Patient Follow-up Rates Research Articles

Factors affecting patient retention to hypertension treatment in a North Indian State: A mixed-method study.

Hypertension is a global health challenge, especially in low-to-middle-income countries, where awareness and control are suboptimal. Despite available treatments, poor medication adherence hampers blood pressure control, leading to adverse outcomes and increased costs. In response, the GOI has initiated national action plans to address noncommunicable diseases, including hypertension. The study aimed to analyze patient retention rates in hypertension treatment across healthcare levels and understand providers' and patients' perspectives on control factors. Using a mixed-method concurrent design in a North Indian district, retrospective data collection covered hypertensive patients registered from January 2020 to July 2020, followed for a year (August 2020-July 2021). Quantitative data included socio-demographic characteristics and patient follow-up rates. Qualitative data comprised focus group discussions (FGD) and in-depth interviews (IDI) with healthcare providers (HCPs) and patients. Findings identified challenges in patient retention and medication adherence, notably among females and at higher-level healthcare facilities, leading to substantial loss of follow-up. Only 63% of hypertensive outpatients maintained controlled blood pressure in the past year. Male patients exhibited more consistent attendance than females. Despite sufficient HCP knowledge, patient retention was better at Health and Wellness Centers (HWCs) levels, while blood pressure control was poorer at higher facilities. Barriers such as medication side effects, pill burden, and limited healthcare access hindered hypertension control, highlighting the need for improved primary care services, including extended clinic hours and diagnostic facilities. Improving hypertension control requires addressing medication adherence and healthcare access barriers. Strengthening primary care services and implementing patient-centered interventions are crucial steps.

Medical management of early pregnancy loss with mifepristone and misoprostol in emergency departments compared to a Complex Family Planning office: Implementation of a COVID-19 institutional policy change

ObjectivesTo evaluate the implementation of mifepristone and misoprostol for medical management of early pregnancy loss (EPL) in emergency departments (EDs) by comparing efficacy, complication, and follow-up rates for patients treated in EDs to those in the Complex Family Planning (CFP) outpatient office. Study DesignIn COVID-19's first wave, we expanded medication management of EPL to our EDs. This retrospective study evaluated 72 patients receiving mifepristone and misoprostol for EPL from 4/1/2020-3/31/2021, comparing treatment success, safety outcomes, and follow-up rates by location. We did not perform a power calculation. ResultsThirty-three (46%) patients received care in the ED and 39 (54%) at CFP. Treatment success was lower in the ED (23, 70%) compared to CFP (34, 87.2%), but after adjusting for insurance status and type of pregnancy (miscarriage, uncertain viability, unknown location) this was not significant: aOR 0.48 (95%CI 0.13-1.81), p=0.28. More ED patients underwent emergent interventions (3 vs 0). Complications in the ED cohort included two emergent uterine aspirations, one uterine artery embolization, and two blood transfusions. Among these, two cases were attributed to misdiagnosis (a cesarean scar and a cervical ectopic pregnancy interpreted as incomplete miscarriages) and one to guideline nonadherence (anticoagulated patient). No complications occurred in the CFP group. Follow-up rates were over 80% in both groups. More ED patients engaged in telehealth follow-up (67% vs 18.0%, p≤0.0001). ConclusionsIn this small sample, we observed a trend toward lower rates of treatment success following medication management of EPL in the ED, compared to the CFP office. This analysis highlights that both correctly making uncommon diagnoses and adhering to new guidelines presented challenges during our implementation process. IMPLICATIONSImplementing mifepristone and misoprostol for EPL in our EDs achieved lower rates of pregnancy resolution compared to outpatient management. Complex uncommon diagnoses and implementing new care pathways in EDs may have contributed to complications and highlight opportunities for improvement. Additional studies are needed to further quantify safety outcomes for EPL management in EDs. TWEETABLE ABSTRACTED provision of mifepristone and misoprostol for early pregnancy loss during COVID-19 was less effective than outpatient care. There were more serious complications in the ED group due to misdiagnosis and guideline nonadherence.

Real-world effectiveness of cytology and HPV-based screening strategy in cervical cancer screening: A cross-sectional population-based study in Chengdu, China.

