Use In Outpatient Department Research Articles

81 Developing and Validating for Cognitive Screening Tools for Identifying and Intervening Dementia among Older Persons in Rural Uganda.

Objective:The study aimed to develop, validate and field test the cognitive screening tool for use in outpatient departments within health facilities in Uganda.Participants and Methods:In the rural eastern region of Uganda, twenty-three (23) purposively selected health facilities and administered a scientifically derived cognitive screening tools to all eligible older persons. We conducted an inter-rater reliability in all the health facilities using three raters. Diagnosis of dementia (DSM IV) was classified as a major cognitive impairment and was quality checked by physiatrist who were blinded to results of the screening assessment.Results:The area under the receiver operating characterizes (AUROC) curve in health facilities was 0.912. The inter-rater reliability was good (Intra-class correlation coefficient of 0.692 to 0.734). the predictive accuracy of the tool to discriminate between dementia and other cognitive impairment was 0.892. In regression modal, the cognitive screening tool, didn’t appear to be biased by age.Conclusions:The cognitive screening tool if performed well among the older persons, can be proved useful for screening dementia in other developing countries.

Developing and Validating for Cognitive Screening Tools for Identifying and Intervening Dementia among Older Persons in Rural Uganda.

Introduction: BackgroundAlthough risk of developing dementia increase in later years, identification and assessment of older persons with dementia in developing countries is still low. Access to easy and user friendly cognitive screening tools by the health care professional in developing countries is difficult.ObjectivesThe study aimed to develop, validate and field test the cognitive screening tool for use in outpatient departments within health facilities in Uganda.MethodsIn the rural eastern region of Uganda, twenty-three (23) purposively selected health facilities and administered a scientifically derived cognitive screening tools to all eligible older persons. We conducted an inter-rater reliability in all the health facilities using three raters. Diagnosis of dementia (DSM-IV) was classified as a major cognitive impairment and was quality checked by physiatrist who were blinded to results of the screening assessment.ResultsThe area under the receiver operating characterizes (AUROC) curve in health facilities was 0.912. The inter-rater reliability was good (Intra-class correlation coefficient of 0.692 to 0.734). the predictive accuracy of the tool to discriminate between dementia and other cognitive impairment was 0.892. In regression modal, the cognitive screening tool, didn’t appear to be biased by age.ConclusionsThe cognitive screening tool if performed well among the older persons, can be proved useful for screening dementia in other developing countriesDisclosure of InterestNone Declared

Characteristics of frequent emergency department users in Korea: a 4-year retrospective analysis using Korea Health Panel Study data

Objective We aimed to investigate the characteristics of frequent emergency department (ED) users in Korea.Methods We analyzed the Korea Health Panel Study data of a sampled population from the 2005 Population Census of Korea data, and adults (age ≥18 years) who visited the ED at least once a year between 2014 and 2017 were included in the study. People who visited three or more times a year were classified as frequent users. We compared demographic, socioeconomic, and health-related factors between nonfrequent and frequent users. We used a multivariable logistic regression analysis to determine factors related to frequent ED visits. We also compared the characteristics of ED use in both nonfrequent and frequent users.Results A total of 5,090 panels were included, comprising 6,853 visits. Frequent users were 333 (6.5% of all panels), and their ED visits were 1,364 (19.9% of all ED visits). In the multivariable regression analysis, medical aid coverage (adjusted odds ratio [aOR] of the National Health Service coverage, 0.55; 95% confidence interval [CI], 0.40–0.75), unemployment (aOR of employment, 0.72; 95% CI, 0.56–0.91), prior ward admission in a year (aOR, 2.14; 95% CI, 1.67–2.75), and frequent outpatient department use (aOR, 1.72; 95% CI, 1.35–2.20) were associated with frequent use. Moreover, frequent users visited the ED of public hospitals more often than than nonfrequent users (19.2% vs. 9.8%). Medical problems rather than injury/poisoning were the more common reasons for visiting the ED (84.5% vs. 71.2%).Conclusion We found that frequent ED users were likely to be those with socioeconomic disadvantage or with high demand for medical service. Based on this study, further studies on interventions to reduce frequent ED use are required for better ED services.

Characteristics of frequent emergency department users in Korea: a 4-year retrospective analysis using Korea Health Panel Study data.

