Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 9 de 9
Filtrar
Mais filtros

Bases de dados
País/Região como assunto
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
Indian J Med Res ; 157(4): 231-238, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-37282386

RESUMO

BACKGROUND & OBJECTIVES: Information and communications technology (ICT) has often been endorsed as an effective tool to improve primary healthcare. However, evidence on the cost of ICT-enabled primary health centre (PHC) is lacking. The present study aimed at estimating the costs for customization and implementation of an integrated health information system for primary healthcare at a public sector urban primary healthcare facility in Chandigarh. METHODS: We undertook economic costing of an ICT-enabled PHC based on health system perspective and bottom-up costing. All the resources used for the provision of ICT-enabled PHC, capital and recurrent, were identified, measured and valued. The capital items were annualized over their estimated life using a discount rate of 3 per cent. A sensitivity analysis was undertaken to assess the effect of parameter uncertainties. Finally, we assessed the cost of scaling up ICT-enabled PHC at the state level. RESULTS: The estimated overall annual cost of delivering health services through PHC in the public sector was ₹ 7.88 million. The additional economic cost of ICT was ₹ 1.39 million i.e. 17.7 per cent over and above a non-ICT PHC cost. In a PHC with ICT, the cost per capita increased by ₹ 56. On scaling up to the state level (with 400 PHCs), the economic cost of ICT was estimated to be ₹ 0.47 million per year per PHC, which equates to approximately six per cent expenditure over and above the economic cost of a regular PHC. INTERPRETATION & CONCLUSIONS: Implementing a model of information technology-PHC in a state of India would require an augmentation of cost by about six per cent, which seems fiscally sustainable. However, contextual factors related to the availability of infrastructure, human resources and medical supplies for delivering quality PHC services will also need to be considered.


Assuntos
Custos de Cuidados de Saúde , Tecnologia da Informação , Humanos , Índia/epidemiologia , Atenção Primária à Saúde , Tecnologia
2.
Glob Health Sci Pract ; 10(2)2022 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-35487543

RESUMO

INTRODUCTION: Implementation research with pre- and post-comparison was planned to improve the quality of evidence-based intrapartum care services in Indian medical schools. We present the baseline study results to assess the status of adherence to intrapartum evidence-based practices (IP-EBP) in study schools in 3 states in India and the perception of the faculty. METHODS: A concurrent mixed-methods approach was used to conduct the baseline assessment in 9 medical schools in Rajasthan, Gujarat, and Union Territory from October 2018 to June 2019. IP-EBP among pregnant women in uncomplicated first (n=135), second (n=120), and third stage (n=120) of labor were observed using a predesigned, pretested checklist quantitatively. We conducted in-depth interviews with 33 obstetrics and gynecology faculty to understand their perceptions of intrapartum practices. Quantitative data were analyzed using SPSS (version 22). COM-B (Capability, Opportunity, and Motivation Behavior) model was used to understand the behaviors, and thematic analysis was done for the qualitative data. FINDINGS: Unindicated augmentation of labor was done in 64.4%, fundal pressure applied in 50.8%, episiotomy done in 58.3%, and delivery in lithotomy position was performed in 86.7% of women in labor. CONCLUSIONS: Intrapartum practices that are not recommended were routinely practiced in the study medical schools due to a lack of staff awareness of evidence-based practices and incorrect beliefs about their impact.


Assuntos
Prática Clínica Baseada em Evidências , Faculdades de Medicina , Lista de Checagem , Feminino , Humanos , Índia , Parto , Gravidez
3.
PLoS One ; 14(11): e0211168, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693671

