IntroductionThe management of fever can be a stressful situation for caregivers of young children. Accessing emergency departments and urgent care centres (ED/UCCs) due to concerns about fever and the potential consequences of child fever is common, despite fever rarely being considered a medical emergency. Objectives and ApproachDetermine the non-compliance rate with public health advice for self-care at home for young children (3-35 months) with a fever. Non-compliance was defined based on the presence of a record of healthcare use within 72 hours following a call to a nurse telephone triage line, Health Link (HL), and receiving a self-care recommendation. Callers between October 2015-March 2016 were identified and linked with four databases: registry files, National Ambulatory Care Reporting System; Inpatient-Discharge Abstract Database and Physician Claims (N = 879). Overall non-compliance rate and descriptive analysis by child age, caregiver age, geography, and call time were completed. ResultsThe overall non-compliance rate with HL advice was 35.6%. Among callers, 17.5% visited an ED/UCC, 1.1% had an inpatient hospital admission, and 21.3% visited a physician’s office. Among the patients that utilized health care services after the HL call, 13.6% only visited ED/UCC, 18% only visited a physician’s office, and 4% utilized more than one type of health care service. Callers in rural and rural remote areas had lower odds of visiting a physician’s office compared to the urban areas (p-value <0.01). No significant differences were found by child age, caregiver age or time of call. Conclusion/ImplicationsFindings of this study suggest that approximately one-third of callers are not following the telephone triage advice, potentially leading to unnecessary increased burden on the healthcare system. Further study is warranted to examine reasons for non-compliance. Strategies to increase compliance in caregivers should be explored.
IntroductionVaccinating pregnant patients for neonatal protection needs to be integrated into prenatal care as new vaccines emerge. Uptake of influenza vaccine, universally recommended in pregnancy, is low. Immunization was offered and administered to pregnant women at point of care (POC) during two flu seasons at an urban tertiary care center. Objectives and ApproachPrimary objective is to determine if POC impacts immunization rate during flu season among a cohort of pregnant women by location and gestational age. Secondary objectives are to examine the pattern of influenza-like illnesses (ILI) among vaccinated and unvaccinated women, and to describe pilot outcomes of POC. Four consecutive influenza seasons (2014/2015, 2015/2016, 2016/2017, 2017/2018) will be examined using seven databases: a) Clinibase, b) National Ambulatory Care Reporting System; C) Discharge Abstract Database; d) Physician Claims; e) Alberta Perinatal Health Program; f) Calgary Zone Public Health; and g) Pharmaceutical Information Network. Outcomes will be examined descriptively using frequencies and proportions. ResultsBased on the preliminary analysis, approximately 10, 000 visits among 2,500 women occurred during each flu season at the four obstetric care locations: two outpatient clinics and two inpatient units. The proportion of pregnant women who received the flu vaccine ranged from 15-21% during the first three flu seasons. Majority of the women received the vaccine at the flu campaigns (range 48-67%), followed by pharmacy (20-32%). For the 2017-2018 season, year to date uptake rates in outpatient clinics are significantly higher. Final results on additional outcomes will be available by September 2018. Conclusion/ImplicationsIn completing this study, we hope to better understand the patterns of immunization uptake in pregnancy by place of immunization and gestational age, i.e. identifying optimal “window of opportunity”. Results will inform the infrastructure needed to collect data on vaccines administered during pregnancy and linkage to maternal and infant outcomes.
Introduction: Alberta has one of the highest rates of domestic violence (DV) in the country. Emergency departments (EDs) and urgent care centres (UCCs) are significant points of opportunity to screen for DV and intervene. In Alberta, the Calgary Zone began a universal education and direct inquiry program for DV in EDs and UCCs for patients > = 14 years in 2003. The Calgary model is unique in that (a) it provides universal education in addition to screening and (b) screening is truly universal as it includes all age groups and genders. While considering expanding this model provincially, we engaged in the GRADE Adolopment process, to achieve multi-stakeholder consensus on a provincial approach to DV screening, as herewith described. Methods: Using GRADE, we synthesized and rated the quality of evidence on DV screening and presented it to an expert panel of stakeholders from the community, EDs, and Alberta Health Services. There was moderate certainty evidence that screening improved DV identification in antenatal clinics, maternal health services and EDs. There was no evidence of harm and low certainty evidence of improvement in patient-important outcomes. As per Adolopment, the expert panel reviewed the evidence in the context of: a) values and preferences b) benefits and harms, and c) acceptability, feasibility, and resource implications. Results: The panel came to a unanimous decision to conditionally recommend universal screening, i.e., screening all adults above 14 years of age in EDs and UCCs. By conditional, the panel noted that EDs and UCCs must have support resources in place for patients who screen positive to realize the full benefit of screening and avoid harm. The panel deemed universal screening to be a logistically easier recommendation, compared to training healthcare professionals to screen certain subpopulations or assess for specific symptoms associated with DV. The panel noted that despite absence of evidence that screening would impact patient-important outcomes, there was evidence that effective interventions following a positive screen could positively impact these outcomes. The panel stressed the importance of evidence creation in the context of absence of evidence. Conclusion: A GRADE Adolopment process achieved consensus on provincial expansion of an ED-based DV screening program. Moving forward, we plan to gather evidence on patient-important outcomes and understudied subpopulations (i.e. men and the elderly).
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