Number Of Outpatient Clinic Visits Research Articles

The effectiveness of continuity of care in patients with inflammatory bowel disease: a systematic review

AimTo investigate the effectiveness of continuity of care in patients with inflammatory bowel disease.BackgroundThe prevalence of inflammatory bowel disease(IBD) is increasing by years, especially in China. Moreover, IBD is prolonged and difficult to heal, which seriously impairs the quality of life of patients. Some studies have identified that continuity of care could contribute to the improvement of the quality of life, but the results remains inconclusive in patients with IBD.MethodsPRISMA guidelines was the outline of this study. Review Manager Software (version 5.3) was used to carry out the data analysis. Outcome assessments included quality of life (QoL), remission rates, number of outpatient clinic visits, and medication adherence.ResultsUltimately, 12 studies involving 2415 patients were brought into this meta-analysis. The results indicated there was no significant difference for continuity of care to improve the QoL in intervention group (SMD = 0.02, 95% CI: -0.08, 0.12). Besides, the remission rates of disease had no difference with those patients in the two groups (OR = 1.07, 95% CI: 0.72, 1.60). However, continued care could contribute to the number of outpatient clinic visits (MD = -0.84, 95% CI: -1.19, -0.49) and patients’ adherence to medication significantly (OR = 2.40, 95% CI: 1.16, 4.95).ConclusionsIBD patients could benefited from continuity of care with reducing their number of clinic visits and improving medication adherence. Nonetheless, there was no evidence of continuity of care contribute to QoL and remission of disease for these patients.

Показатели первичной медико-санитарной помощи населению с учетом медико-демографических особенностей региона.

One of the pertinent issues in practical healthcare is the enhancement of the organization of primary medical and sanitary assistance (PMSA) to the population. The evaluation of the quality, completeness, and adequacy of PMSA is inherently linked to medicodemographic indicators such as population size, age structure, and life expectancy. Additionally, issues related to the accessibility of PMSA for the population are of considerable importance. This study aims to conduct a statistical analysis of indicators of primary medical and sanitary assistance, including consideration of the medicodemographic characteristics of the region. This involves the analysis of specific demographic indicators in the Republic of Tatarstan over the past decade, an examination of the number of outpatient clinic visits in the regions and cities of the Republic of Tatarstan during the period 2018–2022, an assessment of the population’s provision with outpatient and polyclinic institutions (OPI) in Kazan and the regions of the Republic of Tatarstan during the period 2018–2022, and an analysis of the number of paramedical obstetric points in the Republic of Tatarstan during the period 2018–2022. It was observed that in the Republic of Tatarstan, there is an increase in population size and life expectancy during the studied period. The dynamics of the number of visits to OPI during the period from 2018–2022 revealed a pattern of reduced attendance during the COVID‑19 pandemic, followed by an increase in the indicator to levels comparable to the pre-COVID era. It was also noted that in the Republic of Tatarstan as a whole, there is an overall increase in the provision of OPI by 3.4% during the period from 2018 to 2022, and in Kazan, the increase is 8.6%. Intra-regional differentiation of the regions of the Republic of Tatarstan was identified, with areas exhibiting positive and negative trends in attendance and provision indicators for OPI.

The Effect of the COVID-19 Pandemic on the Frequency and Course of Inflammatory Bowel Disease in Children

Abstract Objective Inflammatory bowel disease is a chronic inflammatory disease of the gastrointestinal tract. Some difficulties and differences were experienced during the coronavirus disease 2019 (COVID-19) pandemic period for monitoring of chronic diseases. In this study, the effect of the COVID-19 pandemic on the frequency and course of inflammatory bowel disease in children was evaluated. Methods The first severe acute respiratory syndrome coronavirus 2 case in Türkiye was diagnosed on March 11, 2020. The pandemic period was defined as the year following this date, and the pre-pandemic period as the preceding year. The number of patients newly diagnosed with inflammatory bowel disease and their clinical presentations during the pandemic period and pre-pandemic period was compared. In addition, the clinical features of previously diagnosed inflammatory bowel disease patients in the pandemic period and pre-pandemic period were compared. Results Eighty-six patients in a pediatric gastroenterology clinic between 2009 and 2021 were included. The number of newly diagnosed patients was higher during the pandemic period (n = 14) compared with the pre-pandemic period (n = 18; p = 0.017). Fifty-four patients were follow-up patients diagnosed before 2019: the mean number of outpatient clinic visits, disease attacks, and hospitalizations was lower pandemic period than pre-pandemic period (p < 0.01). Conclusion The changes experienced during pandemic period may have triggered more cases of inflammatory bowel disease. However, we found no evidence that either less face-to-face follow-up of, or life changes in, existing inflammatory bowel disease patients during the pandemic period adversely affected their clinical outcomes.