ObjectiveWe aimed to investigate the characteristics of frequent emergency department (ED) users in Korea.MethodsWe analyzed the Korea Health Panel Study data of a sampled population from the 2005 Population Census of Korea data, and adults (age ≥18 years) who visited the ED at least once a year between 2014 and 2017 were included in the study. People who visited three or more times a year were classified as frequent users. We compared demographic, socioeconomic, and health-related factors between nonfrequent and frequent users. We used a multivariable logistic regression analysis to determine factors related to frequent ED visits. We also compared the characteristics of ED use in both nonfrequent and frequent users.ResultsA total of 5,090 panels were included, comprising 6,853 visits. Frequent users were 333 (6.5% of all panels), and their ED visits were 1,364 (19.9% of all ED visits). In the multivariable regression analysis, medical aid coverage (adjusted odds ratio [aOR] of the National Health Service coverage, 0.55; 95% confidence interval [CI], 0.40–0.75), unemployment (aOR of employment, 0.72; 95% CI, 0.56–0.91), prior ward admission in a year (aOR, 2.14; 95% CI, 1.67–2.75), and frequent outpatient department use (aOR, 1.72; 95% CI, 1.35–2.20) were associated with frequent use. Moreover, frequent users visited the ED of public hospitals more often than than nonfrequent users (19.2% vs. 9.8%). Medical problems rather than injury/poisoning were the more common reasons for visiting the ED (84.5% vs. 71.2%).ConclusionWe found that frequent ED users were likely to be those with socioeconomic disadvantage or with high demand for medical service. Based on this study, further studies on interventions to reduce frequent ED use are required for better ED services.

Lean transformation framework for treatment-oriented outpatient departments

Long wait times and low resource utilisation are the most critical issues in treatment-oriented outpatient departments. While Lean has been utilised to resolve similar issues in healthcare, the literature provides no structured means of implementing Lean in outpatient departments. This study establishes a Lean transformation framework to identify a balanced patient demand by determining proper patient compositions, to schedule non-specialists to increase resource utilisation, and to level patient schedule throughout the day to reduce wait times. This framework includes a series of activities and Lean tools that are specifically adapted for use in outpatient departments. A case study is presented to illustrate the implementation of the proposed framework and its possible impacts, using data from a community hospital oncology department in Montreal, Canada. Results suggests that this framework reduces patient visit time by 36% and increases daily treatments by 39% and utilisation of chemotherapy chairs by 22%, with a possibility to implement a one-day treatment regime. The proposed framework can assist treatment-oriented outpatient departments to overcome their operational challenges and to serve as an effective guideline in their Lean transformation.

Evaluation of corticosteroid use in outpatient department of dermatology of a tertiary care teaching hospital: a prospective observational study

Background: Corticosteroids are widely prescribed drugs in dermatology. Rational prescribing of steroids is important for best therapeutic outcome at lowest possible dose. A study was carried out at a tertiary care teaching hospital in order to evaluate the use of corticosteroids which provided a picture of trends in the usage of corticosteroids in dermatology at that set-up. Materials and Methods: This prospective, observational study was carried out in department of dermatology for 1 year after ethical approval. Data was analysed for parameters related to corticosteroids, their potency, WHO drug prescribing indicators, effectiveness as well as effects of corticosteroids on quality of life of patients. Statistical analysis was done using Microsoft Excel Office 365. Results: In the 223 patients, 44.84% patients belonged to 21-40 years age group. Mostcommon indication was eczema in 29.15% cases. Topical betamethasone (25.11%) and oral prednisolone (20.17%) were most frequently prescribed. 95/140 topical steroids prescribed were super highly potent. Among concomitant drugs, a majority of 38% were antihistaminics. Degree of polypharmacy showed 04 drugs in a majority (43.15%) of prescriptions. Only 6.27% drugs were prescribed by generic name. Conclusion: Corticosteroids were beneficial to a large no. of patients. Initial usage of low potency steroids topically wherever possible can be emphasized. WHO drug prescribing indicators analysis indicated the need to adhere to WHO guidelines as well as prescribing drugs by generic name. To maintain a balance between judicious use and frequent abuse with corticosteroid is important along with physician’s vigilance and patient education.

Pattern of Cardiovascular Drugs Use in Outpatient Department in a Tertiary Care Hospital of Bangladesh

Objective: The objective of the present study was to provide recent population-based information on use of cardiovascular drugs in outpatients in a tertiary care hospital of Dhaka, Bangladesh.Methods: A prospective study of cardiovascular prescriptions of Outpatient Department of Department of Cardiology of Shaheed Suhrawardy Medical college hospital Dhaka, Bangladesh was carried out. A total of 215 prescriptions were collected for the study in Shaheed Suhrawardy Medical College Hospital Dhaka, Bangladesh from July 2015 to June 2016. The prescriptions were evaluated for rationality based on WHO model list of essential medicines. The prescriptions were critically analyzed using predetermined parameters.Results: Out of 215 prescriptions collected, 120 drugs were found to be repeatedly prescribed. The results revealed that all single dose formulations prescribed were rationally in accordance with WHO essential drug list whereas fixed dose combinations prescribed remain questionable. A pattern of polypharmacy was clearly evident.Conclusion: Medications are a critical modality for prolongation and improved quality of life. Campaign and intervention should be focused on patients with more than three diagnostic cardiovascular conditions in order to minimize polypharmacy in patients particularly elderly.Bangladesh Heart Journal 2017; 32(2) : 65-69

