Good Medical Outcomes Research Articles

A new framework for teaching the art of general practice consultation to registrars and supervised doctors.

Medicine is a science; conducting a consultation is an art form. Honing this art enhances patients' satisfaction and good medical outcomes and can also improve general practitioners' satisfaction in their role. A good consultation needs to be effective and efficient. Effectiveness occurs when thepatient is heard, understood and acknowledged, and when the doctor isempathic, credible and delivers information and recommendations easily understood by the patient. Efficiency occurs when the consultation is time efficient and flows smoothly. The aim of this article is to propose an adaptable, patient-centred consultation framework that is well suited to the modern context and practical for teaching to registrars and supervised doctors. The model for consultation presented articulates a structure of 10 components. The model can be the basis for teaching registrars and supervised doctors how to better structure their consultations. Later, it can be the basis for analysis and critique of reviewed consultations. While the model was developed for the face-to-face context, this article also includes recommendations for how the framework may be adopted for telehealth consultations.

Missed appointment at specialist outpatient clinics: The Federal Medical Centre Bida, Northern Nigeria experience

Background/Objective: Thousands of patients miss their appointments every year in all kind of practices including specialists’ cares. Timely access at scheduled clinic appointment is important for achieving good medical outcomes to smoothen workflow, reduce crowding and waiting period, and often determines patient’s satisfaction. However, the after effect of missed appointment include; disruption of daily work planning of both physicians and administrative staff, interfered with adequate medical care, time lost and decreased efficiency on the part of physicians and as well as prolonged waiting time at the clinic. This study aims to determine the rate of missed appointments, reasons for missing appointments, the predisposing factors and aftereffect of missed appointments at specialist outpatient clinics of the hospital. Methods/Design: This was a cross-sectional study carried out at the consultative outpatient clinics of FMC Bida. Out of 38,837 patients’ population, a total of 380 patients were systematically co-opted into the study using a stratified sampling technique. A semi structured questionnaire was used to collect data. The questionnaires comprised of questions that assessed the participant’s demographic characteristics, rate, reasons and predisposing factors of missed appointment. Results: out of 380 participants co-opted into the study, 315 responses were obtained. The result showed that the majority of the participants was within the age range of 25-34 (105, 33.3%), mostly female (220, 69.8%) and predominately Nupe dialect. A total of 139(44.1%) participants claimed to have ever missed their appointment. The reasons for the missed are; forgetfulness, lack of money for treatment, lack of money for transport and work commitment respectively. The majority who missed their appointment attend gyne infertility, orthopedic and psychiatric clinics. They are uneducated, artisans and from villages outside Bida town. Conclusion: since the reasons of missed appointment and predisposing factors have been identified, healthcare professionals and hospital management will need to pay serious attention with regards to the following; reduce waiting time at the clinic, restructure appointment scheduling system, educate patients on appointment, subsidize the cost of treatment for

Barriers to care in episodic and chronic migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study.

To assess rates of and factors associated with traversing fundamental barriers to good medical outcomes and pharmacologic care in individuals with episodic migraine (EM) and chronic migraine (CM), including socioeconomic status and race. Barriers to good outcomes in migraine include the lack of appropriate medical consultation, failure to receive an accurate diagnosis, not being offered a regimen with acute and preventive pharmacologic treatments (if indicated), and not avoiding medication overuse. The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a longitudinal Internet-based survey. Respondents who met criteria for migraine consistent with the International Classification of Headache Disorders, 3rd edition, had a Migraine Disability Assessment score≥6, and provided health insurance coverage status were included in this analysis. Successfully traversing each barrier to care and the effects of sociodemographic characteristics were examined. Among 16,789 respondents with migraine, 9184 (54.7%; EM: 7930; CM: 1254) were eligible. Current headache consultation was reported by 27.6% (2187/7930) of EM and 40.8% (512/1254) of CM respondents. Among consulters, 75.7% (1655/2187) with EM and 32.8% (168/512) with CM were accurately diagnosed. Among diagnosed consulters, 59.9% (992/1655) with EM and 54.2% (91/168) with CM reported minimally appropriate acute and preventive pharmacologic treatment. Among diagnosed and treated consulters, in the EM group 31.8% (315/992) and in the CM group 74.7% (68/91) met medication overuse criteria. Only 8.5% (677/7930) of EM and 1.8% (23/1254) of CM respondents traversed all four barriers. Higher income was positively associated with likelihood of traversing each barrier. Blacks and/or African Americans had higher rates of consultation than other racial groups. Blacks and/or African Americans and multiracial people had higher rates of acute medication overuse. Efforts to improve care should focus on increasing consultation and diagnosis rates, improving the delivery of all appropriate guideline-based treatment, and avoidance of medication overuse.

