Difference In Number Of Visits Research Articles

Unplanned pregnancy and the association with maternal health and pregnancy outcomes: A Swedish cohort study.

Unplanned pregnancies are common and associated with late initiation and inadequate antenatal care attendance, which may pose health risks to mother and child. How pregnancy planning relates to maternal health and delivery in Sweden, a country with free antenatal care and free abortion, has not been studied previously. Our aims were to study whether pregnancy planning was associated with antenatal care utilization and pregnancy outcomes in a Swedish setting. Data for 2953 women, who answered a questionnaire when recruited at antenatal clinics in Sweden and later gave birth, was linked to the Swedish Medical Birth Register. The degree of pregnancy planning was estimated using the London Measure of Unplanned Pregnancy. Unplanned (comprising unplanned and ambivalent intention to pregnancy) was compared to planned pregnancy. Differences between women with unplanned and planned pregnancy intention and associated pregnancy outcomes were analyzed using Fisher's exact test and logistic regression. There were 31% unplanned (2% unplanned and 29% ambivalent) pregnancies, whereas most woman (69%) reported their pregnancy to be planned. Women with an unplanned pregnancy enrolled later to antenatal care, but there was no difference in number of visits compared with planned pregnancy. Women with an unplanned pregnancy had higher odds to have induced labor (17% versus 13%; aOR 1.33 95% CI 1.06-1.67) and a longer hospital stay (41% versus 37%; aOR 1.21 95% CI 1.02-1.44). No associations were found between pregnancy planning and pregnancy-induced hypertension, gestational diabetes mellitus, preeclampsia, epidural analgesia use, vacuum extraction delivery, Caesarean section or sphincter rupture. Unplanned pregnancy was associated with delayed initiation of antenatal care, higher odds for induction of labor and longer hospital stay, but not with any severe pregnancy outcomes. These findings suggest that women with an unplanned pregnancy cope well in a setting with free abortion and free health care.

Health care centre and emergency department utilization by patients with episodes of tachycardia

BackgroundOutpatients seek to visit health care facilities for episodes of tachycardia-related signs and symptoms. The challenge for physicians is to balance a proper initial assessment and avoid overlooking a possible arrhythmia. This common clinical situation affects individuals and health care utilization, and effective management may substantially affect health care resources. This study aimed to explore health care utilization for outpatients with episodes of tachycardia visiting health care centres (HCCs) and/or emergency departments (EDs).MethodThis retrospective study used data of adult outpatients (≥ 18 years) who were assessed by a physician as having a specific or nonspecific diagnosis of arrhythmia between 2017 and 2018, and data were retrieved from medical records and a regional registry database. Data was analysed with appropriate statistical analyses to identify disparities between sex, age and terms of search pattern for each health care facility. Analysis of variance was used to test disparities between the sexes, and one-factor ANOVA was used for the incidence of missed arrhythmias.ResultsA total of 2719 visits with 2373 outpatients were included in the study. The result showed a significant difference in the total number of visits (n = 2719) between female and male patients (68% vs. 32%, p < .001). In the 60–69- and 70–79-year age groups, females had significantly higher frequencies of visits than males (p = .018). A significant difference was also observed between sexes in terms of which health care facility they tended to visit (p < .001). Ninety-five percent of the outpatients visiting EDs were hospitalized. When estimating the incidence of missed arrhythmias (diagnoses) in relation to assessments, the results showed a 5% missed diagnosis involving potential atrioventricular nodal re-entry tachycardia and atrioventricular re-entry tachycardia. Moreover, the referral rate was low, especially from HCCs to cardiologists.ConclusionsThis study shows a significant difference in total visits in HCCs and/or EDs by patients of different sexes and indicates the need for improved care for outpatients with episodes of tachycardia. Sex- and age-related differences must be addressed with an aim of providing equal care. Finally, the low rate of referral from HCCs to cardiologists compared to the high proportion of hospitalizations from EDs, deserves further investigation.

Effects of Implementation of Infection Control Measures against COVID-19 on the Condition of Japanese Rural Nursing Homes.

