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1.
Einstein (Sao Paulo) ; 18: eGS4442, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576910

RESUMO

OBJECTIVE: To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease. METHODS: We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center. RESULTS: Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage. CONCLUSION: Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.


Assuntos
Broncodilatadores/economia , Medicamentos Essenciais/provisão & distribução , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Função Jurisdicional , Doença Pulmonar Obstrutiva Crônica/economia , Brometo de Tiotrópio/economia , Brasil , Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Programas Nacionais de Saúde , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo
3.
Pan Afr Med J ; 33: 152, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558949

RESUMO

Introduction: Access to free diagnoses and treatments has been shown to be a major determinant in malaria control. The Cameroon government launched in 2011 and 2014 the exemption of the under-fives' simple and severe malaria treatment policy to increase access to health care and reduce inequality, so as to reduce the mortality related to malaria among the under-fives. This study assessed the effect of providing free malaria treatment in the Buea health district. Methods: This retrospective and cross sectional study was carried out in the Buea health district. Aggregated monthly data from (2008-2010) before and (2012-2014) after the implementation of free malaria treatment was compared, to assess the attributable outcomes of free treatment. A semi-structure questionnaire was also used to assess barriers faced in providing free malaria treatment services by health care workers. Data was collected using a semi-structure questionnaire and a data review summary sheet. The data was analysed using Epi-Info 7, Excel and SPSS (Statistical Package for the Social Sciences) version 20.0 for Windows. All statistical tests were performed at 95% confidence interval (significance level of 0.05). Results: Increase utilisation of health care; as general and malaria related consultations (by 5.7% (p=0.001) witnessed an increase after the implementation of free malaria treatment services. Severe malaria hospitalisation also increased, indicating that most caregivers used the health facility when complications had already set in, which could have led to no significant reduction in mortality due to malaria among under-five children (4.4%, p=0.533). Conclusion: Utilisation of health care increased; as consultation and morbidity rate increased after the implementation of free malaria treatment services. Communication strategy should therefore be strengthened so as to better disseminate information, so as to enhance the effectiveness of the program. There is the need to make a large-scale study to assess the impact of subsidized malaria treatment.


Assuntos
Antimaláricos/administração & dosagem , Política de Saúde , Acesso aos Serviços de Saúde/economia , Malária/tratamento farmacológico , Antimaláricos/economia , Camarões , Cuidadores/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Financiamento Governamental/economia , Hospitalização/estatística & dados numéricos , Humanos , Malária/economia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Inquéritos e Questionários
5.
West Afr J Med ; 36(2): 103-111, 2019.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-31385594

RESUMO

BACKGROUND: Out of pocket payment for health services in the midst of financial hardship is a major contributor to poor access to healthcare in Nigeria with the resultant poor health indices. Towards the goal of Universal Health Coverage, Community Based Health Insurance (CBHI) was introduced in addition to the National Health Insurance Scheme but with minimal impact and utilization. OBJECTIVE: The objective of this study was to assess health insurance-related knowledge and attitudes and to examine the uptake of CBHI. METHODS: This was a descriptive cross-sectional study. A multi-stage sampling method was used to select 419 respondents from the Ajeromi-Ifelodun community. A semi-structured interviewer-administered questionnaire was used to collect data for the study. Data analysis was done using Microsoft Excel and Epi-Info 7.1. RESULTS: Most of the respondents (80.2%) had not heard of Community-Based Health Insurance and only about 9% of respondents had good knowledge about it. However, most (62.5%) of the respondents had a positive attitude towards health insurance generally. Only 4.5% of the respondents were enrolled in the CBHI scheme and had paid their premium up to date. There was a significant association between the respondents' knowledge and their uptake of the scheme (<0.001), and also between their attitudes and uptake (p = 0.002). CONCLUSION: This study suggests that for CBHI to be successful, certain strategies must be implemented towards increasing awareness and knowledge about CBHI. This will in turn increase the uptake of the scheme, a necessary requirement for achieving the goal of Universal Health Coverage.


