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1.
J Ambul Care Manage ; 45(1): 13-21, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34392258

RESUMO

Federally Qualified Health Centers (FQHCs) have been essential in response to COVID-19 outbreaks among vulnerable populations. Our rural FQHC had a primary role in early detection of and response to a poultry plant-related outbreak at the outset of the pandemic that disproportionately and gravely affected the local Hispanic community. The health center activated a rapid local response that included the community's first mass testing event and first acute respiratory treatment clinic, both of which were central to abatement. Lessons learned from this experience provide important guidance for the potential role of FQHCs in infection outbreak preparedness in marginalized communities.


Assuntos
COVID-19 , Instituições de Assistência Ambulatorial , Humanos , Pandemias , SARS-CoV-2 , Populações Vulneráveis
2.
BMC Health Serv Res ; 21(1): 1200, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34740361

RESUMO

BACKGROUND: Healthcare workers (HCW) are at higher risk of tuberculosis (TB) than the general population. We assessed healthcare facilities for their TB infection control standards and priorities. METHODS: A standardised tool was applied. The assessment was conducted by direct observation, documents review and interviews with the facility heads. RESULTS: Twenty healthcare facilities were assessed; 17 dispensaries, an HIV-clinic, a private not-for-profit hospital and a public regional hospital. In both hospitals, outpatient departments, internal medicine wards, paediatric wards, emergency departments; and the MDR-TB unit of the public regional hospital were assessed. In Gabon, there are currently no national guidelines for TB infection control (TBIC) in healthcare settings. Consequently, none of the facilities had an infection control plan or TBIC focal point. In three departments of two facilities (2/20 facilities), TB patients and presumed TB cases were observed to be consistently provided with surgical masks. One structure reported to regularly test some of its personnel for TB. Consultation rooms were adequately ventilated in six primary care level facilities (6/17 dispensaries) and in none of the hospitals, due to the use of air conditioning. Adequate personal protective equipment was not provided regularly by the facilities and was only found to be supplied in the MDR-TB unit and one of the paediatric wards. CONCLUSIONS: In Moyen-Ogooué province, implementation of TBIC in healthcare settings is generally low. Consequently, HCW are not sufficiently protected and therefore at risk for M. tuberculosis infection. There is an urgent need for national TBIC guidelines and training of health workers to safeguard implementation.


Assuntos
Infecção Hospitalar , Controle de Infecções , Tuberculose , Instituições de Assistência Ambulatorial , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Atenção à Saúde , Gabão/epidemiologia , Pessoal de Saúde , Humanos , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
3.
J Korean Med Sci ; 36(42): e295, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34725979

RESUMO

BACKGROUND: To minimize nosocomial infection against coronavirus disease 2019 (COVID-19), most hospitals conduct a prescreening process to evaluate the patient or guardian of any symptoms suggestive of COVID-19 or exposure to a COVID-19 patient at entrances of hospital buildings. In our hospital, we have implemented a two-level prescreening process in the outpatient clinic: an initial prescreening process at the entrance of the outpatient clinic (PPEO) and a second prescreening process is repeated in each department. If any symptoms or epidemiological history are identified at the second level, an emergency code is announced through the hospital's address system. The patient is then guided outside through a designated aisle. In this study, we analyze the cases missed in the PPEO that caused the emergency code to be applied. METHODS: All cases reported from March 2020 to April 2021 were analyzed retrospectively. We calculated the incidence of cases missed by the PPEO per 1,000 outpatients and compared the incidence between first-time hospital visitors and those visiting for the second time or more; morning and afternoon office hours; and days of the week. RESULTS: During the study period, the emergency code was applied to 449 cases missed by the PPEO. Among those cases, 20.7% were reported in otorhinolaryngology, followed by 11.6% in gastroenterology, 5.8% in urology, and 5.8% in dermatology. Fever was the most common symptom (59.9%), followed by cough (19.8%). The incidence of cases per 1,000 outpatients was significantly higher among first-time visitors than among those visiting for the second time or more (1.77 [confidence interval (CI), 1.44-2.10] vs. 0.59 [CI, 0.52-0.65], respectively) (P < 0.001). CONCLUSION: Fever was the most common symptom missed by the PPEO, and otorhinolaryngology and gastroenterology most frequently reported missed cases. Cases missed by the PPEO were more likely to occur among first-time visitors than returning visitors. The results obtained from this study can provide insights or recommendations to other healthcare facilities in operating prescreening processes during the COVID-19 pandemic.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , COVID-19/diagnóstico , COVID-19/prevenção & controle , Tosse/etiologia , Febre/etiologia , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , COVID-19/epidemiologia , Criança , Feminino , Humanos , Incidência , Controle de Infecções , Masculino , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
4.
Int J Equity Health ; 20(1): 239, 2021 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-34736459