This study aimed to clarify the effect of coronavirus disease (hereafter, COVID-19) control on patients’ health conditions and staff’s working conditions in rural nursing homes. An interventional study including all staff and patients in a rural nursing home was performed from 1 April 2019 to 31 March 2021. Infection control measures against COVID-19 were initiated on 1 April 2020. The primary outcome was the frequency of patients’ medical care visits to the outpatient and emergency departments. The secondary outcome was the number of days-off taken by staff. Each group (pre- and post-COVID-19 control groups) had 48 participants. The number of visits to the outpatient department reduced from the pre-COVID-19 to post-COVID-19 control period the difference in number of visits to the emergency department was not significant, due to the low statistical power. The number of days-off taken by the staff was increased from the pre-COVID-19 to post-COVID-19 control period. This is the first study investigating COVID-19 control measures in a rural nursing home. It may help reduce the number of patient visits to medical facilities without increasing the risk of emergencies. A strict health check of the staff can allow staff to take more days off in rural contexts.

A Comparison of Conventionally Versus Digitally Fabricated Denture Outcomes in a University Dental Clinic.

The purpose of this retrospective, cross-sectional study is to evaluate if there is a difference in number of visits (including fabrication and postoperative) and remake rate when comparing conventionally fabricated and digitally fabricated complete dentures by dental students in a predoctoral student dental clinic. This two-year retrospective cross-sectional study consisted of a chart review for patients receiving maxillary and/or mandibular complete dentures between 2017 and 2019 (n = 314) at the UNC Adams School of Dentistry predoctoral student clinic. No control group was determined for this study. Data were extracted for 242 conventional dentures and 39 digital dentures. Objective treatment outcomes were obtained for each included denture: the number of patient appointments from preliminary impressions to denture placement, the number of postoperative visits, any complications noted, and any need for remakes. Fisher's Exact Test and Cochran-Mantel-Haenszel analysis were completed with statistical significance set at p < 0.05. For the number of visits from preliminary impression to placement, 50% of conventionally fabricated dentures had 6 or more visits, while only 5% of digitally fabricated dentures had 6 or more visits. This difference for the number of patient visits was statistically significant (p < 0.05). Additionally, conventionally fabricated dentures required an average of 2-3 postoperative visits, whereas digitally fabricated dentures required 1-2 postoperative visits. This difference was also statistically significant (p < 0.05). For the number of dentures requiring remake, there was no statistical difference (p = 0.1904). When comparing conventionally fabricated and digitally fabricated dentures in the predoctoral clinic, the digitally fabricated dentures required fewer patient appointments from start to finish, and fewer postoperative appointments than conventionally fabricated dentures. Fewer visits may be an important consideration for patients, especially those with limited access to care.

Improving Resource Utilization and Outcomes Using a Minimally Invasive Pilonidal Protocol

PurposeThe purpose of this study was to evaluate the resource utilization and outcome of a minimally invasive pilonidal protocol (MIPP) versus surgical excision (SE) in adolescents with pilonidal disease. MethodsImproved hygiene, laser epilation (LE), and sinusectomy were implemented as a minimally invasive pilonidal protocol (MIPP) in March 2016. Following IRB approval, 34 consecutive MIPP patients with moderate and severe disease were compared with a random sample of 17 SE patients treated prior to MIPP implementation. Number of visits, laser epilation (LE) treatments, care duration, operations, operating room (OR) time, charges, and condition at last visit were analyzed. Charges were standardized for 2018. ResultsNo differences were found in age or body mass index between groups. SE patients underwent an average 1.6 excisions/patient (cumulative 2598 OR minutes) and no LE. MIPP patients underwent an average 1.4 sinusectomies and 3.5 LEs/patient. Six sinusectomies (0.17/patient) were performed in OR (cumulative 258 OR minutes). No differences in number of visits or care duration were found between groups. At last follow-up, 82% of MIPP and 18% of SE patients were healed or asymptomatic (p < 0.01). Average charges were $29,098 for SE versus $8440 for MIPP (p < 0.01). ConclusionA minimally invasive pilonidal protocol reduces charges and improves outcome compared with surgical excision in adolescents. Level of evidenceIII. Type of studyRetrospective comparative study.

