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1.
J Natl Black Nurses Assoc ; 32(1): 35-40, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34562351

RESUMO

Nurses experience high levels of stress. In this study, functional social support and perceived stress of nurses working in secular and religious hospitals were examined. The social support model, the job demands-resources theory, and the transactional model of stress guided this study. The population that was examined was comprised of a convenience and snowballing sample of 84 registered nurses from across the United States. The data collected using the Expanded Nursing Stress Scale, the Inventory of Socially Supportive Behavior survey, and a demographic questionnaire were statistically analyzed using Pearson's correlation and Fisher's Test. Results showed no significant relationship between support and nurses' stress in secular hospitals and no significant relationship between the same variables for nurses' in religious hospitals. Findings also revealed that there was no significant difference in the compared correlations for nurses' support and stress between the two groups. The outcomes will inform healthcare professionals about the association between nurses' support and stress in hospitals with unique missions.


Assuntos
Hospitais Religiosos , Enfermeiras e Enfermeiros , Estudos Transversais , Humanos , Apoio Social , Estresse Psicológico , Inquéritos e Questionários
2.
Trop Doct ; 51(3): 375-378, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34018887

RESUMO

Human factors and a safe operating theatre environment are of paramount importance, wherever surgery is undertaken. The majority of patients in sub-Saharan Africa do not yet have access to safe surgery. The Paediatric ENT Skills and Airway Course introduced and evaluated here was designed to improve outcomes and safety in a typical East African environment. The lectures, tutorials and practicals covered technical and non-technical skills. Responses from pre- and post-course questionnaires were evaluated as an initial surrogate for effectiveness of this course. The latter showed improvement in all taught skills and found universal recommendation. The course had been established to try to minimise morbidity and mortality after paediatric surgery at our institution, KCMC. We encouraged team co-operation in the care of patients, and recommend other centres consider similar courses building on human factors for safer operating theatre working practices.


Assuntos
Anestesia/efeitos adversos , Anestesiologia/educação , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/educação , Pediatria/educação , Adulto , Criança , Competência Clínica , Avaliação Educacional , Hospitais , Hospitais Religiosos , Humanos , Segurança do Paciente , Ressuscitação , Inquéritos e Questionários , Tanzânia
3.
Contraception ; 104(4): 377-382, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34023379

RESUMO

OBJECTIVE: To estimate prevalence of being turned away from a Catholic healthcare setting without receiving desired reproductive care among Wisconsin women and to document firsthand accounts of these experiences. STUDY DESIGN: Between October 2019 and April 2020, we fielded a two-stage survey to Wisconsin women aged 18-45, oversampling rural census tracts and rural counties served by Catholic sole community hospitals. We present prevalence of ever being turned away from a Catholic hospital or clinic without receiving desired contraceptive or fertility care and document accounts of referrals, perceived barriers, and wait times to acquire services elsewhere. RESULTS: The screener response rate was 37.6% (N = 828) and the survey response rate was 83.4% (N = 675). While only 23 (2.0%) of Wisconsin women had ever been turned away from a Catholic hospital or clinic without receiving desired contraceptive or fertility care (95% confidence interval: 1.2%-3.5%), these experiences were more common among women in counties served by Catholic sole community hospitals (n = 9, 8.1% [4.0%-15.6%]) compared to women in other rural census tracts (n = 6, 2.8% [1.3%-6.2%]) and urban census tracts (n = 8, 1.5% [0.7%-3.2%]). Sixteen (69.6%) cited religious restrictions as a barrier to accessing care. Some women - especially those denied tubal ligation - experienced long delays in acquiring time-sensitive care elsewhere. CONCLUSIONS: About 1-in-12 women in Wisconsin rural counties served by Catholic sole community hospitals reported ever being turned away from a Catholic healthcare setting without receiving desired reproductive care. After tubal ligation denials in Catholic facilities, many women faced long wait times to receive care elsewhere. IMPLICATIONS: Wisconsin women in rural counties served by Catholic sole community hospitals were about three times more likely than urban women to have ever been turned away from a Catholic facility. As Catholic healthcare expands nationally, it will be increasingly important to better understand how healthcare prohibitions influence patients' lives.


