Doctor Contact Research Articles

The impact of shortening patient–doctor contact duration on early peritoneal dialysis-related infections

Early peritoneal dialysis (PD)-related infection is a severe complication. This study investigated the relationship between patient–doctor contact (PDC) duration and early PD-related infection. In the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) Korea, incident dialysis patients receiving PD were divided into two groups based on PDC duration (< 15 min versus ≥ 15 min), which was defined as the duration a nephrologist typically spends with a patient receiving PD during each visit according to the facility practice pattern. Early risks of PD-related infections, such as peritonitis and catheter-related infection (onset within 3 and 12 months of PD), were compared to the PDC duration using Cox regression. The study included 276 patients (184 [66.7%] in the shorter PDC group [< 15 min] and 92 [33.3%] in the longer PDC group [≥ 15 min]). The average age did not differ between the groups. The incidences of 3- and 12-month PD-related infections were significantly lower in the longer PDC group than in the shorter PDC group (3 months: 1.1% versus 9.8%, P = 0.007; 12 months: 9.8% versus 23.4%, P = 0.007). Longer PDC was independently associated with a lower risk of PD-related infections at 3 and 12 months (3 months: adjusted hazard ratio [aHR], 0.11; 95% confidence interval [CI], 0.02–0.85, P = 0.034; 12 months: aHR, 0.43; 95% CI 0.19–0.99, P = 0.048). Overall, a longer PDC duration was associated with a significantly lower risk of early PD-related infection.

A pilot project harnessing surveillance systems to support clinicians providing clinical care for people diagnosed with hepatitis C in Victoria, Australia, September 2021 to 31 March 2022.

BackgroundActive follow-up of chronic hepatitis C notifications to promote linkage to care is a promising strategy to support elimination.AimThis pilot study in Victoria, Australia, explored if the Department of Health could follow-up on hepatitis C cases through their diagnosing clinicians, to assess and support linkage to care and complete data missing from the notification.MethodsFor notifications received between 1 September 2021 and 31 March 2022 of unspecified hepatitis C cases (i.e. acquired > 24 months ago or of unknown duration), contact with diagnosing clinicians was attempted. Data were collected on risk exposures, clinical and demographic characteristics and follow-up care (i.e. HCV RNA test; referral or ascertainment of previous negative testing or treatment history). Reasons for unsuccessful doctor contact and gaps in care provision were investigated. Advice to clinicians on care and resources for clinical support were given on demand.ResultsOf 513 cases where information was sought, this was able to be obtained for 356 (69.4%). Reasons for unsuccessful contact included incomplete contact details or difficulties getting in touch across three attempts, particularly for hospital diagnoses. Among the 356 cases, 307 (86.2%) had received follow-up care. Patient-management resources were requested by 100 of 286 contacted diagnosing clinicians.ConclusionsMost doctors successfully contacted had provided follow-up care. Missing contact information and the time taken to reach clinicians significantly impeded the feasibility of the intervention. Enhancing system automation, such as integration of laboratory results, could improve completeness of notifications and support further linkage to care where needed.

Evaluation of completeness of hematology requisition forms leading preanalytical errors in laboratory of a tertiary care teaching hospital

Background: Laboratory services provide crucial information for the optimal management of patients in a hospital setting. A crucial step in the preanalytical phase of sample testing is the correct filling up of the laboratory requisition form (LRF). Objectives: this study as planned to identify the possible parameters for pre analytical errors. Methodology: We analyzed the LRF submitted to the Hematology Section of Central Laboratory of a tertiary care teaching hospital from Hyderabad to assess the degree of completeness of the submitted LRF as a cause of preanalytical error in the laboratory workflow. Randomly selected laboratory forms submitted along with specimens to the Central Hematology Laboratory of a tertiary hospital over a period of 1 month for their completeness, as laid down in standard operating procedures. Collected data were entered in an Microsoft Excel Worksheet and analyzed by SPSS version 23. Only the patient's name, identification number, gender, type of sample, and examination requested were correctly filled. Results: Patient contact details were available only in 0.82% of LRFs. The diagnosis and clinical history were correctly filled in only 39.62% and 0.27% LRFs, respectively. There was a significant lack of information regarding the doctor requesting the investigation (doctor's name written in 8.47% of forms and doctor's contact telephone number written in 0.27% of forms evaluated). It was also found that the present format of the LRF was inadequate for providing the necessary details of the samples received. Conclusion: The existing LRF needs to be re-designed to enable the clinicians to provide more clinical details and patient-related details. Clinicians need to be sensitized regarding the necessity of submitting correctly filled LRFs. The use of system generated online requisition forms can also be done, where forms cannot be submitted unless complete.

