The Impact of Primary Care Clinic and Family Physician Continuity on Patient Health Outcomes: A Retrospective Analysis From Alberta, Canada.

PURPOSE: Continuity of care is broadly associated with better patient health outcomes. The relative contributions of continuity with an individual physician and with a practice, however, have not generally been distinguished. This retrospective observational study examined the impact of continuity of care for patients seen at their main clinic but by different family physicians. METHODS: We analyzed linked health administrative data from 2015-2018 from Alberta, Canada to explore the association of physician and clinic continuity with rates of emergency department (ED) visits and hospitalizations across varying levels of patient complexity. Physician continuity was calculated using the known provider of care index and clinic continuity with an analogous measure. We developed zero-inflated negative binomial models to assess the association of each with all-cause ED visits and hospitalizations. RESULTS: High physician continuity was associated with lower ED use across all levels of patient complexity and with fewer hospitalizations for highly complex patients. Broadly, no (0%) clinic continuity was associated with increased use and complete (100%) clinic continuity with decreased use, with the largest effect seen for the most complex patients. Levels of clinic continuity between 1% and 50% were generally associated with slightly higher use, and levels of 51% to 99% with slightly lower use. CONCLUSIONS: The best health care outcomes (measured by ED visits and hospitalizations) are associated with consistently seeing one's own primary family physician or seeing a clinic partner when that physician is unavailable. The effect of partial clinic continuity appears complex and requires additional research. These results provide some reassurance for part-time and shared practices, and guidance for primary care workforce policy makers.

Perceptions of barriers towards dental appointment keeping among patients of a tertiary care setting: A mixed method exploration.

Objectives: To explore the barriers governing dental appointment keeping among patients reporting to a tertiary care setting. To assess the prevalence of missed dental appointments in a tertiary care center. Primary: To explore the barriers governing dental appointment keeping among patients reporting to a tertiary care setting. Secondary: To assess the prevalence of missed dental appointments in a tertiary care center. Methodology: The study design adopted is a sequential explanatory mixed method design; here, quantitative data collection and analysis is followed by qualitative data/analysis. The quantitative arm recorded six months of retrospective data on missed appointments in the centre. Prevalence was estimated, and descriptive and inferential statistics were performed. For the qualitative component, focus group discussions and in-depth interviews were conducted among dental health professionals and patients. Data was transcribed, and thematic content analysis was performed using NVivo software. Results: The prevalence of missed appointments in the tertiary care centre was 8.4 %. Personal/health issues (30.7 %) were noticed to be the most reported reason for missed appointments. Other causes include distance to the clinic (17.2 %), inflexible work schedule (14.7 %), transportation (12.3 %), dental anxiety (6.7 %), and economic issues (5.5 %). Qualitative data revealed the appointment system, experiences, consequences, responsible factors, management, and prevention of missed appointments in a tertiary care dental centre. Conclusion and recommendations: Multiple barriers are identified for dental appointment-keeping behavior. Missed appointments are prevalent in the study setting, as dental treatments require multiple sittings to complete. The study's findings primarily focus on a tertiary care center and may reflect reduced prevalence due to the COVID-19 pandemic. Tailor-made interventions are suggested for tertiary care settings to manage and prevent missed appointments, paving the way for successful health care delivery.

Evidence for Access: Systematic Scoping Review of Access Systems in General Practice.

BACKGROUND: Access to GP appointments is increasingly challenging in many high-income countries, with an overstretched workforce and rising demand. Various access systems have been developed and evaluated internationally. AIM: We aimed to systematically consolidate the current international evidence base related to different types of GP access systems. DESIGN AND SETTING: A scoping review examining international literature. METHOD: Literature searches were run across relevant databases in May 2022. Title, abstract and full text screenings were carried out. Data from included studies were extracted and mapped to synthesise the components and aims within different GP access systems. RESULTS: 49 studies were included in the review. The majority of these were set in the UK. Some access systems featured heavily in the literature, such as Advanced Access, telephone triage and online consultations, and others less so. There were two key strategies adopted by systems which related to either changing appointment capacity or modifying patient pathways. Components related to these strategies are summarised and illustrated as a schematic representation. Most rationales behind access systems were practice, rather than patient, focused. 'Add on' systems and aims for efficiency became more popular in recent years. CONCLUSION: The synthesis provides a useful tool in understanding access systems' aims, design, and implementation. With focus on alleviating demand, patient-focused outcomes appear to be under investigated and potentially overlooked during design and implementation. More recently, digital services are promoted as offering patient choice and convenience. But a context where demand outweighs resources challenges the premise that extending choice is possible.

