Number Of Outpatient Department Visits Research Articles

Effects of the lockdown measure amid COVID-19 pandemic on outpatient department visits associated with air pollution reduction in Thailand.

We investigated the effects of COVID-19 lockdown on air quality and its consequences health and economic benefits in Thailand. The conditional Poisson regression model was applied to examine the association between air pollution and outpatient department (OPD) visits in each province and pooled the province-specific estimates using the random-effects meta-analysis to derive the national estimates. We then applied a random forest model with meteorological normalization approach to predict the concentration of air pollutants by means of business as usual during the lockdown period (April 3-May 3) in 2020 and further calculated the changes in the number of OPD visits and their consequent expenditure attributable to air pollution reduction using the obtained risk function performed earlier. The number of cardiovascular OPD visits attributed to PM10, PM2.5 and NO2 decreased by 4,414 (95% CI 982, 8,401), 4,040 (95% CI 326, 7,770), and 13,917 (95% CI 1,675, 27,278) cases, respectively, leading to reduced medical expenditure by 14,7180.21, 13,4708.31, and 46,4025.04 USD, respectively. The number of respiratory OPD visits attributed to PM10, PM2.5, NO2, and O3 reduction decreased by 2,298 (95% CI 1,223, 3,375), 2,056 (95% CI 740, 3,252), 3,326 (95% CI 542, 6,295), and 1,160 (95% CI 5,26, 1,804) cases, respectively, where the consequent medical expenditure was reduced by 76,618.48, 68,566.36, 11,0908.31, and 38,685.50 USD, respectively. Finding from this study showed that air quality during the lockdown period in Thailand was improved, contributing to the reduction of cardiovascular and respiratory OPD visits, and consequent medical service costs attributable to air pollution.

Feasibility and impact of a one-stop thyroid clinic in a low- and middle-income country.

The study was done to evaluate the feasibility, safety and outcomes of a one-stop thyroid clinic (OSTC) in a low- and middle-income country (LMIC) setting. This was a prospective non-randomised case control study consisting of patients with thyroid nodules evaluated and managed at a tertiary referral centre in an LMIC between February 2019 and January 2020. Patients were divided into two groups based on the kind of preoperative evaluation protocol: OSTC group (n = 118) - OSTC protocol, and control group (CG, n = 108) - routine protocol. Baseline clinical characteristics of the two groups including median age (p = 0.13) and gender distribution (p = 0.76) were comparable. The majority of patients in both groups belonged to a low-income group (46.6% vs 47.3%; p = 0.91), followed by a middle-income group (35.6% vs 30.5%; p = 0.41). The median number of outpatient department visits (1 vs 3 days; p = < 0.001), waiting time for neck ultrasonography (1 vs 3 days; p = < 0.0001), fine needle aspiration cytology (1 vs 2 days; p = < 0.0001), and out of pocket expenditure (INR 3 965 vs 6 624; p = < 0.001) was significantly less in the OSTC group compared to the CG. Patients in the OSTC group reported better satisfaction levels (p = < 0.0001). Accuracy of diagnosis did not differ between the two groups (p = 0.14). OSTC practice is feasible, provides comparative clinical outcomes and seems cost effective in an LMIC. This protocol can be adopted as a routine practice in any health system.

Dynamic Performance Assessment of Hospitals by Applying Credibility-Based Fuzzy Window Data Envelopment Analysis.

The goal of the current research is to propose the credibility-based fuzzy window data envelopment analysis (CFWDEA) approach as a novel method for the dynamic performance evaluation of hospitals during different periods under data ambiguity and linguistic variables. To reach this goal, a data envelopment analysis (DEA) method, a window analysis technique, a possibilistic programming approach, credibility theory, and chance-constrained programming (CCP) are employed. In addition, the applicability and efficacy of the proposed CFWDEA approach are illustrated utilizing a real data set to evaluate the performance of hospitals in the USA. It should be explained that three inputs including the number of beds, labor-related expenses, patient care supplies, and other expenses as well as three outputs including the number of outpatient department visits, the number of inpatient department admissions, and overall patient satisfaction level, are considered for the dynamic performance appraisal of hospitals. The experimental results show the usefulness of the CFWDEA method for the evaluation and ranking of hospitals in the presence of fuzzy data, linguistic variables, and epistemic uncertainty.

Pediatric urology surgical practice in the time of COVID-19: Results from tertiary Saudi Arabia hospitals.

