Physician Encounters Research Articles

Antihypertensive Treatment Patterns in CKD Stages 3 and 4: The CKD-REIN Cohort Study

Rationale & ObjectiveBlood pressure (BP) control is essential for preventing cardiorenal complications in chronic kidney disease (CKD), but most patients fail to reach BP target. We assessed longitudinal patterns of antihypertensive drug prescription and systolic BP (SBP). Study DesignProspective observational cohort study Setting & Population2755 hypertensive patients with CKD stages 3–4, receiving care from a nephrologist, from the French CKD-REIN cohort study ExposurePatient factors, including sociodemographic characteristics, medical history, and laboratory data, and provider factors, including number of primary-care physician and specialist encounters. OutcomesChanges in antihypertensive drug class prescription during follow-up: add-on, or withdrawal. Analytical ApproachHierarchical shared-frailty models to estimate hazard ratios (HR) to deal with clustering at the nephrologist level, and linear mixed models to describe Systolic BP trajectory. ResultsAt baseline, median age was 69, mean eGFR, 33 ml/min/1.73m2; 66% of patients were men, 81% had BP ≥130/80 mmHg and 75% were prescribed ≥2 antihypertensive drugs. During a median 5-year follow-up, the rate of changes of antihypertensive prescription was 50 per 100 person-years, 23 per 100 for add-ons and 25 per 100 for withdrawals. After adjusting for risk factors, Systolic BP, and the number of antihypertensive drugs, poor medication adherence was associated with increased HR for add-on, 1.35 (95% confidence interval, 1.01-1.80), while a shorter education level was associated with increased HR for withdrawal, 1.23 (1.02-1.49) for 9-11 years versus ≥12 years. More frequent nephrologist visits (≥4 versus none) were associated with higher HRs of add-on and withdrawal (1.52; 95% CI 1.06-2.18 and 1.57; 1.12-2.19, respectively), while associations with visit frequency to other physicians varied with their specialty. Mean Systolic BPdecreased by 4 mmHg following drug add-on but tended to rise thereafter. LimitationsLack of information on prescriber, and drug dosing. Conclusions: In patients with CKD and poor BP control, changes in antihypertensive drug prescriptions are common and relate to clinician preferences and patients’ tolerability. Sustainable reduction in Systolic BPafter add-on of a drug class is infrequently achieved.

12511 Rhabdomyolysis Related Acute Kidney Injury Presenting as First Manifestation of Autoimmune Hypothyroidism: A Case Report

Abstract Disclosure: A. Tiwari: None. S. Mantravadi: None. N. Doshi: None. A. Dabaja: None. C. Saad: None. Introduction: Autoimmune thyroiditis is the predominant cause of primary hypothyroidism, with an incidence of estimated 0.3-1.5 cases per 1000 people, with female to male predominance of 7-10[1]. Hypothyroid myopathy affects 79 % of the affected population. Its common presentation is fatigue and cramp but in rare instances rhabdomyolysis can occur with trivial triggers like alcohol, exercise2, Case Presentation: A 32-year-old male with no significant medical history, presented with generalized weakness, myalgia, and facial puffiness for last three months. The patient engaged in regular-intensity workouts and reported consuming 12 beers several times a week for past 5 years. Physical examination revealed facial puffiness and proximal muscle weakness. Initial Laboratory findings showed elevated creatinine (1.68 mg/dL, baseline 1.0 mg/dL in April 2020), CK (8113 U/L), AST (260 U/L), ALT (129 U/L). Urinalysis revealed hematuria and mild proteinuria. Serum electrolytes were unremarkable. Abdominal ultrasound showed diffuse hepatic steatosis with normal kidney appearance. This could not explain the reason for the Acute Kidney Injury and further workup showed TSH (>150 mIU/L) and TPO antibodies (197.9 U/mL). Autoimmune panel was unremarkable. Thyroid ultrasound done subsequently revealed a markedly heterogeneous gland. Treatment included parenteral crystalloids, low-dose prednisone which was empirically added for suspected autoimmune myositis and was later discontinued once the autoimmune panel was negative, and Levothyroxine at the recommended dose. At the time of discharge, his creatinine was reduced to 1.33 mg/dL and CK to 2,298 U/L. Discussion: Severe rhabdomyolysis is a rare but significant complication of autoimmune thyroiditis, potentially leading to acute kidney injury (AKI) if not promptly diagnosed and treated. Resident physicians often attribute symptoms like myalgia and generalized weakness in males to clear evident rhabdomyolysis if they find a cause like alcohol consumption and exercise, potentially overlooking the actual etiology. We recommend thyroid workup in such patients to promptly detect and manage underlying etiology predisposing to muscle damage and subsequent kidney injury. Our patient never had any Physician encounter as his prior medical history was unremarkable, however we suggest thorough family history and thyroid profile should be a part of outpatient workup as well for patients who show other risk factors for rhabdomyolysis like daily alcohol consumption, vigorous workout, consume medications like HMG CoA inhibitors, antipsychotics etc. Presentation: 6/3/2024

