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1.
Zhonghua Er Ke Za Zhi ; 57(12): 913-916, 2019 Dec 02.
Artigo em Chinês | MEDLINE | ID: mdl-31795556

RESUMO

Objective: To investigate general condition of children's rheumatic disease associated medical resources in Fujian Province. Methods: This questionnaire-based survey was conducted in 19 hospitals in Fujian province from December 2, 2018 to May 1, 2019. The questionnaire was designed to survey the general condition of the medical resources and the hospitalization of patients with rheumatic diseases from January 1, 2014 to December 1, 2018. Results: In the 19 hospitals, there were 15 general hospitals and 4 children's hospitals, and only 5 hospitals had children's rheumatic specialist clinic. There were only 53-62 beds for rheumatic disease patients in the 19 hospitals, accounting for 1.7%-2.0% of the total inpatient beds (3 137). There are 29 pediatric rheumatologists in total, accounting for 2.6% (29/1 120) of the total pediatricians. In the past five years, 613 patients with rheumatic diseases, accounting for 0.1% (613/625 214) of total hospitalized patients, were treated in these hospitals. Among them, 201 had juvenile idiopathic arthritis, 295 had systemic lupus erythematosus, 39 had dermatomyositis, 7 had scleroderma, and 57 had inflammatory bowel disease, 9 had Sjogren's syndrome, 5 had Behcet's disease, and none had overlap syndrome or mixed connective tissue disease. Conclusion: The medical resources of children rheumatic diseases in Fujian province are insufficient which need to be developed.


Assuntos
Recursos em Saúde/provisão & distribução , Recursos em Saúde/estatística & dados numéricos , Doenças Reumáticas/terapia , Criança , China , Hospitais , Humanos , Inquéritos e Questionários
2.
Afr J Reprod Health ; 23(3): 57-67, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31782632

RESUMO

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


Assuntos
Serviços de Saúde da Criança/organização & administração , Assistência à Saúde/organização & administração , Eficiência Organizacional , Recursos em Saúde/estatística & dados numéricos , Hospitais Religiosos/organização & administração , Serviços de Saúde Materna/organização & administração , Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Custos e Análise de Custo , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Feminino , Financiamento Governamental , Hospitais Religiosos/estatística & dados numéricos , Humanos , Masculino , Serviços de Saúde Materna/estatística & dados numéricos , Nigéria , Gravidez , Estudos Retrospectivos
3.
West Afr J Med ; 36(3): 267-273, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622490

RESUMO

BACKGROUND: Asthma is known to constitute a huge economic burden to its sufferers and their carers. There is a dearth of studies documenting this burden among asthmatics in Nigeria. OBJECTIVE: This study assessed the relationship between economic cost and psychiatric morbidity among stable Nigerian patients with asthma. METHODS: 85 patients with asthma completed a socio-demographic and illness-related questionnaire, the modified Economic Cost Questionnaire and General Health Questionnaire 12 (GHQ 12). Associations between socio-demographic characteristics, illness related variables, psychiatric morbidity and the direct, indirect and total costs in relation to asthma were assessed. RESULTS: The average annual total, direct and indirect cost were $309, $190.65 and $118.34 respectively per patient for subjects with asthma. Direct cost constituted 62.7% while the indirect cost was 38.3% of the total cost for asthma. Drugs and hospitalisation were leading contributors to direct costs for asthma. Psychiatric morbidity was found to be present in 35% of subjects with asthma, those with psychiatric morbidity had a higher economic burden. CONCLUSION: The economic cost of asthma is high, psychiatric morbidity increases this cost. The cost is largely due to drugs and hospitalisations for exacerbation. There is an urgent need to optimize means of helping to minimize this cost and increase measures for detecting and treating psychiatric morbidity.


Assuntos
Antiasmáticos/economia , Asma/economia , Gastos em Saúde , Hospitalização/economia , Transtornos Mentais/epidemiologia , Antiasmáticos/administração & dosagem , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/epidemiologia , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Custos Diretos de Serviços/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Humanos , Morbidade , Nigéria/epidemiologia , Qualidade de Vida
4.
Pan Afr Med J ; 33: 186, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565146

