Decrease in unscheduled pediatric outpatient visits due to SARS-CoV-2.
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ABSTRACT:
SUBMITTER: Wakabayashi T
PROVIDER: S-EPMC8662230 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
Publications
Decrease in unscheduled pediatric outpatient visits due to SARS-CoV-2.
Wakabayashi Tomohiro T Sasaoka Yuta Y Sakai Yoshiyuki Y Hinotsu Shiro S Kawasaki Yukihiko Y
Pediatrics international : official journal of the Japan Pediatric Society 20211101 1
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Project description:ObjectiveLive interactive telemedicine is increasingly covered by state Medicaid programs, but whether telemedicine is improving equity in utilization of subspecialty care is not known. We examined patterns of telemedicine use for outpatient pediatric subspecialty care within the state Medicaid programs.MethodsWe identified children ≤17 years old in 2014 Medicaid Analysis eXtract data for 12 states. We identified telemedicine-using and telemedicine-nonusing medical and surgical subspecialists. Among children cared for by telemedicine-using subspecialists, we assessed child and subspecialist characteristics associated with any telemedicine visit using logistic regression with subspecialist-level random effects. Among children cared for by telemedicine-using and nonusing subspecialists, we compared visit rates across child characteristics by assessing negative binomial regression interaction terms.ResultsOf 12,237,770 pediatric Medicaid beneficiaries, 2,051,690 (16.8%) had ≥1 subspecialist visit. Of 42,695 subspecialists identified, 146 (0.3%) had ≥1 telemedicine claim. Among children receiving care from telemedicine-using subspecialists, likelihood of any telemedicine use was increased for rural children (odds ratio [OR] 10.4, 95% confidence interval [CI] 6.3-17.1 compared to large metropolitan referent group) and those >90 miles from the subspecialist (OR 13.4, 95% CI 10.2-17.7 compared to 0-30 mile referent group). Compared to children receiving care from telemedicine-nonusing subspecialists, matched children receiving care from telemedicine-using subspecialists had larger differences in visit rates by distance to care, county rurality, ZIP code median income, and child race/ethnicity (P < .001 for interaction terms).ConclusionsChildren in rural communities and at distance to subspecialists had increased likelihood of telemedicine use. Use overall was low, and results indicated that early telemedicine policies and implementation did not close disparities in subspecialty visit rates by child geographic and sociodemographic characteristics.
| S-EPMC7194998 | biostudies-literature
Project description:BackgroundIn 2022-2023, 15- and 20-valent pneumococcal conjugate vaccines (PCV15/PCV20) were recommended for infants. We aimed to estimate the incidence of outpatient visits and antibiotic prescriptions in US children (≤17 years) from 2016-2019 for acute otitis media, pneumonia, and sinusitis associated with PCV15- and PCV20-additional (non-PCV13) serotypes to quantify PCV15/20 potential impacts.MethodsWe estimated the incidence of PCV15/20-additional serotype-attributable visits and antibiotic prescriptions as the product of all-cause incidence rates, derived from national health care surveys and MarketScan databases, and PCV15/20-additional serotype-attributable fractions. We estimated serotype-specific attributable fractions using modified vaccine-probe approaches incorporating incidence changes post-PCV13 and ratios of PCV13 versus PCV15/20 serotype frequencies, estimated through meta-analyses.ResultsPer 1000 children annually, PCV15-additional serotypes accounted for an estimated 2.7 (95% confidence interval, 1.8-3.9) visits and 2.4 (95% CI, 1.6-3.4) antibiotic prescriptions. PCV20-additional serotypes resulted in 15.0 (95% CI, 11.2-20.4) visits and 13.2 (95% CI, 9.9-18.0) antibiotic prescriptions annually per 1000 children. PCV15/20-additional serotypes account for 0.4% (95% CI, 0.2%-0.6%) and 2.1% (95% CI, 1.5%-3.0%) of pediatric outpatient antibiotic use.ConclusionsCompared with PCV15-additional serotypes, PCV20-additional serotypes account for > 5 times the burden of visits and antibiotic prescriptions. Higher-valency PCVs, especially PCV20, may contribute to preventing pediatric pneumococcal respiratory infections and antibiotic use.
