The impact of urgent care centers on nonemergent emergency department visits

ObjectiveTo estimate the impact of urgent care centers on emergency department (ED) use.Data SourcesSecondary data from a novel urgent care center database, linked to the Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) from six states.Study DesignWe used a difference‐in‐differences design to examine ZIP code‐level changes in the acuity mix of emergency department visits when local urgent care centers were open versus closed. ZIP codes with no urgent care centers served as a control group. We tested for differential impacts of urgent care centers according to ED wait time and patient insurance status.Data Collection/Extraction MethodsUrgent care center daily operating times were determined via the urgent care center database. Emergency department visit acuity was assessed by applying the NYU ED algorithm to the SEDD data. Urgent care locations and nearby emergency department encounters were linked via zip code.Principal FindingsWe found that having an open urgent care center in a ZIP code reduced the total number of ED visits by residents in that ZIP code by 17.2% (P < 0.05), due largely to decreases in visits for less emergent conditions. This effect was concentrated among visits to EDs with the longest wait times. We found that urgent care centers reduced the total number of uninsured and Medicaid visits to the ED by 21% (P < 0.05) and 29.1% (P < 0.05), respectively.ConclusionsDuring the hours they are open, urgent care centers appear to be treating patients who otherwise would have visited the ED. This suggests that urgent care centers have the potential to reduce health care expenditures, though questions remain about their net cost impact. Future work should assess whether urgent care centers can improve health care access among populations that often experience barriers to receiving timely care.     

Practitioner-researchers in occupational therapy

Few occupational therapy clinicians are research productive even though their involvement in research is encouraged. The role of 'research-practitioner' is put forward as a means by which practitioners can be research productive. There is, however, an absence of studies exploring experience of the minority of practitioners who do produce research. This study used a qualitative approach to do this in occupational therapy. Purposive sampling was conducted of all research productive clinicians in acute-care hospitals in one Australian city. Of the 20 possible researchers, 15 participated in in-depth interviews which explored their experience of research. Results were analysed using the constant comparative method and six conceptual categories were developed to describe their experience. The key findings were that clinicians who did research perceived themselves to be different from other clinicians in terms of attributes; and they described special ways of getting research done, and ways of reflecting on outcomes of their research involvement. The study provides an empirical foundation to further consider the practitioner-researcher role in practice professions such as occupational therapy.     

Integrating occupational health services and occupational prevention services

BACKGROUND: Despite the human and monetary costs of occupational injury and illness, occupational health care has focused more on treatment than prevention, and prevention is not part of many clinical occupational health practices. This represents a failure of occupational health care to meet the health care needs of the working patients. METHODS: MEDLINE searches were conducted for literature on occupational medical treatment and the prevention of occupational injury and illness were reviewed to for linkages between prevention and treatment. Policy discussions which identify examples of programs that integrated prevention and treatment were included. RESULTS: Although examples of the integration of clinical and preventive occupational health services exist, there are challenges and barriers to such integration. These include inaction by clinicians who do not recognize their potential role in prevention; the absence of a relationship between the clinician and an employer willing to participate in prevention; economic disincentives against prevention; and the absence of tools that evaluate clinicians on their performance in prevention. CONCLUSIONS: Research is needed to improve and promote clinical occupational health preventive services.     

Inappropriate use of emergency ambulance services and the implications for primary health care in Japan

The number and per-capita emergency transports by public ambulancesand the percentage of transports of patients with non-emergencyconditions has been increasing in Japan, especially in urbanareas. Public ambulance services are, of course, essential fortransporting patients with crucial health problems. However,inappropriate ambulance use by patients who do not need emergencytreatment, but who need primary health care, means that thesepatients cannot get suitable health care, and diminishes theeffectiveness and efficiency of emergency medical-care servicesystems. The purposes of this study were to identify the factorsrelating to usage of public ambulance services in urban areas,to determine how to make these services more effective and moreefficient, and to discuss how to provide primary health-careservices so as to reduce the inappropriate use of public ambulanceservices. We investigated the accessibility of primary health-careservices, the characteristics of public ambulance service utilization,and the potential needs of the elderly for emergency-care servicesin two Tokyo wards: Edogawa andSetagaya. There were less healthresources, such as clinics, hospital beds and physicians, percapita in Edogawa than in Setagaya. Both the percentage of ambulancetransports of patients suffering from mild problems and thepercentage of ambulance transports on Sundays were higher inEdogawa than in Setagaya. Our survey showed that the percentagesof the elderly who would call for ambulances for each of threespecific health problems (fever, chest pain and ankle sprain)were all higher in Edogawa than in Setagaya. In both wards,elderly people living with their children and/or grandchildrenwere more likely to choose different health resources accordingto the specific problem being experienced than were elderlypeople living with other aged persons but without young people.The insufficient development of primary healthcare resourcesand systems increased the inappropriate use of high-cost emergencyambulance services by the elderly living in urban areas, wherefamily support is weakening. Health systems therefore need tobe reoriented so as to enhance accessibility to primary healthcareservices.     

