ABSTRACT
Musculoskeletal urgent care centers (MUCCs) are an increasingly common alternative to emergency departments for patients with orthopedic injuries. As there is a lack of longitudinal data regarding MUCCs' impact on the emergency health care system, our study seeks to understand recent trends in MUCC growth and their acceptance of Medicaid insurance. Over the last 6 years, at 2-year intervals (2019, 2021, and 2023), we performed a search to identify all MUCCs in the United States. We determined the affiliation and Medicaid acceptance status of all MUCCs, including those that closed/opened between 2019, 2021, and 2023, to analyze trends in MUCC availability and Medicaid acceptance. In 2019, there were 558 MUCCs, which increased to 596 MUCCs in 2021 and then decreased to 555 MUCCs in 2023, representing a growth and then decline of approximately 7%. Overall, since June 2019, 90 MUCCs have opened and 95 MUCCs have closed. Medicaid acceptance increased nationally between 2019 and 2023, from 58% to 71%. Medicaid acceptance increased for both nonaffiliated and privately affiliated MUCCs. Medicaid acceptance has increased nationally from 2019 to 2023, while MUCC availability has gone through a period of growth and then reversion to 2019 levels. As MUCCs have demonstrated limited Medicaid acceptance previously, it is promising that Medicaid acceptance has improved and MUCCs are providing patients with an additional avenue to access orthopedic care.
Subject(s)
Ambulatory Care Facilities , Health Services Accessibility , Medicaid , United States , Medicaid/statistics & numerical data , Medicaid/trends , Humans , Health Services Accessibility/trends , Health Services Accessibility/statistics & numerical data , Ambulatory Care Facilities/statistics & numerical data , Ambulatory Care Facilities/trends , Musculoskeletal Diseases/therapyABSTRACT
BACKGROUND: Kerala has initiated many Universal Health Coverage (UHC) reforms in the last decade. The Aardram Mission launched in 2017 stands out owing to its scope, objectives, and commitments for strengthening Primary Health Care (PHC) in the State. The current study proposes to explore access and financial protection through the lens of equity in Kerala especially in the context of major UHC reforms carried out during the last decade. This paper will also highlight the key lessons from Kerala's approach towards UHC and health systems strengthening through a political economy approach. METHODS: Data from the Kerala state sample of 75th Round (2017-18) National Sample Survey is used for this study. Comparison is also drawn from the 71st Round Sample Survey, 2014, to measure the state's progress in terms of access and financial protection. Logistic regression was used for the calculation. The findings were further explored through a political economy approach. RESULTS: The share of public facilities for outpatient care is 47.5%, which is a significant increase from 34.0% (in 2014) in the state. The share of public sector for out-patient care has increased for the lower socio-economic population in the state. The share of public sector for in-patient care has also increased to 37.3% in 2017-18 from 33.9% in 2014, but not to the extent as the increase shown in outpatient care. The average out-of-pocket-expenditure during hospitalization has increased more in private facilities as compared to public for both outpatient care and hospitalization. CONCLUSIONS: Overall increase in the share of public facilities for both outpatient care and hospitalization is indicative of the enhanced trust among the people at large of the public healthcare delivery system in Kerala, post the launch of UHC reforms in the State. The insurance linked UHC reforms would be insufficient for the State to progress further towards UHC. Kerala with a long and successful history in 'public provisioning' should focus more on strengthening PHC through Aardram Mission in its journey towards pursuit of UHC.
Subject(s)
Health Services Accessibility , Universal Health Insurance , Humans , Universal Health Insurance/trends , Health Services Accessibility/trends , India , Health Care Reform/trends , Primary Health Care/statistics & numerical data , Public SectorABSTRACT
Although biotherapeutic drugs have the potential of transforming the management of many life-threatening diseases, their affordability and accessibility remain an issue. This study offers an overview of the global affordability of biotherapeutic products. For this, prices for 10 representative biotherapeutic products were examined in 40 countries, including high-income countries (HICs), upper middle-income countries (UMICs), lower middle-income countries (LMICs), and low-income countries (LICs). The affordability of these biotherapeutics was calculated based on the World Health Organization/Health Action International (WHO/HAI) method. As expected, affordability was found to be better in HICs, followed by UMICs, LMICs, and finally, LICs. Furthermore, based on the trend of per capita income, we predict that in UMICs and LMICs, the affordability of high molecular weight biologics will worsen by 1.5× and 2× by 2030, respectively, and further by 4× and 6× by 2040. On the other hand, affordability will stay nearly the same for people living in HICs in the coming decades. Our analysis suggests that it is imperative that measures be taken to make this class of products more affordable and accessible. Governments can contribute by creating conducive policies. Global institutions like the WHO can play a significant role as well. Finally, manufacturers need to invest in and implement manufacturing innovations.
