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Cassidy, Irving B., Matthew R. Keith, Edward L. Coffey, and Margaret A. Noyes. "Impact of Pharmacist-Operated General Medicine Chronic Care Refill Clinics on Practitioner Time and Quality of Care." Annals of Pharmacotherapy 30, no. 7-8 (July 1996): 745–51. http://dx.doi.org/10.1177/106002809603000707.
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OBJECTIVE: To assess the impact of pharmacist-operated refill clinics on practitioner (physician/physician assistant) time. Secondary objectives included assessment of disease state control, drug acquisition costs, and human resource allocation. DESIGN: The study ran from October 1, 1993 through January 31, 1994. At one clinic the pharmacist performed chart review only and did not see the patient. At the second site the pharmacist also interviewed the patient. The pharmacist used no treatment algorithms. Practitioner and pharmacist time before and after implementation of the refill clinics was measured on 3 consecutive days of normal clinic operation. SETTING: TWO state correctional facilities. PATIENTS: The study population consisted of patients receiving chronic care who were observed during regular clinic hours. MAIN OUTCOME MEASURES: We evaluated pharmacist and practitioner time before and after pharmacist involvement. Hypertension was the only disease state yielding sufficient numbers for statistical analysis. We used a two-tailed paired t-test with the a priori level set at 0.05. We also evaluated the number of patients with disease state control before and after clinic implementation, drug acquisition costs, and human resource allocation. RESULTS: The refill clinic pharmacist reduced practitioner time commitment in both clinics. The greatest impact on practitioner time was found in the interview clinic. Quality of care was maintained equally between the two clinics, with a positive impact on human resource allocation. CONCLUSIONS: In the managed care environment, pharmacist-run refill clinics can decrease practitioner time commitment allowing reallocation of human resources while maintaining current quality of care.
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Nguyen, Quynh, Van Hieu Nguyen, Hoang Liem Luong, and Phuc Thanh Kim. "Some factors affecting the provision of medical examination and treatment services at 02 general clinics under Thu Duc District Hospital, Ho Chi Minh City from 2017-2019." Journal of Health and Development Studies 05, no. 03 (May 30, 2021): 115–24. http://dx.doi.org/10.38148/jhds.0503skpt20-065.
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Objective: To study to find out some factors affecting medical service provision of 02 general clinics under Thu Duc District Hospital. Method: Qualitative research. Data collected through 06 in-depth interviews and 02 group discussions. Results: Research results show that a number of factors affecting medical examination and treatment activities of the two clinics are positive ones: Newly built facilities, clean and airy rooms, most of the facilities The equipment is fully invested and equipped with a number of modern equipment such as Ct-san, endoscopy system. The drugs in 02 general clinics are provided by the hospital, so most of the drugs available in the hospital are available in the clinic, this helps the patient feel secure when coming to the examination, both clinics have made the master cabinet. On the financial side, this makes it easier for the clinic to have autonomy in revenue and expenditure. The staff of the clinics are always supported by the hospital. The information technology system meets all activities of the clinic.In addition to the positive factors, there are also negative factors affecting medical examination and treatment: Lack of qualified post-graduate doctors study, especially the specialties. Negative factor: The facilities of Linh Tay clinic are still narrow, lacking some equipment to serve the people. Some drugs are not on the list of drugs approved for use in the clinic or are not covered by health insurance. Due to being located far from the hospital, the network system is not stable. Security coordination between clinics and local authorities has not been effective. The burden of medical equipment depreciation costs and hospital overheads also affect the financials of the clinic. Keywords: General clinic, medical service provider, Hospital Thu Duc district.
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Mason, Julie D., and Colleen A. Colley. "Effectiveness of an Ambulatory Care Clinical Pharmacist: A Controlled Trial." Annals of Pharmacotherapy 27, no. 5 (May 1993): 555–59. http://dx.doi.org/10.1177/106002809302700503.
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OBJECTIVE: To compare two general medicine clinics to determine the effectiveness of an ambulatory care clinical pharmacist in assisting recognition of drug therapy problems for physicians and decreasing drug therapy costs. DESIGN: Controlled trial SETTING: Two general medicine ambulatory care clinics associated with a large, tertiary-care teaching hospital. PATIENTS: Those with scheduled and completed appointments in the clinics during the two-week study period. METHODS: Medication profiles of patients attending clinic A (pharmacist intervention) and clinic B (no pharmacist intervention) were reviewed by the pharmacist prior to clinic appointments. Potential drug therapy problems were identified at each clinic, but interventions were performed only at clinic A. Postappointment audits determined the number of recommendations implemented at clinic A versus the number of drug therapy problems (potential interventions) recognized and addressed by clinic B physicians independently of pharmacist intervention. Potential and actual savings were extrapolated to one year from the two-week study period. RESULTS: Implementation of interventions at clinic A was greater than at clinic B (p<0.001). Drug therapy cost savings at clinic A were annualized to yield $185 per intervention. Potential cost savings of $176 724, or four times the pharmacist salary costs, is projected. CONCLUSIONS: An ambulatory care pharmacist is effective in identifying drug therapy problems, resulting in significant cost savings to the institution.
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Kerrison, Susan, and Roslyn Corney. "Private Provision of ‘outreach’ Clinics to Fundholding General Practices in England." Journal of Health Services Research & Policy 3, no. 1 (January 1998): 20–22. http://dx.doi.org/10.1177/135581969800300106.
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Objectives: To establish the contribution of the private sector in providing outpatient ‘outreach’ clinics in general practitioner fundholding practices. Method: Postal survey of all 13 first-wave fundholders and four of the 13 second-wave fundholders in the former South East Thames Region of the National Health Service in 1995. Results: Fourteen practices responded. Ten practices had set up at least one medical specialist ‘outreach’ clinic and 12 at least one paramedical clinic since becoming fundholders. Eight practices reported their arrangements for consultant ‘outreach’ clinics and ten practices their arrangements for paramedical clinics. Forty-nine per cent of the total medical specialist hours and 46% of total paramedical hours were provided by private practitioners. The largest number of hours provided privately was in gynaecology. Conclusion: This small study identified considerable private provision of fundholders' ‘outreach’ clinics. However, there is no system in the NHS to monitor the extent of this market, the types of activities undertaken or the relative quality and cost of the services provided.
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Chong, C. K. L., J. C. N. Chan, S. Chang, Y. H. Yuen, S. C. Lee, and J. A. J. H. Critchley. "A patient compliance survey in a general medical clinic." Journal of Clinical Pharmacy and Therapeutics 22, no. 5-6 (October 1997): 323–26. http://dx.doi.org/10.1111/j.1365-2710.1997.tb00013.x.
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Aksha sharen Arul Edwin, Lakshmi T, and Karthik Ganesh Mohanraj. "Medical Emergency in Dental Clinic - An update." International Journal of Research in Pharmaceutical Sciences 11, SPL3 (September 18, 2020): 831–39. http://dx.doi.org/10.26452/ijrps.v11ispl3.3031.
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In general, one of the convincing methods to tackle an emergency is to be well-organized and prepared priory. The intention of the study is to analyze the availability of medical emergency procedures and equipment in dental clinics. Also, the aim is to determine the level of awareness, knowledge, perceptions, individual experiences and preparedness of the dental practitioners and dental students for the management of medical emergency situations in their hospitals or clinics. A cross-sectional survey based study was done from April to among 100 dental students in Chennai. The self-structured well-designed questionnaire containing the protocols and emergency procedures followed in their clinic. The questionnaire forms were circulated online through Google forms. The data from all the participants were collected and analyzed through SPSS software. In the present study, it was inferred that the majority of the population are aware about the medical emergencies in dental clinics (99%) and the remaining 1% of the population are not aware of it. The conclusion of this study is that the above statistical analysis about knowledge awareness on recent advances in the treatment of medical emergencies in dental clinics has provided an alarming situation about the capability of dentists to deal with such conditions for the betterment of patients .
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Rochow, S. B., A. D. Blackwell, and VJ Brown. "Quality of Life in Parkinson's Disease: Movement Disorders Clinic vs General Medical Clinic - A Comparative Study." Scottish Medical Journal 50, no. 1 (February 2005): 18–20. http://dx.doi.org/10.1177/003693300505000107.
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Objectives: to determine the effect of attending a movement disorders (MD) clinic on quality of life (QOL) outcomes for patients with Parkinson's disease (PD). Methods: Postal questionnaire study of forty-two patients with Parkinson's disease attending either a movement disorders clinic or more conventional general medical clinic were selected consecutively to complete the Parkinson's Disease Quality of Life Questionnaire (PDQL). All patients were diagnosed by a consultant physician with an interest in Parkinson's disease (S.B.R.) and had attended either the movement disorders clinic or the general medical clinic on at least three occasions. Questionnaires were completed independently of the examiners and returned by post. Results: Mean PDQL score was 124.1 [5.16] in the movement disorders clinic and 95.9 [5.86] in the general medical clinic. Analysis of covariance revealed that those subjects attending the MD clinic reported a significantly higher QOL than those subjects in general medical care (F(1,39)= 161.98, P<0.001). Conclusion: These data indicate that the quality of life of respondents attending the movement disorders clinic is significantly higher than those attending the general medical clinic.
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Kerry, TP, P. G. T. Cudahy, H. L. Holst, A. Ramsunder, and N. G. McGrath. "A doctor at a PHC clinic: A ‘must-have’ or ‘nice-to-have’?" South African Medical Journal 113, no. 1 (December 20, 2022): 24–30. http://dx.doi.org/10.7196/samj.2023.v113i1.16700.