RESUMO

OBJECTIVES: The objectives of the study were to assess the knowledge and skills of medical interns and nurses regarding family planning (FP) services, and document the prevailing FP practices in the teaching hospitals in India. STUDY DESIGN: A cross-sectional study was conducted in three states (Delhi, Rajasthan, and Maharashtra) of India, among randomly selected 163 participants, including medical interns (n = 81) and in-service nurses (n = 82), during 2017. The semi-structured, pre-tested interview schedule, was used to assess the knowledge and status of training received; and objective structured clinical examination (OSCE) based checklist was used to evaluate the skills. RESULTS: About 60% of the interns and 48% of the nurses knew more than five contraceptives that could be offered to the clients. About 22% (11.1% interns and 33.3% nurses) respondents believed that contraceptives should not be given to a married woman coming alone, and 31.9% (17.3% interns and 46.3% nurses) respondents reported that it was illegal to provide contraceptives to unmarried people. Nearly 43.3% interns and 69.5% nurses refused to demonstrate intrauterine contraceptive device (IUCD) insertion in the dummy uterus as per OSCE, and among those who did, 12.3% interns and 18.3% nurses had failed. About 63% interns and 63.4% of nurses had observed IUCD insertion, and 12.3% interns and 17.1% had performed IUCD insertion, during their training. CONCLUSIONS: Knowledge and skills of interns and nurses regarding FP services were inadequate. The medical training during graduation or internship, and during the job, was found to be inadequate to provide quality FP services as per guidelines of nursing/medical council of India and Government of India on FP.


Assuntos
Competência Clínica , Serviços de Planejamento Familiar , Internato e Residência , Enfermeiras e Enfermeiros , Adulto , Anticoncepcionais , Estudos Transversais , Serviços de Planejamento Familiar/educação , Serviços de Planejamento Familiar/métodos , Serviços de Planejamento Familiar/normas , Feminino , Humanos , Índia , Dispositivos Intrauterinos , Masculino , Adulto Jovem
4.
J Family Med Prim Care ; 7(1): 39-44, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29915731

RESUMO

OBJECTIVE: To determine pattern of health care utilization and extent of out-of-pocket healthcare expenditure in rural areas of Punjab in India. METHODS: Using multi stage sampling procedure, 660 participants were selected from 110 villages, out of all 22 districts; 440 participants had utilized outpatient care in past 15 days, and 220 had been hospitalized in past one year. Pretested semistructured questionnaires were used to enquire about household and healthcare expenditures. Out-of-pocket (OoP) expenditure included only direct costs of healthcare. Sevety seven 77 (12%) participants could not provide expenditures, hence were excluded from analysis. More than 10% of total household expenditure on healthcare was considered catastrophic. RESULTS: Majority of the participants had used public sector health facilities for outpatient (57%) and inpatient (51.5%) care. Public sector facilities were utilized more often for communicable diseases and gynaecological problems whereas private sector services were used more commonly for accidents and non-communicable diseases. Mean healthcare expenditure on outpatient and inpatient healthcare services was Indian Rupees (INR) 8501 and INR 53889 respectively. Expenditure in private sector was significantly higher compared to the public sector facilities. Catastrophic expenditure was incurred by 7% of the households while seeking outpatient care and by 53% while seeking inpatient care. To pay for outpatient and inpatient care, 23.3% and 61.5% of the participants respectively had to borrow money or sell their assets. CONCLUSIONS: Healthcare expenditure places households under considerable financial strain in rural areas of Punjab in India. Improvements of public hospitals may increase their utilization and decrease financial burden.

5.
PLoS One ; 13(5): e0198172, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29851982

RESUMO

Verbal autopsy methods have been developed to determine medical causes of deathforprioritizing disease control programs. Additional information on social causesmay facilitate designing of more appropriate prevention strategies. Use of social autopsy in investigations of causes of adult deaths has been limited. Therefore, acommunity-based study was conducted in NandpurKalour Block of Fatehgarh Sahib District in Punjab (India)for finding social causes of adult deaths. An integrated verbal and social autopsy toolwas developed and verbal autopsies of 600 adult deaths, occurring over a reference period of one year, were conducted in 2014. Quantitative analysis described the socio-demographic characteristics of the deceased, number and type of consultations from health care providers, and type of care received during illness. Qualitative data was analyzed to find out social causes of death by thematic analysis. The median duration of illness from symptom onset till death was 9 days (IQR = 1-45 days). At the onset of illness, 72 (12%) deceased utilized home remedies and 424 (70.7%)received care from a clinic/hospital, and 104 (17.3%) died withoutreceiving any care. The number of medical consultations varied from one to six (median = 2). The utilization of government health facilities and qualified allopathic doctor increased with each consultation (p value<0.05). The top five social causes of adult deaths in a rural area of Punjab in India. (1) Non availability of medical practitioner in the vicinity, (2) communication gaps between doctor and patient on regular intake of medication, (3) delayed referral by service provider, (4) poor communication with family on illness, and (5) perception of illness to be 'mild' by the family or care taker. To conclude, social autopsy tool should be integrated with verbal autopsy tool for identification of individual, community, and health system level factors associated with adult mortality.