The COVID-19 Pandemic and Routine Prenatal Care: Use of Online Visits.

OBJECTIVE: To evaluate whether prenatal visits or screening/testing were fewer or occurred later during the initial phase of the COVID-19 pandemic in 2020 (CINT) as compared to the prior year (PreCINT). METHODS: A retrospective cohort study compared CINT (n = 2,195) to PreCINT (n = 2,395) at seven public hospitals in New York City. The primary outcome was total number of prenatal-care visits. Secondary outcomes were components of prenatal-care visits completion, timing of standard pregnancy screening tests, and adverse neonatal outcomes. RESULTS: CINT patients had more total prenatal-care visits (B = 1.30, 95% CI:1.04, 1.56, p < 0.001), lower odds for initiation of prenatal care which was inadequate according to widely used criteria (OR:0.39, 95% CI:0.34, 0.45, p < 0.001), and lower gestational age at initial visit (B=-4.51, 95% CI:-5.10, -3.93, p < 0.001) than PreCINT patients. In-person visits did not differ between the two groups. PreCINT patients had no televisits, while CINT patients had a median of one televisit (Median = 1, p < 0.001). CINT patients had increased odds for group B Streptococcus screening (OR:1.27, 95% CI: 1.10, 1.48, p = 0.001), quadrivalent screening (OR:1.30, 95% CI:1.15, 1.48, p < 0.001), and anatomy sonogram (OR:2.30, 95% CI:2.04, 2.59, p < 0.001) but decreased odds for glucose challenge test screening (OR:0.81, 95% CI:0.72, 0.91, p < 0.001). Adverse neonatal outcome did not differ between CINT and PreCINT pregnancies. CONCLUSIONS FOR PRACTICE: Despite the difficulties and perceived dangers of in-person visits during the COVID-19 pandemic, the COVID-19 pandemic had little negative impact upon the outpatient prenatal care received by patients in this hospital system.

Factors related to the waiting time for scheduling an oral biopsy in Brazil: a multilevel analysis.

BACKGROUND: Timely diagnosis of oral cancers is critical, and performing biopsies of oral lesions with suspected malignancy is a crucial step in achieving this goal. The waiting time for the diagnosis may be related to the progression and prognosis of malignant neoplasms. OBJECTIVE: The aim of this observational, cross-sectional, national-level study was to identify the factors associated with the waiting time for scheduling an oral biopsy, based on the identification of its need. METHODS: We used secondary data from the Brazilian public health system, obtained from the 2nd cycle of the National Program to Improve Access and Quality of Dental Specialty Centers (PMAQ-CEO). The study outcome was the waiting time for scheduling an oral biopsy, starting from the identification of the need for the exam. We analyzed individual and contextual variables using multilevel statistical analysis. RESULTS: In 51.8% of DSC the waiting time for scheduling a biopsy was non-immediate; in 58.1% of CEOs, the sum of the weekly workload of dentists working in the Stomatology specialty is up to 20 h per week; in terms of coverage, 67.1% of the CEOs have only municipal coverage and 34.0% are references for up to 12 oral health teams in primary health care; only the coverage variable remained significant in the multivariate model (p < 0.05). Of the contextual variables, none of the variables remained significant (p > 0.05). When these were analyzed together, only the coverage remained significant (p < 0.05); CONCLUSION: Our analysis indicates that the waiting time for scheduling an oral biopsy is longer in CEOs that cover only one municipality and is not related to contextual factors.

Patient Attitudes and Barriers to Endoscopy During the COVID-19 Pandemic.