| S-EPMC11481348 | biostudies-literature
Project description:This study aims to identify reasons for unscheduled return visits (URVs), and risk factors for diagnostic errors leading to URVs, with comparisons to data from a similar study conducted in the same institution 9 years ago. This retrospective study included adult patients who attended the emergency department (ED) of a tertiary hospital in Singapore between January 2014 and June 2014, with re-attendance within 72 h for the same or similar complaint. The primary outcome was wrong or delayed diagnoses. Secondary outcomes include admission to the ED observation unit or ward on return visit. Findings were compared with the previous study performed in 2005 to identify trends. Of 67,422 attendances, there were 1298 (1.93%) URVs from 1207 patients (median age 34, interquartile range 24 to 52 years; 59.7% male). The most common presenting complaint was abdominal pain (22.2%). One hundred ninety-one (15.8%) patients received an initial wrong or delayed diagnosis. Factors (adjusted odds ratio; 95% CI) associated with this were: presenting complaints of abdominal pain (2.99; 2.12-4.23), fever (1.60; 1.1-2.33), neurological deficit (4.26; 1.94-9.35), and discharge without follow-up (1.61; 1.1-2.26). Among re-attendances, 459 (38.0%) required admission. Factors (adjusted odds ratio; 95% CI) associated with admission were: male gender (1.88; 1.42 to 2.48); comorbidities of diabetes mellitus (2.07; 1.29-3.31), asthma (5.23; 1.59-17.26), and renal disease (7.48; 2.00-28.05); presenting complaints of abdominal pain (1.83; 1.32-2.55), fever (3.05; 2.10-4.44), and giddiness or vertigo (2.17; 1.26-3.73). There was a reduction in URV rate compared to the previous study in 2005 (1.93% versus 2.19%). Abdominal pain at the index visit remains a significant cause of URVs (22.2% versus 25.1%). Presenting complaints of neurological deficits, abdominal pain, fever, and discharge without follow-up were associated with wrong or delayed diagnoses among URVs.
| S-EPMC6723936 | biostudies-literature
Project description:IntroductionCongenital heart defects (CHD) are the most frequent congenital birth defects, affecting approximately 1% of newborns and constituting the main cause of death among all congenital malformations. The prevalence of CHD in Andean America is heterogeneous and in Peru the burden of CHD is unknown.ObjectiveTo describe the trends of CHD outpatient visits and mortality and their variation according to sex, age and altitude levels.MethodsWe performed a secondary data analysis of CHD outpatient visits and mortality using publicly available information from the Peruvian Ministry of Health national registries from 2000 to 2020.ResultsThere was a statistically significant increase in CHD outpatient visits of 20.4 over time. Pediatric patients, those who lived at low altitude (≤2500 m above sea level) and those who lived in the capital of Peru had a higher average number of outpatient visits per 100 000 population. CHD-related mortality increased by 0.31 per million population per year. Although this trend was not statistically significant overall, pediatric patients experienced higher mortality than adults.ConclusionIn Peru, the outpatient CHD volume has increased significantly over the last two decades, however CHD-related mortality has remained constant. Children in the first decade of life are the predominant group in both, outpatient CHD volume and mortality.
| S-EPMC11658395 | biostudies-literature
Project description:This clinical trial studies if enhanced outpatient symptom management with telemedicine and remote monitoring can help reduce acute care visit due to chemotherapy-related adverse events. Receiving telemedicine and remote monitoring may help patients have better outcomes (such as fewer avoidable emergency room visits and hospitalizations, better quality of life, fewer symptoms, and fewer treatment delays) than patients who receive usual care.
