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3.
Ann Otol Rhinol Laryngol ; 129(2): 128-134, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31544468

RESUMEN

OBJECTIVE: To understand differences in patient demographics, insurance-related treatment delays, and average waiting times for Medicare and private insurance patients undergoing upper airway stimulation (UAS) for treatment of obstructive sleep apnea (OSA). METHODS: Retrospective chart review of all Medicare and private insurance patients undergoing upper airway stimulation (UAS) from 2015 to 2018 at a single academic center. Primary outcomes were insurance-related procedure cancellation rate and time from drug induced sleep endoscopy (DISE) and UAS treatment recommendation to UAS surgery in Medicare versus private insurance patients. RESULTS: In our cohort 207 underwent DISE and were recommended treatment with UAS. Forty-four patients with Medicare and 30 patients with private insurance underwent UAS procedure. Patients with Medicare undergoing UAS were older (67.4 ± 11.1 years) than patients with private insurance (54.9 ± 8.1 years). Medicare patients had a shorter mean wait time of 121.9 ± 75.8 days (range, 15-331 days) from the time of UAS treatment recommendation to UAS surgery when compared to patients with private insurance (201.3 ± 102.2 days; range, 33-477 days). Three patients with Medicare (6.4%) and 8 patients with private insurance (21.1%) were ultimately denied UAS. CONCLUSION: Medicare patients undergoing UAS have shorter waiting periods, fewer insurance-related treatment delays and may experience fewer procedure cancellations when compared to patients with private insurance. The investigational status of UAS by private insurance companies delays care for patients with OSA. LEVEL OF EVIDENCE: 4.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Terapia por Estimulación Eléctrica/métodos , Cobertura del Seguro , Apnea Obstructiva del Sueño/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Nervio Hipogloso , Masculino , Medicare , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos
5.
Acta Neurol Scand ; 141(1): 81-89, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31602640

RESUMEN

OBJECTIVES: Clinical research has documented a range of evidence-based treatment approaches for spatial neglect (SN), but there is a lack of research on the implementation of treatment into clinical practice. The purpose of this study is to describe the current clinical practice of SN treatment across healthcare sectors including involved professions, methods, timing and sources of evidence. MATERIAL AND METHODS: This is the second part of a nationwide, anonymous, open Internet survey that was conducted among healthcare professionals in Denmark on assessment and treatment of SN. RESULTS: A total of 525 healthcare professionals participated in the survey of which 411 (78.3%) reported that SN treatment was provided at their workplace. Occupational and physiotherapist were most often involved in the treatment, most commonly characterized by training of activities of daily living (ADL), sensoric stimulation and cueing. Less frequently reported were evidence-based methods such as prism adaptation and visual scanning. The overall intensity of the SN treatment varied considerably across sectors and might consequently be inadequate. A minority of the participants consulted clinical research evidence in their choice of SN treatment approaches. CONCLUSIONS: There is a profound lack of dissemination and translation of clinical research into current clinical practice, which unarguably leads to an underuse of evidence-based treatment approaches in SN rehabilitation. The results call for international multidisciplinary clinical guidelines for the treatment of SN at different stages of rehabilitation and the tailoring of treatment approaches to the individual patient.


Asunto(s)
Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/estadística & datos numéricos , Trastornos de la Percepción/rehabilitación , Adulto , Dinamarca , Personal de Salud , Humanos , Masculino , Encuestas y Cuestionarios
6.
Rev Saude Publica ; 53: 110, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31826176

