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1.
Med Oncol ; 39(6): 104, 2022 Apr 10.
Article in English | MEDLINE | ID: covidwho-1782949

ABSTRACT

Limited knowledge exists on the effectiveness of preventive preparedness plans for the care of outpatient cancer patients during epidemics or pandemics. To ensure adequate, timely and continuous clinical care for this highly vulnerable population, we propose the establishment of preventive standard safety protocols providing effective early phase identification of outbreaks at outpatient cancer facilities and communicating adapted standards of care. The prospective cohort study Protect-CoV conducted at the LMU Klinikum from mid-March to June 2020 investigated the effectiveness of a rapid, proactive and methodical response to protect patients and interrupt SARS-CoV-2 transmission chains during the first pandemic wave. The implemented measures reduced the risk of infection of individual cancer patients and ensured safe adjunctive infusion therapy in an outpatient setting during the early COVID-19 pandemic. In addition to the immediate implementation of standard hygiene procedures, our results underscore the importance of routine PCR testing for the identification of asymptomatic or pre-symptomatic COVID-19 cases and immediate tracing of positive cases and their contacts. While more prospective controlled studies are needed to confirm these results, our study illustrates the importance of including preventative testing and tracing measures in the standard risk reduction procedures at all out patient cancer centers.


Subject(s)
COVID-19 , Pandemics , Ambulatory Care Facilities , Cohort Studies , Humans , Pandemics/prevention & control , Prospective Studies , Risk Reduction Behavior , SARS-CoV-2
2.
3.
Reprod Health ; 18(1): 166, 2021 Aug 04.
Article in English | MEDLINE | ID: covidwho-1770551

ABSTRACT

BACKGROUND: Nigeria, like many other countries, has been severely affected by the COVID-19 pandemic. While efforts have been devoted to curtailing the disease, a major concern has been its potential effects on the delivery and utilization of reproductive health care services in the country. The objective of the study was to investigate the extent to which the COVID-19 pandemic and related lockdowns had affected the provision of essential reproductive, maternal, child, and adolescent health (RMCAH) services in primary health care facilities across the Nigerian States. METHODS: This was a cross-sectional study of 307 primary health centres (PHCs) in 30 Local Government Areas in 10 States, representing the six geopolitical regions of the country. A semi-structured interviewer-administered questionnaire was used to obtain data on issues relating to access and provision of RMCAH services before, during and after COVID-19 lockdowns from the head nurses/midwives in the facilities. The questionnaire was entered into Open Data Kit mounted on smartphones. Data were analysed using frequency and percentage, summary statistics, and Kruskal-Wallis test. RESULTS: Between 76 and 97% of the PHCS offered RMCAH services before the lockdown. Except in antenatal, delivery and adolescent care, there was a decline of between 2 and 6% in all the services during the lockdown and up to 10% decline after the lockdown with variation across and within States. During the lockdown. Full-service delivery was reported by 75.2% whereas 24.8% delivered partial services. There was a significant reduction in clients' utilization of the services during the lockdown, and the difference between States before the pandemic, during, and after the lockdown. Reported difficulties during the lockdown included stock-out of drugs (25.7%), stock-out of contraceptives (25.1%), harassment by the law enforcement agents (76.9%), and transportation difficulties (55.8%). Only 2% of the PHCs reported the availability of gowns, 18% had gloves, 90.1% had hand sanitizers, and a temperature checker was available in 94.1%. Slightly above 10% identified clients with symptoms of COVID-19. CONCLUSIONS: The large proportion of PHCs who provided RMCAH services despite the lockdown demonstrates resilience. Considering the several difficulties reported, and the limited provision of primary protective equipment more effort by the government and non-governmental agencies is recommended to strengthen delivery of sexual and reproductive health in primary health centres in Nigeria during the pandemic.


