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Primary care waiting

Xindi Zhang, Jim Warren, Arden Corter, Felicity Goodyear-Smith
This paper describes development of a prototype data analytics portal for analysis of accumulated screening results from eCHAT (electronic Case-finding and Help Assessment Tool). eCHAT allows individuals to conduct a self-administered lifestyle and mental health screening assessment, with usage to date chiefly in the context of primary care waiting rooms. The intention is for wide roll-out to primary care clinics, including secondary school based clinics, resulting in the accumulation of population-level data...
2016: Studies in Health Technology and Informatics
Peng Li, Zhenmin Wang, Qiangyi Zhou, Shiwei Li, Jing Zhang, Ying Wang, Xingchao Wang, Bo Wang, Fu Zhao, Pinan Liu, Zhijun Yang
BACKGROUND: Vision is extremely important for patients with hearing loss due to neurofibromatosis type 2 (NF2). Tumors adjacent to the anterior visual pathway can potentially impair the vision. To date, only a few case reports and small-series studies have been reported. OBJECTIVE: To evaluate the clinical features of tumors adjacent to the anterior visual pathway in a large series of NF2 patients. METHODS: Seventy-three patients with potentially vision-impairing tumors were carefully screened from among 467 NF2 patients...
October 21, 2016: World Neurosurgery
Marc Licker, Wolfram Karenovics, John Diaper, Isabelle Frésard, Frédéric Triponez, Christoph Ellenberger, Raoul Schorer, Bengt Kayser, Pierre-Olivier Bridevaux
BACKGROUND: Impairment in aerobic fitness is a potential modifiable risk factor for postoperative complications. In this randomized controlled trial, we hypothesized that a high-intensity interval training (HIIT) program enhances cardiorespiratory fitness before lung cancer surgery and therefore reduces the risk of postoperative complications. METHODS: Patients with operable lung cancer were randomly assigned to usual care (UC, N=77) or preoperative rehabilitation based on HIIT (Rehab, N=74)...
October 5, 2016: Journal of Thoracic Oncology
W Holmes, R Shajehan, S Kitnasamy, C Abeywickrama, Y Arsath, F Gnanaraj, S Inbaraj, G Jayakody, K Durrant, S Luchters
: The growing burden of vision impairment (VI) among older people is a development challenge in Asian countries. This study aimed to understand older people's views and experiences about the impact of VI and barriers to eye care to inform policies to address this challenge. We conducted 12 focus group discussions in 2013 with retired Tamil and Sinhala elders in Nuwara Eliya district, Sri Lanka (n = 107). Data were analysed thematically. Older people described the broad impacts VI has on their lives...
October 19, 2016: Global Public Health
F Bootz, S Greschus, T van Bremen
The parapharyngeal space extends from the nasopharynx to the oropharynx. It is bordered medially by the pharyngeal wall and the constrictor pharyngis muscles, and laterally by the mandible. One distinguishes between a pre- and a poststyloid space. Tumors of the parapharyngeal space are rare and represent less than 1 % of all head and neck neoplasms. Benign (70-80 %) as well as malignant (20-30 %) tumors arise from different structures of the parapharyngeal space, mainly from salivary glands and nerve structures...
October 18, 2016: HNO
Meri Kankaanpää, Maria Raitakari, Leila Muukkonen, Siv Gustafsson, Merja Heitto, Ari Palomäki, Kimmo Suojanen, Veli-Pekka Harjola
BACKGROUND: To assess whether the use of point-of-care testing (POCT) and early assessment team (EAT) model shortens emergency department (ED) length of stay (LOS). METHODS: This prospective, observational study with comparison between three study periods was performed in three phases in a metropolitan ED with 57,000 annual visits. Data were collected from adult ambulatory patients who were discharged home. Phase 1 served as a control (n = 1559 in one month)...
