In the wake of the COVID-19 pandemic, and its negative impact on both acute and elective care and decline in available inpatient resources, there is an imperative to maximize safe and effective alternatives to inpatient hospital care. Properly governed outpatient parenteral antimicrobial therapy (OPAT) services embed the principles of antimicrobial stewardship (AMS) (including use of early oral therapy) and support admission avoidance and early discharge for a growing range of patient groups with complex infections through well-organized multidisciplinary team working. Expansion of OPAT aligns with the UK\'s national strategy to deliver care closer to home and cost-effectively maximize use of inpatient resources. OPAT serves as an exemplar to other ambulatory services and presents opportunities for developing and assuring AMS strategies within the rapidly developing hospital-at-home and virtual ward environments.

BACKGROUND: The short-term adverse effects of ambient fine particulate matter (PM2.5) and ozone (O3) on anxiety disorders (ADs) remained inconclusive.
METHODS: We applied an individual-level time-stratified case-crossover study, which including 126,112 outpatient visits for ADs during 2019-2021 in Guangdong province, China, to investigate the association of short-term exposure to PM2.5 and O3 with outpatient visits for ADs, and estimate excess outpatient visits in South China. Daily residential air pollutant exposure assessments were performed by extracting grid data (spatial resolution: 1 km × 1 km) from validated datasets. We employed the conditional logistic regression model to quantify the associations and excess outpatient visits.
RESULTS: The results of the single-pollutant models showed that each 10 μg/m3 increase of PM2.5 and O3 exposures was significantly associated with a 3.14 % (95 % confidence interval: 2.47 %, 3.81 %) and 0.88 % (0.49 %, 1.26 %) increase in odds of outpatient visits for ADs, respectively. These associations remained robust in 2-pollutant models. The proportion of outpatient visits attributable to PM2.5 and O3 exposures was up to 7.20 % and 8.93 %, respectively. Older adults appeared to be more susceptible to PM2.5 exposure, especially in cool season, and subjects with recurrent outpatient visits were more susceptible to O3 exposure.
CONCLUSIONS: As our study subjects were from one single hospital in China, it should be cautious when generalizing our findings to other regions.
CONCLUSIONS: Short-term exposure to ambient PM2.5 and O3 was significantly associated with a higher odds of outpatient visits for ADs, which can contribute to considerable excess outpatient visits.

BACKGROUND: The quality of care for the chronically ill is to be improved through interprofessional cooperation (IPC). To date, evaluation projects on IPC have mostly focused on the inpatient sector. The aim was to use a multiple case study design to investigate forms of IPC in primary care and to identify facilitating and inhibiting factors. Factors that facilitated the implementation of IPC included having a responsible person employed to provide the service, supportive training, and the introduction of evidence-based interventions. There appeared to be insufficient incentives to implement IPC and the needs of the chronically ill were poorly integrated. More systematic evaluation of IPC initiatives is needed to demonstrate their added value. Greater integration of patient needs is key.
UNASSIGNED: Formen interprofessioneller Zusammenarbeit in der ambulanten Gesundheitsversorgung - Eine fallübergreifende Analyse in der deutschsprachigen Schweiz.
UNASSIGNED: Die Qualität der Versorgung chronisch kranker Menschen soll durch eine verstärkte interprofessionelle Zusammenarbeit (IPZ) verbessert werden. Bisher konzentrieren sich (Forschungs-) Projekte zur IPZ meist auf den stationären Bereich. Ziel war es, mittels eines multiplen Fallstudiendesigns Formen von IPZ in der Grundversorgung zu untersuchen, um fördernde und hemmende Faktoren zu identifizieren. Zu den Faktoren, die die Implementierung von IPZ förderten, gehörten eine verantwortliche Person, die für diese Leistung angestellt wurde, unterstützende Schulungsmassnahmen, sowie die Einführung evidenzbasierter Interventionen. Insgesamt schienen die Anreize zur Implementierung von IPZ unzureichend und die Bedürfnisse chronisch kranker Menschen wenig integriert. Es bedarf einer systematischeren Evaluation ambulanter IPZ-Initiativen, um deren Mehrwert für eine nachhaltige Versorgung aufzuzeigen. Zentral ist eine stärkere Integration der Bedürfnisse von Patient/-innen.
UNASSIGNED: Formes de coopération interprofessionnelle dans les soins de santé ambulatoires. Une analyse transversale en Suisse alémanique.
BACKGROUND: La qualité des soins aux malades chroniques doit être améliorée par la collaboration interprofessionnelle (CIP). Jusqu’à présent, les évaluations de la CIP se sont focalisées sur le secteur hospitalier. L‘objectif de cette analyse était d‘examiner les formes de CIP en soins ambulatoires pour en déterminer les facteurs favorisants et entravants. Les facteurs favorisant la CIP incluent : avoir un gérant, assister à des formations, et utiliser des données scientifiques. Dans l‘ensemble, les programmes d’incitations à la CIP sont insuffisants et les besoins des malades chroniques mal intégrés au reste du système médical. Une évaluation systématique des initiatives à la CIP en ambulatoire est nécessaire pour démontrer leurs valeurs. Il est essentiel de prendre d’avantage compte des besoins des patients.