RESUMO

BACKGROUND: For many low and middle-income countries poor quality health care is now responsible for a greater number of deaths than insufficient access to care. This has in turn raised concerns around the distribution of quality of care in LMICs: do the poor have access to lower quality health care compared to the rich? The aim of this study is to investigate the extent of inequalities in the availability of quality health services across the Indonesian health system with a particular focus on differences between care delivered in the public and private sectors. METHODS: Using the Indonesian Family Life Survey (wave 5, 2015), 15,877 households in 312 communities were linked with a representative sample of both public and private health facilities available in the same communities. Quality of health facilities was assessed using both a facility service readiness score and a knowledge score constructed using clinical vignettes. Ordinary least squares regression models were used to investigate the determinants of quality in public and private health facilities. RESULTS: In both sectors, inequalities in both quality scores existed between major islands. In public facilities, inequalities in readiness scores persisted between rural and urban areas, and to a lesser extent between rich and poor communities. CONCLUSION: In order to reach the ambitious stated goal of reaching Universal Health Coverage in Indonesia, priority should be given to redressing current inequalities in the quality of care.


Assuntos
Instalações de Saúde , Acesso aos Serviços de Saúde , Instituições de Assistência Ambulatorial , Humanos , Indonésia , Atenção Primária à Saúde , Qualidade da Assistência à Saúde
5.
Bull World Health Organ ; 99(11): 795-804, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34737472

RESUMO

Objective: To evaluate the impact of a peer-referral and clinic welcome programme for reducing barriers to adolescents' uptake of family planning services in Uganda. Methods: We developed an intervention using behavioural design and carried out a stratified, randomized controlled evaluation of the intervention in girls aged 15-19 years. Sexual and reproductive health clinics were randomized into control (56 clinics) and intervention groups (60 clinics). All intervention clinics received the core intervention (materials to create an adolescent-friendly environment and referral cards to give to friends), while a subset of clinics additionally received training in youth-friendly service provision. We collected clinics' routine data on monthly numbers of visits by adults and adolescents over a 15-month baseline and 6-month intervention period, 2018-2020. Findings: In multivariate regression analysis we found significant effects of the intervention on primary outcomes in the pooled intervention group compared with control. Mean monthly visits by adolescents increased by 45% (incidence rate ratio, IRR: 1.45; 95% confidence interval, CI: 1.14-1.85), or over five additional adolescent clients per clinic per month. The mean adolescent proportion of total clients improved by 5.3 percentage points (95% CI: 0.02-0.09). Within treatment arms, clinics receiving the training in youth-friendly service provision showed the strongest effects: a 62% increase (IRR: 1.62; 95% CI: 1.21-2.17) in adolescent clients, or over seven additional adolescents per clinic per month, relative to the control group. Conclusion: A behavioural change intervention designed to target identified barriers can increase adolescents' uptake of family planning counselling and services.


Assuntos
Serviços de Planejamento Familiar , Educação Sexual , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Feminino , Humanos , Encaminhamento e Consulta , Uganda
6.
Artigo em Inglês | MEDLINE | ID: mdl-34770141

RESUMO

BACKGROUND: An increasing number of maternity care providers encounter pregnant women who request less care than recommended. A designated outpatient clinic for women who request less care than recommended was set up in Nijmegen, the Netherlands. The clinic's aim is to ensure that women make well-informed choices and arrive at a care plan that is acceptable to all parties. The aim of this study is to make the clinic's approach explicit by examining care providers' experiences who work with or within the clinic. METHODS: qualitative analysis of in-depth interviews with Dutch midwives (n = 6) and obstetricians (n = 4) on their experiences with the outpatient clinic "Maternity Care Outside the Guidelines" in Nijmegen, the Netherlands. RESULTS: Four main themes were identified: (1) "Trusting mothers, childbirth and colleagues"; (2) "A supportive communication style"; (3) "Continuity of carer"; (4) "Willingness to reconsider responsibility and risk". One overarching theme emerged from the data, which was "Guaranteeing women's autonomy". Mutual trust is a prerequisite for a constructive dialogue about birth plans and can be built and maintained more easily when there is continuity of carer during pregnancy and birth. Discussing birth plans at the clinic was believed to be successful because the care providers listen to women, take them seriously, show empathy and respect their right to refuse care. A change in vision on responsibility and risk is needed to overcome barriers such as providers' fear of adverse outcomes. Taking a more flexible approach towards care outside the guidelines demands courage but is necessary to guarantee women's autonomy. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: In order to fulfil women's needs and to prevent negative choices, care providers should care for women with trust, respect for autonomy, and provide freedom of choice and continuity. Care providers should reflect on and discuss why they are reluctant to support women's wishes that go against their personal values. The structured approach used at this clinic could be helpful to maternity care providers in other contexts, to make them feel less vulnerable when working outside the guidelines.


