Analysis of factors that determine hospitalization of emergency department patients

Background. Optimization of health care financing under current standards of treatment can be achieved by determining the factors that affect the number of hospital admissions at emergency departments (ED), and their significance. Objectives . Identification of factors determining hospitalizations at emergency department. Material and methods . The study involved 150 emergency department patients in Kedzierzyn-Kozle. An original questionnaire, the Health Behaviors Inventory, and a modified version of the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) were used. Results. At greatest risk of hospitalization are those patients who: take more than 4 drugs (OR 12.17, 95% CI 2.97–73.67); are being treated for chronic diseases (OR 5.37, 95% CI 2.56–11.62); are above 44.5 years of age (OR 3.14, 95% CI 1.54–6.51); are being treated at an outpatient specialist clinic (OR 3.87, 95% CI 1.85–8.32); have a BMI above 27.1 (OR 2.84, 95% CI 1.39–5.88); have at most average material status (OR 0.42, 95% CI 0.20–0.87); have symptoms of severity greater than 5 (OR 2.23, 95% CI 1.11–4.55); and have a low index of unsatisfied needs (a Camberwell index lower than 0.825: OR 0.36, 95% CI 0.17–0.72). Conclusions . Any program to prevent hospitalization should be based on the measurement of health behavior, should focus on promoting knowledge of chronic diseases and the means of preventing them, and should involve patient education on the purpose of emergency departments. It is necessary to strive for increase responsiveness of healthcare to patients’ needs and to support the area of primary-care-oriented services in the field of ‘small surgery’

Experiences of family physicians after a CME ultrasound course

Background. Ultrasonography is an inexpensive, safe, noninvasive tool for obtaining diagnoses without performing further imaging tests, and for the timely referral of patients to further diagnosis or specialist care. Objectives . To determine which ultrasound tests are most often performed by family physicians, and what factors contribute to their use of ultrasound imaging. Material and methods . This survey-based study using the authors’ questionnaire was conducted in March 2016 among 81 primary care physicians who had completed weekend courses on ultrasound abdominal cavity imaging. Results . Family physicians most often took ultrasounds of the abdominal cavity (35/50; 70%) and thyroid gland (35/50, 12%). The odds of an ultrasound being performed at primary care centers with at least two physicians with the necessary skills were about 29.29 times higher than at centers with less than two skilled physicians (OR 29.29, 95% CI 3.77, 1347.92). Family physicians (46/81; 56.79%) referred 274 patients for further specialist diagnosis. The diagnosis of neoplastic disease was confirmed in 168 cases (168/274; 61.31%). The anomalies that were most often detected by family physicians using ultrasound imaging included: cholelithiasis (24/50; 48%), renal cysts (16/50; 32%), nephrolithiasis (5/50; 10%), aortic aneurysms (2/50; 4%). Conclusions . Family physicians’ ability to perform ultrasound scans increases the probability of other doctors acquiring this skill. Weekend courses for family physicians significantly shorten patients’ waiting time for such examinations. A network of professional and upto-date workshops improving the practical skills of family physicians in ultrasound diagnostics, as well as peer review groups focused on ultrasound diagnostics performed by family physicians, are recommended

A qualitative study examining everyday frailty management strategies adopted by Polish stakeholders

Background: Frailty is a multidimensional clinical state that is common in older age and can be managed through intervention. Strategies to manage frailty have not been previously explored with stakeholders in Poland. This may stem from misperceptions about the nature and malleability of frailty, which has resulted in it being viewed as a lower priority healthcare concern. Objectives: To explore stakeholders' views to determine whether there are effective everyday strategies that they can adopt to reduce, reverse or prevent frailty. Methods: Semi-structured focus groups were conducted with five stakeholder groups (frail/pre-frail and robust older adults, health and social care professionals and family caregivers) in Poland ( n  = 44). Data was analysed using a reflexive thematic analysis approach. Results: Two themes were developed. The first emphasized both the positive everyday and more effortful strategies used by individuals to counter frailty; these included the adoption of healthy lifestyle behaviours, social engagement and shared experiences. Stakeholders perceived that older adults, even frail ones, might benefit from engaging in meaningful activities to build resilience against frailty. The second examined formal interventions delivered by health and social care professionals. Stakeholders noted the need to increase awareness of the malleability of frailty among professionals. Conclusion: Raising awareness of the malleability of frailty amongst health and social care professionals is critical. Further, information provision and personal support should be essential elements of health interventions aimed at older adults and family caregivers. Interventions to support resilience building in older adults should also be framed within a model of fostering self-efficacy.[Box: see text]

