Impact of Using the Internet of Medical Things on e-Healthcare Performance: Blockchain Assist in Improving Smart Contract.

Background: This paper explores the use of blockchain technology and smart contracts in the Internet of Medical Things (IoMT). It aims to identify the challenges and benefits of implementing smart contracts based on blockchain technology in the IoMT. It provides solutions and evaluates the IoMT uses in e-healthcare performance. Methods: A quantitative approach used an online survey from public and private hospital administrative departments in Dubai, United Arab Emirates (UAE). ANOVA, t-test, correlation, and regression analysis were performed to assess the e-healthcare performance with and without IoMT (smart contract based on blockchain). Patients and Methods: A mixed method was used in this research, a quantitative approach for data analysis utilizing online surveys from public and private hospitals' administrative departments in Dubai, UAE. A correlation, regression through ANOVA, and independent two-sample t-test were performed to assess the e-healthcare performance with and without IoMT (smart contract based on blockchain). Results: Blockchain application in smart contracts has proven to be significant in the healthcare sector. Results highlight the importance of integrating smart contracts and blockchain technology in the IoMT infrastructure to improve efficiency, transparency, and security. The study provides empirical evidence to support the implementation of smart contracts in the e-healthcare sector and suggests improved e-healthcare performance through this transition. Conclusion: The emergence of e-healthcare systems with upgraded smart contracts and blockchain technology brings continuous health monitoring, time-effective operations, and cost-effectiveness to the healthcare sector.

Impact of Implementing Key Performance Indicators on Catheter-Associated Urinary Tract Infection (CAUTI) Rates Among Adult ICU Patients in Saudi Arabia.

Background: The prevalence of catheter-associated urinary tract infections (CAUTIs) in hospitals characterizes one of the most significant problems in healthcare. This study aims to assess whether the implementation of impact of key performance indicators (KPIs) checklist reduces the number of CAUTI in adults present in intensive care unit (ICU) with indwelling catheters. Methods: This is a retrospective analytical study conducted in a tertiary hospital in Riyadh, Saudi Arabia, from June 2020 to June 2021. One hundred and thirty-four patients with CAUTIs met the criteria and were included in the study. Socio-demographic data was collected to enable informed analysis based on personal information (age, gender, marital status, monthly income, level of education, and department) and medical history (duration of catheterization, types of organisms, history of chronic illness, and duration of hospitalization). The research also used a prevention of CAUTI checklist containing 26 items. The outcome measures were 1) the rate of CAUTIs measured pre- and post-implementing performance measurement indicators (KPI) of CAUTIs prevention practice and 2) the prevention of catheter-associated urinary tract infection in three areas: general information recording, insertion practices, and maintenance practices. Results: The study found that there was compliance with the prevention of CAUTIs in terms of recording the general patient's information (72%), insertion practices (52%), and maintenance practices (50%). However, most safety practices, including poor hygiene and safety standards, patient handling, and audited protocol programs, were not strictly followed, resulting in increased risk factors for CAUTIs. Conclusion: Compliance with the prevention of CAUTIs in terms of recording the general patient's information, insertion practices, and maintenance practices lies within the range of 50-75%, and the recommended practices are usually followed. A targeted education on CAUTI-prevention practices curtailing the most aggravating risk factors and adopting a safety culture driven by a patient handling and audited protocol program should be explored to reduce hospital CAUTIs.

Digital Disruption and Big Data in Healthcare - Opportunities and Challenges.

