Outpatient Consultations Research Articles

Content and Duration of Doctor-Patient Communication in Outpatient Oncology Follow-Up Consultations in China.

Purpose This study aimedto analyze the content of counseling between cancer patients and physicians during outpatient follow-up, assess the duration of different communication content, and explore the influencing factors. Patients and methods We observed consecutive cancer patients without a first diagnosis of malignancy who presented to the oncology outpatient clinic of a public hospital from October through December 2023. A structured observation form was used to record the content and duration of doctor-patient communication. All variables were electronically recorded and stored on a data management platform. Multiple linear regression was used to examine the determinants of consultation duration. Results Our study included 620 cancer patients, of whom 281 individuals had distant metastasis. The average consultation duration for 620 cancer patients was 4.85 minutes (standard deviation of 3.09 minutes). The category of doctor-patient communication was routine outpatient follow-up, involving 182 patients, with an average consultation duration of 3.81 minutes (standard deviation of 2.24 minutes). The main communication content for 51 patients was about the admission procedures, with an average consultation duration of 3.00 minutes (standard deviation of 1.92 minutes). For 67 patients, the primary communication involved the prescription of anti-tumor medications, with an average consultation duration of 3.70 minutes (standard deviation of 2.30 minutes). Symptom control discussions were the main communication content with 107 patients, with an average consultation duration of 5.91 minutes (standard deviation of 3.44 minutes). The main communication content of 24 patients involved medical insurance reimbursement, with an average duration of 7.75 minutes (standard deviation of 4.63 minutes). Consultations accompanied by caregivers and the presence of metastatic tumors were positively associated with consultation duration, whereas female patients with genital malignancies were negatively associated with consultation duration. Communication about symptom management and communication about medical insurance reimbursement waspositively associated with the duration of medical consultations. Communication about administering the formalities requisite for patient admission was negatively associated with the consultation duration. Conclusion We classified the main contents of doctor-patient communication in the oncology outpatient clinic and found that the contents of doctor-patient communication tended to be monotone and systematized. Oncology outpatient models should consider the integration of caregiver involvement. The reason for the shorter outpatient consultation duration in female patients of cancer primary in the reproductive system needs further investigation. The intricate medical insurance reimbursement process poses an increasing time challenge for outpatient clinicians. In addition, the adequacy and effectiveness of symptom management services provided to cancer patients during oncology outpatient follow-up requirefurther evaluation and review.

Medication Adherence of School Personnel in Public Secondary Schools of Tigaon District, Philippines

This study used the descriptive-correlational research method to determine the medication adherence of school personnel of select public schools in Tigaon, Camarines Sur. The respondents include 213 school personnel from public secondary schools of Tigaon, Camarines Sur. The data collected were classified and tabulated systematically and statistically treated using various statistical tools. The study concluded that most of the school personnel who participated in this study were 46 years old and above. The majority were female college graduates with a gross income of 22,000 to 44,000 pesos, assigned as classroom teachers, with no known illness or comorbidities, and had outpatient consultation more than 12 months ago; majority of the respondents were adherent to their medications; socio-economic factors, healthcare team and system-related factors, therapy-related factors, and patient-related factors are significant barriers to medication adherence; and there is significant relationship between medication adherence and sex, educational level, gross income per month, illness or comorbidities, and date of last outpatient consultation. Primary actions include strengthening health education that fosters a positive attitude towards medication adherence, additional resources for medicine supplies in schools and training for healthcare workers, improving the implementation of Gulayan sa Paaralan, and exploring options to simplify treatment regimens and affordable medications. With these, the researcher proposed measures and recommendations that school administrators and public school nurses can adopt to improve the health and safety of school personnel.

The Lasting impact of the COVID-19 pandemic on outpatient neurology consultations

BackgroundThe COVID-19 pandemic prompted rapid changes in outpatient neurology services and there remain unanswered questions regarding its long-term impact. First, what are the lasting changes of the pandemic on demographics...

Effect of the AADE7 Self-Care Behaviors Framework on Diabetes Education Management in a Shared Care Model.