Subject(s)
Biological Products , Developing Countries , Humans , Biological Products/economics , Biological Products/therapeutic use , Developing Countries/economics , Drug Costs/trends , Global Health/economics , Health Services Accessibility/economics , Health Services Accessibility/trends , World Health OrganizationABSTRACT
Importance: In the US, the COVID-19 pandemic led to a significant rise in unemployment and economic loss that disproportionately impacted low-income individuals. It is unknown how health care and prescription medication affordability changed among low-income adults during the COVID-19 pandemic overall and compared with their higher-income counterparts. Objective: To evaluate changes in health care affordability and prescription medication affordability during the COVID-19 pandemic (2021 and 2022) compared with pre-COVID-19 pandemic levels (2019) and whether income-based inequities changed. Design, Setting, and Participants: This retrospective cross-sectional study included adults 18 years and older participating in the National Health Interview Survey (NHIS) in 2019, 2021, and 2022. Low-income adults were defined as having a household income of 200% or less of the federal poverty level (FPL); middle-income adults, 201% to 400% of the FPL; and high-income adults, more than 400% of the FPL. Data were analyzed from June to November 2023. Main Outcomes and Measures: Measures of health care affordability and prescription medication affordability. Results: The study population included 89â¯130 US adults. Among the weighted population, 51.6% (95% CI, 51.2-52.0) were female, and the mean (SD) age was 48.0 (0.12) years. Compared with prepandemic levels, during the COVID-19 pandemic, low-income adults were less likely to delay medical care (2022: 11.2%; 95% CI, 10.3-12.1; 2019: 15.4%; 95% CI, 14.3-16.4; adjusted relative risk [aRR], 0.73; 95% CI, 0.66-0.81) or avoid care (2022: 10.7%; 95% CI, 9.7-11.6; 2019: 14.9%; 95% CI, 13.8-15.9; aRR, 0.72; 95% CI, 0.64-0.80) due to cost, while high-income adults experienced no change, resulting in a significant improvement in income-based disparities. Low-income and high-income adults were less likely to experience problems paying medical bills but experienced no change in worrying about medical bills during the COVID-19 pandemic compared with prepandemic levels. Across measures of prescription medication affordability, low-income adults were less likely to delay medications (2022: 9.4%; 95% CI, 8.4-10.4; 2019: 12.7%; 95% CI, 11.6-13.9; aRR, 0.74; 95% CI, 0.65-0.84), not fill medications (2022: 8.9%; 95% CI, 8.1-9.8; 2019: 12.0%; 95% CI, 11.1-12.9; aRR, 0.75; 95% CI, 0.66-0.83), skip medications (2022: 6.7%; 95% CI, 5.9-7.6; 2019: 10.1%; 95% CI, 9.1-11.1; aRR, 0.67; 95% CI, 0.57-0.77), or take less medications (2022: 7.3%; 95% CI, 6.4-8.1; 2019: 11.2%; 95% CI, 10.%-12.2; aRR, 0.65; 95% CI, 0.56-0.74) due to costs, and these patterns were largely similar among high-income adults. Improvements in measures of health care and prescription medication affordability persisted even after accounting for changes in health insurance coverage and health care use. These patterns were similar when comparing measures of affordability in 2021 with 2019. Conclusions and Relevance: Health care affordability improved for low-income adults during the COVID-19 pandemic, resulting in a narrowing of income-based disparities, while prescription medication affordability improved for all income groups. These findings suggest that the recent unwinding of COVID-19 pandemic-related safety-net policies may worsen health care affordability and widen existing income-based inequities.
Subject(s)
COVID-19 , Poverty , Prescription Drugs , Humans , COVID-19/epidemiology , Cross-Sectional Studies , United States/epidemiology , Male , Female , Middle Aged , Retrospective Studies , Adult , Prescription Drugs/economics , Prescription Drugs/therapeutic use , Income , Aged , Health Services Accessibility/economics , Health Services Accessibility/statistics & numerical data , Health Services Accessibility/trends , Young Adult , Adolescent , PandemicsABSTRACT
PURPOSE: To assess the changing trends in barriers towards accessing eye care in a rural population cohort from Southern India. METHODS: This is a population-based longitudinal cohort of participants (the Andhra Pradesh Eye Disease study [APEDS]) from three rural regions of Telangana and Andhra Pradesh who were evaluated at baseline (APEDS I; 1996-2000), along with follow-ups at 10 years (APEDS II; 2009-10) and 15 years (APEDS III; 2012-2016). At follow-up, all participants 30 years and above were administered a structured questionnaire on barriers to uptake of eye care services. RESULTS: Of 3810 participants, 1449 had visual impairment (VI). Among them, 1302 noticed a reduction in vision over last five years and 722 sought treatment, a significant improvement from baseline (P < 0.001). Participants were more likely to seek treatment if they were educated (OR = 1.43, 95%CI: 1.07-1.89), had hypertension (OR = 1.36, 95%CI: 1.04-1.77), had VI from causes other than cataract and refractive error (OR = 2.49, 95%CI: 1.56-3.99) and were residents of Adilabad (OR = 2.21; 95%CI: 1.58-3.08) and Mahbubnagar (OR = 3.55; 95%CI: 2.48-5.08) districts. Those with moderate or worse VI were less likely to seek treatment (moderate VI: OR = 0.56; 95%CI: 0.42-0.75, severe VI: OR = 0.34; 95%CI: 0.19-0.57, blindness: OR = 0.38; 95%CI: 0.2-0.73). The most important barriers to uptake of services were, not perceiving loss of vision as a serious problem (25.9%), accepting it an aging process (21.4%) or due to economic reasons (16.0%). CONCLUSION: Personal and economic elements accounted for considerable amounts of barriers for utilization of eye care services. The uptake of services could be improved by addressing these specific barriers and risk factors for non-compliance.
