Number Of Outpatient Clinic Visits Research Articles

The effect of community-based health management on the health of the elderly: a randomized controlled trial from China

BackgroundAn aging population poses significant challenges to health care in China. Health management has been implemented to reduce the costs of care, raise health service utilization, increase health knowledge and improve quality of life. Several studies have tried to verify the effectiveness of health management in achieving these goals worldwide. However, there have been insufficient randomized control trials (RCTs) to draw reliable conclusions. The few small-scale studies conducted in China include mostly the general population rather than the elderly. Our study is designed to evaluate the impact of community-based health management on the health of the elderly through an RCT in Nanjing, China.MethodsTwo thousand four hundred participants, aged 60 or older and who gave informed consent, were randomly allocated 1:1 into management and control groups, the randomization schedule was concealed from community health service center staff until allocation. Community-based health management was applied in the former while the latter was only given usual care. After 18 months, three categories of variables (subjective grading health indices, objective health indices and health service utilization) were measured based on a questionnaire, clinical monitoring and diagnostic measurements. Differences between the two groups were assessed before and after the intervention and analyzed with t-test, χ2-test, and multiple regression analysis.ResultsCompared with the control group, the management group demonstrated improvement on the following variables (P<0.01): health knowledge score, self-evaluated psychological conditions, overall self-evaluated health conditions, diet score, physical activity duration per week, regular blood pressure monitoring, waist-to-hip ratio, systolic blood pressure and fasting blood sugar. The number of outpatient clinic visits did not differ significantly (P=0.60) between the two groups before intervention, while after intervention it was smaller in the management group than in the control group (P<0.01). However, the number of hospital admissions in the preceding 6 months was not different between the two groups even after intervention (P=0.36). Multiple regression analysis showed that gender, age, education level, chronic disease status and self-evaluated psychological conditions were important factors affecting health knowledge score, BMI, and waist-to-hip ratio.ConclusionCommunity-based health management improved both subjective grading health indices, objective health indices and decreased the number of outpatient clinic visits, demonstrating effectiveness in improving elderly health.Trial registrationChiCTR-OCH-11001716

Benefits of a Well-Structured Diagnostic Process in Colon Cancer

Introduction: Preoperative work-up in colorectal cancer is comprehensive and can be time consuming. In our institution, the preoperative track for colorectal patients was reorganized in order to reduce the therapeutic delay and the number of outpatient clinic visits. We assessed the impact upon the patient outcomes. Methods: All consecutive patients with colon cancer who entered the reorganized preoperative track between January 2008 and December 2009 (n = 87) were retrospectively compared with a consecutively diagnosed traditionally evaluated patient group diagnosed between January 2005 and December 2006 (n = 108). Time between diagnostic procedures and surgery as well as needed number of preoperative outpatient department visits were calculated. All rectal malignancies, patients who received preoperative chemotherapy and/or radiotherapy and patients who underwent emergency procedures were excluded from analysis. Results: Time between colonoscopy and surgery was reduced from [median (25–75%)] 44 (34–54) to 27 (21–34) days, p < 0.001. The number of outpatient department visits declined from 6 (5–7) to 3 (3–4), p < 0.001. Time between first diagnostic test and colonoscopy was reduced from 44 (11–68) to 9 days (0–30), p < 0.001. Time between first diagnostic test and operation was reduced from 85.5 (56–120.5) to 42 days (28–62), p < 0.001. Before the reorganizations, 7% of colonoscopies were ordered by GPs and went up afterwards to 60%. Conclusion: Reorganization of traditional logistic routes for patients diagnosed with colon cancer reduces therapeutic delay and improves care. Moreover, the surgeon, gastroenterologist and oncologist can focus on the oncologic patient and his/her family instead of having to perform administrative tasks.

Montelukast therapy and psychological distress in chronic obstructive pulmonary disease (COPD): A preliminary report

Chronic obstructive pulmonary disease (COPD) is an alteration in which ventilatory function, exercise capacity and health status of patients progressively decline and it is characterized by an increase of inflammatory cytokines such as TNF-α, LTB4, IL-8, etc. In this study we considered twenty patients (15 males and 5 females; mean age: 72.8 ± 6.3) with stable COPD. All patients were performed evaluation of psychological stress at enrollment and were treated with leukotriene receptor antagonists (montelukast tablets) 10 mg/day for 12 months. After 12 months we observed a significant decrease of serum levels of LTB4, IL-8 and also a decrease of the number of outpatient clinic visits, of the number of hospitalizations and of the duration of hospitalization.

The association of socioeconomic status with outcomes in cystic fibrosis patients in the United States.

There is considerable variability in the clinical course of disease in cystic fibrosis (CF). Although currently unidentified modifier genes might explain some of this heterogeneity, other factors are probably contributory. Socioeconomic status (SES) is an important predictor of health status in many chronic polygenic diseases, but its role in CF has not been systematically evaluated. We performed a historical cohort analysis of pediatric CF patients in the United States using National Cystic Fibrosis Foundation Patient Registry (NCFPR) data for 1986 to 1994, and used Medicaid status as a proxy for low SES. The adjusted risk of death was 3.65 times higher (95% confidence interval [CI]: 3.03 to 4.40) for Medicaid patients than for those not receiving Medicaid. The percent predicted FEV(1) of surviving Medicaid patients was less by 9.1% (95% CI: 6.9 to 11.2). Medicaid patients were 2.19 times more likely to be below the 5th percentile for weight (95% CI: 1.91 to 2.51) and 2.22 times more likely to be below the 5th percentile for height (95% CI: 1.95 to 2.52) than were non-Medicaid patients. Medicaid patients were 1.60 times more likely to require treatment for a pulmonary exacerbation (95% CI: 1.29 to 1.98). There was no difference in the number of outpatient clinic visits for Medicaid and non-Medicaid patients. We conclude that low SES is associated with significantly poorer outcomes in children with CF. Barriers in access to specialty health care do not seem to explain this difference. Further study is indicated to determine what adverse environmental factors might cluster in CF patients of low SES to cause worse outcomes.

HOSPITALIZATION OF CHILDREN EXPOSED TO ILLICIT DRUGS IN UTERO. 617

Illicit drug use has been spiraling in United States and this leads to increased environmental and intrauterine exposure of children. We retrospectively identified 190 children born in 1988, 1991 and 1990 with positive maternal drug screen and or maternal drug history. They were 5, 3, and 1 year old respectively at the time of the study. 95 of the drug exposed children were included in the subject group. There was no follow up for the rest. 95 children with no history of drug exposure were randomly matched for age, sex, gender, socioeconomic status and gestational age as control group. Besides hospital admissions and child abuse, diagnosis of developmental delays and seizure disorders were also recorded. Out of 95 drug exposed children 3 were diagnosed with seizure disorder and 5 with developmental delay. The difference from the control group was not statistically significant for both diagnosis; (x=0.29; p=0.59) and (x=0.15; p=0.69) respectively. This was attributed to the small sample size. Even though there was no statistically significant difference in the number of outpatient clinic visits (mean of drug exposed group=0.87, mean of control=1.1; t=0.71, p=0.47), there was a significant difference in hospitalization rate (x=14.6; p<0.0001). Drug exposed children were more likely to have a history of hospitalization (50%) than the control group (22%). Furthermore, drug exposed children were more likely to be hospitalized for accidents, injuries and burns (28%) when compared to control group (5%); (x=3.2; p=0.07). Child abuse and or neglect was reported for 30% of the drug exposed children. These data suggest that children exposed to drugs in utero need to be followed more closely by the pediatrician and interventions in this group may decrease hospital admissions.