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Primary care waiting

Regina Wing Shan Sit, Keith Kwok Wai Chan, Benjamin Hon Kei Yip, Daisy Dexing Zhang, Kenneth Dean Reeves, Ying Ho Chan, Vincent Chi Ho Chung, Samuel Yeung Shan Wong
INTRODUCTION: Knee osteoarthritis (KOA) is a common, disabling and costly medical condition. The patellofemoral joint is a critical source of pain in individuals with KOA, and coexistence of patellofemoral osteoarthritis (PFOA) and tibiofemoral osteoarthritis (TFOA) is sometimes observed. The identification of subgroups with PFOA and customised interventions to correct underlying pathomechanics is beneficial for individuals with KOA. This study aims to evaluate whether a clinic-based patella mobilisation therapy (PMT) leads to significant improvement in pain, physical function and quality of life of individuals with KOA...
March 14, 2018: BMJ Open
Kamila Premji, Bridget L Ryan, William E Hogg, Walter P Wodchis
OBJECTIVE: To gain a more comprehensive understanding of patients' perceptions of access to their primary care practice and how these relate to patient characteristics. DESIGN: Cross-sectional study. SETTING: Ontario. PARTICIPANTS: Adult primary care patients in Ontario (N = 1698) completing the Quality and Costs of Primary Care (QUALICOPC) Patient Experiences Survey. MAIN OUTCOME MEASURES: Responses to 11 access-related survey items, analyzed both individually and as a Composite Access Score (CAS)...
March 2018: Canadian Family Physician Médecin de Famille Canadien
Laura Coll-Planas, Sergi Blancafort, Xavier Rojano, Marta Roqué, Rosa Monteserín
BACKGROUND: Older people living in socio-economic deprived urban areas especially suffer the effects of health inequalities but have been insufficiently targeted. Strategies promoted by local primary health care agents might influence health and social behaviours as intermediate social determinants that are modifiable and thus can potentially mitigate health inequalities. Therefore, we aim to develop and assess the effectiveness of a complex intervention based on a community programme that promotes self-management, health literacy and social capital targeting older people from urban socioeconomically disadvantaged areas in order to improve their self-perceived health as an indicator of health inequality reduction...
March 13, 2018: BMC Public Health
Malhar P Patel, Priscille Schettini, Colin P O'Leary, Hayden B Bosworth, John B Anderson, Kevin P Shah
PURPOSE: Ideally, a referral from a primary care physician (PCP) to a specialist results in a completed specialty appointment with results available to the PCP. This is defined as "closing the referral loop." As health systems grow more complex, regulatory bodies increase vigilance, and reimbursement shifts towards value, closing the referral loop becomes a patient safety, regulatory, and financial imperative. OBJECTIVE/DESIGN: To assess the ability of a large health system to close the referral loop, we used electronic medical record (EMR)-generated data to analyze referrals from a large primary care network to 20 high-volume specialties between July 1, 2015 and June 30, 2016...
March 12, 2018: Journal of General Internal Medicine
Clare Liddy, Isabella Moroz, Amir Afkham, Erin Keely
PURPOSE: Excessive wait times for specialist appointments pose a serious barrier to patient care. To improve access to specialist care and reduce wait times, we launched the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service in April 2011. The objective of this study is to report on the impact of our multiple specialty eConsult service during the first 5 years of use after implementation, with a focus on growth and sustainability. METHODS: We conducted a cross-sectional study of all eConsult cases submitted between April 1, 2011 and April 30, 2016, and measured impact with system utilization data and mandatory close-out surveys completed at the end of each eConsult...
March 2018: Annals of Family Medicine
Katherine E Gallagher, Tusajigwe Erio, Kathy Baisley, Shelley Lees, Deborah Watson-Jones
BACKGROUND: The burden of cervical cancer and shortage of screening services in Tanzania confers an urgent need for human papillomavirus (HPV) vaccination. However, the sustainability and impact of another new vaccine campaign in an under-resourced health system requires consideration. We aimed to determine the impact of the government's school-based HPV vaccine campaign in Kilimanjaro region on the provision of routine primary health services and staff workload. METHODS: Data on daily numbers of consultations were collected from health facility register books in 63 dispensaries and health centres in North-West Tanzania for 20 weeks in 2014...
