Number Of Phone Calls Research Articles

Moderation Effects of Daily Behavior on Associations Between Symptoms and Social Participation Outcomes After Burn Injury: A 6-Month Digital Phenotyping Study

ObjectiveTo examine the moderation effects of daily behavior on the associations between symptoms and social participation outcomes after burn injury. DesignA 6-month prospective cohort study. SettingCommunity. ParticipantsTwenty-four adult burn survivors. InterventionsNot applicable. Main Outcome MeasuresSymptoms and social participation outcomes were assessed weekly using smartphone surveys, including symptoms of pain (Patient-Reported Outcomes Measurement Information System [PROMIS] Pain Intensity and Pain Interference), anxiety (PROMIS Anxiety), and depression (Patient Health Questionnaire), as well as outcomes of social interactions and social activities (Life Impact Burn Recovery Evaluation [LIBRE] Social Interactions and Social Activities). Daily behaviors were automatically recorded by a smartphone application and smartphone logs, including physical activity (steps, travel miles, and activity minutes), sleep (sleep hours), and social contact (number of phone calls and message contacts). ResultsMultilevel models controlling for demographic and burn injury variables examined the associations between symptoms and social participation outcomes and the moderation effects of daily behaviors. Lower (worse) LIBRE Social Interactions and LIBRE Social Activities scores were significantly associated with higher (worse) PROMIS Pain Intensity, PROMIS Pain Interference, PROMIS Anxiety, and Patient Health Questionnaire-8 scores (P<.05). Additionally, daily steps and activity minutes were associated with LIBRE Social Interactions and LIBRE Social Activities (P<.05), and significantly moderated the association between PROMIS Anxiety and LIBRE Social Activities (P<.001). ConclusionsSocial participation outcomes are associated with pain, anxiety, and depression symptoms after burn injury, and are buffered by daily physical activity. Future intervention studies should examine physical activity promotion to improve social recovery after burns.

Quality Improvement Initiative: Utilization of Video Postoperative Instructions in Breast Reduction Enhances Patient Experience

Abstract Goals/Purpose The current standard of care for providing postoperative instructions to patients undergoing elective, ambulatory surgeries often falls short in efficiency, clarity, and patient-centeredness. Patients are given a single set of written instructions at the time of discharge after their surgery, which often leads to confusion and increased reliance on phone calls, urgent clinic appointments, and even unnecessary visits to the emergency department. Recognizing this, we propose a quality improvement initiative to enhance postoperative instructions for breast reduction patients through a video format. Methods/Technique With institutional IRB approval, all adult patients undergoing bilateral breast reduction (CPT 19318) at an urban academic hospital were included over a 3-month period. A 2-minute video with standardized narrative instructions and visual aids was created. Patients viewed the video during the preoperative visit, and a QR code link to the video was provided in the visit summary on the day of surgery. A Spanish version of the video was available if a Spanish interpreter was used during informed consent. The number of phone calls and emergency department visits within 30 days were recorded and compared to a cohort of patients before this intervention. Qualitative surveys were administered pre- and post-operatively to collect patient feedback. Results/Complications During the study period, 59 patients received breast reduction surgery and were given the standardized video instructions pre- and post-operatively (video group). In comparison, 75 breast reduction patients from the prior 3 months, who received nonstandardized, written instructions post-operatively, served as the control group. In the video group, 47% of patients (28 out of 59) made at least one phone call to the clinic, averaging 0.7 calls per patient, while 56% of the control group patients (42 out of 75) made at least one phone call, averaging 1.1 calls per patient. Categorizing reasons for the calls, there was a significantly higher proportion of calls related to wound dehiscence or minor drainage in the video group (41%) compared to the control group (22%; p=0.03). This shift may be attributed to a reduction in routine postoperative care questions due to the clarity provided by the video instructions (FIGURE1). There were 4 unnecessary emergency department visits within 30 days post-surgery in the study period, slightly decreased from the control period's 6 visits (after excluding 1 visit with the patient diagnosed with pulmonary embolism); however, the difference was not statistically significant. Fifteen patients who received the video instruction completed a survey, with 80% rating the video as very helpful, and 80% were able to access the QR code without assistance. These patients scored an average of 81 out of 100 on satisfaction with information measured using the BREAST-Q module after receiving the video instruction. There was no difference in complication between the two groups of patients. Conclusion Video instruction proves to be a viable format for patient education and postoperative instruction, offering consistency, multilingual support, and enhanced learning through visual aids. Patient acceptance is high, indicating good baseline digital literacy and encouraging the use of this technology among surgery providers.

