1
|
Sinai D, Lassri D, Spira C, Lipsitz JD. Telephone interpersonal counseling treatment for frequent attenders to primary care: Development and piloting. Psychother Res 2024; 34:555-569. [PMID: 37079921 DOI: 10.1080/10503307.2023.2200982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/01/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Frequent attenders in primary care (FAs) consume a disproportionate amount of healthcare resources and often have depression, anxiety, chronic health issues, and interpersonal problems. Despite extensive medical care, they remain dissatisfied with the care and report no improvement in quality of life. OBJECTIVE To pilot a Telephone-based Interpersonal Counseling intervention for Frequent Attenders (TIPC-FA) and assess its feasibility and efficacy in reducing symptoms and healthcare utilization. METHOD Top 10% of primary care visitors were randomly assigned to TIPC-FA, Telephone Supportive Contact (Support), or Treatment as Usual (TAU). TIPC-FA and Support groups received six telephone sessions over twelve weeks, while the TAU group was interviewed twice. Multilevel regression tested for changes over time, considering patient and counselor variance. RESULTS TIPC-FA and Support groups demonstrated reduced depressive symptoms, and the TIPC-FA group showed decreased somatization and anxiety. The TIPC-FA group demonstrated a trend towards less healthcare utilization than the TAU group. CONCLUSION This pilot study suggests that IPC via telephone outreach is a feasible approach to treating FAs, achieving a reduction in symptoms not seen in other groups. Promising reduction in healthcare utilization in the TIPC-FA group warrants further exploration in larger-scale trials.
Collapse
Affiliation(s)
- Dana Sinai
- Department of Psychology, Ben-Gurion University of the Negev., Beer-Sheva, Israel
| | - Dana Lassri
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel
- Research Department of Clinical, Educational and Health Psychology, UCL (University College London), London, UK
| | | | - Joshua D Lipsitz
- Department of Psychology, Ben-Gurion University of the Negev., Beer-Sheva, Israel
| |
Collapse
|
2
|
Moona H, Mimmi T, Helvi K, Outi K. Long- and short-term frequent attenders' perceptions of patient-centredness in Finnish primary healthcare: A cross-sectional survey and the equivalence of the factor structure of the 36-item patient-centred primary care instrument. Scand J Caring Sci 2024. [PMID: 38523061 DOI: 10.1111/scs.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/13/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
AIM The study aimed to compare long- and short-term frequent attenders' (FAs) perceptions of patient-centredness and to assess the equivalence of the factor structure of patient-centred primary care (PCPC) instrument for long- and short-term FAs. METHODS A cross-sectional survey of long-term (n = 234) and short-term (n = 261) FAs within the primary healthcare of one city in Finland. The data collected in January-July 2020 via 'the 36-item PCPC instrument' were analysed using Pearson's chi-squared test, Mann-Whitney U-test, Cronbach's alpha, and multigroup confirmatory factor analysis (MGCFA). RESULTS Long-term FAs had worse perceptions of patient-centredness than short-term FAs across all subscales: patients' preferences, physical comfort, coordination of care, continuity and transition, emotional support, access to care, information and education, and family and friends. The MGCFA indicated a good fit for the predicted eight-factor model. CONCLUSIONS Long-term FAs' care needs are currently not being met, indicating the need for considering how the way healthcare services are arranged and care is provided affects prolonged and high care needs. Various dimensions of patient-centredness need to be addressed when developing not only FAs' care but also wider service paths. A distinction should be made between long- and short-term frequent attendance when identifying and addressing FAs' service needs.
