Health Care Services For Patients Research Articles

Demographic and clinical profiles of admitted psychiatric patients of the East London Mental Health Unit in the Eastern Cape, South Africa.

Integration of psychiatric care at the Primary Health Care (PHC) could be an important strategy towards addressing the shortages of in-patient mental health care services in South Africa. This study describes the profiles of admitted psychiatric patients at the East London Mental Health Unit (ELMHU) of the Eastern Cape from January 2016 to December 2016.In this retrospective cross-sectional study, an audit of medical records of all psychiatric in-patients managed at the ELMHU during the study period was undertaken. Simple descriptive and inferential statistics were used to describe the profiles and examine the associations with the common psychiatric conditions.Of the participants with complete data (n = 186), the majority were males (n = 108); single (72.6%) and had secondary education (45.7%). The majority of in-patients were psychotic (38%), violent (31%), manic (16%) or suicidal (9.2%) at the time of admission. Patients who were 35 years and above, resided in urban areas, and presented with suicidal and depressive symptoms were more likely to be admitted voluntarily. Schizophrenia (31.6%), cannabis-related psychiatric disorders (31.6%), bipolar Type-1 disorder (21.9%) and alcohol related disorders (15.5%) were the main reasons for admission. There was a significant association between demographic characteristics and the common psychiatric disorders of the patients.Schizophrenia, bipolar 1 disorder, cannabis-related disorders and alcohol-related disorders are the predominant disorders leading to in- patient mental health care services being utilized in the study setting. Findings might inform training of health care workers at the PHCs with a view to integrating mental health care services in the Eastern Cape.

Depressive Symptoms, Lack of Physical Activity, and Their Combination Towards Health Care Utilisation Frequency

Depressive symptoms and lack of physical activity are independent factors that lead to higher health care utilisation, often occurring simultaneously. We aimed to assess the effects of depressive symptoms, lack of aerobic physical activity (PA), and the combination of those factors on the probability of using in- and outpatient health care services in men and women. Data from 15,770 people from the nationally representative Austrian Health Interview Survey (AT-HIS) were used. In analysis, depressive symptoms, adjusted for sociodemographic, health related, and lifestyle-related factors were associated with higher odds of outpatient health care utilisation (OR: 1.60; 95% CI: 1.19–2.14) in men and (OR: 2.10; 95%CI: 1.65–2.66) in women, and with higher odds of inpatient health care utilisation (OR: 1.52; 95% CI: 1.09–2.10) in men and (OR: 2.09; 95% CI: 1.64–2.68) in women. However, depressive symptoms were not associated with higher health care utilisation in the fully adjusted models. In men, co-existence of depressive symptoms and lack of health enhancing physical activity (HEPA) was associated with higher odds of using inpatient health care services, compared to the presence of only one or none of the factors. In conclusion, our results show that depressive symptoms are associated with more health care utilisation in both men and women and that the co-existence of both depressive symptoms and lack of HEPA elevated the odds for inpatient health care utilisation in men even more.

Financial Affordability, Health Insurance, and Use of Health Care Services by the Elderly: Findings From the China Health and Retirement Longitudinal Study.

The rapidly growing aging population has attracted global attention. This study explores the associations between 3 basic health insurances, and it identifies factors associated with health care services among the elderly populations. This study is based on multistage stratified cluster sampling method from the 2013 China Health and Retirement Longitudinal Study (CHARLS) resulting in 7589 participants. Medical Insurance for Urban Employees (MIUE) members were more likely to use inpatient health care services. Health insurance programs were associated with inpatient services usage but not outpatient services usage. There are significant disparities in medical costs and health care service usage among the 3 insurance programs. Health insurance program is only associated with inpatient care. These findings may provide some suggestions to support improvements to the Chinese health care system.

