Medical Referral Research Articles

Evaluation of a Medical Fitness Referral Program at a Single Institution From 2015 to 2022

Purpose: To assess whether biometric data of participants (i.e., weight, body mass index (BMI), body fat percentage (BFP), heart rate, and blood pressure) would be statistically different from pre- to post-program assessments after completion of a single institution medical fitness referral program. Methods: This is a retrospective analysis of randomly selected participants from August 2015 to December 2022. Analysis of variance was performed for each outcome with groups separated by gender, age, and time period relative to COVID. Results: Analysis included 984 participants, 653 (66%) were female, mean age was 55.5 years (SD = 14.9) with 297 (30%) of participants ≥65, and 747 (76%) completed the program prior to COVID. Significant mean reductions from pre- to post-program were seen for BMI (−.43, SD = 1.16), weight (-2.69 pounds, SD = 7.44), BFP (.44%, SD = 2.35%), systolic blood pressure (3.33 mmHg, SD = 14.58), and diastolic blood pressure (2.18 mmHg, SD = 8.65). Additional significant interactions identified: weight difference for participants less than age 65 (−3.16, SD = 8.31) vs participants ≥65 (−1.60, SD = 4.66), P = .003. Conclusions: In this analysis, participants of the program from August 2015 to December 2022 were seen to have statistically significant reductions in the delineated biometric parameters. However, due to limitations, specific conclusions regarding causation cannot be drawn.

Pharmacists’ clinical decision making when responding to a self-medication request for a cough in a developing country

BackgroundSome studies have reported that community pharmacies in developing countries, including Indonesia, provided sub-optimal advice when handling patient's self-medication request for cough. The reasons behind such advice, therefore, need to be investigated. ObjectivesTo describe Indonesian pharmacists’ clinical decision making when handling self-medication cases for a cough. MethodsAn open-ended questionnaire consisting of two cough clinical vignettes (case 1: cough due to asthma worsening and case 2: cough as a symptom of common cold) were developed. Pharmacists were interviewed to provide recommendations and reasons for their recommendations for these scenarios. Content analysis was used to analyse participants’ statements for the two scenarios. The number of participants who provided appropriate recommendations and reasons were then counted. ResultsA total of 245 community pharmacists participated in the study. In the case of cough due to asthma worsening, recommending a product because the product was indicated to help with the symptoms was the most common recommendation and stated reason (40%). Appropriate recommendation (direct medical referral) with appropriate reasoning (indicating warning symptoms and/or making a symptom diagnosis) was provided by 25% participants. In the case of cough as a symptom of common cold, recommending products to help with the symptoms was also the most common recommendation and stated reason (53%). Appropriate recommendations (recommending product) with appropriate reasoning (providing product to treat the symptoms and/or indicating no warning symptoms and/or making a symptom diagnosis) was provided by 81% participants. ConclusionThe ability of Indonesian community pharmacists to provide appropriate recommendations for cough self-medication requests is dependent on whether triage is required. The inability of most community pharmacists to differentiate between major and minor conditions may lead to serious health implications for patients and therefore educational interventions should be undertaken to improve community pharmacists’ differential diagnostic skills for triage.

The Effect of a Mental Health Intervention on Health Behaviors among Cancer Survivors

The Effect of a Mental Health Intervention on Health Behaviors among Cancer Survivors

Pharmaceutical Interventions in Benzodiazepine users during the COVID-19 Pandemic

Pharmaceutical Intervention aims to optimize and rationalize the use, effectiveness, and safety of dispensed medications resolving drug-related problems (DRPs) and negative medicine outcomes (NMOs). To evaluate Pharmaceutical Interventions in Benzodiazepines users during the COVID-19 pandemic from a Community Pharmacy. Prospective observational, descriptive, and cross-sectional study (AEMPS code: DAA-CLO-2020-01) of Pharmaceutical Interventions offered by the community pharmacy between August 2020 and February 2021. A total of 306 Pharmaceutical Interventions were conducted involving 127 patients. Health education and personalized medication information were the most common Pharmaceutical Interventions after detecting a high level of unfamiliarity with the Benzodiazepines among patients. Pharmaceutical Interventions leading to medical referrals accounted for 37.8% of the total, triggered by the detection of DRPs and/or NMOs or after identifying the patient as candidate for deprescription. These referrals included patients with a very high level of depression according to the Euroqol 5D-3L test. Pharmaceutical Interventions resulting in Medication Review with Follow-up Service were performed in 3.1% of patients. The patient acceptance rate of Pharmaceutical Interventions reached 98.4%. The high acceptance rate of Pharmaceutical Interventions reinforces the value of Community Pharmacy in optimizing and rationalizing Benzodiazepines usage, while strengthening the pharmacist-patient relationship. The COVID-19 pandemic posed challenges to pharmacist-physician collaboration despite of the availability of telecommunication protocols among healthcare professionals.