Optimizing physician-encounter frequency for type 2 diabetes patients in primary care based on cardiovascular risk assessment: A target trial emulation study.

To investigate whether the physician-encounter interval for patients with type 2 diabetes (T2D) can be optimized from 2-3 to 4-6 months among those with a calculated 10-year cardiovascular disease (CVD) risk score of less than 20% without compromising their long-term outcomes. Using territory-wide public electronic medical records in Hong Kong, we emulated a target trial to compare the effectiveness of the physician-encounter intervals of 4-6 versus 2-3 months for T2D patients without prior CVDs and with a predicted risk for CVDs of less than 20% (i.e. those patients not in the high-risk category). Propensity score matching was used to emulate the randomization of participants at baseline, where 42 154 matched individuals were included for analysis. The marginal structural model was applied to estimate the hazard ratio (HR) for CVD incidence and all-cause mortality, the incidence rate ratio of secondary and tertiary care utilization, as well as the between-group differences in HbA1c, blood pressure and cholesterol levels. During a follow-up period of up to 12 (average: 5.1) years, there was no significantly increased risk of CVD in patients with physician-encounter intervals of 4-6 months compared with those patients with physician-encounter intervals of 2-3 months (HR [95% confidence interval {CI}]: 1.01 [0.90, 1.14]; standardized 10-year risk difference [95% CI]: -0.1% [-0.7%, 0.6%]), nor for all-cause mortality (HR: 1.00 [0.84, 1.20]; standardized 10-year risk difference: -0.1% [-0.5%, 0.3%]). Additionally, there was no observable difference in the utilization of secondary and tertiary care or key clinical parameters between these two follow-up frequencies. For T2D patients with a calculated 10-year CVD risk of less than 20%, the interval of regular physician encounters can be optimized from 2-3 to 4-6 months without compromising patients' long-term outcomes and saving substantial service resources in primary care.

An After-Hours Telemedicine Urgent Care Service May Not Improve Access to Care for Underserved Populations.

Background: After-hours telemedicine services for emergency care are thought to offer a solution for patients who live at a distance from traditional face-to-face emergency services. This study evaluates such a service in a Health Maintenance Organization, focusing on the differences between central and peripheral populations. Methods: In this cross-sectional database study, we collected data regarding the encounter and patient characteristics, including prescriptions, referrals for further evaluation in a traditional emergency department (ED), and the distance from a traditional ED. Other outcome measures included health care utilization after the encounter such as primary care physician (PCP) encounters, additional telemedicine encounters, ED visits, and hospitalization. Results: In total, 45,411 patient visits were analyzed. Medication was prescribed in 25% of the encounters, and a referral to an ED was given in 22%. In total, 17.7% of the patients visited an ED within 24 h of the index encounter. In total, 64.8% of patients visited a PCP in the following 30 days. No further care was needed in 32.4% of the encounters. In multivariable logistic regression, the odds of using the service were lower for low socio-economic status groups and inhabitants of the periphery than the central areas. A weak reverse correlation was observed in Jewish sectors regarding distance from traditional ED, whereas no correlation was found in the Arab sector. Conclusion: It is commonly believed that telemedicine overcomes geographical barriers. The results of this research do not support this hypothesis.

