The effects of information and interpersonal continuity on physician service online: from the continuity of care perspective (Preprint)

BACKGROUND Online medical services have become an effective supplement to traditional services in hospitals and an essential organization in medical service. Prior studies have revealed that it’s useful to shorten the delayed admission time and enhance the treatment effect from the service continuity perspective. However, what specific measures the patients and physicians should take to improve service continuity remains unknown. OBJECTIVE Based on the information richness theory and continuity of care, this study investigates the dynamic impacts of information continuity and interpersonal continuity on physician’ service online. METHODS Data of 7200 patients with 360 physicians covering complete interaction records is collected from a professional online platform in China. Content analysis is used to recognize matching patient and physician and least square regression analysis is used to get all empirical results. RESULTS Empirical results show that in the short term, information continuity (including offline experience, medical records, and detailed information) influences physicians’ online service. And, their influences show heterogeneity. Moreover, by recognizing if a patient’s online physician is the same physician who he has visited offline, we find that interpersonal continuity is also important for service. In the long term, information and interpersonal continuity positively improve service continuity by facilitating repeat purchases. CONCLUSIONS Overall, our findings not only shed new light on patient behavior online and cross-channel behavior, but also provide practical insights into improving continuity of care in OHCs.

Clinical and Financial Implications of Consulting Physicians in the Management of Surgical Patients

Background The present study was designed to evaluate the immediate consequences that the number of consulting physicians has on length of stay (LOS), in-hospital mortality, 30-day readmission rates, direct health care costs, and contribution margins. Methods A retrospective review of administrative databases for the years 2013 and 2014 was performed at the Florida Hospital Adventist Healthcare System. Results 11 274 patients were included in the analysis. Total and variable costs increased by $1347 and $592, respectively, with each consulting physician service per patient. The contribution margin decreased by $354 per patient/consulting physician. Each consulting physician increased LOS by .72 days and increased odds ratio of mortality and 30-day readmission by 5% and 3%, respectively. Conclusions Our research suggests that each consulting physician added to the care of an individual surgical patient negatively affected LOS, readmission rates, in-hospital mortality, and costs.

Consequences of Gift Giving in Online Health Communities on Physician Service Quality: Empirical Text Mining Study

Background Gift giving, which has been a heavily debated topic in health care for many years, is considered as a way of expressing gratitude and to be beneficial for the physician-patient relationship within a reasonable range. However, not much work has been done to examine the influence of gift giving on physicians’ service quality, especially in the online health care environment. Objective This study addressed the consequences of gift giving by mining and analyzing the dynamic physician-patient interaction processes in an online health community. Specifically, gift types (affective or instrumental) based on the motivations and physician-patient tie strength were carefully considered to account for differences in physicians’ service quality. Methods The dynamic interaction processes (involving 3154 gifts) between 267 physicians and 14,187 patients from a well-known online health community in China (haodf.com) were analyzed to obtain empirical results. Results Our results reveal that patient gift giving inspires physicians to improve their service quality as measured by physicians’ more detailed responses and improved bedside manner, and the degree of influence varied according to the strength of the physician-patient tie. Moreover, affective gifts and instrumental gifts had different effects in improving physicians’ service quality online. Conclusions This study is among the first to explore gift giving in online health communities providing both important theoretical and practical contributions. All of our results suggest that gift giving online is of great significance to promoting effective physician-patient communication and is conducive to the relief of physician-patient conflicts.

Consequences of Gift Giving in Online Health Communities on Physician Service Quality: Empirical Text Mining Study (Preprint)

BACKGROUND Gift giving, which has been a heavily debated topic in health care for many years, is considered as a way of expressing gratitude and to be beneficial for the physician-patient relationship within a reasonable range. However, not much work has been done to examine the influence of gift giving on physicians’ service quality, especially in the online health care environment. OBJECTIVE This study addressed the consequences of gift giving by mining and analyzing the dynamic physician-patient interaction processes in an online health community. Specifically, gift types (affective or instrumental) based on the motivations and physician-patient tie strength were carefully considered to account for differences in physicians’ service quality. METHODS The dynamic interaction processes (involving 3154 gifts) between 267 physicians and 14,187 patients from a well-known online health community in China (haodf.com) were analyzed to obtain empirical results. RESULTS Our results reveal that patient gift giving inspires physicians to improve their service quality as measured by physicians’ more detailed responses and improved bedside manner, and the degree of influence varied according to the strength of the physician-patient tie. Moreover, affective gifts and instrumental gifts had different effects in improving physicians’ service quality online. CONCLUSIONS This study is among the first to explore gift giving in online health communities providing both important theoretical and practical contributions. All of our results suggest that gift giving online is of great significance to promoting effective physician-patient communication and is conducive to the relief of physician-patient conflicts.