The onset of COVID-19 has raised concerns that it may compromise women's access to sexual and reproductive health and rights. Although data are still emerging, some reports indicate reduced access to sexual and reproductive health services, largely due to disruptions in the demand and supply of contraceptive commodities, the diversion of staff and resources to other clinical services, and clinic closures. While these concerns have similarly been broached for Nigeria, there has been no systematic documentation of the extent of the disruptions of reproductive health services caused by COVID-19 and its effects on the provision and utilization of related services in the country This study was a cross-sectional facility-based survey conducted in 10 states, 30 Local Government Areas and 302 primary health centres in Nigeria. The objective of the study was to explore through key informant interviews with service providers in the health centres, the effects of the COVID-19 pandemic on demand and supply of sexual and reproductive health services. Field assistants administered a semi-structured interview guide to the heads of the health centres that elicited information on availability and use of the health centres before, during and after the lock-downs associated with the pandemic. The results indicate that a large proportion of the health centres opened for the provision of essential sexual and reproductive health services during the COVID-19 pandemic lockdown. However, fewer clients used the services due to difficulties in travel because of the lockdowns, stock-outs in the health centres, and the fear that they may contract the virus if they leave their houses to the health centres. Although the health centres reported some cases of COVID-19, there was limited provision for personal protective equipment to motivate the health workers to optimize services for clients. From this study, we conclude that efforts should be made to identify innovations for addressing these challenges to enable the continued provision of sexual and reproductive health services by health centres despite the COVID-19 pandemic in Nigeria's health centres.


Subject(s)
COVID-19 , Reproductive Health Services , Adolescent , Ambulatory Care Facilities , Child , Communicable Disease Control , Cross-Sectional Studies , Female , Health Facilities , Humans , Nigeria/epidemiology , Pandemics , Pregnancy , SARS-CoV-2
4.
BMC Prim Care ; 23(1): 58, 2022 03 29.
Article in English | MEDLINE | ID: covidwho-1770485

ABSTRACT

BACKGROUND: Responding to the COVID-19 pandemic requires safe and efficient testing on a large scale over a prolonged period. Outpatient testing facilities can clinically assess and test symptomatic individuals and test asymptomatic contacts. This study identified the resources required to establish and maintain an Australian general practitioner (GP) led testing facility that combined a respiratory clinic for clinical assessment and testing with a drive-through testing facility. METHODS: Data were taken from clinic administrative records to identify the number of patients tested over the period April-June 2020. An independent auditor's report identified the resources used in establishing, running, and staffing both clinics for the same period. Analyses were performed using the minimum and maximum daily throughput to understand the effect of demand on price per sample collected. RESULTS: The respiratory clinic tested an average of 19 patients per day, at an estimated cost of $340.04 AUD. This varied to $687.99 AUD during the lowest demand scenario, and $281.04 AUD during the high demand scenario. The drive-through clinic tested an average of 47 patients per day, at an estimated cost of $153.57 AUD. This varied to $279.51 AUD during the lowest demand scenario, and $99.92 AUD during the high demand scenario. CONCLUSION: This study provides insight into the cost of testing at a drive through and respiratory clinic in Australia. The evidence highlights importance of considering variation in demand and the impact on efficiency, particularly where resource use is fixed in the short term.


Subject(s)
COVID-19 , General Practice , Ambulatory Care Facilities , Australia/epidemiology , COVID-19/diagnosis , Humans , Pandemics
5.
Qual Manag Health Care ; 31(2): 92-98, 2022.
Article in English | MEDLINE | ID: covidwho-1758963

ABSTRACT

BACKGROUND AND OBJECTIVES: COVID-19 is highly infectious and the pandemic requires many adaptations to how we deliver medical care. Early in the pandemic, much of this focus was on hospital and emergency department care delivery models to ensure the safety of non-COVID-19 patients and health care workers. However, providing much needed outpatient assessments for COVID-19 patients during a pandemic is also fraught with challenges. From our review of the literature, best practices for a dedicated pandemic ambulatory outpatient clinic have not previously been described. We present a model for creating a dedicated ambulatory pandemic clinic at our institution for the acute care needs of COVID-19 patients. METHODS: To address the current pandemic, the Mayo Acute Symptoms of COVID-19 Clinic was implemented on April 13, 2020, with the aims of providing a stand-alone location for COVID-19 patients to have acute outpatient evaluations as well as diagnostics. RESULTS: Recognized challenges addressed included consideration of airflow recirculation patterns in standard medical office buildings, optimization of protocols to conserve personal protective equipment (PPE), limiting total exposure time during patient flow, and reducing surfaces and spaces that patients would physically contact. To this end, unique methods of patient scheduling, patient flow process, staff training, and PPE protocols were developed and are explained in detail in this article. CONCLUSION: In the COVID-19 pandemic, as well as inevitably in future pandemics, outpatient medical facilities need to be prepared to care for nonhospitalized and nonemergent pandemic patients. We offer a practical approach that has been successful at our institution, with opportunity for local adaptation based on need and resources.


