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1.
MMWR Morb Mortal Wkly Rep ; 70(13): 461-466, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33793461

RESUMO

Clinical preventive services play an important role in preventing deaths, and Healthy People 2020 has set national goals for using clinical preventive services to improve population health (1). The Patient Protection and Affordable Care Act (ACA) requires many health plans to cover certain recommended clinical preventive services without cost-sharing when provided in-network (covered clinical preventive services).* To ascertain prevalence of the use of selected recommended clinical preventive services among persons aged ≥18 years, CDC analyzed data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), a state-based annual nationwide survey conducted via landline and mobile phones in the United States, for 10 clinical preventive services covered in-network with no cost-sharing pursuant to the ACA. The weighted prevalence of colon, cervical, and breast cancer screening, pneumococcal and tetanus vaccination, and diabetes screening ranged from 66.0% to 79.2%; the prevalence of the other four clinical preventive services were <50%: 16.5% for human papillomavirus (HPV) vaccination, 26.6% for zoster (shingles) vaccination, 33.2% for influenza vaccination, and 45.8% for HIV testing. Prevalence of HIV testing had the widest variation (3.1-fold differences) across states among the 10 services included in this report. The prevalence of use of clinical preventive services varied by insurance status, income level, and rurality, findings that are consistent with previous studies (2-6). The use of nine of the 10 services examined was lower among the uninsured, those with lower income, and those living in rural communities. Among those factors examined, insurance status was the dominant factor strongly associated with use of clinical preventive services, followed by income-level and rurality. Understanding factors influencing use of recommended clinical preventive services can potentially help decision makers better identify policies to increase their use including strategies to increase insurance coverage.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Reforma dos Serviços de Saúde , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
2.
Artigo em Inglês | MEDLINE | ID: mdl-33806051

RESUMO

Refugees who have fled from the ongoing civil war in Syria that arrived in Germany often develop post-traumatic stress symptoms (PTSS). The aim of this study was to determine health care services utilization (HCSU), health care costs and health-related quality of life (HrQoL) of Syrian refugees with mild to moderate PTSS without current treatment in Germany. The study was based on the baseline sample of a randomized controlled trial of a self-help app for Syrian refugees with PTSS (n = 133). HCSU and HrQoL based on the EQ-5D-5L and its visual analogue scale (EQ-VAS) were assessed with standardized interviews. Annual health care costs were calculated using extrapolated four-month HCSU and standardized unit costs. Associations between health care costs, HrQoL and PTSS severity were examined using generalized linear models. Overall, 85.0% of the sample utilized health care services within four months. The mean total annual health care costs were EUR 1920 per person. PTSS severity was not associated with health care costs. The EQ-5D-5L index score and the EQ-VAS score was 0.82 and 73.6, respectively. For Syrian refugees with higher PTSS severity, the EQ-5D-5L index score was lower (-0.17; p < 0.001). The HCSU and the resulting health care costs of Syrian refugees with mild to moderate PTSS without current treatment are low and those with a higher PTSS severity had a lower HrQoL.


Assuntos
Refugiados , Transtornos de Estresse Pós-Traumáticos , Utilização de Instalações e Serviços , Alemanha , Humanos , Qualidade de Vida , Transtornos de Estresse Pós-Traumáticos/terapia , Síria
3.
Global Health ; 17(1): 51, 2021 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902638

