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1.
Sci Rep ; 12(1): 13244, 2022 Aug 02.
Artículo en Inglés | MEDLINE | ID: mdl-35918427

RESUMEN

Urban development continues to face the dilemma of spatial inequality of public facilities, particularly educational and medical facilities. Identifying inequalities in various types of public facilities and their driving mechanisms is crucial in reducing social inequality. However, information on this topic is limited. This study took 10 typical cities in China as cases. We used the methods of the Gini coefficient and hedonic price model as bases in evaluating the equality of nine types of education and medical facilities, focusing on the differences between urban and rural areas. Moreover, we further analyzed the driving factors of facility equality. Results showed that equality of public facilities in urban areas was significantly higher than that in rural areas. Primary schools, middle schools, and health service centers were relatively equal, and kindergartens and pharmacies were unequal only in rural areas. However, the equality of facilities with large-size or commercial attributes was not optimistic. Furthermore, there remained a significant gap among counties (or districts), which was mainly driven by population, economy, and building density in the form of logarithm and logarithmic linear models. Our research contributes to an in-depth understanding of the inequality of public facilities and further supports decision-making to improve social equality.


Asunto(s)
Servicios de Salud , Instalaciones Públicas , China , Ciudades , Humanos , Población Rural , Factores Socioeconómicos , Población Urbana
2.
BMC Health Serv Res ; 22(1): 984, 2022 Aug 02.
Artículo en Inglés | MEDLINE | ID: mdl-35918690

RESUMEN

BACKGROUND: Telerehabilitation (TR) interventions are receiving increasing attention. They have been evaluated in various scientific areas through systematic reviews. However, there is a lack of data on how to standardize assessment and report on their domains to guide researchers across studies and bring together the best evidence to assess TR for chronic diseases. AIMS AND OBJECTIVES: The aim of this study was to identify domains of assessment in TR and to qualitatively and quantitatively analyze how and when they are examined to gain an overview of assessment in chronic disease. METHODS: A scoping meta-review was carried out on 9 databases and gray literature from 2009 to 2019. The keyword search strategy was based on "telerehabilitation", "evaluation", "chronic disease" and their synonyms. All articles were subjected to qualitative analysis using the Health Technology Assessment (HTA) Core Model prior to further analysis and narrative synthesis. RESULTS: Among the 7412 identified articles, 80 studies met the inclusion criteria and addressed at least one of the noncommunicable diseases (NCD) categories of cardiovascular disease (cardiovascular accidents), cancer, chronic respiratory disease, diabetes, and obesity. Regarding the domains of assessment, the most frequently occurring were "social aspect" (n = 63, 79%) (e.g., effects on behavioral changes) and "clinical efficacy" (n = 53, 66%), and the least frequently occurring was "safety aspects" (n = 2, 3%). We also identified the phases of TR in which the assessment was conducted and found that it most commonly occurred in the pilot study and randomized trial phases and least commonly occurred in the design, pretest, and post-implementation phases. CONCLUSIONS: Through the HTA model, this scoping meta-review highlighted 10 assessment domains which have not been studied with the same degree of interest in the recent literature. We showed that each of these assessment domains could appear at different phases of TR development and proposed a new cross-disciplinary and comprehensive method for assessing TR interventions. Future studies will benefit from approaches that leverage the best evidence regarding the assessment of TR, and it will be interesting to extend this assessment framework to other chronic diseases.


Asunto(s)
Servicios de Salud , Evaluación de Procesos, Atención de Salud , Enfermedad Crónica , Humanos , Proyectos Piloto , Estándares de Referencia
3.
PLoS One ; 17(8): e0272346, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35921361

RESUMEN

This study examines the role of knowledge creation, knowledge sharing and information communication technologies, which are organizational factors that influence the quality of healthcare services. In today's knowledge-intensive environment, understanding and gaining in-depth knowledge on how to improve the quality of healthcare services is gaining in importance and recognition. Quantitative data collected in 2019 with 151 respondents employed in healthcare organizations was used. Running a series of hierarchical linear regression models, we found a significant positive relationship between knowledge creation and quality of healthcare services, and a significant positive relationship between knowledge sharing and quality of healthcare services. Empirical data additionally provides support for information communication technologies that act as a moderator both in the relationship between knowledge creation and knowledge sharing with quality of healthcare services. With our data, we provide empirical backing for the impact of knowledge creation, knowledge sharing and information communication technologies on the quality of healthcare services that are provided by Montenegrin healthcare organizations. Our paper offers theoretical and practical implications derived from our research study.