Assuntos
Assistência à Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/economia , Seguro Saúde , Programas Nacionais de Saúde , Participação da Comunidade , Estudos Transversais , Humanos , Nigéria
7.
BMC Health Serv Res ; 19(1): 352, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159785

RESUMO

BACKGROUND: As a result of financial barriers to the utilization of Maternal and Child Health (MCH) services, the Government of Sierra Leone launched the Free Health Care Initiative (FHCI) in 2010. This study aimed to examine the impact of the FHCI on wealth related inequity in the utilization of three MCH services. METHODS: We analysed data from 2008 to 2013 Sierra Leone Demographic Health Surveys (SLDHS) using 2008 SLDHS as a baseline. Seven thousand three hundred seventy-four and 16,658 women of reproductive age were interviewed in the 2008 and 2013 SLDHS respectively. We employed a binomial logistic regression to evaluate wealth related inequity in the utilization of institutional delivery. Concentration curves and indices were used to measure the inequity in the utilization of antenatal care (ANC) visits and postnatal care (PNC) reviews. Test of significance was performed for the difference in odds and concentration indexes obtained for the 2008 and 2013 SLDHS. RESULTS: There was an overall improvement in the utilization of MCH services following the FHCI with a 30% increase in institutional delivery rate, 24% increment in more than four focused ANC visits and 33% increment in complete PNC reviews. Wealth related inequity in institutional delivery has increased but to the advantage of the rich, highly educated, and urban residents. Results of the inequity statistics demonstrate that PNC reviews were more equally distributed in 2008 than ANC visits, and, in 2013, the poorest respondents ranked by wealth index utilized more PNC reviews than their richest counterparts. For ANC visits, the change in concentration index was from 0.008331[95% CI (0.008188, 0.008474)] in 2008 to - 0.002263 [95% CI (- 0.002322, - 0.002204)] in 2013. The change in concentration index for PNC reviews was from - 0.001732 [95% CI (- 0.001746, - 0.001718)] in 2008 to - 0.001771 [95% CI (- 0.001779, - 0.001763)] in 2013. All changes were significant (p value < 0.001). CONCLUSION: The FHCI appears to be improving access to and utilization of MCH services, narrowing the inequity in ANC visits and PNC reviews, but is insufficient in addressing wealth- related inequity that exists for institutional deliveries. If Sierra Leone is to realize a significant reduction in maternal and child mortality rates, it needs to strengthen the effective implementation of FHCI considering incorporating a sector wide approach (SWAp) or a "Health in all Policy" framework to reach the less educated, rural residents and ensuring culturally sensitive quality services.


Assuntos
Acesso aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Materno-Infantil , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Criança , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Lactente , Serviços de Saúde Materno-Infantil/economia , Serviços de Saúde Materno-Infantil/provisão & distribução , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Gravidez , Serra Leoa
8.
BMC Health Serv Res ; 19(1): 383, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196078

RESUMO

BACKGROUND: Previous studies have shown limited availability of medicines in health facilities in Bangladesh. While medicines are dispensed for free in public facilities, they are paid out-of-pocket in private pharmacies. Availability, price and affordability are key concerns for access to medicines in Bangladesh. METHODS: The World Health Organization/Health Action International survey methodology was used to determine price, availability and affordability of 61 lowest price generic (LPG) and originator branded medicines in public facilities, private retail pharmacies and private clinics across 6 regions of Bangladesh. Medicines for non-communicable and infectious diseases, and both on and off the national Essential Medicines List were included. Prices were compared internationally using Median Price Ratio (MPR). RESULTS: Mean LPG (originator brand) availability in the public sector, private retail pharmacies, and private clinics was 37%, 63 (4) percent, and 54 (2) percent, respectively. Medicines for Non-Communicable Diseases (NCD) and essential medicines were significantly less available than infectious disease medicines and non-essential medicines, respectively. Mean LPG (originator brand) MPR was 0.977 in the public sector, 1.700 (3.698) in private retail pharmacies and 1.740 (3.758) in private clinics. Six medicines were expensive by international standards across all sectors. The least affordable treatments in both private sectors were bisoprolol (hypertension), metformin (diabetes) and atorvastatin (hypercholesterolemia). CONCLUSION: Availability and affordability of NCD medicines are key concerns where the burden of NCD is rising. These findings show improvement from earlier studies, but room for further advances in availability and affordability of NCD medicines in Bangladesh. A small number of medicines are consistently expensive across sectors in Bangladesh, suggesting the need for strategies to address prices for certain medicines.