Cervical cancer poses a significant health challenge in developing countries, emphasizing the need for appropriate screening strategies to accelerate the elimination of this disease. This study summarized the results of a large-scale community-based cervical cancer screening program conducted in Chengdu, China, to understand the prevalence of HPV infection and cervical lesions in the population, and to compare the real-world effectiveness of two different screening methods implemented in the program. From January 2021 to December 2022, a total of 363,376 women aged 35-64 years in Chengdu received free screenings. Among these participants, 70.1% received cytology screening and 29.9% received HPV testing combined with 16/18 genotyping and cytology triage. Ultimately, 824 cases of high-grade lesions and cervical cancer were detected, with a total detection rate of cervical cancer and precancerous lesions of 226.8 per 100,000. The follow-up rate of patients with high-grade lesions and above was 98.9%, and the treatment rate was 86.6%. The overall high-risk HPV infection rate was 11.7%, with the HPV 16/18 infection rate of 1.4%. The rate of abnormal cytology results was 2.8%. The attendance rates for colposcopy and histopathology were 71.6% and 86.1%, respectively. By calculating the age-standardized rates to eliminate the different age composition between the two group, the HPV-based screening strategy had a higher rate of primary screening abnormalities (3.4% vs. 2.8%, P<0.001), higher attendance rates of colposcopy (76.5% vs. 68.9%, P<0.001) and histopathological diagnosis (94.1% vs. 78.0%, P<0.001), higher percentage of abnormal colposcopy results (76.0% vs. 44.0%, P<0.001), and higher detection rate of cervical precancerous lesions and cancer (393.1 per 100,000 vs. 156.4 per 100,000, P<0.001) compared to cytology screening. Our study indicates that the combination of HPV testing with 16/18 genotyping and cytology triage has demonstrated superior performance in cervical cancer screening compared to cytology alone in large-scale population.

Surgery of Primary Spontaneous Pneumothorax about 289 Cases

Objectives: Primary spontaneous pneumothorax is a public health problem because of its frequency and its occurrence in a population often young. It is a pathology which natural evolution is marked by the occurrence of recurrence. The purpose of the surgical treatment of PSP is to resect the apical bulla and bleb areas. In addition, various pleural adhesion procedures are recommended to prevent recurrence. Methods: Between 2015 and July 2021, the results of 289 operations performed patients with PSP were examined. The variables analyzed were age, sexe, risk factor, morbidity and mortality surgical results. The average patient follow-up rate is 26 months. Results: Recurrent PSP largely dominated the surgical indications with a rate of 73.8%. Complications were seen at a rate of 5.1%. These complications required revision surgery in 3 cases. The recurrence rate is around 1.7%. However, the residual postoperative pain is around 10.7%. The average length of stay is around 6.8 ±1.2. The mortality rate was nil. Conclusion: Surgery for primary spontaneous pneumothorax has shown encouraging results, during which it must be performed as soon as possible once the indication for surgery has been established.

Patient Referral and Acceptance of Maxillomandibular Advancement for Obstructive Sleep Apnea.

Maxillomandibular advancement (MMA) is an effective surgical treatment for obstructive sleep apnea (OSA); however, it is unclear how many patients who are referred for MMA actually undergo surgery. This study aims to determine follow-up rates for patients referred for MMA and the reasons behind their choices. Via retrospective review, we assessed consecutive patients with OSA intolerant to continuous positive airway pressure (CPAP) who underwent drug induced sleep endoscopy (DISE) between 2018 and 2020 at our institution. Patients recommended for MMA based on DISE and other findings were included. Patients were then contacted and administered an IRB-approved survey in present time. One hundred and fifty nine patients were referred to oral maxillofacial surgery (OMFS) for MMA consult. Seventy seven patients (48%) followed up with OMFS and 29 (18%) underwent MMA. Sixty two (40%) patients resumed CPAP. Fifty eight patients (36.5%) were lost to follow up. Seventy three patients (46%) completed our survey. Of those patients, 37 (51%) followed up with OMFS and 17 (23%) underwent MMA. Patients who did not follow up with OMFS cited the invasiveness of the surgery (39%), recovery time (17%), or both (31%) as reasons. Those who pursued consultation cited inability to tolerate CPAP (73%), not being a candidate for inspire (14%), and desire to learn about alternative treatments (14%) as reasons. Of those who did not undergo MMA, 28.6% are not using OSA treatment. Less than half of patients referred for MMA followed up, and less than half of those patients underwent MMA. Most patients cited concerns about the invasiveness of the surgery and recovery process. 4 Laryngoscope, 134:2964-2969, 2024.

