Non-urgent Health Care Research Articles

The carbon footprint of health care delivery in Western Australia's public health system

Health systems have a dual imperative to take action on climate change. First, they must develop climate resilient health services in response to the direct and indirect impacts of climate change on health. Second, they must reduce their own carbon footprint since health systems are a significant contributor to global greenhouse gas emissions. An environmentally-extended multi-region input-output analysis was carried out, incorporating National Accounts data for Australia and annual expenditure data from WA Health for financial year 2019-20. Expenditure data were categorised to one of 344 economic sectors and by location of the provider of goods or services purchased. WA Health contributes 8% of WA's total carbon footprint, driven by expenditure on chemicals (23.8% of total), transport (20.2% of total), and electricity supply (19.7% of total). These 3 sectors represent 63.7% of WA Health's carbon footprint, but only 10.8% of its total expenditure. Reducing emissions related to health service provision in WA will require a holistic approach that leverages carbon footprinting insights and integrates them into organisational decision-making across all health programs. The high carbon-intensity of the transport and chemicals sectors supports previous research calling for a reduction in unnecessary pathology testing and the transition to delivery of non-urgent health care via sustainable models of telehealth. The impact of WA's size and location presents challenges, with a predominantly non-renewable energy supply and reliance on transport and supply chains from other states adding significantly to emissions. The study received funding from the Australian Research Council, The University of Sydney, and the WA Department of Health. The full list of funding information can be found in Acknowledgements.

Procedure Prioritization During a Nationwide Ban on Non-Urgent Healthcare: A Quasi-Experimental Retrospective Study of Hospital Data in Switzerland.

During the COVID-19 lockdown in spring 2020, Switzerland restricted non-urgent healthcare services to safeguard capacity. While prioritization of care was supposed to be driven by medical urgency, demographic factors or economic incentives might have influenced the hospitals' resource allocation decisions. This study investigates potential determinants of procedure prioritization in hospitalized patients during the lockdown period. Quasi-experimental retrospective study of hospital data in Switzerland. We analyzed 496 456 adult patients with known insurance status and a recorded procedure, admitted for cardiovascular, orthopedic/musculoskeletal or oncological reasons from January 2017 (3 years before the COVID-19 outbreak) to mid-April 2020 (in the first year of the COVID-19 pandemic), to obtain admission rate ratios (ARRs, "lockdown" admission rates divided by "normal" rates) from negative binomial regression analysis of fortnightly admissions for frequent procedure-diagnosis combinations. Quade and Wilcoxon signed-rank tests compared ARRs between sex×age, insurance and comorbidity strata. Admission rates showed significant reductions for 29 of 53 procedure-diagnosis combinations. Reductions varied strongly by emergency, with largest decreases in orthopedic procedures for arthrosis (osteoarthritis) and non-arthritic joint disorders, and the smallest in cerebral imaging for stroke patients and surgical procedures for malignant neoplasms. The only difference in ARRs between strata was a stronger decrease in admission rates for cardiovascular combinations for patients with private versus basic health insurance. While medical procedures were affected to varying degrees by the ban on non-urgent healthcare during the COVID-19 lockdown, we found no robust evidence that factors other than medical urgency influenced healthcare prioritization.

Characteristics and correlates of disease-related knowledge and exercise self-efficacy among cardiac patients attending virtual cardiac rehabilitation during the first COVID-19 lockdown in Peru

