scholarly journals Effectiveness of A 24-h Access Outpatient Clinic for Patients with Chronic Conditions in Hospital Outpatient Follow-Up: A Registry-Based Controlled Cohort Study of Healthcare Utilisation and Mortality

2020 ◽  
Author(s):  
Anders Damgaard Møller Schlünsen ◽  
David Høyrup Christiansen ◽  
Ulrich Fredberg ◽  
Peter Vedsted
Keyword(s):  
General Practice ◽  
Cohort Study ◽  
Outpatient Clinic ◽  
Chronic Conditions ◽  
Healthcare Utilisation ◽  
Regional Hospital ◽  
Hospital Outpatient ◽  
Outpatient Visits ◽  
Hospital Outpatient Clinic

Abstract Background: In 2015, Regional Hospital Silkeborg in Denmark introduced a 24-h telephone access hospital outpatient clinic (24-h access clinic). The 24-h access clinic allowed patients to call the hospital outpatient clinic in case of an exacerbation of symptoms. The aim of this study was to evaluate the effectiveness of a 24-h access clinic in terms of healthcare utilisation and mortality in patients with chronic conditions.Methods: This study was designed as a registry-based controlled cohort study. The 24-h access clinic was established at Silkeborg Regional Hospital in Central Denmark Region, and the five other regional hospitals served as comparison hospitals. We included patients in hospital outpatient follow-up with chronic obstructive pulmonary disease, congestive heart failure, atrial fibrillation/flutter, inflammatory bowel disease and chronic liver disease. Outcomes were hospital admissions, length of stay (LOS), intensive care unit assistance and outpatient visits, contacts to general practice, municipal home nursing and all-cause mortality. Follow-up was 18 months.Results: The study included 992 24-h access patients and 3,878 usual care patients. For the five conditions combined, the 24-h access patients had fewer all-cause admissions (incidence rate ratio (IRR) = .81, 95% confidence interval (Cl) = .71 to .92), general practice out-of-hours contacts (IRR = .81, CI = .71 to .92) and shorter LOS (IRR = .71, CI = .57 to .88), but the rate of all-cause outpatient visits was higher (IRR = 1.07, CI = .99 to 1.15). General practice daytime contacts were similar between the groups, and there was no significant difference in mortality.Conclusions: A 24-h access clinic reduced acute admissions and LOS compared to usual outpatient care. Planned outpatient visits increased and substituted unplanned acute care, thus enhancing integration of care by allowing for access to the correct level of care and ensuring continuity of care.

scholarly journals Patient characteristics and healthcare utilisation among Danish patients with chronic conditions: a nationwide cohort study in general practice and hospitals

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Anders Damgaard Møller Schlünsen ◽  
David Høyrup Christiansen ◽  
Ulrich Fredberg ◽  
Peter Vedsted
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
General Practice ◽  
Chronic Conditions ◽  
Healthcare Utilisation ◽  
Patient Characteristics ◽  
Chronic Obstructive ◽  
Healthcare Resources ◽  
Obstructive Pulmonary Disease ◽  
Hospital Outpatient

Abstract Background The complexity of caring for patients with chronic conditions necessitates new models of integrated care to accommodate an increasing demand. To inform the development of integrated care models, it is essential to map patients’ use of healthcare resources. In this nationwide registry-based cohort study, we describe and compare patient characteristics and healthcare utilisation between Danish patients with chronic conditions in general practice follow-up and in hospital outpatient follow-up. Methods On 1 January 2016, we identified 250,402 patients registered in 2006–2015 with a hospital diagnosis of atrial fibrillation/flutter, congestive heart failure, chronic liver disease, inflammatory bowel disease or chronic obstructive pulmonary disease. By linkage to national social and health registries, patient characteristics and 12-month healthcare utilisation were extracted. Incidence rates of health care utilisation were compared between patients with chronic conditions in general practice follow-up and patients in hospital outpatient follow-up using negative binomial regression. Results Across all five conditions, the largest proportions of patients were in general practice follow-up (range = 59–87%). Patients in hospital outpatient follow-up had higher rates of exacerbation-related admissions (adjusted incidence rate ratio (IRR) range = 1.3 to 2.8) and total length of stay (IRR range = 1.2 to 2.2). For these five conditions, all-cause admissions and lengths of stay, general practice daytime and out-of-hours contacts, and municipal home nursing contacts were similar between follow-up groups or higher among patients in general practice follow-up. The exception was patients with chronic obstructive pulmonary disease, where patients in hospital outpatient follow-up had higher utilisation of healthcare resources. Conclusions Patients in general practice follow-up accounted for the largest proportion of total healthcare utilisation, but patients in hospital outpatient follow-up were characterised by high exacerbation rates. Enhanced integration of chronic care may be of most benefit if patients in general practice follow-up are targeted, but it is also likely to have an impact on exacerbation rates among patients in hospital outpatient follow-up.