Collapse
Affiliation(s)
- Huhtakangas Moona
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Tolvanen Mimmi
- Northern Finland Birth Cohort, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Kyngäs Helvi
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Kanste Outi
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| |
Collapse
|
3
|
Sharabani R, Kagan I, Cojocaru S. Frequent attenders in primary health care: a mixed-methods study of patient and staff perspectives. J Clin Nurs 2023; 32:7135-7146. [PMID: 37264682 DOI: 10.1111/jocn.16772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/23/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023]
Abstract
AIMS AND OBJECTIVE To understand the frequent attendance phenomenon from the perspective of patients and healthcare professionals and how it can be reduced. BACKGROUND Frequent attenders (FAs) are characterised by the consumption of a disproportionate number of medical consultations and a high number of visits per year to primary care physicians (PCP). Although FAs constitute about 10% of all primary clinic attendees, they are responsible for ~40-50% of clinic visits, affecting the efficiency, accessibility and quality of health services provided to other patients. DESIGN Mixed methods (STROBE Statement: Data S1; COREQ checklist: Data S2). METHODS Eighteen FAs were interviewed in a qualitative approach. PCPs and nurses (n = 184) completed a cross-sectional survey. RESULTS FAs are driven by their personal, emotional and mental state. FAs viewed clinics as a source for information and resolving medical problems. They perceived PCPs as authoritative and knowledgeable, and nurses as treatment managers and mediators between PCPs and patients. In contrast, FAs evoked more negative emotions than positive ones among medical staff. PCPs and nurses attributed frequent visits to FAs' personal and emotional states. A model based on the findings was constructed to provide a framework for grasping frequent attendance from a sociological perspective and for planning and managing it. CONCLUSIONS The accessibility and availability of health services at primary clinics, and collaboration and trust in medical staff facilitate the frequent attendance phenomenon. RELEVANCE TO CLINICAL PRACTICE The frequent attendance phenomenon should be proactively prevented, even before patients become FA, using the model constructed, which serves as a foundation for introducing an intervention program to identify and prevent frequent attendance. PCPs and nurses working in primary care clinics should be made aware of the FA phenomenon and should be educated and given tools to deal with it within the clinic. The process should be facilitated by organisational support. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript.
Collapse
Affiliation(s)
- Rachel Sharabani
- Edith Wolfson School of Nursing, Holon, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Ilya Kagan
- Department of Nursing, Ashkelon Academic College, Ashkelon, Israel
| | - Stefan Cojocaru
- Department of Sociology and Social Work, Alexandru Ioan Cuza University, Iasi, Romania
| |
Collapse
|
4
|
Cohen JN, Nguyen A, Rafiq M, Taylor P. Impact of a case-management intervention for reducing emergency attendance on primary care: randomised control trial. Br J Gen Pract 2022; 72:BJGP.2021.0545. [PMID: 35577585 PMCID: PMC9119815 DOI: 10.3399/bjgp.2021.0545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The impact on primary care workload of case-management interventions to reduce emergency department (ED) attendances is unknown. AIM To examine the impact of a telephone-based case-management intervention targeting people with high ED attendance on primary care use. DESIGN AND SETTING A single-site data extract from a larger randomised control trial, using the patient-level data from primary care electronic health records (2015-2020), was undertaken. METHOD A total of 363 patients at high risk of ED usage were randomised to receive a 6-month case-management intervention (253 patients) or standard care (110 patients). Poisson regression models were used to calculate monthly rates of primary care use over time for the 2 years post-randomisation, comparing both arms. Usage was subclassified into face-to-face, telephone, letter, and community and secondary care referrals, stratified by patient demographics. RESULTS No significant difference was found in the mean annual rate of primary care events between the intervention and control arms (P = 0.70). Secondary care referrals saw a 26% reduction in the mean annual referral rate (incident rate ratio [IRR] 0.74, 95% confidence interval [CI] = 0.64 to 0.86, P<0.001) and letters sent increased by 6% in the intervention arm compared with the control arm (IRR 1.06, 95% CI = 1.01 to 1.11, P = 0.01). In the case-managed arm, in patients aged ≥80 years there was a 33% increase in primary care usage (IRR 1.33, 95% CI = 1.28 to 1.40, P<0.001); with a corresponding 10% decrease in patients aged <80 years when compared with controls (IRR 0.90, 95% CI = 0.87 to 0.92, P<0.001). CONCLUSION A targeted case-management intervention to reduce ED attendances did not increase overall primary care use. Redistribution of usage is seen among some patient groups, particularly older people, which may have important implications for primary healthcare planning.