RESUMEN

OBJECTIVE: To evaluate the influence of the Mais Médicos (More Doctors) Program on the performance of primary health care by quantifying health services access and use in Northeast Brazil, based on the population size of the municipalities, on the financial investment in health, and on the number of physicians in the family health teams. METHOD: Evaluative research of quantitative nature. Access was evaluated by the population coverage ratio of the Family Health Strategy and use of health services, which were measured by medical appointments conducted between April 2013 and September 2015. We defined processes for database selection, adjustment, and validation, including explanatory variables for a sample of 896 municipalities. The analysis was based on the time periods before and after the implementation of the program. The Wilcoxon signed-rank test and non-parametric alternatives constituted statistical tests in the comparative analysis of the data. RESULTS: A 19.2% increase was observed in the number of medical appointments between the first six months and the final six months of the data series. In this period, the median appointments in municipalities with up to 5,000 inhabitants increased from 701.0 to 768.0; while in those with more than 100,000 inhabitants it decreased from 285.5 to 280.0 (p < 0.05). Between April 2013 and September 2015, the median coverage ratio of the family health teams increased from 89.2% to 95.3%, approaching 100% in the municipalities with up to 20,000 inhabitants. CONCLUSIONS: The study highlights the expansion of access and use of primary health care services in the northeast region after the implementation of the Mais Médicos (More Doctors) Program. Between April 2013 and September 2015, the coverage of family health teams and the production of medical appointments increased, constituting important achievements for SUS.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Programas de Gobierno , Médicos/provisión & distribución , Atención Primaria de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Brasil , Prestación de Atención de Salud/economía , Salud de la Familia , Asignación de Recursos para la Atención de Salud , Humanos , Atención Primaria de Salud/economía , Evaluación de Programas y Proyectos de Salud , Recursos Humanos
7.
BMC Neurol ; 19(1): 318, 2019 Dec 10.
Artículo en Inglés | MEDLINE | ID: mdl-31823737

RESUMEN

BACKGROUND: Huntington's disease (HD) is a rare, genetic, neurodegenerative and ultimately fatal disease with no cure or progression-delaying treatment currently available. HD is characterized by a triad of cognitive, behavioural and motor symptoms. Evidence on epidemiology and management of HD is limited, especially for Germany. This study aims to estimate the incidence and prevalence of HD and analyze the current routine care based on German claims data. METHODS: The source of data was a sample of the Institute for Applied Health Research Berlin (InGef) Research Database, comprising data of approximately four million insured persons from approximately 70 German statutory health insurances. The study was conducted in a retrospective cross-sectional design using 2015 and 2016 as a two-year observation period. At least two outpatient or inpatient ICD-10 codes for HD (ICD-10: G10) during the study period were required for case identification. Patients were considered incident if no HD diagnoses in the 4 years prior to the year of case identification were documented. Information on outpatient drug dispensations, medical aids and remedies were considered to describe the current treatment situation of HD patients. RESULTS: A 2-year incidence of 1.8 per 100,000 persons (95%-Confidence interval (CI): 1.4-2.4) and a 2-year period prevalence of 9.3 per 100,000 persons (95%-CI: 8.3-10.4) was observed. The prevalence of HD increased with advancing age, peaking at 60-69 years (16.8 per 100,000 persons; 95%-CI: 13.4-21.0) and decreasing afterwards. The most frequently observed comorbidities and disease-associated symptoms in HD patients were depression (42.9%), dementia (37.7%), urinary incontinence (32.5%), extrapyramidal and movement disorders (30.5%), dysphagia (28.6%) and disorders of the lipoprotein metabolism (28.2%). The most common medications in HD patients were antipsychotics (66.9%), followed by antidepressants (45.1%). Anticonvulsants (16.6%), opioids (14.6%) and hypnotics (9.7%) were observed less frequently. Physical therapy was the most often used medical aid in HD patients (46.4%). Nursing services and speech therapy were used by 27.9 and 22.7% of HD patients, respectively, whereas use of psychotherapy was rare (3.2%). CONCLUSIONS: Based on a representative sample, this study provides new insights into the epidemiology and routine care of HD patients in Germany, and thus, may serve as a starting point for further research.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Enfermedad de Huntington/epidemiología , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad , Estudios Transversales , Bases de Datos Factuales , Progresión de la Enfermedad , Femenino , Alemania/epidemiología , Humanos , Enfermedad de Huntington/diagnóstico , Enfermedad de Huntington/terapia , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos
8.
BMC Health Serv Res ; 19(1): 967, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31842870

