Suburban Primary Care Research Articles

Factors influencing optimal diabetes care and clinical outcomes in Thai patients with type 2 diabetes mellitus: a multilevel modelling analysis

BackgroundIncreasing levels of poor glycaemic control among Thai patients with type 2 diabetes mellitus (T2DM) motivated us to compare T2DM care between urban and suburban primary care units (PCUs), to...

Improving Diabetes Screening in the Primary Care Clinic.

In our suburban primary care clinic, the average rate of screening for diabetes among eligible patients was only 51%, similar to national screening data. We conducted a quality improvement project to increase this rate. During the 6-month preintervention phase, we collected baseline data on the percentage of eligible patients screened per week (percentage of patients with hemoglobin A1c checked in the prior 3 years out of patients eligible for screening who completed a visit during the week). We then implemented a two-phase intervention. In phase 1 (approximately 8 months), we generated an electronic health record (EHR) report to identify eligible patients and pended laboratory orders for physicians to sign. In phase 2 (approximately 3 months), we replaced the phase 1 intervention with an EHR clinical decision support tool that automatically identifies eligible patients. We compared screening rates in the preintervention vs. intervention period. For phase 1, we also assessed laboratory completion rates and the laboratory results. We surveyed physicians regarding intervention acceptability and satisfaction at 3, 6, 9, and 12 months during the intervention period. The weekly percentage of patients screened increased from an average of 51% in the preintervention phase to 65% in the intervention phase (p < 0.001). During phase 1, most patients underwent laboratory blood testing as recommended (83% within 3 months), and results were consistent with prediabetes in 23% and with diabetes in 4%. Overall, most physicians believed that the intervention appropriately identified patients due for screening and was helpful (100% of respondents agreed at 9 months vs. 71% at 3 months). We successfully implemented a systematic screening intervention involving a manual workflow and EHR tool and improved diabetes screening rates in our clinic.

Race, economic status, and disparities in the receipt of benzodiazepine prescriptions in a large primary care sample

ObjectiveTo evaluate the relationship between race, economic status, and patient characteristics with benzodiazepine prescribing in an urban and suburban primary care context. MethodThis retrospective study used data from a previously described cohort of patients seen in a large Ohio healthcare system's primary care clinics from 2019 to 2020. Associations and interactions between race, economic status (using median income of patient ZIP code as a proxy), patient characteristics, and prescription of benzodiazepines were assessed using multivariable logistic regression. Results455,537 patients had 1,643,473 primary care visits, and 5.8% of patients were prescribed a benzodiazepine. White patients were prescribed benzodiazepines more often than Multiracial/Multicultural, African American and Asian American patients (6.5%, 3.8%, 2.7% and 2.0% respectively). Patients from lower income ZIP codes were less likely to receive a prescription. Interaction effects were observed between race, patient economic status, gender, insurance status, and diagnoses (general anxiety disorder, insomnia, and panic disorder). The largest prescribing disparities by race were among patients with these three diagnoses. The largest disparity in prescription by income was seen in African American patients. ConclusionAfrican American, Multicultural/Multiracial and Asian American patients were less likely than White patients to receive benzodiazepine prescriptions. Middle and lower-income patients are particularly susceptible to this prescribing disparity.

Implementing Effective Care Through Utilization of Diabetes-Focused "Right Care" Visits in a Suburban Primary Care Setting.

