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2.
J. health med. sci. (Print) ; 7(3): 151-156, jul.-sept. 2021. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1381368

RESUMO

La enfermedad cardiovascular es una de las principales causas de morbimortalidad en Chile, según resultados entregados por la Encuesta Nacional de Salud 2017 un 3,3% de la población ha presentado un infarto agudo al miocardio, un 2,6% reporta haber sufrido un ataque cerebrovascular, el 74% de los chilenos presenta obesidad y un 87% sedentarismo, siendo la diabetes mellitus tipo 2 (DM2) con un 12% y la hipertensión arterial con un 28% resultados que preocupan por su importante incremento. La investigación tuvo un diseño observacional de corte transversal. Se realizó en 69 pacientes con DM2 e hipertensos esenciales, entre 40 y 80 años de edad, pertenecientes al Sistema salud municipal (SMS) y privado (SPS) en la ciudad de Iquique. Se realizó encuesta alimentaria, medición antropométrica y exámenes bioquímicos y presión arterial. Al analizar ambos grupos se destaca los siguientes resultados: actividad física 17,24% SPS y 42,5% en SSM, presión arterial controlada 55,2% SPS y 87,5% en SSM, control de hemoglobina glicosilada 26,9% SPS y 52,5% en SSM, colesterol total alterado 17,9% SPS y 45% en SSM, síntomas depresivos 96,5% SPS y 26,3% en SSM. Se evidenció una prevalencia de mal nutrición por exceso de un 89,7% SPS y 95% SSM, riesgo cardiovascular (RCV) según circunferencia de cintura (CC) 96,5% SPS y 92,3% SSM. En relación a la encuesta alimentaria se observó que un 44,8% en usuarios SPS y 52,5% de SSM presentaron consumo alimentario hipercalórico. Los usuarios de atención privada y pública presentaron factores de riesgo cardiovascular, donde destacan la obesidad, sedentarismo y RCV según CC. Al comparar ambos grupos los usuarios SPS presentan menor control metabólico de su enfermedad y factores de riesgo cardiovascular aumentados en relación a los usuarios SSM.


Cardiovascular disease is one of the main causes of morbidity and mortality in Chile, according to the results provided by the 2017 National Health Survey, 3.3% of the population has presented acute myocardial infarction, 2.6% reported have suffered a cerebrovascular accident, 74% of Chileans are obese and 87% have sedentary behavior, belonging to type 2 diabetes mellitus (DM2) into 12% and arterial hypertension into 28%, alarming results due to their significant increase. The research had a cross-sectional observational study design. 69 patients with DM2 and essential hypertensive patients, between 40 and 80 years of age were studied, belonging to the municipal (SSM) and private (SPS) health systems in the city of Iquique. A food intake survey, anthropometric measurements, and biochemical and blood pressure tests were taken. When analyzing both groups, the following results stand out: physical activity 17.24% in SPS and 42.5% in SSM, controlled blood pressure 55.2% in SPS and 87.5% in SSM, controlled glycosylated hemoglobin 26.9% in SPS and 52.5% in SSM, altered values of total cholesterol 17.9% in SPS and 45% in SSM, depression symptoms 96.5% in SPS and 26.3% in SSM. Prevalence of malnutrition due to excess 89.7% in SPS and 95% in SSM, cardiovascular risk (RCV) according to waist circumference (CC) 96.5% in SPS and 92.3% in SSM were evidenced. In relation to the food intake survey, it was observed that 44.8% of SPS users and 52.5% of SSM users consume hypercaloric diet. The users of private and public care presented cardiovascular risk factors, where the obesity, sedentary lifestyle and RCV related to CC stand out. When comparing both groups, SPS users have less control of their disease in relation to SSM users.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Sistemas Locais de Saúde , Diagnóstico Clínico , Inquéritos Nutricionais/estatística & dados numéricos , Estudos Transversais , Fatores de Risco , Ingestão de Alimentos , Comportamento Sedentário , Fatores Sociológicos , Instituições Privadas de Saúde/estatística & dados numéricos , Hipertensão/complicações , Consentimento Livre e Esclarecido , Estilo de Vida , Obesidade/epidemiologia
3.
RFO UPF ; 25(2): 191-197, 20200830. graf, tab
Artigo em Português | LILACS, BBO - odontologia (Brasil) | ID: biblio-1357787