BackgroundGovernment responses and restrictions due to the COVID-19 pandemic (e.g., limits to non-urgent health care services, including non-urgent outpatient appointments) led to the suspension of center-based (in-person) cardiac rehabilitation (CR), with many programs switching to virtual delivery. This study aimed to understand the characteristics and correlates of disease-related knowledge and exercise self-efficacy in a group of patients attending a virtual CR program during the first COVID-19 lockdown in Peru. MethodsIn this prospective observational study, 240 patients receiving virtual CR care (exercise instructions and patient education) between August/2020 and December/2021 completed questionnaires pre- and post-CR assessing disease-related knowledge (CADE-Q SV questionnaire) and self-efficacy (SE; Bandura's Exercise SE scale). Paired t tests were used to investigate changes pre/post-CR and Pearson correlation coefficients were used to determine the association between knowledge/SE and patients’ characteristics. ResultsParticipants were mainly comprised of men, with a cardiac diagnosis of stable coronary artery disease, who underwent percutaneous coronary intervention or had a known diagnosis of hypertension and with at least one cardiovascular risk factor (95.8%). Mean total knowledge scores improved significantly at post-CR (12.9 ± 2.4 to 15.6 ± 2.0/20; p<0.001), as well as in 4/5 knowledge areas (cardiovascular risk factors, exercise, nutrition, and psychosocial risk; p<0.001). Mean SE scores improved significantly at post-CR (1.9 ± 0.9 to 3.0 ± 0.9/5; p = 0.01). Post-CR knowledge and SE were significantly correlated with cardiac diagnosis and surgical procedures (r = 0.17, p = 0.02 and r = 0.27, p = 0.02, respectively). ConclusionsThe virtual CR program improved disease-related knowledge and SE of cardiac patients during the first months of the COVID-19 pandemic. Post-CR outcomes were correlated with cardiac diagnosis and surgical procedures and more research with other characteristics is warrantied.

The Impact of the COVID-19 Pandemic on Anal Dysplasia Disease Surveillance in High-Risk Patients

INTRODUCTION: Anal intraepithelial neoplasia (AIN) is premalignant lesion to anal cancer primarily caused by HPV infection. AIN is commonly screened for by anal cytology or health risk assessment. However, by March 13, 2020, the US was part of a global pandemic caused by the COVID-19 virus. As a result, non-urgent health care practices were disrupted and delayed, including those which needed scheduled surveillance and treatment for AIN. We explore effects of the pandemic on anal dysplasia progression and recurrence. METHODS: Data on patients managed with a diagnosis of dysplastic anal lesion was retrospectively reviewed from October 2019 to October 2021 (n = 168). Patients with anal dysplasia were managed at a large single urban institution using trichloroacetic acid, fulguration, and excision. The primary aim assessed recurrence during this time period. Secondary aims focused on the follow-up visits and postoperative complication. RESULTS: Demographically the pre-COVID and post-COVID cohorts were evenly matched in terms of age, height, weight, BMI, sex, and race with most patients being HIV-positive African American men. The average time between procedures was longer post-COVID (20.0 months) compared with the pre-COVID cohorts (15.8 months). The rate of recurrence (26.9% vs 31.0%) and time to recurrence in months (14.2 vs 14.3) were similar in the pre- and post-COVID cohorts, respectively (Table 1).CONCLUSION: Despite COVID-19 causing delay in procedures, the outcomes between the pre-COVID and post-COVID groups were similar, suggesting that we can safely delay surveillance in these patients beyond current guidelines.

Digital Health Technology for Remote Care in Primary Care During the COVID-19 Pandemic: Experience from Dubai

Introduction: We aimed to provide an insight on the feasibility and impact of telemedicine use among primary health care (PHC) providers and on nonurgent health care delivery during the coronavirus disease 2019 (COVID-19) outbreak in the United Arab Emirates (UAE). Methods: This observational study was conducted using telemedicine data from Dubai Health Authority from January 2020 to July 2021. Results: Of 123,944 individuals who booked an appointment for the telemedicine service, 106,408 (86%) showed up. Most patients were 19-59 years old, UAE nationals, female, and having government insurance. The telemedicine care volume grew from 188 visits in January 2020 to 11,757 in April 2020. The most common diagnosis was general health consultation (55,672; 52%), followed by COVID-19-related consultation (18,523; 17%) and laboratory test requests (11,064; 10%). Around 4,997 (5%) telemedicine consultations were for a medication refill. A multiple linear regression model predicting the types of diagnosis-related telemedicine needs by age and the interaction of gender and nationality was statistically significant for dermatology (p = 0.0000), respiratory (p = 0.0000), and cardiovascular (p = 0.0000) diseases. Conclusions: Virtual care services in PHC clinics have been highly successful in meeting the needs of patients during the COVID-19 pandemic. Telemedicine has enabled clinicians to continue providing care to patients while maintaining the necessary public health measures adopted in the fight against COVID-19. However, will the switch to telemedicine be sustainable in the long term and what will be the level and degree of telemedicine adoption beyond COVID-19? This requires more studies to explore how the PHC organizations will provide further support and guidance on the suitability of telemedicine in various circumstances and clinical conditions.