Ophthalmological practices in COVID pandemic during first and second wave: Learnings and new beginnings

Purpose: TO study the impact of covid 19 in a tertiary eye care hospital.Study type: single centre retrospective observational study.Method: Novel corona virus “COVID-19” is now an established global Pandemic. Index case of Novel Corona virus “COVID-19” virus was first reported from Wuhan, People's Republic of China on 31 December 2019. Bihar with a population of 120 million is one of the most densely populated and least developed states in India. With 1 doctor/29,000 persons and1 hospital bed/8,645 people, it was expected to be one of the worst hit state in COVID-19 pandemic. All patient visiting an ophthalmologist were seen with full precaution and with a practical Standard Operating Protocol (SOP), advised by World Health Organization (WHO), Centre for disease control (CDC), MOHFW, American Academy Of Ophthalmology(AAO) and All India Ophthalmological Society(AIOS). Patient visiting and treatment protocol followed in a tertiary care hospital were analysed.Results: 3617(2432 males ,1185 females) new patients and 3145(2149 males, 996 females) old/follow up patients visited RIO OPD from lockdown (25 march 2020) till unlock 4(30 September, 2020) which is about 85.41% decrement in comparison to last year in same period 21747(13335 males, 8412 females) new patients and 24610(15508 males, 9102 females).Conclusion: Proper use of n95 masks, gloves, caps, face shield, PPE kit while examining patients and operating them were few important precautions. Regular use of sanitizer, hand washing, minimizing patient doctor contact time, minimal hospital stays, use of artificial intelligence are few other ways practiced to prevent exposure to COVID 19. This pandemic has taught us a lot about people unity cooperation, what is important in life, ophthalmologically tele-ophthalmology will play a big role in future an evident in this pandemic.

Analysis of interest in vaccination against COVID-19 and other pro-health initiatives at the workplace among employees in Poland.

The COVID-19 pandemic re-raised the subject of vaccines and their importance for public health. Given the number of employees, one of the key environments in which vaccination should be promoted is the workplace. An original, anonymous and voluntary questionnaire with 13 questions regarding health behaviors of employees in Poland was distributed through HR departments of the companies invited to the research (Computer-Assisted Web Interview - CAWI technique) This publication presents the results of answers to the 3 chosen questions concerning: health issues related to work, interest in health promoting initiatives and following recommendations for physical activity. According to the research presented in this article, 39% of employees in Poland were interested in vaccination against COVID-19. The most popular preventive initiatives are still healthy eating and sport activities. The government allowed organizing vaccinations at the workplace, which gives new opportunities but also obligations and risks. Overall, the potential of a workplace in fighting the coronavirus seems to be used to a very small extent. This carries the need to consult systemic solutions with representatives of employers and occupational medicine practitioners as well as the government. The workplace should be one of the key habitats for health promoting activities, including vaccinations. The above-mentioned issue should still be the subject of research for solutions tailored to the needs and capabilities of each group (employers, occupational medicine professionals and government). One of the circumstances of promoting the health of employees should be preventive examinations of employees - a doctor's visit and contact with an occupational medicine nurse. The potential of preventive employee examinations in this area seems to be unused and limited. The level of immunization of employees has an obvious impact on the state of the economy. In view of the voluntary vaccination against COVID-19, this requires educational campaigns aimed at both employees and employers. Med Pr. 2021;72(6):653-9.

Acute respiratory infections in an adult refugee population: an observational study

The presence of acute infectious respiratory diseases (ARD) is one of the main reasons why recently arrived refugees seek medical help. This paper investigates the incidence rates of acute respiratory diseases in an adult refugee population as well as associated sociodemographic factors and drug treatments. We conducted a retrospective observational study of deidentified medical records. The data were collected between 2015 and 2019 in the health care centers of two large German initial reception centers for refugees. Multivariable analyses controlling for sociodemographics were carried out using generalized estimating equations. Out of 10,431 eligible residents, 6965 medical encounters of 2840 adult patients were recorded over 30 months. Of all the adult patients, 34.4% sought medical help for a respiratory symptom or diagnosis at least once. Older patients and patients from Sub-Saharan Africa sought help less often. The occurrence of ARD showed a typical distribution over the course of the year. Facility occupancy was not associated with ARD occurrence. Acute respiratory symptoms are a leading cause for adult refugee patients to seek medical care. The doctor contact rates due to ARD were consistently two to three times higher among refugees than among German residents.