ACUTE CARE USE FOR OLDER ADULTS WITH DIABETES AND DEMENTIA IN A PRAGMATIC CLINICAL TRIAL OF PANEL MANAGEMENT

Abstract Individuals with diabetes mellitus and Alzheimer’s disease and related disorders (DM-ADRD) face greater self-management challenges, over and under treatment, and more acute care episodes. Enhanced Quality in Primary Care for Elders with Diabetes-ADRD (EQUIPED-ADRD) is a pragmatic randomized controlled trial providing practice guidelines alone (control) compared to practice guidelines plus panel management (intervention) in primary care. Panel management includes patient self-management support and enhanced engagement and support for staff. Thirty-one primary care practices were randomized (14 control versus 17 intervention clinics). We assessed differences in emergency department (ED) use and hospitalizations in individuals with DM-ADRD comparing groups using univariate analysis. Included patients receiving care at randomized clinics were &amp;gt;65 years old, had DM, ADRD, an identified caregiver, and available utilization data. We tracked ED use and hospitalizations over 24 months using electronic health records. Panel management dose was number of phone calls. Among those having utilization data, 177 received panel management versus 349 who did not (total n=526). Patients were predominantly 75-84 years old (41.3%), female (59.9%), and non-Hispanic white (50.9%); 25.9% were Hispanic and 10.7% were non-Hispanic Black. 52.0% (n=92) panel managed patients had ED visits versus 41.8% (n=146) not panel managed [(p=0.027]; Odds Ratio (OR) 1.50; 95%CI: 1.05-2.16). Hospital use did not significantly differ between groups [35.0%; vs. 31.5%, respectively; p=0.418]. Increased panel management dose did not impact acute care use. These findings suggest panel management increases ED use. Whether this is due to greater detection of clinical problems or other issues needing attention requires further investigation.

Prediction of Diagnosis and Treatment Response in Adolescents With Depression by Using a Smartphone App and Deep Learning Approaches: Usability Study.

Lack of quantifiable biomarkers is a major obstacle in diagnosing and treating depression. In adolescents, increasing suicidality during antidepressant treatment further complicates the problem. We sought to evaluate digital biomarkers for the diagnosis and treatment response of depression in adolescents through a newly developed smartphone app. We developed the Smart Healthcare System for Teens At Risk for Depression and Suicide app for Android-based smartphones. This app passively collected data reflecting the social and behavioral activities of adolescents, such as their smartphone usage time, physical movement distance, and the number of phone calls and text messages during the study period. Our study consisted of 24 adolescents (mean age 15.4 [SD 1.4] years, 17 girls) with major depressive disorder (MDD) diagnosed with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and 10 healthy controls (mean age 13.8 [SD 0.6] years, 5 girls). After 1 week's baseline data collection, adolescents with MDD were treated with escitalopram in an 8-week, open-label trial. Participants were monitored for 5 weeks, including the baseline data collection period. Their psychiatric status was measured every week. Depression severity was measured using the Children's Depression Rating Scale-Revised and Clinical Global Impressions-Severity. The Columbia Suicide Severity Rating Scale was administered in order to assess suicide severity. We applied the deep learning approach for the analysis of the data. Deep neural network was employed for diagnosis classification, and neural network with weighted fuzzy membership functions was used for feature selection. We could predict the diagnosis of depression with training accuracy of 96.3% and 3-fold validation accuracy of 77%. Of the 24 adolescents with MDD, 10 responded to antidepressant treatments. We predicted the treatment response of adolescents with MDD with training accuracy of 94.2% and 3-fold validation accuracy of 76%. Adolescents with MDD tended to move longer distances and use smartphones for longer periods of time compared to controls. The deep learning analysis showed that smartphone usage time was the most important feature in distinguishing adolescents with MDD from controls. Prominent differences were not observed in the pattern of each feature between the treatment responders and nonresponders. The deep learning analysis revealed that the total length of calls received as the most important feature predicting antidepressant response in adolescents with MDD. Our smartphone app demonstrated preliminary evidence of predicting diagnosis and treatment response in depressed adolescents. This is the first study to predict the treatment response of adolescents with MDD by examining smartphone-based objective data with deep learning approaches.