RESUMO

BACKGROUND: Due to the implementation of social distancing and quarantine measures, loneliness has been a major public health concern during the COVID-19 pandemic. However, few studies have examined loneliness in Chinese residents during the COVID-19 epidemic, as well as its associations with mental health needs and services utilization. METHODS: The present study was a cross-sectional survey during the COVID-19 outbreak in China. A total of 7741 adults were invited and completed an online self-administered questionnaire. The Chinese 12-item General Health Questionnaire was used to screen for common mental health problems, loneliness was measured with a single-item self-report question ("How often do you feel lonely in recent days?"), and two standardized questions were used to assess perceived needs for and use of mental health services. RESULTS: In total, 24.2 % of the participants felt lonely in recent days. Age of 16-29 years (OR = 1.36, P = 0.020), marital status of never-married (OR = 1.47, P < 0.001), marital status of "others" (re-married, co-habiting, separated, divorced, and widowed) (OR = 1.72, P < 0.001), having infected family members or close relatives (OR = 1.64, P = 0.026), and having infected colleagues, friends, or classmates (OR = 1.62, P < 0.001) were significant correlates of loneliness. Rates of mental health needs (17.4 % vs. 4.9 %, P < 0.001) and services utilization (2.7 % vs. 1.0 %, P < 0.001) were significantly higher in lonely than not lonely participants. After adjusting for socio-demographic and epidemic characteristics and common mental health problems, loneliness was still significantly associated with mental health needs (OR = 2.50, P < 0.001) and services utilization (OR = 1.62, P = 0.020). CONCLUSIONS: Feelings of loneliness are prevalent among Chinese residents affected by the COVID-19 epidemic and the presence of loneliness is associated with high levels of mental health needs and greater services utilization. Effective measures aiming at preventing or reducing loneliness are potentially beneficial for the mental wellbeing of COVID-19-affected population and reducing the use of the limited mental health service resources during the COVID-19 pandemic.


Assuntos
/epidemiologia , Epidemias , Utilização de Instalações e Serviços/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Solidão/psicologia , Serviços de Saúde Mental/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
4.
BMC Health Serv Res ; 21(1): 311, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827556

RESUMO

BACKGROUND: While international students form an increasing population of higher education students in Turkey, there is limited empirical evidence about their health services utilization. The study aim was to investigate healthcare access among a group of international students studying in Ankara city and identify potential barriers that affect full healthcare utilization. METHOD: A total of 535 international students from 83 countries completed an online-based questionnaire. The survey was conducted from September until October 2020. Variables between groups within the study sample were compared using ANOVA and Chi-square tests (with Fisher's exact test). Logistic regression analysis was used to evaluate the relationships between variables related to access to health services. RESULTS: Of the study population, 80.6% accessed the general practitioner (GP), 40% accessed the student health centres, and 11.4% were admitted to the hospital at least once. About 80% of international students reported changing their views to access healthcare more because of the COVID-19 pandemic. CONCLUSION: Lack of awareness of healthcare support systems, perceived stigma associated with mental health services, and language barriers were the main barriers affecting healthcare access by international students. IMPLICATIONS: Study findings indicate the need for education of international students on available healthcare, targeted health promotion, and training of health providers on effective communication.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Transtornos Mentais/psicologia , Estigma Social , Estudantes/psicologia , Migrantes/estatística & dados numéricos , Adulto , Barreiras de Comunicação , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Transtornos Mentais/etnologia , Serviços de Saúde Mental , Pandemias , Turquia/epidemiologia
5.
Ann Acad Med Singap ; 50(2): 126-134, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33733255

RESUMO

INTRODUCTION: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. METHODS: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). RESULTS: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January-July 2019, to 274 per day in January-July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January-July 2019 (19,629) to January-July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January-July 2019 and 21% in January-July 2020. CONCLUSION: Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally.


Assuntos
Serviço Hospitalar de Emergência/tendências , Utilização de Instalações e Serviços/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Síndrome Respiratória Aguda Grave , Adolescente , /prevenção & controle , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Política de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Admissão do Paciente/tendências , Pediatria , Estudos Retrospectivos , Síndrome Respiratória Aguda Grave/epidemiologia , Singapura/epidemiologia
7.
Orv Hetil ; 162(14): 542-554, 2021 03 30.
Artigo em Húngaro | MEDLINE | ID: mdl-33784247