Asunto(s)
Comunicación , Servicios de Salud , Tecnología de la Información , Conocimiento , Calidad de la Atención de Salud
4.
Afr J Prim Health Care Fam Med ; 14(1): e1-e9, 2022 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-35924626

RESUMEN

BACKGROUND:  Africa is the last region to incorporate family physicians into its health systems. They are still a relatively new concept in many countries, small in numbers and deployed in a variety of ways. There is a need for more evidence on their contribution to African health systems to guide policymakers. AIM:  The aim of this study was to review the special collection of short reports on the contribution of family physicians to African health systems, published in the African Primary Health Care and Family Medicine Journal in 2021. METHOD:  Seventeen short reports from eight countries were qualitatively and thematically analysed in ATLAS.ti. Codes, which were derived inductively, were organised into categories according to the World Health Organization's primary health care monitoring framework. RESULTS:  In the domain of health system determinants, family physicians made little contribution to governance, adjustment to population health needs or financing. They did, however, contribute substantially to the capacity of the health workforce, supply of equipment, functioning of the health information system and use of digital technologies. In the domain of service delivery, they strengthened the model of care and championed systems for improving the quality of care. This translated into improved availability and utilisation of services, core functions of primary care, quality of care and patient safety. CONCLUSION:  Family physicians described their important contribution to service delivery in district hospitals and primary health care. This should lead to improvements in outcomes and impact for the health system. Their contribution to the concept of resilient facilities and health services needs further exploration.


Asunto(s)
Medicina Familiar y Comunitaria , Médicos de Familia , África , Servicios de Salud , Fuerza Laboral en Salud , Humanos
6.
PLoS One ; 17(8): e0272041, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35939485

RESUMEN

Diabetes Mellitus, affecting nearly half a billion people worldwide, is a substantial global public health issue. Although diabetes predominantly affects men, women with diabetes have specific risks and self-management characteristics. Women have a higher risk of either presenting with or developing depression or anxiety, as well as being high users of complementary medicine which can create clinical governance issues. In spite of these known gender differences, limited research has explored gender-specific diabetes care, especially health service use patterns. As increasing attention has turned to supporting people with diabetes to successfully self-manage their diabetes, it is important that we understand how women with diabetes are using health services, and if their specific risk profile is influencing their health care choices. Our study sought to examine the relationship between mental health status and the patterns of conventional and complementary medicine health service use by women diagnosed with diabetes mellitus. Our results showed that women with diabetes and any mental health co-morbidity were more likely to visit their general practitioner more frequently or use herbal medicine than those without a mental health co-morbidity. Women with depression and anxiety were also less likely to consult a physiotherapist and those with anxiety less likely to consult a podiatrist over time when compared to the other mental health groups.


Asunto(s)
Diabetes Mellitus , Salud Mental , Trastornos de Ansiedad , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Femenino , Servicios de Salud , Humanos , Masculino , Morbilidad
7.
BMC Public Health ; 22(1): 1474, 2022 08 02.
Artículo en Inglés | MEDLINE | ID: mdl-35918692