OnabotulinumtoxinA Injections for the Treatment of Myofascial Pelvic Pain: 12-Year Experience at a Tertiary Care Academic Center

Objective: The aim of this study was to highlight the safety of OnabotulinumtoxinA (BTA) injections, with or without concurrent pudendal nerve block, in treating women with myofascial pelvic pain (MFPP). Design: This was a retrospective cohort study. Setting: The review was conducted in a tertiary care academic center. Participants/Materials: We conducted a chart review of patients who were diagnosed with MFPP and treated with BTA with or without pudendal nerve block between January 2010 and February 2022. Methods: BTA was injected transvaginally into the pelvic floor muscle group. The primary outcomes were adverse events after BTA injections, and the secondary outcome was the effect of concomitant pudendal nerve block at the time of BTA injections. Results: The cohort included 182 patients; 103 (56.6%) received BTA injections with pudendal nerve block, and 79 (43.4%) received BTA alone. There were no significant demographic differences between the two groups. Post-treatment complications of BTA administration included worsening of pelvic pain (11.5%), constipation (6.6%), urinary tract infection (2.7%), urinary retention (3.8%), and fecal incontinence (2.7%). No statistical difference was noted in the number of phone calls, patient-initiated electronic messages, emergency room visits, or clinic visits for both groups within 30 days post-treatment. The mean number of total injections was 1.6 in the BTA-only group and 1.7 in the BTA with pudendal block group (p = 0.421). Median time to re-intervention with a second BTA injection was 6.0 months; 5.6 months in the BTA with pudendal block group; and 6.8 months in the BTA-only group, p = 0.46. There were 63 re-intervention events after BTA injections. Limitations: Limitations of our study include the retrospective design making it vulnerable to missing or incomplete data available for review. Conclusion: OnabotulinumtoxinA is beneficial in treating women with MFPP; with a duration of therapeutic effect of approximately 6 months. The use of a concurrent pudendal nerve block did not impact clinical outcomes.

Starting Home Telemonitoring and Oxygen Therapy Directly after Emergency Department Assessment Appears to Be Safe in COVID-19 Patients.

Since data on the safety and effectiveness of home telemonitoring and oxygen therapy started directly after Emergency Department (ED) assessment in COVID-19 patients are sparse but could have many advantages, we evaluated these parameters in this study. All COVID-19 patients ≥18 years eligible for receiving home telemonitoring (November 2020-February 2022, Albert Schweitzer hospital, the Netherlands) were included: patients started directly after ED assessment (ED group) or after hospital admission (admission group). Safety (number of ED reassessments and hospital readmissions) and effectiveness (number of phone calls, duration of oxygen usage and home telemonitoring) were described in both groups. 278 patients were included (n = 65 ED group, n = 213 admission group). ED group: 23.8% (n = 15) was reassessed, 15.9% (n = 10) was admitted and 7.7% (n = 5) ICU admitted. Admission group: 15.8% (n = 37) was reassessed, 6.5% (n = 14) was readmitted and 2.4% (n = 5) ICU (re)admitted. Ten patients died, of whom 7 due to COVID-19 (1 in ED group; 6 in the admission group). ED group: median duration of oxygen therapy was 9 (IQR 7-13) days; the total duration of home telemonitoring was 14 (IQR 9-18) days. Admission group: duration of oxygen therapy was 10 (IQR 6-16) days; total duration of home telemonitoring was 14 (IQR 10-20) days. it appears to be safe to start home telemonitoring and oxygen therapy directly after ED assessment.

A quiet place: The impact of the word "quiet" on clinical workload.

This study aimed to determine the impact of uttering the word "quiet" on clinical workload during the overnight otolaryngology call shift and understand the factors contributing to resident busyness. A multicenter, single-blind, randomized-controlled trial was conducted. A total of 80 overnight call shifts covered by a pool of 10 residents were randomized to the quiet or to the control group. At the start of shift, residents were asked to state aloud, "Today will be a quiet night" (quiet group) or "Today will be a good night" (control group). Clinical workload, as measured by number of consults, was the primary outcome. Secondary measures included number of sign-out tasks, unplanned inpatient and operating room visits, number of phone calls and hours of sleep, and self-perceived busyness. There was no difference in the number of total (P = 0.23), nonurgent (P = 0.18), and urgent (P = 0.18) consults. Tasks at signout, total phone calls, unplanned inpatient visits, and unplanned operating room visits did not differ between the control and quiet groups. While there were more unplanned operating room visits in the quiet group (29, 80.6%) compared to the control group (34, 94.4%), this was not found to be significant (P = 0.07). The majority of residents reported feeling "not busy" during control nights (18, 50.0%) compared to feeling "somewhat busy" during quiet nights (17, 47.2%; P = 0.42). Contrary to popular belief, there is no clear evidence that uttering the word "quiet" significantly increases clinical workload.

An Interdisciplinary Dashboard to Streamline Medication Processing at Patient Discharge: A Quality Improvement Initiative.

