1. Mobility of Unidade Pediátrica do Porto's patients across different health institutions Final Presentation Class 13 03-05-2007

2. INTRODUCTION Increased interest for information and communication technologies (Yoo S,2006) People resort to different institutions Scattered clinical data Redundant clinical data (Katehakis, 2001; Lambrinoudakis, 2000)

3. INTRODUCTION Patients resort to more than one medical institution Repeated medical exams and anamnesis Patient's data is spread in all places where they have received clinical services [Katehakis, 2001] In: hospitals, private clinics, pharmacies... [Lambrinoudakis, 2000] Error in medicine is frequent and results in substantial harm [Bates DW, 2001]

4. INTRODUCTION Solutions that integrate data are necessary [Yoo S, 2003] The physical location of a patient record can be replaced by a virtual one by linking databases from the different health institutions attended [van Bemmel, 1998] When used, computer-based decision support significantly improved decision quality [Coeira, 2004] Helped reducing the frequency and consequences of errors in medical care: CPOE – Computerized Physician Order Entry - reduces medication errors up to 81% [Koppel R, 2005] In some cases medication errors increased [Bates DW, 2001]

5. INTRODUCTION Data integration Increased coordination of information and correction of gaps in communication in cases where patients are receiving shared care, which involves more that one physician [Branger PJ, 1994, 1995] Fundamental due to the higher number of interdisciplinary practice and tests [Wyatt, 1998] Improves quality and reduction of health care cost [Kahn MG, 1997]] Improves safety and efficiency of clinical care [Shapiro, 2006] Leads to the creation of large databases of deidentified aggregate data for research [Shapiro, 2006]

6. INTRODUCTION The application of new systems may bring some problems: difficulty felt by some emergency physicians to remember passwords time required to search for the information [Overhage JM, 2002]

7. INTRODUCTION Children Vulnerability; unpredictable behavior One of the groups who requests more health services (Scanaill NC,2006) Parental protection Different specialists Second opinion Visits to several institutions

8. INTRODUCTION Assessing the number of institutions visited by children as well as the proportion that goes to a second health care centre is an issue of major importance as it may allow, in the future, a conclusion about the number of people that would benefit from generalized electronic patient records

9. AIM The aim of this study is to assess the mobility of UPP's (Porto’s Paediatrics Unit) patients among different healthcare institutions (hospitals, private clinics and community health centres)

10. METHODS Study design This study is transversal and retrospective Data collection is done in a single moment by interviews, to parents of attendants in the UPP, about events occurred since January of 2006 until 8th, 11th and 12th March 2007 The study population consisted of children attending the Paediatric Emergency of Porto (children with or under the age of 13). A total of 151 individuals accompanying children who attended UPP, were approached in the waiting room to answer the designed questionnaire about the patient

11. METHODS Data collection methods A questionnaire was applied on 8th, 11th and 12th March (a Sunday and two working days), two shifts a day, between 8 to 10 a.m. and 8 to 10 p.m Three interviewers in the waiting room of UPP, approached people who were accompanying children The first stage of the interview was to explain the purposes of the study and ask a consent declaration (elaborated by the Ethics Commission) to be signed. The next stage was to proceed with the questionnaire

12. METHODS Data collection methods Everyone who entered in the emergency room during the shifts was accounted for The questionnaire was applied to all individuals, except the ones who refused to answer or entered directly to be attended; some of the questionnaires were incomplete because in the meantime, the interviewed was called by the doctor. Refusing to answer was the only exclusion criteria considered; even the incomplete questionnaires were included in the study. The interviews lasted about 5 minutes each

13. METHODS Questionnaire design Eleven questions were developed and tested on investigators relatives who fitted the profile. Some adjustments were made until the final questionnaire was obtained. Data collected from the interviews included questions about the person who was answering (profession, kinship, and years of school) and about the child they were accompanying (age, address, gender) The remaining questions were the purpose of our study - type and number of health institutions visited since January 2006: hospitals, health centres and private clinics

14. RESULTS TNPUPP: 151 ED: 25SWR: 126 RA: 6AA: 120 ACQ: 112 (valid ones) IQ: 8 TNPUPP: total number of people that entered UPP ED: entered directly the doctor’s room SWR: stayed in the waiting room RA: refused to answer AA: accepted to answer ACQ: answered the complete questionnaire IQ: incomplete questionnaire Participants

15. RESULTS Age Distribution Living place distribution

16. RESULTS Qualifications of the persons responsible for the attendants Employment of the people responsible for the attendants Taxa Nacional de desemprego

17. RESULTS Number of visits to UPP Percentage of transfers from other institutions Mobility

18. RESULTS Number of transfers Total 0123 Number of visits to UPP 128101039 2-539193263 >5422210 Total713164112 Cross table of the number of visits to UPP and the number of transfers

19. RESULTS Cases (N) Health Centre 83 Private Clinics 56 Paediatrics 53 General Clinics 4 Otorhinolaryngology 2 Ophthalmology 2 Orthopaedics 2 Psychology 1 Dermatology 1 Cases (N) Out Patient Department frequency 49 H. São João 14 H. Pedro Hispano 10 H.G. Santo António 9 Health Centres 9 H. Maria Pia 4 Others 5 Missing 1 Table of the number of visits to Health Centers and Private Clinics with its specialities Table of the different institutions attended for external consulting

20. RESULTS Attended a Health Centre Attended a Private Clinic YesNo Attended Out Patient Department Yes 15 (13%)4 (4%)Yes 22 (20%)14 (12%)No 22 (20%)8 (7%)Yes 24 (21%) 3 (3%) No 83 (74%) Cross table of the attendance of Private Clinics, Health Centres and Out Patient Department

21. RESULTS Number of visits to UPP Age12-5>5Total ≤214 (13%)36 (32%)1 (1%)51 (46%) >225 (22%)27 (24%)9 (8%)61 (54%) Total39 (35%)63 (56%)10 (9%)112 (100%) Cross table between number of visits to UPP and patient age

22. DISCUSSION/CONCLUSION Health Centers are the type of Health Institutions most often visited Children under the age of 2 are approximatly half of the visiting patients 97% of the attending patients had already been to at least one medical consult Further studies should focus on the under 2 year old or the population attending Health Centers