Assuntos
Serviços de Saúde Materna , Tocologia , Instituições de Assistência Ambulatorial , Feminino , Hospitais , Humanos , Gravidez , Pesquisa Qualitativa
7.
Glob Health Action ; 14(1): 1989807, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34779363

RESUMO

BACKGROUND: The majority of deaths amongst children under 5 years are still due to preventable infectious causes. Emergency care has been identified as a key health system weakness, and referrals are often challenging. OBJECTIVE: We aimed to establish how prepared frontline facilities in Malawi are to implement WHO Emergency Triage Assessment and Treatment (ETAT) guidelines, to support policy and planning decisions. METHODS: We conducted a concurrent mixed-methods study, including facility audit; healthcare provider survey; focus group discussions (FGD) and semi-structured interviews with facility staff. The study was conducted in two districts in Malawi, Zomba and Mchinji, between January and May 2019. We included all frontline facilities, including dispensaries, primary health centres, rural and community hospitals. Quantitative data were described using proportions, means and linear regression. Qualitative data was analysed using a framework approach. Data were analysed separately and then triangulated into common themes. RESULTS: Forty-seven facilities and 531 healthcare providers were included in the audit and survey; 6 FGDs and 5 interviews were completed. Four common themes emerged: (1) current emergency case management; (2) referral practices; (3) trained staff capacity; (4) opportunities and barriers for ETAT. Triage was conducted in most facilities with various methods described, and 53% reporting all staff are responsible. Referrals were common, but challenging due to issues in transportation. Twelve percent of survey respondents had ETAT training, with clinical officers (41%) reporting this more frequently than other cadres. Training was associated with increased knowledge, independent of cadre. The main barriers to ETAT implementation were the lack of resources, but opportunities to improve quality of care were reported. CONCLUSIONS: Malawian frontline facilities are already providing a level of emergency paediatric care, but issues in training, drug supplies and equipment were present. To effectively scale-up ETAT, policies need to include supply chain management, maintenance and strengthening referral communication.


Assuntos
Serviço Hospitalar de Emergência , Triagem , Instituições de Assistência Ambulatorial , Criança , Pré-Escolar , Humanos , Malaui , Atenção Primária à Saúde
8.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 29(Special Issue): 1271-1274, 2021 Aug.
Artigo em Russo | MEDLINE | ID: mdl-34792876

RESUMO

The relevance of the problem under study is due to the fact that the medical organization must be aware of the target patient: to know who he is, how and why he wants to receive a particular medical service. All the information received and its analysis will allow us to develop a real scheme of mutually beneficial communication, convenient for each of the parties-the medical organization and the patient, which will allow us to reveal the weaknesses in the work and respond to them in a timely manner. The purpose of the study: to form an assessment of the patient's satisfaction with the medical organization and its services, taking into account the interest, feelings, purpose, arguments and thoughts that appear in the patient from the moment of the first contact with the clinic, with the display of the point of contact in graphic form, in order to minimize all possible obstacles in his route to receiving quality medical services and increasing the economic efficiency of the clinic.


Assuntos
Comunicação , Satisfação do Paciente , Instituições de Assistência Ambulatorial , Humanos , Masculino , Organizações , Satisfação Pessoal
9.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 29(Special Issue): 1331-1337, 2021 Aug.
Artigo em Russo | MEDLINE | ID: mdl-34792886

RESUMO

Scientific research and their inclusion in the health care system is an important part of modern medical science. To study the readiness of primary care physicians as well as administration staff to introduce a research component into the national health care system, "The Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department" conducted an online survey of two groups of respondents - physicians of primary care settings (n = 593) and heads of outpatient clinics in Moscow (n = 168) in 2021. The results of the study show the insufficient involvement of primary care doctors in research activities in their working places: more than half do not consider scientific activities as a priority, motivating it by the lack of conditions, practical skills, age and health status as well as high level of employment, although they do not reject it in the future. Heads of Moscow primary health care settings demonstrate similar answers. According to their opinion, research activities are poorly represented in organizations of this type, and most likely the situation will not be changed in the near future; about half do not have sufficient information about the number of employees engaged in scientific work and are rarely familiar with their topics (often extensive, represented by various fields of medicine); about one third of managers reported participating in research projects of Moscow City Department of Health. The study made it possible to identify barriers that prevent the introduction of research components into the activities of Moscow primary health care organizations, which should be taken into account when making managerial decisions.


