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At least 487 records · Page 27Linked to original sources
PubMed2000

National Hospital Ambulatory Medical Care Survey: 1998 outpatient department summary.

OBJECTIVE: This report describes ambulatory care visits to hospital outpatient departments in the United States. Statistics are presented on selected hospital, clinic, patient, and visit characteristics. METHODS: The data presented in this report were collected from the 1998 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to hospital outpatient and emergency departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual estimates. RESULTS: During 1998, an estimated 75.4 million visits were made to hospital outpatient departments in the United States, an overall rate of 28.0 per 100 persons. Visit rates did not vary by age except in a comparison of the 15-24 year old group with the 75 years and over age group. Black persons had higher rates of visits than white persons as did women compared with men. Of all visits made to hospital outpatient departments in 1998, 33.8 percent and 25.9 percent, respectively, listed private insurance and Medicaid as the primary expected source of payment, and 21.9 percent were made by patients belonging to a health maintenance organization. There were an estimated 7.1 million injury-related outpatient department visits during 1998.

Adolescent↗
PubMed2005

[Employment of professional help by patients with obsessive-compulsive disorders].

BACKGROUND: Several studies have investigated the pathway to psychiatric care. There are no results available for OCD. METHODS: Therefore, 23 patients with OCD were recruited among individuals seeking treatment at our university hospital outpatient clinic for anxiety and obsessive-compulsive disorders. All patients underwent a semistructured interview aimed at investigating their individual pathways to psychiatric care, to their experiences in the health system and to the first appearances of the psychiatric disorder. RESULTS: Those affected often trivialize and normalize the first symptoms of OCD. Also, in many cases, family members of OCD-patients do not understand the first symptoms of OCD. Contrary to patients with depression and anxiety disorder, OCD-patients often choose psychiatrists as their first professional contact. DISCUSSION: The first symptoms of the disorder must be diagnosed at an early stage in order to provide the patients with the acknowledged therapy for OCD.

Adult↗
PubMed2003

Ambulatory diagnosis and medical management of ectopic pregnancy in a public teaching hospital serving indigent women.

OBJECTIVE: The study was undertaken to evaluate the outcomes of indigent women with possible ectopic pregnancy who were cared for in a public teaching hospital outpatient clinic by multiple residents. STUDY DESIGN: Retrospective review of patients seen in the Obstetric-Gynecologic Urgent Care Center at Harbor-UCLA Medical Center from September 1, 2000, through August 30, 2001, was performed. RESULTS: Of the 243 women being evaluated for possible ectopic pregnancy, 4 required surgical intervention during their diagnostic workup and 58 were lost to follow-up. Of the 31 women given methotrexate therapy, 25 successfully completed therapy, 2 required surgery, and 4 were lost to follow-up. Substantial investment was needed to contact patients who missed appointments. CONCLUSION: It is feasible to manage women with possible ectopic pregnancies on an ambulatory basis in a public teaching hospital, but close oversight is needed and both staff and patients must commit to significant follow-up. Local protocols can be modified to reduce the numbers of visits required.

Adolescent↗
PubMed1992

[3-year results of 'gallstone outpatient clinic' in an academic hospital].

On April 1st 1988 an outpatient clinic solely for patients with gallstones was started. 594 patients visited the gallstone outpatient clinic during the first three years of its existence and the data of all these patients were collected and examined retrospectively. Mean age was 49.0 years (SD: 15; range: 20-88), male-female ratio was 0.34 and the majority of patients were symptomatic (86.9%). 60.3% were referred by their general practitioners, 21.7% by another specialist en 18.0% sought help on their own initiative. In 8.1% of the cases there were acute biliary problems and 2.4% had an increased surgical mortality risk. Cholecystectomy was advised in the majority of patients (51.9%), expectant management in 20.2%, analysis was stopped in 2.5% and the others (25.4%) were advised a treatment alternative to cholecystectomy. Medical, but most of all public interest in the different therapeutic modalities for symptomatic cholelithiasis has a trend-sensitive character which is reflected in patterns of referral, diagnostic procedures and therapeutic advice given.

Academic Medical Centers↗
PubMed2000

APCs challenge hospital EDs and outpatient clinics.

As the uneasily awaited Medicare outpatient prospective payment system becomes reality July 1, hospital emergency department and outpatient clinics face an even greater need for accurate coding models and systems, as well as vigorous cost-reduction strategies. By the nature of the services they provide, such facilities will find securing adequate payment for appropriate, quality care to be a complex and challenging task. Those organizations that have prepared effectively, however, may benefit under the prospective payment system.