The purpose of this quality improvement project was to develop and evaluate the use of an electronic medication request dashboard to reduce the amount of time required for medication processing and decrease time lost to workflow interruptions during patient discharge. Delayed discharges are associated with increased health care costs and adverse patient outcomes. Processing of medication requests at discharge contributes to these delays and to workflow interruptions for nursing and pharmacy staff at the project site. Electronic dashboards have been successfully implemented in multiple medical settings to streamline patient processing and enhance communication. The Human Protections Office at Carl R. Darnall Army Medical Center (Fort Hood, TX) reviewed and approved the project with a non-human research determination. A multi-disciplinary workgroup with representatives from nursing, pharmacy, and health information technology (HIT) was formed to develop the dashboard. Based on a logic flow diagram of the desired communication, HIT created a medication request form and status dashboard using SharePoint and Nintex workflows. The dashboard was implemented for a 30-day pilot on a 25-bed medical/surgical nursing unit. The time required for medication processing, the time from discharge order to patient exit, the number of phone calls between nursing and pharmacy, and the usability of the medication request process were measured before and after implementation. The results were analyzed with descriptive statistics and evaluated for statistical significance with a P value ≤.05. With implementation of the dashboard, the average medication processing time decreased from 125 minutes to 48 minutes (P < .0001), and the average patient discharge time decreased from 137 minutes to 117 minutes (P = .002). The usability score of the medication request process increased from 40 to 87 for nursing (P < .0001) and from 62 to 85 for pharmacy (P = .003). The total number of voice calls between nursing and pharmacy decreased from 1,115 to 434, while the total time on voice calls decreased from 33 hours and 50 minutes to 13 hours and 19 minutes (P < .0001). The electronic dashboard is an effective method to enhance interdisciplinary communication during patient discharge and significantly reduces medication processing times. However, despite the medication processing time decreasing by over an hour, the discharge time only decreased by 20 minutes. Additional investigation is needed to evaluate other contributors to delayed discharge. A key limitation of this study was the convenience sampling used over a 30-day pilot on a single unit. The process has since been adopted by the entire hospital, and additional analysis could better reveal the impact to the organization. This communication system shows high usability and reduces phone call interruptions for both nursing and pharmacy staff. Additionally, this technology could easily be applied to other communication pathways or request processes across military medicine.

A prospective observational real world feasibility study assessing the role of app-based remote patient monitoring in reducing primary care clinician workload during the COVID pandemic

BackgroundThe novel coronavirus disease in 2019 (COVID-19) has placed unprecedented strain on healthcare providers, in particular, primary care services. General practitioners (GP) have to effectively manage patients remotely preserving social distancing. We aim to assess an app-based remote patient monitoring solution in reducing the workload of a clinician and reflect this as time-saved in an economic context. Primary care COVID patients in West London deemed medium risk were recruited into the virtual ward. Patients were monitored for 14 days by telephone or by both the Huma app and telephone. Information on number of phone calls, duration of phone calls and duration of time spent reviewing the app data was recorded.ResultsThe amount of time spent reviewing one patient in the telephone only arm of the study was 490 min, compared with 280 min spent reviewing one patient who was monitored via both the Huma app and telephone. Based on employed clinicians monitoring patients, this equates to a 0.04 reduction of full-time equivalent staffing I.e. for every 100 patients, it would require 4 less personnel to remotely monitor them. There was no difference in mortality or adverse events between the two groups.ConclusionApp-based remote patient monitoring potentially holds large economic benefit to COVID-19 patients. In wake of further waves or future pandemics, and even in routine care, app-based remote monitoring patients could free up vital resources in terms of clinical team’s time, allowing a better reallocation of services.

Influence spreading model in analysing ego-centric social networks

In an earlier study one of us had developed a model of influence spreading for analysing human behaviour and interaction with others in a social network. Here we apply this model and corresponding influence centrality measures to real data of mobile phone call detail records. From this we get structures of human ego-centric networks and use a simple model, based on the number of phone calls, to describe the strengths of social relationships. To analyse 48,000 egos in their ego-centric networks we define normalised out-centrality and in-centrality influence measures, by dividing with out-degree and in-degree, respectively. With these and the betweenness centrality measures, we analyse the influence spreading in the ego-centric networks under different scenarios of link strengths between individuals reflecting the network structure being either interaction or connectivity oriented. The model reveals characteristics of social behaviour that are not obvious from the data analysis of raw empirical data or from the results of standard centrality measures. A transition is discovered in behaviour from young to older age groups for both genders and in both normalised out-centrality and in-centrality as well as betweenness centrality results.

Mobile App-Based Remote Patient Monitoring in Acute Medical Conditions: Prospective Feasibility Study Exploring Digital Health Solutions on Clinical Workload During the COVID Crisis.