Background: Diabetes is the seventh leading cause of death in the United States and the leading cause of lower limb amputations, adult-onset blindness, and renal failure. It is estimated that 34.2 million Americans have a diabetes diagnosis, and the prevalence of this condition has continually increased over the last two decades. This study includes patients at a large, suburban primary care practice in southwest Ohio who were considered to have uncontrolled diabetes based on their last Hemoglobin A1c of greater than 9%. Compliance with recommended annual screenings among this population was 15%. Objectives: The aim of this project was to improve glycemic control and increase the number of patients who received the recommended annual screenings through the implementation of nurse practitioner-driven, diabetes-focused "Right Care" visits.C Methods: This quality improvement pilot study consisted of interventions implemented over the four plan-do-study-act cycles. Each cycle included a test of change that was identified based on data from previous cycles to ensure continuous improvement throughout project implementation. Four interventions were evaluated including the utilization of a diabetes registry, implementation of a "Right Care" checklist during "Right Care" visits, use of a patient engagement tool with a focus on individualizing diabetes medication regimens, and implementation of a team-engagement plan. Results: Average Hemoglobin A1c reduction was 2.4% post-"Right Care" visit. Compliance with the annual screening bundle increased to 44% over 8 weeks. Utilization of the patient/provider relationship increased visit compliance by 18%, and the team engagement plan decreased work-related stress by 12%. Conclusions: The implementation of "Right Care" visits led to improved glycemic control and increased compliance with the recommended annual screenings among patients with an A1c greater than 9%. The patient engagement tool identified key factors related to diabetes medication adherence and team engagement decreased work-related stress and improved annual fundoscopic exam screening compliance. Implications for Nursing: Nurse practitioner-led "Right Care" visits utilize the knowledge and skills of advanced practice registered nurses to improve glycemic control in patients with uncontrolled diabetes.

Risk of Depression in a Suburban Primary Care Setting Before and During the COVID-19 Pandemic.

Major depression is a common disorder affecting millions of adults each year. Many population-based surveys showed an increase in the number people with symptoms of depression at the onset of the COVID-19 pandemic. Our aim was to determine and compare the prevalence of depression risk in a primary care setting before and during the COVID-19 pandemic. We conducted a cross-sectional study based on retrospective review of medical records from a large suburban primary care clinic. Records of adults 18 years and older, seen between January 1, 2019 and December 31, 2020 and who had also been screened for depression using the 9-item Patient Health Questionnaire (PHQ-9) were analyzed. Adults 18 years and older who completed the PHQ-9 assessment in 2019 and 2020 were 5078 and 4338, respectively. Risk of depression was 18.2% in 2019 and 14.8% in 2020 (P < .001). In adults under 50 years and those 50 years and older, depression risk was 20.7% versus 15.3% in 2019 (P < .001) and 17.3% versus 12.6% in 2020 (P < .001), respectively. In females, depression risk was 20.0% in 2019 and 16.8% in 2020 (P < .01), and in males, 14.1% in 2019 and 10.6% in 2020 (P < .01). Although our results did not reflect the published literature reporting a higher prevalence of depression during the COVID-19 pandemic, they were consistent with reports of increased risk in females and younger adults.

Comparison of Hand Hygiene Behaviors among Primary Care Unit Outpatients and Visitors before and after Installation of Behavioral Nudges during the COVID-19 Situation: A Quasi-Experimental Study

Objective: To describe the probability of appropriate hand hygiene behaviors among outpatients and visitors at a primary care unit before and after installation of additionally strategically placed hand rub dispensers and empirically-designed behavioral nudges. Material and Methods: We conducted a quasi-experimental study at a suburban primary care unit in southern Thailand. The intervention consisted of included installation of hand rub dispensers and attachment of behavioral nudges. We designed the behavioral nudges using qualitative data from a focus-group discussion with local residents, who identified disgust and normative expectations from children as the main behavioral drivers for following appropriate hand hygiene behaviors. We then conducted surreptitious observations of hand hygiene behaviors among outpatients and visitors before intervention delivery during Wave 1 and Wave 2 of the pandemic (Phase 1 and Phase 2, respectively), after installation of the hand gel dispensers alone (Phase 3), and after attaching behavioral nudge signs to the dispensers (Phase 4). Results: The probability of appropriate hand hygiene behavior increased from 0.6 percent in Phase 1 to 13.5 percent in Phase 4. However, the increase was statistically significant only from Phase 2 to Phase 3 in the zones where the dispensers were located (adjusted odds ratio 10.58; 95% confidence interval 1.95, 57.24). Conclusion: The probability of appropriate hand hygiene behavior after installation of the dispensers was significantly higher than at pre-intervention, but the difference in appropriate hand hygiene before and after attachment of the nudges to the dispensers was not statistically significant. The study findings could nonetheless contribute empirical evidence on observed changes in hand hygiene behaviors in a primary care setting.