Background: As the amount of medical data in the electronic medical records system (EMR) is increasing tremendously, the required time to read it by health providers is growing by the exact proportionality. This means that physicians must increase the time spared for each patient again by the precise proportionality. This may lead to exposing the accuracy and quality of the course of action to be taken for the patients. Increasing the physician's required time for one patient means that the physician can see fewer patients. This will create an issue with the medical management authority as more physicians are needed, and higher expenses will be required. Purpose: The two questions that arise here are 1. Identify the potential opportunities and challenges for extensive data analysis in the healthcare sector. 2. Evaluate different ways in which big medical data can be analyzed? Methods: The authors identified the four concerned parties representing the four potential solutions dimensions to answer these two questions. These parties are 1. physicians, 2. health information systems management (HISM) departments, mainly the EMR system, and 3. Health management departments 4. Relevant Health Information Systems (HIS) parties. A literature review and 25 interviews were conducted. The interviews covered 1: Two global organizations: John Hopkins and Joint Commission International (JCI), 2: Three United Arab Emirates-based health organizations: Department of health in Abu Dhabi, SEHA in Abu Dhabi, Dubai health Authority (DHA) in Dubai, 3: 10 Physicians from different specialties, 4: Five EMR managers and 5: Five IT (Information Technology) professionals representing the HIS parties. Qualitative analysis is used as the approach for data analysis. Results: Identifying the managerial and the technical recommendations to be utilized mainly based on digital disruption technologies, tools, and processes. Conclusion: Healthcare has been slow in embracing digital disruption and transformation. In most areas, it is still in the initial stages. Recommendations are based on the UAE cases, highlighting the specific technologies and their features.

Healthcare resource utilization and direct costs of transfusion-dependent thalassemia patients in Dubai, United Arab Emirates: a retrospective cost-of-illness study.

BACKGROUND: Patients with transfusion-dependent thalassemia (TDT) require lifelong blood transfusions and iron chelation therapy. Thus, patients afflicted with TDT often have to undergo blood transfusion and iron chelation therapy, which causes a major economic burden on them. However, this topic has not been reported in Dubai, United Arab Emirates (UAE). Hence, this study aimed to evaluate healthcare resource utilization and associated direct costs related to patients with TDT in Dubai, UAE. METHODS: For this study, a retrospective prevalence-based cost-of-illness analysis based on the UAE healthcare system and patient perspectives was conducted among patients with TDT treated at the Dubai Thalassemia Center in 2019. Information regarding healthcare resource utilization and direct medical costs was collected from the billing system connected to the electronic medical record system. Patients and their families were interviewed for direct non-medical cost estimations. RESULTS: A total of 255 patients with TDT were included in the study. The mean annual direct medical cost was estimated at AED 131,156 (USD 35,713) (95% CI: 124,735 - 137,578). The main driver of the medical cost for the participants as iron chelation therapy AED 78,372 (95% CI: 72,671 - 84,074) (59.8%), followed by blood transfusions, which accounted for AED 34,223 (95% CI: 32,854 - 35,593) 26.1% of the total direct medical costs. The mean annual direct non-medical costs was AED 2,223 (USD 605) (95% CI: 1,946 - 2,500). Age (p < 0.001), severe serum ferritin levels (p = 0.016), the presence of complications (p < 0.001), and the type of iron chelation therapy (p < 0.001) were significant predictors of higher direct medical costs incurred by the participants. CONCLUSION: Transfusion-dependent thalassemia poses a substantial economic burden on the healthcare system, patients, and their families. Our results show that the highest medical cost proportion was due to iron chelation therapy. In this regard, efforts must be made to improve the patients' acceptance and satisfaction with their iron chelation therapy to increase their compliance and improve the effectiveness of treatment, which could play an essential role in controlling the economic burden of this disease. Moreover, greater support is essential for families that suffer catastrophic out-of-pocket expenses.

Productivity Loss and Associated Costs Among Patients with Transfusion-Dependent Thalassemia in Dubai, United Arab Emirates.