Assuntos
Catolicismo , Esterilização Tubária , Feminino , Hospitais Religiosos , Humanos , Prevalência , Wisconsin
4.
Contraception ; 104(2): 194-201, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33657425

RESUMO

OBJECTIVES: Postpartum tubal ligation provides demonstrated benefits to women, but access to this procedure is threatened by restrictions at Catholic healthcare institutions. We aimed to understand how insured employees assign responsibility for postpartum sterilization denial and how it impacts their view of the quality of care provided. STUDY DESIGN: We conducted a nationally representative, cross-sectional survey of employees at Standard and Poor's (S&P) 500 companies utilizing a dual panel drawn from Amerispeak, a probability-based research panel, and a non-probability panel. Respondents answered questions about a scenario of a woman denied a tubal ligation due to Catholic hospital policy when her employer-sponsored insurance provided no other hospital choices. Of 1113 eligible panel members, 1001 (90%) completed the survey. Weighted analysis accounted for complex survey design. RESULTS: In response to the tubal ligation denial scenario, 42% of respondents rated hospital quality-of-care as poor or very poor. Sixty percent felt that something should have been done differently, with about half assigning responsibility to the religiously-affiliated hospital for not providing the procedure and half to the insurance company for not including secular hospitals in its network. Finding employers/insurance companies responsible was more common with higher education (RRR = 3.17; 95% CI: 1.58-6.33 some college; RRR = 4.26; 95% CI: 2.10-8.62 bachelor's or more) and less common among non-white respondents (RRR = 0.54; 95% CI: 0.31-0.97). Three quarters of respondents thought the employer should have intervened. CONCLUSIONS: The majority of insured employees do not think women should be denied postpartum tubal ligation. They assign hospitals, insurers, and employers responsibility to remove barriers to care. IMPLICATIONS: Most people who receive health insurance through a large employer disapprove of Catholic hospital restrictions when the patient's insurance restricts her hospital choice. To improve access to comprehensive reproductive care, employers and insurers should assure employees have in-network coverage of hospitals without religious restrictions.


Assuntos
Hospitais Religiosos , Esterilização Tubária , Atitude , Estudos Transversais , Feminino , Hospitais , Humanos , Seguro Saúde
5.
Obstet Gynecol ; 137(6): e169-e176, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33760784

RESUMO

ABSTRACT: Sterilization is one of the most effective and popular forms of contraception in the United States, relied upon by 18.6% of women aged 15-49 years using contraception. Nearly half of procedures are performed during the postpartum period, yet many women who desire postpartum sterilization do not actually undergo the procedure. Factors that may decrease the likelihood of a patient obtaining desired postpartum sterilization include patient-related factors, physician-related factors, lack of available operating rooms and anesthesia, federal consent requirements, and receiving care in some religiously affiliated hospitals. In all discussions and counseling regarding contraception, including postpartum sterilization, it is important to engage in shared decision making while supporting personal agency and patient autonomy. Equitable access to postpartum sterilization is an important strategy to ensure patient-centered care while supporting reproductive autonomy and justice when it comes to decisions regarding family formation. This revision includes updates on barriers to postpartum sterilization and guidance for contraceptive counseling and shared decision making.


Assuntos
Acesso aos Serviços de Saúde , Medicaid , Esterilização Reprodutiva , Tomada de Decisão Compartilhada , Feminino , Hospitais Religiosos , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Medicaid/legislação & jurisprudência , Política Organizacional , Autonomia Pessoal , Período Pós-Parto , Esterilização Reprodutiva/legislação & jurisprudência , Estados Unidos
6.
J Healthc Manag ; 66(1): 33-45, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33411484