Purpose:Our study aimed to evaluate the effect of COVID-19 on pediatric urology practice in the Kingdom of Saudi Arabia (KSA).Methods:Data of 10 tertiary hospitals in KSA were retrospectively analyzed. Data of outpatient department (OPD) visits and pediatric urology surgical procedures from January 1, 2019, to April 30, 2019, and from January 1, 2020, to April 30, 2020, were extracted. The primary outcome was to compare OPD visits and pediatric urology workload in the first third of 2020 versus 2019, where there was no curfew. The secondary outcome was to compare the same variables during the full curfew time, i.e., April 2020 versus April 2019.Results:The number of OPD visits was lower in the first third of 2020 (7390 vs. 10,379 in 2019 P < 0.001). OPD visits in April 2020 were 78.6% lower than in April 2019, and teleclinics represented 850 (94.3%). Elective procedures in the first third of 2020 were 688, with a reduction rate of 34.3% compared to the same period of 2019 (P < 0.001). In April 2020, there were 18 elective surgeries, with a 91.4% decrease than in April 2019. Ureteric reimplantation, hypospadias, cryptorchidism, and circumcision stopped, while pyeloplasty (n = 14) and urolithiasis (n = 4) procedures had declined by 50% and 76.5%, respectively. Most of the procedures (71.8%) were day surgery. Emergency procedures were similar in the first third of 2020 (65 vs. 64 in 2019, P = 0.994) and declined in April 2020 by 6.7% versus April 2019. During the full curfew, the most common emergency intervention were cases with obstructive uropathy (42.8%), followed by torsion testis (28.6%), posterior urethral valve (14.3%), and urological trauma (14.3%).Conclusions:In KSA, the number of elective pediatric surgical procedures were reduced by >90%, while the number of emergency pediatric surgical procdures were similar during COVID-19 pandemic compared with non-COVID-19 time. Ureteric reimplantation, hypospadias repair, cryptorchidism, and circumcision procedures were postponed. Pyeloplasty and urolithiasis-related procedures were performed to prevent irreversible disease progression or organ damage. There was an increase in rate of teleclinic and day surgery to reduce the risk of COVID-19 infection.

Impact of COVID-19 on endourology surgical practice in Saudi Arabia: A national multicenter study

ObjectiveTo identify the impact of COVID-19 on endourology surgical practice in Saudi Arabia. MethodsA retrospective study of seven tertiary hospitals from January 2019 to April 2019, and from January 2020 to April 2020 was performed. Records of urology outpatient department (OPD) visits and endourology procedures in the first third of 2020 were analyzed and compared with those in the first third of 2019, as well as, during the full curfew time, i.e. April 2020 versus April 2019. ResultsNumber of OPD visits in the first third of 2020 and 2019 were 19 499 and 26 594, respectively (p<0.001). Number of OPD visits in April 2020 was 1512, with a 78.6% decrease compared to that in April 2019, and among them 1373 (90.8%) were teleclinics. Number of elective procedures in the first third of 2020 has decreased by 34.3% (from 3025 to 1988) compared to that in the first third of 2019 (p<0.001). There were 120 elective procedures in April 2020, 84.1% lower than that in April 2019. Percutaneous nephrolithotomy, shockwave lithotripsy, and transurethral resection of prostate procedures declined by 94.2%, 98.5%, and 93.8%, respectively. Most procedures were performed as day surgery (85.0%). Number of emergency procedures in 2020 have fallen by 9.3% compared to 2019 (p=0.286). Urolithiasis was the commonest pathology (52.6%) presented to the emergency room (52.6%). ConclusionDuring COVID-19 pandemic, urology services slashed by >75%, including OPD visits and elective endourology procedures. Most hospitals have changed their strategic preventive measures by increasing the rate of teleclinics and day surgeries.

The experience of executing preventive measures to protect a nursing home in Taiwan from a COVID-19 outbreak.

