scholarly journals Increased Urgent Care Center Visits among Southeast European Migrants. A Retrospective, Controlled Trial from Switzerland

2018 ◽  
Author(s):  
Jolanta Klukowska-Rötzler ◽  
Maria Eracleous ◽  
Martin Müller ◽  
David S. Srivastava ◽  
Gert Krummrey ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Controlled Trial ◽  
Care Center ◽  
Population Level ◽  
Urgent Care ◽  
Southeast Europe ◽  
Swiss Population ◽  
Working Age ◽  
Triage Level

BACKGROUND: We investigated whether immigrants from Southeast Europe (SE) and Swiss patients have different reasons for visiting the emergency department (ED). METHODS: Our retrospective data analysis for the years 2013-2017 describes the pattern of ED consultations for immigrants from SE living in Switzerland (Canton Bern), in comparison with Swiss nationals, with a focus on type of referral and reason for admission. RESULTS: A total of 153,320 Swiss citizens and 12,852 immigrants from SE were included in the study. The mean age was 51.30 (SD=21.13) years for the Swiss patients and 39.70 (SD=15.87) years for the SE patients. For some countries of origin (Albania, Bosnia and Herzegovina, and Turkey), there were highly statistically significant differences in sex distribution with the predominance for male. SE immigrants had a greater proportion of patients in the lower triage level (level 3: SE: 67.3% vs. Swiss: 56.0%) and a greater proportion of patients in the high triage level than the Swiss population (level 1: SE: 3.4% vs. Swiss: 8.8%,). SE patients of working age (16-65 years) were six times more often admitted by ambulance than older (≥65 years) SE patients, whereas in the Swiss population this ratio was similar. In both groups, fast track service was primarily used for patients of working age (<65) and more than three times more often in the SE than the Swiss group (SE: 39.1%, Swiss: 12.6%). CONCLUSION: We identified some indications in access to primary care in Emergency Department for immigrants highlighting the need for attention to the role of organizational characteristics of primary health care in the Switzerland. The authors have highlighted the need for professional support to improve the quality of healthcare for immigrants. In the future, more primary care services and general practitioners will need to be provided with a migrant background.

scholarly journals Increased Urgent Care Center Visits by Southeast European Migrants: A Retrospective, Controlled Trial from Switzerland

2018 ◽  
Vol 15 (9) ◽  
pp. 1857 ◽  
Author(s):  
Jolanta Klukowska-Röetzler ◽  
Maria Eracleous ◽  
Martin Müller ◽  
David Srivastava ◽  
Gert Krummrey ◽  
...  
Keyword(s):  
Primary Care ◽  
Controlled Trial ◽  
Care Center ◽  
Population Level ◽  
Quality Of Healthcare ◽  
Urgent Care ◽  
Southeast Europe ◽  
Swiss Population ◽  
Working Age ◽  
Triage Level

We investigated whether immigrants from Southeast Europe (SE) and Swiss patients have different reasons for visiting the emergency department (ED). Our retrospective data analysis for the years 2013–2017 describes the pattern of ED consultations for immigrants from SE living in Switzerland (Canton Bern), in comparison with Swiss nationals, with a focus on type of referral and reason for admission. A total of 153,320 Swiss citizens and 12,852 immigrants from SE were included in the study. The mean age was 51.30 (SD = 21.13) years for the Swiss patients and 39.70 (SD = 15.87) years for the SE patients. For some countries of origin (Albania, Bosnia and Herzegovina, and Turkey), there were highly statistically significant differences in sex distribution, with a predominance of males. SE immigrants had a greater proportion of patients in the lower triage level (level 3: SE: 67.3% vs. Swiss: 56.0%) and a greater proportion of patients in the high triage level than the Swiss population (level 1: SE: 3.4% vs. Swiss: 8.8%). SE patients of working age (16–65 years) were six times more often admitted by ambulance than older (≥65 years) SE patients, whereas this ratio was similar in the Swiss population. In both groups, the fast track service was primarily used for patients of working age (<65) and more than three times more often in the SE than the Swiss group (SE: 39.1%, Swiss: 12.6%). We identified some indications for access to primary care in emergency departments for immigrants and highlighted the need for attention to the role of organizational characteristics of primary health care in Switzerland. We highlighted the need for professional support to improve the quality of healthcare for immigrants. In the future, we will need more primary care services and general practitioners with a migrant background.