Assuntos
Causas de Morte , Comportamento Social , Classe Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Planejamento em Saúde Comunitária/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
PLoS One ; 11(6): e0157831, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27351743

RESUMO

OBJECTIVE: A rapid survey was carried out in Shaheed Bhagat Singh Nagar District of Punjab state in India to ascertain health seeking behavior and out-of-pocket health expenditures. METHODS: Using multistage cluster sampling design, 1,008 households (28 clusters x 36 households in each cluster) were selected proportionately from urban and rural areas. Households were selected through a house-to-house survey during April and May 2014 whose members had (a) experienced illness in the past 30 days, (b) had illness lasting longer than 30 days, (c) were hospitalized in the past 365 days, or (d) had women who were currently pregnant or experienced childbirth in the past two years. In these selected households, trained investigators, using a tablet computer-based structured questionnaire, enquired about the socio-demographics, nature of illness, source of healthcare, and healthcare and household expenditure. The data was transmitted daily to a central server using wireless communication network. Mean healthcare expenditures were computed for various health conditions. Catastrophic healthcare expenditure was defined as more than 10% of the total annual household expenditure on healthcare. Chi square test for trend was used to compare catastrophic expenditures on hospitalization between households classified into expenditure quartiles. RESULTS: The mean monthly household expenditure was 15,029 Indian Rupees (USD 188.2). Nearly 14.2% of the household expenditure was on healthcare. Fever, respiratory tract diseases, gastrointestinal diseases were the common acute illnesses, while heart disease, diabetes mellitus, and respiratory diseases were the more common chronic diseases. Hospitalizations were mainly due to cardiovascular diseases, gastrointestinal problems, and accidents. Only 17%, 18%, 20% and 31% of the healthcare for acute illnesses, chronic illnesses, hospitalizations and childbirth was sought in the government health facilities. Average expenditure in government health facilities was 16.6% less for acute care, 15% less for hospitalization and 50% less for childbirth than in the private healthcare facilities. Out-of-pocket expenditure was mostly on medicines followed by diagnostic and laboratory tests. Among households experiencing hospitalization, 56.5% had incurred catastrophic expenditures, which was significantly higher in the poorest compared to richest household expenditure quartile (p <0.002). CONCLUSIONS: Expenditure on healthcare remains high in Punjab state of India. Efforts to increase utilization of the public sector could decrease out-of-pocket healthcare expenditure.


Assuntos
Pesquisas sobre Atenção à Saúde/métodos , Gastos em Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Computadores , Características da Família , Pesquisas sobre Atenção à Saúde/instrumentação , Humanos , Índia
8.
Glob Health Action ; 9: 31473, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27189200

