Retrospective Analysis of Adult Patients Presenting to the Acute Care Setting Requesting Prescriptions

Introduction: Patient visits to the emergency department (ED) or urgent care centre (UCC) for the sole purpose of requesting prescriptions are challenging for the patient, the physician, and the department. The primary objective of this study was to determine the characteristics of these patients, the nature of their requests, and the response to these requests. Our secondary objective was to determine the proportion of these medication requests that had street value. Methods: This was a retrospective, electronic chart review of all adult patients requesting a prescription from a two-site ED and/or an UCC in a medium-sized Canadian city between April 1, 2014–June 30, 2017. Recorded outcomes included patient demographic data and access to a family doctor, medication requested, whether or not a prescription was given, and ED length of stay. Medication street value was determined using a local police service listing. Results: A total of 2,265 prescriptions were requested by 1,495 patients. The patient median [interquartile range] age was 43 [32-54] years. A family doctor was documented by 55.4% (939/1,694) of patients. The two most commonly requested categories of medications were opioid analgesics 21.2% (481/2,265) and benzodiazepine anxiolytics 11.7% (266/2,265). Of patients requesting medication, 50.5% (755/1,495) requested medications without street value including some with potential to cause serious adverse health effects if discontinued. The requested prescription was received by 19.9% (298/1,495) of patients; 15.3% (173/1,134) returned for further prescription requests. The 90th percentile length of stay was 3.2 and 5.6 hours at the UCC and ED, respectively. Conclusion: Patients who presented to the ED or UCC sought medications with and without street value in almost equal measure. A more robust understanding of these patients and their requests illustrates why a ‘one-size-fits-all’ response to these requests is inappropriate and signals some fault lines within our local healthcare system.

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P029: Requesting prescriptions in the emergency department: the patient, the request and the response

CJEM ◽

10.1017/cem.2020.236 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S74-S75

Author(s):

L. Shepherd ◽

M. Mucciaccio ◽

K. VanAarsen

Keyword(s):

Emergency Department ◽

Family Doctor ◽

Wait Time ◽

Primary Objective ◽

Urgent Care ◽

Care Centre ◽

Medication Prescription ◽

Physician Decision Making ◽

Service Gap ◽

Urgent Care Centre

Introduction: Patients presenting to the Emergency Department (ED) for the sole purpose of requesting prescriptions are problematic. Problematic for the patient, who may have a long wait to be seen and may leave dissatisfied. Problematic for the ED physician, who is in the business of episodic not comprehensive care and is diligently trying to avoid the misappropriation of medications. The primary objective of this study was to determine the characteristics of patients who present to the ED or Urgent Care Centre (UCC) requesting a prescription, the nature of these requests and the resulting action by the attending physician. The secondary objective was to determine the proportion of medication requests and responses that have potential street value. With this knowledge we may be better positioned to serve these patients and support physician decision-making. Methods: This was a single-centre, retrospective electronic chart review looking at all adult patients with a presenting complaint of medication request who attended a two-site tertiary ED or an Urgent Care Centre (UCC) in London, Ontario between April 1, 2014 and June 30, 2017. Data was tested for normality and analyzed using descriptive statistics. Results: A total of 1923 cases met the inclusion criteria. Cases were removed (n = 421) if it was unclear which prescription was requested or if a non-medication prescription or injection was requested. The patient median (IQR) age was 44 (32-54) with 58% being male and 55% having a family doctor. There were a total of 2261 prescriptions requested by 1502 patients. The top 3 most commonly requested classes of medications were opioids 433/1502 (28.8%), antidepressants/antipsychotics 371/1502 (24.7%) and benzodiazepines 252/1502 (16.8%). The median (IQR) wait time was 73 minutes (35-128). 298/1502 (19.8%) of patients received their requested prescription (opioids 12.7%; antidepressant/antipsychotic 55.3% and benzodiazepines 16.3%). 740/1502 (49.3%) of patients requested a medication that had street value. Of those, 118/740 (15.9%) received the requested medication. Conclusion: There is no “one size fits all” solution for the patient who presents to the ED requesting a prescription. The large number of requests for psychiatric medications suggests a service gap for mental health patients in the community. This data supports the need for comprehensive electronic medication records to guide physicians’ decisions.