Aged↗
PubMed1994

Costs vs quality in different types of primary care settings.

OBJECTIVE: To determine the relationship between efficiency in use of resources and quality of care provided by physicians serving as the usual source of care for patients in a state Medicaid program. DESIGN: Retrospective quality-of-care review of 2024 outpatient medical records of 135 providers sampled from system-wide Medicaid claims data in Maryland. SUBJECTS: Providers in three types of practice settings (hospital outpatient clinic, community health center, and physician's office) were stratified into three case mix-adjusted resource use groups (high, medium, and low). A sample of patients with the diagnoses of diabetes, hypertension, asthma, well-child care, or otitis media were identified from Medicaid claims forms from visits during 1988. Case mix was controlled by the application of the ambulatory care groups, a method that characterizes populations according to their burden of morbidity. MAIN OUTCOME MEASURES: Nurses from the local peer review organization audited medical records using explicit criteria for quality of care in several categories: evidence of impaired access, evidence of compromised technical quality, evidence of inappropriate care, outcome of care, and several generic indicators of quality. Well-adult care was assessed for patients with the adult diagnoses. RESULTS: Although there were some systematic differences by type of facility in some aspects of quality of care (more access problems for patients in hospital clinics and more technical quality problems for patients in office-based practice), there were no consistent differences in quality of care overall for patients in different types of settings and no consistent relationships between cost-efficiency and quality of care. However, patients in medium-cost community health centers had the best or second best scores for most of the 21 comparisons of type of quality assessed. CONCLUSIONS: Quality of care provided for common conditions in primary care is not associated with costs generated by providers. Policies directed toward the choice of low-cost vs high-cost providers will not necessarily lead to a deterioration in the quality of care. States can both improve quality and lower costs by consistent monitoring of programs over time. The finding of generally higher quality of care for patients in medium-cost community health centers deserves further study.

Adult↗
PubMed2005

Relationship between fasting serum glucose, age, body mass index and serum 25 hydroxyvitamin D in postmenopausal women.

OBJECTIVE: Because it has been reported that vitamin D, given to mother or infant, can prevent type I diabetes in children, that diabetes is more common in adults with low serum vitamin D and that insulin secretion and action are related to vitamin D levels in healthy young adults we examined the relationship between serum vitamin D metabolites and fasting serum glucose in patients attending our outpatient clinics. DESIGN: Retrospective examination of convenience sample of postmenopausal women attending our osteoporosis clinics. PATIENTS: A total of 753 postmenopausal women attending a university hospital outpatient clinic and not on any treatment known to affect glucose metabolism. MEASUREMENTS: Body weight and height, serum 25-hydroxyvitamin D [25(OH)D], serum 1,25-dihydroxyvitamin D [1,25(OH)2D], serum PTH and fasting serum glucose. RESULTS: On simple correlation fasting serum glucose was a positive function of age (P < 0.05), weight (P < 0.001) and body mass index (BMI) (P < 0.001) and a negative function of serum 25(OH)D (P < 0.001), but it was not significantly related to either serum 1,25(OH)2D, PTH or creatinine. When fasting serum glucose was regressed simultaneously on age, BMI and 25(OH)D, glucose was still an inverse function of 25(OH)D (P = 0.006). CONCLUSIONS: Fasting serum glucose increased as 25(OH)D levels fell throughout the range of serum 25(OH)D measured but the greatest increase was observed in those with 25(OH)D below 40 nmol/l.

Adult↗
PubMed2004

Variation in participation in health care settings associated with race and ethnicity.

