Request Appointments Research Articles

System for Tracking and Assessing Issues of Students in College Life

This project explores the development and implementation of a web-based platform designed to connect mentors and mentees, fostering meaningful interactions through messaging and appointment scheduling. The platform aims to bridge the gap between individuals seeking guidance (mentees) and experienced professionals willing to share their expertise (mentors). By offering a user-friendly interface and various functionalities, the website seeks to streamline the mentorship process, creating a conducive environment for communication and learning. The platform's primary features include comprehensive user profiles, a secure messaging system enabling direct communication between mentors and mentees, and an intuitive appointment scheduling mechanism. Mentors can showcase their expertise and availability, while mentees can search for mentors based on specific criteria and request appointments at their convenience. The project delves into the technological and design considerations essential for the platform's success, emphasizing the significance of a secure messaging system, personalized user experiences, efficient appointment scheduling, and reliable data privacy measures. Additionally, the implementation of a robust review and feedback system fosters trust and transparency, allowing mentees to make informed decisions when selecting mentors. Key Words: Web platform, mentorship,

Association of Simulated Patient Race/Ethnicity With Scheduling of Primary Care Appointments

Racial and ethnic disparities in access to health care may result from discrimination. To identify differences in the rates at which patients belonging to racial/ethnic minority groups are offered primary care appointments and the number of days they wait for their primary care appointment and to understand the mechanisms by which discrimination occurs. This cross-sectional study used 7 simulated black, Hispanic, and white patient callers to request appointments from 804 randomized primary care offices in 2 urban centers in Texas from November 2017 to February 2018. Data analysis was conducted between February and December 2018. Research assistants called randomly assigned offices to schedule an appointment, supplying the same basic information. Race and ethnicity were signaled through callers' names and voices. Appointment offer rates, days to appointment, and questions asked during the call. Of the 7 callers (age range, 18-29 years), 2 (28.6%) self-identified as non-Hispanic black, 3 (42.9%) self-identified as non-Hispanic white, and 2 (28.6%) self-identified as Hispanic. Of the 804 calls they made, 299 (37.2%) were from simulated white callers, 215 (26.7%) were from simulated black callers, and 290 (36.1%) were from simulated Hispanic callers. Overall, 582 callers (72.4%) were offered appointments. In unadjusted models, black and Hispanic callers were more likely to be offered an appointment than white callers (black callers, 32.2 [95% CI, 25.1-39.3] percentage points more likely; P < .001; Hispanic callers, 21.1 [95% CI, 13.7-28.5] percentage points more likely; P < .001). However, after adjusting for whether insurance status was revealed, this statistical significance was lost. In adjusted models, black callers were 44.0 (95% CI, 36.2-51.8) percentage points more likely to be asked about their insurance status than white callers (P < .001), and Hispanic callers were 25.3 (95% CI, 17.1-33.5) percentage points more likely to be asked about their insurance status (P < .001) than white callers. Black and Hispanic callers received appointments further in the future than white callers (black callers: marginal effect estimate, 3.650; 95% CI, 0.579 to 6.721; P = .08; Hispanic callers: marginal effect estimate, 2.644; 95% CI, -0.496 to 5.784; P = .02). In this study, black and Hispanic patients were more likely to be offered an appointment, but they were asked more frequently about their insurance status than white callers. Black and Hispanic callers experienced longer wait times than white patients, indicating a barrier to timely access to primary care.

Improving care transitions helps individuals and organizations

When I had triple bypass surgery last fall, I left the hospital with a clear plan for what would happen next. I was enrolled in a cardio rehab program, and my primary care physician's care navigator called to remind me about screenings and appointments. I used my providers' patient portals to request appointments, send messages and track my progress.

Patient Self-Referral to Infectious Diseases Clinic: You Don’t Always Get What You Want, But Hopefully What You Need

BackgroundPatients call into the departments at the Cleveland Clinic Foundation (CCF) to request appointments directly for all specialties. The Infectious Diseases (ID) department chose to evaluate these self-referred patients being seen in our clinic due to (1) limited outpatient clinic appointment availability and (2) patients’ perception of need may not align with the subspecialty care provided.MethodsIn spring 2016, all self-referred patients requesting an outpatient ID evaluation were screened by the ID Access Plus program. Patients were called by administrative staff with a request for records from a licensed practitioner, and when received, were reviewed within 72 hours of receipt by a staff ID physician. Requests were either (1) accepted for appointment, (2) declined, or (3) referred to a more appropriate department within the CCF system. Patients who were declined appointments were informed by an administrator via telephone call. All patients were also informed of the ability for urgent referrals to be accepted with an MD to MD discussion.ResultsDuring a 12-month period a total of 1000 referrals were processed through the ID Access Plus program: 25% were declined for appointments; 45% were tabled as requested records were not received; and 30% had appointments scheduled. The most common patient reported reasons for self-referral to ID clinic were “Lyme disease” (10%) and “parasites” (4%). The “no-show” rate for scheduled self-referred patients was <5%. The median wait period for a new patient ID appointment in the department declined from over 40 days to < 10 days.ConclusionA system of prescreening patients self-referred to ID, requiring a review of medical records by ID clinicians, resulted in improved access for patients.Disclosures All authors: No reported disclosures.