BACKGROUND: After COVID-19 restrictions on nonessential procedures were lifted and safety protocols established, utilization rates of endoscopic procedures remained reduced. AIMS: This study assessed patient attitudes and barriers to scheduling endoscopy during the pandemic. METHODS: A survey was administered to patients with ordered procedures at a hospital-based setting (7/21/2020-2/19/2021) collecting demographic data, body mass index, COVID-19 relevant comorbidities, level of procedural urgency (defined by recommended scheduling window), scheduling and attendance, concerns, and awareness of safety measures. RESULTS: The average respondent was female (63.8%), age 57.6 ± 14, White (72.3%), married (76.7%), insured (99.3%), affluent English speakers (92.3%) and highly educated (at least college 90.2%). Most reported moderate to excellent COVID-19 knowledge (96.6%). Of 1039 procedures scheduled, emergent cases accounted for 5.1%, urgent 55.3% and elective 39.4%. Respondents identified appointment convenience (48.53%) as the most frequent factor impacting scheduling, also noting concern for results (28.4%). Age (p = .022), native language (p = .04), education (p = .007), self-reported COVID knowledge (p = .002), and a desire to be COVID tested pre-procedure (p = .023) were associated with arrival, more commonly in an ambulatory surgical center than hospital (p = .008). Diabetes mellitus (p = .004) and an immunocompromised state (p = .009) were adversely related to attendance. Attitudes towards safety protocols did not affect scheduling. Multivariate analysis demonstrated age, education and COVID knowledgeability were associated with procedure completion. CONCLUSIONS: Safety protocols and urgency levels were not associated with procedure completion. Pre-pandemic barriers to endoscopy persisted as dominant factors amid pandemic concerns.

One-Week versus Two-Week Chemoradiotherapy Followed by Curative Surgery in Rectal Cancer: Long-Term Comparative Pooled Analysis of Two Prospective Multicenter Phase II Trials.

PURPOSE: The optimal short-course chemotherapeutic regimen for rectal cancer has not been clearly defined until now. KROG 10-01 and KROG 11-02 prospective trials investigated the efficacy and safety of 1- and 2-week chemoradiotherapy (CRT), respectively. Materials and Methods: Patients eligible for KROG 10-01 and KROG 11-02 involved those with clinical T3-4N0-2M0 rectal cancers. They received preoperative CRT and total mesorectal excision. Patients in KROG 10-01 received radiation of 25 Gy in 5 fractions during 1 week with 5-fluorouracil/leucovorin. Patients in KROG 11-02 received radiation of 33 Gy in 10 fractions for 2 weeks with oral capecitabine. RESULTS: A total of 150 patients consisting of 70 patients from KROG 10-01 and 80 patients from KROG 11-02 were collectively analyzed. With a median follow-up time of 89.2 months, the 5-year overall survival rate was 86.5% in 1-week CRT and 85.3% in 2-week CRT (p=0.841). The 5-year recurrence-free survival rate was 83.5% in 1-week CRT and 77.1% in 2-week CRT (p=0.448). One patient (1.4%) in 1-week CRT and 11 patients (13.8%) in 2-week CRT exhibited pathologic complete regression (ypT0N0M0) after radiotherapy (p=0.006). One-week CRT had significantly higher acute hematologic (12.8% vs. 3.8%, p=0.040) and nonhematologic (38.6% vs. 16.3%, p=0.002) toxicity than 2-week CRT. CONCLUSION: Both 1- and 2-week schedules of CRT showed favorable survival outcomes after 7 years of follow-up. But, 2-week course achieved more increased tumor response and decreased acute toxicity than 1-week course.

Predicting no-show appointments in a pediatric hospital in Chile using machine learning.

