Outpatient Consultations Research Articles

Âge vasculaire et risque cardiovasculaire chez les patients hypertendus suivis à l'institut de cardiologie d'Abidjan

ObjectiveTo calculate the vascular age of hypertensive patients and assess the risk at 10 years of occurrence of an absolute cardiovascular event in outpatient consultation of the Abidjan Heart Institute. Patients and methodology: Cross-sectional study with descriptive and analytical purposes from June 2021 to September 2021, i.e. 4 months in patients at least 30 years of age followed in the outpatient department for arterial hypertension without cardiovascular complications. Data were collected using a questionnaire. We considered the parameters established in the D'Agostino chart for the calculation of vascular age. Each parameter was weighted and the total points obtained corresponded to the vascular age. The cardiovascular risk at 10 years was also obtained from another abacus established by D'Agostino by cross-referencing the total points of each patient with pre-established data. ResultsThree hundred hypertensive people were included in this study. The calendar average age was 62.0 ± 10 years with extremes of 30 and 95 years. The gender distribution showed female predominance and there was no significant difference in vascular age by sex. The mean vascular age of all patients was 73.4 ± 9.9 years. The mean difference between actual and vascular age was 11.4 years. Dyslipidemia (p = 0.0002), diabetes (p = 0.0004) and unstandardized BP (p = 0.0000) significantly influenced vascular age. There was no significant difference between smokers and non-smokers (p = 0.1349). All men had a greater than 30% risk of having a cardiovascular accident while women before the age of 35 had no risk. Over the age of 60, almost all patients (both men and women) had a greater than 30% risk of having a cardiovascular accident at 10 years. ConclusionThe calculation of vascular age made it possible to assess arterial aging and calculate the probability at 10 years of occurrence of a cardiovascular event. This study also highlights the importance of cardiovascular risk and vascular age assessment for management adaptation and therapeutic education.

Study protocol of a randomized controlled trial to assess safety of teleconsultation compared with face-to-face consultation: the ECASeT study

BackgroundThe use of remote consultation modalities has exponentially grown in the past few years, particularly since the onset of the COVID-19 pandemic. Although a huge body of the literature has described the use of phone (tele) and video consultations, very few of the studies correspond to randomized controlled trials, and none of them has assessed the safety of these consultation modalities as the primary objective. The primary objective of this trial was to assess the safety of remote consultations (both video and teleconsultation) in the follow-up of patients in the hospital setting.MethodsMulticenter, randomized controlled trial being conducted in four centers of an administrative healthcare area in Catalonia (North-East Spain). Participants will be screened from all individuals, irrespective of age and sex, who require follow-up in outpatient consultations of any of the departments involved in the study. Eligibility criteria have been established based on the local guidelines for screening patients for remote consultation. Participants will be randomly allocated into one of the two study arms: conventional face-to-face consultation (control) and remote consultation, either teleconsultation or video consultation (intervention). Routine follow-up visits will be scheduled at a frequency determined by the physician based on the diagnostic and therapy of the baseline disease (the one triggering enrollment). The primary outcome will be the number of adverse reactions and complications related to the baseline disease. Secondary outcomes will include non-scheduled visits and hospitalizations, as well as usability features of remote consultations. All data will either be recorded in an electronic clinical report form or retrieved from local electronic health records. Based on the complications and adverse reaction rates reported in the literature, we established a target sample size of 1068 participants per arm. Recruitment started in May 2022 and is expected to end in May 2024.DiscussionThe scarcity of precedents on the assessment of remote consultation modalities using randomized controlled designs challenges making design decisions, including recruitment, selection criteria, and outcome definition, which are discussed in the manuscript.Trial registrationNCT05094180. The items of the WHO checklist for trial registration are available in Additional file 1. Registered on 24 November 2021.

Frequency of strongyloidiasis and associated factors: Analysis of 13 years of laboratory results in a tertiary referral hospital in Honduras, 2010-2022.

