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Other Clinics (other + clinic)
Selected AbstractsA simple primary care information system featuring feedback to cliniciansINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 3 2008Gary Gaumer Abstract A simple information system for primary care clinics was designed to support the USAID funded health system strengthening project in the Suez Governorate in Egypt. This system (FACT,Feedback and Analytic Comparison Tool) was implemented in December 2003 in 14 primary care clinics. The MS Access-based system was designed and prototyped in several months, and was easily and cheaply modified several times after implementation. A total of 128,562 persons have been registered in the system (as of June 2005) and 36,083 visits have been documented. A key feature of FACT is the ease with which clinicians can conduct exploratory research about practice patterns, and variations in them across doctors and the other clinics. This analytic feature enables the clinicians to self-diagnose quality problems and take action accordingly. Several of the clinics have used this feature of FACT to identify important gaps in service use among patients, and have taken steps to remove barriers to promote more appropriate patterns of utilization. The paper reviews the design and implementation issues and early evidence of the system's utility in helping support quality improvement (QI) work in the clinics. Copyright © 2007 John Wiley & Sons, Ltd. [source] Trial of nurse-run asthma clinics based in general practice versus usual medical careRESPIROLOGY, Issue 3 2004Louis S. PILOTTO Objective: The aim of this study was to assess the ability of nurse-run asthma clinics based in general practice compared with usual medical care to produce at least a moderate improvement in the quality of life of adults with asthma. Methodology: A randomized controlled trial involving 80 asthma clinic and 90 usual medical care asthma participants, aged 18 years and older was conducted in 11 general practices in Adelaide. The main outcome measure was the St George's respiratory questionnaire (SGRQ), from which quality-of-life scores were used to assess therapeutic benefit. Lung function measurements and health services utilization data were also collected. Results: One hundred and fifty-three participants (90%) were reviewed at follow up after 6,9 months. There was little difference between groups in baseline measures or for the 6-month follow-up, outcomes,, including, the, mean, difference, in, total, SGRQ, scores, (,0.5,, 95%, confidence, interval, (CI) ,4.0, 2.9) and the mean difference in percentage predicted FEV1 (2.3%, 95% CI ,0.7, 5.3 pre-bronchodilator; 0.4%, 95% CI ,5.1, 5.9 post-bronchodilator). Trends in health services utilization were noted. Conclusions: Nurse-run asthma clinics based in general practice and usual medical care were similar in their effects on quality of life and lung function in adults. These findings cannot be generalized to hospital outpatients and other clinics that manage more severe asthmatic patients. [source] Comparison of diagnostic accuracy for cutaneous malignant melanoma between general dermatology, plastic surgery and pigmented lesion clinicsBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2003J.E. Osborne SummaryBackground Since the 1980s there have been dedicated pigmented lesion clinics (PLCs) in the U.K. Important considerations when comparing the efficacy of the PLC with other referral clinics include diagnostic accuracy. Objectives To compare the false-negative rate of clinical diagnosis (FNR) in the PLC with that in the other clinics of primary referral of malignant melanoma (MM) in the same geographical area. We have previously shown that certain clinical features are risk factors for diagnostic failure of MM. A further aim of this study was to correct for any differences in frequency of these factors in the melanoma populations between clinics and to estimate the false-positive diagnostic rate (FPR) in the PLC. Methods To compare the FNR between clinics, the case notes of all patients presenting with histologically proven cutaneous MM in Leicestershire between 1987 and 1997 were examined retrospectively. A false-negative diagnosis was defined as documentation of another diagnosis and/or evidence in the case notes that the diagnosis was not considered to be MM. The FNR was estimated as the number of false-negative clinical diagnoses/number of true-positive histological diagnoses. To estimate the diagnostic FPR, which was defined as the number of false-positive clinical diagnoses of MM/total number of positive clinical diagnoses, in the PLC, the outcome of 500 consecutive patients attending the PLC was surveyed. Results The case notes of 731 patients were available, of whom approximately two-thirds initially attended the PLC, one-fifth the General Dermatology clinics (D) and the remainder were divided approximately equally (one-twentieth each) between Plastic Surgery clinics (P), other clinics (O) and the surgery of the general practitioner (GP). The last was regarded as the primary referral clinic if the lesion were excised there prior to any referral. The FNR was lowest for the PLC, at 10%, compared with 29% (D), 19% (P), 55% (O) and 54% (GP) (P < 0·0001). Lesions with risk factors for diagnostic failure were under-represented in the PLC (P < 0·0001), the mean frequencies of the risk factors being 20% (PLC), 25% (D), 22% (P), 31% (O) and 30% (GP). Differences were not large but still could partially explain the lower FNR of the PLC. However, when the FNR was estimated for lesions exhibiting each of these risk factors, the PLC was found to have the lowest rate in every case (PLC vs. all clinics combined, P = 0·04 to P < 0·0001). The mean FNR for the risk factors combined was 18% (PLC), 45% (D), 50% (P), 68% (O) and 71% (GP). Also on logistic multivariable analysis of the PLC vs. all the other clinics on FNR and the above factors, the higher FNR of the other clinics retained significance (odds ratio 5·9, P < 0·0001). In the 500 patients surveyed separately in the PLC, the MM pick-up rate on biopsy was 32% and the diagnostic FPR was 41%. Conclusions The FNR of MM was lower in the PLC than in the other clinics, while the pick-up rate for MM on biopsy and the FPR were acceptably low. [source] Issues regarding nonattendance at a paediatric dermatology centreCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 8 2002K. L. Hon Summary Nonattendance in paediatric dermatology clinics is a significant problem. We reviewed the charts of all 400 new referrals to the Prince of Wales Hospital (PWH) paediatric dermatology clinic in the year 2000. Sixty-six patients (17%) did not attend. The mean age ± SD of attenders (7.5 ± 5.1 years) and nonattenders (7.7 ± 4.5 years) did not differ significantly. Forty-eight per cent of the referrals were females, 50% of the attenders were females and 67% of the nonattenders were male. Males were 2.1-fold more likely not to attend clinic relative to females (95% confidence interval 1.14,3.71, P = 0.010). Nonattendance was significantly higher among referrals from the PWH emergency department, compared with referrals by private practitioners (P = 0.05) and referrals by other clinics in the PWH. Data in this retrospective study confirm that there is a gender disparity in hospital nonattendance. More dermatological referrals but more nonattendance were associated with the male patients. [source] | ||||||||||