It is hypothesized that the number of outpatient visits can be represented by three different probability models: the truncated Poisson distribution, the Zeta distribution and the logarithmic series distribution. Maximum likelihood estimates of parameters of the above distributions were obtained by using grouped data according to the number of visits. A goodness-of-fit test was also made to compare the fit of the three distributions and the value of this statistic was classified and compared according to the types of medical care facilities. Based on the likelihood ratio statistic as a test criterion, both the truncated Poisson and Zeta distributions were not appropriate for the model of the number of outpatient visits. However, the logarithmic series distribution provides a good fit to data in the case of university hospitals, general hospitals and hospitals. When we apply this distribution in the 10 most common diseases, the estimates of the parameter vary from 0.39567 to 0.54176 for university hospitals, from 0.45329 to 0.65387 for general hospitals, and from 0.55104 to 0.77625 for hospitals. On the other hand in the case of clinics, even the logarithmic series distribution cannot be fitted to the data well. A characteristic of clinic utilization with almost homogeneous treatment patterns, in spite of the fact that there are a great many clinics, could be the reason for the above results.
Ambulatory Care Facilities/utilization* ; Dermatitis, Contact ; Gastrointestinal Diseases ; Human ; Korea ; Probability ; Respiratory Tract Infections

Ambulatory Care Facilities ; utilization ; Asthma ; diagnosis ; prevention & control ; Child ; Humans ; Mass Screening

INTRODUCTIONChronic kidney disease (CKD) is a major public health problem in Singapore. Efforts are being made to right-site CKD care (stage 1 to 3) from specialist outpatient clinics (SOCs) to general practitioners (GPs) to ease congestion. This study aims to identify factors influencing screening and management of CKD among GPs in Singapore.

MATERIALS AND METHODSA survey was conducted among the 1202 GPs between April and September 2010. The survey questionnaire was developed in collaboration with experts in nephrology and general practice, it included questions about screening, awareness and management of CKD.

POPULATION STUDIEDGPs registered with the National Healthcare Group General Practitioner (NHG GP) partner database.

RESULTSThree hundred and two GPs completed the survey. A total of 70% of the respondents were males and with their median years of practice as 18. A total of 86% of them reported screening for CKD while 50% of GPs were confident of managing patients with CKD stage 1; and 38% of GPs are aware of CKD guidelines. Majority of GPs (64%) agreed that right-siting of early CKD patients would ease congestion at SOCs. Some of the obstacles in CKD management listed by the GPs were lack of patient trust, experience and communication with the specialist and the inability of the patient to pay.

CONCLUSIONGPs screen patients for CKD, however their awareness of guidelines is limited. Opportunities exist for improving physician recognition of CKD, awareness of CKD guidelines, improving collaborative care and reimbursement for the patient and the provider. This study has identified factors which when addressed could lead to wider acceptance of CKD right-siting by both the patients and the GPs.

Ambulatory Care Facilities ; utilization ; Female ; General Practice ; Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Practice Patterns, Physicians' ; statistics & numerical data ; Renal Insufficiency, Chronic ; diagnosis ; therapy ; Singapore

INTRODUCTIONIncreasing demand for public healthcare and access to specialist care has become a major concern. Characterising the referral pattern to a national centre's cardiology specialist outpatient clinics (SOCs) and the diagnostic outcomes may be useful in formulating referral guidelines to contain rising demand.

MATERIALS AND METHODSA prospective observational followup study was conducted of all consecutive new patient referrals to the cardiology SOCs of the National Heart Centre over a 1-month period. The records of these 1224 patients were reviewed following their first visit and again after 3 months of evaluation and investigation. Patients' demographics, referral sources, indications of referral, risk factors, provisional and final diagnoses were collected. Referrals from the top 2 volume sources (government polyclinics and hospital Emergency Department) accounted for 600 referrals. These subsidised referrals formed the study group for analysis.

RESULTSThe mean age of referred patients was 56 +/- 15.2 years, with equal proportion of males and females. Most patients had known cardiac risk factors of hypertension (53.2%) and hyperlipidaemia (42.3%). Only 23% of referrals had significant cardiac abnormalities. Referrals for typical chest pain derived the highest yield whereas referrals for atypical chest pain, non-cardiac chest pain derived the lowest yield. Referrals for asymptomatic electrocardiogram (ECG) changes (except for atrial flutter/fibrillation) did not yield cardiac abnormalities. Multivariate analysis of chest pain referrals showed typical chest pain and hyperlipidaemia to be statistically significant predictors for coronary artery disease.

CONCLUSIONReferrals to cardiology outpatient specialist clinics should be based on the presence of patient symptoms, particularly that of typical chest pain. In asymptomatic patients, routine ECG screening did not appear to yield significant cardiac abnormalities.

Adult ; Aged ; Ambulatory Care Facilities ; Cardiology ; Cardiovascular Diseases ; diagnosis ; physiopathology ; Female ; Health Services Needs and Demand ; Humans ; Male ; Medicine ; Middle Aged ; Prospective Studies ; Referral and Consultation ; economics ; utilization ; Singapore ; Specialization

Climate change has been referred to as one of the greatest threats to human health, with reports citing likely increases in extreme meteorological events. In this study, we estimated the relationships between temperature and outpatients at a major hospital in Qingdao, China, during 2015-2017, and assessed the morbidity burden. The results showed that both low and high temperatures were associated with an increased risk of outpatient visits. High temperatures were responsible for more morbidity than low temperatures, with an attributed fraction (AF) of 16.86%. Most temperature-related burdens were attributed to moderate cold and hot temperatures, with AFs of 5.99% and 14.44%, respectively, with the young (0-17) and male showing greater susceptibility. The results suggest that governments should implement intervention measures to reduce the adverse effects of non-optimal temperatures on public health-especially in vulnerable groups.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ambulatory Care/statistics & numerical data* ; Cardiovascular Diseases/therapy* ; Child ; Child, Preschool ; China/epidemiology* ; Cold Temperature/adverse effects* ; Cost of Illness ; Digestive System Diseases/therapy* ; Facilities and Services Utilization/statistics & numerical data* ; Female ; Hot Temperature/adverse effects* ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Poisson Distribution ; Respiratory Tract Diseases/therapy* ; Risk Factors ; Young Adult