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PubMed2004

[Outpatient rehabilitation as mirrored by the users--findings on the quality of outpatient orthopaedic rehabilitation provided by the Federal Insurance Institute for Employees, BfA].

This article presents the central results of a survey including all persons insured by the BfA (Bundesversicherungsanstalt für Angestellte, German Federal Insurance Institute for Employees) who had participated in outpatient orthopaedic rehabilitation between March and August of 2002. A total of 3838 insured persons were addressed, 69 % replied (n = 2660 questionnaires). The standardized survey included an appraisal of the outpatient rehabilitation measure, the care provided by physicians, psychologists and therapists, the organisation and performance of the rehabilitation measure, as well as of the stressors and general conditions specific to various outpatient measures. The assessment of treatment outcome, physical and psychosocial improvements, and the attainment of therapy goals were of particular importance. Overall, the results show a positive appraisal of outpatient rehabilitation but also indicate the necessity for optimisation--particularly with regard to resting rooms, physician and psychological care, as well as the suitability of the therapy for everyday life. Above all, however, the comparison of the rehabilitation centres shows a great variance in quality of care. Some rehabilitation centres show extraordinary results in many aspects of quality, whereas others reveal systematic deficits of quality.

Ambulatory Care↗
PubMed1997

"Intensive" outpatient substance abuse treatment: comparisons with "traditional" outpatient treatment.

UNLABELLED: Do "intensive," freestanding outpatient substance abuse treatment programs actually provide more intensive services than "traditional" outpatient programs? Three hundred and thirty-eight patients in 6 "intensive" outpatient (IO) programs (three or more times weekly) were compared with 580 patients from 10 "traditional" outpatient (TO) programs (one or two times weekly) on severity of admission problems, treatment services received and six month outcomes. RESULTS: 1. IO subjects generally had the most severe medical, employment, legal and psychiatric problems at admission. 2. IO patients received more alcohol and drug focused services; but fewer medical and employment focused services than the TO patients. Both groups received very few psychosocial services. 3. There were not significant differences between the IO and TO program samples at follow-up. However, both groups showed significant reductions in substance use, improvements in personal health and social function.

Adult↗
PubMed2004

Evaluation of drug prescription at the Geneva prison's outpatient service in comparison to an urban outpatient medical service.

PURPOSE: To analyse non-psychotropic drug prescription in a prison outpatient clinic in comparison with an urban medical outpatient service. METHODS: Comparative study during 3 weeks at Geneva: prison outpatient service and medical policlinic (MP) of the University Hospital. RESULTS: The most often prescribed non-psychotropic drugs at the Geneva prison were systemic analgesics (mostly non-steroidal anti-inflammatory drugs (NSAID) and paracetamol), dermatologicals, systemic anti-infectives and drugs for the gastrointestinal system. For most types of non-psychotropic drugs, frequency of prescription as well as the prescribing patterns were similar in the prison ambulatory service and the urban MP. Dermatologicals were prescribed more frequently at the prison than at the MP. Analgetics have been prescribed mainly for osteoarticulary reasons, especially low back pain at the MP, and for traumatism and headache at the prison. CONCLUSIONS: The higher frequency of dermatological prescriptions could be due to prison environmental factors. We do not have arguments for any overprescription of analgesics or other non-psychotropic drugs. The data did not show any prescription or co-prescription of several substances that violated clinical guidelines.

Adult↗
PubMed1998

Can we trust the quality of routine hospital outpatient information in the UK? Validating outpatient data from the patient administration system (PAS).