Diabetes self-management education (DSME) provides diabetic patients with knowledge of diabetes, requires attention and recording of dietary habits, and increases the frequency and accuracy of blood glucose monitoring. DSME also achieves better blood glucose control, thus benefiting diabetic patients and reducing the risk of diabetes complications. However, few studies have systematically examined whether DSME follows AADE 7 Self-Care Behaviors (AADE7™). Therefore, this study aimed to investigate the control effect of AADE7™-based management on laboratory test indicators of diabetic patients. The patients with diabetes who received shared care management in our hospital between June 2014 and April 2022 were analyzed retrospectively. According to the process of outpatient consultation, each patient received health education provided by diabetes education nurses and dietitians after consultation. Health education was a process from assessment to health guidance. The basic information of all patients was recorded, and AADE7™ behavior assessment and health education session were conducted through interviews. A total of 13,650 were given shared care management, requiring more than 6 follow-up visits per year, as well as health education. It was reassessed annually according to AADE standards. The impact of the patients' behavior change after the AADE7™-based management on the relevant test indicators was observed. After eight years of intervention, a total of 8319 samples were obtained after excluding the outliers. Stepwise regression analysis was performed, and the results showed that, with other conditions held constant, a greater number of days per week to follow a healthy diet, to take hypoglycemic medication as prescribed, to monitor blood glucose, and to exercise and higher education level were associated with lower levels of glycosylated hemoglobin. The change from drinking to nondrinking was associated with lower triglycerides. If low blood glucose was monitored, patients who reviewed and took immediate action showed lower levels of low-density lipoprotein, urine microalbumin, and urine microalbumin/creatinine ratio compared with those without review and immediate action. Significance tests for each term showed P value <0.05. The AADE7™ framework is a tool supporting patient-centered self-management and education. In the AADE7™ standards, successful self-management is considered as a key outcome in the care of patients with diabetes and related diseases. This tool can effectively improve patient compliance and increase the rate of blood glucose compliance rates in patients with diabetes and therefore is worthy of clinical promotion.

THE RELATIONSHIP KNOWLEDGE AND OBEDIENCE DIET WITH BLOOD SUGAR LEVELS IN PATIENTS WITH TYPE II DIABETES MELLITUS IN THE DEPARTAMENT SURGICAL AND OUT PATIENT CONSULTATION, HNGV, DILI, TIMOR-LESTE 2023

According to the IDF in 2017 stated that the number of DM in 2017 reached 425 million people, for adults ranging from ages 20-79 (IDF, 2017) in 2019 the prevalence of DM cases in the world continues to increase to reach 436 million people in the world (IDF, 2019) global DM prevalence in 2021 will reach 536 million with a total mortality of 6.7 million people (OMS, 2021). East Timor population 1,5 % suffers from the disease diabetes mellitus, based on the result of the national survey that was implemented by the Ministry of Health with UNTL in 2014 on the risk of non-infected diseases in East Timor. MdS (2015). Agreement on the last date that WHO published in relation to service with MdS in 2020 mortality rate of diabetes mellitus in East Timor reaches number 156 or 2,21 % with total mortality 22.46 % 100.000 inhabitants klasifika East Timor occupies number 104 in the World (WHO &amp; MdS 2020). To identify the relationship between level of knowledge and obedience with diet against glucose level to the patient with DM type II in the Departament Surgical and Outpatient Consultation, HNGV, Dili, of 2023 year. The research desing uses quantitative corelational analytical study type with its cross sectional. Based on the result analyzes test statistics Spearman Rank P value 0,000 demonstrates that value is less than 0,05 means that there is a relationship between knowledge with blood glucose level and result with correlation value r = 0,539 which located between 0,50-0,74 category to strong correlation. And the relationship between obedience, diet and blood glucose level, the result analyzes a statitical test that uses Spearman Rank P value 0,000, which shows that a value of 0,000 is less than 0,05 and a result with a correlation value of r=0,785, which is located between 0,75-0,99 category is the strongest correlation. This survey sample has a positive and significant relationship between knowledge and obedience to diet agaist blood glucose level with DM type II in the Department of Surgery and External Consultation and Ambulatory HNGV,Dili,year 2023.

Oncology and Palliative Care Integration Model: A Cost Analysis Study in a Brazilian Hospital Setting.