Antibiotics prescribing practices for sore throat in a sub-urban primary care clinic

&lt;p&gt;&lt;strong&gt;Background and Objective:&lt;/strong&gt; Antimicrobial resistance (AMR) is one of the serious health problems in Pakistan. Excessive use of antibiotics during pandemics has aggravated AMR; hence, rational use in the future is even more important to consider and implement. Clinical audits on antibiotic prescribing in general practice can help improve antimicrobial stewardship. This study was designed as an audit to evaluate if the antibiotics prescribed for Streptococcus pharyngitis at a sub-urban primary care center in Pakistan were in line with the standard and latest guidelines.&lt;br /&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective audit was carried out at the primary care center located at Nainsukh, Lahore, Pakistan during 1 month period. Both adult and pediatric patients (above 3 years of age) presenting with upper respiratory tract infections were included in the study. A total of 48 consultation cards were identified using International Classification of Diseases 10 coding. The antibiotic prescribing practice of primary care physicians was evaluated against the Modified Centor Criteria (MCC) which was used as a standard. A score of &amp;le;3 required no antibiotic whereas a score of &amp;ge; 3 needed a same-day antibiotic prescription for sore throat.&lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 28 (58.3%) patients presenting with MCC of &amp;le;3 and were not given antibiotics. Antibiotic prescriptions issued on the day of presentation were n = 20; however, only n = 7 (35%) met the standard criteria, i.e., MCC score of &amp;ge;3 and among these patients, penicillin remained the first choice with 71% patients receiving amoxicillin, while 28% received co-amoxiclav.&lt;br /&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Antibiotic stewardship is lacking among general physicians working at the sub-urban primary health care center in Lahore city. Clinical audits, as a part of clinical governance, may help improving the quality of care provided to the community by the regional primary health care physicians.&lt;/p&gt;

Improving Influenza Vaccination Rates in an Underserved Primary Care Clinic Using a Simple Educational Tool.

Influenza is a preventable communicable illness that has a significant impact on people of all ages. In 2018, it was estimated that 80 000 people died of influenza-related illnesses. In the 2018-2019 influenza season, only 34.9% of individuals in the 18 to 49 years age group received the influenza vaccine. Despite the low vaccination rate for influenza, the vaccine has multiple evidence-based benefits that demonstrate the importance of improving its uptake among adults. According to data from the Centers for Disease Control and Prevention (CDC), the vaccine prevented around "6.2 million influenza illnesses, 3.2 million influenza-associated medical visits 91 000 influenza-associated hospitalizations, and 5700 influenza-associated deaths" in the 2017-2018 influenza season. In a suburban family medicine clinic, a primary care provider (PCP) observed that greater than 50% of adult patients in his family medicine practice declined influenza vaccine when offered during the 2018-2019 season compared with the site rate of 43.4% and the department rate of 47.9%. The goal of this project was to educate patients who initially decline the vaccine to agree to receive the vaccine and to increase the percentage of patients who get an influenza vaccine from 43.4% to 50% in adult patients at a suburban primary care clinic by having them read the CDC document and asking them after they read the document whether they would like to receive the vaccine. From October 1, 2018, to February 28, 2019, adult patients in a primary care clinic were asked whether they wanted to receive the influenza vaccination and responses were recorded. During this time, 589 patients were questioned, with 56% (n = 330) answering no, or 43% of patients receiving the influenza vaccination. In total, 658 patients were offered the flu shot during the intervention period, representing 27.7% of the patients seen in this clinic. While there was some monthly variation, the PCP was able improve the percentage of patients receiving the influenza vaccination from 43% to 60.9% with this simple educational intervention. The overall clinic rate for this time frame increased from 56.6% to 58.2%. This simple intervention was effective in improving influenza vaccine rates for one provider in a suburban safety-net clinic. It added minimal workload to the provider, and the intervention is easily replicable in other settings.

