scholarly journals P010: Use of the emergency department by refugees under the Interim Federal Health Program

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S81-S82
Author(s):  
F. Bakewell ◽  
S. Addleman ◽  
V. Thiruganasambandamoorthy
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Family Physician ◽  
Financial Burden ◽  
Tertiary Care ◽  
Family Doctor ◽  
Number Of Patients ◽  
Refugee Claimants ◽  
Before And After

Introduction: In June 2012, the federal government made cuts to the Interim Federal Health (IFH) Program that reduced or eliminated health insurance for refugee claimants in Canada. The purpose of this study was to examine the effect of the cuts on emergency department (ED) use among patients claiming IFH benefits. Methods: We conducted a health records review at two tertiary care EDs in Ottawa. We reviewed all ED visits wherein an IFH claim was made at triage, for 18 months before and 18 months after the changes to the program on June 30, 2012 (2011-2013). Claims made before and after the cuts were compared in terms of basic demographics, chief presenting complaints, acuity, diagnosis, presence of primary care, and financial status of the claim. Results: There were a total of 612 IFH claims made in the ED from 2011-2013. The demographic characteristics, acuity of presentation and discharge diagnosis were similar during both the before and after periods. Overall, 28.6% fewer claims were made under the IFH program after the cuts. Of the claims made, significantly more were rejected after the cuts than before (13.7% after vs. 3.9% before, p<0.05). The majority (75.0%) of rejected claims have not been paid by patients. Fewer patients after the cuts indicated that they had a family physician (20.4% after vs. 30% before, p<0.05) yet a higher proportion of these patients were still advised to follow up with their family doctor during the after period (67.2% after vs. 41.8% before, p<0.05). Conclusion: A higher proportion of both rejected and subsequently unpaid claims after the IFH cuts in June 2012 represents a potential barrier to emergency medical care, as well as a new financial burden to be shouldered by patients and hospitals. A reduction in IFH claims in the ED and a reduction in the number of patients with access to a family physician also suggests inadequate care for this population. Yet, the lack of primary care was not reflected in the follow-up advice offered by ED physicians to patients.

Resource Utilization in the Emergency Department of a Tertiary Care University-Based Hospital in Tokyo Before and After the 2011 Great East Japan Earthquake and Tsunami

2012 ◽  
Vol 27 (6) ◽  
pp. 515-518 ◽  
Author(s):  
Mai Shimada ◽  
Aska Tanabe ◽  
Masataka Gunshin ◽  
Robert H. Riffenburgh ◽  
David A. Tanen
Keyword(s):  
Emergency Department ◽  
Resource Utilization ◽  
Error Rate ◽  
Tertiary Care ◽  
Great East Japan Earthquake ◽  
Publication Type ◽  
Patient Acuity ◽  
Number Of Patients ◽  
Before And After ◽  
Laboratory Utilization

AbstractIntroductionThe objective of this study was to determine the resource utilization of a tertiary care Japanese emergency department (ED) that was not immediately adjacent to the area of the 2011 Great East Japan earthquake and tsunami.MethodsA retrospective chart review was performed at a tertiary care university-based urban ED located approximately 290 km from the primary site of destruction secondary to an earthquake measuring 9.0 on the Richter Scale and the resulting tsunami. All patients who presented for a period of twelve days before and twelve days after the disaster were included. Data were collected using preformed data collection sheets, and stored in an Excel file. Abstracted data included gender, time in the ED, intravenous fluid administration, blood transfusion, oxygen, laboratories, electrocardiograms (ECGs), radiographs, ultrasound, diagnoses, surgical and medical referrals, and prescriptions written. Ten percent of the charts were reviewed for accuracy, and an error rate reported. Data were analyzed using 2-tailed t-tests, Fisher's exact tests or rank sum tests. Bonferroni correction was used to adjust P values for multiple comparisons.ResultsCharts for 1193 patients were evaluated. The error rate for the abstracted data was 3.2% (95% CI, 2.4%-4.1%). Six hundred fifty-seven patients (53% male) were evaluated in the ED after the earthquake, representing a 23% increase in patient volume. Mean patient time spent in the ED decreased from 61 minutes to 52 minutes (median decrease from 35 minutes to 32 minutes; P = .005). Laboratory utilization decreased from 51% to 43% (P = .006). The percentage of patients receiving prescriptions increased from 48% to 54% (P = .002). There was no change in the number of patients evaluated for surgical complaints, but there was an increase in the number treated for medical or psychiatric complaints.ConclusionThere was a significant increase in the number of people utilizing the ED in Tokyo after the Great East Japan earthquake and tsunami. Time spent in the ED was decreased along with laboratory utilization, possibly reflecting decreased patient acuity. This information may help in the allocation of national resources when planning for disasters.ShimadaM, TanabeA, GunshinM, RiffenburghRH, TanenDA. Resource utilization in the emergency department of a tertiary care university-based hospital in Tokyo before and after the 2011 Great East Japan Earthquake and tsunami. Prehosp Disaster Med. 2012;27(6):1-4.

