Characteristics of Office-based Physician Visits, 2018

Examines physician office visit rates by age and sex and visit characteristics, including insurance status, reason for visit, and services.

Factors associated with successful completion of outpatient parenteral antibiotic therapy in an area with a high prevalence of multidrug-resistant bacteria: 30-day hospital admission and mortality rates

Objectives To identify factors associated with hospital admission and mortality within the first 30 days after enrolment in an outpatient parenteral antimicrobial therapy (OPAT) program, also analysing adequacy of the treatment regimen and clinical outcomes. Patients and methods This was a retrospective cohort study conducted between October 2016 and June 2017 in the state of São Paulo, Brazil. Variables related to hospital admission and mortality were subjected to bivariate analysis, and those with a P<0.05 were subjected to multivariate analysis as risk factors. Results We evaluated 276 patients, of whom 80.5% were ≥60 years of age and 69.9% had more than one comorbidity. Of the patients evaluated, 41.3% had pneumonia and 35.1% had a urinary tract infection. The most common etiological agent, isolated in 18 (31.6%) cases, was Klebsiella pneumoniae, and 13 (72,2%) strains were carbapenem resistant. The OPAT was in accordance with the culture results in 76.6% of the cases and with the institutional protocols in 76.4%. The majority (64.5%) of the patients were not admitted, and a cure or clinical improvement was achieved in 78.6%. Multivariate analysis showed that, within the first 30 days after enrolment, the absence of a physician office visit was a predictor of hospital admission (P<0.001) and mortality (P = 0.006). Conclusions This study demonstrated the viability of OPAT in elderly patients with pulmonary or urinary tract infections in an area with a high prevalence of multidrug-resistant bacteria and that a post-discharge physician office visit is protective against hospital admission and mortality.

Is ADHD Really Increasing in Youth?

Objective: It would be useful to compare temporal changes in the diagnostic prevalence of ADHD obtained from identical population surveys with time-trend survey findings based on individual ADHD features. Method: Changes in the diagnostic prevalence of ADHD over time were recorded from parent reports and from physician office visit data. Associated features of ADHD were temporally recorded from standardized teacher, parent, and youth surveys. Results: Time-trend diagnostic findings on ADHD prevalence based on 6 parent surveys and 12 outpatient physician office visit surveys revealed consistent rate increases. By contrast, 26 sets of standard ratings of the primary and associated features of ADHD assessed systematically by different teachers, parents, and students during different years indicated little change. Conclusion: Time-trend national surveys of ADHD in youth over the last two decades reveal consistent increases in its diagnostic prevalence, whereas time-trend findings for individual ADHD-related symptoms remained relatively stable.

Establishing a direct laboratory access program

Direct Laboratory Access (DLA) refers to a program whereby individuals who wish to have laboratory testing performed can avail themselves of such testing independently of a physician referral. DLA benefits both physicians and consumers. Physicians benefit by not having to invest time and office resources for consumers who do not seek medical intervention but rather who visit physicians for the sole purpose of obtaining permission to have laboratory tests performed. Consumers benefit by avoiding physician encounters they do not want, by receiving state-of-the-art laboratory testing they do want, and by avoiding the added expense and inconvenience of a physician office visit. DLA appeals to an anxious, educated, and somewhat affluent niche market. The program fills a void in the provision of health services while providing a small stream of revenue for laboratories.