RESUMEN

BACKGROUND: Obesity, a complex public health problem, is generally associated with other chronic diseases. The association of obesity with health service utilization has been little investigated in low- and middle-income countries. This study aimed to analyze the association between obesity and health service utilization (considering those services related to hypertension and/or diabetes). METHODS: A cross-sectional, nationally-representative, study of Brazilians aged ≥18 years was conducted. Data from the National Health Survey (2013) for 59,402 individuals were analyzed, including measured weight and height. The association between body mass index (BMI) category (under/normal weight, overweight, and obesity) and health service utilization due to hypertension and/or diabetes was investigated using Poisson regression models (crude and adjusted). To analyze the health services utilization, the following variables were considered: 1) routine visits to a general doctor or health service; 2) referrals/consultations with a specialist; 3) prescribed exams done; and 4) hospital admission due to the disease or related complication. All analyses were stratified by sex. RESULTS: Compared with under/normal-weight individuals, subjects with obesity (both male and female) made roughly double the use of all health care services assessed. Men with hypertension that had obesity had a higher risk of hospital admission (adjusted PR = 2.55; 95%CI 1.81-3.61), than those with under/normal weight. Women with diabetes that had obesity had more referrals/consultations with specialists (adjusted PR = 2.56; 95%CI 1.94-3.38), than those with under/normal weight. CONCLUSIONS: The presence of obesity was associated with increased use of health care services for hypertension and/or diabetes, indicating greater demand for human resources and materials, and a greater burden on the national health system.


Asunto(s)
Diabetes Mellitus , Hipertensión , Adolescente , Adulto , Índice de Masa Corporal , Brasil/epidemiología , Estudios Transversales , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Femenino , Servicios de Salud , Encuestas Epidemiológicas , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Hipertensión/terapia , Masculino , Obesidad/complicaciones , Obesidad/epidemiología , Obesidad/terapia , Prevalencia
8.
Arch Iran Med ; 25(4): 214-223, 2022 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-35942993

RESUMEN

BACKGROUND: Universities of medical sciences (UMSs) in Iran have geographic catchment areas (normally a province) in which they are responsible for public health services as well as provision of care by public providers. The present study strived to analyze and rank the performance of the medical sciences universities in improving the public health and primary healthcare. METHODS: Data on 41 indicators on the output (16 indicators), outcome (16 indicators), and impact (9 indicators) levels were extracted from various data sources. Principal component analysis (PCA) was used to calculate the weight for each of the indicators. The score range for each level of performance is between 0 and 1. A score of 1 indicates the highest and a score of 0 indicates the lowest level of performance. Finally, the UMSs were ranked by their scores. RESULTS: The national mean performance scores of the UMSs on the output, outcome, impact, and the composite indicator levels were 0.756, 0.641, 0.561, and 0.563, respectively. The results show that the changes in performance scores at different levels of the results chain are remarkable. CONCLUSION: The national mean performance of the UMSs of Iran is not satisfactory. However, there is considerable dispersion in their performance. Designing effective interventions in proportion to the conditions of universities on different levels of the results chain, developing a robust information system, conducting continuous monitoring and evaluation of public health are recommended for balanced improvements in public health and primary healthcare indicators in the country.


Asunto(s)
Servicios de Salud , Humanos , Irán , Universidades
9.
Int J Public Health ; 67: 1604924, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35910432

RESUMEN

Objectives: We carried out a mixed method study to understand why patients did not avail of surgical care in an urban slum in India. Methods: In our earlier study, we found that out of 10,330 people, 3.46% needed surgery; 42% did not avail of surgery (unmet needs). We conducted a follow-up study to understand reasons for not availing surgery, 141 in met needs, 91 in unmet needs. We administered 2 instruments, 16 in-depth interviews and 1 focused group discussion. Results: Responses from the 2 groups for "the Socio-culturally Competent Trust in Physician Scale for a Developing Country Setting" scale did not have significant difference except for, prescription of medicines, patients with unmet needs were less likely to agree (p = 0.076). Results between 2 groups regarding "Patient perceptions of quality" did not show significant difference except for doctors answering questions where a higher proportion of unmet need group agreed (p = 0.064). Similar observations were made in the in depth interviews and focus group. Conclusion: There is a need for understanding trust issues with health service delivery related to surgical care for marginalized populations.


