Outpatient Health Care Research Articles

Patients' preferences for virtual outpatient consultations and health care professionals' assessment of suitability for their patients: A single-centre survey.

To explore patients' preferences regarding virtual consultations (via telephone or video) and to explore healthcare professionals' assessment of whether virtual consultations can maintain the same clinical quality as in-person consultations for outpatient care. A cross-sectional survey was conducted among patients with an in-person consultation at the outpatient clinic for internal medicine and among healthcare professionals who treated the patients. The prevalence of preference was determined using descriptive statistics based on cross-tabulated frequencies. Percentages are presented with 95% confidence intervals (95%CI). In total, 218 patients (response rate 67%) completed the questionnaire; 79 patients (36%) preferred a virtual consultation (95%CI: 30%-43%); telephones were the most popular and preferred by 72 patients (33%; 95%CI: 27%-39%) followed by video preferred by 54 patients (25%; 95%CI: 19%-31%). Regarding contextual factors, male gender and previous experiences with telephone or video consultations were statistically significant predictors in favour of virtual consultations. Healthcare professionals estimated that 58 consultations (21%; 95%CI: 17%-26%) could have been conducted virtually with the same professional and clinical quality as the current in-person consultations. Current practice does not fully align with patient preferences for virtual visits in internal medicine outpatient clinics. Patients should be given the choice of virtual consultations whenever they are deemed professionally and clinically possible to enhance patient autonomy and satisfaction, while being mindful of speciality-specific considerations.

Excess mortality and life-years lost in people diagnosed with depression: A 20-year population-based cohort study of 126,573 depressed individuals followed for 1,139,073 persons-years

Depression is associated with premature mortality, but evidence is mainly derived from Western countries. Very limited research has evaluated shortened lifespan in depression using life-years-lost (LYLs), a recently developed mortality metric taking into account the illness onset for life expectancy estimation. Temporal trends of differential mortality gap are understudied. This population-based cohort study, which utilized a territory-wide medical-record database of public inpatient and outpatient healthcare services in Hong Kong, evaluated the extent of premature mortality in 126,573 individuals with depression (persons-years=1,139,073) between January 2002 and December 2021 regarding the standardized mortality ratio (SMR) and excess LYLs. Trends in annual SMRs over 20 years were assessed by joinpoint analyses. The results showed that individuals with depression exhibited significantly higher all-cause (SMR=1.84 [95% CI=1.82–1.88]), natural-cause (1.69 [1.66–1.72]), and unnatural-cause (5.24 [4.97–5.51]) mortality rates than the general population. Suicide-specific SMR was markedly elevated (7.92 [7.47–8.38]), particularly in the 15–34 year-olds (12.75 [10.87–14.79]). Respiratory diseases, cardiovascular diseases and cancers accounted for the majority of deaths. Excess LYLs extended to men (5.67 years, 95% CI = 5.45–5.90) and women (4.06 years, 95% CI = 3.89–4.23). Overall and natural-cause mortality rates improved over time, but unnatural-cause and suicide-related mortality gaps persisted. Taken together, this study indicates that depression is associated with increased premature mortality and reduced lifespan in a predominantly Chinese population, mainly attributed to natural causes. Relative suicide-specific mortality is substantially elevated, especially among young people. The pronounced mortality gap underscores an urgent need for effective interventions targeting improved physical health and suicide risk reduction in individuals with depression.

The impact of COVID-19 on private healthcare service utilisation: time series analysis in the capital region of Finland during 2020–2022

