mobility of unidade pediátrica do porto's patients across different health institutions final...
DESCRIPTION
INTRODUCTION Patients resort to more than one medical institution Repeated medical exams and anamnesis Patient's data is spread in all places where they have received clinical services [Katehakis, 2001] In: hospitals, private clinics, pharmacies... [Lambrinoudakis, 2000] Error in medicine is frequent and results in substantial harm [Bates DW, 2001]TRANSCRIPT
Mobility of Unidade Mobility of Unidade Pediátrica do Porto's Pediátrica do Porto's
patients across different patients across different health institutionshealth institutions
Final PresentationClass 13
03-05-2007
INTRODUCTION Increased interest for information and
communication technologies (Yoo S,2006)
People resort to different institutions
Scattered clinical dataRedundant clinical data
(Katehakis, 2001; Lambrinoudakis, 2000)
INTRODUCTION Patients resort to more than one medical institution
Repeated medical exams and anamnesis Patient's data is spread in all places where they have
received clinical services [Katehakis, 2001]
In: hospitals, private clinics, pharmacies... [Lambrinoudakis, 2000]
Error in medicine is frequent and results in substantial harm
[Bates DW, 2001]
INTRODUCTION Solutions that integrate data are necessary
[Yoo S, 2003] The physical location of a patient record can be replaced by a
virtual one by linking databases from the different health institutions attended
[van Bemmel, 1998] When used, computer-based decision support significantly
improved decision quality [Coeira, 2004]
Helped reducing the frequency and consequences of errors in medical care: CPOE – Computerized Physician Order Entry - reduces medication errors up to 81%
[Koppel R, 2005] In some cases medication errors increased
[Bates DW, 2001]
INTRODUCTION
Data integration Increased coordination of information and correction of gaps in
communication in cases where patients are receiving shared care, which involves more that one physician
[Branger PJ, 1994, 1995] Fundamental due to the higher number of interdisciplinary
practice and tests[Wyatt, 1998]
Improves quality and reduction of health care cost [Kahn MG, 1997]]
Improves safety and efficiency of clinical care [Shapiro, 2006]
Leads to the creation of large databases of deidentified aggregate data for research
[Shapiro, 2006]
INTRODUCTION
The application of new systems may bring some problems: difficulty felt by some emergency physicians to
remember passwords time required to search for the information
[Overhage JM, 2002]
INTRODUCTIONChildren
Vulnerability; unpredictable behavior
One of the groups who requests more health services
(Scanaill NC,2006)
Parental protection
Different specialists Second opinion
Visits to several
institutions
INTRODUCTION
Assessing the number of institutions visited by children as well as the proportion that goes to a second health care centre is an issue of major importance as it may allow, in the future, a conclusion about the number of people that would benefit from generalized electronic patient records
AIM
The aim of this study is to assess the mobility of UPP's (Porto’s Paediatrics Unit) patients among different healthcare institutions (hospitals, private clinics and community health centres)
METHODS Study design
This study is transversal and retrospective Data collection is done in a single moment by interviews, to
parents of attendants in the UPP, about events occurred since January of 2006 until 8th, 11th and 12th March 2007
The study population consisted of children attending the Paediatric Emergency of Porto (children with or under the age of 13).
A total of 151 individuals accompanying children who attended UPP, were approached in the waiting room to answer the designed questionnaire about the patient
METHODS Data collection methods
A questionnaire was applied on 8th, 11th and 12th March (a Sunday and two working days), two shifts a day, between 8 to 10 a.m. and 8 to 10 p.m
Three interviewers in the waiting room of UPP, approached people who were accompanying children
The first stage of the interview was to explain the purposes of the study and ask a consent declaration (elaborated by the Ethics Commission) to be signed. The next stage was to proceed with the questionnaire
METHODS Data collection methods
Everyone who entered in the emergency room during the shifts was accounted for
The questionnaire was applied to all individuals, except the ones who refused to answer or entered directly to be attended; some of the questionnaires were incomplete because in the meantime, the interviewed was called by the doctor. Refusing to answer was the only exclusion criteria considered; even the incomplete questionnaires were included in the study.
The interviews lasted about 5 minutes each
METHODS Questionnaire design
Eleven questions were developed and tested on investigators relatives who fitted the profile. Some adjustments were made until the final questionnaire was obtained.
Data collected from the interviews included questions about the person who was answering (profession, kinship, and years of school) and about the child they were accompanying (age, address, gender)
The remaining questions were the purpose of our study - type and number of health institutions visited since January 2006: hospitals, health centres and private clinics
RESULTS
TNPUPP: 151
ED: 25 SWR: 126
RA: 6 AA: 120
ACQ: 112 (valid ones) IQ: 8
TNPUPP: total number of people that entered UPP
ED: entered directly the doctor’s room
SWR: stayed in the waiting room
RA: refused to answer
AA: accepted to answer
ACQ: answered the complete questionnaire
IQ: incomplete questionnaire
Participants
RESULTS
Age Distribution Living place distribution
RESULTS
Qualifications of the persons responsible for the attendants
Employment of the people responsible for the attendants
Taxa Nacional de desemprego
RESULTS
26%
63%
12%Hospitals
Health Centers
Private Clinics
Transferences
9%
56%
35%
>5 times2-5 timesonce
Number of visits to UPP
Number of visits to UPP Percentage of transfers from other institutions
Mobility
RESULTS
Number of transfersTotal
0 1 2 3
Number of visits to UPP
1 28 10 1 0 39
2-5 39 19 3 2 63
>5 4 2 2 2 10
Total 71 31 6 4 112
Cross table of the number of visits to UPP and the number of transfers
RESULTS
Cases (N) Health Centre 83Private Clinics 56
Paediatrics 53General Clinics 4Otorhinolaryngology 2Ophthalmology 2Orthopaedics 2Psychology 1Dermatology 1
Cases (N) Out Patient Department frequency 49
H. São João 14H. Pedro Hispano 10H.G. Santo António 9Health Centres 9H. Maria Pia 4Others 5Missing 1
Table of the number of visits to Health Centers and Private Clinics with its specialities
Table of the different institutions attended for external consulting
RESULTS
Attended a Health Centre
Attended a Private Clinic Yes No Attended Out Patient
Department
Yes15 (13%) 4 (4%) Yes
22 (20%) 14 (12%) No
No22 (20%) 8 (7%) Yes
24 (21%) 3 (3%) No
83 (74%)Cross table of the attendance of Private Clinics,
Health Centres and Out Patient Department
RESULTS
Number of visits to UPP
Age 1 2-5 >5 Total
≤2 14 (13%) 36 (32%) 1 (1%) 51 (46%)
>2 25 (22%) 27 (24%) 9 (8%) 61 (54%)
Total 39 (35%) 63 (56%) 10 (9%) 112 (100%)
Cross table between number of visits to UPP and patient age
DISCUSSION/CONCLUSION Health Centers are the type of Health
Institutions most often visited Children under the age of 2 are approximatly
half of the visiting patients 97% of the attending patients had already
been to at least one medical consult Further studies should focus on the under 2
year old or the population attending Health Centers