BACKGROUND: A validation study of routine hospital outpatient data was carried out as part of a broader project focusing on outpatient re-attendance. The aim was to compare two patient administration system (PAS) data items with the same information collected directly from hospital clinicians. METHODS: A total of 140 cases from four specialties at four National Health Service hospitals was randomly selected for comparison. The specific data items compared were the grade of doctor seen and the management decision taken following an outpatient appointment. The proportion of cases in which there was agreement was calculated, together with kappa values and relevant statistics indicating the accuracy of the PAS data when compared with information compiled immediately after the consultation by the relevant clinician. RESULTS: There was agreement between the clinician's data and the PAS data in 118/140 (84.3%) cases for grade of doctor seen and in 105/139 (76.7%) cases for the management decision. There was complete agreement for both items in 88/139 (62.6%) cases. Kappa values indicated good agreement between the two data sources. However, 'sensitivity' statistics suggested that the likely accuracy of each data item varied. CONCLUSION: Although there was good agreement within individual categories between the two sources, 37% of patient computerised records held at least one inconsistency in this small study focusing on only two data items. Further systematic evaluation is needed to test the extent to which other items are similarly discrepant.

Data Collection↗
PubMed1997

[Project geriatric outpatient clinic. A study on geriatric outpatient clinics and patient basis].

In 1996 PROJECT: geriatric outpatient clinic was initiated by the Ministry of Health and Social Affairs. The purpose was to collect more extensive information about geriatric outpatient clinics in Norway with regard to organization of the clinics, the types of activities and the clinics and the patients attending them. Information on the activities in 1995 was collected, and a summary prepared. Detailed records were made of the activities at 15 geriatric outpatient clinics during March 1996: 288 initial contacts and 239 repeat contacts were recorded. Assessment for mental impairment and multimorbidity constituted 41% of the referrals. The average number og patients per opening hour was rather low: 0.7 (range 0.08-2.5). The pay-back for the hospital was low and there was little incentive to operate the clinics.

Aged↗
PubMed1998

Prescription of cardiovascular drugs in outpatient care: a survey of outpatients in a German university hospital.

AIMS: We evaluated ambulatory prescriptions by general practitioners for outpatients with cardiovascular (CV) disease referred to the cardiology outpatient clinic of the Frankfurt University Hospital in order to prove adherence to generally acknowledged therapy standards for treating CV disease. METHODS AND RESULTS: Appropriateness of current CV medication was assessed according to the following criteria: aspirin or anticoagulants obligatory after myocardial infarction (MI), unless contraindicated; beta-blockers should be prescribed after MI, unless contraindicated or not tolerated; ACE inhibitors should be given in left ventricular dysfunction (LVD) after MI, unless contraindicated; and hypertension should be adequately controlled. 346 patients (28-94 years) received a median of 3 CV drug prescriptions (range 0-7). 240 patients had CAD, 142 patients previous MI, 121 patients had LVD (59 after MI), 143 patients were hypertensive. Aspirin was used appropriately in 80% of all MI patients, 13% received oral anticoagulants due to atrial fibrillation. However, 7% received no antithrombotic therapy. ACE inhibitors were administered in 65% of the MI patients with LVD. beta-blockers were used in 25% of the MI-patients. In the remaining patients, beta-blockers were contraindicated, not tolerated, and/or verapamil had been prescribed. However, in 14% of the patients beta-blockers were withheld without evident reason or alternative drug. In 41% of the hypertensive patients, blood pressure was not sufficiently controlled. CONCLUSION: A considerable number of ambulatory prescriptions for CV drugs are not in accordance with current therapeutic guidelines. The role of a cardiology outpatient clinic to detect the misuse or underuse of CV drugs is emphasised.

Adult↗
PubMed1986

Comparison of MMPI clinical scale and critical item changes of adult outpatients and parents of child psychiatry outpatients during the 1970s.

The present investigation is a replication of the Holmes, Sabalis, Chestnut, and Khoury (1984) study of MMPI critical item endorsement changes and MMPI clinical scale shifts in the parents of children seen at the William S. Hall Psychiatric Institute, Columbia, South Carolina during the 1970s. The current study evaluates MMPIs (N = 749) of adult, female, and male psychiatric outpatients seen during the 1970s. The general MMPI changes observed in the adult psychiatric outpatient population were not similar to those changes seen in the parent population. However, an important specific change on the Masculine/Feminine Scale for the adult outpatients was discussed.

Adult↗
PubMed1996

Medical referrals for hypnotherapy: opinions of physicians, residents, family practice outpatients, and psychiatry outpatients.

