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2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Artin Entezarjou ◽  
Maria Sjöbeck ◽  
Patrik Midlöv ◽  
Veronica Milos Nymberg ◽  
Lina Vigren ◽  
...  

Abstract Background The use of chat-based digital visits (eVisits) to assess infectious symptoms in primary care is rapidly increasing. The “digi-physical” model of care uses eVisits as the first line of assessment while assuming a certain proportion of patients will inevitably need to be further assessed through urgent physical examination within 48 h. It is unclear to what extent this approach can mitigate physical visits compared to assessing patients directly using office visits. Methods This pre-COVID-19-pandemic observational study followed up “digi-physical” eVisit patients (n = 1188) compared to office visit patients (n = 599) with respiratory or urinary symptoms. Index visits occurred between March 30th 2016 and March 29th 2019. The primary outcome was subsequent physical visits to physicians within two weeks using registry data from Skåne county, Sweden (Region Skånes Vårddatabas, RSVD). Results No significant differences in subsequent physical visits within two weeks (excluding the first 48 h) were noted following “digi-physical” care compared to office visits (179 (18.0%) vs. 102 (17.6%), P = .854). As part of the “digital-physical” concept, a significantly larger proportion of eVisit patients had a physical visit within 48 h compared to corresponding office visit patients (191 (16.1%) vs. 19 (3.2%), P < .001), with 150 (78.5%) of these eVisit patients recommended some form of follow-up by the eVisit physician. Conclusions Most eVisit patients (68.9%) with respiratory and urinary symptoms have no subsequent physical visits. Beyond an unavoidable portion of patients requiring urgent physical examination within 48 h, “digi-physical” management of respiratory and urinary symptoms results in comparable subsequent health care utilization compared to office visits. eVisit providers may need to optimize use of resources to minimize the proportion of patients being assessed both digitally and physically within 48 h as part of the “digi-physical” concept. Trial registration Clinicaltrials.gov identifier: NCT03474887.


2022 ◽  
Vol 13 ◽  
pp. 215013192110658
Author(s):  
Laura J. Samander ◽  
Jeffrey Harman

Purpose The primary purpose of this article was to determine if race and ethnicity played a role in if primary care physicians offered anxiety treatment in office visits by adult patients who were diagnosed with an anxiety disorder(s). Methods This study pooled data from the 2011 to 2018 National Ambulatory Medical Care Survey (NAMCS) that included adult patients with an anxiety disorder and the type of treatment offered to them. Logistic regressions were performed to examine the odds of offered anxiety treatment in office visits by non-Hispanic Black, Hispanic, and other race/ethnicity patients compared to office visits by non-Hispanic White patients. Results Physicians offered anxiety treatment in more than half of office visits where the patient was diagnosed with an anxiety disorder. Providers offered counseling or talk therapy in less than 13% of all office visits. Office visits by non-Hispanic Black patients had half the odds of being offered counseling/talk therapy ( P = .068) compared to those by non-Hispanic White patients. Conclusions These findings suggest that statistically significant differences in the offering of any anxiety treatments in office visits to minorities compared to non-Hispanic White patients do not exist; however, there are still differences in the rates of counseling/talk therapy offered in office visits by minorities versus non-minorities. Future studies may want to examine reasons for lower rates of counseling/talk therapy offered to minority and majority patients and the specific pharmacological or therapeutic treatments offered to different races.


2021 ◽  
Vol 11 (1) ◽  
pp. 71
Author(s):  
Ikenna Unigwe ◽  
Seonkyeong Yang ◽  
Hyun Jin Song ◽  
Wei-Hsuan Lo-Ciganic ◽  
Juan Hincapie-Castillo ◽  
...  

