Follow-up Appointments For Patients Research Articles

Implementing a Quality Intervention to Improve Confidence in Outpatient Venous Thromboembolism Management.

Guidelines recommend that patients with acute venous thromboembolism (VTE) represented by low-risk deep vein thrombosis (DVT) and pulmonary embolism (PE) receive initial treatment at home versus at the hospital, but a large percentage of these patients are not managed at home. This study assessed the effectiveness of a quality intervention on provider knowledge and confidence in evaluating outpatient treatment for patients with VTE in the emergency department (ED). A pilot program to overcome obstacles to outpatient VTE treatment in appropriate patients was initiated at Baylor Scott & White Health Temple ED. Subsequently, a formalized quality intervention with a targeted educational program was developed and delivered to ED providers. Provider surveys were administered pre- and post-quality intervention in order to assess clinical knowledge, confidence levels, and perceived barriers. Patient discharge information was extracted from electronic health records. Twenty-five ED providers completed the pre- and post-surveys; 690 and 356 patients with VTE were included in the pre- and post-pilot and pre- and post-quality intervention periods, respectively. Many ED providers reported that a major barrier to discharging patients to outpatient care was the lack of available and adequate patient follow-up appointments. Notably, after the quality intervention, an increase in provider clinical knowledge and confidence scores was observed. Discharge rates for patients with VTE increased from 25.6% to 27.5% after the pilot intervention and increased from 28.5% to 29.9% after the quality intervention, but these differences were not statistically significant. Despite instantaneous uptick in discharge rates after the interventions, there was not a long-lasting effect. Although the quality intervention led to improvements in provider clinical knowledge and confidence and identified barriers to discharging patients with VTE, discharge rates remained stable, underscoring the need for additional endeavors.

The relationship between practice ownership and follow-up of comprehensive dental care. A Swedish register study.

The aims of this register study were: 1. To study whether the type of ownership of the dental practice was correlated with the type of dental care provided, that is public versus private ownership and professional (dentist or dental hygienist) versus non-professional ownership. 2. To study the extent of follow-up of patients who have undergone two types of treatments. Material and method: Two types of dental care were defined in the two groups studied, periodontitis/peri-implantitis and comprehensive restorative/rehabilitation. All relevant treatment codes that fall under these definitions are noted when they are performed. Also, the follow-up of each treatment code is noted. Differences in dental and socioeconomic status over time and between regions were adjusted for. A drop-out analysis was performed. Results: Dental practices owned by dentists or dental hygienists schedule follow-up appointments for patients who have undergone comprehensive restorative or rehabilitation dentistry more often than practices with other types of ownership. Dental practices owned by dentists or dental hygienists follow up patients with periodontitis and peri-implantitis less frequently. Type of ownership of a dental business influences the extent to which periodontal, and comprehensive restorative or rehabilitation dentistry were followed up.

THE USE OF A MULTIMEDIA POSTOPERATIVE REPORT FOR PATIENTS UNDERGOING ARTHROSCOPIC KNEE SURGERY: IMPROVING COMMUNICATION WHILE SIMULTANEOUSLY REDUCING FACE-TO-FACE CLINICAL FOLLOW-UP APPOINTMENTS. A QUALITATIVE STUDY

AbstractIntroductionTransforming outpatient services is a key commitment set out in the NHS Long Term Plan, with particular emphasis on digital solutions to reduce outpatient follow-up (FU) by 25%. This study looks at the potential for removing knee arthroscopy FU by providing a bespoke multimedia report for each individual patient, generated using the Synergy™ Surgeon App (Arthrex)MethodologySingle District Hospital using a 3 Phase studyPhase 1 – Assessment of cost and environmental impact of outpatient follow up appointmentsPhase 2 – Bench marking of existing pathways and patient experience.Phase 3 – Qualitative assessment of multimedia report feedback of 30 patientsResultsPhase 1 – Impact per year for Trust in released clinician time 135hrs. Cost avoidance £40-£60k. Reduction of the carbon footprint from reduced FU of 3132 KgCo2e2.Phase 2 – Deep dive on 2019 n. 353 procedures. 1206 outpatient appointments required. Average 1.2 post-operative appointments.Phase 3 – 87% of patients who received the e-op report needed no further FU. This compares to only 25% using a traditional post op discussion after surgery. 94% of patients felt the report aided their recovery.ConclusionsReducing patient FU appointments is crucial to the future of the NHS. Achieving this whilst simultaneously improving the quality of patient communication is achievable as this study has demonstrated. The potential scalability of this project to be applied other arthroscopic procedures is enormous. The study has demonstrated patients are comfortable with modern technology and feel it enhances their understanding whilst decreasing the need for routine post-op FU.