PP064 Registration Of Healthcare Mobile Apps In Brazil

INTRODUCTION:The use of applications (app) on mobile phones to health care is a trend. Its applications range from the use as energy calculators, monitoring clinical parameters, as well association with medical devices, personal health records or used to request appointments (1). Thus, it is intended to evaluate the regulatory instruments available in Brazil as to their sufficiency to analyze this new technology.METHODS:Assessment of regulatory instruments for mobile app registration by the Brazillian Health Regulatory Agency (Anvisa) (2). The main variables in the form of Class I and II are: Submission type, Postal Code, Electronic Site, Product code, Classification Rule, Class, Indication of Use / Purpose, Principle of Operation, Platform, Target Audience, Type of Environment, Compatibility, Safety Characteristics, Technical Standards used, Product Origin.RESULTS:Since 2010, the registration of software in Anvisa has been observed. The evaluation of Class I and II software is performed through the registration analysis to be completed by the requesting company. Class III (high risk) software is registered as a medical device embedded software (2).Anvisa's analysis of the software still depends directly on the application for registration of the companies. In this way most of the analyzed software are for use by health professionals and health services.CONCLUSIONS:There are Brazilian regulations for health products with software registration forecast, however its use as a health service still lacks studies mainly with the trends of new information and communication technologies (3).The regulation of mobile applications becomes difficult because applications are freely downloaded in virtual stores, their domains are usually in foreign territory and their use is given directly by the user.

Blood donation mobile applications: are donors ready?

The rapid rise of mobile communication technologies has the potential to dramatically change and improve blood donor recruitment and retention efforts. E-mail invitations were sent to blood donors in a large metropolitan area to participate in a Web-based survey designed to gauge their readiness and interest level for a blood donation mobile application ("app"). A total of 982 ethnically diverse respondents of various age groups and prior donation experiences were surveyed. Among the respondents, 87.3% had ready access to smart phones. E-mail was chosen by 62.1% as the currently preferred method when contacted by the blood center, followed by texting (10.1%). App features desired by most respondents were the abilities to request appointments 24/7 (76.8%) and to receive appointment confirmations quickly (81.3%). Many were concerned about receiving too many alerts or messages (64.1%) or insufficient protection for personal information (53.5%). Overall, 67.7% of respondents indicated that they were likely to use a blood donation mobile app. Likelihood was not significantly different by sex or ethnicity, and the impact of education level was limited. Donors who currently made donation appointments via telephone or a website were equally likely to use such an app. However, donors older than 45 years were less likely than younger donors (p = 0.001), and donors with more than five lifetime donations were more likely than less frequent donors to use such an app (p = 0.02). In a metropolitan area, donors are very receptive to using a mobile app to manage their donations.

Online appointment sequencing and scheduling

We formulate and solve a new stochastic integer programming model for dynamic sequencing and scheduling of appointments to a single stochastic server. We assume that service durations and the number of customers to be served on a particular day are uncertain. Customers are sequenced and scheduled dynamically (online) one at a time as they request appointments. We present a two-stage stochastic mixed integer program that uses a novel set of non-anticipativity constraints to capture the dynamic multi-stage nature of appointment requests as well as the sequencing of customers. We describe several ways to improve the computational efficiency of decomposition methods to solve our model. We also present some theoretical findings based on small problems to help motivate decision rules for larger problems. Our numerical experiments provide insights into optimal sequencing and scheduling decisions and the performance of the solution methods we propose.

