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1.
Ann Plast Surg ; 92(6S Suppl 4): S387-S390, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38857000

RESUMEN

ABSTRACT: Accessing treatment at ACPA (American Cleft Palate-Craniofacial Association)-approved centers is challenging for individuals in rural communities. This study aims to assess how pediatric plastic surgery outreach clinics impact access for patients with orofacial cleft and craniosynostosis in Mississippi. An isochrone map was used to determine mean travel times from Mississippi counties to the sole pediatric hospital and the only ACPA-approved team in the state. This analysis was done before and after the establishment of two outreach clinics to assess differences in travel times and cost of travel to specialized plastic surgery care. Two sample t-tests were used for analysis.The addition of outreach clinics in North and South Mississippi led to a significant reduction in mean travel times for patients with cleft and craniofacial diagnoses across the state's counties (1.81 hours vs 1.46 hours, P < 0.001). Noteworthy travel cost savings were observed after the introduction of outreach clinics when considering both the pandemic gas prices ($15.27 vs $9.80, P < 0.001) and post-pandemic prices ($36.52 vs $23.43, P < 0.001).The addition of outreach clinics in Mississippi has expanded access to specialized healthcare for patients with cleft and craniofacial differences resulting in reduced travel time and cost savings for these patients. Establishing specialty outreach clinics in other rural states across the United States may contribute significantly to reducing burden of care for patients with clefts and craniofacial differences. Future studies can further investigate whether the inclusion of outreach clinics improves follow-up rates and surgical outcomes for these patients.


Asunto(s)
Labio Leporino , Fisura del Paladar , Accesibilidad a los Servicios de Salud , Humanos , Mississippi , Fisura del Paladar/cirugía , Fisura del Paladar/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Labio Leporino/cirugía , Labio Leporino/economía , Craneosinostosis/cirugía , Craneosinostosis/economía , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Procedimientos de Cirugía Plástica/economía , Relaciones Comunidad-Institución , Masculino , Niño , Viaje/estadística & datos numéricos
2.
BMC Med ; 22(1): 228, 2024 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-38853270

RESUMEN

BACKGROUND: Supermarket interventions are promising to promote healthier dietary patterns, but not all individuals may be equally susceptible. We explored whether the effectiveness of nudging and pricing strategies on diet quality differs by psychological and grocery shopping characteristics. METHODS: We used data of the 12-month Supreme Nudge parallel cluster-randomised controlled supermarket trial, testing nudging and pricing strategies to promote healthier diets. Participants were Dutch speaking adults aged 30-80 years and regular shoppers of participating supermarkets (n = 12) in socially disadvantaged neighbourhoods. Data on psychological characteristics (food-related behaviours; price sensitivity; food decision styles; social cognitive factors; self-control) and grocery shopping characteristics (time spent in the supermarket; moment of the day; average supermarket visits; shopping at other retailers; supermarket proximity) were self-reported at baseline. These characteristics were tested for their moderating effects of the intervention on diet quality (scored 0-150) in linear mixed models. RESULTS: We included 162 participants from intervention supermarkets and 199 from control supermarkets (73% female, 58 (± 10.8) years old, 42% highly educated). The interventions had no overall effect on diet quality. Only five out of 23 potential moderators were statistically significant. Yet, stratified analyses of these significant moderators showed no significant effects on diet quality for one of the subgroups and statistically non-significant negative effects for the other. Negative effects were suggested for individuals with lower baseline levels of meal planning (ß - 2.6, 95% CI - 5.9; 0.8), healthy shopping convenience (ß - 3.0, 95% CI - 7.2; 1.3), and healthy food attractiveness (ß - 3.5, 95% CI - 8.3; 1.3), and with higher levels of price consciousness (ß - 2.6, 95% CI - 6.2; 1.0) and weekly supermarket visits (ß - 2.4, 95% CI - 6.8; 1.9). CONCLUSIONS: Adults with varying psychological and grocery shopping characteristics largely seem equally (un)susceptible to nudging and pricing strategies. It might be that certain characteristics lead to adverse effects, but this is not plausible, and the observed negative effects were small and statistically non-significant and may be explained by chance findings. Verification of these findings is needed in real-world trials based on larger sample sizes and with the use of more comprehensive interventions. TRIAL REGISTRATION: Dutch Trial Register ID NL7064, 30th of May, 2018, https://onderzoekmetmensen.nl/en/trial/20990.