Collapse
Affiliation(s)
- Jonathan N Cohen
- Institute of Health Informatics, University College London, London
| | | | - Meena Rafiq
- Epidemiology of Cancer and Healthcare Outcomes, Institute of Epidemiology and Health Care, University College London, London
| | - Paul Taylor
- Institute of Health Informatics, University College London, London
| |
Collapse
|
5
|
Mak CCM, Mao DRH, Siddiqui FJ, Lim A, Davamoni-Thomas J, Tang JP, Bachik R, Ng CWL, Kandasami G, Lee C. A new paradigm in management of frequent attenders to emergency departments with severe alcohol use disorder-A pilot study for assertive community treatment in Singapore. Front Health Serv 2022; 2:1029455. [PMID: 36925838 PMCID: PMC10012780 DOI: 10.3389/frhs.2022.1029455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Introduction A majority of frequent users of emergency medical services in Singapore present with alcohol-related problems. These patients are known to engage poorly with traditional addiction services and frequently attend Emergency Departments (EDs) instead, resulting in high healthcare burden. Assertive Community Treatment (ACT) is an alternative intervention to traditional addiction management. ACT involves community visits with focus on holistic care and harm-reduction. Materials and methods We conducted a prospective before-and-after cohort study at the major tertiary center for addiction disorders in Singapore. The main objective was to evaluate effectiveness of ACT in reducing alcohol-related attendances at EDs nationwide. Socio-demographics, alcohol-related ED attendances, and the Christo Inventory for Substance-misuse Services (CISS) scores were collected for the patients recruited from April 2018 to March 2019. Descriptive analyses and the Wilcoxon Signed-Rank Test were performed. Results All 14 patients were male with a mean age of 55 years. There was a significant 45.3% reduction in average alcohol-related ED attendances from 6.8 (range 3-22, median 5.5) in the pre-intervention 6-month period, to 3.7 (range 0-28, median 1.5) in the post-intervention 6-month period (Z = -2.244, p = 0.025). CISS scores showed significant improvement from a pre-intervention median of 13.5 (range 9-16) to a post-intervention median of 6.5 (range 1-10, p = 0.001), corresponding to reduction in alcohol-related problem severity. Conclusion This pilot study suggests that ACT can be effective in reducing alcohol-related ED attendances and alcohol-related problem severity in patients with AUD who frequently attend ED. A multicenter, prospective study using ACT for such patients across four hospitals in Singapore is currently underway.
Collapse
Affiliation(s)
- Charles Chia Meng Mak
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | | | - Fahad Javaid Siddiqui
- Prehospital and Emergency Care Research Center (PERC), Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Alex Lim
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | - Jayson Davamoni-Thomas
- Population Health & Community Transformation, Khoo Teck Puat Hospital, Singapore, Singapore
| | - June Peiwen Tang
- Clinical and Forensic Psychology Service, Ministry of Social and Family Development, Singapore, Singapore
| | - Rozinah Bachik
- Education Office, Institute of Mental Health, Singapore, Singapore
| | - Charis Wei Ling Ng
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| | | | - Cheng Lee
- National Addictions Management Service, Institute of Mental Health, Singapore, Singapore
| |
Collapse
|
6
|
McDermott A, Sanderson E, Metcalfe C, Barnes R, Thomas C, Cramer H, Kessler D. Continuity of care as a predictor of ongoing frequent attendance in primary care: a retrospective cohort study. BJGP Open 2020; 4:bjgpopen20X101083. [PMID: 33051221 PMCID: PMC7880190 DOI: 10.3399/bjgpopen20x101083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/20/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Frequent attenders (FAs) in primary care receive considerable resources with uncertain benefit. Only some FAs attend persistently. Modestly successful models have been built to predict persistent attendance. Nevertheless, an association between relational continuity of care and persistent frequent attendance remains unclear, and could be important considering both the UK government and Royal College of General Practitioner's (RCGP) aim of improving continuity. AIM To identify predictive measures (including continuity) for persistent frequent attendance that may be modified in future interventions. DESIGN & SETTING This is a retrospective cohort study sampling 35 926 adult patients registered in seven Bristol practices. METHOD The top 3% (1227) of patients by frequency of GP consultations over 6 months were classed as FAs. Individual relational continuity was measured over the same period using the Usual Provider Continuity (UPC) index. Attendance change was calculated for the following 6 months. Multivariable logistic regression analysis was used to determine variables that predicted attendance change. RESULTS FAs were on average 8.41 years older (difference 95% confidence interval [CI] = 7.33 to 9.50, P<0.001) and more likely to be female (65.36% versus 57.88%) than non-FAs. In total, 79.30% of FAs decreased attendance over the subsequent 6 months. No association was found between continuity and subsequent attendance. Increasing age was associated with maintained frequent attendance. CONCLUSION Continuity does not predict change in frequent attendance. In addition to improving continuity, recent government policy is focused on increasing primary care access. If both aims are achieved it will be interesting to observe any effect on frequent attendance.