Pediatric patients accessing Accident and Emergency Department (A&E) for non-urgent treatment: Why do parents take their children to the A&E?

IntroductionAbout 20–30% of children access the Pediatric Accident and Emergency Department (A&E) for non-urgent health care that should normally follow other health care paths. This study aimed to investigate why parents take their children to the A&E for non-urgent visits rather than using primary care services. MethodsA one-year cross-sectional study was conducted in a large pediatric A&E in Italy. A paper-and-pencil 40-item questionnaire was administered to parents of children aged between 3 months to 6 years who accessed the A&E for non-urgent visits between July 2018 and June 2019. ResultsParents of 238 children completed the questionnaire (mean age = 2.6 years; male 58%). The most common symptoms were fever (n = 105; 44.1%) and skin rash (n = 63; 26.5%); symptoms usually started more than 24 h earlier (n = 163; 69.4%). Reasons for accessing the A&E for non-urgent visits included the availability of rapid medical tests (n = 71; 29.8%), deterioration of the clinical conditions after the pediatrician’s visit (n = 67; 28.2%), and the perceived need for urgent care (n = 65; 27.3%). Besides, 26.6% (n = 63) of parents reported not being able to contact their pediatrician before accessing A&E. ConclusionParents may need further education to distinguish between urgent and non-urgent pediatric health conditions.

Changes in obstetric interventions and preterm birth during COVID-19: A nationwide study from Iceland.

IntroductionPrevious evidence has been conflicting regarding the effect of coronavirus disease 2019 (COVID‐19) pandemic lockdowns on obstetric intervention and preterm birth rates. The literature to date suggests potentially differential underlying mechanisms based on country economic setting. We aimed to study these outcomes in an Icelandic population where uniform lockdown measures were implemented across the country.Material and methodsThe study included all singleton births (n = 20 680) during 2016–2020 identified from the population‐based Icelandic Medical Birth Register. We defined two lockdown periods during March–May and October–December in 2020 according to government implemented nationwide lockdown. We compared monthly rates of cesarean section, induction of labor and preterm birth during lockdown with the same time periods in the 4 previous years (2016–2019) using logit binomial regression adjusted for confounders.ResultsOur results indicated a reduction in the overall cesarean section rate, which was mainly evident for elective cesarean section, both during the first (adjusted odd ratio [aOR] 0.71, 95% CI 0.51–0.99) and second (aOR 0.72, 95% CI 0.52–0.99) lockdown periods, and not for emergency cesarean section. No change during lockdown was observed in induction of labor. Our results also suggested a reduction in the overall preterm birth rate during the first lockdown (aOR 0.69, 95% CI 0.49–0.97) and in the months immediately following the lockdown (June–September) (aOR 0.67, 95% CI 0.49–0.89). The reduction during the first lockdown was mainly evident for medically indicated preterm birth (although not statistically significant) and the reduction during June–September was mainly evident for spontaneous preterm birth.ConclusionsThis study suggested a reduction in elective cesarean section during COVID‐19 lockdown, possibly reflecting changes in prioritization of non‐urgent health care during lockdown. We also found a reduction in overall preterm birth during the first lockdown and spontaneous preterm birth following the first lockdown, but further research is needed to shed light on the underlying mechanisms for these findings.

Protecting the Global Mental Health of Forcibly Displaced Children From the COVID-19 Pandemic.