Asunto(s)
Supermercados , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Países Bajos , Anciano de 80 o más Años , Comercio , Promoción de la Salud/métodos , Dieta Saludable/economía , Costos y Análisis de Costo
3.
Sex Reprod Health Matters ; 32(1): 2355790, 2024 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38864373

RESUMEN

Across sub-Saharan Africa, there remains disagreement among local expert providers over the best ways to improve access to assisted reproduction in low-income contexts. Semi-structured qualitative interviews were conducted between 2021 and 2023 with 19 fertility specialists and 11 embryologists and one clinic manager from South Africa, Zimbabwe, Namibia, Kenya, Ethiopia and Uganda to explore issues surrounding access and potential low-cost IVF options. Lack of access to ART was variously conceptualised as a problem of high cost of treatment; lack of public funding for medical services and medication; poor policy awareness and prioritisation of fertility problems; a shortage of ART clinics and well-trained expert staff; the need for patients to travel long distances; and over-servicing within the largely privatised sector. All fertility specialists agreed that government funding for public sector assisted reproduction services was necessary to address access in the region. Other suggestions included: reduced medication costs by using mild stimulation protocols and oocyte retrievals under sedation instead of general anaesthetics. Insufficient data on low-cost interventions was cited as a barrier to their implementation. The lack of skilled embryologists on the continent was considered a major limitation to expanding ART services and the success of low-cost IVF systems. Very few specialists suggested that profits of pharmaceutical companies or ART clinics might be reduced to lessen the costs of treatments.


This is a qualitative study involving interviews conducted between 2021 and 2023 with 19 fertility specialists and 11 embryologists and one clinic manager from South Africa, Zimbabwe, Namibia, Kenya, Ethiopia and Uganda to explore issues surrounding access and potential low-cost IVF options. The study found that across sub-Saharan Africa, clinical providers disagree over the best ways to provide assisted reproduction to improve access and affordability while maintaining high standards of care in low-income contexts. The lack of political, human resource and professional support to succeed in sub-Saharan Africa inhibits the implementation of low-cost initiatives to improve access and affordability. The study affirms the importance of giving more attention to infertility care in sub-Saharan Africa and increasing access and affordability of ARTs in the public health sector; the further development of national policies and professional guidelines; the need for more studies to evaluate low-cost initiatives; clarification of existing controversies about these initiatives; and the need for more training for embryologists in SSA.


Asunto(s)
Accesibilidad a los Servicios de Salud , Técnicas Reproductivas Asistidas , Humanos , Técnicas Reproductivas Asistidas/economía , África del Sur del Sahara , Femenino , Actitud del Personal de Salud , Entrevistas como Asunto , Masculino , Investigación Cualitativa
4.
BMC Oral Health ; 24(1): 684, 2024 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-38867214

RESUMEN

BACKGROUND: The high treatment cost of oral diseases is a barrier for accessing oral health services (OHS), particularly in low-income countries. Therefore, this study aimed to evaluate the impact of health insurance on the use of OHS in the Peruvian population from 2015 to 2019. METHODS: We conducted a prospective, longitudinal study of secondary data using the National Household Survey (ENAHO) 2015-2019 panel databases, which collected information from the same participants during each of the five years. The dependent variable was the use of OHS in the three months prior to the survey (yes/no). The independent variable was health insurance affiliation (four years or less/all five years). Both were measured by survey questions. Generalized estimating equation (GEE) Poisson regression models with robust standard errors were used to estimate the relative risk (RR) associated with use of OHS. RESULTS: We included 4064 individuals distributed in 1847 households, who responded to the survey during each of the five years. The adjusted GEE model showed that those who had health insurance during all five years without interruption were more likely to attend OHS than those who had insurance for four years or less (adjusted relative risk [aRR]: 1.30; 95%CI: 1.13-1.50). In addition, we carried out a sensitivity analysis by recategorizing the independent variable into three categories (never/some years/ all five years), which also showed (aRR: 1.45; 95%CI: 1.11-1.89) that participants with health insurance during all five years were more likely to have used OHS than those who never had insurance. CONCLUSION: Therefore, in the Peruvian context, health insurance affiliation was associated with greater use of OHS. The panel data used derives from a subsample of consecutive nationally representative samples, which may have led to a loss of representativeness. Furthermore, the data was collected between 2015 and 2019, prior to the onset of the COVID-19 pandemic, and insurance conditions may have changed.


Asunto(s)
Seguro de Salud , Humanos , Perú , Femenino , Masculino , Estudios Prospectivos , Adulto , Persona de Mediana Edad , Seguro de Salud/estadística & datos numéricos , Estudios Longitudinales , Adolescente , Adulto Joven , Servicios de Salud Dental/estadística & datos numéricos , Servicios de Salud Dental/economía , Niño , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Anciano , COVID-19/epidemiología , Preescolar , Lactante
5.
PLoS One ; 19(6): e0304028, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38870150