Taking the pulse of Timor-Leste's cardiac needs: a 10-year descriptive time-trend analysis.

Timor-Leste is one of the poorest countries in the world. The East Timor Hearts Fund is a charitable organisation involving Australian cardiologists providing outreach screening and access to cardiac interventions. To assess ten years of clinical volume, demographics and patient outcomes. Our intention was to identify existing limitations to facilitate planning for further capacity building over the next decade. The East Timor Hearts Fund database was sectioned into 2-year intervals (2009/2010, 2011/2012, 2013/2014, 2015/2016 and 2017/2018). Demographics and clinical outcomes of patients were compared, with subgroup analysis of adult (>18 years old), paediatric and interventional patients. Over 10 years, 2050 patient encounters have occurred; 1119 (54.6%) encounters occurred in 2017/2018; 73.6% of patients were assessed in the capital Dili. Rheumatic and congenital cardiac diseases remain very common (39.1% of adult new patients and 74.2% of paediatric new patients), with 1.4% of new patients exhibiting both pathologies. The number of new patients with rheumatic or congenital heart disease tripled in 2017/2018 compared to 2009/2010 (99 vs 34 patients, P < 0.0001). Paediatric case volume increased over 10-fold over 10 years (288 new patients in 2017/2018 vs 24 in 2009/2010, P < 0.0001), with corresponding increase in proportion of paediatric interventions (59.4% in 2017/2018 vs 25.0% in 2009/2010, P = 0.027). For patients undergoing intervention (n = 87), post-procedural complications and mortality are extremely low (3.4% and 1.1%, respectively), with all eligible patients attending at least one post-procedure appointment. Demand for cardiac services in Timor-Leste is rising exponentially, with inequitable geographic coverage. Rheumatic and congenital cardiac diseases remain priorities for assessment, and paediatric case volume is increasing. Patients undergoing intervention experience good medical outcomes.

Validity of the Self‐efficacy for Interprofessional Experimental Learning Scale in Korea

Interprofessional education (IPE) can promote high-quality patient care and good medical outcomes through teamwork among health professionals. However, there are no valid measurements to prove the effectiveness of IPE in Korea. This study aimed to develop and test a Korean version of the Self-efficacy for Interprofessional Experimental Learning Scale (SEIEL). The original SEIEL was translated into Korean by two experienced medical professors, and 368 questionnaires were collected from medical and nursing students (third and fourth year). To analyze the validity of the Korean version of the SEIEL, an exploratory and confirmatory factor analysis was conducted. Cronbach’s α was used to evaluate reliability. Results from the exploratory factor analysis identified two functions: “interprofessional collaboration” and “interprofessional team evaluation.” A significant cross-correlation was found between the two functions (r=0.690, p

Frailty and geography: should these two factors be added to the ABCDE contemporary guide to diabetes therapy?

On the road towards personalized treatments for type 2 diabetes, we suggest here that two parameters could be added to the ABCDE algorithm, 'F' for frailty and 'G' for geography. Indeed, the progressive ageing of population is causing a simultaneous increase of frailty worldwide. The identification of the optimal therapeutic approach is often difficult in frail subjects because of the complexity of 'frailty syndrome'. Nevertheless, given the relevance of diabetes in the development and progression of frailty, a safe and effective cure of diabetes is extremely important to guarantee a good medical outcome. There are few data about diabetes treatment in this delicate category of patients, and the choice of the appropriate therapy mostly remains a challenge. Moreover, type 2 diabetes affects more than 382 million people of different countries, races and ethnicities. To face the lack of solid evidence-based medicine for the treatment of diabetes in different ethnic groups, it is extremely important to increase knowledge about the different pathophysiology of diabetes according to ethnicity. In this way, a tailored approach to treatment of various ethnic groups living in the same or different regions can eventually be developed. Copyright © 2016 John Wiley & Sons, Ltd.

A Retrospective Study of Survivors of Endovascular Coiling for Posterior and Anterior Aneurysms: Medical and Patient Perspectives.

