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1.
Postgrad Med ; 132(1): 102-108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31928276

RESUMO

Background: Little is known about patient preference regarding the physical exam in non-urgent primary care settings.Objective: To determine the differences between a patient's expectations of the physical exam and the actual components of the physical examination performed during a non-urgent visit.Design: A total of 452 surveys administered in the waiting room of a VA primary care clinic in West Haven, CT.Key results: The response rate was 91.6% (n = 414). For 15 of 16 maneuvers on the survey, more respondents believed a reasonable provider should conduct it than received it at their annual physical exam; for 7 of them (breast, axillary, rectal, pelvic, total body skin exam, electrocardiogram, and stress test), over twice as many respondents believed they should be done than received them. There was an association between a patient's perception of their primary care provider and the number of maneuvers recalled at their annual exam (P < 0.001), and a gap in the number of maneuvers expected from a reasonable provider by nonwhite and white patients (P < 0.001).Limitations: Convenience sample, response bias (healthy patients are more likely to respond) and recall bias.Conclusion: Patient perception of their primary care provider is strongly associated with the number of maneuvers recalled during an annual physical. Furthermore, the number of maneuvers expected by a patient is influenced by race, with nonwhite patients desiring more. This suggests the need for further research on the role of race in the expectations of healthcare providers.


Assuntos
Preferência do Paciente , Exame Físico , Atenção Primária à Saúde/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico/métodos , Exame Físico/psicologia , Inquéritos e Questionários , Adulto Jovem
3.
Psychiatr Prax ; 47(1): 39-42, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31412368

RESUMO

OBJECTIVE: Assessment of patients' preferences regarding depression treatment using a ranking approach. METHODS: 641 primary care patients (mean age 43.9 years) ranked their primary preference for depression treatment out of 9 options. Logistic Regression analyses were used to determine factors associated with the most prioritized treatment options. RESULTS: The most frequently prioritized treatment options were psychotherapy (30 %), combination treatment of psychotherapy and drug treatment (18.4 %) and sole drug treatment (15.4 %). 12.3 % of women prioritized alternative therapy options. CONCLUSION: Patients with depression report individually different treatment preferences. These findings underline the importance of elucidating patients' preferences within a shared decision making process as recommended by treatment guidelines. There is a need of evidence-based information on the role of alternative therapies in the context of depression treatment.


Assuntos
Depressão/terapia , Preferência do Paciente , Atenção Primária à Saúde , Psicoterapia/métodos , Adulto , Tomada de Decisões , Feminino , Alemanha , Humanos , Masculino , Participação do Paciente
6.
Artigo em Russo | MEDLINE | ID: mdl-31884752

RESUMO

The article presents theoretical propositions concerning placement and dissemination of information about medical organization and practical recommendations of the advertising campaign of medical services. The analysis of the advertising activities' influence on the patient choice of the medical organization out of top annual revenue medical institutions in Russia was carried out. In economically developed countries, the support of possibility of choosing particular medical organization and physician in economic theory and in practice of organization of health care system is targeted to improving medical care quality and health care efficiency. The process of expanding possibilities of choice is officially declared as one of the priorities of development of Russian health care. However, the influence of consumer choice of patient of medical organization while addressing for medical care is still to be an object of research study in Russia.


Assuntos
Assistência à Saúde , Preferência do Paciente , Humanos , Qualidade da Assistência à Saúde , Federação Russa
7.
BMC Health Serv Res ; 19(1): 810, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699085

