scholarly journals Aging, patient-bed management and overcrowding in the medical departments

2013 ◽  
pp. 35-43
Author(s):  
Aldina Gardellini ◽  
Roberto Nardi ◽  
Vincenzo Arienti ◽  
Domenico Panuccio ◽  
Raffaella Bernardi ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Patient Flow ◽  
Local Health Authority ◽  
Local Health ◽  
Community Resources ◽  
Term Care ◽  
Frequent Users ◽  
Bed Management ◽  
The Impact

BACKGROUND Hospital overcrowding (HO) profoundly affects the whole hospital system, reducing productivity and efficiency. The aging population and the increased prevalence of chronic-degenerative diseases, susceptible to acute exacerbations, make the elderly as frequent users of the emergency room (ER). There is a general agreement that the current disease-oriented and episodic model of care does not adequately cope with the complex needs of older patients. Hospital admission and discharge do not sufficiently link with primary care and other community resources, such as long-term care facilities and outpatient clinics. AIM OF THE STUDY To evaluate, using a simple dedicated software, the activity data of nine hospitals of Local Health Authority of Bologna (Italy) (ER accesses, hospital admissions, average length of stay – LOS) and the impact of a patient and bed management net in which managers, doctors and nurses share their operational skills to improve patient flow in medical and geriatric wards. RESULTS Data show that 24% ER accesses concern people > 75 years old; 51% admissions concern people > 75 years old; half of these admissions are from ER frequent users (FU = ≥ 3 ER accesses/ year). Only 15% admissions of younger people are from ER frequent users. Each of > 75 years old frequent users produces an average of 2 admissions/year. At the end of the first year of this experience, ER accesses and admissions rose more than 8%. In our model of bed-management (patient and bed management net-software matching hospital capacity with admission, escalation measures) LOS was shortened by an average 0.5-1 day to a range from 0,5 to 1 day. DISCUSSION HO is due to mismanagement of chronic diseases (CD). Further actions are needed in primary health care to avoid unscheduled hospital due to CD. Applications for admission to hospital should be administered in the real context of the needs, developing both measures to face the contingent situation (setting temporary additional beds in one of the highest step of escalation measures) and post-discharge case management for selected “high risk-FU” patient profiles. CONCLUSIONS Our experience shows that an organizational model with a simple software is effective only to manage patient flow for relative small variations. Biggest peak of admissions requires strong link with primary care and other community resources, by systemic administration of health, particularly in frail people, with not scheduled hospital readmissions, for which hospital-centred care is not ever the best choice. Further research in initial ER assessment of FU is needed, by an identification of the high risk patient’s profile and its appropriate setting allocation.

scholarly journals The impact of integrated disease management in high-risk COPD patients in primary care

2019 ◽  
Vol 29 (1) ◽  
Author(s):  
Madonna Ferrone ◽  
◽  
Marcello G. Masciantonio ◽  
Natalie Malus ◽  
Larry Stitt ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Disease Management ◽  
Integrated Disease Management ◽  
Copd Patients ◽  
The Impact

scholarly journals How primary care and public health interact in local health contracts in France?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M s Kendir ◽  
Mr Le Bodo ◽  
M r Breton ◽  
M r Bourgueil
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Access To Care ◽  
Health Care Services ◽  
Local Level ◽  
Rapid Decline ◽  
Local Health ◽  
Epidemiological Changes ◽  
The Impact ◽  
Primary Care Professionals