Subject(s)
Health Services Accessibility , Rural Population , Humans , India/epidemiology , Male , Female , Rural Population/statistics & numerical data , Middle Aged , Health Services Accessibility/trends , Health Services Accessibility/statistics & numerical data , Adult , Aged , Surveys and Questionnaires , Eye Diseases/epidemiology , Eye Diseases/therapy , Longitudinal Studies , Visual Acuity , Patient Acceptance of Health Care/statistics & numerical dataABSTRACT
BACKGROUND: There has been a growing imbalance between supply of dermatologists and demand for dermatologic care. To best address physician shortages, it is important to delineate supply and demand patterns in the dermatologic workforce. The goal of this study was to explore dermatology supply and demand over time. METHODS: We conducted a cross-sectional analysis of workforce supply and demand projections for dermatologists from 2021 to 2036 using data from the Health Workforce Simulation Model from the National Center for Health Workforce Analysis. Estimates for total workforce supply and demand were summarized in aggregate and stratified by rurality. Scenarios with status quo demand and improved access were considered. RESULTS: Projected total supply showed a 12.45% increase by 2036. Total demand increased 12.70% by 2036 in the status quo scenario. In the improved access scenario, total supply was inadequate for total demand in any year, lagging by 28% in 2036. Metropolitan areas demonstrated a relative supply surplus up to 2036; nonmetropolitan areas had at least a 157% excess in demand throughout the study period. In 2021 adequacy was 108% and 39% adequacy for metropolitan and nonmetropolitan areas, respectively; these differences were projected to continue through 2036. CONCLUSIONS: The findings suggest that the dermatology physician workforce is inadequate to meet the demand for dermatologic services in nonmetropolitan areas. Furthermore, improved access to dermatologic care would bolster demand and especially exacerbate workforce inadequacy in nonmetropolitan areas. Continued efforts are needed to address health inequities and ensure access to quality dermatologic care for all.
Subject(s)
Dermatologists , Dermatology , Health Services Needs and Demand , Humans , United States , Cross-Sectional Studies , Dermatology/statistics & numerical data , Dermatology/trends , Health Services Needs and Demand/trends , Health Services Needs and Demand/statistics & numerical data , Dermatologists/supply & distribution , Dermatologists/statistics & numerical data , Dermatologists/trends , Health Workforce/statistics & numerical data , Health Workforce/trends , Workforce/statistics & numerical data , Workforce/trends , Health Services Accessibility/statistics & numerical data , Health Services Accessibility/trends , ForecastingABSTRACT
BACKGROUND: When today's efforts to achieve universal health coverage are mainly directed towards low-income settings, it is perhaps easy to forget that countries considered to have universal, comprehensive and high-performing health systems have also undergone this journey. In this article, the aim is to provide a century-long perspective to illustrate Sweden's long and ongoing journey towards universal health coverage and equal access to healthcare. METHODS: The focus is on macro-level policy. A document analysis is divided into three broad eras (1919-1955; 1955-1989; 1989-) and synthesises seven points in time when policies relevant to overarching goals and regulation of universal health coverage and equal access were proposed and/or implemented. The development is analysed and concluded in relation to two egalitarian goals in the context of health: equality of access and equal treatment for equal need. RESULTS: Over the past century, macro-level policy evolved from the concept of creating access for the neediest and those reliant on wages for their survival to a mandatory insurance with equal right to healthcare for all. However, universal health coverage was not achieved until 1955, and individuals had to rely on their personal financial resources to cover the cost at the time of care utilization until the 1970s. It was not until 1983 that legislation explicitly stated that access to healthcare should be equal for the entire population (horizontal equity), while a vertical equity-principle was not added until 1997. Subsequently, ideas of free choice and privatization have gained significance. For instance, they aim to increase service access, addressing the Swedish health system's Achilles' heel in this regard. However, the principle of equal access for all is now being challenged by the emergence of private health insurance, which offers quicker access to services. It can be concluded that there is no perpetual Swedish healthcare model and various dimensions of access have been the focus of policy discussion. The discussion on access barriers has shifted from financial to personal and organizational ones. Today, Sweden still ranks high in terms of affordability and equity in international comparisons: although not as well as a decade ago. Whether this marks the beginning of a new trend intertwined with a decline in Sweden's welfare 'exceptionalism', or is a temporary decline remains to be assessed in the future.