Epidemiology of Bone-Stress Injuries and Health Care Use in Pac-12 Cross-Country Athletes.

Bone-stress injury (BSI) is common in collegiate athletes. Injury rates and health care use in running athletes are not well documented. To describe the rate and classification of injury and associated health care use in collegiate cross-country runners with BSI. Descriptive epidemiology study. Sports medicine facilities participating in the Pac-12 Health Analytics Program. Pac-12 Conference collegiate cross-country athletes. Counts of injury and health care resources used for each injury. Injury rates were calculated based on athlete-seasons. A total of 168 BSIs were reported over 4 seasons from 80 team-seasons (34 men's and 46 women's team-seasons) and 1220 athlete-seasons, resulting in 1764 athletic training services and 117 physician encounters. Bone-stress injuries represented 20% of all injuries reported by cross-country athletes. The average BSI rate was 0.14 per athlete-season. Injury rates were higher in female (0.16) than male (0.10) athletes and higher in the 2019-2020 season (0.20) than the 2020-2021 (0.14), 2018-2019 (0.12), and 2021-2022 (0.10) seasons. Most BSIs occurred in the lower leg (23.8%) and the foot (23.8%). The majority of injuries were classified as overuse and time loss (72.6%) and accounted for most of the athletic training services (75.3%) and physician encounters (72.6%). We found a mean of 10.89 athletic training services per overuse and time-loss injury and 12.20 athletic training services per overuse and non-time-loss injury. Mean occurrence was lower for physician encounters (0.70), prescription medications (0.04), tests (0.75), procedures (0.01), and surgery (0.02) than for athletic training services (10.50). Bone-stress injuries are common in collegiate cross-country runners and require considerable athletic training resources. Athletic trainers should be appropriately staffed for this population, and suspected BSIs should be confirmed with a medical diagnosis. Future investigators should track treatment codes associated with BSI to determine best-practice patterns.

Outcome After Self-Triage App Referral in Urgent Direct-to-Consumer Telemedicine Encounter.

Background: The quantification of self-triage effectiveness, guided by mobile applications, in urgent direct-to-consumer telemedicine (TM) encounters requires further investigation. The objective of this study was to evaluate the outcomes of referral guidance provided by a symptom-based self-management mobile application decision algorithm in the context of remote urgent care assessments. Methods: An observational retrospective single-center study was conducted from May 2022 to December 2023. The inclusion criteria encompassed individuals aged >18 years old, and those spontaneously seeking virtual emergency care through the EINSTEIN CONECTA application. Patients experiencing connectivity issues, preventing completion of the encounter, were excluded. The primary outcomes included the rate of patient concurrence with the algorithm's recommendation for seeking in-person emergency care and the referral rate to face-to-face assessment among cases evaluated through TM. The application's algorithm employs scientific evidence based on symptoms to recommend referrals to emergency departments (EDs). Results: Out of 88,834 patients connected to the TM Center, self-triage obviated the need for virtual physician assessment in 53,302 (60%) encounters. A total of 35,532 patients were remotely evaluated by 316 on-duty physicians, resulting in 1,125 ICD-coded diagnoses. Among these, 21,722 (61.1%) were initially advised by self-triage to visit the ED, with subsequent medical assessment leading to in-person referrals in 6,354 (29.3%) of the evaluations. Of the 13,810 patients recommended to continue with virtual care post-self-triage, 157 (1.1%) were referred for in-person assessment. Conclusions: Self-triage effectively reduced the need for physician encounters in approximately three-fifths of TM consultations. Despite being based on scientific evidence, symptom-based referral algorithms demonstrated high sensitivity but poor correlation with physician decision-making.

Clotrimazole-Betamethasone Dipropionate Prescribing for Nonfungal Skin Conditions

This cross-sectional study identifies the common diagnoses and physician encounter types associated with clotrimazole-betamethasone dipropionate prescriptions among Medicare enrollees in 2021.