RESUMEN

SIGNIFICANCE: For decades, tobacco advertisements and promotions have been common in mass media and public places in China. In 2015, China amended the Advertising Law to prohibit the distribution of tobacco advertising, while also initiating waves of tobacco control media campaigns. This study investigates the associations between exposure to anti- and pro-smoking messages, smoking status, and people's smoking-related beliefs and willingness to support tobacco control policies. METHODS: A secondary data analysis was performed with the 2018 Global Adult Tobacco Survey of 19,376 adults aged ≥15 years in China. Anti- and pro-smoking message exposures were measured as the sum of sources (media or places) where respondents have seen the messages. Multivariable logistic regression analyses were conducted to examine the relationships among smoking status, message exposure, and the outcome variables (health harm beliefs, support for increasing tax on cigarettes, support for using part of the increased tax on tobacco control) controlling for smoking status and demographic differences. RESULTS: Overall, 63.3% of the respondents reported being exposed to anti-smoking messages from at least 1 source, while 18.1% were exposed to pro-smoking messages from at least 1 source. Adults who currently, formerly, and never smoked differed in their beliefs about smoking and willingness to support tobacco control policies. Greater reported exposure to anti-smoking messages was positively associated with belief that smoking is harmful, support for increased cigarette tax, and support for using increased tax revenue for tobacco control measures. Meanwhile, greater reported exposure to pro-smoking messages was negatively related to willingness to support cigarette tax increases. CONCLUSIONS: While national and local tobacco control campaigns in China have reached a large proportion of the adult population, there is still room for improvement. China might consider expanding anti-tobacco campaigns, as reported exposure to these messages is associated with increased public awareness of the health hazards of smoking and support for increasing cigarette taxes.


Asunto(s)
Fumar , Humanos , Adulto , China/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Adolescente , Adulto Joven , Encuestas y Cuestionarios , Fumar/psicología , Fumar/epidemiología , Publicidad , Productos de Tabaco/economía , Productos de Tabaco/legislación & jurisprudencia , Anciano , Medios de Comunicación de Masas , Impuestos , Prevención del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología
6.
MMWR Morb Mortal Wkly Rep ; 73(24): 558-564, 2024 Jun 20.
Artículo en Inglés | MEDLINE | ID: mdl-38900702

RESUMEN

In September 2022, CDC funded a nationwide program, Together TakeMeHome (TTMH), to expand distribution of HIV self-tests (HIVSTs) directly to consumers by mail through an online ordering portal. To publicize the availability of HIVSTs to priority audiences, particularly those disproportionately affected by HIV, CDC promoted this program through established partnerships and tailored resources from its Let's Stop HIV Together social marketing campaign. The online portal launched March 14, 2023, and through March 13, 2024, distributed 443,813 tests to 219,360 persons. Among 169,623 persons who answered at least one question on a postorder questionnaire, 67.9% of respondents were from priority audiences, 24.1% had never previously received testing for HIV, and 24.8% had not received testing in the past year. Among the subset of participants who initiated a follow-up survey, 88.3% used an HIVST themselves, 27.1% gave away an HIVST, 11.7% accessed additional preventive services, and 1.9% reported a new positive HIVST result. Mailed HIVST distribution can quickly reach large numbers of persons who have never received testing for HIV or have not received testing as often as is recommended. TTMH can help to achieve the goal of diagnosing HIV as early as possible and provides a path to other HIV prevention and care services. Clinicians, community organizations, and public health officials should be aware of HIVST programs, initiate discussions about HIV testing conducted outside their clinics or offices, and initiate follow-up services for persons who report a positive or negative HIVST result.


Asunto(s)
Infecciones por VIH , Humanos , Estados Unidos/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Infecciones por VIH/epidemiología , Adulto , Masculino , Femenino , Adulto Joven , Persona de Mediana Edad , Adolescente , Financiación Gubernamental , Pruebas Dirigidas al Consumidor , Evaluación de Programas y Proyectos de Salud , Prueba de VIH/estadística & datos numéricos , Autoevaluación , Anciano
7.
J Infect Public Health ; 17(7): 102447, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38824739

RESUMEN

BACKGROUND: Current clinical care for common bacterial STIs (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Mycoplasma genitalium (MG)) involves empiric antimicrobial therapy when clients are symptomatic, or if asymptomatic, waiting for laboratory testing and recall if indicated. Near-to-patient testing (NPT) can improve pathogen-specific prescribing and reduce unnecessary or inappropriate antibiotic use in treating sexually transmitted infections (STI) by providing same-day delivery of results and treatment. METHODS: We compared the economic cost of NPT to current clinic practice for managing clients with suspected proctitis, non-gonococcal urethritis (NGU), or as an STI contact, from a health provider's perspective. With a microsimulation of 1000 clients, we calculated the cost per client tested and per STI- and pathogen- detected for each testing strategy. Sensitivity analyses were conducted to assess the robustness of the main outcomes. Costs are reported as Australian dollars (2023). RESULTS: In the standard care arm, cost per client tested for proctitis, NGU in men who have sex with men (MSM) and heterosexual men were the highest at $247.96 (95% Prediction Interval (PI): 246.77-249.15), $204.23 (95% PI: 202.70-205.75) and $195.01 (95% PI: 193.81-196.21) respectively. Comparatively, in the NPT arm, it costs $162.36 (95% PI: 161.43-163.28), $158.39 (95% PI: 157.62-159.15) and $149.17 (95% PI: 148.62-149.73), respectively. Using NPT resulted in cost savings of 34.52%, 22.45% and 23.51%, respectively. Among all the testing strategies, substantial difference in cost per client tested between the standard care arm and the NPT arm was observed for contacts of CT or NG, varying from 27.37% to 35.28%. CONCLUSION: We found that NPT is cost-saving compared with standard clinical care for individuals with STI symptoms and sexual contacts of CT, NG, and MG.