The role of Lesotho community pharmacists in preventing and controlling cardiovascular diseases: The perceived facilitators and barriers.

Cardiovascular diseases are a leading cause of mortality globally. The impact of cardiovascular diseases can be minimized by addressing modifiable risk factors at primary health care level. Community pharmacists are well-positioned to identify patients at risk of cardiovascular diseases for early detection and initiation of treatment. However, the role of Lesotho community pharmacists in preventing and controlling cardiovascular diseases is not well understood. The purpose of this study was to explore the Lesotho community pharmacists' role in preventing and controlling cardiovascular diseases. The methodological reporting of this study was guided by the consolidated criteria for reporting qualitative studies. A list of registered community pharmacists was obtained from the Ministry of Health. Pharmacists were selected based on their close proximity to the researcher and invited to participate. Semi-structured interviews were conducted until data saturation was reached. The interviews were audio-recorded, transcribed verbatim, and analysed thematically. Five themes were identified namely: 1) Current roles 2) Future role 3) Facilitators, 4) Barriers, and 5) Community pharmacists' perceptions of their roles. Generally, community pharmacists were involved in medication counselling, health promotion, and referral of patients. Lack of support from government, patients' lack of adherence, poor interprofessional relationship, and lack of clear community pharmacy practice guidelines were identified as barriers. Despite the challenges, community pharmacists are motivated by patients' gratitude for their services. Lesotho community pharmacists can potentially improve cardiovascular diseases' health outcomes at primary healthcare level through early detection of CVD risk factors, and health promotion.

Kretschmer´s Sensitive Delusion Of Reference: Clinical Case Report

IntroductionThe sensitive delusion of reference represents a clinical entity described by Kretschmer in 1918, arising in people with sensitive personality. This personality type is mainly characterized by a tendency towards social isolation, introversion, low self-esteem and by a greater sensibility to interpersonal judgement. In this personality type, the presence of specific environmental triggers may provoke a reference delusion of persecutory content, feelings of guilty and injustice. Although eliminated from the current diagnostic classifications, the sensitive delusion of reference represents a key milestone in the history of psychopathology.ObjectivesThe goal of this report is to report on a clinical case of a patient diagnosed with Kretschmer´s sensitive delusion of reference.MethodsThe present work consists on a descriptive report of a clinical case through consultation of the patient´s clinical file as well as a survey of relevant articles on Pubmed.ResultsThis is a 38 year old, married man with no children. He describes himself as a private, introverted individual, who has little interaction with his peers, and has been very sensitive to criticism ever since his adolescence. His first psychiatry appointment took place in April 2021, following the medical referral of his general practitioner as, according to the patient´s mother and wife, he had been, for quite some time, implying that his mobile phone had been under wire and that someone had been monitoring him. As stated by these relatives, these ideas surfaced after a workplace conflict. At the time, the patient was medicated with olanzapine 10mg and lorazepam 2.5mg before bedtime, exhibiting significant improvements with full remission of psychotic symptomatology. Succeeding the antipsychotic tapering attempt, the patient had begun to suffer from insomnia and recrudescence of psycotic symptomatology, namely, the delusion ideation of persecutory content and auditory hallucinations, as a result, the previous treatment regimen was resumed, which resulted in significant improvements of the clinical picture. Following new observation, in 2023, the patient mentions weight gain and drowsiness during the day, leading to the switch of olanzapine 10mg for aripiprazole 15mg. The current treatment plan consists of aripiprazole 15mg once a day and lorazepam 1mg 1/2 before bedtime, resulting in an improvement of the previous complaints and maintenance of the psychosocial functioning, unaccompanied by psychotic symptomatology.ConclusionsIn conclusion, and relatively to the condition´s prognosis, Kretschmer observed that, although in some situations the episodes were brief and self-limiting, in others, the patients maintained psycothic symptomatology, during the following years. In the present clinical case we recognised the need to sustain the antipsycothic treatment regimen, as the respective dosage reduction lead to an aggravation in symptomatology.Disclosure of InterestNone Declared