Finding the path of least resistance: Locally adapting the MITIGATE toolkit in emergency departments and urgent care centers

2021 ◽  
pp. 1-3
Author(s):  
Joanne Huang ◽  
Zahra Kassamali Escobar ◽  
Todd S. Bouchard ◽  
Jose Mari G. Lansang ◽  
Rupali Jain ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Emergency Departments ◽  
Urgent Care ◽  
Complex Data ◽  
University Of Washington ◽  
Primary Care Clinics ◽  
Urgent Care Centers ◽  
The University

Abstract The MITIGATE toolkit was developed to assist urgent care and emergency departments in the development of antimicrobial stewardship programs. At the University of Washington, we adopted the MITIGATE toolkit in 10 urgent care centers, 9 primary care clinics, and 1 emergency department. We encountered and overcame challenges: a complex data build, choosing feasible outcomes to measure, issues with accurate coding, and maintaining positive stewardship relationships. Herein, we discuss solutions to challenges we encountered to provide guidance for those considering using this toolkit.

scholarly journals Evaluation of a Health Information Technology–Enabled Collective Intelligence Platform to Improve Diagnosis in Primary Care and Urgent Care Settings: Protocol for a Pragmatic Randomized Controlled Trial

10.2196/13151 ◽  
2019 ◽  
Vol 8 (8) ◽  
pp. e13151 ◽  
Author(s):  
Valy Fontil ◽  
Elaine C Khoong ◽  
Mekhala Hoskote ◽  
Kate Radcliffe ◽  
Neda Ratanawongsa ◽  
...  
Keyword(s):  
Primary Care ◽  
San Francisco ◽  
Collective Intelligence ◽  
Controlled Trial ◽  
Urgent Care ◽  
Diagnostic Process ◽  
Diagnostic Confidence ◽  
Digital Tool ◽  
Diagnostic Uncertainty ◽  
Randomized Controlled

Background Diagnostic error in ambulatory care, a frequent cause of preventable harm, may be mitigated using the collective intelligence of multiple clinicians. The National Academy of Medicine has identified enhanced clinician collaboration and digital tools as a means to improve the diagnostic process. Objective This study aims to assess the efficacy of a collective intelligence output to improve diagnostic confidence and accuracy in ambulatory care cases (from primary care and urgent care clinic visits) with diagnostic uncertainty. Methods This is a pragmatic randomized controlled trial of using collective intelligence in cases with diagnostic uncertainty from clinicians at primary care and urgent care clinics in 2 health care systems in San Francisco. Real-life cases, identified for having an element of diagnostic uncertainty, will be entered into a collective intelligence digital platform to acquire collective intelligence from at least 5 clinician contributors on the platform. Cases will be randomized to an intervention group (where clinicians will view the collective intelligence output) or control (where clinicians will not view the collective intelligence output). Clinicians will complete a postvisit questionnaire that assesses their diagnostic confidence for each case; in the intervention cases, clinicians will complete the questionnaire after reviewing the collective intelligence output for the case. Using logistic regression accounting for clinician clustering, we will compare the primary outcome of diagnostic confidence and the secondary outcome of time with diagnosis (the time it takes for a clinician to reach a diagnosis), for intervention versus control cases. We will also assess the usability and satisfaction with the digital tool using measures adapted from the Technology Acceptance Model and Net Promoter Score. Results We have recruited 32 out of our recruitment goal of 33 participants. This study is funded until May 2020 and is approved by the University of California San Francisco Institutional Review Board until January 2020. We have completed data collection as of June 2019 and will complete our proposed analysis by December 2019. Conclusions This study will determine if the use of a digital platform for collective intelligence is acceptable, useful, and efficacious in improving diagnostic confidence and accuracy in outpatient cases with diagnostic uncertainty. If shown to be valuable in improving clinicians’ diagnostic process, this type of digital tool may be one of the first innovations used for reducing diagnostic errors in outpatient care. The findings of this study may provide a path forward for improving the diagnostic process. International Registered Report Identifier (IRRID) DERR1-10.2196/13151

scholarly journals Guideline Adherence and Antibiotic Utilization by Community Pediatricians, Private Urgent Care Centers, and a Pediatric Emergency Department

2019 ◽  
Vol 59 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Shamim Islam ◽  
Mary Kathryn Mannix ◽  
Ryan K. Breuer ◽  
Amanda B. Hassinger
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
New York ◽  
Otitis Media ◽  
Pediatric Emergency ◽  
Urgent Care ◽  
Medical Society ◽  
Pediatric Emergency Department ◽  
Antibiotic Utilization ◽  
Urgent Care Centers

Pediatric antibiotic prescriptions originate from an increasingly broad range of ambulatory settings. In this retrospective study, pharyngitis, otitis media, sinusitis, pneumonia, and upper respiratory infection cases, at 11 primary care offices, 2 independent urgent care centers (UCCs), and a pediatric emergency department in Western New York, were analyzed relative to medical society practice guidelines and antibiotic utilization. Of 2358 eligible visits across all sites, 25% were for study diagnoses, with 38% at UCC ( P < .01). Across all sites, 26% of pharyngitis cases given antibiotics did not have diagnostic evidence of bacterial infection. At primary care offices and UCCs, guideline recommended first-line agents for pharyngitis and otitis media were used in only 58% and 63% of treated cases, respectively. Overall, an estimated 9855 to 12 045 avoidable antibiotic and 8030 non-guideline antibiotic courses annually are represented by the 14 sites studied. These and other study findings highlight numerous opportunities for outpatient pediatric antibiotic stewardship.

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