Periodontal clinical status, microbial profile, and expression of interleukin-1β in men under androgenic anabolic steroids abuse.

Androgenic anabolic steroids (AAS) abuse is a serious health problem associated to several systemic complications. Here, we evaluated the periodontal clinical status, microbial profile, and expression of total protein (TP) and interleukin (IL)-1β in men using AAS. Men using AAS were recruited (case group) and matched for age with men who had never used AAS (control group) but also performed physical activities. Plaque index (PI), marginal bleeding (MB), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BoP) were evaluated. Crevicular fluid and subgingival biofilm were collected from healthy and diseased sites (PD ≥ 4 mm with CAL ≥ 1 mm and BoP) and evaluated for TP, IL-1β, and proportions of 40 bacterial species. Thirty patients were included (n = 15/group). AAS consumers had significantly higher mean PD and higher percentage of diseased sites; sites with PD ≥ 4 mm or with CAL ≥ 1 mm than non-consumers. Also, AAS users showed a more dysbiotic biofilm containing lower proportions of host-compatible species and higher proportions of pathogens. IL-1β expression was statistically higher in diseased than in healthy sites only in the control group. A statistically positive correlation was detected between periodontal pathogens and IL-1β expression. The number of AAS cycles was positively associated with higher percentages of periodontal pathogens, but not with IL-1β or total protein concentrations. AAS intake can worsen clinical and immunological periodontal conditions and the biofilm composition in healthy sites. Dental care professionals should perform full mouth periodontal screening and schedule regular follow-up appointments for patients under AAS use.

Influence of the COVID-19 Pandemic on Quality of Life of Patients with Parkinson's Disease.

Introduction This study investigated the influence of lockdown during the 2019 coronavirus disease (COVID-19) pandemic on the quality of life of patients with Parkinson's disease (PD). Methods We conducted a questionnaire survey involving 113 patients with PD from Xihu District, Hangzhou, Zhejiang. During the epidemic prevention and control period (February 1 to March 31, 2020), patients enrolled were asked to fill out questionnaires, including the “COVID-19 Questionnaire for PD Patients during the Period of Epidemic Prevention and Control” and “39-item Parkinson's Disease Questionnaire (PDQ-39).” During the phase of gradual release of epidemic prevention and control (April 1 to April 30, 2020), all patients were followed up again, and PDQ-39 questionnaires were completed. Results The quality of life for patients during the period of epidemic prevention and control was worse than that after epidemic prevention and control (P < 0.001). The biggest problem that they faced was that they could not receive their doctor's advice or guidance regularly. The quality of life of patients who had difficulty getting doctors' guidance or those who changed their routine medication due to lockdown was even worse. Telemedicine was quite effective and efficient for patients to get doctors' guidance during lockdown. Conclusions The inconvenient treatment during the pandemic directly caused the aggravation of patients' symptoms and the decline in their quality of life. It is suggested that social media (such as WeChat or Tencent QQ) are used for regular interactions and follow-up appointments for patients with inconvenient medical treatment.

Management System Development of Diagnostic Imaging in Batu Pahat Hospital

Management System Development Department of Diagnostic Imagingat Hospital Batu Pahat is an effort to automate the existing manualsystem which includes the application of radiological, patientinformation storage, information storage staff, patient follow-upappointments, patient and personal property items stored equipmentinformation manually. Storage of records in this manual will result induplication of information if the patient came to do the x-ray followup.In addition, all patients who undergoing treatment radiological arerequired to leave their personal belongings outside the treatment room.This is likely the patient will lose personal items is high. The mainpurpose of this system to ensure the Diagnostic Imaging Departmentof Hospital Batu Pahat in upgrading and improving its serviceperformance. Prototype Model development methodology used in thisproject. The system will help facilitate the management of dailyoperations of the Department of Diagnostic Imaging. As a result ofthis project is expected to assist the Department of Diagnostic Imagingtowards more efficient management of the organization, in line withgovernment efforts to provide the best service to the people.

Diagnostic Imaging Management System in Batu Pahat Hospital

 Management System Development Department of Diagnostic Imagingat Hospital Batu Pahat is an effort to automate the existing manualsystem which includes the application of radiological, patientinformation storage, information storage staff, patient follow-upappointments, patient and personal property items stored equipmentinformation manually. Storage of records in this manual will result induplication of information if the patient came to do the x-ray followup.In addition, all patients who undergoing treatment radiological arerequired to leave their personal belongings outside the treatment room.This is likely the patient will lose personal items is high. The mainpurpose of this system to ensure the Diagnostic Imaging Departmentof Hospital Batu Pahat in upgrading and improving its serviceperformance. Prototype Model development methodology used in thisproject. The system will help facilitate the management of dailyoperations of the Department of Diagnostic Imaging. As a result ofthis project is expected to assist the Department of Diagnostic Imagingtowards more efficient management of the organization, in line withgovernment efforts to provide the best service to the people.