RESUMEN

BACKGROUND: Coverage is an important indicator to assess both the performance and effectiveness of public health programs. Recommended methods for coverage estimation for the treatment of severe acute malnutrition (SAM) can involve active and adaptive case finding (AACF), an informant-driven sampling procedure, for the identification of cases. However, as this procedure can yield a non-representative sample, exhaustive or near exhaustive case identification is needed for valid coverage estimation with AACF. Important uncertainty remains as to whether an adequate level of exhaustivity for valid coverage estimation can be ensured by AACF. METHODS: We assessed the sensitivity of AACF and a census method using a capture-recapture design in northwestern Nigeria. Program coverage was estimated for each case finding procedure. RESULTS: The sensitivity of AACF was 69.5% (95% CI: 59.8, 79.2) and 91.9% (95% CI: 85.1, 98.8) with census case finding. Program coverage was estimated to be 40.3% (95% CI 28.6, 52.0) using AACF, compared to 34.9% (95% CI 24.7, 45.2) using the census. Depending on the distribution of coverage among missed cases, AACF sensitivity of at least ≥70% was generally required for coverage estimation to remain within ±10% of the census estimate. CONCLUSION: Given the impact incomplete case finding and low sensitivity can have on coverage estimation in potentially non-representative samples, adequate attention and resources should be committed to ensure exhaustive or near exhaustive case finding. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT03140904. Registered on May 3, 2017.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Tamizaje Masivo , Desnutrición Aguda Severa/diagnóstico , Preescolar , Humanos , Lactante , Nigeria/epidemiología , Prevalencia , Muestreo , Desnutrición Aguda Severa/epidemiología , Desnutrición Aguda Severa/terapia
9.
BMC Health Serv Res ; 19(1): 976, 2019 Dec 19.
Artículo en Inglés | MEDLINE | ID: mdl-31856814

RESUMEN

BACKGROUND: In 2009 health insurers AOK and Bosch BKK introduced the "FacharztProgramm Kardiologie" - a program for coordinated ambulatory cardiology care in the German state of Baden-Württemberg. It aims for efficient, medical guideline-oriented cardiology care to reduce avoidable hospitalizations as well as costs of care. A high number of cardiologists participate and the program has served as blueprint for programs in other medical fields. With many prerequisites and conditions involved, its implementation cannot be expected to be self-directed. Still, only little data on the actual implementation exists. We aimed to determine to what extent medical specialists and cooperating general practitioners implemented the program, which components they adapted, and which contextual factors they deemed relevant. METHODS: We collected data from primary care practices of medical specialists and general practitioners within Baden-Württemberg. Qualitative data was obtained through structured telephone interviews with participating and non-participating medical specialists as well as general practitioners cooperating with the program and general practitioners not cooperating. Interviews were analyzed through content-structuring qualitative content analyses via MAXQDA. Quantitative data was obtained using anonymous written questionnaires completed by participating and non-participating medical specialists as well as general practitioners cooperating with the program. Analyses were performed using SPSS Statistics, mainly with regard to differences within and between groups of physicians. RESULTS: Most components of the program regarding medical care were well implemented. However, access to medical care was not completely as intended due to high numbers of patients participating in the program and prioritization by physicians. Procedures for communication and cooperation between medical specialists and general practitioners were only partially adhered to and standardized communication was not implemented. A range of regional and practice-related contextual factors influenced implementation and outcomes. CONCLUSIONS: Implementation of this program was mixed. Contextual factors posed individual challenges to participating physicians which can't be captured by an encompassing program. Both control mechanisms and tailoring of the program to medical care seem needed. TRIAL REGISTRATION: Though not a clinical study, we deemed registration appropriate to ensure transparency. The study has been registered as a non-interventional observation study at the German Clinical Trials Register under ID: DRKS00013070.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Cardiología/estadística & datos numéricos , Médicos Generales/estadística & datos numéricos , Instituciones de Atención Ambulatoria , Enfermedades Cardiovasculares/terapia , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Alemania , Hospitalización/estadística & datos numéricos , Humanos , Seguro de Salud/estadística & datos numéricos , Masculino , Programas Controlados de Atención en Salud/estadística & datos numéricos , Persona de Mediana Edad , Encuestas y Cuestionarios
10.
BMC Health Serv Res ; 19(1): 845, 2019 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-31739783