RESUMO

BACKGROUND: An m-health application has been developed and implemented with community health workers to improve their counseling in a rural area of India. The ultimate aim was to generate demand and improve utilization of key maternal, neonatal, and child health services. The present study aims to assess the impact and cost-effectiveness of this project. METHODS/DESIGN: A pre-post quasi-experimental design with a control group will be used to undertake difference in differences analysis for assessing the impact of intervention. The Annual Health Survey (2011) will provide pre-intervention data, and a household survey will be carried out to provide post-intervention data.Two community development blocks where the intervention was introduced will be treated as intervention blocks while two controls blocks are selected after matching with intervention blocks on three indicators: average number of antenatal care checkups, percentage of women receiving three or more antenatal checkups, and percentage of institutional deliveries. Two categories of beneficiaries will be interviewed in both areas: women with a child between 29 days and 6 months and women with a child between 12 and 23 months. Propensity score matched samples from intervention and control areas in pre-post periods will be analyzed using the difference in differences method to estimate the impact of intervention in utilization of key services.Bottom-up costing methods will be used to assess the cost of implementing intervention. A decision model will estimate long-term effects of improved health services utilization on mortality, morbidity, and disability. Cost-effectiveness will be assessed in terms of incremental cost per disability-adjusted life year averted and cost per unit increase in composite service coverage in intervention versus control groups. CONCLUSIONS: The study will generate significant evidence on impact of the m-health intervention for maternal, neonatal, and child services and on the cost of scaling up m-health technology for accredited social health activists in India.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Agentes Comunitários de Saúde , Serviços de Saúde Materna/estatística & dados numéricos , Aplicativos Móveis/economia , Serviços de Saúde Rural/economia , Telemedicina/economia , Serviços de Saúde da Criança/economia , Análise Custo-Benefício , Aconselhamento , Países em Desenvolvimento , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Serviços de Saúde Materna/economia , Modelos Estatísticos , Gravidez , Cuidado Pré-Natal , Pontuação de Propensão , Anos de Vida Ajustados por Qualidade de Vida , Serviços de Saúde Rural/estatística & dados numéricos
9.
BMC Public Health ; 11: 549, 2011 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-21745381

RESUMO

BACKGROUND: Targeted interventions (TIs) have been a major strategy for HIV prevention in India. We evaluated the impact of TIs on HIV prevalence in high HIV prevalence southern states (Tamil Nadu, Karnataka, Andhra Pradesh and Maharashtra). METHODS: A quasi-experimental approach was used to retrospectively compare changes in HIV prevalence according to the intensity of targeted intervention implementation. Condom gap (number of condoms required minus condoms supplied by TIs) was used as an indicator of TI intensity. Annual average number of commercial sex acts per female sex worker (FSW) reported in Behavioral Surveillance Survey was multiplied by the estimated number of FSWs in each district to calculate annual requirement of condoms in the district. Data of condoms supplied by TIs from 1995 to 2008 was obtained from program records. Districts in each state were ranked into quartiles based on the TI intensity. Primary data of HIV Sentinel Surveillance was analyzed to calculate HIV prevalence reductions in each successive year taking 2001 as reference year according to the quartiles of TI intensity districts using generalized linear model with logit link and binomial distribution after adjusting for age, education, and place of residence (urban or rural). RESULTS: In the high HIV prevalence southern states, the number of TI projects for FSWs increased from 5 to 310 between 1995 and 2008. In high TI intensity quartile districts (n = 30), 186 condoms per FSW/year were distributed through TIs as compared to 45 condoms/FSW/year in the low TI intensity districts (n = 29). Behavioral surveillance indicated significant rise in condom use from 2001 to 2009. Among FSWs consistent condom use with last paying clients increased from 58.6% to 83.7% (p < 0.001), and among men of reproductive age, the condom use during sex with non-regular partner increased from 51.7% to 68.6% (p < 0.001). A significant decline in HIV and syphilis prevalence has occurred in high prevalence southern states among FSWs and young antenatal women. Among young (15-24 years) antenatal clinic attendees significant decline was observed in HIV prevalence from 2001 to 2008 (OR = 0.42, 95% CI 0.28-0.62) in high TI intensity districts whereas in low TI intensity districts the change was not significant (OR = 1.01, 95% CI 0.67-1.5). CONCLUSION: Targeted interventions are associated with HIV prevalence decline.


Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Promoção da Saúde/normas , Heterossexualidade , Adolescente , Preservativos/estatística & dados numéricos , Feminino , Infecções por HIV/prevenção & controle , Humanos , Índia/epidemiologia , Masculino , Vigilância da População/métodos , Estudos Retrospectivos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA