
Vol 10 (2) ◽  
pp. 124 ◽  
Author(s):  
Nathaniel M. Lewis ◽  
Jacqueline C. Gahagan ◽  
Carlye Stein
Keyword(s):  
Nova Scotia ◽  
North America ◽  
Hiv Testing ◽  
Point Of Care ◽  
Urban Environments ◽  
Health Clinic ◽  
Test Results ◽  
Community Based ◽  
Hiv Test ◽  
Timely Access

Rapid point-of-care (POC) testing for HIV has been shown to increase the uptake of testing, rates of clients receiving test results, numbers of individuals aware of their status and timely access to care for those who test positive. In addition, several studies have shown that rapid POC testing for HIV is highly acceptable to clients in a variety of clinical and community-based health care settings. Most acceptability studies conducted in North America, however, have been conducted in large, urban environments where concentrations of HIV testing sites and testing innovations are greatest. Using a survey of client preferences at a sexual health clinic in Halifax, Nova Scotia, we suggest that HIV test seekers living in a region outside of Canada’s major urban HIV epicentres find rapid POC testing highly acceptable. We compare the results of the Halifax survey with existing acceptability studies of rapid POC HIV testing in North America and suggest ways in which it might be of particular benefit to testing clients and potential clients in Nova Scotia and other regions of Canada that currently have few opportunities for anonymous or rapid testing. Overall, we found that rapid POC HIV testing was highly desirable at this study site and may serve to overcome many of the challenges associated with HIV prevention and testing outside of well-resourced metropolitan environments.

scholarly journals 969. Antibiotic Prescribing in a Large Retail Health Clinic Chain: Opportunities for Stewardship

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S32-S33
Author(s):  
Katherine E Fleming-Dutra ◽  
Laura M King ◽  
Safia Boghani ◽  
Lauri Hicks ◽  
John Hou ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Respiratory Infections ◽  
Acute Otitis Media ◽  
Adult Patients ◽  
Urgent Care ◽  
Health Clinic ◽  
Antibiotic Prescribing ◽  
First Line

Abstract Background Retail health is a growing outpatient setting. Research using claims data found that antibiotics were linked with 46% of urgent care, 17% of medical office, and 14% of retail health visits for acute respiratory infections (ARIs) for which antibiotics are not needed. We aimed to quantify antibiotic prescribing rates to adult patients in a large retail health clinic chain using electronic health records and to identify future stewardship targets. Methods We included visits by adults ≥18 years to network retail health clinics from 2012 to 2016. We classified diagnoses by ICD codes. We calculated the percent of visits with systemic antibiotics prescribed among all visits, by individual diagnosis, and for ARIs as a group (e.g., pneumonia, sinusitis, pharyngitis, acute otitis media [AOM], bronchitis, and viral upper respiratory infections [URI]). We also assessed the percent of visits for sinusitis and pharyngitis with first-line antibiotics prescribed. Results Of 2,893,413 visits by adults during 2012–2016, 1,866,145 (66%) resulted in antibiotic prescriptions. ARIs accounted for 2,039,423 (72%) of visits and 1,475,069 (79%) of antibiotic prescriptions. The most common diagnoses regardless of antibiotic prescription were sinusitis (31% of visits), pharyngitis (15%, of which 81% were coded as streptococcal pharyngitis), urinary tract infection (9%), viral URI (8%), AOM (7%), and bronchitis (5%). Antibiotics were frequently prescribed for sinusitis, urinary tract infection, pharyngitis, and AOM but not for viral URI and bronchitis (Figure 1). First-line antibiotics were prescribed in the majority of sinusitis and pharyngitis visits (Figure 2). Conclusion ARIs are major drivers of visits by adult patients and of antibiotic prescribing to adults in this retail clinic network. Inappropriate antibiotic use was low in this setting for viral URI and bronchitis and first-line antibiotic selection was high for sinusitis and pharyngitis, although additional opportunities for improvement exist. Future antibiotic stewardship efforts may target examining adherence to guideline-recommended diagnostic criteria for sinusitis, AOM, and pharyngitis and increasing use of watchful waiting for sinusitis and AOM. Disclosures All Authors: No reported Disclosures.

Preventing 30-day readmissions for patients with cancer: A root-cause analysis.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 226-226
Author(s):  
Manan P Shah ◽  
Irena Tan ◽  
Sarah K. Garrigues ◽  
Jennifer Hansen ◽  
Douglas W. Blayney ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Academic Medical Center ◽  
Root Cause Analysis ◽  
Urgent Care ◽  
Cancer Center ◽  
Cause Analysis ◽  
Patients With Cancer ◽  
Root Cause ◽  
Timely Access ◽  
Key Drivers

226 Background: The high rate of unplanned 30-day readmissions for patients with cancer is a significant driver of costs and a marker of poor quality. In this study, we analyzed 30-day readmissions at our cancer center to determine causality and propose key drivers to prevent them. Methods: Patients with known cancer who were readmitted to our academic medical center within 30 days of a previous hospitalization were identified in our electronic health record by a third-party algorithm. Among patients with hematologic malignancies, only those undergoing bone marrow transplant care were included. Surveys querying causality and preventability of the readmissions were sent to the patients’ attending oncologists. Electronic chart documentation of readmissions were reviewed by two investigators to assess causality and preventability of each readmission. Results were discussed in focus groups to determine key drivers to prevent 30-day readmissions. Results: 437 readmissions were identified between 9/1/19 and 8/31/20, and 182 readmissions with corresponding surveys completed by their oncologists were identified (Table). Based on survey responses, 30 (16%) of the 182 readmissions were preventable, whereas based on our review, 56 (31%) were preventable. The top three causes of the 56 preventable readmissions were: underutilized ambulatory care (43%), premature discharge (23%), and goals of care discordance (16%). For underutilized ambulatory care, the primary treatments provided during those readmissions were: procedures such as thoracentesis and paracentesis (42%), medication administration for pain or nausea (33%), and infusions or transfusions (25%). Notably, most of these patients either did not attempt to seek outpatient care (42%) or were not able to secure an ambulatory appointment (29%) prior to their readmission. Through focus group discussions, we found that the key drivers to reduce preventable 30-day readmissions at our institution are (1) timely access to outpatient pleural effusion and ascites management, (2) timely access to ambulatory management of cancer-related symptoms (e.g., pain, nausea, weakness), (3) increased systems-wide awareness and utility of avenues of urgent care, and (4) increased palliative care efforts in patients with readmissions. Conclusions: Systematic review of 30-day readmissions revealed a greater than anticipated portion of preventable readmissions. Root-cause analysis yielded key drivers to reduce 30-day readmissions at our cancer center.[Table: see text]

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