Data from the IBISWorld Industry Report Urgent Care Centers in the US, March 2014 show that the urgent care market can be segmented by the source of payment for services. On the basis of data from the U.S. Census Bureau, IBISWorld finds that the main sources of revenue for urgent care are private insurance, Medicare, patients (out-of-pocket payments), and Medicaid. Private insurance accounted for about 54.8% of industry revenue in 2014. Many private insurance companies …
Read MoreAbstracts in Urgent Care: March, 2015
Strict Rest Unnecessary After Concussion Key point: strict rest after a concussion offers no advantage over standard stepwise return to play. Citation: Thomas DG, Apps JN, Hoffmann RG, et al. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics 2015;135:213–223. Concussion treatment has been frequently debated. In this prospective study, patients with concussion were treated with either strict rest for 5 days or standard stepwise return to play. A total of 88 …
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Is It Measles or Something Else?
Urgent message: Although measles was declared eliminated in the United States in 2000, outbreaks continue to occur, with unvaccinated travelers most often being the carriers and transmitting the disease to clusters of unvaccinated individual residents. Overview and Current Outbreak According to the World Health Organization, 145,700 people around the world died of measles in 2013, which equates to 400 deaths per day or 16 deaths per hour. Measles remains one of the leading causes of …
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Boy with Leg Rash, Knee Pain, and Abdominal Pain
This photograph was taken of a 6-year-old boy who presented with a rash on his legs. Two weeks earlier, he had an upper respiratory infection. His father said that he had 2 weeks of fever and headache before the rash began. The boy also reported knee pain and diffuse abdominal pain. On physical examination, purpuric papules were apparent on his lower extremities. View the image taken (Figure 1) and consider what your diagnosis would be.
Read MoreMedical Boards: Part 2
JESSICA HOFFMANN, MS-4, and JOHN SHUFELDT, MD, JD, MBA, FACEP The probability that you will receive a certified letter from your medical board informing you about an investigation is relatively low. But one day, you may be one of the unlucky souls who receives such a letter. What do you do? Different boards have different rules about what gets reviewed or investigated and what does not. Some boards are mandated to investigate, at least to …
Read MoreDeveloping Data: February, 2015
Abstracts in Urgent Care: February, 2015
Duration of Troponin Testing for ACS Key point: No definitive evidence for the 2-hour troponin rule-out for ACS. Citation: Kelly A–M, Klim S. Prospective external validation of an accelerated (2-h) acute coronary syndrome rule-out process using a contemporary troponin assay. Int J Emerg Med. 2014 Oct 16. doi: 10.1136/emermed-2014-204442. [Epub ahed of print.] As with other serious diseases, ruling out acute coronary syndrome (ACS) is a balance between not missing it and over testing or …
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Serious Pathology Masquerading as Chronic Back Pain
Urgent message: Do not be fooled by the diagnosis made by clinicians before you. Many seemingly benign symptoms can be harbingers of more serious pathology. JESSICA HOFFMANN, MS-4, and JOHN SHUFELDT, MD, JD, MBA, FACEP Chronic back pain is a common presentation in both the urgent care and emergency department (ED) settings. Care-on-demand providers often find themselves deciding how extensive a workup to do for a patient with acute-on-chronic back pain. After a patient has …
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Medication Issues in Urgent Care
Urgent message: Polypharmacy—taking multiple medications to treat several chronic medical problems—puts patients at increased risk of developing additional health issues when they are prescribed even more medications for acute conditions in an urgent care center. JASMEET SINGH BHOGAL, MD It is not uncommon for patients, especially elderly patients, presenting to an urgent care center to have multiple medical problems. This makes it more likely that they are taking multiple medications as well. In fact, according …
Read MoreEvaluating Chest Pain in Urgent Care— “Catch 22 and the Three Bears”: Part 1
Lee A. Resnick, MD, FAAFP What can Joseph Heller and Goldilocks teach us about managing no-win situations in urgent care? As it turns out, if you look under the covers of Baby Bear’s bed, you might find something meaningful, perhaps even something that’s “just right.” Take the classic no-win situation when patients present to urgent care with chest pain. Without a definitive and reliable test to guide our decision making, we are stuck with the …
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