Assuntos
Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Organização Mundial da Saúde , Bangladesh , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde/economia , Humanos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Inquéritos e Questionários
9.
BMC Public Health ; 19(Suppl 4): 548, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196020

RESUMO

BACKGROUND: The presence of homelessness in Malaysia is not a new issue. The existence of homeless population is growing, along with the development of this country. With the increasing number of homelessness, the range of issues, such as health services financier among them, has surfaced. However, there was limited study conducted on this subject. The main objective of this study was thus, to identify the financier of health services among the homelessness in Kuala Lumpur and factors associated with it. METHODS: In this cross-sectional study, we include 196 homeless people aged above 18 years, Malaysian who were able to communicate with interviewers, and respondents who were not aggressive. These respondents were transits at Pusat Transit Gelandangan Kuala Lumpur and Anjung Singgah Kuala Lumpur and were available during interview sessions. They were selected via simple random sampling and were interviewed via face to face guided interviews using a validated structured questionnaire. Data were analysed descriptively, as well as using bivariate and multivariate analysis to explore the associated factors. RESULTS: The study showed that 57.7% homeless utilized the health services with only 37.8% assessed government health services. Only 42.5% of the respondents use their own money and 46.9% received aids to finance their health. Major influencing factors that influence homeless people to use their own money for health services were education level, income and disability, with adjusted OR (95% CI) of 3.15 (1.07-9.25), 0.08 (0.029-3.07) and 0.05 (0.003-0.88) while p value was 0.037, < 0.001 and 0.041 respectively. The influencing factors for receiving aid for health services were income and those who took drugs with adjusted OR (95% CI) of 6.50 (2.30-18.39), and 0.33 (0.11-0.95) while p value was < 0.001 and 0.041 respectively. CONCLUSION: There is low healthcare services utilization and affordability among homelessness. All parties should play a role in ensuring that homeless people are not left behind in the health care accessibility in Malaysia.


Assuntos
Acesso aos Serviços de Saúde/economia , Serviços de Saúde/economia , Financiamento da Assistência à Saúde , Pessoas em Situação de Rua/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Adulto Jovem
11.
BMC Public Health ; 19(1): 706, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174506

RESUMO

BACKGROUND: Whilst people with intellectual disability grow older, evidence has emerged internationally about the largely unmet health needs of this specific ageing population. Health checks have been implemented in some countries to address those health inequalities. Evaluations have focused on measuring process outcomes due to challenges measuring quality of life outcomes. In addition, the cost-effectiveness is currently unknown. As part of a national guideline for this population we sought to explore the likely cost-effectiveness of annual health checks in England. METHODS: Decision-analytical Markov modelling was used to estimate the cost-effectiveness of a strategy, in which health checks were provided for older people with intellectual disability, when compared with standard care. The approach we took was explorative. Individual models were developed for a selected range of health conditions, which had an expected high economic impact and for which sufficient evidence was available for the modelling. In each of the models, hypothetical cohorts were followed from 40 yrs. of age until death. The outcome measure was cost per quality-adjusted life-year (QALY) gained. Incremental cost-effectiveness ratios (ICER) were calculated. Costs were assessed from a health provider perspective and expressed in 2016 GBP. Costs and QALYs were discounted at 3.5%. We carried out probabilistic sensitivity analysis. Data from published studies as well as expert opinion informed parameters. RESULTS: Health checks led to a mean QALY gain of 0.074 (95% CI 0.072 to 0.119); and mean incremental costs of £4787 (CI 95% 4773 to 5017). For a threshold of £30,000 per QALY, health checks were not cost-effective (mean ICER £85,632; 95% CI 82,762 to 131,944). Costs of intervention needed to reduce from £258 to under £100 per year in order for health checks to be cost-effective. CONCLUSION: Whilst findings need to be considered with caution as the model was exploratory in that it was based on assumptions to overcome evidence gaps, they suggest that the way health systems deliver care for vulnerable populations might need to be re-examined. The work was carried out as part of a national guideline and informed recommendations about system changes to achieve more equal health care provisions.