RESUMO

Objetivo: identificar a percepção de cirurgiões-dentistas das redes pública e privada do município de Erechim, RS, sobre atenção em saúde a pacientes com necessidades especiais, avaliando conhecimento, preparo e limitações para o atendimento odontológico. Métodos: este estudo de caráter transversal ocorreu no período de março a agosto de 2019, por meio da aplicação de questionário próprio semiestruturado para cirurgiões-dentistas. Resultados: participaram da pesquisa 82 cirurgiões-dentistas, sendo a maioria (58,54%) atuantes na rede privada; 56,10% não cursaram uma disciplina específica em sua graduação sobre cuidados a pacientes com necessidades especiais. Em contrapartida, dos que cursaram, para a maioria, a disciplina era obrigatória e teórico-prática. Conclusão: apesar de somente 42,68% se sentirem muito bem ou bem preparados, somente 10,98% nunca realizaram atendimentos. Mesmo não tendo cursado uma disciplina específica em sua graduação, os cirurgiões-dentistas de Erechim, RS, realizam o atendimento e, quando necessário, o encaminhamento desses pacientes. Por manifestarem o interesse em se manterem atualizados sobre o tema, ações de educação continuada serão de fundamental importância.(AU)


Objective: assess dentists perception, about oral health care for patients with special needs, of public and private service of Erechim, RS, evaluating their knowledge, preparation and limitations for dental care. Methods: this cross-sectional research was conducted from March to August 2019, using questionnaires for dentists. Results: eighty-two dentists participated in the research, the majority (58.54%) are from the private service, 56.10% did not attend a specific discipline, in their graduation, about dental care for patients with special needs. In contrast, for those who attended, the discipline was compulsory and theoretical- -practical. Conclusion: although only 42.68% feel very well, or well prepared, only 10.98% never attended dental care. Even though they did not attend a specific discipline in their graduation, the dentists of Erechim, RS, perform dental care and, when necessary, they referral these patients. As they express their interest in keeping up to date on the topic, continuing education actions will be of fundamental importance.(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Assistência Odontológica para a Pessoa com Deficiência/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Odontólogos/estatística & dados numéricos , Serviços Públicos de Saúde/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Percepção , Brasil , Estudos Transversais , Inquéritos e Questionários , Distribuição por Sexo
5.
Rev Chilena Infectol ; 36(3): 283-291, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859746

RESUMO

INTRODUCTION: Condylomas or genital warts (GW) are the most frequently diagnosed sexually transmitted infection (STI) in STI centers in Chile, but there are no population statistics available. OBJECTIVES: To describe the prevalence of GW in patients from 18-60 years of age who attend outpatient dermatology, gynecology and urology practice; the demographic characteristics of the patients and the diagnostic and treatment tools. METHODS: A sample of Chilean specialists stratified by region, population and gender of patients was provided with a logbook and answered a questionnaire. RESULTS: The GW prevalence was 2.44% for the whole group; 3.76% for the 18-34 age group and 1.29% for the 35-60 years group (p = 0.0000). The average age of patients with GW was 29.4 years in women and 32.7 years in men (p = 0.019). The distribution by age was different according to gender and health system. Visual inspection was the most frequent diagnostic method used and imiquimod cream the most common treatment, however, there were differences in the use of diagnostic and therapeutic tools according to the patient's gender, specialty of the doctor and health system. CONCLUSIONS: The high prevalence of GW confirmed the need and importance of public health interventions to address this problem.


Assuntos
Condiloma Acuminado/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Adolescente , Adulto , Antineoplásicos/uso terapêutico , Chile/epidemiologia , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/tratamento farmacológico , Demografia/estatística & dados numéricos , Dermatologistas/estatística & dados numéricos , Feminino , Ginecologia/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Imiquimode/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Adulto Jovem
6.
Health Serv Res ; 54(6): 1357-1365, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31429482

RESUMO

OBJECTIVE: To identify differences between independent treatment centers (ITCs) and general hospitals (GHs) regarding costs, quality of care, and efficiency. DATA SOURCES: Anonymous claims data (2013-2015) were used. We also obtained quality indicators from a semipublic platform. STUDY DESIGN: This study uses a comparative multilevel analysis, controlling for case mix, to evaluate the performance of ITCs and GHs for patients diagnosed with cataract. DATA COLLECTION: Reimbursement claims were extracted from existing claims databases of the largest Dutch health insurer. Quality indicators were obtained by external agencies through a mixed-mode survey. PRINCIPAL FINDINGS: There are no stark differences in complexity of cases for cataract care. ITCs seem to perform surgeries more frequently per care pathway, but conduct a lower number of health care activities per surgical claim. Total average costs are lower in ITCs compared with GHs, but when adjusted for case mix, the differences in costs are lower. The findings with the adjusted quality differences suggest that ITCs outperform GHs on patient satisfaction, but patients' outcomes are similar. CONCLUSION: This finding supports the postulation-based on the focus factory theory-that ITCs can provide more value for cataract care than GHs.