UNASSIGNED: Patient referral prioritizations is an essential process in coordinating healthcare delivery, since it organizes the waiting lists according to priorities and availability of resources.
UNASSIGNED: This study aims to highlight the consequences of decentralizing ambulatory patient referrals to general practitioners that work as family physicians in primary care clinics.
UNASSIGNED: A qualitative case study was carried out in the municipality of Rio de Janeiro. The ten health regions of Rio de Janeiro were visited during fieldwork, totalizing 35 hours of semi-structured interviews and approximately 70 hours of analysis based on the Grounded Theory.
UNASSIGNED: The findings of this study show that the obstacles to adequate referrals are beyond the management of vacancies, ranging from the standardization of prioritization criteria to ensuring the proper employment of referral protocols in diverse locations assisted by overloaded health workers with different backgrounds and perceptions. Efforts in decentralizing patient referral to primary care still face the growing dilemmas and challenges of expanding the coverage of health services while putting pressure on risk assessment, as well as sustaining the autonomy of physicians\' work while respecting the eligibility when ordering waiting lists.
UNASSIGNED: A major strength of this work is on the method to organize and aggregate qualitative data using visual representations. Limitations concerning the reach of fieldwork in vulnerable and hardly accessible areas were overcame using snowball sampling techniques, making more participants accessible.

Within the last decade, there has been a dramatic increase in the rate of emergency department (ED) visits and death from opioid overdose. Those who present to the ED are at high risk for subsequent morbidity and mortality. Despite effective treatment, many patients do not get rapidly connected to outpatient care. The aim of this investigation was to describe outpatient treatment engagement after ED discharge among patients with opioid use disorder (OUD) enrolled in a virtual Addiction Bridge Clinic (ABC).
This was a retrospective case series describing an ED-initiated referral for rapid telehealth follow-up among patients with OUD. The primary outcome was addiction treatment engagement among those who completed the initial virtual ABC visit (engaged in ABC) vs. those who did not complete an ABC visit (Not engaged in ABC) at 1 week, 1 month, and 3 and 6 months timepoint intervals after the initial ED presentation.
Of the N = 201 patients referred to the ABC between March and December 2021, a majority were Black (71%) and male (77%). Of the 201 referrals, 85 (42%) completed an initial ABC telehealth visit. Subsequent treatment engagement was 26% at 1 week, 26% at 1 month, 22% at 3 months, and 18% at 6 months after the index ED visit.
A telehealth-enabled virtual addiction bridge clinic is one potential approach to reduce barriers to rapid treatment access. Strategies are needed to improve subsequent addiction treatment engagement after a virtual addiction bridge clinic visit.

BACKGROUND: Long-term mental health (MH) policies in Finland aimed at investing in community care and promoting reforms have led to a reduction in the number of psychiatric hospital beds. However, most resources are still allocated to hospital and community residential services due to various social, economic and political factors. Despite previous research focussing on the number and cost of these services, no study has evaluated the emerging patterns of use, their technical performance and the relationship with the workforce structure.
OBJECTIVE: The purpose of this study was to observe the patterns of use and their technical performance (efficiency) of the main types of care of MH services in the Helsinki-Uusimaa region (Finland), and to analyse the potential relationship between technical performance and the corresponding workforce structure.
METHODS: The sample included acute hospital residential care, non-hospital residential care and outpatient care services. The analysis was conducted using regression analysis, Monte Carlo simulation, fuzzy inference and data envelopment analysis.
RESULTS: The analysis showed a statistically significant linear relationship between the number of service users and the length of stay, number of beds in non-hospital residential care and number of contacts in outpatient care services. The three service types displayed a similar pattern of technical performance, with high relative technical efficiency on average and a low probability of being efficient. The most efficient acute hospital and outpatient care services integrated multidisciplinary teams, while psychiatrists and nurses characterized non-hospital residential care.
CONCLUSIONS: The results indicated that the number of resources and utilization variables were linearly related to the number of users and that the relative technical efficiency of the services was similar across all types. This suggests homogenous MH management with small variations based on workforce allocation. Therefore, the distribution of workforce capacity should be considered in the development of effective policies and interventions in the southern Finnish MH system.

