RESUMO
BACKGROUND: Federally funded health centers (HCs) provide care to the most vulnerable populations in the U.S., including populations with disproportionately higher smoking prevalence such as those with lower incomes. METHODS: This study compared characteristics of adult HC patients, by cigarette smoking status, and assessed smoking cessation-related behaviors using 2014 Health Center Patient Survey data; analysis was restricted to adults with data on cigarette smoking status (n = 5583). Chi-square and logistic regression analyses were conducted. RESULTS: Overall, 28.1 % were current smokers and 19.2 % were former smokers. Current smokers were more likely to report fair/poor health (48.2 %) and a high burden of behavioral health conditions (e.g., severe psychological distress 23.9 %) versus former and never smokers. Most current smokers reported wanting to quit in the past 12 months (79.0 %) and receiving advice to quit from a healthcare professional (78.7 %). In a multivariable model, age <45, non-white race, COPD diagnosis, and past 3-month marijuana use were significantly associated with desire to quit. Few former smokers (15.2 %) reported using cessation treatment, though use was higher among those who quit within the previous year (30.6 %). CONCLUSIONS: Although most current smokers reported a desire to quit, low uptake of evidence-based treatment may reduce the number who attempt to quit and succeed. Given the burden of tobacco use, future efforts could focus on identifying and overcoming unique personal, healthcare professional, or health system barriers to connecting them with cessation treatments. Increasing access to cessation treatments within HCs could reduce smoking-related disparities and improve population health.
Assuntos
Fumar Cigarros/psicologia , Hospitais Federais/estatística & dados numéricos , Fumantes/psicologia , Abandono do Hábito de Fumar/psicologia , Populações Vulneráveis/psicologia , Adolescente , Adulto , Distribuição de Qui-Quadrado , Fumar Cigarros/epidemiologia , Feminino , Comportamentos Relacionados com a Saúde , Disparidades nos Níveis de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Populações Vulneráveis/estatística & dados numéricos , Adulto JovemRESUMO
The COVID-19 pandemic has altered mental health care delivery like no other event in modern history. The purpose of this study was to document the magnitude of that effect by examining (a) the amount of psychologists' telepsychology use before the COVID-19 pandemic, during the pandemic, and anticipated use after the pandemic; as well as (b) the demographic, training, policy, and clinical practice predictors of these changes. This study used a cross-sectional, national online design to recruit 2,619 licensed psychologists practicing in the United States. Prior to the COVID-19 pandemic, psychologists performed 7.07% of their clinical work with telepsychology, which increased 12-fold to 85.53% during the pandemic, with 67.32% of psychologists conducting all of their clinical work with telepsychology. Psychologists projected that they would perform 34.96% of their clinical work via telepsychology after the pandemic. Psychologists working in outpatient treatment facilities reported over a 26-fold increase in telepsychology use during the pandemic, while those in Veterans Affairs medical centers only reported a sevenfold increase. A larger increase in percentage telepsychology use occurred in women, in psychologists who reported an increase in telepsychology training and supportive organizational telepsychology policies, and in psychologists who treated relationship issues, anxiety, and women's issues. The lowest increases in percentage telepsychology use were reported by psychologists working in rural areas, treating antisocial personality disorder, performing testing and evaluation, and treating rehabilitation populations. Although there was a remarkable increase in telepsychology use during the COVID-19 pandemic, individual and practice characteristics affected psychologists' ability to adopt telepsychology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Assuntos
Assistência Ambulatorial/estatística & dados numéricos , COVID-19 , Atenção à Saúde/estatística & dados numéricos , Hospitais Federais/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Psicologia Clínica/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , United States Department of Veterans Affairs/estatística & dados numéricosRESUMO
BACKGROUND: Depression, which is a serious medical illness, is prevalent worldwide and it negatively impacts the adolescent lifestyle. Adolescent depression is associated with adverse emotional and functional outcomes and suboptimal physical health. Over the last decade, it has been found that approximately 9% of teenagers meet the criteria for depression at any given time, and one in five teenagers have a history of depression during adolescence. Ninety per cent of paediatricians believe that recognition of child and adolescent depression is their responsibility; however, it has been reported that 46% lacked confidence that they could recognise depression. METHODS: In this study, adolescents between 12 and 17 years of age were screened during their well-child visits using the Patient Health Questionnaire Modified for Adolescents. A score of 10 or higher warrants a referral to a social worker and psychiatrist. The goals of this quality improvement project were to implement a standardised questionnaire and to improve the screening, diagnosis and treatment of depression in children from 12 to 17 years of age. RESULTS: It was found that the adolescent depression screening rate significantly improved within 6 months of implementing this quality improvement project. The screening rate improved to 50% by mid-cycle (Plan-Do-Study-Act (PDSA) cycle 3) and up to 70% at the end of the 6-month period (PDSA cycle 5). Improvement was noted among all providers, across all age groups, and in both male and female patients by the end of the study period. CONCLUSION: Standardised screening tests with a scoring system help providers to identify and monitor depression symptoms using a common language, especially in the outpatient clinical setting where the patient may be seen by different providers.