Assuntos
Catarata/economia , Catarata/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Instituições Privadas de Saúde/economia , Instituições Privadas de Saúde/estatística & dados numéricos , Hospitais Gerais/economia , Hospitais Gerais/estatística & dados numéricos , Feminino , Humanos , Masculino , Estados Unidos
7.
Rev. chil. infectol ; 36(3): 283-291, jun. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1013785

RESUMO

Resumen Introducción: Los condilomas o verrugas genitales (VG) son la infección de transmisión sexual (ITS) más diagnosticada en los centros de ITS en Chile, pero no existen estadísticas poblacionales. Objetivos: Describir la prevalencia de VG en pacientes de 18-60 años que acuden a consulta ambulatoria de dermatología, ginecología y urología; características demográficas de los pacientes y prácticas de diagnóstico y tratamiento. Material y Métodos: A una muestra de especialistas chilenos estratificados por región, población y sexo de pacientes se les proporcionó un diario de registro y aplicó un cuestionario. Resultados: Prevalencia VG grupo total: 2,4%; en grupo etario 18-34 años: 3,7%; en grupo etario 35-60 años: 1,29% (p = 0,0000). La edad media de los pacientes con VG fue 29,4 años en mujeres y 32,7 años en hombres (p = 0,019); la distribución por edad fue diferente según sexo y sistema de salud. La inspección visual fue el método diagnóstico más frecuente y la crema de imiquimod el tratamiento más común. Hubo diferencias en el uso de herramientas diagnósticas y terapéuticas según sexo del paciente, especialidad del médico y sistema de salud. Conclusiones: Existe una alta prevalencia de VG, que debería ser tomada en cuenta para planificar las intervenciones de salud pública para abordar este problema.


Introduction: Condylomas or genital warts (GW) are the most frequently diagnosed sexually transmitted infection (STI) in STI centers in Chile, but there are no population statistics available. Objectives: To describe the prevalence of GW in patients from 18-60 years of age who attend outpatient dermatology, gynecology and urology practice; the demographic characteristics of the patients and the diagnostic and treatment tools. Methods: A sample of Chilean specialists stratified by region, population and gender of patients was provided with a logbook and answered a questionnaire. Results: The GW prevalence was 2.44% for the whole group; 3.76% for the 18-34 age group and 1.29% for the 35-60 years group (p = 0.0000). The average age of patients with GW was 29.4 years in women and 32.7 years in men (p = 0.019). The distribution by age was different according to gender and health system. Visual inspection was the most frequent diagnostic method used and imiquimod cream the most common treatment, however, there were differences in the use of diagnostic and therapeutic tools according to the patient's gender, specialty of the doctor and health system. Conclusions: The high prevalence of GW confirmed the need and importance of public health interventions to address this problem.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Pacientes Ambulatoriais/estatística & dados numéricos , Condiloma Acuminado/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/estatística & dados numéricos , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/tratamento farmacológico , Chile/epidemiologia , Demografia/estatística & dados numéricos , Incidência , Prevalência , Inquéritos Epidemiológicos , Dermatologistas/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Imiquimode/uso terapêutico , Ginecologia/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Antineoplásicos/uso terapêutico
8.
PLoS One ; 14(3): e0197789, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30822307