Subject(s)
COVID-19 , Pandemics , Ambulatory Care Facilities , COVID-19/epidemiology , Health Personnel , Humans , Personal Protective Equipment
6.
Turk J Med Sci ; 51(SI-1): 3350-3358, 2021 12 17.
Article in English | MEDLINE | ID: covidwho-1726155

ABSTRACT

Although we have enough and cumulative information about acute effects of COVID-19, our knowledge is extremely limited about long-term consequences of COVID-19, in terms of its impacts and burdens on patients, families, and the health system. Considering the underlying pathophysiological mechanisms affecting all of the organ systems in critically ill COVID-19 patients who are admitted to intensive care units, the development of post-intensive care syndrome is inevitable. This situation brings along the development of long-COVID. These patients should be followed regarding cognitive, physical, and psychiatric aspects and necessary specialist referrals should be carried out. In this article, we are presenting the experience and recommendations of our center, as a guide for the establishment process of post-intensive care outpatient clinics for the critically ill patients who required intensive care admission due to COVID-19 and could be discharged.


Subject(s)
COVID-19/complications , Critical Care/methods , Respiratory Distress Syndrome/therapy , Ambulatory Care Facilities , COVID-19/diagnosis , COVID-19/therapy , Critical Illness , Humans , Intensive Care Units , Pandemics , SARS-CoV-2 , Survivors , Treatment Outcome
7.
Public Health Rep ; 137(2): 362-369, 2022.
Article in English | MEDLINE | ID: covidwho-1724141

ABSTRACT

OBJECTIVES: Testing remains critical for identifying pediatric cases of COVID-19 and as a public health intervention to contain infections. We surveyed US parents to measure the proportion of children tested for COVID-19 since the start of the pandemic, preferred testing venues for children, and acceptability of school-based COVID-19 testing. METHODS: We conducted an online survey of 2074 US parents of children aged ≤12 years in March 2021. We applied survey weights to generate national estimates, and we used Rao-Scott adjusted Pearson χ2 tests to compare incidence by selected sociodemographic characteristics. We used Poisson regression models with robust SEs to estimate adjusted risk ratios (aRRs) of pediatric testing. RESULTS: Among US parents, 35.9% reported their youngest child had ever been tested for COVID-19. Parents who were female versus male (aRR = 0.69; 95% CI, 0.60-0.79), Asian versus non-Hispanic White (aRR = 0.58; 95% CI, 0.39-0.87), and from the Midwest versus the Northeast (aRR = 0.76; 95% CI, 0.63-0.91) were less likely to report testing of a child. Children who had health insurance versus no health insurance (aRR = 1.38; 95% CI, 1.05-1.81), were attending in-person school/daycare versus not attending (aRR = 1.67; 95% CI, 1.43-1.95), and were from households with annual household income ≥$100 000 versus income <$50 000-$99 999 (aRR = 1.19; 95% CI, 1.02-1.40) were more likely to have tested for COVID-19. Half of parents (52.7%) reported the pediatrician's office as the most preferred testing venue, and 50.6% said they would allow their youngest child to be tested for COVID-19 at school/daycare if required. CONCLUSIONS: Greater efforts are needed to ensure access to COVID-19 testing for US children, including those without health insurance.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/diagnosis , Parents/psychology , Patient Acceptance of Health Care/psychology , Adult , Ambulatory Care Facilities/statistics & numerical data , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Physicians' Offices/statistics & numerical data , SARS-CoV-2 , Schools/statistics & numerical data , Surveys and Questionnaires , United States
8.
BMC Emerg Med ; 22(1): 35, 2022 03 05.
Article in English | MEDLINE | ID: covidwho-1724414