Assuntos
Continuidade da Assistência ao Paciente/economia , Acesso aos Serviços de Saúde/economia , Deficiência Intelectual/economia , Pessoas com Deficiência Mental/estatística & dados numéricos , Adulto , Idoso , Análise Custo-Benefício , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida
12.
Public Health ; 173: 1-4, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31203136

RESUMO

OBJECTIVE: The short communication is prompted by the debate relating to the effect of pharmaceutical patents on access to affordable medicines, particularly in Africa. A recent amendment made to the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement creates a policy space for the regional alliance of low-income countries for the collective procurement and local production of drugs under compulsory licensing. This article examines the extent to which the regional mechanism can deliver access to pharmaceuticals. The article examines the regional mechanism in the light of the recent regional trade agreements and pharmaceutical plans of some regional economic blocs in Africa as well as the newly signed African Continental Free Trade Agreement (AfCFTA). STUDY DESIGN: This short communication adopts a descriptive approach in linking the regional mechanism in the TRIPS amendment to the regional trade agreements of African countries at the subregional and continental levels. METHODS: To ascertain the extent to which TRIPS Agreements regional model can deliver access to medicines in Africa, the article adopts a desk review approach by examining the relevant provisions of TRIPS Agreement, particularly the newly added Article 31bis, and the provisions of the relevant regional and continental free trade agreements in Africa. RESULTS: The article finds that although the regional model has great prospects in supporting the wider effort to deliver access to medicine, the limitations to its operative utilization may weaken its potency in addressing the urgent public health needs of the continent. CONCLUSION: The article concludes by stressing the inevitability of Africa's integration in tackling the deficiency of access to generic medicines in Africa. It was noted that even though there could be some potential challenges, the regional mechanism is indeed the way to go for low-income countries.


Assuntos
Acesso aos Serviços de Saúde , Propriedade Intelectual , Cooperação Internacional , Preparações Farmacêuticas/provisão & distribução , Saúde Pública , África , Comércio/economia , Comércio/legislação & jurisprudência , Indústria Farmacêutica/economia , Indústria Farmacêutica/legislação & jurisprudência , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Cooperação Internacional/legislação & jurisprudência , Patentes como Assunto/legislação & jurisprudência , Preparações Farmacêuticas/economia , Políticas , Pobreza
13.
Int J Equity Health ; 18(1): 98, 2019 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234940

RESUMO

BACKGROUND: Through a number of healthcare reforms, Kenya has demonstrated its intention to extend financial risk protection and service coverage for poor and vulnerable groups. These reforms include the provision of free maternity services, user-fee removal in public primary health facilities and a health insurance subsidy programme (HISP) for the poor. However, the available evidence points to inequity and the likelihood that the poor will still be left behind with regards to financial risk protection and service coverage. This study examined the experiences of the poor with health financing reforms that target them. METHODS: We conducted a qualitative cross-sectional study in two purposively selected counties in Kenya. We collected data through focus group discussions (n = 8) and in-depth interviews (n = 30) with people in the lowest wealth quintile residing in the health and demographic surveillance systems, and HISP beneficiaries. We analyzed the data using a framework approach focusing on four healthcare access dimensions; geographical accessibility, affordability, availability, and acceptability. RESULTS: Health financing reforms reduced financial barriers and improved access to health services for the poor in the study counties. However, various access barriers limited the extent to which they benefited from these reforms. Long distances, lack of public transport, poor condition of the roads and high transport costs especially in rural areas limited access to health facilities. Continued charging of user fees despite their abolition, delayed insurance reimbursements to health facilities that HISP beneficiaries were seeking care from, and informal fees exposed the poor to out of pocket payments. Stock-outs of medicine and other medical supplies, dysfunctional medical equipment, shortage of healthcare workers, and frequent strikes adversely affected the availability of health services. Acceptability of care was further limited by discrimination by healthcare workers and ineffective grievance redress mechanisms which led to a feeling of disempowerment among the poor. CONCLUSIONS: Pro-poor health financing reforms improved access to care for the poor to some extent. However, to enhance the effectiveness of pro-poor reforms and to ensure that the poor in Kenya benefit fully from them, there is a need to address barriers to healthcare seeking across all access dimensions.