Assuntos
Comportamento do Adolescente/psicologia , Depressão/diagnóstico , Programas de Rastreamento/normas , Questionário de Saúde do Paciente/estatística & dados numéricos , Adolescente , Criança , Depressão/psicologia , Feminino , Hospitais Federais/organização & administração , Hospitais Federais/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Desenvolvimento de Programas/métodos , Inquéritos e Questionários , Estados UnidosRESUMO
BACKGROUND: With the transition toward value-based care, health care organizations have a business imperative to simultaneously focus on improved health outcomes, improved patient and staff experience, and reduced costs (the Quadruple Aim). For federally qualified health centers-which provide care to some of nation's most vulnerable populations-balancing the complex task of systems change in the face of overwhelming volumes of information and best practices is challenging and can be supported through a guiding framework. PURPOSE: This need for synthesis and translation of evidence in an actionable and practical way led to the design of a model for health center systems change. This article describes the development process and defines the resulting conceptual framework. METHODS: Deployed a four-step process between 2016 and 2018 to develop and test a framework for value transformation in health centers. RESULTS: NACHC's Quality Center developed the Value Transformation Framework to guide health center systems change toward high value care. The framework identifies 15 change areas across three Domains: infrastructure, care delivery, and people and summarizes evidence-based action steps within the change areas. CONCLUSIONS: The framework shows promise in supporting health center efforts to adapt, transform, and balance competing demands as they advance value-based models of care.
Assuntos
Atenção à Saúde/economia , Atenção à Saúde/estatística & dados numéricos , Medicina Baseada em Evidências/economia , Medicina Baseada em Evidências/estatística & dados numéricos , Hospitais Federais/economia , Hospitais Federais/estatística & dados numéricos , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Humanos , Estados UnidosRESUMO
Introduction: This study aimed to describe clinical trials approved by the Brazilian Health Surveillance Agency (ANVISA) and coordinated by federal university hospitals (FUHs), as well as to investigate the relationship between the number of clinical trials and the assistance provided by these FUHs. Methods: This is a cross-sectional study based on data obtained from the ANVISA clinical trial consultation system. The National Register of Health Care Facilities and the Ambulatory Care Information System of the Unified Health System (SUS) were used as sources of information on the assistance provided by FUHs, such as the mean number of specialized medical consultations and the number of beds. Scatter plot and Spearman's correlation coefficient analyses were used to verify the association between these aspects of FUHs and the number of clinical trials. Results: Between 2012 and 2013, ANVISA authorized 209 trials to be coordinated by 23 FUHs; 75% of the trials were coordinated by 7 FUHs, 69.8% were phase III trials, and 94% were multicenter studies. The number of clinical trials presented positive and statistically significant associations with the mean number of specialized medical consultations and the number of beds (Spearman's correlation coefficients r = +0.70 and r = +0.64, respectively). Conclusion: FUHs have a leadership role in the conduction of clinical trials in Brazil, but showed heterogeneity regarding their assistance capacities and the number of clinical trials. A predominance of phase III trials may be interpreted as a low use of the scientific potentiality of these facilities. (AU)
Assuntos