The frequency of detected strongyloidiasis is affected by the selected laboratory method in the studied population. Considering that Honduras has few community-based studies, the analysis of the laboratory record data can provide information helping to understand this parasitosis. To estimate the frequency and to identify the factors associated with strongyloidiasis, analyzing the laboratory records of the Servicio de Parasitología at Hospital Escuela in Tegucigalpa (Honduras) between 2010 and 2022. We carried out a descriptive, cross-sectional, analytical study. The laboratory diagnosis consisted of stool samples' examination by direct smear and modified Baermann technique. We estimated frequencies and percentages. The statistical association was calculated with prevalence ratios and a 95% confidence interval. Software R, version 4.2.0, and epiR package, version 2.0.46, were used to perform the analysis. The frequency of strongyloidiasis was 0.29% (112/38,085). It was higher with the modified Baermann technique (0.87%; 40/4,575) among male patients (0.44%; 70/15,758). Regarding the age, strongyloidiasis was higher in the 20-40 years old group (0.41%; 28/6,886) with direct smear and 41-61 years old (1.14%; 14/1,232) group with the modified Baermann technique. Among the factors associated with strongyloidiasis were age between 20 and 61 years old (PR=2.26, CI 95%=1.53-3.31), male patients (PR=2.34, CI 95%=1.60‑3.44), mucus (PR=1.86, CI 95%=1.22-2.83) and Charcot-Leyden crystals in stool (PR=8.47, CI 95%=5.14-13.96); watery stool (PR=2.39, CI 95%=1.55-3.68), and other helminthiases (PR=6.73, CI 95%=3.98-11.38). Associated factors to cases detected with the modified Baermann technique were outpatient consultation (PR=4.21, CI 95%=1.91-9.28) and formed stools (PR=3.99, CI 95%=1.94-8.19). The modified Baermann technique increased the detection of strongyloidiasis almost four times. Most cases were distributed among male adults. The cases diagnosed exclusively with the modified Baermann technique have differences from those with observed larvae in the direct smear. It is necessary to develop community-based population studies.

Reducing Operating Room (OR) Cancellations: Results from a Quality Improvement Study from a Tertiary Care Children's Cancer Center

Introduction: Operating Room (OR) is a critical resource that may be used inefficiently in pediatric hematology oncology services and surgical cancellations is a major cause of OR underutilization with major implications on cost-savings, patient satisfaction, quality-of-care and hospital metrics. The purpose of this performance improvement (PI) study was to reduce the surgical cancellation rate by 10% (Pre-PI cancellation rate,22%) at pediatric hematology oncology services at a large tertiary care children's cancer center in Riyadh, Saudi Arabia. Methods: Plan, Do, Study, Act (PDSA) cycle was adapted as project methodology on this performance improvement study. Preoperative checklist was created using REDCap electronic data capture tool hosted at our institution, also served as project database. Daily OR -Huddle was conducted to identify key points of intervention that included customized medical plans involving provision of pre-anesthesia evaluation clinic, sub-specialized inpatient and outpatient consultations, blood product support, while intervention required for improved communication included patient and nursing education. Patients were re-evaluated and preoperative checklist rechecked for provision of 24-hour notice of cancellation to the OR-scheduling team. All elective procedures scheduled between November 2021 and December 2022 were included, cancelled procedures were examined to identify potential reasons. Results: During the PI period, a total of 1063 elective surgical procedures were scheduled, majority 77% (816) were line-related, followed by bone marrow harvest in stem cell transplant donors, 11% (118) ; dental extraction and restoration, 6% (63) ; bone marrow aspiration or biopsy,4% (47) and other (lumbar puncture, Intrathecal chemotherapy etc.) procedures ,2% (19). Majority 58% (621), of the procedures scheduled for malignant diagnoses; followed by stem cell harvests or patients requiring line-insertion for stem cell infusion in 29% (308) and non-malignant diagnoses in 13% (134). Post-intervention, surgical cancellation observed in 54 cases, with majority 93% (50) being line-related cancellation. When compared to the pre-intervention period (12 months prior to PI-project initiation) rate of surgical cancellation dropped from 22% to 5% resulting in 17% improvement. Root cause analysis reports a significant decrease in cancellation related to inappropriate preoperative workup, 40%; followed by co-morbid conditions related to patients disease requiring sub-specialized consultation in 29% ; insufficient routine blood tests in 19% and inappropriate patient education in 8%. The preoperative checklist was approved and adapted as standard of care - clinical pathway to be integrated with the institutional Electronic medical records. Conclusion: In our experience, the observed high rate of elective OR cancellations were associated with ineffective preoperative workflow, team communication, patient coordination and education. Post-intervention measures enabled a visual system to harmonize patients' preoperative progress and the multi-disciplinary, daily OR-Huddle allowed lean-decision minimizing “last minute” cancellations. These interventions are easy to replicate against available resources by other tertiary care centers to improve inefficient OR utilization. Cost-effectiveness analysis resulting from the improvement is warranted.

