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1.
Can J Surg ; 63(3): E226-E228, 2020 05 08.
Artículo en Inglés | MEDLINE | ID: mdl-32386471

RESUMEN

Summary: The coronavirus disease 2019 (COVID-19) pandemic has had a massive impact on waits for elective operations, with tens of thousands of scheduled surgeries being cancelled or postponed across Canada. Provincial governments will likely not only reopen elective surgical capacity when it is deemed safe, but also target new funding to address the backlog of cases. There is a dearth of research on whether the provinces' approaches to managing wait lists are equitable from a patients' needs perspective or if they are associated with patients' perception of outcomes. The surgical cost models used in the past won't be useful to governments and hospital managers. New models based on hospitals' marginal costs, associated with running on weekends or off-hours and social distancing parameters, will be needed. Surgeon input, collaboration and leadership during the strategy development, implementation and management of surgical wait lists postpandemic will be imperative, as these decisions will significantly affect the health and lives of many Canadians.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/organización & administración , Pandemias , Neumonía Viral/epidemiología , Triaje/normas , Listas de Espera , Canadá/epidemiología , Procedimientos Quirúrgicos Electivos/economía , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Triaje/organización & administración
6.
Soins Gerontol ; 25(141): 24-27, 2020.
Artículo en Francés | MEDLINE | ID: mdl-32200986

RESUMEN

In their daily practice, professionals are called upon to meet older people who are more in distress than others. In order to best meet their needs, it is necessary first to define these difficulties and then to consider the mechanisms that can provide assistance adapted to the requirements and needs of the people. Access to hospital health care services and coordination support mechanisms, as defined by the law of 26 July 2019, can contribute to this assistance, without criteria limiting access to care. Examples of prevention and coordination actions carried out by the Access to Health Care, Rights and Education Network.


Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Anciano , Francia , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Humanos
8.
Lancet ; 395(10223): 524-533, 2020 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-32061298

RESUMEN

Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Ahorro de Costo/métodos , Prestación de Atención de Salud/economía , Costos de los Medicamentos/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Medicare/economía , Patient Protection and Affordable Care Act , Pronóstico , Estados Unidos , Atención de Salud Universal
9.
Rev Saude Publica ; 54: 25, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32074220

RESUMEN

OBJECTIVE: To analyze the obstacles and challenges faced by managers and coordination professionals in their practices in municipal coordinating centers. METHODS: An exploratory descriptive study with a qualitative focus, applied in 40 managers and coordination professionals, from September 2017 to November 2018, with semi-structured interviews, resulting in two categories of analysis: limiting factors and factors that facilitate the management and operationalization of the Brazilian Unified Health System (SUS) coordinating sector. RESULTS: Analyzing the statements, we found evidence of the following limiting factors: failure in the criteria of referral, unavailability of beds, high demand, systemic difficulties in relation to the coordinating system, procedures of difficult scheduling and execution, increased repressed demand for elective procedures and difficulties in the flow of information between primary care and coordination. In the category of facilitating factors, the most significant possibilities were: expansion of the capability to know the user's reality, improvement in primary care and increase in health financial resources, health training and education and restructuring, in addition to reorganizing internal coordinating procedures. CONCLUSION: The limiting factors of coordination show the need to promote actions that offer all SUS users full access to health services.


Asunto(s)
Gestores de Casos , Personal de Salud , Accesibilidad a los Servicios de Salud/organización & administración , Programas Nacionales de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Actitud del Personal de Salud , Brasil , Necesidades y Demandas de Servicios de Salud , Humanos , Investigación Cualitativa
11.
Medicine (Baltimore) ; 99(8): e19188, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080101

RESUMEN

This study concerns the accessibility of health information for people with disabilities. More specifically, by interviewing policy elites who have backgrounds in this area, we seek to obtain their opinions regarding the type of information people with disabilities require, and people with disabilities overall awareness of such information. Based on the information obtained, we also aim to identify methods of improving this accessibility.A focus group interview was conducted involving policy elites who had previously participated in decision-making processes for health policy. These elites were sourced from the fields of academia, medicine, and government. Content analysis was performed using NVivo 10, which is a computer-assisted/aided qualitative data-analysis software.The focus-group participants felt that relevant information for people with disabilities is provided in a fragmentary manner through several channels that have relatively low reliability, which creates difficulties for a significant portion of the target recipients. Discussions regarding the type of health information required by people with disabilities yielded the following topic clusters: information regarding health-care providers who specialize in specific disability types and regarding health behaviors for certain lifecycles, and information that helps people with disabilities return to society. Further, the focus group recommended 2 means of providing essential health information to PWDs in the future. As short-term strategies, the participants proposed simplifying the existing, fragmented information channels and the creation of a comprehensive web-based information portal with an associated call center. As a long-term strategy, they proposed the development of smart-device-based information services that are tailored to the needs of individuals.Efforts to reduce the disparities in health information for people with disabilities are essential for addressing the existing inequality regarding the availability of health information.