BackgroundMost current studies on COVID-19 have focused on the first weeks or months of the pandemic or have addressed specific diseases. The long-term effects of the COVID-19 pandemic on healthcare services are insufficiently understood. We analysed the long-term effects of the COVID-19 pandemic on outpatient healthcare utilisation in the full spectrum of diseases in Uusimaa, the capital region of Finland.MethodsOur data included 632 466 individual patients between the ages of 18 and 65 and 6 521 394 visits to healthcare personnel from electronic health records. We fitted an autoregressive integrated moving average (ARIMA) model to pre-2020 data to predict the expected quantity of diagnoses for the period between 1 January 2020 and 16 June 2022. Expected and observed quantities of diagnoses were compared.ResultsThe overall quantity of diagnoses declined by one-fourth immediately following the onset of the pandemic and remained around 15% below predicted values for most of the pandemic. After the pandemic-related restrictions were lifted, the total diagnostic activity started to recover to pre-pandemic projection levels. However, this recovery has been mainly driven by upper respiratory system-related activity. The number of diagnoses for many diagnosis groups has remained below the predicted levels, even after the concurrent removal of mobility restrictions and increased coverage of vaccinations in this population.ConclusionsThe pandemic resulted in an overall reduction in outpatient healthcare utilisation which persisted for 30 months. While the overall diagnostic activity has eventually recovered to predicted levels, many classes of diagnoses display reduced levels in the study population over the follow-up period. Some diseases that may have long-lasting effects when left untreated seem to remain underdiagnosed, potentially increasing pressure on the healthcare system in the future.

Nationwide Epidemiology and Outpatient Healthcare Resource Use of Children with Respiratory Syncytial Virus from 2005 to 2021.

Respiratory syncytial virus (RSV) poses a global health challenge, particularly among younger children. While the disease burden in Japan has been preliminarily quantified in short-term or inpatient settings, a comprehensive understanding of outpatient settings at a national level is still lacking. In this retrospective cohort study, we followed 697,802 children until they reached 60 months of age, amounting to 25,680,468 million person-months, using two nationally representative databases from the fiscal years 2005-2021. We analyzed trends in the epidemiology of RSV infections and associated outpatient health resource use. Incidence rates of RSV and associated hospitalizations among infants showed fluctuations of 50-100 cases and 20-30 hospitalizations per 1000 person-years, respectively, during the 2010s. These rates dropped to 8.7 cases and 2.2 hospitalizations per 1000 person-years in 2020, then returned to the same levels in the 2010s. Similar patterns were noted for RSV testing, outpatient visits, healthcare cost and the proportion of cases hospitalized (case-hospitalization risk). Whereas antibiotic use decreased from 56.4% in 2005 to 27.8% in 2021, palivizumab use increased from 95.2-195.9 days of therapy per 1000 person-years. Applying the calculated incidence rates to national data, annual outpatient healthcare costs for RSV infections were estimated to be 7-9 billion JPY (50-64 million USD) for children aged <60 months in the late 2010s. Our study highlights the changes in epidemiology and outpatient health resource utilization for children with RSV infections. These findings are valuable for policymakers and clinicians aiming to develop strategies, including newly developed maternal vaccines and single-dose long-acting monoclonal antibodies.

Utilization of Syndromic Vaginitis Diagnostic Testing Reduces 6-Month Follow-Up Outpatient Service Healthcare Costs—A Real-World Data Analysis

Background/Objectives: Vaginitis is a common infection among women of reproductive age. Although various diagnostic methodologies exist, diagnosis without the utilization of available diagnostic tests remains prevalent. This study aimed to assess downstream healthcare utilization and the cost of patients with and without diagnostic testing. Methods: This retrospective, observational study utilized the IQVIA PharMetrics® Plus database from July 2020 to October 2023. Patients with an index claim (ICD-10 code indicating vaginitis) were categorized into two cohorts: those who received a syndromic polymerase chain reaction (PCR) test and those who had no documented test on the index date or within two days. Total and service-specific healthcare resource utilization and costs were assessed for 6 months following the index event. This study was designed to inform how Syndromic Vaginitis PCR testing is used to make treatment decisions and to track outpatient and inpatient healthcare utilization for 6 months post index date represented by cost. Results: Patients who received a Syndromic Vaginitis PCR test had significantly fewer outpatient medical services in the 6 months following initial diagnosis compared to those who received no diagnostic test. This was largely attributed to a substantial decrease in other medical service visits, resulting in mean cost savings of USD 2067 (Syndromic PCR = USD 6675, SD = USD 17,187; No Test = USD 8742, SD = USD 29,894) (p-value 0.0009). Conclusions: Many vaginitis patients do not receive testing, but Syndromic Vaginitis PCR testing may be an effective diagnostic tool for reducing costs associated with vaginitis infections.