Optimization of Health Care Services with Limited Resources

Health services are an integral part of hospitals or health clinics. Maximum service can get if the availability of resources in the service center is very adequate, but the availability of resources cannot be ascertained that it will always be adequate, and excessive availability of resources can also result in waste. The problem that often occurs is the lack of optimal services provided to patients due to limited available resources. Various obstacles, such as services that are not permitted are repeated, uncertain service distances, and service time are optimal barriers to service. This study aims to solve the problem of optimizing health care services for patients in hospitals using a number of variables in the hospital environment such as available resources, namely doctors, nursing medical personnel, technicians, technical equipment. This study is subject to the aim of minimizing all costs incurred to perform services, namely travel time from places to provide health services to patients, medical staff costs to provide services of the type of service, and so on. These variables are explained in the form of mathematical models that are able to explain existing constraints and minimize costs and time when performing services. The modeling results were tested using Linear Ineraktive Discrete Optimizer (LINDO) programming to determine errors that might occur in the model. The test results provide information that the maximum value of the objective function is 88.00 at the 25th iteration step so that the new model is expected to optimize health services for hospital patients and existing health clinics.

Protocol for the Data-Linkage Alcohol Cohort Study (DACS): investigating mortality, morbidity and offending among people with an alcohol-related problem using linked administrative data

IntroductionThe aims of this program of research are to use linked health and law enforcement data to describe individuals presenting to emergency and inpatient healthcare services with an acute alcohol...

INTERRATER RELIABILITY DAN INTERNAL CONSISTENCY PENGKAJIAN LUKA KAKI DIABETIK THE NEW DIABETIC FOOT ULCER ASSESSMENT SCALE (DFUAS) BERBASIS FOTO

Diabetic foot ulcers have a high prevalence that requires good management of care. One of them is by assessing diabetic foot wounds. Currently, there has been a review of diabetic foot healing footage of New Diabetic Foot Ulcer Assessment Scale (DFUAS) which has been tested for validity and photo-based reliability. Nevertheless, in the DFUAS Assessment Reliability Test, there are still differences in perceptions on several DFUAS assessment variables on wound nurses. One reason is that there is no socialization given to the wound nurses on how to assess the DFUAS assessment. In addition, the previous DFUAS assessment reliability test is only performed on certified wound nurses whereas in health care services in patients with diabetic foot injuries are also performed by non-certified general nurses. This study aims to assess the interrater reliability and internal consistency of DFUAS-based on photo assessment on expert nurses and general nurses. The design of this study was cross sectional study. The samples in this study were certified nurses with ETN, CWCC, CWCCA and general non-certified Nurses with more than 2 years experience of wound care. The nurse as an observer evaluated 8 wounded images divided according to the wound stage (necrotic, slough, granulation and epithelial) using DFUAS assessment. Interrater reliability was assessed by spearman rho while internal consistency was assessed by cronbach's alpha. Interrater reliability shows good correlation with spearman rho> 0.60. Internal consistency shows good reliability between DFUAS assessment items and Cronbach's alpha 0.98. This study shows that the DFUAS assessment is reliable on different nurses both certified nurses and general nurses.

Determinants of Health-seeking Behaviour in Northeast India

India’s northeast region comprises eight states, which, together, is home to 3.8 per cent of the country’s population. The quality of healthcare and manpower availability remains a cause for concern in the region, affecting the overall health-seeking behaviour of the people. This study attempts to understand the determinants of utilization of healthcare services in Northeast India. Healthcare and morbidity data for this study are based on a Northeast India sample from the National Sample Survey Organization’s (NSSO’s) health consumption data (2014). Probit, multinomial and mixed conditional logit models were employed in the study. In Northeast India, uneducated, higher-aged, Schedule Castes/Schedule Tribes (SCs/STs), Muslims, rural people and district people are served less by medical institutions and because of poor road connectivity they either remain untreated or seek care at underequipped primary healthcare services, while their counterparts utilize private facilities mostly for outpatient care and either public hospital or private facilities for inpatient care. There is also a tendency to substitute alternative healthcare when the cost of an inpatient healthcare service rises. To protect the interest of marginalized people and achieve the target of accessible, affordable and quality healthcare, the government needs to strengthen the primary healthcare in rural areas and improve the quality of healthcare in urban areas without increasing the cost of treatment.