Laser Treatment of Pilonidal Disease — Immediate and Mid-term Results

Different forms of treatment of pilonidal disease include traditional open surgery with or without flap reconstruction, phenolization, and laser treatment. However, no significantly large series have been published about the laser method. This case series analysis consisted of 69 consecutive pilonidal disease patients, who were operated upon with a Fistula-tract laser Closure in the plastic surgery department of a single academic teaching hospital between August 2019 and December 2021. The follow-up was done by phone at 2 weeks and 4 weeks. The outpatient clinic follow-ups were at 6 weeks and 6 months postoperatively. The mean number of sick leave days was 6.2 ± 8.9 days. The mean number of outpatient clinic visits (including phone calls) was 3.4 ± 3.9. The mean secretion time was 22.1 ± 20.3 days. During the follow-up, 54 (81.8%) patients wounds healed. Eight (12.1%) patients had postoperative wound infection. There were no other complications. The mean follow-up time was 15.3 ± 7.7 months. Laser treatment for sinus pilonidal is promising and minimally invasive procedure. The procedure can be performed under local anesthesia. A re-operation comes into question if the operation area does not heal in the primary operation.

Comparison of the diagnoses, the outpatient clinics they visited, and the number of visits of patients with and without a diagnosis of fibromyalgia syndrome: Do patients with fibromyalgia syndrome come to the hospital more often?

Fibromyalgia syndrome (FMS) has a wide spectrum of symptoms that includes all body parts. So FMS is a great imitator. This brings to mind the possibility that fibromyalgia patients visit outpatient clinics in many departments more than non-fibromyalgia patients. However, there is not enough data on this subject. This study aims to compare the number of outpatient visits of patients with FMS with those without a diagnosis of FMS and to examine their diagnoses. The diagnoses of 140 patients (70 with fibromyalgia and 70 controls), and departments of the outpatient clinics they visited were analyzed retrospectively. In the control group, patients who visited the same outpatient clinic with the complaint of knee pain, but who did not have FMS and who had never been diagnosed with FMS before, were recruited as age- and gender-matched. The total number of outpatient clinic visits, as well as the number of visits to physical medicine and rehabilitation, obstetrics and gynecology, general surgery, internal medicine, and psychiatry departments, were significantly higher in fibromyalgia group patients compared to the control group. In addition, the number of diagnoses in the 5th chapter (mental, behavioral, and neurodevelopmental disorders, F01-F99) of International Classification of Diseases-10 was significantly higher in the fibromyalgia group. It should be kept in mind that patients with FMS visit more hospitals and outpatient clinics than other patients. Physicians and patients should be informed about this issue to reduce unnecessary health costs.

The Impact of COVID-19 on the Orthopaedic Patient in Slovenia: Hip and Knee Replacement Surgery, 90-Day Mortality, Outpatient Visits and Waiting Times.