The Chilean public health system serves 74% of the country's population, and 19% of medical appointments are missed on average because of no-shows. The national goal is 15%, which coincides with the average no-show rate reported in the private healthcare system. Our case study, Doctor Luis Calvo Mackenna Hospital, is a public high-complexity pediatric hospital and teaching center in Santiago, Chile. Historically, it has had high no-show rates, up to 29% in certain medical specialties. Using machine learning algorithms to predict no-shows of pediatric patients in terms of demographic, social, and historical variables. To propose and evaluate metrics to assess these models, accounting for the cost-effective impact of possible intervention strategies to reduce no-shows. We analyze the relationship between a no-show and demographic, social, and historical variables, between 2015 and 2018, through the following traditional machine learning algorithms: Random Forest, Logistic Regression, Support Vector Machines, AdaBoost and algorithms to alleviate the problem of class imbalance, such as RUS Boost, Balanced Random Forest, Balanced Bagging and Easy Ensemble. These class imbalances arise from the relatively low number of no-shows to the total number of appointments. Instead of the default thresholds used by each method, we computed alternative ones via the minimization of a weighted average of type I and II errors based on cost-effectiveness criteria. 20.4% of the 395,963 appointments considered presented no-shows, with ophthalmology showing the highest rate among specialties at 29.1%. Patients in the most deprived socioeconomic group according to their insurance type and commune of residence and those in their second infancy had the highest no-show rate. The history of non-attendance is strongly related to future no-shows. An 8-week experimental design measured a decrease in no-shows of 10.3 percentage points when using our reminder strategy compared to a control group. Among the variables analyzed, those related to patients' historical behavior, the reservation delay from the creation of the appointment, and variables that can be associated with the most disadvantaged socioeconomic group, are the most relevant to predict a no-show. Moreover, the introduction of new cost-effective metrics significantly impacts the validity of our prediction models. Using a prototype to call patients with the highest risk of no-shows resulted in a noticeable decrease in the overall no-show rate.

Regulação do acesso ao tratamento do câncer de boca no estado do Rio de Janeiro / Study of the regulation system for access to oral cancer treatment in the state of Rio de Janeiro

Objetivos: Descrever o perfil das solicitações de vaga para tratamento do câncer de boca e analisar o tempo entre a solicitação e o agendamento. Métodos. Pesquisa com dados secundários do Sistema Estadual de Regulação do Estado do Rio de Janeiro, entre setembro de 2015 e junho de 2018. Incluiu-se as solicitações para "Oncologia Ambulatório de 1ª vez- Cirurgia de Cabeça e Pescoço" classificadas como câncer de boca e excluiu-se as com status "cancelada". Resultados. Foram exportados 5802 registros, sendo 1663 elegíveis. A idade média foi de 61 anos, com um desvio padrão de 12,3 anos. O tempo médio de espera foi de 19 dias com um desvio padrão de 16,6 dias. 19% dos agravos referiram-se as "Neoplasia maligna de outras partes e partes não especificadas da língua". Conclusão. O perfil dos pacientes corrobora o encontrado na literatura e o tempo de espera para o atendimento é considerado aceitável.

Objectives: To describe the profile of vacancy requests for treatment of oral cancer and to analyze the time between the request and the schedule. Methods. Research with secondary data from the State Regulation System of the State of Rio de Janeiro, between September 2015 and June 2018. Included were requests for "First-time Ambulatory Oncology - Head and Neck Surgery" classified as oral cancer and those with "canceled" status were excluded. Results. 5,802 records were exported, of which 1663 were eligible. The average age was 61 years, with a standard deviation of 12.3 years. The average waiting time was 19 days with a standard deviation of 16.6 days. 19% of the complaints referred to "Malignant neoplasm from other parts and unspecified parts of the tongue". Conclusion. The profile of patients corroborates that found in the literature and the waiting time for care is considered acceptable.

Missed antenatal diabetes care appointments and neonatal outcomes for pregnancies with Type 1 and Type 2 diabetes.

BACKGROUND: There is limited information regarding the association between missed appointments and neonatal outcomes for diabetes in pregnancy. STUDY METHODS: This retrospective live birth cohort included pregnant women with Type 1 or 2 diabetes who attended specialized clinics from 2008 to 2020. The association between at least one missed antenatal diabetes appointments and outcomes were assessed using logistic regression and reported as adjusted odds ratios (aOR) (95% confidence interval). Mediation analyses were conducted to examine if above target HbA1c mediated these relationships. RESULTS: The cohort included 407 and 902 women with Type 1 and 2 diabetes, respectively, of whom 25.1% and 34.5% missed at least one appointment. Women with Type 1 diabetes who missed an appointment were more likely to have a caesarean section (aOR 1.95 [1.15, 3.31]) and their babies more likely to be admitted to the neonatal intensive care unit (aOR 2.25 [1.35, 3.75]). Women with Type 2 diabetes who missed an appointment were more likely to have a large-for-gestational-age infant (aOR 1.61 [1.13, 2.28]), and an extreme large-for-gestational-age infant (aOR 1.69 [1.02, 2.81]) compared with women who did not miss appointments. Above target HbA1c mediated the relationship between missed appointments and caesarean delivery in Type 1 diabetes and large-for-gestational age and extreme large-for-gestational age in Type 2 diabetes. CONCLUSION: In individuals with Type 1 and 2 diabetes, there are differences in neonatal outcomes between those who missed an appointment compared to those who did not. It remains unclear if missed diabetes appointments are causative or a marker of other health behaviours or risk factors leading to neonatal morbidity.