Acceptance of Supportive Illustrations for Preparation of Patients for an Orthopedic Telemedical Consultation.

Introduction: Telemedical video consultations are a powerful support for patient–doctor interactions. For optimal digital settings, explanatory illustrations may be helpful for patients. This study analyzed patients' the attitude of patients to illustrations preparing for an orthopedic telemedical consultation (OTC).Methods: A leaflet with eight illustrations was designed and their acceptance and estimated necessity was evaluated among patients who had experienced an OTC (EXP-group) and others who had not (NOV-group) with a 12-item-questionnaire.Results: Sixty patients participated (n = 30 each group). All illustrations were evaluated positively. The EXP-group gave significantly higher ratings than the NOV-group for improved understanding by the given keywords of the illustrations (p = 0.046), preference for being informed by illustrations than by merely by a pure text (p = 0.023), better feeling of preparation for an OTC by the illustrations (p = 0.005), and the impression of a simplified process of the OTC by the illustrations (p = 0.012).Discussion: While the illustrations were well-accepted by the participants, significant differences were revealed between the valuation of single aspects by patients, depending on a previous experience with an OTC. Therefore, a leaflet with explanatory illustrations may be helpful in preparing patients for an OTC to support the digital patient–doctor contact.

Long-term quality of life, sexual health and gastrointestinal function following colorectal cancer resection in an Asian cohort.

As populations age and cancer management improves, long-term survivorship and quality-of-life (QOL) outcomes are becoming equally important as oncological results. Data from Asian populations are scarce. We aimed to evaluate the sexual health, gastrointestinal function and QOL amongst colorectal cancer survivors in a tertiary referral centre in Singapore. Adults who had undergone elective curative surgery for non-metastatic colorectal cancer at least 2 years prior were included. Exclusion criteria were cognitive disease, serious postoperative complications or recurrent cancer. Participants were invited to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires EORTC-QLQ-C30 and QLQ-CR29. Using multiple bivariate analysis, rscores were used to examine relationship trends between QOL domains and survivor sociodemographic and disease-specific characteristics. From February 2017 to July 2019, 400 responses were recorded. Median age and follow-up duration were 64 years (range 32-90) and 78 months (interquartile range 49-113) respectively. Patients who had Stage III cancer had better overall QOL scores compared to Stage I/II. Rectal (vs. colon) cancer negatively influenced sexual health and gastrointestinal function, but did not appear to affect overall QOL. Amongst our cohort, 57% (n=129) of men and 43% (n=75) of women were sexually active. Markers of socioeconomic status, including employment, education and housing type, were found to significantly impact perception of various aspects of QOL. Knowledge of factors which influence well-being can identify individuals who may benefit from tailored management strategies. Regular patient-doctor contact may play a role in building and maintaining positive perspectives of cancer survivors. Normative data should be obtained from local populations to facilitate future comparative research.

Improved Inpatient Care through Greater Patient-Doctor Contact under the Hospitalist Management Approach: A Real-Time Assessment.

Objective: To examine the difference between hospitalist and non-hospitalist frequency of patient–doctor contact, duration of contact, cumulative contact time, and the amount of time taken by the doctor to resolve an issue in response to a medical call. Research Design and Measures: Data from 18 facilities and 36 wards (18 hospitalist wards and 18 non-hospitalist wards) were collected. The patient–doctor contact slip and medical call response slips were given to each inpatient ward to record. A total of 28,926 contacts occurred with 2990 patients, and a total of 8435 medical call responses occurred with 3329 patients. Multivariate logistic regression analyses and regression analyses were used for statistical analyses. Results: The average frequency of patient–doctor contact during a hospital stay was 10.0 times per patient for hospitalist patients. Using regression analyses, hospitalist patients had more contact with the attending physician (β = 5.6, standard error (SE) = 0.28, p < 0.0001). Based on cumulative contact time, hospitalists spent significantly more time with the patient (β = 32.29, SE = 1.54, p < 0.0001). After a medical call to resolve the issue, doctors who took longer than 10 min were 4.14 times (95% CI 3.15–5.44) and those who took longer than 30 min were 4.96 times (95% CI 2.75–8.95) more likely to be non-hospitalists than hospitalists. Conclusion: This study found that hospitalists devoted more time to having frequent encounters with patients. Therefore, inpatient care by a hospitalist who manages inpatient care from admission to discharge could improve the care quality.

Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping review

Teleophthalmology may assist the healthcare sector in adapting to limitations imposed on clinical practice by a viral pandemic. A scoping review is performed in this study to assess the current applications of teleophthalmology for its suitability to diagnose, monitor or manage ophthalmological conditions with accuracy. A search of PubMed was conducted for teleophthalmology-related articles published from 1 January 2018 to 4 May 2020. Only articles that focused on the use of teleophthalmology in terms of diagnosis and management, as well as its benefits and detriments, were included. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included articles. A total of 38 articles were assessed at the full-text level. There were 2 qualitative studies and 1 quantitative randomised controlled trial, while the majority were either quantitative descriptive studies (19, 50.0%) or quantitative non-randomised studies (16, 42.1%). Overall, 8 studies described reducing manpower requirements, 4 described reducing direct patient-doctor contact, 17 described storage of medical imaging and clinical data, and 9 described real-time teleconferencing. The MMAT analysis revealed limitations in appropriate sampling strategy in both quantitative non-randomised studies (9 of 16, 56.3%) and quantitative descriptive studies (9 of 19, 47.4%). Cost-effectiveness of teleophthalmology was not performed in any included study. This current review of the various aspects of teleophthalmology describes how it may potentially assist the healthcare sector to cope with the limitations imposed by a viral pandemic through technology. Further research is required to evaluate the cost-effectiveness of the various strategies.

‘GP Live’- recorded General Practice consultations as a learning tool for junior medical students faced with the COVID-19 pandemic restrictions

ABSTRACT Background First year medical students value doctor and patient contact. However, it can be challenging to achieve positive exposure to primary care on a large scale. The COVID-19 pandemic has placed even greater pressure on placing students in General Practice (GP). Aim To assess the feasibility and acceptability of showing Year 1 medical students authentic recorded consultations between GPs and patients, and then explore what they gained from this. Method Using Panopto® Video Platform, we pre-recorded real Primary Care consultations, with patient and GP consent, which were then processed securely using the University of Aberdeen server. These were shown to all Year 1 medical students who immediately debriefed these consultations in small groups with a GP tutor. Subsequently two focus groups were held with 11 students to evaluate what they had learnt. Learning outcomes The consultations were easy to record and play during the teaching session, although there were some issues with sound quality. All students in the focus groups enjoyed the experience. They gained new knowledge about the skills of GPs, and recognised GPs as positive role models. Students were able to identify a variety of communication and consultation skills used by the GP, which reinforced their teaching on these delivered elsewhere in the course. Conclusion Using pre-recorded consultations as a teaching tool is reproducible, time-efficient and beneficial to students. We propose that this model of using authentic ‘live’ interactions between GPs and patients represents a valuable undergraduate educational opportunity and could be utilised by medical schools internationally.

The Adolescent Patient Experiences of Diabetes Care Questionnaire (APEQ-DC): Reliability and Validity in a Study Based on Data from the Norwegian Childhood Diabetes Registry.

PurposePatient-reported experiences are a key source of information on quality in health care. Most patient experience surveys only include adults’ assessments including parent or proxy surveys in child health care settings. The aim of this study was to determine the psychometric properties of the Adolescent Patient Experiences of Diabetes Care Questionnaire, a new instrument developed to measure adolescent experiences of paediatric diabetes care at hospital outpatient departments in Norway.Patients and MethodsThe questionnaire was developed based on a literature review, qualitative interviews with adolescents, expert-group consultations, pretesting of the questionnaire and a pilot study. The pilot study involved adolescents aged 12–17 years with type 1 diabetes, sampled from the four largest paediatric outpatient departments in Norway. We assessed the levels of missing data, ceiling effects, factor structure, internal consistency, item discriminant validity and construct validity.ResultsThe pilot study included responses from 335 (54%) patients. Low proportions of missing or “not applicable” responses were found for 17 of the 19 items, and 14 of these 19 items were below the ceiling-effect criterion. Five indicators were identified: consultation, information on food and physical activity/exercise, nurse contact, doctor contact and outcome. All except one indicator met the criterion of 0.7 for Cronbach’s alpha. Each of the single items had a stronger correlation with its hypothesized indicator than with any of the other indicators. The construct validity of the instrument was supported by 38 out of 45 significant associations.ConclusionThe content validity of the instrument was secured by a rigorous development process. Psychometric testing produced good evidence for data quality, internal consistency and construct validity. Further research is needed to assess the usefulness of the Adolescent Patient Experiences of Diabetes Care Questionnaire as a basis for quality indicators.