Assuntos
Instituições de Assistência Ambulatorial , Atenção à Saúde , Humanos , Moscou , Atenção Primária à Saúde , Inquéritos e Questionários
10.
Jt Dis Relat Surg ; 32(3): 759-766, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34842110

RESUMO

OBJECTIVES: The aim of the present study was to assess the prescriptions of patients who were admitted to the orthopedics and traumatology outpatient clinic of a tertiary care hospital according to the WHO prescribing indicators. PATIENTS AND METHODS: Between January 2020 and March 2020, a total of 1,024 patients (273 males, 751 females; mean age: 51.9±13.9 years; range, 19 to 103 years) were included in the study. Only patients who were prescribed drugs and 18 years of age or older were included in the study. The WHO core prescribing indicators were utilized for the assessment of rational drug use. The WHO prescribing indicators percentages between the age categories were analyzed. The average number of drugs between the age categories was also examined. RESULTS: The average number of drugs per encounter was 2.9. The percentage of encounters with an antibiotic prescribed was 2.6% and with an injection prescribed was 10.7%. The percentage of drugs prescribed from essential drugs list was 33.8%. There were no prescriptions consisting generic name of drugs (0%). Polypharmacy was significantly higher in the ≥65 age group compared to the 18-44 age group (p=0.001). CONCLUSION: The percentage of encounters with an antibiotic and injection prescribed were optimal according to WHO standards, while the average number of drugs per encounter was higher than the WHO ideal ranges. Unfortunately, the parameters such as the percentage of prescribing with generic name and from essential drug list was far more behind the optimal range.


Assuntos
Medicamentos Essenciais , Ortopedia , Traumatologia , Adolescente , Adulto , Idoso , Instituições de Assistência Ambulatorial , Estudos Transversais , Prescrições de Medicamentos , Uso de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica
11.
N Z Med J ; 134(1545): 91-105, 2021 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-34788275

RESUMO

AIM: To develop a distance-based index of patients' spatial accessibility to healthcare services as a quantifiable basis for analysing health services and health outcomes in urban, rural and remote locations. METHOD: A distance score was calculated based on each primary health organisation enrollee's shortest distance to the nearest primary care facility and to the nearest secondary or tertiary hospital. The distance scores were then grouped into ten distance deciles (DDs). RESULTS: When these DDs are compared with Stats NZ's urban-rural indicator, "small urban areas" fall mainly along with rural and remote areas into the two DDs (DD9 and DD10) based on the greatest distance scores. When compared with Stats NZ's urban accessibility classification, the same two DDs correspond mainly to the most rural and remote areas. In both the North and South islands, 25% or more of enrollees in DD9 and DD10 are aged 60+. Of enrollees in DD10 in the North Island, 32% are Maori and 33% live in highly deprived areas (NZDep2013 deciles 9 and 10). CONCLUSION: The results provide an initial validation of the patient-centred health services spatial accessibility index as a measure of rurality and remoteness for analysis of health service provision and health outcomes.


Assuntos
Instituições de Assistência Ambulatorial , Acesso aos Serviços de Saúde , Assistência Centrada no Paciente , Serviços de Saúde Rural , Humanos , Nova Zelândia
12.
Appl Nurs Res ; 62: 151493, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34814997

RESUMO

BACKGROUND: Falls impose a prominent public health problem among older adults. Falls are preventable through multi-factorial interventions offered by a Falls Prevention Clinic. Yet, adherence to recommendations is often average or low, particularly for lifestyle recommendations. To achieve full health benefits from such a multifactorial intervention, improving adherence is critical. PURPOSE: Our primary objective was to conduct a narrative review to develop a theoretical framework, categorized by intrinsic and extrinsic factors that impact adherence to falls prevention interventions, considering a Falls Prevention Clinic setting. MATERIALS AND METHODS: We conducted a comprehensive literature review of all peer-reviewed manuscripts published between 1998 through August 2020 among older adults (i.e., aged 60 years and older) who fall. We used the following search engines: Pubmed, CINAHL, Embase, MedLine, Cochrane and Google Scholar. RESULTS: The theoretical framework categorizes two dominate factors (comprised of specific domains) that affect adherence among older adults who fall. Intrinsic factors comprised of three domains included: demographics (age, gender, ethnicity), individual factors (participation, control, behavioural habits) and health factors (physical health, mental state, perceived severity). Extrinsic factors comprised of four domains included: caregiver factors (family dynamics, miscarried helping) medication factors (availability, accessibility, drug handling, reliability), health system (costs, communication, relationship with doctors, attention) and environmental factors (public health policy interventions). Intrinsic factors such as high socioeconomic status, high health literacy, being married and extrinsic factors such as low healthcare cost, better communication and useful policy interventions were associated with greater adherence. CONCLUSION: This theoretical model elucidates priority factors to target for promoting adherence to reduce falls, decrease mortality and, lower fall-related healthcare costs.