RESUMO

BACKGROUND AND OBJECTIVES: Nursing or care home characteristics may have a long-term impact on the residents' mortality risks that has not been studied previously. The study's main objective was to assess the association between facility ownership and long-term, all-cause mortality. RESEARCH DESIGN AND METHODS: We conducted a mortality follow-up study on a cohort of 611 nursing-home residents in the city Madrid, Spain, from their 1998-1999 baseline interviews up to September 2013. Residents lived in three types of facilities: public, subsidized and private, which were also sub-classified according to size (number of beds). Residents' information was collected by interviewing the residents themselves, their caregivers and facility physicians. We used time-to-event multivariable models and inverse probability weighting to estimate standardized mortality risk differences. RESULTS: After a 3728 person-year follow-up (median/maximum of 4.8/15.2 years), 519 participants had died. In fully-adjusted models, the standardized mortality risk difference at 5 years of follow-up between medium-sized private facilities and large-sized public facilities was -18.9% (95% confidence interval [CI]: -33.4 to -4.5%), with a median survival (95% CI) of 3.6 (0.5 to 6.8) additional years. The fully-standardized 5-year mortality difference (95% CIs) between for-profit private facilities and not-for-profit public institutions was -15.1% (-31.1% to 0.9%), and the fully-standardized median survival difference (95% CIs) was 3.0 (-1.7 to 7.7) years. DISCUSSION AND IMPLICATIONS: These results are compatible with an association between factors related with the ownership of facilities and the long-term mortality risk of their residents. One of these factors, the facility size, could partly explain this association.


Assuntos
Instituições Privadas de Saúde/organização & administração , Instituição de Longa Permanência para Idosos/organização & administração , Mortalidade , Casas de Saúde/organização & administração , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Instituições Privadas de Saúde/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Assistência de Longa Duração/organização & administração , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Casas de Saúde/estatística & dados numéricos , Propriedade , Espanha/epidemiologia
9.
Emerg Med Australas ; 31(2): 262-265, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30033561

RESUMO

OBJECTIVE: While prior experience, favourable location and anticipation of high quality care are known to influence patient choice to attend a private ED, it is likely that decision-making is also influenced by other persons. In particular, patients arriving by ambulance are under the care of paramedics, whose values towards healthcare and rationale for choosing one ED over another have not been studied. This study aimed to describe reasons why paramedics choose to bring patients to a private ED. METHODS: Exploratory, qualitative study using semi-structured, face-to-face interviews with paramedics bringing patients to a private ED from the community. Two primary questions reinforced by structured prompts were asked: 'Why did you choose to come to this emergency department?' and 'What are your general expectations of this emergency department visit?' Interviews were audio recorded, transcribed verbatim and analysed thematically. RESULTS: Fifty paramedics were interviewed with 48 interviews able to be transcribed and used in analysis. Four factors were identified to increase the likelihood of a private ED destination: specific direction, institutional allegiance, hospital logistics and systems and receiving hospital service ethos. CONCLUSIONS: Paramedics take into consideration when possible patient's wishes and are more likely to bring a patient to a private ED if they have specific direction from the patient or the patient's family or GP. The likelihood of presenting to a private ED is increased if the patient has an allegiance with the facility and the paramedics perceive favourably the hospital logistics and systems as well as service ethos.


Assuntos
Pessoal Técnico de Saúde/psicologia , Ambulâncias , Comportamento de Escolha , Serviço Hospitalar de Emergência/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa
10.
J Health Econ ; 63: 1-18, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30439574

RESUMO

Many markets maintain a nontrivial mix of both nonprofit and for-profit firms, particularly in health care industries such as hospice, nursing homes, and home health. What are the effects of coexistence vs. dominance of one ownership type? We show how the presence of both ownership types can lead to greater diversity in consumer types served, even if both firms merely profit-maximize. This is the case where firms serve consumers for multiple consumption durations, but where donations are part of a nonprofit firm objective function and happen after services have been provided. This finding is strengthened if the good or service has value beyond immediate consumption or the direct consumer. We show these predictions empirically in the hospice industry, using data containing over 90 percent of freestanding U.S. hospices, 2000-2008. Nonprofit and for-profit providers split the patient market according to length of stay, leading to a wider range of patients being served than in the absence of this coexistence.


Assuntos
Instituições Privadas de Saúde , Hospitais para Doentes Terminais , Organizações sem Fins Lucrativos , Idoso , Idoso de 80 Anos ou mais , Feminino , Instituições Privadas de Saúde/economia , Instituições Privadas de Saúde/organização & administração , Instituições Privadas de Saúde/estatística & dados numéricos , Hospitais para Doentes Terminais/economia , Hospitais para Doentes Terminais/organização & administração , Humanos , Masculino , Medicare/estatística & dados numéricos , Modelos Estatísticos , Organizações sem Fins Lucrativos/economia , Organizações sem Fins Lucrativos/organização & administração , Organizações sem Fins Lucrativos/estatística & dados numéricos , Estados Unidos
11.
Aten Primaria ; 51(10): 610-616, 2019 12.
Artigo em Espanhol | MEDLINE | ID: mdl-30409504