Subject(s)
Health Policy , Health Services Accessibility , Universal Health Insurance , Sweden , Universal Health Insurance/trends , Universal Health Insurance/history , Humans , Health Services Accessibility/trends , Health Policy/history , Health Policy/trends , History, 20th Century , History, 21st CenturyABSTRACT
OBJECTIVE: There has been a modest but progressive increase in the neurosurgical workforce, training, and service delivery in Nigeria in the last 2 decades. However, these resources are unevenly distributed. This study aimed to quantitatively assess the availability and distribution of neurosurgical resources in Nigeria while projecting the needed workforce capacity up to 2050. METHODS: An online survey of Nigerian neurosurgeons and residents assessed the country's neurosurgical infrastructure, workforce, and resources. The results were analyzed descriptively, and geospatial analysis was used to map their distribution. A projection model was fitted to predict workforce targets for 2022-2050. RESULTS: Out of 86 neurosurgery-capable health facilities, 65.1% were public hospitals, with only 17.4% accredited for residency training. Dedicated hospital beds and operating rooms for neurosurgery make up only 4.0% and 15.4% of the total, respectively. The population disease burden is estimated at 50.2 per 100,000, while the operative coverage was 153.2 cases per neurosurgeon. There are currently 132 neurosurgeons and 114 neurosurgery residents for a population of 218 million (ratio 1:1.65 million). There is an annual growth rate of 8.3%, resulting in a projected deficit of 1113 neurosurgeons by 2030 and 1104 by 2050. Timely access to neurosurgical care ranges from 21.6% to 86.7% of the population within different timeframes. CONCLUSIONS: Collaborative interventions are needed to address gaps in Nigeria's neurosurgical capacity. Investments in training, infrastructure, and funding are necessary for sustainable development and optimized outcomes.
Subject(s)
Health Services Accessibility , Neurosurgeons , Neurosurgery , Nigeria , Humans , Neurosurgery/trends , Neurosurgery/education , Health Services Accessibility/trends , Health Services Accessibility/statistics & numerical data , Neurosurgeons/supply & distribution , Neurosurgeons/trends , Health Workforce/trends , Health Workforce/statistics & numerical data , Neurosurgical Procedures/trends , Neurosurgical Procedures/statistics & numerical data , Workforce/statistics & numerical data , Workforce/trends , Internship and Residency/trends , Surveys and Questionnaires , ForecastingABSTRACT
This article examines historical trends in health inequalities over the 20th and 21st centuries. Drawing on studies from the United States, United Kingdom, Sweden, and Western Europe, it concludes that there is evidence of a u-shaped curve in (relative) health inequalities. These trends in health inequalities broadly parallel those identified by economists with regards to the u-shaped curve of income and wealth inequalities across the 20th and 21st centuries. The article argues that-as with income inequalities-health inequalities generally decreased across the twentieth century through to the early 1980s. They then started to increase and accelerated further from 2010, particularly in the United Kingdom and the United States. The article sets out four distinct policy periods that shaped the evolution of trends in health inequalities: the Interbellum Era, 1920-1950; the Trente Glorieuse, 1950-1980; Neoliberalism, 1980-2010; and the Crisis Age, 2010-present. The u-shaped curve of health inequalities over this period suggests that social policies, health care access, and political incorporation have driven changes over time. Taking this long view of changes in health inequalities emphasizes the importance of politics and policy for future health improvement.
Subject(s)
Health Status Disparities , Humans , History, 20th Century , History, 21st Century , Socioeconomic Factors , Europe , United States , Politics , Health Policy/history , Health Policy/trends , Health Services Accessibility/trends , Health Services Accessibility/history , United KingdomABSTRACT
Importance: The Supreme Court decision in Dobbs v Jackson Women's Health Organization overturned the right to choose abortion in the US, with at least 16 states subsequently implementing abortion bans or 6-week gestational limits. Prior research indicates that in the 6 months following Dobbs, approximately 32â¯360 fewer abortions were provided within the US formal health care setting. However, trends in the provision of medications for self-managed abortion outside the formal health care setting have not been studied. Objective: To determine whether the provision of medications for self-managed abortion outside the formal health care setting increased in the 6 months after Dobbs. Design, Setting, and Participants: Cross-sectional study using data from sources that provided abortion medications outside the formal health care setting to people in the US between March 1 and December 31, 2022, including online telemedicine organizations, community networks, and online vendors. Using a hierarchical bayesian model, we imputed missing values from sources not providing data. We estimated the change in provision of medications for self-managed abortion after the Dobbs decision. We then estimated actual use of these medications by accounting for the possibility that not all provided medications are used by recipients. Exposure: Abortion restrictions following the Dobbs decision. Main Outcomes and Measures: Provision and use of medications for a self-managed abortion. Results: In the 6-month post-Dobbs period (July 1 to December 31, 2022), the total number of provisions of medications for self-managed abortion increased by 27â¯838 (95% credible interval [CrI], 26â¯374-29â¯175) vs what would have been expected based on pre-Dobbs levels. Excluding imputed data changes the results only slightly (27â¯145; 95% CrI, 25â¯747-28â¯246). Accounting for nonuse of medications, actual self-managed medication abortions increased by an estimated 26â¯055 (95% CrI, 24â¯739-27â¯245) vs what would have been expected had the Dobbs decision not occurred. Conclusions and Relevance: Provision of medications for self-managed abortions increased in the 6 months following the Dobbs decision. Results suggest that a substantial number of abortion seekers accessed services despite the implementation of state-level bans and restrictions.
