ObjectiveTo analyze the characteristics of outpatients in Neurological Department in different periods and to provide guidance on medical decision-making for Neurological Department. MethodOutpatients treated between August and September 1994 (group 1994) and between August and September 2012 (group 2012) in the Department of Neurology of a general hospital were included in our study. Group 1994 had 1 000 consecutive patients; while group 2012 had 18 995 patients excluding those repeat visitors, patients waiting to be treated (including dizziness), patients misdiagnosed to have severe mental diseases (such as schizophrenia), and patients with physical diseases. Then we compared the demographic and disease distribution of patients in the two groups, and performed statistical analysis. ResultsCompared with the year 1994, the year 2012 had more female, less young and more elderly patients (P<0.05). The constituent ratio of neurosis, cerebrovascular disease, internal medicine diseases with nerve damage, peripheral nerve disease, brain post-traumatic syndrome, intracranial space-occupying lesions reduced significantly while headache, epilepsy, extrapyramidal disease (such as Parkinson's disease) increased significantly (P<0.01) with no obvious change of constituent ratio of muscle disease, neuropathic muscular dystrophy, spinal cord, brain atrophy and dementia diseases. ConclusionsThere are significant changes in characteristics of neurology clinical patients between 1994 and 2012. Revelation of these differences can provide evidence for the optimization of outpatient resources allocation and the prevention policy.
ObjectiveTo understand the experiences of out-patient services of the elderly patients, and to analyze the impact factors of the satisfaction of elderly patients, so as to produce evidence for healthcare quality improvement. MethodsBased on the data collected from the out-patient survey of the 2015 Evaluation of the National Healthcare Improvement Initiative, we compared the disparities of patient satisfaction among different age-groups, between different geographic regions and different types of hospitals. We conducted multivariate binary logistic regression analysis to identify factors, associated with the satisfaction of the elderly outpatients. We also compared satisfaction of the Chinese elderly patients with healthcare services with other countries. ResultsSatisfaction scores of the Chinese elderly out-patients were statistically significant higher than that of the young and middle aged out-patients in the domains of hospital environment (satisfaction score=4.42), process efficiency (satisfaction score=4.20), and overall satisfaction (satisfaction score=4.47) (P < 0.001). On the contrary, the elderly out-patients were less satisfied in the domain of hospital informationization experience (satisfaction score=4.25) than the young and middle aged out-patients. This was also the case for the three indicators under this domain, including convenient appointment (satisfaction score=4.27), diversified payment methods (satisfaction score=4.24) and self-service devices (satisfaction score=4.26) (P < 0.001). Western region and traditional Chinese hospitals had significantly lower elderly outpatient satisfaction comparing with eastern and central regions, and general & specialist hospitals (P < 0.05). Trustful doctor-patient relationship (OR=3.45), respected and comfortable care (OR=1.45), clear and reliable mechanism and channel for praise and complain (OR=1.39), length of communication time with doctors (OR=1.35) and length of waiting time until consultation is acceptable (OR=1.29) were the major factors associated with the overall satisfaction of the elderly out-patients. The overall satisfaction of the Chinese elderly out-patients is a bit lower than that in our neighboring country Japan. The satisfaction towards length of communication with doctors of the Chinese elderly patients is lower than that in most of the industrialized countries. ConclusionSpecial demands of the elderly patients should be carefully considered by hospitals in the process of developing new appointment methods and hospital informationization with the aim of healthcare improvement. Longer communication time with doctors, shorter waiting time until consultation, improving human care and building efficiency mechanism and channel for praise and complain are the priorities for future healthcare improvement.
ObjectiveTo assess the feasibility and safety of percutaneous transcatheter closure of atrial septal defect (ASD) guided by transthoracic echocardiography (TTE) in outpatients.MethodsFrom December 2016 to June 2018, 50 simple ASD patients underwent TTE-guided transcatheter closure in the outpatient operating room of our hospital (a TTE group) including 22 males and 28 females at the age of 16-48 (27.40±6.95) years. Fifty patients with simple ASD treated with the guidance of conventional fluoroscopy during the same period were treated as a control group, including 22 males and 28 females at the age of 15-48 (28.58±6.96) years. Both groups were re-examined by TTE during follow-up at 1 month, 3 months, 6 months and 1 year.ResultsThe mean age, body weight, the size of ASD and occluder and success rate had no statistical difference between the two groups (P>0.05). Compared with the control group, the TTE group had significantly lower mean operation time (P<0.01) and less cost (P<0.01) since patients need not to be hospitalized. No related complications were found in the TTE group during follow-up.ConclusionPercutaneous transcatheter closure of ASD guided by TTE appears safe and effective for outpatients, and can significantly reduce the cost.