Dialogue between doctor and patient: modern realities

The purpose of the scientific article – to clarify the current state of communication dyad «doctor – patient». On the basis of these in-depth interviews with doctors to show the realities occurring in the relationship between the doctor and the patient about the unity and harmony, mutual claims, trust in the choice of treatment, awareness of mutual responsibility. Questions of professional competence of the doctor, social and psychological contact between doctors and patients are raised. The average characteristics of a modern patient and a modern doctor are proposed. The most common social and psychological problems that negatively affect the process of communication between the doctor and the patient are listed. Discussed on the theme of social portrait of the «ideal» patient. The current views on the modern realities of domestic medicine and health care are discussed. The main errors in the behavior of a typical patient at a doctor’s appointment are indicated. It is established that in the media and literature the issue of compliance with ethical standards, principles and rules of responsible behavior at the doctor’s appointment is not given due attention. It is emphasized that the modern patient should know that in addition to the rights, there are legally prescribed obligations that should be followed. It is emphasized that there is a need to establish the boundaries of patient responsibility and responsibility of health workers. It is specified that in the conditions of change of views on health protection from the principle of administrative and legal positions on civil, medical care began to be called medical service which from the point of view of the civil law is understood as the compensated bilateral transaction granting the parties equal rights, duties and responsibility. It is generalized that the negative attitude to the state medicine is more forced and maintained artificially. It is summarized that in the relations between doctors and patients, a public request for a new partner model of their interaction has long been formed.

The right to medical assistance for seafarers. Ethical and practical consequences of the introduction of telemedicine to improve healthcare on board ships

Quality and easy access to healthcare is considered a Fundamental Right in most countries. While access to care has progressed, the ethical challenges related with medical error, confidentiality of patient information and risk of technology over-riding human judgement have become important to address. In the case of seafarers, the challenges are compounded by the fact that they spend a significant amount of time on the high seas with no direct access to medical care. With the introduction of Tele-medicine, quality and access to care has improved. However due to the fact that there is no direct patient – doctor contact, ethical issues related to consent and care are important to review to safegaurds the interest both the doctor and patient. The gradual introduction of advanced technologies present improved medical assistance to seafarers onboard.

Introducing a new collaborative prenatal clinic model.

To measure quality of care-planning for women in a new collaborative prenatal model of care. A collaborative patient-centered (CPC) model was introduced into a tertiary prenatal clinic, replacing the traditional model. A retrospective analysis was conducted of women with a first documented hospital doctor contact between February 1, 2015, and October 1, 2016. Quality of care-planning before and after introduction of the model was compared by measuring the number and size of documented care plans and amount of doctor contact. Categorical data were compared using χ2 or Fisher exact tests; continuous data were analyzed using the student t test. Quality of care was measured for 3606 women before, and 3511 after, introduction of the CPC model. Under the model, more women had clinical risks identified and care plans documented (2224 [63.3%] vs 1883 [52.2%]; P<0.001), and more clinical risks were identified (1.07 vs 0.74; P<0.001). Doctors documented more in each care plan (P<0.001) and had more subsequent clinical contact with women (0.69±1.23 vs 0.88±1.34; P<0.001) in the model. Introduction of a collaborative model in a tertiary prenatal clinic improvedidentification of clinical risks and documentation of care plans, and increased doctor contacts.

Clinical validation of RIA-G, an automated optic nerve head analysis software.