Estudos Retrospectivos , Ensaios Clínicos como Assunto/estatística & dados numéricos , Hospitais Federais/estatística & dados numéricos , Hospitais de Ensino/organização & administração , Pesquisa Biomédica/organização & administração , Agência Nacional de Vigilância Sanitária , Assistência AmbulatorialRESUMO
PURPOSE: Federally Qualified Health Centers (FQHCs), which were expanded under the Affordable Care Act, are federally funded health centers that aim to improve access to primary care in underserved areas. With continued federal support, the number of FQHCs in the United States has increased >80% within a decade. However, the expansion patterns and their impact on the population served are unknown. METHODS: A pre (2007)-post (2014) study of FQHC locations. FQHC locations were identified from the Provider of Services Files then linked to primary care service areas (PCSAs), which represent the service markets that FQHCs served. Road-based travel time was estimated from each 2007 FQHC to the nearest new FQHC as an indicator of geographic expansion in access. PCSA-level characteristics were used to compare 2007 and 2014 FQHC service markets. FINDINGS: Between 2007 and 2014, there was greater expansion in the number of FQHCs (3,489 vs 6,376; 82.7%) than in the number of service markets (1,835 vs 2,695; 46.9%). Nearly half of 2007 FQHCs (47%) had at least one new FQHC within 30 minutes travel time. Most newly certified FQHCs (81%) were located in urban areas. Compared to 2007 service markets, the new 2014 markets (N = 174) were much less likely to be in areas with >20% of the population below poverty (31.4% vs 14.9%, P < .001). CONCLUSIONS: The latest expansion of FQHCs was less likely to be in rural or high poverty areas, suggesting the impact of expansion may have limitations in improving access to care among the most financially disadvantaged populations.
Assuntos
Mapeamento Geográfico , Hospitais Federais/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , Adolescente , Adulto , Criança , Feminino , Acessibilidade aos Serviços de Saúde/normas , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hospitais Federais/organização & administração , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/tendências , Estados UnidosRESUMO
PURPOSE: To compare the serology profile of donors from Hospital Cornea Retrieval Programme-donors (HCRP-D) and voluntary cornea donors (VC-D) from a large eye bank in Eastern India. METHODS: This is a retrospective analysis of donor details from January 2011 to December 2016. Donor demographics, cause of death, and serology reports were compiled. Postmortem blood was tested for human immunodeficiency virus 1 and 2 (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis using government-approved kits as per the National Programme for Control of Blindness Standards of Eye Banking. Donors for whom serology was not possible were excluded. RESULTS: A total of 4300 of 4353 donors were included of which 74.3% were hospital donors and 25.7% were voluntary donors. A total of 93 (2.2%) donors with 94 seropositive reports were noted: 79 (84.9%) from HCRP-D and 14 (15.1%) from VC-D which was statistically significantly higher (P = 0.02). Among seropositive reports, HIV, HBV, HCV, and syphilis accounted for 12 (12.8%), 38 (40.4%), 36 (38.3%), and eight (8.5%), respectively. There was no correlation between the cause of death and seropositivity. A statistically significant decreasing trend in seroprevalence among hospital donors was observed over the years (5.3% in 2011 to 1.4% in 2016; P = 0.004). Two (0.47%) of 421 hospital donors with prior negative serology were found to be seropositive. CONCLUSION: Seropositive rates are significantly higher among hospital donors in spite of medical prescreening compared to nonscreened voluntary donors. Serology should be repeated even when prior reports are available.
