Access To Care Services Research Articles

Does disability increase households\u2019 health financial risk: evidence from the Uganda demographic and health survey

BackgroundIn the last few years, there has been a worldwide commitment to protect the vulnerable individuals from higher financial risk through out-of-pocket (OOP) health expenditure. This study examines the influence of disability and socio-demographic factors on households’ health financial risks in Uganda.MethodsWe used nationally representative cross-sectional data from the Uganda Demographic and Health Survey (UDHS) collected in 2016 by the Uganda Bureau of Statistics (UBOS) in Uganda. We measured financial risk (households’ health expenditure) by money paid for health care services. We estimated the “probit” model to investigate the effect of disability on health financial risk.ResultsA total of 19,305 households were included in this study. Almost 32% of households paid money for health care services access, among which 32% paid through out-of-pocket. Almost 41% of household heads were affected by disability. The majority (73%) of families went to the public sector for health care services. The mean age was 45 years (SD ± 15). We find that disability is significantly associated with the household financial risk (p < 0.01). The private sector’s choice for health care services is likely to positively affect the financial risk compared to the public sector (p < 0.01). The wealthier the household was, the more money paid for health service was (p < 0.01).ConclusionOur results indicated that disability and household socio-demographic characteristics were associated with health financial risk in Uganda. Identifying families with disability and experiencing difficult living conditions constitute an entry point for health authorities to enhance health coverage progress in low and middle-income countries.

Stroke services in Africa: What is there and what is needed.

Over the past few years, the incidence and prevalence of stroke has been rising in most African countries and has been reported as one of the leading causes of morbidity and mortality. To study this problem, we need to realize the quality and availability of stroke care services as a priori to improve them. In this study, we investigated the availability of different stroke-related services in 17 countries from different African regions. An online survey was conducted and fulfilled by stroke specialists and included primary prevention, acute management, diagnostic tools, medications, postdischarge services, and stroke registries. The results showed that although medications for secondary prevention are available, yet many other services are lacking in various countries. This study displays the deficient aspects of stroke services in African countries as a preliminary step toward active corrective procedures for the improvement of stroke-related health services.

Prevalence and risk factors of early childhood caries in the Middle East region: A systematic review.

The purpose of this systematic review was to assess the prevalence and risk factors of early childhood caries (ECC) in the Middle East region in the age group 0-6 years. A systematic literature search was performed in three major databases, Web of Science, PubMed, and Cochrane database, from January 1, 1960 to December 31, 2020, to identify the published literature on the prevalence and risk factors of ECC. All preschool children of 0-6 years of age irrespective of gender and socioeconomic status from the selected geographics were included. A total of 26 full-text articles with a study population of 14,479, age group 0-6 years, were included in the study. The overall ECC prevalence in the Middle East region ranged from 26.50 to 99% in the 0-6-years age group. The mean decayed missing filled teeth ranged from 0.95 to 16.9, reported in studies from Jeddah, West Province, and Al-Jouf, Northern region of Saudi Arabia. In the United Arab Emirates, the prevalence ranged from 41 to 83%. The evaluation of the included studies revealed a total of 103 risk factors for ECC. Low socioeconomic status, dietary habits, poor oral hygienic attitude and behaviors, and poor access and availability of dental care services were the major risk factors. Most studies found low socioeconomic status, gender, age of the child, parents' education, low maternal education, and type of school to be significant risk factors for ECC. Children attending public schools were at a greater risk of having ECC. Gender (male) was another important risk factor. ECC can be prevented by focusing on prevention programs of dental caries, developing awareness-generating programs focusing on oral health education, and increasing access and availability of dental care services.