Assuntos
Acidentes por Quedas , Instituições de Assistência Ambulatorial , Acidentes por Quedas/prevenção & controle , Idoso , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
13.
Invest Educ Enferm ; 39(3)2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34822237

RESUMO

OBJECTIVES: To identify the proportion of poor of glycemic control and associated factors among people with type 2 diabetes attending a regional reference outpatient clinic in Mato Grosso (Brazil). METHODS: This is a cross-sectional quantitative study based on data from medical records of 338 people with type 2 diabetes who attend a state reference outpatient clinic in Mato Grosso (Brazil). Information on glycemic control, sociodemographic factors, lifestyle and clinical conditions was collected. RESULTS: The prevalence of elevated glycated hemoglobin was 47.34%. In the Poisson multiple regression model analysis with robust variance, poor glycemic control was significantly associated (p<0.05) with the following factors: insulin use (Prevalence Ratio -PR = 2.03), fasting glucose ≤70 and ≥100 mg/dL (PR = 2.0), postprandial glucose ≥180 mg/dL (PR = 1.76), no physical activity (PR = 1.62), the interaction between age group ≤59 years and the time of disease diagnosis >10 years (PR = 1.58), and presence of arterial hypertension (PR = 0.79). CONCLUSIONS: Most users of the reference outpatient clinic with type 2 diabetes had poor glycemic control associated with risk factors that alter glycated hemoglobin and negatively affect the achievement of established glycemic levels.


Assuntos
Diabetes Mellitus Tipo 2 , Instituições de Assistência Ambulatorial , Glicemia , Brasil/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Controle Glicêmico , Humanos , Pessoa de Meia-Idade
14.
BMC Med Res Methodol ; 21(1): 247, 2021 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-34773971

RESUMO

BACKGROUND: Participation of general practitioners is crucial for health care studies. However, recruiting them is an ongoing challenge and participation rates of general practitioners around the globe are often low. One feasible and cost-efficient approach to potentially enhance participation rates among general practitioners are personalized invitation letters, since they may increase one's attention to and appreciation of a study. Still, evidence whether this method actually affects participation is scarce and ambiguous in relation to physicians. METHODS: We undertook a randomized trial in a sample of general practitioners from three German states in the context of a large, observational study on physicians' coordination and uptake of recommended cardiovascular ambulatory care. An intervention group (n = 757 general practitioners) received a personalized invitation to participate in the observational study, the control group (n = 754 general practitioners) received a generic invitation. Both groups were blinded to group assignment. Eventual participation rates as well as the number and types of responses overall were compared between arms. Besides the main intervention, sociodemographic and geographical context factors were considered as well. RESULTS: The overall participation rate among physicians was 2.6% (2.8% in the intervention group and 2.4% in the control group). No statistically significant effect of personalization on participation of physicians was found (relative risk to participate when receiving a personalized invitation of 1.17 [95%-CI: 0.62, 2.21]). However, the number of responses to the invitation varied significantly between the geographical regions. CONCLUSIONS: Personalization of first written contact alone did not improve research participation among general practitioners, which was overall very low. TRIAL REGISTRATION: The study in which the trial was embedded has been registered prospectively at the German Clinical Trials Register (DRKS) under registration number DRKS00019219 .


Assuntos
Clínicos Gerais , Assistência Ambulatorial , Instituições de Assistência Ambulatorial , Atenção à Saúde , Humanos , Projetos de Pesquisa
15.
J Glob Health ; 11: 05016, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34804513

RESUMO

Background: The COVID-19 pandemic has resulted in both direct and indirect impacts on patients and population health. To better understand the impact of the measures put in place by the Kenyan government on health care provision, this project sought to document and quantify the impact of the restriction measures on patients' attendance in Machakos County. Methods: Hospital attendance at 10 public hospitals were obtained including Machakos Level 5 Hospital (the county referral facility) and one health facility from each of the 9 Sub-counties of Machakos County. Data on outpatient and inpatient attendance from November 2019 to May 2020 were obtained and compared with a similar calendar period from the previous year. Key informant interviews (KIIs), focused group discussions (FGDs) and in-depth interviews were conducted with the hospital management personnel (n = 46), as well as with the patients (n = 453) who missed scheduled clinic appointments at Machakos Level 5 Hospital to understand the reasons behind the drop in attendance numbers. Results: Overall, there was a decline in the number of patient attendances compared to the prior calendar period. Outpatient attendance reduced by 24.7% in April 2020 (n = 39 704) compared with April 2019 (n = 52 731). Inpatient attendance reduced by 13.7% in April 2020 (n = 3298) compared with April 2019 (n = 2845). Declines in patient attendance were observed in all hospitals that had inpatient services. A great decline in attendance was noted among larger hospitals that run specialty clinics, which were suspended mid-March 2020 when the first case of COVID-19 was announced. Some increase in attendance was noted in May when most clinics resumed operations. Most hospital management staff highlighted the closure of clinics as the main reason for reduced attendance while patients added that they also feared contracting COVID-19 at the hospital and the stigma they would face should they be quarantined. Conclusions: The findings from this study provide evidence that the COVID-19 pandemic outbreak and measures put in place by the government to curb its spread disrupted the provision of health services in Machakos County. Efforts to minimize adverse impacts of indirect impacts on access to health care and preventative services to counter increased morbidity and mortality require attention throughout the pandemic.