Effect of a clinical evidence technology on patient skin disease outcomes in primary care: a cluster-randomized controlled trial.

ObjectiveProviders’ use of clinical evidence technologies (CETs) improves their diagnosis and treatment decisions. Despite these benefits, few studies have evaluated the impact of CETs on patient outcomes. The investigators evaluated the effect of one CET, VisualDx, on skin problem outcomes in primary care.MethodsA cluster-randomized controlled pragmatic trial was conducted in outpatient clinics at an academic medical center in the northeastern United States. Participants were primary care providers (PCPs) and their adult patients seen for skin problems. The intervention was VisualDx, as used by PCPs. Outcomes were patient-reported time from index clinic visit to problem resolution, and the number of follow-up visits to any provider for the same problem. PCPs who were randomly assigned to the intervention agreed to use VisualDx as their primary evidence source for skin problems. Control group PCPs agreed not to use VisualDx. Investigators collected outcome data from patients by phone at thirty-day intervals. Cox proportional hazards models assessed time to resolution. Wilcoxon-rank sum tests and logistic regression compared the need for return appointments.ResultsThirty-two PCPs and 433 patients participated. In proportional hazards modelling adjusted for provider clusters, the time from index visit to skin problem resolution was similar in both groups (hazard ratio=0.92; 95% confidence interval [CI]=0.70, 1.21; p=0.54). Patient follow-up appointments did not differ significantly between groups (odds ratio=1.26; CI=0.94, 1.70; p=0.29).ConclusionThis pragmatic trial tested the effectiveness of VisualDx on patient-reported skin disease outcomes in a generalizable clinical setting. There was no difference in skin problem resolution or number of follow-up visits when PCPs used VisualDx.

Radiation Dose Monitoring for Fluoroscopically Guided Interventional Procedures: Effect on Patient Radiation Exposure.

Purpose To analyze the clinical effect of continuous dose monitoring and patient follow-up for fluoroscopically guided vascular interventional procedures over 8 years. Materials and Methods In this retrospective study, an in-house semiautomated system was developed for fluoroscopic dose monitoring. The quarterly number of procedures from January 2010 to December 2017 was analyzed with count time series to estimate quarterly change rate. Technologists recorded four dose surrogates in custom fields of institutional dictation software through a Web interface. Radiation doses were transferred automatically to the radiology report and a centralized dose database when the radiologist initiated procedure dictation. A medical physicist reported weekly on procedures with air kerma at the reference point (Ka,r) of 2 Gy or higher to a division-designated radiologist and hospital radiation safety committee who required the attending radiologist to set up follow-up appointments for patients who underwent procedures with a Ka,r greater than or equal to 5 Gy. Results There were a total of 41 585 procedures; 1553 (3.7%) procedures had a Ka,r of 2-5 Gy. Among 240 procedures with Ka,r greater than 5 Gy, 22 had Ka,r greater than 9 Gy. The percentage of high Ka,r procedures decreased over time, going from 5.9% in 2010 to 2.0% in 2017 for procedures with Ka,r of 2-5 Gy and from 1.0% in 2010 to 0.13% in 2017 for procedures with Ka,r greater than or equal to 5 Gy. Relative reduction per quarter was approximately 2.7% (95% confidence interval: 1.5%, 3.8%) for Ka,r of 2-5 Gy and 4.5% (95% confidence interval: 1.5%, 7.6%) for Ka,r greater than or equal to 5 Gy. Conclusion Eight-year temporal trends show three- to eightfold reduction in the number of high-dose procedures. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Balter in this issue.