RESUMEN

BACKGROUND: Mathematical modelling has been a vital research tool for exploring complex systems, most recently to aid understanding of health system functioning and optimisation. System dynamics models (SDM) and agent-based models (ABM) are two popular complementary methods, used to simulate macro- and micro-level health system behaviour. This systematic review aims to collate, compare and summarise the application of both methods in this field and to identify common healthcare settings and problems that have been modelled using SDM and ABM. METHODS: We searched MEDLINE, EMBASE, Cochrane Library, MathSciNet, ACM Digital Library, HMIC, Econlit and Global Health databases to identify literature for this review. We described papers meeting the inclusion criteria using descriptive statistics and narrative synthesis, and made comparisons between the identified SDM and ABM literature. RESULTS: We identified 28 papers using SDM methods and 11 papers using ABM methods, one of which used hybrid SDM-ABM to simulate health system behaviour. The majority of SDM, ABM and hybrid modelling papers simulated health systems based in high income countries. Emergency and acute care, and elderly care and long-term care services were the most frequently simulated health system settings, modelling the impact of health policies and interventions such as those targeting stretched and under resourced healthcare services, patient length of stay in healthcare facilities and undesirable patient outcomes. CONCLUSIONS: Future work should now turn to modelling health systems in low- and middle-income countries to aid our understanding of health system functioning in these settings and allow stakeholders and researchers to assess the impact of policies or interventions before implementation. Hybrid modelling of health systems is still relatively novel but with increasing software developments and a growing demand to account for both complex system feedback and heterogeneous behaviour exhibited by those who access or deliver healthcare, we expect a boost in their use to model health systems.


Asunto(s)
Investigación sobre Servicios de Salud/métodos , Modelos Teóricos , Anciano , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Programas de Gobierno , Política de Salud , Servicios de Salud/estadística & datos numéricos , Humanos , Irlanda , Masculino , Asistencia Médica , Análisis de Sistemas
11.
BMJ ; 367: l6326, 2019 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-31776110

RESUMEN

OBJECTIVE: To determine how the UK National Health Service (NHS) is performing relative to health systems of other high income countries, given that it is facing sustained financial pressure, increasing levels of demand, and cuts to social care. DESIGN: Observational study using secondary data from key international organisations such as Eurostat and the Organization for Economic Cooperation and Development. SETTING: Healthcare systems of the UK and nine high income comparator countries: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US. MAIN OUTCOME MEASURES: 79 indicators across seven domains: population and healthcare coverage, healthcare and social spending, structural capacity, utilisation, access to care, quality of care, and population health. RESULTS: The UK spent the least per capita on healthcare in 2017 compared with all other countries studied (UK $3825 (£2972; €3392); mean $5700), and spending was growing at slightly lower levels (0.02% of gross domestic product in the previous four years, compared with a mean of 0.07%). The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per capita, despite having average levels of utilisation (number of hospital admissions). The UK had slightly below average life expectancy (81.3 years compared with a mean of 81.7) and cancer survival, including breast, cervical, colon, and rectal cancer. Although several health service outcomes were poor, such as postoperative sepsis after abdominal surgery (UK 2454 per 100 000 discharges; mean 2058 per 100 000 discharges), 30 day mortality for acute myocardial infarction (UK 7.1%; mean 5.5%), and ischaemic stroke (UK 9.6%; mean 6.6%), the UK achieved lower than average rates of postoperative deep venous thrombosis after joint surgery and fewer healthcare associated infections. CONCLUSIONS: The NHS showed pockets of good performance, including in health service outcomes, but spending, patient safety, and population health were all below average to average at best. Taken together, these results suggest that if the NHS wants to achieve comparable health outcomes at a time of growing demographic pressure, it may need to spend more to increase the supply of labour and long term care and reduce the declining trend in social spending to match levels of comparator countries.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Países Desarrollados/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Salud Poblacional/estadística & datos numéricos , Medicina Estatal/estadística & datos numéricos , Producto Interno Bruto , Gastos en Salud/estadística & datos numéricos , Humanos , Renta , Reino Unido
12.
BMC Health Serv Res ; 19(1): 846, 2019 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-31744504