Analysis of safety and factors influencing the surgical efficacy of benign biliary stenosis treated with autologous gastric flap repair with the vascular tip

Objective: To investigate the complication rate and risk factors associated with using autologous gastric flap tissue with a vascular tip to treat benign biliary strictures. Methods: A retrospective analysis was conducted on clinical data of 92 patients with benign biliary stenosis who applied autologous gastric flap tissue to repair the stenosis at the PLA General Hospital from January 2006 to May 2022. Among them, there were 40 males and 52 females, aged from 25 to 79 (50.5±12.9) years. The perioperative clinical data of the patients were recorded(Body Mass Index、preoperative platelets et.), and a multivariate logistic regression model was used to analyze the factors influencing postoperative complications. Long-term follow-up was conducted to evaluate the long-term efficacy of autologous gastric flap tissue with vascular tissues for benign biliary stenosis surgery. Results: The incidence of recent postoperative complications in patients was 26.1%, and univariate analysis showed that preoperative bile-intestinal anastomosis, positive intraoperative bile bacterial culture, low preoperative hemoglobin, and low preoperative platelet count were significantly associated with the occurrence of postoperative complications after biliary stenosis repair with a vascularized gastric flap (P<0.05). Multifactorial analysis showed that low preoperative platelets (OR=0.990, 95%CI: 0.982-0.998, P=0.015), low preoperative hemoglobin (OR=4.953, 95%CI: 1.405-15.010, P=0.012) and positive intraoperative bile bacterial culture (OR=19.338, 95%CI: 3.618-103.360, P<0.001) were independent risk factors for the development of postoperative complications. The excellent long-term follow-up rate of patients was 92.0%. Conclusions: The procedure of repairing benign biliary stenosis with a vascularized gastric flap preserves the function of the sphincter of Oddi and reconstructs the normal physiological passage of the bile duct. This procedure is safe and feasible and provides a reliable option for the surgical treatment of bile duct injury and bile duct stenosis.

Transition-of-care program from emergency department to gastroenterology clinics improves follow-up

ObjectivesPatients discharged from the emergency department (ED) with gastrointestinal (GI) symptoms need to appropriately transition their care to a GI outpatient clinic in a timely manner to have their health needs met and avoid significant morbidity. When this transition isn't optimal, patients are lost to follow-up, potentially placing them at risk for adverse events. We sought to study the effectiveness of implementing an electronic medical record (EMR) based transition-of-care (TOC) program from the ED to outpatient GI clinics. MethodsWe performed a retrospective single center cohort study of patients discharged from the ED of a tertiary care academic medical center referred to outpatient GI clinic before (Pre-TOC patients) and after implementation of an EMR based TOC program (TOC patients). We further stratified patients based on the Distressed Communities Index (DCI), which is a composite measure of economic well-being. We compared rates of appointment scheduling and appointment attendance between the two groups, as well as 30-day readmission rates to the ED. We also performed a subgroup analysis to determine if socioeconomic status would affect patient follow-up rates. ResultsWe included 380 Pre-TOC and 399 TOC patients in our analysis. TOC patients were found to both schedule appointments (50% vs 27% p-value <0.01) as well as show up to appointments (34% vs 24% p-value <0.01) at significantly higher rates compared to Pre-TOC patients. There was no significant difference between 30-day readmission rates between the two groups. In addition, TOC patients from At-Risk and Distressed Communities were over 22 times more likely to schedule an appointment compared to Pre-TOC patients from similar neighborhoods (OR 22.18, 95% CI 4.23–116.32). ConclusionOur study shows that patients who are discharged from the ED with outpatient GI follow-up are more likely to both schedule and show up to appointments with implementation of an EMR-based direct referral program compared to no patient navigation, particularly among patients of lower socioeconomic status.

Dermatological Needs in an Urban Free Health Care Setting.

Introduction A large proportion of the United States' underinsured population relies on free health clinics for their health care needs. With only a few free health clinics nationwide hosting specialty clinics, a small subset of which are dermatology clinics, there is a dearth of information in the literature on which dermatological pathologies and treatment modalities are most common in this setting. The purpose of this study was to establish the most common dermatological conditions and treatments in the free health care setting as well as understand which facets of care need improvement. Methods A total of 57 patients with dermatological findings were identified at an urban student-run free health clinic in the southern United States in the past two years (2019-2021). Information reviewed for each patient included general demographics, chief complaint, medical/surgical history, treatments/procedures required for each visit, treatments/procedures available for each visit, referrals, and follow-up rate. Qualitative analysis was performed. Results The median age of the patients that presented with dermatological findings was 40 while the most common ethnicities were white (26.2%), Hispanic/Latino (28.6%), and black (28.6%). The most common chief complaints were rashes and cysts with a majority (63.2%) of these patients presenting to this particular clinic for the first time. Seven patients (12.3%) were unable to receive treatment due to expense, procedure unavailability, or an unknown reason. The most common treatment prescribed included a topical steroid. A majority (71.9%) of the patients were unable to follow up as scheduled. A majority of patients (81.2%) that were able to follow up were adherent to their prescribed medication. Conclusion Although dermatological conditions are plentiful in the free health care setting, the literature currently contains no information regarding this topic. This may be due to low patient follow-up rates and inadequately charted outcomes on often outdated electronic health records. In order to best care for dermatology patients in this setting, it is necessary to understand the barriers to care and available treatment options.