Collapse
Affiliation(s)
- Adam McDermott
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Sanderson
- Bristol Randomised Trials Collaboration, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christopher Metcalfe
- Bristol Randomised Trials Collaboration, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca Barnes
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Clare Thomas
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Helen Cramer
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Kessler
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
7
|
Huhtakangas M, Tuomikoski AM, Kyngäs H, Kanste O. Frequent attenders' experiences of encounters with healthcare personnel: A systematic review of qualitative studies. Nurs Health Sci 2020; 23:53-68. [PMID: 33034401 DOI: 10.1111/nhs.12784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Abstract
Rather than measure demographic factors such as socioeconomics, the aim of this study was to examine the lived experience of frequent attenders by synthesizing findings on their encounters with healthcare personnel. The Scopus, CINAHL, PsycARTICLES, and PubMed (Medline) databases were searched in May 2020 in order to screen studies by title and abstract (n = 1794) and full-text (n = 20). Findings from the included studies (n = 6) were then pooled using meta-aggregation, yielding the following results: difficulties in resolving frequent attenders' situations may create "service circles," frustrating patients with their situation; frequent attenders' own expertise regarding their condition should be recognized and valued alongside that of healthcare professionals when performing collaborative care; a lack of empathy and disparagement may make frequent attenders feel misunderstood and unappreciated; frequent attenders should be recognized as individuals by taking their circumstances into account and providing support accordingly. Frequent attenders' experiences demonstrate the importance of shared decision-making, continuity of care, and acknowledging these patients' individual circumstances. Identifying the variety of frequent attenders' service needs by synthesizing their experiences is a practical way of organizing patient-centered healthcare services.
Collapse
Affiliation(s)
- Moona Huhtakangas
- Department of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Anna-Maria Tuomikoski
- Oulu University of Applied Sciences (Principal Lecturer), The Finnish Centre for Evidence-Based Health care: A JBI Centre of Excellence, Oulu, Finland
| | - Helvi Kyngäs
- Department of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Department of Nursing Science and Health Management, University of Oulu, Medical Research Centre, University Hospital of Oulu, Oulu, Finland
| | - Outi Kanste
- Department of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| |
Collapse
|
8
|
Jadhakhan F, Lindner OC, Blakemore A, Guthrie E. Prevalence of common mental health disorders in adults who are high or costly users of healthcare services: protocol for a systematic review and meta-analysis. BMJ Open 2019; 9:e028295. [PMID: 31488474 PMCID: PMC6731873 DOI: 10.1136/bmjopen-2018-028295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION In all healthcare settings, a small proportion of patients account for a large level of healthcare use and associated high healthcare costs. Depression and anxiety are common co-morbidities in patients who are high users of care. The aims of this systematic review are to: (1) estimate the prevalence of anxiety/depression in adults who are high users of general physical healthcare services and/or who accrue high healthcare costs (2) estimate the magnitude of healthcare use associated with the presence of anxiety/depression. METHODS AND ANALYSIS This review will include any studies where patients are high users of primary, secondary or emergency healthcare services and/or accrue high healthcare costs. This is the first systematic review to focus on patients who are over the age of 18, whose degree of anxiety/depression has been evaluated with a standardised questionnaire or by a clinical interview generating a diagnosis according to international diagnostic criteria. The review will include eligible studies indexed in Medline, PsychINFO, Embase, Cumulative Index to Nursing and Allied Health Literature, Prospective Register of Systematic Reviews, Cochrane Library from inception to 1 April 2019. We will estimate the prevalence of anxiety/depression in these populations and the magnitude of use associated with anxiety/depression across various general physical healthcare settings. We will provide a narrative description of findings and factors that may influence them. A meta-analysis may be pursued if the degree of heterogeneity across studies is acceptable. ETHICS AND DISSEMINATION This systematic review will use data from existing studies, hence no ethical approvals are required. Findings will be disseminated in a peer-reviewed publication and at relevant academic meetings. PROSPERO REGISTRATION NUMBER PROSPERO CRD42018102628.
Collapse
Affiliation(s)
- Ferozkhan Jadhakhan
- Institute of Mental Health, School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, West Midlands, UK
- Research and Innovation, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Oana C Lindner
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, West Yorkshire, UK
| | - Amy Blakemore
- Division of Nursing, Social Work and Midwifery, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Elspeth Guthrie
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, West Yorkshire, UK
| |
Collapse
|
9
|
Jensen H, Møller H, Vedsted P. Characteristics of customary non-attenders in general practice who are diagnosed with cancer: A cross-sectional study in Denmark. Eur J Cancer Care (Engl) 2019; 28:e13143. [PMID: 31433525 DOI: 10.1111/ecc.13143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/22/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to explore individual and structural factors in patients with cancer and their potential association with customary non-attendance in general practice. MATERIALS AND METHODS We conducted a population-based cross-sectional study of all patients aged 50-89 years who were diagnosed with an incident cancer in 2009-2013 in Denmark. We investigated associations between being a customary non-attender (defined as having no consultations in general practice in the 19-36 months before diagnosis) and selected patient-related factors (demography, socioeconomic status), health-related factors (multimorbidity) and structural factors (urbanisation degree, list size of general practice and use of out-of-hours services) using logistic regression. RESULTS A total of 123,943 cancer patients were included; 11,567 (9.3%) of these were non-attenders. Non-attendance was associated with being more than 70 years of age, being single, having short or long education and being financially affluent. Non-attendance was rarely seen in cancer patients with (multi)morbidity, in individuals living in an area with 2,000-99,999 inhabitants and in individuals having contact with the out-of-hours services. CONCLUSION Specific groups of cancer patients were more often customary non-attenders in general practice. General practice may need to reach out more directly to these patients to ensure more timely cancer diagnosis.
