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PubMed1993

The completeness of AIDS case reporting in New York City.

OBJECTIVE--To assess the completeness of acquired immunodeficiency syndrome (AIDS) case reporting in New York City (NYC), and to determine whether the completeness of reporting differs in various populations. DESIGN--Retrospective record review of hospital laboratory logs, death certificates, hospital discharge records, and patient registries at private physicians' offices and hospital outpatient clinics. SETTING--Public and private hospitals, and private physicians' offices in NYC. PATIENTS--Adults and adolescents with AIDS or with illnesses suggestive of AIDS were identified using both population-based and nonrandom sampling techniques. These persons were matched with the NYC AIDS case registry, and the medical records of nonmatching persons were reviewed to determine whether they met the 1987 Centers for Disease Control and Prevention surveillance case definition for AIDS. MAIN OUTCOME MEASURES--The completeness of reporting was calculated for the five individual projects and for the aggregate database by gender, race/ethnicity, risk, borough of residence, age, first AIDS diagnosis, and year of diagnosis. RESULTS--Of 7015 persons with AIDS identified in the five projects, 5912 (84%) had been previously reported (range, 77% to 89%). The completeness of reporting ranged from 81% to 87% in all major gender, race/ethnicity, risk, borough of residence, and age subgroups. In a multivariate analysis, the odds of being unreported were significantly higher among outpatients in hospital clinics, out-of-state residents, persons with diagnoses other than Pneumocystis carinii pneumonia, and persons recently diagnosed with AIDS. CONCLUSIONS--This study indicates that the NYC AIDS surveillance system functioned effectively during the first decade of the AIDS epidemic. Completeness-of-reporting studies are an integral part of AIDS surveillance, providing data that are critical for assessing the validity of the AIDS surveillance database.

Acquired Immunodeficiency Syndrome↗
PubMed1977

The continuing emergency care clinic: improving patient compliance with follow-up care.

Traditionally, emergency patients have been noted for high rates of noncompliance with appointments in outpatient clinics for follow-up care. S study of cases referred for follow-up care at the outpatient clinic of The Medical College of Pennsylvania showed that less than 20% of the patients kept their appointments. To cope with this problem, a Continuing Emergency Care (CEC) clinic was established on the assumption that a change in structural environment could change noncompliance behavior patterns. The clinic is a small unit near the emergency department, separate from the larger hospital outpatient clinic area. Patient compliance data were collected on each case referred to the CEC clinic during a three-month period. Findings showed a threefold increase in appointment compliance over the previous study in which referrals were made to the hospital clinics.

Appointments and Schedules↗
PubMed2005

Randomised controlled trial to compare GP-run orthopaedic clinics based in hospital outpatient departments and general practices.

BACKGROUND: To reduce outpatient waiting times, a growing number of outpatient clinics for selected groups of patients are being provided by GPs with special interests (GPwSIs). AIM: To determine whether there are differences in patient satisfaction or clinical outcome among patients attending orthopaedic clinics provided by GPwSIs in hospital or community settings. DESIGN OF STUDY: Randomised controlled trial. SETTING: Hospital outpatient departments or general practices. METHOD: Three hundred and twenty-one patients with minor orthopaedic problems were referred by GPs to the orthopaedic surgery department of the University Hospitals of Leicester NHS Trust; 168 patients were randomised to care by GPwSIs in practices, and 153 were randomised to care by the same GPwSIs in clinics held at hospital outpatient departments. Patients completed the SF-36v2 and satisfaction questionnaires at their first appointment, and again 3 months later. RESULTS: There was no significant difference between the sites in changes in health. After the first clinic attendance, patients attending practice-based clinics were more satisfied with access to appointments and information received. CONCLUSION: For selected orthopaedic referrals seen by GPwSIs, there were no significant differences in clinical outcomes between practice-based and hospital-based clinics, but some features of practice-based clinics tend to be preferred by patients.

Adult↗
PubMed1989

[Remission as an index of treatment effectiveness in psoriasis].