5 Year Health Care Burden after Allogeneic Hematopoietic Stem Cell Transplantation (HSCT): Impact of Graft Source

BACKGROUND: Recipients of allogeneic HSCT experience significant short- and long-term healthcare burdens with differing general patterns of late effects between graft sources. For example, recipients of peripheral blood stem cell (PBSC) grafts benefit from more rapid engraftment after transplant as compared to bone marrow (BM) or umbilical cord blood (UCB), but experience a greater risk of chronic graft-versus-host disease (cGVHD) at later time points after HSCT. Little data exist regarding healthcare burden beyond first year of allogeneic HSCT, limiting our understanding of the long-term impact for each graft source.METHODS: To estimate the healthcare burden in adult allogeneic HSCT recipients over time, we analyzed clinical data from 1077 consecutive allogeneic HSCT recipients at the University of Minnesota Medical Center (UMMC) transplanted between 2000-2016. In order to understand changes in healthcare burden over time, we assessed the raw number of visits (both face-to-face and non-face-to-face care coordination visits), procedures, laboratory studies, medications, and relative value units (RVUs) over 3 time periods: (1) Day 0 to day 100, (2) 101 - 365 days, and (3) >1 year - 5 years after HSCT. We analyzed the counts of these healthcare elements both individually and as a composite score of all these elements (visits, procedures, labs, medications, RVUs). We then compared the estimated healthcare burden by graft source over each time period. We included only patients undergoing their first allogeneic HSCT in this analysis, and we included all clinical data from transplant to death or 5 years, whichever came first. We retained data from patients experiencing post-HSCT relapse in this analysis.RESULTS: Of the 1077 HSCT recipients, 102 received BM, 458 received PBSC, and 517 received UCB (84.7% double). The majority of BM donors were matched but unrelated to the recipient (57%), and the majority of PBSC donors were matched siblings (88%). The median age was 52.2 years (range 18.1 - 75.1 years), and 41.4% of the patients were female. The median distance from the patients' address to the transplant center was <30 miles, with no significant difference between the graft sources at any of the 3 time periods (p=0.12, p=0.10, p=0.09, respectively). The majority of patients had acute myeloid leukemia (40.8%), acute lymphoblastic leukemia (13.7%), non-Hodgkin lymphoma (13%), and myelodysplastic syndrome (12.8%). There was no significant difference in the proportions of patients with death (p=0.50) or relapse/progression (p=0.22) between graft sources over these time periods. As expected from previous data, recipients of PBSC had the lowest median composite healthcare burden in the first 100 days (p<0.01, Figure). During this earliest time period, the median number of laboratory studies (2,213 vs 2,448.0 vs 2,960, p<0.01), medications (132 vs 232 vs 203, p<0.01), and RVUs billed (423.2 vs 480.7 vs 466.7, p<0.01) were significantly lower for recipients of PBSC vs BM vs UCB respectively, with no difference in number of visits (p=0.07). From day 101 - 365, UCB had the lowest composite score (p=0.02) due to the fewest labs and visits performed (p<0.01 for each). There was no difference between medications (p=0.16) or RVUs (p=0.06) between graft sources in this second time period. Beyond 1 year, UCB continued to have the lowest composite score (p=0.02), with the lowest number of visits (p<0.01), labs (p<0.01), procedures (p=0.03), medications (p<0.01), and RVUs (p=0.02) with this graft source compared to BM and PBSC.CONCLUSION: Adult recipients of UCBT appear to experience a lower long-term healthcare burden compared to other graft sources. After the first year post-HSCT, recipients of UCBT have fewer clinic visits, laboratory tests, procedures, and medications. This study is the first step in analysis of complex, long-term healthcare burden data in allogeneic HSCT recipients within a single healthcare system. Despite the absence of cost data and details of care outside of Fairview, these data support the hypothesis that healthcare burden varies by graft source with favorable outcomes in long-term survivors after UCBT compared recipients of BM and PBSC. [Display omitted] DisclosuresBrunstein:Gamidacell: Research Funding. MacMillan:Angiocrine: Membership on an entity's Board of Directors or advisory committees; CSL Behring: Consultancy; Equillium: Consultancy. Wagner:Novartis: Research Funding; Magenta Therapeutics: Consultancy, Research Funding. Weisdorf:SL Behring: Consultancy; Seattle Genetics: Consultancy; Pharmacyclics: Consultancy; FATE: Consultancy; Equillium: Consultancy. Holtan:Incyte: Consultancy.