RESUMO

Összefoglaló. Bevezetés: Az idoalku (time trade-off) egy nemzetközileg széles körben alkalmazott életminoség- és egészséghasznosság-mérési módszer. Az idoalkuval mért hasznosságértékek az egészségügyi technológiák költséghatékonysági vizsgálatakor az életminoséggel korrigált életév (quality-adjusted life year, QALY) mutatószám számítására használhatók. Kevés ismerettel rendelkezünk arról, hogy Magyarországon milyen betegségekben állnak rendelkezésre idoalkuval mért hasznosságértékek. Célkituzés: Célunk szisztematikus irodalmi áttekintés keretében összefoglalni és katalogizálni az idoalku módszerrel mért hasznosságértékeket közlo publikációkat Magyarországon. Módszer: 2020 januárjában szisztematikus folyóirat-keresést végeztünk a PubMed, Web of Science és Matarka elektronikus adatbázisokban. Beválogatási kritériumaink a következok voltak: (1) eredeti közlemények, melyek (2) idoalku módszerrel mértek hasznosságértéket, és (3) magyarországi mintán mért adatokat közöltek. Eredmények: 9 eredeti közleményt válogattunk be, amelyek összesen 7 krónikus betegségben (Crohn-betegség, idoskori maculadegeneratio, krónikus migrén, pemphigus, psoriasis, primer dysmenorrhoea és rheumatoid arthritis) 23 egészségi állapot hasznosságát határozták meg. A kutatások mintanagysága 108 és 1996 fo között alakult. Két kutatás betegcsoportokat vizsgált, ketto az általános populációt, és három vizsgálatban szerepelt mindketto. Hat kutatás használta a hagyományos idoalku valamelyik formáját, egy pedig az összetett idoalku módszert. Egy kutatásban szerepelt 'rosszabb a halálnál' válaszlehetoség. A leggyakrabban alkalmazott idotáv a standard 10 év volt (71%). Az egyes állapotok hasznosságának átlaga 0,34 (kezeletlen pemphigus vulgaris) és 0,94 (enyhe primer dysmenorrhoea) között változott. A 'non-traderek' aránya az egyes kutatásokban 0 és 29% között változott. Következtetések: Egyre több krónikus betegségben elérhetok a magyar társadalom vagy betegek preferenciáin alapuló egészséghasznosság-értékek. A hazai idoalku-vizsgálatok többsége megfelel a nemzetközi minoségi követelményeknek. Az idoalku módszer alkalmazása javasolt más krónikus állapotokban is, a felmért hasznosságértékek segíthetik az egészségügyi technológiákkal kapcsolatos finanszírozói döntéshozatalt. Orv Hetil. 2021; 162(14): 542-554. INTRODUCTION: Time trade-off (TTO) is a widely used method to assess health-related quality of life and health utilities for economic evaluations of health technologies. Little is known about the use of TTO in the Hungarian context. OBJECTIVE: To systematically summarize the existing literature on the method in Hungary. METHOD: In January 2020, we conducted a systematic literature search in three electronic databases (MEDLINE, Web of Science and the Hungarian Periodicals Table of Contents Database). Our inclusion criteria were: (1) original publications, which (2) measured utilities by using TTO, (3) from a Hungarian sample. RESULTS: Nine publications containing seven original studies were included that reported utilities for 23 different health states in seven chronic diseases (age-related macular degeneration, chronic migraine, Crohn's disease, pemphigus, primary dysmenorrhoea, psoriasis and rheumatoid arthritis). Sample sizes ranged from 108 to 1996 respondents. Two studies used general population samples, another two used patient groups and three studies used both. Six studies used a form of conventional TTO and one used composite TTO method. The most frequent timeframe was 10 years (71%). The lowest mean utility was 0.34 (uncontrolled pemphigus vulgaris), while the highest was 0.94 (mild primary dysmenorrhoea). The overall proportion of non-traders ranged between 0 and 29% across studies. CONCLUSIONS: A growing number of studies are using TTO to assess utilities for chronic conditions from the general population or patients in Hungary. The majority of Hungarian TTO studies have met international quality standards. The assessment of TTO utilities is recommended also in other chronic conditions to assist health technology assessment. Orv Hetil. 2021; 162(14): 542-554.