Availability of postabortion care services in Ethiopia: Estimates from a 2020 national sample of public facilities

Unsafe abortion is a leading cause of global maternal mortality and morbidity. This study sought to estimate availability of essential postabortion care (PAC) services among publicly managed health facilities in Ethiopia. Data from public hospitals and health centers in Ethiopia were collected in 2020. Among facilities offering labor and delivery, we assessed the proportion that: (1) offered PAC, (2) were equipped for each PAC signal function, and (3) were equipped for all PAC signal functions falling within their scope of care by facility type. Our primary outcome was PAC service provision status. Descriptive statistics summarized the proportion of hospitals and health centers, respectively, categorized as each PAC status and with necessary equipment for individual signal functions. Per Federal Ministry of Health (FMOH) guidelines, hospitals are expected to provide comprehensive PAC, while health centers are expected to provide basic PAC. Altogether, 69.1% (n=94) of hospitals were equipped to provide comprehensive PAC, and 65.2% (n=131) of health centers were equipped for basic PAC. Least available signal functions included obstetric surgery among hospitals (83.8%; n=114) and uterine evacuation among health centers (84.6%; n=170). Meaningful progress has been made toward achieving the Ethiopian FMOH's goal of universal PAC service availability at hospitals and health centers by 2020. Despite this, sizable gaps remain and may endanger maternal health in Ethiopia, underscoring a need for continued prioritization of PAC services. Ethiopia's commitment to PAC has fostered a service landscape that is stronger than many other low-resource settings; however, notable shortcomings are present. Further research is needed to understand the potential role of clinical training and supply-side interventions.

Health equity & tribal populations: Challenges & way forward.

Health equity & tribal populations: Challenges & way forward.

The pressing need for integrated nephrology services in Northeastern India.

Chronic kidney disease (CKD) is a major public health problem with an estimated prevalence ranging from 5% to 13% over South Asian region. CKD care and the need for provision of care for the management of end-stage renal disease are an increasingly growing need in India with rising rates of CKD, especially those attributable to uncertain etiologies in certain regions of India. There is a wide disparity between nephrology care services and availability between geographical regions of the kidney with the representation of nephrologists and nephrology care centers more in the Southern and Western regions than in the rest of the country. The Northeastern region of the country is poorly presented in terms of both availability as well as the accessibility of nephrology care services. Better integration and provision of care are the sole need of the hour.

Primary care doctor and nurse consultations among people who live in slums: a retrospective, cross-sectional survey in four countries

ObjectivesTo survey on the availability and use of primary care services in slum populations.DesignRetrospective, cross-sectional, household, individual and healthcare provider surveys.SettingSeven slum sites in four countries (Nigeria, Kenya, Pakistan and...

Non-utilization of postnatal care and its associated factors among women who gave birth in rural districts of Northern Ethiopia: A community-based mixed-method study.

Objectives:This study assessed the non-utilization of PNC services, identified factors associated with PNC non-utilization, and explored barriers to PNC utilization in the rural community.Method:A community-based mixed-cross-sectional study was conducted from 20 March to 20 April 2020 among 521 women who gave birth in the last 12 months prior to this survey. A multistage sampling and face-to-face interview techniques were used for the quantitative data collection, and a purposive sampling technique was used to select the study participants. In-depth interviews were used for the qualitative data collection. The quantitative data were entered into EpiData version 3.1 and then exported to SPSS version 25 for analysis. A binary logistic regression analysis was used to test the association between the independent and outcome variables. A p-value of <0.2 was used as the cutoff value to include variables in the multivariate analysis. Finally, a p-value of <0.05 was used to declare an independent association. The qualitative data were manually sorted, cleaned up, and labeled as themes. Every major theme was identified and enumerated, and the meaning units were cited together with the relevant participant’s socio-demographic details.Result:The non-utilization of postnatal care was found to be 75.4% in the area. Normal delivery, fewer than four antenatal care visits, inaccessibility to transportation, and poor knowledge of postnatal care were all identified as factors enhancing non-utilization of postnatal care. However, being informed about postnatal care positively influences postnatal care utilization. Poor awareness, information gaps, cultural and religious beliefs, service inaccessibility, and the unfriendly approach of healthcare workers were all explored as barriers in the qualitative study.Conclusions:The non-utilization of PNC services in this study was higher than the majority, but not all, of the previous comparable local and worldwide findings. Mode of delivery, hearing postnatal care information, the number of antenatal visits, transportation availability, and knowledge of postnatal care services were factors affecting the non-utilization of postnatal care. The clients’ poor awareness, information gaps, cultural and religious beliefs, service inaccessibility, and healthcare staff’s inauspicious approach were barriers explored. Therefore, counseling and transportation access need to be reinforced in the setting.