Assuntos
COVID-19 , Pandemias , Instituições de Assistência Ambulatorial , Hospitais Públicos , Humanos , Quênia , SARS-CoV-2
16.
MMWR Surveill Summ ; 70(7): 1-20, 2021 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-34735419

RESUMO

PROBLEM: Sexually transmitted diseases (STDs) are a major cause of morbidity in the United States, with an estimated $15.9 billion in lifetime direct medical costs. Although the majority of STDs are diagnosed in the private sector, publicly funded STD clinics have an important role in providing comprehensive sexual health care services, including STD and HIV screening, for a broad range of patients. In certain cases, STD clinics often are the only source of sexual health care for patients, particularly among gay, bisexual, and other men who have sex with men (MSM). PERIOD COVERED: 2010-2018. DESCRIPTION OF THE SYSTEM: The STD Surveillance Network (SSuN) is an ongoing sentinel surveillance system for monitoring clinical information among patients attending STD clinics. SSuN is a collaboration of competitively selected state and city health departments that conduct facility-based sentinel surveillance in STD clinics. Information routinely collected through the course of patient encounters is obtained for all patients seeking care in the participating STD clinics. This information includes demographic, behavioral, and clinical characteristics (e.g., STD and HIV tests performed and STD and HIV diagnoses). This report presents 2010-2018 SSuN data from 14 STD clinics in five cities (Baltimore, Maryland; New York City, New York; Philadelphia, Pennsylvania; San Francisco, California; and Seattle, Washington) to describe the patient populations seeking care in these STD clinics. Estimated numbers and percentages of patients receiving selected STD-related health services were calculated for each year by using an inverse variance weighted random-effects model, adjusting for heterogeneity among SSuN jurisdictions. Trends in receipt of selected STD-related health services were examined and included HIV screening after an acute STD diagnosis among persons not previously known to have HIV infection, annual chlamydia screening among adolescent and young females, and extragenital chlamydia and gonorrhea screening among MSM. RESULTS: During 2010-2018, the total number of annual visits made in the 14 participating STD clinics decreased 29.8% (from 145,728 to 102,275 visits), and the total number of unique patients examined in the clinics decreased 35.1% (from 94,281 to 61,172 patients). Decreases in the number of unique patients occurred both among men who have sex with women only (42.4%; from 37,842 in 2010 to 21,781 in 2018) and among females (51.4%; from 36,485 in 2010 to 17,721 in 2018). The decreases in the number of female patients were observed across all age groups, although they were more pronounced among females aged ≤24 years (66.4%; from 17,721 in 2010 to 5,962 in 2018). In contrast, the number of patients identified as MSM increased 44.0% (from 12,859 in 2010 to 18,512 in 2018), with the greatest increase among MSM aged ≥25 years (58.6%; from 9,918 in 2010 to 15,733 in 2018). Among visits during which an acute STD (defined as chlamydia, gonorrhea, or primary or secondary syphilis) was diagnosed, the percentage of visits during which an HIV test was performed within approximately 14 days of the STD diagnosis increased from 58.2% in 2010 to 70.2% in 2018. Among those patients tested, 1,672 HIV infections were identified, of which 84.0% were among MSM. Among females aged 15-24 years, the percentage screened for chlamydia in any calendar year increased from 88.6% in 2010 to 90.6% in 2018. However, because fewer females aged 15-24 years attended these clinics during the study period, the crude number of adolescent and young females tested for chlamydia decreased from 14,249 in 2010 to 4,507 in 2018. During 2010-2018, the percentage of females retested after their first positive chlamydia diagnosis during the same year ranged from 11.4% to 13.3%. During 2010-2018, the percentage of MSM tested for rectal chlamydia and rectal gonorrhea increased (from 54.7% to 57.8% and from 55.0% to 58.4%, respectively). During the same period, increases were noted in the percentage of MSM with diagnosed rectal chlamydia (from 15.5% in 2010 to 17.7% in 2018) and rectal gonorrhea (from 13.3% in 2010 to 17.1% in 2018). In contrast with pharyngeal chlamydia, pharyngeal gonorrhea screening was more common (from 69.5% in 2010 to 74.6% in 2018), and the percentage positive doubled during the study period (from 7.3% in 2010 to 14.8% in 2018). Pharyngeal chlamydia testing also increased (from 50.3% in 2010 to 72.9% in 2018), with concurrent decreases in positivity (from 4.2% in 2010 to 2.6% in 2018). INTERPRETATION: During 2010-2018, changes occurred in the demographic composition of patients attending STD clinics participating in SSuN. Understanding trends in the demographic profile of STD patients and services provided can help identify addressable gaps in STD control efforts and direct public health action. Overall, fewer females, especially those aged 15-24 years, accessed care in these STD clinics during the study period. Untreated STDs among adolescent and young females can have serious consequences, including pelvic inflammatory disease and infertility. Additional efforts to monitor where adolescent and young females seek care and to ensure they are receiving quality STD-related health services are needed, especially considering increases in reported cases of STDs among females. Increases in the number of MSM attending STD clinics present a unique opportunity to reach this population with STD and HIV prevention services. Although a large percentage of STD cases are diagnosed outside of STD clinics, publicly funded STD clinics are an important safety-net provider of STD-related health services and provide vital STD-related health services for patient populations at risk for the consequences of STDs and HIV infection. PUBLIC HEALTH ACTIONS: STD-related health services represent effective strategies for preventing STD and HIV transmission and acquisition or STD-related sequelae. Ensuring that all persons receive quality HIV and STD prevention and treatment services is vital for an effective public health approach to reducing STDs. STD clinics provide crucial safety-net services for preventing STD-related morbidity, including timely identification and treatment of curable STDs such as chlamydia, gonorrhea, and syphilis. Increases in the numbers of MSM attending STD clinics participating in SSuN provide additional opportunities for linking patients to high-impact HIV preventive services (e.g., pre-exposure prophylaxis), and the clinics are positioned to facilitate initiation or resumption of treatment among persons living with HIV.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vigilância de Evento Sentinela , Doenças Sexualmente Transmissíveis/terapia , Adolescente , Distribuição por Idade , Feminino , Humanos , Masculino , Distribuição por Sexo , Comportamento Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
17.
Glob Health Res Policy ; 6(1): 44, 2021 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-34753513