Out-of-Pocket Health Expenditures Among Insured and Uninsured Patients in Vietnam

Out-of-pocket expenditure/payment (OOP) is one of the indicators measuring the achievement of Universal Health Coverage. This article aimed to compare OOP among the insured and uninsured for their outpatient and inpatient health care services. The data of 6710 individuals using outpatient care and 924 individuals using inpatient care at 78 district hospitals and 246 commune health centers in 6 provinces from the World Bank survey, "The 2015 Vietnam District and Commune Health Facility," were used for analysis. In the ordinary least square model, the estimated coefficient of the insurance status variable suggested that insurance reduced OOP by 31.1% for outpatient care and 31.5% for inpatient care of the insured as compared with the uninsured (P <0.001). For outpatient care, insurance reduced OOP more for those enrollees using commune health centers than those using district health facilities, 42.3% and 20.2%, respectively. For inpatient care at district health facilities, insurance reduced OOP by 34.9% as compared with the uninsured (P <0.001). The study suggested that more active solutions should be created to promote the universal health insurance in Vietnam.

Investigating the Factors Affecting Health Services Utilization in Hepatitis B Patients of Yazd City in 2017

Background: We can achieve a clear picture of the demands for services and the ways to respond to them by examining the status of health care services in patients with hepatitis B. In this way, we can minimize the gap between the promotion and improvement of the performance of service providers. Therefore, the aim of this study was to evaluate the utilization of healthcare services in patients with hepatitis B.&#x0D; Methods: This cross-sectional study was conducted among 464 patients with hepatitis B who were selected by simple random sampling using a researcher-made questionnaire containing 20 items, according to the study variables. We entered the data into the Excel software and analyzed them by STATA 13 software using descriptive statistical tests and linear regression.&#x0D; Results: There was a significance association between the utilization of education and counseling services, specialist visits, clinical services, and the place of provision of services. In addition, the utilization of education and counseling services had a significant association with the supplemental insurance and the incidence of hepatitis B in the family. A significance relationship was also observed between the number of visits to the specialist and the type of occupation, educational level, and duration of diagnosis. Utilization of inpatient cares had a significant relationship with the place of residence and the basic insurance status.&#x0D; Conclusion: Generally, the rate of visits to access the healthcare services is low among patients with hepatitis B. Considering the fact that this disease is special, we suggest the authorities to provide health care services in three preventive levels free of charge (by providing a health insurance card for the patients). Furthermore, the government needs to implement the national health insurance (NHI) and therefore does not receive the franchise. Patients should refer to specialist according to the general practitioner's opinion. They also should have access to the services during the evening.&#x0D; &#x0D; Key words: Utilization of health services, Hepatitis B, Specific Patients

Dostupnost orfan lekova - osnovna pravna pitanja razvoja i finansiranja

This paper critically analyzes the basic models for the development and financing of orphan drugs, i.e. medicines for the treatment of rare diseases, starting from the principle of equality in health care proclaimed within the framework of the World Health Organization and to the protection of the rights of vulnerable categories of the population as well. A comparative and normative method has been applied. On the basis of the regulations of the European Union and the national laws of the member states, the paper emphasizes the possible solutions for the development of domestic law in the context of ensuring access to patients and exercising the right to health care. The opinion of the European Court of Human Rights in the case of Nitecki v. Poland is, specifically, analyzed from the aspect of refunding the price of an orphan medicinal product and exercising the right to access to health care services for patients. The model of public-private partnership was identified as the most adequate one in the conditions of limited public resources, taking into account the interest of the state, and the need for expressing social responsibility considering the interest of the (pharmaceutical) companies. The model is based on the (bio)ethic principle of justice, conceptualized as assistance to those people who suffer from bad health condition and who are economically worse off.

Primary health care services for patients with chronic disease in Newfoundland and Labrador: a descriptive analysis.

