Patterns of Outpatient Follow-up Visits After Hospitalizations for Acute Bronchiolitis.
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ABSTRACT:
SUBMITTER: Shapiro DJ
PROVIDER: S-EPMC10334290 | biostudies-literature | 2023 Sep
REPOSITORIES: biostudies-literature
Publications
Patterns of Outpatient Follow-up Visits After Hospitalizations for Acute Bronchiolitis.
Shapiro Daniel J DJ Wu Ann Chen AC Hersh Adam L AL Coon Eric R ER
JAMA pediatrics 20230901 9
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| S-EPMC5885832 | biostudies-literature
Project description:OBJECTIVE:Access to outpatient psychiatric care remains problematic in Canada. We have been using group medical visits (GMV) to treat psychiatric outpatients with mood and anxiety disorders. Our study aimed to show that patients are similarly satisfied with GMV and individual psychiatric treatment, hence the concern that patients truly prefer individual treatment may be unfounded. METHOD:Our study compared patient satisfaction in people who have had previous individual psychiatric care and are now receiving GMV to determine whether there is a treatment preference. RESULTS:Questionnaire data were analyzed using repeated measures ANOVA. The ANOVAs showed no differences in patients' experiences with individual treatment, compared with GMV. In addition, we found when asked directly, most patients preferred GMV or had no treatment preference. CONCLUSIONS:These findings indicate that patients' perspectives of individual psychiatric treatment and GMV are roughly equal. This suggests that the method of GMV deserves further study and comparison with other clinical models of psychiatric outpatient treatment.
| S-EPMC4079228 | biostudies-literature
Project description:BackgroundRhinovirus is linked to asthma exacerbations and chronic obstructive pulmonary disease exacerbations in adults. The severity and rates of rhinovirus acute respiratory illnesses (ARIs) in adults are uncertain.ObjectivesWe sought to determine rhinovirus-associated ARI rates in adults presenting for care in multiple settings and identify factors associated with rhinovirus detection.MethodsThis prospective, population-based cohort enrolled Tennessee residents 18 years or older in the emergency department (ED), outpatient clinics, or hospitalized for ARI from December 2008 to May 2010. Nasal/throat swabs were collected and tested for rhinovirus and other viruses by using RT-PCR. Rates of ED visits and hospitalizations were calculated and rhinovirus-positive and rhinovirus-negative patients were compared.ResultsAmong 2351 enrollees, rhinovirus was detected in 247 (11%). There were 7 rhinovirus-associated ED visits and 3 hospitalizations per 1000 adults annually. Patients with rhinovirus, compared with virus-negative ARI, were more likely to present with wheezing (odds ratio [OR], 1.7; 95% CI, 1.23-2.35; P < .001), to be a current smoker (OR, 2.31; 95% CI, 1.68-3.19) or live with a smoker (OR, 1.72; 95% CI, 1.10-2.67), have a history of chronic respiratory disease (OR, 1.61; 95% CI, 1.17-2.22), and were less likely to be hospitalized versus seen in the outpatient setting (OR, 0.58; 95% CI, 0.41-0.83).ConclusionsRhinovirus is associated with a substantial number of ED visits and hospitalizations for ARIs in adults. There may be modifiable factors that can reduce the likelihood of presenting with rhinovirus-associated ARIs.
