The Impact of Senior Mobility Funding on Hearing Aid Acquisition and Compliance to Hearing Aid Use in a Singapore Hospital

Background and Objectives: In 2013, the Singapore government reviewed and expanded the Senior Mobility Fund (SMF) to provide subsidy for assistive devices, including hearing aids (HA). While SMF has improved accessibility to HA, its impact on HA acquisition has not been determined. The study aims to elucidate the influence of SMF on HA acquisition and the relationship between financial funding and compliance to HA use.Subjects and Methods: Retrospective review of 643 patients seen between January 2017 to January 2018 at the earnose and throat specialist outpatient clinic, who were referred for a hearing aid evaluation. Of the 643 patients, 109 patients with baseline hearing handicap (HH) scores recorded, and no formal diagnosis of cognitive impairment were included. The patients were grouped according to SMF eligibility and clinical data were obtained.Results: The odds ratio for acquiring HA was significantly higher with SMF, regardless of HH scores. When looking at actual degree of hearing loss (DHL), HA uptake was significantly higher in the least severe of DHL categories. There is no relationship between SMF and compliance to HA use. However, HH score is positively correlated with data log in regression analyses.Conclusions: SMF appears to influence HA acquisition. Especially in financially funded patients with low self-perceived HH, the benefits of HA may be underappreciated given the few hours of HA use. Further studies are warranted to investigate the impact of financial funding on outcomes of HA users to help policy planners and clinicians be prudent in the utilization of SMF.

Experiences with specialist clinics health care: a cross-sectional study among adult patients

Background The measurement of patient experiences is gaining importance in many healthcare systems, including the Slovenian one. The need for a national survey on patient experiences in the specialist outpatient settings emerged recently, leading to the establishment of a new questionnaire in Slovenia. The aim of the study was to measure patients' experiences in the outpatient specialist medical settings in the fields of surgery, gastroenterology, otorhinolaryngology, diabetology, endocrinology and metabolic diseases, dermatovenerology and pulmonology. Methods The survey takes into account various aspects of healthcare such as waiting period to the visit, admission, waiting time in the waiting room, physician work, nurse work, privacy, patient rights information, and familiarity with continuation of treatment. As part of the study, patients evaluated treatment at a specialist outpatient clinic on a scale of 0 to 10, and were able to give praise and suggestions for improvements. The questionnaire used was a newly developed one, based on a review of the literature and focus groups with patients. The questionnaire was also cognitively tested and piloted before national rollout. Results The national survey was conducted in March 2019 and included adult patients who attended a specialist outpatient clinic in certain clinical fields. The survey included 149 specialist outpatient medical offices. 8,616 questionnaires were received. The response rate was estimated to be 32%. 79.0% of patients stated that waiting period to the visit did not pose any problem for them. 80.3% of the surveyed patients rated the medical treatment with a score of 9 or 10. Conclusions The surveyed patients in our study rate highly the treatment in selected outpatient specialist clinics. The strength of the findings is limited by suboptimal sampling. Possible changes to the sampling methods to be used in future iterations of the survey are currently being evaluated. Key messages In March 2019, the first national survey on patients' experience in selected public outpatient specialist clinics in Slovenia was conducted. 80.3 percent of the surveyed patients rate the medical treatment highly with a score of 9 or 10.

Use of Predictive and Simulation Models to Develop Strategies for Better Access Specialists Care

No-shows are patients who miss scheduled Specialist Outpatient Clinic (SOC) appointments. No-shows can impact patients' access to care and appointment lead time. This chapter describes a data-driven strategy of improving access to specialist care through first developing a stratified predictive scoring model to identify patients at risk of no-shows; second, studying the impact of a dynamic overbooking strategy that incorporates the use of the no-show prediction model using discrete event simulation (DES) on lead time. Seventeen variables related to new SOC appointments for subsidized patients in 2016 were analyzed. Multiple logistic regression (MLR) found eight variables independently associated with no-shows with area under receiver operation curve (AUC) 70%. The model was tested and validated. DES model simulated the appointment overbooking strategy as applied to the top highest volume specialties and concluded that lead time of Specialty 1 and 2 can be shortened by 27.5 days (49% improvement) and 21.3 (33%) respectively.