Previous studies surveying attitudes and education regarding the clinical use of hypnosis have been conducted with patient populations only. The current study was undertaken to assess the attitudes, experiences, training levels, and interest in future education regarding the use of hypnosis by staff physicians, medical resident physicians, family practice outpatients, and psychiatry outpatients. All subjects were drawn from a 400-physician group practice in Central Texas affiliated with a large university health science center. Results indicate that the majority of physicians (79%) and residents (67%) had received no prior training and even fewer had experienced hypnosis. The percentages for personal experience with hypnosis were similar for psychiatric outpatients, physicians, and residents. The need for patient and practitioner education was elucidated by the high rate of endorsement of misconceptions regarding hypnosis by patients (over half) and by some medical practitioners as well. Limited awareness of the appropriate applications of hypnosis was reported. However, 85% of practitioners expressed an interest in hypnosis education. Further research in medical setting demographics is recommended to validate generalizability of results and facilitate construction of medical education programs in hypnosis.

Adolescent↗
PubMed2000

Sexual and physical abuse of chronically ill psychiatric outpatients compared with a matched sample of medical outpatients.

Because there are few controlled studies, we aimed to determine the prevalence of sexual and physical abuse reported by psychiatric outpatients compared with matched controls. The sample consisted of 158 outpatients with major mental disorders including schizophrenia and bipolar disorder who responded to a semi-structured interview (response rate = 64.8%) and who were individually matched for gender, age, and ethnicity with 158 outpatients who had never been treated for psychiatric illness. They answered questions about whether and when they had ever been sexually or physically abused, and about the type and circumstances of abuse. Abuse was more common during adulthood (16 years or older); 45 psychiatric patients (28.5%) were sexually abused and 43 (27.3%) were physically abused. Compared with the controls, patients were significantly more likely to report a history of sexual or physical abuse during adulthood (chi2 = 5.15, df = 1, p = .02; chi2 = 4.09, df = 1, p = .04 respectively). During adulthood, female patients were significantly more likely to be sexually and physically abused than male patients, and those sexually abused were significantly more likely to report a history of sexual abuse during childhood. However, patients were not significantly more likely to report a history of sexual or physical abuse during childhood compared with the controls. These findings demonstrate that psychiatrically ill patients are vulnerable to sexual and physical abuse during adulthood and underscore psychiatrists' responsibility to routinely inquire about abuse experiences.

Adolescent↗
PubMed2006

Remission and relapse in the outpatient care of schizophrenia: three-year results from the Schizophrenia Outpatient Health Outcomes study.

Remission and relapse are clinical outcomes of increasing interest in schizophrenia. We analyzed remission and relapse, and the sociodemographic and clinical factors associated with these outcomes, in the usual care of schizophrenia using the 3-year, follow-up data from a large cohort of outpatients with schizophrenia taking part in the prospective, observational, European Schizophrenia Outpatient Health Outcomes study. Of the 6516 patients analyzed for remission, 4206 (64.6%) achieved remission during the 3-year, follow-up period. Logistic regression analysis revealed that being female, having a good level of social functioning at study entry, and a shorter duration of illness were factors significantly associated with achieving remission. Treatment with olanzapine was also associated with a higher frequency of remission compared with other antipsychotic agents. A Kaplan-Meier survival curve estimated that relapse occurred in approximately 25% of the patients who achieved remission, with the risk of relapse remaining constant during the follow-up period. Shorter duration of illness, having hostile behaviors, and substance abuse were factors associated with a higher risk of relapse, whereas good level of social functioning and the use of olanzapine and clozapine were associated with a lower risk of relapse. In conclusion, the 3-year results of the Schizophrenia Outpatient Health Outcomes study indicate that the likelihood of remission decreases over the longitudinal course of schizophrenia, but risk of relapse is maintained even after 3 years of achieving remission severity levels. Results suggest that treatment with olanzapine is associated with a better chance of achieving remission than other antipsychotics. Moreover, the use of olanzapine and clozapine is associated with a lower risk of relapse compared with risperidone, quetiapine, and typical antipsychotics. The results should be interpreted conservatively because of the observational, nonrandomized study design.