Características clínicas e sociodemográficas dos usuários de um centro de atenção psicossocial infantojuvenil em Porto Alegre a partir do Sistema de Gerenciamento de Consultas (GERCON) / Clinical and sociodemographic characteristics of users of centro de atenção psicossocial infantojuvenil in Porto Alegre since the implementation of Sistema de Gerenciamento de Consultas (GERCON)

Introdução: Desde maio de 2019, o acesso aos serviços especializados de saúde mental infantojuvenil do município de Porto Alegre ocorre através da regulação assistencial por intermédio do sistema Gerenciamento de Consultas (GERCON). O objetivo deste estudo foi caracterizar o perfil clínico e sociodemográfico dos usuários encaminhados para um Centro de Atenção Psicossocial Infantojuvenil (CAPSi) nos dois primeiros anos do GERCON. Métodos: Estudo transversal em que foram resgatados dados dos prontuários eletrônicos de crianças e adolescentes encaminhados para primeira consulta em um CAPSi de Porto Alegre, capital do estado do Rio Grande do Sul, no período de maio de 2019 a abril de 2021. Resultados: A maioria dos 134 usuários era do sexo masculino (59,8%), autodeclarados brancos (69,7%), naturais de Porto Alegre (87,9%) e com hipótese diagnóstica inicial de Retardo mental (28,9%), Transtornos emocionais e de comportamento com início usualmente ocorrendo na infância e adolescência (24,2%) e Transtornos do humor (20,3%). A média de idade foi 13,4 anos e a mediana 15 anos. A taxa de absenteísmo na primeira consulta foi de 24,7%. Conclusão: A maioria dos usuários encaminhados para o CAPSi HCPA era do sexo masculino, adolescente, natural de Porto Alegre e com a hipótese diagnóstica inicial de transtornos do neurodesenvolvimento. Há uma elevada taxa de absenteísmo. Ao planejar intervenções para crianças e adolescentes que necessitam de atendimento em CAPSi é importante considerar o perfil nosológico e as características sociodemográficas dos usuários, assim como pensar em estratégias para diminuir o absenteísmo.

Introduction: Since May 2019, access to child and adolescent mental health services in the city of Porto Alegre has been managed through a regulatory system called sistema de regulação assistencial (GERCON). The aim of this study is to describe the clinical and sociodemographic characteristics of users referred to a Child and Adolescent Psychosocial Care Center (Centro de Atenção Psicossocial Infantojuvenil [CAPSi]) in the first two years of GERCON. Methods: This is a cross-sectional study. Data were retrieved from electronic medical records of children and adolescents referred for their first consultation at a CAPSi in Porto Alegre, capital of the state of Rio Grande do Sul, from May 2019 to April 2021. Results: Most of the 134 users were male (59.8%), self declared white (69.7%), from Porto Alegre (87,9%) and with an initial diagnostic hypothesis of Mental retardation (28,9%), Behavioral and emotional disorders with onset usually occurring in childhood and adolescence (24,2%) e Mood disorders (20,3%). The mean age was 13.4 years and the median was 15 years. The rate of absenteeism in the first appointment was 24.7%. Conclusion: Most users referred to the CAPSi HCPA were male, teenagers, born in Porto Alegre and with the initial diagnostic hypothesis of neurodevelopmental disorders. There is a high rate of absenteeism. When planning interventions for children and adolescents who need CAPSi care, it is important to consider the nosological profile and sociodemographic characteristics, as well as thinking about strategies to reduce absenteeism.

Illicit Drug Use and Endoscopy: When Do We Say No?