345 Analysis of the Caribbean Neurosurgery Workforce: Scope of Practice, Challenges and Ways Forward

INTRODUCTION: There are close to 45 neurosurgeons for 16 million people in the Caribbean Community (CARICOM) region. The aim of our study is to understand the current scope of practice for neurosurgical providers in the Caribbean, as very sparse information has been published. METHODS: This study surveyed neurosurgeons within Caribbean and CARICOM countries online using qualitative and quantitative methods via Qualtrics. RESULTS: Of 38 countries within the Caribbean, 26 (68%) were surveyed of which 18 (69%) replied. In total 61 neurosurgeons were identified, with a majority of general neurosurgeons (56%). Remarkably, the majority of countries failed to meet the threshold workforce density for safe health care - either expressed by FTE neurosurgeons or neurosurgical centers. Most neurosurgical practices denied receiving or sending medical referrals. If otherwise, most referrals took longer than 8 hours without significant difference regarding the destination. Lastly, challenges confronting neurosurgical advancement were found in: technology and equipment (40%), trained personnel (31%), hospital or medical center infrastructure (14%), neurosurgical education and training (44%). CONCLUSIONS: To our knowledge, this is the first comprehensive qualitative and quantitative study exploring the current status of the Caribbean neurosurgery workforce, the challenges and the potential ways forward. Arming the local providers with improved resources and support would only serve to add value to the region thus making excellent patient care the standard for a region in need of just that.

The effectiveness of neck strengthening exercises on jaw mobility and clicking in anterior disc displacement with reduction of temporomandibular joint: A randomized controlled trial

Background: The studies in the literature have focused on the biomechanical and neurophysiological aspects of cervical and temporomandibular joint (TMJ) function. Addressing the cervical spine correlation with the TMJ may lead to long-term improvement in the derangement. This study desired to deduce the effectiveness of deep neck muscle strengthening exercises on jaw motion and clicking sounds in anterior disc displacement with reduction of the TMJ. Methods: This controlled clinical trial was conducted using a single-blinded design in a tertiary care teaching hospital affiliated with The University of Lahore- from March 2020 to January 2021. A count of 68 patients were enrolled each with 34 patients. The inclusion criteria were being 18–50 years old, suffering from TMJ pain and disc displacement with reduction, medical referral for temporomandibular disorders by a dentist or a maxillofacial surgeon, and having symptoms for more than one month before the first treatment. The exclusion criteria were having a tumor, fracture, or trauma in recent medical history, systemic, rheumatic diseases, degenerative changes, and history of surgery of the cervical spine or TMJ. The control group (group A) was only given TMJ mobilization and soft tissue release. The Intervention group (group B) did neck strengthening exercises in addition to the TMJ mobilization. The subjects were assessed twice. Results: To analyze the data, SPSS version.21 was used. To assess the frequency of qualitative factors like clicking, the chi-square test was employed. The mean scores of quantitative factors such as mandibular lateral deviation and maximal mouth opening were approximated between the two categories of subjects using the Mann-Whitney test. The findings demonstrated that there was no change between the groups’ pre- and post-treatment means for jaw mobility and clicking sounds. Nonetheless, the Intervention group’s mandibular lateral deviation significantly improved (P≤0.037). Conclusion: The findings revealed that neck strengthening exercises in addition to routine physical therapy of the TMJ do not affect clicks and mobility between the two groups. The exercises were found out to be effective only in improving the lateral deviation of the mandible.