BackgroundDigital remote patient monitoring can add value to virtual wards; this has become more apparent in the context of the COVID-19 pandemic. Health care providers are overwhelmed, resulting in clinical teams spread more thinly. We aimed to assess the impact of introducing an app-based remote patient monitoring system (Huma Therapeutics) on a clinician’s workload in the context of a COVID-19–specific virtual ward.ObjectiveThis prospective feasibility study aimed to evaluate the health economic effects (in terms of clinical workload) of a mobile app on a telephone-based virtual ward used in the monitoring of patients with COVID-19 who are clinically ready for discharge from the hospital.MethodsA prospective feasibility study was carried out over 1 month where clinician workload was monitored, and full-time equivalents savings were determined. An NHS hospital repurposed a telephone-based respiratory virtual ward for COVID-19. Patients with COVID-19 in the amber zone (according to the National Health Service definition) were monitored for 14 days postdischarge to help identify deteriorating patients earlier. A smartphone-based app was introduced to monitor data points submitted by the patients via communication over telephone calls. We then comparatively evaluated the clinical workload between patients monitored by telephone only (cohort 1) with those monitored via mobile app and telephone (cohort 2).ResultsIn all, 56 patients were enrolled in the app-based virtual ward (cohort 2). Digital remote patient monitoring resulted in a reduction in the number of phone calls from a mean total of 9 calls to 4 calls over the monitoring period. There was no change in the mean duration of phone calls (8.5 minutes) and no reports of readmission or mortality. These results equate to a mean saving of 47.60 working hours. Moreover, it translates to 3.30 fewer full-time equivalents (raw phone call data), resulting in 1.1 fewer full-time equivalents required to monitor 100 patients when adjusted for time spent reviewing app data. Individual clinicians spent an average of 10.9 minutes per day reviewing data.ConclusionsSmartphone-based remote patient monitoring technologies may offer tangible reductions in clinician workload at a time when service is severely strained. In this small-scale pilot study, we demonstrated the economic and operational impact that digital remote patient monitoring technology can have in improving working efficiency and reducing operational costs. Although this particular RPM solution was deployed for the COVID-19 pandemic, it may set a precedent for wider utilization of digital, remote patient monitoring solutions in other clinical scenarios where increased care delivery efficiency is sought.

Psychiatry after-hours: factors impacting workload and workflow.

The study evaluated the workload and workflow of registrars engaged in a psychiatry after-hours roster, quantified their perceptions of this experience and provided recommendations for system redesign. Multiple sources of information, including medical student observers and telephone logs, quantified the tasks performed during shifts. Registrars completed a satisfaction questionnaire. After-hours shifts often started with a lack of attendance of key clinicians at handover. Tasks handed over and completed during shifts varied; there was very little difference between evening, weekends and night shifts except for the higher likelihood of seclusion reviews on weekends. Registrars experienced a significant and complex workload including emergency department and ward reviews, and admissions. Workflow interruptions were frequent; the high number of phone calls and critical incidence warrant further investigation. Registrars were confident in their own ability, but had less confidence in other key clinicians. Many registrars did not discuss after-hours work during supervision. The after-hours experience of psychiatry registrars at a university hospital is arduous and includes a wide range of clinical tasks. This activity is an essential service provision undertaking as well as a training activity. This must be weighed against the impact of after-hours work on registrar well-being.

Initial Results From an Everyday Memory and Metacognitive Intervention for Older Adults

We report results from a new intervention study implementing an Everyday Memory and Metacognitive Intervention (EMMI). This intervention trains older adults on self-regulatory procedures for achieving everyday life goals by implementing a metacognitive perspective where participants learn mindful control over life tasks that place demands on planning and memory (e.g., learning new names and managing prospective memory demands). Fifty-three participants, age range 65 to 83, were assigned to either the EMMI treatment group (n = 32, mean age = 70.13, SD = 3.2) or a waitlist control group (n = 21, mean age = 71.76, SD = 4.7). Individuals with probable memory impairments, as indexed by low MOCA scores, were excluded from the study. Outcomes included daily diary reports of everyday memory errors and a prospective memory telephone task. EMMI participants had fewer reported memory errors per day (M = 0.42) than controls (M = 0.64), one-tailed p = .03. EMMI participants also performed better than controls on the telephone task outcome variables: total number of phone calls completed and mean absolute deviation of call times from scheduled times for successfully completed calls (ps<.001). Subjective outcomes, including personal memory beliefs, life satisfaction, and perceived stress, showed greater pretest-posttest improvement in the EMMI group compared to the control group. This study is a successful initial demonstration of the efficacy of our intervention for improving everyday cognition in older adults and highlights the possibility of improving success in memory-demanding everyday life contexts, thereby contributing to resilient aging in an older population.

