Outpatient Medical Facilities Research Articles

Predictors of High-Risk Sexual Behavior Among People Living With HIV/AIDS

Several recent studies have found that a significant number of HIV+ individuals are engaging in unsafe sexual practices. This study was conducted to explore the correlates of high-risk sex among a sample of 360 HIV+ adults recruited from outpatient medical care facilities. The study showed that 34% of all respondents reported at least 1 occasion of unprotected anal or vaginal intercourse in the previous 6 months. Consistent with other research, there were multiple correlates of high-risk sex: lower income, an elevated number of sexual partners, negative attitudes about condoms, lack of risk avoidance strategies, and recreational and intravenous drug use prior to sex. However, contrary to other research, no association was found between low self-esteem, depression/anxiety, or the use of alcohol with unprotected sex. Unlike most studies that have focused exclusively on gay and bisexual men, this study included an additional sample of women and poorer, ethnically diverse individuals. Although there were some gender and ethnic differences, neither gender nor ethnicity moderated any of the significant relationships between psychosocial variables and sexual behavior, suggesting the commonality of issues confronting people living with HIV/AIDS in maintaining safer sex practices. Implications for designing interventions for HIV+ persons are discussed.

Modeling and analyzing a physician clinic environment using discrete-event (visual) simulation

This paper examines the design and development of a discrete-event (visual) simulation model of a physician clinic environment within a physician network. Biological & Popular Culture, Inc. (Biopop) sought to partner with healthcare professionals to provide high-quality, cost-effective medical care within a physician network setting. Towards this end, a discrete-event (visual) simulation model that captures both the operations of a family practice healthcare clinic and a centralized information center is presented. The research presented in this article focuses on the family practice healthcare clinic. This simulation model is built in an object-oriented, visual manner utilizing the visual simulation environment (VSE). Application of the object-oriented paradigm (OOP) allows simulation objects in the model to be easily reused. The simulation model provides a tool for risk-free evaluation of operating policies in the clinical environment. Results of a fractional factorial design to determine those input factors which significantly affect overall clinic effectiveness are reported. Scope and purpose With increased pressures from governmental and insurance agencies, today's physician devotes less time to patient care and more time to administration. To alleviate this problem, Biological & Popular Culture, Inc. (Biopop) proposed the building of partnerships with healthcare professionals to provide high-quality, cost-effective medical care in a physician network setting. The proposed physician network is to be composed of clinics (i.e., outpatient medical facilities where patient care is delivered) located throughout the United States. Member clinics would benefit from centrally managed non-medical operations and business consultation from Biopop. Biopop's overall goal is to increase patient flow and customer satisfaction in the clinical environment. To assist Biopop in evaluating potential operating procedures, a discrete-event simulation model has been constructed. The model is built in an object-oriented, visual manner utilizing Orca Computer, Inc.'s visual simulation environment (VSE). The model examines both internal Biopop operations and external clinic operations. The research presented herein describes how the simulation model was designed and built, including the verification, validation, and testing procedures applied. Results of simulation experiments run on the clinical environment using the simulation model are also reported. The results of these computer runs suggest ways in which healthcare clinics can be redesigned, without sacrificing service levels or profitability of the facility.

Part 6: Advanced Cardiovascular Life Support

Part 6: Advanced Cardiovascular Life Support

Toxoplasmic encephalitis in HIV-infected persons: risk factors and trends. The Adult/Adolescent Spectrum of Disease Group.

To evaluate the incidence of and risk factors for toxoplasmic encephalitis among HIV-infected persons. Medical facility-based prospective medical record reviews of consecutive patients. We analysed data collected from January 1990 through August 1995 in more than 90 inpatient and outpatient medical facilities in nine US cities. Incidence was calculated as cases per 100 person-years and risk ratios (RR) for annual incidence were calculated using proportional hazards regression while controlling for city, sex, race, age, county of birth, HIV exposure mode, and prior prescription of trimethoprim-sulfamethoxazole (TMP-SMX). The incidence of TE was 4.0 cases per 100 person-years among persons with a CD4+ T-lymphocyte count of < 100 x 10(6)/l. In multivariate analysis, among the nine cities the annual incidence of toxoplasmosis was significantly lower only in Denver [RR, 0.3; 95% confidence interval (CI), 0.1-0.7; referent city, Seattle]. Persons prescribed TMP-SMX were half as likely to develop toxoplasmic encephalitis as those who were not (RR, 0.5; 95% CI, 0.4-0.7). Of the 4173 persons with AIDS (1987 Centers for Disease Control and Prevention definition) who died during the study period, 267 (6.4%) had toxoplasmic encephalitis in the course of HIV disease. Toxoplasmic encephalitis in HIV-infected persons varies by geographic area in the United States. TMP-SMX reduces the risk for toxoplasmic encephalitis.