Background: In 2019, the São Paulo State Cancer Institute (ICESP) implemented a novel model integrating Oncology with Palliative Care specialists. We evaluated the impact of this model on healthcare resource utilization and costs. Methods: We analyzed data from all patients who passed away in February (1month prior to implementation) and November (8months after model implementation group) at ICESP, Brazil. Healthcare utilization data, including emergency department visits, hospital and intensive care unit admissions, chemotherapy, and radiotherapy use, were retrieved from Electronic Medical Records. Unit cost values were obtained from the administrative database. Results: A total of 198 patients who died in February and 196 in November were included in the analysis. Groups exhibited similarities in sex, age, ECOG, cancer type, previous outpatient palliative care consultations, and place of death (ward: 56.6% pre-intervention, 50% post-intervention). The mean cost per patient was US$13,226.29 pre-intervention and US$11,445.82 post-intervention (P = .007). Statistically significant differences were noted in days hospitalized in the surgical ward (227 vs 115), emergency department visits (233 vs 45), chemotherapy sessions (140 vs 26), and radiotherapy sessions (146 vs 10). Excluding outpatient treatments, the total costs for chemotherapy and radiotherapy in the last 30days of life were US$16,924.45 pre-intervention and US$7851.65 post-intervention. Reductions were more pronounced in patients with ECOG 3-4 (P = .039). Conclusion: Our data suggests that the integration model was associated with a reduction in potentially inappropriate treatments during the last month of life, leading to decreased healthcare utilization and costs.

Living with schizophrenia and type 2 diabetes and the implication for diabetes self-care: A qualitative study.

To achieve an in-depth understanding of the challenges associated with diabetes management when having both schizophrenia and type 2 diabetes, while also identifying the needs for improved diabetes self-care. The study employed a qualitative explorative design utilizing a phenomenological-hermeneutic inspired approach, involving field observations and individual semistructured interviews. Data were collected during 2020-2021 through 17 field observations of outpatient consultations and 13 individual semistructured interviews. Data, including field notes and verbatim transcribed interviews, underwent analysis following Ricoeur's interpretive philosophy, encompassing three levels: naïve reading, structural analysis and critical interpretation and discussion. This study adheres to the COREQ guidelines for qualitative research. Three key themes emerged: 'Diabetes when life is noisy', 'Sacrifices and compromises in life' and 'The double silence'. Everyday life is significantly affected when having both schizophrenia and T2D. The mental health state dominates in relation to diabetes self-care and individuals experience challenges balancing between the two conditions. However, there exists a general acknowledgement for diabetes and its long-term complications as a serious medical condition demanding careful attention and treatment. Self-managing two such complex conditions can be overwhelming and make it difficult for the individual to differentiate symptoms and prioritize diabetes care. Moreover, the existing fragmentation within healthcare systems poses communication challenges, resulting in disjointed patient pathways. The study emphasizes the need for a holistic re that addresses the physical, emotional and social challenges. There is also a need for increased awareness and education among informal caregivers and healthcare professionals to foster better understanding and support.

Optimizing Outpatient Radiation Oncology Consult Workflow by Using Time-Driven Activity-Based Costing: Efficiency and Financial Impacts.

Clinical efficiency is a key component of value-based health care. Our objective here was to identify workflow inefficiencies by using time-driven activity-based costing (TDABC) and evaluate the implementation of a new clinical workflow in high-volume outpatient radiation oncology clinics. Our quality improvement study was conducted with the Departments of GI, Genitourinary (GU), and Thoracic Radiation Oncology at a large academic cancer center and four community network sites. TDABC was used to create process maps and optimize workflow for outpatient consults. Patient encounter metrics were captured with a real-time status function in the electronic medical record. Time metrics were compared using Mann-Whitney U tests. Individual patient encounter data for 1,328 consults before the intervention and 1,234 afterward across all sections were included. The median overall cycle time was reduced by 21% in GI (19 minutes), 18% in GU (16 minutes), and 12% at the community sites (9 minutes). The median financial savings per consult were $52 in US dollars (USD) for the GI, $33 USD for GU, $30 USD for thoracic, and $42 USD for the community sites. Patient satisfaction surveys (from 127 of 228 patients) showed that 99% of patients reported that their providers spent adequate time with them and 91% reported being seen by a care provider in a timely manner. TDABC can effectively identify opportunities to improve clinical efficiency. Implementing workflow changes on the basis of our findings led to substantial reductions in overall encounter cycle times across several departments, as well as high patient satisfaction and significant financial savings.