Assuntos
Doença Crônica , Utilização de Instalações e Serviços , Qualidade de Vida , Avaliação da Tecnologia Biomédica , Doença Crônica/terapia , Utilização de Instalações e Serviços/estatística & dados numéricos , Humanos , Hungria , Avaliação da Tecnologia Biomédica/métodos , Fatores de Tempo
8.
CMAJ Open ; 9(1): E271-E279, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33757964

RESUMO

BACKGROUND: Understanding resource use for coronavirus disease 2019 (COVID-19) is critical. We conducted a descriptive analysis using public health data to describe age- and sex-specific acute care use, length of stay (LOS) and mortality associated with COVID-19. METHODS: We conducted a descriptive analysis using Ontario's Case and Contact Management Plus database of individuals who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Ontario from Mar. 1 to Sept. 30, 2020, to determine age- and sex-specific hospital admissions, intensive care unit (ICU) admissions, use of invasive mechanical ventilation, LOS and mortality. We stratified analyses by month of infection to study temporal trends and conducted subgroup analyses by long-term care residency. RESULTS: During the observation period, 56 476 individuals testing positive for SARS-CoV-2 were reported; 41 049 (72.7%) of these were younger than 60 years, and 29 196 (51.7%) were female. Proportion of cases shifted from older populations (> 60 yr) to younger populations (10-39 yr) over time. Overall, 5383 (9.5%) of individuals were admitted to hospital; of these, 1183 (22.0%) were admitted to the ICU, and 712 (60.2%) of these received invasive mechanical ventilation. Mean LOS for individuals in the ward, ICU without invasive mechanical ventilation and ICU with invasive mechanical ventilation was 12.8 (standard deviation [SD] 15.4), 8.5 (SD 7.8) and 20.5 (SD 18.1) days, respectively. Among patients receiving care in the ward, ICU without invasive mechanical ventilation and ICU with invasive mechanical ventilation, 911/3834 (23.8%), 124/418 (29.7%) and 287/635 (45.2%) died, respectively. All outcomes varied by age and decreased over time, overall and within age groups. INTERPRETATION: This descriptive study shows use of acute care and mortality varying by age and decreasing between March and September 2020 in Ontario. Improvements in clinical practice and changing risk distributions among those infected may contribute to fewer severe outcomes.


Assuntos
/epidemiologia , Cuidados Críticos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Utilização de Instalações e Serviços , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Ontário , Respiração Artificial/estatística & dados numéricos , Fatores Sexuais , Taxa de Sobrevida , Adulto Jovem
9.
Int J Equity Health ; 20(1): 77, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33722225

RESUMO

Global response to COVID-19 pandemic has inadvertently undermined the achievement of existing public health priorities and laregely overlooked local context. Recent evidence suggests that this will cause additional maternal and childhood mortality and morbidity especially in low- and middle-income countries (LMICs). Here we have explored the contextual factors influencing maternal, neonatal and children health (MNCH) care in Bangladesh, Nigeria and South Africa amidst the pandemic. Our findings suggest that between March and May 2020, there was a reduction in utilisation of basic essential MNCH services such as antenatal care, family planning and immunization due to: a) the implementation of lockdown which triggered fear of contracting the COVID-19 and deterred people from accessing basic MNCH care, and b) a shift of focus towards pandemic, causing the detriment to other health services, and c) resource constraints. Taken together these issues have resulted in compromised provision of basic general healthcare. Given the likelihood of recurrent waves of the pandemic globally, COVID-19 mitigation plans therefore should be integrated with standard care provision to enhance system resilience to cope with all health needs. This commentary suggests a four-point contextualised mitigation plan to safeguard MNCH care during the pandemic using the observed countries as exemplars for LMIC health system adaptations to maintain the trajectory of progress regarding sustainable development goals (SDGs).


