Design and Evaluation of a Smartphone Medical Guidance App for Outpatients of Large-Scale Medical Institutions: A Retrospective Observational Study (Preprint)

BACKGROUND The greatest stressor for outpatients is the waiting time before the start of the examination. If the patient is able to use their smartphone to check in with the reception, the patient can wait for their examination at any location, and the burden of waiting time can be reduced. OBJECTIVE This study aimed to report the design approach and post-introduction outcomes of the Tori RinRin (TR2) system that was developed to reduce outpatient burden imposed by wait times before examination. METHODS The TR2 system was introduced at Tottori University Hospital, a large medical facility that accepts an average of 1,500 outpatients daily. The system, which links the hospital’s electronic medical record database with patients’ mobile devices, has the following two functions: 1) GPS-based examination check-in processing and 2) sending appointment notification messages via a cloud notification service. RESULTS In an investigation of 363 subjects, the mean examination call message response time using the TR2 system was 31 seconds (median 14 seconds). After 12 months, the system had 5,994 registered users and was used by a daily average of 18% of outpatients (mean ± SD = 155.7 ± 30.3). Among 166 subjects who responded to a user survey, 86.7% (144 of 166 patients) said that the system was useful. CONCLUSIONS The ability of 18% of outpatients at a large medical facility to check in remotely and wait for examinations anywhere is effective for preventing the spread of infection, especially during pandemics such as the coronavirus disease. The app reported in this study is beneficial for large medical facilities striving to reduce outpatient burden imposed by wait times.

Evaluation of Medical Care for Diabetic and Hypertensive Patients in Primary Care in Mexico: Observational Retrospective Study

Introduction. The present study evaluated the quality of medical care for patients diagnosed with diabetes mellitus (DM), hypertension (HBP), and both pathologies (DM+HBP) within a public health system in Mexico. Methods. 45,498 patients were included from 2012 to 2015. All information was taken from the electronic medical record database. Each patient record was compared against the standard to test the quality of medical care. Results. Glycemia with hypertension goals reached 29.6% in DM+HBP, 48.6% in DM, and 53.2% in HBP. The goals of serum lipids were reached by 3% in DM+HBP, 5% in DM, and 0.2% in HBP. Glycemia, hypertension, and LDL cholesterol reached 0.04%. 15% of patients had an undiagnosed disease. Clinical follow-up examinations reached 20% for foot examination and clinical eye examination. Specialty referrals reached 1% in angiology or cardiology. Conclusion. Goals for glycemic and hypertension reached 50% in the overall population, while serum lipids, clinical follow-up examinations, and referral to a specialist were deficient. Patients who had both diseases had more consultations, better control for hypertension and lipids, but inferior glycemic control. Overall, quality care for DM and/or HBP has not been met according to the standards.

Real-world time on treatment with immuno-oncology therapy in recurrent/metastatic head and neck squamous cell carcinoma

Aim: We report real-world time on treatment (rwToT) with immuno-oncology (I-O) and other systemic therapies in second-line recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) previously treated with platinum therapies. Materials & methods: Adult patients receiving first-line platinum therapy for R/M HNSCC between January 2017 and December 2018 and a second-line therapy were selected from a US electronic medical record database. Results: In our study sample of 619 R/M HNSCC patients, second-line treatments primarily included I-O therapies (71%) and resulted in median rwToT of 2.8 months and 12-month on-treatment rate of 19.3%. For other second-line therapies, median rwToT and 12-month on-treatment rate was 1.9 months and 1.3%, respectively. Conclusion: Use of second-line I-O therapies was common and resulted in rwToT consistent with R/M HNSCC clinical trials.