Asunto(s)
Enfermedades de Transmisión Sexual , Humanos , Masculino , Femenino , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/economía , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Gonorrea/diagnóstico , Gonorrea/economía , Gonorrea/tratamiento farmacológico , Australia , Adulto , Análisis Costo-Beneficio , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/economía , Infecciones por Chlamydia/tratamiento farmacológico , Chlamydia trachomatis , Neisseria gonorrhoeae/aislamiento & purificación , Mycoplasma genitalium , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/tratamiento farmacológico , Infecciones por Mycoplasma/economía , Uretritis/diagnóstico , Uretritis/economía , Uretritis/tratamiento farmacológico , Uretritis/microbiología
8.
J Ment Health Policy Econ ; 27(2): 63-70, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38904275

RESUMEN

BACKGROUND: The economic cost of perinatal mood and anxiety disorders (PMADs) is high and includes the cost of reduced maternal economic productivity, more preterm births, and increases in other maternal mental health expenditures. PMADs also substantially contribute the cost of maternal morbidity. This paper offers a discussion of the quality-of-care cascade model of PMADs, which outlines care pathways that people typically face as well as gaps and unmet needs that frequently happen along the way. The model uses the US health system as an example. A discussion of international implications follows. DISCUSSION: The quality-of-care cascade model outlines downward dips in quality of care along the perinatal mental health treatment continuum, including access (many Americans do not have access to affordable health insurance), enrollment (even when individuals are offered health insurance, some do not enroll), coverage (even if individuals have health insurance, some needed services or providers may not be covered), choice (even if services and providers are covered, patients may not be able to choose among plans, institutions, or clinicians), consistency (even if patients have a choice of plan or provider, a consistent source of care may not be accessible), referral (even if care is available and accessible, referral services may not be), quality (even if patients have access to both care and referral services, there may be gaps in the quality of care provided), adherence (even if patients receive high-quality care, they may not be adherent to treatment), barriers (societal forces that may influence people's choices and behaviors), and shocks (unanticipated events that could disrupt care pathways). In describing the quality-of-care cascade model, this paper uses the US healthcare system as the primary example. However, the model can extend to examine quality-of-care dips along the perinatal mental health treatment continuum within the international context. Although the US healthcare system may differ from other healthcare systems in many respects, shared commonalities lead to quality-of-care dips in countries with healthcare systems structured differently than in the US. IMPLICATIONS FOR HEALTH POLICIES: The global cost of PMADs remains substantial, and addressing the costs of these conditions could have a significant impact on overall cost and quality of care internationally. The quality-of-care cascade model presented in this paper could help identify, understand, and address the complex contributing factors that lead to dips in quality-of-care for perinatal mental health conditions across the world.


Asunto(s)
Política de Salud , Servicios de Salud Mental , Calidad de la Atención de Salud , Humanos , Femenino , Servicios de Salud Mental/economía , Estados Unidos , Accesibilidad a los Servicios de Salud , Embarazo , Salud Mental , Trastornos de Ansiedad/terapia , Salud Reproductiva
9.
Int J Equity Health ; 23(1): 116, 2024 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-38840134

RESUMEN

BACKGROUND: PCSK9 inhibitors are a novel class of lipid-lowering drugs that have demonstrated favorable efficacy and safety. Evolocumab and alirocumab have been added to China's National Reimbursement Drug List through the National Drug Price Negotiation (NDPN) policy. This study aims to evaluate the impact of the NDPN policy on the utilization and accessibility of these two PCSK9 inhibitors. METHODS: The procurement data of evolocumab and alirocumab were collected from 1,519 hospitals between January 2021 and December 2022. We determined the monthly availability, utilization, cost per daily defined dose (DDDc), and affordability of the two medicines. Single-group interrupted time series (ITS) analysis was performed to assess the impact of the NDPN policy on each drug, and multiple-group ITS analysis was performed to compare the differences between them. RESULTS: The NDPN policy led to a significant and sudden increase in the availability and utilization of PCSK9 inhibitors, along with a decrease in their DDDc. In the year following the policy implementation, there was an increase in the availability, utilization, and spending, and the DDDc remained stable. The affordability of PCSK9 inhibitors in China have been significantly improved, with a 92.97% reduction in out-of-pocket costs. The availability of both PCSK9 inhibitors was similar, and the DDDc of alirocumab was only $0.23 higher after the intervention. The market share of evolocumab consistently exceeded that of alirocumab. Regional disparities in utilization were observed, with higher utilization in the eastern region and a correlation with per capita disposable income. CONCLUSIONS: The NDPN policy has successfully improved the accessibility and utilization of PCSK9 inhibitors in China. However, regional disparities in utilization indicate the need for further interventions to ensure equitable medicine access.