RESUMO

Introduction: Acute gastroenteritis (AGE) is a leading cause of mortality in children in developing countries. Management of AGE consumes medical resources, including antibiotics and intra-venous fluids, but factors affecting resource utilization in the management of AGE are under-studied. We hope to identify clinical predictors of resource utilization in AGE. Methods: We performed a retrospective chart review of patients 1-60 months of age admitted to a tertiary hospital in Northern Ghana between January 2013 and December 2014 with an admitting diagnosis of AGE. We collected data on patient demographics, presenting symptoms, and subsequent management. Our primary outcome was prolonged hospital length of stay, defined as >4 days. Secondary outcomes included other measures of resource utilization, such as use of antibiotics, antimalarials and intravenous fluids. Demographic and clinical characteristics were compared between groups with Pearson chi square test for categorical variables and ANOVA for continuous variables. Multivariable logistic regression modeling for each outcome included all variables found to be significant in the bivariate analysis. Results: We reviewed charts for 473 patients admitted for AGE during this timeframe. 264 (56%) were male, median age was 12 months. 448 (95%) received antibiotics, 396 (84%) received antimalarials and 365 (77.2%) received intravenous fluids. 167 (35.3%) had prolonged LOS >4 days. Following multiple logistic regression analysis, clinical features associated with prolonged LOS included fever duration (OR 2.87, 95% CI 2.28-3.61 per 1-day increase), mild (OR 2.39, 95% CI 1.12-5.08) or moderate (OR 3.13, 95% CI 1.57-6.21) dehydration (compared to none) and symptom duration (OR 1.13, 95% CI 1.01-1.27 per 1-day increase). Conclusion: Dehydration and duration of symptoms prior to presentation predict prolonged hospital LOS in young children with AGE in Northern Ghana.


Assuntos
Desidratação/terapia , Gastroenterite/terapia , Hospitalização/estatística & dados numéricos , Doença Aguda , Antibacterianos/administração & dosagem , Antimaláricos/administração & dosagem , Pré-Escolar , Desidratação/epidemiologia , Feminino , Febre/epidemiologia , Hidratação/estatística & dados numéricos , Gana , Recursos em Saúde/estatística & dados numéricos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária
5.
Artigo em Japonês | MEDLINE | ID: mdl-31527355

RESUMO

OBJECTIVE: The Organisation for Economic Co-operation and Development (OECD) pointed out the deterioration of the performance of health systems (performance) in Japan. To correct this, we evaluated the performances in different prefectures. METHODS: By the OECD method, we set 27 indicators concerning "health status (HS)", " risk factors (RFs)", " access to care (AC)", " quality of care (QC)", and " health care resources (HRs)". Next, the relative value (RV, ±4 standard deviation) from the average value of each indicator in each prefecture was obtained. On the basis of this RV, the prefectures were divided into A, B, and C by cluster analysis. Then, the 27 indicators of the three groups were subjected to multiple comparison tests and the performances were evaluated. RESULTS: A included Hokkaido, Ishikawa, Kyoto, Shimane, Okayama, Hiroshima, Yamaguchi, Tokushima, Kagawa, Ehime, Kochi, Fukuoka, Saga, Nagasaki, Kumamoto, Oita, Miyazaki, Kagoshima, and Okinawa, B included Aomori, Iwate, Akita, Fukushima, Ibaraki, Tochigi, Saitama, Tokyo, Osaka, and Wakayama, C included Miyagi, Yamagata, Gunma, Chiba, Kanagawa, Niigata, Toyama, Fukui, Yamanashi, Nagano, Gifu, Shizuoka, Aichi, Mie, Shiga, Hyogo, Nara, and Tottori. The multiple comparison test results showed that HS and RFs were not significantly different between A and C. In A, AC and QC were poor, but HRs were excessive, and the local allocation tax was high. RFs, AC, QC, HRs, and the local allocation taxes were not significantly different between B and C, but HS was poor in B. CONCLUSIONS: The performance of health systems was deteriorating in the 19 prefectures included in A, and correction is necessary in these prefectures.


Assuntos
Análise por Conglomerados , Planejamento em Saúde Comunitária/estatística & dados numéricos , Organização para a Cooperação e Desenvolvimento Econômico/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Japão , Qualidade da Assistência à Saúde/estatística & dados numéricos , Fatores de Risco
6.
BMC Health Serv Res ; 19(1): 642, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492130