How common are Chinese patients with multimorbidity involved in decision making and having a treatment plan? a cross-sectional study

Background Creating a treatment plan (TP) through shared decision making (SDM) with healthcare professionals, is of paramount importance for patients with multimorbidity. This study aims to estimate the prevalence of SDM and TP in patients with multimorbidity, and study the association between SDM/TP with demographics and patients’ confidence to manage their diseases.Method This cross-sectional study used an internationally recognized survey. 1,032 patients aged 60 or above with multimorbidity, were recruited from a specialist outpatient clinic, general outpatient clinic (GOPC) and a geriatric day hospital. The proportion of patients reported to have SDM and TP were estimated. Associations between the presence of SDM/TP and patients’ demographic data, and the confidence level to manage their illnesses, were then studied using logistic regression.Results The prevalence of SDM and TP were 35.8% and 82.1%, respectively. The presence of TP was associated with receiving healthcare from the same doctor or in the same facilities, and being recruited from GOPC. Presence of SDM (OR 1.381, p=0.054) and TP(OR 2.195, p<0.0001) were associated with enhanced confidence in dealing with diseases.Conclusion Most people with multimorbidity had TP in Hong Kong, but fewer patients had SDM.Practice implications: Ways to promote SDM in HK are needed.

Internalized stigma, disclosure and self-esteem among psychiatric patients in a general hospital outpatient clinic

Objective: Psychiatric patients often experience internalized stigma. This occurs when persons accept the negative attitudes of others towards them, then internalize and apply these beliefs to themselves. We assess the effects of internalized stigma on illness disclosure and on self-esteem in psychiatric outpatients, hypothesizing that internalized stigma is more pronounced in psychiatric patients than in medical patient controls and that internalized stigma is associated with avoidance of disclosure, as well as reduced self-esteem. Methods: Psychiatric and medical outpatients were randomly selected to participate in the study, conducted at a general hospital specialist outpatient clinic. Results: Psychiatric patients demonstrated significantly lower self-esteem than controls. Internalized stigma was the highest for singles, and the lowest among married and older patients. Among psychiatric patients, a higher internalized stigma was significantly associated with experienced discrimination and with lower levels of self-esteem. Those who avoided disclosure had significantly higher internalized stigma than those who self-disclosed. Conclusion: The results confirmed our study hypotheses. Marriage and older age seemed to confer a protective effect on self-esteem.

Development of predictive scoring model for risk stratification of no-show at a public hospital specialist outpatient clinic

Aim: No-shows are patients who miss scheduled specialist outpatient clinic (SOC) appointments. A predictive scoring model for the risk stratification of no-shows was developed to improve the utilisation of resources. Method: The administrative records of new SOC appointments for subsidised patients in 2013 were analysed. Univariate analysis was performed on 16 variables comprising patient demographics, appointment/visit records and historical outpatient records. Multiple logistic regression (MLR) was applied to determine independent risk factors of no-shows. The adjusted parameter estimates from MLR were used to develop a predictive model for risk stratification of no-show. Model validation was performed using 2014 data. Result: Out of 75,677 appointments in 2013, 28.6% were no-shows. Univariate analysis showed that 11 variables were associated with no-shows. Six variables (age, race, specialty, lead time, referral source, previous visit status) remained independently associated with no-shows in the MLR model, and their odds ratios were used to develop the weighted predictive scoring model. Weighted scores were 0 to 19, and five levels of no-show risk were derived: extremely low (score: 0–4; odds ratio (OR): 1.0); low (5–6; OR: 2.5); medium (7–8; OR: 5.6); high (9–10; OR: 9.2); and extremely high (11–19; OR: 16.7). The predictive ability of the model was tested using receiver operation curve analysis, where the area under curve (AUC) was 72%. AUC remained at 72% upon validation with 2014 data. Conclusion: The prediction model developed using only administrative data was robust and can be used for the risk stratification of SOC no-show for better resource utilisation to improve access to care.

Irreducible Dislocation of the Great Toe Interphalangeal Joint Secondary to an Incarcerated Sesamoid

Irreducible dorsal dislocation of the interphalangeal (IP) joint of the great toe is rare. We report a case of a 29-year-old gentleman who presented to the Orthopaedic Surgery Specialist Outpatient Clinic with an irreducible IP joint of the great toe that had been untreated for 4 weeks. The mechanism of injury is believed to be a combination of axial loading with a hyperdorsiflexion force when the patient fell foot first into a drain. As the patient did not report severe symptoms and a true lateral radiograph was not ordered, the dislocation was missed initially at the emergency department. The patient had continued to run and play field hockey prior to visiting us. Incarceration of the sesamoid became a block to manipulation and reduction at the specialist outpatient clinic 3 weeks later. The patient was treated with open surgical exploration, resection of the interposed sesamoid, and Kirschner-wire fixation of the IP joint followed by occupational therapy for mobilization exercises. The operative course was uneventful. At 6 months after surgery, the patient could walk, run, and return to sports.