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At least 19 recordsLinked to original sources
PubMedDate not supplied

[Supply of outpatient care in the Lazio region: geographic distribution and characteristics of outpatient clinics].

Outpatient care accounts every year for a large share of the National Health Fund spending, however characteristics of supply have not been thoroughly investigated. Objective of the study is the description of the outpatient care system of Lazio region and of the main characteristics of outpatient clinics, through indicators obtained using data from the Outpatient Care Information System (SIAS) for 1999. Outpatient clinics were classified into three categories: ASL managed clinics, private clinics and hospital trusts. Absolute and relative density of supply (respectively DAO and DRO) were used as indicators of clinics distribution in the regional area. Number of specialties, average procedure weight and volume of procedures performed were used as indicators of complexity. Absolute density of supply (DAO = n. of dispatch points/population) is generally high, and a large and statistically significant variability is observed (p < 0.001). The relative density (i.e. the correlation coefficient between DAO and population density) is positive overall (r = 0.43), but it is higher within the private sector (r = 0.62) independently from provider category. Statistically significant differences were observed among categories of providers in terms of average number of specialties (ASL managed: 9.9; private clinics: 1.7; hospital trusts: 16.1), average weight (ASL managed: 1.1; private clinics: 0.9; hospital trusts: 1.3) and average volume of procedures supplied (ASL managed: 35.000; private clinics: 59.000; hospital trusts: 282.000). The administrative SIAS database was a useful tool to define indicators aimed at describing characteristics of the outpatient care system, although these results must be confirmed with a higher and more homogeneous level of coverage.

Ambulatory Care↗
PubMed1999

Reducing non-attendance at outpatient clinics.

Outpatient non-attendance is a common source of inefficiency in a health service, wasting time and resources and potentially lengthening waiting lists. A prospective audit of plastic surgery outpatient clinics was conducted during the six months from January to June 1997, to determine the clinical and demographic profile of non-attenders. Of 6095 appointments 16% were not kept. Using the demographic information, we changed our follow-up guidelines to reflect risk factors for multiple non-attendances, and a self-referral clinic was introduced to replace routine follow-up for high risk non-attenders. After these changes, a second audit in the same six months of 1998 revealed a non-attendance rate of 11%--i.e. 30% lower than before. Many follow-up appointments are sent inappropriately to patients who do not want further attention. This study, indicating how risk factor analysis can identify a group of patients who are unlikely to attend again after one missed appointment, may be a useful model for the reduction of outpatient non-attendance in other specialties.

Appointments and Schedules↗
PubMed1998

Compliance with depot antipsychotic medication by patients attending outpatient clinics.

Outpatients with schizophrenia often have problems complying with a regimen of oral antipsychotic medications. Use of depot medications improves compliance, but patients' geographic location and access to transportation may affect compliance with a depot regimen. The authors used retrospective chart review to examine whether patients' geographic location and sociodemographic characteristics and characteristics of their medication use were related to compliance with a depot regimen. The subjects were 75 patients attending an urban clinic and 23 patients attending a rural clinic in New York State. Median rates of compliance were 94.7 percent for the urban patients and 96.4 percent for the rural patients, not a significant difference. The only characteristic associated with a decreased compliance rate was a history of substance abuse.

Ambulatory Care↗
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↗
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↗
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↗
PubMed1995

A comparison of demographic variables, symptom profiles, and measurements of functioning in symptomatic volunteers and an outpatient clinical population.

There is consistent concern about the generalizability of research findings generated by clinical trials. There are several reasons for concern about these findings: (1) most clinical trials involve symptomatic volunteers who are recruited by means of advertisements rather than patients recruited from general clinical populations; (2) most clinical trials have restrictive criteria for admission into the study; and (3) the design of most trials is not representative of prescribing practices in the community. These methodological issues require investigators to question whether results from trials adequately model what will be seen in a general clinical situation. This report begins to evaluate the representativeness of initial samples by studying the demographic characteristics, symptom profiles, and measurements of functional disability for clinical outpatients and symptomatic volunteers recruited for clinical trials. We found that symptomatic volunteers were statistically more likely to be older than outpatients, were less likely to be single, and reported using more alcohol and cigarettes than outpatients. The two groups had similar levels of functional impairment and similar ages at onset of symptoms, but symptomatic volunteers reported more symptoms of depression and anxiety than outpatients. However, we believe the differences identified in this study did not seem to be clinically significant.

Adult↗
PubMed1983

Is there a characteristic pattern to the treatment history of clinic outpatients with borderline personality?