Asunto(s)
Anticuerpos Monoclonales Humanizados , Costos de los Medicamentos , Análisis de Series de Tiempo Interrumpido , Inhibidores de PCSK9 , Humanos , China , Anticuerpos Monoclonales Humanizados/uso terapéutico , Anticuerpos Monoclonales Humanizados/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Anticolesterolemiantes/uso terapéutico , Anticolesterolemiantes/economía , Política de Salud
10.
Am Soc Clin Oncol Educ Book ; 44(3): e431272, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38843475

RESUMEN

The worldwide cancer burden is growing, and populations residing in low- and middle-income countries (LMICs) are experiencing a disproportionate extent of this growth. Breast, colorectal, and cervical cancers are among the top 10 most frequently diagnosed malignancies, and they also account for a substantial degree of cancer mortality internationally. Effective screening strategies are available for all three of these cancers. Individuals from LMICs face substantial cost and access barriers to early detection programs, and late stage at diagnosis continues to be a major cause for cancer mortality in these communities. This chapter will review the epidemiology of breast, colorectal, and cervical cancers, and will explore prospects for improving global control through novel approaches to screening in cost-constrained environments.


Asunto(s)
Países en Desarrollo , Detección Precoz del Cáncer , Humanos , Detección Precoz del Cáncer/economía , Neoplasias/epidemiología , Neoplasias/diagnóstico , Femenino , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/diagnóstico , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/diagnóstico
12.
PLoS One ; 19(6): e0301985, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38861489

RESUMEN

Policymakers are increasingly focusing on structural adjustment and efficiency to cope with the pressures that the economic downturn has placed on local finances. Accordingly, the Chinese government should shift from using standard passive investments to high-quality active investments for its social guarantees, such as education. Based on panel data of 274 cities from 2010 to 2019, this study conducted the first examination of the impact of tax structure and government debt on the relative power of the local education supply (LES) in China. The study found that, first, in general, increases in the tax structure-represented by the proportion of personal income tax to budgetary revenue strengthen the relative power of LES, which is more sensitive in the southern region with a more developed market economy system. And the impact of government debt-represented by the urban investment debt ratio on the relative power of LES is initially negative and then positive. Second, the study revealed that the tax structure can stimulate the relative power of LES through the intermediary channel of an increase in the urban consumption rate; however, the mechanism of promoting the relative power of LES by encouraging localities to attract more floating populations is not obvious. Third, excessive investment in local governance adjusts the positive effect of local debt on the relative power of LES. Therefore, the government should pay attention to the promotion of personal income tax status, standardize their debt risk management, improve the efficiency of governance, and emphasize the pull of urban consumption, so as to enhance the ability to support livelihood and fully mobilize initiatives for local education development.


Asunto(s)
Impuestos , Impuestos/economía , Humanos , China , Educación/economía , Renta , Gobierno Local , Ciudades , Gobierno
13.
BMC Prim Care ; 25(1): 210, 2024 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-38862899

RESUMEN

BACKGROUND: Deprescribing of medication for cardiovascular risk factors and diabetes has been incorporated in clinical guidelines but proves to be difficult to implement in primary care. Training of healthcare providers is needed to enhance deprescribing in eligible patients. This study will examine the effects of a blended training program aimed at initiating and conducting constructive deprescribing consultations with patients. METHODS: A cluster-randomized trial will be conducted in which local pharmacy-general practice teams in the Netherlands will be randomized to conducting clinical medication reviews with patients as usual (control) or after receiving the CO-DEPRESCRIBE training program (intervention). People of 75 years and older using specific cardiometabolic medication (diabetes drugs, antihypertensives, statins) and eligible for a medication review will be included. The CO-DEPRESCRIBE intervention is based on previous work and applies models for patient-centered communication and shared decision making. It consists of 5 training modules with supportive tools. The primary outcome is the percentage of patients with at least 1 cardiometabolic medication deintensified. Secondary outcomes include patient involvement in decision making, healthcare provider communication skills, health/medication-related outcomes, attitudes towards deprescribing, medication regimen complexity and health-related quality of life. Additional safety and cost parameters will be collected. It is estimated that 167 patients per study arm are needed in the final intention-to-treat analysis using a mixed effects model. Taking loss to follow-up into account, 40 teams are asked to recruit 10 patients each. A baseline and 6-months follow-up assessment, a process evaluation, and a cost-effectiveness analysis will be conducted. DISCUSSION: The hypothesis is that the training program will lead to more proactive and patient-centered deprescribing of cardiometabolic medication. By a comprehensive evaluation, an increase in knowledge needed for sustainable implementation of deprescribing in primary care is expected. TRIAL REGISTRATION: The study is registered at ClinicalTrials.gov (identifier: NCT05507177).


