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PubMed1977

Acute schizophrenia: an efficacious outpatient treatment approach as an alternative to full-time hospitalization.

A research study was designed to test the hypothesis that acutely schizophrenic patients treated for a few minutes a day in a specially designed, city-county hospital outpatient clinic could remit as frequently, rapidly, and economically as a similar group managed on the ward of the same hospital. The results of the study permitted acceptance of the hypothesis. To wit, 90% of the clinic patients remitted in a median time of 12.5 days, as opposed to 70% of the ward patients remitting in a median time of 19.5 days and for approximately six times the cost.

Acute Disease↗
PubMedDate not supplied

Hospital or health centre? A comparison of the costs and quality of urban outpatient services in Maseru, Lesotho.

Urban hospital outpatient clinics in developing countries are said to be overburdened and some policy experts are proposing a new intermediate tier of advanced health centres between hospitals and health centres to solve this problem (termed 'reference centres' by the World Health Organization). In Maseru, Lesotho, hospital congestion led the Ministry of Health to decide to build reference centres. To delineate precisely how these centres should operate, research was carried out on the existing system comparing utilization, quality and cost between health centre and hospital outpatient care. The study showed that throughout per clinician at the hospital and the city health centres was similar; that the hospital service saw a greater proportion of adults and more men; that the technical care quality was similar; and, that health centre staff took longer with patients and had higher interpersonal consultation scores. Average costs at the hospital were 39 per cent greater, but, the calculated net costs to the provider at the hospital and at government centres were very similar once user fees had been taken into account. The results questioned the assumptions underlying the decision to build reference centres in Maseru, and also the relevance of a new tier to solve health service delivery problems in the city. The study highlights the need for national and municipal planners to examine carefully existing health services with respect to utilization, quality and cost before adopting urban reference centres as a standard solution to congested hospitals.

Community Health Centers↗
PubMedDate not supplied

Intestinal parasitic infestation in pediatric gastroenterology outpatient clinic Dr. Pirngadi Hospital Medan.

A retrospective study had been done at the outpatient clinic sub division of Pediatric Gastroenterology, Dr. Pirngcdi Hospital Medan, comprising patients from 1 January 1985-31 December 1987. There were 874 patients. Three hundred seventy eight (43.25%) patients consisting of 210 (55.56%) males and 168 (44.44%) females had intestinal parasitic infestations. The youngest patient was 5 months and the oldest was 14 years and 3 months. Ascaris lumbricoides was found in 215 patients (24.60%) while Trichuris trichiura, hookworm, Oxyuris vermicularis, Hymenolepis nana, and Taenia were in 152 (17.39%), 13 (1.49%), 4 (0.46%), 15 (1.72%) and 4 (0.46%) cases respectively. Entamoeba histolytica was found in 121 (13.84%) and Giardia lamblia in 16 (1.83%) patients. The highest age specific attack rate was found in the age group of 5-10 years (65.67%). Ascaris lumbricoides was most frequently found namely in 100 children (26.46%), followed by Entameba histolytica in 73 (19.31%) and mixed infestation of Ascaris lumbricoides and Trichuris trichiura in 68 (17.99%) patients. One hundred seventy three (66.28%) under five patients with intestinal parasitic infestation had malnutrition while of the 433 under fives without intestinal parasitic infestation only 201 (46.42%) suffered from malnutrition (P less than 0.001).

Adolescent↗
PubMed2006

Pre-hospital treatment of febrile illness in children attending the General Outpatients Clinic, University College Hospital, Ibadan, Nigeria.

Many childhood febrile illnesses are treated at home prior to presentation. This study gathered information on treatment practices of caregivers for febrile illnesses in an urban area. A Cross sectional survey of consenting guardians of 535 consecutive febrile children under 10 years presenting at General Outpatients' (GOP) Clinic. University College Hospital. Ibadan was carried out. Thick blood smears were examined for malaria parasite. The mean (SD) age of the febrile children was 3.2 (2.8) years. Nineteen (17.5%) children were brought within 24 hours of noticing fever. Malaria was presumed to be the diagnosis by 217 (40.6%) respondents: 247 (46.2%) did not know the cause of fever. Most. 469 (87.7%) respondents gave drugs bought from chemists/pharmacy shops before presentation at the GOP. Paracetamol 1380 (81.0%)] and chloroquine [171 (36.5%)] were the most commonly used drugs. Twenty-six (15.2%) respondents used chloroquine correctly. One hundred and ninety-nine of 476 children (41.8%) were smear positive and 88 of 191 (46.1%) children whose guardians presumed malaria had parasites. This study reiterates the fact that majority of childhood febrile illnesses are first treated at home. It underscores the need to empower caregivers by appropriate education on knowledge, attitude and practice of the management including home management of malaria.