Improving Access to Comprehensive Care for Pediatric Sickle Cell Patients through the Creation of Multispecialty Clinics

There are many barriers to health care for those in underserved populations such as the pediatric sickle cell population. Due to limitations of transportation, clinical availability, and lack of care coordination, pediatric sickle cell patients are at an increased risk of not receiving the extensive multi-subspecialty health care recommended to prevent potential sickle cell related complications that affect every organ system. To improve access to this multidisciplinary care, UPMC Children's Hospital of Pittsburgh (CHP) pediatric sickle cell program developed a multi-subspecialty collaborative clinic model to offer coordinated sickle cell and pulmonary care, which is critical for sickle cell patients due to the increased risk of pulmonary complications associated with sickle cell disease. By considering health care barriers experienced by our pediatric sickle cell population, we proposed that this coordinated subspecialty clinic model will increase compliance by offering patients and families the opportunity to receive synchronized care from two essential subspecialty groups in just one medical center trip. This increased access to preventative health care for the pediatric sickle cell population should contribute to decreased acute medical events that require critical care and other extensive resources within the health care system. Methods: Two adjacent clinic appointments within the sickle cell and pulmonology clinics were designated for sickle cell patients also requiring preventative pulmonary care to be seen consecutively by both clinical teams during the same half day (one in sickle cell clinic and one in pulmonary clinic). The effect of improving completed referrals using this multi-specialty clinic model was assessed by retrospective electronic medical record review comparing the number of pulmonology referrals made by SCD team and pulmonary visits completed pre- and post- coordinated multi-subspecialty clinic initiative. The studied time period prior to the multispecialty clinic creation was chosen to be calendar year 2019 in order to eliminate the variable of the COVID-19 pandemic affecting outpatient clinic participation. Post-intervention data were collected during calendar year 2022 soon after the creation of this multi-subspecialty initiative. Prior to the creation of this multi-subspecialty clinic model, coordinating CHP sickle cell and pulmonology care, only 24% of pediatric sickle cell patients referred for outpatient pulmonology consultation completed the clinical evaluation. Our program referred 53 of 168 total families during calendar year 2019, with only 17 patients completing their visit. Since beginning this multi-subspecialty clinic initiative, pulmonology evaluations completed by referred sickle cell patients increased to 55%. Thus, CHP's multispecialty clinic offering coordinated sickle cell and pulmonology care increased completed pulmonology referrals by 129%. Using Pearson's chi-square test to compare the relationship between the two categorical variables of prior- and post- multispecialty clinic formation with a null hypothesis of multispecialty clinics will not increase completed referrals, we found a value of 10.76, which is greater than the applied critical value of 9.21 (p=0.01). Therefore, these results are significant, and the null hypothesis was rejected. In summary, by establishing this multi-subspecialty coordinated care at CHP for our pediatric sickle cell population, our goal of improving compliance with critical preventive care was achieved. We hope that this type of intervention will enhance the quality of life for children with sickle cell disease currently, as well as contribute to better health in the patients' futures. We also predict that this improved preventive care will also contribute to decreased emergency care and extensive treatments required for patients cared by CHP. This multi-subspecialty care model also has the potential to benefit other pediatric patients with chronic diseases from underserved populations who experience similar barriers, both in CHP's Western Pennsylvania region as well as underserved populations and health care organizations beyond our region. By applying an approach to care focused on reducing health care barriers to underserved populations, impactful improvements may be seen not only in the pediatric sickle cell population, but in the health care system at large.

Glycemic Control, Renal Progression, and Use of Telemedicine Phone Consultations Among Japanese Patients With Type 2 Diabetes Mellitus During the COVID-19 Pandemic: Retrospective Cohort Study.