Collapse
Affiliation(s)
- Henry Jensen
- Research Centre for Cancer Diagnosis in Primary Care, Department of Public Health, Aarhus University, Aarhus, Denmark.,Research Unit for General Practice, Aarhus, Denmark
| | - Henrik Møller
- Research Centre for Cancer Diagnosis in Primary Care, Department of Public Health, Aarhus University, Aarhus, Denmark.,The Danish Clinical Registries (RKKP), Aarhus, Denmark
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care, Department of Public Health, Aarhus University, Aarhus, Denmark.,Research Unit for General Practice, Aarhus, Denmark
| |
Collapse
|
10
|
Tan AL, Iyer NG, Putri N, Nadkarni N, Skanthakumar T, Wong TH, Tay GCA. Factors driving frequent attendance at emergency departments for patients with head and neck cancer. Head Neck 2019; 41:3798-3805. [PMID: 31423688 DOI: 10.1002/hed.25916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 06/28/2019] [Accepted: 07/30/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with head and neck cancer have a higher risk of emergency department (ED) frequent attender (FA). We hypothesized that FAs present with issues different from non-FAs. METHODS A retrospective cohort study was conducted on Singapore residents with head and neck cancers using de-identified registry merged with electronic medical record data. A competing risk regression analysis was performed to identify factors associated with FA. Aggregated primary diagnoses were compared for patients with and without FA risk factors. RESULTS Thirteen percent of patients with head and neck cancer were FAs. FA risk factors were Charlson comorbidity index (3+), and socioeconomic status (SES). FAs had a higher proportion of respiratory infections. The spectrum of diagnosis was similar for patients with low and high SES. Current smokers had a greater proportion of respiratory complaints, relative to never smokers. CONCLUSION Patients with greater comorbidity scores or higher SES were more likely to be FA. FAs were more likely to present with respiratory complaints, likely related to cancer treatment, or smoking status.
Collapse
Affiliation(s)
- Aidan L Tan
- Preventive Medicine, National University Hospital, Singapore.,Health Services Research Unit, Singapore General Hospital, Singapore
| | - Narayanan Gopalakrishna Iyer
- Health Services Research Unit, Singapore General Hospital, Singapore.,Division of Surgical Oncology, National Cancer Centre, Singapore.,Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School, Singapore
| | - Natascha Putri
- Division of Surgical Oncology, National Cancer Centre, Singapore.,Singhealth Duke-NUS Head and Neck Centre, Singapore General Hospital, Singapore
| | - Nivedita Nadkarni
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | | | - Ting Hway Wong
- General Surgery, Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Gerald Ci An Tay
- Singhealth Duke-NUS Head and Neck Centre, Singapore General Hospital, Singapore.,General Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
11
|
Jadhakhan F, Lindner OC, Blakemore A, Guthrie E. Prevalence of medically unexplained symptoms in adults who are high users of health care services: a systematic review and meta-analysis protocol. BMJ Open 2019; 9:e027922. [PMID: 31270115 PMCID: PMC6609118 DOI: 10.1136/bmjopen-2018-027922] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Medically unexplained symptoms (MUS) are common in primary-care and secondary-care settings. Persistent symptoms of MUS are associated with a variety of poor outcomes including increased disability, poor quality of life and high healthcare costs. The aim of this systematic review is to review the relevant literature to determine the prevalence of MUS in patients who are high users of healthcare and/or who accrue high healthcare costs. METHODS AND ANALYSIS This review will include studies with cases that are either high users of general healthcare or are patients who accrue high healthcare costs, aged ≥18 years and where a recognised measure of MUS, either a standardised clinical interview or questionnaire, was employed. The following citation databases MEDLINE, PsycINFO, EMBASE, CINAHL, PROSPERO and the Cochrane library will be systematically searched from inception to 30 June 2018. The Cochrane library was included because of the significant proportion of non-observational studies currently published in the database. The prevalence of MUS and associated disorders along with the costs or use of healthcare associated with the presence of MUS will be estimated with 95% CI. If possible, study results will be pooled into a meta-analysis. However, if heterogeneity is high, data analysis will be presented descriptively. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review since only data from existing studies will be used. Results of this review will be disseminated in peer-reviewed publications and at national and international conferences. PROSPERO REGISTRATION NUMBER CRD42018100388.