A "silent storm": uncovering the escalating crisis in mental healthcare for children and adolescents in Slovenia during and after the COVID-19 pandemic.

Our aim was to assess the burden of children and adolescents' mental health problems on the Slovenian outpatient healthcare system before, during and after the pandemic. In a retrospective analysis of healthcare indicators from 2008 to 2023, we analysed data from the National Institute of Public Health. Key domains included initial visits for mental and behavioural disorders (MBDs) to primary care for the population aged 0-19; the number of referrals to an initial assessment with a child and adolescent psychiatrist (CAP) at the secondary level for the population aged 0-17 along with the corresponding waiting times; and the number of urgent referrals for the population aged 0-17 to emergency mental health centres at the tertiary level. The calculations included rates per 1000 people. Descriptive statistics and diagrams were used to compare the data. Segmented linear regression analysis (SLR) was conducted on the primary healthcare data to identify the distinct temporal point indicating an increase. Comparing the average rates of the 2020-2022 period to those of the 2018-2019 period, there was a 20% increase in initial visits to primary care, a 23% increase in the referral rate to a CAP at the secondary level, and a 41% increase to the tertiary level of care. In secondary care, a four- to sevenfold increase in waiting times for the initial CAP assessment was observed between 2019 and 2023. The incidence of initial visits to primary healthcare services for MBD increased from 2008 to 2019 (average annual growth rate of 4.5%). The average annual growth rate for the 2020-2022 period tripled to 13.9%. The SLR showed that the trend of accelerating growth could have begun in 2017 for the 0-5 age group and possibly for the 15-19 age group as well. After the initial decline in 2020, all levels of the Slovenian healthcare system faced an increased burden of MBD in children and adolescents from 2021 to 2022 compared to pre-pandemic levels. Nevertheless, a portion of this increase aligns with longitudinal growing trends from 2008 onwards. Tackling the crisis requires urgent national action, significant improvement in organization, and investments in mental health.

Healthcare utilisation patterns and drivers amongst inflammatory bowel disease patients in the outpatient clinic.

Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, impose an escalating burden on healthcare systems globally, with a rising prevalence contributing to increased costs. This study explored healthcare utilisation patterns and its drivers amongst IBD patients in an outpatient clinic. A longitudinal cohort study was conducted at a Dutch academic teaching hospital. IBD patients (n = 180) were followed for 1 year and were categorised based on disease activity and consultation frequency. Healthcare utilisation was assessed through consultations and laboratory tests. Patient-reported outcomes and biochemical disease activity were measured, and subsequently the reasons for consultations were analysed. The frequency of outpatient healthcare utilisation exceeded the recommended IBD care guidelines by two-fold. Comorbidities were the leading reason for consultations (40.4%), followed by remission induction, medication changes and pending test results. Moreover, clinical disease activity, reported problems with self-care, daily activities and pain were predictive of an increase in annual consultations. This study identified factors influencing healthcare utilisation in IBD outpatients. Personalised care pathways using eHealth technologies have the potential to reduce unnecessary consultations and optimise resource allocation.

Driving innovation in primary healthcare though co-creation with stakeholders in Switzerland

Abstract Issue/problem Primary healthcare systems worldwide face challenges such as socio-demographic shifts, increasing chronic diseases, rising costs, and workforce shortages, demanding innovative solutions for the future of primary care. Description of the problem Addressing the complex challenges of creating a resilient primary healthcare model involves considering interdependent factors such as health policies, funding, workforce training, technology, and evolving diseases, alongside diverse stakeholder interests. To tackle this, the ‘Health2040: Co-creation of a Future Outpatient Primary Healthcare Model in Switzerland’ project was launched in 2023 to develop a forward-looking model by integrating insights from various stakeholders. Results The project involved 40 stakeholders, including patients, researchers, healthcare professionals, policy-makers, and insurers, in two full-day workshops aimed at co-creating a vision and actionable framework for Switzerland’s future primary care. The first workshop focused on developing and visualizing potential models, while the second targeted the transition to these new models and the creation of an implementation plan. These sessions were underpinned by a comprehensive literature review on emerging primary care models, providing a scientific foundation for the discussions. Lessons Successful co-creation requires significant preparatory efforts and innovative creativity techniques, such as Future Newspapers, brainstorming, games, and user personas. Engaging stakeholders throughout various stages of the project helped to enhance relevance. Feedback from a steering group on the workshop’s concept, methodologies, and evidence synthesis was instrumental. Healthcare practitioners also contributed their insights on patient personas, ensuring the models developed were pertinent to actual healthcare practices. Stakeholder engagement process was essential for fostering innovative ideas and ensuring stakeholder buy-in for the developed solutions. Key messages • Co-creation with stakeholders is a promising way to develop innovative solutions for health systems. • Integrating stakeholder input is crucial at all the project stages, from preparation to evaluation.