Microbiological profile and antibiotic susceptibility profile of urine cultures in patients with spinal cord injury-retrospective study.

Urinary tract infections (UTIs) and urinary tract colonizations (UTCs) are common in patients with spinal cord injury (SCI). The aim of this study was to characterize the microbiological profile of urine cultures in patients with SCI and to determine the antibiotic susceptibility profile of most common microorganisms, to track antibiotic resistance and facilitate empiric antibiotic selection. A retrospective observational study was conducted on 235 urine culture results of 29 patients with SCI followed at a Physical and Rehabilitation Medicine outpatient consultation between January 2016 and April 2024. Data regarding sociodemographics, cause of SCI, American Spinal Injury Association Impairment Scale classification, voiding method, microbiological urine culture profile, and antimicrobial resistance were collected and statistically analyzed. UTIs (defined as bacteriuria, leukocyturia, positive urine culture, and new onset of signs and/or symptoms) were differentiated from UTCs. Patients were mostly men (86%), with a mean age of 52.1 years. UTIs occurred in 134 specimens (57%) and UTCs in 101 (43%). In both UTIs and UTCs, microbiological agents were mostly bacteria; Escherichia coli was the commonest overall (39%) and more frequent in indwelling catheterization (in UTIs) and intermittent self-catheterization (in UTCs); more frequently identified microorganisms were E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, and Enterococcus faecalis. For these 5 more frequent bacteria, antibiotic susceptibility profiles were determined. High resistance to fluoroquinolones, low resistance to cephalosporins, and very low resistance to nitrofurantoin were found. Specific multidrug-resistant organisms (MDROs) accounted for 11.2%, mostly identified in patients with indwelling catheters. Antibiotic prescriptions in UTIs were according to antibiograms. In UTIs and UTCs, E. coli was the most common microorganism; microorganisms were distinct on different types of voiding methods. Antibiotic susceptibility profiles were determined for the more frequent bacteria. Very low resistance to nitrofurantoin of E. coli and E. faecalis, low resistance to cephalosporins, and high resistance to fluoroquinolones were found. The data now reported can, in selected cases, facilitate empiric antibiotic selection.

Examining Postoperative Posterior Cruciate Ligament Index: A Structural Paradigm in Anterior Cruciate Ligament (ACL) Reconstructions With Hamstring Tendon Autograft.

The current study aimed to compare the posterior cruciate ligament (PCL) index values of patients who underwent hamstring tendon (HT) autograft reconstruction due to an anterior cruciate ligament (ACL) tear. The comparison involved assessing these values in a similar cohort and evaluating the association between the alteration in the PCL index and functional results. Patients who were clinically diagnosed with a complete, unilateral ACL tear and underwent ACL reconstruction (ACLR) using HT autograft between January 2018 and January 2021 constituted the operated group (Group 1) of the study. The control group (Group 2) consisted of patients selected from a convenience sample without ACL rupture, meniscal lesion, or cartilage damage who underwent an MRI during an outpatient orthopaedic consultation for knee pain. The operated group was submitted for an MRI of the knee one year after the operation for any reason such as pain, graft healing, the presence of tunnel widening, or suspicion of re-rupture. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form and the Lysholm Scoring System were applied to the patients in the operated group in the preoperative and postoperative periods to evaluate their complaints, function, and participation in sports and to assess functional ability and functional capacity. A radiologist with five years of experience measured the PCL index in the sagittal section of an MRI. In the operated group, changes in PCL index, IKDC, and Lysholm values during the postoperative period were assessed, along with their correlation. Additionally, a comparison was made between the values of the operated group and the non-operated group. No statistically significant correlation was found between the PCL index alteration and the functional score alteration (IKDC and Lysholm) in the operated group (p>0.05). In comparison to the non-operated group, the preoperative PCL index measures of the operated group were significantly lower (p: 0.000; p<0.05). The increase in the postoperative PCL index measurements of the operated group was similarly statistically significant (p: 0.000; p<0.05). Although the PCL index appears to be a strong anatomical structural parameter in ACLR patients performing HT autograft in the postoperative period, its correlation with functional results is weak.