Role of Gynaecology Oncology Specialist Nurses in Improving Patient Follow-Up and Integration With the Health Care Team

Background: All advanced gynecologic cancers treated initially with a curative intent should also be referred to palliative care at the outset for symptom management. Specialist nurses can play an integral role in this process as patients feel more comfortable to relay their symptoms to nurses rather than busy clinicians. The concept of specialist nurses has been introduced in June 2016 in the Gynecologic Oncology Department in Tata Medical Center. We aim evaluate our services through this prospective audit. Aim: i: To assess whether pre and posttreatment counseling and follow-up by gynecologic oncology specialist nurses lead to better patient care in the following areas. Increased patient participation in self-reporting of PROM (patient reported outcome monitoring) and uptake of follow-up methods via e-mail, telephone etc. ii: Coordinate administration of intraperitoneal chemotherapy and follow-up. iii: Detection of posttreatment complications and symptoms by telephonic follow up and coordination with the treating team including quality of life data collection. iv: Communicating MDT decisions to patients and arrange appropriate follow-up. v: Reduction of patient follow-up appointments and distress by coordinating with other departments i.e., palliative care team and gynae/medical oncology at same visit. vi: Develop patient information leaflets and providing preoperative education Methods: Prospective audit for service evaluation. Patients follow-up was done by face to face, telephone, e-mail in the pre and postoperative period, during chemotherapy and follow-up visits by 4 specialist nurses. Results: Between June 2016 and December 2017, specialist nurses conducted follow-up of 225 patients both in preoperative and postoperative period and collected 30 day morbidity data. Preoperative health education was given to all. 36 patients were coordinated with palliative care team on same day with gynecologic visit to reduce harassment/repeat appointments. Postchemotherapy follow-up was done for 80 patients after each cycle of chemotherapy. Coordination for 19 intraperitoneal chemotherapy was done by nurses during a 9 month period. As a result of regular follow-up visits, women were more comfortable in self-reporting of symptoms to the nurse including sensitive issues like body image and sexuality even by nonface to face methods including telephone calls/e-mails and postal mails. This has led to early detection of recurrences in 4 women, participation in multicentric national/international quality of life studies (SOCQER2/ SOCQER IND) and successful organization of survivorship programs in gynecologic oncology. Conclusion: Counseling, education and building up of interpersonal relationship with specialist nurses can improve patient participation. The role of CNS is vital to the advancement of nursing practice.

Outpatient follow-up appointments for patients having curative treatment for cancer of the head and neck: are the current arrangements in need of change?

Although there are recommendations, there is little evidence about the rationale for the frequency and duration of review appointments for patients with cancer of the head and neck. We have recorded the pattern of follow-up in a tertiary cancer centre and its association with survival and recurrent disease. We used clinical letters and a prospectively maintained database to obtain details on 297 patients who were treated curatively for squamous cell carcinoma (SCC) of the oral cavity between 2005 and 2008. Mean (SD) age was 63 (12) years and 58% (n = 171) were male. Most patients were seen about 6 times in year one, 3 times in year 2, twice in year 3, twice in year 4, once or twice in year 5, and once yearly beyond year 5. Fewer clinics were scheduled for and attended by patients over 75 years of age, those with overall clinical grades 0-1, and those treated by operation alone in contrast to those who also had adjuvant radiotherapy. Patients were usually seen about 15 times over the 5 years. Taking into account the stage of the tumour and overall mortality, the number and timing of follow-up visits is adequate for the needs of patients with stage II-IV disease. Those with stage I disease may be considered for discharge after the third year if they are told about the risk factors, and signs and symptoms of recurrent disease, and surveillance in primary care.

Stewart–Treves syndrome: a case report

We present a case of chronic lymphoedema that progressed to Stewart-Treves syndrome in a 63-year-old woman with a previous modified radical mastectomy, associated lymph node dissection, chemotherapy and radiotherapy. While producing stabilisation of most cutaneous lesions initially, chemotherapeutic treatment of the angiosarcoma did not prevent subsequent metastasis and patient death. We urge vigilance and regular follow-up appointments for patients following a mastectomy with chronic lymphoedema to facilitate prevention or early treatment of this devastating syndrome.

P151 Cost of pulmonary rehabilitation is offset by reduction in healthcare utilisation

151 patients completed pulmonary rehabilitation over a period of over 4 years at our hospital. Retrospective analysis of 71 patients from this group was done. This showed that there was...

Does Day Length Affect Cognitive Performance in Memory Clinic Patients?

To determine whether day length affects cognitive performance in rural and remote memory clinic patients. A rural and remote memory clinic in Saskatoon, Saskatchewan provided an opportunity to examine how cognitive performance on the Mini-Mental State Exam (MMSE) is influenced by day length. Saskatchewan is an ideal location to test this association as day length varies greatly both seasonally and geographically. Following an initial assessment by the Rural and Remote Memory Clinic (RRMC) team in Saskatoon, patient follow-up appointments were performed either in-person or via telehealth videoconference. At each follow-up appointment the clinic neurologist administered the MMSE. The relationship between day length and MMSE scores at the six-week follow-up appointment was analyzed in 154 patients. The mean daily temperature was controlled for in the analysis. Bivariate correlate and linear regression analyses were conducted. There was no significant association between MMSE scores and either minutes of day length or mean daily temperature. Day length does not appear to have significant effect on cognitive performance of rural and remote memory clinic patients.