Availability and Utilization of Postabortion Care Services in Burkina Faso, Côte d'Ivoire, and Guinea: A Secondary Analysis of Emergency Obstetric and Neonatal Care Needs Assessments (EmONC).

SYNOPSIS: Generally, there are disparities in the availability and utilization of postabortion care services within the different regions at the national level in Burkina Faso, Cote d’Ivoire, and Guinea and between the 3 countries. Access to postabortion care at the primary level must be improved and the adoption of family planning when providing postabortion care.Unsafe abortion remains one of the leading causes of maternal mortality in sub-Sahara Africa, with relatively poor access to quality postabortion care (PAC) services. This study evaluated the quantity and distribution as well as the utilization of PAC services in Burkina Faso, Cote d’Ivoire, and Guinea. We conducted a secondary data analysis using the most recent EmONC surveys in the 3 countries between 2016 and 2017. We used PAC signal functions approach to assess facilities’ capacity to provide basic PAC at both primary and referral level of care and comprehensive PAC at the referral level. We illustrated population coverage of PAC services based on the WHO benchmark, and then assessed the utilization of PAC services. Basic PAC capacity at primary level was low (36.6%), ranging from 16.2% in Burkina Faso to 36% in Cote d’Ivoire. About 82.0% of hospitals could provide comprehensive PAC. There were disparities in the geographical distribution of PAC services at both national and subnational levels. Abortion complications represented 16.2% of all obstetric emergencies, and uptake of PAC modern contraceptive was low (37.1%) in all countries. There is a need to focus on access to PAC at the primary level of care in the 3 countries.

Assessing Global Kidney Nutrition Care.

Nutrition intervention is an essential component of kidney disease management. This study aimed to understand current global availability and capacity of kidney nutrition care services, interdisciplinary communication, and availability of oral nutrition supplements. The International Society of Renal Nutrition and Metabolism (ISRNM), working in partnership with the International Society of Nephrology (ISN) Global Kidney Health Atlas Committee, developed this Global Kidney Nutrition Care Atlas. An electronic survey was administered among key kidney care stakeholders through 182 ISN-affiliated countries between July and September 2018. Overall, 160 of 182 countries (88%) responded, of which 155 countries (97%) answered the survey items related to kidney nutrition care. Only 48% of the 155 countries have dietitians/renal dietitians to provide this specialized service. Dietary counseling, provided by a person trained in nutrition, was generally not available in 65% of low-/lower middle-income countries and "never" available in 23% of low-income countries. Forty-one percent of the countries did not provide formal assessment of nutrition status for kidney nutrition care. The availability of oral nutrition supplements varied globally and, mostly, were not freely available in low-/lower middle-income countries for both inpatient and outpatient settings. Dietitians and nephrologists only communicated "sometimes" on kidney nutrition care in ≥60% of countries globally. This survey reveals significant gaps in global kidney nutrition care service capacity, availability, cost coverage, and deficiencies in interdisciplinary communication on kidney nutrition care delivery, especially in lower-income countries.

System- and Individual-Level Barriers to Accessing Medical Care Services Across the Rural-Urban Spectrum, Washington State.