Recovery After Adenotonsillectomy-Do Steroids Help? Outcomes From a Randomized Controlled Trial.

The primary objective was to compare pain control following adenotonsillectomy (AT) in children with and without a single postoperative dose of oral dexamethasone in addition to standard analgesic medication. The secondary objective was to compare changes in caregiver-reported snoring, return to normal diet and baseline function, and the number of phone calls and emergency department (ED) visits. Prospective randomized controlled trial. Tertiary care university hospital. Children aged 3 to 10 years with sleep-disordered breathing who were scheduled to undergo AT were randomized to receive standard analgesia with or without dexamethasone (0.6 mg/kg) administered on the third postoperative day. Standard analgesia was defined as alternating weight-based doses of ibuprofen and acetaminophen. A nurse practitioner blinded to the study condition performed telephone surveys postoperatively, and the electronic medical record was reviewed. Enrollment comprised 149 children, of whom 119 were included. When compared with the control group (n = 61, 51%), children who received dexamethasone (n = 58, 49%) had a greater decrease in reported pain score on day 4 (mean ± SD, 2.5 ± 3.1 vs 1.1 ± 3.5, P < .001). Additionally, steroid use was associated with fewer caregiver phone calls (18 [29.5%] vs 6 [10%]) and ED visits (6 [10%] vs 1 [2%]). A single dose of dexamethasone administered on day 3 after adenotonsillectomy significantly improved pain control. There were fewer phone calls and ED visits in the steroid arm. These results support the use of oral steroids as an adjunct for postoperative pain control in children undergoing AT.

Dissemination Strategies and Usage of Psychological Assistance Hotlines During the COVID-19 Outbreak in China

When the 2019 novel coronavirus disease (COVID-19) was rapidly spreading in China in early 2020, China’s National Health Commission quickly responded to the psychological crisis by issuing guidelines for establishing mental health intervention systems, including providing psychological assistance hotlines. However, recent critiques have emphasized China’s lack of pre-established mental health interventions which resulted in an inefficient response. This is the first empirical study to systematically examine mental health service use in China during the COVID-19 outbreak. The current study focused on the use of mental health hotlines in a Northern Chinese region. This region originally had a regional level hotline. During the outbreak, 12 out of its 16 sub-regional juridical areas started providing their own hotlines. Data regarding the regional level hotline and the 12 sub-regional level hotlines were obtained, including daily number of calls received, strategies for disseminating hotline services, and callers’ expressed concerns. Confirmed COVID-19 cases in China, in the region, and in each of the sub-regional juridical area were also recorded daily during China’s peak period of COVID-19. Analyses of these data revealed that the mental health hotlines tended to have low usage overall. Hotlines that merely provided their numbers to community centers and quarantine centers tended to receive few calls. Hotlines that encouraged individuals to advertise the service on personal social media accounts tended to receive more calls. The daily number of confirmed COVID-19 cases in the country was closely related the number of phone calls received at the regional hotline. Sub-regional hotline operators reported that a significant proportion of callers had concerns about contracting COVID-19, negative emotions from prolonged social isolation, and family conflicts while stay-at-home policies were implemented. It was also observed that the sub-regional level hotlines did not start until COVID-19 cases in the country started to decline. Overall, the psychological assistance hotlines provided during COVID-19 satisfied some mental health needs. However, consistent with recent commentaries, the hotline services were not established during the time that demand likely peaked. Future studies are warranted to determine the best strategies to improve the accessibility of mental health hotline services.

Evaluation of a new model for assessment and treatment of uncomplicated ADHD – effect, patient satisfaction and costs

Aim: Attention-deficit/hyperactivity disorder (ADHD) is the most common diagnosis within child- and adolescent psychiatry. Waiting lists and delayed care are major issues. The aim was to evaluate if standardized care (SC) for assessment and treatment of uncomplicated ADHD would reduce resource utilization and increase satisfaction with preserved improvement within the first year of treatment.Method: Patients 6–12 years with positive screen for uncomplicated ADHD at the brief child and family phone interview (BCFPI), a routine clinical procedure, were triaged to SC. The control group consisted of patients diagnosed with ADHD in 2014 and treated as usual. BCFPI factors at baseline and follow-up after one year and resource utilization were compared.Results: Patients improved in ADHD symptoms (Cohen’s d = 0.78, p < 0.001), child function (Cohen’s d = 0.80, p < 0.001) and in family situation (Cohen’s d = 0.61, p < 0.001) without group differences. Parents of SC patients participated more often in psychoeducational groups (75.5 vs. 49.5%, p < 0.001). SC had shorter time to ADHD diagnosis (8.4 vs. 15.6 weeks, p = 0.01) and to medication (24.6 vs. 32.1 weeks, p = 0.003). SC families were more satisfied with the waiting time (p = 0.01), otherwise there were no differences in satisfaction between the groups. Families of SC patients had fewer visits (4.7 vs. 10.8, p < 0.001) but used the same number of phone calls (6.3 vs. 6.2, p = 0.71). Costs were 55% lower.Conclusions: A SC for ADHD can markedly reduce costs with preserved quality. As resources are limited, child psychiatry would benefit from standardization.