Collapse
Affiliation(s)
- Ferozkhan Jadhakhan
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, UK
- Research and Innovation, Birmingham and Solihull Mental Health NHS Foundation Trust, The Barberry, Research and Innovation, Edgbaston, Birmingham, West Midlands, United Kingdom
| | - Oana C Lindner
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Amy Blakemore
- Division of Nursing, Social Work and Midwifery, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Elspeth Guthrie
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
12
|
Wong TH, Lau ZY, Ong WS, Tan KB, Wong YJ, Farid M, Teo MCC, Yee ACP, Nguyen HV, Ong MEH, Iyer NG. Cancer patients as frequent attenders in emergency departments: A national cohort study. Cancer Med 2018; 7:4434-4446. [PMID: 30117313 PMCID: PMC6144141 DOI: 10.1002/cam4.1728] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cancer patients contribute significantly to emergency department (ED) utilization. The objective of this study was to identify factors associated with patients becoming ED frequent attenders (FA) after a cancer-related hospitalization. METHODS A retrospective cohort study was conducted using national administrative, billing, and death records of Singapore residents discharged alive from Singapore public hospitals from January 2012 to December 2015, with a primary discharge diagnosis of cancer. Patients with four or more ED visits within any 12-month period after discharge from their index hospitalization were classified as FA. Time to FA distribution was estimated using the Kaplan-Meier method, and factors associated with risk of FA were identified using multivariate Cox regression analyses. RESULTS Records for 47 235 patients were analyzed, of whom 2980 patients were FA within the study period. Age (<17 years, hazard ratio [HR] 2.92, 95% CI 2.28-3.74; 75-84 years, HR 1.29, 95% CI 1.16-1.45; and ≥85 years, HR 1.71, 95% CI 1.45-2.02, relative to age 55-64), male gender (HR 1.26, 95% CI 1.16-1.37), Charlson comorbidity index (HR 1.21, 95% CI 1.19-1.23), and socioeconomic factors (Medifund use, HR 1.40, 95% CI 1.23-1.59; housing subsidy type, HR 2.12, 95% CI 1.77-2.54) were associated with increased risk of FA. Primary malignancies associated with FA included brain and spine (HR 2.51, 95% CI 1.67-3.75), head and neck cancers (tongue, HR 2.05, 95% CI 1.27-3.31; hypopharynx, HR 2.72, 95% CI 1.56-4.74), lung (trachea and lung, HR 1.57, 95% CI 1.13-2.18; pleural, HR 3.69, 95% CI 2.12-6.34), upper gastrointestinal (stomach, HR 1.93, 95% CI 1.26-2.74; esophagus, HR 4.13, 95% CI 2.78-6.13), hepato-pancreato-biliary (liver, HR 1.42, 95% CI 1.01-2.00, pancreas, HR 2.48, 95% CI 1.72-3.59), and certain hematological malignancies (diffuse non-Hodgkin's lymphoma, HR1.59, 95% CI 1.08-2.33, lymphoid leukemia, HR 1.86, 95% CI 1.21-2.86). Brain (HR 1.69, 95% CI 1.27-2.26), lung (HR 1.31, 95% CI 1.01-1.71), liver (HR 1.46, 95% CI 1.14-1.89), and bone (HR 1.35, 95% CI 1.04-1.76) metastases were also associated with FA. CONCLUSION There are cancer-specific factors contributing to ED frequent attendance. Additional resources should be allocated to support high-risk groups and prevent unnecessary ED use.