RESUMO

BACKGROUND: After its landfall in Puerto Rico in 2017, Hurricane Maria caused the longest blackout in United States history, producing cascading effects on a health care system that had already been weakened by decades of public sector austerity and neoliberal health reforms. This article addresses how health care professionals and administrators experienced the health care system's collapse and the strategies used by them to meet their communities' health needs. METHODS: Data were collected between September 2018 and February 2020. Ethnographic observations in health care facilities and semi-structured qualitative interviews with representatives of the health care system were conducted. This paper focuses on data from interviews with health care providers (n = 10) and administrators (n = 10), and an ethnographic visit to a pop-up community clinic. The analysis consisted of systematic thematic coding of the interview transcripts and ethnographic field notes. RESULTS: Results provide insight on how participants, who witnessed first-hand the collapse of Puerto Rico's health care system, responded to the crisis after Maria. The prolonged power outage and lack of a disaster management plan were partly responsible for the death of 3,052 individuals who experienced extended interruptions in access to medical care. Participants reported a sense of abandonment by the government and feelings of mistrust. They also described the health sector as chaotic and lacking clear guidelines on how to provide services or cope with personal crises while working under extreme conditions. In such circumstances, they developed resilient responses to meet communities' health needs (e.g., itinerant acupuncture services, re-locating physicians to local pharmacies). CONCLUSIONS: Participants' narratives emphasize that the management of Hurricane Maria was fraught with political and economic constraints affecting Puerto Rico. Ineffective planning and post-Maria responses of the local and federal governments were determinants of the disaster's impact. The findings contribute to a growing scientific literature indicating that Hurricane Maria revealed 'the collapse before the collapse,' alluding to the structural deficiencies that presaged the catastrophic event. In the context of governmental abandonment, the authors argue for the importance of developing alternative strategies in post-disaster health care provision among health professionals and administrators who work at the front lines of recovery.