‘Trying to fly the plane while we were building it’. Applying a learning health systems approach to evaluate early-stage barriers and facilitators to implementing primary care transformation: a qualitative study

ObjectiveA learning health system (LHS) uses data to generate evidence and answer questions required to continually improve system performance and patient care. Given the complexities of practice transformation, an area...

S1391 Reducing Inappropriate PPI Usage – A QI Initiative at a Suburban Primary Care Clinic

S1391 Reducing Inappropriate PPI Usage – A QI Initiative at a Suburban Primary Care Clinic

1059. Evaluating Hepatitis C Screening Rates and Successful Interventions at an Outpatient Medicine/Pediatrics Practice

BackgroundDespite the 2013 United States Preventive Services Task Force (USPSTF) recommendations, Hepatitis C (HCV) screening rates among patients born between 1945-1965 has remained below 25% (MacLean, 2018). At our outpatient academic suburban primary care practice in Albany County, NY, our hepatitis C baseline prior to interventions was 31.75%. In collaboration with Project FOCUS through Gilead, our practice attempted to increase screening rates among this birth cohort.MethodsWe performed a retrospective chart review on patients eligible for HCV screening with birth years 1945-1965 at the time of their visit at the Albany Med Internal Medicine/Pediatrics practice. We report monthly HCV screening from January 2018 to April 2020. In addition, we determined whether HCV screening rates differed by race, gender, ethnicity, private vs public insurance, and risk stratification or RAF (standard vs. high-risk patient).ResultsThe chance that a test conducted for eligible patients increased from 29.9% (pre-intervention) to 58.76% in 2019 (post-intervention). From June 2019- December 2019, the testing rates were consistently above the 2019 average (Figure 1). There were no significant differences in HCV screening due to gender, race, ethnicity, or type of insurance (Table 1).Figure 1. Hepatitis C Screening Rates at an Outpatient Medicine/Pediatrics Practice 2018-2020 Table 1. Demographics - Hepatitis C Screening Rates ConclusionIn this outpatient Med/Peds practice, hepatitis C screening rates increased dramatically after incorporation of an EMR prompt, as well as nursing-generated orders for patients due for screening. There was no statistical difference in screening based on race, ethnicity, gender, or insurance type. Of note, high-risk patients were more likely to be screened, perhaps as they receive more case management services and are more likely to be in the office, increasing the opportunities for screening. The next step would be to adapt these interventions to screening all patients age 18-79, as per the updated 2020 USPSTF guidelines.Disclosures Danielle P. Wales, MD, MPH, Gilead (Grant/Research Support) Abigale Eichelman, MA, Gilead FOCUS Foundation (Other Financial or Material Support, Employee of Albany Medical Center with Salary Support on Grant) Ashar Ata, MD, MPH, PHD, GILEAD FOCUS Foundation (Grant/Research Support) Michael Waxman, MD, MPH, Gilead FOCUS Foundation (Grant/Research Support)

Behavioral Health Screening: Validation of a Strength-Based Approach.

To evaluate the validity of the Behavioral Health Checklist (BHCL) strength-based factor scores and the extent to which this factor has a buffering effect on the relationship between behavioral health symptom severity and children's social problems. The parents of 1,392 children aged 4 to 12 completed the BHCL and Child Behavior Checklist (CBCL) during sick and well-child visits to urban and suburban primary care practices affiliated with a large children's hospital. Findings support a single, strength-based factor on the BHCL, and the structure was largely invariant across race, sex, and socioeconomic status. Increased psychopathology symptoms (internalizing, externalizing, and attention-deficit hyperactivity disorder) and lower levels of strengths predicted increased social problems (p < 0.001). Moreover, the interaction terms were statistically significant in all analyses, suggesting that higher levels of strengths may buffer the deleterious impact of psychopathology symptoms on social problems. Post hoc analyses indicated that the buffering influence of strengths on the relationship between psychopathology symptoms and social problems was clinically meaningful except in the older sample for the relationship between externalizing and social problems. The findings support the validity of a strength-based factor of the BHCL and indicate that this factor has a buffering effect on the association between the degree of child mental health symptoms and level of social impairment. This factor, in combination with the problem-focused factors of the BHCL, provides a balanced approach to screening children's mental health functioning.

0929 Caregiver-Reported Versus Clinician-Documented Child Sleep Problems and Sleep-Related Health Behaviors in Primary Care

Abstract Introduction Sleep problems are highly prevalent in early childhood but often under-identified in pediatric primary care. This study identified the prevalence of caregiver-reported versus primary care provider (PCP)-documented sleep problems and sleep-related health behaviors in young children presenting to well child visits (WCVs). Methods Caregivers (85.4% mothers) of 198 young children (2-5 years, M = 3.3, 53.7% female, 62.9% Black) presenting to urban (74.1%) and suburban (25.9%) primary care sites for well child visits (WCVs) completed research surveys on child behavioral sleep problems, snoring, and sleep-related health behaviors (e.g., caffeine consumption) on the day of their child’s WCV. Electronic medical record review was used to identify the rate of PCP-documented sleep problems and related recommendations in the WCV progress note. Results Fifteen percent of caregivers reported a child sleep problem according to questionnaire data, which did not significantly differ from the 12.0% of children with a PCP-documented sleep problem in the WCV progress note (p = .31). However, significantly more caregivers (28.3%) reported bedtime difficulties (resistance; tantrums) on questionnaires (p &amp;lt;.001), which were not captured in the 12.0% of WCVs noting sleep problems. A total of 8% of WCVs included child sleep recommendations. Child snoring was reported by 17.0% of caregivers, but was less frequently documented in WCVs (4.5%, p &amp;lt;.001). Although many caregivers reported poor child sleep-related health behaviors, including daily child caffeine consumption (21.1%) and bedroom electronics (62.9%), significantly fewer PCPs documented these issues (caffeine: 2.0%; electronics: 6.6%) or related recommendations (decrease caffeine: 1.0%; eliminate electronics: 3.5%) in the progress note (all p-values &amp;lt;.001). Conclusion Although caregiver-endorsed child sleep problems on surveys did not differ from PCP-documented concerns, there are gaps in documenting other problematic sleep-related health behaviors, such as caffeine consumption and electronics use. More resources to address sleep-related health behaviors, as well as sleep problems, in pediatric primary care are needed. Support Sleep Research Society Foundation and K23HD094905 (AAW)

Su1494 – Screening for Nafld At a Suburban Primary Care Practice: is It Worth Screening and Which Non-Invasive Tool Should Be Used?

Su1494 – Screening for Nafld At a Suburban Primary Care Practice: is It Worth Screening and Which Non-Invasive Tool Should Be Used?

Outpatient Management of Chronic Obstructive Pulmonary Disease: Physician Adherence to the 2017 Global Initiative for Chronic Obstructive Lung Disease Guidelines and its Effect on Patient Outcomes.