| 2389176 | ecrin-mdr-crc
Project description:ImportanceStreptococcus pneumoniae is a known etiology of acute respiratory infections (ARIs), which account for large proportions of outpatient visits and antibiotic use in children. In 2023, 15- and 20-valent pneumococcal conjugate vaccines (PCV15, PCV20) were recommended for routine use in infants. However, the burden of outpatient healthcare utilization among U.S. children attributable to the additional, non-PCV13 serotypes in PCV15/20 is unknown.ObjectiveTo estimate the incidence of outpatient visits and antibiotic prescriptions in U.S. children for acute otitis media, pneumonia, and sinusitis associated with PCV15- and PCV20-additional serotypes (non-PCV13 serotypes) to quantify potential impacts of PCV15/20 on outpatient visits and antibiotic prescriptions for these conditions.DesignMulti-component study including descriptive analyses of cross-sectional and cohort data on outpatient visits and antibiotic prescriptions from 2016-2019 and meta-analyses of pneumococcal serotype distribution in non-invasive respiratory infections.SettingOutpatient visits and antibiotic prescriptions among U.S. children.ParticipantsPediatric visits and antibiotic prescriptions among children captured in the National Ambulatory Medical Care Survey (NAMCS), the National Hospital Ambulatory Medicare Care Survey (NHAMCS), and Merative MarketScan, collectively representing healthcare delivery across all outpatient settings. Incidence denominators estimated using census (NAMCS/NHAMCS) and enrollment (MarketScan) data.Main outcomes and measuresPediatric outpatient visit and antibiotic prescription incidence for acute otitis media, pneumonia, and sinusitis associated with PCV15/20-additional serotypes.ResultsWe estimated that per 1000 children annually, PCV15-additional serotypes accounted for 2.7 (95% confidence interval 1.8-3.9) visits and 2.4 (1.6-3.4) antibiotic prescriptions. PCV20-additional serotypes resulted in 15.0 (11.2-20.4) visits and 13.2 (9.9-18.0) antibiotic prescriptions annually per 1,000 children. Projected to national counts, PCV15/20-additional serotypes account for 173,000 (118,000-252,000) and 968,000 (722,000-1,318,000) antibiotic prescriptions among U.S. children each year, translating to 0.4% (0.2-0.6%) and 2.1% (1.5-3.0%) of all outpatient antibiotic use among children.Conclusions and relevancePCV15/20-additional serotypes account for a large burden of pediatric outpatient healthcare utilization. Compared with PCV15-additional serotypes, PCV20-additional serotypes account for >5 times the burden of visits and antibiotic prescriptions. These higher-valency PCVs, especially PCV20, may contribute to preventing ARIs and antibiotic use in children.Key pointsQuestion: What is the incidence of pediatric outpatient visits and antibiotic prescriptions for acute respiratory tract infections associated with the additional (non-13-valent pneumococcal conjugate vaccine) serotypes in 15- and 20-valent pneumococcal conjugate vaccines (PCV15, PCV20)? Findings: PCV15- and PCV20-additional serotypes account for an estimated 197,000 and 1,098,000 visits and 173,000 and 968,000 antibiotic prescriptions, respectively, for acute respiratory infections among U.S. children annually. Visit and antibiotic prescription burdens were concentrated among children aged <5 years. Meaning: Respiratory infections caused by serotypes in PCV15/20, especially PCV20, may be important contributors to outpatient visits and antibiotic use in children.
| S-EPMC10473805 | biostudies-literature
Project description:BackgroundTo effectively utilize available healthcare resources, integrated care models are recommended. According to such model's, registered nurses have the potential to increase patient access to health care services and alleviate organizational workload. Studies on acute home consultation assessments by registered nurses are sparse. The aim was to describe the reasons and actions for unscheduled same-day face-to-face registered nurse consultation at home offered to patients calling the national telephone helpline for healthcare in Sweden (SHD 1177), according to the integrated Collaborative Health Care model.MethodsA descriptive cross-sectional study was designed. Data from registered nurses (n = 259) working within the Collaborative Health Care model, who performed unscheduled consultations at home (n = 615) using a data collection tool from 2017 to 2018 were collected.ResultsAmong the 615 unscheduled home consultations performed by registered nurses, > 50% of the patients were managed at home as their health problems were not deemed as requiring a same-day referral to a clinic when assessed by the registered nurses. The most frequent health problems and reasons for contact were urinary tract problems, followed by medical and surgical conditions. Social factors, including living alone, impacted referral. Those living with a partner received care at home to a greater extent than those who lived alone.ConclusionAn integrated model for healthcare involving registered nurses direct assessment, action and accountability seems to be an efficient option for providing integrated care at home and reducing acute clinic visits.