Abstract The demographic and epidemiological changes orient health care services towards communities with a focus on prevention and health promotion. Moreover, in France, the rapid decline of General Practitioners affect access to care in certain areas. Thus, it has made a call for interaction of primary care (PC) services and public health which can be strengthened by the actions at the local level. In 2009, the local health contracts (Contract local de santé; CLS) were developed to foster collaborative actions on the social determinants of health and to improve access to care. Considering the critical contribution of PC in these issues, one may ask how CLS mobilized PC and facilitate linkages between actions oriented toward population and primary care. The objective of this ancillary study (part of the CloterreS project), is to explore how often and how CLS involve PC in access to care and public health related actions. A mixed-method study based on document analysis, with a random sample of 17 CLSs (N = 165) from all French regions, was developed. A quantitative analysis of the 440 forms identified in 17 CLS computed frequency of involvement of PC actors and/or PC organizations and a qualitative analysis defined typology of interactions. All CLS and 20.1% (n = 86) of the forms involved PC actors and 43.2% (n = 185) concerned access to care. Of the access to care forms, 35.7% (n = 66) concerned PC. The most common strategies related to actions on the health workforce and on planning of services. The role of primary care professionals was as the target of the action and rarely as leader and partner. PC, mostly GP’s involvement, had a big place and access to care was at the core of local health contracts. The impact of CLS as an instrument to invite interaction public health and healthcare at the local level should be further assessed. Key messages Many of the local access to care actions involved primary care professionals. The local level appears strategic to integrate public health and health services yet more evidence is needed on its role.

scholarly journals The impact of long-term care on primary care doctor consultations for people over 75 years

2018 ◽  
Vol 20 (3) ◽  
pp. 375-387 ◽  
Author(s):  
Julien Forder ◽  
Katerina Gousia ◽  
Eirini-Christina Saloniki
Keyword(s):  
Primary Care ◽  
Long Term Care ◽  
Primary Care Doctor ◽  
Term Care ◽  
The Impact

scholarly journals General practitioner attitudes and confidence to deprescribing for elderly patients

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Pier Riccardo Rossi ◽  
Sarah E. Hegarty ◽  
Vittorio Maio ◽  
Marco Lombardi ◽  
Andrea Pizzini ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Real Life ◽  
Care Physician ◽  
Local Health Authority ◽  
Local Health ◽  
Cross Sectional Survey ◽  
Patient Centered ◽  
Cross Sectional ◽  
Factors Affecting

Deprescribing is a patient-centered process of medication withdrawal intended to achieve improved health outcomes through discontinuation of one or more medications that are either potentially harmful or no longer required. The objective of this study was to assess the perceptions of primary care physicians on deprescribing and potential barriers to deprescribing in the Local Health Authority (LHA) of Turin, Piedmont, Italy. Secondary objective was to evaluate educational needs of primary care physician. Cross sectional survey of primary care physicians working in the LHA of Turin, Piedmont, Italy. 439 GPs (71.3% of the total number of primary care physicians) attended an educational session related to deprescribing and were asked to anonymously answer a paper survey. Participants were asked to complete a previously published questionnaire about deprescribing and potential factors affecting the deprescribing process. A correlation coefficient was calculated to assess the association between physicians’ confidence in deprescribing and attitudes or barriers associated with deprescribing. Many GPs (71%) reported general confidence in their ability to deprescribe. Most respondents (83%) reported they were comfortable deprescribing preventive medications, however almost half expressed doubts regarding deprescribing when medication was initially prescribed by a colleague (45%) or when patient and/or caregiver supported the opportunity to continue the assumption (49%). Around a third of doctors maintain that the absence of strong evidence supporting deprescribing prevents them from considering it (38%), that they do not have the necessary time to effectively go through the process of deprescribing (29%), and that fear of possible effects due on withdrawal prevents them from deprescribing (31%). There was no strong correlation between physicians’ confidence and attitudes or barriers associated with deprescribing. The present study confirms that general practitioners sense the importance of deprescribing and feel prepared to face it managing communication with patients and caregivers, but find barriers when enacting the practice in a real-life context.

scholarly journals Integration between Primary Care and Mental Health Services in Italy: Determinants of Referral and Stepped Care

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Paola Rucci ◽  
Antonella Piazza ◽  
Marco Menchetti ◽  
Domenico Berardi ◽  
Angelo Fioritti ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Urban Area ◽  
Mental Health Center ◽  
Shared Care ◽  
Stepped Care ◽  
Patterns Of Care ◽  
Classification And Regression Tree ◽  
Local Health Authority ◽  
Local Health