ОСОБЕННОСТИ ДИАГНОСТИКИ И ВЕДЕНИЯ ПАЦИЕНТКИ С СИНДРОМОМ ФРЕДЕРИКА (КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ)

Description of a clinical case. The article presents a clinical observation of a 77-year-old patient with newly diag-nosed Frederick’s syndrome, which is a combination of a permanent form of atrial fibrillation and complete atrioven-tricular block. An exacerbation of chronic pancreatitis was the reason for hospitalization of the patient. The patient had no complaints of bradycardia or syncope, but treatment of the underlying disease was difficult due to the development of acute kidney injury against the background of chronic kidney disease and uncompensated chronic heart failure. The cause of the development of Frederick’s syndrome was pronounced myocardium remodeling due to diseases that make up the classic complex of metabolic syndrome – coronary heart disease, arterial hypertension, type 2 dia-betes mellitus and obesity. Conclusion. The analysis of a few domestic and foreign literature sources showed that the development of Frederick’s syndrome is associated with a worsening prognosis and the development of various complications, which is usually underestimated by attending physicians. Taking into account the difficulties of diagnosis and management of patients with this pathology, it is necessary to be wary of the development of Frederick’s syndrome, especially in comorbid elderly and senile patients. Timely medical correction and referral of the patient for surgical treatment will improve the prognosis and reduce mortality in patients with atrial fibrillation.

Efficacy of Virechana and Erandmooladi Niruha Basti in the management of Aamvata (rheumatoid arthritis): A case report

Aamvata, also known as rheumatoid arthritis, is a common inflammatory condition that affects about 1% of the global population. It is more prevalent in females, with a 3:1 ratio to males. This systemic autoimmune disease primarily affects the joints, specifically the small joints in the hands and feet. However, it can be challenging to diagnose due to its differential diagnosis and patient presentations. Early treatment is often difficult due to delays in seeking medical attention, diagnosis, and specialist referral. Unfortunately, modern medicine still lacks a completely safe and effective treatment for rheumatoid arthritis without any side effects. The study aims to evaluate the effectiveness of Virechana and Erandmooladi Niruha Basti in treating Aamvata. In a recent clinical study, a 25-year-old female patient with Aamvata was treated with Ayurveda management. This treatment was based on the approach given by Chakradatta in Chikitsa Siddhant. The patient was examined before and after the treatment, and her condition improved tremendously.

Implementation of Web Based (Sisrute) Application Patient Referral From Public Health Center in Pamekasan

Health service referrals are a form of health service that regulates the delegation of duties and responsibilities for health services with the aim of healing and restoring the patient's health status. One important aspect in human life is health referrals which require fast, practical, efficient and accurate and reliable information. The purpose of this study was to determine to what extent the implementation of the web-based community health center patient referral application (SISRUTE) in Pamekasan can overcome obstacles in medical referrals, making it easier for health workers to optimize health services. The method used in this research is a qualitative approach which is defined as a research procedure that produces descriptive data which aims to reveal the in-depth meaning behind a phenomenon. Data were collected using Purposive Sampling with in-depth interview techniques by asking 13 questions consisting of 8 nurses and 5 midwife accompanied by 1 Triangulator, head of the Pamekasan district referral department. Data collection techniques use observation, interviews, documentation and case studies. From the results of this research it is known that the implementation of the use of the integrated referral system application (SISRUTE) in Pamekasan district for individual health service referrals can improve the quality, coverage, effectiveness and efficiency of integrated health services with the help of supporting facilities and infrastructure as well as the ability of human resources to operate, and with the web referral application, health workers feel that it is very helpful in speeding up patient referrals to the next level of health facilities.

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients-A Review: Part I-Epidemiology, Risk Factors, and Atherosclerosis-Related Diversities in Elderly Patients.

Atherosclerosis is a generalized and progressive disease. Ageing is a key risk factor for atherosclerosis progression that is associated with the increased incidence of ischemic events in supplied organs, including stroke, coronary events, limb ischemia, or renal failure. Cardiovascular disease is the leading cause of death and major disability in adults ≥ 75 years of age. Atherosclerotic occlusive disease affects everyday activity and quality of life, and it is associated with reduced life expectancy. Although there is evidence on coronary artery disease management in the elderly, there is insufficient data on the management in older patients presented with atherosclerotic lesions outside the coronary territory. Despite this, trials and observational studies systematically exclude older patients, particularly those with severe comorbidities, physical or cognitive dysfunctions, frailty, or residence in a nursing home. This results in serious critical gaps in knowledge and a lack of guidance on the appropriate medical treatment and referral for endovascular or surgical interventions. Therefore, we attempted to gather data on the prevalence, risk factors, and management strategies in patients with extra-coronary atherosclerotic lesions.