Assuntos
Bancos de Olhos/estatística & dados numéricos , Soropositividade para HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Hospitais Federais/estatística & dados numéricos , Sífilis/epidemiologia , Doadores de Tecidos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/sangue , Anticorpos Antivirais/sangue , Causas de Morte , Criança , Córnea , Ensaio de Imunoadsorção Enzimática , Feminino , Soropositividade para HIV/sangue , Soropositividade para HIV/diagnóstico , Hepatite B/sangue , Hepatite B/diagnóstico , Hepatite C/sangue , Hepatite C/diagnóstico , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estudos Soroepidemiológicos , Sífilis/sangue , Sífilis/diagnóstico , Estados UnidosRESUMO
BACKGROUND: Current cervical cancer screening guidelines include the option of lengthening the screening interval to 5 years for average-risk women aged 30-65 years when screened with Pap and human papillomavirus (HPV) test (co-test). Because many providers are reluctant to extend screening intervals, we launched an educational intervention to promote recommended screening practices. The study objective was to assess changes in provider attitudes and beliefs to extending screening intervals among low-income women. METHODS: The study was conducted in 15 clinics in Federally Qualified Health Centers in Illinois. Providers in the intervention arm received a multicomponent educational intervention. Fifty-six providers (n = 29 intervention and n = 27 control) completed baseline and 12-month follow-up surveys assessing beliefs and intentions about extending screening intervals. RESULTS: The 12-month assessment showed providers in the intervention arm were significantly more likely than those in the control arm to recommend a 3-year screening interval (guideline recommendation at time of study) with a normal co-test result. Providers who received the intervention were significantly more likely to agree that routine co-testing is the best way to screen for cervical cancer, that extending the screening interval would be good, easy, and beneficial, and to disagree that the increased screening interval would cause patients to lose contact with the medical system. CONCLUSION: Educating providers on the natural history of HPV infection and cervical cancer and the benefits of extended intervals increased their willingness to follow guidelines. This study provides evidence that an educational intervention delivered with HPV testing materials may be effective in encouraging appropriate cervical screening intervals.
Assuntos
Atitude do Pessoal de Saúde , Detecção Precoce de Câncer/métodos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Programas de Rastreamento/psicologia , Infecções por Papillomavirus/prevenção & controle , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/métodos , Adulto , Idoso , Centers for Disease Control and Prevention, U.S. , Estudos Transversais , Avaliação Educacional , Feminino , Seguimentos , Mau Uso de Serviços de Saúde , Hospitais Federais/estatística & dados numéricos , Humanos , Illinois , Pessoa de Meia-Idade , Pobreza , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Fatores de Tempo , Estados UnidosRESUMO
OBJECTIVE: A retrospective evaluation of waiting times for elective procedures was conducted in a sample of Mexican public hospitals from the following institutions: the Mexican Institute for Social Security (IMSS), the Institute for Social Security and Social Services for Civil Servants (ISSSTE) and the Ministry of Health (MoH). Our aim was to describe current waiting times and identify opportunities to redistribute service demand among public institutions. MATERIALS AND METHODS: We examined current waiting times and productivity for seven elective surgical and four diagnostic imaging procedures, selected on the basis of their relative frequency and comparability with other national health systems. RESULTS: Mean waiting time for the seven surgical procedures in the three institutions was 14 weeks. IMSS and ISSSTE hospitals showed better performance (12 and 13 weeks) than the MoH hospitals (15 weeks). Mean waiting time for the four diagnostic procedures was 11 weeks. IMSS hospitals (10 weeks) showed better average waiting times than ISSSTE (12 weeks) and MoH hospitals (11 weeks). CONCLUSION: Substantial variations were revealed, not only among institutions but also within the same institution. These variations need to be addressed in order to improve patient satisfaction.
