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PubMedDate not supplied

[Skin reactivity in allergic conjunctivitis].

Allergic conjunctivitis is a very common disease in our country. We intend to determine the most frequent ocular involvement and the specific sensitivity to common aeroallergens. A longitudinal prospective study was performed on 20 patients from the allergy/immunology and ophthalmology outpatient service, Hospital Infantil de Mexico Federico Gomez, from May to July 1990. All of them had allergic conjunctivitis and were evaluated for ocular involvement and reactivity to common aeroallergens by skin prick test.

Adolescent↗
PubMed1986

Familial cancer: consequences for the oncological practice.

Pedigree data were systematically collected from patients with newly diagnosed malignant diseases in hospital outpatient services and private offices in Basel. Special efforts were made to verify every tumor diagnosis. The families of 380 adult cancer patients (greater than 16 years; 160 men and 220 women) were evaluated. The mean number of relatives per family tree was 33 (5.9 first degree) in men and 39 (6.4 first degree) in women. There were 29% of families with one, 11% with two, and 6% with three or more first-degree relatives who had cancer. In 6% of the families there was one or more first-degree relative with cancer of the same site as in the proband. Hereditary cancer syndromes were detected in several families. Fifty-four percent of all families showed no tumor occurrence in first-degree relatives. Our program clearly demonstrates that a carefully obtained family history can lead to the recognition of persons with high cancer risk in oncological practice.

Adolescent↗
PubMed1992

Making the most of the shift to outpatient services.

As hospitals watch an increasing percentage of their business shift to the outpatient setting, they will have to adapt their facilities and services to the new requirements of ambulatory care. Convenience and accessibility head the list of patient expectations. The following case studies show how two hospitals captured more ambulatory business in their markets--one by expanding its home health care program, the other by introducing management control systems and streamlining operations.

Ambulatory Care↗
PubMed2005

Hospital and outpatient health services utilization among HIV-infected adults in care 2000-2002.

BACKGROUND: Rapid changes in HIV epidemiology and antiretroviral therapy may have resulted in recent changes in patterns of healthcare utilization. OBJECTIVE: The objective of this study was to examine sociodemographic and clinical correlates of inpatient and outpatient HIV-related health service utilization in a multistate sample of patients with HIV. DESIGN: Demographic, clinical, and resource utilization data were collected from medical records for 2000, 2001, and 2002. SETTING: This study was conducted at 11 U.S. HIV primary and specialty care sites in different geographic regions. PATIENTS: In each year, HIV-positive patients with at least one CD4 count and any use of inpatient, outpatient, or emergency room services. Sample sizes were 13,392 in 2000, 15,211 in 2001, and 14,403 in 2002. MAIN OUTCOME MEASURES: Main outcome measures were number of hospital admissions, total days in hospital, and number of outpatient clinic/office visits per year. Inpatient and outpatient costs were estimated by applying unit costs to numbers of inpatient days and outpatient visits. RESULTS: Mean numbers of admissions per person per year decreased from 2000 (0.40) to 2002 (0.35), but this difference was not significant in multivariate analyses. Hospitalization rates were significantly higher among patients with greater immunosuppression, women, blacks, patients who acquired HIV through drug use, those 50 years of age and over, and those with Medicaid or Medicare. Mean annual outpatient visits decreased significantly between 2000 and 2002, from 6.06 to 5.66 visits per person per year. Whites, Hispanics, those 30 years of age and over, those on highly active antiretroviral therapy (HAART), and those with Medicaid or Medicare had significantly higher outpatient utilization. Inpatient costs per patient per month (PPPM) were estimated to be 514 dollars in 2000, 472 dollars in 2001, and 424 dollars in 2002; outpatient costs PPPM were estimated at 108 dollars in 2000, 100 dollars in 2001, and 101 dollars in 2002. CONCLUSION: Changes in utilization over this 3-year period, although statistically significant in some cases, were not substantial. Hospitalization rates remain relatively high among minority or disadvantaged groups, suggesting persistent disparities in care. Combined inpatient and outpatient costs for patients on HAART were not significantly lower than for patients not on HAART.

AIDS-Related Opportunistic Infections↗
PubMed1979

Survey of outpatient pharmaceutical services in university hospitals.

The results of a 1978 survey of outpatient pharmacies in university-affiliated hospitals are reported. A questionnaire with 55 items was sent to 75 university-affiliated hospitals with outpatient clinics. Sixty hospitals responded. Of the 47 usable responses, 44 were from hospitals with outpatient pharmacies. The outpatient pharmacies served a mean of 163 patients/day, dispensing a mean of 295 prescriptions/day. Prescriptions from outpatient clinics accounted for a mean of 57% of the outpatient pharmacies' prescriptions. Only four outpatient pharmacies provided 24-hour, seven-day/week services; the remainder provided a mean 11.1 hours of service per day on weekdays. The mean number of full-time equivalent pharmacists employed in the outpatient pharmacies (2.9) correlated positively with the number of prescriptions dispensed daily. The straight-fee pricing system was used by 62% of outpatient pharmacies but pricing systems varied with the type of product dispensed. Computer services were used in 28% of the outpatient pharmacies but were restricted mainly to accounting and inventory functions. Only 15% of the outpatient pharmacies maintained patient profiles for all patients served, and only 21% conducted special patient education programs in drug therapy.