Background:Residents of rural areas face barriers beyond geography and distance when accessing medical care services. The purpose of this study was to characterize medical care access barriers across several commonly used classifications of rurality.Methods:Washington State household residents completed a mixed-mode (paper/online) health care access survey between June 2018 and December 2019 administered to a stratified random sample of ZIP codes classified as urban, suburban, large rural, and small rural (4-tier scheme). For analyses, rurality was also classified into 2-tier schemes (rural/urban) based on ZIP code and county. Respondents reported availability of medical care services and system- and individual-level barriers to accessing services. Logistic regression models estimated the odds of reporting system- or individual-level barriers in accessing medical care services across rurality (4- and 2-tier schemes), adjusting for respondent characteristics, and weighted to account for survey design.Results:About 617 households completed the survey (25.7% response rate). Compared to urban residents (across all 3 schemes), more rural residents reported traveling to a distant city or town for medical care (P < .001). Rurality was significantly associated with increased odds of facing system-level barriers. Respondents from small rural areas had greater odds access barriers for primary care (OR 7.31, 95% CI 1.84-29.09) and having no primary care provider (OR 11.37, 95% CI 3.03-42.75) compared to urban respondents. Individual-level barriers were not associated with rurality.Conclusions:To improve healthcare access across the rural-urban spectrum, policymakers must consider system-level barriers facing rural populations.

Choiceless options: when hospital-based services represent the only palliative care offering.

Lack of availability of community-based pediatric palliative care and home-based hospice services for children limits care location options for families. For many families from rural regions, hospital-based care models may be perceived as the only viable choice due to geographic gaps in service coverage. Gaps exist not only in access to these key services but also in service quality without national pediatric service standards. While families from rural regions may express a goal to be home with their child for relational and communal care purposes the current setting of services may limit the feasibility of home-based care. Several potential pediatric systems changes (workforce, finance, policy) have the capacity to create and sustain a care model that allows a child with complex, chronic, or life-limiting diagnoses to experience a home other than the hospital. The existence of community-based pediatric palliative and pediatric home-based hospice services with a sustained workforce and high-quality national standard for children would bolster the ultimate congruence of a family's preference with actual care choices. IMPACT: Families of children with life-limiting diagnoses may express a preference to be home together. Disparities in access to community-based pediatric palliative care and hospice exist for children, particularly in rural regions. These gaps may translate into families experiencing hospital-based settings as the only feasible care model which may result in care escalations and medicalization. Expansion of the community-based workforce and development of pediatric-specific standards for key palliative services would increase home-based care options for families. This paper acknowledges the pediatric palliative and hospice availability crisis in rural regions and urges for improved access to high-quality, community-based services for children.

Who Should Make Care Arrangement for Older Adults? Heteronormative Family Responsibility in Japan

In Japan, despite the greater availability of public care services upon implementation of national long-term care insurance, families are still considered as primarily responsible to make care arrangement for older adults. My aim in this study was to explore (hetero)normative ideas about families that underlie Japan’s institutionalized practices of elder care. In doing so, I focused on care managers, who are certified care practitioners helping families to make care arrangement, and whether they would count older adults’ same-sex partners as legitimate family members to participate in such arrangement. Data were collected from 1,580 care managers working for officially designated in-home care providers across the nation. Preliminary analysis revealed that although most care managers believed the voices of same-sex partners should be preferably reflected in the process of care arrangement, they also thought that these partners could not participate in such process without permission from older adult’s “blood relatives” (e.g., siblings).

Association between local spatial accessibility of dental care services and dental care quality

BackgroundThe aim of our study was to evaluate the allocation of dental resources and explore access to dental care in Taiwan. In addition, we tried to understand the spatiotemporal characteristics of dental care quality and analyze the relationship between dental care quality and areas with deficiencies in dental resources.MethodsThe study used a two-step floating catchment area to calculate the dental resources accessibility and explore the spatiotemporal distributions of dental care quality. The association between dental care quality and spatial accessibility was analyzed using a spatial error model.ResultsMost areas with deficient dental resources and lower dental care quality were remote townships, agricultural towns, or aging towns with spatial clustering. The quality of children's preventive dental care had increased over time. Most highly urbanized areas had higher dental care quality. The quality of some dental care types such as children's preventive care and full-mouth calculous removal was associated with higher accessibility.ConclusionsUnderstanding the spatiotemporal distribution of both dental care accessibility and quality can assist in allocation of dental care resources. Adequate dental resources may elevate dental care quality. Suggestions include policies to balance dental resources and routinely monitor improvement in areas with deficient dental care.