IntroductionThe purpose of the study was to analyse the impact of the COVID-19 pandemic on the healthcare of the orthopaedic patient, i.e. numbers of hip and knee replacement surgeries, 90-day mortality, waiting times and outpatient clinic visits.MethodsThe Hip (HR) and Knee Replacement (KR) records from The National Arthroplasty Registry of Slovenia in the pandemic year 2020 were compared to the year 2019. To compare reasons for revision and 90-day mortality the Chi-square test was used. The median values of the number of operations and waiting times were compared with the 95% confidence intervals. The number of outpatient clinic visits was tested with the Wilcoxon Signed Ranked test.ResultsAll operations fell by 19%, from 7825 to 6335. The number of Primary Total HR declined from 3530 to 2792 (21%) and the number of Primary KR from 3191 to 2423 (24%). The number of hip revisions declined by 10% and knee revisions by 25%. We did not find differences in 90-day mortality (p=0.408). Outpatient clinic visits fell from 228682 to 196582 (14%) per year. Waiting times increased by 15% for HR and by 12% for KR.ConclusionThere was an inevitable drop in the number of surgeries and outpatient clinic visits in the spring and autumn lockdown. With the reorganisation of the orthopaedic service in Slovenia, the number of KR and HR stayed at a relatively high level despite the pandemic. An epidemiological model and mechanisms for the reduction of waiting times could overcome the impact of the epidemic.

The RAPID3 questionnaire as a screening tool to reduce the number of outpatient clinic visits: a retrospective cohort study

BackgroundTreat-to-target strategies require frequent on-site evaluations of disease activity in patients with rheumatoid arthritis (RA), burdening patients and caregivers. However, this frequency may not be required in patients in a stable low disease activity state. The Routine Assessment of Patient Index Data 3 (RAPID3) is a reliable tool to detect such states in groups but has not been tested to reduce the frequency of on-site evaluations in individual patient care. In Reade, an outpatient rheumatology clinic, patients can complete the questionnaire online prior to consultation, and the results are directly fed into the electronic patient record. Focusing on low disease activity, we retrospectively studied the test characteristics of RAPID3 and its agreement with the DAS28 in our database of routine patient care.ObjectiveTo assess the test characteristics and agreement between de DAS28 and the RAPID3 in patients with RA, with a focus on the low disease activity categories.MethodsWe performed a retrospective database study with available clinical data collected as part of usual care from the electronic medical record at Reade Amsterdam. The dataset comprised RAPID3 assessments followed by a DAS28 within 2 weeks, obtained between June 2014 and March 2021. We dichotomized the disease activity categories for both the RAPID3 and DAS28 into low (remission and low disease activity) and high (moderate and high disease activity). With cutoff values of 2.0 for RAPID3 and 3.2 for DAS28, we calculated test characteristics and agreement (Cohen’s kappa).ResultsA total of 5009 combined RAPID3 and DAS28 measurements were done at Reade in 1681 unique RA patients. The mean age was 60 years, and 76% of patients were female with a median disease duration of 4 years. Agreement was considered fair (kappa = 0.26). In total, 1426 (28%) of the RAPID3 measurements were classified as low and could be potentially targeted to skip their consultations. The sensitivity to detect low disease activity was 0.39, specificity was 0.93, and the positive predictive value was 0.92.ConclusionWe showed that when the RAPID3 classifies a patient into low disease activity state, the accuracy is 92%. Of all consultations, 28% could possibly be postponed following the screening with RAPID3.Key Points• Most studies conclude that the RAPID3 alone is insufficient to monitor the disease activity of RA due to its general overestimation of the disease activity compared with the DAS28.• Our results show that in 92% of the cases patients with a RAPID3 ≤ 2.0 have a DAS28 ≤ 3.2.• We propose a system where the RAPID3 is used to screen for patients in remission/low disease activity, in order to postpone consultations of these patients and reduce the number of unnecessary outpatient clinic visits.

Single stage first layer biosynthetic cellulose dressing versus non-adherent gauze management in paediatric burns