Personal Health Records for Patients with Chronic Disease

Personal health records (PHRs) connected to a physician's electronic health record system hold substantial promise for supporting and engaging patients with chronic disease. To explore how U.S. health care organizations are currently utilizing PHRs for chronic disease populations. A mixed methods study including semi-structured interviews and a questionnaire was conducted. A purposive sample was developed of health care organizations which were recognized as exemplars for PHRs and were high performers in national patient satisfaction surveys (H-CAHPS or CAHPS). Within each organization, participants were health IT leaders or those managing high-risk or chronic disease populations. Interviews were conducted with 30 informants and completed questionnaires were received from 16 organizations (84% response rate). Most PHRs allowed patients to access health records and educational material, message their provider, renew prescriptions and request appointments. Patient generated data was increasingly being sought and combined with messaging, resulted in greater understanding of patient health and functioning outside of the clinic visit. However for chronic disease populations, there was little targeted involvement in PHR design and few tools to help interpret and manage their conditions beyond those offered for all. The PHR was largely uncoupled from high risk population management interventions and no clear framework for future PHR development emerged. This technology is currently underutilized and represents a major opportunity given the potential benefits of patient engagement and shared decision making. A coherent patient-centric PHR design and evaluation strategy is required to realize its potential and maximize this natural hub for multidisciplinary care co-ordination.

Support for e-Health Services Among Elderly Primary Care Patients

E-health has a substantial potential to improve access to as well as support efficient and effective care for the elderly. Questions remain and must be addressed, however, regarding the challenges faced by the elderly in the use of this technology. The aim of the study was to assess the attitude (needs) and preferences of the elderly in a selected region of Poland regarding selected e-health services and the factors associated with them. The study was conducted among 286 patients over 60 years of age being served by general practitioners in southwest Poland's Lower Silesia Province. The assessment pertaining to e-health was based on a specially designed questionnaire. Nearly one-third of the study respondents had a computer at home, and 61% of these (19% of all surveyed elderly) used it. Twenty-two percent of respondents used the Internet, at least occasionally, whereas 62% used mobile phones. Approximately 41% (n=116) of the elderly had a favorable attitude toward e-health services (labeled here as supporters) and were willing to use it if/when offered an opportunity to do so. A substantial majority (84%) of supporters expressed a desire to receive simple medical recommendations via mobile phone or a computer, although significant majorities (61% and 60%, respectively) would like to receive the results of tests by e-mail or short message service reminders for scheduled visits or prescribed medications. Slightly less than half (47%) of e-health supporters would request appointments online. Among the more important factors associated with support of e-health services were urban residence, higher education, and normal cognitive function, as well as having a computer, Internet access, or a mobile phone. The majority of elderly patients in this Polish community are not overly enthusiastic about using information and communications technology tools in their healthcare. Nevertheless, a substantial percentage (41%) among this group support selected e-health services.

Electronic Reminders to Patients Within an Interactive Patient Health Record

Keeping patients with complex medical illnesses up to date with their preventive care and chronic disease management services, such as lipid testing and retinal exam in patients with diabetes, is challenging. Within a commercially available electronic health record (EHR) with a secure personal health record (PHR), we developed a system that sends up to three weekly reminders to patients who will soon be due for preventive care services. The reminder messages reside within the secure PHR, which is linked to the EHR, and are displayed on a screen where patients can also send to the physician's office an electronic message to request appointments for the needed services. The reminder messages stop when the patient logs on to review the reminders. The system, designed with patient input, groups together all services that will be due in the next 3 months to avoid repeatedly messaging the patient. After 2 months, the cycle of reminders begins again. This system, which is feasible and economical to build, has the potential to improve care and compliance with quality measures.

Dynamic Appointment Scheduling of a Stochastic Server with Uncertain Demand

We formulate and solve two new stochastic linear programming formulations of appointment scheduling problems that are motivated by the management of health services. We assume that service durations and the number of customers to be served on a particular day are uncertain. In the first model, customers may fail to show up for their appointments (“no-show”). This model is formulated as a two-stage stochastic linear program. In the second model, customers are scheduled dynamically, one at a time, as they request appointments. This model is formulated as a multistage stochastic linear program with stages defined by customer appointment requests. We analyze the structure of the models and adapt decomposition-based algorithms to solve the problems efficiently. We present numerical results that illustrate the impact of uncertainty on dynamic appointment scheduling, and we identify useful insights that can be applied in practice. We also present a case study based on real data for an outpatient procedure center.

Sequential clinical scheduling with patient no-show: The impact of pre-defined slot structures

This paper develops a sequential scheduling algorithm for consultation periods not divided into slots. Patients call a scheduler and request appointments with a specified provider. The scheduler provides the patient with an appointment time before the call terminates. In making the appointment, the scheduler cannot alter the appointments of previously scheduled patients. Service times are random and each scheduled patient has a probability of “no-showing” for the appointment. Each arriving patient generates a given amount of revenue, and costs are incurred from patient waiting and provider overtime. The scheduling method selects the calling patient's appointment time by minimizing the total expected cost. We prove that total expected cost is a convex function of appointment times and that the expected profit of the schedule is unimodal, which provides a unique stopping criterion for the scheduling algorithm. Computational studies compare this approach with no-show based sequential scheduling methods for out-patient clinics where a predefined slot structure is assumed. The new method yields higher expected profit and less overtime than when service periods are pre-divided into slots. Because slot scheduling is ingrained in healthcare, we use the model to design slot structures that account for no-show and service time variation.

