Dimensions Of Access Research Articles

Factors affecting access to health services by older adults in an urban community in Thailand: a cross-sectional study.

Background: The impending rapid change in Thailand's older population has many important implications for health policy, especially older adults' health problems, which are major cause of them accessing health services. This study aimed to study factors affecting access to health services for older adults in urban communities in Thailand, as well as performing a situational survey of health service utilization. Methods: This cross-sectional study included 886 older adults from four types of urban communities (slum, city, suburban, and community building). Data were collected using an interview questionnaire. Information about health service variables were extracted and followed the five dimensions of accessibility by Penchansky & Thomas: availability, accessibility, accommodation, affordability and acceptability. Data were analyzed using percentage mean and standard deviation (SD). Analysis of factors affecting access to health service was performed using Logistic regression. Results: The utilization of health services was high among five dimensions. They were composed of availability (mean 4.2, SD.=0.59), accessibility (mean 4.1, SD.=0.69), accommodation (mean 3.9, SD.=0.67), affordability (mean 4.2, SD.= 0.62), and acceptability (mean 4.1, SD.=0.62). A summary of all dimensions revealed a mean of 4.1 (SD.= 0.52). Factors affecting older adults access to health services were using health insurance rights for health care service, and concern about the necessity of health care. Conclusions: Encouraging older adults to change their health insurance rights to the nearest hospital and promoting the provision of holistic health information, which will support older adults in accessing more health services to improve their health outcomes.

Associations of Healthcare Affordability, Availability, and Accessibility with Quality Treatment Metrics in Patients with Ovarian Cancer.

Differential access to quality care is associated with racial disparities in ovarian cancer survival. Few studies have examined the association of multiple healthcare access (HCA) dimensions with racial disparities in quality treatment metrics, that is, primary debulking surgery performed by a gynecologic oncologist and initiation of guideline-recommended systemic therapy. We analyzed data for patients with ovarian cancer diagnosed from 2008 to 2015 in the Surveillance, Epidemiology, and End Results-Medicare database. We defined HCA dimensions as affordability, availability, and accessibility. Modified Poisson regressions with sandwich error estimation were used to estimate the relative risk (RR) for quality treatment. The study cohort was 7% NH-Black, 6% Hispanic, and 87% NH-White. Overall, 29% of patients received surgery and 68% initiated systemic therapy. After adjusting for clinical variables, NH-Black patients were less likely to receive surgery [RR, 0.83; 95% confidence interval (CI), 0.70-0.98]; the observed association was attenuated after adjusting for healthcare affordability, accessibility, and availability (RR, 0.91; 95% CI, 0.77-1.08). Dual enrollment in Medicaid and Medicare compared with Medicare only was associated with lower likelihood of receiving surgery (RR, 0.86; 95% CI, 0.76-0.97) and systemic therapy (RR, 0.94; 95% CI, 0.92-0.97). Receiving treatment at a facility in the highest quartile of ovarian cancer surgical volume was associated with higher likelihood of surgery (RR, 1.12; 95% CI, 1.04-1.21). Racial differences were observed in ovarian cancer treatment quality and were partly explained by multiple HCA dimensions. Strategies to mitigate racial disparities in ovarian cancer treatment quality must focus on multiple HCA dimensions. Additional dimensions, acceptability and accommodation, may also be key to addressing disparities.

Measures of Perceived Neighborhood Food Environments and Dietary Habits: A Systematic Review of Methods and Associations.

Access to healthy food is a necessity for all people. However, there is still a lack of reviews on the assessment of respondent-based measures of neighborhood food environments (perceived food environments). The aim of this systematic review was to evaluate the measurement tools for perceived food environments by five dimensions of food access and to obtain the overview of their associations with dietary habits among people aged 18 years and older in middle- and high-income countries. Observational studies using perceived food environment measures were identified through a systematic review based on two databases for original studies published from 2010 to 2020. A total of 19 final studies were extracted from totally 2926 studies. Pertaining to the five dimensions of food access, 12 studies dealt with accessibility, 13 with availability, 6 with affordability, 10 with acceptability, 2 with accommodation, and 8 with a combination of two or more dimensions. Perceived healthy food environments were positively associated with healthy dietary habits in 17 studies, but 8 of them indicated statistically insignificant associations. In conclusion, this review found accessibility and availability to be major dimensions of perceived food environments. The relationship between healthy food environments and healthy diets is presumably positive and weak.