Purpose:To clinically validate a new automated glaucoma diagnosis software RIA-G.Methods:A double-blinded study was conducted where 229 valid random fundus images were evaluated independently by RIA-G and three expert ophthalmologists. Optic nerve head parameters [vertical and horizontal cup–disc ratio (CDR) and neuroretinal rim (NRR) changes] were quantified. Disc damage likelihood scale (DDLS) staging and presence of glaucoma were noted. The software output was compared with consensus values of ophthalmologists.Results:Mean difference between the vertical CDR output by RIA-G and the ophthalmologists was − 0.004 ± 0.1. Good agreement and strong correlation existed between the two [interclass correlation coefficient (ICC) 0.79; r = 0.77, P < 0.005]. Mean difference for horizontal CDR was − 0.07 ± 0.13 with a moderate to strong agreement and correlation (ICC 0.48; r = 0.61, P < 0.05). Experts and RIA-G found a violation of the inferior–superior NRR in 47 and 54 images, respectively (Cohen's kappa = 0.56 ± 0.07). RIA-G accurately detected DDLS in 66.2% cases, while in 93.8% cases, output was within ± 1 stage (ICC 0.51). Sensitivity and specificity of RIA-G to diagnose glaucomatous neuropathy were 82.3% and 91.8%, respectively. Overall agreement between RIA-G and experts for glaucoma diagnosis was good (Cohen's kappa = 0.62 ± 0.07). Overall accuracy of RIA-G to detect glaucomatous neuropathy was 90.3%. A detection error rate of 5% was noted.Conclusion:RIA-G showed good agreement with the experts and proved to be a reliable software for detecting glaucomatous optic neuropathy. The ability to quantify optic nerve head parameters from simple fundus photographs will prove particularly useful in glaucoma screening, where no direct patient–doctor contact is established.

Parent experiences of diabetes care questionnaire (PEQ-DC): reliability and validity following a national survey in Norway

BackgroundPatient experiences are acknowledged as an important aspect of health care quality but no validated instruments have been identified for the measurement of either parent or patient experiences with outpatient paediatric diabetes care. The aim of the current study was to assess the psychometric properties of a new instrument developed to measure parent experiences of paediatric diabetes care at hospital outpatient departments in Norway.MethodsThe development of the questionnaire was based on a literature review of existing questionnaires, qualitative interviews with both parents and children/adolescents, expert-group consultations, pretesting of the questionnaire and a pilot study. The national pilot study included parents of 2606 children/adolescents aged 0–17 years with Type 1 Diabetes registered in The Norwegian Childhood Diabetes Registry, a nationwide, population-based registry. Levels of missing data, ceiling effects, factor structure, internal consistency, item discriminant validity and construct validity were assessed.ResultsA total of 2606 patients were included in the survey, but 80 were excluded due to incorrect addresses. 1399 (55%) parents responded to the questionnaire. Low levels of missing or “not applicable” responses were found for 31 of the 35 items (< 10%), and 27 of 35 items were below the ceiling-effect criterion. Psychometric testing and theoretical considerations identified six scales: Consultation (six items), organisation (five items), equipment (three items), nurse contact (four items), doctor contact (four items) and outcome (five items). All six scales met the 0.7 criterion for Cronbach’s alpha (range: 0.71–0.90). As expected, each item had a higher correlation with its hypothesised scale than with any of the other five scales. The construct validity of the Parent Experiences of Diabetes Care Questionnaire (PEQ-DC) was supported by 17 out of 18 associations with variables expected to be related to parent experiences.ConclusionThe psychometric testing of the PEQ-DC showed good evidence for data quality, internal consistency and construct validity. The instrument includes important aspects of diabetes care at paediatric outpatient departments from the perspective of the parent. The content validity of the PEQ-DC was secured by a rigorous development process, and the instrument was tested following a national survey in Norway, securing generalisability across Norway.

A randomized comparison of three data collection models for the measurement of parent experiences with diabetes outpatient care