OBJECTIVE: The aim of this study was to assess the indirect burden of patients with transfusion-dependent thalassemia (TDT) in Dubai, the United Arab Emirates (UAE). METHODS: Adult patients with TDT were enrolled during blood transfusion sessions. Productivity loss for patients in the preceding four weeks was reported using the validated iMTA Productivity Cost Questionnaire (iPCQ). RESULTS: A total of 161 adult patients with TDT were included in the study. The annual total productivity loss cost at paid work among 79 employed patients was AED 17,230 (USD 4691) (95% CI: 12,302-22,159), out of which absenteeism contributed AED 10,328 (USD 2812) and presenteeism contributed AED 6902 (USD 1879), whereas the annual total productivity loss cost at unpaid work was AED 4053 (USD 1104) (95% CI: 3471-4661). The annual mean total indirect cost for paid and unpaid work was AED 21,283 (USD 5795). Monthly income, nationality, and having two and more disease complications were the significant predictors of higher productivity loss costs. Having previously had a splenectomy was a negative and significant predictor of productivity loss costs. CONCLUSION: TDT was associated with substantial productivity loss and indirect costs in the UAE. Health policies that aim to control transfusion-dependent thalassemia effectively are necessary and could result in cost savings for patients and employers.

Burden of Transport-Related Injuries in the Eastern Mediterranean Region: A Systematic Analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age. METHODS: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs). RESULTS: In 2017, there were 5.5 million (UI 4.9-6.2) transport-related incident cases in the EMR - a substantial increase from 1990 (2.8 million; UI 2.5-3.1). The age-standardized incidence rate for the EMR in 2017 was 787 (UI 705.5-876.2) per 100000, which has not changed significantly since 1990 (-0.9%; UI -4.7 to 3). These rates differed remarkably between countries, such that Oman (1303.9; UI 1167.3-1441.5) and Palestine (486.5; UI 434.5-545.9) had the highest and lowest age-standardized incidence rates per 100000, respectively. In 2017, there were 185.3 thousand (UI 170.8-200.6) transport-related fatalities in the EMR - a substantial increase since 1990 (140.4 thousand; UI 118.7-156.9). The age-standardized death rate for the EMR in 2017 was 29.5 (UI 27.1-31.9) per 100000, which was 30.5% lower than that found in 1990 (42.5; UI 36.8-47.3). In 2017, Somalia (54; UI 30-77.4) and Lebanon (7.1; UI 4.8-8.6) had the highest and lowest age-standardized death rates per 100,000, respectively. The age-standardised DALY rate for the EMR in 2017 was 1,528.8 (UI 1412.5-1651.3) per 100000, which was 34.4% lower than that found in 1990 (2,331.3; UI 1,993.1-2,589.9). In 2017, the highest DALY rate was found in Pakistan (3454121; UI 2297890- 4342908) and the lowest was found in Bahrain (8616; UI 7670-9751). CONCLUSION: The present study shows that while road traffic has become relatively safer (measured by deaths and DALYs per 100000 population), the number of transport-related fatalities in the EMR is growing and needs to be addressed urgently.

Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990-2017.

BACKGROUND: Nonrheumatic valvular diseases are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease Study 2017, mortality, prevalence, and disability-adjusted life-years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease, and other nonrheumatic valvular diseases were estimated for 195 countries and territories from 1990 to 2017. METHODS: Vital registration data, epidemiologic survey data, and administrative hospital data were used to estimate disease burden using the Global Burden of Disease Study modeling framework, which ensures comparability across locations. Geospatial statistical methods were used to estimate disease for all countries, because data on nonrheumatic valvular diseases are extremely limited for some regions of the world, such as Sub-Saharan Africa and South Asia. Results accounted for estimated level of disease severity as well as the estimated availability of valve repair or replacement procedures. DALYs and other measures of health-related burden were generated for both sexes and each 5-year age group, location, and year from 1990 to 2017. RESULTS: Globally, CAVD and degenerative mitral valve disease caused 102 700 (95% uncertainty interval [UI], 82 700-107 900) and 35 700 (95% UI, 30 500-42 500) deaths, and 12.6 million (95% UI, 11.4 million-13.8 million) and 18.1 million (95% UI, 17.6 million-18.6 million) prevalent cases existed in 2017, respectively. A total of 2.5 million (95% UI, 2.3 million-2.8 million) DALYs were estimated as caused by nonrheumatic valvular diseases globally, representing 0.10% (95% UI, 0.09%-0.11%) of total lost health from all diseases in 2017. The number of DALYs increased for CAVD and degenerative mitral valve disease between 1990 and 2017 by 101% (95% UI, 79%-117%) and 35% (95% UI, 23%-47%), respectively. There is significant geographic variation in the prevalence, mortality rate, and overall burden of these diseases, with highest age-standardized DALY rates of CAVD estimated for high-income countries. CONCLUSIONS: These global and national estimates demonstrate that CAVD and degenerative mitral valve disease are important causes of disease burden among older adults. Efforts to clarify modifiable risk factors and improve access to valve interventions are necessary if progress is to be made toward reducing, and eventually eliminating, the burden of these highly treatable diseases.