Subject(s)
Abortifacient Agents , Abortion, Induced , Health Services Accessibility , Supreme Court Decisions , Female , Humans , Pregnancy , Abortifacient Agents/supply & distribution , Abortifacient Agents/therapeutic use , Abortion, Induced/legislation & jurisprudence , Abortion, Induced/methods , Abortion, Legal/legislation & jurisprudence , Abortion, Legal/methods , Cross-Sectional Studies , Health Services Accessibility/legislation & jurisprudence , Health Services Accessibility/statistics & numerical data , Health Services Accessibility/trends , Mifepristone/supply & distribution , Mifepristone/therapeutic use , Misoprostol/supply & distribution , Misoprostol/therapeutic use , Self Care/methods , Self Care/trends , United States/epidemiologyABSTRACT
This Viewpoint outlines the potential effects of the Supreme Court case regarding mifepristone restrictions: a decision for the FDA would allow current dispensing, while ruling against the FDA would severely curtail access to reproductive health options.
Subject(s)
Abortifacient Agents , Abortion, Legal , Health Services Accessibility , Mifepristone , Reproductive Health Services , Supreme Court Decisions , Humans , Abortifacient Agents/therapeutic use , Abortion, Induced/legislation & jurisprudence , Abortion, Induced/methods , Abortion, Induced/trends , Abortion, Legal/legislation & jurisprudence , Abortion, Legal/methods , Abortion, Legal/trends , Health Services Accessibility/legislation & jurisprudence , Health Services Accessibility/trends , Mifepristone/therapeutic use , Nonprescription Drugs/therapeutic use , Reproductive Health Services/legislation & jurisprudence , Reproductive Health Services/trends , United States , United States Food and Drug Administration/legislation & jurisprudenceABSTRACT
Introducción: la medicina basada en el valor ha logrado mejorar la calidad de atención del paciente y/o la satisfacción de las personas, reduciendo costos y obteniendo mejores resultados. Se apoya sobre tres pilares básicos: la medicina basada en la evidencia, la atención centralizada en el paciente, y la sustentabilidad. Sin embargo, existen pocas publicaciones sobre la estrategia de personas navegadoras para pacientes con cáncer de pulmón, que podrían ser una herramienta clave para brindar apoyo, asegurando que tengan acceso al conocimiento y los recursos necesarios a fin de completar la vía de atención clínica recomendada. Estado del arte: se trata de una intervención en salud cuyo objetivo principal es lograr vencer las barreras relacionadas con la atención (p. ej., logísticas, burocrático-administrativas, de comunicación y financieras) para poder mejorar la calidad y el acceso a la salud en el marco de la atención del cáncer. Estas personas cumplen un papel de guía para pacientes durante el proceso de diagnóstico y tratamiento activo. Su labor consiste en vincular al paciente con los proveedores clínicos, brindar un sistema de apoyo, asegurar un acompañamiento individualizado, garantizar que tengan acceso al conocimiento y a los recursos necesarios para completar el seguimiento y/o tratamiento adecuado. Discusión/Conclusión: indudablemente, es un elemento cada vez más reconocido en los programas de cáncer, centrado en el paciente y de alta calidad. Su implementación será de especial interés en la Unidad de Práctica Integrada para personas con cáncer de pulmón. (AU)
Introduction: Value-based medicine has succeeded in improving the quality of patient care and or patient satisfaction, reducing costs, and obtaining better outcomes. It rests on three fundamental pillars: evidence-based medicine, patient-centered care, and sustainability. However, there are few publications on the people navigator strategy for lung cancer patients, which could be a crucial tool for providing support, ensuring that they have access to the knowledge and resources needed to complete the recommended clinical care pathway. State of the art: It is a health intervention whose main objective is to overcome care-related barriers (e.g., logistical, bureaucratic-administrative, communication, and financial) to improve quality and access to health in the context of cancer care. These individuals play a guiding role for patients during the diagnostic and active treatment process. Their job is to link the patient with clinical providers, provide a support system, ensure individualized accompaniment, and guarantee that they get access to the knowledge and resources necessary to complete the appropriate follow-up and, or treatment. Discussion/Conclusion: Undoubtedly, patient navigators represent an increasingly recognized element of high-quality, patient-centered cancer programs. Its implementation will be of specific interest in the Integrated Practice Unit for people with lung cancer. (AU)