Neuropathic pain of the superficial branch of the radial nerve — Factors influencing surgical outcome and patient satisfaction

BackgroundDue to its partially superficial course, the superficial branch of the radial nerve is vulnerable to injury by trauma or surgery, potentially leading to painful neuroma. Surgical treatment is difficult. Among other factors, smoking and duration of pain before revision surgery have been suggested as risk factors for persistent pain after surgical revision, without concrete evidence. The aim of this study was therefore to identify factors influencing the outcome of revision surgery in SBRN neuropathic pain in our department. MethodsAll 51 patients receiving revision surgery of the superficial branch of the radial nerve for neuropathic pain from 2010 to 2020 were contacted; 19 agreed to return for assessment. A medical chart review was performed to collect patient-, pain- and treatment-specific factors. Outcomes were recorded. In an outpatient consultation, clinical follow-up was performed and patients filled out the DASH, MHQ and painDETECT questionnaires. ResultsAfter revision surgery, all patients experienced persistent pain. On multivariate logistic regression evaluating the risk of persistent pain, only smoking emerged as an independent risk factor. Age, gender, dominant side, location, time between trigger and surgery or diagnosis did not emerge as risk factors. No predictor for successful return to work could be identified. ConclusionsTreatment of painful neuroma of the superficial branch of the radial nerve is a challenge. Patients with neuropathic pain should be coached toward smoking cessation before neuroma surgery. Surgery can show benefit even after long symptom duration. No correlations between study clinical variables or test results and return to work could be identified, suggesting that other factors play a role in return to work.

Effects of first year COVID-19 pandemic on urology practice in three major Arab Countries: Sub-Analysis of a survey by Arab association of urology research group.

The World Health Organization (WHO) declared the coronavirus disease-19 (COVID-19) pandemic on March 11, 2020. The health care system faced tremendous challenges in providing ethical and high-quality care. The impact of COVID-19 on urological practices varied widely worldwide, including in Arab countries. This study aimed to compare the influence of the COVID-19 pandemic on urology practice in Egypt, the KSA, and the UAE during the first year of the pandemic. This sub-analysis assessed the demographics and COVID-19's effects on urological practice in terms of adjustments to hospital policy, including outpatient consultations, the management of elective and urgent surgical cases, and the continuation of education across the three countries. The availability of personal protective equipment (PPE) and urologists' emotional, physical, and verbal intimidation during COVID-19 were also compared. Regarding the impact on hospital policy, consultations replaced by telemedicine were significantly higher in the KSA (36.15%), followed by the UAE (33.3%), then Egypt (10.4%) (P = 0.008). Elective cases requiring ICU admission were 65.1% in Egypt, 45.2% in the KSA, and 58.2% in the UAE and were performed only in high-risk patients. PPE was freely available in 20.8% of the Egyptian hospitals compared to 83.3% in the KSA and 81.8% in the UAE. Online courses were significantly higher in Egypt (70.8%), followed by the UAE (53%) and the KSA (41.7%) (P = 0.02). Emotional intimidation was higher than verbal intimidation, representing 80%, 75.9%, and 76% in the UAE, KSA, and Egypt, respectively. This sub-analysis outlined significant hospital policy changes across the three Arab countries. Exposure to emotional, verbal, and physical intimidation was observed. The development of teleconsultations and online platforms for educational purposes was observed.

Topic modeling on clinical social work notes for exploring social determinants of health factors.