OBJECTIVE: To use the ecology model of health care to contrast participation of black, non-Hispanics (blacks); white, non-Hispanics (whites); and Hispanics of any race (Hispanics) in 5 health care settings and determine whether disparities between those individuals exist among places where they receive care. DESIGN: 1996 Medical Expenditure Panel Survey data were used to estimate the number of black, white, and Hispanic people per 1,000 receiving health care in each setting. SETTING: Physicians' offices, outpatient clinics, hospital emergency departments, hospitals, and people's homes. MAIN MEASUREMENT: Number of people per 1,000 per month who had at least one contact in a health care setting. RESULTS: Fewer blacks and Hispanics than whites received care in physicians' offices (154 vs 155 vs 244 per 1,000 per month, respectively) and outpatient clinics (15 vs 12 vs 24 per 1,000 per month, respectively). There were no significant differences in proportions hospitalized or receiving care in emergency departments. Fewer Hispanics than blacks or whites received home health care services (7 vs 14 vs 14 per 1,000 per month, respectively). After controlling for 7 variables, blacks and Hispanics were less likely than whites to receive care in physicians' offices (odds ratio [OR], 0.65, 95% confidence interval [CI], 0.60 to 0.69 for blacks and OR, 0.79, 95% CI, 0.73 to 0.85 for Hispanics), outpatient clinics (OR, 0.73, 95% CI, 0.60 to 0.90 for blacks and OR, 0.71, 95% CI, 0.58 to 0.88 for Hispanics), and hospital emergency departments (OR, 0.80, 95% CI, 0.69 to 0.94 for blacks and OR, 0.80, 95% CI, 0.68 to 0.93 for Hispanics) in a typical month. The groups did not differ in the likelihood of receiving care in the hospital or at home. CONCLUSIONS: Fewer blacks and Hispanics than whites received health care in physicians' offices, outpatient clinics, and emergency departments in contrast to hospitals and home care. Research and programs aimed at reducing disparities in receipt of care specifically in the outpatient setting may have an important role in the quest to reduce racial and ethnic disparities in health.

Black or African American↗
PubMed1989

[The use of medicines by children attending the outpatient clinic at Kafalong Hospital].

Repeated visits by some children to the outpatient department of Kalafong Hospital seem to cast doubt on the efficacy of treatment taken at home. Four hundred persons accompanying children less than 14 years of age were interviewed. Most of the children were less than 6 years old, with a mean age of 36.6 months. Three or fewer drugs were issued to more than 80% of the children and 72% of the accompanying adults in this group knew the correct dosage. However, when 4 or more items were issued, only 52% knew the correct dosage. Understanding of the required duration of therapy was inadequate. The correct administration of the prescribed drugs correlated well with a higher education of the patient escorts. People living in the urban areas were better educated and had fewer children than those from rural localities. Some recommendations are made to improve drug administration by supervising adults.

Adolescent↗
PubMed2000

[Psychiatric/psychological work with refugees and asylum seekers].

BACKGROUND: In 1998 the Psychosocial Centre for Refugees performed a survey in order to study the number of refugees/asylum seekers referred during 1997 and to look for special problems in the work with these patients. MATERIAL AND METHODS: A questionnaire was sent to 115 psychiatric outpatient clinics, hospitals and family counselor offices. Items included were diagnoses, treatment, areas of work experienced as difficult, and the existence of cooperation between primary care and psychiatric services. RESULTS: The majority of units reported that less than ten refugee patients were referred during 1997. Problems related to culture and communication as well as trauma-related problems were reported as the most difficult areas. Only one third of the units reported regular cooperation with primary health care. INTERPRETATION: The number of referred refugee patient was lower than expected. One explanation may be that general practitioners view psychiatric units as inaccessible for referral due to lack of resources. As a consequence, psychiatric health personnel do not develop the experience and competence that is necessary for treating these patients. Regular cooperation between psychiatric units treating refugees and the primary health care is also important because of the fact that many traumatized refugees have somatic complaints resulting from maltreatment and torture.

Clinical Competence↗
PubMed2002

The development of a time-based nursing information system in dermatology outpatients and day therapy areas.

Over the past 10 years the provision of dermatology services in Nottingham has moved away from inpatient care and towards nurse-led day therapy and outpatient care. The current nursing information system supplies nursing activity data for management information and is a ward-based patient dependency classification system. Recently, it became apparent that nursing activity in day therapy and outpatients was being measured with a tool that was not designed for the purpose and managers were using professional judgement to aid their decisions. An evaluative internal consultancy was conducted to investigate the situation and provide recommendations for the development of an appropriate system that would supply more accurate information for non-ward areas. The report recommended a 'time-based' system that avoided the fundamental philosophical mismatch between a reductionist, task-orientated system and the reality of holistic nursing care. The new system was developed on a departmental personal computer using Microsoft Excel spreadsheets. The full co-operation and input of the nursing staff was an essential ingredient in its success. The original consultancy concentrated on the day therapy unit but the time-based system was developed to include all dermatology non-ward areas.

Ambulatory Care Information Systems↗