IntroductionPaediatric burn is a common emergency presentation with a variety of treatment options available. Major parental concerns include pain, healing and scarring, in addition to high parental anxiety. Epiprotect® is a biosynthetic cellulose-based sheet, applied as a single stage first layer contact dressing following initial debridement. Materials and MethodsA retrospective case control comparison study was carried out in our hospital on 28 patients, 14 with biosynthetic cellulose, and 14 with non-adherent gauze. Pain and parental anxiety were measured by the parental perception of child’s pain on Wong-Baker faces pain rating scale and STAI-6 questionnaire (compatible with the STAI-S scoring system) respectively in first clinic visit during outer dressing change. Scar score was calculated using the Vancouver scar scale (VSS). ResultsPatients in both groups had a similar demographic and clinical distribution of location, mechanism of burn, first aid, surface area and depth of burn. Pain and parental anxiety were significantly reduced in the cellulose dressing group (p = 0.0001). Time to complete healing were similar in both groups. Mean VSS scar score was 4 (1–5) in cellulose dressing group compared to 6 (4–11) in non-adherent gauze group (p = 0.0463). Two patients developed hypertrophied scar in non-adherent gauze group. The mean number of outpatient clinic visits in cellulose dressing group were 2.5 (1–5) as compared to 3 (2–6) in the non-adherent gauze group (p = 0.0607). ConclusionSingle stage first layer application of biosynthetic cellulose dressing is associated with reduced pain, parental anxiety, and improved scarring. The dressing is safe and can be applied to patients with superficial and mixed depth burns.

PCN79 Healthcare Resource Utilization (HRU) of Immune Checkpoint Inhibitors in Metastatic LUNG Cancer Patients

Multiple immune checkpoint inhibitors are expensive therapies for metastatic lung cancer, which can be healthcare resource use (HRU) intensive. We aimed to analyze the HRU among patients with metastatic lung cancer on pembrolizumab, nivolumab, or atezolizumab, using real-world data. We conducted a retrospective cohort study in adult patients with metastatic lung cancer on pembrolizumab, nivolumab or atezolizumab identified from IBM MarketScan Commercial database from January 2014 to December 2018. Outcomes assessed were hospital admissions, length of stay, outpatient clinic visits, facility days, out-of-pocket cost (OOP) and non-out-of-pocket cost measured in per patient per month (PPPM). Adjusted group analysis was also conducted using propensity score matching with 1:1 ratio between pembrolizumab and nivolumab groups. A total of 3,647 patients were identified (pembrolizumab=1,364, nivolumab=2,121, atezolizumab=162). Mean ages were around 57yo and about half of patients were females. Comorbidities were mostly balanced except for diabetes and chronic kidney disease. In the base case analysis, the number of hospital admissions were 0.42, 0.38 and 0.41 PPPM for pembrolizumab, nivolumab and atezolizumab, respectively. The pembrolizumab group had the longest length of stay (2.53 days PPPM, SE=0.1) and lowest number of outpatient clinic visits (5.69 visits PPPM, SE=0.09). Number of facility days were similar. Total non-OOP cost was the lowest for nivolumab ($31,228 PPPM, SE=620) and total OOP the lowest for pembrolizumab ($295 PPPM, SE=16). In the adjusted group analysis, all HRU outcomes were similar to the base-case analysis results except that inpatient admissions were significantly lower for pembrolizumab than nivolumab. Total non-OOP cost was significantly higher for pembrolizumab compared to nivolumab while the total OOP cost was the lowest for pembrolizumab. The HRU outcomes are different among immune checkpoint inhibitors in the metastatic lung cancer population. Pembrolizumab-based therapy may be cheaper and lead to less clinic visits for metastatic lung cancer patients.

Return on investment of the Enhanced Recovery After Surgery (ERAS) multiguideline, multisite implementation in Alberta, Canada.

Enhanced Recovery After Surgery (ERAS) is a global surgical qualityimprovement initiative. Little is known about the economic effects of implementing multiple ERAS guidelines in both the short and long term. We performed a return on investment (ROI) analysis of the implementation of multiple ERAS guidelines (for colorectal, pancreas, cystectomy, liver and gynecologic oncology procedures) across multiple sites (9 hospitals) in Alberta using 30-, 180- and 365-day time horizons. The effects of ERAS on health services utilization (length of stay of the primary admission, number of readmissions, length of stay of the readmissions, number of emergency department visits, number of outpatient clinic visits, number of specialist visits and number of general practitioner visits) were assessed by mixed-effect multilevel multivariate negative binomial regressions. Net benefits and ROI were estimated by a decision analytic modelling analysis. All costs were reported in 2019 Canadian dollars. The net health system savings per patient ranged from $26.35 to $3606.44 and ROI ranged from 1.05 to 7.31, meaning that every dollar invested in ERAS brought $1.05 to $7.31 in return. Probabilities for ERAS to be cost-saving were from 86.5% to 99.9%. The effects of ERAS were found to be larger in the longer time horizons, indicating that if only the 30-day time horizon had been used, the benefits of ERAS would have been underestimated. These results demonstrated that ERAS multiguideline implementation was cost-saving in Alberta. To produce a better ROI, it is important to consider a broad range of health service utilizations, long-term impact, economies of scale, productive efficiency and allocative efficiency for sustainability, scale and spread of ERAS implementations.