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P067: Factors associated with prolonged length of stay of admitted patients in a tertiary care emergency department

CJEM ◽

10.1017/cem.2017.269 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S101

Author(s):

K. Johns ◽

S. Smith ◽

E. Karreman ◽

A. Kastelic

Keyword(s):

Length Of Stay ◽

Multiple Regression ◽

Significant Relationship ◽

Demographic Data ◽

Healthcare Access ◽

Tertiary Care ◽

Outcome Variable ◽

Prolonged Length ◽

Patient Demographic Data ◽

Major Predictor

Introduction: Extended length of stay (LOS) in emergency departments (EDs) and overcrowding are a problems for the Canadian healthcare system, which can lead to the creation of a healthcare access block, a reduced health outcome for acute care patients, and decreased satisfaction with the health care system. The goal of this study is to identify and assess specific factors that predict length of stay in EDs for those patients who fall in the highest LOS category. Methods: A total of 130 patient charts from EDs in Regina were reviewed. Charts included in this study were from the 90th-100th percentile of time-users, who were registered during February 2016, and were admitted to hospital from the ED. Patient demographic data and ED visit data were collected. T-tests and multiple regression analyses were conducted to identify any significant predictors of our outcome variable, LOS. Results: None of the demographic variables showed a significant relationship with LOS (age: p=.36; sex: p=.92, CTAS: p=.48), nor did most of the included ED visit data such as door to doctor time (p=.34) and time for imaging studies (X-ray: p=.56; ultrasound: p=.50; CT p=.45). However, the time between the request for consult until the decision to admit did show a significant relationship with LOS (p<.01).Potential confounding variables analyzed were social work consult requests (p=.14), number of emergency visits on day of registration (p=.62), and hour of registration (00-12 or 12-24-p<.01). After adjustment for time of registration, using hierarchical multiple regression, time from consult request to admit decision maintained a significant predictor (p<.01) of LOS. Conclusion: After adjusting for the influence of confounding factors, “consult request to admit decision” was by far the strongest predictor of LOS of all included variables in our study. The results of this study were limited to some extent by inconsistencies in the documentation of some of the analyzed metrics. Establishing standardized documentation could reduce this issue in future studies of this nature. Future areas of interest include establishing a standard reference for our variables, a further analysis into why consult requests are a major predictor, and how to alleviate this in the future.

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OP0257-PARE USING PATIENT HEALTH LITERACY PROFILES TO IDENTIFY SOLUTIONS TO CHALLENGES FACED IN RHEUMATOLOGY CARE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.877 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 162.2-162

Author(s):

M. Bakker ◽

P. Putrik ◽

J. Rademakers ◽

M. Van de Laar ◽

H. Vonkeman ◽

...

Keyword(s):