Continuing professional development of occupational medicine practitioners: a needs assessment

OBJECTIVE: The aim of this study was to identify elements of occupational medicine practice used on a frequent basis which are considered to be of high priority for continuing professional development (CPD). METHODS: A postal questionnaire covering 28 areas of knowledge or practice was sent to all members of the Society of Occupational Medicine in September 2000. Respondents were asked to allocate scores to the 28 items for both CPD priority and frequency of use. RESULTS: The return rate for questionnaires was 29.5%. There was reasonable agreement between frequency of use and CPD priority ratings for the elements covered in the questionnaire. CONCLUSIONS: Despite the low return rate for questionnaires, this survey has helped identify themes which are important to physicians practising occupational medicine and has also highlighted those which are less important for inclusion in a CPD programme. Some differences in responses were identified between accredited specialists, specialist registrars and non-specialist practitioners of occupational medicine. The findings from this survey should be useful to providers of continuing medical education in planning courses, study days and electronic or distance learning educational packages.     

Use of medical emergency services

Background

In the Wesel District (North Rhine-Westphalia), emergency ambulances have been called out with increasing frequency and clinics report that their emergency departments (ED) are increasingly being used outside the consultation hours of panel doctors/compulsory health insurance (CHI) physicians. Therefore, the District Health Conference put this issue on its agenda.

Aims of the study

The aims were to obtain data on the following questions: 1. What do people do when they need medical help outside consultation hours of panel doctors? 2. Do people know that there is a duty panel doctor on call? Do they know how to contact this service? Do people know about the medical emergency service and phone number 112, and the new phone number 19222 for patient transport ambulances?

Material and methods

The study comprised all residents of the District of Wesel between 18 and 87 years of age (approximately 385,000 people). The sample contained 1089 persons drawn in accordance with the Gabler-Häder method and in a second step with the “birthday method”. The survey was carried out by the CATI (computer-assisted telephone interviews) laboratory at the Institute of Public Health (LÖGD, Bielefeld) between 18 February and 28 March 2002.

Results

On being asked “how would you act in case of a non-life-threatening disease outside consultation hours of panel doctors”, 48.6% of respondents were “correct” (i.e. on-call CHI duty physicians), while 51.5% of respondents were “incorrect”, for example “I go to the hospital/emergency department” (24.3%) or “I call the number 112” (13%). About 80% of respondents said they knew about on-call CHI duty physicians. More than 95% of respondents stated they knew about the emergency service of the fire department, and 86% of these respondents were able to recall the correct number 112. About 4% of the respondents said they knew the national telephone number for patient transport, and 58% of these respondents mentioned the correct number (19222).

Discussion

The tiered medical emergency system should be used properly. This aim could be achieved by: (1) informing the public about the 24-hour on-call service provided by panel doctors, that the majority of medical conditions can be treated by panel doctors, and in severe cases a professional and quick referral will be done, and that self-referral to hospital may reduce or even obstruct professional resources for the treatment of “real” emergency patients; (2) informing target groups (elderly people) about the emergency number 112; and (3) informing the public about the national number 19222 for patient transport. Structural measures include: (1) Specific on-call services, and (2) improvement in the transparency and reachability of panel doctors’ on-call services.     