BackgroundChronic obstructive pulmonary disease (COPD) is a common and preventable illness that carries significant economic and social burden. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides a comprehensive review of the available literature for the diagnosis and management of COPD. Despite being considered the standard of care, adherence to the GOLD guidelines varies among practitioners. In addition, there is yet to be a clear correlation between misalignment with GOLD practicing guidelines and patient outcomes. We studied the outpatient management of COPD, with special attention paid to whether or not adherence to the 2017 GOLD guidelines affected patient outcomes.MethodsThis retrospective electronic medical record review study observed the outpatient management of patients with COPD, aged 18 year or older, who presented to the suburban primary care office. Patients who received treatment according to the GOLD guidelines were compared with the patients who did not. Categorical data were analyzed as frequencies with percentages. Frequencies were compared using Chi-square and Fisher’s exact tests. A P value < 0.05 was used to determine statistical significance.ResultsA total of 158 patients were included in this study. Thirty-six percent of the patients were treated according to the GOLD guidelines. There was no significant difference in the mortality, exacerbations or hospitalizations between the patients who were treated according to the GOLD guidelines and those who were not. Comparing prescribing practices for those treated according to the GOLD guidelines versus those who were not, a significant difference in management occurred in regards to long acting beta agonist (P < 0.05) and inhaled corticosteroid therapy (P < 0.001). The differences in the use of other pharmacological and nonpharmacological agents were not significant.ConclusionsAdherence to the 2017 GOLD guidelines had no statistically significant difference in patient outcomes. GOLD nonadherent patients received long-acting beta agonist and inhaled corticosteroid therapy at a significantly higher frequency compared to GOLD-adherent patients.

Pathogens Causing Respiratory Tract Infections in Children Less Than 5 Years of Age in Senegal.

Introduction:While acute respiratory tract infections are the main cause of paediatric mortality and morbidity worldwide, pathogen patterns shift due to factors such as hygiene, vaccinations, and antibiotic resistance. Knowledge about current cause of respiratory infections is lacking, particularly in low- and middle-income countries. The aim of this study was to identity the various respiratory pathogens causing acute respiratory tract infections in children below 5 years of age visiting a sub-urban primary care clinic in Senegal.Methods:A case-control study was performed in September and October 2018. Oropharyngeal swabs were collected from cases; infants with fever and respiratory symptoms, and controls; children involved in the vaccination programme. Viral identification was conducted by polymerase chain reaction for 21 different viruses; bacteria were identified by culture studies. Associations between microorganisms, acute respiratory infection and severity of disease were calculated by multivariate regression adjusting for confounders such as age, sex, and living area.Results:Overall, 102 cases and 96 controls were included. Microorganisms were detected in 90.1% of cases and 53.7% of controls (P < .001). Influenza virus A (including H1N1), influenza virus B, respiratory syncytial virus (RSV), and Streptococcus pneumoniae were independently associated with acute respiratory tract infections. Co-detection of two or more pathogens was present in 49.5% of cases; 31.7% of cases had a pneumonia and 90.2% was treated with antibiotics.Conclusions:This case-control study in a primary care setting in sub-Saharan Africa found influenza virus A and B, RSV, and S pneumoniae to be the main causes of acute respiratory tract infections in children below 5 years of age. We recommend evaluation of antibiotics prescription behaviour in this setting.

A retrospective analysis of treatment and retention outcomes of pregnant and/or parenting women with opioid use disorder

AimTo determine factors associated with positive outcomes of buprenorphine maintenance treatment for opioid use disorder among pregnant women and women with children under the age of five years. MethodsThis retrospective, de-identified electronic health record review of a cohort of 108 female patients at a suburban primary care outpatient clinic followed patients for one year of treatment at the clinic. Positive outcomes were defined as 1) treatment retention and 2) urine toxicology at 12 months free of all substances other than buprenorphine. This study also evaluated a variety of potential correlates of treatment retention and toxicology, including patient demographics, medical and social history, and clinical factors (i.e., participation in a women's group and assigned treatment provider). ResultsPatient retention was 73.2% at 12 months. Compared to those retained in treatment, patients not retained were more likely to have received past treatment for a psychiatric illness (65.4% vs. 38.2%; p < 0.02) or have prior criminal history of a misdemeanor conviction (56.0% vs. 27.9%; p < 0.02). There was a significant association between time in treatment and reduction in opiate use (p < 0.01). ConclusionsIn this population, certain baseline characteristics were predictive of failure to be retained in treatment. As such, specific patients may need more intensive treatment. These findings have important public health and child welfare implications and may offer insight for providers to tailor treatment and refer for comprehensive services.