Resource Utilization and Factors Prolonging Hospitalization for Patients with Relapsed and Refractory Large B-Cell Lymphoma Receiving Tisagenlecleucel Versus Axicabtagene Ciloleucel

Resource Utilization and Factors Prolonging Hospitalization for Patients with Relapsed and Refractory Large B-Cell Lymphoma Receiving Tisagenlecleucel Versus Axicabtagene Ciloleucel

The influence of integrated geriatric outpatient clinics on the health care utilization of older people

BackgroundThe number of people aged greater than 65 years is growing in many countries. Taiwan will be a superaged society in 2026, and health care utilization will increase considerably. Our study aimed to evaluate the efficacy of the geriatric integrated outpatient clinic model for reducing health care utilization by older people.MethodsThis was a retrospective case-control study. Patients aged greater than 65 years seen at the geriatric outpatient clinic (Geri-OPD) and non-geriatric outpatient clinic (non-Geri-OPD) at a single medical centre were age and sex matched. Data on the number of outpatient clinic visits, emergency department visits, hospitalizations and medical expenditures were collected during the first and second years. A subgroup analysis by Charlson comorbidity index (CCI) and older age (age≧80 years) was performed, and the results were compared between the Geri-OPD and non-Geri-OPD groups.ResultsA total of 6723 patients were included (3796 women and 2927 men). The mean age was 80.42 ± 6.39 years. There were 1291 (19.2%) patients in the Geri-OPD group and 5432 (80.8%) patients in the non-Geri-OPD group. After one year of regular follow-up, the Geri-OPD patients showed a significant reduction in the types of drugs included in each prescription (5.62 ± 10.85) and the number of clinic visits per year (18.18 ± 48.85) (P < 0.01). After a two-year follow-up, the number of clinic visits, emergency department visits, and hospitalizations and the annual medical costs were still decreased in the Geri-OPD patients. The Geri-OPD patients had more comorbidities and a higher rate of health care utilization than the non-Geri-OPD patients. In the subgroup analysis, patients with more comorbidities (CCI≧2) and an older age (≧80 years) in the Geri-OPD group showed a significant reduction in health care utilization. The Geri-OPD patients also showed a significant decrease in medical utilization in the second year compared with the non-Geri-POD patients.ConclusionThe Geri-OPD reduced medical costs, the number of drugs prescribed, and the frequency of outpatient clinic visits, emergency department visits and hospitalizations in older patients with complicated conditions. The effect was even better in the second year.

A Smartphone App for Self-Monitoring of Rheumatoid Arthritis Disease Activity to Assist Patient-Initiated Care: Protocol for a Randomized Controlled Trial.