RESUMEN

BACKGROUND: The decline of the incidence rate of tuberculosis in Taiwan has been partly attributed to the launch of the directly observed therapy short course (DOTS) program in 2006, followed by the DOTS-Plus in 2007. However, with the phasing out of the specialized tuberculosis care system and the declining incidence, clinical workers in Taiwan might become less familiar with the presentation of tuberculosis. Complementing the patient-pathway analysis with health system delay estimates, the objective of this study is twofold: to estimate the alignment between patient care initiation and the availability of prompt diagnostic and treatment services, and to identify the risk factors of delayed tuberculosis treatment. METHODS: The study population included all Taiwanese patients with incident tuberculosis in 2013. We (1) identified 11,507 incident tuberculosis patients from the 2013 National TB Registry, and (2) linked 10,932 Taiwanese from the registry to the 2012-2013 National Health Insurance Research Database. We assessed patient's care-seeking pathways and associated the determinants of health system delay in a Cox model. RESULTS: The overall health system delay was 46 days. We found that 20.5 and 3.5% of 10,932 tuberculosis patients were diagnosed and treated respectively at the initial visit to seek care for TB-related symptoms. Risk factors related to the prolonged health system delay included female gender (adjusted HR = 0.921, 95% CI: 0.884, 0.960), age > =65 years (adjusted HR = 0.720, 95% CI: 0.692, 0.750), non-severe (chest X-ray without cavities) (adjusted HR =0.721, 95% CI 0.683-0.760), chronic respiratory diseases (adjusted HR = 0.544, 95% CI: 0.522, 0.566), living in long-term care facilities (adjusted HR = 0.580, 95% CI: 0.525,0.640), an initial visit at a primary care clinic (adjusted HR = 0.588, 95% CI: 0.565, 0.612), and living in southern Taiwan (adjusted HR = 0.887, 95% CI: 0.798, 0.987). CONCLUSIONS: The low access to TB diagnostic and treatment services at the initial visit and the prolonged health system delay indicate inefficiency in the health care system. Strengthening training of physicians at public hospitals and health workers at nursing homes might improve the efficiency and timeliness of tuberculosis diagnosis and treatment in Taiwan.


Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Tuberculosis/terapia , Adulto , Anciano , Diagnóstico Tardío , Prestación de Atención de Salud/estadística & datos numéricos , Terapia por Observación Directa/estadística & datos numéricos , Femenino , Instituciones de Salud , Hospitales/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Taiwán/epidemiología , Tiempo de Tratamiento , Tuberculosis/epidemiología , Adulto Joven
13.
Afr J Reprod Health ; 23(3): 57-67, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31782632

RESUMEN

The health system in many parts of Nigeria has been dysfunctional in several domains including financing, human resources, infrastructure, health management information system and hospital services. In an attempt to scale up Maternal and Child Health (MCH) services and ensure efficiency, Ebonyi State Government in Southeast Nigeria provided funding to mission hospitals across the State as a grant. This study used nonparametric method to assess the effect of this public financing on the efficiency of the mission hospitals. Operational cost and number of hospital beds were used as the input variables, while antenatal registrations, number of immunization doses and hospital deliveries were the output variables. The hospitals were disaggregated into 15 hospital-years. The mean overall technical efficiency of the mission hospitals was 84.05 22.45%. The mean pure technical efficiency was 95.56±6.9% and the scale efficiency was 88.05±22.20%. About 46.67% of all the hospital-years were technically and scale efficient. Although, 55.33% were generally inefficient, only 33.33% of hospital-years exhibited pure technical inefficiency. Low immunization coverage was the major cause of inefficiency. The study showed increased maternal health service output as result of public funding or intervention; however, the mission hospitals could have saved 16% of input resources if they had performed efficiently. It also shows that data envelopment analysis can be used in setting targets/benchmarks for relatively inefficient health facilities, and in monitoring impact of interventions on efficiency of hospitals over-time.


Asunto(s)
Servicios de Salud del Niño/organización & administración , Prestación de Atención de Salud/organización & administración , Eficiencia Organizacional , Recursos en Salud/estadística & datos numéricos , Hospitales Religiosos/organización & administración , Servicios de Salud Materna/organización & administración , Niño , Servicios de Salud del Niño/estadística & datos numéricos , Costos y Análisis de Costo , Estudios Transversales , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Financiación Gubernamental , Hospitales Religiosos/estadística & datos numéricos , Humanos , Masculino , Servicios de Salud Materna/estadística & datos numéricos , Nigeria , Embarazo , Estudios Retrospectivos
14.
BMC Health Serv Res ; 19(1): 722, 2019 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-31638984