【摘要】 目的 了解成都市综合医院门诊患者抑郁障碍和焦虑障碍的患病率及门诊医生的识别率。 方法 2007年4-5月应用医院焦虑抑郁量表（Hospital Anxiety and Depression Scale，HADS）、患者健康问卷（Patient Health Questionnaire 15-Item，PHQ-15）对在四川大学华西医院和华西第二医院神经内科、消化内科、妇科和心血管内科门诊就诊的685例患者进行筛查。HADS≥8分者进入精神科访谈，由精神科医生使用国际神经精神科简式访谈问卷进行诊断。 结果 综合医院门诊患者抑郁障碍校正后的现患率和终身患病率分别为19.26%和22.32%，焦虑障碍校正后的现患率和终身患病率分别为9.16%和9.63%。各科患病率不同，科室间患病率的差异有统计学意义。门诊医生的识别率为10.57%。 结论 成都市综合医院门诊患者抑郁障碍和焦虑障碍的患病率较高，识别率有待提高。【Abstract】 Objective To investigate the prevalence of depressive disorders and (or) anxiety disorders and physicians’ detection rate of these disorders in general hospitals in Chengdu. Methods From April to May, 2007, a hospital-based cross-sectional survey was conducted in neurology, gastrointestinal, gynecology and vasculocardiology departments in West China Hospital and West China Second Hospital. Outpatients were screened by using Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire 15-Item (PHQ-15). Psychiatrists interviewed subjects whose score of HADS were 8 and above and made diagnoses by using Mini International Neuropsychiatric Interview (MINI) according to the criteria of Diagnostic and Statistical Manual of Mental Health Disorders 4th Edition (DSM-IV). Results The adjusted current and lifetime prevalence of depressive disorders were 19.26% and 22.32%, respectively, and those of anxiety disorders were 9.16% and 9.63%, respectively. The prevalence of depressive disorders and/or anxiety disorders among four departments had statistically significant difference. The detection rate of these disorders by outpatient physicians was 10.57%. Conclusion Prevalence of depressive disorders and anxiety disorders among outpatients in West China Hospital and West China Women and Children Hospital is high, and the rate of physicians’ detection needs to be improved.
ObjectiveTo explore the disability of social function of gastrointestinal outpatients with depressive or anxiety disorders in general hospitals. MethodsA multicenter cross-sectional study was conducted from May to June in 2007. A total of 1 995 subjects from 13 general hospitals in China were screened by using the Hospital Anxiety and Depression Scale (HADS). The subjects scored≥8 on HADS were diagnosed via the Mini International Neuropsychiatric Interview by psychiatrists. The Sheehan Disability Scale (SDS) was used to assessed patients' disability of life, work, and social intercourse aspects. Then, compared the subjective quality of life, number of doctor visits, and monthly loss of working days between outpatients with and without depressive or anxiety disorders in last six months. Further, compared the social dysfunction between patients with depression/anxiety disorders (the case group) and without depression/anxiety disorders (the control group) in functional disorders group and organic disease group of gastroenterology respectively. ResultsIn comparison to the control group, the case group had much higher score of SDS, including life, work, and social intercourse (P<0.05) aspect and had more doctor visits and loss of more working days (P<0.05). In functional disorders group of gastroenterology, the case group had much higher score of SDS, including life, work, and social intercourse (P<0.05) aspect and had more doctor visits, loss of more working days (P<0.05) compared with those in the control group. In organic disease group of gastroenterology, the case group had much higher score of SDS, including life, work, and social intercourse (P<0.05) aspect and had loss of more working days (Z=-4.307, P<0.001) compared with those in the control group. ConclusionFor the patients with functional disorders or organic disease of gastroenterology, the depressive and anxiety disorders may lead to the disability of social function.