Assuntos
Técnicas e Procedimentos Diagnósticos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Estudos Transversais , Eficiência , Hospitais Federais/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , México/epidemiologia , Estudos Retrospectivos , Estudos de Amostragem , Previdência Social , Fatores de Tempo , Tempo para o Tratamento , Estados UnidosRESUMO
This study evaluates the efficiency of federal hospitals, specifically those hospitals administered by the US Department of Veterans Affairs and the US Department of Defense. Hospital executives, health care policymakers, taxpayers, and federal hospital beneficiaries benefit from studies that improve hospital efficiency. This study uses data envelopment analysis to evaluate a panel of 165 federal hospitals in 2007 and 157 of the same hospitals again in 2011. Results indicate that overall efficiency in federal hospitals improved from 81% in 2007 to 86% in 2011. The number of federal hospitals operating on the efficiency frontier decreased slightly from 25 in 2007 to 21 in 2011. The higher efficiency score clearly documents that federal hospitals are becoming more efficient in the management of resources. From a policy perspective, this study highlights the economic importance of encouraging increased efficiency throughout the health care industry. This research examines benchmarking strategies to improve the efficiency of hospital services to federal beneficiaries. Through the use of strategies such as integrated information systems, consolidation of services, transaction-cost economics, and focusing on preventative health care, these organizations have been able to provide quality service while maintaining fiscal responsibility. In addition, the research documented the characteristics of those federal hospitals that were found to be on the Efficiency Frontier. These hospitals serve as benchmarks for less efficient federal hospitals as they develop strategies for improvement.
Assuntos
Eficiência Organizacional/normas , Hospitais Federais/normas , Hospitais Militares/normas , Eficiência Organizacional/estatística & dados numéricos , Sistemas de Informação Hospitalar , Hospitais Federais/organização & administração , Hospitais Federais/estatística & dados numéricos , Hospitais Militares/organização & administração , Hospitais Militares/estatística & dados numéricos , Hospitais de Veteranos/organização & administração , Hospitais de Veteranos/normas , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Medicina Preventiva/organização & administração , Melhoria de Qualidade/organização & administração , Estados Unidos , United States Department of Defense/organização & administraçãoRESUMO
OBJECTIVE: Cervical cancer screening using the human papillomavirus (HPV) test and Pap test together (co-testing) is an option for average-risk women ≥ 30 years of age. With normal co-test results, screening intervals can be extended. The study objective is to assess primary care provider practices, beliefs, facilitators and barriers to using the co-test and extending screening intervals among low-income women. METHOD: Data were collected from 98 providers in 15 Federally Qualified Health Center (FQHC) clinics in Illinois between August 2009 and March 2010 using a cross-sectional survey. RESULTS: 39% of providers reported using the co-test, and 25% would recommend a three-year screening interval for women with normal co-test results. Providers perceived greater encouragement for co-testing than for extending screening intervals with a normal co-test result. Barriers to extending screening intervals included concerns about patients not returning annually for other screening tests (77%), patient concerns about missing cancer (62%), and liability (52%). CONCLUSION: Among FQHC providers in Illinois, few administered the co-test for screening and recommended appropriate intervals, possibly due to concerns over loss to follow-up and liability. Education regarding harms of too-frequent screening and false positives may be necessary to balance barriers to extending screening intervals.
Assuntos
Atitude do Pessoal de Saúde , Cultura , Detecção Precoce de Câncer/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Atenção Primária à Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Hospitais Federais/estatística & dados numéricos , Humanos , Illinois , Padrões de Prática Médica/estatística & dados numéricos , Estados Unidos , Revisão da Utilização de Recursos de SaúdeAssuntos
Hospitais Federais/economia , Hospitais Federais/estatística & dados numéricos , Hospitais de Ensino/economia , Hospitais de Ensino/estatística & dados numéricos , National Institutes of Health (U.S.)/economia , National Institutes of Health (U.S.)/estatística & dados numéricos , Pesquisadores , Ensaios Clínicos como Assunto/instrumentação , Ensaios Clínicos como Assunto/métodos , Hospitais Federais/organização & administração , Hospitais de Ensino/organização & administração , Humanos , National Institutes of Health (U.S.)/organização & administração , Médicos/provisão & distribuição , Pesquisadores/provisão & distribuição , Estados UnidosRESUMO