PERBANDINGAN KEPUASAN PASIEN PESERTA JKN DAN NON JKN TERHADAP PELAYANAN RAWAT INAP DI RUMAH SAKIT UMUM PRIMA MEDIKA TAHUN 2020

The Public Relations Satisfaction Survey of Prima Medika Hospital (RSPM) states that an inpatient feels a difference in hospital staff services when he comes for treatment using the Jaminan Kesehatan Nasional (JKN). This study aims to determine differences in patient satisfaction with inpatient services between JKN and non-JKN patients at the RSPM by using quantitative research methods and case survey data collection methods. The sample survey was conducted in a cross-sectional manner with 96 patient respondents consisting of 48 JKN respondents and 48 non-JKN respondents. The satisfaction questionnaire data includes the dimensions of reliability, responsiveness, competence, accessibility, communication, ethics, credibility, security and completeness. Data were analyzed by univariate and bivariate, then hypothesis testing was carried out with the Mann Whitney U. The mean score of JKN patient satisfaction was 3.29 (quite satisfied) and non-JKN patients 3.73 (quite satisfied). The results of the Mann-Whitney statistical test showed a significant difference in satisfaction (p = 5.0704E-10) between JKN and non-JKN respondents. Significant differences were found in doctor's visite service (p = 2.3144E-7), suitability of prescription drugs (p = 7.0098E-11), ease of obtaining inpatient rooms (p = 9.5274E-15) and information on room availability (p = 4.3919E -13). In general, there are differences in satisfaction, where JKN patient satisfaction average is lower than non-JKN patients.
 Keywords: Satisfaction, JKN, Non JKN, Hospital

Unraveling social inequalities in urban health care accessibility in Montevideo: A space-time approach

ABSTRACT Access to urban health care opportunities is a major factor in explaining health outcomes. We propose an innovative methodology to analyze spatio-temporal accessibility considering spatial, temporal, and individual variability on both the demand and the supply side. To construct the measure, we use three primary sources: an exhaustive survey of the space-time provision of pediatric services in Montevideo (i.e., a survey of the times when pediatric care appointments are available at particular clinic locations), a representative sample of pediatric health care users, and a fine-grained travel-time matrix for different transport modes. Our results show that, while different socioeconomic groups have similar levels of access at the aggregate level, access is not evenly distributed. Poorer households compose the highest percentage of households facing a critical lack of access. In addition, we find that space-time constraints associated with employment limit access for low-socioeconomic households more so than for other socioeconomic groups. This methodological contribution allows us to reveal existing inequality patterns in health care access and indicates the need for policymakers to consider the space-time dimensions of access when developing health care policies.

Food security and agricultural challenges in West-African rural communities: a machine learning analysis

ABSTRACT This article investigated household-level food security for Ghana, Liberia, and Senegal. Different agroclimatic, ecological, social, and farming conditions in West Africa were represented. Using data-driven Random Forest and Chi-Square Automatic Interaction Detection (CHAID) decision tree methodology, this study classified 644 Ghanaian, 323 Liberian, and 510 Senegalese households for comparison and interpretation on food security. The predictors growing Liberian and Senegalese decision trees imply community support, diverse selling channels outside villages, resolving the dispute over farmland, and increasing community-level investment for food availability and access demonstrate household food security. Predictor importance on food security for Ghana highlighted the role of independent producers and food suppliers toward stability. Household food security or insecurity was distinguished by location-specific and gender-led households in Liberia and Senegal. Practically, the results presented a need to step-up agricultural education and extension based on an empirical field survey and its interpretations. The results can add considerations to the role of farming households as independent and individual suppliers and consumers to long-standing dimensions of food security, i.e., food availability, access, and stability.

The impact of medical cyber–physical systems on healthcare service delivery

PurposeThe pandemic has reinforced the need for revamping the healthcare service delivery systems around the world to meet the increased challenges of modern-day illnesses. The use of medical cyber–physical system (MCPS) in the healthcare is one of the means of transforming the landscape of the traditional healthcare service delivery system. The purpose of this study is to critically examine the impact of MCPS on the quality of healthcare service delivery.Design/methodology/approachThis paper uses an evidence-based approach, the authors have conducted a systematic literature review to study the impact of MCPS on healthcare service delivery. Fifty-four articles were thematically examined to study the impact of MCPS on eight characteristics of the healthcare service delivery proposed by the world health organisation.FindingsThe study proposes support that MCPS will positively impact (1) comprehensiveness, (2) accessibility, (3) coverage, (4) continuity, (5) quality, (6) person-centredness, (7) coordination, (8) accountability and (9) efficiency dimension of the healthcare service delivery. The study further draws nine propositions to support the impact of MCPS on the healthcare service delivery.Practical implicationsThis study can be used by stakeholders as a guide point while using MCPS in healthcare service delivery systems. Besides, healthcare managers can use this study to understand the performance of their healthcare system. This study can further be used for designing effective strategies for deploying MCPS to be effective and efficient in each of the dimensions of healthcare service delivery.Originality/valueThe previous studies have focussed on technology aspects of MCPS and none of them critically analysed the impact on healthcare service delivery. This is the first literature review carried out to understand the impact of MCPS on the nine dimensions of healthcare service delivery proposed by WHO. This study provides improved thematic awareness of the resulting body of knowledge, allowing the field of MCPS and healthcare service delivery to progress in a more informed and multidisciplinary manner.

Housing, Transportation and Quality of Life among People with Mobility Limitations: A Critical Review of Relationships and Issues Related to Access to Home- and Community-Based Services

Anecdotal reports suggest that adequate housing and transportation could be fundamental elements required to ensure quality of life (QOL) for people with mobility limitations. Certain home- and community-based services (HCBS) are also necessary to ensure that housing and transportation needs are met. Understanding QOL as it relates to housing and transportation is critical for people with mobility limitations but requires appropriate assessment of these constructs. The aims of this research were to explore the relationships between housing and transportation on QOL for people with mobility limitations, to describe the current conceptual measurement issues and to propose dimensions of access that could facilitate assessment of QOL as it relates to housing, transportation and HCBS. A critical review of the literature was conducted by experts in disability, QOL and access theory. While evidence indicated a potential influence of housing and transportation on QOL for people with mobility limitations, the relationships between these concepts were weak and inconclusive. Moreover, the measurement tools used lacked appropriateness to specifically measure these constructs. Approaching these measurement issues within an access theory may better position future research to address the housing, transportation and HSBS needs of people with mobility limitations. Future research may consider elements of availability, accessibility, accommodation, affordability, acceptability and awareness to ensure access for people with mobility limitations. A better understanding of QOL as it relates to housing, transportation and HCBS will improve the quality of research, which may in turn improve access of adequate services for people with mobility limitations.

A qualitative study of rural healthcare providers\u2019 views of social, cultural, and programmatic barriers to healthcare access

BackgroundEnsuring access to healthcare is a complex, multi-dimensional health challenge. Since the inception of the coronavirus pandemic, this challenge is more pressing. Some dimensions of access are difficult to quantify, namely characteristics that influence healthcare services to be both acceptable and appropriate. These link to a patient’s acceptance of services that they are to receive and ensuring appropriate fit between services and a patient’s specific healthcare needs. These dimensions of access are particularly evident in rural health systems where additional structural barriers make accessing healthcare more difficult. Thus, it is important to examine healthcare access barriers in rural-specific areas to understand their origin and implications for resolution.MethodsWe used qualitative methods and a convenience sample of healthcare providers who currently practice in the rural US state of Montana. Our sample included 12 healthcare providers from diverse training backgrounds and specialties. All were decision-makers in the development or revision of patients’ treatment plans. Semi-structured interviews and content analysis were used to explore barriers–appropriateness and acceptability–to healthcare access in their patient populations. Our analysis was both deductive and inductive and focused on three analytic domains: cultural considerations, patient-provider communication, and provider-provider communication. Member checks ensured credibility and trustworthiness of our findings.ResultsFive key themes emerged from analysis: 1) a friction exists between aspects of patients’ rural identities and healthcare systems; 2) facilitating access to healthcare requires application of and respect for cultural differences; 3) communication between healthcare providers is systematically fragmented; 4) time and resource constraints disproportionately harm rural health systems; and 5) profits are prioritized over addressing barriers to healthcare access in the US.ConclusionsInadequate access to healthcare is an issue in the US, particularly in rural areas. Rural healthcare consumers compose a hard-to-reach patient population. Too few providers exist to meet population health needs, and fragmented communication impairs rural health systems’ ability to function. These issues exacerbate the difficulty of ensuring acceptable and appropriate delivery of healthcare services, which compound all other barriers to healthcare access for rural residents. Each dimension of access must be monitored to improve patient experiences and outcomes for rural Americans.