Existing research on social determinants of health (SDoH) predominantly focuses on physician notes and structured data within electronic medical records. This study posits that social work notes are an untapped, potentially rich source for SDoH information. We hypothesize that clinical notes recorded by social workers, whose role is to ameliorate social and economic factors, might provide a complementary information source of data on SDoH compared to physician notes, which primarily concentrate on medical diagnoses and treatments. We aimed to use word frequency analysis and topic modeling to identify prevalent terms and robust topics of discussion within a large cohort of social work notes including both outpatient and in-patient consultations. We retrieved a diverse, deidentified corpus of 0.95 million clinical social work notes from 181 644 patients at the University of California, San Francisco. We conducted word frequency analysis related to ICD-10 chapters to identify prevalent terms within the notes. We then applied Latent Dirichlet Allocation (LDA) topic modeling analysis to characterize this corpus and identify potential topics of discussion, which was further stratified by note types and disease groups. Word frequency analysis primarily identified medical-related terms associated with specific ICD10 chapters, though it also detected some subtle SDoH terms. In contrast, the LDA topic modeling analysis extracted 11 topics explicitly related to social determinants of health risk factors, such as financial status, abuse history, social support, risk of death, and mental health. The topic modeling approach effectively demonstrated variations between different types of social work notes and across patients with different types of diseases or conditions. Our findings highlight LDA topic modeling's effectiveness in extracting SDoH-related themes and capturing variations in social work notes, demonstrating its potential for informing targeted interventions for at-risk populations. Social work notes offer a wealth of unique and valuable information on an individual's SDoH. These notes present consistent and meaningful topics of discussion that can be effectively analyzed and utilized to improve patient care and inform targeted interventions for at-risk populations.

P17 A Multisite Service Evaluation of Paediatric Teleconsultations

Abstract Paediatric dermatology teleconsultations have become familiar territory since the Covid-19 pandemic. There is a continued drive to provide teleconsultations, with efficiency and cost-saving cited as benefits. Yet, this is not supported by a recent UK-wide survey of health professionals.1 We evaluated practice across two paediatric dermatology centres, to assess time required for teleconsultations. Data were collected prospectively from paediatric dermatology outpatient consultations for patients &amp;lt;16 years over 2 weeks in March and 4 weeks in September 2022. Consultation type (face-to-face/telephone/video), patient demographics, diagnosis and consultation length were reviewed. Caldicott approval was obtained. A total of 173 consultations were included. There was a range of diagnoses including eczema (n=60), skin lesions (n=22), vascular lesions (n=28) and other inflammatory skin conditions (n=63). Most consultations were face-to-face (n=108, 62%), while 38% (n=65) were teleconsultations. Median consultation duration was 13 minutes, 45 seconds (range: 2.5min–1hour 5min 2s). Comparison of consultation duration across 3 modalities (face-to-face vs telephone vs video) demonstrated no statistical significance between groups. (H(2)=5.76, P=0.056). There was a trend toward significance, likely due to 3 face-to-face consultations with duration of &amp;gt;50 minutes. Limitations include relatively small sample size and consultations carried out by few clinicians. Consultation modality is often influenced by case complexity, i.e., more complex consultations are likely to be held face-to-face. Future work includes a health-economic analysis of teleconsultations to determine if these are cost-effective.

REAL-WORLD VALIDATION OF A MACHINE-LEARNING ALGORITHM PREDICTING TREATMENT STRATEGY FOR HIP OSTEOARTRITIS

Artificial Intelligence (AI) is becoming more powerful but is barely used to counter the growth in health care burden. AI applications to increase efficiency in orthopedics are rare. We questioned if (1) we could train machine learning (ML) algorithms, based on answers from digitalized history taking questionnaires, to predict treatment of hip osteoartritis (either conservative or surgical); (2) such an algorithm could streamline clinical consultation.Multiple ML models were trained on 600 annotated (80% training, 20% test) digital history taking questionnaires, acquired before consultation. Best performing models, based on balanced accuracy and optimized automated hyperparameter tuning, were build into our daily clinical orthopedic practice. Fifty patients with hip complaints (&gt;45 years) were prospectively predicted and planned (partly blinded, partly unblinded) for consultation with the physician assistant (conservative) or orthopedic surgeon (operative). Tailored patient information based on the prediction was automatically sent to a smartphone app. Level of evidence: IV.Random Forest and BernoulliNB were the most accurate ML models (0.75 balanced accuracy). Treatment prediction was correct in 45 out of 50 consultations (90%), p&lt;0.0001 (sign and binomial test). Specialized consultations where conservatively predicted patients were seen by the physician assistant and surgical patients by the orthopedic surgeon were highly appreciated and effective.Treatment strategy of hip osteoartritis based on answers from digital history taking questionnaires was accurately predicted before patients entered the hospital. This can make outpatient consultation scheduling more efficient and tailor pre-consultation patient education.