Methotrexate Central Nervous System Toxicity Identified in a Pharmacogenomics Pharmacist Consult Patient

OBJECTIVE: To report a possible pharmacogenomics (PGx)-related, cognitive dysfunction, adverse drug reaction from methotrexate (MTX) that may be multifactorial in origin. SUMMARY: The patient subject is a 76-year-old Caucasian female of Russian ancestry suffering from rheumatoid arthritis and treated with MTX who presented to the diagnostic and consultative physician service in a medical clinic with advancing cognitive dysfunction, manifesting as memory loss, dizziness, and confusion. Components of this possible adverse drug reaction (ADR) may include ancestry, pharmacogenomics (PGx) characteristics of the patient, and a change in route of administration, among others. The case demonstrates how patients referred to a pharmacist consult service for a suspected ADR with possible PGx implications may uncover other contributory factors to the ADR. CONCLUSION: PGx testing may increase clinical pharmacist referrals to identify a PGx etiology to an ADR. However, they may also identify other non-PGx contributory factors to an ADR.

Methotrexate Central Nervous System Toxicity Identified in a Pharmacogenomics Pharmacist Consult Patient

OBJECTIVE: To report a possible pharmacogenomics (PGx)-related, cognitive dysfunction, adverse drug reaction from methotrexate (MTX) that may be multifactorial in origin. SUMMARY: The patient subject is a 76-year-old Caucasian female of Russian ancestry suffering from rheumatoid arthritis and treated with MTX who presented to the diagnostic and consultative physician service in a medical clinic with advancing cognitive dysfunction, manifesting as memory loss, dizziness, and confusion. Components of this possible adverse drug reaction (ADR) may include ancestry, pharmacogenomics (PGx) characteristics of the patient, and a change in route of administration, among others. The case demonstrates how patients referred to a pharmacist consult service for a suspected ADR with possible PGx implications may uncover other contributory factors to the ADR. CONCLUSION: PGx testing may increase clinical pharmacist referrals to identify a PGx etiology to an ADR. However, they may also identify other non-PGx contributory factors to an ADR.

Neurodevelopmental disorders among term infants exposed to antenatal corticosteroids during pregnancy: a population-based study

ObjectiveAn increasing proportion of fetuses are exposed to antenatal corticosteroids (ACS). Despite their immediate beneficial effects, the long-term safety of ACS has been an ongoing source of concern. In the current study, we assessed the likelihood of neurodevelopmental problems among term infants exposed to ACS earlier in pregnancy compared with non-exposed term infants.DesignRetrospective cohort study (2006–2011). Median duration of follow-up was 7.8 (IQR 6.4–9.2) years.SettingPopulation-based study, Ontario, Canada.ParticipantsAll live singleton infants born at term (≥370/7weeks gestation) (n=529 205).ExposureACS during pregnancy.Primary and secondary outcome measuresA composite of diagnostic or billing codes reflecting proven or suspected neurodevelopmental problems during childhood including audiometry testing, visual testing or physician service claim with a diagnosis code related to a suspected neurocognitive disorder.ResultsAt 5 years of age, the cumulative rate for the primary outcome was higher among infants exposed to ACS compared with non-exposed infants: 61.7% (3346/5423) vs 57.8% (302 520/523 782), respectively (p<0.001; number needed to harm (NNH)=25, 95% CI 19 to 38; adjusted HR (aHR) 1.12, 95% CI 1.08 to 1.16). Similar findings were observed for each of the individual components of the primary outcome: 15.3% vs 12.7% for audiometry testing (p<0.001; NNH=39, 95% CI 29 to 63; aHR 1.18, 95% CI 1.11 to 1.25); 45.4% vs 43.5% for visual testing (p=0.006; NNH=54, 95% CI 31 to 200; aHR 1.08, 95% CI 1.04 to 1.12) and 25.8% vs 21.6% for suspected neurocognitive disorder (p<0.001; NNH=24, 95% CI 19 to 33; aHR 1.16, 95% CI 1.10 to 1.21).ConclusionsWe found an association among term infants between exposure to ACS during pregnancy and healthcare utilisation during childhood related to suspected neurocognitive and neurosensory disorders.