This article documents the longer-term medical and psychosocial outcomes of patients referred for endovascular coiling.There is limited research investigating outcome following endovascular coiling for posterior compared to anterior circulation aneurysms, and minimal understanding of how medical outcomes relate to patient experiences of treatment and quality of life.We studied a consecutive cohort of 80 patients referred Australia wide for endovascular coiling between 1995 and 2003 (49% posterior; 76% ruptured; 69% women, mean age 51.5 years). We used a mixed methods approach, assessing medical outcome with the Modified Rankin Scale (MRS) in 61 patients (76%), and health-related quality of life and psychosocial functioning using the EuroQol questionnaire and a qualitative semistructured interview in 49 patients (61%).Despite the high proportion of posterior aneurysms, the majority of patients (80%) showed good medical outcomes as indicated by regained independence of activities of daily living (MRS score ≤3). Patients with unruptured aneurysms were significantly more likely to show good outcomes (P < 0.04), whereas aneurysm location (posterior, anterior, or mixed) showed no significant effect. In patients with good medical outcomes, greater functional disability was associated with neurological complications surrounding treatment (P < 0.05). Good outcomes correlated with higher EuroQol ratings (P < 0.001) and the experience of less change after treatment (P < 0.001), although psychosocial adjustment issues were reported by most of the patients, including those with no medical symptoms.These results support the long-term efficacy of endovascular coiling, particularly for posterior circulation aneurysms. They have implications for guiding clinicians and patients in their choice of treatment, as well as the provision of psychological counseling for patient adjustment issues posttreatment.

Perceived barriers and difficulties of intermittent catheterization: In Korean patients with spinal dysraphism and their parents.

Integrating regular intermittent catheterization (IC) into daily life is essential for good medical outcomes in patients with neurogenic bladders. The goal is to identify long-term IC-related barriers, or difficulties in Korean patients with spinal dysraphism and their parents. The data were prospectively collected using questionnaires from spinal dysraphism patients from two sources: an online community, and those visiting the outpatient clinic of Seoul National university hospital. The questions included were barriers in general and school life, respectively. Also, an open question was included regarding suggestions for school managers or the government in order to overcome identified IC related difficulties. A total of 20 patients and 40 parents answered the questionnaire. Common barriers found in general life were related to lack of places, time, or helpers to perform IC. Substantial numbers of adolescent patients also complained that IC could not be adequately performed due to problems related to privacy or lack of understanding at school. However, the number and nature of barriers varied according to the developmental stage and school environments. Almost all IC barriers seemed to be significant in adolescence. Some parents requested that the government provide space and broaden insurance coverage of catheters in order to facilitate IC. Various perceived barriers were identified in those who need IC and differences were demonstrated over time. Both dedicated space and time are issues. In addition, patients may benefit from emotional support and enhanced communication with community agencies and government to resolve the problems related with privacy.

Consent, confidentiality and curing sexually transmitted infection: an ethical trilemma

When treating contacts of patients with sexually transmitted infections (STIs), health professionals may face conflicting ethical imperatives. We surveyed middle grade doctors in genitourinary (GU) medicine and asked how they would manage a hypothetical clinical scenario. This was analysed on the basis of principles of respect for autonomy and beneficence/non-maleficence to assess how they weigh up duties of informed consent (autonomy of patient), partner confidentiality (autonomy of partner) and the need to achieve a good medical outcome. Responses indicated that the strategies that they employ in practice - what they actually say to patients (and what they leave unsaid) - balance the conflicting requirements of these ethical principles in quite different ways, some of which appear ethically problematic.

United States Government Oversight and Regulation of Medication Assisted Treatment for the Treatment of Opioid Dependence

The federal government has a fundamental as well as critical role in the successful development, implementation and utilization of controlled medications for the treatment of opioid abuse and dependence. The development and implementation of a federal regulatory structure establishes minimum standards which provide the basis for the development of treatment policies and medical best practices for the treatment of drug abuse and dependence. In the United States, the use of pharmacotherapies in combination with counseling, behavior therapies and other core services including primary medical care provide a comprehensive therapeutic approach termed as an evidence-based best practice termed "Medication Assisted Treatment" (MAT). Federally supported research studies have shown that the most efficacious treatment for opioid abuse and dependence comprises treatment programs that utilize pharmacotherapies and include psychosocial counseling, financial, legal, educational services as well as wrap around social services (NIDA, 2000). Federal programs catalogue such evidence-based best medical practices and promote their implementation in the care and treatment of patients to optimize good medical outcomes. In a non regulatory role, federal programs can also mandate medical education and training as well as support the piloting of treatment improvement projects to develop national implementation strategies. Drug treatment programs that utilize MAT are regulated by the federal government in their adherence to treatment standards through accreditation and in their record keeping requirements for use of controlled pharmaceuticals. Thus, multiple federal agencies combine to support MAT in the treatment of opioid dependence throughout the treatment continuum from drug discovery to patient care and treatment outcome. Salient policy issues that involve MAT as a direct result of the federal regulatory structure(s) include the provision and integration of medical services into Opioid Treatment Programs (OTPs), infectious diseases prevention counseling, the availability of opioid treatment using either buprenorphine or methadone, the limited use of Suboxone/Subutex in OTPs and which health care providers can prescribe as well as the number of patients prescribed Suboxone/Subutex in an office based setting.