Successful outcomes of outpatient substance use disorder treatment result from many factors for clients-including intersections between individual characteristics, choices made, and social determinants. However, prioritizing which of these and in what combination, to address and provide support for remains an open and complex question. Therefore, we ask: What factors are associated with outpatient substance use disorder clients remaining in treatment for > 90 days and successfully completing treatment? To answer this question, we apply a virtual twins machine learning (ML) model to de-identified data for a census of clients who received outpatient substance use disorder treatment services from 2018 to 2021 from one treatment program in the Southeast U.S. We find that primary predictors of outcome success are: (1) attending self-help groups while in treatment, and (2) setting goals for treatment. Secondary predictors are: (1) being linked to a primary care provider (PCP) during treatment, (2) being linked to supplemental nutrition assistance program (SNAP), and (3) attending 6 or more self-help group sessions during treatment. These findings can help treatment programs guide client choice making and help set priorities for social determinant support. Further, the ML method applied can explain intersections between individual and social predictors, as well as outcome heterogeneity associated with subgroup differences.

OBJECTIVE: This study was conducted to determine the paediatric forensic cases under the age of 18 from of the year of the outbreak of war.
UNASSIGNED: The population of the study included 16,970 people under the age of 18, who were accepted as forensic cases among 88,052 cases, who presented to the emergency department of Kilis State Hospital between January 2011 and November 2019. The application time of the patients, their nationality, age, gender, their types of application to the emergency department, the event causing the forensic case, and the follow-up and treatment methods in the emergency department were recorded on the standard data entry form.
RESULTS: Among all the paediatric forensic cases, it was determined that 52.0% were Syrian, 70.8% were boys, 30.0% were in the age range of 11 and 15 years and 20.5% had an outpatient treatment.
CONCLUSIONS: In this study, although juvenile forensic rates are consistent with the literature, the higher forensic cases of Syrian nationality was determined as a striking result.
CONCLUSIONS: Today, considering extraordinary situations such as wars and armed conflicts, more refugees may benefit from Turkish healthcare services in the in the forthcoming periods and it is important for community health to conduct studies in this field.

Introduction: A retrospective case-controlled study was performed to evaluate the outcomes of shoulder arthroplasty performed as a day case in carefully selected patients, compared to the traditional inpatient approach. Materials and Methods: Patients who had total or hemiarthroplasty of the shoulder performed as a day case or inpatient procedure were recruited. The primary outcome compared rates of uneventful recovery, defined by the absence of complications or readmission to the hospital within six months of surgery, between the inpatient and outpatient groups. Secondary outcomes included examiner-determined functional and patient-determined pain scores at one, six, twelve, and twenty-four weeks post-surgery. A further assessment of patient-determined pain scores was carried out at least two years post-surgery (5.8 ± 3.2). Results: 73 patients (36 inpatients and 37 outpatients) were included in the study. Within this time frame, 25/36 inpatients (69%) had uneventful recoveries compared to 24/37 outpatients (65%) (p = 0.17). Outpatients showed significant improvement over pre-operative baseline levels in more secondary outcomes (strength and passive range-of-motion) by six months post-operation. Outpatients also performed significantly better than inpatients in external rotation (p < 0.05) and internal rotation (p = 0.05) at six weeks post-surgery. Both groups showed significant improvement compared to pre-operative baselines in all patient-determined secondary outcomes except the activity level at work and sports. Inpatients, however, experienced less severe pain at rest at six weeks (p = 0.03), significantly less frequent pain at night (p = 0.03), and extreme pain (p = 0.04) at 24 weeks, and less severe pain at night at 24 weeks (p < 0.01). By a minimum of two years post-operation, inpatients were more comfortable repeating their treatment setting for future arthroplasty (16/18) compared to outpatients (7/22) (p = 0.0002). Conclusions: At a minimum of two years of follow-up, there were no significant differences in rates of complications, hospitalizations, or revision surgeries between patients that underwent shoulder arthroplasty as an inpatient versus an outpatient. Outpatients demonstrated superior functional outcomes but reported more pain at six months post-surgery. Patients in both groups preferred inpatient treatment for any future shoulder arthroplasty. What is Known About This Subject: Shoulder arthroplasty is a complex procedure and has traditionally been performed on an inpatient basis, with patients admitted for six to seven days post-surgery. One of the primary reasons for this is the high level of post-operative pain, usually treated with hospital-based opioid therapy. Two studies demonstrated outpatient TSA to have a similar rate of complications as inpatient TSA; however, these studies only examined patients within a shorter-term 90-day post-operative period and did not evaluate functional outcomes between the two groups or in the longer term. What This Study Adds to Existing Knowledge: This study provides evidence supporting the longer-term results of shoulder arthroplasty done as a day case in carefully selected patients, which are comparable to outcomes in patients that are admitted to the hospital post-surgery.