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has challenged healthcare globally. An acute increase in the number of hospitalized patients has necessitated a rigorous reorganization of hospital care, thereby creating circumstances that previously have been identified as facilitating prescribing errors (PEs), e.g. a demanding work environment, a high turnover of doctors, and prescribing beyond expertise. Hospitalized COVID-19 patients may be at risk of PEs, potentially resulting in patient harm. We determined the prevalence, severity, and risk factors for PEs in post-COVID-19 patients, hospitalized during the first wave of COVID-19 in the Netherlands, 3 months after discharge. METHODS: This prospective observational cohort study recruited patients who visited a post-COVID-19 outpatient clinic of an academic hospital in the Netherlands, 3 months after COVID-19 hospitalization, between June 1 and October 1 2020. All patients with appointments were eligible for inclusion. The prevalence and severity of PEs were assessed in a multidisciplinary consensus meeting. Odds ratios (ORs) were calculated by univariate and multivariate analysis to identify independent risk factors for PEs. RESULTS: Ninety-eight patients were included, of whom 92% had ≥1 PE and 8% experienced medication-related harm requiring an immediate change in medication therapy to prevent detoriation. Overall, 68% of all identified PEs were made during or after the COVID-19 related hospitalization. Multivariate analyses identified ICU admission (OR 6.08, 95% CI 2.16-17.09) and a medical history of COPD / asthma (OR 5.36, 95% CI 1.34-21.5) as independent risk factors for PEs. CONCLUSIONS: PEs occurred frequently during the SARS-CoV-2 pandemic. Patients admitted to an ICU during COVID-19 hospitalization or who had a medical history of COPD / asthma were at risk of PEs. These risk factors can be used to identify high-risk patients and to implement targeted interventions. Awareness of prescribing safely is crucial to prevent harm in this new patient population.


Subject(s)
COVID-19 , Ambulatory Care Facilities , COVID-19/epidemiology , Hospitalization , Humans , Prevalence , Prospective Studies , Risk Factors , SARS-CoV-2
10.
Arch Dis Child ; 107(3): e14, 2022 03.
Article in English | MEDLINE | ID: covidwho-1691374

ABSTRACT

OBJECTIVE: To determine the feasibility and impact of having paediatric clinicians working in the Clinical Assessment Services (CAS) within NHS 111, a national telephone advice service. DESIGN: Observational study. SETTING: Six NHS 111 providers across England with CAS where volunteer paediatric clinicians (doctors and advanced nurse practitioners (ANPs)) worked between May and December 2020. A data reporting framework was used to compare the outcomes of calls taken by paediatric vs non-paediatric clinicians. PATIENTS: Under 16-year-olds prompting calls to NHS 111 over the study period. MAIN OUTCOME MEASURES: The disposition (final outcome of calls) taken by paediatric versus non-paediatric clinicians, paediatric clinicians' and patient experience. RESULTS: 70 paediatric clinicians (66 doctors and 4 ANPs) worked flexible shifts in six NHS 111 providers' CAS over the study period: 2535 calls for under 16-year-olds were taken by paediatric clinicians and 137 008 by non-paediatric clinicians. Overall, disposition rates differed significantly between the calls taken by paediatric versus (vs) non-paediatric clinicians: 69% vs 43% were advised on self-care only, 13% vs 18% to attend emergency departments (EDs), 13% vs 29% to attend primary care, 1% vs 4% to receive an urgent ambulance call out and 4% vs 6% referred to another health service, respectively. When compared with recent (all age) national whole data sets, the feedback from calls taken by paediatricians noted a greater proportion of patients/carers reporting that their problem was fully resolved (92% vs 27%). CONCLUSIONS: Introducing paediatric specialists into NHS 111 CAS is likely to increase self-care dispositions, and reduce onward referrals to primary care, ED and ambulances. Future work will evaluate the impact of a national paediatric clinical assessment service to which specific case types are streamed.


Subject(s)
Health Personnel , Pediatrics/methods , Remote Consultation/methods , Telephone , Adolescent , Ambulances/statistics & numerical data , Ambulatory Care Facilities/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , England , Humans , Physicians , Pilot Projects , Primary Health Care/statistics & numerical data , Referral and Consultation/statistics & numerical data , State Medicine , Surveys and Questionnaires , Triage/methods
11.
Clin Lab ; 68(3)2022 Mar 01.
Article in English | MEDLINE | ID: covidwho-1689822