| S-EPMC4744574 | biostudies-literature
Project description:BackgroundTimely, in-person access to health care is a challenge for people living with conditions such as stroke that result in frailty, loss of independence, restrictions in driving and mobility, and physical and cognitive decline. In Southeastern Ontario, access is further complicated by rurality and the long travel distances to visit physician clinics. There is a need to make health care more accessible and convenient. Home virtual visits (electronic visits, eVisits) can conveniently connect physicians to patients. Physicians use a secure personal videoconferencing tool to connect to patients in their homes. Patients use their device of choice (smartphone, tablet, laptop, or desktop) for the visit.ObjectiveThis study aimed to assess the feasibility and logistics of implementing eVisits in a stroke prevention clinic for seniors.MethodsA 6-month eVisit pilot study was initiated in the Kingston Health Sciences Centre stroke prevention clinic in August 2018. eVisits were used only for follow-up patient encounters. An integrated evaluation was used to test the impact of the program on clinic workflow and patient satisfaction. Patient satisfaction was evaluated by telephone interviews, using a brief questionnaire. Access and patient satisfaction metrics were compared with concurrent standard of care (patients' prior personal experience with in-person visits). Values are presented as median (interquartile range).ResultsThere were 75 subjects in the pilot. The patients were aged 65 (56-73.5) years, and 39% (29/75) resided in rural areas. There was a shorter wait for an appointment by eVisit versus in-person (mean 59.98 [SD 48.36] days vs mean 78.36 [SD 50.54] days; P<.001). The eVisit was also shorter, taking on an average of only 10 min to deliver follow-up care with a high degree of patient satisfaction versus 90 (60-112) min for in-person care. The total time saved by patients per eVisit was 80 (50-102) min, 44 (21-69) min of which was travel time. Travel distance avoided by the patients was 30.1 km (11.2-82.2). The estimated total out-of-pocket cost savings for patients per eVisit was Can $52.83 (31.26-94.53). The estimated savings (opportunity cost for in-person outpatient care) for our eVisit pilot project was Can $23,832-$28,584. The patient satisfaction with eVisits was very good compared with their prior personal experience with in-person outpatient care.ConclusionsThe eVisit program was well received by patients, deemed to be safe by physicians, and avoided unnecessary patient travel and expense. It also has the potential to reduce health care costs. We plan to scale the project within the department and the institution.
| S-EPMC6803894 | biostudies-literature
Project description:Little is known about cancellation frequencies in telemedicine vs. in-person appointments and its impact on clinical outcomes. Our objective was to examine differences between in-person and video telemedicine appointments in terms of cancellation rates by age, race, ethnicity, gender, and insurance, and compare 30-day inpatient hospitalizations rates and 30-day emergency department visit rates between the two visit types. Demographic characteristics and comorbidities for adults scheduled for an Emory Healthcare ambulatory clinic appointment from June 2020 to December 2020 were extracted from the electronic medical record. Each appointment was identified as either a video telemedicine or in-person clinic appointment. The outcomes were ambulatory clinic cancellation rates, 30-day hospitalization rates, and 30-day emergency department visit rates. Multivariable logistic regression was used to assess differences between appointment types. A total of 1,652,623 ambulatory clinic appointments were scheduled. Ambulatory appointment cancellations rates were significantly lower among telemedicine compared to in-person appointments overall (20.4% vs. 31.0%, p < .001) and regardless of gender, age, race, ethnicity, insurance, or specialty (p < .05 for all sub-groups). Telemedicine appointments were associated with lower 30-day hospitalization rates compared to in-person appointments (AOR: 0.72, 95% CI: 0.71-0.74). There was no difference in 30-day emergency department visit rates between telemedicine and in-person appointment patients (AOR: 1.00, 95% CI: 0.98-1.02). Our findings suggest that there are fewer barriers to attending an ambulatory care visit via telemedicine relative to in-person. Using video telemedicine was not associated with more frequent adverse clinical events compared with in-person visits.