PURPOSE: Clinical analysis of inpatients with multidrug-resistant tuberculosis in Kyushu. OBJECT AND METHOD: Clinical analysis of fifty-six patients with multidrug-resistant tuberculosis, who were admitted between 1998 and 2003, at 12 national hospitals in Kyushu was performed retrospectively. RESULTS: The average age was 62.1 +/- 18.6 years, with an age range of 21 to 95 years. There were 44 males and 12 females. Seven of the 14 patients, who were under 49 years old, had not received treatment previously. Twenty nine patients had underlying diseases, which included 10 (17.9%) diabetes mellitus, 5 (8.9%) hepatic disease, and 4 (7.1%) renal insufficiency. Clinical classification of the cases were 54 pulmonary and 2 extrapulmonary tuberculosis. There were 41 (75.9%) bilateral lesions of the lung. In 8 cases, strains were resistant to only 2 drugs (isoniazid, rifampicin). In 27 cases, strains were resistant to at least 5 drugs. The prognosis was as follows: In 27 patients who were resistant to at least 5 drugs, six patients (22.2%) converted to negative on culture and 10 patients (37.0%) died. In 29 patients who were resistant to less than 5 drugs, seventeen patients (58.6%) converted to negative on culture and 6 patients (20.7%) died. Surgical operation was performed in only 7 cases. The sputum smear and culture of 2 surgical patients, who had poor control of diabetes mellitus, became positive thereafter. The other 5 surgical patients were in remission with negative cultures. CONSIDERATION: Half of the patients who were under 49 years old had not received treatment previously. More than half of the patients had underlying diseases. Patients, who were resistant to at least 5 drugs showed a lower bacteriological negative conversion-rate and higher death rate than patients who were resistant to less than 5 drugs.
Assuntos
Hospitais Federais/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologiaRESUMO
OBJECTIVES: To review and compare the incidence rate of obstetric hysterectomised patients between two seven-year periods. Theperiods were from October 1, 1988 to September 30, 1995 andfrom October P', 1995 to September 30th, 2002. The data included demographic characteristics, indications, possible risk factors, complications, and operative managements. MATERIAL AND METHOD: Retrospective analysis of the data that was collected from medical and labor records of the obstetric hysterectomised patientsfrom October 1, 1995 to September 30, 2002, the second seven-year period, compared with those in Pratumthong and Wattanaruangkowit's study from October 1, 1988 to September 30, 1995, the first seven-year period. RESULTS: Between 1998 and 2002, there were 201, 696 total deliveries with 111 obstetric hysterectomies. A significant increase in the average incidence rate of hysterectomy from 0.42 to 0.76/1000 deliveries and maternal age, placenta previa and blood transfusion in the second period compared with the first period (p < 0.05). Postoperative complications and the other risk factors of obstetric hysterectomy were not significant difference. CONCLUSION: The present study of obstetric hysterectomy demonstrates a significant increase in the incidence of hysterectomised rate, maternal age, blood transfusion, and placenta previa in the second period compared with the first period.
Assuntos
Hospitais Federais/estatística & dados numéricos , Histerectomia/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Incidência , Idade Materna , Placenta Prévia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Risco , Tailândia/epidemiologia , Fatores de TempoRESUMO
OBJECTIVES: To provide a nontechnical discussion of the development of a palliative care casemix classification and some policy implications of its implementation. SAMPLE: 3866 palliative care patients who, in a three month period, had 4596 episodes of care provided by 58 palliative care services in Australia and New Zealand. METHOD: A detailed clinical and service utilization profile was collected on each patient with staff time and other resources measured on a daily basis. A statistical summary of the clinical variables was compiled as the first stage of the analysis. RESULTS: Palliative care phase was found to be a good predictor of resource use, with patients fairly evenly distributed across the five categories. Clients treated in an inpatient setting had poorer function and higher symptom severity scores than those treated in an ambulatory setting, a result that is not surprising in this Australian setting. DISCUSSION: Implementation of the resultant AN-SNAP classification has been proceeding since 1998 in some Australian jurisdictions. The development and implementation of a classification such as AN-SNAP provides the possibility of having a consistent approach to collecting palliative care data in Australia as well as a growing body of experience on how to progressively improve the classification over time.