BACKGROUND: To determine the prevalence of chronic disease conditions based on outpatient health insurance data, we often rely on repeated occurrence of a diagnosis over the course of a year, usually in two or more quarters (M2Q). It remains unclear whether prevalence estimates change after adapting repeated occurrence of a diagnosis in different quarters of a year compared to a single occurrence or to some other case selection criteria. This study applies different case selection criteria and analyses their impact on the prevalence estimation based on outpatient diagnoses.
METHODS: Administrative prevalence for 2019 was estimated for eight chronic conditions based on outpatient physician diagnoses. We applied five case selection criteria: (1) single occurrence, (2) repeated occurrence (including in the same quarter or treatment case), (3) repeated occurrence in at least two different treatment cases (including in the same quarter), (4) occurrence in two quarters and (5) occurrence in two consecutive quarters. Only information on persons with continuous insurance history within the statutory health insurance provider AOK Niedersachsen in 2019 was used (n=2,168,173).
RESULTS: Prevalence estimates differed quite strongly depending on the diagnosis and on age group if a criterion with repeated occurrence of a diagnosis was applied compared to a single occurrence. These differences turned out to be higher among men and younger patients. The application of a repeated occurrence (criterion 2) did not show different results compared to the repeated occurrence in at least two treatment cases (criterion 3) or in two quarters (criterion 4). The application of the strict criterion of two consecutive quarters (criterion 5) resulted in further reduction of the prevalence estimates.
CONCLUSIONS: Repeated occurrence is increasingly becoming the standard for diagnosis validation in health insurance claims data. Applying such criteria results partly in a distinct reduction of prevalence estimates. The definition of the study population (e. g., repeated visits to a physician in two consecutive quarters as a mandatory condition) can also strongly influence the prevalence estimates.
UNASSIGNED: Zur Ermittlung der Prävalenz von chronischen Erkrankungen auf Basis von ambulanten Krankenkassendaten wird häufig auf eine wiederholte Nennung einer Diagnose im Laufe eines Jahres zurückgegriffen, meist in zwei oder mehr Quartalen (M2Q). Dabei bleibt bisher unklar, ob sich die Prävalenzschätzungen stark verändern, wenn anstatt zwei Nennungen in unterschiedlichen Quartalen nur eine Diagnosenennung oder wenn andere Festlegungen als Aufgreifkriterium angewendet werden. Ziel dieser Studie ist daher die Anwendung unterschiedlicher Aufgreifkriterien und die Analyse der Auswirkungen dieser Aufgreifkriterien auf die Prävalenzschätzungen auf Basis von ambulanten Diagnosedaten.
METHODS: Für acht ausgewählte chronische Erkrankungen wurde die administrative Prävalenz auf Basis der ambulanten ärztlichen Diagnosen im Jahr 2019 ermittelt. Dabei wurden fünf verschiedene Aufgreifkriterien verwendet: (1) einmalige Nennung, (2) zweimalige Nennung (auch im selben Quartal oder Behandlungsfall), (3) Nennung in mindestens zwei Behandlungsfällen (auch im selben Quartal), (4) Nennung in zwei Quartalen und (5) Nennung in zwei aufeinander folgenden Quartalen. Für die Analysen wurden die Daten der im Jahr 2019 durchgehend bei der AOK Niedersachsen versicherten Personen verwendet (n=2 168 173).
UNASSIGNED: In Abhängigkeit von der Diagnose und der Altersgruppe zeigten sich teilweise größere Unterschiede zwischen den Prävalenzschätzungen bei den Kriterien der wiederholten Nennung einer Diagnose verglichen mit der einmaligen Nennung. Diese Unterschiede in den ermittelten Prävalenzen fielen insbesondere unter Männern und jüngeren Versicherten recht deutlich aus. Bei der Anwendung der zweimaligen Nennung (Kriterium 2) unterschieden sich die Ergebnisse nicht von der Prävalenz, die durch Nennung in mindestens zwei Behandlungsfällen (Kriterium 3) oder zwei Quartalen (Kriterium 4) ermittelt wurde. Die Anwendung des strengen Kriteriums von zwei aufeinander folgenden Quartalen (Kriterium 5) führte zur weiteren Verringerung der ermittelten Prävalenz.
UNASSIGNED: Die Nutzung der Kriterien der wiederholten Nennung einer Diagnose, die sich zunehmend als Standard zur Diagnosevalidierung in Krankenkassendaten durchsetzt, führt zu einem teilweise deutlichen Absinken der Prävalenz. Auch die Definition der Studienpopulation (z. B. wiederholter Kontakt zu niedergelassenen Ärzt:innen in zwei aufeinander folgenden Quartalen als zwingende Bedingung) kann die Prävalenzschätzung stark beeinflussen.