A Comparison of the Number of Patient Visits Required for Different Management Options for Early Pregnancy Loss at an Early Pregnancy Assessment Clinic

ObjectiveTo compare the total number of patient visits required for the conservative, medical, or surgical management of early pregnancy loss in an early pregnancy assessment clinic (EPAC). MethodsA retrospective study of the number of patient visits at an EPAC for conservative, medical, or surgical management of early spontaneous abortion from October 2013 to September 2015 was undertaken. Visits counted included initial assessment, follow-up visits, and surgery date, if separate from a clinic visit. ResultsA total of 945 patients were seen, with 2144 visits during the study period. Conservative management required an average of 3.01 visits (n = 159, median = 3, SD = 1.16, range [1,7]) and misoprostol treatment required an average of 2.51 visits (n = 329, median = 2, SD = 0.83, range [1,6]) to achieve a complete abortion. Dilatation and curettage (D&C) required an average of 1.60 visits (n = 417, median = 1, SD = 0.80, range [1–6]), when including scheduling limitations or an average of 1.13 visits when excluding these limitations. The difference in the number of visits required for the three management options was statistically significant (P < 0.0001). Management with D&C was more likely to require less than two visits to achieve complete abortion compared with the other options (93.8% for D&C vs. 64.5% for misoprostol vs. 37.8% for conservative). ConclusionAn EPAC provides a significant value in the management of early pregnancy losses. There is a significant difference in the total number of visits required for different treatment options. Patients may find this information helpful when considering and deciding upon their preferred treatment option.

Prevalência de hiperutilizadores de serviços de saúde com histórico positivo para depressão em Atenção Primária à Saúde

Objetivo: estudar a associação entre história de depressão e hiperutilização de serviços de saúde (HSS) entre usuários da Atenção Primária à Saúde (APS), além de estabelecer a prevalência de HSS, o número médio de consultas e o perfil epidemiológico dos grupos com história positiva e negativa para depressão. Métodos: os dados foram obtidos de prontuários familiares de duas Unidades de Saúde. Para analisar dados sobre o desfecho primário e para comparar o perfil epidemiológico dos grupos foi utilizado o teste qui-quadrado. Para comparar a diferença na média de consultas entre os grupos, utilizou-se o teste t de student. Resultados: foram analisados 278 pacientes. As prevalências de depressão e de HSS na amostra foram, respectivamente, de 15,1 e 4,3%. Houve diferença na prevalência de HSS no grupo com história positiva para depressão, 14,3%, quando comparado ao grupo com história negativa para depressão, 2,5% (RP = 5,62, IC 95% 1,90 a 16,59, p = 0,004). A média de consultas no grupo com história positiva para depressão foi de 5,25 consultas/ano, enquanto no grupo com história negativa para depressão foi de 2,59, com diferença de médias de 2,65 (IC 95% 1,90 a 3,40; p &lt; 0,001). Observou-se também maior prevalência de dispepsia e uso de antidepressivos entre HSS. Conclusão: os resultados reforçam dados da literatura, indicando que pessoas com histórico de depressão tendem a utilizar mais os serviços de APS, apresentando uma prevalência maior de HSS. Dessa forma, um maior conhecimento acerca do perfil dos HSS permitirá desenvolver abordagens mais resolutivas para esses usuários.