Comparison of Virtual Management of Vulvovaginal Candidiasis to Traditional In-Person Care.

Objective: Compare demographics, treatment, and follow-up rates for patients with complaints of vulvovaginitis suggestive of candida infection evaluated via e-visit, face-to-face (F2F) visits, or nurse-administered phone protocol. Methods: Manual review of 150 vaginitis visits of each visit type (e-visit, F2F, and phone protocol) completed between May 5, 2018 through January 31, 2020 by Mayo Clinic patients residing in Minnesota. Outcomes: Comparison between the three visit types of patient characteristics, treatment rates, type of treatment, follow-up rates, and types of follow-up. Results: Patients utilizing phone visits were significantly older than those seeking care via e-visit (p < 0.0001) or F2F (p = 0.001) and were more likely to be treated with oral fluconazole than those treated by e-visit (p < 0.0001) or F2F (p < 0.0001) encounters. Patients were significantly less likely to receive fungal directed treatment at a F2F visit than an e-visit (p < 0.0001) or phone encounter (p < 0.0001). There was no significant difference in follow-up rates between the three groups. Conclusion: Virtual visits (non-F2F) for suspected vulvovaginal candidiasis are unlikely to result in more follow-up visits than F2F encounters; however, prescriptions for antifungals are significantly higher with virtual visits.

System-driven longitudinal follow-up of incidental imaging findings.

Increasing utilization of cross-sectional imaging has resulted in more clinically significant incidental findings being discovered. However, the current approach for handling these findings is commonly inconsistent and relies greatly on the efforts of individual clinicians. Making sure every actionable incidental finding is handled in a consistent and reliable manner can be difficult, especially for a large health system. We propose an approach to handling incidental findings aimed at improving patient follow-up rates, which involves implementing system-level processes that standardize the reporting of incidental findings, notification of clinicians and the patient, and centralized monitoring of longitudinal patient follow-up. We will lay out a general framework for standardized reporting of incidental findings by the radiologist using software integrated into the daily workflow. This should enable simultaneous notification of the ordering clinician, the patient's primary-care provider, and an incidental findings navigator. The navigator will "close the loop" by working with clinicians to notify the patient of the finding, coordinate patient follow-up, and document the finding and long-term follow-up. We hope this can serve as a basic framework to help large health systems design an incidental findings workflow to improve follow-up rates and reduce patient harm.

Antiviral Treatment and One-Year Follow-Up of Chronic Hepatitis B Patients in Bandung: An Observational Study

Background: Hepatitis B Virus (HBV) is a health problem that has chronically infected 257 million globally. Appropriate therapy is immensely needed to prevent disease progression to cirrhosis and hepatocellular carcinoma (HCC). Moreover, routine monitoring is required to assess the efficacy of the given treatment. This study aims to describe the treatment and its follow-up outcomes among chronic HBV patients after one year of therapy in Bandung.Method: This was a cross-sectional descriptive study with a data sampling method obtained from assessing the medical records of treated chronic HBV outpatients at the Gastrohepatoenterology Clinic of Hasan Sadikin Hospital Bandung from 2018 to 2020. Laboratory findings before and after one year of therapy were further assessed.Results: Out of 107 patients treated, the proportion of tenofovir was 72.90%, telbivudine 16.80%, lamivudine 8.40%, and interferon group 1.90%. There were 52.30% of patients who did follow-up visits after one year of therapy. The therapeutic outcome rate was evaluated among total patients with the criteria of decreasing AST (91.18%) and ALT levels (93.10%) levels, reduction of HBV-DNA values (100%), and HBeAg seroconversion (14.29%).Conclusion: The most given therapy among chronic HBV outpatients was tenofovir. The follow-up rate of patients after one year of treatment was 52.30%. Overall, antiviral therapies produced decreases in liver laboratory parameters, HBV-DNA, and HBeAg.