Newfoundland and Labrador has a rapidly aging population, much of which is rural, with poor health behaviours and high rates of chronic disease. These factors contribute to a unique challenge in health care delivery. Our aim was to describe the availability of publicly funded primary health care programs and services delivered by regional health authorities across the province. We performed a descriptive analysis using data from a cross-sectional provincial primary health care survey deployed across Newfoundland and Labrador. Survey data included location, disease-specific chronic disease prevention programming, types of routine primary care, allied health prevention and promotion, chronic disease prevention and management services, and team-based care. The mode of service delivery was identified for most programs and services. Surveys were returned by 153 sites (99.4% response rate). Family physician services were available at 66% of sites (95/145) and nurse practitioner services were available at 51% (74/144) of sites. Many sites offered screening for cervical (60%, 86/144), colon (42%, 59/142) and prostate cancers (43%, 60/141), in addition to various self-management and education services. Allied health services, such as clinical nutrition counselling (47%, 68/46) and occupational therapy (46%, 68/147), were available at many sites. Available health care services were most often offered by on-site staff, and few sites provided primary health care services through telehealth. Overall, rural sites offered a greater variety of services than urban sites. Considerable variability exists in the range of primary health care services available across Newfoundland and Labrador, with limited delivery of some programs and services. Future research should examine how availability of programs and services affects health outcomes and costs.

Assessing the dose-response relationship between number of office-based visits and hospitalizations for patients with type II diabetes using generalized propensity score matching.

BackgroundWhether inpatient services can be successfully substituted by office-based services has been debated for many decades, but the evidence is still inconclusive. This study aims to investigate the effect of office-based care on use and the expenditure for other healthcare services in patients with type II diabetes (T2D).MethodsA generalized propensity score matching approach was used on pooled Medical Expenditure Panel Survey (MEPS) data for 2000–2012 to explore a dose-response effect. Patients were matched by using a comprehensive set of variables selected following a standard model on access to care.FindingsOffice-based care (up to 5 visits/year) acts as a substitute for other healthcare services and is associated with lower use and expenditure for inpatient, outpatient and emergency care. After five visits, office-based care becomes a complement to other services and is associated with increases in expenditure for T2D. Above 20 to 26 visits per year, depending on the healthcare service under consideration, the marginal effect of an additional office-based visit becomes non-statistically significant.ConclusionsOffice-based visits appear to be an effective instrument to reduce use of inpatient care and other services, including outpatient and emergency-care, in patients with T2D without any increase in total healthcare expenditure.

Real-Time Heart Pulse Monitoring Technique Using Wireless Sensor Network and Mobile Application

Wireless Sensor Networks (WSNs) for healthcare have emerged in the recent years. Wireless technology has been developed and used widely for different medical fields. This technology provides healthcare services for patients, especially who suffer from chronic diseases. Services such as catering continuous medical monitoring and get rid of disturbance caused by the sensor of instruments. Sensors are connected to a patient by wires and become bed-bound that less from the mobility of the patient. In this paper, proposed a real-time heart pulse monitoring system via conducted an electronic circuit architecture to measure Heart Pulse (HP) for patients and display heart pulse measuring via smartphone and computer over the network in real-time settings. In HP measuring application standpoint, using sensor technology to observe heart pulse by bringing the fingerprint to the sensor via used Arduino microcontroller with Ethernet shield to connect heart pulse circuit to the internet and send results to the web server and receive it anywhere. The proposed system provided the usability by the user (user-friendly) not only by the specialist. Also, it offered speed andresults accuracy, the highest availability with the user on an ongoing basis, and few cost.

Effects of high-speed rail on health-care service utilization

IntroductionThe development of public transportation in a community might facilitate the utilization of health-care services in the region. The purpose of this study was to identify the effects of high-speed rail service on the utilization of health-care services among the patients diagnosed with cancer. MethodsThe study population comprised patients living in rural regions and who were diagnosed as having cancer during a five year period (2002–2006). The final sample included 3449 (49% men, 51% women). Of those, 918 participants used health-care services in Seoul. The pattern of outpatient and inpatient visits was estimated using interrupted time series analysis. ResultsThere were significant differences in healthcare utilization by gender, age, region, and income levels. In the patient population studied, prior to the introduction of the Korean Train Express, the utilization of outpatient services had been increasing. Beginning with the introduction of the Korean Train Express, the number of patients utilizing outpatient services significantly increased across time. The introduction of the Korean Train Express did not influence the utilization of inpatient health-care services among those in the population studied. ConclusionsThe development of public transportation appeared to help facilitate the utilization of outpatient services for higher income patients diagnosed with cancer in Korea. This research can inform both transportation and Healthcare service planning for rural communities. Additional efforts need to be considered for low income populations.