This study, carried out in the context of a collaborative care program for common mental disorders, is aimed at identifying the predictors of Primary Care Physician (PCP) referral to Community Mental Health Center (CMHC) and patterns of care. Patients with depression or anxiety disorders who had a first contact with CMHCs between January 1, 2007–December 31, 2009 were extracted from Bologna Local Health Authority database. A classification and regression tree procedure was used to determine which combination of demographic and diagnostic variables best distinguished patients referred by PCPs and to identify predictors of patterns of care (consultation, shared care, and treatment at the CMHC) for patients referred by PCPs. Of the 8570 patients, 57.4% were referred by PCPs. Those less likely to be referred by PCPs were living in the urban area, suffered from depressive disorder, and were young. As to the pattern of care, patients living in the urban area were more likely to receive shared care compared with those living in the nonurban area, while the reverse was true for consultation. Predictors of CMHC treatment were depression and young age. Prospective studies are needed to assess length, quantity, and quality of collaborative treatment for common mental disorder delivered at any step of care.

scholarly journals Out-of-hours primary care services: Demands and patient referral patterns in a Veneto region (Italy) Local Health Authority

Health Policy ◽  
2015 ◽  
Vol 119 (4) ◽  
pp. 437-446 ◽  
Author(s):  
Alessandra Buja ◽  
Roberto Toffanin ◽  
Stefano Rigon ◽  
Paolo Sandonà ◽  
Daniela Carraro ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Authority ◽  
Local Health Authority ◽  
Local Health ◽  
Veneto Region ◽  
Referral Patterns ◽  
Out Of Hours ◽  
Patient Referral ◽  
Care Services ◽  
Primary Care Services

scholarly journals The impact of interventions applied in primary care to optimize the use of laboratory tests: a systematic review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Serena Lillo ◽  
Trine Rennebod Larsen ◽  
Leif Pennerup ◽  
Steen Antonsen
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Laboratory Tests ◽  
Marked Change ◽  
Risk Of Bias ◽  
Low Risk ◽  
Order Entry ◽  
Physician Order Entry ◽  
The Impact ◽  
Made In

Abstract Laboratory tests are important tools in primary care, but their use is sometimes inappropriate. The aim of this review is to give an overview of interventions applied in primary care to optimize the use of laboratory tests. A search for studies was made in the MEDLINE and EMBASE databases. We also extracted studies from two previous reviews published in 2015. Studies were included if they described application of an intervention aiming to optimize the use of laboratory tests. We also evaluated the overall risk of bias of the studies. We included 24 studies. The interventions were categorized as: education, feedback reports and computerized physician order entry (CPOE) strategies. Most of the studies were classified as medium or high risk of bias while only three studies were evaluated as low risk of bias. The majority of the studies aimed at reducing the number of tests, while four studies investigated interventions aiming to increase the use of specific tests. Despite the studies being heterogeneous, we made results comparable by transforming the results into weighted relative changes in number of tests when necessary. Education changed the number of tests consistently, and these results were supported by the low risk of bias of the papers. Feedback reports have mainly been applied in combination with education, while when used alone the effect was minimal. The use of CPOE strategies seem to produce a marked change in the number of test requests, however the studies were of medium or high risk of bias.

scholarly journals Improving the Use of Healthcare Resources in Canadian Hospitals: The Impact of a Reintegration Unit in Expanding Acute Care Capacity and Resource Use in Sunnybrook Health Sciences Centre

2020 ◽  
Author(s):  
Ivy Cheng ◽  
G. Ross Baker ◽  
Debra Carew ◽  
Stacy Landau ◽  
Debra Walko ◽  
...  
Keyword(s):  
Service Providers ◽  
Patient Flow ◽  
Business Case ◽  
Level Of Care ◽  
Term Care ◽  
Healthcare Budget ◽  
Hospital Capacity ◽  
Alternate Level Of Care ◽  
Care Capacity ◽  
The Impact