March 12, 2018: BMC Health Services Research
Amanda Williams, John Wiggers, Kate M O'Brien, Luke Wolfenden, Sze Lin Yoong, Rebecca K Hodder, Hopin Lee, Emma K Robson, James H McAuley, Robin Haskins, Steven J Kamper, Chris Rissel, Christopher M Williams
We assessed the effectiveness of a 6-month healthy lifestyle intervention, on pain intensity in patients with chronic low back pain who were overweight or obese. We conducted a pragmatic randomised controlled trial (RCT), embedded within a cohort multiple RCT of patients on a waiting list for outpatient orthopaedic consultation at a tertiary hospital in NSW, Australia. Eligible patients with chronic low back pain (>3 months in duration) and BMI ≥27kg/m and <40kg/m were randomly allocated, using a central concealed random allocation process, to receive advice and education and referral to a 6-month telephone-based healthy lifestyle coaching service, or usual care...
March 8, 2018: Pain
Adrienne W Henize, Andrew F Beck, Melissa D Klein, John Morehous, Robert S Kahn
Introduction Children and families living in poverty frequently encounter social risks that significantly affect their health and well-being. Physicians' near universal access to at-risk children and their parents presents opportunities to address social risks, but time constraints frequently interfere. We sought to redesign our waiting room to create a clinic-to-community bridge and evaluate the impact of that redesign on family-centered outcomes. Methods We conducted a pre-post study of a waiting room redesign at a large, academic pediatric primary care center...
March 10, 2018: Maternal and Child Health Journal
Jesse D Schold, Stuart M Flechner, Emilio D Poggio, Joshua J Augustine, David A Goldfarb, John R Sedor, Laura D Buccini
BACKGROUND: The effects of underlying noncodified risks are unclear on the prognosis of patients with end-stage renal disease (ESRD). We aimed to evaluate the association of residential area life expectancy with outcomes and processes of care for patients with ESRD in the United States. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Adult patients with incident ESRD between 2006 and 2013 recorded in the US Renal Data System (n=606,046)...
March 7, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Federica Picariello, Rona Moss-Morris, Iain C Macdougall, Sam Norton, Maria Da Silva-Gane, Ken Farrington, Hope Clayton, Joseph Chilcot
INTRODUCTION: Fatigue is one of the most common and disabling symptoms in end-stage kidney disease, particularly among in-centre haemodialysis patients. This two-arm parallel group feasibility randomised controlled trial will determine whether a fully powered efficacy trial is achievable by examining the feasibility of recruitment, acceptability and potential benefits of a cognitive-behavioural therapy (CBT)-based intervention for fatigue among in-centre haemodialysis patients. METHODS: We aim to recruit 40 adult patients undergoing in-centre haemodialysis at secondary care outpatient dialysis units, who meet clinical levels of fatigue...
March 8, 2018: BMJ Open
Ting Bao, Wanqing Iris Zhi, Emily A Vertosick, Qing Susan Li, Janice DeRito, Andrew Vickers, Barrie R Cassileth, Jun J Mao, Kimberly J Van Zee
PURPOSE: Approximately 20% of breast cancer survivors develop breast cancer-related lymphedema (BCRL), and current therapies are limited. We compared acupuncture (AC) to usual care wait-list control (WL) for treatment of persistent BCRL. METHODS: Women with moderate BCRL lasting greater than six months were randomized to AC or WL. AC included twice weekly manual acupuncture over six weeks. We evaluated the difference in circumference and bioimpedance between affected and unaffected arms...
March 8, 2018: Breast Cancer Research and Treatment
Xiaowen Ge, Na Zhu, Jiamei Yao, Haiying Zeng, Jieakesu Su, Zhengzeng Jiang, Yuan Ji, Yunshan Tan, Yingyong Hou
RATIONALE: Primary nodal CD4-positive T-cell lymophoproliferative disorder with a relatively indolent process is a rare kind of lymphoproliferative disease. Here we report the first case of a 49 year-old man developed indolent nodal CD4-positive T-cell lymophoproliferative disorder. To our knowledge, based on a careful search of PubMed, it is the first case of primary nodal CD4-positive T-cell lymophoproliferative disorder. PATIENT CONCERNS: A 49-year-old Chinese man presented to our hospital with fever, enlargement of multiple superficial lymphonodes more than 14 years and splenomegaly...
March 2018: Medicine (Baltimore)
N Mundi, J Theurer, A Warner, J Yoo, K Fung, D MacNeil, S Dhaliwal, E Winquist, D A Palma, A C Nichols
Background: Operating room slowdowns occur at specific intervals in the year as a cost-saving measure. We aim to investigate the impact of these slowdowns on the care of oral cavity cancer patients at a Canadian tertiary care centre. Methods: A total of 585 oral cavity cancer patients seen between 1999 and 2015 at the London Health Science Centre (lhsc) Head and Neck Multidisciplinary Clinic were included in this study. Operating room hours and patient load from 2006 to 2014 were calculated...