Epidemiology of facial fractures: incidence, prevalence and years lived with disability estimates from the Global Burden of Disease 2017 study.

BACKGROUND: The Global Burden of Disease Study (GBD) has historically produced estimates of causes of injury such as falls but not the resulting types of injuries that occur. The objective of this study was to estimate the global incidence, prevalence and years lived with disability (YLDs) due to facial fractures and to estimate the leading injurious causes of facial fracture. METHODS: We obtained results from GBD 2017. First, the study estimated the incidence from each injury cause (eg, falls), and then the proportion of each cause that would result in facial fracture being the most disabling injury. Incidence, prevalence and YLDs of facial fractures are then calculated across causes. RESULTS: Globally, in 2017, there were 7 538 663 (95% uncertainty interval 6 116 489 to 9 493 113) new cases, 1 819 732 (1 609 419 to 2 091 618) prevalent cases, and 117 402 (73 266 to 169 689) YLDs due to facial fractures. In terms of age-standardised incidence, prevalence and YLDs, the global rates were 98 (80 to 123) per 100 000, 23 (20 to 27) per 100 000, and 2 (1 to 2) per 100 000, respectively. Facial fractures were most concentrated in Central Europe. Falls were the predominant cause in most regions. CONCLUSIONS: Facial fractures are predominantly caused by falls and occur worldwide. Healthcare systems and public health agencies should investigate methods of all injury prevention. It is important for healthcare systems in every part of the world to ensure access to treatment resources.

Epidemiology of injuries from fire, heat and hot substances: global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study.

BACKGROUND: Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. METHODS: We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. RESULTS: Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). CONCLUSIONS: The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.

Corrigendum to "Oral Health Knowledge and Behavior among Adults in the United Arab Emirates".

[This corrects the article DOI: 10.1155/2019/7568679.].

Oral Health Knowledge and Behavior among Adults in the United Arab Emirates.

Background: The prevalence of periodontal diseases is increasing in the United Arab Emirates (UAE) despite a worldwide decline in the prevalence of dental caries among children and adolescents. The aims of this study were to determine the levels of oral health knowledge and health-related behavior in adult UAE residents, and the relationship between these variables and oral health. Methods: A descriptive cross-sectional survey with nonprobability sampling was used in this study. A sample of 630 adults residing in the UAE completed an oral health survey to assess their oral health knowledge and behavior. Mean oral health knowledge and behavior scores were calculated and correlated with population demographic and behavioral variables. Results: Participants were found to have an acceptable oral health knowledge score (OHKS) of 10.50 (2.36) where 62 % of participants answered the questions correctly. Results showed that age, gender, nationality, smoking, and physical activity were significantly associated with the knowledge score. However, only gender, nationality, and smoking predicted oral health knowledge scores after further regression analysis. On the other hand, the mean oral health behavior score (OHBS) for all participants was 8.91 (2.29); 98% of all participants practiced at least an acceptable level of oral behavior and 53% practiced a good to perfect level. Age, gender, educational level, employment status, insurance status, marital status, nationality, smoking, and physical activity showed significant statistical association with the score of behaviors related to oral health. Only gender, number of diabetes sessions attended, and health information sources used remained significant after further regression analysis. Conclusion: Further efforts are required to spread awareness about oral health and encourage the UAE population to develop healthy oral habits. Such programs will decrease the occurrence and burden of many chronic oral diseases especially periodontal diseases.