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Background. Many patients have their healthcare needs met at primary healthcare (PHC) clinics in KwaZulu-Natal (KZN), without having to travel to a hospital. Doctors form part of the teams at many PHC clinics throughout KZN, offering a decentralised medical service in a PHC clinic.Objectives. To assess the benefit of having a medical doctor managing patients with more complex clinical conditions at PHC clinic level in uMgungundlovu District, KZN. Two key questions were researched: (i) were the patients whom the clinic doctors managed of sufficient clinical complexity that they warranted a doctor managing them, rather than a PHC nurse clinician? and (ii) what was the spectrum of medical conditions that the clinic doctors managed?Methods. Doctors collected data at all medical consultations in PHC clinics in uMgungundlovu during February 2020. A single-pagestandardised data tool was used to collect data at every consultation.Results. Thirty-five doctors were working in 45 PHC clinics in February 2020. Twenty-six of the clinic doctors were National HealthInsurance (NHI)-employed. The 35 doctors conducted 7 424 patient consultations in February. Staff in the PHC clinics conducted 143 421 consultations that month, mostly by PHC nurse clinicians. The doctors concluded that 6 947 (93.6%) of the 7 424 doctor consultations were of sufficient complexity as to warrant management by a doctor. The spectrum of medical conditions was as follows: (i) consultations for maternal and child health; n=761 (10.2%); (ii) consultations involving non-communicable diseases (NCDs), n=4 372 (58.9%) – the six most common NCDs were, in order: hypertension, diabetes, arthritis, epilepsy, mental illness and renal disease; (iii) consultations involving communicable diseases constituted 1 745 (23.5%) of cases; and (iv) consultations involving laboratory result interpretation 1 180 (15.9%).Conclusion. This research showed that at a PHC clinic the more complex patient consultations did indeed require the skills and knowledge of a medical doctor managing these patients. These data support the benefit of a doctor working at every PHC clinic: the doctor is a ‘musthave’ member of the PHC clinic team, offering a regular, reliable and predictable medical service.
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Francis, Maureen D., Whitney E. Zahnd, Andrew Varney, Steven L. Scaife, and Mark L. Francis. "Effect of Number of Clinics and Panel Size on Patient Continuity for Medical Residents." Journal of Graduate Medical Education 1, no. 2 (December 1, 2009): 310–15. http://dx.doi.org/10.4300/jgme-d-09-00017.1.
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Abstract Background Accreditation Council for Graduate Medical Education program requirements for internal medicine residency training include a longitudinal, continuity experience with a panel of patients. Objective To determine whether the number of resident clinics, the resident panel size, and the supervising attending physician affect patient continuity. To determine the number of clinics and the panel size necessary to maximize patient continuity. Design We used linear regression modeling to assess the effect of number of attended clinics, the panel size, and the attending physician on patient continuity. Participants Forty medicine residents in an academic medicine clinic. Measurements Percent patient continuity by the usual provider of care method. Results Unadjusted linear regression analysis showed that patient continuity increased 2.3% ± 0.7% for each additional clinic per 9 weeks or 0.4% ± 0.1% for each additional clinic per year (P = .003). Conversely, patient continuity decreased 0.7% ± 0.4% for every additional 10 patients in the panel (P = .04). When simultaneously controlling for number of clinics, panel size, and attending physician, multivariable linear regression analysis showed that patient continuity increased 3.3% ± 0.5% for each additional clinic per 9 weeks or 0.6% ± 0.1% for each additional clinic per year (P < .001). Conversely, patient continuity decreased 2.2% ± 0.4% for every additional 10 patients in the panel (P < .001). Thus, residents who actually attend at least 1 clinic per week with a panel size less than 106 patients can achieve 50% patient continuity. Interestingly, the attending physician accounted for most of the variability in patient continuity (51%). Conclusions Patient continuity for residents significantly increased with increasing numbers of clinics and decreasing panel size and was significantly influenced by the attending physician.
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Hua, Natalie T., Chia-Ding Shih, and David Tran. "Medical and Economic Impact of a Free Student-Run Podiatric Medical Clinic." Journal of the American Podiatric Medical Association 105, no. 5 (September 1, 2015): 418–23. http://dx.doi.org/10.7547/13-022.
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Background Data from the free student-run podiatric medical clinic at Clínica Tepati at the University of California, Davis, were used to analyze medical and economic impacts on health-care delivery and to extrapolate the economic impact to the national level. Clínica Tepati also provides an excellent teaching environment and services to the uninsured Hispanic population in the Greater Sacramento area. Methods In this analysis, we retrospectively reviewed patient medical records for podiatric medical encounters during 15 clinic days between November 2010 and February 2012. The economic impact was evaluated by matching diagnoses and treatments with Medicare reimbursement rates using International Classification of Diseases codes, Current Procedural Terminology codes, and the prevailing Medicare reimbursement rates. Results Sixty-three podiatric medical patients made 101 visits during this period. Twenty patients returned to the clinic for at least one follow-up visit or for a new medical concern. Thirty-nine different diagnoses were identified, and treatments were provided for all 101 patient encounters/visits. Treatments were limited to those within the clinic's resources. This analysis estimates that $17,332.13 worth of services were rendered during this period. Conclusions These results suggest that the free student-run podiatric medical clinic at Clínica Tepati had a significant medical and economic impact on the delivery of health care at the regional level, and when extrapolated, nationally as well. These student-run clinics also play an important role in medical education settings.
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Z, Clifford, Morrish P, Strait C, and Hinze S. "WED 031 Neuro hot clinics: direct access clinic for acute medical patients." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 10 (September 13, 2018): A5.2—A5. http://dx.doi.org/10.1136/jnnp-2018-abn.18.
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20% of acute medical patients present with neurological symptoms, yet are often managed by non-specialist acute physicians. This district general hospital (DGH) introduced a direct access neurology clinic, to reduce hospital admissions and improve access to neurological expertise for vulnerable patients. Patients would otherwise have been admitted to await ward consultation. 20 ‘Hot’ clinic appointments each week were allocated by administration prior to discharge from the medical admissions unit. All appointments were within 48 hours. Common diagnoses were migraine, first seizure, and non-epileptic attack disorder and rarer presentations included 5 with transverse myelitis, 1 with cerebral vasculitis, and 1 with Hepatitis E related encephalomyelopathy.243 patients were seen by a Consultant Neurologist in 9 months in this hot clinic, thus saving at least 243 bed days and £73 000. Only 4 of these patients were readmitted. The hot clinic required 4PAs of consultant time split across weekdays, at an estimated cost of £30 000 per annum.This neurology acute clinic successfully provided front door neurological input, a vital service for GPs and patients, and made approximate annual saving of £70 000. Evidently, every DGH should consider implementing neurology ‘hot’ clinics.
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Borre, Ethan D., Suephy C. Chen, Matilda W. Nicholas, Edward W. Cooner, Donna Phinney, Amanda Morrison, Natalie Combs, and Meenal Kheterpal. "Early Implementation and Evaluation of a Teledermatology Virtual Clinic Within an Academic Medical Center." Iproceedings 6, no. 1 (December 20, 2021): e35432. http://dx.doi.org/10.2196/35432.
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Background Teledermatology can increase patient access; however, its optimal implementation remains unknown. Objective This study aimed to describe and evaluate the implementation of a pilot virtual clinic teledermatology service at Duke University. Methods Leaders at Duke Dermatology and Duke Primary Care identified a teledermatology virtual clinic to meet patients’ access needs. Implementation was planned over the exploration, preparation, implementation, and sustainment phases. We evaluated the implementation success of teledermatology using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and prioritized outcome collection through a stakeholder survey. We used the electronic health record and patient surveys to capture implementation outcomes. Results Our process consisted of primary care providers (PCPs) who sent clinical and dermatoscopic images of patient lesions or rashes via e-communication to a teledermatology virtual clinic, with a subsequent virtual clinic scheduling of a video visit with the virtual clinic providers (residents or advanced practice providers, supervised by Duke Dermatology attending physicians) within 2-5 days. The teledermatology team reviews the patient images on the day of the video visit and gives their diagnosis and management plan with either no follow-up, teledermatology nurse follow-up, or in-person follow-up evaluation. Implementation at 4 pilot clinics, involving 19 referring PCPs and 5 attending dermatologists, began on September 9, 2021. As of October 31, 2021, a total of 68 e-communications were placed (50 lesions and 18 rashes) and 64 virtual clinic video visits were completed. There were 3 patient refusals and 1 conversion to a telephonic visit. Participating primary care clinics differed in the number of patients referred with completed visits (range 2-32) and the percentage of providers using e-communications (range 13%-53%). Patients were seen soon after e-communication placement; compared to in-person wait times of >3 months, the teledermatology virtual clinic video visits occurred on average 2.75 days after e-communication. In total, 20% of virtual clinic video visits were seen as in-person visit follow-up, which suggests that the majority of patients were deemed treatable at the virtual clinic. All patients who returned the patient survey (N=10, 100%) agreed that their clinical goals were met during the virtual clinic video visits. Conclusions Our virtual clinic model for teledermatology implementation resulted in timely access for patients, while minimizing loss to follow-up, and has promising patient satisfaction outcomes. However, participating primary care clinics differ in their volume of referrals to the virtual clinic. As the teledermatology virtual clinics scale to other clinic sites, a systematic assessment of barriers and facilitators to its implementation may explain these interclinic differences. Acknowledgments We are grateful to the Private Diagnostic Clinic and Duke Institute for Health Innovation for their support. Conflicts of Interest None declared.