Collapse
Affiliation(s)
- Ting Hway Wong
- Singapore General HospitalSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Zheng Yi Lau
- Policy Research and Evaluation DivisionMinistry of HealthSingaporeSingapore
| | | | - Kelvin Bryan Tan
- Policy Research and Evaluation DivisionMinistry of HealthSingaporeSingapore
- Saw Swee Hock School of Public HealthSingaporeSingapore
| | - Yu Jie Wong
- Policy Research and Evaluation DivisionMinistry of HealthSingaporeSingapore
| | - Mohamad Farid
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- National Cancer CentreSingaporeSingapore
| | - Melissa Ching Ching Teo
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- National Cancer CentreSingaporeSingapore
| | - Alethea Chung Pheng Yee
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- National Cancer CentreSingaporeSingapore
| | - Hai V. Nguyen
- School of PharmacyMemorial University of NewfoundlandSt John'sNewfoundlandCanada
| | - Marcus Eng Hock Ong
- Singapore General HospitalSingaporeSingapore
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - N. Gopalakrishna Iyer
- Duke‐National University of Singapore Medical SchoolSingaporeSingapore
- National Cancer CentreSingaporeSingapore
| |
Collapse
|
13
|
Shen Y, Teo EWK, Liu N, Lam SW, Hock MOE. Data-Driven Approach to Defining the Emergency Department Frequent Attender Using a Cohort of 10 Years. J Acute Med 2018; 8:6-16. [PMID: 32995196 DOI: 10.6705/j.jacme.201803_8(1).0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Aims To identify, based on the measure of resource utilization, the number of visits per calendar year that defines the emergency department (ED) frequent attender; and examine for significant trends in patient characteristics and outcomes which may support the use of our definition. Materials and Methods We conducted a retrospective observational study of electronic clinical records of all ED visits over a 10-year period from January 2005 to December 2014 to an urban tertiary general hospital. We defined the ED frequent attender based on the number of ED attendances per calendar year which would yield a patient group representing more than 20% of all patient visits. Chi-square tests were conducted on each categorical factor individually to assess if they were independent of time, and the Student's t-test was used to assess continuous variables on their association with being a frequent attender. Results 1.381 million attendance records were analyzed. Patients who attended three or more times per year accounted for about 22.1% of all attendances and were defined as frequent attenders. They were associated with higher triage acuity, complex chronic illnesses, greater 30-day mortality for patients with three to six visits, and increased markers of resource utilization, such as ambulance use (15.5% vs. 11.6%), time to disposition (180 vs. 155 minutes), admissions rate (47.4% vs. 30.7%) and inpatient length of stay (6 days vs. 4 days). All p values were statistically significant (p < 0.001). Conclusion We have demonstrated a data-driven approach to defining an ED frequent attender. Frequent attenders are associated with increased resource utilization, more complex illness and may be associated with greater 30-day mortality rates.
Collapse
Affiliation(s)
- Yuzeng Shen
- Singapore General Hospital Department of Emergency Medicine Singapore
| | | | - Nan Liu
- Singapore General Hospital Department of Emergency Medicine Singapore
| | - Shao Wei Lam
- SingHealth Health Services Research Centre Singapore
| | | |
Collapse
|
14
|
Davies ML, Goffman RM, May JH, Monte RJ, Rodriguez KL, Tjader YC, Vargas DL. Large-Scale No-Show Patterns and Distributions for Clinic Operational Research. Healthcare (Basel) 2016; 4:healthcare4010015. [PMID: 27417603 PMCID: PMC4934549 DOI: 10.3390/healthcare4010015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/22/2016] [Accepted: 02/02/2016] [Indexed: 11/16/2022] Open
Abstract
Patient no-shows for scheduled primary care appointments are common. Unused appointment slots reduce patient quality of care, access to services and provider productivity while increasing loss to follow-up and medical costs. This paper describes patterns of no-show variation by patient age, gender, appointment age, and type of appointment request for six individual service lines in the United States Veterans Health Administration (VHA). This retrospective observational descriptive project examined 25,050,479 VHA appointments contained in individual-level records for eight years (FY07-FY14) for 555,183 patients. Multifactor analysis of variance (ANOVA) was performed, with no-show rate as the dependent variable, and gender, age group, appointment age, new patient status, and service line as factors. The analyses revealed that males had higher no-show rates than females to age 65, at which point males and females exhibited similar rates. The average no-show rates decreased with age until 75-79, whereupon rates increased. As appointment age increased, males and new patients had increasing no-show rates. Younger patients are especially prone to no-show as appointment age increases. These findings provide novel information to healthcare practitioners and management scientists to more accurately characterize no-show and attendance rates and the impact of certain patient factors. Future general population data could determine whether findings from VHA data generalize to others.
Collapse
Affiliation(s)
- Michael L Davies
- Access and Clinic Administration Program (ACAP), U.S. Department of Veterans Affairs, Washington, DC 57741, USA.
| | - Rachel M Goffman
- Veterans Engineering Resource Center, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA.
| | - Jerrold H May
- Joseph M. Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA 15260, USA.
| | - Robert J Monte
- Veterans Engineering Resource Center, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA.
| | - Keri L Rodriguez
- Veterans Engineering Resource Center, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA.