MP63-05 A RANDOMIZED CONTROLLED TRIAL COMPARING TELEMEDICINE VERSUS IN-PERSON OFFICE VISITS FOR THE FOLLOW-UP OF OVERACTIVE BLADDER

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II (MP63)1 Sep 2021MP63-05 A RANDOMIZED CONTROLLED TRIAL COMPARING TELEMEDICINE VERSUS IN-PERSON OFFICE VISITS FOR THE FOLLOW-UP OF OVERACTIVE BLADDER Spencer Mossack, Igor Inoyatov, Chris Du, Phillip Fonseca, Edwin Lee, Heng Ruan, and Jason Kim Spencer MossackSpencer Mossack More articles by this author , Igor InoyatovIgor Inoyatov More articles by this author , Chris DuChris Du More articles by this author , Phillip FonsecaPhillip Fonseca More articles by this author , Edwin LeeEdwin Lee More articles by this author , Heng RuanHeng Ruan More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002103.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Telemedicine has been increasingly utilized in the management of urologic patients since the start of the global COVID-19 pandemic. Overactive bladder (OAB) is a condition that may ideally suited for the use of telemedicine as initial treatment options are behavioral modification and pharmacotherapy. We sought to evaluate if there was an overall difference in patient follow up rates between telemedicine visits and in-person visits. METHODS: New patients presenting to our clinic with OAB from 7/2020 to 2/2021 were randomized into 2 follow-up groups, telemedicine and in-person visits. After each visit, patients were prompted to complete a survey regarding their visit experience. A prospective database was maintained to compare follow-up rates, satisfaction rates, and time commitment in each group. RESULTS: A total of 46 patients were randomized, 24 to the telemedicine group and 22 to the in-person group. There were no significant differences in baseline demographics, Urogenital Distress Inventory-6/Incontinence Impact Questionnaire-7 scores, or history of telemedicine experience. There was no significant difference in follow-up rates between the telemedicine and in-person follow-up groups at 30-days (33% vs. 27%, p=0.66), or 60-days (63% vs. 50% p=0.39). Satisfaction rates were extremely high and there was no significant difference between the groups. There was a significant difference between the average telemedicine visit time and in-person visit time (10.88 mins vs. 21.84 mins, p=0.004). For in-person visits, the average travel time was 48 minutes (range 10-90 mins) and average miles traveled was 21 miles (range 5-35 miles). Patients in the telemedicine group reported technical difficulties in 12% of follow-up appointments (N=2). CONCLUSIONS: There was no significant difference in follow-up or satisfaction rates between telemedicine and in-person visits. In-person visits took half the length of time compared to in-person visits. On average patients in the telemedicine group saved approximately 1 hour per follow-up visit. Telemedicine visits save both the provider and patient significant amounts of time without sacrificing patient satisfaction and follow-up rates. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1103-e1103 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Spencer Mossack More articles by this author Igor Inoyatov More articles by this author Chris Du More articles by this author Phillip Fonseca More articles by this author Edwin Lee More articles by this author Heng Ruan More articles by this author Jason Kim More articles by this author Expand All Advertisement Loading ...

Follow-up rates for patients needing regular intravitreal therapy in rural north-western Western Australia.

Regular intravitreal injections are an important treatment for significant vision impairment caused by diabetic macular oedema. Barriers to intravitreal treatment for rural Australian patients include travel time to appointments, especially as patients face a high volume of other medical appointments for their diabetes and related co-morbidities. This audit addresses intravitreal injection compliance by identifying patients lost to follow up in north-western Western Australia. A retrospective audit of all injections was performed in the Pilbara and Kimberley between January and December 2018. Outcome measures included total injections, number of injection patients, rates of patients lost to follow-up by region, Aboriginal and Torres Strait Islander status and diagnosis. The audit was extended to include the first 6 months of 2019 to ensure further treatment plan timeframes had lapsed. A total of 140 patients received injections, resulting in 346 injections. Ten patients were excluded due to relocation to another region and three patients were deceased. Seventeen patients were lost to follow-up (12.1%). Of those lost to follow-up, 14.3% were in the Pilbara region and 10% in the Kimberley region. Similar rates with respect to Indigenous status with 12.6% identifying as Aboriginal and 11.4% not. 15.8% were treated for diabetic macular oedema and 3.8% for age-related macular degeneration. The logistics of providing appropriate intravitreal therapy, including scheduling timely visits and working in hospital and community-controlled settings, requires a specific focus on those needing intravitreal treatment. The study highlights the importance of coordination and systems to enable patients to receive injections in remote settings. Further analysis of optimal patient management plans for appropriate frequency and treatment outcomes is required.