Reduced or delayed medical follow-ups have been reported during the COVID-19 pandemic, which may lead to worsening clinical outcomes for patients with diabetes. The Japanese government granted special permission for medical institutions to use telephone consultations and other remote communication modes during the COVID-19 pandemic. We aimed to evaluate changes in the frequency of outpatient consultations, glycemic control, and renal function among patients with type 2 diabetes before and during the COVID-19 pandemic. This is a retrospective single-cohort study conducted in Tokyo, Japan, analyzing results for 3035 patients who visited the hospital regularly. We compared the frequency of outpatient consultations attended (both in person and via telemedicine phone consultation), glycated hemoglobin A1c (HbA1c), and estimated glomerular filtration rate (eGFR) among patients with type 2 diabetes mellitus during the 6 months from April 2020 to September 2020 (ie, during the COVID-19 pandemic) with those during the same period of the previous year, 2019, using Wilcoxon signed rank tests. We conducted a multivariate logistic regression analysis to identify factors related to the changes in glycemic control and eGFR. We also compared the changes in HbA1c and eGFR from 2019 to 2020 among telemedicine users and telemedicine nonusers using difference-in-differences design. The overall median number of outpatient consultations attended decreased significantly from 3 (IQR 2-3) in 2019 to 2 (IQR 2-3) in 2020 (P<.001). Median HbA1c levels deteriorated, though not to a clinically significant degree (6.90%, IQR 6.47%-7.39% vs 6.95%, IQR 6.47%-7.40%; P<.001). The decline in median eGFR was greater during the year 2019-2020 compared to the year 2018-2019 (-0.9 vs -0.5 mL/min/1.73 m2; P=.01). Changes in HbA1c and eGFR did not differ between patients who used telemedicine phone consultations and those who did not. Age and HbA1c level before the pandemic were positive predictors of worsening glycemic control during the COVID-19 pandemic, whereas the number of outpatient consultations attended was identified as a negative predictor of worsening glycemic control during the pandemic. The COVID-19 pandemic resulted in reduced attendance of outpatient consultations among patients with type 2 diabetes, and these patients also experienced deterioration in kidney function. Difference in consultation modality (in person or by phone) did not affect glycemic control and renal progression of the patients.

Validation of Risk Scale in Febrile Neutropenic Patients with Cancer in Guatemala

Abstract Background In National Unit of Pediatric Oncology (UNOP) located in Guatemala City an average of 150 patients are treated per day in outpatient and emergency consultation. The episodes of neutropenia post chemotherapy were recognized as predisposing factors for infections. Methods Prospective analytical observational study of pediatric cancer patients with episodes of febrile neutropenia, attended at the National Pediatric Oncology Unit (UNOP) in Guatemala. The following inclusion criteria apply: Patients age under 18 years old and diagnosis of cancer and febrile neutropenia defined by temperature above 38.3 C, ANC ≤ 500 secondary to chemotherapy in the past 7 days. Exclusion criteria apply patients with fever and neutropenia but not received chemotherapy and patients with an infectious focus. The primary endpoint was evaluated the performance of the risk categorization scale in febrile neutropenic patients. Secondary end points were admission to paediatric intensive care unit, death, reactive protein C value (CRP) and bacterial infection. Results A total of 28 episodes of fever and neutropenia recruited between November 2021 and July 2022 were classified 14 (50%) in low risk and 14 (50%) in high risk. Blood cultures were positive in 5 patients (17.9%). The risk scale was not statistically significative to predict bacteremia because two low risk patients have positive blood cultures, X2 was 0.243 (p=0.622) RR 0.917 95% CI (0.648 – 1.30). The majority of pathogens (4/5) were Gram- negative. Admission at intensive care unit in patients with high risk was statistically not significant x2 1.17 (p = 0.280). The calculated relative risk is 3.01 95% CI (0.621-1.15) without any deaths. According to the risk classification CRP ≥ 90 mg/L at 72 hours was 21.4% and 64.3% in patients with low and high risk respectively, X2 5.25 (p = 0.022). Conclusion The scale performance in the study was not statistically significative to predict bacteriemia in patients with febrile neutropenia, however it was clinically relevant to predict admission at unit intensive care for high risk patients. The early detection of a bacteremia and the rapid therapeutic intervention are crucial to improve the outcome

How Does Social Media Correlate With Clinical Appointments: A Quantitative Analysis.

Social media has become an important part of plastic surgeons' practices. Is it true that the more followers, the more efficient it is to the plastic surgeon's branding? This study is to verify the quantitative correlation between social media and clinical appointments and to optimize its utilization. One hundred and five plastic surgeons were divided into 3 groups according to titles. WEIBO served as a targeted platform and descriptive data, including numbers of followers and clinic appointments were collected for analysis. The promotive effect was quantified as and correlation analysis was conducted to quantify the relationship between followers and outpatient appointments. From this research, it was found that 62% of participants were social media users, while 38% were not. No statistical significance was found between them by comparing the number of clinic appointments. For surgeons with social media, a positive correlation was proven between followers and clinic appointments, whose Pearson's correlation was 0.266 (attending: 0.557, associate consultant: 0.315, consultant: 0.060). Meanwhile, the conversion rates in this study were 22.49±44.67% (attending), 13.10±24.57% (associate consultant), and 18.88±36.05% (consultant). Outpatient consultations of senior surgeons without social media (2652±14492) were significantly higher than young surgeons with social media (1800±1718, P <0.05). The regression equation was Clinical Appointments=ln (Followers)×316.906-992.588 ( R2 =0.270, P =0.023). In conclusion, this study proved that social media positively influenced clinic appointments but the traditional personal brandings like reputations, academic pedigree, and word of mouth still played an indispensable role in career development. Young surgeons benefited most from social media. The promotive effect of social media would reach its saturation when the followers were up to ∼50,000.

