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      The epidemiology and treatment of conjunctivitis at Urgent Care Centres in Israel

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          Abstract

          Purpose: Conjunctivitis is the most common ocular condition diagnosed at emergency departments (ED) in the USA, although it is generally not an emergent condition. Treatment of conjunctivitis at Urgent Care Centres (UCC) could offer lower cost than ED. This study describes the demographics and outcomes of a cohort presenting with conjunctivitis to a nationwide UCC system.

          Methods: This retrospective study included 17 branches of UCC. Electronic Medical Record data (November 2015–October 2016) of patients diagnosed with conjunctivitis or ocular disorder were retrieved. Data included gender, age, diagnosis, treatment, discharge status and temperature. Patients without conjunctivitis, presenting to UCC during this period served as the control. Results were compared to all ED patients in Israel (from a public report). Descriptive statistics, Chi-square and Z-proportion test were used.

          Results: Altogether, 602,074 patients presented to UCC, of which 5,045 (0.84%, 95% CI 0.74–0.94%) were diagnosed with conjunctivitis. Conjunctivitis was more prevalent among young males (0–14, p<0.001) and older females. The conjunctivitis cohort at UCC was significantly younger than the ED cohort ( p<0.01). UCC treated and released home 96.7% (95% CI 96.2–97.2%) of cases. This is significantly higher than the treatment rate for the entire UCC cohort (93.2%, CI 93.2–93.3%, p<0.05). Treatment in most cases (82.0%, 95% CI 80.9–83.0%) involved the prescription of ocular antibiotic.

          Conclusion: Similar to previous studies at ED, conjunctivitis patients are primarily young males. Most patients were treated with antibiotics at UCC and released home. This suggests that UCC may be a good venue for treatment of conjunctivitis.

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          Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses.

          Ateev Mehrotra, Hangsheng Liu, John L Adams … (2009)
          Retail clinics are an increasingly popular source for medical care. Concerns have been raised about the effect of these clinics on the cost, quality, and delivery of preventive care. To compare the care received at retail clinics for 3 acute conditions with that received at other care settings. Claims data from 2005 and 2006 from the health plan were aggregated into care episodes (units that included initial and follow-up visits, pharmaceuticals, and ancillary tests). After 2100 episodes (700 each) were identified in which otitis media, pharyngitis, and urinary tract infection (UTI) were treated first in retail clinics, these episodes were matched with other episodes in which these illnesses were treated first in physician offices, urgent care centers, or emergency departments. Enrollees of a large Minnesota health plan. Enrollees who received care for otitis media, pharyngitis, or UTI. Costs per episode, performance on 14 quality indicators, and receipt of 7 preventive care services at the initial appointment or subsequent 3 months. Overall costs of care for episodes initiated at retail clinics were substantially lower than those of matched episodes initiated at physician offices, urgent care centers, and emergency departments ($110 vs. $166, $156, and $570, respectively; P 0.05 vs. retail clinics). In emergency departments, average prescription costs were higher and aggregate quality scores were significantly lower than in other settings. A limited number of quality measures and preventive care services were studied. Despite matching, patients at different care sites might differ in their severity of illness. Retail clinics provide less costly treatment than physician offices or urgent care centers for 3 common illnesses, with no apparent adverse effect on quality of care or delivery of preventive care. California HealthCare Foundation.
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            Characterising non-urgent users of the emergency department (ED): A retrospective analysis of routine ED data