Assuntos
/prevenção & controle , Serviços de Saúde da Criança , Controle de Doenças Transmissíveis/métodos , Utilização de Instalações e Serviços/tendências , Serviços de Saúde Materna , Adulto , Bangladesh , Criança , Países em Desenvolvimento , Feminino , Humanos , Nigéria , Gravidez , Saúde Pública/legislação & jurisprudência , Quarentena/legislação & jurisprudência , África do Sul , Populações Vulneráveis
10.
South Med J ; 114(4): 193-198, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33787930

RESUMO

OBJECTIVES: Scoring systems, such as the Assessment of Blood Consumption (ABC) Score, are used to identify patients at risk for massive transfusion (MT, ≥10 U red blood cells in 24 hours). Our aeromedical transport helicopter uses ultrasound to perform the Focused Assessment with Sonography for Trauma (FAST) examination. Our objective was to evaluate the ability of the Prehospital ABC (PhABC) Score to predict blood transfusions and the need for emergent laparotomy. METHODS: Post hoc analysis of a prospective observational study of trauma patients who underwent an in-flight FAST during aeromedical transport during a 7-month period. PhABC Score was positive if ≥2 of the following were present in flight: penetrating trauma, heart rate >120 bpm, systolic blood pressure <90 mm Hg, or a positive abdominal FAST. The PhABC Score was evaluated by area under the receiver operating characteristic (AUROC) curves and logistic regression. RESULTS: A total of 291 trauma patients met inclusion criteria, 23 underwent emergent laparotomy, and 12 received an MT. A positive PhABC Score predicted emergent laparotomy, with a positive predictive value of 48% and a negative predictive value of 95% (sensitivity 46%, specificity 96%, AUROC curve 0.83). A positive PhABC Score also predicted receipt of an MT with a positive predictive value of 28% and a negative predictive value of 94% (sensitivity 33%, specificity 93%, AUROC curve 0.77). Multiple logistic regression identified FAST as the most powerful contributor of the PhABC Score to the prediction of both emergent laparotomy (odds ratio 8.5, P < 0.001) and MT (odds ratio 5.9, P < 0.001). CONCLUSIONS: The PhABC Score effectively predicts in-hospital resource utilization. It provides an outstanding undertriage rate from the prehospital setting, and it is helpful to improve trauma team activation, mobilize blood products, and prepare the operating room.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Regras de Decisão Clínica , Utilização de Instalações e Serviços/estatística & dados numéricos , Avaliação Sonográfica Focada no Trauma , Índices de Gravidade do Trauma , Triagem/métodos , Ferimentos e Lesões/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparotomia/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Ferimentos e Lesões/terapia
15.
Lancet Public Health ; 6(3): e155-e163, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33571459

RESUMO

BACKGROUND: Many patients prefer to avoid hospital-based care towards the end of life, yet hospitalisation is common and more likely for people with low socioeconomic position. The reasons underlying this socioeconomic inequality are not well understood. This study investigated health, service access, and social support as potential mediating pathways between socioeconomic position and receipt of hospital-based care towards the end of life. METHODS: For this observational cohort study, we included deceased participants from the nationally representative English Longitudinal Study of Ageing of people aged 50 years or older in England. We used a multiple mediation model with age-adjusted and gender-adjusted probit regression to estimate the direct effect of socioeconomic position (measured by wealth and education) on death in hospital and three or more hospital admissions in the last 2 years of life, and the indirect effects of socioeconomic position via three mediators: health and function, access to health-care services, and social support. FINDINGS: 737 participants were included (314 [42·6%] female, 423 [57·4%] male), with a median age at death of 78 years (IQR 71-85). For death in hospital, higher wealth had a direct negative effect (probit coefficient -0·16, 95% CI -0·25 to -0·06), which was not mediated by any of the pathways tested. For frequent hospital admissions, health and function mediated the effect of wealth (-0·04, -0·08 to -0·01), accounting for 34·6% of the total negative effect of higher wealth (-0·13, -0·23 to -0·02). Higher wealth was associated with better health and function (0·25, 0·18 to 0·33). Education was associated with the outcomes only indirectly via wealth. INTERPRETATION: Our findings suggest that worse health and function could partly explain why people with lower wealth have more hospital admissions, highlighting the importance of socioeconomically driven health differences in explaining patterns of hospital use towards the end of life. The findings should raise awareness about the related risk factors of low wealth and worse health for patients approaching the end of life, and strengthen calls for resource allocation to be made on the basis of health need and socioeconomic profile. FUNDING: Dunhill Medical Trust Fellowship Grant (RTF74/0116).