February 2018: Current Oncology
Lynne Parkinson, Annie Banbury, Anne Livingstone, Steven Gordon, Biplob Ray, Louise Byrne, Susan Nancarrow, Chris Doran, Margaret McAllister, Carrie Petersen, Sonja Pedell, Denise Wood
In rural Australia, knowledge and utilisation of support by informal carers is lacking. During the caregiving period, socioemotional support from family and friends plays an important role in sustaining caregiving activities. Post-care, these social networks facilitate adjustment to role change and dealing with grief. Developing and improving access to peer support to enable carers to effectively cope with the challenges of caring may positively influence their caring experience. The primary objective of this project is to examine the response of isolated rural carers for older people with dementia to a videoconference (VC) based peer support and information program...
2018: Studies in Health Technology and Informatics
Vinicius Coelho Carrard, Michelle Roxo Gonçalves, Jéssica Rodriguez Strey, Carlos Pilz, Marco Antonio Trevizani Martins, Manoela Domingues Martins, Carlos Aita Schmitz, Rafael Gustavo Dal Moro, Otávio Pereira D'Ávila, Dimitris Rucks Varvaki Rados, Erno Harzheim, Marcelo Rodrigues Gonçalves
OBJECTIVE: The diagnosis of oral lesions are often challenging for primary health care providers, which explains the high number of referrals to specialist care. This favors increases in waiting lines and delays in diagnosis, contributing to high mortality rates from oral cancer. This study aimed to summarize the experience of the EstomatoNet, a telediagnosis program catering to primary care dentists and physicians from southern Brazil. STUDY DESIGN: This exploratory study included all queries received by EstomatoNet from June/2015 to December/2016...
March 5, 2018: Oral Diseases
Caroline A Smith, Mike Armour, Myeong Soo Lee, Li-Qiong Wang, Phillipa J Hay
BACKGROUND: Depression is recognised as a major public health problem that has a substantial impact on individuals and on society. People with depression may consider using complementary therapies such as acupuncture, and an increasing body of research has been undertaken to assess the effectiveness of acupuncture for treatment of individuals with depression. This is the second update of this review. OBJECTIVES: To examine the effectiveness and adverse effects of acupuncture for treatment of individuals with depression...
March 4, 2018: Cochrane Database of Systematic Reviews
Onarheim Kristine Husøy, Sisay Mitike Molla, Gizaw Muluken, Moland Karen Marie, Norheim Ole Frithof, Miljeteig Ingrid
BACKGROUND: The first month of life is the period with the highest risk of dying. Despite knowledge of effective interventions, newborn mortality is high and utilization of health care services remains low in Ethiopia. In settings without universal health coverage, the economy of a household is vulnerable to illness, and out-of-pocket payments may limit families' opportunities to seek health care for newborns. In this paper we explore intra-household resource allocation, focusing on how families prioritize newborn health versus other household needs and their coping strategies for managing these priorities...
March 2, 2018: BMC Health Services Research
Anne Martin, Josephine N Booth, Yvonne Laird, John Sproule, John J Reilly, David H Saunders
BACKGROUND: The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions...
March 2, 2018: Cochrane Database of Systematic Reviews
Diane M Flynn, Linda H Eaton, Honor McQuinn, Ashley Alden, Alexa R Meins, Tessa Rue, David J Tauben, Ardith Z Doorenbos
Chronic pain is a significant problem among military personnel and a priority of the military health system. The U.S. Army Surgeon General's Pain Management Task Force recommends using telehealth capabilities to enhance pain management. This article describes the development and evaluation of a telehealth intervention (TelePain) designed to improve access to pain specialist consultation in the military health system. The study uses a wait-list controlled clinical trial to test: 1) effectiveness of the intervention, and 2) interviews to assess barriers and facilitators of the intervention implementation...
December 2017: Contemporary Clinical Trials Communications
Amin Andalib, Philippe Bouchard, Alexandre Bougie, Sarah-Eve Loiselle, Sebastian Demyttenaere, Olivier Court
BACKGROUND: Despite an increase in bariatric surgery across Quebec, Canada, access is still limited. Furthermore, there are differences in resources and multidisciplinary capabilities of providing centers that may impact quality of care and outcomes. METHODS: We performed an online survey of all bariatric surgeons in the province of Quebec, Canada, using the LimeSurvey software. RESULTS: Forty-six surgeons from 15 centers were surveyed. Response rate was 87% (n = 40)...
February 28, 2018: Obesity Surgery
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