scholarly journals EMERGENCY DEPARTMENT VISITS BY CHILD REFUGEE CLAIMANTS AT A PEDIATRIC TERTIARY CARE CENTER

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e7-e7 ◽  
Author(s):  
Andrea Evans ◽  
Savithiri Ratnapalan
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Provider ◽  
Primary Care Provider ◽  
Tertiary Care ◽  
Emergency Department Visits ◽  
Refugee Children ◽  
Care Hospital ◽  
Clinical Presentations ◽  
Refugee Claimants

Abstract BACKGROUND The Canadian government has announced the resettlement of 50 000 refugees from the Middle East by 2018. The proportion of refugees that are below 18 years of age have increased from 20% to almost 40% from 2005 to 2014 and is expected to increase further with new refugee influxes. Barriers to timely health care can worsen clinical presentations and outcomes, especially in vulnerable children such as refugees. This study aims to provide an overview of the epidemiology, clinical presentations, hospital stay metrics, and non-clinical support needs for child refugee claimants presenting to the emergency department at a large tertiary care hospital in Canada. OBJECTIVES To describe the emergency department visits by refugee claimants with IFH, including demographics, primary care access, immunization status, acuity of presentation, repeat visits, and admission rates. DESIGN/METHODS A retrospective chart review of all refugee children presenting to the emergency department at this tertiary care hospital from April 1 2014 to March 31st 2017. A case was defined as a child who presented to the hospital with Interim Federal Health (IFH) which is the federal health insurance program covers newly arrived refugee claimants in Canada. Descriptive statistics and chi square test for categorical data was used. Data was analyzed using SPSS v21 IBM 2012. Ethics was approved by the Ethics Review Board of the hospital. RESULTS In total, there were 646 visits to the emergency department by 388 patients with IFH. The average age was 6.4 years (IQR 2.9–9.3), of which 58% were females. Travel history was documented in 65% of cases. The majority of patients arrived from Southeast Asia and the Middle East. The average time spent in Canada was 217 days (IQR 78–205). Sixty percent of patients did not have an identified primary care provider. Those with an identified primary care provider had more non-acute (CTAS 4–5) visits than those without an identified primary care provider (p<0.05). Immunizations were not up-to-date per Canadian standard in 25% of those who had an immunization history documented. Translation services was used in 11% of visits. Admission rate was 12%, with average length of stay 3.4 days (std 4). Top three reasons for admission were febrile neutropenia, respiratory distress, and blood per rectum. One fifth (20%) of admissions occurred on the same day as the arrival of the patient to Canada. CONCLUSION A significant number of refugee children are needing emergency care and admission to hospital on the day they arrive to Canada. Most child refugees presenting to the emergency department did not have an identified primary care provider, and a quarter did not have up-to-date immunizations. Association with primary care provider suggests that linkage to primary care in this population should be a priority.

scholarly journals Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

2021 ◽  
Vol 18 (8) ◽  
pp. 4350
Author(s):  
Antoni Sisó-Almirall ◽  
Pilar Brito-Zerón ◽  
Laura Conangla Ferrín ◽  
Belchin Kostov ◽  
Anna Moragas Moreno ◽  
...  
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Signs And Symptoms ◽  
Diagnostic Process ◽  
Press Releases ◽  
Expert Opinions ◽  
Number Of Patients ◽  
Patient Groups

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors’ clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.