Subject(s)
Humans , Patient Navigation/organization & administration , Lung Neoplasms , Patient Care Team , Patient Satisfaction , Patient-Centered Care/methods , Access to Information , Quality Improvement , Patient Navigation/history , Patient Outcome Assessment , Patient Reported Outcome Measures , Health Services Accessibility/trendsABSTRACT
O Plano de Enfrentamento à Violência Autoprovocada do Estado do Tocantins com Ênfase na Atenção Integral à Saúde foi desenvolvido para fortalecer a rede de atenção psicossocial, em colaboração com o Sistema Único de Saúde (SUS) e o Sistema Único de Assistência Social (SUAS). Elaborado pelo Grupo de Trabalho "Flor de Pequi", o plano tem como objetivo qualificar a Rede de Atenção à Saúde, orientando gestores e profissionais de saúde na prevenção da violência autoprovocada, automutilação e suicídio, além de promover o acolhimento e compartilhamento do cuidado na rede de atenção à saúde. O documento foi elaborado em resposta a demandas relacionadas aos dados de violência autoprovocada, solicitações do Conselho Estadual de Defesa de Direitos da Criança e do Adolescente e do Conselho Regional de Psicologia. A metodologia, discussão, metas, ações e monitoramento também são abordados no plano.
The Plan for Confronting Self-Inflicted Violence in the State of Tocantins with an Emphasis on Comprehensive Health Care was developed to strengthen the psychosocial care network in collaboration with the Unified Health System (SUS) and the Unified Social Assistance System (SUAS). Elaborated by the "Flor de Pequi" Working Group, the plan aims to enhance the Health Care Network by providing guidance to managers and health professionals in the prevention of self-inflicted violence, self-harm, and suicide, while promoting care and support within the health care system. The document was created in response to demands related to self-inflicted violence data, requests from the State Council for the Defense of the Rights of Children and Adolescents, and the Regional Psychology Council. The plan also addresses methodology, discussion, goals, actions, and monitoring.
El Plan de Enfrentamiento a la Violencia Autoinfligida en el Estado de Tocantins con Énfasis en la Atención Integral de Salud fue desarrollado para fortalecer la red de atención psicosocial en colaboración con el Sistema Único de Salud (SUS) y el Sistema Único de Asistencia Social (SUAS). Elaborado por el Grupo de Trabajo "Flor de Pequi", el plan tiene como objetivo calificar la Red de Atención a la Salud, brindando orientación a los gestores y profesionales de la salud en la prevención de la violencia autoinfligida, la automutilación y el suicidio, además de promover el cuidado y apoyo dentro de la red de atención sanitaria. El documento fue elaborado en respuesta a demandas relacionadas con datos de violencia autoinfligida, solicitudes del Consejo Estatal para la Defensa de los Derechos de la Niñez y la Adolescencia y del Consejo Regional de Psicología. El plan también aborda la metodología, la discusión, las metas, las acciones y el monitoreo
Subject(s)
Humans , Child , Adolescent , Adult , Public Health Administration/education , Mental Health/education , Adolescent Health Services/trends , Child Welfare/psychology , Indigenous Peoples/psychology , Suicide Prevention , Health Policy , Health Services Accessibility/trendsABSTRACT
Resumo O SUS trouxe os princípios de universalidade, integralidade e equidade para nortear as ações e os serviços de saúde, que devem ser livres de preconceito e discriminação. A rede formal de cuidados foi compreendida como a que está institucionalizada e a rede informal é uma rede afetiva. O objetivo da pesquisa foi compreender o acesso à rede de cuidados à saúde na percepção de transexuais em um município da Zona da Mata mineira, por meio da abordagem metodológica qualitativa com estudo descritivo. Foram realizadas entrevistas semiestruturadas com oito pessoas transexuais. As informações foram analisadas por meio da hermenêutica-dialética. Foram identificadas como barreiras à rede formal de cuidados o desrespeito ao uso do nome social nos serviços de saúde e o preconceito dos profissionais. Buscam-se cuidados e informações sobre uso de hormônios nas redes informais. A rede informal acolhe, mas a busca por cuidados somente nessas redes pode trazer riscos à saúde. A pesquisa evidenciou a existência de uma forte rede afetiva no município e a necessidade do estabelecimento de uma sólida rede formal de cuidados para a população transexual com ampla participação da rede informal. A rede formal é instável e não atende as necessidades de saúde dessa população.