| S-EPMC8684024 | biostudies-literature
Project description:Alcohol-related emergency department attendance in adolescents should be considered as a valuable opportunity to address and mitigate future alcohol consumption. Therefore, a paediatric department of a major district hospital in the Netherlands developed an outpatient preventive program targeting adolescents admitted for acute alcohol intoxication. The primary aim of this study is to evaluate how adolescent drinking patterns participating in the preventive program developed over time. This retrospective observational study involved 310 patients from the Reinier de Graaf Hospital, Delft, the Netherlands (years 2014-2022). The outpatient preventive program consists of three main components: an initial intervention, subsequent an extended counselling session and psychological interventions. The alcohol consumption was compared at three time points: before the admission for acute alcohol intoxication(T = 0), 4-6 weeks after hospital admission (T = 1) and 6-12 months after the hospital admission (T = 2). Moreover, sociodemographic variables, adolescent risk-taking behaviour and family and pedagogical factors were included in secondary analysis. Adolescents who experienced an alcohol intoxication exhibited more adolescent risk-taking behaviour (higher rates of lifetime smoking, substance use and sexual intercourse) compared to the Dutch average. Initially, these adolescents had significantly higher rates of alcohol consumption and drunkenness. Alcohol use decreased significantly in the month following intoxication, even below the Dutch average. Though 6-12 months later, their alcohol consumption increased but remained statistically lower and involved less binge drinking than the Dutch average.ConclusionsThe findings of this study demonstrate that a preventive program following acute alcohol intoxication contributes to the reduction of adolescent alcohol use and associated risk-taking behaviours.What is known• Earlier studies showed that adolescents with problematic alcohol use reported reduced alcohol consumption and fewer alcohol-related problems after participating in a motivational interviewing intervention compared to standard care. • During the follow-up assessment of adolescents with acute alcohol intoxication it is possible to signalize mental disorders and to determine whether the patient requires referral to specialized mental healthcare.What is new• These findings suggest that the preventive program had a short-term impact in reducing alcohol consumption among adolescents with acute alcohol intoxication, as well as a long-term impact in reducing binge-drinking behaviours. • The program's success in mitigating binge-drinking behaviours aligns with its goals of promoting safer drinking habits among adolescents.
| S-EPMC11564360 | biostudies-literature
Project description:BackgroundWe estimated the cost-per-episode and the annual economic burden associated with influenza in Kenya.MethodsFrom July 2013-August 2014, we recruited patients with severe acute respiratory illness (SARI) or influenza-like illness (ILI) associated with laboratory-confirmed influenza from 5 health facilities. A structured questionnaire was used to collect direct costs (medications, laboratory investigations, hospital bed fees, hospital management costs, transportation) and indirect costs (productivity losses) associated with an episode of influenza. We used published incidence of laboratory-confirmed influenza associated with SARI and ILI, and the national population census data from 2014, to estimate the annual national number of influenza-associated hospitalizations and outpatient visits and calculated the annual economic burden by multiplying cases by the mean cost.ResultsWe enrolled 275 patients (105 inpatients and 170 outpatients). The mean cost-per-episode of influenza was US$117.86 (standard deviation [SD], 88.04) among inpatients; US$114.25 (SD, 90.03) for children < 5 years, and US$137.45 (SD, 76.24) for persons aged ≥5 years. Among outpatients, the mean cost-per-episode of influenza was US$19.82 (SD, 27.29); US$21.49 (SD, 31.42) for children < 5 years, and US$16.79 (SD, 17.30) for persons aged ≥5 years. National annual influenza-associated cost estimates ranged from US$2.96-5.37 million for inpatients and US$5.96-26.35 million for outpatients.ConclusionsOur findings highlight influenza as causing substantial economic burden in Kenya. Further studies may be warranted to assess the potential benefit of targeted influenza vaccination strategies.