Health Care Utilization and Direct Costs Prior to Subspecialty Care in Children with Chronic Pain Compared with Other Chronic Childhood Diseases: A Cohort Study

ObjectivesTo understand the burden associated with pediatric chronic pain (CP) on the healthcare system compared with other costly chronic diseases prior to subspecialty care. Study designIn this retrospective cohort study, we assessed all-cause healthcare utilization and direct healthcare costs associated with pediatric CP (n=91) compared with juvenile-onset arthritis (JA, n=135), inflammatory bowel disease (IBD, n=90), type 1 or type 2 diabetes (T1D, n=475, T2D, n=289), anxiety (n=7,193) and controls (n=273) two and five years prior to patients entering subspecialty care in Manitoba, Canada. Linked data from physician encounters, emergency department visits, hospitalizations, and prescriptions were extracted from administrative databases. Differences in healthcare utilization and direct healthcare costs associated with CP versus the other conditions were tested using negative binomial and zero-inflated negative binomial regression models, respectively. ResultsAfter adjustment for age at diagnosis, sex, location of residence, and socioeconomic status, CP continued to be associated with the highest number of consulted physicians and subspecialists and the highest number of physician billings compared with all other conditions (p<0.01, respectively). CP was significantly associated with higher physician costs than JA, IBD, T1D, T2D, or controls (p<0.01, respectively); anxiety was associated with the highest physician and prescription costs among all cohorts (p<0.01, respectively). ConclusionCompared with chronic inflammatory and endocrinologic conditions, pediatric CP and anxiety were associated with substantial burden on the healthcare system prior to subspecialty care, suggesting a need to assess gaps and resources in the management of CP and mental health conditions in the primary care setting.

Optimizing the frequency of physician encounters in follow - up care for patients with type 2 diabetes mellitus: a systematic review

BackgroundDecisions on the frequency of physician encounters for patients with type 2 diabetes mellitus (T2DM) have significant impacts on both patients’ health outcomes and burden on health systems, whereas definitive intervals for physician encounters are still lacking in most clinical guidelines. This study systematically reviewed the existing evidence evaluating different frequencies of physician encounters among T2DM patients.MethodsSystematic search of studies evaluating different visit frequencies for follow - up care in T2DM patients was performed in MEDLINE Ovid, Embase Ovid, and Cochrane library from database inception to 25 March 2022. Studies on the follow - up encounters driven by non - physicians and those on the episodic visits in the acute care settings were excluded in the screening. Citation searching was conducted via Google Scholar on the identified papers after screening. The risk of bias was assessed using Cochrane RoB2 tool for randomized controlled trials and Newcastle - Ottawa Scale for cohort studies. Findings were summarized narratively.ResultsAmong 6363 records from the database search and 231 references from the citation search, 12 articles were eligible for in - depth review. The results showed that for patients who had not achieved cardiometabolic control, intensifying encounter frequency could enhance medication adherence, shorten the time to achieve the treatment target, and improve the patients’ quality of life. However, for the patients who had already achieved the treatment targets, less frequent encounters were equivalent to intensive encounters in maintaining their cardiometabolic control, and could save considerable healthcare costs without substantially lowering the quality of care and patients’ satisfaction.ConclusionExisting evidence suggested that the optimal frequency of physician encounters for patients with T2DM should be individualized, which can be stratified by patients’ risk levels based on the cardiometabolic control to guide the differential scheduling of physician encounters in the follow - up. More research is needed to determine how to optimize the frequency of physician encounters for this large and heterogeneous population.

Are patients with primary glomerular disease at increased risk of malignancy?