RESUMEN

BACKGROUND: Thai massage is a highly gendered and culturally specific occupation. Many female Thai masseuses migrate to Norway as marriage migrants and as such are entitled to the same public healthcare as Norwegian citizens. Additionally, anyone who is not fluent in Norwegian is entitled to have an interpreter provided by the public healthcare system. Norway and most other countries aspire to universal health coverage, but certain immigrant populations continue to experience difficulties accessing appropriate healthcare. This study examined healthcare access among Thai migrant masseuses in Oslo. METHODS: Guided by access to healthcare theory, we conducted a qualitative exploratory study in 2018 with Thai women working as masseuses in Oslo, Norway. Through semi-structured in-depth interviews with 14 Thai women, we explored access to healthcare, health system navigation and care experiences. We analyzed the data using thematic analysis and grouped the information into themes relevant to healthcare access. RESULTS: Participants did not perceive that their occupation limited their access to healthcare. Most of the barriers participants experienced when accessing care were related to persistent language challenges. Women who presented at healthcare facilities with their Norwegian spouse were rarely offered interpreters, despite their husband's limited capacity to translate effectively. Cultural values inhibit women from demanding the interpretation services to which they are entitled. In seeking healthcare, women sought information about health services from their Thai network and relied on family members, friends and contacts to act as informal interpreters. Some addressed their healthcare needs through self-treatment using imported medication or sought healthcare abroad. CONCLUSIONS: Despite having the same entitlements to public healthcare as Norwegian citizens, Thai migrants experience difficulties accessing healthcare due to pervasive language barriers. A significant gap exists between the official policy that professional interpreters should be provided and the reality experienced by study participants. To improve communication and equitable access to healthcare for Thai immigrant women in Norway, health personnel should offer professional interpreters and not rely on Norwegian spouses to translate. Use of community health workers and outreach through Thai networks, may also improve Thai immigrants' knowledge and ability to navigate the Norwegian healthcare system.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Emigrantes e Inmigrantes , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Masaje , Ocupaciones , Adulto , Barreras de Comunicación , Femenino , Humanos , Noruega/epidemiología , Derechos del Paciente , Investigación Cualitativa , Tailandia
15.
Mem Inst Oswaldo Cruz ; 114: e190253, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31664313

RESUMEN

BACKGROUND: Timely diagnosis is recommended by the Brazilian Visceral Leishmaniasis (VL) Surveillance and Control Program to reduce case fatality. Attempts at assessing this topic in Brazil are scarce. OBJECTIVE: This study aimed to describe where, when, and how the diagnosis of VL has been performed in a Brazilian endemic setting. METHODS: Data of all autochthonous cases confirmed between 2011 and 2016 (N = 81) were recorded. The care-seeking itinerary until the confirmation of VL diagnosis was assessed among 57 patients. FINDINGS: The majority of VL cases (79.1%) were reported by referral hospitals. The patients mainly sought primary health care centres at the onset of symptoms. However, they had to visit seven health services on average to achieve a confirmed diagnosis. The time from the onset of symptoms to the diagnosis of VL (TD) ranged from 1-212 (median, 25) days. The TD was longer among adult patients. There was a direct correlation between the patient's age and TD (r = 0.22; p = 0.047) and a higher occurrence of deaths due to the disease among older patients (p = 0.002). Almost all the patients (98.9%) underwent laboratory investigation, and the VL diagnosis was mainly confirmed based on clinical-laboratory criteria (92.6%). Positive results for the indirect fluorescence antibody test (22.7%) and parasitological examination plus rk39-based immunochromatographic tests (21.3%) were commonly employed. MAIN CONCLUSIONS: VL diagnosis was predominantly conducted in hospitals with a long TD and wide application of serology. These findings may support measures focused on early diagnosis, including a greater involvement of the primary health care system.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Leishmaniasis Visceral/diagnóstico , Adolescente , Adulto , Brasil/epidemiología , Niño , Preescolar , Cromatografía de Afinidad , Prestación de Atención de Salud/clasificación , Femenino , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , Lactante , Recién Nacido , Leishmaniasis Visceral/epidemiología , Masculino , Estudios Retrospectivos
16.
Curr Med Sci ; 39(5): 843-851, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31612406