RESUMO

BACKGROUND: Malnutrition is a comprehensive challenge for the nursing home, home care- and home nursing sector. Nutritional care and the subsequent documentation are a common and multifaceted healthcare practice that requires that the healthcare professionals possess complex combinations of competencies in order to deliver high-quality care and treatment. The purpose of this study was to investigate how a varied group of healthcare professionals' perceive their own competencies within nutrition and documentation and how organizational structures influence their daily work and the quality of care provided. METHODS: Two focus groups consisting of 14 healthcare professionals were conducted. The transcribed focus group interviews was analyzed using the qualitative content analysis approach. RESULTS: Six categories were identified: 1) Lack of uniform and systematic communication affect nutritional care practices 2) Experience-based knowledge among the primary workforce influences daily clinical decisions, 3) Different attitudes towards nutritional care lead to differences in the quality of care 4) Differences in organizational culture affect quality of care, 5) Lack of clear nutritional care responsibilities affect how daily care is performed and 6) Lack of clinical leadership and priorities makes nutritional care invisible. CONCLUSIONS: The six categories revealed two explanatory themes: 1) Absent inter- and intra-professional collaboration and communication obstructs optimal clinical decision-making and 2) quality deterioration due to poorly-established nutritional care structure. Overall, the two themes explain that from the healthcare professionals' point of view, a visible organization that allocates resources as well as prioritizing and articulating the need for daily nutritional care and documentation is a prerequisite for high-quality care and treatment. Furthermore, optimal clinical decision making among the healthcare professionals are compromised by imprecise and unclear language and terminology in the patients' healthcare records and also a lack of clinical guidelines and standards for collaboration between different healthcare professionals working in nursing homes, home care or home nursing. The findings of this study are beneficial to support organizations within these settings with strategies focusing on increasing nutritional care and documentation competencies among the healthcare professionals. Furthermore, the results advocate for the daily involvement and support of leaders and managers in articulating and structuring the importance of nutritional care and treatment and the subsequent documentation.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Desnutrição/enfermagem , Casas de Saúde/normas , Competência Clínica/normas , Tomada de Decisão Clínica , Comunicação , Estudos Transversais , Assistência à Saúde/normas , Documentação , Feminino , Grupos Focais , Recursos em Saúde/estatística & dados numéricos , Serviços de Assistência Domiciliar/normas , Assistência Domiciliar/normas , Humanos , Liderança , Desnutrição/prevenção & controle , Estado Nutricional , Cultura Organizacional , Atenção Primária à Saúde/normas , Autoimagem
7.
Reprod Health ; 16(1): 119, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382989

RESUMO

OBJECTIVE: There is no consensus on the essential parameters to monitor during childbirth, when to start, and the rate of monitoring them. User disagreement contributes to inconsistent use of the twelve-item modified World Health Organization partograph that is started when the cervix is at least 4 cm dilated. The inconsistent use is associated with poor outcomes at birth. Our objective was to identify the perspectives of childbirth experts on what and when to routinely monitor during childbirth in low resource settings as we develop a more acceptable childbirth clinical decision support tool. METHOD: We carried out a Delphi study with two survey rounds in early 2018. The online questionnaire covered the partograph items like foetal heart, cervical dilation, and blood pressure, and their monitoring rates. We invited panellists with experience of childbirth care in sub-Saharan Africa. Consensus was pre-set at 70% panellists rating a parameter and we gathered some qualitative reasons for choices. RESULTS: We analysed responses of 76 experts from 13 countries. There was consensus on six important parameters including foetal heart rate, amniotic fluid clearness, cervical dilation, strength of uterine contractions, maternal pulse, and blood pressure. Two in three experts expressed support for changing the monitoring intervals for some parameters in the partograph. 63% experts would raise the partograph starting point while 58% would remove some items from it. Consensus was reached on monitoring the cervical dilation at 4-hourly intervals and there was agreement on monitoring the foetal heart rate one-hourly. However, other parameters only showed majority intervals and without reaching agreement scores. The suggested intervals were two-hourly for strength of uterine contractions, and four-hourly for amniotic fluid thickness, maternal pulse and blood pressure. The commonest reason for their opinions was the more demanding working conditions. CONCLUSION: There was agreement on six partograph items being essential for routine monitoring at birth, but the frequency of monitoring could be changed. To increase acceptability, revisions to birth monitoring guidelines have to be made in consideration of opinions and working conditions of several childbirth experts in low resource settings.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Técnica Delfos , Guias como Assunto/normas , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Monitorização Fisiológica , Parto/fisiologia , Adulto , África ao Sul do Saara , Parto Obstétrico/economia , Prova Pericial , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez
8.
Int J Equity Health ; 18(1): 111, 2019 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324184