Asunto(s)
Información de Salud al Consumidor/organización & administración , Personas con Discapacidad , Información de Salud al Consumidor/normas , Femenino , Grupos Focales , Conductas Relacionadas con la Salud , Personal de Salud/normas , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Internet , Masculino , Teléfono
14.
Rev Saude Publica ; 54: 05, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31939578

RESUMEN

OBJECTIVE: To describe the scope and limitations of the main strategies of cooperation in health, adopted between 2005 and 2017, in the context of the triple border Brazil, Colombia and Peru. METHOD: Single, explanatory, qualitative, integrated case study carried out in 2017, in the context of the triple Amazon border, Brazil, Colombia and Peru, in the city of Tabatinga, state of Amazonas, Brazil. Our sources of evidence were: documentary data; interviews with health managers of the State Health Secretariats of Amazonas and Municipal Health of Tabatinga, Municipal Health Council of Tabatinga and Consulate of Peru in Colombia; and direct observations in four health services of Tabatinga. Data were organized with MaxQDA12® software. RESULTS: Data analyzed showed that, during the study period, the Brazilian federal government made several health cooperation agreements with both Peru and Colombia and that the state government of Amazonas undertook strategies to improve the health conditions of the dwellers of Tabatinga and the region of Alto Solimões, which indirectly reached the populations of neighboring countries, supporting the interrelationships between the countries of the region. Regarding the municipal government, we verified the existence of health integration agreements, established informally, to minimize the adversities of the local health. CONCLUSION: The cooperation strategies in health adopted in the triple Amazon border have different purposes, benefits and limitations. It is noteworthy that the existence of cooperation agreements between the federal governments of Brazil, Colombia and Peru and the presence of informal cooperation agreements between the municipal governments of Tabatinga (Brazil), Leticia (Colombia) and Santa Rosa (Peru). The limitations of this study are the lack of knowledge of local managers about the cooperation agreements established between federal governments and the lack of legitimacy of the informal agreements established by the Tabatinga government.


Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Administración de los Servicios de Salud , Cooperación Internacional , Brasil , Colombia , Necesidades y Demandas de Servicios de Salud , Humanos , Programas Nacionales de Salud , Perú , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa
15.
Rev Saude Publica ; 54: 06, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31967275

RESUMEN

OBJECTIVE: To evaluate the performance of comprehensive care for older adults in primary care services in the Brazilian Unified Health System in the state of São Paulo, Brazil. METHODS: A total of 157 primary care services from five health regions in midwestern São Paulo responded, from October to December 2014, the pre-validated 2014 questionnaire for primary care services assessment and monitoring. We selected 155 questions, based on national policies and guidelines on this theme. The responses indicate the service performance in older adults' care, clustered into three areas of analysis: health care for active and healthy aging (45 indicators, d1), chronic noncommunicable diseases care (89 indicators, d2), and support network in aging care (21 indicators, d3). Performance was measured by the sum of positive (value 1) or negative (value 0) responses for each indicator. Services were clustered according to k-means of the performance scores of each domain. After weighting the domains (Z tests), we estimated the associations between the scores of each domain and independent management variables (typology, planning and evaluation of services), with simple and multiple linear regression. RESULTS: Chronic noncommunicable diseases care (d2) showed, for all clusters, better average performance (55.7) than domains d1 (35.4) and d3 (39.2). Service performance in the general area of planning and evaluation associates with the performance of older adults' care. CONCLUSIONS: The evaluated services had incipient implementation of comprehensive care for older adults. The evaluation framework can contribute to processes to improve the quality of primary health care.


