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PubMed1984

A discussion of tasks that can be performed by a computerized orthodontic office management system.

A decision to use a computerized office management system is an option now available to the orthodontist. The present article describes some of the ways in which such a system can serve the orthodontist's office. The opinions and conclusions expressed are the result of the author's experience in a team effort, with a professional computer programmer, to develop a software system to serve his own office.

Appointments and Schedules↗
PubMed1984

The distinctive marketing roles of physician office managers and staff.

In their roles as public contact personnel in health care marketing, physician office managers are involved in communicative relationships with patients. Such relationships underscore the importance of researching these individuals in their roles of producers, promoters and agents of health care services. The nature of these roles is investigated in this research.

Analysis of Variance↗
PubMedDate not supplied

Desirable behaviours in the office management of hypertension addressed through continuing medical education.

Twenty family physicians in Saskatchewan participated in this randomized controlled study which examined the effects of relatively low-cost educational techniques on the office management of hypertension. We measured 1,538 episodes of care relating to the office management of hypertension by chart review, prior to, and at six and 12 months following education. The family physicians who participated in the education were found to perform the recommended behaviours significantly more often at six and 12 months post education than those physicians who did not have the education. Our findings indicate that carefully planned, inexpensive educational techniques can improve clinical behaviour in areas where there is identified educational need.

Behavior↗
PubMed2006

Implementation of a Project Management Office (PMO)--experiences from year 1.

Recognized as an early leader in clinical information systems, the University of Illinois Medical Center was challenged to meet the ever-increasing demand for information systems. Interviews with key stakeholders revealed unfavorable attitudes toward the Information Services department. Reasons given were that projects often are not aligned with business strategy, projects are delayed, IS itself is a barrier to progress, and a lack of proactive planning precipitates crises. Under the leadership of a new CIO, IS began developing a Project Management Office, or PMO, to better meet medical center business objectives and to more effectively manage technology projects. Successes during the first year included comprehensive IT strategic planning. Collaborative relationships were established with departmental leaders for planning, prioritizing, budgeting, and executing projects. A formal Web-based process for requesting IS projects was implemented, project management training was provided, and elements of standard project management methodology were implemented. While a framework for effective project management was created, significant effort is still required to firmly root these new processes within the organizational culture. Project management office goals for the second year include implementing a project portfolio management tool, refining the benefits methodology, and continuing the advancement of the project management methodology.

Academic Medical Centers↗
PubMedDate not supplied

Office management of minor burns.

About 2 million people are burned in the United States each year. About 80% of these are treated as outpatients. Flame burns are the most common type of burn injury in adults, and scald burns are the primary type in children. Primary care providers must be familiar with burn assessment so burn injuries can be triaged appropriately to a regional burn center, an acute care (facility, or office management. Assessment includes extent and depth of burns, location of burns, patient reliability, and the home situation. Office management involves emergency care, debridement and dressings, topical antimicrobials, and pain control. Patient education for care in the home environment is essential for optimal healing.

Adult↗
PubMed1998

Assessment of vulvovaginal complaints: agreement between phone and office management.

Objective: To examine the agreement between nursing phone and provider office management of vulvovaginitis.Methods: Patients who called the Kaiser Permanente Phone Call Center with vulvovaginal complaints were evaluated by a registered nurse, who took a standardized history, and made an assessment and plan; additionally, she made a judgment regarding whether she would have treated the patient over the phone. These patients were seen in the office the same day and examined and treated by a clinician following a protocol that included cultures for typical vaginal and cervical pathogens. Providers also made a judgment about phone treatment. Nurses and providers were blinded to each others' diagnosis and therapy. Kappa coefficients were used to evaluate the interexaminer agreement between nurses on the phone and providers in the office with respect to diagnosis and treatment.Results: Four hundred eighty-five patients underwent phone evaluation. Of these, 253 (52%) completed the study protocol and were considered in the final analysis. Kappa values for the diagnosis of trichomoniasis (0.05), bacterial vaginosis (0.12), candidiasis (0.22), chlamydia, herpes simplex, and urinary tract infections (0.05), and "other" (0.05) demonstrated poor agreement between nurses and providers. There was also poor agreement between phone nurses and providers regarding the necessity of an office visit (0.14).Conclusion: This prospective study challenges the notion that the telephone is an effective tool for diagnosing and treating vulvovaginal complaints. Patients with these complaints should be evaluated in the office. Alternatively, programs should be developed and analyzed to educate nurses involved in telephone triage of vulvovaginitis.