Containment, curiosity and consultation: an exploration of theory and process in individual systemic psychotherapy with an adult survivor of trauma

AbstractThis paper describes an individual therapy from the author's private practice. On referral, the client came to therapy requesting help with her 8‐year‐old daughter. Within the assessment, a single episode of trauma was revealed. Further therapeutic conversations told of multiple memories of trauma. The main therapeutic work has now ended, the contract being left that the client can continue to request appointments if she wishes. I show how systemic therapy from Post Milan and Narrative models, including practices from other orientations, has been useful and name three key practices as being crucial to the work, containment, curiosity and consultation. I suggest parallel processes operating between myself and my client as well as between the therapy and consultation. Distinct phases in the therapy recovery are identified. The discussion will consider themes of containment, curiosity and consultation.

Disponibilité des pédiatres libéraux et communautaires en Île-de-France après une sortie précoce de maternité

Objectives. – To assess the possibility and time period within which a mother and her newborn can consult a pediatrician after their early discharge from the maternity ward. Methods. – In May 2004, 2 investigators presenting themselves as mothers just discharged from the maternity ward, called pediatricians' offices and public infant cliniques (PMI centers) in the Paris metropolitan region, to request appointments. Results. – Of 99 pediatricians' offices contacted, 89 (89%) offered appointments, for an average of 4.4 days later. Of the 93 PMI centers contacted, 55 (59%) offered appointments by telephone, with a mean waiting time of 18 days. Conclusion. – This study, conducted in the spring of 2004 in the Paris metropolitan region, showed that private-practice pediatricians are capable of taking over management of newborns rapidly after early discharge from the maternity ward. It is more difficult to make appointments by telephone with PMI centers, which operate differently, and the delay is substantially longer. We underline that these results observed in a region with a high density of pediatricians and during a favourable period for managing appointments. Further studies are needed in other regions and at different periods. The management of newborns after early discharge from the maternity ward should be actually throught the arising development of health networks.

An Internet-Based Patient-Provider Communication System: Randomized Controlled Trial

BackgroundInternet-based interactive websites for patient communication (patient portals) may improve communication between patients and their clinics and physicians.ObjectiveThe aim of the study was to assess the impact of a patient portal on patients’ satisfaction with access to their clinic and clinical care. Another aim was to analyze the content and volume of email messages and telephone calls from patients to their clinic.MethodsThis was a randomized controlled trial with 606 patients from an academic internal medicine practice. The intervention “portal” group used a patient portal to send secure messages directly to their physicians and to request appointments, prescription refills, and referrals. The control group received usual care. We assessed patient satisfaction at the end of the 6-month trial period and compared the content of telephone and portal communications.ResultsPortal group patients reported improved communication with the clinic (portal: 77/174 [44%] “a little better” or “a lot better;” control: 18/146 [12%]; χ2 = 38.8, df = 1, P < .001) and higher satisfaction with overall care (portal: 103/174 [59%] “very good” or “excellent;” control: 78/162 [48%]; χ2 = 4.1, df = 1, P = .04). Portal group patients also reported higher satisfaction with each of the portal’s services. Physicians received 1 portal message per day for every 250 portal patients. Total telephone call volume was not affected. Patients were more likely to send informational and psychosocial messages by portal than by phone. Of all surveyed patients, 162/341 (48%) were willing to pay for online correspondence with their physician. Of those willing to pay, the median amount cited was US $2 per message.ConclusionsPortal group patients demonstrated increased satisfaction with communication and overall care. Patients in the portal group particularly valued the portal’s convenience, reduced communication barriers, and direct physician responses. More online messages from patients contained informational and psychosocial content compared to telephone calls, which may enhance the patient-physician relationship.

New Guidelines Will Help Avert E-Mail Crash

New Guidelines Will Help Avert E-Mail Crash

Health Information and Teenagers in Residential Care: A qualitative Study to Identify Young People's Views

Annabelle Bundle presents the results of a qualitative study, undertaken in a mixed residential children's home, which aimed to identify what looked after young people see as important in terms of health information. The young people wanted information particularly on mental health issues, keeping fit, substance use and sexual health. Many were reluctant to request appointments for personal matters and did not feel they were encouraged to ask about personal health concerns during medical examinations.