Outpatient consultant physician service usage in Australia by specialty and state and territory

Objectives To determine national service usage for initial and subsequent outpatient consultations with a consultant physician and any variation in service-use patterns between states and territories relative to population. Methods An analysis was conducted of consultant physician Medicare claims data from the year 2014 for an initial (item 110) and subsequent consultation (item 116) and, for patients with multiple morbidities, initial management planning (item 132) and review (133). The analysis included 12 medical specialties representative of common adult non-surgical medical care (cardiology, endocrinology, gastroenterology, general medicine, geriatric medicine, haematology, immunology and allergy, medical oncology, nephrology, neurology, respiratory medicine and rheumatology). Main outcome measures were per-capita service use by medical speciality and by state and territory and ratio of subsequent consultations to initial consultations by medical speciality and by state and territory. Results There was marked variation in per-capita consultant physician service use across the states and territories, tending higher than average in New South Wales and Victoria, and lower than average in the Northern Territory. There was variation between and within specialties across states and territories in the ratio of subsequent consultations to initial consultations. Conclusion Significant per-capita variation in consultant physician utilisation is occurring across Australia. Future studies should explore the variation in greater detail to discern whether workforce issues, access or economic barriers to care, or the possibility of over- or under-servicing in certain geographic areas is leading to this variation. What is known about the topic? There are nearly 11million initial and subsequent consultant physician consultations billed to Medicare per year, incurring nearly A$850million in Medicare benefits. Little attention has been paid to per-capita variation in rates of consultant physician service use across states and territories. What does this paper add? There is marked variation in per-capita consultant physician service use across different states and territories both within and between specialties. What are the implications for practitioners? Variation in service use may be due to limitations in the healthcare workforce, access or economic barriers, or systematic over- or under-servicing. The clinical appropriateness of repeated follow-up consultations is unclear.

COST-EFFECTIVENESS ANALYSIS OF CEFTRIAXONE GENERIC AND PATENT IN CHILDREN WITH TYPHOID

Objective: This study aimed to measure and compare the effectivity and cost of the two types of ceftriaxone to determine the more cost-effectivetreatment.Methods: In a cross-sectional analytical study, prescription and administrative financial data were retrospectively collected using the total samplingmethod. Data of 63 patients, comprising 43 and 20 patients treated with generic and patent ceftriaxone, respectively, were analyzed. The effectivenessof the treatment was measured in terms of the length of hospital stay of the patients. The total cost of the treatment was the total median of the costsof drugs, laboratory examinations, medical device usage, physician service, and hospitalization.Results: The effectiveness of both generic and patent ceftriaxone was 4 days of hospital stay. Cost-effectiveness ratio of generic ceftriaxone was Rp575,937.25/day and that of patent ceftriaxone was Rp 888,601.75/day.Conclusion: Generic ceftriaxone was more cost-effective than patent ceftriaxone.

Factors Associated With U.S. Army Physician Service After Obligation Completion

Introduction Approximately, 320 physicians enter active duty in the U.S. Army each year, replacing a similar number separating from service. Despite the significant costs involved in educating and training physicians, factors associated with continued active service after completing obligations have not been well studied. Materials and Methods A retrospective cohort study was conducted of all U.S. Army physicians who graduated medical school in 1987 or later and entered active physician service on or before December 31, 2015. A Cox proportional hazards model was used to evaluate the likelihood of continued service after initial obligations to the Army were satisfied. A logistic regression model examined the likelihood of reaching retirement eligibility for the subgroup entering service before October 1998. Results Of the 10,490 physicians who met inclusion criteria, 8,009 physicians completed their service obligation by the end of the study. There were 4,524 physicians who entered service before October 1998 and were eligible for the retirement analysis. Several factors were found to be independently associated with a higher likelihood of continued post-obligation service and reaching retirement eligibility. These factors were: years of active service accumulated when obligations were complete; preventive medicine and infectious disease specialization; and male gender. Conclusions The physicians most likely to continue serving after completion of their obligation and ultimately retire are those who had the most years of service accumulated when they could leave the Army. Graduates from the Uniformed Services University of the Health Sciences (USU) incur an obligation of 7 years vs. 4 years for most other programs. USU also attracts a higher proportion of applicants with prior military service and pre-medical school service obligations. The lack of significant difference in service after obligation completion or achievement of retirement eligibility between USU and non-USU graduates was explained by the greater total service of USU graduates when their obligations were complete. Changing the obligation and incentives, such as salary, for other accessioning programs to mirror the USU model would likely minimize service differences between USU and non-USU graduates.