Examining the association between educational attainment and life expectancy in MENA region: A panel data analysis.

BACKGROUND: The purpose of this study is to investigate the association between educational attainment and life expectancy in 18 countries in MENA region. METHODS: We used World Bank database for a panel of 18 MENA countries during the years 1995 to 2009. We used Life Expectancy at Birth, as the key health care output measure. Additionally, we used six health care input independent variables. All variables were transformed into natural logarithms. We estimated the production function using Cobb-Douglas function. RESULTS: Results indicate that 1% increase in educational attainment of males 25 to 34 years old, males 25 years and older, females 25 to 34 years old, females 25 years and older, and females aged 15 to 44 years old will increase life expectancy by 0.14%, 0.07%, 0.04%, 0.03%, and 0.04%, respectively, while everything else remains constant. CONCLUSION: Our results suggest that for MENA region countries investing in education to broaden access would improve health outcomes and life expectancy. Boosting educational attainment for both male and female population may close the life expectancy gaps between the MENA region and other developed countries, and males and females within the same country. Education attainment has the potential to be a social remedy for better health outcomes in MENA countries.

Global Cardiovascular and Renal Outcomes of Reduced GFR.

The burden of premature death and health loss from ESRD is well described. Less is known regarding the burden of cardiovascular disease attributable to reduced GFR. We estimated the prevalence of reduced GFR categories 3, 4, and 5 (not on RRT) for 188 countries at six time points from 1990 to 2013. Relative risks of cardiovascular outcomes by three categories of reduced GFR were calculated by pooled random effects meta-analysis. Results are presented as deaths for outcomes of cardiovascular disease and ESRD and as disability-adjusted life years for outcomes of cardiovascular disease, GFR categories 3, 4, and 5, and ESRD. In 2013, reduced GFR was associated with 4% of deaths worldwide, or 2.2 million deaths (95% uncertainty interval [95% UI], 2.0 to 2.4 million). More than half of these attributable deaths were cardiovascular deaths (1.2 million; 95% UI, 1.1 to 1.4 million), whereas 0.96 million (95% UI, 0.81 to 1.0 million) were ESRD-related deaths. Compared with metabolic risk factors, reduced GFR ranked below high systolic BP, high body mass index, and high fasting plasma glucose, and similarly with high total cholesterol as a risk factor for disability-adjusted life years in both developed and developing world regions. In conclusion, by 2013, cardiovascular deaths attributed to reduced GFR outnumbered ESRD deaths throughout the world. Studies are needed to evaluate the benefit of early detection of CKD and treatment to decrease these deaths.

Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013.

OBJECTIVES: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR). METHODS: The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs). RESULTS: For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries. CONCLUSIONS: This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.

The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013.

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost-YLLs) and nonfatal outcomes (years lived with disability-YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25-49 age group, with a peak in the 35-39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region.

QUANTITATIVE ASSESSMENT OF SOME PREVENTIVE HEALTH SERVICES PROVIDED FOR ADOLESCENT INDIVIDUALS IN DUBAI.

The United Arab Emirate (UAE) of Dubai, faces significant adolescent health problems. In 2009, evidence based clinical guidelines were developed for primary health care professionals in Dubai to help reduce adolescent health problems. This research study explores adolescents' self-reports about health education services received between 2008 and 2010. The sample consisted of 730 public high school students in grades 10 through 12 between the ages of 15 and 19. 357 (48.9%) of the sample were males and 373 (51.1%) were female. The major language spoken in the home was Arabic (77.4%). All students completed a 27-item survey in Arabic that was adapted from the Young Adult Health Care Survey (YAHCS). The YAHCS is a 56-item research instrument traditionally administered in English and Spanish. The sample reported they had received little or no health education from their health care providers. 94.2% reported receiving no information about using a helmet for bicycle and motorbike safety; 88.2% reported receiving no information about drug use; and 81.9% reported that they received no information about smoking. The instrument also explored the health education material students received within the last 12 months. 65.5% of the sample reported seeing and/or hearing safety tips; 84.9% reported hearing and/or seeing health information about healthy diet, physical activity and exercise; and 79.2% reported seeing and/or hearing information about the risks of smoking and substance abuse.