Assuntos
Assistência Ambulatorial/classificação , Grupos Diagnósticos Relacionados/classificação , Política de Saúde , Cuidados Paliativos/classificação , Algoritmos , Assistência Ambulatorial/estatística & dados numéricos , Custos e Análise de Custo , Coleta de Dados , Hospitais Federais/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Humanos , New South Wales , Cuidados Paliativos/estatística & dados numéricosRESUMO
OBJECTIVE: To determine the neonatal mortality risk according to gestational age and birth weight. MATERIAL AND METHODS: The cohort consisted of 19,668 newborns of Centro Médico Nacional (National Medical Center) Ignacio García Téllez, a tertiary level healthcare institution of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security, IMSS) of the Yucatan Peninsula. All newborns discharged from the hospital between January 1st, 1995 and October 31st, 1999 were included in the study. Birth weight, gestational age, and conditions upon discharge were recorded. Absolute risk (AR) of mortality was calculated for each week-of-gestation- and birth group. RESULTS: Observed AR in newborns 34 to 44 weeks of gestational age and weighing at least 2,250 g was 0.4, while that for those 26 to 32 weeks of gestational age and weighing between 1000 g was 15%. CONCLUSIONS: AR of neonatal mortality increased inversely proportional to gestational age and birth weight. These data can be used as reference values for our hospital and for comparison with other hospitals. The English version of this paper is available at: http://www.insp.mx/salud/index.html.
Assuntos
Mortalidade Infantil , Peso ao Nascer , Estudos de Coortes , Apresentação de Dados , Feminino , Idade Gestacional , Hospitais Federais/estatística & dados numéricos , Maternidades/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , México , Gravidez , Resultado da Gravidez , Gravidez de Alto Risco , Padrões de Referência , Fatores de Risco , Previdência SocialRESUMO
OBJECTIVE: Although the state of Oklahoma has traditionally reported very high incidence rates of Rocky Mountain spotted fever (RMSF) cases, the incidence of RMSF among the American Indian population of the state has not been studied. The authors used data from several sources to estimate the incidence of RMSF among American Indians in Oklahoma. METHODS: The authors retrospectively reviewed an Indian Health Service (IHS) hospital discharge database for 1980-1996 and available medical charts from four IHS hospitals. The authors also reviewed RMSF case report forms submitted to the Centers for Disease Control and Prevention (CDC) for 1981-1996. RESULTS: The study data show that American Indians in the IHS Oklahoma City Area were hospitalized with RMSF at an annual rate of 48.2 per million population, compared with an estimated hospitalization rate of 16.9 per million Oklahoma residents. The majority of cases in the IHS database (69%) were diagnosed based on clinical suspicion rather than laboratory confirmation. The incidence of RMSF for Oklahoma American Indians as reported to the CDC was 37.4 cases per million, compared with 21.6 per million for all Oklahoma residents (RR 1.7, 95% confidence interval [CI] 1.5, 2.1). CONCLUSIONS: Rates derived from the IHS database may not be comparable to state and national rates because of differences in case inclusion criteria. However, an analysis of case report forms indicates that American Indians n Oklahoma have a significantly higher incidence of RMSF than that of the overall Oklahoma population. Oklahoma American Indians may benefit from educationa campaigns emphasizing prevention of tick bites and exposure to tick habitats.