284 Explaining the Transportation Dimension of Food Access

OBJECTIVES/GOALS: Lack of a vehicle and the distant location of supermarkets influence the ease with which people can shop for healthy foods. The aim of this qualitative study is to understand how transportation impacts food access and food purchases of Baltimore residents who do not own an automobile. METHODS/STUDY POPULATION: The Lyft Grocery Access Program was piloted in Baltimore, MD from November 2019 through September 2020. Eligible households resided in Healthy Food Priority Areas, formerly known as food deserts, in south and west Baltimore and also did not own a vehicle. Enrolled households were offered discounted Lyft rides to select supermarkets. Participants for the present study will be purposively recruited via email and phone using contact information that was provided by enrolled households during the pilot program. Each in-depth interview will be conducted via Zoom and recorded, transcribed and analyzed for themes by two trained coders. Data collection and analysis will occur simultaneously. Data collection will cease once data saturation is reached and themes will be derived from the data. RESULTS/ANTICIPATED RESULTS: This study is in progress. Anticipated themes may relate to the food environment, transportation and food access. DISCUSSION/SIGNIFICANCE: Access to healthy foods is an important determinant of health, and how food access is impacted by broader aspects of daily living such as transportation will add to the food access literature. Findings may provide new insights that can help inform food policy and transportation planning in urban communities.

Swimming with the “Current”: An Access-Informed Exploration of Envisioned Blended Learning at Tishreen University in Syria

Today, Tishreen university in Syria is translating its emergency response to crises-prompted disruptions into an intentional blended learning model through the official inception of Moodle. The present study adopts a holistic approach to explore faculty's perceptions of this transition at the Higher Institute of languages. To this end, four pilot interviews, the researcher’s lived experience and the literature were used to design a web-based questionnaire. The questionnaire, completed by 23 teachers, elicited comparative reflections on teachers’ access to Moodle as opposed to their other digitally mediated informal experiences of access, mainly to YouTube. Analysis was largely informed by the digital divide layers: physical-material, instrumental (tool-related), substantial (content-related), motivational, and usage-related. The article argues that re-thinking academic structure and infrastructure is irreducibly grounded in formal-informal networked experiences. Although access divide models have evolved vertically into layers or generations, the current study suggests the need for a horizontal expansion. Firstly, current access divide models do not lucidly reflect distinctions between formal and informal access. Since the digital landscape we increasingly inhabit is not monthlithic in terms of its affordances, structure, modality or genre of information; formal and informal access outcomes are necessarily diverse, yet dynamically intersecting. Secondly, despite accentuating the role of digital proficiency theoretically, access research only tangentially differentiates between the consumption versus production dimensions of substantial content-related skills access. Questions regarding the impact of access on effective blended learning models in general and on academic knowledge in particular, emerge from the data. It is hoped that future research will fathom these distinctions and the relationships between them more profoundly to empower similar initiatives of transition. This is particularly impactful in a country like Syria where an added political-economic affordability layer engulfs the existing physical divide, resulting in mounting boundaries to digital academic and professional knowledge.

Challenges of State Ethnographies in Uruguayan Enclosed Facilities for Children and Adolescents

In this paper, we address the challenges to ethnographically-oriented qualitative research in Uruguayan state facilities for children and adolescents. Based on two qualitative studies, we examine the relevance of conducting research in enclosed institutions that manage the daily lives of children and adolescents within a state framework. Several methodological challenges and questions arise including the different dimensions of institutional access, transit and permanence; the rapport and communication with research participants and key institutional actors; and the writing and dissemination of the results of this type of research. We discuss the possibilities and obstacles associated with qualitative methodologies when carrying out state ethnographies, and the importance of such studies as a way to evidence the living conditions of children and adolescents in these institutions. In the conclusion, we reflect on the ethical dimensions of research. State ethnographies allow us to think about the future of qualitative research, and especially of ethnography, in relation to an ethical task that is constructed in the encounter with those others that shape the research processes. An ethical-political approach that gives agency to the participants in our research, despite the fact that living conditions in these institutions often violate people’s right to be heard. We wonder about the ethical and political relevance of the knowledge produced, considering that public information about some affected groups does not necessarily imply an improvement of their living conditions.

Deep brain stimulation of the thalamus restores signatures of consciousness in a nonhuman primate model.

Loss of consciousness is associated with the disruption of long-range thalamocortical and corticocortical brain communication. We tested the hypothesis that deep brain stimulation (DBS) of central thalamus might restore both arousal and awareness following consciousness loss. We applied anesthesia to suppress consciousness in nonhuman primates. During anesthesia, central thalamic stimulation induced arousal in an on-off manner and increased functional magnetic resonance imaging activity in prefrontal, parietal, and cingulate cortices. Moreover, DBS restored a broad dynamic repertoire of spontaneous resting-state activity, previously described as a signature of consciousness. None of these effects were obtained during the stimulation of a control site in the ventrolateral thalamus. Last, DBS restored a broad hierarchical response to auditory violations that was disrupted under anesthesia. Thus, DBS restored the two dimensions of consciousness, arousal and conscious access, following consciousness loss, paving the way to its therapeutical translation in patients with disorders of consciousness.

Health literacy and health promoting behaviors among inpatient women during COVID-19 pandemic

BackgroundOne of the leading health indicators during the COVID-19 crisis is health literacy and health-promoting behaviors. The present study aimed to investigate health literacy and health-promoting behaviors among women hospitalized during the COVID-19 pandemic in the southern part of Iran in 2020.MethodsThis descriptive-analytical study encompassed 465 women hospitalized and treated in none teaching hospitals affiliated with the Shiraz University of Medical Sciences. Data collection tools were the Health Literacy for Iranian Adults (HELIA) and Health Promoting Lifestyle Profile II (HPLP-II). The collected data were analyzed using descriptive and inferential statistical methods.ResultsThe mean scores of the participants’ "health literacy" and "health-promoting behaviors" were 64.41 ± 11.31 and 112.23 ± 16.09, respectively, indicating the poor level of health literacy and the average level of health-promoting behaviors. Moreover, there was a significant direct correlation between health literacy and health-promoting behaviors (P < 0.001, r = 0.471). Furthermore, all health literacy dimensions of comprehension (P < 0.001), accessibility (P < 0.001), reading skills (P < 0.001), evaluation (P = 0.002), and decision making and behavior (P = 0.003) were detected as the predictors of health-promoting behaviors. Further, statistically significant relationships were noticed between the mean score of health literacy with age (r = − 0.327, P = 0.007), level of education (F = 3.119, P = 0.002), and place of residence (t = 2.416, P = 0.004) and between health-promoting behaviors with level of education (F = 3.341, P = 0.001) and marital status (F = 2.868, P = 0.02).ConclusionAccording to the findings, health policymakers should adopt national measures for educational planning to promote health literacy and support health-promoting behaviors to encourage women to adopt a healthy lifestyle.

Exploring access to care from the perspective of patients with breast cancer: A qualitative study.

ObjectivesPatients face a myriad of personal and system‐based challenges in accessing breast cancer care, but less is known about access as expressed and experienced by patients themselves. The objective of this qualitative study was to further explore the breadth of issues related to access from the perspective of patients with breast cancer across their care journey.MethodsTwelve women participated in 1‐h semi‐structured interviews and 48 women participated in 2‐h focus groups at six oncology practices in 2018. Grounded theory was used to analyze the data.ResultsSix primary themes emerged concerning access to care: information, psychosocial support, health insurance, financial resources, timeliness, and emotions.ConclusionsThis study identified six core dimensions of access to care. Access encompassed not only gaining entrée to care services—in the traditional sense of access—but also the continuing support needed to effectively use those services throughout the cancer care journey. Future strategies aimed at improving access to breast cancer care should attend to these ongoing patient‐centric and system‐based issues which are mostly amenable to change.