Over the past decade, several observational studies and case series have provided evidence suggesting a connection between glomerular diseases and the development of malignancies, with an estimated risk ranging from 5 to 11%. These malignancies include solid organ tumours as well as haematologic malignancies such as lymphoma and leukaemia. However, these risk estimates are subject to several sources of bias, including unmeasured confounding from inadequate exploration of risk factors, inclusion of glomerular disease cases that were potentially secondary to an underlying malignancy, misclassification of glomerular disease type and ascertainment bias arising from an increased likelihood of physician encounters compared with the general population. Consequently, population-based studies that accurately evaluate the cancer risk in glomerular disease populations are lacking. While it is speculated that long-term use of immunosuppressive medications and glomerular disease activity measured by proteinuria and estimated glomerular filtration rate may be associated with cancer risk in patients with glomerular disease, the independent role of these risk factors remains largely unknown. The presence of these knowledge gaps could lead to a lack of awareness of cancer as a potential chronic complication of glomerular disease, underutilization of routine screening practices in clinical care that allow early diagnosis and treatment of malignancies and underrecognition of modifiable risk factors to decrease the risk of de novo malignancies over time. This review summarizes the current evidence on the risk of cancer in patients with glomerular diseases, explores the limitations of prior studies and discusses methodological challenges and potential solutions for obtaining accurate estimates of cancer risk and identifying modifiable risk factors unique to GN populations.

Physician continuity of care in the last year of life in community-dwelling adults: retrospective population-based study

ObjectiveTo describe the timing of involvement of various physician specialties over the last year of life across different levels of primary care physician continuity for differing causes of death.MethodsWe conducted...

The journey of patients with psoriasis and psoriatic arthritis

IntroductionTo describe the journey of patients with psoriatic arthritis (PsA), and psoriasis (PsO) with special emphasis on diagnosis and treatment delays. Materials and methodsAll patients with PsA registered between 2000 and 2016 were included. Mean lag time between first musculoskeletal symptom and diagnosis of PsA, between first musculoskeletal symptom and first physician encounter, mean lag time to first DMARD and mean lag time between PsO diagnosis and PsA diagnosis were calculated. Descriptive statistics are reported. Variables associated with a delay in PsA diagnosis >1 year were analyzed in multivariable analysis. ResultsOne hundred and eighty nine patients were included (139 PsA and 50 PsO), mean age 60.8 years (SD: 16.3), 57% were males. Mean lag time between first musculoskeletal symptom and diagnosis of PsA was 1.9 (SD: 4.7) years. In 90 patients (97%), the diagnosis of PsO preceded the diagnosis of PsA, a mean time of 14.3 years (SD: 13.9). Forty-nine patients (35%) had a delay of PsA diagnosis ≥1 year. Of the PsA patients, 84.7% received cDMARDs as first line therapy. The mean lag time between PsA diagnosis and initiation of DMARDs was 2 years (SD: 7.6). In logistic regression analysis no variable was independently associated with a delay equal or greater than 1 year in PsA diagnosis. ConclusionsA significant delay in consultation and diagnosis of PsA was evident in this single center study in a third of patients. None of the variables studied was associated with a delay in diagnosis greater than one year.

795-P: Elucidating the Role of Weight Loss and Glycemia with Observed Benefits of GLP-1 Receptor Agonist Treatment in Patients with T2D

Weight loss has been associated with reduced cardiovascular disease (CVD) risk in people with type 2 diabetes (T2D). Glucagon-like peptide-1 receptor agonists (GLP-1RA) are an advancement in T2D treatment that can regulate glycemia and promote weight loss. However, the impact of weight loss, independent of glycemic control, on real-world clinical outcomes is not well understood. Here, the Cleveland Clinic electronic health record system was utilized to investigate the independent contributions of glycemic control and body mass index (BMI) change on clinical outcomes such as CVD, chronic kidney disease (CKD), hypertension, dyslipidemia, and time to insulin initiation in patients with T2D treated with GLP-1RA. Patients (n=4161) with T2D seen at the Cleveland Clinic between 8/2/2005 and 12/31/2021 who initiated GLP-1RA treatment without documented congestive heart failure, insulin use, and/or an estimated glomerular filtration rate &amp;lt;30 mL/min at the time of treatment initiation were retrospectively analyzed. Patients were required to be receiving GLP-1RA treatment for ≥12 months and have &amp;lt;18 months between physician encounters. Independent of glycemic control, each 1% reduction in BMI was associated with a 4% reduction in CVD risk (P=.008) and a 3% reduction in insulin initiation risk (P=.002). Independent of BMI change, each 1% reduction in HbA1c was associated with a 4% reduction in CKD risk (P=.001) and a 16% reduction in insulin initiation risk (P&amp;lt;.0001). Associations between BMI variability and CVD (HR=1.12, P&amp;lt;.0001) and osteoarthritis (HR=1.09, P=.014) and between HbA1c variability and CKD (HR=1.73, P=.032) and hypertension (HR=1.07, P&amp;lt;.0001) were observed. Durable BMI reduction was associated with a 28% decrease in CKD risk (P=.016) and a 61% reduction in hypertension risk (P=.005). In the real-world setting, decreased BMI was independently associated with reduced risk of CVD, CKD, hypertension, osteoarthritis, and insulin initiation. Disclosure A.Sharma: None. B.Burguera: Research Support; Novo Nordisk. M.Kattan: Consultant; Renalytix, Verici, Research Support; Novo Nordisk, Bayer Inc. A.D.Misra-hebert: Research Support; Bayer Inc., Merck Sharp &amp; Dohme Corp., Novo Nordisk. K.M.Pantalone: Consultant; AstraZeneca, Bayer Inc., Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk, Sanofi, Research Support; Bayer Inc., Merck &amp; Co., Inc., Novo Nordisk, Twin Health, Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck &amp; Co., Inc., Novo Nordisk. D.M.Rotroff: Research Support; Novo Nordisk, Stock/Shareholder; Clarified Precision Medicine. A.Mariam: None. E.Zacherle: None. A.Milinovich: Research Support; Novo Nordisk, Merck &amp; Co., Inc., AbbVie Inc., Amgen Inc., Bayer Inc., Eli Lilly and Company, Twin Health. J.Bauman: None. D.S.Sugano: None. J.Noone: Employee; Novo Nordisk. J.R.Rajpura: Employee; Novo Nordisk. R.S.Zimmerman: Speaker's Bureau; Xeris Pharmaceuticals, Inc.

The journey of patients with psoriasis and psoriatic arthritis

IntroductionTo describe the journey of patients with psoriatic arthritis (PsA), and psoriasis (PsO) with special emphasis on diagnosis and treatment delays. Materials and methodsAll patients with PsA registered between 2000 and 2016 were included. Mean lag time between first musculoskeletal symptom and diagnosis of PsA, between first musculoskeletal symptom and first physician encounter, mean lag time to first DMARD and mean lag time between PsO diagnosis and PsA diagnosis were calculated. Descriptive statistics are reported. Variables associated with a delay in PsA diagnosis >1 year were analyzed in multivariable analysis. ResultsOne hundred and eighty nine patients were included (139 PsA and 50 PsO), mean age 60.8 years (SD: 16.3), 57% were males. Mean lag time between first musculoskeletal symptom and diagnosis of PsA was 1.9 (SD: 4.7) years. In 90 patients (97%), the diagnosis of PsO preceded the diagnosis of PsA, a mean time of 14.3 years (SD: 13.9). Forty-nine patients (35%) had a delay of PsA diagnosis ≥1 year. Of the PsA patients, 84.7% received cDMARDs as first line therapy. The mean lag time between PsA diagnosis and initiation of DMARDs was 2 years (SD: 7.6). In logistic regression analysis no variable was independently associated with a delay equal or greater than 1 year in PsA diagnosis. ConclusionsA significant delay in consultation and diagnosis of PsA was evident in this single center study in a third of patients. None of the variables studied was associated with a delay in diagnosis greater than one year.

Healthcare Utilization After Respiratory Tuberculosis: A Controlled Interrupted Time Series Analysis.