Cross-Sectional study of differences in phenomenology of acute psychosis with or without cannabis

Background: Therehas been plethora of research regarding cannabis use disorder but very few studiesreporteddemographicand phenomenological differences of acute psychosis with cannabis use to those of acute psychosis without cannabis use. This study attempted to evaluate the demographic and phenomenology differences between two groups of patients presenting with acute psychosis with cannabis use and acute psychosis without cannabis use. Material & Method: Two group of patients recruited for study were ‘Cases with Cannabis’ and ‘control without Cannabis’ presenting with acute psychosis with preceding cannabis use and second one presenting with acute psychosis without preceding cannabis use in out-patient department of psychiatry, M. Yhospital, Indore Assessment done using rating scales. Results: Acute psychosis with cannabis wascharacterizedby primarily polymorphic clinical picture with predominance of positive and mood symptoms both in clear and disturbed sensorium.Acute psychosis without cannabis was characterized by mixed positive and negative symptoms in clear sensorium. In ‘Cases with cannabis’ group 96.7% were males and 3.3% were females, mean age was higher (33.7%) than control (27.7%) group. Conclusion: Acute psychosis with cannabis is characterized by primarily polymorphic clinical picture with predominance of positive and mood symptoms both in clear and disturbed sensorium. Acute psychosis without cannabis is characterized by mixed positive and negative symptoms. General symptoms of psychosis were also more in acute psychosis without cannabis.

Drug utilization study of off-label drug use in outpatient department of psychiatry: a prospective study at a tertiary care teaching hospital

Background: In the absence of standard psychiatric prescribing information, physician often use drugs in an off-label way. Many studies have been published across the globe reporting different rates of off-label use. There is currently no study based on Indian Drug Formulary.Methods: After taking permission from Institutional Ethics Committee (IEC), a prospective study was conducted among 285 patients attending Psychiatry outpatient department for the period of 4 months. Data related to demographic parameters, diagnosis of psychiatry conditions and drugs details were collected directly from the patient's medical records and entered in Case Record Form (CRF).The off-label drugs were categorized as per National Formulary of India. Multivariate binary logistic regression model was used to determine the predictors of off- label drug prescribing. The data were statistically analyzed using SPSS version 19 and chi-square test.Results: A total of 285 patients (169 males, 116 females) were included in the study with mean age of 36.54±13.91 years. Most of the patients (n=65, 22.8%) were diagnosed as schizophrenic. Out of 285 patients, 133(46.6%) received at least one off-label drug. A total 841 drugs were prescribed out of which 167(19.85%) were off-label. The drug most frequently prescribed as off-label were trihexiphenidyl HCL 29 (10.2%), clozapine 23 (8.1%) and clonazepam 13 (4.6%).Conclusions: Off label drugs used among psychiatry patients was 19.85%. The most frequently used off-label drugs was trihexiphenidyl HCL. The use of off-label drugs in psychiatric patients has been reportedly increasing which warrant national drug regulatory authorities to review and revise safe administration such drugs.

Poverty Reduction in India through Palliative Care: A Pilot Project.

Poverty Reduction in India through Palliative Care: A Pilot Project.

Changes in the prescription pattern of antipsychotics for schizophrenic outpatients after the implementation of a global budgeting program

BackgroundA hospital-based global budget (GB) program was implemented by the Taiwan Bureau of National Health Insurance (TBNHI) to control the rising costs of medical care. We investigated whether the introduction of the GB program affected prescriptions for second-generation antipsychotics (SGAs) for schizophrenic outpatients in public and private medical and psychiatric centers. MethodsThe prescription data of schizophrenic outpatients treated between 2001 and 2004 were retrieved from the TBNHI database, which included outpatients who were diagnosed as having schizophrenia during the period from 1996 to 2001. Because the new health insurance policy may have had a lag effect on physicians' decision regarding SGA prescription, we used January 2004 as the timepoint to divide the data, which was 6 months after GB implementation. Thus, data from the 6-month period immediately after the GB implementation were included in the pre-GB period. Second-generation antipsychotics included in the study were clozapine, risperidone, olanzapine, quetiapine, ziprasidone, zotepin, and amisulpride. ResultsAfter January 2004, the proportion of SGA use in outpatient departments did not show an upward trend, as had been observed in the pre-GB period, which appeared at a staggering pace lasting for 12 months (p = 0.0004). Compared with medical centers, SGA expenditures in the psychiatric centers were less affected in the GB period (p < 0.0001). Compared to the private sector, the SGA expenditures in the public sector were less affected in the GB period (p < 0.019). ConclusionWe concluded that the GB implementation reduced SGA expenditures significantly. The extent of influence varied among hospitals (i.e., public versus private, medical versus psychiatric centers), which was most likely caused by financial factors.