RESUMO

BACKGROUND: Health expenditure efficiency (HEE) is an important research area in health economics. As a large agricultural country, China is faced with the daunting challenge of maintaining equality and efficiency in health resource allocation and health services utilization in the context of rapid economic growth in rural areas. The reasonable allocation of limited rural health resources may be achieved by scientifically measuring the current rural HEE. This subject may help to formulate effective policy or provide incentives for the health sector. METHODS: The combination of a super-slack-based measure (SBM) model with the Malmquist productivity index (MPI) is proposed to evaluate the static health expenditure efficiency (HEE) and dynamic health expenditure efficiency (DHEE) in rural China from 2007 to 2016. RESULTS: The results show that the HEE and DHEE values exhibit unstable trends over time. The HEE does not follow China's economic development and presents an average of 0.598 (< 1); and the DHEE presents an average value of approximately 0.949 (< 1), indicating that the DHEE of most provinces is not moving in a desirable direction. The level of technological progress and scale optimization are the main factors hindering total factor productivity (TFP) growth. CONCLUSIONS: The Chinese government could improve the efficiency of rural health resources allocation by improving the rural health service system, optimizing the allocation of material resources and enhancing the level of health of financial resources allocation. The state should continue to moderate policy for different regions. Moreover, scientific and technological advancements should be introduced to improve the scale optimization levels.


Assuntos
Desenvolvimento Econômico , Alocação de Recursos para a Atenção à Saúde/organização & administração , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Agricultura , China , Eficiência Organizacional , Recursos em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde , Humanos , Alocação de Recursos
9.
Glob Health Action ; 12(1): 1636611, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282315

RESUMO

Background: Type 2 diabetes mellitus (T2DM) is known to require continuous clinical care and management that consumes significant health-care resources. These costs are not well understood, particularly in low- and middle-income countries. Objective: The aim of this study was to estimate the direct medical costs associated with T2DM in the South African public health sector and to project an estimate of the future direct costs of T2DM by 2030. Methods: A cost of illness study was conducted to estimate the direct medical costs of T2DM in South Africa in 2018 and to make projections for potential costs in 2030. Costs were estimated for diagnosis and management of T2DM, and related complications. Analyses were implemented in Microsoft Excel, with sensitivity analysis conducted on particular parameters. Results: In 2018, public sector costs of diagnosed T2DM patients were approximately ZAR 2.7 bn and ZAR 21.8 bn if both diagnosed and undiagnosed patients are considered. In real terms, the 2030 cost of all T2DM cases is estimated to be ZAR 35.1 bn. Approximately 51% of these estimated costs for 2030 are attributable to the management of T2DM, and 49% are attributable to complications. Conclusion: T2DM imposes a significant financial burden on the public healthcare system in South Africa. Treatment of all prevalent cases would incur a cost equivalent to approximately 12% of the total national health budget in 2018. With rising prevalence, direct costs will grow if current care regimes are maintained and case-finding improved. Increased financial resources are necessary in order to deliver effective services to people with T2DM.


Assuntos
Efeitos Psicossociais da Doença , Diabetes Mellitus Tipo 2/economia , Complicações do Diabetes/economia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Humanos , Renda , Prevalência , Saúde Pública , África do Sul/epidemiologia
10.
Lupus ; 28(7): 906-913, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31159650

RESUMO

OBJECTIVES: Systemic lupus erythematosus (SLE) is a chronic, multisystemic, immune-mediated disorder associated with a substantial hospitalization risk. As a comparatively rare disease, there is a sparsity of research examining the burden of hospital admission in the contemporary era. We aim to describe national trends in hospitalization rates in England between 1998 and 2015 for SLE, using rheumatoid arthritis (RA) and general population rates as comparison cohorts for benchmarking. METHODS: Hospital admission rates, emergency and day-case admission rates, length of stay and bed days used were calculated using finished consultant episodes from Hospital Episode Statistics data. Cochran-Armitage tests and linear regression quantified the significance and magnitude of change over time. RESULTS: SLE admissions increased from 8.97 to 9.04 per 100,000 (p < 0.001) between 1998 and 2015. By comparison, RA admissions rose from 71.0 to 171.6 per 100,000 (p < 0.001) and all-cause admissions rose from 24,500 to 34,500 per 100,000 (p < 0.001). Emergency admissions decreased both for SLE (2.6 to 1.2 per 100,000) and RA (12.8 to 4.4 per 100,000) despite all-cause emergency admissions increasing from 9400 to 10,300 per 100,000. SLE and RA day cases increased, whilst median length of stay decreased. Despite increasing admissions, total bed days for SLE and RA fell by 60% and 90%, respectively. CONCLUSIONS: Whilst all-cause emergency admissions rose in the general population, those for SLE fell. Length of stay and bed days reduced and day cases increased, probably reflecting changing therapeutic strategies. This potentially large reduction in resource utilization warrants consideration when assessing the impact of new therapies.