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA.
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.
| | - Youxu C Tjader
- Joseph M. Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA 15260, USA.
| | - Dominic L Vargas
- Joseph M. Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA 15260, USA.
| |
Collapse
|
15
|
Watkins L. Should emergency nurses attempt to meet patients' spiritual needs? Emerg Nurse 2014; 22:36-8. [PMID: 25270820 DOI: 10.7748/en.22.6.36.e1333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Research suggests there is a positive correlation between addressing some patients' spiritual needs and the outcomes of their care. This article describes a case study in which a patient with mental health problems who frequently re-attended an emergency department (ED) sought spiritual support from a hospital chaplain. The patient was referred to a charitable organisation that offers spiritual care and her re-attendance at the ED has become less frequent.
Collapse
|
16
|
van den Bussche H, Kaduszkiewicz H, Niemann D, Schäfer I, Koller D, Hansen H, Scherer M, Wegscheider K, Glaeske G, Schön G. [Size and type of frequent use of ambulatory medical care among the elderly population in Germany: a study based on statutory health insurance data]. Z Evid Fortbild Qual Gesundhwes 2013; 107:435-41. [PMID: 24238020 DOI: 10.1016/j.zefq.2012.12.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 12/17/2012] [Accepted: 12/21/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The authors report the results of a study on frequent attenders in ambulatory medical care among elderly people in Germany and on the factors related to frequent attendance such as age, sex, multi-morbidity and long-term care dependency. METHODS The study was based on claims data of all policy holders aged 65 and over of a statutory health insurance company operating nationwide in Germany in 2004 (n=123,224). Utilisation was analysed by the number of contacts with practices of physicians working in the ambulatory medical care sector and by the number of different practices contacted. The criteria for frequent attendance included greater than or equal to 50 contacts and/or greater than or equal to 10 different practices contacted and/or greater than or equal to 3 practices of the same discipline contacted within one year. Descriptive statistical analysis and logistic regression were used. RESULTS 19% of the elderly were identified as frequent attenders, which corresponds to some 3.5 million people in Germany. Two main types of frequent attendance were identified: one is characterised by very many contacts, old age, frequent presence of multi-morbidity, and/or long-term care dependency. The other type is the younger, less frequently multi-morbid attender who is considerably less often dependent on long-term care, and characterised by large numbers of contacted practices and/or practices of the same discipline. CONCLUSION Frequent attendance is due to several factors. The problem of frequent attendance needs further research that is not exclusively based on claims data. We found a high rate of frequent attendance. Further research should clarify if this is to the benefit of elderly people.
Collapse
|
17
|
Rugg S, Paterson C, Britten N, Bridges J, Griffiths P. Traditional acupuncture for people with medically unexplained symptoms: a longitudinal qualitative study of patients' experiences. Br J Gen Pract 2011; 61:e306-15. [PMID: 21801509 PMCID: PMC3103693 DOI: 10.3399/bjgp11x577972] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 09/15/2010] [Accepted: 09/23/2010] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND People with medically unexplained physical symptoms (MUPS) are helped by interventions that combine physical and psychological explanations and treatment. Traditional acupuncture may offer such a perspective, but its use for these patients has not been investigated. AIM To ascertain how patients with MUPS perceive and experience five-element acupuncture treatment. DESIGN AND SETTING A longitudinal qualitative interview study, nested in a randomised controlled trial was carried out in four general practices in socioeconomically diverse areas of London. METHOD A purposive sample of 20 trial participants was interviewed twice, at the start and the end of 6 months of acupuncture treatment. Semi-structured interviews were transcribed, coded, and analysed thematically, summarising both across-case as themes and within-case individual vignettes. RESULTS Acupuncture, initially accepted as 'just another referral' - one like many others that had been tried and proved unsuccessful - was valued for the amount of time allotted with a caring practitioner who listened and responded, as well as for the interactive and holistic nature of the sessions. These attributes encouraged many patients to take an active role in their treatment, including making cognitive or behavioural lifestyle changes. Interviewees cited a wide range of changes in their health that spanned physical, psychological, and social dimensions. These were largely positive and included an increase in physical and/or mental energy, as well as feelings of greater personal control, calmness, and relaxation. Three interviewees reported worsening health but did not ascribe this to acupuncture. CONCLUSION Many patients who were treated with five-element acupuncture perceived a range of positive effects and appeared to take on a more active role in consultations and self-care.
Collapse
Affiliation(s)
- Sue Rugg
- Institute of Health Service Research, University of Exeter, UK
| | | | | | | | | |
Collapse
|