External Vs Internal e-Referrals: Results from a Nationwide Epidemiological Study Utilizing Secondary Collected Data.

E-referral systems, streamlining patient access to specialists, have gained global recognition yet lacked a comparative study between internal and external referrals in Saudi Arabia (KSA). This retrospective study utilized secondary data from the Saudi Medical Appointments and Referrals Centre system. The data covers 2020 and 2021, including socio-demographic data, referral characteristics, and specialties. Logistic regression analysis was used to assess factors associated with external referrals. Out of 645,425 e-referrals from more than 300 hospitals, 19.87% were external. The northern region led with 48.65%. Males were 55%, and those aged 25-64 were 56.68% of referrals. Outpatient clinic referrals comprised 47%, while 61% of referrals were due to a lack of specialty services. Several significant determinants are associated with higher rates of external referral with (p-value <0.001) and a 95% Confidence interval. Younger individuals under 25 exhibit higher referral rates than those aged 25-64. Geographically, compared to the central region, in descending order, there were increasing trends of external referral in the northern, western, and southern regions, respectively (OR = 19.26, OR = 4.48, OR 3.63). External referrals for outpatient departments (OPD) and dialysis services were higher than for routine admissions (OR = 1.38, OR = 1.26). The rate of external referrals due to the lack of available equipment was more predominant than other causes. Furthermore, in descending order, external referrals for organ transplantation and oncology are more frequent than for medical specialties, respectively (OR = 9.39, OR = 4.50). The study reveals trends in e-referrals within the KSA, noting regional differences, demographic factors, and types of specialties regarding external referrals, benefiting the New Model of Care for the 2030 Vision. Findings suggest expanding virtual consultations to reduce external referrals. Strengthening primary care and preventive medicine could also decrease future referrals. Future studies should assess resource distribution, including infrastructure and workforce, to further inform healthcare strategy.

Analysis of Medical Referrals from Primary Health Centers to the Otorhinolaryngology Department at Sótero del Río Hospital

The main objectives of this study are to characterize the profile of consultations referred from primary health care to the Otorhinolaryngology Service and to assess the agreement in their prioritization. Data from consultations sent to the Otorhinolaryngology Service from primary care were collected and analyzed. The prioritization of these consultations was evaluated using the Kappa Index, which measures the level of agreement between the two parties involved. The analysis revealed a Kappa Index of 0.086, indicating a poor level of concordance in the prioritization. This finding highlights potential issues in the referral process from primary care to the higher complexity center. Evaluating the concordance in the prioritization of consultations is essential for gaining insights into the reality of referrals from primary care to higher complexity centers. Identifying the quality of these referrals can lead to the implementation of strategies to improve the process. Our study suggests that there is a need of improving the communication and education between higher complexity centers and primary health care centers.

Orthopedic surgery in Palau-Current capacity, needs, and future directions.

Palau, an island nation in Micronesia, is a medically underserved area with a shortage of specialty care services. Orthopedic diagnoses in Palau remain among the three most common reasons for costly off-island medical referral. The purpose of this study was to assess Palau's current orthopedic surgery capacity and needs to inform interventions to build capacity to improve care access and quality. Orthopedic needs and capacity assessment tools developed by global surgical outreach experts were utilized to gather information and prompt discussions with a broad range of Palau's most knowledgeable stakeholders (n=6). Results were reported descriptively. Finance, community impact, governance, and professional development were the lowest-scored domains from the Capacity Assessment Tool for orthopedic surgery (CAT-os), indicating substantial opportunity to build within these domains. According to administrators (n=3), governance and finance were the greatest capacity-building priorities, followed by professional development and partnership. Belau National Hospital (BNH) had adequate surgical infrastructure. Skin grafting, soft tissue excision/resection, infection management, and amputation were the most commonly selected procedures by stakeholders reporting orthopedic needs. This study utilizes a framework for orthopedic capacity-building in Palau which may inform partnership between Palau's healthcare system and orthopedic global outreach organizations with the goal of improving the quality, safety, and value of the care delivered. This demonstration of benchmarking, implementation planning, and subsequent re-evaluation lays the foundation for the understanding of capacity-building and may be applied to other medically underserved areas globally to improve access to high-quality orthopedic care.