RESUMO

EXECUTIVE SUMMARY: More than 600 Catholic hospitals operating in the United States face pressures for efficiency and effectiveness as well as compliance with demands of the Roman Catholic Church. They have responded to the pressures in various ways that have led to mixed models of organizational ownership and management. The purpose of this study was to describe and analyze the status of Catholic hospital ownership and management, especially the strategic and structural features of the parent health systems. Longitudinal data (2008-2017) were acquired and analyzed using repeated-measures analysis. Descriptive statistics were prepared using cross-sectional matched pairing for 2008 and 2017 data. Of 4,253 hospitals studied, 534 changed ownership or management. More Catholic Church-operated hospitals, regardless of type of ownership (for-profit, not-for-profit, church), became decentralized to a greater degree over the 8-year period and took on more attributes of non-Catholic hospitals.The 21st century Catholic hospital is more likely to be partnered with a non-Catholic hospital or to be owned by a for-profit system than to be solely partnered with or operated by another Catholic system. Today's Catholic hospitals appear to be more similar to their non-Catholic counterparts. With the trend toward larger systems that comprise more diverse partners, an increase in lay oversight could lead to further movement away from Catholic identity and the original mission of a hospital. As systems grow in size but shrink in number, administrators must make difficult decisions about the type and scope of services offered as well as the partners they need to deliver their services.


Assuntos
Catolicismo , Propriedade , Estudos Transversais , Hospitais , Hospitais Religiosos , Estados Unidos
8.
Perspect Sex Reprod Health ; 52(3): 171-179, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33191575

RESUMO

CONTEXT: Catholic hospitals represent a large and growing segment of U.S. health care. Because these facilities follow doctrines that restrict reproductive health services, including miscarriage management options when a fetal heartbeat is present, it is critical to understand whether and how women would want to learn about miscarriage treatment restrictions from providers. METHODS: From May 2018 to January 2019, semistructured interviews were conducted with 31 women aged 21-44 who had had exposure to religious-based health care; all were drawn from a nationally representative survey sample. Participants responded to a hypothetical scenario regarding the anticipatory disclosure of miscarriage management policy during routine prenatal care. Responses were inductively coded and thematically analyzed using modified grounded theory to understand women's attitudes and considerations related to receiving anticipatory miscarriage management information. RESULTS: Respondents supported the routine disclosure of miscarriage management policies during prenatal care. Some expressed concern that this might increase patient anxiety during pregnancy, but most felt that the information would serve to prepare and empower patients, and likened the topic to other anticipatory health information provided during prenatal care. Identified themes related to how providers can disclose this information (including the need for a precautionary framing to reduce patient stress), sharing the rationale for institutional policy, and the importance of provider neutrality to ensure patient autonomy. CONCLUSIONS: To respect patient autonomy, health care providers working in Catholic hospitals should routinely discuss institutional miscarriage management policies with patients, and anticipatory counseling should give patients the balanced information they need to decide where to go for care should pregnancy complications arise.


Assuntos
Aborto Espontâneo/psicologia , Aborto Espontâneo/terapia , Catolicismo/psicologia , Aconselhamento/métodos , Hospitais Religiosos/organização & administração , Preferência do Paciente/psicologia , Adaptação Psicológica , Adulto , Atitude Frente a Saúde , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez/psicologia , Cuidado Pré-Natal/organização & administração , Saúde da Mulher , Adulto Jovem
9.
Niger J Clin Pract ; 23(10): 1333-1338, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047688

RESUMO

Backround: The fiduciary duty of a managing physician makes paediatric discharges against medical advice (DAMA) particularly challenging as children lack the legal power or authority to make their health decisions. Aim: It is aimed in the present study to determine the prevalence of paediatric DAMA in a mission tertiary hospital. Methods: This was a prospective descriptive study carried out from June 2018 to May 2019 among paediatric inpatients at the Bowen University Teaching Hospital, Ogbomoso, Nigeria whose parent/ care giver signed DAMA, despite adequate counselling. Data was analysed using SPSS version 23. Results: The prevalence of DAMA in the study was of 4.1%, and the neonatal group accounted for the largest bulk of DAMA. Birth asphyxia was the commonest diagnosis among this group. There was a slight female predominance among the patients whose parents signed DAMA. Financial constraint was the commonest reason [13(30.2%)] given for DAMA and none of the children whose parents signed DAMA was enrolled on the National Health Insurance Scheme (NHIS). Conclusion: Rate of DAMA in a private mission tertiary hospital was lower than previously reported from government tertiary hospitals in the present-day Nigeria.