Parental Education on Asthma Severity in the Emergency Department and Primary Care Follow-up Rates

2013 ◽  
Vol 52 (7) ◽  
pp. 612-619 ◽  
Author(s):  
Kelli W. Williams ◽  
Carolyn Word ◽  
Maria R. Streck ◽  
M. Olivia Titus
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Parental Education ◽  
Asthma Severity

scholarly journals Asthma Management at Discharge from the Emergency Department: A Descriptive Study

2005 ◽  
Vol 12 (4) ◽  
pp. 219-222 ◽  
Author(s):  
Pascale Gervais ◽  
Isabelle Larouche ◽  
Lucie Blais ◽  
Anne Fillion ◽  
Marie-France Beauchesne
Keyword(s):  
Emergency Department ◽  
Inhaled Corticosteroids ◽  
Tertiary Care ◽  
Airflow Obstruction ◽  
Asthma Management ◽  
Descriptive Study ◽  
Management Plan ◽  
Oral Corticosteroids ◽  
Tertiary Care Hospitals

BACKGROUND: The management of asthma remains suboptimal despite the publication of Canadian asthma guidelines in 1999.OBJECTIVES AND METHODS: A descriptive study was conducted to estimate the proportion of patients admitted to the emergency department (ED) for an asthma exacerbation who received a management plan at discharge that was in accordance with seven criteria stated in the Canadian asthma guidelines. The present study took place in two tertiary care hospitals in Montreal, Quebec.RESULTS: A total of 37 patients were enrolled. Three (8%) patients received a management plan at discharge that was in accordance with all seven criteria. Inhaled corticosteroids and oral corticosteroids were prescribed at discharge for 29 (78%) and 35 (95%) patients, respectively. Minimal asthma education was provided for 29 (78%) patients and a medical follow-up was recommended to 22 (60%) patients. Airflow obstruction was evaluated at discharge for only 20 (54%) patients.CONCLUSION: Overall, asthma management at discharge from the ED was generally not in accordance with the 1999 Canadian asthma guidelines. A standardized management plan should be implemented in the ED to improve the care of patients with asthma exacerbations.

scholarly journals Results of early versus standard silicone stent removal following external dacryocystorhinostomy under local anesthesia

2020 ◽  
Vol 17 (3) ◽  
pp. 263-272
Author(s):  
Ben Limbu ◽  
Benjamin Sim ◽  
Mohan K. Shrestha ◽  
Geoffrey Tabin ◽  
Rohit Saiju
Keyword(s):  
Statistical Difference ◽  
Financial Burden ◽  
Controlled Trial ◽  
Silicone Tube ◽  
Number Of Patients ◽  
Tube Removal ◽  
Silicone Stent ◽  
External Dacryocystorhinostomy ◽  
Lost To Follow Up

Introduction: Many patients in Nepal travel vast distances to have their surgeries in Kathmandu. They often remain close by until their follow-up visit for their silicone tube removal, which contributes to a large financial burden on them and their families. Hence, reducing the time for which silicone tubes remain in situ following external dacryocystorhinostomy (DCR) provides significant benefits to patients. Furthermore, this is the first comparative study which has successfully demonstrated the earliest timeframe for which silicone tubes can be removed following DCR in the medical literature. Methods: A randomized controlled trial consisting of 144 patients was designed to compare patient outcomes after early (2 weeks postoperatively) versus standard (6 weeks postoperatively) removal of silicone stents. The success of their procedures was determined when patients were assessed both symptomatically and anatomically at their 6-month follow-up. Results: The surgical success in both groups was high at 97.8% collectively in both groups and there were only a small number of patients who were lost to follow-up (5 patients) at 6 months. There was no statistical difference at removing silicone stents at 2 or 6 weeks postoperatively. Conclusion: These results were consistent with our pilot study, which showed no statistical difference in long-term success following silicone tube removal at 2 and 6 weeks.

scholarly journals Factors Associated with Family Physician Follow-up 30 Days Post-discharge from a Local Canadian Community Emergency Department

Cureus ◽  
2020 ◽  
Author(s):  
Kelly Lien ◽  
Barrett A Grattan ◽  
Alexandra L Reynard ◽  
Jocelynn Peters ◽  
Jennifer L Parr
Keyword(s):  
Emergency Department ◽  
Family Physician ◽  
Post Discharge ◽  
Factors Associated
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