Health Literacy ◽

The Netherlands ◽

Health System ◽

Demographic Data ◽

Family Doctor ◽

List Type ◽

Research Support ◽

Score Distribution ◽

Patient Health ◽

Literacy Profiles

Background:The prevalence of limited health literacy (i.e. cognitive and social resources of individuals to access, understand and apply health information to promote and maintain good health) in the Netherlands is estimated to be over 36% [1]. Access to and outcomes of rheumatological care may be compromised by limited patient health literacy, yet little is known about how to address this, thus action is required. As influencing individual patients’ health literacy in the rheumatology context is often unrealistic, it is paramount for the health system to be tailored to the health literacy needs of its patients. The OPtimising HEalth LIteracy and Access (Ophelia) process offers a method to inform system change [2].Objectives:Following the Ophelia approach:a. Identify health literacy profiles reflecting strengths and weaknesses of outpatients with RA, SpA and gout.b. Use the health literacy profiles to facilitate discussions on challenges for patients and professionals in rheumatological care and identify possible solutions the health system could offer to address these challenges.Methods:Patients with RA, SpA and gout attending outpatient clinics in three centres in the Netherlands completed the Health Literacy Questionnaire (HLQ) and questions on socio-demographic and health-related characteristics. Hierarchical cluster analysis using Ward’s method identified clusters based on the nine HLQ domains. Three researchers jointly examined 24 cluster solutions for meaningfulness by interpreting HLQ domain scores and patient characteristics. Meaningful clusters were translated into health literacy profiles using HLQ patterns and demographic data. A patient research partner confirmed the identified profiles. Patient vignettes were designed by combining cluster analyses results with qualitative patient interviews. The vignettes were used in two two-hour co-design workshops with rheumatologists and nurses to discuss their perspective on health literacy-related challenges for patients and professionals, and generate ideas on how to address these challenges.Results:In total, 895 patients participated: 49% female, mean age 61 years (±13.0), 25% lived alone, 18% had a migrant background, 6.6% did not speak Dutch at home and 51% had low levels of education. Figure 1 shows a heat map of identified health literacy profiles, displaying the score distribution per profile across nine health literacy domains. Figure 2 shows an excerpt of a patient vignette, describing challenges for a patient with profile number 9. The workshops were attended by 7 and 14 nurses and rheumatologists. Proposed solutions included health literacy communication training for professionals, developing and improving (visual) patient information materials, peer support for patients through patient associations or group consultations, a clear referral system for patients who need additional guidance by a nurse, social worker, lifestyle coach, pharmacist or family doctor, and more time with rheumatology nurses for target populations. Moreover, several system adaptations to the clinic, such as a central desk for all patient appointments, were proposed.Conclusion:This study identified several distinct health literacy profiles of patients with rheumatic conditions. Engaging with health professionals in co-design workshops led to numerous bottom-up ideas to improve care. Next steps include co-design workshops with patients, followed by prioritising and testing proposed interventions.References:[1]Heijmans M. et al. Health Literacy in the Netherlands. Utrecht: Nivel 2018[2]Batterham R. et al. BMC Public Health 2014, 14:694Disclosure of Interests:Mark Bakker: None declared, Polina Putrik: None declared, Jany Rademakers Speakers bureau: In March 2017, Prof. Dr. Rademakers was invited to speak about health literacy at the “Heuvellanddagen” Conference, hosted by Janssen-Cilag., Mart van de Laar Consultant of: Sanofi Genzyme, Speakers bureau: Sanofi Genzyme, Harald Vonkeman: None declared, Marc R Kok Grant/research support from: BMS and Novartis, Consultant of: Novartis and Galapagos, Hanneke Voorneveld: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis, Maarten de Wit Grant/research support from: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Consultant of: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Speakers bureau: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Richard Osborne Consultant of: Prof. Osborne is a paid consultant for pharma in the field of influenza and related infectious diseases., Roy Batterham: None declared, Rachelle Buchbinder: None declared, Annelies Boonen Grant/research support from: AbbVie, Consultant of: Galapagos, Lilly (all paid to the department)

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Venous stent versus conventional stent for the treatment of central vein obstruction in hemodialysis patients: a retrospective study

Acta Radiologica ◽

10.1177/02841851211005163 ◽

2021 ◽

pp. 028418512110051

Author(s):

Surasit Akkakrisee ◽

Keerati Hongsakul

Keyword(s):