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Ross, Jonathan D. C., and Jennifer Champion. "How are men with urethral discharge managed in general practice?" International Journal of STD & AIDS 9, no. 4 (April 1, 1998): 192–95. http://dx.doi.org/10.1258/0956462981922025.
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Chlamydia and gonorrhoea remain major causes of morbidity despite the availability of effective therapy. Because of the asymptomatic nature of many infections, particularly in women, active case finding is necessary to trace and offer screening and treatment to sexual contacts of those infected. Genitourinary medicine (GUM) clinics provide investigation and treatment for a variety of sexual health problems but the proportion of infections treated outside these clinics is unknown. A questionnaire survey of general practitioners (GPs) was used to examine the prevalence and management of male urethritis in Scotland. Responses were received from 277/347 (80%) of GPs. A median of one case/year of male urethritis was seen and screening for gonorrhoea and chlamydia was undertaken in 82% and 63% of cases not referred to a GUM clinic respectively. Six per cent of GPs attempted to trace sexual contacts. Twenty-nine per cent (60) of patients were not referred to a GUM clinic and increasing distance to the clinic was associated with non-referral. Eleven per cent (18) of patients objected to referral to a GUM clinic. There is scope to improve the management of male urethritis by providing greater support for GPs, encouraging clinic referral where possible and appropriate investigations and treatment when not.
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Gusman, Delfina, and Marryo Borry WD. "TUMPAH TINDIH DALAM PROSES PERIZINAN KLINIK PRATAMA DI DINAS PENANAMAN MODAL DAN PELAYANAN TERPADU SATU PINTU KOTA PADANG." UNES Law Review 1, no. 2 (December 26, 2018): 148–56. http://dx.doi.org/10.31933/law.v1i2.23.
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Clinics are health care facilities that provide individual health services that provide basic medical and / or specialist services. Primary Clinic is a clinic that provides basic medical services both general and special. To establish primary clinics until they can operate through a series of licensing processes, namely the Hinder Ordonnantie (HO) Permit, Clinical Establishment Permit (IMK) and Clinical Operational Permit (IOK). The results of the process are overlapping or suggesting requirements that make the process ineffective and inefficient
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Kukull, W. A., T. D. Koepsell, T. S. Inui, S. Borson, J. Okimoto, M. A. Raskind, and J. L. Gale. "Depression and physical illness among elderly general medical clinic patients." Journal of Affective Disorders 10, no. 2 (March 1986): 153–62. http://dx.doi.org/10.1016/0165-0327(86)90037-6.
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Roche, Laura, Saul Zepeda, Blair Harvey, Karen A. Reitan, and Raekiela D. Taylor. "Routine HIV Screening as a Standard of Care: Implementing HIV Screening in General Medical Settings, 2013-2015." Public Health Reports 133, no. 2_suppl (November 2018): 52S—59S. http://dx.doi.org/10.1177/0033354918801833.
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Objective: We implemented routine HIV screening as part of the 4-year Care and Prevention in the United States Demonstration Project, whose aim was to reduce HIV/AIDS–related morbidity and mortality among racial/ethnic minority groups in the United States. We describe the capacity-building efforts to implement routine HIV screening and provide lessons learned and implications for practice. Methods: From January 2013 through September 2015, the Public Health Institute of Metropolitan Chicago (PHIMC) implemented routine HIV screening in 7 health care systems in Illinois by providing capacity-building assistance focused on systems and operational infrastructure, staff member skills and organizational structure, and clinic culture. Each site received funding to integrate routine HIV screening into the existing clinic flow, engage the entire health care team in the process, and transform the system and shift clinic culture to sustain HIV screening. Results: All 7 systems established policies and procedures to implement routine screening, 5 systems integrated HIV test ordering and documentation into their electronic health records, and 4 systems established a third-party billing and reimbursement process for testing. The 7 systems conducted a total of 49 285 tests and identified 160 people living with HIV. The number of tests increased by more than 40% each year. Conclusions: PHIMC identified the following practices for consideration when implementing routine HIV screening in general medical settings: create a culture that supports HIV screening, use champions in clinics, integrate HIV screening into clinic flow and electronic health records, and train clinic staff members on HIV messaging. Incorporating these practices can help other clinical settings build capacity to make routine HIV screening a standard of care.
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Ziemer, David C., Christopher D. Miller, Mary K. Rhee, Joyce P. Doyle, Clyde Watkins, Curtiss B. Cook, Daniel L. Gallina, et al. "Clinical Inertia Contributes to Poor Diabetes Control in a Primary Care Setting." Diabetes Educator 31, no. 4 (July 2005): 564–71. http://dx.doi.org/10.1177/0145721705279050.
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Purpose The purpose of this study was to determine whether “clinical inertia”—inadequate intensification of therapy by the provider—could contribute to high A1C levels in patients with type 2 diabetes managed in a primary care site. Methods In a prospective observational study, management was compared in the Medical Clinic, a primary care site supervised by general internal medicine faculty, and the Diabetes Clinic, a specialty site supervised by endocrinologists. These municipal hospital clinics serve a common population that is largely African American, poor, and uninsured. Results Four hundred thirty-eight African American patients in the Medical Clinic and 2157 in the Diabetes Clinic were similar in average age, diabetes duration, body mass index, and gender, but A1C averaged 8.6% in the Medical Clinic versus 7.7% in the Diabetes Clinic (P < .0001). Use of pharmacotherapy was less intensive in the Medical Clinic (less use of insulin), and when patients had elevated glucose levels during clinic visits, therapy was less than half as likely to be advanced in the Medical Clinic compared to the Diabetes Clinic (P < .0001). Intensification rates were lower in the Medical Clinic regardless of type of therapy (P < .0001), and intensification of therapy was independently associated with improvement in A1C (P < .001). Conclusions Medical Clinic patients had worse glycemic control, were less likely to be treated with insulin, and were less likely to have their therapy intensified if glucose levels were elevated. To improve diabetes management and glycemic control nationwide, physicians in training and generalists must learn to overcome clinical inertia, to intensify therapy when appropriate, and to use insulin when clinically indicated.
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Pincavage, Amber T., Rabia R. Razi, Vineet M. Arora, Julie Oyler, and James N. Woodruff. "Resident Education in Free Clinics: An Internal Medicine Continuity Clinic Experience." Journal of Graduate Medical Education 5, no. 2 (June 1, 2013): 327–31. http://dx.doi.org/10.4300/jgme-d-12-00127.1.
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Abstract Background Most internal medicine (IM) residency programs provide ambulatory training in academic medical centers. Community-based ambulatory training has been suggested to improve ambulatory and primary care education. Free clinics offer another potential training setting, but there have been few reports about the experience of IM residents in free clinics. Objective We assessed the feasibility and acceptability of inclusion of an ambulatory rotation in a free clinic and IM residency curriculum and the advantages of the free clinic setting over the traditional ambulatory clinic model. Methods In 2010, the University of Chicago Internal Medicine Residency Program partnered with a free clinic in order to establish a community-based continuity clinic experience. To assess the feasibility of this innovation, 16 residents were surveyed 9 months after implementation of the clinic to determine satisfaction, perceived preparation to address common medical conditions, and attitudes toward the underserved care population. A subset of these responses was compared to responses from residents in the traditional clinic model. Results Residents in the free clinic rotation were more satisfied and perceived they were more prepared to work in low-resource settings and reported similar levels of preparation regarding common outpatient conditions than residents in a traditional continuity clinic format. They reported increased future likelihood of working in an underserved clinic. Conclusions Our exploratory study suggests free clinics may be an effective platform for community-based continuity clinic training.
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McCusker, Jane, Jean-Philippe Boulenger, Richard Boyer, François Bellavance, and Jean-Marc Miller. "Use of Health Services for Anxiety Disorders: A Multisite Study in Quebec." Canadian Journal of Psychiatry 42, no. 7 (September 1997): 730–36. http://dx.doi.org/10.1177/070674379704200705.
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Objective: We investigated patient characteristics and use of services for anxiety disorders among patients seeking care from participating clinicians at 7 anxiety clinics in Quebec: 3 general hospital clinics, 3 psychologist-run clinics, and one psychiatric hospital clinic. Methods: Persons eligible for the study were those who were visiting the clinics for the first time, had a current diagnosis of an anxiety disorder, and could communicate in French or English. Subjects recruited through advertisements were excluded. Data, collected by a self-administered questionnaire, included demographics, treatment history, use of services for anxiety, and the Beck Anxiety Inventory (BAI). Results: The sample comprised 235 subjects: 146 seen at 3 general hospital clinics, 54 at 3 psychologist-run clinics, and 35 at a psychiatric hospital clinic. There were statistically significant differences by clinic type in the prevalence of specific anxiety diagnoses, BAI score, referral source, antidepressant use, and use of services. High-intensity use (10 or more consultations during the previous year) was reported by 23.4% of the sample for medical services and 19.6% for mental health services. Multiple logistic regression identified variables associated with high-intensity use of medical services (higher BAI score, 1 to 4 years since first sought treatment, and less than 12 years of education) and high-intensity use of mental health services (clinic type, obsessive–compulsive disorder [OCD], and 5 or more years since first sought treatment). Conclusions: The patient populations seen at different types of anxiety clinics differ in several respects, including referral source, previous treatment, and severity of symptoms. Regardless of type of clinic, patients with a longer time since they first sought treatment use more services, particularly mental health services. Those with less education use more medical services than those with greater education.