We examined the prevalence trends of non-human immunodeficiency virus (HIV) sexually transmitted infections (STI) and associated patient characteristics in U.S. ambulatory-care settings from 2005–2016. We conducted a retrospective repeated cross-sectional analysis using data from the National Ambulatory Medical Care Survey (NAMCS) for individuals aged 15–64 with a non-HIV STI-related visit. Data were combined into three periods (2005–2008, 2009–2012, and 2013–2016) to obtain reliable estimates. Logistic regression was used for analysis. A total of 19.5 million weighted, non-HIV STI-related ambulatory visits from 2005–2016 were identified. STI-related visits per 100,000 ambulatory care visits increased significantly over the study period: 206 (95% CI = 153–259), 343 (95% CI = 279–407), and 361 (95% CI = 277–446) in 2005–2008, 2009–2012, and 2013–2016, respectively (Ptrend = 0.003). These increases were mainly driven by increases in HPV-related visits (56 to 163 per 100,000 visits) from 2005–2008 to 2009–2012, followed by syphilis- or gonorrhea-related visits (30 to 67 per 100,000 visits) from 2009–2012 to 2013–2016. Higher odds of having STI-related visit were associated with younger age (aged 15–24: aOR = 4.45; 95% CI = 3.19–6.20 and aged 25–44: aOR = 3.59; 95% CI = 2.71–4.77) vs. 45–64-year-olds, Black race (aOR = 2.41; 95% CI = 1.78–3.25) vs. White, and HIV diagnosis (aOR = 10.60; 95% CI = 5.50–20.27) vs. no HIV diagnosis. STI-related office visits increased by over 75% from 2005–2016, and were largely driven by HPV-related STIs and syphilis- or gonorrhea-related STIs.


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Mohit Butaney ◽  
Amarnath Rambhatla
Keyword(s):  

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Varun Rao ◽  
Michael GeRue ◽  
Douglas Gray

Background  The purpose of this study is to compare open heart surgery (OHS) Telehealth patients (TP) and non-Telehealth patients (NTP) using outcomes data such as hospital readmission, emergency department (ED) presentations, observation hours, and office visits. Visits for atrial fibrillation (Afib), pleural effusions (PE), and sternal wound complications (SWC) are of particular interest for this study.      Methods  A retrospective chart review of 110 patients above 18 years old who had OHS at Parkview Heart Institute from 2020 were assessed using hospital readmissions, ED presentations, observation hours, and office visits outcomes. Separate forms for blinding, demographic data, and surgery information were completed for every patient. A Telehealth form was completed out for every Telehealth intervention had per TP. An outcomes form was completed for each outcome had by each patient. TP outcomes were compared with NTP outcomes. Fisher’s exact test and X2 was used for statistical analysis (p=0.05).    Results  Results display a sample size of the total patient population (110/436). There was no significant difference found between NTP and TP in terms of office visits (79.5% vs 93%, p=0.598), readmissions (3 vs 6, p=0.889), and observation visits (0 vs 3, p=0.558). Significance was found between NTP and TP in terms of ED visits (0 vs 9, p=0.025). Most frequent reason for NTP readmission “other” (7.7%) and TP “other” (4.2%), reason for ED visit for NTP (all 0%) and TP “other” (7.0%), reason for observation visit for NTP (all 0%) and TP “other” (1.4%), reason for office visit for NTP “other” (76.9%) and TP “other” (91.5%).     Conclusion  TP presented to the ED significantly more than NTP. The largest outcome category was “surgery follow up” office visits listed in the “other” section. Data collection and analysis are in progress. At the time of writing this abstract, final results are not yet available. 


Author(s):  
Dorothy Y. Hung ◽  
Gabriela Mujal ◽  
Anqi Jin ◽  
Su-Ying Liang

Abstract Purpose To assess the impact of Lean primary care redesigns on the amount of time that physicians spent working each day. Methods This observational study was based on 92 million time-stamped Epic® EHR access logs captured among 317 primary care physicians in a large ambulatory care delivery system. Seventeen clinic facilities housing 46 primary care departments were included for study. We conducted interrupted time series analysis to monitor changes in physician work patterns over 6 years. Key measures included total daily work time; time spent on “desktop medicine” outside the exam room; time spent with patients during office visits; time still working after clinic, i.e., after seeing the last patient each day; and remote work time. Results The amount of time that physicians spent on desktop EHR activities throughout the day, including after clinic hours, decreased by 10.9% (95% CI: −22.2, −2.03) and 8.3% (95% CI: −13.8, −2.12), respectively, during the first year of Lean implementation. Total daily work hours among physicians, which included both desktop activity and time in office visits, decreased by 20% (95% CI: −29.2, −9.60) by the third year of Lean implementation. Conclusions These findings suggest that Lean redesign may be associated with time savings for primary care physicians. However, since this was an observational analysis, further study is warranted (e.g., randomized trial) —to determine the impact of Lean interventions on physician work experiences.


2021 ◽  
Vol 2 (4) ◽  
Author(s):  
J De Juan Baguda ◽  
M Pachon Iglesias ◽  
J J Gavira Gomez ◽  
V Martinez Mateo ◽  
M F Arcocha Torres ◽  
...  