RESUMO

BACKGROUND: Even though maternal mortality during the time of delivery can be prevented with proper medical care in the health facilities with skilled healthcare professionals, unexpectedly death is still high and is a persistent challenge for low-income countries. Therefore identifying factors affecting the preference of institutional delivery after antenatal care service attendance is a key intervention to reduce maternal morbidity and mortality. METHOD: A community-based cross-sectional study was conducted using face to face using interviewer-administered questionnaire from a total of 528 women who gave their last birth within 12 months prior to the study period who attended antenatal care (ANC) services. Descriptive statistics, bivariable and multivariable logistic regressions analysis were performed. Statistical significance was considered at p < 0.05 and odds ratio with 95% CI were calculated to examine factors associated with institutional delivery. RESULTS: Of the 528 pregnant women attending ANC services, 250 (47.3%) gave birth in health facilities (95% CI: 43.2, 51.7%). Urban residence [AOR = 7.8, 95% CI: 4.1, 15.6], four or more ANC visits [AOR = 4.5, 95% CI: 1.6, 12.3], those who got health education on ANC [AOR = 2.9, 95% CI: 1.5, 5.6] and decision on place of delivery with her partner agreement [AOR = 3.3, 95% CI: 1.3, 8.7] were found to be contributing factors for the preference of institutional delivery. CONCLUSION: Institutional delivery was not adequate. Residence, number of antenatal care visits, health education, decisions making on a place of delivery and having awareness of the difference of place of delivery were contributing factors for the preference of institutional delivery.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Estudos Transversais , Tomada de Decisões , Etiópia , Feminino , Educação em Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Gravidez , Características de Residência/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
9.
BMC Health Serv Res ; 19(1): 799, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690299

RESUMO

INTRODUCTION: Female Sex workers (FSW) and their clients accounted for 18% of the new HIV infections in 2015/2016. Special community-based HIV testing service delivery models (static facilities, outreaches, and peer to peer mechanism) were designed in 2012 under the Most At Risk Populations Frame work and implemented to increase access and utilization of HIV care services for key populations like female sex workers. However, to date there is no study that has been done to access the preference and uptake of different community-based HIV testing service delivery models used to reach FSW. We assessed preference and uptake of the current community-based HIV testing services delivery models that are used to reach FSW and identified challenges faced during the implementation of the models. METHODS: We conducted a cross-sectional study design using quantitative (interview with the health workers in facilities providing services to female sex workers and interviews with FSWs) and qualitative (interviews with Ministry of Health staff, health workers, district health team members, program staff at different levels involved in delivery of HIV care services, FSWs and political leaders to assess for the enabling environment created to deliver the different community-based HIV testing services to FSWs along the Malaba-Kampala highway. Malaba - Kampala high way is one of the major high ways with many different hot spots where the actual buying and selling of sex takes place. We defined FSWs as any female, who undertakes sexual activity after consenting with a man for money or other items/benefits as an occupation or as a primary source of livelihood irrespective of site of operation within the past six months. We assessed the preference and uptake of different community based HIV testing services delivery model among FSWs based on two indicators, i.e., the proportion of FSWs who had an HIV Counseling and Testing (HCT) in the last 12 months and the proportion of FSWs who were positive and linked to care. RESULTS: Overall, 86% (390/456) of the FSWs had taken an HIV test in the last 12 months. Of the 390 FSWs, 72% (279/390) had used static facilities, 25% (98/390) had used outreaches, and 3.3% (13/390) used peer to peer mechanisms to have an HIV test. Overall, 35% (159/390) of the FSWs who had taken an HIV test were HIV positive. Of the 159, 83% (132/159) were successfully linked into care. Ninety one percent (120/132) reported to have been linked into care by static facilities. Challenges experienced included; lack of trust in the results given during outreaches, failure to offer other testing services including hepatitis B and syphilis during outreaches, inconsistent supply of testing kits, condoms, STI drugs, and unfriendly health services due to the infrastructure and non-trained health workers delivering KP HIV testing services. CONCLUSIONS: Most of the FSWs had HCT services and were linked to care through static facilities. Community-based HIV testing service delivery models are challenged with inconsistent supply of HIV testing commodities and unfriendly services.. We recommended strengthening of all HIV testing community-based HIV testing service deliverymodels by ensuring constant supply of HIV testing/AIDS care commoditiesoffering FSW friendly services, and provision of comprehensive HIV/AIDS health care package.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Profissionais do Sexo/psicologia , Adolescente , Adulto , Serviços de Saúde Comunitária/organização & administração , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Profissionais do Sexo/estatística & dados numéricos , Uganda , Adulto Jovem
11.
Medicine (Baltimore) ; 98(48): e17093, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770192