Endovascular Treatment ◽

Patency Rate ◽

Demographic Data ◽

Hemodialysis Patients ◽

Primary Patency ◽

Central Vein ◽

Primary Patency Rate ◽

Patient Demographic Data ◽

Upper Thoracic ◽

Vein Stenosis

Background Endovascular treatment is a first-line treatment for upper thoracic central vein obstruction (CVO). Few studies using bare venous stents (BVS) in CVO have been conducted. Purpose To evaluate the treatment performance of upper thoracic central vein stenosis between BVS and conventional bare stent (CBS) in hemodialysis patients. Methods Hemodialysis patients with upper thoracic central vein obstruction who underwent endovascular treatment at the interventional unit of our institution from 1 January 2008 to 31 December 2018 were enrolled in the present study. CBS was used to treat central vein obstruction in 43 patients and BVS in 34 patients. We compared the primary patency rates and complications between the two stent types. P values < 0.05 were considered statistically significant. Results The patient demographic data between the CBS and BVS groups were similar. The characteristics of the lesions, procedures, and complications were not significantly different between the two groups ( P > 0.05). There were no statistically significant differences of primary patency rates at three and six months between the BVS and CBS groups (94.1% vs. 86.0% and 73.5% vs. 58.1%, respectively; P > 0.05). The primary patency rate at 12 months in the BVS group was significantly higher than that in the CBS group (61.8% vs. 32.6%; P = 0.008). Conclusion Endovascular treatment of central vein obstruction with BVS provided a higher primary patency rate at 12 months than CBS.

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A deep attention model to forecast the Length Of Stay and the in-hospital mortality right on admission from ICD codes and demographic data

Journal of Biomedical Informatics ◽

10.1016/j.jbi.2021.103778 ◽

2021 ◽

pp. 103778

Author(s):

Gaspard Harerimana ◽

Jong Wook Kim ◽

Beakcheol Jang

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Demographic Data ◽

Attention Model ◽

Icd Codes

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Effect of a Reduced Postpartum Length of Stay Program on Primary Care Services Use by Mothers and Infants

PEDIATRICS ◽

10.1542/peds.106.s3.937 ◽

2000 ◽

Vol 106 (Supplement_3) ◽

pp. 937-941

Author(s):

Kenneth D. Mandl ◽

Charles J. Homer ◽

Oren Harary ◽

Jonathan A. Finkelstein

Keyword(s):

Primary Care ◽

Length Of Stay ◽

Early Discharge ◽

Urgent Care ◽

Care Utilization ◽

Care Services ◽

Primary Care Services ◽

Ambulatory Services ◽

The Impact ◽

Services Use

Objective. To determine the impact of reduced postpartum length of stay (LOS) on primary care services use. Methods. Design: Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for time trends.Setting: A managed care plan.Intervention: A reduced obstetrical LOS program (ROLOS), offering enhanced education and services.Participants: mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect.Independent Measures: Pre-ROLOS or the post-ROLOS year.Outcome Measures: Telephone calls, visits, and urgent care events during the first 3 weeks postpartum summed as total utilization events. Results. Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) and after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, there were between 2.37 and 2.72 utilization events per dyad; after, there were 4.60. Well-child visits increased slightly to .98 visits per dyad, but urgent visits did not. Conclusion. This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.

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Cement-in-cement femoral component revision

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-1953.r2 ◽

2021 ◽

Vol 103-B (7) ◽

pp. 1215-1221

Author(s):

John W. Kennedy ◽

Nigel Y. B. Ng ◽

David Young ◽

Nicholas Kane ◽

Andrew G. Marsh ◽

...

Keyword(s):