Factors Predicting Adherence with Psychiatric Follow-up Appointments for Patients Assessed by the Liaison Psychiatric Team in the Emergency Department

Several factors may predict adherence with psychiatric follow-up appointment for patients seen in the emergency department (ED) by liaison psychiatric teams. Awareness of these factors would allow for interventions targeted at vulnerable groups. To examine the factors which could predict adherence with psychiatric follow-up appointments for patients assessed in the ED by the liaison psychiatric team. The records of all patients assessed over a 3-month period by the liaison psychiatric team in the emergency department of Beaumont Hospital who were then referred for follow-up to their community mental health team were examined for relevant demographic and clinical variables. Phone contact was then made with the teams to which patients had been referred, to confirm the appointments made and if the patients had attended for their follow-up appointment. The data was analyzed with SPSS (version 17) using descriptive statistics and logistic regression. Overall, 56% of the patients were found to have attended their follow-up appointments. Being previously known to psychiatric services was the only statistically significant predictor of adherence with out-patient appointments; with an odds ratio of 7 and p-value of 0.034 when controlling for other variables. Patients who are not known to psychiatric services prior to assessment in the emergency department may need a more proactive outreach if compliance with psychiatric follow-up appointments is to be improved.

P02-02 - Factors predicting adherence with follow-up appointments for patients assessed by the liaison psychiatric team in the emergency department

BackgroundSeveral factors may predict adherence with adherence with follow-up appointment for patients seen in the emergency department by liaison psychiatric teams. Awareness of these factors would allow for interventions targeted at vulnerable groups.AimTo examine the factors which could predict adherence with psychiatric follow-up appointments for patients assessed in the ED by the liaison psychiatric team.MethodsThe records of all patients assessed over a three month period by the liaison psychiatric team in the emergency department of Beaumont Hospital who were then referred for follow-up were examined for relevant demographic and clinical variables. Phone contact was then made with the centres to which patients had been referred to confirm the appointments made and if the patients had attended follow-up appointments. The data was analysed with SPSS (version 17).ResultsOverall, only 55.9% of the patients were found to have attended their follow-up appointments with lrsquo;known to psychiatric services’ being the only statistically significant predictor of adherence. Patients’ who were single, separated, divorced or widowed and those who had consumed alcohol before an act of deliberate self-ham were more likely to attend follow-up appointments compared with those who were either married or cohabiting and those who did not consumed alcohol respectively. However these were not statistically significant when controlling for other predictors.ConclusionPatients who are not known to psychiatric services prior to assessment in the emergency department may need a more proactive outreach if compliance with psychiatric follow-up appointments is to be improved.

What is the best way to schedule patient follow-up appointments?

What is the best way to schedule follow-up appointments? The most popular model requires the patient to negotiate a follow-up appointment time on leaving the office. This process accounts for the majority of follow-up patient scheduling. There are circumstances when this immediate appointment arrangement is not possible, however. The two common processes used to contact patients for follow-up appointments after they have left the office are the postcard reminder method and the prescheduled appointment method. In 2001 the two methods used to contact patients for follow-up appointments after they had left the clinic were used for all 2,116 reappointment patients at an ophthalmology practice at Dartmouth-Hitchcock Medical Center. The number of completed successful appointments, the no-show rate, and patient satisfaction for each method were calculated. A larger number of patient reappointments were completed using the prescheduled appointment procedure than the postcard reminder system (74% vs 54%). The difference between completed and pending appointments (minus no-shows) of the two methods equaled 163 patients per quarter, or 652 patients per year. Additional revenues associated with use of the prescheduled appointment letter method were estimated at $594,600 for 3 years. Using the prescheduled appointment method with a patient notification letter is advised when patients do not schedule their appointments on the way out of the office.

Who keeps the first outpatient appointment?

The authors studied 1,106 consecutive patients who called for an initial outpatient appointment at a medical center department of psychiatry during a one-year period. The 759 (68.6%) patients who kept their initial scheduled appointment differed from the 347 (31.4%) who did not in age, previous psychiatric treatment, source of referral, chief complaint, and number of days they waited for an appointment. A telephone follow-up conducted with almost 30% of those who did not keep their initial appointment revealed that of those contacted, 26 (25%) sought other routes for psychiatric help and 23 (22%) made a subsequent contact at the facility studied.