Abstract Background The HeartLogic algorithm measures data from multiple implantable cardioverter-defibrillator-based (ICD) sensors and combines them into a single index. The associated alert has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation. Objective To analyze the association between HeartLogic alerts and clinical events and to describe the implementation in clinical practice of the algorithm for remote management of HF patients. Methods The association between HeartLogic alerts and clinical events has been analyzed in the blinded study Phase 1 (from ICD implantation to HeartLogic alert activation) and in the following unblinded Phase 2 and 3 (after HeartLogic activation). During Phase 1, patients were managed according to the standard clinical practice and physicians were blinded to the alert status. During Phase 2 physicians reacted to alerts according to their clinical practice, while during Phase 3 they followed a standardized protocol in response to alerts. Results We enrolled 288 patients who received HeartLogic-enabled ICD or CRT-D at 15 centers. 101 patients contributed to Phase 1. During a median observation period of 10 [95% CI: 5 – 19] months, the HeartLogic index crossed the alert-threshold value 73 times (0.72 alerts/patient-year) in 39 patients. 8 HF hospitalizations and 2 emergency room admissions occurred in 9 patients (0.10 events/patient-year) during HeartLogic IN alert state. Other 10 minor events (HF in-office visits and non-HF hospitalization) were associated with HeartLogic alerts. During the active phases 267 patients were observed for a median follow-up of 16 [95% CI: 15 – 22] months. 277 HeartLogic alerts (0.89 alerts/patient-year) occurred in 136 patients. Thirty-three HeartLogic alerts were associated with hospitalizations for HF or with HF death (n=6), and 46 alerts were associated with unplanned in-office visits for HF. In 78 cases, HeartLogic alerts were associated with other clinically relevant events. The rate of unexplained alerts was low (0.39 alerts/patient-year). During the active phases, one HF hospitalization and one unplanned in-office visit for HF occurred when patients were in OUT of alert state. Patient phone contacts or in-person assessments were performed more frequently in Phase 3 (85%) than in Phase 2 (73%; p=0.047), while alert-triggered actions were similar in the two phases. Most alerts in both Phases (82% in 2 and 81% in 3; p=0.861) were managed remotely. The total number of patient phone contacts performed during Phase 2 was 35 (0.65 contacts/patient-year) and during Phase 3 was 287 (1.12 contacts/patient-year; p=0.002). Conclusions HeartLogic index was frequently associated with HF-related clinical events, with a low rate of unexplained events. The HeartLogic alert and a standardize protocol of actions allowed to remotely detect impending decompensation events and to implement clinical actions with a low workload for the centers. Funding Acknowledgement Type of funding sources: None.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052146
Author(s):  
Siyu Ma ◽  
Donald S Shepard ◽  
Grant A Ritter ◽  
Robert E Martell ◽  
Cindy Thomas

ObjectivesTo explore the association between hormone therapy (HT) adherence and non-drug healthcare utilisation and healthcare costs among patients with breast cancer.DesignRetrospective longitudinal cohort study.SettingThe US Medicare beneficiaries in the SEER-Medicare-linked databaseParticipantsWomen aged ≥ 65 with hormone-receptor positive breast cancer from 2007 through mid-2009 in the USA.InterventionsWe examined the relationship between HT and adherence and outcomes of our interests.Primary and secondary outcome measuresOur study cohort’s HT adherence, non-drug healthcare utilisation and healthcare costs for the first year of HT and each year, thereafter, for a total of 5 years.Results6045 eligible Medicare beneficiaries that met our selection criteria were included. We found that patients who were adherent to HT were associated with lower healthcare utilisation of all kinds (inpatient (0.35 vs 0.43, p<0.001), length of study during hospitalisation (4.19 vs 4.89, p<0.01), physician office visits (25.16 vs 26.17, p<0.001)), and significant reductions in many types of medical costs and neutral total healthcare costs despite the increased pharmacy costs. Half of the total medical cost reduction came from savings in hospitalisation costs.ConclusionsOur study suggests that the added cost of HT adherence was all but offset by the reduced cost for other medical care. Our study provides evidence on the potential success of implementing value-based insurance design (VBID) plans among patients with breast cancer to improve their long-term oral medication adherence. Policymakers should consider adherence improvement strategies such as VBID plans, given that the costs likely will not surpass the total savings.


2021 ◽  
pp. 100088
Author(s):  
Haley L. Dusek ◽  
Isaac H. Goldstein ◽  
Adam Rule ◽  
Michael F. Chiang ◽  
Michelle R. Hribar

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