Despite data suggesting elevated morbidity and mortality among people who have survived tuberculosis disease, the impact of respiratory tuberculosis on healthcare utilization in the years following diagnosis and treatment remains unclear. Using linked health administrative data from British Columbia, Canada, we identified foreign-born individuals treated for respiratory tuberculosis between 1990 and 2019. We matched each person with up to four people without a tuberculosis diagnosis from the same source cohort using propensity score matching. Then, using a controlled interrupted time series analysis, we measured outpatient physician encounters and inpatient hospital admissions in the 5 years following respiratory tuberculosis diagnosis and treatment. We matched 1216 individuals treated for respiratory tuberculosis to 4864 non-tuberculosis controls. Immediately following the tuberculosis diagnostic and treatment period, the monthly rate of outpatient encounters in the tuberculosis group was 34.0% (95% confidence interval [CI]: 30.7%, 37.2%) higher than expected, and this trend was sustained for the duration of the post-tuberculosis period. The excess utilization represented an additional 12.2 (95% CI: 10.6, 14.9) outpatient encounters per person over the post-tuberculosis period, with respiratory morbidity a large contributor to the excess healthcare utilization. Results were similar for hospital admissions, with an additional 0.4 (95% CI: .3, .5) hospital admissions per person over the post-tuberculosis period. Respiratory tuberculosis appears to have long-term impacts on healthcare utilization beyond treatment. These findings underscore the need for screening, assessment, and treatment of post-tuberculosis sequelae, as it may provide an opportunity to improve health and reduce resource use.

Physicians' Perspectives on a Multi-Dimensional Model for the Roles of Electronic Health Records in Approaching a Proper Differential Diagnosis.

Many healthcare organizations have adopted Electronic Health Records (EHRs) to improve the quality of care and help physicians make proper clinical decisions. The vital roles of EHRs can support the accuracy of diagnosis, suggest, and rationalize the provided care to patients. This study aims to understand the roles of EHRs in approaching proper differential diagnosis and optimizing patient safety. This study utilized a cross-sectional survey-based descriptive research design to assess physicians' perceptions of the roles of EHRs on diagnosis quality and safety. Physicians working in tertiary hospitals in Saudi Arabia were surveyed. Three hundred and fifty-one participants were included in the study, of which 61% were male. The main participants were family/general practice (22%), medicine, general (14%), and OB/GYN (12%). Overall, 66% of the participants ranked themselves as IT competent, most of the participants underwent IT self-guided learning, and 65% of the participants always used the system. The results generally reveal positive physicians' perceptions toward the roles of the EHR system on diagnosis quality and safety. There was a statistically significant relationship between user characteristics and the roles of the EHR by enhancing access to care, patient-physician encounter, clinical reasoning, diagnostic testing and consultation, follow-up, and diagnostic safety functionality. The study participants demonstrate positive perceptions of physicians toward the roles of the EHR system in approaching differential diagnosis. Yet, areas of improvement in the design and using EHRs are emphasized.

A narrative review of studies assessing the quality of life in patients with generalized pustular psoriasis.

Generalized pustular psoriasis (GPP) is a clinical entity distinct from psoriasis, associated with a poor clinical prognosis, often resulting in severe systemic complications and mortality. The relapsing nature of the disease with recurrent or intermittent flares imposes a significant burden on patients' quality of life (QoL). Although inadequately studied, QoL data in GPP patients has been a recent point of investigation. We conducted a literature search on PubMed/MEDLINE using the following search terms: 'generalized pustular psoriasis' OR 'pustular psoriasis' AND 'quality of life'. We identified 12 relevant articles that provide insight into the large impact of GPP on the QoL of patients, the burden of the disease and the treatment, and the success of new treatment options in making a clinically important difference to QoL. This review illustrates a need for routine assessment of the QoL in interventional clinical trials for GPP and during physician encounters. This information can help guide clinicians on how to tailor the treatment approach from the patient's perspective or illustrate whether new therapies offer meaningful benefits to patient care as we enter an era of exciting new treatments for this challenging condition.

