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AbstractIn an integrated system of care for persons with chronic mental illness, the emergency and outpatient department can control access to the system, expedite patient transfers, and help ensure continuity of care.

chapter 1 Defining Outpatient Healthcare -- chapter 2 Creating a Structure for Quality and Safety -- chapter 3 Engineering the Customer Connection -- chapter 4 Policies, Procedures, and Plans -- chapter 5 e Human Resource Factor -- chapter 6 Measuring Quality and Safety -- chapter 7 Medication Safety -- chapter 8 Infection Prevention in the Ambulatory Setting -- chapter 9 Clinical Documentation -- chapter 10 Risk Management and Safety -- chapter 11 Licensing, Deemed Status, Accreditation, and Certification -- chapter 12 Practice Makes Perfect.

Women Veterans are the largest growing population Veterans, yet have a significant mental health disparity, greater than both civilian women and Veteran men. This disparity continues in the mental health outpatient treatment options for women Veterans. Veteran Administration (VA) healthcare services may not be suited to their needs as women, and civilian services are not well suited to manage their needs as Veterans. Therefore, this dissertation study used constructivist Grounded Theory methods to explore the experiences of women Veterans when accessing mental health outpatient services, their decision-making process when make the choice to enter mental health service, and aspects of the experience that are important or meaningful to them.Twelve women Veterans revealed meaningful, personal stories on their experiences of trauma and their use of mental health outpatient services. While addressing each of these factors, what emerged from the data was a broader Grounded Theory Process model of how women Veterans process trauma, and the categories of Trauma, Transitions, Identity and Structure. Women Veterans who participated in the study used mental health outpatient services to assist in reestablishing identity after trauma and to propel forward in their lives.This research provides key insight into how women Veterans make healthcare related choices and process traumatic events, like military sexual trauma (MST). This has implications for research, practice, and policy to improve the provision of care for women Veterans.

A survey of the outpatient service provided by a consultant dermatologist at the national dermatology department in Malta was carried out. The aims of this study were to identify the main conditions being treated and to analyze management and referral practices. Possible implications for future training of primary care physicians were also investigated. The survey was carried out for one week every season over a 12-month period, giving a total study period of four weeks. Data was collected on a total of 662 patients (401 new patients and 261 follow-ups). The average waiting time for a routine clinic appointment for new cases was 4 weeks, but 18% of patients were seen within 48 hours of referral and 7% were seen within one week. Age-specific attendance rates were highest for females over 50 years and males over 60. Overall, the commonest conditions seen were chronic leg ulcers, psoriasis, skin infections and seborrhoeic keratoses. Skin biopsy was the most frequent investigation performed and topical treatment was the commonest form of therapy. Private general practitioners and government doctors based in health centres accounted for 51% and 29% of all referrals respectively. A diagnosis was offered in 65% of referral notes. Of these, 44% had a diagnosis matching that given by the dermatologist at the patient's first visit. Treatment was attempted prior to referral in 64% of patients with acne but in only 15% of patients with viral warts. ; peer-reviewed

Background: Leprosy is a major public health problem in many low and middle income countries, especially in India, and contributes considerably to the global burden of the disease. Leprosy and poverty are closely associated, and therefore the economic burden of leprosy is a concern. However, evidence on patient's expenditure is scarce. In this study, we estimate the expenditure in primary care (outpatient) by leprosy households in two different public health settings. Methodology/Principal findings: We performed a cross-sectional study, comparing the Union Territory of Dadra and Nagar Haveli with the Umbergaon block of Valsad, Gujrat, India. A household (HH) survey was conducted between May and October, 2016. We calculated direct and indirect expenditure by zero inflated negative binomial and negative binomial regression. The sampled households were comparable on socioeconomic indicators. The mean direct expenditure was USD 6.5 (95% CI: 2.4–17.9) in Dadra and Nagar Haveli and USD 5.4 (95% CI: 3.8–7.9) per visit in Umbergaon. The mean indirect expenditure was USD 8.7 (95% CI: 7.2–10.6) in Dadra and Nagar Haveli and USD 12.4 (95% CI: 7.0–21.9) in Umbergaon. The age of the leprosy patients and type of health facilities were the major predictors of total expenditure on leprosy primary care. The higher the age, the higher the expenditure at both sites. The private facilities are more expensive than the government facilities at both sites. If the public health system is enhanced, government facilities are the first preference for patients. Conclusions/Significance: An enhanced public health system reduces the patient's expenditure and improves the health seeking behaviour. We recommend investing in health system strengthening to reduce the economic burden of leprosy.