Femoral Component ◽

Short Form ◽

Demographic Data ◽

Senior Author ◽

Inclusion Criteria ◽

Reliable Technique ◽

Patient Demographic Data ◽

Oxford Hip Score ◽

Component Revision

Aims Cement-in-cement revision of the femoral component represents a widely practised technique for a variety of indications in revision total hip arthroplasty. In this study, we compare the clinical and radiological outcomes of two polished tapered femoral components. Methods From our prospectively collated database, we identified all patients undergoing cement-in-cement revision from January 2005 to January 2013 who had a minimum of two years' follow-up. All cases were performed by the senior author using either an Exeter short revision stem or the C-Stem AMT high offset No. 1 prosthesis. Patients were followed-up annually with clinical and radiological assessment. Results A total of 97 patients matched the inclusion criteria (50 Exeter and 47 C-Stem AMT components). There were no significant differences between the patient demographic data in either group. Mean follow-up was 9.7 years. A significant improvement in Oxford Hip Score (OHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 12-item Short-Form Survey (SF-12) scores was observed in both cohorts. Leg lengths were significantly shorter in the Exeter group, with a mean of -4 mm in this cohort compared with 0 mm in the C-Stem AMT group. One patient in the Exeter group had early evidence of radiological loosening. In total, 16 patients (15%) underwent further revision of the femoral component (seven in the C-Stem AMT group and nine in the Exeter group). No femoral components were revised for aseptic loosening. There were two cases of femoral component fracture in the Exeter group. Conclusion Our series shows promising mid-term outcomes for the cement-in-cement revision technique using either the Exeter or C-Stem AMT components. These results demonstrate that cement-in-cement revision using a double or triple taper-slip design is a safe and reliable technique when used for the correct indications. Cite this article: Bone Joint J 2021;103-B(7):1215–1221.

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90 Lung ultrasound in pediatric asthma patients: A pilot study characterizing findings at baseline stat

Paediatrics & Child Health ◽

10.1093/pch/pxab061.072 ◽

2021 ◽

Vol 26 (Supplement_1) ◽

pp. e65-e66

Author(s):

Noah Marzook ◽

Alexander Dubrovsky

Keyword(s):

Pediatric Patients ◽

Lung Ultrasound ◽

Demographic Data ◽

Tertiary Care ◽

Challenge Test ◽

Primary Objective ◽

Upper Respiratory Tract ◽

The Past ◽

Asthma Patients ◽

B Lines

Abstract Primary Subject area Emergency Medicine - Paediatric Background Unlike the lung ultrasound (LU) findings of pneumonia, bronchiolitis, pleural effusions and pneumothorax, which have all been well described, the sonographic pattern of asthma remains unclear. Previous pediatric studies have shown that pediatric patients with acute asthma exacerbations had positive LU findings. It is also unclear whether these findings were the result of acute infections associated with the exacerbation or if the findings would be present at baseline, outside an exacerbation in an asthmatic patient. Objectives The primary objective of this study is to characterize lung ultrasound (LU) findings in stable asthma pediatric patients presenting in a tertiary care asthma or respiratory clinic. Design/Methods Eligible patients >6 years of age, underwent a LU by the study sonographer between December 19, 2017 to June 25, 2019, during their regular follow up visit at the pulmonology clinic or scheduled pulmonary function test. Patients were defined as asthmatic if they had a positive methacholine challenge test (MCT) or spirometry at the day of the visit or in the past. Patients were excluded if they had an upper respiratory tract infection in the past 4 weeks, or had any other known pulmonary diseases. Baseline demographic and asthma severity (ISAAC score, ACQ-7) questionnaires were filled out by the patients, following which they underwent a LU by a novice sonographer using a 6-zone protocol. A blinded expert sonographer interpreted the images offline. A positive LU was defined as presence of more than 3 B-lines, consolidation (<1cm or >1cm), absent lung slide, and/or presence of pleural fluid. Results Fifty-two patients were enrolled in the study and 19.2% (CI 8.31-30.15) of the asthma patients had positive LU findings. The positive LU findings were diverse including B-lines (80%), small consolidation (80%), pleural line anomalies (10%). Positive LU findings were not correlated to any demographic value. Conclusion In our study, 19.2% of asthma patients at baseline have a positive LU. Lung consolidations larger than 1 cm were rarely seen. There were no significant differences between demographic data in asthmatic patients with positive compared to those with negative LUS. This positive LU scan rate is in keeping with a prior study on LU in pediatrics.

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