RESUMEN

Throughout the duration of the New Cooperative Medical Scheme (NCMS), it was found that an increasing number of rural patients were seeking out-of-county medical treatment, which posed a great burden on the NCMS fund. Our study was conducted to examine the prevalence of out-of-county hospitalizations and its related factors, and to provide a scientific basis for follow-up health insurance policies. A total of 215 counties in central and western China from 2008 to 2016 were selected. The total out-of-county hospitalization rate in nine years was 16.95%, which increased from 12.37% in 2008 to 19.21% in 2016 with an average annual growth rate of 5.66%. Its related expenses and compensations were shown to increase each year, with those in the central region being higher than those in the western region. Stepwise logistic regression reveals that the increase in out-of-county hospitalization rate was associated with region (X1), rural population (X2), per capita per year net income (X3), per capita gross domestic product (GDP) (X4), per capita funding amount of NCMS (X5), compensation ratio of out-of-county hospitalization cost (X6), per time average in-county (X7) and out-of-county hospitalization cost (X8). According to Bayesian network (BN), the marginal probability of high out-of-county hospitalization rate was as high as 81.7%. Out-of-county hospitalizations were directly related to X8, X3, X4 and X6. The probability of high out-of-county hospitalization obtained based on hospitalization expenses factors, economy factors, regional characteristics and NCMS policy factors was 95.7%, 91.1%, 93.0% and 88.8%, respectively. And how these factors affect out-of-county hospitalization and their interrelationships were found out. Our findings suggest that more attention should be paid to the influence mechanism of these factors on out-of-county hospitalizations, and the increase of hospitalizations outside the county should be reasonably supervised and controlled and our results will be used to help guide the formulation of proper intervention policies.


Asunto(s)
Prestación de Atención de Salud/economía , Gastos en Salud/estadística & datos numéricos , Hospitalización/economía , Seguro de Salud/economía , Salud Rural/economía , Teorema de Bayes , China , Prestación de Atención de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Seguro de Salud/estadística & datos numéricos , Salud Rural/estadística & datos numéricos , Población Rural , Factores Socioeconómicos
17.
Pan Afr Med J ; 33: 159, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31565121

RESUMEN

Introduction: Hospital-based surveillance programs only capture people presenting to facilities and may underestimate disease burden. We conducted a healthcare utilisation survey to characterise healthcare-seeking behaviour among people with common infectious syndromes in the catchment areas of two sentinel surveillance hospitals in Johannesburg, South Africa. Methods: A cross-sectional survey was conducted within three regions of Johannesburg from August to November 2015. Premises were randomly selected from an enumerated list with data collected on household demographics and selected syndromes using a structured questionnaire. Fisher's exact or chi-square tests were used to determine association of characteristics among different regions. Results: Of 3650 selected coordinates, 3358 were eligible dwellings and 2930 (87%) households with 9850 individuals participated. Four percent of participants (431/9850) reported influenza-like illness (ILI) in the last 30 days; equal numbers of participants (0.2%, 20/9850) reported pneumonia or tuberculosis symptoms in the last year and <1% reported diarrhoea or meningitis symptoms. Sixty eight percent (295/431) of participants who reported ILI, 75% (6/8) of children with diarrhoea and all participants who reported pneumonia (20), tuberculosis (20) or meningitis (6) sought healthcare. For all syndromes most sought care at registered healthcare providers. Of these only 10% (24/237) attended sentinel hospitals, predominantly those that lived closer to the hospitals. In contrast, of patients with meningitis, 50% (3/6) sought care at sentinel hospitals. Conclusion: Patterns of seeking healthcare differed by syndrome and distance from facilities. Surveillance programs are still relevant in collecting information on infectious syndromes and reflect a proportion of the hospital's catchment area.


Asunto(s)
Enfermedades Transmisibles/epidemiología , Prestación de Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Vigilancia de Guardia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Enfermedades Transmisibles/terapia , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Sudáfrica/epidemiología , Encuestas y Cuestionarios , Síndrome , Adulto Joven
18.
Med Care ; 57(11): 905-912, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31568165