Clinical patterns of psoriasis in 155 inpatients are analyzed, as are case histories of 2083 patients in the town of Saratov. Spontaneous and prolonged remissions of the condition have been recorded in 36.1 and 13.4% of the patients, respectively. The mean period between the disease manifestation and the onset of a prolonged remission has been 8.5 +/- 0.6 years, the length of the remission being 9.8 +/- 0.9 in men and 9.6 +/- 1.0 years in women. The authors compare the stability of the remissions after various treatment modalities. Combined stage-by-stage rehabilitation (outpatient clinic--hospital--health resort--outpatient clinic) has yielded the best results.

Adult↗
PubMed2006

Communication between older women and physicians: preliminary implications for satisfaction and intention to have mammography.

OBJECTIVE: To explore the associations between physician communication styles and their older patients' intentions to get mammography and satisfaction with physician communication. METHODS: This cross-sectional mixed methods study was conducted in a teaching hospital outpatient clinic with faculty general internists (n=7) and their female patients aged 65 years and older (n=56). Audiotaped communication was coded by researchers using the multidimensional interactional analysis and assisted doctor-elderly patient transactions coding systems. Demographic data was collected prior to the visit. Data on intention to have mammography and satisfaction with communication were collected immediately post-visit. RESULTS: The majority of encounters had some degree of joint decision-making. Communication styles tended to be associated with women's intentions to have screening mammography. Patients who described communication as "deep", "trusting" and "bonding" were more satisfied with communication than women who rated physician communication as less trusting (p=0.03, 0.02 and 0.02, respectively). CONCLUSION: Physicians' communication styles affect their older female patients' satisfaction. In this preliminary study, older women who rated communication as being deep, trusting and bonding tended to have a greater intention to have mammography. PRACTICE IMPLICATIONS: Improving physicians' communication styles may increase satisfaction with physician communication and result in higher mammography adherence among older female patients.

Aged↗
PubMed2005

Characteristics associated with neuropathy and/or retinopathy in a hospital outpatient diabetic clinic.

BACKGROUND: The incidence of diabetes is increasing worldwide and with it the risk of diabetic complications. The aim of this study was to characterise parameters associated with neuropathy and/or retinopathy in a hospital outpatient diabetic clinic population. METHOD: A structured questionnaire addressing diabetes related factors and demography was administered to a cross-sectional sample of patients (n = 290) with type 1 and type 2 diabetes attending a hospital diabetic outpatient clinic. Additional clinical measures were obtained from patient medical files and computerised records. Logistic regression analysis was used to identify characteristics associated with the presence of complications. RESULTS: When controlling for other predictors, increasing age (P < 0.01), type 1 diabetes (P = 0.05), longer duration of diabetes (P < 0.01), increased serum triglyceride levels (P = 0.03), HbA1c (>8%; P = 0.03), self-reported low physical activity levels (P = 0.05) and being a smoker (P = 0.01) were positively related to retinopathy and/or neuropathy. Patients within the study population had reasonably well controlled BP and serum lipids, thus explaining the absence of these particular variables from the list of predictor parameters. Other factors including diabetes knowledge, home blood glucose monitoring, gender, body mass index, clinic attendance and occupational status were not significantly associated with retinopathy or neuropathy in the present study population. CONCLUSIONS: Pharmacists and other health practitioners who are in a position to be involved in the care and management of patients with diabetes should raise awareness of complications, particularly amongst patients who present with the above risk factors and provide necessary counselling and advice as required.

Adult↗
PubMed1994

Integrated care for asthma: a clinical, social, and economic evaluation. Grampian Asthma Study of Integrated Care (GRASSIC)

