Earliest Appointment Research Articles

Conjoint Analysis of Telemedicine Preferences for Hypertension Management Among Adult Patients.

Background: Telemedicine has been differentially utilized by different demographic groups during COVID-19, exacerbating inequities in health care. We conducted conjoint and latent class analyses to understand factors that shape patient preferences for hypertension management telemedicine appointments. Methods: We surveyed 320 adults, oversampling participants from households that earned <$50K per year (77.2%) and speak a language other than English at home (68.8%). We asked them to choose among 2 hypothetical appointments through 12 conjoint tasks measuring 6 attributes. Individual utilities for attributes were constructed using logit estimation, and latent classes were identified and compared by demographic and clinical characteristics. Results: Respondents preferred in-person visits (0.353, standard error [SE] = 0.039) and video appointments conducted through a secure patient portal (0.002, SE = 0.040). Respondents also preferred seeing a clinician with whom they have an established relationship (0.168, SE = 0.021). We found four latent classes: "in-person" (26.5% of participants) who strongly weighted in-person appointments, "cost conscious" (8.1%) who prioritized the lowest copay ($0 to $10), "expedited" (19.7%) who prioritized getting the earliest appointment possible (same/next day or at least within the next week), and "comprehensive" (45.6%) who had preferences for in-person care and telemedicine appointments through a secure portal, low copayments, and the ability to see a familiar clinician. Conclusions: Appointment preferences for hypertension management can be segmented into four groups that prioritize (1) in-person care, (2) low copayments, (3) expedited care, and (4) balanced preferences for in-person and telemedicine appointments. Evidence is needed to clarify whether aligning appointment offerings with patients' preferences can improve care quality, equity, and efficiency.

Do Type of Insurance, Geographical Variation and Type of Practice Impact Access to Foot and Ankle Care?

Category:Foot & AnkleIntroduction/Purpose:Medical coverage gap in United States refers to people who are uninsured because the state they are living has still opted-out of Medicaid expansion under Patient Protection and Affordable Care Act (PPACA) and they are too poor to be benefited from subsidies designed for middle-class Americans. A large percentage of this population lives in south. Despite increasing participation of the states in expanded Medicaid, it is still unclear that if such an expansion has led to improve the access to care. However, approximately one in three American is covered under Blue Cross Blue Shield (BCBS) private insurance. The purpose of this study is to determine the access to foot and ankle care based on medical insurance, nature of illness and Medicaid expansion of the state.Methods:Five pairs of Medicaid expended (California, New York, Ohio, Minnesota and Washington) and non-expanded (Utah, Texas, Alabama, Missouri, and North Carolina) states with different geographic location were selected for the study. Twenty providers from each state were randomly selected via American Orthopedic Foot & Ankle Society (AOFAS) directory with private or academic affiliations. Each provider’s office was contacted by fictitious call for the earliest available appointment in foot and ankle clinic. A standardized script was used by the same researcher every time for a 30 year old male patient with acute Achilles tendon rupture or chronic bunion with either Medicaid or BCBS insurances. Available appointment for physician was considered as an access to foot and ankle care. We registered time until appointment (if given) and reason for denial (if denied) on phone. We also recorded requirements for insurance details, PCP (Primary Care Physician) referral or imaging records.Results:200 providers’ offices were contacted on phone for foot and ankle clinic appointment. Successful appointment was given by 36%(72/200) offices irrespective of condition and insurance. 29% of calls with Medicaid could successfully schedule an appointment compared to 43% when calling with BCBS(P=0.03). Success rate for appointment was same for Achilles rupture and Bunion (36% each). The mean time until earliest appointment was 10.7(range 1-37) days with Medicaid and 10.5 (range 1-45) days with BCBS. For Medicaid patients, no significant difference was found in appointment rates between expanded states (30%) and non-expanded (28%) states (P=0.82). Overall appointment success rate was highest in Utah (65%) and lowest in New York (10%). Differences were observed across geographical locations, as well as between academic and private institutes.Conclusion:In our study, access to foot and ankle care clinic seems to be significantly better with BCBS private insurance compared to Medicaid. Sample size is surely a limitation, but we have included more states than similarly-designed studies for better geographic variability. There was no significant difference for appointment wait-time between Achilles tendon rupture and Bunion as well as Medicaid and BCBS insurance. Medicaid expansion facility in the state has not been associated with higher success rate but associated with lengthening of wait-time. Inability to provide insurance details or PCP-referral is definitely an important barrier for the access to podiatric care.