Effects of Urban Vibrancy on an Urban Eco-Environment: Case Study on Wuhan City.

In the context of rapid urbanisation and an emerging need for a healthy urban environment, revitalising urban spaces and its effects on the urban eco-environment in Chinese cities have attracted widespread attention. This study assessed urban vibrancy from the dimensions of density, accessibility, liveability, diversity, and human activity, with various indicators using an adjusted spatial TOPSIS (technique for order preference by similarity to an ideal solution) method. The study also explored the effects of urban vibrancy on the urban eco-environment by interpreting PM 2.5 and land surface temperature using “big” and “dynamic” data, such as those from mobile and social network data. Thereafter, spatial modelling was performed to investigate the influence of urban vibrancy on air pollution and temperature with inverted and extracted remote sensing data. This process identified spatial heterogeneity and spatial autocorrelation. The majority of the dimensions, such as density, accessibility, liveability, and diversity, are negatively correlated with PM 2.5, thereby indicating that the advancement of urban vibrancy in these dimensions potentially improves air quality. Conversely, improved accessibility increases the surface temperature in most of the districts, and large-scale infrastructure construction generally contributes to the increase. Diversity and human activity appear to have a cooling effect. In the future, applying spatial heterogeneity is advised to assess urban vibrancy and its effect on the urban eco-environment, to provide valuable references for spatial urban planning, improve public health and human wellbeing, and ensure sustainable urban development.

Exploring variation of coverage and access to dental care for adults in 11 European countries: a vignette approach

BackgroundOral health, coupled with rising awareness on the impact that limited dental care coverage has on oral health and general health and well-being, has received increased attention over the past few years. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a vignette approach.MethodsWe used three patient vignettes to highlight the differences of the dimensions of coverage and access to dental care (coverage, cost-sharing and accessibility). The three vignettes describe typical care pathways for patients with the most common oral health conditions (caries, periodontal disease, edentulism). The vignettes were completed by health services researchers knowledgeable on dental care, dentists, or teams consisting of a health systems expert working together with dental specialists.ResultsCompleted vignettes were received from 11 countries: Bulgaria, Estonia, France, Germany, Republic of Ireland (Ireland), Lithuania, the Netherlands, Poland, Portugal, Slovakia and Sweden. While emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions are covered in most responding countries, root canal treatment, periodontal care and prosthetic restoration often require cost-sharing or are entirely excluded from the benefit basket. Regular dental visits are also limited to one visit per year in many countries. Beyond financial barriers due to out-of-pocket payments, patients may experience very different physical barriers to accessing dental care. The limited availability of contracted dentists (especially in rural areas) and the unequal distribution and lack of specialised dentists are major access barriers to public dental care.ConclusionsAccording to the results, statutory coverage of dental care varies across European countries, while access barriers are largely similar. Many dental services require substantial cost-sharing in most countries, leading to high out-of-pocket spending. Socioeconomic status is thus a main determinant for access to dental care, but other factors such as geography, age and comorbidities can also inhibit access and affect outcomes. Moreover, coverage in most oral health systems is targeted at treatment and less at preventative oral health care.

Sense of Inclusion and Race in a Public, Outdoor Recreation Setting: Do Place Meanings Matter?

Just and equitable access to public lands is of critical importance. A key dimension of access is the sense of inclusion, or how people feel welcome and belonging in space. We analyzed how trail users experienced the sense of inclusion within a public greenspace in eastern Pennsylvania, USA. We found that people of color felt less included than whites while on the trail, even when controlling for trail use behaviors, demographic characteristics, and other factors. For all trail users, more positive place meanings associated with their visit and more social interaction with other trail users increased the sense of inclusion. Overall, our study suggests that greenspace managers could enhance the sense of inclusion among people of color by working with underrepresented communities to identify and incorporate place meanings into public space features.

Perceptions of diabetes patients and their caregivers regarding access to medicine in a severely constrained health system: A qualitative study in Harare, Zimbabwe.