Patient cost-sharing for ambulatory neuropsychiatric services in Abu Dhabi, UAE.

BACKGROUND AND OBJECTIVES: Neuropsychiatric disorders are of high concern and burden of disease in the United Arab Emirates (UAE). The aim of this study is to describe patient cost-sharing patterns, insurance coverage of ambulatory neuropsychiatric disorders, and utilization of neuropsychiatric services in Abu Dhabi. METHODS: The study utilized the data published by Health Authority-Abu Dhabi (HAAD) and the American Center for Psychiatry and Neurology (ACPN) records in Abu Dhabi. The data were collected from the ACPN to describe patterns of insurance coverage and patient cost-sharing. The data included information on patient visits to the ACPN from January 1, 2010 till May 16, 2013. The data also included insurance coverage, total cost of treatment for each patient and the amount of coinsurances and deductibles paid by each patient. Additionally, the study utilized data published by HAAD on health services utilization, and health insurance plans in 2014. The percentage of total costs paid by patients and insurance were calculated by insurance groups and health service. Insurance plans with different patient cost-sharing arrangements for mental health treatment benefits were divided into three groups. ANOVA and MANOVA analyses were performed to test for differences among three categories of neuropsychiatric services (neurology, psychiatry and psychotherapy) in terms of the total costs and patient cost-sharing. The data were analysed using STATA version 12. RESULTS: About 36 % of the total costs on ambulatory neuropsychiatric services was paid directly by patients; 1 % of total costs was covered by patients as co-insurances and deductibles, and 63 % of total costs was covered by insurance providers. The average cost per visit was about 485 AED ($132), including 304 AED ($83) paid by insurance and 181 AED ($49) paid by patient. About 44 % of total costs was related to psychiatry services, 28 % of total costs was related to neurology services, and 28 % of total costs was related to psychotherapy services. Using ANOVA analyses, statistical differences were found among three categories of neuropsychiatric services in terms of the total costs and patient cost-sharing. These findings provide hint on some degree of association between patient cost-sharing and neuropsychiatry services utilization. CONCLUSIONS: The determination of parities in the coverage and finance between neuropsychiatric and physical health services will help policymakers make informed decisions on regulations of health insurance plans. Given the level of unmet need for neuropsychiatric services in Abu Dhabi, there is a need to fully include neuropsychiatric services in all basic and enhanced insurance plans. The study provided a description of patient cost-sharing and coverage of neuropsychiatric services in order for policymakers to recognize the disparities of the coverage and the degree of economic burden on households.

Measuring Efficiency of Health Systems of the Middle East and North Africa (MENA) Region Using Stochastic Frontier Analysis.

OBJECTIVE: The main purpose of this study is to measure the technical efficiency of twenty health systems in the Middle East and North Africa (MENA) region to inform evidence-based health policy decisions. In addition, the effects of alternative stochastic frontier model specification on the empirical results are examined. METHODS: We conducted a stochastic frontier analysis to estimate the country-level technical efficiencies using secondary panel data for 20 MENA countries for the period of 1995-2012 from the World Bank database. We also tested the effect of alternative frontier model specification using three random-effects approaches: a time-invariant model where efficiency effects are assumed to be static with regard to time, and a time-varying efficiency model where efficiency effects have temporal variation, and one model to account for heterogeneity. RESULTS: The average estimated technical inefficiency of health systems in the MENA region was 6.9 % with a range of 5.7-7.9 % across the three models. Among the top performers, Lebanon, Qatar, and Morocco are ranked consistently high according to the three different inefficiency model specifications. On the opposite side, Sudan, Yemen and Djibouti ranked among the worst performers. On average, the two most technically efficient countries were Qatar and Lebanon. We found that the estimated technical efficiency scores vary substantially across alternative parametric models. CONCLUSION: Based on the findings reported in this study, most MENA countries appear to be operating, on average, with a reasonably high degree of technical efficiency compared with other countries in the region. However, there is evidence to suggest that there are considerable efficiency gains yet to be made by some MENA countries. Additional empirical research is needed to inform future health policies aimed at improving both the efficiency and sustainability of the health systems in the MENA region.