Asunto(s)
Atención Integral de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud para Ancianos/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Anciano , Brasil , Estudios de Cohortes , Atención Integral de Salud/organización & administración , Estudios Transversales , Femenino , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Salud para Ancianos/organización & administración , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Atención Primaria de Salud/organización & administración
16.
PLoS One ; 15(1): e0227293, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31940375

RESUMEN

BACKGROUND: Nepal has achieved a significant reduction of TB incidence over the past decades. Nevertheless, TB patients continue to experience barriers in access, diagnosis and completion of the treatment. The main objective of this study was to explore the factors affecting the access to the health services, diagnosis and the treatment completion for TB patients in central and western Nepal. METHODS: Data were collected using in-depth interviews (IDI) with the TB patients (n = 4); Focus Group Discussions (FGDs) with TB suspected patients (n = 16); Semi Strucutred Interviews (SSIs) with health workers (n = 24) and traditional healers (n = 2); and FGDs with community members (n = 8). All data were audio recorded, transcribed and translated to English. All transcriptions underwent thematic analysis using qualitative data analysis software: Atlas.ti. RESULTS: Barriers to access to the health centre were the long distance, poor road conditions, and costs associated with travelling. In addition, lack of awareness of TB and its consequences, and the belief, prompted many respondents to visit traditional healers. Early diagnosis of TB was hindered by lack of trained health personnel to use the equipment, lack of equipment and irregular presence of health workers. Additional barriers that impeded the adherence and treatment completion were the need to visit health centre daily for DOTS treatment and associated constraints, complex treatment regimen, and the stigma. CONCLUSIONS: Barriers embedded in health services and care seekers' characteristics can be dealt by strengthening the peripheral health services. A continuous availability of (trained) human resources and equipment for diagnosis is critical. As well as increasing the awareness and collaborating with the traditional healers, health services utilization can be enhanced by compensating the costs associated with it, including the modification in current DOTS strategy by providing medicine for a longer term under the supervision of a family member, peer or a community volunteer.


Asunto(s)
Grupos Focales , Accesibilidad a los Servicios de Salud/organización & administración , Colaboración Intersectorial , Medicina Tradicional , Tuberculosis/terapia , Adulto , Participación de la Comunidad , Familia , Femenino , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Nepal , Aceptación de la Atención de Salud/psicología , Investigación Cualitativa , Estigma Social , Encuestas y Cuestionarios/estadística & datos numéricos , Tuberculosis/diagnóstico , Tuberculosis/psicología , Adulto Joven
17.
PLoS One ; 15(1): e0227298, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31945092

RESUMEN

BACKGROUND: Substance use is disproportionately high among people who are homeless or vulnerably housed. We performed a systematic overview of reviews examining the effects of selected harm reduction and pharmacological interventions on the health and social well-being of people who use substances, with a focus on homeless populations. METHODS AND FINDINGS: We searched MEDLINE, EMBASE, PsycINFO, Joanna Briggs Institute EBP, Cochrane Database of Systematic Reviews and DARE for systematic reviews from inception to August 2019. We conducted a grey literature search and hand searched reference lists. We selected reviews that synthesized evidence on supervised consumption facilities, managed alcohol programs and pharmacological interventions for opioid use disorders. We abstracted data specific to homeless or vulnerably housed populations. We assessed certainty of the evidence using the GRADE approach. Our search identified 483 citations and 30 systematic reviews met all inclusion criteria, capturing the results from 442 primary studies. This included three reviews on supervised consumption facilities, 24 on pharmacological interventions, and three on managed alcohol programs. Supervised consumption facilities decreased lethal overdoses and other high risk behaviours without any significant harm, and improved access to care. Pharmaceutical interventions reduced mortality, morbidity, and substance use, but the impact on retention in treatment, mental illness and access to care was variable. Managed alcohol programs reduced or stabilized alcohol consumption. Few studies on managed alcohol programs reported deaths. CONCLUSIONS: Substance use is a common chronic condition impacting homeless populations. Supervised consumption facilities reduce overdose and improve access to care, while pharmacological interventions may play a role in reducing harms and addressing other morbidity. High quality evidence on managed alcohol programs is limited.


