Characteristics of Future Models of Integrated Outpatient Care

The Benefits of Integrating Electronic Medical Record Systems Between Primary and Specialist Care Institutions: Mixed Methods Cohort Study

BACKGROUND

The benefits of a fully integrated electronic medical record (EMR) system across primary and specialist care institutions have yet to be formally established. Integrating the EMR systems between primary and specialist care is the first step in building a medical neighborhood. A medical neighborhood is a set of policies and procedures implemented through integrated systems and processes that support the joint management of patient care across primary care physicians, specialist physicians, and other health care providers.

OBJECTIVE

This study aims to quantify the impacts of integrating the EMR systems of primary and specialist care institutions in the process of developing a medical neighborhood. The impacts are operationalized in both quantitative and qualitative measures, measuring the benefits of such an integration in 3 specific areas, namely, patient diagnosis tracking, patient care management, and patient coordination.

METHODS

A comprehensive, mixed methods examination was conducted using 3 different data sources (EMR consultation data, clinician survey data, and in-depth interviews). The EMR data consist of patient encounters referred to a specialist clinic from 6 primary care providers before and after integrating the EMR system into the primary and specialist care institutions. We analyzed 25,404 specialist consultation referrals to the specialist clinics by the primary care partners for a 12-month period, during which the integration of the EMR system was conducted. A cohort empirical investigation was used to identify the quantitative impacts of the EMR integration, and a follow-up survey was conducted with the clinicians 18 months post integration. The clinicians' perceptions of the integration were measured to triangulate the empirical observation from the patient encounters, and the postimplementation perception survey was analyzed to triangulate the empirical investigation of consultation instances of the earlier cohort. Concurrently, a total of 30 interviews were conducted between March 16, 2021, and July 28, 2021, with clinicians and operations staff to gather on-the-ground sentiments engendered by this integration, which further informed our quantitative findings.

RESULTS

The integration of EMR systems between primary and specialist care institutions was associated with benefits in patient diagnosis tracking, patient care management, and patient coordination. Specifically, it was found that the integration resulted in a decrease in wait time for specialist appointments of an average of 16.5 days (P<.001). Patients were also subjected to fewer repeated procedures and tests; the number of procedures (P=.006), radiographies (P=.02), and overall bill sizes (P=.004) all decreased by between 4.08% and 39.7%, resulting in reduced health care resource wastage while maintaining similar medical outcomes (P=.37).

CONCLUSIONS

Our study's results are among the first instances of empirical evidence to show that the integration and sharing of data between primary and specialist care institutions promote continuity in health care delivery and joint patient management in a medical neighborhood. The findings go beyond the traditional benefits of improved referral communication, as shown in prior literature.

Did pediatric drug development advance epilepsy treatment in young patients? It is time for new research goals

Modern drugs have changed epilepsy, which affects people of all ages. However, for young people with epilepsy, the framework of drug development has stalled. In the wake of the thalidomide catastrophe, the misconception emerged that for people < 18 years of age drugs, including antiseizure medications (ASMs), need separate proof of efficacy and safety, overall called "pediatric drug development". For ASMs, this has changed to some degree. Authorities now accept that ASMs are effective in < 18 years as well, but they still require "extrapolation of efficacy," as if minors were another species. As a result, some of the pediatric clinical epilepsy research over the past decades was unnecessary. Even more importantly, this has hampered research on meaningful research goals. We do not need to confirm that ASMs work before as they do after the 18th birthday. Instead, we need to learn how to prevent brain damage in young patients by preventing seizures and optimize ASMs' uses. Herein we discuss how to proceed in this endeavor.

[Models of community-based psychiatric care in Italy and England]

THE AIM OF THE STUDY

Is to study and compare models of out-of-hospital psychiatric care in different countries-Italy and England.

In the Italian model of community-based psychiatric care, institutions have been created - homes for permanent residence with a security regime (REMS), the most common of which are intensive (or assertive) treatment in the community and mandatory outpatient treatment. The form of intensive treatment is an active and long-term maintenance and treatment of patients. The essence of the methodology is to provide assistance at home, which is carried out by specially trained multidisciplinary teams, including psychiatrists, nurses, psychologists, social workers. However, in the long term, there is a tendency to increase relapses and acute conditions. The English model of community psychiatric care is based on the practice of the method of «individual case management». After the acute attack is stopped, the main work program includes work with a psychologist and/or a psychotherapist in the form of a number of multidimensional group and family therapy activities, training of social skills and ways of independent living, development of communication, self-esteem and confident behavior, which is achieved through psychocorrective work, as well as drug therapy and didactic training on appropriate simulators.

Special attention is paid to social recovery, work with the family, social and labor recovery and instrumental support.