Fractures and diabetes

Fractures and diabetes

Rozwój strefowych i ponadstrefowych organów niemieckich w zachodnich strefach okupacyjnych

The aim of allied superpowers confirmed in the Potsdam agreement was building a new German state authority on all stages of management and maintaining Germany’s state unity. The earliest appointment of German authorities took place at the municipal and lower, district level. The next stage of political development was establishing of new territorial division by occupation authorities in particular countries’zones. However, further development of the political situation in Germany as well of the relations between the Allies led to departing from the conception of one German state and to the establishment of two separate countries in 1949. All the earlier formed German countries were included in new states, except for Saara, which was united with France. Along with organizing the countries and forming of German national bodies, western occupation superpowers began to establish first all-zones German institutions. The first to do it were the Americans. As soon as October 1945 there was called into being the States Council, which in the beginning consisted of national prime ministers. Also the British authorities started creating all-zones institutions relatively quickly; those were: the Conference of National Prime Ministers and the Zonal Advisory Council. Only the French delayed for a long time, forming similar German institutions. It was only the middle of 1948, i.e. after making the decision about the creation of Trizonia that French authorities began to arganize the extranational institution within their zone. At the end of 1946, due to the lack of possibilities to come to agreement on working out a common stance of the four superpowers on the subject of restoring of Germany’s state unity, there were undertaken actions, initiated by the USA, aimed at joining the occupation zones with regard to the economic aspect. This offer was accepted by the Great Britain only, which caused the foundation of so-called Bizonia, whose official name was the United Economic Area. The two-zonal istitutions were: the Economic Council as the quasi-Parliament, the Executive Council, later on transformed into the States Council, which had the features of the second house of Parliament, and the Directors Board, later on the Administrative Council as the quasi-office, as well as, starting from 1948, the Supreme Court. After establishing the Federal Republic of Germany, the so far existing zonal institutions were either dissolved or transformed into federal authorities of the newly created State.

Medical Society Battles Carveout Over Managed Care Practices

Medical Society Battles Carveout Over Managed Care Practices

Shopping Around for Hospital Services. A Comparison of the United States and Canada

Context.—Historical comparisons indicate that US hospitals are more expensive than Canadian hospitals, but health care system reform might have changed the relative costs and timeliness of health care in the 2 countries.Objective.—To estimate the price and convenience of selected hospital services in the United States and Canada for patients in 1997 had they paid out-of-pocket.Design.—Cross-sectional telephone survey conducted May 1996 to April 1997.Participants.—The 2 largest acute care general hospitals from every city in the United States and Canada with a population greater than 500000.Measures.—Each hospital was telephoned and asked their price and waiting time for 7 services: magnetic resonance imaging of the head without gadolinium; a screening mammogram; a 12-lead electrocardiogram; a prothrombin time measurement; a session of hemodialysis; a screening colonoscopy; and a total knee replacement. Waiting times were measured in days until earliest appointment and charges were converted to American currency.Results.—Overall, 48 US and 18 Canadian hospitals were surveyed. Median waiting times were significantly shorter in American hospitals for 4 services, particularly a magnetic resonance imaging of the head (3 days vs 150 days; P<.001). Median charges were significantly higher in American hospitals for 6 services, particularly for a total knee replacement ($26805 vs $10651; P<.001). Individual services showed no association between shorter waiting times and higher prices within each country, with the exception of a total knee replacement in the United States.Conclusion.—US hospitals still provide higher prices and faster care than Canadian hospitals for patients who pay out-of-pocket.

Mr. L. de Whalley

MR. LAWRENCE DE WHALLEY, formerly chief chemist of Messrs. Tate and Lyle, died at his home at Orpington on January 9 aged eighty-three years. He was born and educated in Lancashire, and was successful in obtaining a scholarship at the Royal School of Mines, London, where he worked under Huxley, Valentin and Edward Frankland, whose honorary assistant he became. He attended Prof. Seeley's geological excursions and was keenly interested in Nature and natural history, an interest he never forsook. At the University of London he obtained his B.Sc. with honours in physics, and was one of the original members both of the Physical Society and of the Society of Chemical Industry, being honoured at the latter's jubilee in 1931, when he was presented with its memorial plaque. He was also a fellow of the Institute of Chemistry and of the Chemical Society, a member of the Society of Public Analysts and one of the founders of the Chemical Club. His earliest appointment was at the works of Messrs. Forbes, Abbot and Leonard, now part of the South Metropolitan Gas Co. In 1890 he joined his two brothers-in-law, the late John Joseph Eastick and Charles E. Eastick, later managing director of Martineaus, Ltd., at the refinery of Messrs. Abram Lyle and Sons at Plaistow Wharf, Victoria Docks, London, and became chief chemist when J. J. Eastick left to take up an appointment in Australia. This position he held until his retirement in 1930.