Development of health care expenditures in Finland up to 2040

Abstract Background Increasing health care expenditures are threatening public health by complicating the supply of adequate health services. Exploration of possible future developments of the expenditures is needed to understand how to prepare for future or to change an unwanted course of development. We provided projections by health care sectors taking into account demographic and other developments. Methods We used national data on the realized expenditures per capita by age group, sex and health care sectors from 2017 to 2020, and official forecasts of the population in Finland up to 2040. Future per capita expenditures were projected with Bayesian linear regression models incorporating a priori dependency structure for the slope parameters of the age groups such that the time trends of adjacent groups would be more similar than other groups. These projections were then combined with the population forecasts to estimate the total expenditures. Results The greatest increase (164%) was estimated for the total costs of the primary outpatient healthcare: from 2153 to 5677 million euros in 2020-2040, such that 7% of the growth was attributed to demographic developments. The estimated growths were 68% for the primary inpatient healthcare, 14% for the specialised somatic healthcare, and 52% for the urgent and emergency health services, of which 91%, 98% and 21% were attributed to demographic developments, respectively. Conclusions Notable increases in expenditures are expected in all considered health care sectors, but there are great differences in the proportions of the growth attributed to demographic developments. Due to the limited role of demographic changes, it is worth focusing on controlling the impacts of other developments by, e.g., improving the population health and the efficiency of the health care system. Key messages • Notable increases are expected in health care expenditures up to 2040. • Impacts of demographic changes varies markedly between health care sectors.

Sick-leave trajectories among people sickness absent with stress-related diagnoses; cohort studies

Abstract Background Stress-related disorders are common sickness absence (SA) diagnoses in many Western countries. Knowledge of SA and disability pension (DP) patterns among people with such SA is needed. Thus, the aim was to identify future SADP trajectories among people with a new SA spell due to stress-related diagnosis and to examine sociodemographic and health-related factors associated with identified trajectories. Methods Using microdata from nationwide registers, we included all people living in Sweden with a new SA spell &amp;gt;14 days due to stress-related diagnoses (ICD-10 code F43) in 2011 (N = 32,417) or 2018 (N = 65,511), respectively. These two cohorts were followed prospectively for 13 months from the SA spell start, to identify trajectory groups of mean SA/DP days/month using group-based trajectory modeling. We used multinomial logistic regression to explore associations between sociodemographic and health-related predictors and trajectory membership. Results We identified the following SA/DP trajectories in both cohorts: steep drop (30.6% and 35.9% of all included in 2018 and 2011, respectively); fluctuating (8.7%, 11.2%); fast decrease (25.5%, 24.4%); medium decrease (18.1%, 13.1%); slow decrease (10.8%, 7.3%), and constant high (6.2%, 8.0%). Compared to the steep drop trajectory, individuals in the other trajectories were more likely women, older, and had prior SA/DP or secondary outpatient healthcare visits. Starting the SA spell full-time was the strongest predictor for the slow decrease and constant high trajectory, and previous SA or diagnosis of other mental disorders were predictors of the constant fluctuating and constant high trajectory. Conclusions The similarity of the identified trajectories in the two cohorts is a strength. The results reveal the diversity of future SA/DP in this patient group, indicating the importance of identifying patients at risk of long-term SA who might need further interventions early in the process. Key messages • In two population-wide cohorts with a new sickness absence (SA) spell with stress-related diagnoses, six trajectories of SA/disability pension days were identified during the 13-month follow-up. • Most of those in the cohorts had trajectories that ended with no SA/DP after 13 months, while two trajectories, including 15-19% of individuals, showed high or varying SA/DP days during the follow-up.