BackgroundTelemedicine based on self-measurement of disease activity could be one of the key components to create the health care system of the future. Previous publications in various medical fields have shown that it is possible to safely telemonitor patients while reducing the number of outpatient clinic visits. For this purpose, we developed a mobile phone app for patients with rheumatoid arthritis (RA), which allows them to self-monitor their disease.ObjectiveThe objective of this study is to assess the safety and efficacy of self-initiated care assisted by a smartphone app in patients with RA.MethodsThis is a randomized controlled trial that will be performed for 1 year. A total of 176 patients with RA will be randomized to either self-initiated care with only one scheduled follow-up consultation assisted by our app or usual care. The coprimary outcome measures are the number of outpatient clinic consultations with a rheumatologist taking place during the trial period and the mean disease activity score as measured by the disease activity score 28 (DAS28) at 12 months. The secondary outcomes are patient satisfaction, adherence, patient empowerment, and cost evaluation of health care assisted by the app.ResultsRecruitment started in May 2019, and up to 18 months will be required for completion of recruitment. Thus far, 78 patients have been randomized, and thus far, experiences with the app have been positive. The study results are expected to be published by the end of 2021.ConclusionsThe completion of this study will provide important data regarding the following: (1) safety of self-initiated care supported by a smartphone app in terms of DAS28 and (2) efficacy of lowering health care usage with this new strategy of providing health care.Trial RegistrationNetherlands Trial Register NL7715; https://www.trialregister.nl/trial/7715International Registered Report Identifier (IRRID)DERR1-10.2196/15105

Reducing seroma formation and its sequelae after mastectomy by closure of the dead space: The interim analysis of a multi-center, double-blind randomized controlled trial (SAM trial)

ObjectiveThe main objective of this double-blind randomized controlled trial (RCT) was to assess seroma formation and its sequelae in patients undergoing mastectomy. Patients were randomized into one of three groups in which different wound closure techniques were applied: 1) conventional wound closure without flap fixation (CON) 2) flap fixation using sutures (FF–S) and 3) flap fixation using an adhesive tissue glue (FF-G). BackgroundSeroma formation is still a bothersome complication after mastectomy. Flap fixation seems promising in reducing seroma formation. Various flap fixation techniques remain to be analyzed, including long-term outcome measures. MethodsThis trial was conducted in three different hospitals between June 2014 and November 2016. Patients were allocated to one of three groups. The primary outcome was the number of seroma needle aspirations. Secondary outcomes were (surgical site) infections, number of outpatient clinic visits, shoulder function, postoperative pain, patient-reported cosmesis and skin dimpling. ResultsA total of 187 patients were randomly assigned to CON (n = 61), FF-S (n = 64) and FF-G (n = 62). The number of seroma aspirations was significantly higher in CON when compared to both flap fixation groups (p = 0.032), with no difference between FF-S and FF-G. Secondary outcomes showed no statistical differences between all groups. The higher number of outpatient clinic visits in CON was considered to be of clinical importance (CON = 27 (44.3%), FF-S = 19 (30.6%) and FF-G = 21 (34.4%)). ConclusionsMastectomy followed by flap fixation with either sutures or adhesive tissue glue reduces the number of seroma aspirations when compared to simple wound closure.

Effects of home prothrombin international ratio (PT-INR) management in children with mechanical prosthetic valves – Importance of individual correlations between laboratory and CoaguChek device PT-INRs

BackgroundWarfarin administration is essential but requires difficult management and frequent clinic visits in patients with mechanical prosthetic atrioventricular valve replacement (MPAVVR). This study investigated how home prothrombin international ratio (PT-INR) monitoring with CoaguChek® (Roche Diagnostics, Basel, Switzerland) safely reduced clinic visits in children with MPAVVR. We also compared individual correlations between the CoaguChek and laboratory PT-INR. MethodsThis study included four pediatric patients who started frequent warfarin home-monitoring after MPAVVR (three mitral valves and one tricuspid valve). We collected information regarding the number of outpatient clinic visits and measurements of PT-INR before and after starting home CoaguChek monitoring (each one year) from medical records. We also compared individual correlations between laboratory and CoaguChek PT-INR in three patients. ResultsNo major clinical events were encountered during the study period. The ratio of outpatient clinic visits in the second year to those in the first year was decreased in all patients (0.30–0.66). The ratio of the numbers of home measurements to all PT-INR measurements in the second year ranged from 0.55 to 0.64 indicating that CoaguChek home monitoring approximately halved the number of outpatient clinic visits. CoaguChek measurements tended to be slightly overestimated in two patients but were greatly underestimated in one patient. ConclusionsCoaguChek home monitoring in children with MPAVVR reduced the number of their clinic visits without compromising the safety of warfarin management. Given considerable individual differences in correlations between CoaguChek and laboratory PT-INR, individual correlation needs to be identified to fairly interpret the CoaguChek PT-INR values.