Vitamin D deficiency was common in all patients at a Swedish primary care centre, but more so in patients born outside of Europe

BackgroundVitamin D is associated with extra-skeletal processes, and vitamin D deficiency might contribute to the development of chronic diseases.AimTo investigate vitamin D levels in an unselected patient population at a Swedish suburban primary care centre.MethodsVitamin D levels were assessed in 102 patients aged 20 to 65 years visiting the primary care centre, independent of cause of visit, during 2 weeks in January 2014. The difference in vitamin D levels between patients born in Europe and patients born outside Europe was calculated using linear regression, adjusting for gender and age. The difference in prevalence of vitamin D deficiency (< 25 nmol/l) was calculated using logistic regression adjusting for gender, age, vitamin D supplement, and sun exposure.ResultsPatients born outside Europe (n = 66) had 15 nmol/l [95% confidence interval (CI) 9.17–20.84] lower levels of vitamin D than patients born in Europe. Vitamin D deficiency was more common in patients born outside Europe (50%) than in patients born in Europe (11%, odds ratio 8.20 95% CI 2.49–26.98, p < 0.001).ConclusionLower levels of vitamin D and the prevalence of vitamin D deficiency were more common in patients born outside Europe compared to patients born in Europe.

Acceptability and Results of Dementia Screening Among Older Adults in the United States.

To measure older adults acceptability of dementia screening and assess screening test results of a racially diverse sample of older primary care patients in the United States. Cross-sectional study of primary care patients aged 65 and older. Urban and suburban primary care clinics in Indianapolis, Indiana, in 2008 to 2009. Nine hundred fifty-four primary care patients without a documented diagnosis of dementia. Community Screening Instrument for Dementia, the Mini-Mental State Examination, and the Telephone Instrument for Cognitive Screening. Of the 954 study participants who consented to participate, 748 agreed to be screened for dementia and 206 refused screening. The overall response rate was 78.4%. The positive screen rate of the sample who agreed to screening was 10.2%. After adjusting for demographic differences the following characteristics were still associated with increased likelihood of screening positive for dementia: age, male sex, and lower education. Patients who believed that they had more memory problems than other people of their age were also more likely to screen positive for dementia. Age and perceived problems with memory are associated with screening positive for dementia in primary care.

The effect on the patient flow in local health care services after closing a suburban primary care emergency department: a controlled longitudinal follow-up study

BackgroundIt has not been studied what happens to patient flow to EDs and other parts of local health care system if distances to ED services are manipulated as a part of health policy in urban areas.MethodsThe present work was an observational and quasi-experimental study with a control and it was based on before-after comparisons. The impact of terminating a geographically distant suburban primary care ED on patient flow to doctors in local public primary care EDs, office-hour primary care, secondary care EDs and in private primary care was studied. The effect of this intervention was compared with a primary care system where no similar intervention was performed. The number of monthly visits to doctors in different departments of health care was scored as the main measure of the study in each department studied (e.g. in primary care EDs, secondary care ED, office-hour public primary care and private primary care). Monthly mortality rates were also recorded.ResultsIncreasing the distance to ED services by terminating a peripheral ED did not cause an increase in the use of local office-hour services in those areas whose local ED was terminated, although use of ED services decreased by 25% in these areas (P < 0.001). The total use of primary care doctor services rather decreased - if anything - after this intervention while use of doctor services in secondary care ED remained unaffected. Doctor visits to the complementary private primary care increased but this was probably not associated with the intervention because a simultaneous increase in this parameter was observed in the control. There was no increased mortality in any age groups.ConclusionManipulating distances to ED services can be used to direct patient flows to different parts of the health care system. The correlation between distance to ED and the tendency to use ED by inhabitants is negative. If secondary care ED was available there were no life-threatening side-effects at the level of general public health when a minor ED was closed in a primary care ED system.