Adult↗
PubMed2004

Outpatient Osteopathic Single Organ System Musculoskeletal Exam Form series: validation of the Outpatient Osteopathic SOS Musculoskeletal Exam Form, a new standardized medical record.

The authors validate the Outpatient Osteopathic SOS (Single Organ System) Musculoskeletal Exam Form (SOS MSEF), a 1-page form contained within the 4-page Outpatient Osteopathic Single Organ System Musculoskeletal Exam Form Series (SOS-FS). Handwritten physician progress notes (PPNs) in the medical record (considered to be the "gold standard" for clinical records) were compared with information placed on the SOS MSEF for the same patient encounter. Data recorded by 14 trained and certified investigators on the standardized SOS MSEF-which was designed for use with the previously validated Outpatient Osteopathic SOAP (Subjective, Objective, Assessment, Plan) Note Form (SNF)-was compared with data recorded by the same investigators in PPNs. The authors compared the accuracy and efficiency of physicians recording musculoskeletal information in these two formats for 165 patient encounters. Descriptive statistics and t tests were used to compare data recorded after patient encounters. Ninety-seven variables input from the PPNs or SOS MSEFs were significantly different at the P < or = .05 level, whereas 38 variables were not. Insufficient data was recorded for a determination of significance in 3 variables. For 121 variables, more data were recorded using the SOS MSEFs than PPNs; for 84 variables, the amount of data recorded exceeded twice that recorded using PPNs. For 10 variables, more data were recorded in PPNs; however, these differences were not significant. The authors conclude that the SOS MSEF is superior to PPNs for recording patient-encounter data in the osteopathic care setting. Moreover, they argue that the use of the validated SOS MSEF nationwide would ensure that osteopathic physicians would be recording data in a similar manner for uniform insurance claim coding, easy tracking of physicians-in-training and patient outcomes, and data collection for future research.

Forms and Records Control↗
PubMed1987

[Comparative effectiveness of the combined outpatient-hospital and outpatient treatments of hypertension patients with high and stable arterial pressure indices].

The paper is concerned with an analysis of the effectiveness of the outpatient and hospital stages in the treatment of patients with essential hypertension with stable and high AP indices. The absence of significant changes in the time course of AP, the number and nature of complications and the number of days of temporary disability was shown in 197 patients treated in the groups of outpatient and outpatient-hospital therapy.

Absenteeism↗
PubMed1989

General practitioners' referrals to specialist outpatient clinics. I. Why general practitioners refer patients to specialist outpatient clinics.

There has been much concern about the wide variations in general practitioners' referral rates and the consequent implications for cost and quality of care. This has led to a call to evaluate the appropriateness and effectiveness of referrals. A collaborative audit of referrals to outpatient clinics was conducted by 127 general practitioners in 33 practices in the Oxford region. Records were kept of 18,754 referrals, which included data on diagnoses and reasons for referral. Overall, 6553 (35.4%) of the referrals were for particular treatments or operations and a further 6475 (34.9%) were for specific investigation or diagnosis. Advice on management was the main reason for referral in 2656 (14.3%) cases, and in 1719 (9.3%) cases the general practitioners wanted the consultants to take over managing their patients. Reassurance of either the general practitioner or the patient was recorded as the main reason in only 762 (4.1%) referrals. There seems to be scope for rationalising the referral process. A programme with three stages for evaluating referrals to outpatient clinics is recommended.

England↗
PubMed1989

General practitioners' referrals to specialist outpatient clinics. II. Locations of specialist outpatient clinics to which general practitioners refer patients.

Although linkage by computer of hospital administration systems across all clinics in a health district is becoming a practical possibility, complete records of general practitioners' referrals to outpatient clinics will be difficult to achieve. Data from a large study of general practitioners' referrals to such clinics were used to calculate the proportion of referrals that crossed district boundaries, the proportion that were made to the private sector; and the number of locations that each practice referred patients to. Of the 17,601 referrals from practices in Oxford Regional Health Authority, 13,857 (78.7%) were made to NHS outpatient clinics within practices' own districts, 1524 (8.7%) to clinics in other districts in the same region, 420 (2.4%) to NHS clinics in other regions, and 1800 (10.2%) to the private sector; but these proportions varied considerably among the practices. The mean number of different NHS hospitals or clinics that each practice referred patients to was 15.8 (range 4-42).