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Classe Social , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
16.
Br J Surg ; 108(1): 97-103, 2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33640927

RESUMO

BACKGROUND: The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical acivirt, was modelled. METHODS: This was a modelling study using Hospital Episode Statistics data (2014-2019). Surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1 March 2020 and 28 February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1 June 2020. Costs were calculated using NHS reference costs and are reported as millions or billions of euros. Estimates are reported with 95 per cent confidence intervals. RESULTS: A total of 4 547 534 (95 per cent c.i. 3 318 195 to 6 250 771) patients with a pooled mean age of 53.5 years were expected to undergo surgery between 1 March 2020 and 28 February 2021. By 31 May 2020, 749 247 (513 564 to 1 077 448) surgical procedures had been cancelled. Assuming that elective surgery is reintroduced gradually, 2 328 193 (1 483 834 - 3 450 043) patients will be awaiting surgery by 28 February 2021. The cost of delayed procedures is €5.3 (3.1 to 8.0) billion. Safe delivery of surgery during the pandemic will require substantial extra resources costing €526.8 (449.3 to 633.9) million. CONCLUSION: As a consequence of the Covid-19 pandemic, provision of elective surgery will be delayed and associated with increased healthcare costs.


Assuntos
/epidemiologia , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Custos Hospitalares , Pandemias , /diagnóstico , Inglaterra/epidemiologia , Utilização de Instalações e Serviços/economia , Hospitalização/estatística & dados numéricos , Humanos , Modelos Estatísticos , Equipamento de Proteção Individual , Cuidados Pré-Operatórios , Tempo para o Tratamento/economia
17.
Medicina (Kaunas) ; 57(2)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33567770

RESUMO

Background and objectives: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread to more than 200 countries. In light of this situation, the Japanese Government declared a state of emergency in seven regions of Japan on 7 April 2020 under the provisions of the law. The medical care delivery system has been under pressure. Although various surgical societies have published guidelines on which to base their surgical decisions, it is not clear how general anesthesia has been performed and will be performed in Japan. Materials and Methods: One of the services provided by the social network service Twitter is a voting function-Twitter Polls-through which anonymous surveys were conducted. We analyzed the results of a series of surveys 17 times over 22 weeks on Twitter on the status of operating restrictions using quadratic programming to solve the mathematical optimizing problem, and public data provided by the Japanese Government were used to estimate the current changes in the number of general anesthesia performed in Japan. Results: The minimum number of general anesthesia cases per week was estimated at 67.1% compared to 2015 on 27 April 2020. The timeseries trend was compatible with the results reported by the Japanese Society of Anesthesiologists (correlation coefficient r = 0.69, p < 0.001). Conclusions: The number of general anesthesia was reduced up to two-thirds during the pandemic of COVID-19 in Japan and was successfully quantitatively estimated using a quick questionnaire on Twitter.