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Cain, Steven M., Robert Moore, Lauren Sturm, Travis Mason, Caitlin Fuhrman, Robin Smith, Irfan Bojicic, and Brandon Carter. "Clinical assessment and management of general surgery patients via synchronous telehealth." Journal of Telemedicine and Telecare 23, no. 2 (July 9, 2016): 371–75. http://dx.doi.org/10.1177/1357633x16636245.
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Objective This paper describes how a clinical team at Landstuhl Regional Medical Center (LRMC) successfully integrated synchronous telehealth (TH) into their routine clinical practice. Methods and materials Synchronous TH encounters were performed using Polycom® software on surgeons’ computers with high-definition (HD) cameras on monitors at distant sites and PolyCom HDX9000® Telehealth Practitioner Carts at originating sites. Patients provided consented and were presented to general surgeons by nurses and medical technicians at Army health clinics throughout the European Theater. Results In calendar year (CY) 2014, five general surgeons and two surgical physician assistants (PAs) at Landstuhl Regional Medical Center along with registered nurses (RNs) at six originating clinic sites throughout Europe completed 130 synchronous TH encounters for 101 general surgery patients resulting in 73 completed and 16 recommended surgeries. Eighty-eight percent of patients had a completed or recommended surgery. No surgeries or procedures planned after initial TH evaluation were cancelled. Originating site clinics ranged in distance from 68 miles to 517 miles. Acceptance by providers, patients and clinic staff was high. Conclusion Synchronous TH was effective and safe in evaluating common general surgical conditions. We excluded sensitive and complex conditions requiring a nuanced physical examination. The TH efforts of the general surgery staff have resulted in high-quality, seamless and predictable TH activities that continue to expand into other surgical and medical specialties beyond general surgery. Seven surgeons and two PAs use synchronous TH regularly serving patients over a broad geographic area.
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Dobanovacki, Dusanka, Nada Vuckovic, Radmila Gudovic, Vladimir Sakac, Milanka Tatic, and Vesna Tepavcevic. "Development of the city hospital in Novi Sad - part II." Medical review 72, no. 7-8 (2019): 251–56. http://dx.doi.org/10.2298/mpns1908251d.
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At the end of the Second World War, the General State Hospital had seven departments, the same facilities, and the same bed capacity as in the pre-war period. In the newly formed state of Yugoslavia, intensive growth and modernization of the hospital began, despite the great financial difficulties. The hospital became the Main Provincial Hospital and new departments and services were established. Mainly during the 1960s and 1970s, ten new surgery departments were established, which later became independent clinics. The surgery departments occupied pavilions 1, 2, 3 and 4. Complex and contemporary abdominal and thoracic surgeries were performed. The Department of Internal Diseases became the Clinic of Internal Diseases and in 1964 it was moved to a newly equipped four-story building. The Clinic of Gynecology and Obstetrics was founded and it was moved into a modern, purpose-built facility with a 230 bed capacity for adult patients and 105 for newborns. Rapid progress has also been made in the development of the Clinic of Infectious Diseases, Clinic of Eye Diseases, Clinic of Ear, Nose and Throat Diseases, Neurology and Psychiatry Clinics, Clinic of Dermatovenereology Diseases, Medical Rehabilitation Clinic - as well as a modern laboratory, X-ray, blood transfusion, and polyclinic services. After the establishment of the Faculty of Medicine and the Clinical Center of Vojvodina, this large tertiary medical institution is the source of pride for Novi Sad. Founded 110 years ago, the hospital is still dedicated to providing better healthcare for patients.
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DAUBE, Jasper R. "Medical Education at Mayo Clinic (Mayo Medical School)." Journal of UOEH 13, no. 3 (1991): 207–15. http://dx.doi.org/10.7888/juoeh.13.207.
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Becker, JH. "Curriculum at the Scholl College. Toward mainstream medical education." Journal of the American Podiatric Medical Association 82, no. 6 (June 1, 1992): 300–303. http://dx.doi.org/10.7547/87507315-82-6-300.
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The Dr. William M. Scholl College of Podiatric Medicine in Chicago recently affiliated with a teaching hospital, the Illinois Masonic Medical Center, and used this alliance as a catalyst to effect a change in the clinical curriculum. The affiliation set up a joint venture to operate two clinics, one on Scholl College's traditional campus and one at the teaching hospital. At the hospital site, Scholl College students rotate through clinical externships in areas such as internal medicine, emergency medicine, and podiatric elective; podiatric and general medical residents assist in the tutelage of the students. At the Scholl College campus, beginning clinical students learn basic skills in a teaching clinic, then refine and further their skills in a comprehensive clinic under the guidance of faculty members. The faculty and administration at Scholl College have embraced the concept of mainstream medical education, and are striving to prepare podiatric physicians to practice 21st century medicine.
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SAMANTA, A., and S. ROY. "Referrals from General Practice to a Rheumatology Clinic." Rheumatology 27, no. 1 (1988): 74–76. http://dx.doi.org/10.1093/rheumatology/27.1.74.
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Abiodun, O. A. "A Validity Study of the Hospital Anxiety and Depression Scale in General Hospital Units and a Community Sample in Nigeria." British Journal of Psychiatry 165, no. 5 (November 1994): 669–72. http://dx.doi.org/10.1192/bjp.165.5.669.
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BackgroundThe utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depressive disorders in non-psychiatric units (medical & surgical wards; gynaecology & antenatal clinics of a teaching hospital) and a community sample in Nigeria was investigated.MethodA two-stage screening procedure was employed. This involved the use of GHQ–12/GHQ–30 and HADS against the criteria of a standardised (PSE schedule) psychiatric interview, with psychiatric diagnosis assigned in accordance with ICD–9 criteria.ResultsSensitivity for the anxiety sub-scale ranged from 85.0% in the medical and surgical wards to 92.9% in the ante-natal clinic, while sensitivity for the depression sub-scale ranged from 89.5% in the community sample to 92.1% in the gynaecology clinic. Specificity for the anxiety sub-scale ranged from 86.5% in the gynaecology clinic to 90.6% in the community sample, while specificity for the depression sub-scale ranged from 86.6% in the medical and surgical wards to 91.1 % in the ante-natal clinic and community sample. Misclassification rates ranged from 9.9% in the community sample to 13.2% in the medical and surgical wards. Relative Operating Characteristic (ROC) analyses showed the HADS and the GHQ–12 to be quite similar in ability to discriminate between cases (anxiety and depression) and non-cases.ConclusionsThe HADS is valid for use as a screening instrument in non-psychiatric units and although initially developed for use in hospital settings, it could be usefully employed in community settings of developing countries to screen for mental morbidity.
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Barańska, Agnieszka, Urszula Religioni, Bartłomiej Drop, Magdalena Bogdan, Anna Kłak, Andrzej Warunek, Jolanta Herda, Ewelina Firlej, and Piotr Merks. "Assessment of the Level of Satisfaction with Medical Care of Patients Treated in Osteoporosis Clinics as an Indicator of the Quality of Medical Care." International Journal of Environmental Research and Public Health 19, no. 12 (June 15, 2022): 7343. http://dx.doi.org/10.3390/ijerph19127343.
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The aims of this research are to assess the level of satisfaction with medical care among patients treated in osteoporosis clinics and to determine the relationship among the frequency of visits to the doctor, the duration of treatment, socio-demographic factors, and patient satisfaction with the medical care they receive. The study was conducted from August 2016 to July 2018 at osteoporosis clinics in eastern Poland. The study participants were 312 patients treated for osteopenia or osteoporosis. The authors utilized two research instruments: the PASAT POZ questionnaire and their own questionnaire. The results indicate that the duration of osteoporosis treatment is a factor that significantly influences the level of satisfaction with medical care: the longer the treatment time, the poorer the assessment of the clinic, and therefore, the lower the patient degree of satisfaction. Our analysis shows that women assess clinics more positively overall. Additionally, the higher the study participants’ age, the lower the general assessment of the clinic. A further analysis showed that respondents in better financial situations and with higher levels of education tended to assess clinics more favorably. The Pareto-Lorenz analysis indicated that the key element in general assessments of specialist clinics is the doctor. It is advisable for health service providers to monitor the quality of health care they are providing and make improvements. Therefore, further research is needed, especially in relation to chronic diseases such as osteoporosis.
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Coe, Antoinette B., Rebecca E. Bookstaver, Andrew C. Fritschle, Michael T. Kenes, Pamela MacTavish, Rima A. Mohammad, Robert J. Simonelli, Jessica A. Whitten, and Joanna L. Stollings. "Pharmacists’ Perceptions on Their Role, Activities, Facilitators, and Barriers to Practicing in a Post-Intensive Care Recovery Clinic." Hospital Pharmacy 55, no. 2 (January 28, 2019): 119–25. http://dx.doi.org/10.1177/0018578718823740.