Asunto(s)
Deprescripciones , Atención Primaria de Salud , Anciano , Femenino , Humanos , Antihipertensivos/uso terapéutico , Antihipertensivos/economía , Factores de Riesgo Cardiometabólico , Enfermedades Cardiovasculares/tratamiento farmacológico , Comunicación , Análisis Costo-Beneficio , Toma de Decisiones Conjunta , Diabetes Mellitus/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipoglucemiantes/uso terapéutico , Hipoglucemiantes/economía , Países Bajos , Participación del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto
14.
BMC Health Serv Res ; 24(1): 709, 2024 Jun 07.
Artículo en Inglés | MEDLINE | ID: mdl-38849826

RESUMEN

BACKGROUND: Disparities in rates of contraceptive use are frequently attributed to unequal access to and affordability of care. There is a need to better understand whether common definitions of affordability that solely relate to cost or to insurance status capture the reality of individuals' lived experiences. We sought to better understand how individuals with low incomes and the capacity for pregnancy conceptualized one domain of contraceptive access-affordability --in terms of health system and individual access and how both shaped contraceptive care-seeking in the US South. METHOD: Between January 2019 to February 2020, we conducted twenty-five life-history interviews with low-income individuals who may become pregnant living in suburban counties in Georgia, USA. Interviews covered the ways individual and health system access factors influenced care-seeking for family planning over the life course. Interview transcripts were analyzed using a thematic analysis approach to identify experiences associated with individual and health system access. RESULTS: Affordability was identified as a major determinant of access, one tied to unique combinations of individual factors (e.g., financial status) and health system characteristics (e.g., cost of methods) that fluctuated over time. Navigating the process to attain affordable care was unpredictable and had important implications for care-seeking. A "poor fit" between individual and health system factors could lead to inequities in access and gaps in, or non-use of contraception. Participants also reported high levels of shame and stigma associated with being uninsured or on publicly funded insurance. CONCLUSIONS: Affordability is one domain of contraceptive access that is shaped by the interplay between individual factors and health system characteristics as well as by larger structural factors such as health and economic policies that influence both. Assessments of the affordability of contraceptive care must account for the dynamic interplay among multilevel influences. Despite the expansion of contraceptive coverage through the Affordable Care Act, low-income individuals still struggle with affordability and disparities persist.


Asunto(s)
Accesibilidad a los Servicios de Salud , Pobreza , Humanos , Femenino , Adulto , Georgia , Servicios de Planificación Familiar/economía , Adulto Joven , Adolescente , Entrevistas como Asunto , Anticoncepción/estadística & datos numéricos , Anticoncepción/economía , Anticoncepción/métodos
15.
Rev Mal Respir ; 41(6): 409-420, 2024 Jun.
Artículo en Francés | MEDLINE | ID: mdl-38824115

RESUMEN

INTRODUCTION: The "Programme d'Accompagnement du retour à Domicile" (PRADO) COPD is a home discharge support program dedicated to organizing care pathways following hospitalization for COPD exacerbation. This study aimed at assessing its medico-economic impact. METHODS: This was a retrospective database study of patients included in the PRADO BPCO between 2017 and 2019. Data were extracted from the National Health Data System. A control group was built using propensity score matching. Morbi-mortality and costs (national health insurance perspective) were measured during the year following hospitalization. RESULTS: While the proportion of patients with a care pathway complying with recommendations from the National Health Authority was higher in the PRADO group, there was no significant effect on mortality and 12-month rehospitalization. In the PRADO group, the rehospitalization rate was lower when the care pathway was optimal. Healthcare costs per patient were 670 € higher in the PRADO group. CONCLUSIONS: The PRADO COPD improves quality of care but without decreasing rehospitalizations and mortality, although rehospitalizations did decrease among PRADO group patients benefiting from an optimal care pathway.