Abstract Background: Alternate level of care (ALC) patients are those who reside in acute hospital beds but can be managed in non-hospital settings. They contribute to high occupancy levels in Canadian hospitals. Between 2017-18, Ontario spent 1.1 billion dollars on hospitalized patients waiting for alternate level of care (ALC) beds. To improve value for care, Ontario Ministry of Health (MOHLTC) invested into reintegration units which are designed to transfer ALC patients out of hospital and transition them back into the community or long-term care (LTC). Given today’s healthcare budget pressures, it is unclear if reactivation units are feasible. In 2018, the MOHLTC funded a reintegration unit, Pine Villa with an operational partner, Sunnybrook Hospital and community service providers (SPRINT Senior Care, LOFT) in Toronto, Ontario. The objective was to determine averted costs for ALC-patients and impact on Sunnybrook patient flow-through if ALC-patient Pine Villa transfers occurred on the day of ALC readiness. Methods: Retrospective, observational analysis of Sunnybrook ALC-patients discharged to Pine Villa between January 9, 2018 to February 4, 2019. From the healthcare payer’s perspective (MOHTLC), cost analysis was modelled for ALC patients designated for 1) LTC and 2) home with supports. Avoided costs at time of ALC readiness were determined by case-costing. Averted hospital ALC days were established. Results: If ALC patients were transferred to Pine Villa at time of ALC readiness for LTC, the healthcare system could have averted 5.4 million dollars from Sunnybrook. If the patients were transferred for home, 2.3 million dollars could have been averted. Both models increased acute Sunnybrook Hospital capacity by 34 beds. Conclusion: There is a business case supporting reintegration units if ALC-patients are discharged from the hospital on the day of ALC-readiness.

Neighbourhood walking tours for physicians-in-training

2020 ◽  
pp. postgradmedj-2020-138914
Author(s):  
Jeremiah Joseph Cross ◽  
Anita Arora ◽  
Benjamin Howell ◽  
Dowin Boatright ◽  
Pavithra Vijayakumar ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Participation Rate ◽  
Community Resources ◽  
Individual Level ◽  
Walking Tour ◽  
Neighbourhood Level ◽  
Patient Health ◽  
The Impact ◽  
Walking Tours

Social and economic factors have a profound impact on patient health. However, education about these factors has been inconsistently incorporated into residency training. Neighbourhood walking tours may help physician-residents learn about the social determinants of health (SDoH). We assessed the impact of a neighbourhood walking tour on physician-residents’ perceptions of SDoH, plans for counselling patients and knowledge of community resources. Using a community-based participatory research approach, in 2017 we implemented a neighbourhood walking tour curriculum for physician-residents in internal medicine, internal medicine/primary care, emergency medicine, paediatrics, combined internal medicine/paediatrics and obstetrics/gynaecology. In both pre-tour and post-tour, we asked participants to (1) rank the importance of individual-level and neighbourhood-level factors affecting patients’ health, (2) describe strategies used to improve health behaviours and (3) describe knowledge of community resources. Eighty-one physician-residents participated in walks (pre-tour surveys (93% participation rate (n=75)), and post-tour surveys (53% participation rate (n=43)). Pre-tour, the factor ranked most frequently affecting patient health was ‘access to primary care’ (67%) compared with post-tour: ‘income’ (44%) and ‘transportation’ (44%). In describing ways to improve diet and exercise, among pre-tour survey respondents, 67% discussed individual-level strategies and 16% discussed neighbourhood-level, while among post-tour survey respondents, 39% of respondents discussed individual-level strategies and 37% discussed neighbourhood-level. Percentage of respondents aware of community resources changed from 5% to 76% (p<0.001). Walking tours helped physician-residents recognise the importance of SDoH and the value of community resources, and may have broadened frameworks for counselling patients on healthy lifestyles.

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