| S-EPMC11531198 | biostudies-literature
Project description: Not available
| S-BSST379 | biostudies-other
Project description:BackgroundUnscheduled emergency department return visits (EDRVs) are key indicators for monitoring the quality of emergency medical care. A high return rate implies that the medical services provided by the emergency department (ED) failed to achieve the expected results of accurate diagnosis and effective treatment. Older adults are more susceptible to diseases and comorbidities than younger adults, and they exhibit unique and complex clinical characteristics that increase the difficulty of clinical diagnosis and treatment. Older adults also use more emergency medical resources than people in other age groups. Many studies have reviewed the causes of EDRVs among general ED patients; however, few have focused on older adults, although this is the age group with the highest rate of EDRVs.ObjectiveThis aim of this study is to establish a model for predicting unscheduled EDRVs within a 72-hour period among patients aged 65 years and older. In addition, we aim to investigate the effects of the influencing factors on their unscheduled EDRVs.MethodsWe used stratified and randomized data from Taiwan's National Health Insurance Research Database and applied data mining techniques to construct a prediction model consisting of patient, disease, hospital, and physician characteristics. Records of ED visits by patients aged 65 years and older from 1996 to 2010 in the National Health Insurance Research Database were selected, and the final sample size was 49,252 records.ResultsThe decision tree of the prediction model achieved an acceptable overall accuracy of 76.80%. Economic status, chronic illness, and length of stay in the ED were the top three variables influencing unscheduled EDRVs. Those who stayed in the ED overnight or longer on their first visit were less likely to return. This study confirms the results of prior studies, which found that economically underprivileged older adults with chronic illness and comorbidities were more likely to return to the ED.ConclusionsMedical institutions can use our prediction model as a reference to improve medical management and clinical services by understanding the reasons for 72-hour unscheduled EDRVs in older adult patients. A possible solution is to create mechanisms that incorporate our prediction model and develop a support system with customized medical education for older patients and their family members before discharge. Meanwhile, a reasonably longer length of stay in the ED may help evaluate treatments and guide prognosis for older adult patients, and it may further reduce the rate of their unscheduled EDRVs.
| S-EPMC8367131 | biostudies-literature
Project description:This study measured rates and trends in antibiotic dispensing for emergency department (ED) and outpatient visits by age groups. This retrospective analysis used data from the National Institutes of Health Collaboratory Distributed Research Network. The analysis included children (aged > 3 months to <12 years) and adolescents (aged 12 to <19 years) with or without an antibiotic dispensed within 3 days following visits for infectious diagnoses occurring from 2006 to 2016, with no antibiotic fills 90 days prior. Diagnoses were classified as: 1) respiratory tract infections (RTIs) for which antibiotics are mostly indicated; 2) RTIs for which antibiotics are mostly not indicated; 3) respiratory conditions for which antibiotics are never indicated; 4) infectious conditions beyond RTIs regardless of antibiotic indication. The largest annual decrease in any dispensed antibiotics (5% per year) was seen in ED visits for not indicated RTIs and never indicated respiratory conditions (incidence rate ratio [IRR] 0.95, 95% confidence interval [CI] 0.95-0.96). In outpatient settings, a 2% per year decrease was seen for not indicated RTIs and never indicated respiratory conditions (IRR 0.98, 95% CI 0.98-0.98). Broad-spectrum antibiotics had a 1% per year increase in outpatient settings for mostly indicated RTIs (IRR 1.01, 95% CI 1.01-1.01). Compared with adolescents, broad-spectrum antibiotic dispensing rates and trends were consistently higher for children regardless of diagnosis or care setting. Using national claims data, this real-world analysis found uneven decreases in potentially inappropriate antibiotic dispensing, suggesting the need for antibiotic stewardship interventions to become more common in outpatient settings.
| S-EPMC6711353 | biostudies-literature