Asunto(s)
Áreas de Pobreza , Cobertura Universal del Seguro de Salud , Estudios de Seguimiento , Servicios de Salud , Humanos , India
12.
East Mediterr Health J ; 28(6): 444-453, 2022 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-35815876

RESUMEN

Background: In 2004, Tunisia has implemented health insurance reform in order to remedy several problems related to alarming inequity, insufficient health coverage, and exponential growth in health costs and out of pocket spending. Aims: This paper aimed at sharing a critical vision and qualitative assessment of health insurance reform implemented during 2004 in Tunisia. Methods: Using several sources of information such as the national health insurance fund and the national institute of statistics, we identified the major problems of the health insurance system, the objectives outlined by the reform in relation to these problems, the implementation of measures taken and the level of achievement of these objectives. Results: 17% of the population remains without health coverage. In 2015, the out-of-pocket health expenditures was 39.8%, which does not avoid the risk of catastrophic expenditure. Almost all (91%) of out-of-pocket health expenditures are spent for private sector related healthcare services. Coverage for chronic disease control remains insufficient. The health expenditure contribution of supplementary schemes is estimated at 3.3%. The fragmentation of the health coverage accentuates the inequalities in access to healthcare. Conclusion: In general, the measures taken by the health insurance reform were not found to be sufficiently efficient to achieve its objectives. Out-of-pocket health expenditures remain high. For better social health protection, policy makers have to restructure health coverage, promote the public health sector and guarantee access to medicines, particularly for chronic diseases.


Asunto(s)
Gastos en Salud , Seguro de Salud , Servicios de Salud , Humanos , Sector Privado , Túnez
13.
Cien Saude Colet ; 27(8): 3153-3156, 2022 Aug.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-35894326

RESUMEN

The IBGE has been playing a leading role in the public policy evaluation in Brazil since 2019. After the National Health Survey (PNS) evaluated primary care services in the Unified Health System (SUS) provided to adults, in 2022, the Continuous National Household Sample Survey (PNAD-C) investigated child health. To this end, it adopted one version of the Primary Care Assessment Tool (PCAT), developed and disseminated by Starfield and Shi to assess the existence and extent of the attributes of PHC services. The target audience surveyed included children under 13 years of age, and the questionnaires were answered by their guardians/caregivers. It included all the 27 federative units of the country in random probabilistic samples, also unfolding in the Brazilian metropolitan regions and capitals. This is the largest household survey on child health assessment ever conducted in Brazil. With the PNS-2019 and the PNAD-C in 2022, IBGE inaugurates its greatest legacy for Brazilian primary health care regarding the evaluation of SUS users, with all federative units recognizing and understanding how Brazilian society evaluates health services at the first level of care.


Desde 2019, o IBGE vem ocupando no cenário da avaliação de políticas públicas no Brasil um local de protagonismo. Após a Pesquisa Nacional de Saúde (PNS) avaliar os serviços de atenção primária no Sistema Único de Saúde (SUS) prestados aos adultos, em 2022 a Pesquisa Nacional por Amostra de Domicílios Contínua (PNAD-C) investigou o cuidado infantil. Para isso, utilizou uma das versões do Primary Care Assessment Tool (PCAT), desenvolvido e disseminado por Starfield e Shi para avaliar a existência e extensão dos atributos dos serviços de atenção primária à saúde (APS). O público-alvo pesquisado incluiu crianças menores de 13 anos, e os questionários foram respondidos por seus responsáveis/cuidadores. Contemplou todas as 27 unidades da federação do país, em amostras aleatórias probabilísticas, desdobrando-se ainda pelas regiões metropolitanas e capitais do Brasil. Trata-se do maior inquérito domiciliar sobre avaliação da saúde infantil já realizado no Brasil. A partir da PNS-2019 e da PNAD-C em 2022, o IBGE inaugura seu maior legado para a atenção primária à saúde no Brasil no que se refere à avaliação dos usuários do SUS, com todas as unidades da federação (re)conhecendo como a sociedade brasileira avalia os serviços de saúde no primeiro nível de atenção.