IntroductionThe increased life expectancy of HIV patients in the era of highly active antiretroviral therapy has had profound consequences for the healthcare systems that provide their care. It is useful to assess whether healthcare resources need to be adapted to the different stages of HIV infection or to patient characteristics [1]. To study how patient features influence utilization of out patient services, we retrospectively analyzed the electronic health record of HIV‐positive patients who had followed day‐care programs at the AIDS Center of the University of Palermo, Italy.Materials and Methods223 HIV‐infected subjects were recruited and divided into two groups according to CD4 cell counts (117 with a CD4 count ≤500/mm3 and 106 with CD4 count ≥500/mm3). Data on age, gender, race, lifestyle habits (including educational level, drug abuse history, smoking status, alcohol consumption, sexual behaviour) BMI, HIV‐RNA, CD4+ T‐cell count, antiretroviral therapy (ART), comorbidities such as HCV co‐infection, osteoporosis biomarker, dyslipidemia, diabetes, renal function and systolic and diastolic blood pressure were recorded in a purposely designed database and were analyzed in relation to AIN by uni‐ and multivariable logistic regression.ResultsTable 1 shows the characteristics of enrolled patients; the average age of the recruited patients was 45.4±9.5 years. 163 individuals were male (73%), 26 were immigrants (12%) and 91 (40%) were treatment‐naïve. Mean day care access for laboratory tests to evaluate stage of HIV and for treatment monitoring was 6.5 days for CD4 cell count measurements and 9.6 for HIV RNA/drug‐resistance testing. When patients were stratified according to CD4 count, mean day care access for laboratory tests to evaluate HIV stage and to monitor treatment was negatively correlated with CD4 cell counts.ConclusionsOnly patients with CD4 counts ≤500/mm3 showed higher rates of healthcare utilization; these data may be useful for monitoring and revising implementation plans for the different phases of HIV disease.

Background: The government established a national health insurance program (NHI) to increase access to health services but the program is still not optimal, it affects the number of hospital visits and income. Therefore it required an analysis of patient's willingness to pay out of pocket for outpatient services. The purpose of this study was to determine factors affecting patient's willingness to pay. Method: This research is a cross sectional study involving 124 internal medicine outpatients at General Hospital (RSU) South Tangerang City in November 2019. Data were obtained from a questionnaire. Patient's income, information, treatment experience, health insurance, distance to hospital, health service, ability to pay, and willingness to pay was investigated using chi square and logistic regression analysis. Results: The results outcomes showed that the level of willingness to pay of respondents is quite high and is influenced by patient's income (p = 0.001), information (p = 0.045), treatment experience (p = 0.010), and ability to pay (ATP) (p = 0.001). Factors that have the most significant associations were patient's ability to pay (OR = 14,502). Conclusion: Patient's income, information, treatment experience, and ATP affect the willingness to pay of patients.

Background: Despite increasing research on activity-based funding (ABF), there is no empirical evidence on the accuracy of outpatient service data for payment. Objective: This study aimed to identify data entry errors affecting ABF in two drug and alcohol outpatient clinic services in Australia. Methods: An audit was carried out on healthcare workers' (doctors, nurses, psychologists, social workers, counsellors, and aboriginal health education officers) data entry errors in an outpatient electronic documentation system. Results: Of the 6919 data entries in the electronic documentation system, 7.5% (518) had errors, 68.7% of the errors were related to a wrong primary activity, 14.5% were due to a wrong activity category, 14.5% were as a result of a wrong combination of primary activity and modality of care, 1.9% were due to inaccurate information on a client's presence during service delivery and 0.4% were related to a wrong modality of care. Conclusion: Data entry errors may affect the amount of funding received by a healthcare organisation, which in turn may affect the quality of treatment provided to clients due to the possibility of underfunding the organisation. To reduce errors or achieve an error-free environment, there is a need to improve the naming convention of data elements, their descriptions and alignment with the national standard classification of outpatient services. It is also important to support healthcare workers in their data entry by embedding safeguards in the electronic documentation system such as flags for inaccurate data elements.