ABSTRACT

BACKGROUND: Patients who come to the emergency pandemic outpatient clinic with a pre-diagnosis of COVID-19 are still a burden on the health system. Rapid triage of patients is important to reduce transmission. The aim of this study is to evaluate the biochemistry and hemogram results of real-time reverse transcription-polymerase chain reaction (RT-PCR) positive and negative patients in the emergency pandemic outpatient clinic and to investigate predictive values of the initial tests that will help to make rapid diagnosis. METHODS: Patients who applied to the emergency pandemic outpatient clinic with the suspicion of COVID-19 between November 01, 2020 and January 01, 2021 were evaluated with RT-PCR and laboratory examinations. RESULTS: A total of 551 patients were included in the study. The mean age of the patients was 50.31 ± 18.47 (min. 18 - max. 94), and 47.2% (n = 260) of the patients included in the study were male and 52.8% (n = 291) were female. In the comparison of hemogram parameters, we found that mean platelet volume (MPV) was significantly higher (p = 0.023), whereas white blood cell (WBC), platelet counts (PLT), lymphocyte and neutrophil values were significantly lower in RT-PCR positive patients (p < 0.001). There were no significant differences between the PCR positive and negative patients in terms of other parameters. In the comparison of biochemical parameters, we found that lactate dehydrogenase LDH (p = 0.001), creatinine (p = 0.002), and AST (p < 0.001) values were significantly higher in PCR positive patients, while there were no significant differences in terms of other biochemical parameters (p > 0.05). CONCLUSIONS: Our study results show that the practical quick-look hemogram and MPV can be used as a specially evaluated parameter in the rapid management of the first application COVID-19 patients. In addition, biochemically high levels of LDH and creatinine can be used to guide the clinician in terms of early hydration of the patient with a pre-diagnosis of COVID-19 to alleviate acute kidney damage.


Subject(s)
COVID-19 , Ambulatory Care Facilities , COVID-19/diagnosis , Female , Humans , Male , Pandemics , Real-Time Polymerase Chain Reaction , Retrospective Studies , SARS-CoV-2 , Triage
12.
Ann Neurol ; 91(4): 445-454, 2022 04.
Article in English | MEDLINE | ID: covidwho-1680264

ABSTRACT

OBJECTIVE: The objective of this study was to assess the feasibility, acceptability, and benefits of a teleneurology clinic serving adults usually attending a neurology outpatient clinic in Lusaka, Zambia during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Televisits were offered to patients scheduled for neurology appointments between March and July 2020 using the telephone, WhatsApp video, or Zoom calls based on patient accessibility. Visit outcomes were documented, and patient and neurologist satisfaction surveys were completed. RESULTS: Of 323 patients, 195 (60%) were reachable by telephone, 179 of these were alive, and 74% (133/179) of those alive agreed to a televisit. Stroke (30%), seizures (20%), and headache (16%) were the most common diagnoses seen via televisit. Most televisits (80%) were by telephone call, 14% by WhatsApp video call, and 6% by Zoom. Nearly one-third (30%) of the patients were stable and discharged from the clinic, 32% only required medication refills, and 19% required an in-person visit. Sixty patients (out of 85 reachable and 71% response rate) and 7 of 9 neurologists (78% response rate) completed satisfaction surveys. Neurologists reported greater assessment confidence with Zoom, but confidence was high for all modalities. Patients preferring televisits (75%, 45/60) noted reduced expense and time requirements, whereas those preferring in-person visits (22%, 13/60) cited the desire for physical examinations. Overall, 98% of patients and 100% of neurologists were satisfied with televisits. INTERPRETATION: Teleneurology visits were acceptable and feasible for adults attending an outpatient neurology clinic in Zambia and their neurologists. They offer a promising supplement to in-person visits in resource-limited settings, even when video-conference capabilities and electronic medical records are absent. ANN NEUROL 2022;91:445-454.


Subject(s)
COVID-19 , Neurology/organization & administration , Pandemics , Telemedicine/organization & administration , Adult , Aged , Aged, 80 and over , Ambulatory Care Facilities , Cross-Sectional Studies , Feasibility Studies , Female , Humans , Male , Middle Aged , Neurologists , Patient Acceptance of Health Care , Patient Satisfaction , Prospective Studies , Smartphone , Surveys and Questionnaires , Videoconferencing , Zambia
13.
BMC Pediatr ; 22(1): 80, 2022 02 07.
Article in English | MEDLINE | ID: covidwho-1673907