Asunto(s)
Trastornos Relacionados con Alcohol/rehabilitación , Sobredosis de Droga/prevención & control , Personas sin Hogar/estadística & datos numéricos , Trastornos Relacionados con Opioides/rehabilitación , Poblaciones Vulnerables/estadística & datos numéricos , Trastornos Relacionados con Alcohol/epidemiología , Sobredosis de Droga/epidemiología , Reducción del Daño , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Personas sin Hogar/psicología , Vivienda/organización & administración , Vivienda/estadística & datos numéricos , Humanos , Antagonistas de Narcóticos/uso terapéutico , Estudios Observacionales como Asunto , Tratamiento de Sustitución de Opiáceos/métodos , Tratamiento de Sustitución de Opiáceos/estadística & datos numéricos , Trastornos Relacionados con Opioides/epidemiología , Prevalencia , Evaluación de Programas y Proyectos de Salud , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento , Poblaciones Vulnerables/psicología
18.
Int J Cancer ; 146(5): 1208-1218, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31087650

RESUMEN

Breast cancer is the leading cancer diagnosis and second most common cause of cancer deaths in sub-Saharan Africa (SSA). Yet, there are few population-level survival data from Africa and none on the survival differences by stage at diagnosis. Here, we estimate breast cancer survival within SSA by area, stage and country-level human development index (HDI). We obtained data on a random sample of 2,588 breast cancer incident cases, diagnosed in 2008-2015 from 14 population-based cancer registries in 12 countries (Benin, Cote d'Ivoire, Ethiopia, Kenya, Mali, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Uganda and Zimbabwe) through the African Cancer Registry Network. Of these, 2,311 were included for survival analyses. The 1-, 3- and 5-year observed and relative survival (RS) were estimated by registry, stage and country-level HDI. We equally estimated the excess hazards adjusting for potential confounders. Among patients with known stage, 64.9% were diagnosed in late stages, with 18.4% being metastatic at diagnosis. The RS varied by registry, ranging from 21.6%(8.2-39.8) at Year 3 in Bulawayo to 84.5% (70.6-93.5) in Namibia. Patients diagnosed at early stages had a 3-year RS of 78% (71.6-83.3) in contrast to 40.3% (34.9-45.7) at advanced stages (III and IV). The overall RS at Year 1 was 86.1% (84.4-87.6), 65.8% (63.5-68.1) at Year 3 and 59.0% (56.3-61.6) at Year 5. Age at diagnosis was not independently associated with increased mortality risk after adjusting for the effect of stage and country-level HDI. In conclusion, downstaging breast cancer at diagnosis and improving access to quality care could be pivotal in improving breast cancer survival outcomes in Africa.


Asunto(s)
Neoplasias de la Mama/mortalidad , Factores Socioeconómicos , África del Sur del Sahara/epidemiología , Factores de Edad , Mama/patología , Neoplasias de la Mama/patología , Femenino , Estudios de Seguimiento , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Persona de Mediana Edad , Estadificación de Neoplasias , Mejoramiento de la Calidad , Sistema de Registros/estadística & datos numéricos , Medición de Riesgo , Tasa de Supervivencia
20.
Am J Public Health ; 110(1): 27-31, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31725313

RESUMEN

The federal government has proposed an end to HIV transmission in the United States by 2030. Although the United States has made substantial overall progress in the fight against HIV/AIDS, data released by the Centers for Disease Control and Prevention have raised concerns about widening, yet largely unrecognized, HIV infection disparities among Hispanic and Latino populations.This commentary identifies underlying drivers of increasing new HIV infections among Hispanics/Latinos, discusses existing national efforts to fight HIV in Hispanic/Latino communities, and points to gaps in the federal response. Consideration of the underlying drivers of increased HIV incidence among Hispanics/Latinos is warranted to achieve the administration's 2030 HIV/AIDS goals.Specifically, the proposed reinforcement of national efforts to end the US HIV epidemic must include focused investment in four priority areas: (1) HIV stigma reduction in Hispanic/Latino communities, (2) the availability and accessibility of HIV treatment of HIV-positive Hispanics/Latinos, (3) the development of behavioral interventions tailored to Hispanic/Latino populations, and (4) the engagement of Hispanic/Latino community leaders.


Asunto(s)
Infecciones por VIH/etnología , Hispanoamericanos , Vacunas contra el SIDA , Antirretrovirales/uso terapéutico , Centers for Disease Control and Prevention, U.S./organización & administración , Participación de la Comunidad/métodos , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Conductas Relacionadas con la Salud/etnología , Accesibilidad a los Servicios de Salud/organización & administración , Homosexualidad Masculina/etnología , Humanos , Liderazgo , Masculino , Profilaxis Pre-Exposición/métodos , Vigilancia en Salud Pública , Asunción de Riesgos , Estigma Social , Personas Transgénero , Estados Unidos/epidemiología
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