Improving the Diagnosis and Early Follow-up of Children with Sickle Cell Disease Born in Mirebalais Haiti

Background: In Haiti, nearly 1% of babies are born with sickle cell disease (SCD) and up to 90% will die before their fifth birthday. Despite a high prevalence and the knowledge that newborn screening and early intervention greatly reduce morbidity and mortality associated with the disease, no national newborn screening program exists in the country. While a SCD program that focuses on newborn screening and early treatment for children with SCD was established in Mirebalais, Haiti in 2014, it has struggled to provide regular and accurate screening that leads to babies returning for routine SCD care. We developed a pilot quality improvement (QI) initiative to improve the diagnosis and early follow-up of children with SCD in Haiti.Objective: To increase by 20% the accuracy of SCD diagnosis by Haitian technicians and decrease the time to first penicillin prophylaxis prescription to 120 days or less for babies born at the University Hospital of Mirebalais within 6 months of start of QI initiative.Methods: We performed a needs assessment of the University of Mirebalais SCD program consisting of interviews with key stakeholders. A Strength, Weaknesses, Opportunities, and threats analysis and process map were developed to identify areas of improvement. Rapid cycle changes were tested using QI methodology based on Plan, Do, Study, Act cycles to streamline the process. Key interventions included: training of on-site laboratory technicians in isoelectric focusing (IEF) and nursing in care coordination every 3 months, review of every test and result by US based IEF consultant and nursing director, and creation of a shared database to track patient progress through our screening to follow-up process.Results: We compared the first 3 months of our study period (February to April 2017) to that of the next 3 months of the study period (May to July 2017). The number of gels run increased from 14 from February to April to 31 from May to July. We also found a reduction in the number of tests that needed to be repeated due to improperly run tests (32% to 28%), despite an increase in the total number of tests run (526 to 1706) and sustained accuracy in identifying IEF bands above 85%. 13 children were diagnosed with SCD. 3 patients could not be found and 1 died. Of the 9 patients contacted, the median time from screening date to start of penicillin was 109 days. This improved from 210 days in the first 3 months of the study period to 106 in the last 3 months of the study period.Conclusions: Training of technicians every 3 months greatly improved outcomes of IEF SCD diagnosis. The accuracy of SCD diagnosis did not improve but we increased the number of tests run while maintaining high accuracy at greater than 85%. The lack of patient contact information and slow turnaround of sample results influenced patient follow-up rates and the number of patients lost to follow-up. Improvement in time from heel stick to confirmation of IEF result and employment of community health workers when patient contact information is incomplete may improve follow-up. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Late outcomes after endovascular and open repair of large abdominal aortic aneurysms

ObjectiveThe risk of aortic abdominal aneurysm (AAA) rupture increases with an increasing aneurysm diameter. However, the effect of the AAA diameter on late outcomes after aneurysm repair is unclear. Therefore, we assessed the association of a large AAA diameter with late outcomes for patients undergoing open and endovascular AAA repair. MethodsWe identified all patients who had undergone elective open or endovascular infrarenal aneurysm repair from 2003 to 2016 in the Vascular Quality Initiative linked to Medicare claims for long-term outcomes. A large AAA diameter was defined as a diameter >65 mm. We assessed the 5-year reintervention, rupture, mortality, and follow-up rates. We constructed propensity scores and used inverse probability-weighted Kaplan-Meier estimations and Cox proportional hazard models to identify independent associations between large AAA repair and our outcomes. ResultsOf the 21,119 aneurysm repairs identified, 15.2% were for large AAAs. Of the 21,119 repairs, 19,017 were endovascular and 2102 were open. The large AAA cohort was less likely to have undergone endovascular aneurysm repair (EVAR; 84.9% vs 91%; P < .001), more likely to be older (median age, 76 vs 75 years; P < .001), and were less likely to be women (16.2% vs 21.7%; P < .001). After EVAR, patients with large AAAs had had lower adjusted 5-year freedom from reintervention (73.9% vs 84.6%; P < .001), freedom from rupture (88.5% vs 93.6%; P < .001), survival (58.0% vs 66.4%; P < .001), and freedom from loss to follow-up (77.7% vs 83.3%; P < .001) compared with patients with smaller AAAs. However, after open repair, the adjusted 5-year freedom from reintervention (95.8% vs 93.3%; P = .11), freedom from rupture (97.4% vs 97.8%; P = .32), survival (70.4% vs 74.0%; P = .13), and loss to follow-up (60.5% vs 62.8%; P = .86) were similar to the results for patients with smaller AAAs. For patients with large AAAs, the adjusted 5-year survival was lower after EVAR than that after open repair (55.3% vs 63.7%) but not after smaller AAA repair (67.3% vs 70.6%). ConclusionsThe 5-year adjusted reintervention, ruptures, mortality, and loss to follow-up rates for patients who had undergone large AAA EVAR were higher than those for patients who had undergone small AAA EVAR and large AAA open repair. Therefore, for patients with large AAAs who are medically fit, open repair should be strongly considered. Furthermore, these findings highlight the necessity for rigorous long-term follow-up after EVAR.