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Background: Complex medication regimen changes burden intensive care unit (ICU) survivors and their caregivers during the transition to home. Intensive care unit recovery clinics are a prime setting for pharmacists to address patients’ and their caregivers’ medication-related needs. The purpose of this study was to describe ICU recovery clinic pharmacists’ activities, roles, and perceived barriers and facilitators to practicing in ICU recovery clinics across different institutions. Methods: An expert panel of ICU recovery clinic pharmacists completed a 15-item survey. Survey items addressed the pharmacists’ years in practice, education and training, activities performed, their perceptions of facilitators and barriers to practicing in an ICU recovery clinic setting, and general ICU recovery clinic characteristics. Descriptive statistics were used. Results: Nine ICU recovery clinic pharmacists participated. The average number of years in practice was 16.5 years (SD = 13.5, range = 2-38). All pharmacists practiced in an interprofessional ICU recovery clinic affiliated with an academic medical center. Seven (78%) pharmacists always performed medication reconciliation and a comprehensive medication review in each patient visit. Need for medication education was the most prevalent item found in patient comprehensive medication reviews. The main facilitators for pharmacists’ successful participation in an ICU recovery clinic were incorporation into clinic workflow, support from other health care providers, and adequate space to see patients. The ICU recovery clinic pharmacists perceived the top barriers to be lack of dedicated time and inadequate billing for services. Conclusions: The ICU recovery clinic pharmacists address ICU survivors’ medication needs by providing direct patient care in the clinic. Strategies to mitigate pharmacists’ barriers to practicing in ICU recovery clinics, such as lack of dedicated time and adequate billing for pharmacist services, warrant a multifaceted solution, potentially including advocacy and policy work by national pharmacy professional organizations.
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Hand (née Davies), Philippa R. "Non-medical prescribing of systemic anticancer therapy in a multidisciplinary team oncology clinic." British Journal of Nursing 28, no. 11 (June 13, 2019): 715–20. http://dx.doi.org/10.12968/bjon.2019.28.11.715.
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The number of people diagnosed and living with cancer in the UK continues to rise, placing increasing demands on specialist cancer care services. The incidence and prevalence of neuroendocrine tumours (NETs) has increased. An NET remains a rare cancer requiring specialist care and the clinical nurse specialist (CNS) team is ideally placed to support these patients. Oncology clinics are becoming increasingly pressured and the need to think of innovative ways of reducing pressure while maintaining and enhancing the patient's experience is important. A new multidisciplinary team (MDT) systemic anti-cancer therapy (SACT) clinic for NET patients was developed that incorporated a CNS SACT non-medical prescriber (NMP) to improve patient experience and reduce the number of oncologist clinic reviews. Methods and analysis: the clinic was designed and a protocol developed to help ensure safe practice and support for the CNS NMP. The patient experience was prioritised and the medical team was involved in the design. All NMP SACT prescriptions were reviewed and questionnaires were given to patients after 3 months. A questionnaire was also given to all oncologists within the clinic and to the oncology pharmacist for analysis. Findings: 29 SACT NMP prescriptions for 15 patients were written. Patient and medical colleague feedback was positive. Discussion: this experience has helped to highlight the positive impact of innovative clinics that combine the expertise of both independent nurse practitioners and the medical team. This has paved the way for further clinics of this kind within the author's trust and the NET service.
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Kochorova, L. V., A. A. Potapchuk, and V. V. Afanasieva. "A BRIEF HISTORY OF UNIVERSITY CLINICS IN RUSSIA AND IN THE WORLD." Scientific Notes of the I. P. Pavlov St. Petersburg State Medical University 25, no. 4 (April 21, 2019): 26–30. http://dx.doi.org/10.24884/1607-4181-2018-25-4-26-30.
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The article discusses the importance of university clinics and historical aspects of their development both abroad and in Russia. The history of the development of university clinics goes side by side with the development of medical education in general. The concept of university clinics has been laid down since the time of the ancient East. The European stage of the formation of university clinics dates back to the Middle Ages and the Renaissance period. Nowadays, university clinics work according to the model of cooperation between the university and the clinic, or according to the model of integration of the clinic into the university. In Russia, in fact, Peter the First laid the notion of university clinics that facilitated the opening of hospital schools. The importance of combining the educational and therapeutic process is proved. Thus, this combination improves the quality of medical care.
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Lyketsos, Constantine G., Anne Hanson, Marc Fishman, Paul R. McHugh, and Glenn J. Treisman. "Screening for Psychiatric Morbidity in a Medical Outpatient Clinic for HIV Infection: The Need for a Psychiatric Presence." International Journal of Psychiatry in Medicine 24, no. 2 (June 1994): 103–13. http://dx.doi.org/10.2190/urtc-aqvj-n9kg-0rl4.
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Objective: To ascertain the prevalence and type of psychiatric morbidity present in HIV infected patients presenting for the first time to a specialty HIV medical clinic. Also, to develop a way of screening for psychiatric cases in this setting using established self-report questionnaires. Method: Fifty patients who presented consecutively for medical care at the Johns Hopkins Hospital General HIV Clinic participated in this study. These patients were first screened using the General Health Questionnaire and the Beck Depression Inventory and subsequently underwent a comprehensive neuropsychiatric evaluation. Results: Fifty-four percent were found to suffer from a psychiatric disorder with an additional 22 percent from an active substance use disorder. These rates are one-and-one-half to two times higher than those reported from other medical clinics. The GHQ and BDI used together as screens could identify psychiatric “cases” with a sensitivity of 81 percent and a specificity of 61 percent, an efficacy similar to that found in other clinics. Conclusions: Given the high prevalence of psychiatric disorders in HIV infected patients presenting for medical care, screening, evaluating, and treating for these disorders is crucial and should be pursued systematically. This is best done through the presence of a psychiatric team within HIV medical clinics rather than in affiliation with such clinics.
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Conte, Hope R., Robert Plutchik, Katherine V. Wild, and Peter Buckley. "Medical School Stressors and Emotional Disturbance." Psychological Reports 57, no. 3_suppl (December 1985): 1192–94. http://dx.doi.org/10.2466/pr0.1985.57.3f.1192.
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Responses of 21 medical students requesting psychiatric evaluation at a personnel clinic were compared on a 33-item measure of stress with those of 25 medical students who had never been involved in psychiatric treatment. Items distinguishing clinic and comparison groups related to general psychological problems such as anxiety and difficulty concentrating on work rather than to problems related to the medical school experience per se, such as dealing with very sick people or worry over having to make life and death decisions.
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Vladut Ionut Feier, Catalin, Calin Muntean, Razvan Bardan, Andra Olariu, and Sorin Olariu. "Impact of Covid-19 pandemic on a general surgery clinic." Journal of Medicine and Life 15, no. 3 (March 2022): 415–19. http://dx.doi.org/10.25122/jml-2022-0087.
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The Covid-19 pandemic has had a massive impact on global health, social and economic well-being worldwide. In addition to the direct effects of the disease on patients infected with the virus, this pandemic has severely affected the activity of surgical clinics around the world. One of the significant issues was an important decrease in the number of surgeries performed even in countries with highly performant medical systems. This study aimed to analyze the effects of the pandemic on the 1st General Surgery Clinic in Timisoara County Hospital, compared to 2018–2019. In order to conduct this study, data regarding the activity of the clinic in the pandemic period and 2018–2019 was collected and analyzed from a statistical point of view, considering a p<0.05 as statistically significant. There were significant differences between the 2 periods regarding the number of hospitalized patients, the number of patients undergoing elective or emergency surgery, and the total number of surgeries performed. Due to the restrictions imposed, there was an increase in the average monthly mortality rate and a decrease in the average length of hospital stay. Covid-19 pandemic led to a severe activity restriction of the surgery clinics due to the restrictions imposed by the authorities and the reorganization of the clinics to comply with the epidemiological requirements. Also, the limitation of patients' access to surgical treatment and their fear of coming in contact with the hospital environment led to their presentation in more advanced stages of the disease, with more severe symptoms and a higher mortality rate during the pandemic.
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Abdullabekov, R. N., and M. A. Komissarova. "The concept of implementing a business plan for a mobile medical clinic." Manager Zdravoochranenia, no. 4 (April 1, 2022): 59–64. http://dx.doi.org/10.21045/1811-0185-2022-4-59-64.
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The article is devoted to the economic aspect of the concept of implementation and functioning of a mobile medical clinic (MMC). Despite the role of mobile medical clinics in providing medical assistance to the entire population, all social groups, the overall impact of mobile medical clinics has not often been the subject of research. The purpose of the study is to analyze the project of implementing the business plan of a mobile (mobile) medical clinic. Materials and methods. The presented business plan has a structure focused on the creation of mobile medical complexes on the territory of each subject of Russia. The introduction of such medical clinics is a necessary and important process within the framework of preserving the health and working capacity of the population. Important stages in the implementation of the business plan are: a legislative plan that includes the main regulations, a marketing plan that takes into account the segment of the services market and the demand for the planned price, and an organizational plan that includes an assessment of the total cost of the project and fixed costs. Results. In the article, the results show that the introduction of mobile medical clinics on the territory of the subjects of Russia will not only improve the state of health and improve the quality of care for people, but also improve the health of the population while reducing the growth rate of costs (within the framework of the all-Russian national strategy). In this regard, an organizational plan was developed that takes into account the fixed costs of the mobile clinic. Conclusion. The development of a business plan for the implementation of mobile medical clinics in the territory of each subject of Russia and the introduction of MMC programs into the healthcare system will increase the level of socio-economic well-being of the population.
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O'Neill, Winifred, James H. O'Boyle, Violet Harford, Conrad Cooper, Teresa Igoe, Martin Farrell, and Paula McKay. "I. A profile of attenders at psychiatric outpatient clinics in Ireland's Eastern Health Board Region." Irish Journal of Psychological Medicine 17, no. 1 (March 2000): 12–14. http://dx.doi.org/10.1017/s0790966700003967.