Incidence, patient characteristics, and treatment patterns of U.S. active-duty service members diagnosed with COVID-19-associated VTE in the outpatient setting

Abstract Background Venous Thromboembolism (VTE) is a well-established complication of acute coronavirus disease 2019 (COVID-19) infection. We sought to clarify the incidence, patient characteristics, and treatment patterns of VTE within United States active-duty service members (ADSM) diagnosed with COVID-19 infection in the outpatient setting. Methods Our team conducted a multicenter retrospective review of the outpatient healthcare records for all U.S. ADSM diagnosed COVID-19-associated VTE between January 1, 2020, and April 30, 2022. The data was obtained from the COVID-19 surveillance case list maintained by the Armed Services Health Surveillance Division (ASHSD) of the U.S. Defense Health Agency (DHA). The Defense Medical Surveillance System (a database containing inpatient and outpatient electronic medical records for active-duty service members) was used to capture all appropriate medical encounters using ICD-10 coding for venous thromboembolic events within 365 days of COVID-19 diagnosis. Chart review for data adjudication was performed by the physician investigator team. Results Among 365,788 ADSM who were diagnosed with COVID-19 in the outpatient setting, a total of 159 patients were identified as having COVID-19-associated VTE. The overall incidence rate of VTE was 43.47 per 100,000 people within 365 days of diagnosis (90-day incidence rate of 32.5/100,000). The median time from COVID-19 diagnosis to VTE was 23 days (IQR 13-87). Of 159 patients, 33 (20.7%) were diagnosed with DVT, 143 (90%) with PE, and 20 (12.5%) with both PE and DVT. The median age was 30 years old (IQR 23-38). The majority of patients were male (85%). 49% were white. The most common medical comorbidity was obesity (33%), 11% had a history of active tobacco use, and 9.4% of patients had a prior VTE diagnosis. Only 34% of patients were vaccinated for COVID-19 prior to their diagnosis (35 Pfizer–BioNTech, 13 Moderna, and 4 other). 148 (93%) of patients were treated with a direct oral anticoagulant, 10 (6.2%) were treated with low molecular weight heparin, and 1 (0.8%) was treated with a vitamin K antagonist. 96 (60.3%) required hospitalization with 4 (2.5%) requiring subsequent thrombectomy. None experienced major bleeding events. Only 2 (1.3%) of the patients died within 22 days from VTE diagnosis. The remaining 98.7% were alive at 875 days (SD 230) of follow-up. Conclusion The incidence of venous thromboembolism in active-duty military patients with COVID-19 was rare, affecting mostly unvaccinated, minority men in their 30s with risk factors such as obesity, prior VTE, and prior tobacco use. Of the women with VTE, 54% were non-white minorities. While VTE diagnosis was associated with a low mortality rate, the majority of patients required hospitalization.

High caregiver adverse childhood experiences are associated with increased pediatric infection-related healthcare utilization and antibiotic use