Cost structure in specialist mental healthcare: what are the main drivers of the most expensive episodes?

BackgroundMental disorders are one of the costliest conditions to treat in Norway, and research into the costs of specialist mental healthcare are needed. The purpose of this article is to present a cost structure and to investigate the variables that have the greatest impact on high-cost episodes.MethodsPatient-level cost data and clinic information during 2018–2021 were analyzed (N = 180,220). Cost structure was examined using two accounting approaches. A generalized linear model was used to explain major cost drivers of the 1%, 5%, and 10% most expensive episodes, adjusting for patients’ demographic characteristics [gender, age], clinical factors [length of stay (LOS), admission type, care type, diagnosis], and administrative information [number of planned consultations, first hospital visits, interval between two hospital episode].ResultsOne percent of episodes utilized 57% of total resources. Labor costs accounted for 87% of total costs. The more expensive an episode was, the greater the ratio of the inpatient (ward) cost was. Among the top-10%, 5%, and 1% most expensive groups, ward costs accounted for, respectively, 89%, 93%, and 99% of the total cost, whereas the overall average was 67%. Longer LOS, ambulatory services, surgical interventions, organic disorders, and schizophrenia were identified as the major cost drivers of the total cost, in general. In particular, LOS, ambulatory services, and schizophrenia were the factors that increased costs in expensive subgroups. The “first hospital visit” and “a very short hospital re-visit” were associated with a cost increase, whereas “the number of planned consultations” was associated with a cost decrease.ConclusionsThe specialist mental healthcare division has a unique cost structure. Given that resources are utilized intensively at the early stage of care, improving the initial flow of hospital care can contribute to efficient resource utilization. Our study found empirical evidence that planned outpatient consultations may be associated with a reduced health care burden in the long-term.

Survey of Sensitization to Common Fungi in an Allergic Dog Population: The Need for Further Focus on Sensitization and Allergy to Fungi in Veterinary Medicine.

Most fungal species are commensals and non-pathogenic to plants, humans, or animals. However, several species of the Alternaria, Aspergillus, Trichophyton, and Microsporum genera are common causes of disease, even for immunocompetent individuals. Besides mucosal damage, fungi may contribute to a skin barrier impairment, favoring sensitization and allergy development. A total of 68 allergic dogs were selected from a veterinary dermatology and allergy outpatient consultation for conditions related to both Malassezia overgrowth and other fungal complications. The allergy diagnosis was made through anamnesis and current clinical criteria, with the involved allergenic species being identified by intradermal tests (IDTs) and allergen-specific immunoglobulin E (sIgE) determination in serum. Dermatophagoides farinae, Dactylis glomerata, and Malassezia pachydermatis showed as the higher sensitization species from house dust mites, grass pollen, and fungi, respectively. Significant correlations at p < 0.05 were found between sensitization to Dactylis glomerata and Phleum pratense grass pollens, Dermatophagoides farinae and Dermatophagoides pteronyssinus, Acarus siro, Tyrophagus putrescentiae, and Lepidoglyphus destructor dust/storage mites, and between fungi like Aspergillus mix and Penicillium or Alternaria alternata. A significant correlation was also found between sensitization to the Aspergillus mix and D. farinae, D. pteronyssinus, or A. siro. Rather severe dermatitis was observed when a positive IDT to Malassezia pachydermatis was found, regardless of the detection of circulating sIgE, allowing us to consider the usefulness of both the IDT and the sIgE for a systematic diagnosis of allergy to fungi.

Management analysis of clinical processes opened in outpatient consultations at Mavalane general hospital between 2019 and 2021

