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Biomedical subjects

N R Bell

Publications and source records attributed to N R Bell.

8 recordsLinked to original sources
PubMed2006

Increased continuity of care associated with decreased hospital care and emergency department visits for patients with asthma.

The objective of this study was to determine the association between continuity of care and emergency room visits/hospital care for patients with asthma. A population-based study was conducted using administrative healthcare datasets obtained from Alberta Health and Wellness, Alberta, Canada. The 4-year study period extended from April 1, 1996 to March 31, 2000, and took place at the Palliser Health Region in Alberta, Canada, which has a population of 88,000 people. A population-based sample of 2774 patients, diagnosed with asthma between ages 5 and 45 with two or more office visits for asthma and who lived in the Palliser Health Region for 2 consecutive years during the study period, was studied. The main outcome measure was the association of continuity of care with hospitalizations and emergency room visits for patients with asthma. Continuity of care was the proportion of total physician visits made to the most frequently visited physician. High continuity of care was associated with a decreased risk of an emergency visit (OR = 0.24: 95% CI 0.19-0.29), number of emergency visits (RR = 0.37; 95% CI 0.32-0.42), decreased risk of number of hospitalizations (RR = 0.69; 95% CI 0.54-0.89), and total days in hospital (average difference = 0.77; 95% CI 0.63-0.95), but not with ever hospitalized. High continuity of care was associated with a 60%-75% reduction in emergency room visits and an approximate 25% reduction in number of hospitalizations in patients with asthma. Interventions to improve continuity of care could have the potential to improve care and reduce cost.

Adolescent↗
PubMed2000

Use of walk-in clinics by rural and urban patients.

OBJECTIVE: To compare use of walk-in clinics by rural and urban family practice patients and to describe patients' perceptions of the quality of care in physicians' offices. DESIGN: Questionnaire completed by patients in family physicians' offices. SETTING: Nine community-based family practices located in rural and urban areas of Alberta. PARTICIPANTS: Patients who had visited their family physicians' offices during April, May, June, or July 1997. Response rate was 89.6% (403 of 450 questionnaires were completed). MAIN OUTCOME MEASURES: Use of walk-in clinics, patients' perceptions of the quality of care in physicians' offices. RESULTS: Overall, 27.5% of patients (22.2% of rural, 35.5% of urban patients) attended walk-in clinics in the 6 months before visiting their family physicians' offices: 43.3% went during weekdays when their family physicians' offices were open. Significantly more rural (91.1%) than urban (60.7%) patients felt they could contact their doctors during evenings and weekends (P.004). Significantly more urban (67.2%) than rural (33.3%) patients did not call their own physicians before going to walk-in clinics (P.002). Patients who attended walk-in clinics were more likely (P.01) than patients who did not to rate their family physicians' office hours poor to good (27.9% vs 15.6%). CONCLUSIONS: Many patients attending the offices of community-based family physicians in both urban and rural areas of Alberta also attend walk-in clinics. Family practice patients attend walk-in clinics primarily because their own physicians' offices are less convenient.

Adolescent↗
PubMed1995

Continuity of care. Opportunity for residents to see repeat patients.

OBJECTIVE: To examine the opportunity for first-year family medicine residents to experience continuity of care during family medicine block time and half-day returns. DESIGN: Retrospective analysis of patient encounter data during the 1987-1988 and 1991-1992 academic years to determine how much contact residents had with repeat patients. SETTING: Two family medicine teaching centres in Edmonton. PARTICIPANTS: First-year family medicine residents: 24 residents during 1987-1988 and 24 during 1991-1992. MAIN OUTCOME MEASURES: Number of patient-resident contacts and number of repeat contacts. RESULTS: During the 4-month block time and half-day return, residents had repeat contact with 25.9% and 20.3% of the patients seen. These patients provided 48.3% and 37.7% of all visits at Centres A and B, respectively. CONCLUSION: Increasing block time from 2 to 4 months resulted in only a slight increase in repeat contact with patients. Half-day returns did not appear to enhance the opportunity for continuity of care.

Alberta↗
PubMed1989

Relation of family physician or specialist care to obstetric interventions and outcomes in patients at low risk: a western Canadian cohort study.

To determine the relation of family physician or specialist care to intrapartum interventions and outcomes, we carried out a historical cohort study of 1456 obstetric patients at low risk admitted between Nov. 15, 1984, and Mar. 15, 1986, to a western Canadian teaching hospital. The patients were classified as being at low risk on admission by means of chart review. Family physicians and specialists were found to have similar rates for most of the interventions measured, although the interventions for which significantly different rates were found suggest a less interventionist style of intrapartum care by family physicians. There were no significant differences in maternal or neonatal outcomes except for a higher proportion of infants weighing less than 2500 g among primigravid women cared for by family physicians compared with those under the care of specialists. Self-selection of physician specialty by patients resulted in differences in the demographic characteristics of the two patient populations. The findings support the continued involvement of family physicians in the provision of obstetric care.

Adolescent↗