ABSTRACT

BACKGROUND: Continued efforts are required to reduce preventable child deaths. User-friendly Integrated Management of Childhood Illness (IMCI) implementation tools and supervision systems are needed to strengthen the quality of child health services in South Africa. A 2018 pilot implementation of electronic IMCI case management algorithms in KwaZulu-Natal demonstrated good uptake and acceptance at primary care clinics. We aimed to investigate whether ongoing electronic IMCI implementation is feasible within the existing Department of Health infrastructure and resources. METHODS: In a mixed methods descriptive study, the electronic IMCI (eIMCI) implementation was extended to 22 health facilities in uMgungundlovu district from November 2019 to February 2021. Training, mentoring, supervision and IT support were provided by a dedicated project team. Programme use was tracked, quarterly assessments of the service delivery platform were undertaken and in-depth interviews were conducted with facility managers. RESULTS: From December 2019 - January 2021, 9 684 eIMCI records were completed across 20 facilities, with a median uptake of 29 records per clinic per month and a mean (range) proportion of child consultations using eIMCI of 15% (1-46%). The local COVID-19-related movement restrictions and epidemic peaks coincided with declines in the monthly eIMCI uptake. Substantial inter- and intra-facility variations in use were observed, with the use being positively associated with the allocation of an eIMCI trained nurse (p < 0.001) and the clinician workload (p = 0.032). CONCLUSION: The ongoing eIMCI uptake was sporadic and the implementation undermined by barriers such as low post-training deployment of nurses; poor capacity in the DoH for IT support; and COVID-19-related disruptions in service delivery. Scaling eIMCI in South Africa would rely on resolving these challenges.


Subject(s)
COVID-19 , Delivery of Health Care, Integrated , Ambulatory Care Facilities , Child , Electronics , Feasibility Studies , Humans , SARS-CoV-2 , South Africa
14.
Age Ageing ; 51(2)2022 02 02.
Article in English | MEDLINE | ID: covidwho-1672125

ABSTRACT

BACKGROUND: climate change is a health emergency. Central to addressing this is understanding the carbon footprint of our daily life and work, in order to reduce it effectively. The coronavirus disease of 2019 (COVID-19) pandemic has brought about rapid change to clinical practice, most notably in use of virtual clinics and personal protective equipment (PPE). AIM: to estimate the carbon footprint of a Geriatric Medicine clinic, including the effect of virtual consultation and PPE, in order to inform design of a service that addresses both the health of our patients and our environment. METHOD: data from the Greenhouse Gas Protocol, NHS Carbon Footprint Plus and UK Government were used to estimate the carbon emissions per consultation. Values were calculated for virtual and face-to-face contact and applied to actual clinics both before and during the COVID-19 pandemic. RESULTS: the carbon footprint of a face-to-face clinic consultation is 4.82 kgCO2e, most of which is patient travel, followed by staff travel and use of PPE. The footprint of a virtual consultation is 0.99 kgCO2e, most of which is staff travel, followed by data use.Using our hybrid model for a single session clinic reduced our annual carbon footprint by an estimated 200 kgCO2e, roughly equivalent to a surgical operation. DISCUSSION: the COVID-19 pandemic has made us deliver services differently. The environmental benefits seen of moving to a partially virtual clinic highlight the importance of thinking beyond reverting to 'business as usual'-instead deliberately retaining changes, which benefit the current and future health of our community.


Subject(s)
COVID-19 , Aged , Ambulatory Care Facilities , Carbon Footprint , Humans , Pandemics , SARS-CoV-2
15.
BMC Health Serv Res ; 22(1): 141, 2022 Feb 03.
Article in English | MEDLINE | ID: covidwho-1666652

ABSTRACT

INTRODUCTION: Evidence shows physical distancing of one metre or more is important to reduce person-to-person SARS-CoV-2 transmission. This puts the Malaysian public healthcare system to a test when overcrowding has always been an issue. A new clinical appointment structure was proposed in the Malaysian public healthcare system amidst the pandemic to reduce the transmission risk. We aim to explore the general public's view on the proposed clinic appointment structure. METHODS: A cross-sectional anonymous web-based survey was conducted between 10th September 2020 and 30th November 2020. The survey was open to Malaysian aged 18 years and older via various social media platforms. The questionnaire consists of sociodemographic, experience of utilising healthcare facilities, and views on clinic appointment structure. RESULTS: A total of 1,144 complete responses were received. The mean age was 41.4 ± 12.4 years and more than half of the respondents had a preference for public healthcare. Among them, 77.1% reported to have a clinical appointment scheduled in the past. Less than a quarter experienced off-office hour appointments, mostly given by private healthcare. 70.2% answered they would arrive earlier if they were given a specific appointment slot at a public healthcare facility, as parking availability was the utmost concern. Majority hold positive views for after office hour clinical appointments, with 68.9% and 63.2% agreed for weekend and weekday evening appointment, respectively. The top reason of agreement was working commitment during office hours, while family commitment and personal resting time were the main reasons for disagreeing with off-office hour appointments. CONCLUSION: We found that majority of our respondents chose to come early instead of arriving on time which disrupts the staggered appointment system and causes over crowdedness. Our findings also show that the majority of our respondents accept off-office hour appointments. This positive response suggests that off-office hour appointments may have a high uptake amongst the public and thus be a possible solution to distribute the patient load. Therefore, this information may help policy makers to initiate future plans to resolve congestions within public health care facilities which in turn eases physical distancing during the pandemic.