We share our strategies for preventing the COVID-19 outbreak in a nursing home in Taiwan. We compared the number of outpatient department visits, the days of prescription from the outpatient department, the number of emergency department visits of the nursing home residents and staff, the number of admissions, and the days of admission of the residents for respiratory tract infection treatment between 2019 and 2020 to examine the effect of our preventive measures in the nursing home. Residents and staff who continuously lived and worked in the nursing home from 2019 to 2020 were included. The differences in outcomes between 2019 and 2020 were examined using pairedsamplet tests. The multivariate analyses were presented through generalized estimating equation analysis. A cohort of 183 residents and 127 staff was included and their electronic medical documentation was analyzed in two periods: January-September 2019 and January-September 2020. These residents had lower numbers of outpatient department visits (P < 0.001), days of prescription from the outpatient department (P < 0.001), number of emergency department visits (P < 0.001), number of admissions (P < 0.001), and days of admission (P < 0.001) to treat respiratory tract infections from January-September 2020 than January-September 2019. These staff members had lower numbers of outpatient department visits (P = 0.015) and days of prescription from the outpatient department (P = 0.009) to treat respiratory tract infections from January-September 2020 than January-September 2019. The association between our preventive measures and decreasing the risk of respiratory tract infection in nursing home residents and staff could be found. Sharing these experiences is valuable, as they provide important insights related to clinical practice during the COVID-19 pandemic.

Nomogram to predict successful smoking cessation in a Chinese outpatient population.

INTRODUCTIONThe study aimed to establish and internally validate a nomogram to predict successful smoking cessation in a Chinese outpatient population.METHODSA total of 278 participants were included, and data were collected from March 2016 to December 2018. Predictors for successful smoking cessation were evaluated by 3-month sustained abstinence rates. Least absolute shrinkage and selection operator (LASSO) regression was used to select variables for the model to predict successful smoking cessation, and multivariable logistic regression analysis was performed to establish a novel predictive model. The discriminatory ability, calibration, and clinical usefulness of the nomogram were determined by the concordance index (C-index), calibration plot, and decision curve analysis, respectively. Internal validation with bootstrapping was performed.RESULTSThe nomogram included living with a smoker or experiencing workplace smoking, number of outpatient department visits, reason for quitting tobacco, and varenicline use. The nomogram demonstrated valuable predictive performance, with a C-index of 0.816 and good calibration. A high C-index of 0.804 was reached with interval validation. Decision curve analysis revealed that the nomogram for predicting successful smoking cessation was clinically significant when intervention was conducted at a successful cessation of smoking possibility threshold of 19%.CONCLUSIONSThis novel nomogram for successful smoking cessation can be conveniently used to predict successful cessation of smoking in outpatients.

To evaluate the effect of COVID-19 pandemic and national lockdown on patient care at a tertiary-care ophthalmology institute.

Purpose:To evaluate the effect of COVID-19 pandemic and national lockdown on patient care at a tertiary-care ophthalmology institute.Methods:Records of all the patients who presented from March 25th to May 3rd, 2020 were scanned to evaluate the details regarding the presenting complaints, diagnosis, advised treatment and surgical interventions.Results:The number of outpatient department visits, retinal laser procedures, intravitreal injections and cataract surgeries during this lockdown decreased by 96.5%, 96.5%, 98.7% and 99.7% respectively compared from the corresponding time last year. Around 38.8% patients could be triaged as non-emergency cases based on history alone while 59.5% patients could be triaged as non-emergency cases after examination. Only eighty-four patients opted for video-consultation from April 15th to May 3rd, 2020. Nine patients presented with perforated corneal ulcer, but could not undergo penetrating keratoplasty due to the lack to available donor corneal tissue. One of these patients had to undergo evisceration due to disease progression. Two patients with open globe injury presented late after trauma and had to undergo enucleation. Around 9% patients could not undergo the advised urgent procedure due to logistical issues related to the lockdown.Conclusion:A significant number of patients could not get adequate treatment during the lockdown period. Hospitals need to build capacity to cater to the expected patient surge post-COVID-19-era, especially those requiring immediate in-person attention. A large number of patients can be classified as non-emergency cases. These patients need to be encouraged to follow-up via video-consultation to carve adequate in-person time for the high-risk patients.

Impact of the coronavirus disease 2019 pandemic on cancer care delivery: A single-center retrospective study