RESUMO

BACKGROUND: Although Billroth II and Roux-en-Y procedures are the two most commonly performed types of reconstruction techniques following distal stomach resection, there is yet no consensus on which reconstruction is the best choice. This meta-analysis aims to compare the perioperative safety and long-term complications of Billroth-II and Roux-en-Y reconstruction. METHOD: We searched the databases of the PubMed, the Cochrane Library, Web of Science, EMBASE, and the Chinese Biomedicine Database from January 2000 to January 2018 and included studies that compared Roux-en-Y with Billroth-II reconstruction after distal gastrectomy for gastric cancer. The meta-analyses were performed using RevMan 5.0 software. RESULT: Four randomized controlled trials (RCTs) and eight non-randomized observational clinical studies (OCS) were included. Billroth-II anastomosis was more beneficial than Roux-en-Y in reducing the operation time (OR = 34.14, 95%CI = 24.19-44.08, P < .00001, I = 54%) and intraoperative blood loss (OR = 54.32, 95%CI = 50.29-58.36, P < .00001, I = 36%). However, Roux-en-Y anastomosis was more beneficial than Billroth-II in reducing the incidence of remnant gastritis (OR = 0.12; 95% CI = 0.08-0.17; P < .00001; I = 8%), reflux esophagitis (OR = 0.26; 95%CI = 0.15-0.44; P < .00001; I = 0%), dumping symptoms (OR = 0.31; 95%CI = 0.13-0.73; P = .008; I = 0%), reflux symptoms (OR = 0.20; 95% CI = 0.10-0.42; P < .0001; I = 0%). No differences were found between the two groups with respect to anastomotic leakage (OR = 1.56, 95%CI = 0.66-3.64, P = .59, I = 0%); postoperative mortality (OR = 1.15, 95%CI = 0.38-3.51, P = .80, I = 0%); overall postoperative morbidity (OR = 0.92, 95%CI = 0.6-1.42, P = .72, I = 0%); and delayed gastric emptying (OR = 0.84, 95%CI = 0.40-1.77, P = .65, I = 0%). CONCLUSION: Roux-en-Y reconstruction does not carry greater postoperative complications than the Billroth II reconstruction. Additionally, it can improve the postoperative quality of life owing to less remnant gastritis, reflux esophagitis, dumping symptoms, and reflux symptoms. Considering the long-term postoperative outcomes, Roux-en-Y reconstruction appears to be a better choice following distal stomach resection.


Assuntos
Anastomose em-Y de Roux/efeitos adversos , Gastrectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Anastomose em-Y de Roux/métodos , Perda Sanguínea Cirúrgica , Esofagite Péptica/etiologia , Feminino , Gastrectomia/métodos , Gastrite/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Preferência do Paciente , Período Pós-Operatório , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Reconstrutivos/métodos
13.
Lakartidningen ; 1162019 Oct 15.
Artigo em Sueco | MEDLINE | ID: mdl-31613375

RESUMO

This article highlights a special subtype of this dilemma, in which the patient requests a treatment that the physician judges to be substandard. Reasons for and against providing substandard treatment in the name of patient autonomy are presented and discussed. It is suggested that physicians carefully consider the risk of crowding out of other patients if substandard treatment is provided.


Assuntos
Necessidades e Demandas de Serviços de Saúde/ética , Preferência do Paciente , Qualidade da Assistência à Saúde/ética , Beneficência , Ética Médica , Prioridades em Saúde , Humanos , Participação do Paciente , Direitos do Paciente , Autonomia Pessoal , Papel do Médico
17.
Tidsskr Nor Laegeforen ; 139(14)2019 Oct 08.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31592608

RESUMO

BACKGROUND: Since 2016, all health regions have been instructed to provide drug-free psychiatric treatment options. The evidence base for such treatment has been called for. At Jæren District Psychiatric Centre we therefore identified the patients' wishes for drug-free treatment. MATERIAL AND METHOD: One hundred patients were sequentially asked upon admission whether they would want a drug-free treatment programme, given that it was available. The patients' age, sex, diagnosis and medical history were recorded, as well as their experience with the use of psychoactive drugs and counselling. RESULTS: Altogether 52 out of the 100 patients would want a drug-free treatment programme if this were available. The largest proportion was registered among patients who had been coercively sectioned (10 out of 13 patients) and among those who experienced least benefit from their drugs (17 out of 25). Even among those who reported to benefit well from their drugs, a considerable proportion wanted a drug-free option (24 out of 58). The majority of the patients had long illness trajectories and a high consumption of psychoactive drugs. INTERPRETATION: The observation that a large proportion of the patients would want a drug-free treatment programme if this were available can be seen as a reflection of frustration caused by persistent symptoms, adverse effects and a large burden of suffering despite the use of medication. An alternative interpretation is that the patients had an insufficient understanding of their need for preventive treatment or for their need for treatment at all.