When Coverage Expands: Children's Health Insurance Program as a Natural Experiment in Use of Health Care Services

Expanding insurance coverage is designed to improve access to primary care and reduce use of emergency department (ED) services. Whether expanding coverage achieves this is of paramount importance as the United States prepares for the Affordable Care Act. Emergency and outpatient department use was examined after the State Children's Health Insurance Program (CHIP) coverage expansion, focusing on adolescents (a major target group for CHIP) versus young adults (not targeted). The hypothesis was that coverage would increase use of outpatient services, and ED use would decrease. Using the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), theyears 1992-1996 were analyzed as baseline and then compared to use patterns in 1999-2009, after the CHIP launch. Primary outcomes were population-adjusted annual visits to ED versus nonemergency outpatient settings. Interrupted time series were performed on use rates to ED and outpatient departments between adolescents (11 to 18years old) and young adults (19 to 29years old) in the pre-CHIP and CHIP periods. Outpatient-to-ED ratios were calculated and compared across time periods. A stratified analysis by payer and sex was also performed. The mean number of outpatient adolescent visits increased by 299 visits per 1,000 persons (95% confidence interval [CI]=140 to 457), while there was no statistically significant increase in young adult outpatient visits across time periods. There was no statistically significant change in the mean number of adolescent ED visits across time periods, while young adult ED use increased by 48 visits per 1,000 persons (95% CI=24 to 73). The adolescent outpatient-to-ED ratio increased by 1.0 (95% CI=0.49 to 1.6), while the young adults ratio decreased by 0.53 across time periods (95% CI=-0.90 to -0.16). Since CHIP, adolescent non-ED outpatient visits have increased, while ED visits have remained unchanged. In comparison to young adults, expanding insurance coverage to adolescents improved use of health care services and suggests a shift to non-ED settings. Expanding insurance through the Affordable Care Act of 2010 will likely increase use of outpatient services, but may not decrease ED volumes.

Counting the cost of complementary and alternative therapies in an Irish neurological clinic

Complementary and alternative therapy (CAT) use is frequent in patients with the common neurological disorders despite little scientific evidence of its efficacy. Little is known about the cost of regular CAT use. The purposes of this study were to determine the frequency and cost of CAT use in patients attending a neurology out-patient clinic and to determine whether neurological diagnosis affects CAT use. All patients attending the neurology out-patient clinic were asked to complete a structured questionnaire which included demographic information, details on the underlying neurological diagnosis, use and cost of CAT. Six hundred and seventy-one patients completed the questionnaire. Over 60% of the patients had used CAT, and 25% used CAT on a regular basis. Only 25% of patients using CAT had informed their doctor. Rates of CAT use varied with neurological diagnosis. Of those using CAM on a regular basis, the mean annual cost was Euro 1351. Patients attending our neurology out-patient department use CAT frequently and often do not inform their doctor. Patients spend a significant amount of personal income on CAT. Given the implications, including potential interactions with prescribed medication, these findings should prompt doctors to ask every patient about CAT use.

P.3.c.084 Causes and implications of urgent hospitalisations in urban settings

A hospital-based global budget (GB) program was implemented by the Taiwan Bureau of National Health Insurance (TBNHI) to control the rising costs of medical care. We investigated whether the introduction of the GB program affected prescriptions for second-generation antipsychotics (SGAs) for schizophrenic outpatients in public and private medical and psychiatric centers.The prescription data of schizophrenic outpatients treated between 2001 and 2004 were retrieved from the TBNHI database, which included outpatients who were diagnosed as having schizophrenia during the period from 1996 to 2001. Because the new health insurance policy may have had a lag effect on physicians' decision regarding SGA prescription, we used January 2004 as the timepoint to divide the data, which was 6 months after GB implementation. Thus, data from the 6-month period immediately after the GB implementation were included in the pre-GB period. Second-generation antipsychotics included in the study were clozapine, risperidone, olanzapine, quetiapine, ziprasidone, zotepin, and amisulpride.After January 2004, the proportion of SGA use in outpatient departments did not show an upward trend, as had been observed in the pre-GB period, which appeared at a staggering pace lasting for 12 months (p = 0.0004). Compared with medical centers, SGA expenditures in the psychiatric centers were less affected in the GB period (p < 0.0001). Compared to the private sector, the SGA expenditures in the public sector were less affected in the GB period (p < 0.019).We concluded that the GB implementation reduced SGA expenditures significantly. The extent of influence varied among hospitals (i.e., public versus private, medical versus psychiatric centers), which was most likely caused by financial factors.

Outpatient treatment of perianal warts by scissor excision.

A method of scissor excision of perianal warts, which is suitable for use in outpatient departments, is described. The low recurrence rate (two of 24 patients) three months after treatment is encouraging.