| S-EPMC6696702 | biostudies-literature
Project description:ImportancePosthospitalization follow-up visits are prescribed frequently for children with bronchiolitis. The rationale for this practice is unclear, but prior work has indicated that families value these visits for the reassurance provided. The overall risks and benefits of scheduled visits have not been evaluated.ObjectiveTo assess whether an as-needed posthospitalization follow-up visit is noninferior to a scheduled posthospitalization follow-up visit with respect to reducing anxiety among parents of children hospitalized for bronchiolitis.Design, setting, and participantsThis open-label, noninferiority randomized clinical trial, performed between January 1, 2018, and April 31, 2019, assessed children younger than 24 months of age hospitalized for bronchiolitis at 2 children's hospitals (Primary Children's Hospital, Salt Lake City, Utah, and Lucile Packard Children's Hospital, Palo Alto, California) and 2 community hospitals (Intermountain Riverton Hospital, Riverton, Utah, and Packard El Camino Hospital, Mountain View, California). Data analysis was performed in an intention-to-treat manner.InterventionsRandomization (1:1) to a scheduled (n = 151) vs an as-needed (n = 153) posthospitalization follow-up visit.Main outcome and measuresThe primary outcome was parental anxiety 7 days after hospital discharge, measured using the anxiety portion of the Hospital Anxiety and Depression Scale, which ranged from 0 to 28 points, with higher scores indicating greater anxiety. Fourteen prespecified secondary outcomes were assessed.ResultsAmong 304 children randomized (median age, 8 months; interquartile range, 3-14 months; 179 [59%] male), the primary outcome was available for 269 patients (88%). A total of 106 children (81%) in the scheduled follow-up group attended a scheduled posthospitalization visit compared with 26 children (19%) in the as-needed group (absolute difference, 62%; 95% CI, 53%-71%). The mean (SD) 7-day parental anxiety score was 3.9 (3.5) among the as-needed posthospitalization follow-up group and 4.2 (3.5) among the scheduled group (absolute difference, -0.3 points; 95% CI, -1.0 to 0.4 points), with the upper bound of the 95% CI within the prespecified noninferiority margin of 1.1 points. Aside from a decreased mean number of clinic visits (absolute difference, -0.6 visits per patient; 95% CI, -0.4 to -0.8 visits per patient) among the as-needed group, there were no significant between-group differences in secondary outcomes, including readmissions (any hospital readmission before symptom resolution: absolute difference, -1.6%; 95% CI, -5.7% to 2.5%) and symptom duration (time from discharge to cough resolution: absolute difference, -0.6 days; 95% CI, -2.4 to 1.2 days; time from discharge to child reported "back to normal": absolute difference, -0.8 days; 95% CI, -2.7 to 1.0 days; and time from discharge to symptom resolution: absolute difference, -0.6 days; 95% CI, -2.5 to 1.3 days).Conclusions and relevanceAmong parents of children hospitalized for bronchiolitis, an as-needed posthospitalization follow-up visit is noninferior to a scheduled posthospitalization follow-up visit with respect to reducing parental anxiety. These findings support as-needed follow-up as an effective posthospitalization follow-up strategy.Trial registrationClinicalTrials.gov Identifier: NCT03354325.
| S-EPMC7489830 | biostudies-literature
Project description:The US federal government is spending billions of dollars in physician incentives to encourage the meaningful use of electronic health records (EHRs). Although the use of EHRs has potential to improve patient health outcomes, the existing evidence has been limited and inconsistent.To examine the association between implementing a commercially available outpatient EHR and emergency department (ED) visits, hospitalizations, and office visits for patients with diabetes mellitus.Staggered EHR implementation across outpatient clinics in an integrated delivery system (Kaiser Permanente Northern California) between 2005 and 2008 created an opportunity for studying changes associated with EHR use. Among a population-based sample of 169,711 patients with diabetes between 2004 and 2009, we analyzed 4,997,585 person-months before EHR implementation and 4,648,572 person-months after an EHR was being used by patients' physicians.We examined the association between EHR use and unfavorable clinical events (ED visits and hospitalizations) and office visit use among patients with diabetes, using multivariable regression with patient-level fixed-effect analyses and adjustment for trends over time.In multivariable analyses, use of the EHR was associated with a statistically significantly decreased number of ED visits, 28.80 fewer visits per 1000 patients annually (95% CI, 20.28 to 37.32), from a mean of 519.12 visits per 1000 patients annually without using the EHR to 490.32 per 1000 patients when using the EHR. The EHR was also associated with 13.10 fewer hospitalizations per 1000 patients annually (95% CI, 7.37 to 18.82), from a mean of 251.60 hospitalizations per 1000 patients annually with no EHR to 238.50 per 1000 patients annually when using the EHR. There were similar statistically significant reductions in nonelective hospitalizations (10.92 fewer per 1000 patients annually) and hospitalizations for ambulatory care-sensitive conditions (7.08 fewer per 1000 patients annually). There was no statistically significant association between EHR use and office visit rates.Among patients with diabetes, use of an outpatient EHR in an integrated delivery system was associated with modest reductions in ED visits and hospitalizations but not office visit rates. Further studies are needed to quantify the association of EHR use with changes in costs.
| S-EPMC4503235 | biostudies-literature