Assuntos
Cuidadores/estatística & dados numéricos , Hospitais Religiosos/estatística & dados numéricos , Pais/psicologia , Alta do Paciente/estatística & dados numéricos , Pediatria , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Cuidadores/psicologia , Criança , Pré-Escolar , Aconselhamento , Feminino , Hospitais Privados , Humanos , Pacientes Internados , Masculino , Nigéria/epidemiologia , Prevalência , Estudos Prospectivos , Fatores Socioeconômicos
10.
AJOB Empir Bioeth ; 11(4): 257-267, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32940553

RESUMO

BACKGROUND: Previous studies have shown that many women who would seek care at Catholic hospitals are unaware of the hospital's religious affiliation. Furthermore, women often do not realize that these institutions operate according to religious beliefs that restrict access to certain reproductive services. Our study aimed to gain patient perspectives on experiences seeking reproductive care at religiously affiliated institutions. METHODS: We conducted a qualitative study using in-depth interviews with 33 women who reported experiences seeking reproductive services at Catholic hospitals. Interview questions focused on women's experiences with religious restrictions, their attitudes towards religious healthcare, and whether and how they think women should be informed of these restrictions. Interviews were thematically analyzed using Dedoose software, applying both a priori concepts such as patient autonomy, informed decision making, and transparency, as well as new concepts that emerged from the data or denoted unanticipated distinctions within codes. RESULTS: In this paper, we present three findings. First, women value both patient autonomy and hospital religious freedom. Struggling to reconcile these, many blamed themselves for not anticipating religious restrictions. Second, barriers to information prevent women from researching restrictions ahead of time. Third, women would like more information about these restrictions from both doctors and hospitals. CONCLUSION: Public policy that regulates hospitals should require transparency from hospitals and physicians about religious restrictions on care. Informing the public about religious policies and how they affect reproductive care will allow patients to better anticipate differences and make informed decisions about where to seek care.


Assuntos
Catolicismo , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/ética , Hospitais Religiosos , Religião e Medicina , Serviços de Saúde Reprodutiva , Saúde Reprodutiva , Acesso à Informação , Adolescente , Adulto , Revelação , Feminino , Liberdade , Humanos , Pessoa de Meia-Idade , Autonomia Pessoal , Pesquisa Qualitativa , Adulto Jovem
13.
Malar J ; 19(1): 267, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703215

RESUMO

BACKGROUND: Health workers' knowledge deficiencies about artesunate-based severe malaria treatment recommendations have been reported. However, predictors of the treatment knowledge have not been examined. In this paper, predictors of artesunate-based treatment knowledge among inpatient health workers in two hospital sectors in Kenya are reported. METHODS: Secondary analysis of 367 and 330 inpatient health workers randomly selected and interviewed at 47 government hospitals in 2016 and 43 faith-based hospitals in 2017 respectively, was undertaken. Multilevel ordinal and binary logistic regressions examining the effects of 11 factors on five knowledge outcomes in government and faith-based hospital sectors were performed. RESULTS: Among respective government and faith-based health workers, about a third of health workers had high knowledge of artesunate treatment policies (30.8% vs 32.9%), a third knew all dosing intervals (33.5% vs 33.3%), about half knew preparation solutions (49.9% vs 55.8%), half to two-thirds knew artesunate dose for both weight categories (50.8% vs 66.7%) and over three-quarters knew the preferred route of administration (78.7% vs 82.4%). Eight predictors were significantly associated with at least one of the examined knowledge outcomes. In the government sector, display of artesunate administration posters, paediatric ward allocation and repeated surveys were significantly associated with more than one of the knowledge outcomes. In the faith-based hospitals, availability of artesunate at hospitals and health worker pre-service training were associated with multiple outcomes. Exposure to in-service malaria case-management training and access to malaria guidelines were only associated with higher knowledge about artesunate treatment policy. CONCLUSION: Programmatic interventions ensuring display of artesunate administration posters in the wards, targeting of health workers managing adult patients in the medical wards, and repeated knowledge assessments are likely to be beneficial for improving the knowledge of government health workers about artesunate-based severe malaria treatment recommendations. The availability of artesunate and focus on improvements of nurses' knowledge should be prioritized at the faith-based hospitals.