Factors related to frequent usage of the primary healthcare services in old age: findings from The Swedish National Study on Aging and Care

People aged 60 or more are the most frequent users of healthcare services. In this age range, however, both frequent and infrequent users can be found. Frequent users have high rates of illnesses. Previous research has found that the frequency may be influenced also by psychological and social factors. The aim of this study was to investigate to what degree such factors add to the explanation of differences in number of visits to a physician. A cross-sectional study was conducted with a random sample consisting of 1017 individuals, aged 60 to 78 years, from the Blekinge part of the Swedish National Study on Aging and Care database. The data were collected during 2001 to 2003. Hierarchical logistic regression analyses were used with frequent (three visits or more during a year) and infrequent use as a dichotomous dependent variable. The final statistical analyses included 643 individuals (63% of the sample). Independent variables were sense of coherence (SOC), internal locus of control, education level and social anchorage. Control variables were age, gender, functional ability and comorbidity. The results showed that comorbidity was most strongly related to frequent use [adjusted odds ratio (OR) = 8.17, 95% confidence interval (CI) 5.54–12.04]. In addition, SOC and internal locus of control had small, but significant effects on the odds of being a frequent user (adjusted OR = 1.03, 95% CI 1.00–1.06 and adjusted OR = 1.14, 95% CI 1.02–1.27, respectively). The lower the SOC and the internal locus of control were, the higher were the odds of frequent use. Education level and social anchorage were unrelated to frequency of use. The results indicate that frequent healthcare services users are more ill than infrequent users. Psychological factors influence the use only marginally, and social factors as well as age and gender are not by themselves reason for frequent healthcare services use.

Pollinators of Chapmannia floridana (Fabaceae) and Their Foraging Preferences

The visitation rates of two major insect visitors, Bombus impatiens Cresson and Augochloropsis sp., of the Florida endemic plant species Chapmannia floridana Torrey & A. Gray, (Fabaceae); are determined for different microhabitats at the Archbold Biological Station in the summer of 1995. Significant differences in the total number of visits to each site were observed. Each pollinator species was found to visit different vegetation densities and sites with different frequencies. Relationships were also found between visitation rates and temperature and flower size. Variation in visitation rates did not significantly affect seed set in C. floridana. Disturbance did not seem to play a major role in determining visitation rates of either of the pollinators. Vegetation composition and flower density appear to be the best indicators of visitation rates to populations of this plant species.

Effects of flower number on estimated pollen transfer in natural populations of three hermaphroditic species: an experiment with fluorescent dye

AbstractThe relationship between the number of open flowers and pollen transfer to stigmas was estimated in three insect‐pollinated species (Cynoglossum officinale, Echium vulgare and Oenothera erythrocepala) in 1995 and 1996, using fluorescent dye as a pollen analogue. Dye was applied to an equal number of flowers on a small, a medium and a large individual and its pattern of dispersal to stigmas of conspecifics in local populations was observed.In Cynoglossum officinale and in Echium vulgare large individuals tended to receive more visits per flower. In Oenothera erythrocepala no difference in number of visits per flower was found between small and large individuals.Geitonogamous pollination clearly occurred in all species. In Cynoglossum officinale large individuals transferred more pollen per flower within the same plant (geitonogamy) and an equal or a slightly smaller amount between plants, compared to small individuals. As a result total pollen transfer per flower increased in both years with increasing flower number. In Echium vulgare and in Oenothera erythrocepala large individuals transferred more pollen per flower within the plant (pollen discounting), but a significantly lower amount per flower to other individuals in the populations compared to small individuals. For both these species, there is no difference in total pollen transfer between small and large individuals.In general, the male fitness curve, as estimated by pollen transfer, is a decelerating function of flower number. We discuss this in relation to optimal sex‐allocation and the pollen donation hypothesis.

Use of Primary Health Care in Spili, Crete, and in Dalby, Sweden

A computerized medical record system was introduced in Greek primary health care (PHC) in the village of Spili in Crete. The present study was carried out to study similarities and differences in the pattern of PHC use in Dalby Health Centre, Sweden (DHC), and Spili Health Centre, Greece (SHC). In both Dalby and Spili more than half the population contacted their respective health centre during 1989. Patients contacted DHC more often than SHC, 3.33 vs 2.30 times. Relatively more females than males used the health services in Dalby (64% vs 50%) but not in Spili (57% vs 55%). More visits were made by appointment at DHC than SHC (36.0% vs 12.6%). There were great similarities in the two areas in the ten most common diagnoses, analysed in four age-groups. In both areas, acute upper respiratory infections dominated in the youngest age-groups, and hypertension and diabetes in those aged 45 years and above.