October 18, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Renata Castro Martins, Clarice Magalhães Rodrigues Dos Reis, Antonio Thomaz Gonzaga da Matta Machado, João Henrique Lara do Amaral, Marcos Azeredo Furquim Werneck, Mauro Henrique Nogueira Guimarães de Abreu
This cross-sectional study evaluated the relationship between primary and secondary oral health care in Brazil. For this purpose, data from the National Program for Improving Access and Quality of Primary Care were used. Dentists from 12,403 oral health teams (OHTs) answered a structured questionnaire in 2012. The data were analyzed descriptively and by cluster analysis. Of the 12,387 (99.9%) OHTs that answered all the questions, 62.2% reported the existence of Dental Specialties Centers (DSCs) to which they could refer patients...
2016: PloS One
Curtis Bone, Lilian Gelberg, Mani Vahidi, Barbara Leake, Julia Yacenda-Murphy, Ronald M Andersen
OBJECTIVE: The Affordable Care Act encourages integration of behavioral health into primary care. We aim to estimate the level of under-reporting of drug use in federally qualified health centers (FQHCs) among self-reported risky drug users. METHODS: Adult patients in the waiting rooms of 4 FQHCs who self-reported risky drug use on the screening instrument World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (score 4-26), who participated in the "Quit Using Drugs Intervention Trial," submitted urine samples for drug testing...
October 6, 2016: Journal of Addiction Medicine
Gisselle Gallego, Angela Dew, Michelle Lincoln, Anita Bundy, Rebecca Jean Chedid, Kim Bulkeley, Jennie Brentnall, Craig Veitch
In Australia and around the world, people with disability and their carers living in rural areas face additional challenges compared to their urban-dwelling counterparts. This cross-sectional study explored current access to therapy services for people with disability living in western New South Wales as reported by their primary carers. Data were collected using an online and paper survey distributed to carers, from December 2012 until June 2013. Information was sought about the carers, the person they care for, access to physiotherapy, speech pathology, occupational therapy and psychology services...
October 17, 2016: Health & Social Care in the Community
J Norton, M David, C Gandubert, C Bouvier, L-A Gutierrez, A Frangeuil, A Macgregor, A Oude Engberink, A Mann, D Capdevielle
OBJECTIVES: The general practitioner (GP) is the most frequently consulted health professional by patients with common mental disorders (CMD). Yet approximately half of cases are not detected by the GP. Many factors linked to the patient, the doctor and the health care system influence detection. For example, detection rates are higher when patients are better known to their GP. On the other hand, patients visiting a different GP for reasons of dissatisfaction with previous care are more likely to be detected on the survey-day...
October 14, 2016: L'Encéphale
Polly Hitchcock Noël, Salene Jones, Michael L Parchman
RATIONALE: Aims and Objective: The validation study of the Patient Assessment of Chronic Illness Care (PACIC) questionnaire suggested a 5-factor structure determined a priori, but subsequent analyses have questioned the validity of the original factor structure. This study analyzed the factor structure of the PACIC using a large and diverse patient sample, and evaluated the identified factors through the lens of recent transformational initiatives in primary care. METHODS: Convenience samples of adults completed surveys in waiting rooms during clinic visits...
2016: European Journal for Person Centered Healthcare
Mehmet Bosnak, Seher Erdogan, E Habibe Aktekin, Ali Bay
We report two children who were diagnosed as having primary hemophagocytic syndrome and who successfully underwent therapeutic plasma exchange (TPE). The first patient was a 6-month-old girl diagnosed with HLH who was admitted to the pediatric intensive care unit. The patient's clinical condition worsened on the 9th day of the HLH-2004 treatment protocol. Her ferritin level was found 50.000 ng/mL, and TPE was performed for 9 sessions, after which her clinical condition and laboratory findings improved. The patient is still on the HLH-2004 protocol and waits for a suitable stem cell transplantation donor...