The use of technology in the context of frailty screening and management interventions:a study of stakeholders' perspectives

BACKGROUND: Health and social care interventions show promise as a way of managing the progression of frailty in older adults. Information technology could improve the availability of interventions and services for older adults. The views of stakeholders on the acceptability of technological solutions for frailty screening and management have not been explored. METHODS: Focus groups were used to gather data from healthy and frail/pre-frail older adults, health and social care providers, and caregivers in three European countries - Italy, Poland and UK. Data were analysed using framework analysis in terms of facilitators or determinants of older adults' adoption of technology. RESULTS: Our findings clustered around the perceived value; usability, affordability and accessibility; and emotional benefits of frailty screening and management technology to stakeholders. We also noted issues relating to social support, previous experience of technology and confidence of stakeholders. CONCLUSIONS: Professionals and caregivers understand the benefits of technology to facilitate frailty care pathways but these views are tempered by concerns around social isolation. Frail older adults raised legitimate concerns about the accessibility and usability of technology, specifically around the potential for their personal information to be compromised. Solutions must be developed within a framework that addresses social contexts and avoids stigma around frailty and ageing

Assessment of the health care system functioning in Poland in light of the analysis of the indicators of the hospital emergency department (ED) and primary health care (PHC) – proposals for systemic solutions

has dramatically increased. The number of visits to EDs can be an important indicator of the quality of primary health care. Objectives. To analyse: 1) the frequency of admissions to EDs, 2) the type and number of medical procedures performed in EDs, and 3) the type and number of services provided by PHC in the Kedzierzyn-Kozle district. Material and methods. A retrospective analysis of the statistical data regarding services provided by PHC in the Kedzierzyn-Kozle district within the National Health Fund (NHF) and data from the hospital emergency department in Kedzierzyn-Kozle (Opole Province, Poland). Results. The results showed an annual increase in the number of hospitalisations (13,815 – 2012, 14,192 – 2013, 15,123 – 2014) and the number of medical procedures performed in the ED (mainly those from I–III categories), as well as the low rate of admission from the ED to ICU (Department of Anaesthesiology and Intensive Care). There was an increase in the overall number of consultations given by a primary health care doctor and the total number of healthcare services provided at night and during holidays. Conclusions. Reducing the number of non-urgent visits to EDs can be achieved by making efforts to meet the needs of patients at the level of primary health care, in particular through better coordination of services provided by EDs and PHC and better motivation of primary care doctors to perform the role of gatekeeper to the health care syste

Analysis of the patients’ with minor injuries attendance to the Emergency Department

Background . The lack of effective system solutions in the field of primary care, long waiting times for outpatient consultation in the framework of specialist care are the cause of those patient’s applications to ED who do not require the use of emergency procedures. The ability to quickly get to ED and unrestricted patient access to health care services financed from public funds increase the likelihood of reporting to ED by the patients in non-urgent cases. Objectives. Analysis of the patient’s attendance with minor injuries to ED. Material and methods . 155 patients of ED in Kędzierzyn-Koźle were examined by a diagnostic survey based on a copyright questionnaire. Results. Patients with minor injuries are generally people aged 11–40 years (66.7%; 100) self-referred to ED (92.7%; 139), with injuries of the extremities (72.7%; 109) that arise from falling, tripping, slipping, impaction (78.7%;118) during three hours of the onset of injury (57.3%; 87) with moderate symptoms. Respondents believe that the minor injuries require diagnostic radiology (38.7%; 58) and specialist consultations (34%; 51) and ED is the most appropriate place for their treatment (45.3%; 68). If these patients do not attend PHC (85.3%; 128) it does not mean that the patient does not trust in the possibility of treatment by a family physician (OR = 1.46, 95% CI [0.52; 4.55]; p = 0.49). Conclusions . It is important to educate patients about the role of ED in the health system, the possibility of dressing minor injuries in PHC, self-care in the field of minor injuries dressing and the harmful effects of excess X-rays on the human body