Assuntos
Artesunato , Competência Clínica/estatística & dados numéricos , Pessoal de Saúde/psicologia , Hospitais/estatística & dados numéricos , Malária/prevenção & controle , Combinação de Medicamentos , Hospitais/classificação , Hospitais Religiosos/estatística & dados numéricos , Humanos , Quênia , Malária/psicologia
14.
Perspect Sex Reprod Health ; 52(2): 107-115, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32597555

RESUMO

CONTEXT: Abortion is generally prohibited in Catholic hospitals, but less is known about abortion restrictions in other religiously affiliated health care facilities. As religiously affiliated health systems expand in the United States, it is important to understand how religious restrictions affect the practices of providers who treat pregnant patients. METHODS: From September 2016 to May 2018, in-depth interviews were conducted with 31 key informants (clinical providers, ethicists, chaplains and health system administrators) with experience working in secular, Protestant or Catholic health care systems in Illinois. A thematic content approach was used to identify themes related to participants' experiences with abortion policies, the role of ethics committees, the impact on patient care and conflicts with hospital policies. RESULTS: Few limitations on abortion were reported in secular hospitals, while Catholic hospitals prohibited most abortions, and a Protestant-affiliated system banned abortions deemed "elective." Religiously affiliated hospitals allowed abortions in specific cases, if approved through an ethics consultation. Interpretation of system-wide policies varied by hospital, with some indication that institutional discomfort with abortion influenced policy as much as religious teachings did. Providers constrained by religious restrictions referred or transferred patients desiring abortion, including for pregnancy complications, with those in Protestant hospitals having more latitude to directly refer such patients. As a result of religiously influenced policies, patients could encounter delays, financial obstacles, restrictions on treatment and stigmatization. CONCLUSIONS: Patients seeking abortion or presenting with pregnancy complications at Catholic and Protestant hospitals may encounter more delays and fewer treatment options than they would at secular hospitals. More research is needed to better understand the implications for women's access to reproductive health care.


Assuntos
Aborto Induzido/psicologia , Catolicismo/psicologia , Acesso aos Serviços de Saúde/organização & administração , Política Organizacional , Protestantismo/psicologia , Religião e Medicina , Adulto , Atitude do Pessoal de Saúde , Clero/psicologia , Eticistas/psicologia , Feminino , Administradores de Instituições de Saúde/psicologia , Pessoal de Saúde/psicologia , Hospitais Religiosos , Humanos , Illinois , Masculino , Pessoa de Meia-Idade , Gravidez , Secularismo , Estados Unidos
15.
West Afr J Med ; 37(3): 268-274, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32476121

RESUMO

BACKGROUND: An increased population growth has led to the proliferation of slums in urban areas. Urban slum dwellers are susceptible to ailments which may be worsened from reduced access to health facilities or weak institutional capacity. Understanding the pattern of morbidity and choice of care among slum dwellers can inform appropriate health interventions among this group. This study was conducted to investigate and document the morbidity patterns and choice of care within an urban slum community of South-western Nigeria. METHODS: The study was a descriptive cross-sectional survey involving 480 respondents selected through a random sampling technique in Idikan community of Southwestern Nigeria. The survey was conducted using a pre-tested semi-structured interviewer administered questionnaire on morbidity pattern and choice of care. Data were analyzed using SPSS Vs version 13 to generate frequencies and association between independent variables and choice of care using Chi-square at 5% level of significance. RESULTS: Among those that were ill, slightly over half of the respondents, 254 (52.9%) used self-medication while only 226 respondents (47.1%) sought medical care Majority of the respondents that sought care did so from Christian based health facilities (66.8%). A significantly higher proportion, (74.3%) of those in the higher occupational class compared with those of low occupational class (55.1%) (p = 0.001) sought care in a health facility. Also, a significantly higher proportion of those with tertiary education (69.0%) sought care in facilities compared to other cadres (p = 0.033). CONCLUSION: Disparities in morbidity patterns and access to care still persists in the surveyed community which requires urgent attention in the urban slums. This is evidently linked to educational and socio-economic status. Re-distribution of national funds to educational institutions and creation of jobs in the slums are advocated to improve the health seeking behaviours of slum dwellers in Ibadan and Nigeria at large.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde/estatística & dados numéricos , Hospitais Religiosos/estatística & dados numéricos , Morbidade/tendências , Áreas de Pobreza , Automedicação/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Fatores Socioeconômicos , População Urbana
17.
Infect Control Hosp Epidemiol ; 41(5): 564-570, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32131910

