A Descriptive Analysis of Patient Demographics at a Sports Medicine Clinic During the COVID-19 Pandemic

Objectives: Gathering of background information during a clinic visit can be time-consuming. Some medical specialties have workflows that pre-screen patients ahead of time to minimize delays. Having background information ahead of time may decrease delays and ensure that the visit is focused on physical examination, diagnosis, and treatment. We have used telemedicine to treat established patients to reduce cost and resource utilization, while maintaining high levels of patient satisfaction. It is conceivable that telemedicine could also be used to pre-screen new patients prior to their in-person clinic visit. The goal of the current study was to evaluate whether utilizing telemedicine to pre-screen new patients to our sports medicine clinic would reduce time in the exam room waiting and being seen, and overall clinic times. Methods: From June 2018 through August 2018, we utilized videoconferencing telemedicine to pre-screen all new patients to a pediatric sports medicine clinic with a chief diagnosis of knee pain. Visits were performed by full-time telemedicine pediatricians who were provided appropriate training and an intake form describing which questions should be asked. All visits utilized the American Well software platform (Boston, USA) and were performed on the patient’s personal device. During the subsequent in-person visit, the overall timing of the visit was recorded including: time checked in, time waiting in waiting room, time waiting in exam room, time spent with provider, and time-checked out, were all recorded. Similar time points were recorded for matched control patients that did not undergo telemedicine pre-screening and were seen in the traditional manner. Inclusion criteria included: being brand new to the practice and unilateral knee pain. Results: There were eight pre-screened patients and ten control patients in this cohort. Compared to controls, pre-screened patients spent less time in the exam room (19 min vs. 31 min), higher percentage of the exam room time with the provider (58% vs. 34%), higher percentage of the overall visit time with the provider (29% vs. 19.5%), and less time for the overall visit (39 min vs. 52 min). Conclusion: Pre-screening patients to obtain background information can decrease exam room waiting time and overall visit time and maximize time during the visit spent with the provider. In addition, it could potentially be used to increase throughput through the clinic and improve patient satisfaction scores.

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AB0587 ASSESSING THE CHARACTERISTICS AND MANAGEMENT OF KNEE OSTEOARTHRITIS PATIENTS WITH HYPERTENSION BY CLINICIAN SPECIALITY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.549 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1330.2-1331

Author(s):

D. Baldock ◽

E. Baynton ◽

C. F. Ng

Keyword(s):

Knee Osteoarthritis ◽

Sports Medicine ◽

Primary Care Physicians ◽

Bone Erosion ◽

Holistic Treatment ◽

Knee Oa ◽

Patient Demographics ◽

Medical Chart Review ◽

Complex Patients ◽

Minimum Number

Background:Though the pathogenesis of knee osteoarthritis (OA) is complex, patients with OA frequently have other comorbidities, including hypertension, which eludes to other considerations needed when deciding appropriate treatment management.Objectives:This study aims to examine the profiles of knee OA patients with hypertension vs. those without any comorbidities, and to elucidate key differences between these patient groups as potential areas of consideration.Methods:A multi-center, online medical chart review study of patients with OA was conducted between May – July 2020 among US rheumatologists (rheums), orthopedic surgeons (orthos), primary care physicians with a focus in sports medicine (SM PCPs), and pain specialists. Physicians recruited were screened for duration of practice in their specialty (3-50 years) and caseload (>=35 knee OA patients personally managed, at least 10 being moderate-severe). Patient charts were recorded for the next 5 eligible patients seen during the screening period. Respondents abstracted patient demographics and treatments used. Descriptive statistics were used to analyse the data.Results:260 physicians were recruited and collectively reported 796 knee OA patients; 559 were reported to experience hypertension whilst 237 were reported as not experiencing any comorbidities.Reported hypertension patients were significantly older (mean 67 vs 59 years old, respectively; p≤0.01) and weighed more (mean 82kg vs 77kg, respectively; p≤0.01) than patients without comorbidities; they were also significantly more likely to be previous smokers compared to those without comorbidities (23% vs 8%, respectively; p≤0.01). With regards to current knee OA severity, both orthos and SM PCPs reported a significantly higher proportion of hypertension patients that were deemed ‘severe’ (physician opinion) vs patients without comorbidities (orthos: 50% vs 32%, respectively; SM PCPs: 42% vs 23%, respectively; p≤0.01).Rheums and pain specialists reported greater mild opioid usage amongst hypertension patients compared to those without comorbidities (rheums: 28% vs 10%, respectively (p≤0.05); pain specialists: 40% vs 9%, respectively; (p≤0.01)); orthos and SM PCPs stated significantly greater use of corticosteroid injections amongst their reported hypertension patients vs those without comorbidities (orthos: 60% vs 41%, respectively; SM PCPs: 40% vs 19%, respectively; p≤0.01). Hypertension patients reported by orthos and SM PCPs are more likely to be considered for total knee replacement (TKR) surgery compared to those without comorbidities (orthos: 59% vs 32%, respectively; SM PCPs: 37% vs 19%, respectively; p≤0.01). Conversely, hypertension patients reported by rheums are less likely to be considered for TKR vs those without comorbidities (41% vs 18%, respectively; p≤0.05).Reported hypertension patients had a significantly higher mean Visual Analogue Scale for Pain (VAS) score than patients without comorbidities (6.6 vs 5.9, respectively; p≤0.01). A significantly higher proportion of patients with hypertension demonstrate radiographic evidence of bone erosion compared to those without comorbidities (69% vs 56%, respectively; p≤0.01).Conclusion:From the sample surveyed, knee OA patients with hypertension may require a more specific and holistic treatment approach that takes into account their CV status and managing physician specialty. Further investigation using comparator cohort is warranted.References:[1]Ipsos Osteoarthritis Therapy Monitor (May – July 2020, 260 specialists reporting on 769 knee OA patients seen in consultation, data collected online. Participating physicians were primary treaters and saw a minimum number of 35 knee OA patients). Data © Ipsos 2021, all rights reserved.[2]Ipsos Osteoarthritis Therapy Monitor (May – July 2020, 260 specialists reporting on 769 knee OA patients seen in consultation, data collected online. Participating physicians were primary treaters and saw a minimum number of 35 knee OA patients). Data © Ipsos 2021, all rights reserved.Disclosure of Interests:None declared.