Asunto(s)
Salud Infantil , Servicios de Salud , Adulto , Brasil , Niño , Encuestas Epidemiológicas , Humanos , Encuestas y Cuestionarios
14.
PLoS One ; 17(7): e0271739, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35867648

RESUMEN

OBJECTIVES: To estimate the change to health service costs and health benefits from a decision to adopt temporary isolation rooms that are effective at isolating the patient within a general ward environment. We assess the cost-effectiveness of a decision to adopt an existing temporary isolation room in a Singapore setting. METHOD: We performed a model-based cost-effectiveness analysis to evaluate the impact of a decision to adopt temporary isolation rooms for infection prevention. We estimated changes to the costs from implementation, the number of cases of healthcare associated infection, acute care bed days used, they money value of bed days, the number of deaths, and the expected change to life years. We report the probability that adoption was cost-effective by the cost by life year gained, against a relevant threshold. Uncertainty is addressed with probabilistic sensitivity analysis and the findings are tested with plausible scenarios for the effectiveness of the intervention. RESULTS: We predict 478 fewer cases of HAI per 100,000 occupied bed days from a decision to adopt temporary isolation rooms. This will result in cost savings of $SGD329,432 and there are 1,754 life years gained. When the effectiveness of the intervention is set at 1% of cases of HAI prevented the incremental cost per life year saved is $16,519; below the threshold chosen for cost-effectiveness in Singapore. CONCLUSIONS: We provide some evidence that adoption of a temporary isolation room is cost-effective for Singapore acute care hospitals. It is plausible that adoption is a positive decision for other countries in the region who may demonstrate fewer resources for infection prevention and control.


Asunto(s)
Servicios de Salud , Habitaciones de Pacientes , Análisis Costo-Beneficio , Humanos , Años de Vida Ajustados por Calidad de Vida , Singapur
15.
BMC Pregnancy Childbirth ; 22(1): 582, 2022 Jul 21.
Artículo en Inglés | MEDLINE | ID: mdl-35864462

RESUMEN

BACKGROUND: The lives of babies and mothers are at risk due to the uneven distribution of healthcare facilities required for emergency cesarean sections (CS). However, CS without medical indications might cause complications for mothers and babies, which is a global health problem. Identifying spatiotemporal variations of CS rates in each geographical area could provide helpful information to understand the status of using CS services. METHODS: This cross-sectional study explored spatiotemporal patterns of CS in northeast Iran from 2016 to 2020. Space-time scan statistics and spatial interaction analysis were conducted using geographical information systems to visualize and explore patterns of CS services. RESULTS: The temporal analysis identified 2017 and 2018 as the statistically significant high clustered times in terms of CS rate. Five purely spatial clusters were identified that were distributed heterogeneously in the study region and included 14 counties. The spatiotemporal analysis identified four clusters that included 13 counties as high-rate areas in different periods. According to spatial interaction analysis, there was a solid spatial concentration of hospital facilities in the political center of the study area. Moreover, a high degree of inequity was observed in spatial accessibility to CS hospitals in the study area. CONCLUSIONS: CS Spatiotemporal clusters in the study area reveal that CS use in different counties among women of childbearing age is significantly different in terms of location and time. This difference might be studied in future research to identify any overutilization of CS or lack of appropriate CS in clustered counties, as both put women at risk. Hospital capacity and distance from population centers to hospitals might play an essential role in CS rate variations and spatial interactions among people and CS facilities. As a result, some healthcare strategies, e.g., building new hospitals and empowering the existing local hospitals to perform CS in areas out of service, might be developed to decline spatial inequity.


Asunto(s)
Cesárea , Accesibilidad a los Servicios de Salud , Estudios Transversales , Femenino , Servicios de Salud , Humanos , Irán/epidemiología , Embarazo
16.
PLoS One ; 17(7): e0268588, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35849560