Assuntos
Tempestades Ciclônicas , Desastres , Instituições de Assistência Ambulatorial , Pessoal de Saúde , Humanos , Percepção , Porto Rico , Estados Unidos
18.
BMC Health Serv Res ; 21(1): 1259, 2021 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-34801025

RESUMO

BACKGROUND: Processes such as prior authorization (PA) for medications, implemented by health insurance companies to ensure that safe, appropriate, cost-effective, and evidence-based care is provided to all members, have created inefficiencies within healthcare systems. Thus, healthcare systems have implemented supplemental processes to reduce burden and ensure efficiency, timeliness, and appropriate care. OBJECTIVE: Evaluate implementation outcomes of two initiatives related to PA for medications: a common record that records all PA-related information that was integrated into the health record and an auto-routing of specialty prescriptions to a hospital-owned specialty pharmacy. METHODS: We conducted semi-structured interviews with medical staff to understand their experience, acceptability, adoption, and feasibility of these initiatives guided by Proctor's Framework for Implementation Outcomes. Transcripts were analyzed using consensus coding. RESULTS: Eleven medical staff participated in semi-structured interviews. The two initiatives were analyzed together because the findings were similar across both for our outcomes of acceptability, adoption, and feasibility. Participants found the implemented initiatives to be acceptable and beneficial but felt there were still challenges with the new workflow. The initiatives were fully adopted by only one clinic site within the healthcare system, but limitations arose when adopting to another site. Individuals felt the initiatives were feasible and improved workflow, communication, and transparency. However, participants described future adaptations that would help improve this process including improved standardization, automation, and transparency. CONCLUSION: The acceptability, adoption, and feasibility of two initiatives to improve the PA process within the one clinical site were well received but issues of generalizability limited the initiatives adoption system wide.


Assuntos
Atenção à Saúde , Autorização Prévia , Instituições de Assistência Ambulatorial , Comunicação , Estudos de Viabilidade , Humanos
19.
Front Public Health ; 9: 698030, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34631643

RESUMO

Nepal is a country in south Asia with a high burden of cardiometabolic diseases (CMDs). Strengthening primary healthcare (PHC) is a key strategy to mitigate this increasing burden and achieve universal health coverage. While previous studies in Nepal have assessed PHC use among the elderly, none have specifically explored PHC use among people with CMDs. Therefore, this mixed-methods study aimed to assess the use and perception of PHC services in Nepal among people living with CMDs for primary and secondary prevention of cardiovascular disease. We used a quantitative survey followed-up by semi-structured qualitative interviews. The sampling frame comprised five PHC facilities in Sindhuli district (rural; eastern Nepal) and five in Kailali district (urban; western Nepal), with participants selected from each facility via convenience sampling. 114 people (mean age: 54.5 ± 14.7, sex ratio 1.04) with CMDs participated in the survey. Survey data showed general dissatisfaction with PHC services. Medicine cost was rated "too expensive" by 52 and 63% of rural and urban participants, respectively. Interview data showed that perceived poor bedside manner was tied to negative perceptions of PHC quality, and vice versa. Lack of resources and excessive barriers to care was mentioned by every interviewee. In conclusion, PHC use was high but overall satisfaction relatively low. Our results suggest that bedside manner is a practical target for future research. Additionally, we identified several barriers to care, and, based on existing literature, we suggest electronic-health interventions may have potential to mitigate these challenges.


Assuntos
Doenças Cardiovasculares , Atenção Primária à Saúde , Adulto , Idoso , Instituições de Assistência Ambulatorial , Doenças Cardiovasculares/epidemiologia , Humanos , Pessoa de Meia-Idade , Nepal/epidemiologia , Percepção
20.
Afr J Prim Health Care Fam Med ; 13(1): e1-e6, 2021 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-34636607

RESUMO

BACKGROUND: In South Africa, patients are meant to attend the clinic close to their place of residence. However, patients often choose which clinic to attend, which results in overcrowding. AIM: This study aimed to investigate the structural and process factors influencing patients' choice to attend a community health centre (CHC) in KwaZulu-Natal, South Africa. SETTING: The study was conducted at the Inanda C Community Health Centre (CHC). METHODS: Systematic random sampling was used to select study participants. A structured questionnaire was used to collect socio-demographic data and assess the factors influencing patients' choice to attend this CHC. RESULTS: There were 400 patients who participated. The commonest structural indicator that patients agreed on as the reason they attend Inanda C CHC was because it has enough medication (126, 73.3%). There was a significant difference in the proportion of patients who agreed that seeing a doctor instead of nurse was a reason for attending this clinic with 118 (68.6%) patients from within the catchment area and 170 (74.6%) from outside the catchment area. The commonest process indicators that patients from within and outside the catchment area agreed on as reasons for attending Inanda C CHC were 'the doctor or nurse explains my sickness and treatment to me' and 'I get good quality of care'. CONCLUSION: The structural and process indicators that influence patients' choice of clinic may need to be improved at other clinics in this area in order to decrease the overcrowding at this clinic.


Assuntos
Instituições de Assistência Ambulatorial , Área Programática de Saúde , Humanos , África do Sul , Inquéritos e Questionários
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