Trends in Visits to Acute Care Venues for Treatment of Low-Acuity Conditions in the United States From 2008 to 2015

Poon, Sabrina J.; Schuur, Jeremiah D.; Mehrotra, Ateev

doi:10.1001/jamainternmed.2018.3205

Cited by 98 publications

(91 citation statements)

References 36 publications

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“…Whether these findings would apply to older adults is unknown; however, they do suggest a need for customized antibiotic stewardship interventions to address healthcare setting–specific barriers to appropriate antibiotic prescribing. Additionally, although nonclinic settings may account for only a small proportion of all inappropriate antibiotics, national trend data indicate that an increasing portion of care related to acute infections occur in these settings . As such, they need to be included in comprehensive efforts to improve antibiotic stewardship for older adults.…”

Section: Ambulatory Care Settingsmentioning

confidence: 99%

Antibiotic Stewardship for Older Adults in Ambulatory Care Settings: Addressing an Unmet Challenge

Pulia

Keller

Crnich

et al. 2019

J American Geriatrics Society

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Inappropriate antibiotic use is common in older adults (aged >65 y), and they are particularly vulnerable to serious antibiotic-associated adverse effects such as cardiac arrhythmias, delirium, aortic dissection, drug-drug interactions, and Clostridioides difficile. Antibiotic prescribing improvement efforts in older adults have been primarily focused on inpatient and long-term care settings. However, the ambulatory care setting is where the vast majority of antibiotic prescribing to older adults occurs. To help improve the clinical care of older adults, we review drivers of antibiotic prescribing in this population, explore systems aspects of ambulatory care that can create barriers to optimal antibiotic use, discuss existing stewardship interventions, and provide guidance on priority areas for future inquiry. J Am Geriatr Soc 68:244-249, 2020.

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Section: Ambulatory Care Settingsmentioning

confidence: 99%

Antibiotic Stewardship for Older Adults in Ambulatory Care Settings: Addressing an Unmet Challenge

Pulia

Keller

Crnich

et al. 2019

J American Geriatrics Society

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“…This is supported by the fact that urgent care centers are now gaining overwhelming acceptance as credible alternative for medical treatment for acute care, even potentially replacing primary care for acute complaints . A recent study showed a 119% increase in urgent care visits for the treatment of low‐acuity conditions since 2008 . We found that nearly half (46.2%) of the patients followed up within our healthcare system.…”

Section: Discussionmentioning

confidence: 72%

“…11 A recent study showed a 119% increase in urgent care visits for the treatment of low-acuity conditions since 2008. 12 We found that nearly half (46.2%) of the patients followed up within our healthcare system. Only 40.4% attended a Neurology appointment within our healthcare system for the post urgent care visit.…”

Section: Discussionmentioning

confidence: 84%

A Brief Look at Urgent Care Visits for Migraine: The Care Received and Ideas to Guide Migraine Care in this Proliferating Medical Setting

2019

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Objective There has been a rise in urgent care centers throughout the country over the past 10 years, leading to an increase in patients accessing medical care in these locations. These centers advertise an alternative to the Emergency Department (ED) for the evaluation and treatment of urgent medical conditions. The goal of this analysis was to examine the use of urgent care visits for migraine within 2 urgent care centers within a large academic medical system in New York City. We examined the trends in management and treatment of migraine in these urgent care settings, as well as prescriptions and instructions given to this patient population upon discharge. We paid particular attention to whether the medications administered and prescribed on discharge were those recommended by American Headache Society migraine management guidelines. Methods We conducted a retrospective chart review of patients with migraine diagnoses at 2 different urgent care locations within 1 large urban medical center. We determined baseline patient demographics, previous migraine characteristics, frequencies of reasons for urgent care visits as well as various medications administered, medications prescribed on discharge, and characteristics of patient outcomes post‐discharge. Results Of the 78 patients who visited urgent care with a migraine diagnosis, 20 (25.6%) had a known primary care provider within the urgent care centers' healthcare system. More than three‐fourths of all patients (78.2%) had a self‐reported history of either recurrent headache or migraine prior to the urgent care visit. Of those with a documented frequency of prior headaches, 94.1% (32/34) had episodic migraine and 79.4% (27/34) experienced at most 1‐2 headache days per month. Of those presenting to the urgent care during an episode of migraine, 12.3% (9/73) were given intravenous metoclopramide and none were given subcutaneous sumatriptan or intravenous prochlorperazine. Of those with reported nausea or vomiting with their migraine, 46.2% (18/39) received an anti‐emetic at the visit and 33.3% (13/39) were given an anti‐emetic prescription. Only 11.1% (6/54) of patients who did not have a record of previous triptan use were given a triptan prescription at the urgent care visit. Conclusions The majority of patients in our study who sought medical treatment for migraine in these 2 urgent care centers were not established patients within the urgent care centers' healthcare system. While 93.6% (73/78) of patients were experiencing current pain upon presentation to the urgent care centers, only 12.3% (9/73) received administration of the medications with the highest level of evidence by the American Headache Society (Level B) for acute migraine treatment in an ED. In addition, the majority of patients with a migraine history presenting to the urgent care setting were not given triptans or anti‐emetic prescriptions upon discharge from their urgent care visit. Having these migraine‐specific prescriptions may improve self‐treatment at home should a migraine attack recur.