Assuntos
Anestesia Geral/estatística & dados numéricos , Anestesiologia/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Mídias Sociais/estatística & dados numéricos , Humanos , Japão , Computação Matemática , Projetos de Pesquisa , Sociedades Médicas/estatística & dados numéricos , Inquéritos e Questionários
18.
J Am Board Fam Med ; 34(Suppl): S26-S28, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33622813

RESUMO

COVID-19 is primarily a respiratory illness. Historically, upper and lower respiratory illness has been cared for at home or in the ambulatory primary care setting. It is likely that patients experiencing COVID-19-like symptoms may first contact their primary care provider. The Medical Expenditure Panel Survey (MEPS) is a representative sample of patients from the United States that regularly assesses their use of medical care services. We analyzed 2017 MEPS data to determine the number and proportion of patients who were seen in primary care or family medicine ambulatory settings or hospitalized for upper or lower respiratory illness or pneumonia. In a given year, 19.5 million patients are seen by primary care for an upper respiratory illness, 10.7 million patients for bronchitis, and 9 million for pneumonia. In contrast, 890,000 patients are hospitalized with pneumonia. Given that a primary etiology for respiratory illness in early 2020 was SARS CoV-2 (COVID-19), primary care practices likely were the site of first contact for most patients with COVID-19 illness. Unfortunately, there has been inadequate support for in-person and telehealth visits. Primary care clinicians reported serious shortages of personal protective equipment (PPE) and testing capacity. Inadequate reimbursement for telehealth visits coupled with decreased in-person visits put primary care practices at risk of layoffs and closure. Policies related to primary care payment, federal relief efforts, PPE access, testing and follow-up capacity, and telehealth technical support are essential so primary care can provide first contact and continuity for their patients and communities throughout the COVID-19 pandemic response and recovery.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Medicina de Família e Comunidade/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Assistência Ambulatorial/organização & administração , Medicina de Família e Comunidade/organização & administração , Pesquisas sobre Serviços de Saúde , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Equipamento de Proteção Individual/provisão & distribução , Atenção Primária à Saúde/organização & administração , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Estados Unidos
19.
Australas Psychiatry ; 29(2): 194-199, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33626304

RESUMO

OBJECTIVE: The Australian federal government introduced new COVID-19 psychiatrist Medicare Benefits Schedule (MBS) telehealth items to assist with providing private specialist care. We investigate private psychiatrists' uptake of video and telephone telehealth, as well as total (telehealth and face-to-face) consultations for Quarter 3 (July-September), 2020. We compare these to the same quarter in 2019. METHOD: MBS-item service data were extracted for COVID-19-psychiatrist video and telephone telehealth item numbers and compared with Quarter 3 (July-September), 2019, of face-to-face consultations for the whole of Australia. RESULTS: The number of psychiatry consultations (telehealth and face-to-face) rose during the first wave of the pandemic in Quarter 3, 2020, by 14% compared to Quarter 3, 2019, with telehealth 43% of this total. Face-to-face consultations in Quarter 3, 2020 were only 64% of the comparative number of Quarter 3, 2019 consultations. Most telehealth involved short telephone consultations of ⩽15-30 min. Video consultations comprised 42% of total telehealth provision: these were for new patient assessments and longer consultations. These figures represent increased face-to-face consultation compared to Quarter 2, 2020, with substantial maintenance of telehealth consultations. CONCLUSIONS: Private psychiatrists continued using the new COVID-19 MBS telehealth items for Quarter 3, 2020 to increase the number of patient care contacts in the context of decreased face-to-face consultations compared to 2019, but increased face-to-face consultations compared to Quarter 2, 2020.


Assuntos
/prevenção & controle , Transtornos Mentais/terapia , Serviços de Saúde Mental/tendências , Padrões de Prática Médica/tendências , Prática Privada/tendências , Psiquiatria/tendências , Telemedicina/tendências , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/tendências , Austrália , Utilização de Instalações e Serviços/tendências , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Humanos , Serviços de Saúde Mental/organização & administração , Programas Nacionais de Saúde , Pandemias , Padrões de Prática Médica/organização & administração , Prática Privada/organização & administração , Psiquiatria/organização & administração , Telemedicina/métodos , Telemedicina/organização & administração , Telefone/tendências , Comunicação por Videoconferência/tendências
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