Evaluating an online occupational therapy community of practice and its role in supporting occupational therapy practice

Background/aim: Networking, together with knowledge acquisition and resource sharing, are key components of occupational therapists’ professional development. To enhance the connectedness and clinical support available to occupational therapists, OT AUSTRALIA Queensland developed an online community of practice (CoP). No research regarding the use of online CoPs by occupational therapists has been conducted. This study aimed to explore occupational therapists’ perceptions of the benefits of, barriers to, and reasons for using or not using the online CoP. Methods: Two focus groups were conducted, one with therapists who had used the CoP (n = 5) and the other with therapists who had not used it (n = 9). Participant responses to focus group questions informed the development of a survey asking therapists about their use of the CoP, its benefits and reasons for using/not using it, which was sent via email to all OT AUSTRALIA Queensland members. Results: Motivation to use the CoP, technology, workload management impacts, potential benefits and time considerations emerged as themes from the focus groups. Of the 55 survey respondents, 58.2% were aware of the CoP but only 32.7% had accessed it. Potential benefits of the CoP identified by participants included time efficiency, structural flexibility, networking capabilities and mentoring opportunities. Reasons for not accessing and/or participating in the CoP included access difficulties, usability difficulties, personal communication preferences and perceived irrelevance of available information. Conclusion: The findings of this study suggest that the CoP is still in the early stages of development; however, it has the potential to be further embraced by therapists if further promotion, training and minor usability modifications are undertaken.     

Disease profile of children in Kabul: the unmet need for health care

This study was conducted at the paediatric emergency department of a tertiary care teaching and referral hospital in Kabul, Afghanistan to assess the morbidity and mortality pattern of illness in paediatric population. Afghanistan has one of the highest infant mortality rates in the world, and there is complete breakdown of the health care system in the country because of the continued war. A total of 17,850 children and neonates were seen at the paediatric emergency centre at IGICH, Kabul in one year period from 18 September 2002 to 17 September 2003. The most common illnesses were diarrhoea and respiratory infections. Infectious diseases, neonatal illnesses, and cardiac diseases were other important causes of morbidity. Neonatal deaths formed the major proportion of all deaths. Morbidity and mortality attributable to easily preventable/curable diseases was quite high. There is an urgent need to develop an integrated and effective health care system in the country.     

急诊科应用脑卒中临床路径的效果评价

目的探讨急诊科应用临床路径对脑卒中患者实施管理的效果。方法选取最新的、具有权威性的关于急性脑卒中诊治指南作为编写临床路径的依据,将应用临床路径管理的245例脑卒中患者作为观察组,采用传统的医疗模式管理的237例脑卒中患者作为对照组,对2组患者相关情况进行比较。结果2组患者早期确诊率与患者的服务满意度等方面比较差异有显著性(P<0.05)。结论急诊科应用脑卒中临床路径对患者实施管理可明显提高卒中早期确诊率与患者的服务满意度,是一种新的行之有效的服务管理模式。     

Primary care services for an emergency department population: a novel location for contraception

OBJECTIVE: To assess contraceptive provision site preferences in female urban Baltimore emergency department patients. METHODS: This cross-sectional questionnaire study was completed by 790 women, a population sufficient to detect a 10% intersite difference. The results were analyzed with chi-square, univariate and multivariate logistic regression analyses. RESULTS: Obtaining contraception other than from a physician's office was acceptable to 57.2% of the subjects, particularly those uninsured (p=.006) and without primary care providers (p<.001). Contraceptive provision in the emergency department (ED) was acceptable to 44.0%, particularly those who are frequent ED users (p=.003) and those at risk for unintended pregnancy (p=.024; pooled, p<.001). Care in nontraditional settings may preclude pelvic examination; 34.0% of the subjects felt safe obtaining contraception without this examination, significantly for those desiring contraceptive provision in the ED. CONCLUSION: Contraceptive services are acceptable in nontraditional settings, including the ED, particularly to women of limited resources. This service is acceptable without pelvic examination for a sizable proportion of the women using the ED.     

Emergence of occupational medical services outside the workplace

A new type of occupational medicine clinic has recently emerged in the United States. These clinics are multispecialty in staffing, are located in hospital outpatient departments, and are affiliated with academic medical centers. Their primary goal is to provide personal health and medical services including diagnosis, treatment, and follow-through of occupationally related diseases. Approximately 15 such clinics have been established in the last several years. A review of the medical, economic, and social forces that have historically shaped the content and scope of occupational medical and health services for workers explains in large part the reasons why many of these clinics have now come into being. Characteristics of eight of these clinics are reviewed in detail. These clinics provide a setting for inter-disciplinary and interspecialty education of personnel and offer the medical community a demonstration of a means for better recognition and treatment of occupationally related illnesses.