Patients with shoulder pain referred to specialist care; treatment, predictors of pain and disability, emotional distress, main symptoms and sick-leave: a cohort study with a six-months follow-up

2020 ◽  
Vol 20 (4) ◽  
pp. 775-783
Author(s):  
Kaia B. Engebretsen ◽  
Jens Ivar Brox ◽  
Niels Gunnar Juel
Keyword(s):  
Clinical Trials ◽  
Cohort Study ◽  
Sick Leave ◽  
Shoulder Pain ◽  
Emotional Distress ◽  
Outpatient Clinic ◽  
Treatment Duration ◽  
Specialist Care ◽  
Yellow Flags

AbstractObjectivesRecommendations for referral of patients with shoulder pain from primary to specialist care are mainly clinical. Several patients are referred without meeting these criteria for referral, whereas some are referred for a second opinion although surgery is not recommended. The aims of this study were to describe a shoulder pain cohort in specialist healthcare according to demographic data, clinical, and psychological factors; evaluate changes in pain and disability, distress and main symptoms from baseline to six-month follow-up; and to assess predictors of pain and disability, changes in the main symptoms and sick-leave at six-months. Results were compared to previous randomised trials conducted at the same clinic in patients with subacromial shoulder pain.MethodsThis prospective study included 167 patients from an outpatient clinic in specialist healthcare with shoulder pain for more than 6 weeks. Clinical (pain duration, intensity, pain sites), sociodemographic (age, gender, educational level, work status) and psychological variables (emotional distress (HSCL-10), fear of pain, screening of “yellow flags”, health-related quality of life) were collected. Shoulder pain and disability (SPADI-score) were assessed and the patients were asked about their outcome expectation and to predict their status of their shoulder problem the next month. They underwent a clinical interview, a clinical assessment of shoulder function and orthopaedic tests for diagnostic purposes. After six months they received a questionnaire with main variables.ResultsOf the 167 patients (55% women), 50% had symptoms for more than 12 months and 37 (22%) were on sick-leave. Characteristics were in general comparable to patients previously included in clinical trials at the same department. The SPADI-score was 46 (23) points. Mean emotional distress was within the normal range (1.7 (SD 0.6)). More than 80% had received treatment before, mainly physiotherapy in addition to the GPs treatment. One hundred and thirty-seven patients (82%) were re-referred to physiotherapy, 74 (44%) in the outpatient clinic specialist healthcare, and 63 (38%) in primary care. One hundred and eighteen (71%) answered the follow-up questionnaire. Mean change in SPADI-score was 10.5 points (95% CI (6.5–14.5)), and 29% of the patients improved more than the smallest detectable difference (SDD). The percentage sick-listed was 19.5%, and mean change in main symptoms (−9 to +9) was 3.4 (SD 3.9). The subgroup of patients receiving physiotherapy in outpatient specialist care did not show any significant change in the main variables. The prediction models suggested that a lower level of education, more fear of pain and a high baseline SPADI-score, predicted a higher SPADI-score at follow-up. A high baseline HSCL-10 score was the only significant predictor for a high HSCL-10 score. At follow-up, less pain at rest predicted more change in main symptoms and more yellow flags (a higher score on the Örebro screening test) predicted sick-leave.ConclusionsWithin the limitations of a cohort study, patients with persistent shoulder pain referred to an outpatient specialist clinic had similar baseline characteristics but shorter treatment duration, inferior clinical results and predictors somewhat different compared with previous clinical trials conducted at the same clinic. The study raises some questions about the effectiveness of the routines in daily clinical practice, the selection of patients, the treatment duration and content.

Is Acupuncture for Pain Relief in General Practice Cost-Effective?

1999 ◽  
Vol 17 (2) ◽  
pp. 97-100 ◽  
Author(s):  
Steven Lindall
Keyword(s):  
General Practice ◽  
Pain Relief ◽  
Acupuncture Treatment ◽  
Cost Effective ◽  
Total Saving ◽  
Hospital Outpatient ◽  
The Cost ◽  
Lost To Follow Up ◽  
Practice Cost