Subject(s)
COVID-19 , Pandemics , Adult , Ambulatory Care Facilities , Cross-Sectional Studies , Delivery of Health Care , Humans , Middle Aged , Pandemics/prevention & control , SARS-CoV-2
16.
Appl Clin Inform ; 13(1): 123-131, 2022 01.
Article in English | MEDLINE | ID: covidwho-1655733

ABSTRACT

BACKGROUND: Following the implementation of a new electronic health record (EHR) system at Columbia University Irving Medical Center (CUIMC), the demands of the novel coronavirus disease 2019 (COVID-19) pandemic forced an abrupt reallocation of resources away from EHR adoption. To assist staff in focusing on techniques for improving EHR utilization, an optimization methodology was designed referencing the Consolidated Framework for Implementation Research (CFIR) approach. METHODS: The study was performed using a methodology that comprised of two primary components as follows: (1) analysis of qualitative and quantitative data and (2) participation of frontline staff in project work groups. Working groups mapped out the current state of the identified workflows, designed and implemented interventions, monitored the effectiveness of each intervention, and scaled the proposed changes. RESULTS: As a result of the optimization methodology, clinical and operational workflows improved in the pilot department. Operationally, the pilot department increased enrollment of patients in the virtual patient portal by 20%, increased schedule utilization by 25%, and reduced average check-in time by 19%. Clinically, the pilot department had a statistically significant increase in dictation and NoteWriter tool note composition from their baseline month to their observed month. Compared with the control department, the pilot department had a statistically significant increase in SmartTool and dictation note composition. The control department showed smaller increases, and in some cases a decline in performance, in these areas of operational and clinical workflows. CONCLUSION: The CFIR framework helped design an optimization methodology by applying a set of constructs to support effective organizational optimization, accounting for inner and outer settings. Through this methodology, the inner setting was supported in leading the identification and execution of interventions targeted to impact the outer setting. The phase-1 data at CUIMC suggest this strategy is effective in identifying opportunities, implementing interventions and creating a scalable process for continued organizational optimization.


Subject(s)
COVID-19 , Ambulatory Care Facilities , Humans , Pandemics , Qualitative Research , SARS-CoV-2 , Workflow
17.
Niger J Clin Pract ; 25(1): 49-54, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1637208

ABSTRACT

Background: As the SARS-CoV-2 pandemic continues to ravage the world, its impact on the health systems and survival of people with chronic diseases especially People living with HIV [PLWH] could be undermined. It becomes relevant to assess the challenges PLWH face during this period to institute measures towards combating the negative effects of the pandemic. Aims: This study aims to investigate the challenges faced by PLWH in accessing care during the lockdown period in Lagos, Nigeria. The study was a cross-sectional one involving PLWH aged 18 years and above who presented for care. An interviewer-administered questionnaire was used to obtain information on demographic characteristics, their knowledge about COVID-19 disease, and challenges experienced in accessing care during the COVID-19-induced lockdown. Ethical approval was obtained from the Institution Research Ethics Board (IRB) of NIMR. Patients and Methods: Data generated from the survey was exported to Excel and analyzed using SPSS version 23.0. Results: The mean age of PLWH who participated in the study was 42.2 (±12.2) years. The majority were female (74.3%), married (66.3%), employed (58.9%), and on less than $100 monthly income (80.5%). The commonest challenges experienced were psychological (78.5%), financial (68%) and food (40.7%). There were significant association among the income status, lack of food (OR: 2.5, CI: 1.4-4.5, P = 0.002), financial challenges (OR: 1.7, CI: 1.0-3.0, P = 0.048) and psychological challenges (OR; 1.8, CI: 1.0-3.5, P = 0.05). Ninety-five percent of participants believed SARS-COV-2 infection is a viral infection. Conclusions: PLWH faces a myriad of challenges that would have a significant impact on their overall well-being and the gains of HIV care.