Assuntos
Artrite Reumatoide/terapia , Recursos em Saúde/tendências , Hospitalização/tendências , Lúpus Eritematoso Sistêmico/terapia , Adulto , Artrite Reumatoide/epidemiologia , Serviço Hospitalar de Emergência/tendências , Inglaterra/epidemiologia , Recursos em Saúde/estatística & dados numéricos , Humanos , Tempo de Internação/tendências , Modelos Lineares , Estudos Longitudinais , Lúpus Eritematoso Sistêmico/epidemiologia , Pessoa de Meia-Idade , Admissão do Paciente/tendências
11.
J Surg Res ; 243: 213-219, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31195350

RESUMO

BACKGROUND: Lower extremity amputation rates associated with peripheral arterial disease in Texas are high and vary disproportionately among different populations. We sought to assess the impact of socioeconomic status and health care resource distribution on the geographic prevalence of lower extremity amputation in Texas counties. MATERIALS AND METHODS: We collated 2005-2009 data on all 254 Texas counties. The primary outcome was the number of nontraumatic lower extremity amputations. Population-adjusted regressions identified factors that could explain increasing amputation rates. RESULTS: We identified 33 counties with population-weighted amputation rates in the highest 25%. These counties had higher rates of diabetes, larger populations of people categorized as black, fewer health care resources, and lower health care utilization. In the presence of more emergency room visits, dual Medicare/Medicaid eligibility decreased total amputations. In counties with more than 70% rural communities, additional primary care providers also significantly decreased amputations per 100,000 residents (mean difference = -0.12, 95% confidence interval: -0.23, -0.0008). CONCLUSIONS: Policy-driven strategic health care resource allocation at the local level may benefit patients in high-need, low-resource areas and promote a reduction in amputations.


Assuntos
Amputação/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Extremidade Inferior/cirurgia , Doença Arterial Periférica/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Texas
12.
Scand J Trauma Resusc Emerg Med ; 27(1): 61, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174573

RESUMO

BACKGROUND: Due to its favorable hemodynamic characteristics and by providing good intubation conditions etomidate is often used for induction of general anesthesia in trauma patients. It has been linked to temporary adrenal cortical dysfunction. The clinical relevance of this finding after a single-dose is still lacking appropriate evidence. METHODS: This retrospective multi-centre study is based on merged data from a German Helicopter Emergency Medical Service (HEMS) database and a large trauma patient registry. All trauma patients who were intubated prior to hospital admission with a documented Injury Severity Score ≥ 9 between 2008 and 2012 were eligible for analysis. The primary endpoint was hospital mortality. Other outcome measures were organ failures, sepsis, length of ventilation, as well as length of stay in hospital and ICU. RESULTS: One thousand six hundred ninety seven patients were enrolled into the study. Seven hundred sixty two patients received etomidate and 935 patients received other induction agents. The in-hospital mortality was similar in both groups (18.9% versus 18.2%; p = 0.71). Incidences of organ failures and sepsis were not increased in the etomidate group. However, health care resource utilization parameters were prolonged (after adjusting: + 1.3 days for ICU length of stay, p = 0.062; + 0.8 days for length of ventilation, p = 0.15; + 2,7 days for hospital length of stay, p = 0.034). A multivariable logistic regression analysis did not identify etomidate as an independent predictor of hospital mortality (OR: 1.10, 95% CI: 0.77-1.57; p = 0.60). CONCLUSIONS: This is the largest trial investigating outcome data for trauma patients who had received a single-dose of etomidate for induction of anesthesia. The use of etomidate did not affect mortality. The influence on morbidity and health care resource utilization remains unclear.


Assuntos
Serviços Médicos de Emergência , Etomidato , Recursos em Saúde , Mortalidade Hospitalar , Intubação Intratraqueal , Morbidade , Adulto , Feminino , Recursos em Saúde/estatística & dados numéricos , Hemodinâmica , Hospitalização , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sepse/mortalidade
13.
Pediatr Blood Cancer ; 66(8): e27755, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31044487

RESUMO

BACKGROUND: Children with sickle cell disease (SCD) are at risk for cognitive deficits. Limited data describe whether comprehensive cognitive evaluation improves education resources and whether caregivers perceive the assessment as beneficial. We tested our two hypotheses: (a) an integrated comprehensive cognitive evaluation program in children with SCD results in increased special education services allocation; and (b) caregivers will value comprehensive cognitive evaluation services provided. PROCEDURE: In a tertiary care medical facility, as part of quality improvement project, in a before-and-after evaluation between March 2011 and July 2014, we examined the impact of targeted comprehensive cognitive evaluation on change in special education services. We also evaluated the caregiver's perception regarding the utility of the provided services. RESULTS: A total of 21% (42 of 196) students (median age 11 years, range 3-18) with SCD were referred for cognitive assessment due to overt stroke (n = 11), silent stroke (n = 14), or concerns about cognitive or academic functioning without evidence of strokes (n = 17). At baseline, 45.2% received special education services and after the comprehensive cognitive evaluation 86.7% received special education services (P < 0.001). Among 33 caregivers who completed the survey, 97% reported that the assessment was helpful and 60% indicated that assessment led to beneficial changes for their children at school. CONCLUSION: Education advocacy coupled with comprehensive cognitive assessment in students with SCD improved access to special education services, and caregivers uniformly endorse this service as having added value.