RESUMO

GOAL: Compare the performance of primary health centers managed by the public sector (ICS), the third sector (Hospitals) or by small private organizations known as EBAs. DESIGN: Multidimensional comparative analysis. We follow a quasi-experimental logic comparing primary health centers managed by EBAs with other centers managed by the public sector (ICS) o by the third sector (hospitals). LOCALIZATION: Barcelona, Catalonia, Spain. PARTICIPANTS: We have 368 observations (primary health centers) and 18 indicators measured in 2015. INTERVENTION: Different management models (public, third sector, private). MAIN MEASURES: We compare activity measures, measures of effectiveness in the process of medical assistance, and efficiency. We compare before and after controlling for the socio-economic level corresponding to the basic health area and the characteristics of the population and health region. We conduct a test of significant differences between the indicators corresponding to centers managed differently, after a process of matching using key variables and Propensity Score Matching. RESULTS: Significant differences in the measure of work load for family doctors, in five measures of effectiveness in the process of assistance and in the cost per user. CONCLUSIONS: The diversity in the management model through EBAs shows results that can be interpreted in favor of the maintenance or the expansion of this model of management. The majority of EBAs have been implanted in areas of a medium or high level, but their results are still significantly positive once the socio economic level of the area is controlled.


Assuntos
Medicina de Família e Comunidade/normas , Instituições Privadas de Saúde/normas , Atenção Primária à Saúde/normas , Setor Privado/normas , Setor Público/normas , Carga de Trabalho , Medicina de Família e Comunidade/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Privatização , Pontuação de Propensão , Setor Público/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Fatores Socioeconômicos , Espanha
12.
Health Aff (Millwood) ; 36(7): 1291-1298, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28679817

RESUMO

Hospice care is designed to support patients and families through the final phase of illness and death. Yet for more than a decade, hospices have steadily increased the rate at which they discharge patients before death-a practice known as "live discharge." Although certain live discharges are consistent with high-quality care, regulators have expressed concern that some hospices' desire to maximize profits drives them to inappropriately discharge patients. We used Medicare claims data for 2012-13 and cost reports for 2011-13 to explore relationships between hospice-level financial margins and live discharge rates among freestanding hospices. Adjusted analyses showed positive and significant associations between both operating and total margins and hospice-level rates of live discharge: One-unit increases in operating and total margin were associated with increases of 3 percent and 4 percent in expected hospice-level live discharge rates, respectively. These findings suggest that additional research is needed to explore links between profitability and patient-centeredness in the Medicare hospice program.


Assuntos
Instituições Privadas de Saúde/economia , Hospitais para Doentes Terminais/economia , Medicare/economia , Alta do Paciente/economia , Idoso de 80 Anos ou mais , Feminino , Instituições Privadas de Saúde/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Masculino , Alta do Paciente/estatística & dados numéricos , Estados Unidos
14.
Health Aff (Millwood) ; 35(6): 1036-44, 2016 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-27269020

RESUMO

Previous research has associated declines in health care resources such as hospitals and trauma centers with communities' racial composition. However, little is known about changes in the substance use disorder treatment infrastructure in recent years and the implications for black communities. We used data for the period 2002-10 from the National Survey of Substance Abuse Treatment Services to describe changes in the supply of public and private outpatient facilities for substance use disorder treatment, and to determine whether these trends had implications for the geographical availability of these facilities in counties with high percentages of black residents. During the study period the number of publicly owned facilities declined 17.2 percent, whereas the number of private for-profit facilities grew 19.1 percent. At baseline, counties with very high percentages of black residents (that is, more than one standard deviation above the mean) were more likely than counties with less than the mean percentage of black residents to be served by public facilities and were thus disproportionately affected by the overall decline in public facilities. Future research should examine the effect of expanding eligibility for Medicaid on the supply of substance use disorder treatment facilities across diverse communities.


Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Estudos Transversais , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Medicaid/estatística & dados numéricos , Propriedade , Setor Público , Grupos Raciais , Transtornos Relacionados ao Uso de Substâncias/etnologia , Inquéritos e Questionários , Estados Unidos
15.
Can J Aging ; 35(2): 175-89, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27223577

RESUMO

Ontario has the highest proportion of for-profit nursing homes in Canada. These facilities, which are known in Ontario as long-term care (LTC) homes, offer 24-hour custodial as well as nursing care to individuals who cannot live independently. Increasingly, they are also operating as members of multi-facility chains. Using longitudinal data (1996-2011) from the Residential Care Facilities Survey (n = 627), our analysis revealed discernible differences in staffing levels by profit status and chain affiliation. We found for-profit LTC homes - especially those owned by a chain organization - provided significantly fewer hours of care, after adjusting for variation in the residents' care needs. Findings from this study offer new information on the impact of organizational structure on staffing levels in Ontario's LTC homes and have implications for other jurisdictions where a growing presence of private, chain-affiliated operators has been observed.


Assuntos
Instituições Privadas de Saúde/estatística & dados numéricos , Assistência de Longa Duração/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Humanos , Estudos Longitudinais , Ontário , Propriedade , Qualidade da Assistência à Saúde , Recursos Humanos
16.
Med Care ; 54(3): 229-34, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26765147

RESUMO

BACKGROUND: In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care. OBJECTIVES: To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with care. DATA SOURCES AND STUDY DESIGN: Maryland nursing home care experience reports, the Online Survey, Certification, And Reporting (OSCAR) files, and Area Resource Files are used. Our sample consists of all nongovernmental nursing homes in Maryland from 2007 to 2010. Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. We identified chain characteristics from OSCAR, and estimated multivariate random effect linear models to test the effects of chain ownership on care experience ratings. RESULTS: Independent nonprofit nursing homes have the highest overall rating score of 8.9, followed by 8.6 for facilities in small nonprofit chains, and 8.5 for independent for-profit facilities. Facilities in small, medium, and large for-profit chains have even lower overall ratings of 8.2, 7.9, and 8.0, respectively. We find similar patterns of differences in terms of recommendation rate, and important areas such as staff communication and quality of care. CONCLUSIONS: Evidence suggests that Maryland nursing homes affiliated with large-for-profit and medium-for-profit chains had lower ratings of family reported experience with care.


Assuntos
Instituições Privadas de Saúde/organização & administração , Instituições Privadas de Saúde/estatística & dados numéricos , Casas de Saúde/organização & administração , Casas de Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Meio Ambiente , Serviços de Alimentação/normas , Serviços de Alimentação/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Assistência de Longa Duração , Maryland , Organizações sem Fins Lucrativos/organização & administração , Organizações sem Fins Lucrativos/estatística & dados numéricos , Direitos do Paciente , Autonomia Pessoal , Admissão e Escalonamento de Pessoal , Qualidade da Assistência à Saúde/estatística & dados numéricos , Características de Residência , Fatores Socioeconômicos
17.
J Appl Gerontol ; 35(3): 303-20, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25698720

RESUMO

In 1998, Medicare implemented the Prospective Payment System for post-acute care provided by skilled nursing facilities. This system paid a fixed price per day above the cost of care, creating an incentive to provide longer length of stays to increase revenues. In this paper, we examine whether there are systematic differences in length of stay for post-acute care patients between for-profit and not-for-profit skilled nursing facilities. Based on the financial incentives inherent in the reimbursement system, we develop a conceptual framework that argues for-profits will provide a greater number of days of care to increase profits relative to not-for-profits. We find significant differences in length of stay by ownership, but once patient selection into a facility is accounted for using two-staged residual inclusion, there is no statistical differences in length of stay between for-profit and not-for-profit facilities.


Assuntos
Instituições Privadas de Saúde/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Sistema de Pagamento Prospectivo/economia , Reembolso de Incentivo/economia , Instituições de Cuidados Especializados de Enfermagem/economia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Medicare , Propriedade , Modelos de Riscos Proporcionais , Qualidade da Assistência à Saúde/economia , Estados Unidos
18.
Artigo em Inglês | MEDLINE | ID: mdl-26245591