RESUMO

OBJECTIVE: Despite evidence to the contrary, many practitioners continue to inappropriately screen for and treat bacteria in the urine of clinically asymptomatic patients. The purpose of this study was to evaluate the impact of a new order set on the number of urine culture performed, antibiotic days of therapy (DOT), catheter-associated urinary tract infections (CAUTI), and associated financial impact. DESIGN: A quasi-experimental before-and-after intervention. SETTING: We conducted this study at 5 Catholic Health Initiative (CHI) hospitals in Texas that use the same electronic health record (EHR) system. PATIENTS: The study populations included adult patients who had urine culture performed from June 2017 to June 2019. INTERVENTION: The intervention (implemented June 25, 2018) was the addition of a new order set in the electronic health record that required practitioners to choose an indication for the type of urine study. The primary outcome was number of urine cultures performed adjusted for the number of total patient days. RESULTS: Following implementation of the new order set, the number of urine cultures performed among the 5 sites decreased from 1,175.8 tests per 10,000 patient days before the intervention to 701.4 after the intervention (40.4% reduction; P < .01). Antibiotic DOT for patients with a urinary tract infection indication decreased from 102.5 to 86.9 per 1,000 patient days (15.2% reduction; P < .01). The CAUTI standardized infection ratio was 1.0 before the intervention and 0.8 after the intervention (P = .23). The estimated yearly savings following the intervention was US$535,181. CONCLUSIONS: The addition of a new order set resulted in decreases in the number of urine cultures performed and the antibiotic DOT, as well as substantial financial savings.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/métodos , Sistemas de Apoio a Decisões Clínicas , Uso de Medicamentos/estatística & dados numéricos , Infecções Urinárias , Urina/microbiologia , Catolicismo , Sistemas de Apoio a Decisões Clínicas/estatística & dados numéricos , Hospitais Religiosos , Humanos , Estudos Multicêntricos como Assunto , Texas , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
18.
JAMA Netw Open ; 3(1): e1920053, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995216

RESUMO

Importance: Access to reproductive health services is a public health goal. It is unknown how geographic and health plan network availability of Catholic and non-Catholic hospitals may be associated with access to reproductive health services in the United States. Objective: To characterize the market share of Catholic hospitals in the United States, both overall and within Marketplace health insurance plans' hospital networks. Design, Setting, and Participants: This cross-sectional study of US counties used data on hospitals' Catholic affiliation and discharges, hospital networks in Marketplace health insurance plans, and US Census population data to construct a national, county-level data set. The Catholic hospital market share overall in each county and in Marketplace plans' hospital networks in each county were calculated. The study examined whether the Catholic hospital market share was different within Marketplace networks compared with the counties they served. Data analysis was conducted in May and June 2018. Main Outcomes and Measures: The overall Catholic hospital market share was calculated on the basis of the share of discharges in Catholic hospitals in a county compared with all hospital discharges. Overall market share was categorized as minimal (≤2%), low (>2% to ≤20%), high (>20% to ≤70%), or dominant (>70%). The Catholic hospital market share in Marketplace networks was calculated as the share of Catholic hospital discharges in each Marketplace network. Results: The sample included 4450 hospitals in 3101 counties. Overall, 26.1% of US counties had minimal Catholic hospital market share, 38.6% had low Catholic hospital market share, and 35.3% had high or dominant Catholic hospital market share; 38.7% of US reproductive-aged women resided in counties with high or dominant Catholic hospital market share. Among counties with Catholic hospital market share greater than 2%, the distribution of the median Marketplace network's Catholic hospital market share (median [interquartile range], 4.6% [0%-24.3%]) was lower than overall Catholic hospital market share (median [interquartile range], 18.5% [8.1%-36.5%]). The median Marketplace hospital network had a lower Catholic hospital market share than the county overall in 68.0% of US counties with Catholic hospital market share greater than 2%. Conclusions and Relevance: In this national study, 35.3% of counties had high or dominant Catholic hospital market share serving an estimated 38.7% of US women of reproductive age. Marketplace health insurance plans' hospital networks included a lower share of Catholic hospitals than the counties they serve.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Religiosos/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia/provisão & distribuição , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Catolicismo , Feminino , Humanos , Gravidez , Complicações na Gravidez/prevenção & controle , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estados Unidos
19.
Hist Cienc Saude Manguinhos ; 26(suppl 1): 249-259, 2020.
Artigo em Português | MEDLINE | ID: mdl-31994691