The prior psychiatric histories, dispositions, and treatment plans for a group of patients with borderline personality, evaluated in an outpatient clinic, were compared to those of evaluated patients diagnosed as having neurotic and/or other personality disorders or schizophrenia. Variables that were found to discriminate patients diagnosed as borderline from the other two groups included a history of past hospitalizations and their duration, frequency of prior outpatient treatment, previous use of psychotropic medications, rates of dropout and referral-out of the clinic, and number of treatment sessions received during a 2-year follow-up period. Patients with borderline personality who had the most previous treatment and the most severe symptoms received the least treatment. The histories of extensive previous treatment are consistent with the frequently brief and unsatisfactory nature of the index clinic contacts.

Adult↗
PubMed1983

Impotence in medical clinic outpatients.

One thousand one hundred eighty men in a medical outpatient clinic were screened as to the presence of impotence. Four hundred one men (34%) were impotent, and of those, 188 (47%) chose to be examined for their problem. After a comprehensive evaluation the following diagnoses were obtained: medication effect, 25%; psychogenic, 14%; neurological, 7%; urologic, 6%; primary hypogonadism, 10%; secondary hypogonadism, 9%; diabetes mellitus, 9%; hypothyroidism, 5%; hyperthyroidism, 1%; hyperprolactinemia, 4%; miscellaneous, 4%; and unknown causes, 7%. The mean age of the impotent patients was 59.4 years, and the prevalence of alcoholism was 7%. Luteinizing hormone, follicle-stimulating hormone, testosterone, thyroxine, triiodothyronine (T3), T3 resin uptake, and prolactin studies were necessary to diagnose individual cases. We conclude that erectile dysfunction is a common and often overlooked problem in middle-aged men followed in a medical clinic.

Alcoholism↗
PubMed1994

Operations research survey and computer simulation of waiting times in two medical outpatient clinic structures.

Outpatient services are increasingly recognised as an important component of health care provision and may be improved through the application of modern management techniques. We have performed a time and role audit of consultation and waiting times in two medical clinics using different queuing systems: namely, a serial processing clinic where patients wait in a single queue and a quasi-parallel processing clinic where patients are directed to the shortest queue to maintain clinic flow. Data collected were used to construct a computer simulation of patient flows in clinic. Assessment of patient satisfaction in the clinic process was determined using a self-administered questionnaire. Mean waiting time was shorter in the quasi-parallel processing clinic: 26 (SD 17) minutes compared with 36(24) minutes in the serial processing clinic. In the serial processing clinic 61% of patients waited more than 30 minutes compared with 41% in the quasi-parallel processing clinic. In the serial processing clinic 8% of 142 patients surveyed complained of the time spent waiting. The computer simulation we produced was able to determine waiting times with different clinic structures. The simulation showed that reductions in waiting time up to 30% might be achieved by changing our serial processing clinic to a quasi-parallel processing one. Performance of medical outpatient clinics can be improved by examining and changing clinic management. Computer simulation of outpatient clinics offers a means of assessing the impact of such changes on waiting time in clinic and on waiting lists.

Algorithms↗
PubMed1994

Chlamydia trachomatis direct isolation, antibody prevalence and clinical symptoms in women attending outpatient clinics.

Two hundred and ninety-seven women with complaints of vaginal or urethral discharge and 100 women attending outpatient clinics for contraceptive or other advice (enrolled as controls) were studied and compared. A meticulous sampling for Chlamydia trachomatis was taken from one hundred and seventy-seven women enrolled in the study group (A1). Technical difficulties were encountered with the remaining 120 cases--study group (A2). It was found that ninety-three out of the 177 women (of group A1) were infected with either Chlamydia trachomatis or Neisseria gonorrhoeae (52.5%) compared to four out of 120 (3.4%) in the A2 subgroup. The overall prevalence of C. trachomatis antibodies was found to be 171/397 (43.1%) when all three groups studied were tested by immunoperoxidase (IPA). In comparison, by direct culture alone 92/397 (23.2%) were positive. The most significant clinical symptoms for chlamydial infection were purulent or mucoid discharge, bleeding and vaginitis (p = 0.005). This study demonstrates that immunoperoxidase (IPA) and ELISA techniques for C. trachomatis serology are helpful for the identification of infection by this agent. The possibility of using these serological methods in screening tests for vaginal infections in addition to C. trachomatis direct culture and clinical symptoms in outpatient clinics should be considered.

Ambulatory Care Facilities↗