Subject(s)
COVID-19 , Adult , Ambulatory Care Facilities , Communicable Disease Control , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Nigeria , SARS-CoV-2
18.
J Gen Intern Med ; 37(5): 1270-1274, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1634005

ABSTRACT

The exponential growth of telemedicine in ambulatory care triggered by the COVID-19 public health emergency has undoubtedly impacted the quality of care and patient safety. In particular, the increased adoption of remote care has impacted communication, care teams, and patient engagement, which are key factors that impact patient safety in ambulatory care. In this perspective, we draw on a scoping review of the literature, our own clinical experiences, and conversations with patient safety experts to describe how changes in communication, care teams, and patient engagement have impacted two high priority areas in ambulatory safety: diagnostic errors and medication safety. We then provide recommendations for research funders, researchers, healthcare systems, policy makers, and healthcare payors for how to improve patient safety in telemedicine based on what is currently known as well as next steps for how to advance understanding of the safety implications of telemedicine utilization.


Subject(s)
COVID-19 , Telemedicine , Ambulatory Care Facilities , Delivery of Health Care , Humans , Patient Safety
19.
Rev Bras Enferm ; 74(suppl 1): e20201080, 2021.
Article in English, Portuguese | MEDLINE | ID: covidwho-1626609

ABSTRACT

OBJECTIVE: to describe the experience of a private outpatient network for hematology and oncology treatment in the adoption of management tools to face the risk of contamination by SARS-CoV-2. METHOD: an experience report on the use of a root cause analysis method to identify potential risks of contamination by COVID-19 among patients and employees. Through the risks identified through the Ishikawa Diagram, we built an action plan, linked to the 5W2H tool, for planning and decision-making implemented. RESULTS: the number of attendances in person and people circulating in the units was reduced, protective distance measures and new protection barriers were fundamental to control the risks of spreading COVID-19 in patients and employees. FINAL CONSIDERATIONS: the management tools served as a valuable tool in the construction of measures, making the measures in question more clearly and applicable.


Subject(s)
Adaptation, Psychological , Ambulatory Care Facilities/statistics & numerical data , COVID-19/psychology , Medical Oncology/methods , Occupational Health , Guidelines as Topic , Humans , Pandemics , Personal Protective Equipment , SARS-CoV-2
20.
Muscle Nerve ; 65(4): 447-452, 2022 04.
Article in English | MEDLINE | ID: covidwho-1626917

ABSTRACT

INTRODUCTION/AIMS: Coronavirus disease-2019 (COVID-19) may have a more severe course in patients with myasthenia gravis (MG). We aimed to assess severity of the infection and factors contributing to its severity in a group of MG patients, most of whom were not hospitalized. METHODS: One hundred forty outpatients with MG followed between March 2020 and April 2021 were included in our study. Patients were asked to respond to a brief questionnaire in person, by telemedicine, or through electronic messages. RESULTS: Nineteen patients tested positive for COVID-19 by polymerase chain reaction. Two were asymptomatic. Of the 17 symptomatic patients, 11 had mild symptoms. They either had no treatment or received antivirals, antibiotics, and anticoagulants. Their myasthenia was well-controlled before infection and was unaffected by COVID-19. Three patients with moderate COVID-19 required hospitalization, but not intensive care, and had full recovery. Three other patients, the oldest in the cohort, had severe disease: One patient with a postsurgery myasthenic exacerbation before the infection needed intensive care without intubation, but recovered completely; two morbidly obese patients with comorbidities required intubation and died. Corticosteroids were increased in four of the six moderate/severely affected patients. Immunosuppressive (IS) agents were generally continued. Hydroxychloroquine (HCQ) for COVID-19 was used in one patient. DISCUSSION: Most patients had mild COVID-19 and all but two patients recovered. The design of the study made it possible to capture mild cases. Having well-controlled MG before infection and absence of comorbidities likely affected the course of the infection favorably. IS did not influence the progression.


Subject(s)
COVID-19 , Myasthenia Gravis , Obesity, Morbid , Ambulatory Care Facilities , Humans , Myasthenia Gravis/complications , Myasthenia Gravis/epidemiology , Myasthenia Gravis/therapy , SARS-CoV-2 , Treatment Outcome
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