The clinical archive is the sector that stores and preserves patient information in clinical processes whose management involves collecting and managing a large portion of important information related to each patient, such as personal, clinical data, care data, consultations and any procedures performed in the hospital environment. The objective of this work was to analyze the management process of clinical processes opened in the outpatient clinics of the Hospital Geral de Mavalane, in the period from 2019 to 2021. Methodologically, the research followed a qualitative approach and had as its object of study all clinical processes opened in external consultations between the years 2019 to 2021 and as a target group a total of 20 employees who deal directly with the management of clinical processes, consisting of administrative assigned to the clinical archive sector, external consultations and wards. Data collection was based on in-depth interviews and documentary records. The semi-structured interview guide was used as an instrument for data collection and at the end the information collected was analyzed according to its content. The results showed that the loss of clinical files is a reality at the Mavalane General Hospital and that from 2019 to 2021, it increased by about 0.3%, they also showed that the clinical archive does not have a computerized system for patient data and which has only one employee assigned to the service, which directly affects the quality of the clinical file management process. The research concluded that the lack of staff in the clinical archive directly contributes to the deficient management of clinical files and, consequently, to the loss and duplication of processes in the clinical archive. The research also concluded that Medicine, Surgery and Gynecology consultations were the ones with the highest number of loss of clinical processes during the years under study

Clinical Characterization of Patients with Venous Thromboembolic Disease in 2 Reference Centers in El Salvador

Introduction. During the last decade, venous thromboembolic disease (VTE) has become increasingly important due to its high impact on morbidity and mortality in patients. Suspicion scores together with the diversification of diagnostic methods have allowed rapid and timely diagnosis. Although the annual incidence of VTE is estimated to be approximately 1 in 1,000 people, the risk in certain groups is significantly higher. For the United States, the statistics do not vary significantly. It is estimated that DVT and PE affect between 350,000 and 600,000 people a year, causing between 100,000 and 300,000 deaths. For El Salvador, there are no clinical data related to risk and development factors. Aim. To describe the clinical characteristics of patients with venous thromboembolic disease in 2 reference centers of the Salvadoran Social Security Institute in 2020. Methods. This study is retrospective, observational, cross-sectional and descriptive. All patients with a first-time or recurrent diagnosis that were documented by venous Doppler of the lower and/or upper limbs, computed tomography angiography, magnetic resonance imaging and/or venography at the General Hospital, Medical Surgical and Oncological Hospital of Social Security were included. diagnosed in the internal medicine hospitalization area and in outpatient consultation for the first time in the Hematology Service during the period established between January and December 2020. Results. Of the total of 138 registered patients, the final study population that met all the inclusion criteria was 88, of which the majority corresponded to the female gender in 56.8% (n=50), with a mean age for all of them. the cases of 55 years (range 23 to 88 years). Regarding the associated comorbidities, the 2 main ones were arterial hypertension 52.3% (n=46) and diabetes mellitus 25% (n=22), the most prevalent risk factor being the use of OACs with 9.1% (n=8 ). The most frequent anatomical location was the left lower limb with 45.2% (n=46) of the cases and at the time of diagnosis the initial treatment of all patients with thrombosis was with low molecular weight heparins in 51.1% (n=45). ). VTE in any of its entities continues to be a disease predominantly in adults and women, which is favored by various modifiable and sometimes preventable risk factors. Conclusions. VTE in any of its entities continues to be a disease predominantly in adults and women, which is favored by various modifiable and sometimes preventable risk factors. The main anatomical location of thrombosis is in the lower limbs, mainly on the left side, and in the lungs in main branches. Regardless of the location, mortality is similar in deep vein thrombosis and pulmonary embolism.

Evaluating efficiency of electronic consult requests in an outpatient classical hematology clinic.

46 Background: The classical hematology department at Beth Israel Deaconess Medical Center had 2,200 new outpatient consults in 2022. The conventional process for initiating consults was provider dependent, involving emails to practice hematologists and calls to clinic. Without a standardized process of requesting consults and providing relevant data, providers are not able to efficiently prepare for new visits, which can lead to patient/provider dissatisfaction and repetitive visits. Methods: As a convenience baseline sample in January 2023, hematology-oncology fellows were asked how often they were able to determine the consult reason in coagulation clinic, using a 5-point Likert scale. On 2/1/23, an electronic consult request became available to referring providers within the electronic medical record, and fellows received shared access of the consult list. Following the interventions, fellows were asked how often they were able to determine the consult reason and how often they utilized the electronic order and shared consult list. An additional metric included how often a follow up visit was needed due to insufficient information prior to the appointment. Results: Prior to the intervention, 212 new consults were requested in January 2023. Since the intervention, there have been 963 new consults requested in 115 days, 291 of which were submitted by electronic request [30.2%]. Prior to the intervention, fellows rated ease of finding the consult question an average of 2.2 with median 2.0 on a 5-point Likert scale (1=very difficult, 5=very easy). After addition of the electronic consult request, the average rating improved to 3.75 with median 4.0. To determine the consult question after the intervention, fellows utilized various resources including the new electronic order (28.6%), shared consult list (71.4%) and scanned records or forward emails (42.9%). Prior to the intervention, 3/20 [15%] classical hematology patients in a convenience sample required a follow up visit due to insufficient information available to the provider pre-initial visit. This improved to 0/20 patients after the intervention. Conclusions: Adding electronic consult requests and sharing referral reasons with the entire clinical team improved provider satisfaction with new visits and decreased need for repeat visits. However, utilization of a new electronic consult request by referring physicians remains low. Next steps include efforts to increase electronic consult request use, so that classical hematology clinic visits can be more efficient, which is essential to patient and staff satisfaction and value-based healthcare. [Table: see text]