Nearly half of all sub-Saharan African countries lack operational Diabetes Mellitus policies. This represents an opportunity to build reliable evidence to underpin such policies when they are eventually developed. Representing the interests of those with the experience of living with the condition in national diabetes policies is important, particularly the interests regarding medicine access, a key pillar in diabetes management. One way to achieve this representation is to publish patient perceptions. Patient perspectives are especially valuable in the context of diabetes in Sub-Saharan Africa, where much of the empirical work has focused on clinical and epidemiological questions. We therefore captured the challenges and suggestions around medicine access articulated by a population of diabetes patients and their caregivers. This was a qualitative interpretivist study based on data from focus group discussions with adult diabetes patients and their caregivers. Eight FGDs of 4-13 participants each whose duration averaged 13.35 minutes were conducted. Participants were recruited from diabetes outpatient clinics at two health facilities in Harare. One site was Parirenyatwa Hospital, the largest public referral and teaching hospital in Zimbabwe. The other was a private for-profit facility. Ethics approval was granted by the Joint Research Ethics Committee for University of Zimbabwe College of Health Sciences and the Parirenyatwa Group of Hospitals (Ref: JREC 295/18). Diabetes patients and their caregivers are interested in affordable access to medicines of acceptable form and quality with minimum effort. Yet, they often find themselves privileging one dimension of access over another e.g. prioritising affordability over acceptability. Based on participants' articulations, a sound diabetes policy should: 1. provide for financial and consumer protections, 2. regulate healthcare business practices and medicine prices, 3. provide for a responsive health workforce attentive to patient problems, 4. accord the same importance to diabetes that is accorded to communicable diseases, 5. decentralize diabetes management to lower levels of care, 6. limit wastage, corruption, bad macro-financial governance and a lack of transparency about how funding for health is used, and 7. provide support to strengthen patients' and caregivers' psychosocial networks. A diabetes policy acceptable to patients is one infused with principles of good governance, fairness, inclusiveness and humanity; characterised by: financial protection and price regulation, consumer protection, equity in the attention accorded to different diseases, decentralized service delivery, inclusion of patient voice in political decision-making, a responsive compassionate health workforce, psychosocial support for patients and their caregivers and allocative efficiency and transparency in public expenditure.

Clinical comprehensive evaluation of Tianshu Capsules in treatment of migraine (syndrome of blood stasis blocking collaterals and syndrome of ascendant hyperactivity of liver Yang)

This study systematically sorted out the existing studies about Tianshu Capsules in the treatment of migraine(syndrome of blood stasis blocking collaterals, syndrome of ascendant hyperactivity of liver Yang), and conducted comprehensive clinical evaluation through &quot;6+1&quot; dimensions of safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine(TCM) to embody the advantages and characteristics and clarify the precise clinical position of Tianshu Capsules. The value of each dimension was calculated via health technology assessment, the multi-criteria decision analysis(MCDA) mo-del and CSC v2.0 software. The results were graded into four levels of A, B, C, or D from high to low. According to the available studies, Tianshu Capsules had low and controllable risks, with the safety rated as A. The drug has obvious clinical significance in the treatment of migraine(syndrome of blood stasis blocking collaterals, syndrome of ascendant hyperactivity of liver Yang), with the effectiveness rated as A. It has clear economic results, with the economy rated as B. The clinical innovation, service system innovation, and industrial innovation are all good, and thus the innovation of Tianshu Capsules is grade A. The drug can meet clinical medication demand of medical care and patients, and thus its suitability is grade A. In view of the reasonable drug price, affordability, and availability, the accessibility is grade A. The prescription originated from the Daxiong Pills recorded in the classic Comprehensive Recording of Sage-like Benefit. In clinical trials, 4 675 patients have used Tianshu Capsules, which indicates rich experience in human administration, and the characteristics of traditional Chinese medicine is grade B. The statutory drug information complies with national stan-dards, and the non-statutory information is standard and accurate. Based on the comprehensive evaluation results of various dimensions of evidence, the clinical value of Tianshu Capsules in the treatment of migraine(syndrome of blood stasis blocking collaterals and syndrome of ascendant hyperactivity of liver Yang) is class A. According to the Comprehensive Clinical Evaluation Management Guidelines of Drugs(trial version 2021) issued by the National Health Commission of the People's Republic of China, we recommend that Tianshu Capsules treating migraine can be transformed into relevant policy results for clinical medication management according to procedures.