            Colin O’Keeffe, Suzanne Mason, Richard M Jacques … (2018)
            Background The pressures of patient demand on emergency departments (EDs) continue to be reported worldwide, with an associated negative impact on ED crowding and waiting times. It has also been reported that a proportion of attendances to EDs in different international systems could be managed in settings such as primary care. This study used routine ED data to define, measure and profile non-urgent ED attendances that were suitable for management in alternative, non-emergency settings. Methods We undertook a retrospective analysis of three years of Hospital Episode and Statistics Accident Emergency (HES A&E) data for one large region in England, United Kingdom (April 1st 2011 to March 31st 2014). Data was collected on all adult (>16 years) ED attendances from each of the 19 EDs in the region. A validated process based definition of non-urgent attendance was refined for this study and applied to the data. Using summary statistics non-urgent attenders were examined by variables hypothesised to influence them as follows: age at arrival, time of day and day of week and mode of arrival. Odds ratios were calculated to compare non-urgent attenders between groups. Results There were 3,667,601 first time attendances to EDs, of which 554,564 were defined as non-urgent (15.1%). Non-urgent attendances were significantly more likely to present out of hours than in hours (OR = 1.19, 95% CI: 1.18 to 1.20, P<0.001). The odds of a non-urgent attendance were significantly higher for younger patients (aged 16–44) compared to those aged 45–64 (odds ratio: 1.42, 95% CI: 1.41 to 1.43, P<0.001) and the over 65’s (odds ratio: 3.81, 95% CI: 3.78 to 3.85, P<0.001). Younger patients were significantly more likely to attend non-urgently out of hours compared to the 45–64’s (OR = 1.24, 95% CI: 1.22 to 1.25, P<0.001) and the 65+’s (OR = 1.38, 95% CI: 1.35 to 1.40, P<0.001). 110,605/554,564 (19.9%) of the non-urgent attendances arrived by ambulance, increasing significantly out of hours versus in hours (OR = 2.12, 95% CI: 2.09 to 2.15, P<0.001). Conclusions Younger adults are significantly more likely as older counterparts to use the ED to obtain healthcare that could be provided in a less urgent setting and also more likely to do this out of hours. Alternative services are required to manage non-urgent demand, currently being borne by the ED and the ambulance service, particularly in out of hours.
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              Ophthalmic emergencies in a district general hospital casualty department.

              Jeremy Edwards (1987)
              A survey of ophthalmic emergencies attending the casualty department of a district general hospital over a 12-month period is presented. The total number of new casualty attendances was 30,649 of which 1870 (6.1%) presented with an ophthalmic problem. There was a 3 to 1 male to female preponderance and a peak age of presentation between 20 and 30 years. The main aetiological factors were trauma 65.6% and inflammation 21.7%. Of the trauma patients 80% had sustained minor trauma (abrasions or foreign material to the cornea or conjunctiva) and of the patients with inflammation 71% had either conjunctivitis or blepharitis. There was a trend towards increased numbers in the summer months. The percentage of patients with inflammatory disease was higher in the early summer and the winter months. Nine of the 11 patients with acute angle closure glaucoma presented between November and February. All patients were initially seen by the accident and emergency medical staff, who were able to treat 69% without further consultation. No serious pathology was overlooked. It is suggested that, in the district general hospital setting, co-operation between the eye and the accident and emergency departments can be to their mutual benefit.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Ophthalmol
                Journal ID (iso-abbrev): Clin Ophthalmol
                Journal ID (publisher-id): OPTH
                Journal ID (pmc): clinop
                Title: Clinical Ophthalmology (Auckland, N.Z.)
                Publisher: Dove
                ISSN (Print): 1177-5467
                ISSN (Electronic): 1177-5483
                Publication date (Electronic): 02 May 2019
                Publication date Collection: 2019
                Volume: 13
                Pages: 771-779
                Affiliations
                [1 ]Department of Optometry, Hadassah Academic College , Jerusalem 9101001, Israel
                [2 ]TEREM Emergency Medical Centers , Jerusalem 9546303, Israel
                Author notes
                Correspondence: Einat ShneorDepartment of Optometry, Hadassah Academic College , 37 Hanevi'im Street, 910100, Jerusalem, IsraelTel +97 252 876 7060Fax +972 625 0619Email eshneor@ 123456hac.ac.il
                Author information
                http://orcid.org/0000-0002-1946-832X
                http://orcid.org/0000-0002-7698-3408
                http://orcid.org/0000-0002-7842-5071
                Article
                Publisher ID: 202362
                DOI: 10.2147/OPTH.S202362
                PMC ID: 6504553
                SO-VID: b5873477-4e63-4d6b-882a-4f79b876dda2
                Copyright © © 2019 Gordon-Shaag et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 21 January 2019
                Date accepted : 04 March 2019
                Page count
                Figures: 2, Tables: 4, References: 25, Pages: 9
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: conjunctivitis,urgent care centers,emergency department,public health
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: conjunctivitis, urgent care centers, emergency department, public health

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