OBJECTIVES: To evaluate integrated care for asthma in clinical, social, and economic terms. DESIGN: Pragmatic randomised trial. SETTING: Hospital outpatient clinics and general practices throughout the north east of Scotland. PATIENTS: 712 adults attending hospital outpatient clinics with a diagnosis of asthma confirmed by a chest physician and pulmonary function reversibility of at least 20%. MAIN OUTCOME MEASURES: Use of bronchodilators and inhaled and oral steroids; number of general practice consultations and hospital admissions for asthma; sleep disturbance and other restrictions on normal activity; psychological aspects of health including perceived asthma control; patient satisfaction; and financial costs. RESULTS: After one year there were no significant overall differences between those patients receiving integrated asthma care and those receiving conventional outpatient care for any clinical or psychosocial outcome. For pulmonary function, forced expiratory volume was 76% of predicted for integrated care patients and 75% for conventional outpatients (95% confidence interval for difference -3.6% to 5.0%). Patients who had experienced integrated care were more likely to select it as their preferred course of future management (75% (251/333) v 62% (207/333) (6% to 20%)); they saved 39.52 pounds a year. This was largely because patients in conventional outpatient care consulted their general practitioner as many times as those in integrated care, who were not also visiting hospital. CONCLUSION: Integrated care for moderately severe asthma patients is clinically as effective as conventional outpatient care, cost effective, and an attractive management option for patients, general practitioners, and hospital consultants.

Adult↗
PubMed2000

Dutch transmural nurse clinics for chronic patients: a descriptive study.

'Transmural care' can be defined as patient-tailored care provided on the basis of close collaboration and joint responsibility between hospitals and home care organizations. One form of transmural care is transmural nurse clinics for chronically ill. This study describes 62 transmural nurse clinics in the Netherlands. It was established that most of these nurse clinics are held by a specialized community nurse at a hospital outpatient clinic. The principal tasks of the specialized nurse at the clinic are providing illness-related information and supporting patients in dealing with the illness. Only a few unpublished evaluations of Dutch transmural nurse clinics have been conducted. Future research has to provide more insight into the impact of transmural nurse clinics on the quality and continuity of care.

Chronic Disease↗
PubMed1996

Diabetes mellitus and health service utilization: a case-control study of outpatient visits 8 years after diagnosis.

All incident cases of diabetes mellitus in the age group 15 to 34 years have been prospectively registered in Sweden since January 1983. To analyse the utilization of outpatient services 8 years after disease onset, we selected the cases registered in 1983 and two controls per case from the general population, matched by age, gender, and county of residence. In 1991, retrospective data about utilization patterns during a 3-month period were collected via a mailed questionnaire, returned by 317 (72%) patients with diabetes and 586 (68%) controls. Seventy-four percent of the cases and 19% of the controls reported at least one visit to a hospital outpatient clinic, including accident and emergency departments. The odds ratio for one visit was 14 (95% CI 9.6-20), for two visits 11 (95% CI 7.0-18), and for three or more visits 8.9 (95% CI 5.6-14). Even when specialized diabetes clinics were excluded from the analysis, the cases had higher odds for visits to internal medicine clinics, to ophthalmology clinics, and to gynaecology clinics, but not for visits to surgical clinics or to accident and emergency departments. Of non-hospital outpatient services, only visits to nurse practitioners were reported by a higher percentage of diabetic responders. Twenty-seven percent of patients with diabetes, as compared to 9% of the controls, had visited both hospital and non-hospital outpatient offices. Females were overrepresented among diabetic high-consumers. The results indicate that most young to middle-aged Swedish persons with diabetes are monitored at hospital outpatient offices, but considerable overlap exists between hospital and non-hospital outpatient services. Further research is needed into the determinants of utilization patterns in diabetes, such as gender.

Adolescent↗
PubMed1991

Psychiatric visits to general hospital clinics by elderly persons and younger adults.

Findings of a study of mental health visits to general hospital outpatient clinics and emergency rooms by elderly persons and younger adults were compared with findings from an earlier survey of mental health visits to office-based physicians. In both studies, about half of the visits were to psychiatric clinics or to psychiatrists. However, the findings differed in that 43 percent of all visits to hospital clinics were for substance abuse, compared with only 4 percent of the visits to private physicians. Almost three-fourths of the hospital-based mental health visits by elderly patients were to psychiatric clinics, while only a third of the office visits by elderly patients were to psychiatrists. The authors discuss the policy implications of the high utilization of clinic services by elderly patients.

Adult↗
PubMedDate not supplied

Should physicians perform their own quality assurance audits?