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A descriptive analysis of the impact of COVID-19 on Emergency Department attendance and visit characteristics in Singapore

10.21203/rs.3.rs-149642/v2 ◽

2021 ◽

Author(s):

Mei Qiu Lim ◽

Fahad Javaid Siddiqui ◽

Seyed Ehsan Saffari ◽

Andrew Fu Wah Ho ◽

Johannes Nathaniel Min Hui Liew ◽

...

Keyword(s):

Emergency Department ◽

Severe Disease ◽

Descriptive Analysis ◽

Circuit Breaker ◽

Historical Period ◽

Management Planning ◽

Crowd Management ◽

Patient Demographics ◽

Icd 10 ◽

The Impact

Abstract Background: The coronavirus disease 2019 (COVID-19) has impacted the utilisation of Emergency Department (ED) services worldwide. This study aims to describe the changes in attendance of a single ED and corresponding patient visit characteristics before and during the COVID-19 period. Methods: In a single-centre retrospective cohort study, we used descriptive statistics to compare ED attendance, patient demographics and visit characteristics during the COVID-19 period (1 January – 28 June 2020) and its corresponding historical period in 2019 (2 January – 30 June 2019). Results: Mean ED attendance decreased from 342 visits/day in the pre-COVID-19 period, to 297 visits/day in the COVID-19 period. This was accompanied by a decline in presentations in nearly every ICD-10-CM diagnosis category except for respiratory-related diseases. Notably, we observed reductions in visits by critically ill patients and severe disease presentations during the COVID-19 period. We also noted a shift in ED patient case-mix from ‘Non-fever’ cases to ‘Fever’ cases, likely giving rise to two distinct trough-to-peak visit patterns during the pre-Circuit Breaker and Circuit Breaker period. Conclusions: This descriptive study revealed distinct ED visit trends across different time periods. The COVID-19 pandemic caused a reduction in ED attendances amongst patients with low-acuity conditions and those with highest priority for emergency care. This raises concern about treatment-seeking delays and possible impact on health outcomes. The downward trend in low-acuity presentations also presents learning opportunities for ED crowd management planning in a post-COVID-19 era.

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How to Set Up a Sports Medicine Clinic

The Physician and Sportsmedicine ◽

10.1080/00913847.1985.11708820 ◽

1985 ◽

Vol 13 (6) ◽

pp. 168-176

Author(s):

Heyward L. Nash

Keyword(s):

Sports Medicine ◽

Medicine Clinic ◽

Set Up

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Injuries to the brachial plexus: Experience of a private sports medicine clinic

The Journal of the American Osteopathic Association ◽

10.1515/jom-1982-820715 ◽

1982 ◽

Vol 82 (7) ◽

pp. 69-72

Author(s):

Harlen C. Hunter

Keyword(s):

Brachial Plexus ◽

Sports Medicine ◽

Medicine Clinic

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DELIVERY OF COMMON KNEE PATIENT-REPORTED OUTCOME INSTRUMENTS BY AUTOMATED MOBILE PHONE TEXT MESSAGING IN PEDIATRIC SPORTS MEDICINE

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00040 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0004

Author(s):

Xochitl Mellor ◽

Matthew J. Buczek ◽

J. Todd Lawrence ◽

Theodore J. Ganley ◽

Alexander J. Adams ◽

...