A new perspective on women’s care burden and employment in Turkey

AbstractWomen’s intra-household care burden is one of the main reasons behind women’s low employment rates in Turkey. Many empirical studies have tested this relationship by focusing on the existence of dependent household members, if any. They have largely overlooked the use of care services and the time spent on caring for dependent household members to evaluate women’s care burden.The purpose of this study is to examine the relationship between women’s care burden and employment prospects and status in Turkey from the perspective of access to care services and the time dimension of the care burden. This relationship is analyzed through the logit model by using latest available data from the 2014–2015 Time Use Survey. The article shows that the time spent by women caring for dependent household members, and access to care services, are the most important factors influencing women’s employment probability in Turkey. Benefiting from informal childcare services increases the employment probability of women approximately twenty-seven times, while benefiting from formal childcare services increases two times and informal adult-care services 2.6 times. Ensuring the accessibility of institutional care services improves women’s employment status by enabling women’s transition from part-time to full-time jobs, and from unskilled to professional jobs.

Breaking Barriers Amid the Pandemic: The Status of Telehealth in Southeast Asia and its Potential as a Mode of Healthcare Delivery in the Philippines

Breaking Barriers Amid the Pandemic: The Status of Telehealth in Southeast Asia and its Potential as a Mode of Healthcare Delivery in the Philippines

Understanding the Impact of Digital Health Strategies During the COVID-19 Outbreak in Saudi Arabia.

BackgroundThe impact of COVID-19 has been analyzed from various aspects on the health care services management, accessibility and delivery of health care services. However, the COVID-19 pandemic has led to disruptions in health care services, which led to the increase in adoption of digital health technologies, mostly arising out of need and necessity.ObjectiveFocusing on the prevailing situations (increasing reliance on digital health services), this study investigates the impact of digital health technologies from the perspectives of policymakers and citizens.MethodsA mixed-methods approach was adopted. Twenty-seven semi-structured online interviews were conducted with experts and policymakers for assessing the impact from policymakers' perspectives. An online survey questionnaire instrument was used to collect the responses from 1698 Saudi Arabian citizens in relation to the various aspects of digital health applications.ResultsHealth care expenditures increased during the COVID-19 outbreak, resulting in launch of various digital health applications. While policymakers defended their stand in improving health care services and accessibility; citizens reflected inability to book medicines/personal medical equipment online (Mean=2.4) and suffered a lack of personalized care (Mean=2.9) through digital health applications. Moreover, disparities exist between the population groups with respect to the accessibility, utilization, and perceptions of digital health technologies.ConclusionPolicymakers have to consider and address these differences in formulating digital health policies and implementing them.

Utilization of palliative care services in patients who died from stage IV non-small cell lung cancer (NSCLC): A retrospective study from a tertiary care center in rural Maine.