Assuntos
Anemia Falciforme/psicologia , Anemia Falciforme/terapia , Cuidadores/educação , Cognição , Educação Especial/normas , Recursos em Saúde/estatística & dados numéricos , Educação de Pacientes como Assunto/normas , Adolescente , Adulto , Criança , Pré-Escolar , Aconselhamento , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Avaliação de Programas e Projetos de Saúde , Adulto Jovem
14.
Pediatr Rheumatol Online J ; 17(1): 20, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060557

RESUMO

BACKGROUND: This study aims to describe current practice in identifying and measuring health care resource use and unit costs in economic evaluations or costing studies of juvenile idiopathic arthritis (JIA). METHODS: A scoping review was conducted (in July 2018) in PubMed and Embase to identify economic evaluations, costing studies, or resource utilization studies focusing on patients with JIA. Only English language peer-reviewed articles reporting primary research were included. Data from all included full-text articles were extracted and analysed to identify the reported health care resource use items. In addition, the data sources used to obtain these resource use and unit costs were identified for all included articles. RESULTS: Of 1176 unique citations identified by the search, 20 full-text articles were included. These involved 4 full economic evaluations, 5 cost-outcome descriptions, 8 cost descriptions, and 3 articles reporting only resource use. The most commonly reported health care resource use items involved medication (80%), outpatient and inpatient hospital visits (80%), laboratory tests (70%), medical professional visits (70%) and other medical visits (65%). Productivity losses of caregivers were much more often incorporated than (future) productivity losses of patients (i.e. 55% vs. 15%). Family borne costs were not commonly captured (ranging from 15% for school costs to 50% for transportation costs). Resource use was mostly obtained from family self-reported questionnaires. Estimates of unit costs were mostly based on reimbursement claims, administrative data, or literature. CONCLUSIONS: Despite some consistency in commonly included health care resource use items, variability remains in including productivity losses, missed school days and family borne costs. As these items likely substantially influence the full cost impact of JIA, the heterogeneity found between the items reported in the included studies limits the comparability of the results. Therefore, standardization of resource use items and unit costs to be collected is required. This standardization will provide guidance to future research and thereby improve the quality and comparability of economic evaluations or costing studies in JIA and potentially other childhood diseases. This would allow better understanding of the burden of JIA, and to estimate how it varies across health care systems.


Assuntos
Artrite Juvenil/terapia , Recursos em Saúde/estatística & dados numéricos , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Artrite Juvenil/economia , Cuidadores/economia , Cuidadores/estatística & dados numéricos , Criança , Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/estatística & dados numéricos , Eficiência , Utilização de Instalações e Serviços , Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos
15.
J Med Econ ; 22(8): 814-817, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31038380

RESUMO

Aims: This study aimed to examine the long-term clinical and economic burden of adults with congenital heart disease (ACHD) in Hong Kong. Methods: It retrospectively analyzed 336 consecutive ACHD patients who attended the Adult Congenital Heart Clinic between January 1, 2009 and December 31, 2014. Direct medical costs and clinical outcomes over the 5 years were calculated and documented. The economic evaluation was from the hospital's perspective. Results: The median age of ACHD patients was 47 (31-62) years old, with female predominance (61.5%). Ventricular and atrial septal defects accounted for 70% and severe ACHD for 10% of the study cohort. The prevalence of arrhythmia and heart failure increased with the complexity of CHD. The total mean annual cost for managing each ACHD patient was USD 2,913. The annual cost of management of simple ACHD was USD 2,638 vs complex ACHD (USD 6,425) (p = 0.013). Conclusions: This study demonstrated severe ACHD patients accounted for higher cardiovascular morbidities in arrhythmias and heart failure with a higher cost of management.