* Abbreviation: COVID-19 — : coronavirus disease 2019 Forcibly displaced children and families are among the most vulnerable groups in the world, now with an unprecedented 30 million children displaced by conflict and a peak of 19 million children internally displaced.1 Public health crises, such as the coronavirus disease 2019 (COVID-19) pandemic, highlight the preexisting refugee crisis, placing them at greater mental health risk. Although children are not the highest risk cohort to suffer serious illness from COVID-19,2 pandemic-related policies, health precautions, and psychosocial stressors are potentially damaging for vulnerable children and families such as forcibly displaced youth. Basic public health measures, such as social distancing, hand hygiene, and self-isolation, are difficult to implement in camps, settlements, and homes because of overcrowded living situations, poor access to basic sanitation, and lack of access to health services, leaving displaced children at risk for contracting disease. Many forcibly displaced families are understandably distrusting of government requests for public health measures because they are fleeing governments that are the cause of violence and armed conflict.3 These psychosocial stressors can lead to a worsening of mental health, especially when combined with a history of potentially traumatic events … Address correspondence to Suzan Song, MD, MPH, PhD, Department of Psychiatry, School of Psychiatry and Behavioral Sciences, George Washington University, Medical Faculty Associates, 2120 L St, NW Suite 600, Washington, DC 20037. E-mail: suzan.song{at}post.harvard.edu

Effect of Population Lockdown on Pediatric Emergency Room Demands in the Era of COVID-19

Objectives: The aim of this study was to assess the impact of the COVID-19 pandemic and population lockdown on pediatric ED consultations.Methods: A cross-sectional study on pediatric emergency department consultations before and during the current COVID-19 pandemic (March–May 2019 vs. March–May 2020) was performed in two hospitals in the Campania region (Southern Italy) [i.e., Salerno University Hospital (Salerno) and Pediatric Regional Referral Emergency Hub “AORN Santobono-Pausillipon” (Naples)].Results: 29,368 consecutive ED pediatric patients (13,430 females; mean age ± SD = 5.4 ± 4.7 years) were seen in March–May 2019 and 9,133 (4,494 females; mean age ± SD = 5.9 ± 4.2 years) in March–May 2020. Resuscitation/emergency and urgent care pediatric ED consultations were 1,388 (4.7%, 95% CI 4.5–4.9) in the 2019 trimester, while they were 648 (7.1%, 95% CI 6.6–7.6) in the 2020 trimester (p < 0.01). Mean pediatric ED daily consultations were 326.3 (95% CI 299.9–352.7) in the considered period of 2019 and 101.4 (95%CI 77.9–124.9) in the same period of 2020 (p < 0.001). COVID-19 nasal swabs were performed for 385 children; of those, six resulted positive and four of them were hospitalized.Conclusions: This work provides a unique snapshot of the pediatric EDs demands in the era of COVID-19. We witnessed a significant reduction of non-urgent health care demands during the pandemic but an increase of more severe urgent cases. The COVID-19 pandemic and the following lockdown unveiled the inappropriateness of the majority of pediatric ED consultations. Nevertheless, the current scenario highlighted the need for appropriate and timely clinical evaluations in the pediatric primary care to tackle late and more severe diagnoses in EDs.

Ramping Up the Delivery of Cardiac Surgery During the COVID-19 Pandemic: A Guidance Statement From the Canadian Society of Cardiac Surgeons

The coronavirus disease 2019 (COVID-19) has had a profound global effect. Its rapid transmissibility has forced whole countries to adopt strict measures to contain its spread. As part of necessary pandemic planning, most Canadian cardiac surgical programs have prioritized and delayed elective procedures in an effort to reduce the burden on the health care system and to mobilize resources in the event of a pandemic surge. While the number of COVID-19 cases continue to increase worldwide, new cases have begun to decline in many jurisdictions. This “flattening of the curve” has inevitably prompted discussions around reopening of the economy, relaxing some public health restrictions, and resuming nonurgent health care delivery. This document provides a template for cardiac surgical programs to begin to ramp-up the delivery of cardiac surgery in a deliberate and graded fashion as the COVID-19 pandemic burden begins to ease that is guided by 3 principles. First, all recommendations from public health authorities regarding COVID-19 containment must continue to be followed to minimize disease spread, ensure patient safety, and protect health care personnel. Second, patients awaiting elective cardiac surgery need to be proactively managed, reprioritizing those with high-risk anatomy or whose clinical status is deteriorating. Finally, case volumes should be steadily increased in a mutually agreed upon fashion and must balance the clinical needs of patients awaiting surgery against the overall requirements of the health care system.