Provision of Gynecologic Care at Outpatient Medical Facilities Serving HIV-Infected Persons

ABSTRACT Background: Women with human immunodeficiency virus (HIV) infection may be at increased risk for certain gynecologic conditions, including some that may be more severe in the presence of HIV-induced immunosuppression. Methods: Participating sites for an observational project on the spectrum of HIV disease, conducted by the Centers for Disease Control and selected health departments, provided information regarding gynecologic care practices as documented in medical records at 22 outpatient HIV-care facilities. These facilities served greater than 1,000 HIV-infected women in nine U.S. cities from January 1990 through October 1991. Results: Medical records at 14 (64%) sites routinely contained historical information on gynecologic infections and Pap smear results for new patients. Seven (32%) sites, accounting for 51% of HIV-infected women in the project, routinely provided annual pelvic examinations and Pap smears. Among 15 sites that did not provide gynecologic care, only six (40%) usually receive...

Outpatient Care of Diabetic Patients

To the Editor. —The suggested therapeutic approach to the patients with type lib diabetes outlined in Figure 2 in the article by Lipson and Lipson1requires comment. In each algorithm, they recommend admission to the hospital for full evaluation to rule out infection and to give diabetes education. I suggest that this is an expensive, outmoded, and unnecessary step in the care of these patients. The vast majority of obese, maturity-onset diabetics have symptoms that can easily be controlled on an outpatient basis. Practical and straightforward clinical and laboratory evaluation can usually exclude infection if that is thought to be an issue. The hospitalized patient, however, will not eat his usual diet or exercise in his usual fashion; thus, these two factors must still be confronted at the time of discharge. Finally, every outpatient medical facility that pretends to care for diabetics must have access to a competent, preferably formalized,

Formal and Simulation Models for a Phlebotomy Station Service System

The behavior of a central phlebotomy station for an out-patient medical care facility is analyzed by a formal service system model (queuing theory) and by a computer simulation model. Although the distributions of the intervals between successive patient arrivals and the duration of individual phlebotomies do not conform to the requirements of the formal model, some calculated system characteristics, such as the efficiencies of individual phlebotomists, agree quite closely with the results generated by simulation. The two models yield different values for the optimal number of phlebotomists in an econometric analysis, however.

A hospital use evaluation by numerical taxonomy

The manner of customary use of a small hospital has been evaluated using a retrospective classification by numerical taxonomy. A 60 patient random file sample, of a small hospital outpatient medical facility, was reviewed. Groups of facility users were identified and characterized. No single major disease entity accounted for primary economic liability. The analysis correlating diseases with signs, symptoms, epidemiologic and ecologic variables reveals that the epidemiologic and symptomologic features are more closely related to medical care's economic costs. The validity of the classification appears partially verified by the comparison of predicted to known expenses for drugs. It is apparent that numerical taxonomy can provide a method for inventory for complex medical services.

Evaluating Locations for Outpatient Medical Care Facilities

The distance from patient to provider has always been recognized as an important factor to consider when locating medical facilities. Past locational studies have focused on minimizing aggregate patient-provider distance and/or including travel cost estimates when designing cost-minimizing systems of medical facilities.' Recently Acton has pioneered the use of distance (or some variant based on distance) as a in the estimation of the demand for outpatient medical services.2 Acton's empirical results indicate that the time price faced by a patient can be a significant factor in his decision to purchase medical care. Furthermore, he suggests that his approach to estimating consumer demand may have policymaking implications for locating outpatient medical care facilities.3 In this paper, demand relationships based on a time price similar to Acton's are employed to estimate consumer willingness-to-pay for several different facility sites.4 It is hypothesized that aggregate willingness-to-pay for a particular outpatient facility location is based on the following factors: (1) Travel cost; since part of the total of a visit to a medical facility is the consumer's travel cost, economic theory and Acton's empirical results predict that a reduction in travel cost leads to an increase in the quantity of visits purchased by the consumer. To obtain a new medical facility at a given site, the consumer would potentially be willing to pay an amount equal to the net value he places on his additional visits. This net value can be approximated using estimated demand curves for medical services. (2) Option value; since the existence of some medical problems is highly uncertain, the demand for their treatment is also uncertain. However, each potential consumer may be willing to pay to guarantee the presence of a physician in the event of medical emergency.s The exact amount depends on an individual's