A Pilot Randomized Controlled Trial of a Preoperative Patient Education Intervention to Improve Satisfaction and Reduce Resource Utilization in Gynecologic Surgery

During the initial surgical consult patients may feel overwhelmed by the information they are given regarding their diagnosis and surgical plan. We looked to determine if a preoperative patient educational intervention would improve patient satisfaction and optimize use of medical services after discharge. Methods: We randomized women undergoing major gynecologic surgery by laparoscopy or laparotomy, to standard of care (Control) or a preoperative educational intervention. The pre-operative educational intervention consisted of: 1) a handout with information on inpatient and outpatient recovery and 2) a preoperative phone-call to review the handout and answer questions. At the post-operative visit, patients completed a Patient Satisfaction Questionnaire (PSQ-18), addressing satisfaction, interpersonal manner, communication, time spent with doctors and physician accessibility. The number of phone calls, emergency department visits and unscheduled post-operative clinic visits were quantified during the first 2 weeks after surgery. Descriptive statistics and t-tests were used for analysis.Results: 62 consecutive patients were randomized: 31 to intervention and 31 to the control group. Within the cohort 35 patients underwent laparoscopy and 21 laparotomy, 6 patients withdrew or cancelled their surgery. Forty postoperative patient satisfaction questionnaires were collected, 20 in the intervention group and 20 in the control group (response rate 71%). Intervention was associated to increased patient satisfaction. In the LSC group, the intervention improved patients’ perception of their physicians’ interpersonal manners, communication and time spent with the doctor (p &lt; 0.05). Only one patient (3.5%) in the intervention group visited the ER post-operatively (laparotomy, wound separation) compared to 5 (17.8%) control patients (4 laparoscopy, 1 laparotomy, p &lt; 0.05), all for minor complaints (pain, anxiety, incision).Conclusions: In our randomized trial this low-cost, feasible pre-operative educational intervention improves patients’ perception of their surgeons’ communication skills and decreased post-operative healthcare resource utilization. The effects are most pronounced in women undergoing minimally invasive surgery.

A feasibility study to develop and test a Spanish patient and provider intervention for managing osteoarthritis in Hispanic/Latino adults (PRIMO-Latino)

BackgroundArthritis affects approximately 50 million adults in the USA. Hispanics/Latinos have a higher prevalence of arthritis-attributed activity limitations primarily related to osteoarthritis (OA). Hispanic/Latinos are less likely to receive hip replacement independent of health care access, and they are less likely to receive knee replacement. There have been few interventions to improve OA treatment among the Hispanic/Latino population in the USA. In our study, we aimed to develop and test a telephone delivered culturally appropriate Spanish behavioral intervention for the management of OA in Hispanic/Latino adults.MethodsWe conducted a feasibility study in an academic health center and local community in Durham, North Carolina. We enrolled self-identified Spanish speaking overweight/obese adults (≥ 18) with OA of the knee and/or hip under the care of a primary health care provider. The 12-month patient intervention focused on physical activity, weight management, and cognitive behavioral pain management skills. The patient intervention was delivered via telephone with calls scheduled twice per month for the first 6 months, then monthly for the last 6 months (18 sessions). The one-time provider intervention included delivery of patient-specific OA treatment recommendations, based on patients’ baseline data and published guidelines. The primary measures were metrics of feasibility, including recruitment and intervention delivery. We also assessed pain, stiffness, and function using the Spanish-Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).ResultsA total of 1879 participants were identified for potential enrollment. Of those, 1864 did not meet inclusion criteria, were not able to be reached or refused. Fifteen participants enrolled in the intervention. The mean number of phone calls completed was 14.7. Eighty percent completed more than 16 calls. The mean WOMAC baseline score (SD) was 39 (20); mean improvement in WOMAC scores between baseline and 12 months, among 11 participants who completed the study, was − 13.27 [95% CI, − 25.09 to − 1.46] points.ConclusionRecruitment of Hispanics/Latinos, continues to be a major challenge. A Spanish-based telephone delivering lifestyle intervention for OA management in Hispanic/Latino adults is feasible to deliver and may lead to improved OA symptoms. Future research is needed to further test the feasibility and effectiveness of this type of intervention in this segment of the population.Trial registrationNCT01782417