Assuntos
Hospitais Federais/estatística & dados numéricos , Indígenas Norte-Americanos/estatística & dados numéricos , Febre Maculosa das Montanhas Rochosas/epidemiologia , Centers for Disease Control and Prevention, U.S. , Notificação de Doenças , Educação em Saúde , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Prontuários Médicos , Oklahoma/epidemiologia , Vigilância da População , Estudos Retrospectivos , Estados Unidos/epidemiologia , United States Indian Health ServiceRESUMO
The results of a national survey of pharmaceutical services in federal and nonfederal community hospitals conducted by ASHP during summer 1994 are reported and compared with the findings of earlier ASHP surveys. A simple random sample of community hospitals (federal and nonfederal) was selected from hospitals registered by the American Hospital Association. A questionnaire was mailed to each director of pharmacy. The adjusted gross sample size was 896. The net response rate was 44% (393 usable replies). The mean number of hours that respondents' pharmacies were open per week for inpatient services was 107.5. An increasing number of pharmacy directors were managing other departments within the institution. Of respondents, 18% indicated that a patient-focused-care model was in place. Complete unit dose drug distribution was offered by 92% of respondents, and 67% provided complete, comprehensive i.v. admixture services. A total of 29% provided decentralized inpatient pharmaceutical services. Automation of some type to support drug distribution was used by 55%. Provision of ambulatory care pharmaceutical services was indicated by 82% of nonfederal hospitals and by 98% of federal hospitals. Home infusion therapy services were offered by 27% of respondents. Some 89% had a computerized pharmacy system. The most commonly offered clinical pharmacy services for inpatients were drug-use evaluations and programs to monitor drug therapy, adverse drug reactions, and drug-food interactions. About half of respondents indicated that they did not provide pharmaceutical care. One third indicated that pharmacists had the authority to write drug orders or prescriptions. Pharmacokinetic consultations were provided by 65% and nutritional-support consultations by 35%. Of nonfederal respondents, 86% participated in quality assurance for inpatient dispensing and 28% did so for ambulatory care dispensing. A well-controlled formulary system was in place at 60% of the hospitals. About 74% of inpatient pharmacy expenditures went for drugs and fluids, 20% for staff activities, and 6% for other noncapital expenditures. Almost half of respondents indicated that staff reductions had occurred. About 9% of nonfederal hospitals had an ASHP-accredited residency program. The 1994 ASHP survey revealed a continuation of growth in some areas of hospital pharmacy (clinical services, computerization, formulary management techniques, and residency programs) and identified static areas (ambulatory care services, scope of drug distribution services, and quality assurance programs) that should be addressed by pharmacy leaders.
Assuntos
Hospitais Comunitários/estatística & dados numéricos , Hospitais Federais/estatística & dados numéricos , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Assistência Ambulatorial , Sistemas de Informação em Farmácia Clínica/estatística & dados numéricos , Quimioterapia Assistida por Computador , Número de Leitos em Hospital , Hospitais Comunitários/tendências , Hospitais Federais/tendências , Humanos , Sistemas de Medicação no Hospital/estatística & dados numéricos , Serviço de Farmácia Hospitalar/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Sociedades Farmacêuticas , Inquéritos e Questionários , Estados UnidosRESUMO
The results of a national mail survey of pharmaceutical services in federal hospitals conducted by ASHP from May to July 1993 are reported. Mailing lists were compiled of all Air Force, Army, Navy, Public Health Service, and Department of Veterans Affairs (VA) hospitals, as well as some federal prison hospitals. Questionnaires were mailed to each chief of pharmacy. The adjusted gross population size was 326. The net response rate was 76%. Complete unit dose drug distribution was offered by 85% of respondents, and 83% offered complete, comprehensive i.v. admixture programs. About half of the pharmacies provided decentralized services. Over 99% provided services to ambulatory care patients. A computerized pharmacy system was present in 99% of the departments. More than 95% of hospitals participated in adverse drug reaction, medication error management, and drug-use-evaluation programs. A total of 93% provided drug therapy monitoring, and 89% provided patient education. About 70% provided written documentation of pharmacist interventions in the medical records, and 57% participated in drug research. A total of 42% provided pharmacist-managed drug clinics, 41% participated in drug management of medical emergencies, 30% provided written medication histories, and 30% provided drug therapy management planning. Pharmacokinetic consultations were provided by 64% of departments. About 90% had a well-controlled formulary system and prescribing restrictions. Therapeutic interchange was practiced by 64%. Diversified pharmaceutical services included telephone or mail-in refill services (80%), mail-out pharmaceutical services (58%), and services to long-term-care facilities (49%). A total of 70% of the hospitals were affiliated with a pharmacy school. The first ASHP national survey of pharmaceutical services in federal hospitals showed that comprehensive distributive and clinical services were offered by most of the facilities.