Improving care using outpatient electronic consults in patients with chemotherapy hypersensitivity reactions

Improving care using outpatient electronic consults in patients with chemotherapy hypersensitivity reactions

Pharmaceutical care to hospital outpatients during the COVID-19 pandemic. Telepharmacy

Hospital Pharmacy Service (HPS) in Spain have been impacted by the health crisis caused by the COVID-19 pandemic. Thus, the outbreak has forced HPSs to adapt their outpatient consultation services to Telepharmacy to optimize clinical outcomes and reduce the contagion risk. The purpose of this article is to describe and analyze the experience of HPSs with hospital outpatient through Telepharmacy during the COVID-19 pandemic and expose the learned lessons. Measures have been adopted in on-site outpatient pharmacy clinics to prevent patients and professionals to virus exposure. These measures are based on national and international recommendations on social distancing and hygiene. With regard to remote outpatient pharmacy services, teleconsultation with drug dispensing has been promoted based on five basic procedures, each with its advantages and limitations: home drug delivery from HPSs, with the advantage of universal access and the limitation of entailing a substantial investment in resources; HPS coordination with primary care pharmacists, which requires no investments but with limited access to some geographic areas; HPS coordination with community pharmacists based on a large network of pharmacies, which requires the patient to go to the pharmacy, without confidentiality being guaranteed for any patient; geolocation and hospital-based medication dispensing, which provides universal access and direct traceability, but entails investment in human resources; and HPS coordination with associations of patients, which does not entail any additional cost but limits the information available on the diseases of society members. Three main lessons have been learned during the pandemic: the satisfactory capacity of HPSs to provide outpatient pharmacy consultation services in the setting of a public health crisis; the usefulness of Telepharmacy for the clinical follow-up, healthcare coordination, outpatient counseling, and informed dispensing and delivery of medication (with a high level of satisfaction among patients); and the need to foster Telepharmacy as a complementary tool through a mixed model of outpatient pharmacy consultation service that incorporates the advantages of each procedure and adapts to the individual needs of each patient in a context of humanized healthcare.

Conversation topics in psychiatric consultations conducted with and without a shared decision-making tool: A qualitative content analysis

ObjectivesTo identify 1) conversation topics, 2) who initiated the topics, and 3) differences in topics with and without the use of a shared decision–making (SDM) tool in psychiatric outpatient consultations. MethodsWe conducted qualitative content analysis of audio-recorded and transcribed data of psychiatric outpatient consultations. We included 52 participants – 25 in the SDM group and 27 in the treatment as usual (TAU) group – and 104 consultations were analyzed, two per participant. The word count per topic was calculated using the transcripts. ResultsFive categories for 28 topics were generated. The categories and percentages of word count were: (1) symptoms: 26.1%, (2) life: 37.4%, (3) treatment/service use: 16.3%, (4) global state/goal: 7.3%, and (5) others: 12.9%. The SDM tool significantly increased the overall conversation word count and consultation time. No significant difference was observed for the topic distribution between the two groups. ConclusionDaily life issues – especially those related to work – were the main topics discussed in psychiatric consultations. The SDM tool seems to facilitate discussion of patients’ concerns, but the topic distribution is likely to be similar regardless of whether or not the SDM tool was used. Practice ImplicationsOutpatient psychiatrists are expected to effectively address life-related issues.

Characterization of patients treated with conventional dermatological surgery at hospital level

Introduction: In recent decades the incidence of skin lesions that affect the patient's health has been increasing and the dermatosurgical field has boomed. Objective: To characterize patients treated with conventional dermatological surgery at the hospital level. Methods: An observational, descriptive and cross-sectional study was carried out on patients undergoing dermatological surgery treated in a dermatology consultation at the Faustino Pérez Hernández provincial clinical surgical teaching hospital in the province of Matanzas, Cuba, between September 2020 and September 2021. The sample consisted of 35 cases. The research was carried out in the Dermatology service during four moments (outpatient consultation, surgical procedure, post-surgical re-consultation and re-consultation). Results: The female sex and the sixth decade of life predominated with 62,8 % each. Skin phototype I represented 40 %. Basal cell carcinoma was identified as the predominant clinical diagnosis in 40 %. Elliptical excision with 45,7 % was the most practiced surgical technique. Wound dehiscence with 54,5 % was the most frequent complication of the surgical procedure. Conclusions: The study demonstrated the safety and efficiency of dermatological surgery and the strengthening of the foundations of the specialty as a surgical clinic.

Characterization of patients treated with conventional dermatological surgery at hospital level

Introduction: In recent decades the incidence of skin lesions that affect the patient's health has been increasing and the dermatosurgical field has boomed.Objective: To characterize patients treated with conventional dermatological surgery at the hospital level.Methods: An observational, descriptive and cross-sectional study was carried out on patients undergoing dermatological surgery treated in a dermatology consultation at the Faustino Pérez Hernández provincial clinical surgical teaching hospital in the province of Matanzas, Cuba, between September 2020 and September 2021. The sample consisted of 35 cases. The research was carried out in the Dermatology service during four moments (outpatient consultation, surgical procedure, post-surgical re-consultation and re-consultation).Results: The female sex and the sixth decade of life predominated with 62,8 % each. Skin phototype I represented 40 %. Basal cell carcinoma was identified as the predominant clinical diagnosis in 40 %. Elliptical excision with 45,7 % was the most practiced surgical technique. Wound dehiscence with 54,5 % was the most frequent complication of the surgical procedure.Conclusions: The study demonstrated the safety and efficiency of dermatological surgery and the strengthening of the foundations of the specialty as a surgical clinic.

Evaluation of β-blockers dosage regimen rationality in heart failure patients

Background: β-Blockers are often associated with further cardiac function deterioration, ledding to them being often underused/underdosed by certain physicians in heart failure treatment, although they were seen to be beneficial in decreasing the rates of mortality and morbidity, duration of hospitalization in HFrEF patients, but data on their benefits in HFmEF and HFpEF patients is limited. Objective was to evaluate rationality of β-blockers’ dosage regimen and its effectiveness in HF patients. Methods: 43 HF patients have been enrolled. Data were collected from the medication chart (dose, route, frequency); dosage regimen was evaluated and compared to that of ESC guidelines for HF treatment. Heart rates pre/post drug treatments, ejection fraction (at admission &amp; post-discharge) were recorded; effectiveness was evaluated through heart rate control, reduction in: duration of hospitalization, rehospitalization and mortality rate. Post-discharge updates of the patients were obtained through out-patient consultation reports. Results: In All 43 patients dosage regimen of selected β-Blockers was found to be rational and following the ESC guideline for HF treatment. 65% of patients spent not more than 5 days in the hospital, 16% Re-hospitalized for cardiovascular diseases, and death rate was 4%. Conclusions: The dosage regimen of selected β-Blockers was found to be as per that of ESC-guidelines HF treatment. β-Blockers have also been found to have reduced: hospitalization stay, frequency of rehospitalization, and death rate among patients under study.

Companions' contributions to information gathering in Chinese outpatient clinical interaction.

Patients are commonly accompanied to visit clinicians in Chinese outpatient clinics. Although there has been extensive research on the roles of companions in asymmetric interactions within medical settings, there is a paucity of conversation analytic studies that examine the active participation and contributions of companions on an equal footing in medical consultations. How companions on an equal footing participate and contribute in Chinese outpatient clinical consultations remains under-explored. By employing video recordings of three-party consultations in the Chinese orthopaedic outpatient clinic as the data and adopting conversation analysis as the method, this study investigated how companions participated in and contributed to the information-gathering activity and how their contributions were interactionally negotiated and managed by clinicians and adult patients over sequences of interaction. We showed that companions negotiated epistemic rights in reporting and repairing the information about medical problems in the patients' epistemic domain and displayed different levels of encroachment on patients' epistemic rights by endorsing patients' responses, repairing the information in patients' responses, and offering information directly to clinicians. Companions also exerted deontic authority and shaped the trajectory of the consultations by hindering or facilitating the progressivity of the interaction. We argued that companions' contributions to the information-gathering activity might reflect the family-centred model of the doctor-patient relationship in the Chinese orthopaedic outpatient clinic. Clinicians are suggested to open up opportunities for companions' participation and contributions while respecting patients' rights, especially when there is a collision of knowledge claims between patients and their companions.