September 28, 2016: Transfusion and Apheresis Science
Victoria Porthé, Ingrid Vargas, Belén Sanz-Barbero, Isabel Plaza-Espuña, Lola Bosch, Maria Luisa Vázquez
Policy measures introduced in Spain during the economic crisis included a reduction in public health expenditure and in healthcare entitlements (RDL16/2012), which affected the general population as a whole, but especially immigrants. This paper analyzes changes in immigrants' access to health care during the economic crisis from the perspective of health professionals (medical and administrative) and immigrants. A qualitative descriptive-interpretative study was conducted in Catalonia through individual interviews with a theoretical sample of health professionals (n=34) and immigrant users (n=20)...
September 19, 2016: Health Policy
Chih-Chia Hsieh, Ching-Chi Lee, Hsiang-Chin Hsu, Hsin-I Shih, Chien-Hsin Lu, Chih-Hao Lin
BACKGROUND/PURPOSE: To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED). METHODS: This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records...
September 30, 2016: American Journal of Emergency Medicine
Andriana Barisic, Maxine Kish, Julie Gilbert, Nicole Mittmann, Rahim Moineddin, Jeffrey Sisler, Peter Vedsted, Eva Grunfeld
OBJECTIVE: To examine provincial and regional differences in FPs' direct access to cancer diagnostic investigations and advice from other specialists regarding investigations and referrals, and to explore FPs' perceptions about wait times for diagnostic investigations and receipt of results. DESIGN: A cross-sectional, online survey. SETTING: British Columbia, Manitoba, and Ontario. PARTICIPANTS: A sample of FPs from participating provinces...
October 2016: Canadian Family Physician Médecin de Famille Canadien
Tom Blakeman, Kathryn Griffith, Dan Lasserson, Berenice Lopez, Jung Y Tsang, Stephen Campbell, Charles Tomson
OBJECTIVES: Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care. DESIGN: An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method. SETTING: Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result...
October 11, 2016: BMJ Open
Craig Evan Pollack, Michelle E Ross, Katrina Armstrong, Charles C Branas, Karin V Rhodes, Justin E Bekelman, Alicia Wentz, Christian Stillson, Archana Radhakrishnan, Enny Oyeniran, David Grande
PURPOSE: Prior work suggests that access to health care may influence the diagnosis and treatment of prostate cancer. Mystery-caller methods have been used previously to measure access to care for health services such as primary care, where patients' self-initiate requests for care. We used a mystery-caller survey for specialized prostate cancer care to assess dimensions of access to prostate cancer care. MATERIALS AND METHODS: We created an inventory of urology and radiation oncology practices in southeastern Pennsylvania...
2016: PloS One
Bonnie L Green, Pamela A Saunders, Elizabeth Power, Priscilla Dass-Brailsford, Kavitha Bhat Schelbert, Esther Giller, Larry Wissow, Alejandra Hurtado de Mendoza, Mihriye Mete
Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma's effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment...
2016: Journal of Loss & Trauma
Kate Button, Fiona Morgan, Helen Hodgson, Alison L Weightman, Steve Jones
BACKGROUND: Musculoskeletal (MSK) conditions are the most frequently reported chronic conditions and one of the biggest causes of disability in the UK. Given the ageing population and the impact of these problems, the demand for MSK treatment will rise. Despite reduced waiting times, MSK pathways have remained variable and inconsistent and need to be improved to meet patient needs. The aim of this systematic review is to understand the evidence for the effectiveness of current models of service delivery and care pathways for adult hip/knee pain patients accessing secondary care for specialist opinions...
August 1, 2016: Systematic Reviews
Sarah Tinkler, Rajiv Sharma, Sudeshna Pal, Raven Susu-Mago, Miron Stano
BACKGROUND AND PURPOSE: Access to primary care remains a problem for a substantial portion of the U.S. population, and is predicted to worsen due to an aging population and the increasing burden of chronic diseases. Better integration of nurse practitioners (NPs) into the primary care workforce is a possible solution. We examine offers of appointments with NPs if a requested primary care physician is unavailable. METHODS: Data are from a 2013 audit (simulated patient) study requesting appointment information from a national random sample of primary care physicians...
September 26, 2016: Journal of the American Association of Nurse Practitioners
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