BACKGROUND: Illicit drug use (IDU) is often encountered in patients undergoing elective ambulatory surgical procedures such as endoscopy. Given the variety of systemic effects of these drugs, sedation and anesthetics are believed to increase the risk of cardiopulmonary complications during procedures. Procedural cancelations are common, regardless of the drug type, recency of use, and total dosage consumed. There is a lack of institutional and society recommendations regarding the optimal approach to performing outpatient endoscopy on patients with IDU. AIM: To review the literature for current recommendations regarding the optimal management of outpatient elective endoscopic procedures in patients with IDU. Secondary aim is to provide guidance for clinicians who encounter IDU in endoscopic practice. METHODS: Systematic review of PubMed, CINAHL, Embase, and Google Scholar for articles presenting data on outcomes of elective procedures in patients using illicit drugs. RESULTS: There are no clinically relevant differences in periprocedural complications or mortality in cannabis users compared to non-users. Endoscopy in patients with remote cocaine use was also found to have similar outcomes to recent use. CONCLUSIONS: Canceling endoscopic procedures in patients with recent IDU without consideration of the type of drug, dosage, and chronicity may lead to unnecessary delays in care and increased patient morbidity. Healthcare systems would benefit from additional guidelines for evaluating the patient with recent illicit drug use for acute intoxication and consider proceeding with procedures in the non-toxic population.

Simple Heuristics for Near-Optimal Appointment Scheduling in Primary Care.

In primary care allocating appointments to sequential requests can result in sub-optimal scheduling. Optimal scheduling requires hiring of consultants to analyze historical patterns. Many practices focus their resources on larger problems instead of optimizing appointment schedules. We simulate simple heuristics to compare their performance with optimal schedules uncovered using offline optimization models. We use uncapacitated appointment calendars for a nationally representative heterogeneous primary care panel to meet all patients' requests. The stochastic nature of appointment requests gives a distribution for daily appointments and for the uncovered optimal capacity. The First Minimum heuristic gives near-optimal schedules and can be easily implemented in small practices using pen-and-paper, without any investment in computer-systems.

Quality Improvement Project to Increase Postpartum Clinic Visits for Publicly Insured Women.

OBJECTIVE: To increase the percentage of women who attend postpartum visits and decrease the number of days to the first postpartum visit by implementing a scheduling change. DESIGN: Quality improvement project. SETTING/LOCAL PROBLEM: A small nurse practitioner maternity care clinic in an academic health center at which only 74% of the women who attended two or more prenatal visits attended postpartum clinic visits. PARTICIPANTS: A diverse sample of 25 publicly insured women who gave birth during the 5-month implementation period. INTERVENTION/MEASUREMENTS: We added a 2- to 3-week postpartum appointment to our standard 6-week postpartum appointment. The measurable outcomes were the percentage of women who attended postpartum clinic visits and the number of days to the first postpartum visit. RESULTS: During the first 4 months of the 5-month project implementation phase, 14 of the 20 (70%) women who gave birth attended postpartum visits. The attendance at postpartum visits in the last month of the project was 100% (all five women). Days to first postpartum visit decreased from a mean of 40.7 in the baseline year to a mean of 21.8 by the last month of project implementation. CONCLUSION: Despite the small scope of this project, our outcomes support continuing the practice of scheduling an earlier postpartum clinic appointment. The timing for when to preschedule postpartum appointments and contextual factors, such as the availability and use of telehealth technology and COVID-19 pandemic challenges, should be considered when implementing similar projects in other settings.

Improving Health Care for Patients with Multimorbidity: A Mixed-Methods Study to Explore the Feasibility and Process of Aligning Scheduled Outpatient Appointments through Collaboration between Medical Specialties.

Background: Many patients with multimorbidity have appointments and parallel trajectories in several outpatient clinics across medical specialties. This organisation may disintegrate care and challenges the navigation of the healthcare system. Methods: This study explored the feasibility of an intervention targeting patients seen in several outpatient clinics for multiple diseases. The intervention aimed to coordinate outpatient appointments through enhanced collaboration across medical specialties. Feasibility and process were assessed through mixed methods by tracking the intervention through prospectively collected data and through semi-structured interviews with patients and healthcare professionals. Results: A multidisciplinary outpatient pathway was established as an intervention. Appointments for different medical specialties were scheduled on the same day, information was rapidly transferred to the receiving outpatient clinic, and a multidisciplinary conference resulted in the circulation of a joint summary. In the first year, 20% of eligible patients were enrolled. Appointments were aligned in 15% of patients, and blood samples were reduced by 29%. Overall, intervention components were delivered as intended and seemed acceptable, although the patient selection needed refinement. Conclusion: It seems feasible to set up an intervention for patients attending several hospital outpatient clinics. Future interventions should focus on selecting patients in greatest need for alignment of appointments.