Assuntos
Cardiopatias Congênitas/epidemiologia , Insuficiência Cardíaca/economia , Adulto , Idoso , Arritmias Cardíacas/epidemiologia , Efeitos Psicossociais da Doença , Feminino , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Cardiopatias Congênitas/economia , Cardiopatias Congênitas/fisiopatologia , Insuficiência Cardíaca/epidemiologia , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos
16.
S Afr Med J ; 109(4): 223-226, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-31084685

RESUMO

BACKGROUND: Spotted fever rickettsiosis, also known as tick bite fever (TBF), is a common infectious disease in South Africa (SA). Although the diagnosis of TBF is often based on clinical grounds only, laboratory testing is important to confirm the diagnosis and can contribute to case management in the light of a myriad of differential diagnoses, and in complicated cases. OBJECTIVES: To report on the availability and scope of laboratory tests for investigating suspected cases of TBF in SA, and the outcome of an inter-laboratory comparison (ILC) conducted for serological tests. METHODS: A self-administered questionnaire was circulated to major pathology laboratories in SA to determine what TBF tests they offered for TBF investigation. In addition, a clinical panel was provided to willing laboratories in order to perform an ILC of the serological tests. RESULTS: Serological tests for TBF were available from five laboratories serving both the private and state medical sectors in SA. There was no standardised testing platform or result interpretation across the different laboratories. Polymerase chain reaction (PCR) tests were less frequently available, and not available to state-operated facilities. The outcome of the ILC indicated varied performance and interpretation of serological results for TBF. CONCLUSIONS: Laboratory investigation for TBF is routinely and widely available in SA. Both serological and PCR-based methods were varied, and the lack of standardisation and interpretation of tests needs to be addressed to improve the overall quality of TBF diagnosis in SA. The utility of ILC to identify problem areas in serological testing for TBF is highlighted, and laboratories in SA are encouraged to use it to improve the quality of testing.


Assuntos
Serviços de Laboratório Clínico/estatística & dados numéricos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Laboratórios/estatística & dados numéricos , Rickettsiose do Grupo da Febre Maculosa/diagnóstico , Benchmarking , Biomarcadores/sangue , Serviços de Laboratório Clínico/normas , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/normas , Diagnóstico Diferencial , Recursos em Saúde/normas , Acesso aos Serviços de Saúde/normas , Humanos , Laboratórios/normas , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , África do Sul , Rickettsiose do Grupo da Febre Maculosa/sangue
17.
BMC Health Serv Res ; 19(1): 297, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072363

RESUMO

BACKGROUND: Smoking in pregnancy causes harm to mother and baby. Despite evidence from trials of what helps women quit, implementation in the real world has been hard to achieve. An evidence-based intervention, babyClear©, involving staff training, universal carbon monoxide monitoring, opt-out referral to smoking cessation services, enhanced follow-up protocols and a risk perception tool was introduced across North East England. This paper presents the results of the qualitative analyses, reporting acceptability of the system changes to staff, as well as aids and hindrances to implementation and normalization of this complex intervention. METHODS: Process evaluation was used to complement an effectiveness study. Interviews with maternity and smoking cessation services staff and observations of training were undertaken. Normalization Process Theory (NPT) was used to frame the interview guides and analysis. NPT is an empirically-derived theory, developed by sociologists, that uses four concepts to understand the process of routinising new practices. RESULTS: Staff interviews took place across eight National Health Service trusts at a time of widespread restructuring in smoking cessation services. Principally interviewees worked in maternity (n = 63) and smoking cessation services (n = 35). Five main themes, identified inductively, influenced the implementation: 1) initial preparedness of the organisations; 2) staff training; 3) managing partnership working; 4) resources; 5) review and planning for sustainability. CONCLUSIONS: NPT was used to show that the babyClear© package was acceptable to staff in a range of organisations. Illustrated in Themes 1, 2 & 3, staff welcomed ways to approach pregnant women about their smoking, without damaging their professional relationship with them. Predicated on producing individual behaviour change in women, the intervention does this largely through reorganising and standardising healthcare systems that are required to implement best practice guidelines. Changing organisational systems requires belief and commitment from staff, so that they set up and maintain practical adjustments to their practice and are reflective about adapting themselves and the work context as new challenges are encountered. The ongoing challenge is to identify and maintain the elements of the intervention package which are essential for its effectiveness and how to tailor them to local circumstances and resources without compromising its core ingredients.