Dental Emergencies Management in COVID-19 Pandemic Peak: A Cohort Study

Due to the global coronavirus disease 2019 pandemic, the high risk of cross-contamination and the overload of hospital facilities have resulted in a real urgency for restricting dental emergency patient flow. In this context, the objectives of the current work were to 1) measure the ability of a triage-based management strategy to limit patient admission and 2) evaluate the success rate of both on-site and remote emergency management regarding symptom relief and pain control over a 1-mo period. We included all patients contacting the dental medicine department for an emergency consultation during the lockdown, between April 1 and April 30, 2020 (N = 570). Following a telephone consultation and based on preestablished admission guidelines, a decision was made at baseline (T0) to either admit the patient for treatment or perform remote management by providing advice and/or drug prescription. Patients were then followed up systematically at 1 wk and 1 mo. Management failure was defined as the need for emergency admission for patients managed remotely since T0 and for new emergency admission for those admitted at T0. The global follow-up rate of patients with a complete data set was 91.4% (N = 521). Of included patients, 49.3% could be managed without admission for emergency reasons for 1 mo. The proportion of successful management was 71.8% and 90.2% at 1 mo for remote and on-site management, respectively. To conclude, the proposed triage-based emergency management strategy with systematic follow-up was a good compromise between limiting patient admission and ensuring effective symptom relief and pain control. The strategy can be useful in situations where regulation of the emergency patient flow is required.

Follow-Up Rates at a Free Ophthalmology Clinic at a Homeless Shelter.

Objective Eye health among the homeless community is important, as poor vision makes this population vulnerable and adds significantly to the social and health burden. There is limited knowledge on patient follow-up rates for their eye conditions and barriers to accessing care in this population. The purpose of this retrospective chart review study is to examine follow-up rates and barriers to care for patients referred from a free, medical-student run ophthalmology clinic at a homeless shelter. Methods All patients evaluated at a free ophthalmology clinic from September 2017 to September 2018 were included; no patients were excluded. If indicated, patients were referred for advanced ophthalmologic care at a local county hospital and free eyeglasses at a nonprofit organization. Primary outcomes were follow-up rates at the county hospital and nonprofit organization. Secondary outcomes included prespecified baseline variables hypothesized to be associated with follow-up rates. These categorical variables were compared with Chi-square testing to determine their association with follow-up rates. The hypothesis being tested was formulated before data collection. Results Of the 68 patients, 84% were males with a mean age of 50 years. Overall, 40 patients were referred for free eyeglasses and 17 to the county hospital. Of those referred, 14 patients presented for free eyeglasses and 7 presented to the county hospital. About 79% of patients with a pre-established primary care provider presented to their appointment compared with 20% of those without one ( p = 0.03). The 44% of patients with a high school diploma presented while all patients without a high school diploma failed to present ( p = 0.04). Vision-threatening conditions identified at the shelter clinic did not affect follow-up rates ( p = 0.79). Conclusion Less than half of referred patients in our study presented to their appointments. Barriers to presentation included no primary care provider and lower educational status, with no improvement in follow-up rates among those referred for vision-threatening conditions. Interventions such as health coaching with particular attention to educating patients on the effects of vision-threatening conditions may be warranted, particularly for those not looped into the health care system and those of lower educational attainment.

Integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial

BackgroundPatients continue to suffer from medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS). General practitioners (GPs) play a key role in the management of PPS and require further training. Patients are often frustrated with the care they receive. This study aims to assess the acceptability of an ‘integrated GP care’ approach which consists of offering self-help materials to patients with PPS and offering their GPs training on how to utilise cognitive behavioural skills within their consultations, as well as assessing the feasibility of conducting a future trial in primary care to evaluate its benefit.MethodsA feasibility cluster randomised controlled trial was conducted in primary care, South London, UK. GP practices (clusters) were randomly allocated to ‘integrated GP care plus treatment as usual’ or ‘treatment as usual’. Patients with PPS were recruited from participating GP practices before randomisation. Feasibility parameters, process variables and potential outcome measures were collected at pre-randomisation and at 12- and 24-weeks post-randomisation at cluster and individual participant level.ResultsTwo thousand nine hundred seventy-eight patients were identified from 18 GP practices. Out of the 424 patients who responded with interest in the study, 164 fully met the eligibility criteria. One hundred sixty-one patients provided baseline data before cluster randomisation and therefore were able to participate in the study. Most feasibility parameters indicated that the intervention was acceptable and a future trial feasible. 50 GPs from 8 GP practices (randomised to intervention) attended the offer of training and provided positive feedback. Scores in GP knowledge and confidence increased post-training. Follow-up rate of patients at 24 weeks was 87%. However estimated effect sizes on potential clinical outcomes were small.ConclusionsIt was feasible to identify and recruit patients with PPS. Retention rates of participants up to 24 weeks were high. A wide range of health services were used. The intervention was relatively low cost and low risk. This complex intervention should be further developed to improve patients’/GPs’ utilisation of audio/visual and training resources before proceeding to a full trial evaluation.Trial registrationNCT02444520 (ClinicalTrials.gov).