Abstract Background Higher caregiver adverse childhood experiences (ACEs) have been associated with a range of pediatric outcomes, including hospitalizations. We recently found that higher caregiver ACEs are associated with higher rates of influenza vaccine uptake. However, to our knowledge, no studies have examined links between caregiver ACEs and specific infections or infection-related outcomes, such as antibiotics prescribed. We sought to evaluate associations between caregiver ACEs and pediatric infection-related outcomes. Methods We conducted a retrospective cohort study of two pediatric primary care sites, each serving a predominantly non-Hispanic Black, publicly insured population. At one primary care site (Clinic A), routine screenings for caregiver ACEs began in 2019 at the 1-month well-child check and were retrieved from the electronic health record. For the other primary care site (Clinic B), a prior research study surveyed caregiver ACEs of 283 children. Focusing on children 0-4 years of age in both primary care sites, we retrieved data from the electronic health record, including patient infection-related outcomes, demographic characteristics, and social risk screen results for those who had caregiver ACEs systematically recorded. The number of reported caregiver ACEs was our exposure variable, dichotomized as high (≥4) or low (≤3). Patient demographic characteristics, results of the overall social risk and maternal depression screen, and area deprivation index scores linked to patients’ geocoded home addresses were also collected. Bivariate analyses were pursued using chi square test statistics. Results A total of 1,442 children 0-4 years of age were included in the study, and 50.0% were female, 74.7% Black, and 2.6% Hispanic. Fifteen percent of caregivers had high (≥4) ACEs. Differences in infection-related outcomes, and relevant covariates, based on high and low caregiver ACEs are depicted in Table 1. Children of caregivers with high ACEs had more outpatient infection-related visits (80% versus 72.6%, p = 0.03), including more diagnoses of streptococcal pharyngitis (10.1% versus 4.1%, p = 0.0004). They also had more prescriptions for any oral antibiotic (30.9% versus 23.2%, p = 0.02). In bivariate analyses, high caregiver ACEs (31.3% versus 23.7%, p = 0.03), lower area deprivation index score (mean (SD) of 0.47 (0.16) versus 0.50 (0.16), p &amp;lt; 0.01), older patient age (mean (SD) of 2.73 (1.10) versus 1.73 (1.00) years, p &amp;lt; 0.0001), and any outpatient (35.9% versus 2.2%, p &amp;lt; 0.0001), emergent (40.0% versus 10.9%, p &amp;lt; 0.0001), or inpatient visit (42.7% versus 23.0%, p &amp;lt; 0.0001) were each associated with the presence of antibiotic use. Race, ethnicity, a positive social risk screen, and positive depression screen were not associated with antibiotic use. Conclusion High caregiver ACEs appear to be associated with some types of pediatric infectious diagnoses, antibiotic use and increased infection-related outpatient healthcare utilization. Future adjusted analyses assessing for potential links between ACEs and infection-related outcomes, independent of variables like insurance status, social risk, and area-level deprivation, are warranted and planned.

Hospitalization trends among immigrants and natives in an acute psychiatric service: a descriptive study from Italy

Acute psychiatric services are crucial for immigrants who face barriers in accessing outpatient mental healthcare due to socio-economic, cultural, and linguistic challenges. This study compared psychiatric hospitalization characteristics between immigrants and native Italians at the University of Foggia from 2004 to 2019. A total of 536 inpatients, equally divided between immigrants and natives, were analysed for sociodemographic and clinical variables. Findings revealed that immigrants were hospitalized through emergency departments for severe psychiatric disorders such as psychosis, while natives were more often admitted for mood disorders. Immigrants showed a higher incidence of substance abuse and suicidal attempts and a lower number of prior hospitalizations compared to natives, with higher incidence of first episodes of mental illness. Despite presenting with severe psychopathology, natives exhibited better clinical outcomes, longer hospitalizations and higher functioning improvements. We also found that natives received more psychotropic medications but experienced fewer adverse effects compared to immigrants. Differences in pharmacological treatments and hospital outcomes suggested that culturally tailored interventions could improve the effectiveness of psychiatric care for migrants. These findings emphasized the necessity for systemic changes in mental health services to address disparities and improve care for migrant populations.

Does outpatient mutual-aid reduce oncology patients' utilization of inpatient services?-An empirical study of outpatient mutual-aid policy in Wuhan, China.

The escalating costs of healthcare had prompted countries to undertake reforms, and in recent years China had focused on overhauling its outpatient healthcare system. China implemented the outpatient mutual-aid policy which had led to a change in the costs associated with outpatient treatment from being fully self-paid by the patient to being partially self-paid. This study aimed to assess the impact of the outpatient mutual-aid policy on inpatient services for oncology patients in Wuhan, China, exploring the impact that the cumbersome administration of health insurance would have on patient welfare. 24,260 oncology patients of the health insurance reimbursement database in Wuhan spanning from January 2022 to July 2023 were included. After data processing, 12,985 patients were included in the control group and 11,275 patients were included in the experimental group. The regression discontinuity design was employed to assess the impact of the policy. The findings was that the implementation of the outpatient mutual-aid would result in a reduction of 1.2days in the length of stay for oncology patients, a decrease in hospital costs by 5%, and a decline in expenditure of the health insurance reimbursement funds by 5 per cent. Incorporating outpatient costs into reimbursement supplanted the utilization of inpatient services, enhanced the allocation of healthcare resources, and alleviated the financial burden on oncology patients. Furthermore, it highlighted the detrimental impact of eligibility review to verify that a patient meets the reimbursement requirements of the health insurance policy on patient welfare.