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AbstractObjectives: The aim of this study was to determine the profile of attenders at psychiatric outpatient clinics in community health centres in Dublin.Method: A chart review was undertaken retrospectively on attenders at two clinics in different socioeconomic areas. Demographic data and information on services was recorded. Psychiatric outpatient clinic functioning in a community setting was observed during the period of the study.Results: The findings of this study suggest that attenders at psychiatric OPD clinics are more likely to be long-term, in the 40-50 year age group, female, unemployed and eligible for free medical care within the General Medical Services (GMS). Mood (affective) disorders was the largest diagnostic category. There were financial barriers to patient discharge to primary care and shared care with general practitioners.Conclusions: Opportunitie s have been identified to improve communication and optimise patient flow through the psychiatric OPD system. Such improvements in clinic function would be likely to lead to enhanced health gain for attenders.
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Barreto Caldas, Luciano, Lucélia Batista Cunha Magalhães, and Luciene Lessa Andrade. "PERCEPÇÃO DE PACIENTES QUANTO À HUMANIZAÇÃO NO ATENDIMENTO MÉDICO." Revista Brasileira de Hipertensão 29, no. 2 (June 1, 2022): 37–43. http://dx.doi.org/10.47870/1519-7522/2022290237-43.
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Objective: To evaluate patients’ perception of humanization in medical care, regarding the integrality of the attendance and comparing the humanization of physicians from the FTC clinic with those from outside the FTC clinic. Methods: This was a descriptive, quantitative and cross-sectional study that was carried out with patients in the FTC Clinic – Ogunjá - Salvador /BA from December 2018 to May 2019. Data were obtained through the Patient-doctor relationship questionnaire (PDRQ-9). Results: The questionnaire was applied in 100 patients with mean age of 47.7 ± 14.1 years, the majority of them being female (70%). Regarding the statement related to the help provided by physicians, 42 (84%) patients who were already treated at the FTC clinic consider it as totally appropriate, in contrast only 26 (52%) patients who were never attended at the FTC clinic, consider the statement totally appropriate. Regarding the extent to which physicians are expansive and communicable, 50 (100%) patients who have already been seen at the FTC clinic consider this statement to be at least appropriate, while 16 (32%) participants from the other group judge as at most appropriate. Regarding the affirmative about the ease of access to the physician, the greatest discrepancy occurred in the presente study, when 49 (98%) patients who were already treatedat the FTC clinic declare this statement as atleast appropriate, where as 25 (50% %) patients who have never beenseenat the FTC clinic, judge as atmost appropriate. Conclusion: The physicians of the FTC clinic were better evalutated by their patients when compared too ther physicians in seven of the nine characteristics surveyed, which may berelated to the off erof the curriculum componente of humanism in the curriculum ofthe UNIFTC medical course, which comes contributing to the integrality of the doctor-patient relationship in the FTC clinic.
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Enggar Sulistiyono and Erlinda Sholihah. "PERANCANGAN MEDIA CETAK SEBAGAI MEDIA PROMOSI PADA KLINIK INSAN MEDIKA SEMARANG." Jurnal Ilmiah Teknik Informatika dan Komunikasi 1, no. 3 (October 15, 2021): 46–70. http://dx.doi.org/10.55606/juitik.v1i3.45.
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Clinic is a health service facility that provides individual health services that provide basic and/or specialist medical services, organized by more than one type of health worker (nurse and/or midwife) and led by a medical professional (doctor, specialist doctor, dentist or doctor). specialist dentist).
One of them is the Insan Medika Clinic which serves health services including General Practitioners, Pediatricians and Gynecologists, so that they become a reference for treatment for the community. Over time, the Government held the National Health Insurance Program (JKN) – BPJS.
The target market desired by the Insan Medika Clinic is not only from the lower classes but from all walks of life. With a very affordable price for a big city like Semarang, people flock to medical clinics for treatment. But in reality the Insan Medika Clinic is not well known. The lack of promotion is one of the reasons. The previous promotional media used only nameplates that were not able to reach the wider community.
Moving on from the needs and objectives above, it is necessary to promote this Insan Medika Clinic. In this case the author uses print media which will make it easier for the public to find out about the Insan Medika Clinic. Print media used are leaflets and flyers.
Keywords Business, Print Media, Promotional Media, Insan Medika Clinic Semarang
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Sreedharan, S., A. Hoi, N. Li, G. Littlejohn, R. Buchanan, M. Nikpour, E. F. Morand, and V. Golder. "POS0753 SUBSPECIALTY LUPUS CLINIC CARE IS ASSOCIATED WITH HIGHER QUALITY FOR PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 629.1–629. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2760.
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Background:Healthcare quality for systemic lupus erythematosus (SLE) is a modifiable target for improving patient outcomes. Disease-specific subspecialty clinics offer experienced healthcare professionals, collaborative multidisciplinary teams and streamlined care processes. A single centre study in the USA has suggested superior performance of the subspecialty lupus clinic in the provision of quality care (1), but this has not been examined outside the USA where access to care may be influential.Objectives:To assess the quality of SLE care provided in a subspecialty lupus clinic compared with hospital general rheumatology and private rheumatology clinics in a non-US, universal healthcare setting.Methods:Lupus patients (n = 258) were recruited in 2016 from various clinic settings in Australia, including a subspecialty lupus clinic (n = 147), two hospital general rheumatology clinics (n = 56) and two private clinics (n = 55). Quality of care was assessed using 31 validated SLE quality indicators (QI) encompassing diagnostic work-up, disease and comorbidities assessment, drug monitoring, preventative care and reproductive health (2,3). Data were collected from medical records and patient questionnaires. Overall and individual QI performance was calculated and compared between the three clinic settings, and multivariable regression was performed to adjust for sociodemographic, disease and healthcare factors.Results:Median [IQR] overall performance on eligible QIs was higher in the lupus clinic (66.7% [16.9]) than the hospital general rheumatology (52.7% [10.6]) and private rheumatology (50.00% [18.0]) clinics (p <0.01), and remained significant with multivariable adjustment. This trend was still observed when the overall performance was reassessed to include patient self-report (73.1% [14.8] vs 68.1% [11.5] vs 63.2% [13.4], p <0.01). This difference may be due to consistent formal assessments of disease activity (100% vs 0% vs 0%, p <0.01) and disease damage (95.9% vs 0% vs 0%, p <0.01) at the lupus clinic. Performance was high across all clinic settings for diagnostic work-up, comorbidity assessment, drug monitoring, prednisolone taper, osteoporosis management, lupus nephritis and pregnancy quality indicators. However, the lupus clinic significantly outperformed the other clinic settings on eligible quality indicators for new medication counselling, pre-immunosuppression hepatitis and tuberculosis screening, drug toxicity assessment, sun avoidance education, vaccinations, cardiovascular risk factor assessment and contraception counselling.Conclusion:SLE patients managed in a subspecialty lupus clinic received higher overall quality of care when compared to hospital general rheumatology and private rheumatology clinics. Regular assessment of QI performance can improve quality of care for patients in all clinic settings.References:[1]Arora, S et al. Does Systemic Lupus Erythematosus Care Provided in a Lupus Clinic Result in Higher Quality of Care Than That Provided in a General Rheumatology Clinic? Arthritis Care Res. 2018;70(12):1771-1777.[2]Mosca, M et al. Development of quality indicators to evaluate the monitoring of SLE patients in routine clinical practice. Autoimmune Rev. 2011;10(7):383-8.[3]Yazdany, J et al. A quality indicator set for systemic lupus erythematosus. Arthritis Rheum. 2009;61(3):370-7.Disclosure of Interests:None declared
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Alanazi, Zaid, Nawaf Almutairi, Latifah AlDukkan, Amr A. Arafat, and Monirah A. Albabtain. "Time in therapeutic range for virtual anticoagulation clinic versus in-person clinic during the COVID-19 pandemic: a crossover study." Annals of Saudi Medicine 42, no. 5 (September 2022): 305–8. http://dx.doi.org/10.5144/0256-4947.2022.305.
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BACKGROUND: COVID-19 infection affects the quality of the medical services globally. The pandemic required changes to medical services in several institutions. We established a virtual clinic for anticoagulation management during the pandemic using the Whatsapp application. OBJECTIVES: Compare anticoagulation management quality in virtual versus in-person clinics. DESIGN: A retrospective crossover study SETTINGS: Specialized cardiac care center PATIENTS AND METHODS: The study included patients who presented to Prince Sultan Cardiac Center in Riyadh for anticoagulation management during the pandemic from March 2020 to January 2021. We compared time in therapeutic range (TTR) in the same patients during virtual and in-person clinics. All international normalized ratio (INR) measures during the virtual clinic visits and prior ten INR measures from the in-person clinic were recorded. Patients who had no prior follow-up in the in-person clinic were excluded. MAIN OUTCOME MEASURE: TTR calculated using the Rosendaal method. SAMPLE SIZE: 192 patients RESULTS: The mean age was 58.6 (16.6) years and 116 (60.4%) were males. Patients were diagnosed with atrial fibrillation (n=101, 52.6%), mechanical mitral valve (n=88, 45.8%), mechanical aortic valve (n=79, 41%), left ventricular thrombus (n=5, 2.6%) and venous thromboembolism (n=8, 4.2%). Riyadh residents represented 56.7% of the study population (n=93). The median (IQR) percent TTR was 54.6 (27.3) in the in-person clinic versus 50.0 (33.3) ( P =.07). CONCLUSION: Virtual clinic results were comparable to in-person clinics for anticoagulation management during the COVID-19 pandemic. LIMITATIONS: Number of INR measures during the virtual clinic visits, retrospective nature and single-center experience. CONFLICT OF INTEREST: None.