Catchment Area, Health↗
PubMed1992

Outpatient falloposcopy: intra-luminal imaging of the fallopian tube by trans-uterine fibre-optic endoscopy as an outpatient procedure.

OBJECTIVE: To develop trans-uterine falloposcopy using the linear eversion technique in outpatients. DESIGN: A prospective, descriptive study of the introduction and application of this new technique. SETTING: A tertiary referral University Research Clinic independent of operating theatres and inpatient admission. SUBJECTS: Twenty-one infertile women with previous evidence of fallopian tube disease. MAIN OUTCOME MEASURES: Rate of successful tubal cannulation and procedure completion, tubal section visualized, condition of the tubal epithelium, subsequent treatment plan. RESULTS: A bilateral examination was attempted in 19/21 patients and completed in 18. Two early falloposcopies with inadequate analgesia were aborted due to pain after only one tube had been examined without an attempt to identify or cannulate the contralateral tubal ostium. In one patient, neither ostium was identified or cannulated. After ostial localization, 37/37 tubes were cannulated. If the ostium was not localized but 'blind' cannulation attempted, 1/3 were cannulated successfully. Epithelium characteristic of the ampulla was seen in 31/38 (82%) tubes, and of the proximal tube only in 3/38 (8%). Successful bilateral assessment noted complete bilateral proximal obstruction in 2/18 patients, non-obstructive bilateral endotubal damage in 7/18, unilateral damage in 3/18 and bilateral healthy tubes in 6/18. Unilateral examination in two patients found minimal evidence of damage in one and severe intra-tubal adhesions in the other. After falloposcopy, 11/21 patients elected for IVF, 9/21 tubal surgery and 1/21 for IVF whilst awaiting surgery. CONCLUSION: Falloposcopy is a technique which can be performed in an outpatient clinic. It is well tolerated, and high rates of luminal cannulation and visualization are possible. Atraumatic access to the tube and visualization of its lumen offer exciting opportunities for diagnosis and treatment of tubal conditions.

Ambulatory Care↗
PubMed2004

Involuntary outpatient commitment, community treatment orders, and assisted outpatient treatment: what's in the data?

OBJECTIVE: Involuntary outpatient commitment (OPC), also referred to as community treatment orders or assisted outpatient treatment, is a legal intervention intended to improve treatment adherence among persons with serious mental illness. This paper reviews the empirical literature on the procedure's effectiveness. METHODS: We identified and reviewed all English-language studies of OPC and related procedures available in Medline and other bibliographic search services. RESULTS: Existing naturalistic and quasi-experimental studies, taken as a whole, moderately support the view that the procedure is effective, although all do have methodological limitations. Two randomized controlled studies of OPC have conflicting findings and are reviewed in detail. CONCLUSIONS: On balance, empirical studies support the view that OPC is effective under certain conditions, although some of the evidence has been contested and the policy remains controversial.

Ambulatory Care↗
PubMed1991

This OWL (outpatient work-up liaison) would not fly. Environmental factors foil attempt to shift unnecessary inpatient days to the outpatient setting.

The last days of many appropriate hospital admissions have been identified as unnecessary when utilized for providing diagnostic or therapeutic modalities that could be provided in an outpatient setting. An outpatient work-up liaison team (OWL) was established to facilitate the completion of evaluations or therapy in the community. In spite of the commitment of experienced personnel and the cooperation of the staff physicians and hospital departments, the effort was unsuccessful. The failure is attributed to the socioeconomic environment in the immediate community that could not support the transfer of medical efforts. It is recommended that before any institution undertakes shifting hospital-based services to the community a realistic assessment be made of the socioeconomic milieu.

Ambulatory Care↗