Measuring efficiency of governmental hospitals in Palestine using stochastic frontier analysis.

BACKGROUND: The Palestinian government has been under increasing pressure to improve provision of health services while seeking to effectively employ its scare resources. Governmental hospitals remain the leading costly units as they consume about 60 % of governmental health budget. A clearer understanding of the technical efficiency of hospitals is crucial to shape future health policy reforms. In this paper, we used stochastic frontier analysis to measure technical efficiency of governmental hospitals, the first of its kind nationally. METHODS: We estimated maximum likelihood random-effects and time-invariant efficiency model developed by Battese and Coelli, 1988. Number of beds, number of doctors, number of nurses, and number of non-medical staff, were used as the input variables, and sum of number of treated inpatients and outpatients was used as output variable. Our dataset includes balanced panel data of 22 governmental hospitals over a period of 6 years. Cobb-Douglas function, translog function, and multi-output distance function were estimated using STATA 12. RESULTS: The average technical efficiency of hospitals was approximately 55 %, and ranged from 28 to 91 %. Doctors and nurses appear to be the most important factors in hospital production, as 1 % increase in number of doctors, results in an increase in the production of the hospital of 0.33 and 0.51 %, respectively. If hospitals increase all inputs by 1 %, their production would increase by 0.74 %. Hospitals production process has a decrease return to scale. CONCLUSION: Despite continued investment in governmental hospitals, they remained relatively inefficient. Using the existing amount of resources, the amount of delivered outputs can be improved 45 % which provides insight into mismanagement of available resources. To address hospital inefficiency, it is important to increase the numbers of doctors and nurses. The number of non-medical staff should be reduced. Offering the option of early retirement, limit hiring, and transfer to primary health care centers are possible options. It is crucial to maintain a rich clinical skill-mix when implementing such measures. Adopting interventions to improve the quality of management in hospitals will improve efficiency. International benchmarking provides more insights on sources of hospital inefficiency.

Turnover intention among intensive care unit nurses in Alexandria, Egypt.

BACKGROUND: Given the difficulty in recruiting new nurses, it is imperative to retain those already in the profession. This cross-sectional study explored the relationship of demographic and work-related factors, burnout, conflict management and relationship between nurses and physicians on turnover intentions among ICU nurses in eight major hospitals in Alexandria, Egypt. SUBJECTS AND METHODS: Data on burnout, conflict management, nurse-physician communication, and turnover intention were collected by surveying 100 nurses in eight hospitals in Alexandria governorate. All nurses at the ICU of selected hospitals were approached (n=100) and a 47-item Likert scale questionnaire was administered to explore the factors affecting the turnover intention of ICU nurses in Alexandria. RESULTS: ICU nurses exhibited a mean score for turnover intention of 3.23 (mean score percentage 65.0%). There was a moderately positive statistically significant correlation between turnover intention and emotional exhaustion (r=0.29, P<0.05), nurse-physician communication (r=0.25, P<0.05), and age (r=0.21, P<0.05). The predicting factors for turnover intention were emotional exhaustion and age. CONCLUSION AND RECOMMENDATION: Nurses turnover intention at the ICU of the selected hospitals is high and is significantly associated with nurses' emotional exhaustion, poor nurse-physician communication, and nurses age.