Self-detection of atrial fibrillation in an aged population: three-year follow-up of the LietoAF intervention study

BackgroundAtrial fibrillation (AF) is often asymptomatic and undiagnosed until an ischaemic stroke occurs. An irregular pulse is a key manifestation of AF. We assessed whether pulse self-palpation is feasible in screening of AF.MethodsAltogether 205 residents of Lieto municipality aged ≥75 years were randomized in 2012 to receive brief education on pulse palpation focusing on evaluating rhythm regularity. Self-detected pulse irregularity and new AF diagnoses were recorded, and the subjects’ quality of life and use of health care services were assessed during a three-year follow-up.ResultsThe subjects’ median age was 78.2 [3.8] years, and 89 (43.4%) were men. Overall, 139 (68%) subjects had initial good motivation/capability for regular palpation. At four months, 112 (80.6%) subjects with good and 26 (39.4%) with inadequate motivation/capability palpated their pulse daily. At 12 months, 120 (58.5%) and at 36 months, 69 (33.7%) subjects palpated their pulse at least weekly. During the intervention, 67 (32.7%) subjects reported pulse irregularity. New AF was found in 10 (4.9%) subjects, 7 (70%) of whom had reported pulse irregularity. Pulse irregularity independently predicted new AF, but only one (0.5%) subject with new AF sought undelayed medical attention due to pulse irregularity. Quality of life and number of outpatient clinic visits remained unchanged during follow-up.ConclusionPulse palpation can be learned also by the elderly, but it is challenging to form a continuing habit. The low persistence of pulse self-palpation limits its value in the screening of AF, and strategies to promote persistence and research on alternative screening methods are needed.Trial registrationhttp://www.ClinicalTrials.gov identifier: NCT01721005. The trial was registered retrospectively on October 26, 2012.

The Association Between Internet Use and Ambulatory Care-Seeking Behaviors in Taiwan: A Cross-Sectional Study.

BackgroundCompared with the traditional ways of gaining health-related information from newspapers, magazines, radio, and television, the Internet is inexpensive, accessible, and conveys diverse opinions. Several studies on how increasing Internet use affected outpatient clinic visits were inconclusive.ObjectiveThe objective of this study was to examine the role of Internet use on ambulatory care-seeking behaviors as indicated by the number of outpatient clinic visits after adjusting for confounding variables.MethodsWe conducted this study using a sample randomly selected from the general population in Taiwan. To handle the missing data, we built a multivariate logistic regression model for propensity score matching using age and sex as the independent variables. The questionnaires with no missing data were then included in a multivariate linear regression model for examining the association between Internet use and outpatient clinic visits.ResultsWe included a sample of 293 participants who answered the questionnaire with no missing data in the multivariate linear regression model. We found that Internet use was significantly associated with more outpatient clinic visits (P=.04). The participants with chronic diseases tended to make more outpatient clinic visits (P<.01).ConclusionsThe inconsistent quality of health-related information obtained from the Internet may be associated with patients’ increasing need for interpreting and discussing the information with health care professionals, thus resulting in an increasing number of outpatient clinic visits. In addition, the media literacy of Web-based health-related information seekers may also affect their ambulatory care-seeking behaviors, such as outpatient clinic visits.

Three-year mortality in relation to early hospitalization and number of outpatient clinic visits in people with newly diagnosed bipolar disorder.