Ambulatory Care Facilities↗
PubMed2006

Understanding reasons for asthma outpatient (non)-attendance and exploring the role of telephone and e-consulting in facilitating access to care: exploratory qualitative study.

OBJECTIVE: To understand factors influencing patients' decisions to attend for outpatient follow up consultations for asthma and to explore patients' attitudes to telephone and email consultations in facilitating access to asthma care. DESIGN: Exploratory qualitative study using in depth interviews. SETTING: Hospital outpatient clinic in West London. PARTICIPANTS: Nineteen patients with moderate to severe asthma (12 "attenders" and 7 "non-attenders"). RESULTS: Patients' main reasons for attending were the wish to improve control over asthma symptoms and a concern not to jeopardise the valued relationship with their doctor. Memory lapses, poor health, and disillusionment with the structure of outpatient care were important factors implicated in non-attendance. The patients were generally sceptical about the suggestion that greater opportunity for telephone consulting might improve access to care. They expressed concerns about the difficulties in effectively communicating through non-face to face media and were worried that clinicians would not be in a position to perform an adequate physical examination over the telephone. Email and text messaging were viewed as potentially useful for sending appointment reminders and sharing clinical information but were not considered to be acceptable alternatives to the face to face clinic encounter. CONCLUSIONS: Memory lapses, impaired mobility due to poor health, and frustration with outpatient clinic organisation resulting in long waiting times and discontinuity of care are factors that deter patients from attending for hospital asthma assessments. The idea of telephone review assessments was viewed with scepticism by most study subjects. Particular attention should be given to explaining to patients the benefits of telephone consultations, and to seeking their views as to whether they would like to try them out before replacing face to face consultations with them. Email and text messaging may have a role in issuing reminders about imminent appointments.

Adult↗
PubMed1990

Mothers' satisfaction with the cost of children's care: the role of practice settings and actual expenses.

This paper analyzes mothers' satisfaction with the cost of children's care in six widely-varying ambulatory settings: fee-for-service solo and group practices, a prepaid group, public clinics, hospital outpatient departments, and an emergency room. Data are from a household survey in Washington, DC and represent 638 children. Findings indicate significantly higher satisfaction with cost in public clinics than in solo practice, fee-for-service groups, and the emergency room, adjusting for patient characteristics, attitudes and financial coverage. In fee-for-service settings, both provider charges and out-of-pocket costs had a nonlinear relation to satisfaction with cost; to a point, increasing costs and charges were associated with decreasing satisfaction, but thereafter higher costs and charges appeared to lead, other things equal, to higher satisfaction. Out-of-pocket costs had a significantly greater negative effect on poor mothers' satisfaction than on the more affluent. Implications for current policy trends are discussed.

Black or African American↗
PubMed1995

Cost comparison of psychiatric outpatient clinics based in hospitals and in primary care (general practice health center).

The first study to compare the costs of hospital-based and primary care (general practice health center)-based psychiatric outpatient clinics is reported. The operating costs of both clinic settings were estimated to be similar. There are many advantages of primary care-based clinics compared with hospital-based clinics. However, as there are no evaluative studies of the comparative efficacy of either clinic setting, before policy decisions to encourage primary care clinics are made such evaluative studies should take place.

Cost-Benefit Analysis↗
PubMed2002

Prospective evaluation of the quality of oral anticoagulation management in an outpatient clinic and in general practices.