Keyword(s):

High School Students ◽

Mobile Phone ◽

Sports Medicine ◽

Text Messaging ◽

Text Message ◽

Patient Reported Outcome ◽

Message Delivery ◽

School Students ◽

Patient Demographics ◽

Patient Reported

Background: Patient-reported outcome (PRO) instruments measure a patient’s health status in a variety of domains, including physical, mental and social well-being. The delivery of such instruments has become an integral part of healthcare, commonly employed to assess treatment efficacy and outcomes in sports medicine. With the proliferation of mobile phones, administration of PROs across patient-friendly platforms (e.g. apps, text messaging) may increase completion rates, particularly among younger patients. The purpose of this study was to validate the collection of common knee PROs with text messaging in sports medicine, by correlating text messaging responses with traditional paper delivery in adolescents and young adults. Methods: Patients presenting to a hospital-based pediatric orthopaedic sports medicine clinic with a knee injury were enrolled in this prospective investigation. Patients were excluded if they were undergoing a same-day office procedure, underwent surgery within the previous 90 days, and/or had no access to a mobile phone. Paper versions of the Pediatric International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form and the Pediatric Functional Activity Brief Scale (Pedi-Fab Scale) questionnaires were completed during the patients’ initial clinic visit. Over the next 72 hours, the patients subsequently completed the mobile phone portion of the study outside of the clinic (Figure 1), which included text message delivery of the Pedi-IKDC and Pedi-Fab Scale, assigned in a random order. Correlations between paper and text message delivery of the two PROs were assessed. Secondary analyses were conducted to examine overall completion time and associations between patient demographics and text compliance. Results: Of the 91 patients (Age M=16.0 ±2.0 years; 48% female) initially enrolled in the study, 55 (60.4%) completed the text Pedi-Fab Scale, 48 (52.7%) completed the text Pedi-IKDC, and 39 (42.9%) completed both PROs. Among the evaluable sample, the intraclass correlation coefficient (ICC) between the paper and mobile phone delivery of the Pedi-Fabs was 0.95 (95% CI, 0.91-0.97). The ICC between the paper and mobile phone delivery of the Pedi-IKDC was 0.96 (95% CI, 0.93-0.98). Average Pedi-Fab scores on paper (M=12.7) and mobile phone (M=12.3) were not significantly different (p=0.52). Similarly, average Pedi-IKDC scores on paper (M=68.8) and mobile phone (M=67.7) were not significantly different (p=0.41). A Bland-Altman plot and linear regression revealed there was no proportional bias between the mean and difference for the Pedi-Fab scores (p=0.55) and Pedi-IKDC scores (p=0.56). The average completion time for the text delivered Pedi-Fab and Pedi-IKDC were 102±224 minutes and 159±155 minutes, respectively. For Pedi-Fab, there were no patient demographics that were significantly associated with text completion. However, high school students (p=0.025), female sex (p=0.036), and race (p=0.002), were significantly associated with the text completion of Pedi-IKDC. In addition, order of the delivery of the questionnaires and paper scores were not associated with text completion for either survey. Conclusion: Text message delivery using mobile phones permits valid assessment of Pedi-IKDC and Pedi-Fabs scores in this prospective observational study. Questionnaire delivery by automated text messaging allows asynchronous response and may increase compliance among high school students while also reducing the labor cost of collecting PROs.

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SELF-REPORTED PHYSICAL ACTIVITY IN SPECIALIZED AND UNSPECIALIZED YOUTH

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00218 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0021

Author(s):

Julie A. Young ◽

Amy E Valasek ◽

James Onate

Keyword(s):

Physical Activity ◽

Sports Medicine ◽

Vigorous Physical Activity ◽

Activity Patterns ◽

Daily Basis ◽

Recreational Activities ◽

Physical Activity Patterns ◽

Medicine Clinic ◽

Risk Of Injury

The benefits of physical activity cross all domains of health. Unfortunately, many children are not meeting the current American College of Sports Medicine recommendations of 60 minutes of moderate to vigorous physical activity (MVPA) 7 days a week. This is especially deleterious since physical activity patterns during childhood may carryover to adulthood. Research has also shown that participating in one sport may increase the risk of injury. The purpose of this study was to examine self-reported exercise levels in children reporting to a tertiary sports medicine clinic over a three year period. Subjects were asked “How many minutes of moderate to vigorous physical activity per day?” and “How many days per week do you participate in moderate to vigorous physical activity”. Minutes per week of MVPA was calculated. Age, sex, and current sports and recreational activities were recorded. There were 7427 unique patients (53% female) with an average age of 13.8±2.6. The average minutes per day of exercise was reported as 85.6±44.4, average days per week was 4.4±1.6 and minutes per week was 410.8±266.9. Females reported less minutes per day (83.5 vs. 87.8, p<.001), less days per week (4.2 vs 4.7, p<.001) and less minutes per week (384.1 vs 440.2, p<.001) than males. On average, females reported 56 minutes less activity per week than their male counterparts. There were 3618 participants who only reported one activity and were categorized as specialized in a single physical activity. Those that specialized in a single activity were significantly older (14.1 vs 13.4, p<.001). There were no significant differences between reported minutes per day between specialized and unspecialized athletes (85.8 vs 85.2, p=.57). Those who specialized in one activity reported more days per week (4.6 vs 4.2. p<.001) and more minutes per week (423.8 vs 397.0, p=.001) than unspecialized athletes. Research has consistently shown that females are less active than males. Those who specialized in one activity participated in more minutes per week of activity, mainly through participating in more days of physical activity. Children should be encouraged to participate in a variety of activities on a daily basis to ensure they receive the benefits of physical activity.

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