Whether the early treatment pattern in people with bipolar disorder (BD) could influence later mortality remains to be determined. We aimed to explore the potential effects of early hospitalization and number of outpatient clinic visits on the 3-year mortality in patients with newly diagnosed BD. Adult participants with newly diagnosed BD were identified in Taiwan's National Health Insurance Research Database in 2008. Survival analyses were performed with this national cohort to examine the associations between the first-year treatment pattern (hospitalization and number of outpatient clinic visits) and mortality over a follow-up period of 3 years (2008-2011). A total of 15,254 participants were included. The mean age was 44.9 (S.D.=16.7) years and around 39.9% were male. The average follow-up time was 1055 days. Compared to BD patients with ≥7 times outpatient clinic visits within the first year, the risk of mortality was found elevated [hazard ratio=1.74; 95% confidence interval (CI), 1.40-2.15] for those who needed inpatient treatment. Number of outpatient clinic visits within the first year was found to be negatively associated with later mortality. Besides cancer (hazard ratio=2.14; 95% CI, 1.74-2.63), diabetes mellitus (hazard ratio=1.61; 95% CI, 1.38-1.89) and renal disease (hazard ratio=1.65; 95% CI, 1.36-2.00) were associated with the highest risk of mortality among the physical comorbidities. Substance use disorder stood out as the single comorbid mental illness associated with the highest mortality risk (hazard ratio=1.74; 95% CI, 1.37-2.21). Early treatment pattern, including hospitalization and number of outpatient clinic visits, was associated with later mortality in BD patients. Special care should be given to enhance treatment adherence and to give psychoeducation to those with certain comorbid mental/physical illnesses to reduce health harming behavior and to improve health outcome.

Predictors of rehospitalization after admission for pneumonia in the veterans affairs healthcare system

Although some factors associated with rehospitalization after community-acquired pneumonia have been identified, other factors such as medical care utilization and medication usage have not been previously studied. We investigated novel predictors of rehospitalization in patients admitted with pneumonia. Using Department of Veteran Affairs (VA) administrative data from October 2001 to September 2007, we examined a cohort of patients 65 years old and older, who were hospitalized with pneumonia, in 150 VA acute care hospitals. The cohort was randomly split into derivation and validation samples, and then logistic regression models were used to identify and validate predictors of all-cause rehospitalization within 30 days. Of the 45,134 subjects, 13% were rehospitalized within 30 days. No significant differences were noted between the derivation and validation cohorts. Factors associated with readmission included age, marital status, chronic renal disease, prior malignancy, nursing home residence, congestive heart failure, use of oral corticosteroids, number of emergency department visits a year prior, prior admission, number of outpatient clinic visits in a year prior, and length of hospital stay. The C statistics for the derivation and validation models were 0.615 and 0.613, respectively. Factors associated with readmission were largely unrelated to the underlying pneumonia, but were related to demographics, comorbidities, healthcare utilization, and length of stay on index admission.

Congenital heart disease beyond the age of 60: emergence of a new population with high resource utilization, high morbidity, and high mortality

The population of adults with congenital heart disease (ACHD) is growing and ageing. Limited information about the diagnostic spectrum of this emerging population, its resource utilization at tertiary ACHD centres, and especially about prognostic parameters is available. Retrospective cohort study on all ACHD patients ≥60 years of age under active follow-up. All-cause mortality was the primary outcome measure. Out of a total population of 7315 ACHD patients, 375 [190 females (50.7%), mean age 64.8 ± 5.9 years] fulfilled the inclusion criteria. During a median follow-up of 5.5 (IQR 3.1-8.6) years, 55 of the 375 patients died. The number of interventions (P = 0.0006), the number and length of hospitalization (P < 0.0001), and the number of outpatient clinic visits (P < 0.0001) were significantly higher in patients ≥60 compared with patients aged between 20 and 60 years. Patients ≥60 years of age with moderate or severe congenital heart defects had worse survival prospects than their age- and gender-matched comparison population. On multivariate Cox analysis, coronary artery disease [hazard ratio (HR): 5.04; 95%CI: 1.88-13.51, P = 0.0014], symptoms of heart failure (HR: 2.36; 95%CI: 1.05-5.29, P < 0.05), NYHA class (HR: 1.96; 95%CI: 1.18-3.26, P < 0.01), and moderate to severe reduction in systemic ventricular systolic function (HR: 1.90; 95%CI: 1.20-2.99, P < 0.001) were the strongest prognostic factors. There is a growing number of elderly ACHD patients with high mortality rates and a higher utilization of healthcare resources compared with younger patients. Acquired morbidities, such as coronary artery disease, seem to be key determinants of outcome in this older population in conjunction with the underlying congenital heart disease.