Abstract SUS brought the principles of universality, integrality, and equity to guide health actions and services, which must be free from any form of prejudice and discrimination. The formal care network was understood as the one that is institutionalized, and the informal network is an affective network. This research aimed to understand the access to the health care network in the perception of transsexuals in a municipality in Zona da Mata, Minas Gerais, through the qualitative methodological approach with descriptive study. Semi-structured interviews were conducted with eight transsexual people. The information was analyzed using hermeneutics-dialectics. Barriers to the formal care network were disrespect to the use of the social name in health services, prejudice, and unpreparedness of professionals. Therefore, care and information on hormone use are sought in informal networks. The informal network welcomes, but the search for care only in these networks can bring health risks. The research showed the existence of a strong affective network in the municipality and the need to establish a solid formal care network for the transsexual population with wide participation in the informal network, since the formal network is unstable and does not meet health needs of that population.
Subject(s)
Humans , Male , Female , Adult , User Embracement , Transsexualism , Qualitative Research , Gender Diversity , Health Services Accessibility/trendsABSTRACT
Introduction: Manhiça District, in Southern Mozambique harbors high HIV prevalence and a long history of migration. To optimize HIV care, we sought to assess how caregiver's mobility impacts children living with HIV (CLHIV)´s continuation in HIV care and to explore the strategies used by caregivers to maintain their CLHIV on antiretroviral treatment (ART). Methods: A clinic-based cross-sectional survey conducted at the Manhiça District Hospital between December-2017 and February-2018. We enrolled CLHIV with a self-identified migrant caregiver (moved outside of Manhiça District ≤12 months prior to survey) and non-migrant caregiver, matched by the child age and sex. Survey data were linked to CLHIV clinical records from the HIV care and treatment program. Results: Among the 975 CLHIV screened, 285 (29.2%) were excluded due to absence of an adult at the appointment. A total of 232 CLHIV-caregiver pairs were included. Of the 41 (35%) CLHIV migrating with their caregivers, 38 (92.6%) had access to ART at the destination because either the caregivers travelled with it 24 (63%) or it was sent by a family member 14 (36%). Among the 76 (65%) CLHIV who did not migrate with their caregivers, for the purpose of pharmacy visits, 39% were cared by their grandfather/grandmother, 28% by an aunt/uncle and 16% by an adult brother/sister. CLHIV of migrant caregivers had a non-statistically significant increase in the number of previous reported sickness episodes (OR = 1.38, 95%CI: 0.79-2.42; p = 0.257), ART interruptions (OR = 1.73; 95%CI: 0.82-3.63; p = 0.142) and lost-to-follow-up episodes (OR = 1.53; 95%CI: 0.80-2.94; p = 0.193). Conclusions: Nearly one third of the children attend their HIV care appointments unaccompanied by an adult. The caregiver mobility was not found to significantly affect child's retention on ART. Migrant caregivers adopted strategies such as the transportation of ART to the mobility destination to avoid impact of mobility on the child's HIV care. However this may have implications on ART stability and effectiveness that should be investigated in rural areas.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Caregivers/psychology , Human Migration/trends , Health Services Accessibility/trends , HIV Infections/therapy , HIV-1/pathogenicity , Anti-HIV Agents/therapeutic use , Anti-Retroviral Agents/administration & dosage , Anti-Retroviral Agents/therapeutic use , Ambulatory Care Facilities , Caregiver Burden/psychology , Middle Aged , Mozambique/epidemiologyABSTRACT
Introducción. La apendicitis constituye la principal causa de abdomen agudo quirúrgico en pediatría. Durante la pandemia por COVID-19, se replantearon las estrategias de manejo ydisminuyeron las consultas en las guardias, lo que podría asociarse a diagnósticos tardíos y complicaciones. El objetivo de este estudio fue analizar el impacto de la pandemia en los niños con apendicitis aguda. Métodos. Estudio analítico retrospectivocomparativo de pacientes pediátricos conapendicitis aguda durante los cinco meses del confinamiento por COVID-19 versus los meses equivalentes del año previo. Se analizaron la incidencia, la clínica, el estadio, el abordajequirúrgico y las complicaciones. Resultados. Los casos totales de apendicitisse redujeron un 25 % (n = 67 versus n = 50 en 2020). El tiempo medio hasta la consulta fue de 24 horas en ambos períodos (p = 0,989). La incidencia de peritonitis fue del 44 % (n = 22) versus el 37 % (n = 22) (p = 0,22) en 2019. No se evidenció diferencia en los estadios deenfermedad de acuerdo con lo informado en los partes quirúrgicos. En 2019, todas las cirugías se realizaron por vía laparoscópica; en 2020, solo un42 % (n = 21). La incidencia de complicaciones fue del 6 %, contra 7,5 % en el período previo (p = 0,75). Un paciente fue COVID-19 positivo. Conclusión. A pesar de la reducción en el númerode casos de apendicitis, no se evidenció una demora en la consulta en nuestra población. El mayor impacto se asoció a la readecuación del manejo, evitando el abordaje laparoscópico para reducir la diseminación del virus.