A Secured Medical Booking System Using Qr-Code Authentication

In recent times due to the ever-increasing fast pace of life the number of missed appointments in medical institutions in Nigeria has caused problems, hence the need for a web based healthcare platform to intervene and provide seamless care for patients. Medical appointment scheduling, as the starting point of most non-urgent health care services, is undergoing major developments to support active involvement of patients. Medical appointment scheduling system lies at the intersection of providing efficiency and timely access to health services. By using the Internet as a medium, patients are given more freedom in decision making about their preferences for the appointments and have improved access. In this work a Web-based appointment scheduling system is designed to meet the needs under the current health care environment. The security of patients has been taken under consideration, QR code is been used as the e-authentication technique to protect patients’ and hospital information from unauthorized individuals. The system was developed using PHP, QR code authentication technique, VScode environment, apache and MySQL. This is to ensure that the application is robust, cheap, secured and is able to run on different platforms. The system provides the platform to facilitate the booking and management of patients’ appointment bookings. Patients can also view their appointment reports and progress. The system also provides healthcare workers an easy secured access to manage patients’ appointments, medical records and to generate relevant reports.

Web-Based Medical Appointment Systems: A Systematic Review.

BackgroundHealth care is changing with a new emphasis on patient-centeredness. Fundamental to this transformation is the increasing recognition of patients' role in health care delivery and design. Medical appointment scheduling, as the starting point of most non-urgent health care services, is undergoing major developments to support active involvement of patients. By using the Internet as a medium, patients are given more freedom in decision making about their preferences for the appointments and have improved access.ObjectiveThe purpose of this study was to identify the benefits and barriers to implement Web-based medical scheduling discussed in the literature as well as the unmet needs under the current health care environment.MethodsIn February 2017, MEDLINE was searched through PubMed to identify articles relating to the impacts of Web-based appointment scheduling.ResultsA total of 36 articles discussing 21 Web-based appointment systems were selected for this review. Most of the practices have positive changes in some metrics after adopting Web-based scheduling, such as reduced no-show rate, decreased staff labor, decreased waiting time, and improved satisfaction, and so on. Cost, flexibility, safety, and integrity are major reasons discouraging providers from switching to Web-based scheduling. Patients’ reluctance to adopt Web-based appointment scheduling is mainly influenced by their past experiences using computers and the Internet as well as their communication preferences.ConclusionsOverall, the literature suggests a growing trend for the adoption of Web-based appointment systems. The findings of this review suggest that there are benefits to a variety of patient outcomes from Web-based scheduling interventions with the need for further studies.

Intimate partner violence and comorbid mental health conditions among urban male patients.

We wanted to explore the associations between intimate partner violence (IPV) and comorbid health conditions, which have received little attention in male patients. Using a computer-based self-assessment health questionnaire, we screened sequential emergency department patients who were urban, male, and aged 18 to 55 years. We then examined associations between types of IPV disclosures, co-occurring mental health symptoms, and adverse health behaviors. Of 1,669 men seeking nonurgent health care, 1,122 (67.2%) consented to be screened, and 1,026 (91%) completed the screening; 712 (63%) were in a relationship in the past year. Of these men, 261 (37%) disclosed IPV: 20% (n = 144) disclosed victimization only, 6% (n = 40) disclosed perpetration only, and 11% (n= 77) disclosed bidirectional IPV (defined as both victimization and perpetration in their relationships). Men disclosing both victimization and perpetration had the highest frequencies and levels of adverse mental health symptoms. Rates of smoking, alcohol abuse, and drug use were likewise higher in IPV-involved men. A cumulative risk of poor mental health and adverse health behaviors was associated with IPV disclosures. Self-disclosure by men seeking acute health care provides the potential for developing tools to assess level of risk and to guide tailored interventions and referrals based on the sex of the patient.