Abstract No. 253 Assigning Objective Value to Consultative Interventional Radiology

To evaluate the objective economic impact of a full consultative interventional radiology (IR) service on productivity in an academic medical center. Billing data for evaluation and management (E/M) services provided by IR from the first 3-month period of implementing a full consult and rounding service was compared with the first 3-month period of collecting E/M billing data approximately one year prior. The number and types of E/M services billed in each 3-month period were tabulated and categorized by billing under a physician or a physician assistant license. Additionally, statistics on not billed E/M by deficiency reason were also compared. The number of billed consultative and rounding E/M encounters increased from 514 prior to creation of the full consult service to 998 in the first three months after (1.94-fold increase). Additionally, the work RVU (wRVU) generated from these encounters increased 63.9% after implementation. Most of this increase was from the physician cohort that billed 310 encounters as a consult service versus 3 encounters in the reference period (103.3-fold increase; 12261% increase in wRVU). Additionally, the E/M share from low level complexity (levels 1 and 2) decreased by 12% compared with the reference 3-month period with 26.1% more moderate to high complexity E/M encounters after implementation and guidance on attestations required for billing. The E/M encounters that could not be billed due to inadequate or missing attestations (n = 372, 40%) increased after consult service creation (previously n = 32, 6%). One third of the billed E/M encounters for physicians were from consultancy (20% overall physician and PA encounters), previously 0% (0.6% overall encounters). The creation of a true consultative service is foremost an opportunity to provide better, more efficient, and more effective care. Additionally, there is a significant potential economic impact that a consultative and rounding service can offer, even when in it’s infancy.

Acute and Overuse, Time-Loss and Non-Time-Loss Lateral Ankle Sprains and Health Care Utilization in Collegiate Student-Athletes.

Health care utilization and the occurrence of non-time-loss (NTL) lateral ankle sprains is not well documented in collegiate athletes but could provide better estimates of injury burden and inform clinician workload. Descriptive epidemiologic study. Lateral ankle sprain injury occurrence for Division I collegiate student-athletes in a conference with 32 sports representing 732 team seasons was collected during the 2018-2019 through 2020-2021 academic years. Injuries were designated as acute or overuse, and time-loss (TL) or NTL. Associated health care utilization, including athletic training services (AT services), and physician encounters were reported along with anatomical structures involved and season of occurrence. A total of 1242 lateral ankle sprains were reported over the 3years from 732 team seasons and 17,431 player seasons, resulting in 12,728 AT services and 370 physician encounters. Most lateral ankle sprains were acute-TL (59.7%), which were associated with the majority of AT services (74.1%) and physician encounters (70.0%). Acute-NTL sprains represented 37.8% of lateral ankle sprains and were associated with 22.3% of AT services and 27.0% of physician encounters. On average, there were 12.7 (5.8) AT services per acute-TL sprain and 6.0 (3.6) per acute-NTL sprain. Most sprains involved "ankle lateral ligaments" (45.6%), and very few were attributed to overuse mechanisms (2.4%). Lateral ligament sprains are a common injury across many sports and result in substantial health care utilization from ATs and physicians, including NTL lateral ankle sprains. Although TL injuries were the majority of sprains, a substantial proportion of sprains were NTL and accounted for a considerable proportion of health care utilization.

Lasunadi Agada in Lootha Visha Chikitsa - A Review

Agadatantra had a golden time period in Kerala, and was known in the name of Visha chikitsa. There were excellent Visha vaidhyas who used to treat extreme venomous conditions and even predict the condition of patient just through the Dootha lakshana. As a part of these practices, there were numerous textbooks on Visha chikitsa with unique and exclusive Yogas. Some of the books got maintained, and many got ruined. Among those only few practices are still in use in the management if Visha and still many are untouched. Prayoga samucchaya is a well-known traditional Keraleeya Visha chikitsa textbook written by renowned King Kochunni thamburan, which explains the concepts of Visha and its detail management. Lootha visha is a most frequent and important clinical condition that which a physician encounters in their daily practice. It has got importance in all the time, as its manifestation is in such a way that improper handling of the case may worsen the presentation. There many Agada yogas mentioned in the management of Lootha visha. Lasunadi Agada is a simple yoga explained in Prayoga samucchaya, which contains only 6 drugs, explained in the context of Lootha samanya chikitsa as Pana and Nasya. Presently this yoga is practicing in the name of Lasunadi gulika. So this paper is an attempt to review on the formulation Lasunadi Agada.