Assuntos
Pacientes Internados/psicologia , Transtornos Mentais/terapia , Pessoas Mentalmente Doentes/psicologia , Preferência do Paciente , Adolescente , Adulto , Idoso , Internação Compulsória de Doente Mental , Feminino , Humanos , Tratamento Psiquiátrico Involuntário , Masculino , Transtornos Mentais/tratamento farmacológico , Pessoa de Meia-Idade , Psicotrópicos/administração & dosagem , Psicotrópicos/uso terapêutico , Adulto Jovem
18.
Medicine (Baltimore) ; 98(40): e17440, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577765

RESUMO

To prove the equivalence of the Korean version of the Foot and Ankle Outcome Score (FAOS) in the printed (PFAOS) vs the electronic (EFAOS) form in a multicenter randomized study.Overall, 227 patients with ages ranging from 20 to 79 years from 16 dedicated foot and ankle centers were included. Patients were randomized into either a 'paper first' group (P-F group, n = 113) or an 'electronic device (tablet computer) first' group (E-F group, n = 114). The first evaluation either by paper (P-F group) or tablet (E-F group) was followed by a second evaluation the following day. The difference between the PFAOS and EFAOS results in each group was calculated and analyzed. To evaluate the benefit of each methodology, the time consumed per evaluation was compared and patients were asked which methodology they preferred and which was the easiest to use.There were no significant differences in age or sex between the groups. An intraclass correlation coefficient (ICC) value of 0.934 (95% confidence interval [CI]: 0.912-0.950, P < .001) was confirmed in PFAOS and EFAOS, showing a significant correlation between the 2 methodologies. EFAOS was completed in a shorter amount of time than PFAOS. The majority of patients agreed that EFAOS was easier to complete than PFAOS.The paper or electronic forms of the Korean adaptation of FAOS were considered equivalent. The shorter time of completion and the preference for the electronic version over paper by patients deems the electronic FAOS a promising option to consider in future.


Assuntos
Computadores de Mão , Pé/fisiologia , Medidas de Resultados Relatados pelo Paciente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , República da Coreia , Fatores de Tempo , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-31540517

RESUMO

China has established the universal medical insurance system and individual out of pocket costs have decreased, however, the average healthcare expenditure of the Chinese population and the expenses of the whole society have increased substantially. One major challenge which impedes the progress of attaining sustainable development of the social healthcare system in China is that the number of hospital admissions is disproportionate. Superior hospitals are overcrowded, whereas subordinate hospitals are experiencing low admissions. In this paper, we apply the game theory model to coordinate the healthcare supply chain network, which is composed of the government, medical insurance fund, superior hospitals, subordinate hospitals and patients. Especially by taking the reference price effect into account, this paper analyzes different medical insurance reimbursement strategies and their influence on patient choice and the healthcare supply chain network. The result shows that the reference price effect increases the leverage of medical insurance, guides patients' choice, optimizes the allocation of medical resources and reduces the medical expends. In comparison to a decentralized decision- making strategy, a centralized decision- making strategy can stimulate both superior hospital and subordinate hospital's cooperative intentions which benefits the social healthcare system.


Assuntos
Assistência à Saúde/organização & administração , Órgãos Governamentais/organização & administração , Administração Hospitalar , Programas Nacionais de Saúde/organização & administração , China/epidemiologia , Assistência à Saúde/economia , Teoria do Jogo , Órgãos Governamentais/economia , Humanos , Reembolso de Seguro de Saúde , Programas Nacionais de Saúde/economia , Preferência do Paciente
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