24: Post-operative patient-initiated telephone calls in an academic female pelvic medicine and reconstructive surgery practice: A retrospective study

The purpose of this study was to evaluate reasons for patient calls in the post-operative period. Secondarily we evaluated: (i) factors associated with the number of phone calls in the post-operative period (ii) demographic differences between callers versus non-callers. After IRB approval, a retrospective chart review using electronic medical records was performed on consecutive patients who underwent surgery within our academic FPMRS practice from January 1, 2017 to June 30, 2017, inclusive. Calls following post-operative discharge until their first scheduled post-operative visit were included. Reasons and number of calls were tabulated. Demographic information including clinical and surgical factors was extracted. Continuous data (e.g., number of phone calls) were evaluated with a Student’s t test or ANOVA; categorical data were evaluated with a chi square test. Results yielding p < 0.05 were deemed statistically significant. Three hundred two patients underwent surgery during the designated period of time. One hundred seventy-three (57.3%) patients made a total of 345 calls with mean of 2.0 ± 1.5 calls each. There was no difference in age or BMI between callers and non-callers. A greater number of telephone calls in the post-operative period was recorded among patients discharged home with catheters (p = 0.015) and patients who underwent posterior colporrhaphy (p = 0.005), TVT (p = 0.004), and retropubic urethropexy (p = 0.014) procedures. Reasons for phone calls were categorized under six distinct domains: bowel, pain, activity, medication regimen, urinary, and bleeding. The most frequent concern under each domain included constipation (11.6%), abdominal pain (6.4%), physical activity (8.7%), pain regimen (14.5%), urinary catheter related (13.3%), and vaginal bleeding (12.1%), respectively. The highest volume of phone calls was received for urinary catheter-related issues (10.4%), pain regimen (8.4%), urinary tract infection symptoms (6.7%), constipation (6.7%), vaginal bleeding (6.4%), and voiding issues (5.2%). The volume of phone calls was not impacted by surgical history, medical history, or hospital admission status. Patients discharged with home nursing (11, 6.4%) demonstrated a significantly higher number of phone calls (mean ± SD = 3.82 ± 2.52) than patients discharged home without nursing (153, 88%; 1.89 ± 1.32, respectively; p < 0.001). Thirty-seven percent of callers necessitated an evaluation with a provider or nurse based on their reported concerns. Post-operative patient-initiated telephone calls after FPMRS surgery are common in our practice, occurring in more than half of all patients undergoing a procedure, and specifically more frequent in women discharged home with nursing. Bowel, urinary, and medication-based phone calls account for the highest frequency and volume.

Practical application of opt-out recruitment methods in two health services research studies

BackgroundParticipant recruitment is an ongoing challenge in health research. Recruitment may be especially difficult for studies of access to health care because, even among those who are in care, people using services least often also may be hardest to contact and recruit. Opt-out recruitment methods (in which potential participants are given the opportunity to decline further contact about the study (opt out) following an initial mailing, and are then contacted directly if they have not opted out within a specified period) can be used for such studies. However, there is a dearth of literature on the effort needed for effective opt-out recruitment.MethodsIn this paper we describe opt-out recruitment procedures for two studies on access to health care within the U.S. Department of Veterans Affairs. We report resource requirements for recruitment efforts (number of opt-out packets mailed and number of phone calls made). We also compare the characteristics of study participants to potential participants via t-tests, Fisher’s exact tests, and chi-squared tests.ResultsRecruitment rates for our two studies were 12 and 21%, respectively. Across multiple study sites, we had to send between 4.3 and 9.2 opt-out packets to recruit one participant. The number of phone calls required to arrive at a final status for each potentially eligible Veteran (i.e. study participation or the termination of recruitment efforts) were 2.9 and 6.1 in the two studies, respectively. Study participants differed as expected from the population of potentially eligible Veterans based on planned oversampling of certain subpopulations. The final samples of participants did not differ statistically from those who were mailed opt-out packets, with one exception: in one of our two studies, participants had higher rates of mental health service use in the past year than did those mailed opt-out packets (64 vs. 47%).ConclusionsOur results emphasize the practicality of using opt-out methods for studies of access to health care. Despite the benefits of these methods, opt-out alone may be insufficient to eliminate non-response bias on key variables. Researchers will need to balance considerations of sample representativeness and feasibility when designing studies investigating access to care.