Background: The coronavirus disease 2019 (COVID-19) pandemic and the resultant nationwide lockdown have adversely affected all the aspects of human life, including the access to health-care facilities. However, there is currently a lack of information on the impact of this pandemic on the delivery of routine cancer care. Objectives: In this study, we aimed to evaluate the changes in the number of patients in the day care chemotherapy (DCC) unit and outpatient department (OPD) because of the nationwide COVID-19 lockdown. Materials and Methods: This retrospective audit was conducted at the Department of Medical Oncology of the Indira Gandhi Institute of Medical Sciences in Patna, India. The demographic details and data related to the diagnosis and type and frequency of chemotherapy delivered in the DCC between February 1, 2020, and July 31, 2020, were retrieved. Patient numbers were recorded. Descriptive statistics, odds ratio, Chi-squared test, and Student's t-test were used to assess the changes in the pattern of DCC and OPD patient numbers because of the imposition of a nationwide lockdown on March 24, 2020. The Pearson correlation coefficient was used to assess the correlation between the number of COVID-19 cases and the number of patients visiting the DCC and OPD. Results: A total of 3192 DCCs and 8209 OPD visits were recorded in 126 working days. The median age of the patients was 47 years (interquartile range [34–58]). Cancers of the breast (17%) and gall bladder (15%) were the most common cancers receiving chemotherapy. There was a significant decrease in the number of DCCs delivered after the imposition of the COVID-19 lockdown (mean, 21.97 [±9.7]) compared to pre-lockdown period (mean, 33.30 [±11.4]), (t = 4.11, P = 0.001). Similarly, there was a significant decrease in the number of OPD visits after the imposition of the lockdown (mean, 47.13 [±18.8]) compared to the pre-lockdown period (mean, 89.91 [±30.0]), (t = 7.09, P = 0.001). The odds of receiving weekly chemotherapy over non-weekly regimes significantly decreased after the imposition of the lockdown with an odds ratio of 0.52 (95% confidence interval, 0.36–0.75) and Chi-square value of 12.57(P = 0.001). The daily number of COVID-19 cases reported in the state and the number of patients visiting the OPD was found to be moderately positively correlated (Pearson correlation coefficient, r = 0.35, P = 0.001). Conclusions: There was a significant decrease in the number of patients visiting the OPD and the number of chemotherapy cycles immediately after the imposition of lockdown. The number increased later despite a rise in the number of COVID-19 cases.

PHP32 - Comparing Quality of Life and Clinical Variables for the Prediction of Future Medical Events

Data and Measures • The SF-12v2 Health Survey [4] measures eight domains of health-related quality of life, which can be combined into a Physical Component Summary (PCS) score, providing an overall measure of physical-health related quality of life. • The Medical Expenditures Panel Survey (MEPS) collects health care related data from a nationally representative U.S. sample of households. Two years of data for each panel are collected in 5 rounds of interviews that take place over a 2.5-year period. • Data are drawn from panels 10 (n=12,358; rounds 2/3) and 11 (n=13,944; rounds 4/5) of the MEPS, collected in 2006 and 2007. • The following MEPS round-specific data were used in the analysis: – Total number of outpatient department visits. Types of care received during the visit included: diagnosis or treatment, general check-ups, emergency visits, mental health counseling, vision, maternal care, follow-up visits and other. – Self-reported conditions reported as bothersome by the respondent during the reference period, or identified as have been associated with: 1) a medical event, or 2) one or more episodes of disability days. – PCS of the SF-12

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.

Outpatient drug expenditures and prescription policies for diseases with high cost to the National Health Insurance system in Taiwan.

The high cost of drugs, particularly those used to treat upper respiratory tract infections, is an increasingly important problem for the National Health Insurance system in Taiwan. This study proposed a new classification scheme for reimbursing drug cost and estimated its impact on expenditures and health care utilization. Data were obtained from the National Health Research Institutes' year 2000 computer file of the National Health Insurance Academic Research Database in Taiwan. Two factors were used to classify medications: 1) urgency of medications required; and 2) patient's self-care ability. Among the 10 diseases with the highest number of outpatient department (OPD) visits, 7 were upper respiratory diseases. Acute upper respiratory infections (URIs) and acute nasopharyngitis were the 2 diseases with the highest number of OPD visits. Drug expenditure for acute URIs is about 6% of total expenditure for drugs. Medications suitable for URIs patients' self-care accounted for 42.8% of the total cost of prescribed drugs for these illnesses, and treatment medications unsuitable for patients' self-care accounted for 48.6%. Other medications used for URIs could not be grouped into these categories. The total expenditure for acute nasopharyngitis was about 1.3% of total expenditure for drugs. Medications suitable for self-care in patients with nasopharyngitis accounted for 51.8% of the total cost of medication prescribed for this illness, and medications unsuitable for patients' self-care accounted for 36.8%. Reducing the medications suitable for patients' self-care and enforcing different levels of payment rates on medications unsuitable for patients' self-care may reduce the excessive use of OPD drugs, improve the appropriateness of utilization for acute URIs and the common cold, and allow medical resources to be distributed more efficiently.