Reductions in inpatient and outpatient mental health care in germany during the first year of the COVID-19 pandemic - What can we learn for a better crisis preparedness?

During the COVID-19 pandemic, reports from several European mental health care systems hinted at important changes in utilization. So far, no study examined changes in utilization in the German mental health care inpatient and outpatient mental health care system comprehensively. This longitudinal observational study used claims data from two major German statutory health insurances, AOK PLUS and BKK, covering 162,905 inpatients and 2,131,186 outpatients with mental disorders nationwide. We analyzed changes in inpatient and outpatient mental health service utilization over the course of the first two lockdown phases (LDPs) of the pandemic in 2020 compared to a pre-COVID-19 reference period dating from March 2019 to February 2020 using a time series forecast model. We observed significant decreases in the number of inpatient hospital admissions by 24-28% compared to the reference period. Day clinic admissions were even further reduced by 44-61%. Length of stay was significantly decreased for day clinic care but not for inpatient care. In the outpatient sector, the data showed a significant reduction in the number of incident outpatient diagnoses. Indirect evidence regarding the consequences of the reductions in both the inpatient and outpatient sector of care described in this study is ambiguous and direct evidence on treatment outcomes and quality of trans-sectoral mental healthcare is sparse. In line with WHO and OECD we propose a comprehensive mental health system surveillance to prepare for a better oversight and thereby a better resilience during future global major disruptions.

Improving transitional care after acute myocardial infarction: A scoping review.

Cardiovascular disease remains the leading cause of morbidity and mortality, posing a significant challenge to healthcare systems worldwide. Transitional care interventions, which ensure coordination and continuity of care as patients move between different levels of healthcare, have been shown to reduce unnecessary healthcare utilization and improve patient outcomes. While much attention has been given to transitional care in heart failure, this review aims to map the interventions implemented for patients following an acute myocardial infarction (AMI). A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology, with literature searches performed in the Cochrane, CINAHL, MEDLINE, JBI, and SciELO databases, focusing on publications from 2013 onwards in both Portuguese and English. Seventy-five studies were included, with most combining multiple interventions that contributed to improved cardiovascular health outcomes, including increased adherence to healthy lifestyle behaviors, enhanced medication compliance, and better healthcare self-management. These interventions were effective in reducing cardiovascular-related Emergency Department visits, unplanned 30-day readmissions, and mortality following a first-time myocardial infarction. Key strategies identified included discharge planning, digital health solutions, outpatient care, and healthcare coordination. The findings of this review underscore the need for developing methodologies that enhance the transition of care from hospital to primary care following an AMI. There is an urgent need to design and implement new healthcare programs that integrate discharge interventions, digital health, outpatient care, and healthcare coordination to ensure continuity of care and optimize patient outcomes post-discharge.

Treatments, medical expenses and complications of hospital outpatient healthcare associated with stroke in patients with diabetes in China: a retrospective analysis of the Beijing Municipal Medical Insurance Database

ObjectivesDiabetes is closely associated with risk of stroke and its adverse sequelae. Approximately 20%–33% of patients with stroke have diabetes. In China, however, it is unclear how stroke affects healthcare...