Drug Prescriptions↗
PubMed2002

Hospital and outpatient health services utilization among HIV-infected patients in care in 1999.

BACKGROUND: The evolving epidemiology and therapeutic management of HIV disease has important implications for health care resource utilization in HIV-infected patients, and health care resource use data are also needed to support policy and financial decision making. METHODS: Demographic, clinical, and resource utilization data were collected from 9 U.S. HIV primary and specialty care sites in calendar year 1999. Rates of resource use were calculated for hospital admission, length of hospital stay, and outpatient clinic/office visits. RESULTS: The sample included 5255 patients from HIV primary care sites in 3 eastern, 3 midwestern, and 3 western areas of the United States. Hospital admissions accounted for an annual mean of 297 days per 100 persons/y in 1999. Hospital days ranged from a low of 165 per 100 persons/mo for a CD4 > 500 cells/mm(3) to 840 per 100 persons/mo for a CD4 < 50 cells/mm(3) (p <.01). Mean annual outpatient clinic/office visits were 10.7 per person in 1999. A declining CD4 level and an increasing HIV-1 RNA level were both associated with higher hospital and outpatient utilization. HAART use was associated with fewer hospital days, and a higher outpatient visit rate. Injecting drug use risk was associated with an increase in hospital days. African American race was associated with a higher number of hospital days, but a lower outpatient visit rate. Female gender was associated with higher outpatient utilization. Mean monthly inpatient and outpatient expenditures in 1999 were $423 and $168, respectively. CONCLUSION: As HIV care continues to evolve, data from our network of HIV providers will be useful in quantifying changes in HIV health services utilization to guide policy makers, as well as HIV care payers and providers.

Adolescent↗
PubMed1989

Simulation analysis of an outpatient services facility.

Anderson Memorial Hospital in Anderson, South Carolina is in the process of constructing a new Outpatient Services Center. The Outpatient Services Center will combine existing outpatient services within the hospital and offsite services at the Outpatient Diagnostic Center. A simulation model of the proposed facility has been developed based on historical data. The information obtained from the simulation model includes the analysis of outpatient services utilization, patient waiting and flow times, and service area queue sizes. This information has been used to determine minimum facility design requirements, such as waiting room size, based on the expected demands.

Ambulatory Care↗
PubMedDate not supplied

Health care reform and emergency outpatient use of rural hospitals in Alberta, Canada.

We describe Alberta's publicly funded system of rural hospital emergency outpatient services just before the profound impact of major health care reforms. From a rural physician's perspective, we descriptively analyze a unique government database that contains the number of emergency outpatient visits to all Alberta hospitals in the fiscal year 1992/93. We found that most people in rural Alberta had ready access to an extensive system of physician-based rural hospital emergency outpatient services, that 50% of all emergency visits were made to rural hospitals, and that 70% of physicians providing hospital-based emergency services were rural. There were significant differences in the emergency outpatient use of large urban, regional urban, and rural hospitals, and between rural hospitals that were close, middle, or remote distances from tertiary or secondary care centers. We identify some clinically important factors that are not described by available data, but which should be considered by the reform movement.

Alberta↗
PubMed2005

Hospital and outpatient health services utilization among HIV-infected children in care 2000-2001.

BACKGROUND: The aging of the pediatric HIV cohort and advances in antiretroviral therapy for children may have resulted in recent changes in patterns of healthcare utilization. OBJECTIVES: The objectives of this study were to examine inpatient and outpatient HIV-related health service utilization in a multistate sample of HIV-infected children, and to assess sociodemographic and clinical correlates of utilization. DESIGN: Cohort study of pediatric patients with HIV. Demographic, clinical, and resource utilization data were collected from medical records for 2000 and 2001. SETTING: This study was conducted at 4 U.S. HIV primary pediatric and specialty care sites in different geographic regions. PATIENTS: Three hundred three HIV-positive children with at least one outpatient visit or CD4 test in either 2000 or 2001 were studied. MAIN OUTCOME MEASURES: Mean outcome measures were number of hospital admissions, mean length of hospital stay, and number of outpatient clinic/office visits. RESULTS: Hospitalization rates decreased significantly from 39.2 (95% confidence interval [CI], 28.4-50.1) to 25.3 (95% CI, 16.4-34.3) admissions per 100 patients between 2000 and 2001. Hospitalizations were higher among patients with greater immunosuppression, those 2 years and under, and those with AIDS, but were not significantly related to receipt of highly active antiretroviral therapy. Mean outpatient visits did not change significantly between 2000 and 2001 from 9.09 (95% CI, 8.3-9.9) to 9.06 (95% CI, 8.4-9.7) visits per child per year. Children 2 years and under, those on highly active antiretroviral therapy, those with AIDS, and those with Medicaid had significantly higher outpatient utilization. Those with higher HIV-1 RNA had higher outpatient utilization than those with less advanced disease. CONCLUSION: Inpatient utilization significantly decreased between 2000 and 2001, but outpatient utilization did not change over time. Compared with prior studies, utilization rates appear to be declining over time. Unlike adults, racial/ethnic or gender disparities in healthcare utilization are less pronounced for HIV-infected children.

AIDS-Related Opportunistic Infections↗