Mobility of Unidade Mobility of Unidade Pediátrica do Porto's Pediátrica do Porto's

patients across different patients across different health institutionshealth institutions

Final PresentationClass 13

03-05-2007

INTRODUCTION Increased interest for information and

communication technologies (Yoo S,2006)

People resort to different institutions

Scattered clinical dataRedundant clinical data

(Katehakis, 2001; Lambrinoudakis, 2000)

INTRODUCTION Patients resort to more than one medical institution

Repeated medical exams and anamnesis Patient's data is spread in all places where they have

received clinical services [Katehakis, 2001]

In: hospitals, private clinics, pharmacies... [Lambrinoudakis, 2000]

Error in medicine is frequent and results in substantial harm

[Bates DW, 2001]

INTRODUCTION Solutions that integrate data are necessary

[Yoo S, 2003] The physical location of a patient record can be replaced by a

virtual one by linking databases from the different health institutions attended

[van Bemmel, 1998] When used, computer-based decision support significantly

improved decision quality [Coeira, 2004]

Helped reducing the frequency and consequences of errors in medical care: CPOE – Computerized Physician Order Entry - reduces medication errors up to 81%

[Koppel R, 2005] In some cases medication errors increased

[Bates DW, 2001]

INTRODUCTION

Data integration Increased coordination of information and correction of gaps in

communication in cases where patients are receiving shared care, which involves more that one physician

[Branger PJ, 1994, 1995] Fundamental due to the higher number of interdisciplinary

practice and tests[Wyatt, 1998]

Improves quality and reduction of health care cost [Kahn MG, 1997]]

Improves safety and efficiency of clinical care [Shapiro, 2006]

Leads to the creation of large databases of deidentified aggregate data for research

[Shapiro, 2006]

INTRODUCTION

The application of new systems may bring some problems: difficulty felt by some emergency physicians to

remember passwords time required to search for the information

[Overhage JM, 2002]

INTRODUCTIONChildren

Vulnerability; unpredictable behavior

One of the groups who requests more health services

(Scanaill NC,2006)

Parental protection

Different specialists Second opinion

Visits to several

institutions

INTRODUCTION

Assessing the number of institutions visited by children as well as the proportion that goes to a second health care centre is an issue of major importance as it may allow, in the future, a conclusion about the number of people that would benefit from generalized electronic patient records

AIM

The aim of this study is to assess the mobility of UPP's (Porto’s Paediatrics Unit) patients among different healthcare institutions (hospitals, private clinics and community health centres)

METHODS Study design

This study is transversal and retrospective Data collection is done in a single moment by interviews, to

parents of attendants in the UPP, about events occurred since January of 2006 until 8th, 11th and 12th March 2007

The study population consisted of children attending the Paediatric Emergency of Porto (children with or under the age of 13).

A total of 151 individuals accompanying children who attended UPP, were approached in the waiting room to answer the designed questionnaire about the patient

METHODS Data collection methods

A questionnaire was applied on 8th, 11th and 12th March (a Sunday and two working days), two shifts a day, between 8 to 10 a.m. and 8 to 10 p.m

Three interviewers in the waiting room of UPP, approached people who were accompanying children

The first stage of the interview was to explain the purposes of the study and ask a consent declaration (elaborated by the Ethics Commission) to be signed. The next stage was to proceed with the questionnaire

METHODS Data collection methods

Everyone who entered in the emergency room during the shifts was accounted for

The questionnaire was applied to all individuals, except the ones who refused to answer or entered directly to be attended; some of the questionnaires were incomplete because in the meantime, the interviewed was called by the doctor. Refusing to answer was the only exclusion criteria considered; even the incomplete questionnaires were included in the study.

The interviews lasted about 5 minutes each

METHODS Questionnaire design

Eleven questions were developed and tested on investigators relatives who fitted the profile. Some adjustments were made until the final questionnaire was obtained.

Data collected from the interviews included questions about the person who was answering (profession, kinship, and years of school) and about the child they were accompanying (age, address, gender)

The remaining questions were the purpose of our study - type and number of health institutions visited since January 2006: hospitals, health centres and private clinics

RESULTS

TNPUPP: 151

ED: 25 SWR: 126

RA: 6 AA: 120

ACQ: 112 (valid ones) IQ: 8

TNPUPP: total number of people that entered UPP

ED: entered directly the doctor’s room

SWR: stayed in the waiting room

RA: refused to answer

AA: accepted to answer

ACQ: answered the complete questionnaire

IQ: incomplete questionnaire

Participants

RESULTS

Age Distribution Living place distribution

RESULTS

Qualifications of the persons responsible for the attendants

Employment of the people responsible for the attendants

Taxa Nacional de desemprego

RESULTS

26%

63%

12%Hospitals

Health Centers

Private Clinics

Transferences

9%

56%

35%

>5 times2-5 timesonce

Number of visits to UPP

Number of visits to UPP Percentage of transfers from other institutions

Mobility

RESULTS

Number of transfersTotal

0 1 2 3

Number of visits to UPP

1 28 10 1 0 39

2-5 39 19 3 2 63

>5 4 2 2 2 10

Total 71 31 6 4 112

Cross table of the number of visits to UPP and the number of transfers

RESULTS

Cases (N) Health Centre 83Private Clinics 56

Paediatrics 53General Clinics 4Otorhinolaryngology 2Ophthalmology 2Orthopaedics 2Psychology 1Dermatology 1

Cases (N) Out Patient Department frequency 49

H. São João 14H. Pedro Hispano 10H.G. Santo António 9Health Centres 9H. Maria Pia 4Others 5Missing 1

Table of the number of visits to Health Centers and Private Clinics with its specialities

Table of the different institutions attended for external consulting

RESULTS

Attended a Health Centre

Attended a Private Clinic Yes No Attended Out Patient

Department

Yes15 (13%) 4 (4%) Yes

22 (20%) 14 (12%) No

No22 (20%) 8 (7%) Yes

24 (21%) 3 (3%) No

83 (74%)Cross table of the attendance of Private Clinics,

Health Centres and Out Patient Department

RESULTS

Number of visits to UPP

Age 1 2-5 >5 Total

≤2 14 (13%) 36 (32%) 1 (1%) 51 (46%)

>2 25 (22%) 27 (24%) 9 (8%) 61 (54%)

Total 39 (35%) 63 (56%) 10 (9%) 112 (100%)

Cross table between number of visits to UPP and patient age

DISCUSSION/CONCLUSION Health Centers are the type of Health

Institutions most often visited Children under the age of 2 are approximatly

half of the visiting patients 97% of the attending patients had already

been to at least one medical consult Further studies should focus on the under 2

year old or the population attending Health Centers