SEAN M. McNEELEY, MD Differentiate Bacterial from Viral to Decrease Unneeded Antibiotic Prescriptions Key point: The overprescribing of antibiotics is still an issue. Citation: Jones BE, Sauer B, Jones MM, et al. Variation in outpatient antibiotic prescribing for acute respiratory infections in the veteran population: a cross-sectional study. Ann Intern Med. 2015;163:73–80. Concerns over the amount of antibiotic prescriptions continues. (See also “Delayed Prescribing of Antibiotics for Respiratory Tract Infections” in our September 2015 issue: http://www.jucm. …
Read MoreProtecting Patient Privacy in the Cloud
K Royal, JD, CIPP/E, CIPP/US Urgent message: The shift in medical practice from written charts to integrated digital platforms has dramatically increased the visibility, size, and magnitude of health-care information breaches. There are specific steps urgent care operators should take with vendors to protect patient information in this new technological environment. The news makes it seem that data breaches occur on a fairly regular basis. The Ponemon Institute even named 2014 as the year of …
Read MoreValue-Based Reimbursement Is Premature, But That Won’t Stop It
Lee A. Resnick, MD, FAAFP Private payor reimbursement trends nearly always follow Medicare’s lead, and at no other time in history has the physician reimbursement model been so scrutinized. In an attempt to control unwieldly healthcare spending, payors are understandably looking to be creative. When they look at the drivers for increased health spending, one thing is clear: Diagnostic testing and imaging services grew far faster since 2000 than any other health-care service. According to …
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Managing Hypertensive Emergencies in the Urgent Care Setting
Urgent message: Health-care practitioners frequently see patients in urgent care centers who have elevated blood pressure. It is vital that they be able to identify hypertensive emergencies to immediately start lowering such patients’ blood pressure and then transfer them to an emergency department, to avoid hypertensive damage to the brain, heart, and kidneys. JON JUHASZ, MD Introduction Elevated blood pressure (BP) is very common in the urgent care setting, oftentimes from pain or from chronic …
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Mixed Martial Arts Injuries
Urgent message: Because typical participants in mixed martial arts are young and healthy, many present to urgent care settings with a clear musculoskeletal injury and no other medical problems. Do not be distracted by the most obvious injury. Injuries from atypical mechanisms of injury are common in mixed martial arts and should be considered when evaluating a patient who has sustained injuries while participating in the sport. DEENA R. ZIMMERMAN, MD, MPH, IBCLC; NAHUM KOVALSKI, …
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Fever Phobia: Urgent Fears in Urgent Care
Urgent message: Fear of fever leads many parents to seek urgent care. Addressing their fears should be part of the care of febrile children. DEENA R. ZIMMERMAN, MD, MPH, IBCLC; NAHUM KOVALSKI, MD; BARUCH HAIN, BA; and JOSHUA LIPSITZ, PHD In several studies, researchers have found that a large percentage of parents have fever phobia, or inaccurate beliefs about the harmfulness of an elevated body temperature. Those studies were conducted in primary-care settings, so we …
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Improving the Patient Experience by Thinking Differently About Waiting
Urgent message: Attracting and retaining urgent care patients entails more than reducing the total duration of patient waits. It also requires understanding and managing patient expectations and perceptions of waiting. MICHAEL BURKE, MBA, and GARRETT BOMBA, MD People often respond irrationally in waiting situations. How else can we explain the fact that people are routinely more satisfied with a clearly explained 30-minute wait than with an uncertain 20-minute wait? It is not rational, but it …
Read MoreClinical Challenge: October, 2015
This feature will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected]. Case A 12-year-old presents with severe ankle pain and swelling after twisting an ankle while jumping off a tree limb. View the image taken (Figure 1) and consider what …
Read MoreOctober 2015
Top 3 Blood Tests Performed at U.S. Urgent Care Centers in 2014
Data from the 2014 Urgent Care Chart Survey of 1,778,075 blinded visits by patients to more than 800 different urgent care clinics, conducted by the Journal of Urgent Care Medicine, reveal that the top 3 blood tests performed at U.S. urgent care centers in 2014 were as follows, in descending order: • Comprehensive metabolic panel—3.15 million tests • Glucose level—1.23 million tests • Thyroid-stimulating hormone level—1.19 million tests The survey’s methodology and data abstraction forms …
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