RESUMEN

OBJECTIVE: To explore the experiences and challenges of people with Parkinson's and their family members living in the community through the lens of their transitions to better understand the phases and changes in their lives. DESIGN: Qualitative study using semi-structured interviews and analysed using codebook thematic analysis. SETTING/PARTICIPANTS: Purposive sampling was used in primary and secondary healthcare services across Southern England in 2019 to recruit 21 people with Parkinson's (aged between 45-89 years) and 17 family members (13 spouses and 4 adult children, aged between 26-79 years). RESULTS: Participants' descriptions were classified in three main phases of transition from a place of health towards greater dependency on others: 1) 'Being told you are a person with Parkinson's' (early), 2) 'Living with Parkinson's' (mid), and 3) 'Increasing dependency' (decline). Seven sub-themes were identified to describe the transitions within these three phases: phase 1: receiving and accepting a diagnosis; navigating reactions; phase 2: changing social interactions and maintaining sense of self; information: wanting to know but not wanting to know; finding a place within the healthcare system; and 3: changes in roles and relationships; and increasingly dependent. CONCLUSION: This study has identified points of change and means of supporting key transitions such as diagnosis, changes in social connections, and increased use of secondary healthcare services so that comprehensive, holistic, individualised and well-timed support can be put in place to maintain well-being.


Asunto(s)
Enfermedad de Parkinson , Adulto , Anciano , Anciano de 80 o más Años , Niño , Familia , Servicios de Salud , Humanos , Persona de Mediana Edad , Investigación Cualitativa , Esposos
17.
Semin Speech Lang ; 43(3): 176-197, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35858604

RESUMEN

People with communication disorders face barriers to accessing safe and respectful healthcare. These barriers result in increased healthcare complications and inefficiencies, both of which contribute to increased healthcare costs. One obstacle to advocating for accommodations that could improve healthcare for this population is the absence of cost effectiveness studies of such accommodations specifically, as well as a paucity of data defining the needs of this population in general. The purpose of this study was to explore how people with communication and swallowing difficulties are characterized in the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries aged 65 and older, and how they manage their healthcare. Cross-sectional data from the NHATS rounds 5 to 9 (2015-2019) resulted in 8,038 unique respondents, 3,243 of who reported speech, memory, hearing, and/or swallowing difficulties. More than 90% of respondents with communication difficulties reported having a regular doctor. Less than 60% of respondents with communication difficulties had a family member or caregiver go to medical appointments with them, and around 70% of that subset of participants received help from that caregiver with communication during appointments. Fewer than 15% of respondents with communication difficulties used the internet for healthcare communication or information. Less than 5% of respondents across all communication difficulty categories had received rehabilitation services for communication in the year prior to their survey responses. While the information gleaned from NHATS points to likely gaps between the needs people with communication disorders may have for safe and accessible healthcare, and the support available, future research is needed to improve and clarify how communication disorders are defined and characterized in large-scale surveys to generate more interpretable data. These stronger empirical foundations are needed to support cost-effectiveness analyses to advocate for better communication accessibility of healthcare settings.


Asunto(s)
Trastornos de la Comunicación , Medicare , Anciano , Envejecimiento , Comunicación , Trastornos de la Comunicación/terapia , Estudios Transversales , Servicios de Salud , Accesibilidad a los Servicios de Salud , Humanos , Estados Unidos
18.
BMC Geriatr ; 22(1): 571, 2022 07 11.
Artículo en Inglés | MEDLINE | ID: mdl-35820836

RESUMEN

BACKGROUND: Although universal free healthcare is available for all Sri Lankan citizens, older adults face somewhat unique obstacles when utilizing available healthcare services. The aim of this study was to examine some vital predisposing, enabling, and need factors associated with doctor visits made by urban-dwelling older adults in Sri Lanka. METHODS: A representative sample of 880 urban-dwelling older adults (aged 60 years and above) was surveyed using an interviewer-administered questionnaire. Number of doctor visits, self-rated health, physical activity, and socio-demographic and self-report health conditions were collected. The data were analyzed using chi-squared tests and multinomial logistic regression. RESULTS: Participants' mean age was 70.01 (± 6.02) years. The majority was women (75.0%). The mean number of doctor visits was 6.77 (± 5.92) per year. Nearly half of the participants (47.0%) had made, on average, at least one doctor visit per month. Older men and those of aged 80 years and above were the least likely to make frequent doctor visits. Participants who were physically active and who rated their health as poor were more likely to make frequent doctor visits after adjustment for age, gender, and educational level. CONCLUSIONS: Doctor visits made by Sri Lankan older adults are satisfactory. The factors that best explain high frequency of doctor visits by older adults are female gender, younger age, higher physical activity and poor self-rated health. Attention should be paid to examine possible accessible and affordable issues related to doctor visits by bedridden or physically dependent older adults in advanced age categories.