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Terenteva, Alexandra, Antonina Ukhova, and Irina Okolnishnikova. "IMPROVING THE OPERATION OF A CALL CENTER IN THE PAID MEDICAL SERVICES MARKET FROM THE PERSPECTIVE OF MARKETING." Bulletin of the South Ural State University series "Economics and Management" 15, no. 4 (2021): 164–70. http://dx.doi.org/10.14529/em210417.
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In this article, the authors have substantiated the importance of the role of a call center in the activities of paid medical clinics as the first point of contact of patients with a medical institution. The authors have presented a marketing analysis of the work of a call center of a paid medical clinic on the example of OOO Medical Clinic “FMC”. In order to analyze and develop directions for improving the work of the call center employees of the paid medical clinic, quantitative per-formance indicators and emotional intelligence of call center employees have been assessed, and the key success factors have been analyzed. Based on the results of the analysis, the authors have identified key areas for improving the work of the call center using the tools of internal mar-keting. Moreover, the place and role of the tools of internal marketing in the marketing communi-cations system in the paid medical services market has been substantiated.
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Husain, Nusrat, Imran Chaudhry, S. Afsar, and Francis Creed. "Psychological distress among patients attending a general medical outpatient clinic in Pakistan." General Hospital Psychiatry 26, no. 4 (July 2004): 277–81. http://dx.doi.org/10.1016/j.genhosppsych.2004.03.005.
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Simons, Richard J., Elizabeth Imboden, and Juliann K. Mattel. "Patient attitudes toward medical student participation in a general internal medicine clinic." Journal of General Internal Medicine 10, no. 5 (May 1995): 251–54. http://dx.doi.org/10.1007/bf02599880.
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Febriani, Patrisia. "TANGGUNGJAWAB HUKUM USAHA KLINIK KESEHATAN DI KOTA TARAKAN TERHADAP SEGALA RESIKO USAHA." JURNAL AKTA YUDISIA 6, no. 1 (November 3, 2021): 53–73. http://dx.doi.org/10.35334/ay.v6i1.2205.
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Abstract This study investigated the legal liability of health clinics in the city of Tarakan for all business risks in terms of the Health Act, the Consumer Protection Act and the Minister of Health’s Regulation on Clinics. As one of many health facilities in Indonesia, clinic is easily accessible by the community. Clinical patients are not only protected by the Health Act but also by the Consumer Protection Act. Clinics as providers of health services are responsible for the actions of health workers to their patients because of the relationship between patients and clinics, which is that the clinic guarantees that every health worker who does his work in the clinic will do his best to heal patients. By basing that the importance of the Informed Concent in medical action, the rights of patients are more respected and protected. The results of the study suggest that clarity of rules and consistency of policies must be increased because they have a huge impact on public trust in the government so that responses to health services will be well coordinated. Doctors / health workers must be more responsible for medical actions that will / have been carried out in the context of fulfilling health services to patients in order to foster an honest and responsible attitude for all health workers who perform health services in the clinic.
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Qureshi, Khawar Hussain, Syed Hasan Danish, and Farah Ahmed. "Glycemic Control Among Type 2 Diabetics: Comparison of Patients Coming to Specialized Clinics vs General Clinics for Diabetes." Pakistan Journal of Medical & Health Sciences 16, no. 9 (September 30, 2022): 987–90. http://dx.doi.org/10.53350/pjmhs22169987.
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Objective: To analyze the difference of glycemic control (Mean HBA1c) between patients consulting at specialized Diabetic clinic and those coming to usual general practices. Study Design: Quasi Experimental study Place and Duration: OPDs of general Practice clinics and Outpatient department of a specialized diabetes clinic at Sialkot for 3 months. Methodology: Total n=250 patients were inducted using consecutive sampling technique carried for 3 months. The sample was divided into two groups “Diabetes Specialist clinics” (n=125) and with traditional setup without a team approach as “general practice clinics” (n=125).In this study patients included were of both gender with age group comprising > 40 years and history of T2Dm for at least one year. Type1 dm, gestational diabetes and those without signing consent were excluded. Data was collected using structured questionnaire by primary investigator after informed consent and at the end of three months the difference of means of HBa1c of two different groups. Analysis was done on SPSS version 22 using independent sample t-test. Mean and standard deviation were taken for numerical data, while for categorical data, percentages and frequency were taken out. Statistically significant p value was viewed as < 0.05. Results: When Independent T Test was applied, in specialist clinic HBA1c was 8.51±1.23 whereas in General practice clinic it was 9.57±1.62 with statistically significant difference (p value 0.000). When ANOVA applied to see differences in HBA1c among those with primary, secondary, Intermediate and graduate level education, statistically insignificant results were found (p value 0.373). Likewise, when compared by duration of diabetes, statistically insignificant results were found (p value 0.379). Results were statistically insignificant (p value 0.95), when compared based on rural and urban residence. Conclusion: The study shows statistically significant difference in glycemic control (HBA1c) levels between those coming to general practice clinics and those consulting at specialized diabetic clinics. Keywords: Diabetes, Diabetes Specialist clinic, HbA1C
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Kubina, Natalia, Dmitry Kashparov, Lyudmila Puryzhova, and Irina Kravchenko. "Innovative approach to University clinics positioning in sustainable economic development concept in conditions of changing challenges." E3S Web of Conferences 291 (2021): 03003. http://dx.doi.org/10.1051/e3sconf/202129103003.
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The issues related to the development of university medicine in connection with the emerging epidemiological situation and trends for the future are becoming more and more relevant in both research and practical aspects all over the world. The experience of university clinics abroad has been sufficiently studied, however, in Russia, the process of formation and development of medical clinics at leading Federal Universities has begun recently, and is not active enough. Currently, there are no more than 10 university clinics in the country, their experience, functioning mechanisms and contribution to the general results of a healthcare development has not yet been summarized and described in the scientific literature. At the same time, the scientific description and study of the issues of University clinics as medical institutions of a special type capable of providing high-tech medical services to the population and solving the issues of human resources for developing medicine are very relevant and significant in implementing the sustainable economic development concept in the conditions of changing challenges. Based on the analysis of the experience of foreign University clinics, an attempt is made to study the model and generalize the experience of University clinics formation in Russia in order to identify the main problems and prospects for their development. Without pretending to cover the whole range of problems associated with the development of university medicine, the main objective of the study is the issues of an innovative approach to the formation concept of medical centers positioning on the platform of a “University Clinic” brand. Using the example of the University Clinic - Clinical and Diagnostic Center of Immanuel Kant Baltic Federal University (CDC IKBFU) the process of forming the concept of University clinic positioning was described; a situational analysis of the medical services market was carried out in order to identify the problems in sustainable growth goal-setting; possible approaches to the choice of the positioning concept of the University Clinic were analyzed; the concept of the CDC positioning on the platform of the “University Clinic” brand was proposed; a model of a “pyramid of values” was built for a medical organization of this type; an innovative approach to the formation of the clinic’s media policy was proposed; the recommendations were developed to implement the concept of the platform of the “University Clinic” brand positioning in the online environment in the information openness context. The findings obtained make it possible to continue the study of a whole range of issues, both scientific, methodological and practical, concerning the substantiation of an effective model for University clinics functioning; solving organizational, managerial and legislative aspects related to their departmental subordination, coordination of the ministries of education and healthcare, the sources of their funding, the forms of state support and others.
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Van Hemert, Albert M., Michiel W. Hengeveld, Jan H. Bolk, Harry G. M. Rooijmans, and Jan P. Vandenbroucke. "Psychiatric disorders in relation to medical illness among patients of a general medical out-patient clinic." Psychological Medicine 23, no. 1 (February 1993): 167–73. http://dx.doi.org/10.1017/s0033291700038952.
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SynopsisIn many patients clinical care in general medical settings is complicated by the presence of psychiatric disorders in addition to the presenting physical symptoms. In the present study the prevalence and type of psychiatric disorders was assessed in relation to the medical diagnostic findings in a general internal medicine out-patient clinic. The Present State Examination, a standardized psychiatric interview, was used to detect psychiatric disorders in 191 newly referred patients. Psychiatric disorders were found to be particularly prevalent among patients with medically ill-explained or unexplained symptoms. The prevalence of psychiatric disorders was 15% for patients with a medical explanation for their presenting symptom, 45% for patients with ill-explained and 38% for those with unexplained symptoms. Approximately 40% of the patients with psychiatric disorders met DSM-III-R criteria for somatization disorder or hypochondriasis, suggesting that these disorders contributed in particular to general medical out-patient referrals.
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Nurss, Joanne R., Imad M. El-Kebbi, Daniel L. Gallina, David C. Ziemer, Victoria C. Musey, Stephanie Lewis, Qinghong Liao, and Lawrence S. Phillips. "Diabetes in Urban African Americans: Functional Health Literacy of Municipal Hospital Outpatients With Diabetes." Diabetes Educator 23, no. 5 (October 1997): 563–68. http://dx.doi.org/10.1177/014572179702300508.
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Functional health literacy was assessed in 63 patients from the diabetes outpatient clinic, 20 from the general medicine clinic, and a total of 48 from two satellite medical clinics. All patients received a demographic questionnaire, visual screening, and the Test of Functional Health Literacy in Adults, an instrument with good validity and internal consistency used to measure the ability to read and understand medical instructions. Functional health literacy was adequate in only 47% of new patients at the diabetes clinic and only 25% of established patients at all sites. There were no significant differences in functional health literacy among established patients across all sites. Overall, patients' mean functional health literacy level was inadequate to marginal. Of the patients with inadequate functional health literacy, 43%, denied difficulty in reading. Patient education strategies and materials are needed to address this important barrier to healthcare delivery.