Journal Article↗
PubMed1998

Office management of female urinary incontinence.

The majority of incontinent women are manageable using office-based techniques. This article reviews the basic causes of per urethram urinary incontinence, and summarizes how to optimally evaluate them from a clinical and urodynamic standpoint in the office setting. Emphasis is made on the progress and efficiency of the wide range of ambulatory treatment options, which include behavioral treatments, pharmacotherapy, periurethral injection of bulking agents, anti-incontinence devises, and the use of absorbent products. The economy-driven trend to decrease hospital management of disease and patient interest in noninvasive techniques will continue to increase the importance of the key role played by the office urologist in the management of female urinary incontinence.

Behavior Therapy↗
PubMed2006

Orthopedic trauma: office management of major joint injury.

Orthopedic injuries are common reasons for visits to primary care physicians. Careful history and physical examination with intelligent use of imaging technology will arrive at the correct diagnosis in most patients. Many conditions may be definitively managed by the office internist. Others maybe initially stabilized and referred to orthopedic surgeons for definitive care. Nondisplaced fractures, tendon injuries, sprains, and overuse syndromes are entities within the purview of the primary care physician. Familiarity and confidence with diagnosis and management of these conditions in the office is optimal for the care of the adult patient.

Acute Disease↗
PubMed2001

Office management of elderly hypertensive patients. Focusing on cognition and function.

OBJECTIVE: To review office management of elderly hypertensive patients and to focus on cognition and function both as ways to stratify who gets treated and as end points for treatment. QUALITY OF EVIDENCE: Relevant papers were identified through a MEDLINE search from January 1994 to March 2000, using the MeSH terms hypertension, aged, aged 80 and over, cognition, activities of daily living, therapeutics, hypotension orthostatic, and dementia. Many well conducted randomized controlled trials were found and are included. MAIN MESSAGE: Treatment of combined and systolic hypertension up to age 80 is clearly worthwhile; beyond age 85, other factors (chiefly cognitive and functional impairment) mitigate most routine recommendations. Successful treatment is individualized, taking into account comorbid conditions and their effect on cognition and function. Age is useful for thinking about groups, not individuals: as people age, risk of cognitive and functional impairment increases, but even very elderly people (> 85 years) with no impairment should be treated as younger patients are. Elderly people with signs of having a "brain at risk" should be managed with special vigilance. CONCLUSION: Good evidence supports treating elderly people, who are otherwise well and are cognitively and functionally intact, when their blood pressure is > 160 mm Hg systolic or > 105 mm Hg diastolic. There is insufficient evidence for carrying out routine recommendations for frail elderly people. Treatment of comorbid illnesses dictates choice of therapeutic agent.

Age Factors↗
PubMed2000

A guideline implementation system using handheld computers for office management of asthma: effects on adherence and patient outcomes.

OBJECTIVE: To evaluate effects on the process and outcomes of care brought about by use of a handheld, computer-based system that implements the American Academy of Pediatrics guideline on office management of asthma exacerbations. DESIGN: A before-after trial with randomly selected, office-based Connecticut pediatricians. In both the control and intervention phases, physicians collected data from 10 patient encounters for acute asthma exacerbations. During the intervention phase, the computer provided for structured encounter documentation and offered recommendations based on the guideline of the American Academy of Pediatrics. Patients were contacted by telephone 7 to 14 days after the visit to assess outcomes. RESULTS: Nine study-physicians enrolled 91 patients in the control phase and 74 in the intervention phase. Follow-up information was available for 93% of encounters. Use of the intervention was associated with increased mean frequency/visit of: 1) measurements of peak expiratory flow rate (2.18 vs 1.57) and oxygen saturation (1.12 vs.42), and 2) administration of nebulized beta2-agonists (1.25 vs.71). Visits in the intervention phase lasted longer and fees were higher ($145.61 vs $103.11). There were no significant differences in immediate disposition or subsequent emergency department visits, hospitalizations, missed school, or caretaker's missed work during the 7 days post visit. CONCLUSION: Use of handheld computers that provide guideline-based decision support was associated with increased physician adherence to guideline recommendations; however, visits were prolonged, fees were higher, and no improvement could be demonstrated with regard to the observed intermediate-term patient outcomes. Guideline implementers (and users) should be cautious about putting unvalidated recommendations into practice.