Faktor yang berhubungan dengan Rujukan Pasien Peserta BPJS di Puskesmas Bangkala Kota Makassar Tahun 2023

The health service referral system is the organization of health services that regulates the delegation of duties and responsibilities of health services reciprocally both vertically and horizontally. The purpose of this study was to determine the factors related to patient referral participants (BPJS) at the Bangkala Health Center, Makassar City in 2023. . This type of research is a quantitative observational study using a cross sectional approach. The population in this study is the BPJS participant community who visited the Bangkala Health Center in Makassar City in the last month of 2022 with a total of 956 participants. The samples in this study were 282 samples. The sampling technique is using probability sampling method with accidental sampling technique. The results showed that there was no relationship with knowledge (p=0.873). Meanwhile, the variables significantly related to BPJS patient referrals were the availability of medicines (p=0.000) and the availability of medical devices (p=0.000). The conclusion from this study is that there is a relationship between the availability of medicines, the availability of medical devices and BPJS referrals. While the knowledge variable is not related to BPJS patient referrals.

Artificial intelligence-assisted management of retinal detachment from ultra-widefield fundus images based on weakly-supervised approach.

Retinal detachment (RD) is a common sight-threatening condition in the emergency department. Early postural intervention based on detachment regions can improve visual prognosis. We developed a weakly supervised model with 24,208 ultra-widefield fundus images to localize and coarsely outline the anatomical RD regions. The customized preoperative postural guidance was generated for patients accordingly. The localization performance was then compared with the baseline model and an ophthalmologist according to the reference standard established by the retina experts. In the 48-partition lesion detection, our proposed model reached an 86.42% (95% confidence interval (CI): 85.81-87.01%) precision and an 83.27% (95%CI: 82.62-83.90%) recall with an average precision (PA) of 0.9132. In contrast, the baseline model achieved a 92.67% (95%CI: 92.11-93.19%) precision and limited recall of 68.07% (95%CI: 67.25-68.88%). Our holistic lesion localization performance was comparable to the ophthalmologist's 89.16% (95%CI: 88.75-89.55%) precision and 83.38% (95%CI: 82.91-83.84%) recall. As to the performance of four-zone anatomical localization, compared with the ground truth, the un-weighted Cohen's κ coefficients were 0.710(95%CI: 0.659-0.761) and 0.753(95%CI: 0.702-0.804) for the weakly-supervised model and the general ophthalmologist, respectively. The proposed weakly-supervised deep learning model showed outstanding performance comparable to that of the general ophthalmologist in localizing and outlining the RD regions. Hopefully, it would greatly facilitate managing RD patients, especially for medical referral and patient education.

Assessing Medical Emergency E-referral Request Acceptance Patterns and Trends: A Comprehensive Analysis of Secondary Data From the Kingdom of Saudi Arabia.

Introduction Patient transfers in emergencies have been linked to reduced mortality rates and enhanced quality of care. The Saudi Medical Appointments and Referrals Centre (SMARC), an e-referral system in the Kingdom of Saudi Arabia (KSA) since 2019, plays a crucial role in ensuring quality and continuity of care. The findings of this study can provide valuable insights into the effectiveness of the e-referral system and identify potential areas for improvement in the management of emergency cases. Objective This study aims to examine e-referral patterns for emergency medical cases throughout all 13 administrative regions of KSA. Concurrently, it estimates the acceptance rate of medical emergency referrals and investigates associated factors among KSA hospitals. Methods This retrospective study utilized secondary data from the SMARC e-referral system, specifically focusing on medical emergency e-referral requests in the entire KSAduring 2021. Descriptive univariate analyses were conducted to characterize the referral requests, followed by bivariate analyses to explore associations between factors and referral acceptance. Adjusted multiple logistic regression analyses were then performed to calculate adjusted odds ratios (ORs) and corresponding 95% confidence intervals, controlling for potential confounding variables. Results A total of 29,660 medical emergency referral requests were initiated across all regions of KSA during the study time frame, and, of these,20,523 (69.19%)were accepted. The average age of patients with a medical emergency referral was 52 years old, and referral requests were higher among Saudis (13,781; 54.18%), males (13,781; 54.18%), and those from the Western region (10,560; 35.60%). Nearly 20,854 (70%) were due to the unavailability of specialized doctors or specialties in facilities. Based on multi-logistic regression, referral request acceptance was high in some factors as follows: compared to the Central region, requests from the Northern, Southern, Eastern, and Western regions had higher acceptance rates at 123%, 64%, 54%, and 46%, respectively. In addition, referral requests that were due to the unavailability of a specialized doctor or medical equipment had higher acceptance rates (19% and 16%), respectively, than those due to the unavailability of a specific specialty. Conclusion This study provides valuable insights into regional variations, sociodemographic factors, and referral reasons within the medical emergency e-referral system in the KSA. By estimating the acceptance rate of medical emergency referrals and investigating associated factors, this analysis confirms the effectiveness of the e-referral system in facilitating access to quality care, particularly for marginalized patients. The study highlights the need for health policy improvements to ensure equitable resource allocation and reduce disparities in healthcare access.