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“…According to a cohort study of data from a large commercial health plan in the United States from 2008 to 2015, ED visits per enrollee for the treatment of low‐acuity conditions decreased by 36%, whereas utilization of non‐ED acute care venues increased by 140%. These venues were urgent care centers, retail clinics, and telemedicine . Implementation of these strategies may require flexibility for hospitals to set financial disincentives or mobilization and management of human resources.…”

Section: Discussionmentioning

confidence: 99%

“…These venues were urgent care centers, retail clinics, and telemedicine. 18 Implementation of these strategies may require flexibility for hospitals to set financial disincentives or mobilization and management of human resources. In the context of governance functions in Thailand, this may not be the case for the majority of public hospitals in our study given the ED management obstacles shown in Table 7.…”

Section: Governance Obstaclesmentioning

confidence: 99%

Assessment of nationwide emergency systems in Thailand, a middle‐income country setting with UHC

Suriyawongpaisal

Srithamrongsawad

Thongtan

2019

Health Planning & Management

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Summary Background Evidence has been limited regarding broader emergency systems assessment in low‐ and middle‐income countries. The aim of the present study was to provide the empirical evidence of Thai emergency department (ED) workforce vis‐à‐vis workload on a national scale, the availability of services for selected high‐priority health burdens, and the governance obstacles in addressing the workforce management. Method One hundred thirty public Thai EDs that provide 24‐hour emergency medical care were identified across Thailand as meeting the inclusion criteria. The mailed questionnaires were administered to collect data related to the objectives of the research study. Result Responses were received from 91 of 130 (70%) hospitals. The median number of patients visiting hospital EDs was 51 221 per year with 32.8% considered nonurgent (ESI levels 4‐5). University hospital EDs were staffed with a higher number of ER professionals than EDs of service‐based secondary care and tertiary care hospitals under Ministry of Public Health (MOPH). Almost all hospitals expressed concerns about the deficiency of doctors and nurses especially emergency physician (EP) and emergency nurses. The percentage of hospitals reporting the availability of coronary artery catheterization (34%) and thrombolytic infusion for acute thrombotic stroke (24%) was limited. The governance obstacles to manage emergency systems were considered. Conclusion ED staffing seems to positively correlate with workloads except university hospitals, in our study, which may suggest the influence of teaching status on the allocation of the human resource. Among the governance obstacles in ED management, a better response to nonurgent patients requires flexibility for hospitals to set financial disincentives or mobilization and management of human resources.

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Trends in Visits to Acute Care Venues for Treatment of Low-Acuity Conditions in the United States From 2008 to 2015

Cited by 98 publications

References 36 publications

Antibiotic Stewardship for Older Adults in Ambulatory Care Settings: Addressing an Unmet Challenge

Antibiotic Stewardship for Older Adults in Ambulatory Care Settings: Addressing an Unmet Challenge

A Brief Look at Urgent Care Visits for Migraine: The Care Received and Ideas to Guide Migraine Care in this Proliferating Medical Setting

Assessment of nationwide emergency systems in Thailand, a middle‐income country setting with UHC

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