Adolescent↗
PubMed1953

OFFICE management.

Explore the source record for details and available documents.

Economics, Medical↗
PubMedDate not supplied

Childhood asthma--office management.

Childhood asthma is a major problem in office practice. For an acute life threatening attack (which is indicated by presence of severe distress, pulsus paradoxus, oxygen saturation less than 93%, cyanosis, peak expiratory flow rate of less than 50% of predicted) child should be directly admitted in intensive care unit. If it is a non life threatening attack the child can be managed in the office. Initially, the child should be given b2 agonists by inhalation route with either metered dose inhaler (MDI), MDI with spacer or nebuliser. It there is severe bronchospasm or inhalation therapy is not possible then epinephrine of b2 agonists may be given subcutaneously. The medications can be repeated 2-3 times. If response is adequate the child may be sent home on b2 agonist by oral or inhalation route at an interval of 406 hours. In case of inadequate response the child is started on oral or parenteral corticosteroids. Even after steroids if inadequate response the child is started on intravenous theophylline. Once the acute exacerbation is controlled the child is assessed for starting maintenance therapy. For this purpose his illness is graded from stage I to V depending on the severity. For stage I and II b2 agonists are prescribed as and when required. For stage III sodium cromoglycate by inhalation should be prescribed. For stage IV inhalation steroids in usual doses and for stage V inhalation steroids in higher doses are prescribed along with a minimum dose of oral steroids is added. For symptomatic control slow release theophylline or long acting b2 agonists may be added along with maintenance therapy as and when required. Apart from medications a proper education of parents and patients is necessary to improve the outcome of asthma by increasing the compliance and better control of environment.

Administration, Inhalation↗
PubMedDate not supplied

Application of a depression management office system in community practice: a demonstration.

BACKGROUND: Recent studies provide new insights about strategies that improve depression outcomes. We explored the feasibility of implementing these strategies in community practices. METHODS: Clinicians followed an office system approach to management of depression. There were no controls. The office system was based on established routines performed by a primary care clinician working in a prepared practice, a telephone care manager, and a collaborating psychiatrist, all using a common severity monitoring tool. Five practices with 18 clinicians participated. Sixty-six adult patients had depression diagnosed, and 60 (91%) received care according to the model through 8 weeks of follow-up visits. Depression outcomes were assessed using PHQ-9. RESULTS: At baseline, 48 (80%) patients met criteria for major depressive disorder, chronic depression, or both, while others had less severe symptoms. Of 32 patients with moderately severe or severe depression, the 8-week follow-up severity score decreased by > or = 50% for 23 (70%). Of patient barriers to adherence, ambivalence about treatment and medication side effects were most common. Most patients received three care manager telephone calls requiring 6 to 10 minutes each. CONCLUSION: Application of the office system was feasible in this demonstration project. If results are confirmed in further studies, this approach will be appropriate for widespread application.

Adolescent↗
PubMed1988

Office management of low back pain.

Low back pain, with or without sciatica, is a very common medical problem. Since a great majority of patients can be successfully treated with nonoperative methods, office management of these patients is a very important issue for all clinicians. Patients with low back pain can be divided into three major groups: 1) the first group with acute (initial onset or very occasional recurrent) symptoms, 2) the second group with chronic (frequent intermittent recurrent or persistent) symptoms and 3) the third group with resistant symptoms. For the first group with acute symptoms, establishment of a specific diagnosis is rarely necessary. An active nonoperative treatment program (brief rest, protection, physical therapy modalities, medication, exercises, and reconditioning) provides a high rate (nearly 90 to 95 per cent) of success (return to normal activities and work) within 8 to 12 weeks. For the second group, with chronic symptoms, establishment of a specific diagnosis and a comprehensive and specific history are essential. Diagnostic procedures for specific pathologic conditions are outlined. A clear and specific treatment goal should be established and communicated to all the parties involved. Nonoperative treatment for this group includes back school, postural exercises, bracing, exercises for strength and endurance, work-site modification, vocational counseling, and pain management. For the third group with resistant symptoms, the role of the orthopedic or neurosurgeon is as a consultant to a pain management team for evaluation and treatment of missed diagnosis or complications of previous treatments.

Acute Disease↗