Periodontitis associated with risk of obstructive sleep apnea in Peruvian adult patients: A cross-sectional study.

Patients at high risk for obstructive sleep apnea (OSA) are characterized by intermittent transient hypoxias and upper respiratory tract collapse, with reactive oxygen production and oxidative imbalance which causes an inflammatory cascade. This can generate negative effects on the periodontium, causing severe tooth attachment loss. This study aimed to determine the association between periodontitis and the risk of OSA in adults who attend outpatient otolaryngology consultations. A cross-sectional observational study was carried out with 118 patients seen in the otolaryngology service of the Hospital Victor Lazarte Echegaray-ESSALUD in Trujillo (Peru), between September and October 2023. The presence and severity of periodontitis were determined using the Page and Eke criteria, and the presence and severity of OSA risk were determined using the STOP-BANG questionnaire. The results were analyzed using Chi-square, Spearman correlation and logistic regression tests, considering a significance level of p<0.05. An association was found between periodontitis and risk of OSA (p=0.000), obtaining a positive relationship with rs=0.527. In addition, there was an association between periodontitis and DM2 (p=0.028) and bronchial asthma (0.017). No association was found between periodontitis and sex (0.503) or age (0.741). There is an association between periodontitis and the risk of OSA in Peruvian adult patients who attended outpatient otolaryngology consultations. This association was also found according to age, sex, smoking, DM2 and asthma. In addition, an association was found between periodontitis and DM2 and asthma, but not with sex and age.

SATISFACTION WITH THE INFORMATION RECEIVED TO THE PATIENTS UNDER TREATMENT WITH PSYCHOACTIVE DRUGS

Statement of the problem Our objective in this study is to Know the perception of adverse effects in patients who are being treated with psychotropic medication. We have not found in the reviewed literature another study that emphasizes analysing the factors that influence the perception of side effects of users of psychotropic medication. The incidence of adeverse effects and the information about the effects in patients is a subject not very well Known. There are not many bibliographical references on the degree of satisfaction of the patients about the information received on the effects of the medication they use1,2. A particularly area is the adverse effects3,4,5 of some psychotropic drugs, since in anxious patient, the medication they take may influence their sexual desire, which may contribute to additional anxiety that can be difficult to control. It is in this group of patients, those who take psychotropic medication prescribed in outpatient consultations in general medicine and psychiatry that we have done our research.

Analysis of Hearing Monitoring in Children during Annual Visits to an Outpatient Hearing Health Service Program

Preserving the integrity of the auditory system is crucial for language development, learning, and social interaction. Any interruption in these processes during development can result in significant functional impairments. The objective was to carry out a longitudinal analysis of audiological data from children who underwent an initial assessment at SASA in 2018 and were followed up for 4 years at the outpatient's annual consultations. This is a retrospective cross-sectional study with children who underwent initial assessment for hearing loss and follow-up at a reference service for the Unified Health System (SUS), from January 2018 to December 2022. Children aged 0 to 12 years old who underwent an initial assessment for hearing loss and follow-up in the service's database, where secondary data analyses will be carried out. Data from 127 subjects with an average age of 20 months were analyzed. 60.62% of the subjects were diagnosed with some degree of hearing loss, and the etiology of the change remained unknown in 29.90% of the cases. A considerable percentage of subjects remained under follow-up during annual consultations. There was good adherence to annual returns and follow-ups at the outpatient clinic, indicating a high attendance rate.

Health Benefit Utilization and Out-of-Pocket Expenses in Outpatient Care and Hospitalizations: Baseline Surveys of Three Primary Care Sites in the Philippines.