Thoracic Trauma: Diagnosis And Treatment

The study of chest injuries which profoundly impact quality of life, life expectancy, disability rates, and mortality is of significant importance. In clinical research, the authors analyzed diagnostic results from 527 patients aged 18 to 85 with closed chest trauma, consisting of 82% men and 18% women. The study confirms that traumatic chest injuries are severe conditions that necessitate strict adherence to well-defined diagnostic and treatment guidelines. It is advisable to utilize thoracoscopy and video-assisted thoracoscopy for managing hemothoraxes with small volumes of bleeding, as these minimally invasive techniques can enhance patient outcomes and reduce recovery times. The incorporation of advanced three-dimensional (3D) printing technologies into medical practice for chest injuries is also recommended, as it can improve surgical planning and enable personalized treatment strategies. Moreover, 3D printing can aid in the fabrication of patient-specific implants and prosthetics, thereby enhancing the effectiveness of reconstructive surgeries. Further research is needed on pharmacotherapy when using medications in accordance with the codes of the 11th revision of the International Classification of Diseases, to optimize therapeutic efficacy. Additionally, an in-depth study of the integrated ABC/VEN-analysis of drug prescriptions in pharmacotherapeutic regimens for thoracic trauma treatment dynamics in both inpatient and outpatient healthcare facilities is recommended. This could lead to better resource allocation, improved patient care, and the development of more effective treatment protocols. Emphasizing interdisciplinary collaboration among surgeons, radiologists, and pharmacologists is crucial to advance the management of chest trauma, ensuring that patients receive comprehensive and holistic care throughout their recovery process.

Self-reported smoking status and exhaled carbon monoxide in secondary preventive follow-up after coronary heart events: Do our patients tell the truth?

Smoking cessation reduces the risk of myocardial infarctions (MI) and death in patients with coronary heart disease. Smoking status is frequently assessed based on self-report. The aims of this study were to compare self-reported and objectively measured (exhaled carbon monoxide [eCO]) smoking status after MI, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG), and to assess whether assumed wrongly declared smoking cessation was associated to poorer achievement of other treatment targets for secondary prevention. This study was a sub-analysis from a randomized controlled trial at Sorlandet Hospital, Arendal, Norway, 2007-2022, including patients hospitalized due to MI or after scheduled PCI/CABG, and primarily aimed at comparing secondary preventive follow-up in the outpatient clinic versus primary healthcare. Participants were followed up after the index event through outpatient consultations. Smoking status was assessed by self-report and by eCO (Smokerlyzer, Bedfont, UK) with concentration values ≥6 ppm interpreted as suggesting smoking. A total of 1540 participants aged 18-80 years were included in the main study. Self-reported smoking status and concomitant eCO measurement one year after the index event were available in 1291 (84%) participants. In all, Brussels, Belgium, from the 12th to the 13th of September 2024. The concentration of eCO was ≥6 ppm one year after the index event in 285 (22%) patients, and 72 (25%) of these patients reported non-smoking. Fewer patients with elevated eCO reporting non-smoking achieved the treatment target for blood pressure (<140/90 mmHg) in comparison to those reporting smoking (53% vs 68%, p=0.02). No differences for the other treatment targets for secondary prevention were found. The study indicates a need for objective measures for smoking cessation both in clinical studies and in clinical practice, and may indicate a lack of truthfulness regarding smoking habits. The study is registered on the official website of ClinicalTrials.gov. ID NCT00679237.

The in- and outpatient health care use of patients with COPD before and after initiation of home care: a registry study from Norway

Objective Chronic obstructive pulmonary disease (COPD) is a common condition associated with age, multimorbidity and frequently involves the use of health care across levels. Understanding the factors associated with the initiation of long-term care is important when planning the future need for services. We describe healthcare use before and after the reception of any home care. We further studied the associations between healthcare use and first registered home care service and from first registered home care service to nursing home admission or death. Design and subjects Patients residing in Oslo or Trondheim at the time of first contact with a COPD primary diagnosis, 2009–2018. Patient data were linked across national and municipal registries, covering healthcare and sociodemographics. The sample consisted of 16,738 individuals. Results There was a marked increase in inpatient and outpatient hospital contacts in the years prior to and after the reception of any home care. Adjusted for comorbidities and sociodemographics, high numbers of GP consultations, and inpatient and outpatient hospital contacts for respiratory diagnoses were associated with a significantly higher likelihood of receiving home care the next year (hazard odds ratios > 1.3). Following the reception of home care, the type of home care service received (e.g. home nursing or short-term rehabilitation/treatment) was more important than outpatient services in predicting next-year nursing home admission or death. Conclusion Including data on prior outpatient care when predicting future need for home care is beneficial. A high frequency (top 10%) of yearly GP, in- or outpatient hospital contacts can imply that the patient may be in need of home care in the near future.