Assuntos
Reforma dos Serviços de Saúde , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Financiamento da Assistência à Saúde , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Grupos Focais , Instalações de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
15.
Infect Dis Poverty ; 8(1): 44, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31182164

RESUMO

BACKGROUND: Tuberculosis (TB) prevalence is closely associated with poverty in China, and poor patients face more barriers to treatment. Using an insurance-based approach, the China-Gates TB program Phase II was implemented between 2012 and 2014 in three cities in China to improve access to TB care and reduce the financial burden on patients, particularly among the poor. This study aims to assess the program effects on service use, and its equity impact across different income groups. METHODS: Data from 788 and 775 patients at baseline and final evaluation were available for analysis respectively. Inpatient and outpatient service utilization, treatment adherence, and patient satisfaction were assessed before and after the program, across different income groups (extreme poverty, moderate poverty and non-poverty), and in various program cities, using descriptive statistics and multi-variate regression models. Key stakeholder interviews were conducted to qualitatively evaluate program implementation and impacts. RESULTS: After program implementation, the hospital admission rate increased more for the extreme poverty group (48.5 to 70.7%) and moderate poverty group (45.0 to 68.1%), compared to the non-poverty group (52.9 to 64.3%). The largest increase in the number of outpatient visits was also for the extreme poverty group (4.6 to 5.7). The proportion of patients with good medication adherence increased by 15 percentage points in the extreme poverty group and by ten percentage points in the other groups. Satisfaction rates were high in all groups. Qualitative feedback from stakeholders also suggested that increased reimbursement rates, easier reimbursement procedures, and allowance improved patients' service utilization. Implementation of case-based payment made service provision more compliant to clinical pathways. CONCLUSION: Patients in extreme or moderate poverty benefited more from the program compared to a non-poverty group, indicating improved equity in TB service access. The pro-poor design of the program provides important lessons to other TB programs in China and other countries to better address TB care for the poor.


Assuntos
Assistência à Saúde/economia , Acesso aos Serviços de Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde , Satisfação do Paciente , Tuberculose/economia , Tuberculose/psicologia , Adulto , Idoso , Antituberculosos/economia , Antituberculosos/uso terapêutico , China , Estudos Transversais , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Reembolso de Seguro de Saúde , Modelos Logísticos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Satisfação do Paciente/economia , Pobreza/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Tuberculose/tratamento farmacológico
16.
BMC Health Serv Res ; 19(1): 329, 2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31122226

RESUMO

BACKGROUND: The overuse of tertiary hospitals and underuse of primary care facilities has been one of the key reasons leading to fast health expenditure increase and health service utilization inequity in China. Recent health care reform in China tries to enforce a patient transfer system to make the health services utilization more efficient. This study examined the pattern and associated factors of inter-facility transfer of inpatients in Sichuan province of Western China. METHODS: Patient discharge records (n = 1,490,695) from 604 general hospitals during the period of April to June 2015 in Sichuan were extracted from the front page of the medical records system with individual information on demographics, insurance coverage, diagnoses, hospitals admitted and discharge type. We calculated the percentage of inpatients transferring to other health facilities, the Inter-Facility Transfer Rate (IFTR) with adjustment for Charlson Comorbidity Index (CCI). Multi-level logistic regression models were established to identify factors associated with IFTRs. RESULTS: A small number of tertiary hospitals (n = 75, 12.41%) shared 51.71% (n = 770,823) of all admitted cases while a large number of primary/unrated hospitals (n = 321, 53.15%) shared only 8.15%. The overall CCI-adjusted IFTR was 2.08% with 3.73% among secondary hospitals, 1.87% among tertiary hospitals and 1.30% among primary/unrated hospitals. Uninsured patients (OR = 1.13) and those with a lower level of insurance entitlements (OR = 1.12 for the New Rural Cooperative Medical Scheme and the Basic Medical Insurance for Urban Residents) were more likely to experience inter-facility transfer than those with a higher level of insurance entitlements (the Basic Medical Insurance for Urban Employees). CONCLUSION: The level of IFTR in general hospitals in Sichuan is low, which is associated with the level of hospitals and insurance entitlements. Further studies are needed to better understand how patients and health care providers respond to different insurance policies and make decisions on inter-facility transfer.


