ABSTRACT
BACKGROUND: Chronic diseases are becoming more common due to an increasing ageing population. Patients with chronic conditions managed in outpatient clinics account for a large share of healthcare costs. We developed a 24-h access outpatient clinic offering 24-h telephone support and triaged access to the hospital for patients with acute exacerbation of four selected chronic diseases. The aim of this study was to conduct a 1-year before-after study of the acute healthcare utilisation in patients offered the 24-h access outpatient clinic intervention. METHODS: The study was conducted as an observational register-based cohort study. Data from the patient administrative register and the Danish National Health Service Register were extracted 12 months before and 12 months after implementation of the 24-h access intervention. Patients with chronic obstructive pulmonary disease, chronic liver disease, inflammatory bowel disease and heart failure managed in hospital outpatient clinics were enrolled in the study. Differences in healthcare utilisation were analysed for all patients, including the subgroup of high-risk patients with at least one acute admission in the year before enrolment. RESULTS: Length-of-stay remained unchanged for all diagnostic groups, except for patients with heart failure in whom a statistically significant reduction was observed. Statistically significant reductions of length of stay and acute admissions were observed in all high-risk groups, except for patients with chronic liver disease. A statistically significant reduction in the number of contacts to out-of-hours primary care was seen in patients with chronic obstructive pulmonary disease, whereas the level remained unchanged in the other diagnostic groups. Similar patterns were also seen in high-risk patients. CONCLUSIONS: The 24-h access outpatient clinic did not increase the use of acute healthcare services inpatients with chronic disease. Significant reductions in hospital utilisation were seen in high-risk patients. These preliminary results should be interpreted with caution due to the observational before-after design of the study.
Subject(s)
Ambulatory Care/organization & administration , Chronic Disease/therapy , Health Services Accessibility/organization & administration , Patient Acceptance of Health Care/statistics & numerical data , Adolescent , Adult , After-Hours Care/organization & administration , After-Hours Care/statistics & numerical data , Age Distribution , Aged , Ambulatory Care/statistics & numerical data , Cohort Studies , Controlled Before-After Studies , Denmark , Female , Heart Failure/therapy , Hospitalization/statistics & numerical data , Humans , Inflammatory Bowel Diseases/therapy , Liver Diseases/therapy , Male , Middle Aged , Outpatient Clinics, Hospital , Pulmonary Disease, Chronic Obstructive/therapy , Sex Distribution , Telephone , Young AdultABSTRACT
STUDY DESIGN: Prospective cohort. INTRODUCTION: Assessment of scapular dysfunction is considered important in the clinical evaluation and treatment of patients with symptoms of subacromial impingement. However, sparse research has been conducted into the reliability and predictive value of clinical tests with which to identify scapular dyskinesis. PURPOSE OF THE STUDY: To evaluate intrarater and interrater reliability and predictive value of the Scapular Dyskinesis Test (SDT) in patients with subacromial impingement syndrome. METHODS: Forty-five patients with subacromial impingement syndrome were included. The presence of scapular dyskinesis was classified by 2 raters using the SDT. Intrarater and interrater reliabilities were examined and compared. Patients with and without scapular dyskinesis were compared in terms of Oxford Shoulder Score and EQ-5D-5L scores at baseline and 3 months, as well rating of overall improvement in shoulder condition. RESULTS: SDT could not be performed in 5 patients, leaving 40 patients for further analysis. Kappa with squared weights was 0.64 for rater A and 0.86 for rater B; the intrarater agreement was 88% for A and 96% for B. For interrater comparison, the Kappa value was 0.59 and agreement 86%. No statically significant differences in Oxford Shoulder Score and EQ-5D-5L baseline and change scores or overall improvement in shoulder condition at 3 months were observed between patients with or without scapular dyskinesis. CONCLUSIONS: Intrarater and interrater reliability and agreement of the SDT were determined. The findings that functional impairment and outcomes did not differ between patients with or without the presences of scapular dyskinesis may question the clinical value of the SDT in patients with subacromial impingement syndrome. LEVEL OF EVIDENCE: 1b.