Mature Adults at the GP: Length of Visit and Patient Satisfaction-Associations with Patient, Doctor, and Facility Characteristics.

Background and objectives: The consultation time for more mature adults is often perceived as longer, increasing with the patient's age and boosting their satisfaction with the visit. However, factors determining patient satisfaction (PS) or the consultation time (CT) in the population aged 50+ are not clearly identified. A cross-sectional design was used to identify factors specific to the facility (e.g., size, staff turnover), doctor (e.g., seniority, workload), and patient (e.g., self-rated health, impairment of activities) that are related to PS and the CT. Our secondary focus was on the relation of PS to the CT along with the role of the patient's age and gender for both. Materials and Methods: Doctors (n = 178) and their 1708 patients (aged 50-97) from 77 primary care facilities participated in the study. The Patient Satisfaction with Visit Scale score and the CT were the outcome measures. Results: We identified associations with the CT in terms of the facility-related factors (number of GPs, time scheduling); doctors' workload and health; and patients' education, time attending GP, and impairments. PS was additionally governed by doctors' perceived rate of patients aged 65+, as well as the patients' hospitalization in the prior year, frequency of visits, and impairments. For adults aged 50+ the CT was unrelated to PS and both remained independent of patients' age. Conclusions: Specific factors in terms of the facility, GP, and patient were identified as related to PS and the CT for participating adults in primary care. During visits of patients aged 50+ at their GP, there is scope for both time-savings and patient satisfaction improvements, when paying attention, e.g., to the time scheduled per visit, the number of doctors employed, and the patients' impairments.

Advanced Practice Providers and Wait Times in Urology Offices: A Secret Shopper Study.

INTRODUCTION: Advanced practice providers (APPs), such as nurse practitioners and physician assistants, are a growing part of urology practices. However, the impact of APPs on improving new patient access in urology is unknown. We examined the impact of APPs on new patient wait times in a real-world sample of urology offices. METHODS: Research assistants posing as caretakers called urology offices in the Chicago metropolitan area and attempted to schedule a new patient appointment for an elderly grandparent with gross hematuria. Appointments were requested with any available provider: physician or APP. Descriptive measurements of clinic characteristics were reported and differences in appointment wait times were determined using negative binomial regressions. RESULTS: Of the 86 offices with which we scheduled appointments, 55 (64%) employed at least 1 APP but only 18 (21%) allowed for new patient appointments with APPs. When requested for the earliest appointment regardless of provider type, offices with APPs could offer shorter wait times compared to physician-only offices (10 vs 18 days; p=0.09). Initial appointments with an APP were available with a significantly shorter wait than those with a physician (5 days vs 15 days; p=0.04). CONCLUSIONS: Urology offices are commonly employing APPs but giving them a limited role in new patient visits. This suggests that offices with APPs may have an unrealized opportunity to improve new patient access. Further work is needed to better elucidate the role of APPs in these offices and how they might best be deployed.

Impacto do isolamento social pela pandemia da COVID-19 nas consultas odontopediátricas: uma revisão sistemática e meta-análise / Impact of social isolation caused by the COVID-19 pandemic on pediatric dentistry appointments: a systematic review and meta-analysis