Introduction. Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. Methods. Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. Results. The total number of appendicitis cases went down by 25 % (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44 % (n = 22) versus 37 % (n = 22) (p = 0.22) in 2019. No differences were observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42 % (n = 21). The incidence of complications was 6 % versus 7.5 % in the previous period (p = 0.75). One patient was COVID-19 positive. Conclusion. Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Appendectomy/trends , Appendicitis/surgery , Appendicitis/diagnosis , Appendicitis/epidemiology , Practice Patterns, Physicians'/trends , Delayed Diagnosis/trends , COVID-19/prevention & control , Health Services Accessibility/trends , Appendectomy/methods , Argentina/epidemiology , Acute Disease , Incidence , Retrospective Studies , Laparoscopy/trends , Pandemics/prevention & control , Tertiary Care Centers , COVID-19/diagnosis , COVID-19/epidemiology , Hospitals, GeneralABSTRACT
Objetivo. Describir el impacto de la pandemia por COVID-19 en el programa de cirugía cardiovascular pediátrica y estimar el tiempo para reducir la lista de espera quirúrgica. Métodos. Estudio descriptivo y retrospectivo. Se compararon resultados quirúrgicos del período preCOVID versus el período COVID. Se utilizó un modelo matemático para estimar el tiempo para reducir la lista de espera. Resultados. Entre el 23 de marzo y el 31 de agosto de 2020 se operaron 83 pacientes, que representan una reducción del 60 %, respecto al período preCOVID. La mediana de edad fue de 6 meses (rango intercuartílico [RIC]: 25-75, 1,8 meses a 2,9 años; p = 0,0023. El tiempo para eliminar la lista de espera varía entre 10 y 19 meses. Conclusiones. El programa tuvo una reducción del 60 %. El tiempo de resolución de la lista de espera puede ser al menos 10 a 19 meses
Objective. To describe the impact of the COVID-19 pandemic on a pediatric cardiovascular surgery program and estimate the necessary time to reduce the surgery waiting list. Methods. Retrospective, descriptive study. Surgical outcomes from the pre-COVID-19 period and COVID-19 period were compared. A mathematical model was used to estimate the time necessary to reduce the waiting list. Results. Between March 23rd and August 31st, 2020, 83 patients underwent surgery, accounting for a 60 % reduction compared to the pre-COVID-19 period. Their median age was 6 months (interquartile range [IQR]: 25-75, 1.8 months to 2.9 years; p = 0.0023). The time necessary to eliminate the waiting list ranges from 10 to 19 months. Conclusions. There was a 60 % reduction in the program. The time required to clear the backlog of cases may range from, at least, 10 to 19 month
Subject(s)
Humans , Infant , Child, Preschool , Child , Cardiovascular Surgical Procedures/trends , Waiting Lists , Time-to-Treatment/trends , Health Services Accessibility/trends , Hospitals, Public/trends , Argentina/epidemiology , Retrospective Studies , Pandemics , COVID-19/prevention & control , COVID-19/epidemiology , Models, TheoreticalABSTRACT
Introducción. El menor número de consultas a los centros de atención desde el comienzo de la pandemia por SARS-CoV-2podría afectar la vacunación obligatoria.Objetivo. Evaluar el impacto de la pandemia por SARS-CoV-2en la administración de vacunas pentavalente y triple viral a niños menores de 2 años en el vacunatorio de un hospital pediátrico de la Ciudad de Buenos Aires.Método. Estudio transversal, que utilizó registros informatizados del vacunatorio, de enero a mayo de 2019 y 2020.Resultados. Desde la segunda quincena de marzo de 2020, se observó un 64,2 % de disminución en la aplicación de vacunas. Al examinar la primera dosis de pentavalente y triple viral, la reducción fue del 74,9 % y del 55,1 %, respectivamente.Conclusión. A partir de la segunda quincena de marzo de 2020, se observó una disminución del 64,2 % en las vacunas aplicadas respecto del mismo período en el año anterio
Introduction. The reduction in the number of visits to health care centers since the onset of the SARS-CoV-2 pandemic may affect mandatory vaccination.Objective. To assess the impact of the SARS-CoV-2 pandemic on the administration of the pentavalent and the measles, mumps, and rubella (MMR) vaccines to children younger than 2 years at the vaccination center of a children's hospital in the Autonomous City of Buenos Aires.Method. Cross-sectional study using the vaccination center's digital records from January to May 2019 and 2020.Results. In the second fortnight of March 2020, vaccinations dropped by 64.2 %. When examining the first dose of the pentavalent and MMR vaccines, such reduction was 74.9 % and 55.1 %, respectively.Conclusion. As of the second fortnight of March 2020, vaccinations dropped by 64.2 % compared to the same period of the previous year.