146 Evaluating the Effectiveness of Providing New Primary Care Appointments Prior to Discharge from a Community Hospital Emergency Department

Emergency departments (EDs) across the United States are frequently used to address medical needs that are better suited for the outpatient setting. A key factor that has been noted to increase use of the ED for low-acuity needs is the lack of an established primary care provider (PCP). To help facilitate the process of establishing PCP care after an ED visit, the Swedish Hospital ED (SHED) in northern Chicago can arrange follow up appointments for patients at a partner federally qualified health center (FQHC), Erie Family Health Centers (EFHC), located on its hospital campus. This study analyzes the effectiveness of eliminating logistical barriers by comparing two-week PCP follow up rates between patients given a written referral only versus an appointment on SHED discharge. This was a retrospective chart review of four months from August 1 to November 30, 2018. The investigators compared two-week follow-up rates for patients without established PCPs who were given referrals to EFHC on SHED discharge and patients who were given an actual appointment on discharge. The investigators cross-referenced SHED electronic medical record (EMR) patient data with EFHC EMR data to determine if/when follow up occurred. A successful follow-up visit was defined as a non-established patient being seen at EFHC within two weeks of their ED visit at SHED. Patients were excluded from the study if there was documentation of a visit at EFHC prior to their SHED visit, constituting previously established care. Primary outcome data was subsequently compared using chi square analysis to assess for statistical significance. Additionally, secondary data including demographics and discharge diagnosis were compared using descriptive statistics to assess factors that may correlate with better or worse clinic follow-up. In total, 980 patient encounters occurred during the study period where patients were either referred to or had an appointment scheduled at the EFHC on SHED discharge. After EMR review, 783 patients given a written referral had already established care within the EFHC system and were excluded from the study, leaving 66 patients in the control group. Six (9%) control group patients followed up within two weeks of their ED visit, while 60 patients (91%) did not follow up in the two week window. Of the 131 patients given appointments prior to their SHED discharge, 34 had already established care at the EFHC system and were thus excluded from the study leaving 97 patients in the study group. Fifty-six (58%) study group patients followed up successfully while the other 41 patients (42%) did not (chi-square 39.4272, p-value < 0.00001), indicating statistical significance. This study demonstrates that eliminating barriers to follow up does increase patient follow-up after an ED visit. It validates the tangible benefits of having a supportive collaboration between a FQHC primary care clinic and community hospital ED with many uninsured or underserved patients. Because the ED is a key health care access point for our health system, especially for patients without regular access to care, it is well suited for interventions to increase establishment of primary care which may in turn decrease unnecessary ED visits and promote regular access to care in the clinic setting.

Ophthalmic Emergency Department Visits: Factors Associated With Loss to Follow-up

To describe follow-up rates for patients referred for outpatient ophthalmic care after emergency department (ED) discharge and identify patient and visit characteristics associated with loss to follow-up (LTFU). Single-institution retrospective cohort study. We analyzed the medical records of 2,206 patients seen in the ED for an eye-related issue who were subsequently scheduled for ophthalmology follow-up between 2013 and 2019 at a single tertiary health system. The main outcome measures were the frequency of and risk factors for LTFU and ED revisits. In total, 1,649 (74.8%) patients completed follow-up within 2months of an index ED visit. In multivariable analysis, younger age (P < .001), a nonurgent ophthalmic condition or nonophthalmic primary diagnosis (P < .001), scheduled follow-up >5days after the ED visit (P < .001), additional follow-up appointments (<.001), no prior history of ophthalmology appointments (P= .045), a visual acuity of 20/40 or better (P= .027), and having Medicaid or being uninsured (P < .001) were significantly associated with LTFU. The presence of an interpreter significantly increased the likelihood of follow-up among non-English speaking patients (P < .001). LTFU was significantly associated with an ED revisit within 4months of an index visit, and the ED revisit rate was significantly higher for patients LTFU vs those who completed follow-up (5.7% vs 1.1%; P < .001). A quarter of patients referred for ophthalmic care after an ED presentation were LTFU. We identified numerous factors associated with LTFU that could be used to develop interventions to enhance follow-up. In addition, patients who were LTFU were more likely to revisit the ED for the same ophthalmic condition.