RESUMEN

BACKGROUND: It is unclear whether Medicare data can be used to identify type and degree of collaboration between primary care providers (PCPs) [medical doctors (MDs), nurse practitioners, and physician assistants] in a team care model. METHODS: We surveyed 63 primary care practices in Texas and linked the survey results to 2015 100% Medicare data. We identified PCP dyads of 2 providers in Medicare data and compared the results to those from our survey. Sensitivity, specificity, and positive predictive value (PPV) of dyads in Medicare data at different threshold numbers of shared patients were reported. We also identified PCPs who work in the same practice by Social Network Analysis (SNA) of Medicare data and compared the results to the surveys. RESULTS: With a cutoff of sharing at least 30 patients, the sensitivity of identifying dyads was 27.8%, specificity was 91.7%, and PPV 72.2%. The PPV was higher for MD-nurse practitioner/physician assistant pairs (84.4%) than for MD-MD pairs (61.5%). At the same cutoff, 90% of PCPs identified in a practice from the survey were also identified by SNA in the corresponding practice. In 5 of 8 surveyed practices with at least 3 PCPs, about ≤20% PCPs identified in the practices by SNA of Medicare data were not identified in the survey. CONCLUSIONS: Medicare data can be used to identify shared care with low sensitivity and high PPV. Community discovery from Medicare data provided good agreement in identifying members of practices. Adapting network analyses in different contexts needs more validation studies.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Medicare/estadística & datos numéricos , Grupo de Atención al Paciente/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Interpretación Estadística de Datos , Prestación de Atención de Salud/métodos , Humanos , Colaboración Intersectorial , Enfermeras Practicantes/estadística & datos numéricos , Asistentes Médicos/estadística & datos numéricos , Médicos de Atención Primaria/estadística & datos numéricos , Atención Primaria de Salud/métodos , Texas , Estados Unidos
19.
J Altern Complement Med ; 25(12): 1206-1214, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31580714

RESUMEN

Objective: To quantify differences in patient expectations of healthscape (e.g., interior environment) across Western medicine (WM) and Traditional Chinese Medicine (TCM) paradigms. Data sources/study setting: Primary survey data comprise 469 Taiwanese consumers. National insurance coverage of both TCM and WM is an ideal setting to test for differences in healthscape expectations. Study design: Respondents report their recent experience as either exclusive users of TCM, exclusive WM, neither, or dual usage (both TCM and WM), and are randomly assigned to one of two surveys (identical except one refers to WM contexts, the other TCM) to rate the importance of 28 healthscape factors derived from previous studies. Data collection/extraction methods: Multivariate analysis of variance is used to test the research hypotheses. Principal findings: Dual users accept some differences across paradigms. In contrast, exclusive WM users apply their existing WM expectations to TCM contexts, raising the possibility of dissatisfaction and low adoption. Conclusions: A person's experience with TCM is related to acceptance of healthscape differences. Medical service providers of TCM, and by extension complementary and alternative medicine, should devise strategies to ease initial visitation by exclusive WM users. Healthscape designs need not be modeled closely on a WM standard, as dual users accept differences.


Asunto(s)
Terapias Complementarias/estadística & datos numéricos , Comportamiento del Consumidor/estadística & datos numéricos , Prestación de Atención de Salud , Medicina China Tradicional , Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Satisfacción del Paciente/estadística & datos numéricos , Taiwán , Adulto Joven
20.
Artículo en Inglés | MEDLINE | ID: mdl-31614533

RESUMEN

Background: The primary aim of the research in the present study was to determine the effectiveness of health care in classifying health care financing systems from a sample of OECD (Organisation for Economic Co-operation and Development) countries (2012-2017). This objective was achieved through several stages of analysis, which aimed to assess the relations between and relation diversity in selected variables, determining the effectiveness of health care and the health expenditure of health care financing systems. The greatest emphasis was placed on the differences between health care financing systems that were due to the impact of health expenditure on selected health outputs, such as life expectancy at birth, perceived health status, the health care index, deaths from acute myocardial infarction and diabetes mellitus. Methods: Methods such as descriptive analysis, effect analysis (η2), binomial logistic regression analysis, linear regression analysis, continuity analysis (ρ) and correspondence analysis, were used to meet the above objectives. Results: Based on several stages of statistical processing, it was found that there are deviations in several of the relations between different health care funding systems in terms of their predisposition to certain areas of health outcomes. Thus, where one system proves ineffective (or its effectiveness is questionable), another system (or systems) appears to be effective. From a correspondence analysis that compared the funding system and other outputs (converted to quartiles), it was found that a national health system, covering the country as a whole, and multiple insurance funds or companies would be more effective systems. Conclusions: Based on the findings, it was concluded that, in analyzing issues related to health care and its effectiveness, it is appropriate to take into account the funding system (at least to verify the significance of how research premises affect the systems); otherwise, the results may be distorted.


Asunto(s)
Prestación de Atención de Salud/economía , Prestación de Atención de Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Financiación de la Atención de la Salud , Organización para la Cooperación y el Desarrollo Económico/estadística & datos numéricos , Investigación Empírica , Humanos
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