Assuntos
Complicações na Gravidez/prevenção & controle , Abandono do Hábito de Fumar/métodos , Inglaterra , Feminino , Recursos em Saúde/estatística & dados numéricos , Humanos , Gravidez , Gestantes , Cuidado Pré-Natal/métodos , Encaminhamento e Consulta , Prevenção do Hábito de Fumar/métodos , Fumar Tabaco/efeitos adversos , Fumar Tabaco/prevenção & controle
18.
BMC Health Serv Res ; 19(1): 336, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133032

RESUMO

BACKGROUND: Health service and health outcome data collection across many low- and middle-income countries (LMICs) is, to date largely paper-based. With the development and increased availability of reliable technology, electronic tablets could be used for electronic data collection in such settings. This paper describes our experiences with implementing electronic data collection methods, using electronic tablets, across different settings in four LMICs. METHODS: Within our research centre, the use of electronic data collection using electronic tablets was piloted during a healthcare facility assessment study in Ghana. After further development, we then used electronic data collection in a multi-country, cross-sectional study to measure ill-health in women during and after pregnancy, in India, Kenya and Pakistan. All data was transferred electronically to a central research team in the UK where it was processed, cleaned, analysed and stored. RESULTS: The healthcare facility assessment study in Ghana demonstrated the feasibility and acceptability to healthcare providers of using electronic tablets to collect data from seven healthcare facilities. In the maternal morbidity study, electronic data collection proved to be an effective way for healthcare providers to document over 400 maternal health variables, in 8530 women during and after pregnancy in India, Kenya and Pakistan. CONCLUSIONS: Electronic data collection provides an effective platform which can be used successfully to collect data from healthcare facility registers and from patients during health consultations; and to transfer large quantities of data. To ensure successful electronic data collection and transfer between settings, we recommend that close attention is paid to study design, data collection, tool design, local internet access and device security.


Assuntos
Computadores de Mão/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Adulto , Estudos Transversais , Coleta de Dados/instrumentação , Utilização de Equipamentos e Suprimentos , Feminino , Gana , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Humanos , Índia , Quênia , Paquistão , Pobreza , Gravidez
19.
Medicine (Baltimore) ; 98(22): e15835, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145326

RESUMO

There is ongoing controversy about how to address the growing demand for intensive care for critically ill elderly patients. We investigated resource utilization patterns and mortality rates according to age among critically ill patients.We retrospectively analyzed the medical records of patients admitted to a medical intensive care unit (ICU) in a tertiary referral teaching hospital between July 2006 and June 2015. Patients were categorized into non-elderly (age <65 years, n = 4140), young-elderly (age 65-74 years, n = 2306), and old-elderly (age ≥75 years, n = 1508) groups.Among 7954 admissions, the mean age was 61.5 years, and 5061 (63.6%) were of male patients. The proportion of comorbidities increased with age (64.6% in the non-elderly vs 81.4% in the young-elderly vs 82.8% in the old-elderly, P < .001 and P for trend <.001), whereas the baseline Sequential Organ Failure Assessment (SOFA) score decreased with age (8.1 in the non-elderly vs 7.2 in the young-elderly vs 7.2 in the old-elderly, P < .001, R = -.092 and P for trend <.001). Utilization rates of mechanical ventilation (48.6% in the non-elderly vs 48.3% in the young-elderly vs 45.5% in the old-elderly, P = .11) and renal replacement therapy (27.5% in the non-elderly vs 25.5% in the young-elderly vs 24.8% in the old-elderly, P = .069) were comparable between the age groups. The 28-day ICU mortality rates were lower in the young-elderly and the old-elderly groups than in the non-elderly group (35.6% in the non-elderly vs 34.2% in the young-elderly, P = .011; and vs 32.6% in the old-elderly, P = .002).A substantial number of critically ill elderly patients used medical resources as non-elderly patients and showed favorable clinical outcomes. Our results support that underlying medical conditions rather than age per se need to be considered for determining intensive care.


Assuntos
Estado Terminal/terapia , Recursos em Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Mortalidade Hospitalar/tendências , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Terapia de Substituição Renal/estatística & dados numéricos , República da Coreia , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos
20.
Yakugaku Zasshi ; 139(4): 547-550, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30930386

RESUMO

The "Choosing Wisely" campaign is an activity to promote conversations between patients and doctors about unnecessary examinations, treatments, or procedures. A "Top five list" published by a number of specialty societies consists of five evidence-based recommendations in their own fields. Choosing Wisely Japan was launched in 2016; the campaign soon became widespread among primary care physicians. To make wiser choices in prescriptions of any medicine, it is necessary to consider the balance between its efficacies, risks, and costs. The purpose of this campaign is not only to publish recommendations to reduce waste in health care resources but also to disseminate and implement the recommendations contents. To put them into practice, it is necessary to think about interprofessional and interdisciplinary approaches.


Assuntos
Análise Custo-Benefício , Prática Clínica Baseada em Evidências , Recursos em Saúde/economia , Prescrição Inadequada/prevenção & controle , Sobremedicalização/prevenção & controle , Médicos de Atenção Primária , Padrões de Prática Médica , Medição de Risco , Recursos em Saúde/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Japão , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Padrões de Prática Médica/economia , Prescrições/estatística & dados numéricos
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