Objetivo: Avaliar estudos que mostraram o impacto do isolamento social pela pandemia da COVID-19 nas consultas odontopediátricas. Métodos: Estudos originais que tenham mostrado o impacto do isolamento social nas consultas de crianças e adolescentes com um(a) odontopediatra foram incluídos. Buscas no Web ofScience, Scopus, Embase e PubMed foram realizadas. A seleção dos estudos foi feita por dois autores. O risco de viés foi avaliado com a escala Universidade de Adelaide. Resultados das meta-análises foram fornecidos em razão de chances (RC) e intervalo de confiança (IC). Resultados:Setecentas e noventa e quatro referências foram avaliadas e quatro estudos foram incluídos. A proporção de consultas realizadas em 2019 (antes da pandemia) para tratamento restaurador (RC = 22,65; IC = 20,57­24,93), extração de dentes (RC = 15,96; IC = 14,78­17,23) e tratamento endodôntico (RC = 9,21; IC = 7,72­10,98) foi significativamente maior que a proporção de consultas realizadas em 2020 (após o início da pandemia). A proporção de pais/responsáveis que não levariam seus(suas) filhos(as) à uma consulta com o odontopediatra foi significativamente maior entre indivíduos com mais medo durante a pandemia (escore 6 a 10) do que entre indivíduos com menos medo durante a pandemia (escore 0 a 5) (RC = 8,41; IC = 5,06­13,98). A proporção de pais/responsáveis que não levariam seus(suas) filhos(as) à uma consulta com o odontopediatra em regiões com mais de 100 casos de COVID-19 foi significativamente maior do que em regiões com até 100 casos (RC = 2,45; IC = 1,55­3,88). A avaliação do risco de viés variou de baixo a alto. Uma limitação dessa revisão foi o número restrito de estudos incluídos. Conclusão: O isolamento social pode ter contribuído para uma redução no número de consultas odontopediátricas devido à insegurança dos pais de levarem seus(suas) filhos(as) ao consultório odontológico. Esses resultados podem ser importantes para os clínicos e os organizadores de serviços de saúde.

Aim: To evaluate studies that showed the impact of social isolation caused by the COVID-19 pandemic on pediatric dentistry appointments. Methods: This work included original studies that have evaluated the impact of social isolation in children's and adolescents' appointments with a pediatric dentist. Searches were conducted in Web of Science, Scopus, Embase, and PubMed databases. Study selection was carried out by two authors. Risk of bias was assessed using the University of Adelaide scale. Results of meta-analyses were provided in odds ratio (OR) and confidence interval (CI). Results: Our study evaluated 794 references, of which four studies were included. The proportion of dental appointments performed in 2019 (before the pandemic) for restorative treatment (OR = 22.65; CI = 20.57­24.93), tooth extraction (OR = 15.96; CI = 14.78­17.23), and endodontic treatment (OR = 9.21; CI = 7.72­10.98) was significantly higher than the proportion of dental appointments performed in 2020 (after the onset of the pandemic). The proportion of parents/guardians who would not take their children to an appointment with a pediatric dentist was significantly higher among individuals who were more afrais during the pandemic (score 6 to 10) than among individuals who were less afraid during the pandemic (score 0 to 5) (OR = 8.41; CI = 5.06­13.98). The proportion of parents/guardians who would not take their children to an appointment with a pediatric dentist in regions with more than 100 cases of COVID-19 was significantly higher than in regions with up to 100 cases (OR = 2,45; CI = 1.55­3.88). Risk of bias assessment ranged from low to high. A limitation of this review was the restricted number of included studies. Conclusion: Social isolation caused a decline in the number of appointments with a pediatric dentist due to parents' insecurity about taking their children to the dental office. These results are important for both dental clinicians and healthcare decision-makers.

Determining the impact of a clinic coordinator on patient access and clinic efficiency in a pediatric multidisciplinary spina bifida clinic using medical informatics.

PURPOSE: The objective of this study was to analyze the effects on patient access by decreasing missed appointments after hiring a clinic coordinator using medical informatics. METHODS: A single-center retrospective analysis of the rates of missed appointments before and after hiring a clinic coordinator in a multidisciplinary spinal differences clinic were analyzed using a commercially available business software system (SAP® Business Objects). The total number of clinic visits was collected for each month to determine the access available for patients. RESULTS: The median number of missed appointments per clinic by month before employing the clinic coordinator was higher than in the two years following implementation (p < 0.0005). No differences were seen in the number of available appointment slots per month indicating no new clinics were needed to improve patient access (p = 0.551). Projected billing amounts prior to hiring the clinic coordinator indicated that $91,520 was lost in the 2 years prior to hiring this coordinator compared to $30,160 lost during the 2 years following the creation of this position (p = 0.0009). CONCLUSION: Hiring a clinic coordinator decreased the rate of missed appointments and was a cost-efficient intervention to improve patient access and provide effective patient care in a multidisciplinary setting.