Asunto(s)
Servicios de Salud , Anciano , Escolaridad , Femenino , Humanos , Masculino , Sri Lanka/epidemiología , Encuestas y Cuestionarios , Población Urbana
19.
BMC Health Serv Res ; 22(1): 966, 2022 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-35906627

RESUMEN

BACKGROUND: The relationship between healthcare service accessibility in the community and incarceration is an important, yet not widely understood, phenomenon. Community behavioral health and the criminal legal systems are treated separately, which creates a competing demand to confront mass incarceration and expand available services. As a result, the relationship between behavioral health services, demographics and community factors, and incarceration rate has not been well addressed. Understanding potential drivers of incarceration, including access to community-based services, is necessary to reduce entry into the legal system and decrease recidivism. This study identifies county-level demographic, socioeconomic, healthcare services availability/accessibility, and criminal legal characteristics that predict per capita jail population across the U.S. More than 10 million individuals pass through U.S. jails each year, increasing the urgency of addressing this challenge. METHODS: The selection of variables for our model proceeded in stages. The study commenced by identifying potential descriptors and then using machine learning techniques to select non-collinear variables to predict county jail population per capita. Beta regression was then applied to nationally available data from all 3,141 U.S. counties to identify factors predicting county jail population size. Data sources include the Vera Institute's incarceration database, Robert Wood Johnson Foundation's County Health Rankings and Roadmaps, Uniform Crime Report, and the U.S. Census. RESULTS: Fewer per capita psychiatrists (z-score = -2.16; p = .031), lower percent of drug treatment paid by Medicaid (-3.66; p < .001), higher per capita healthcare costs (5.71; p < .001), higher number of physically unhealthy days in a month (8.6; p < .001), lower high school graduation rate (-4.05; p < .001), smaller county size (-2.66, p = .008; -2.71, p = .007; medium and large versus small counties, respectively), and more police officers per capita (8.74; p < .001) were associated with higher per capita jail population. Controlling for other factors, violent crime rate did not predict incarceration rate. CONCLUSIONS: Counties with smaller populations, larger percentages of individuals that did not graduate high school, that have more health-related issues, and provide fewer community treatment services are more likely to have higher jail population per capita. Increasing access to services, including mental health providers, and improving the affordability of drug treatment and healthcare may help reduce incarceration rates.


Asunto(s)
Prisioneros , Psiquiatría , Servicios de Salud , Humanos , Medicaid , Prisioneros/psicología , Salud Pública , Estados Unidos/epidemiología
20.
BMJ Open ; 12(7): e060347, 2022 07 27.
Artículo en Inglés | MEDLINE | ID: mdl-35896288

RESUMEN

Realist evaluation is a methodology that addresses the questions: 'what works, for whom, in which circumstances, and how?'. In this approach, programme theories are developed and tested against available evidence. However, when complex interventions are implemented in rapidly changing environments, there are many unpredictable forces that determine the programme's scope and architecture, as well as resultant outcome. These forces can be theorised, in real time, and included in realist evaluation outputs for current and future optimisation of programmes. Reflecting on a realist evaluation of first-contact physiotherapy in primary care (the FRONTIER Study), five important considerations are described for improving the quality of realist evaluation outputs when studying rapidly changing health service delivery. These are: (1) ensuring that initial programme theories are developed through creative thinking sessions, empirical and non-empirical literature, and stakeholder consultation; (2) testing the causal impact of formal and informal (eg, emergent) components of service delivery models; (3) contrasting initial programme theories with rival theory statements; (4) envisioning broad system impacts beyond the immediate implementation setting; and (5) incorporating rapidly evolving service developments and context changes into the theory testing process in real-time (eg, Additional Role Reimbursement Scheme, COVID-19). Through the reflections presented, the aim is to clarify the benefit of realist evaluation to assess emerging models of care and rapidly changing health service delivery.


Asunto(s)
COVID-19 , COVID-19/epidemiología , Servicios de Salud , Humanos , Derivación y Consulta
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