The Philippine Primary Care Studies (PPCS) is a network of pilot studies that developed, implemented, and tested strategies to strengthen primary care in the country. These pilot studies were implemented in an urban, rural, and remote setting. The aim is to use the findings to guide the policies of the national health insurance program (PhilHealth), the main payor for individualized healthcare services in the country. The objective of this report is to compare baseline outpatient benefit utilization, hospitalization, and health spending, including out-of-pocket (OOP) expenses, in three health settings (urban, rural, and remote). These findings were used to contextualize strategies to strengthen primary care in these three settings. Cross-sectional surveys were carried out using an interviewer-assisted questionnaire on a random sample of families in the urban site, and a stratified random sample of households in the rural and remote sites. The questionnaire asked for out-patient and hospitalization utilization and spending, including the OOP expenses. A total of 787 families/households were sampled across the three sites. For outpatient benefits, utilization was low in all sites. The remote site had the lowest utilization at only 15%. Unexpectedly, the average annual OOP expenses for outpatient consults in the remote site was PhP 571.92/per capita. This is 40% higher than expenses shouldered by families in the rural area, but similar with the urban site.For hospital benefits, utilization was lowest in the remote site (55.7%) compared to 75.0% and 78.1% for the urban and rural sites, respectively. OOP expenses per year were highest in the remote site at PhP 2204.44 per capita, probably because of delay in access to healthcare and consequently more severe conditions. Surprisingly, annual expenses per year for families in the rural sites (PhP 672.03 per capita) were less than half of what families in the urban sites spent (PhP 1783.38 per capita). Compared to families in the urban site and households in the rural sites, households in remote areas have higher disease rates and consequently, increased need for outpatient and inpatient health services. When they do get sick, access to care is more difficult. This leads to lower rates of benefit utilization and higher out-of-pocket expenses. Thus, provision of "equal" benefits can inadvertently lead to "inequitable" healthcare, pushing disadvantaged populations into a greater disadvantage. These results imply that health benefits need to be allocated according to need. Families in poorer and more remote areas may require greater subsidies.

Evaluation of a multicomponent integrated intervention to improve the quality of care for anticoagulated frail older adults in a home care system in the city of Buenos Aires

Introduction: Anticoagulation in older adults is a real challenge due to the presence of health conditions that can alter the adequate control of the patient. Older adults confined to home probably could not attend outpatient medical consultations. On many occasions, the monitoring of the patient's health process at home is carried out by a health professional who does not monitor the anticoagulant treatment (e.g. due to lack of experience of the professional).&#x0D; For this reason, the home care section of the Italian Hospital of Buenos Aires (HIBA) created an interdisciplinary team for the telephone follow-up of anticoagulated patients in that area.&#x0D; Objectives: Describe the effect of a multicomponent intervention to improve the quality of anticoagulation therapy in frail elderly patients in the home care system of the HIBA.&#x0D; Methods: Prospective pragmatic evaluation study of a multiple intervention with a before-after design. Variables were analyzed from secondary databases 6 months before and after the intervention. The unit of analysis was the patient acting as his own control. The setting was the home medicine section of HIBA. We included patients aged 65 years or over receiving dicumarinics with home care and follow-up by a doctor with fewer tools in the management of anticoagulants and with communication barriers. Telephone contacts with patients were made by family physicians. A hematologist was consulted whenever necessary. Pharmacists sent pills of vitamin K with educational brochures to the patient's home. Health and social counsellors contacted patients in complex cases to strengthen education. Reasons for withdrawal of the program were: death, hospitalization, termination of the home care service, follow-up of the treatment by a hematologist or anticoagulant suspension.&#x0D; Results: Analysis of the data was performed before the intervention (June 1, 2021 to November 30, 2021) and after the intervention ( December 1, 2021, to June 30, 2022), 41 patients were included, 78% were female, average age was 87 years. The mean of basic activities of daily living was 3.35, the average of the Percentage of International Normalized Ratio Measurements in Range (PINRR) in the pre intervention was 31% and 49% in the post. There weren't thrombotic events and the average of bleeding events was 6% in the pre and 0% in the post, extreme values of INR (&gt;6) in the pre was 3% and in the post 0,5%. Finally the mean of emergency medical consultations was 1,15 in the pre and 0,29 in the post.&#x0D; Conclusions: The present work consists in the analysis of an elderly population highly dependent on activities of daily living. The data shows a possible tendency of reduction in the number of emergency medical consultations, bleeding events and improvement in the PINRR. As next steps we propose evaluate patients' satisfaction with the intervention, analize long-term results as the program works in time and generate institutional tools to deprescribe.&#x0D; &#x0D; &#x0D;