RESUMO

The paper presents aspects of the history and archives of Grace Memorial Hospital, founded in 1926 in the former town of Ponte Nova, now Wagner, in the Chapada Diamantina region of Bahia state, Brazil, by the American Presbyterian missionary and doctor Walter Welcome Wood. The documents in question have been kept at the Universidade do Estado da Bahia, campus II, Alagoinhas, since the hospital closed down definitively. They constitute a source of research for different areas of scholarship, especially the history of healthcare in Brazil. The documents are used in analyses of the incidence of diseases, medical treatments, and other care given to a population that had no access to other institutions working in this area.


Assuntos
Hospitais Religiosos/história , Missões Médicas/história , Protestantismo/história , Brasil , História do Século XIX , História do Século XX
20.
Am J Obstet Gynecol ; 222(3): 273.e1-273.e9, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31526788

RESUMO

BACKGROUND: Catholic and other faith-based hospitals often restrict family planning service provision based on institutional doctrine. Approximately 11% of US accredited obstetrics and gynecology residency programs occur at such hospitals, creating a challenge to educational leaders who must ensure comprehensive family planning training. OBJECTIVE: To evaluate and summarize family planning training at obstetrics and gynecology residency programs that are affiliated with Catholic and other faith-based hospitals that restrict reproductive services. MATERIALS AND METHODS: Using an online database search and survey screening questions, we identified 30 of 278 accredited 2017-2018 programs in which at least 70% of resident time is spent in faith-based hospitals that restrict family planning services; Jewish programs were excluded. We queried program leaders between March 2017 and April 2018 about education and training using an online or paper survey, and asked them to report on training settings, provision of family planning services in such settings, and to rate aspects of training as "poor," "adequate," or "strong." We compared responses at Catholic versus other faith-based programs using Fisher exact tests, χ2 analyses, and median tests. RESULTS: Among 30 programs, 25 responded (83%); the majority of respondents were program directors (88%) and represented Catholic hospitals (76%). All reported adequate contraceptive training, with 47% of Catholic programs relying on off-site locations. The majority of Catholic sites (84%) relied on off-site sterilization training sites. Survey respondents from Catholic programs most commonly endorsed concerns for inadequate training in postpartum tubal ligations (53% of Catholic respondents versus 0% of other faith-based program respondents, P = .05). Approximately one-half (56%) offered abortion training as part of the curriculum ("routine"), 32% offered residents the opportunity to arrange training ("elective"), and 12% did not offer; the majority (84%) relied on off-site collaborations. Catholic sites were more likely than other religious programs to report poor abortion training (47% versus 0%, P = .04). Five Catholic programs (26% of Catholic programs) reported that their residents did not meet the graduate training requirement for completion of 20 dilation and curettage procedures. One-third reported a prior Residency Review Committee family planning citation(s), and many commented that these citations helped provide leverage for improved training. CONCLUSION: Although Catholic and other restrictive, faith-based obstetrics and gynecology residency training programs have developed strategies in response to institutional restrictions, many report ongoing deficiencies, and almost one-half reported they were noncompliant with abortion training requirements. Programs with deficient trainings may benefit from strategic approaches, including enhanced onsite education and collaborations with off-site facilities.


Assuntos
Serviços de Planejamento Familiar/educação , Hospitais Religiosos , Internato e Residência , Aborto Induzido/educação , Catolicismo , Currículo , Dilatação e Curetagem/educação , Feminino , Ginecologia/educação , Humanos , Masculino , Obstetrícia/educação , Gravidez , Inquéritos e Questionários , Estados Unidos
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