95 Background: It is known that palliative care involvement in metastatic NSCLC cancer patients has been shown to improve quality of life in previous studies. The aim of our study was to analyze the utilization of palliative care services among patients who died from NSCLC and the setting in which these patients first received palliative care. Methods: This is a retrospective chart review analysis of patients with stage IV NSCLC who were diagnosed at Eastern Maine Medical center and the affiliated cancer center who died between January 2016 and December 2018. We collected demographic data, date and stage of diagnosis, location of palliative referral, location of first palliative care contact with the patient, time between diagnosis and death, utilization of hospice services and time between the initial palliative care consult and death. Results: 255 patients with stage IV NSCLC died between 2016 and 2018. Mean age was 65.5 years. Women were 49% and men were 51%. Majority (60%) of patients had good performance status with ECOG score between 0-1 at presentation. All 255 patients were referred to palliative care. The location of initial palliative care referral following diagnosis was 40% from the hospital, 32% from the oncology clinic and 28% from the outpatient specialist or PCP office. Overall, 174 patients (68%) were seen by palliative care and 81 (32%) were not seen. Of the patients seen 119 (68%) had their initial palliative evaluation in the hospital, and 55 (32%) in the clinic. Majority (55%) had more than one follow-up visit. Consults initiated in the inpatient setting were more likely to be seen by palliative care than in the outpatient setting (p 0.0009). Time between diagnosis to palliative care consult was less than one month in 39%, 1-2 months in 25%, 2-6 months in 21%, and more than 6 months in 14% patients. Patients seen by palliative care had a more likelihood to end up on hospice (p 0.09). The majority of patients seen by palliative care (53%) died within a month of initial consultation. Conclusions: All patients in our study population were referred to palliative care with 100% provider compliance. Among these, 68% were seen by palliative care. Interestingly, inpatient referrals were more likely to be seen by palliative care than the outpatient referrals. We think this is likely related to ease of access to palliative care team in the hospital as well as some of the patients being at terminal stages of their disease. About 33% of patients died within a month of their initial diagnosis, likely giving palliative care team a shorter window of opportunity to be seen in the outpatient setting. Prioritizing referrals of stage IV NSCLC patients might decrease the wait time after initial referral and increase the availability of palliative care services to these patients.

An Exploration study into Good Governance and Equity Aspects of JKN Program in Cardiovascular Care Services in Central Java, Indonesia

To achieve equitable access of its citizen to health care, since 2014, the Government of Indonesia has implemented the national health insurance scheme, namely JKN. However, equal access to specialistic health care is still challenging. Using a convergent parallel mixed-method approach, and the utilization of cardiovascular services as an example, this study aims to evaluate the good governance and equity aspects of the JKN program in Central Java, a province in Indonesia which records a high poverty rate above the national rate. Based on IHME, Central Java has the highest proportion of mortality associated with cardiovascular diseases among the provinces in Indonesia. This study found that most of the districts in this province are struggling to achieve the 2019 JKN roadmap target in terms of JKN participation coverage. Unequal distribution of health facilities and human resources is recorded affecting access to and utilization of cardiovascular care services. More contribution from the district and provincial government as well participation from private sectors (the employers) to fund the JKN program is essential to ensure the availability of specialistic care services in rural areas to narrow the gaps in cardiovascular care services.

Factors influencing clinicians' referral or admission decisions for post-acute stroke or traumatic brain injury rehabilitation: A scoping review.

Demand for post-acute stroke and traumatic brain injury (TBI) rehabilitation outweighs resource availability. Every day, clinicians face the challenging task of deciding which patient will benefit or not from rehabilitation. The objectives of this scoping review were to map and compare factors reported by clinicians as influencing referral or admission decisions to post-acute rehabilitation for stroke and TBI patients, to identify most frequently reported factors and those perceived as most influential. We searched four major databases for articles published between 1946 and January 2021. Articles were included if they reported clinicians' perceptions, investigated referral or admission decisions to post-acute rehabilitation, and focused on patients with stroke or TBI. Twenty articles met inclusion criteria. The International Classification of Functioning, Disability and Health framework was used to guide data extraction and summarizing. Patient-related factors most frequently reported by clinicians were age, mental status prior to stroke or TBI, and family support. The two latter were ranked among the most influential by clinicians working with stroke patients, whereas age was ranked of low importance. Organizational factors were reported to influence decisions (particularly the availability of post-acute care services) as well as clinicians' characteristics (eg, knowledge). Moreover, clinicians' prediction of patient outcome ranked among the most important driver of referral or admission decisions by clinicians working with stroke patients. Findings highlight the complex nature of decision-making regarding patient selection for rehabilitation and provide insight on important factors that frontline clinicians need to consider when having to make rapid decisions in high-pressured acute care environments.