Asunto(s)
Costos de la Atención en Salud , Readmisión del Paciente , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Masculino , Femenino , Enfermedad Pulmonar Obstructiva Crónica/terapia , Enfermedad Pulmonar Obstructiva Crónica/economía , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Costos de la Atención en Salud/estadística & datos numéricos , Costos de la Atención en Salud/normas , Anciano de 80 o más Años , Readmisión del Paciente/estadística & datos numéricos , Readmisión del Paciente/economía , Alta del Paciente/estadística & datos numéricos , Alta del Paciente/normas , Alta del Paciente/economía , Servicios de Atención de Salud a Domicilio/economía , Servicios de Atención de Salud a Domicilio/normas , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/organización & administración , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Francia/epidemiología , Evaluación de Programas y Proyectos de Salud , Análisis Costo-Beneficio
16.
BMJ Open ; 14(6): e080395, 2024 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-38858160

RESUMEN

INTRODUCTION: Multiplathogen home-based self-sampling offers an opportunity to increase access to screening and treatment in endemic settings with high coinfection prevalence of sexually transmitted (HIV, Trichomonas vaginalis (Tv), human papillomavirus (HPV)) and non-sexually transmitted pathogens (Schistosoma haematobium (Sh)). Chronic coinfections may lead to disability (female genital schistosomiasis) and death (cervical cancer). The Zipime-Weka-Schista (Do self-testing sister!) study aims to evaluate the validity, acceptability, uptake, impact and cost-effectiveness of multipathogen self-sampling for genital infections among women in Zambia. METHODS AND ANALYSIS: This is a longitudinal cohort study aiming to enrol 2500 non-pregnant, sexually active and non-menstruating women aged 15-50 years from two districts in Zambia with 2-year follow-up. During home visits, community health workers offer HIV and Tv self-testing and cervicovaginal self-swabs for (1) HPV by GeneXpert and, (2) Sh DNA detection by conventional (PCR)and isothermal (recombinase polymerase assay) molecular methods. Schistosoma ova and circulating anodic antigen are detected in urine. At a clinic follow-up, midwives perform the same procedures and obtain hand-held colposcopic images. High-risk HPV positive women are referred for a two-quadrant cervical biopsy according to age and HIV status. A cost-effectiveness analysis is conducted in parallel. ETHICS AND DISSEMINATION: The University of Zambia Biomedical Research Ethics Committee (UNZABREC) (reference: 1858-2021), the London School of Hygiene and Tropical Medicine (reference: 25258), Ministry of Health and local superintendents approved the study in September 2021.Written informed consent was obtained from all participants prior to enrolment. Identifiable data collected are stored securely and their confidentiality is protected in accordance with the Data Protection Act 1998.


Asunto(s)
Análisis Costo-Beneficio , Infecciones por VIH , Tamizaje Masivo , Infecciones por Papillomavirus , Humanos , Femenino , Zambia/epidemiología , Estudios Longitudinales , Adulto , Adolescente , Adulto Joven , Persona de Mediana Edad , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Tamizaje Masivo/métodos , Tamizaje Masivo/economía , Coinfección/diagnóstico , Autoevaluación , Animales , Esquistosomiasis Urinaria/diagnóstico , Esquistosomiasis Urinaria/epidemiología , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/epidemiología , Trichomonas vaginalis/aislamiento & purificación , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/virología , Virus del Papiloma Humano
17.
Front Public Health ; 12: 1354099, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38883201

RESUMEN

Introduction: The lack of access to a diverse and nutritious diet has significant health consequences worldwide. Governments have employed various policy mechanisms to ensure access, but their success varies. Method: In this study, the impact of changes in food assistance policy on food prices and nutrient security in different provinces of Iran, a sanctioned country, was investigated using statistical and econometric models. Results: Both the old and new policies were broad in scope, providing subsidized food or cash payments to the entire population. However, the implementation of these policies led to an increase in the market price of food items, resulting in a decline in the intake of essential nutrients. Particularly, the policy that shifted food assistance from commodity subsidies to direct cash payments reduced the price sensitivity of consumers. Consequently, the intake of key nutrients such as Vitamin C and Vitamin A, which are often constrained by their high prices, decreased. To improve the diets of marginalized populations, it is more effective to target subsidies towards specific nutrient groups and disadvantaged populations, with a particular focus on food groups that provide essential nutrients like Vitamin A and Vitamin C in rural areas of Iran. Discussion: More targeted food assistance policies, tailored to the specific context of each province and income level, are more likely to yield positive nutritional outcomes with minimal impact on food prices.