Assuntos
Hospitalização/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China , Estudos Transversais , Feminino , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitais , Humanos , Lactente , Recém-Nascido , Pacientes Internados/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Transferência de Pacientes/economia , Saúde da População Rural/economia , Saúde da População Rural/estatística & dados numéricos , Adulto Jovem
17.
S Afr Med J ; 109(4): 227-231, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-31084686

RESUMO

Current research suggests that HIV self-screening (HIVSS) is a feasible and acceptable approach to increase HIV testing among men who have sex with men (MSM). However, few data are available to shape policy around dissemination and implementation. Gaps in knowledge include preferences for distribution of HIVSS kits, potential social harms and benefits of their use, and how much test users would be willing to pay for the kits. The aim was to inform policy recommendations to optimise distribution of HIVSS kits to MSM in South Africa (SA), where there is a high HIV incidence and unmet testing needs. MSM in the high-HIV-prevalence Gert Sibande and Ehlanzeni districts of Mpumalanga Province, SA, were enrolled between October 2015 and May 2017. Participants were provided with their choice of blood or oral fluid HIVSS test kits, receiving 5 kits at enrolment and 4 additional kits at the 3-month follow-up visit. Questionnaires were administered at enrolment, 3 months and 6 months. We analysed participants' reported social benefits and harms, and their preferences for kit distribution and pricing. Among 127 MSM screened and enrolled, 114 responded to follow-up questionnaires regarding distribution preferences, 49.3% preferred to acquire HIVSS kits at a community-based organisation (CBO) and 42.7% at a clinic, with 8% preferring a pharmacy. Participants with higher education preferred CBO sites for distribution; in other respects preferences were similar by demographic characteristics. Reported social benefits were common, including knowing one's status, prevention knowledge gained and improved communication with partners. Despite ubiquitous interest in using the kits, the majority of MSM could not afford to purchase test kits. SA guidelines have integrated HIVSS into HIV and testing policy, but little has been published regarding distribution channels of the kits for MSM and other key populations. There is a partnership between the National Department of Health and CBOs that specialise in key population programming to ensure MSM and other populations with unmet testing needs can access affordable test kits. We observed no social harms, and there were multiple social benefits. Consequently, we recommend immediate free or low-cost distribution of HIVSS kits to MSM through community-based initiatives. Future research should continue to assess optimised linkage to care.


Assuntos
Autoavaliação Diagnóstica , Infecções por HIV/diagnóstico , Política de Saúde , Homossexualidade Masculina , Programas de Rastreamento , Preferência do Paciente/psicologia , Kit de Reagentes para Diagnóstico , Adolescente , Adulto , Seguimentos , Infecções por HIV/economia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Acesso aos Serviços de Saúde/economia , Inquéritos Epidemiológicos , Humanos , Masculino , Programas de Rastreamento/instrumentação , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Preferência do Paciente/economia , Kit de Reagentes para Diagnóstico/economia , Kit de Reagentes para Diagnóstico/provisão & distribução , Autorrelato , África do Sul , Adulto Jovem
19.
Am Surg ; 85(4): 327-334, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043190

RESUMO

Studies have shown high-volume institutions have decreased mortality and increased survival for pancreatectomy. However, not all patients can travel to high-volume centers. Socioeconomic factors may influence treatment decisions. The goal of this study is to examine socioeconomic factors that determine where a patient is treated and how that location affects outcome. This is a retrospective study of the National Cancer Database of patients diagnosed with pancreatic cancer from 2004 to 2014. The primary outcome was to examine socioeconomic factors that predicted where a patient underwent their pancreatectomy. Patients treated at academic programs (APs) had to travel a mean distance of 80.9 miles, whereas patients treated at community programs (CPs) had to travel 31.7 miles (P < 0.0001). Spanish and Hispanic patients were less likely to travel to an AP (69% had surgery at an AP versus 76% of non-Hispanic patients, P < 0.001). Patients with higher comorbidities were also more likely to have care at CPs. Patients who had pancreatic cancer surgery at CPs were more likely to be Hispanic or with higher medical comorbidities. Those who had surgery at AP traveled further distances but had better perioperative outcomes and had an improvement in overall survival.


Assuntos
Adenocarcinoma/cirurgia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Fatores Socioeconômicos , Centros Médicos Acadêmicos , Adenocarcinoma/economia , Adenocarcinoma/etnologia , Adenocarcinoma/mortalidade , Adulto , Idoso , Bases de Dados Factuais , Feminino , Acesso aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/etnologia , Hospitais com Alto Volume de Atendimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatectomia/economia , Neoplasias Pancreáticas/economia , Neoplasias Pancreáticas/etnologia , Neoplasias Pancreáticas/mortalidade , Estudos Retrospectivos , Análise de Sobrevida , Viagem , Resultado do Tratamento , Estados Unidos/epidemiologia
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