BackgroundThe objective of this study was to compare three data collection methods for the measurement of parent experiences with hospital outpatient care for child and adolescent diabetes, based on a randomised national trial in Norway involving both pen-and-paper and electronic response options.MethodsThe sample frame was patients registered in the Norwegian Childhood Diabetes Registry. Parents of patients were randomised into the following groups (n = 2606): group A, who were posted questionnaires with only a pen-and-paper response option (n = 859); group B, who were posted questionnaires with both an electronic and a pen-and-paper response option (n = 886); and group C, who were posted questionnaires with only an electronic response option (n = 861). The three groups were compared on response rate, background variables about respondents, main study results and survey costs. Statistical analysis included logistic regression to test group differences in response probabilities and multilevel linear regression to test differences in parent experiences.ResultsThe response rate was 61.8% for group A, 62.4% for group B and 41.6% for group C. The probability of answering was significantly higher for group A (OR = 2.3, p < 0.001) and B (OR = 2.3, p < 0.001) compared to group C. Respondent age, gender, education, living with the child and the degree of participation in consultations did not differ significantly between the three groups. Group differences in parent-reported experiences were small, varying from 1.0 (equipment and doctor contact) to 2.4 (outcome), on a scale from 0 to 100. Only one of 18 group differences was significant: the mixed group had significantly higher score than the electronic group on the organization scale (p < 0.05). The total cost of the electronic model was less than half the cost of the other models, and cost per response was 5.1 euros for the electronic model compared to 8.2 euros for group A and 7.6 euros for group B.ConclusionsThe models with pen-and paper questionnaire included had more than 20% higher response rate than the model with an electronic-only response option. Background variables and parent-reported experiences were similar between the three groups, and the electronic model was the more cost-effective model.

Telephoned, Texted, or Typed Out: A Randomized Trial of Physician–Patient Communication After Emergency Department Discharge

BackgroundNovel means of emergency department (ED) post-discharge communication—telephone callbacks and text messages—are increasingly being utilized to facilitate patient-oriented outcomes, such as ED revisits, patient adherence, and satisfaction. ObjectiveThe primary measure of interest is the rate of ED revisits in the week after discharge. The secondary measures of interests are rate of primary medical doctor (PMD) or specialist physician contact in the week after discharge and patient satisfaction. MethodsPilot randomized controlled trial with three groups: usual discharge; usual care + phone call 48 h after discharge asking if patients wanted to speak with a physician; or usual care + text message 48 h after discharge asking if patients wanted to speak with a physician. All participants received a 1-week assessment of patient satisfaction. ED revisit and contact with PMD or specialist physician within 7 days of discharge were obtained from electronic medical record and analyzed using χ2 test. ResultsTwo hundred and fifty-one patients were enrolled and randomized (66 control, 103 phone, 82 text). Although the three groups did not show a statistically significant difference, the phone and text groups had similar and lower proportions of patients revisiting the ED (>50% reduction) and calling or visiting their PMD or specialist physician (approximately 30% reduction) than the control group (χ2 = 4.57, degrees of freedom [df] = 2, p = 0.10; χ2 = 1.36, df = 2, p = 0.51). There was no difference in patient satisfaction (χ2 = 2.88, df = 2, p = 0.24). ConclusionsPatients who are contacted for ED follow-up by phone and text, though perhaps not more satisfied, may tend to revisit the ED and contact their PMD or specialty physician less often than patients receiving standard written discharge instructions. However, this pilot study is underpowered, so larger randomized studies are needed to confirm.

Health seeking behavior and related factors among hypertensive and diabetic patients contracting medical service in Fangzhuang community health service center

Objective To investigate the health-seeking behavior and related factors among hypertensive and diabetic patients contracting medical service in Beijing Fangzhuang Community Health Service Center. Methods By using stratified random sampling method, 830 contracted hypertensive and diabetic patients were selected in the study. A face to face questionnaire survey was conducted in Fangzhuang Community Health Service Center from November 2016 to January 2017. Total 800 questionnaires were completed, and the medical behavior and influencing factors of patients were analyzed. Results The first-contact rate of community for hypertensive and diabetic patients was 73.0%(584/800). The reasons for choosing community service were: near home (86.3%, 690/800), shorter waiting time (71.4%, 571/800) and trust in doctors (50.3%, 402/800); while the reasons for not choosing community service were less drug varieties (76.1%, 609/800), poor facilities (32.1%, 257/800) and lower technical level (11.4%, 91/800). Its influencing factors were: frequent need of accompanying for visit (χ2=5.719, P=0.012), family income (χ2=4.540, P=0.021), awareness of service scopes(χ2=64.668, P=0.000), purpose of service(χ2=19.234, P=0.000), frequency of doctor contact(χ2=9.367, P=0.001), the awareness of referral(χ2=5.736, P=0.011). Conclusion The community health service centers should take the advantage of easy access, short waiting time and patients′ trust, at the same time should improve the service conditions and quality, so as to increase the first-contact rate for patients contracting medical service. Key words: Hypertension; Diabetes mellitus; Community health centers; Contract services