RESUMO

BACKGROUND: Involving all relevant healthcare providers in tuberculosis (TB) management through public-private mix (PPM) approaches is a vital element in the World Health Organization's (WHO) Stop TB Strategy. The control of TB in Zambia is mainly done in the public health sector, despite the high overall incidence rates. AIM: We conducted a survey to determine the extent of private-sector capacity, participation, practices and adherence to national guidelines in the control of TB. SETTING: This survey was done in the year 2012 in 157 facilities in three provinces of Zambia where approximately 85% of the country's private health facilities are found. METHODS: We used a structured questionnaire to interview the heads of private health facilities to assess the participation of the private health sector in TB diagnosis, management and prevention activities. RESULTS: Out of 157 facilities surveyed, 40.5% were from the Copperbelt, 4.4% from Central province and 55.1% from Lusaka province. Only 23.8% of the facilities were able to provide full diagnosis and management of TB patients. Although 47.4% of the facilities reported that they do notify their cases to the National TB control programme, the majority (62.7%) of these facilities did not show evidence of notifications. CONCLUSION: Our results show that the majority of the facilities that diagnose and manage TB in the private sector do not report their TB activities to the National TB Control Programme (NTP). There is a need for the NTP to improve collaboration with the private sector with respect to TB control activities and PPM for Directly Observed Treatment, Short Course (DOTS).


Assuntos
Notificação de Doenças/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Tuberculose/prevenção & controle , Estudos Transversais , Notificação de Doenças/normas , Instituições Privadas de Saúde/normas , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/estatística & dados numéricos , Parcerias Público-Privadas/normas , Parcerias Público-Privadas/estatística & dados numéricos , Tuberculose/diagnóstico , Zâmbia
19.
BMC Health Serv Res ; 15: 231, 2015 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-26067426

RESUMO

BACKGROUND: To achieve health development goals, policymakers are increasingly focused on improving primary care in low- and middle-income countries, and private sector drug retailers offer one channel through which basic services may be delivered. In Nigeria, patent and proprietary medicine vendors (PPMVs) serve as a main source of medications, but little is known about their clientele or how care is sought at PPMVs for common illnesses. We explore differences in care-seeking at PPMV shops based on the most commonly reported symptoms. METHODS: In Kogi and Kwara states, Nigeria, 250 PPMV shop workers and 2,359 customers purchasing drugs were surveyed, and each worker-customer interaction was observed. Multivariate regression analysis was used to assess the association of commonly reported symptoms with care-seeking behavior prior to attending the shop and while interacting with the provider at the shop. RESULTS: Most customers sought care for headache (30.5 %), fever (22.9 %), cough/cold (18.1 %), or diarrhea (8.4 %). Customers with fever were more likely to report being diagnosed by a formally trained person, to have discussed the illness with and be examined by the shop worker, and have more difficulty paying. In contrast, customers with headache symptoms were less likely to experience these outcomes and spent less money purchasing drugs. Those reporting cough or cold symptoms were less likely to have been diagnosed by a formally trained person, waited longer before visiting the PPMV shop, and were more likely to discuss the illness with the shop worker, but were less likely to be examined or to recommend the purchased drug themselves. If a sick child was brought to the shop, a discussion of the illness and an exam were more likely and more money was spent on drugs. CONCLUSIONS: Because care-seeking behaviors vary by symptoms and the sick person's age, PPMVs should be trained to treat common illnesses for which customers are unlikely to seek a formal medical consultation. Interventions aimed at improving primary care need to target the places where most people access care, and equip PPMV workers with knowledge and tools to provide basic services.


Assuntos
Comércio/estatística & dados numéricos , Instituições Privadas de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Preparações Farmacêuticas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nigéria , Fatores Socioeconômicos , Adulto Jovem
20.
Emerg Med Australas ; 27(1): 62-5, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25406856

RESUMO

OBJECTIVE: Understanding the reasons patients decide to attend a particular acute care service, and their expectations of that service, is important in providing optimal patient care. The present study aimed to determine factors influencing patient decisions to attend a private Australian ED, an issue that has not been previously addressed in the literature. METHODS: Semi-structured face-to-face interviews with ED patients, purposively sampled to broadly reflect the departmental caseload and casemix. The two primary questions asked were: 'Why did you choose to come to this emergency department?' and 'What are your general expectations of this emergency department visit?'. Interviews were audio recorded, transcribed verbatim, and then analysed using manifest and then latent content analysis techniques. RESULTS: All patients approached (n = 30) agreed to interview. Four key themes were identified: prior experience of the hospital, convenient location of the hospital, anticipated high-quality care and anticipated short wait times. CONCLUSIONS: Patients chose to use the private ED because of prior experience, proximity, and an expectation they would be seen promptly and be provided with competent care.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/normas , Instituições Privadas de Saúde/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/normas , Feminino , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Listas de Espera , Austrália Ocidental , Adulto Jovem
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