Factors affecting the choice of health care utilisation between private and public services among the elderly population in India.

India is experiencing rapid population ageing in recent years. One of the most concomitant issues is the choice of health care services among the elderly, leading to its impact on the magnitude of health expenditure. Applying Andersen's Health Behavioural Model, this study identifies the predictors of the choice of inpatient health care services among the Indian elderly between private and public services. It also examines the nature of interregional disparity in the choice of health care services. Using NSSO data, the results suggest that the elderly belonging to upper caste and having higher levels of education, higher incomes, larger family size, and needing surgery are likely to choose private health care, while those experiencing higher economic dependence, chronic diseases, and higher duration of hospitalisation tend to prefer public inpatient services. The magnitude and significance of these factors, however, vary across regions. The findings of the study provide an understanding of the preferences of the India's geriatric population over hospital services, which may help policymakers better understand their health care needs.

A Social-Ecological Approach to Determine Barriers of DMSM Practice For Patients with Type 2 Diabetes Mellitus: A literature review

Diabetes mellitus is one of the global problems the world. Since the complexity of the patient’s tasks is required in the diabetes care, the consistency to engage this various health behavior for addressing the glycemic control target is difficult to achieve. Failure management may reflect by patient, family, inadequate intervention strategies by health care provider as well as organization factor. Three databases used such as PubMed, MIDLINE, and CINAHL to address patient’s barriers, family’s barriers, and provider’s barriers as well as organization barriers for diabetes management. Patient’s attitudes and belief, knowledge, culture, and ethnicity, self-efficacy, financial resources and economic status, lack of Social Support Perceived, and lack of time may influence the diabetes self-management. Family factors lead to patients’ diabetes self-management such as lack of knowledge and skill to support patients in diabetes management and quality of the relationship between patients-family. Health care providers factors included beliefs, attitudes, knowledge and skill and patient–family-provider interaction and communication. Other factors lead to diabetes self-management and health care provider performance to provide the intervention from organization level such as integrated health system sufficiency health insurance to support resources. A deeper understanding of the barriers in diabetes management is necessary to improve the diabetes care and quality of health care services for patients with diabetes. Further research needs to consider these barriers before designing the effective, sensitive interventions and problem solving for diabetes care

All-cause and cause-specific mortality rates of patients treated for alcohol use disorders: A meta-analysis

Background: Although alcohol use disorders (AUDs) are known to increase the relative risk of all-cause and some cause-specific mortality, the absolute mortality rates of the AUD population are unknown. Such knowledge would benefit planners of the provision of services for this population, including in prioritizing the identification and/or treatment of diseases likely to cause their death. Methods: We conducted a systematic review of studies in English, reporting the cause-specific mortality rates among people treated for AUDs. Number of deaths by cause and total person-years of follow-up were extracted. All-cause and cause-specific mortality rates per 1000 person-years were meta-analyzed assuming random effects. Results: Thirty-one studies were included. Participants were mainly middle-aged males. The quality of studies was generally good. A total of 6768 all-cause deaths in 276,990.7 person-years of follow-up (36,375 patients) were recorded, and the pooled all-cause mortality rate was 27.67/1000 person-years (py) (95% confidence interval [CI]: 23.9, 32.04). The most common cause of death in the AUD population was cardiovascular disease (CVD) (6.9/1000 py; 95% CI: 5.61, 8.49), followed by gastrointestinal deaths (5.63/1000 py; 95% CI: 4.1, 7.74), unnatural deaths (4.95/1000 py; 95% CI: 4.01, 6.09)), neoplasms, respiratory diseases, and substance use disorders. Conclusions: Patients with AUDs have increased rates of all-cause and cause-specific mortality compared with the general population. Like the general population, they are most likely to die of CVD. In contrast to the general population, gastrointestinal and unnatural deaths are the next most common causes of death. We believe these facts should be considered when planning health care services for patients with AUDs.