Quality assurance is required of all hospital outpatient clinics although there is little evidence documenting its value. The purposes of this study were to assess the impact of quality assurance audits on physicians' ordering behavior and to learn whether doctors who actually performed audits behaved differently from physicians who passively received audit results. Baseline influenza vaccination and screening mammography ordering rates were established for the authors' residents' clinic in 1985. In 1986, residents were assigned randomly to three groups. Residents in one group audited their own charts for 1985 influenza vaccination ordering; the second group audited its own charts for 1985 screening mammography ordering; and the third group performed no audit but received the other groups' results. Passive receipt of results improved ordering of vaccination from 40% to 59% and ordering of mammography from 8% to 16%. Actual performance of audits improved ordering of mammography from 16% to 26% but did not improve vaccination ordering. These quality assurance audits were effective in improving the performance of selected preventive health measures in a residents' clinic.

Hospitals, Teaching↗
PubMed1984

Preliminary experience with a hospital blood pressure follow up clinic with nurse practitioner assessment and microprocessor based data retrieval.

Experience over two years with 376 hypertensive patients managed at a clinic where the primary observations are made by a trained nurse, clinical information is held on a microprocessor, and treatment follows a standard stepped care approach has been assessed. Blood pressure control after both one and two years was appreciably improved, with over 70% of patients having diastolic pressure below 90 mm Hg compared with 22% of patients when they first attended the new clinic. The non-attendance rate was half that of the conventional hospital outpatient clinic. A computer based record system with a nurse run hypertension clinic is acceptable to patients and offers the possibility of more effective long term control of blood pressure in large numbers of patients.

Adolescent↗
PubMed1988

Compliance with psychiatric referrals from a general hospital psychiatry outpatient clinic.

This study examines the referral patterns of 949 patients seen in a general hospital psychiatry outpatient clinic during a 15-month period. One hundred patients referred to outpatient psychotherapists were interviewed by telephone to determine compliance rates with referral recommendations. Forty-five percent reported compliance with the referral, defined as attendance at one or more psychiatric follow-up visits. Factors associated with higher compliance rates were being married, being referred at the initiation of the therapist and not the patient, and, for a subgroup of patients, receiving a list of potential psychotherapists. Neither diagnosis nor severity of illness predicted compliance, and self-referral was not associated with improved compliance. There was also no relationship found between satisfaction with the referral procedure and subsequent compliance with the referral. In 49% of the noncompliant cases, reasons cited were a self-perceived lack of need for continuing treatment due to symptom resolution and insufficient motivation.

Adolescent↗
PubMed2005

Prevalence of home blood pressure measurement among selected hypertensive patients: results of a multicenter survey from six hospital outpatient hypertension clinics in Italy.

AIM: The purpose of this study was to evaluate the prevalence of home blood pressure (BP) measurement, the type of devices and accuracy in a large sample of hypertensive patients referred to hospital outpatient hypertension clinics. METHODS: Eight hundred and fifty-five consecutive treated hypertensive patients who attended six specialized centers during a period of 4 months were included. They underwent the following procedures: (i) detailed medical interview by a structured questionnaire; (ii) physical examination; (iii) standard 12-lead electrocardiogram; (iv) BP measurements taken by a validated mercury sphygmomanometer and patient's devices. RESULTS: A total of 640 (74.7%) of 855 patients were regularly performing home BP measurement. These patients were on average younger than those not practising it (58 vs 60 years, p<0.01); men were more numerous than women (58 vs 44%, p=0.03) and had higher educational level. Electronic arm-cuff instruments were the most frequently used devices (58%) followed by wrist devices (19%) and mercury or aneroid sphygmomanometers (23%). Significant correlations were found between BPs measured by validated mercury sphygmomanometers and patients' devices [r=0.85, p<0.0001 for systolic BP (SBP) and r=0.78, p<0.0001 for diastolic BP (DBP)]. Differences 5 mmHg in SBP or DBP were found in 50 and 60% of patients, respectively. CONCLUSIONS: Our findings indicate that: (i) home BP measurement is performed by a majority of treated hypertensives seen in specialized centers; (ii) male gender, age and educational level seem to influence the adoption of home BP monitoring; (iii) electronic arm-cuff devices are the most used instruments; (iv) a notable fraction of patient's devices do not meet the accuracy criteria recommended by US Association for the Advancement of Medical Instrumentation.

Aged↗