Impact of a pharmaceutical algorithm on patients with upper-gastrointestinal symptoms: A pre-post intervention study

ObjectiveTo evaluate the algorithm impact on the upper gastrointestinal patients' symptoms (PROMs) and satisfaction with pharmaceutical care received (PREMs). MethodsThe algorithm was previously developed by clinicians and pharmacists, through a pre-post intervention study in Spain (June–October 2022). We included 1221 patients who were seeking advice and/or medication for symptoms at 134 community pharmacies. Patients' sociodemographic and clinical variables were assessed at baseline and were classified in accordance with the Gastroesophageal Reflux Disease Impact Scale (GIS) into patients with either epigastric, retrosternal or overlapping symptoms. Interventions included medical referral; education on healthy habits; prescription of an OTC treatment or a non-pharmacologic prescription. Fourteen days later, patients were assessed through: a) the change on the GIS score, and b) patients' satisfaction with pharmaceutical care received. ResultsMost patients reported overlapping symptoms (660, 54.0%), 171 (14.0%) reported epigastric symptoms and 390 (32.0%) retrosternal symptoms. Patients with epigastric symptoms did not show a difference in the GIS score after the intervention while those with retrosternal symptoms and those with overlapping symptoms did (mean 1.09 (4.28 SD), p < 0.001 and mean 3.18 (6.01 SD), p < 0.001, respectively). Patients who received education on healthy habits and those with a prescription of a pharmacological treatment (antiacids in monotherapy and alginates-antiacids) showed an increase in the GIS score. Patients' satisfaction with pharmaceutical care received was over 99.2% of sample. ConclusionImplementation of the upper-gastrointestinal symptoms algorithm in Community pharmacies had a positive impact on patients' symptoms, quality of life, and satisfaction with pharmaceutical care received.

Impact of COVID-19 quarantines on clozapine-induced constipation: Experience of utilizing a clozapine-induced constipation protocol at a state forensic psychiatric facility.

Since 2017, Fulton State Hospital (FSH) has implemented a clozapine-induced constipation protocol. In March 2020, FSH initiated unit quarantines to minimize the spread of coronavirus disease (COVID-19). The objective of this study was to evaluate the impact of these quarantines on medical referrals for constipation, the Bristol Stool Chart ratings, utilization of as-needed (PRN) laxatives, and adherence rates with scheduled constipation medication regimens. Patients on the clozapine-induced constipation protocol from May 1, 2019 to December 31, 2020, were included, with 10-month pre- and mid-quarantine implementation. Data collected included patient demographics, primary psychiatric diagnosis, and outcome variables. Descriptive statistics and paired t-tests were performed. A total of 31 patients were included. Most were male (93.5%), with a median age of 40 years. The most common primary diagnosis was schizophrenia. Compared with the pre-quarantine implementation period, there were fewer medical referral contacts per person, less use of PRN laxatives, and slightly lower adherence rates to scheduled constipation medication regimens during the mid-quarantine implementation period. Compared with the pre-quarantine implementation period, there were fewer medical referrals per person during the mid-quarantine implementation period.