Asunto(s)
Asistencia Alimentaria , Irán , Humanos , Asistencia Alimentaria/economía , Asistencia Alimentaria/estadística & datos numéricos , Política Nutricional/economía , Financiación Gubernamental/estadística & datos numéricos , Financiación Gubernamental/economía , Abastecimiento de Alimentos/economía , Abastecimiento de Alimentos/estadística & datos numéricos , Dieta/economía , Dieta/estadística & datos numéricos
18.
BMC Health Serv Res ; 24(1): 739, 2024 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-38886718

RESUMEN

BACKGROUND: Road traffic injuries are a major concern worldwide, with Thailand facing high accident mortality rates. Drunk driving is a key factor that requires countermeasures. Random breath testing (RBT) and mass media campaigns recommended by the World Health Organisation intend to deter such behaviour. This study aimed to evaluate the cost-effectiveness of implementing RBT in combination with mass media campaigns in Thailand. METHODS: A Markov simulation model estimated the lifetime cost and health benefits of RBT with mass media campaigns compared to mass media campaigns only. Direct medical and non-medical care costs were evaluated from a societal perspective. The health outcomes were quality-adjusted life years (QALY). Costs and outcomes were discounted by 3% per year. Subgroup analyses were conducted for both sexes, different age groups, and different drinking levels. Probabilistic sensitivity analyses were conducted over 5,000 independent iterations using a predetermined distribution for each parameter. RESULTS: This study suggested that RBT with mass media campaigns compared with mass media campaigns increases the lifetime cost by 24,486 THB per male binge drinker and 10,475 THB per female binge drinker (1 USD = 35 THB) and results in a QALY gain of 0.43 years per male binge drinker and 0.10 years per female binge drinker. The intervention yielded incremental cost-effectiveness ratios (ICERs) of 57,391 and 103,850 THB per QALY for male and female drinkers, respectively. Moreover, the intervention was cost-effective for all age groups and drinking levels. The intervention yielded the lowest ICER among male-dependent drinkers. Sensitivity analyses showed that at a willingness-to-pay (WTP) threshold of 160,000 per QALY gained, the RBT combined with mass media campaigns had a 99% probability of being optimal for male drinkers, whereas the probability for females was 91%. CONCLUSIONS: RBT and mass media campaigns in Thailand are cost-effective for all ages and drinking levels in both sexes. The intervention yielded the lowest ICER among male-dependent drinkers. Given the current Thai WTP threshold, sensitivity analyses showed that the intervention was more cost-effective for males than females.


Asunto(s)
Pruebas Respiratorias , Análisis Costo-Beneficio , Cadenas de Markov , Años de Vida Ajustados por Calidad de Vida , Humanos , Tailandia , Masculino , Femenino , Adulto , Persona de Mediana Edad , Medios de Comunicación de Masas , Adulto Joven , Política de Salud , Adolescente , Consumo de Bebidas Alcohólicas/prevención & control , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/economía , Promoción de la Salud/economía , Promoción de la Salud/métodos
19.
Public Health Res Pract ; 34(2)2024 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-38889914

RESUMEN

AIM: The decline in the real value of rebates from Australia's national public health insurance scheme, Medicare, over the past decade has contributed to increased out-of-pocket costs for eyecare services, which threatens affordability. This study measured eyecare affordability and cost barriers among patients seen in collaborative care. METHODS: We conducted a cross-sectional survey of 252 patients who had attended a collaborative eyecare clinic in the previous year. A modified affordability subscale was used to measure eyecare and general healthcare affordability. Two population scores were calculated: the average percentage of patients experiencing cost barriers (mean of the five item percentages for general healthcare, and optometric and specialist eyecare), and the proportion indicating one or more cost barriers. Factors associated with eyecare and general healthcare affordability were identified using linear regression. RESULTS: The response rate was 46.8% (n = 118/252). The mean percentage of patients not obtaining services because of cost ranged from 23.4% (standard deviation [SD] 8.8) for general healthcare to 25.5% (SD 6.3) for specialist eyecare. Direct or indirect cost barriers to one or more services were experienced by 45.2% (n = 52/115) of respondents for optometric eyecare and 40.4% (n = 44/109) for specialist eyecare. Services not covered by private health insurance or Medicare (for example, out-of-pocket dental and optical) were ranked the most difficult to afford. Poorer self-rated health (p = 0.004, ß = 0.293) and the lack of private hospital health insurance (p = 0.014, ß= 0.249) were associated with reduced optometric eyecare affordability. This was also true for specialist eyecare affordability (self-rated health p = 0.002, ß = 0.306; private hospital health insurance p = 0.004, ß = 0.286). A lack of private hospital health insurance (p = 0.001, ß = 0.312), younger age (p < 0.001, ß = -0.418) and holding a concession card (p = 0.011, ß = 0.272) were all associated with reduced affordability of general healthcare. CONCLUSION: A high proportion of patients seen in collaborative care experience cost barriers to accessing eyecare, particularly for services not covered by private health insurance or Medicare. These findings indicate that affordability concerns exist despite significant reductions in the direct cost of services within a collaborative care setting. They also provide insights on the subpopulations most vulnerable to rising eyecare costs.


Asunto(s)
Accesibilidad a los Servicios de Salud , Humanos , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Australia , Anciano , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Adulto , Gastos en Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Anciano de 80 o más Años
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