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Sharma, R., S. L. Halder, M. Zachos, C. Radoja, C. Grant, U. Chauhan, E. Brackenridge, et al. "A66 THE IMPACT OF A MULTIDISCIPLINARY ADOLESCENT AND YOUNG ADULT (AYA) INFLAMMATORY BOWEL DISEASE (IBD) ON CLINIC NO SHOW RATES." Journal of the Canadian Association of Gastroenterology 5, Supplement_1 (February 21, 2022): 76–77. http://dx.doi.org/10.1093/jcag/gwab049.065.
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Abstract Background Transitioning from pediatric to adult health care is associated with significant psychosocial and clinical morbidity. Adolescents not only transition their medical care, but also experience vast changes in the physical, social, and psychological spheres of their lives. The medical team must help navigate these changes to provide optimal care. IBD in adolescence is associated with increased hospitalizations and surgery. This is due to several factors, including medication non-adherence and a failure to attend medical appointments. There has been a greater focus on improving care for this unique population. McMaster Children’s Hospital has integrated the AYA IBD clinic for patients between the ages of 16 and 22. The goal is to transition patients using a developmentally appropriate framework to facilitate self-efficacy and help identify comorbid mental health conditions while building resilience. Aims To explore the impact of the implementation of a dedicated transition clinic on attendance at medical visits for AYA patients with IBD. Methods The total numbers of patients booked in the AYA IBD Clinic was compared to an age matched subset of the patients in the adult McMaster Complex IBD (CIBD) Clinic. These visits were assessed based on whether the visit was: attended, cancelled, or no showed. Visits were then stratified between in-person and virtual visits. Unpaired t tests was performed to compare the AYA IBD clinic and the CIBD clinic. Findings were deemed significant based on p-values <0.05. Results The percentages of patients that attended visits (in-person or virtually) was similar between both clinics at 86% versus 79% Year 1 (Y1) and 76% versus 81% Year 2 (Y2). The number of patients seen in the AYA clinic increased from Y1 (n=92) to Y2 (n=131). The CIBD clinic saw fewer patients between Y1 (n=202) and Y2 (n=79). There were a higher number of patients who cancelled or no showed in Y2 versus Y1 for the AYA virtual visits (13 versus 8) compared to the CIBD clinic (Y2,1 versus Y1,1). Conclusions Our results highlight the challenges of transitioning adolescent patients with IBD. Our retrospective study was not powered to show significance. Given the increase in cancellation and no-show rates in Y2, the AYA clinic has incorporated a patient navigator to issue reminder phone calls and facilitate communication with patients between clinics. Future studies will re-assess how the presence of a patient navigator impacts attendance and cancellation rates. Future studies will also assess how the AYA clinic impacts transition readiness and self-efficacy, which is being measured through validated questionnaires in our clinic. Funding Agencies Grants-In-Aid
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Loh, Lik, and Susan Dovey. "Who attends Dunedin's free clinic? A study of patients facing cost barriers to primary health care access." Journal of Primary Health Care 7, no. 1 (2015): 16. http://dx.doi.org/10.1071/hc15016.
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INTRODUCTION: Several methods of reducing the cost barrier to primary health care have been implemented in New Zealand, but research about free primary health care and the patients who use such services is scarce. AIM: To compare the characteristics of patients at Dunedin's free clinic with those at a traditional general practice clinic. METHODS: A written survey was distributed to waiting room patients at the Free Clinic and a fee-charging clinic in close proximity. Patient records were accessed to determine health services utilisation rates at both clinics and the discounting rate at the traditional clinic. RESULTS: There were 126 patient surveys returned at the Traditional Clinic and 65 at the Free Clinic. There was a significantly greater proportion of Maori respondents at the Free Clinic than at the Traditional Clinic (24.1% versus 9.2%, p=0.011). The difference in deprivation profiles of Free Clinic and Traditional Clinic respondents was more marked for the individual deprivation measure (five or more NZiDep deprivation characteristics: 65.5% versus 13.3%, p<0.001) than for residential area deprivation (NZDep2006 quintile 5: 41.4% versus 15.8%, p<0.001). Emergency department presentation rates were high for Free Clinic patients, despite free primary care access and high general practitioner consultation rates. Among Traditional Clinic respondents, 31.7% reported deferring health care because of cost in the previous 12 months. The equivalent figure for Free Clinic respondents was 63.8%. DISCUSSION: This survey suggests that Dunedin's Free Clinic serves a vulnerable population, in whom levels of unmet health need and health service usage are high. KEYWORDS: Disparities, health care; fees, medical; health care surveys; health services research; primary health care; vulnerable populations
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Lin, Ming-Hwai, Hsiao-Ting Chang, Tzeng-Ji Chen, and Shinn-Jang Hwang. "Why people select the outpatient clinic of medical centers: a nationwide analysis in Taiwan." PeerJ 8 (August 27, 2020): e9829. http://dx.doi.org/10.7717/peerj.9829.
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Introduction In contrast to other countries, Taiwan’s National Health Insurance (NHI) program allows patients to freely select the specialists and tiers of medical care facility without a referral. Some medical centers in Taiwan receive over 10,000 outpatients per day. In the NHI program, the co-payment was increased for high-tier facilities for outpatient visits in 2002, 2005, and 2017. However, the policies only mildly reduced the use of high-tier medical care facilities. The main purpose of this study was to evaluate the factors contributing to the patients’ selection of the outpatient clinic of medical centers without a referral. Methods An online anonymous survey was conducted by using the Google Forms platform utilizing a self-constructed questionnaire from September to October 2018. A nationwide sample in Taiwan was recruited using convenience sampling through social media. Based on a literature review and a focus group, 20 factors that may affect the choice of the outpatient institution were constructed. The associations between items that affect the patients selection of outpatient clinics were assessed using exploratory factor analysis. Principal axis factoring was performed to identify the major factors affecting the decision. Multiple logistic regression was performed to determine which factors satisfactorily explained “visiting the outpatient clinic of the medical center for an illness without a referral.” Results During the survey period, 5,060 people browsed the online survey, and 1,003 responded and completed the online questionnaire. Therefore, the response rate was 19.8%. A total of 987 valid responses was collected. Exploratory factor analysis revealed that three main factors, namely the “physician factor”, “image and reputation factor”, and “facility and medication factor”, affected the selection of outpatient clinics. A series of logistic regressions indicated that patients who reported that hospital facilities, high-quality drugs, and diverse specialties were very important were more likely to select the outpatient clinic of a medical center (OR = 2.218, 95% CI [1.514–3.249]). Patients who reported that physician factors were very important were less likely to select a medical center (OR = 0.717, 95% CI [0.523–0.984]). Patients who were previously satisfied with their experience of the primary clinics or had a regular family doctor were less likely to choose a medical center (OR = 0.509, 95% CI -0.435–0.595] and OR = 0.676, 95% CI [0.471–0.969]). Conclusion In Taiwan, patients with good primary medical experience and regular family physicians had significantly lower rates by selecting the outpatient clinic of a medical center. The results of this study support that the key to establishing graded medical care is to prioritize the strengthening of the primary medical system.
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Shilts, Mical K., L. Karina Diaz Rios, Katherine H. Panarella, Dennis M. Styne, Louise L. Lanoue, Christiana M. Drake, Lenna Ontai, and Marilyn S. Townsend. "Feasibility of Colocating a Nutrition Education Program into a Medical Clinic Setting to Facilitate Pediatric Obesity Prevention." Journal of Primary Care & Community Health 12 (January 2021): 215013272110096. http://dx.doi.org/10.1177/21501327211009695.
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Purpose: Within a medical clinic environment, pediatric obesity prevention education for families faces challenges. Existing long-term government-funded nutrition education programs have the expertise and staff to deliver. The purpose is to determine feasibility of colocating the Expanded Food and Nutrition Education Program (EFNEP) into a medical clinic setting to support pediatric obesity prevention. Methods: Physicians from a large university teaching and research hospital (n = 73) and 4 small Medicaid-serving community clinics (n = 18) in the same geographic area in northern California were recruited and trained in the patient-referral protocol for a primary prevention intervention provided by EFNEP. The 8-week intervention deployed in the medical clinics, included general nutrition, physical activity and parenting topics anchored with guided goal setting and motivational modeling. Referral, enrollment, and attendance data were collected for 2 years. Parent and physician feasibility surveys, parent interviews and parent risk assessment tools were administered. Paired-sample t-test analysis was conducted. Results: Twenty intervention series with parents of patients (n = 106) were conducted at 5 clinics. Physicians (n = 92) generated 686 referrals. Every 6 referrals generated 1 enrolled parent. Physicians (91%, n = 34) reported the intervention as useful to families. Parents (n = 82) reported improved child behaviors for sleep, screen time, physical activity, and food and beverage offerings ( P < .0001) and at family mealtime ( P < .001). Focus group interviews (n = 26) with 65 participants indicated that parents (97%) reacted positively to participating in the intervention with about a third indicating the classes were relevant to their needs. Conclusion: The intervention is a feasible strategy for the 5 medical clinics. Physicians referred and parents enrolled in the intervention with both physicians and parents indicating positive benefits. Feasibility is contingent upon physician awareness of the intervention and motivation to refer patients and additional EFNEP and clinic staff time to enroll and keep parents engaged.