Promoting the use of self-management in novice chiropractors treating individuals with spine pain: the design of a theory-based knowledge translation intervention

BackgroundClinical practice guidelines generally recommend clinicians use self-management support (SMS) when managing patients with spine pain. However, even within the educational setting, the implementation of SMS remains suboptimal. The objectives of this study were to 1) estimate the organizational readiness for change toward using SMS at the Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario from the perspective of directors and deans, 2) estimate the attitudes and self-reported behaviours towards using evidence-based practice (EBP), and beliefs about pain management among supervisory clinicians and chiropractic interns, 3) identify potential barriers and enablers to using SMS, and 4) design a theory-based tailored Knowledge Translation (KT) intervention to increase the use of SMS.MethodsMixed method design. We administered three self-administered questionnaires to assess clinicians’ and interns’ attitudes and behaviours toward EBP, beliefs about pain management, and practice style. In addition, we conducted 3 focus groups with clinicians and interns based on the Theoretical Domain Framework (TDF) to explore their beliefs about using SMS for patients with spine pain. Data were analysed using deductive thematic analysis by 2 independent assessors. A panel of 7 experts mapped behaviour change techniques to key barriers identified informing the design of a KT intervention.ResultsParticipants showed high level of EBP knowledge, positive attitude of EBP, and moderate frequency of EBP use. A number of barrier factors were identified from clinicians (N = 6) and interns (N = 16) corresponding to 7 TDF domains: Knowledge; Skills; Environmental context and resources; Emotion; Beliefs about Capabilities; Memory, attention & decision making; and Social Influence. To address these barriers, the expert panel proposed a multifaceted KT intervention composed of a webinar and online educational module on a SMS guided by the Brief Action Planning, clinical vignettes, training workshop, and opinion leader support.ConclusionSMS strategies can help maximizing the health care services for patients with spine pain. This may in turn optimize patients’ health. The proposed theory-based KT intervention may facilitate the implementation of SMS among clinicians and interns.

24-hour access outpatient clinic for patients with exacerbation of chronic disease: a before-after cohort study of differences in acute healthcare utilisation

BackgroundChronic diseases are becoming more common due to an increasing ageing population. Patients with chronic conditions managed in outpatient clinics account for a large share of healthcare costs. We developed a 24-h access outpatient clinic offering 24-h telephone support and triaged access to the hospital for patients with acute exacerbation of four selected chronic diseases. The aim of this study was to conduct a 1-year before-after study of the acute healthcare utilisation in patients offered the 24-h access outpatient clinic intervention.MethodsThe study was conducted as an observational register-based cohort study. Data from the patient administrative register and the Danish National Health Service Register were extracted 12 months before and 12 months after implementation of the 24-h access intervention. Patients with chronic obstructive pulmonary disease, chronic liver disease, inflammatory bowel disease and heart failure managed in hospital outpatient clinics were enrolled in the study. Differences in healthcare utilisation were analysed for all patients, including the subgroup of high-risk patients with at least one acute admission in the year before enrolment.ResultsLength-of-stay remained unchanged for all diagnostic groups, except for patients with heart failure in whom a statistically significant reduction was observed. Statistically significant reductions of length of stay and acute admissions were observed in all high-risk groups, except for patients with chronic liver disease. A statistically significant reduction in the number of contacts to out-of-hours primary care was seen in patients with chronic obstructive pulmonary disease, whereas the level remained unchanged in the other diagnostic groups. Similar patterns were also seen in high-risk patients.ConclusionsThe 24-h access outpatient clinic did not increase the use of acute healthcare services inpatients with chronic disease. Significant reductions in hospital utilisation were seen in high-risk patients. These preliminary results should be interpreted with caution due to the observational before-after design of the study.

Preface

.......This edition, with its range of topics covering preventive / proactive care (detecting those at risk of diabetes and hypertension), non-communicable diseases, end of life care, and the social determinants of health (in the case report), show the extent of conditions which need to be included in any effective UHC (universal health coverage) package. It also demonstrates the breadth of work of family doctors, emphasising the need to be patient-centred and to look at the full context of the patient and community when addressing key health issues.............Improving the capability of physicians in primary care is necessary becasuse as a leading edge of health services, primary care is expected to provide more comprehensive health care services for patients, families, and their communities (patient-centered, family-focused, community-oriented care). A structured, measurable, and sustainable mode of education and training is needed to buid these abilities.......