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Ambulatory Systems
Published in Salvatore Volpe, Health Informatics, 2022
Curtis L. Cole, Adam D. Cheriff, J. Travis Gossey, Sameer Malhotra, Daniel M. Stein
The ambulatory electronic health record (AEHR) as a distinct entity is evolving due to the evolution of more integrated EHRs that combine with inpatient systems. Similarly, over the past several decades, various specialty, acute care, ancillary, and ambulatory systems have advanced individually and also converged. But inpatient and outpatient care are still largely distinct and typically paid for by different payment systems. Whether unified across specialties, AEHRs, especially for primary care, are typically the closest approximation of the patient’s archetype of “my chart”: a cradle-to-grave record of a patient’s healthy growth, sickness, recovery, and aging.
Fibromyalgia Syndrome: Canadian Clinical Working Case Definition, Diagnostic and Treatment Protocols–A Consensus Document
Published in I. Jon Russell, The Fibromyalgia Syndrome: A Clinical Case Definition for Practitioners, 2020
Anil Kumar Jain, Bruce M. Carruthers, Maijorie I. van de Sande, Stephen R. Barron, C. C. Stuart Donaldson, James V. Dunne, Emerson Gingrich, Dan S. Heffez, Y.-K. Frances Leung, Daniel G. Malone, Thomas J. Romano, I. Jon Russell, David Saul, Donald G. Seibel
Evidence from a multi-center study conducted in the United States (14) and a single center study in Canada (15) has assessed the direct medical costs of fibromyalgia syndrome to patients and to the general economy. The findings indicated that the annual direct medical cost of FMS to affected individuals was approximately $2,275.00. When this was multiplied by the 2 percent documented prevalence of FMS in the general population (8,9), the medical cost of this disorder to the U.S. economy has been estimated to be $12-15 billion annually and the Canadian cost appears to be comparable on a per capita basis. These costs can be divided approximately equally into three categories: (14); hospitalization costs, outpatient care costs, and medication adminis tration costs. Hospitalization for the management of FMS pain finds little justification (16-19). A common reason for hospital admission is to exclude alternate diagnoses, but this can be accomplished more efficiently as an outpatient. It is also important that the physician does not assume that a variety of symptoms are due to FMS when other important inter-current medical conditions may just as likely intervene in these patients as in any other. With better education of physicians and increased awareness of FMS, consideration of this diagnosis early in the patient’s course and effective outpatient care may lessen hospitalization care and its associated costs.
Multidisciplinary team approach and the role of psychologists in gastroenterology services
Published in Clarissa Martin, Terence Dovey, Angela Southall, Clarissa Martin, Paediatric Gastrointestinal Disorders, 2019
Alan Silverman, Sara E Williams
In traditional psychological practice settings, therapy is conducted in weekly hour-long sessions involving an individual client and a singular therapist. Many successful therapeutic practices have been built on this model, which is often referred to as individual outpatient care. While this model capitalises on a therapeutic process that has been shown to be efficacious for the treatment of a variety of problems, some clinical populations, including medically complex patients and/or clinical issues involving children, may have better clinical outcomes when an interdisciplinary care model is employed (Sampson, 1999). Gastroenterology, the branch of medicine focused on the digestive system and its disorders, provides a good example of an area of medicine in which integrated treatment teams work to provide care. Individual disciplines working within gastroenterology may include, but are not limited to, gastroenterologists, advanced practice nurses, dietitians, speech and language pathologists, occupational therapists, social workers and psychologists (Kedesdy and Budd, 1998b).
Trends in cost of treatment of lung cancer patients in 2014–2019 in Finland – a descriptive register study
Published in Acta Oncologica, 2023
Riikka-Leena Leskelä, Sonja Korhonen, Ira Haavisto, Mikko Nuutinen, Emmi Peltonen, Fredrik Herse, Sari Käkelä, Anna-Maija Autere, Katja Nolvi, Satu Tiainen, Maria Silvoniemi, Eeva-Liisa Junnila, Jarkko Ahvonen, Aija Knuuttila, Jussi Koivunen
Outpatient care costs were calculated based on the number of outpatient visits per patient. The costs of outpatient visit and other (non-surgery-related) inpatient episodes were calculated based on average unit costs for outpatient visits and inpatient days in pulmonology clinics in university hospitals in Finland. The applied unit costs (adjusted to the 2019 price level) per visit were equal to the average costs in Finnish university hospitals reported by the Finnish Institute of Health and Welfare [18] adjusted for inflation. The costs of outpatient visit and other (non-surgery-related) inpatient episodes were calculated based on average unit costs for outpatient visits and inpatient days in pulmonology clinics in university hospitals in Finland. The unit cost reflects the average cost of visits or inpatient days include e.g., personnel, materials, diagnostics and facilities.
Prehospital Buprenorphine Treatment for Opioid Use Disorder by Paramedics: First Year Results of the EMS Buprenorphine Use Pilot
Published in Prehospital Emergency Care, 2023
H. Gene Hern, Vanessa Lara, David Goldstein, M. Kalmin, S. Kidane, S. Shoptaw, Ori Tzvieli, Andrew A. Herring
The intervention collaborators decided early in the process that an EMS-initiated buprenorphine program would only be successful with the additional outreach processes in place. The results shown in the buprenorphine intervention must not be taken out of context as there were four overlapping pilots (including buprenorphine) occurring at the same time. The additional interventions included a leave-behind naloxone program, a designation of an ED as an ORC, and a warm data handoff between the EMS agency and the public health substance use navigator counseling program. This multifaceted approach was necessary to ensure adequate patient follow-up and linkage to additional outpatient care. It may not always be possible to have a multifaceted program, but such integration in this setting achieved remarkable results. However, it is possible that such results are only possible with all four pilot projects in place. More study is needed to understand the isolated effects of EMSBUP from the other components.
Beyond tobacco – the secondary impact of substance misuse in chronic obstructive lung disease
Published in Journal of Asthma, 2022
M. Macmurdo, R. Lopez, B. L. Udeh, J. Zein
Improving outcomes in chronic asthma and COPD has proved challenging. Our study highlights a previously unquantified contributor to worsening outcomes within this patient population – one that represents both a significant economic burden, and an area for intervention. Treatment of substance dependence is associated with a decrease in healthcare utilization (6,26,27). Increasing attention to identifying patients with active substance misuse during hospitalization or in the outpatient setting could allow us to offer targeted substance use disorder treatment in addition to the traditional aspects of chronic lung disease care. Initiating treatment during hospitalization could also be considered, especially given the frequency of readmissions, and the fact that many of these patients lack access to consistent outpatient care.