OBJECTIVE: To compare the quality of oral anticoagulant therapy (QOAT), before and after referral of patients on oral anticoagulant therapy (OAT) from a hospital outpatient clinic (HOC) to general practitioners (GPs). DESIGN: Prospective observational study. Patients were identified by using the Laboratory Information System (LIS), containing all prescribed International Normalised Ratio of Prothrombin Time (INR) tests, from the HOC and GPs in the hospital submission area. SETTING: The HOC in a rural hospital, Aarhus County, Denmark (55,000 inhabitants), and GPs in the submission area. SUBJECTS: 124 OAT patients (59.7% males. Median age 70.0: 25-75 percentile: 62.0-76.0). MAIN OUTCOME MEASURE: The QOAT in terms of time spent within therapeutic INR interval (TI). The QOAT was compared 8 months before with 8 months after altering the monitoring organization. For patients monitored less than 8 months before the alteration, the QOAT was compared to a corresponding time period after the alteration. RESULTS: We identified 124 OAT patients, and found a significant increase in the QOAT from 65.0% before to 69.1% after referral of the patients to the GPs (P<.0001). In 75 patients with full follow-up, the QOAT increased from 67.5% before to 69.7% after the alteration (P<.0001). CONCLUSION: The results indicate that the QOAT in this geographical area is adequate, and that the quality performed by the GPs was at least as good as in the HOC. In order to document and increase the QOAT, continuous quality surveillance using the LIS has been initiated.

Administration, Oral↗
PubMed2005

Provider and practice characteristics associated with antibiotic use in children with presumed viral respiratory tract infections.

OBJECTIVE: Although overuse of antibiotics in children has been well documented, relatively little information is known about provider and facility characteristics associated with this prescribing practice. This study was done to evaluate the differences in overuse of antibiotics among staff physicians and resident/interns (housestaff [HS]) who work in hospital-based outpatient clinics. METHODS: This cross-sectional study involved patient encounters in outpatient departments that were included in the US National Hospital Ambulatory Medical Care Survey database from 1995 to 2000. Encounters with patients who were aged <18 years and had a primary diagnosis suggestive of viral respiratory tract infection were evaluated. Patients with comorbid conditions that might justify antibiotic use were excluded. RESULTS: This study included 1952 patient encounters with a primary diagnosis suggestive of a viral infection and 33.2% of these patients receiving antibiotics. Overall, antibiotic use was significantly less among HS (19.5%) than staff physicians (36.4%; odds ratio [OR]: 0.44; 95% confidence interval [CI]: 0.33-0.59). This difference between HS (19.5%) and staff physicians (32.5%) persisted even within teaching hospitals (OR: 0.5; 95% CI: 0.4-0.7). Among staff physicians, antibiotic use was greater among those who work in nonteaching (39.6%) compared with teaching hospitals (32.5%; OR: 1.51; 95%: CI 1.15-1.98). Controlling for other patient and provider variables, antibiotic use occurred less among HS than among staff physicians in teaching hospitals (OR: 0.53; 95% CI: 0.38-0.75). CONCLUSIONS: Antibiotic prescribing in the context of an outpatient visit for a diagnosis suggestive of a viral respiratory tract illness occurs more commonly among staff physicians than trainees and among staff physicians more commonly in nonteaching compared with teaching institutions.

Adolescent↗
PubMed1995

The nature of epilepsy in the general population. II. Medical care.

The medical care received by an unselected population of patients with epilepsy identified from the lists of 119 general practitioners in the UK was evaluated and compared with established standards. The study was carried out by questionnaire distributed to the patients and their general practitioners. Information was collected about hospital referral patterns, the doctor responsible for follow-up, investigations performed, attendances at Accident and Emergency (A&E) departments, hospital admissions, medication, and the information supplied to patients. Eighty-one per cent of patients had been referred to a hospital outpatient clinic, and 28% were under continuing hospital follow-up. Only 6% had been seen in a specialist epilepsy clinic. The majority had had an electroencephalogram (EEG), but less than half a CT scan. Forty-three per cent had attended an A&E department on account of epilepsy, and 47% had required hospital admission. Sixty-five per cent of patients were on monotherapy, mostly phenytoin, carbamazepine or sodium valproate: a significant proportion also took phenobarbitone. Except for the issues of free prescriptions and driving, patients could remember being given little information about epilepsy, and this was the most common source of dissatisfaction. The study suggests many accepted recommendations about the care of people with epilepsy are not followed, with hospital referral patterns, a shortage of specialists epilepsy clinics, and lack of patient information being areas of concern.

Adolescent↗