Sixty-five selected patients with pain, mainly of musculo-skeletal origin, were offered treatment by a qualified medical acupuncturist in his general practice surgery as an alternative to hospital outpatient referral. The patients assessed their own outcomes on a digital scale: there were 46 successful treatments and 14 failures, with 5 being lost to follow up. The cost of acupuncture treatment was compared to that of the referral that would have been made if acupuncture had not been offered. The acupuncture was found to have cost £10,943 against a minimum likely cost for hospital referrals of £26,783. A minimum total saving for all 60 patients of £13,916 was determined, giving an average saving per patient of £232. Additional hidden savings through avoiding further hospital procedures and expenditure on medication were not taken into account. It is concluded that acupuncture in selected patients and when used by an appropriately qualified practitioner appears to be a cost-effective therapy for use in general practice, reducing the need for more expensive hospital referrals.

scholarly journals Stroke follow-up in primary care: a Norwegian modelling study on the implications of multimorbidity for guideline adherence

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Rune Aakvik Pedersen ◽  
Halfdan Petursson ◽  
Irene Hetlevik
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Guideline Adherence ◽  
Medical Records ◽  
Chronic Conditions ◽  
Acute Treatment ◽  
Stable State ◽  
Stroke Survivors ◽  
National Guidelines

Abstract Background Specialized acute treatment and high-quality follow-up is meant to reduce mortality and disability from stroke. While the acute treatment for stroke takes place in hospitals, the follow-up of stroke survivors largely takes place in general practice. National guidelines give recommendations for the follow-up. However, previous studies suggest that guidelines are not sufficiently adhered to. It has been suggested that this might be due to the complexity of general practice. A part of this complexity is constituted by patients’ multimorbidity; the presence of two or more chronic conditions in the same person. In this study we investigated the extent of multimorbidity among stroke survivors residing in the communities. The aim was to assess the implications of multimorbidity for the follow-up of stroke in general practice. Methods The study was a cross sectional analysis of the prevalence of multimorbidity among stroke survivors in Mid-Norway. We included 51 patients, listed with general practitioners in 18 different clinics. The material consists of the general practitioners’ medical records for these patients. The medical records for each patient were reviewed in a search for diagnoses corresponding to a predefined list of morbidities, resulting in a list of chronic conditions for each participant. These 51 lists were the basis for the subsequent analysis. In this analysis we modelled different hypothetical patients and assessed the implications of adhering to all clinical guidelines affecting their diseases. Result All 51 patients met the criteria for multimorbidity. On average the patients had 4.7 (SD: 1.9) chronic conditions corresponding to the predefined list of morbidities. By modelling implications of guideline adherence for a patient with an average number of co-morbidities, we found that 10–11 annual consultations with the general practitioner were needed for the follow-up of the stable state of the chronic conditions. More consultations were needed for patients with more complex multimorbidity. Conclusions Multimorbidity had a clear impact on the basis for the follow-up of patients with stroke in general practice. Adhering to the guidelines for each condition is challenging, even for patients with few co-morbidities. For patients with complex multimorbidity, adhering to the guidelines is obviously unmanageable.

Variables associated with the risk of suicide in patients with chronic pain seen in a hospital outpatient clinic in Bogotá☆

2013 ◽  
Vol 41 (4) ◽  
pp. 267-273
Author(s):  
Ana Carolina Amaya Arias ◽  
Angie Bruce ◽  
Deisy Herrán ◽  
Angie Martín Arango ◽  
Katherine Muñoz ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Outpatient Clinic ◽  
Hospital Outpatient ◽  
Hospital Outpatient Clinic

Perspectivas de aprendizagem na consulta para clientes renais e cuidadores: estudo fenomenológico

2019 ◽  
Vol 17 (1) ◽  
pp. 6
Author(s):  
Harlon França de Menezes ◽  
Ann Mary Machado Tinoco Feitosa Rosas ◽  
Alessandra Conceição Leite Funchal Camacho ◽  
Flávia Silva de Souza ◽  
Benedita Maria Rêgo Deusdará Rodrigues ◽  
...  
Keyword(s):  
Qualitative Research ◽  
Outpatient Clinic ◽  
Rio De Janeiro ◽  
Public Hospital ◽  
Face To Face ◽  
Hospital Outpatient ◽  
Hospital Outpatient Clinic ◽  
The Social ◽  
The Face ◽  
Social Phenomenology

Aim: Understanding the repercussions of the educational actions of the nursing consultation on the life of chronic kidney patients and their caregivers. Methods: Qualitative research, using the Social Phenomenology reference. Open-ended interviews with 12 patients and their 12 caregivers were conducted in a public hospital outpatient clinic in Rio de Janeiro, Brazil, in 2016. Results: The analysis of the participants' testimonies allowed the elaboration of two concrete categories of the experience lived concerning the reasons "why": Sum of learning lived by the sick and those who care also learn. Conclusion: The importance of the perspectives of chronic kidney patients and their caregivers for the design of educational actions stands out in the face-to-face interaction, in the shared approach and the approximation of the nurse

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