Health Care Services For Patients Research Articles

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.......

Emergency Department and Inpatient Health Care Services Utilization by the Elderly Population: Hurricane Sandy in The State of New Jersey.

In this investigation, we reported the increase in emergency department and inpatient admission cases during the month of November 2012 post Hurricane Sandy as compared with baseline (November 2010, 2011, and 2013) for elderly patients aged 65 and up. Medical claims data for patients aged 65 and over treated at emergency department and inpatient health care facilities in New Jersey were analyzed to examine the surge in frequencies of diagnoses treated immediately following Hurricane Sandy. The differences were quantified using gap analysis for 2 years before and 1 year after the event. There was an average increase of 1700 cases for the month of November 2012 relative to baseline for the top 15 most frequently diagnosed emergency department medical conditions. On a daily basis, a volume increase by an average 57 cases could be expected, including significant numbers of limb fractures and other trauma cases for these most frequently encountered medical conditions. Understanding the surge level in medical services needed in emergency departments and inpatient facilities during a natural disaster aftermath is critical for effective emergency preparation and response for the elderly population. (Disaster Med Public Health Preparedness. 2018;12:730-738).

The effect of employee ability, hospital’s ethic and leadership on job satisfaction through employee commitment

PurposeThe purpose of this paper is to confirm the direct and indirect effect of employee ability, perceived ethic, and leadership and leadership to service quality through employee commitment.Design/methodology/approachA survey instrument is using to collect the data and to measure the effect of employee ability, perceived ethic, and leadership directly to the quality of inpatient health care services was developed. This study also used the self-perception, leadership evaluation and customer evaluation questionnaires. The effects among variables were also analysed by using the structural equation modelling method.FindingsThe results of the analysis show that the survey instrument was reliable and valid; the implementation of hospital ethic was more emphasised on the nurses (as a front liners); the study proved that there is a direct and indirect effect among variables of employee ability, hospital’s ethic, and leadership to the service quality through the employee commitment; the direct effect of employee commitment variables against the service quality was significantly negative.Research limitations/implicationsAnalyses are developed within the context of a government single hospital of Type A. According to the time sequence of study, this field of study research considered for purpose only (one time study), and was not conducted for experimental study.Originality/valueThis paper’s main contribution is to propose and empirically test a set of constructs that complement the effect of employee ability, hospital’s perceived ethic, leadership on the service quality of inpatient health care through the employee commitment direct and indirectly in the Type A hospital.

Health-care utilization and expenditure patterns in the rural areas of Punjab, India.

Objective:To determine pattern of health care utilization and extent of out-of-pocket healthcare expenditure in rural areas of Punjab in India.Methods:Using multi stage sampling procedure, 660 participants were selected from 110 villages, out of all 22 districts; 440 participants had utilized outpatient care in past 15 days, and 220 had been hospitalized in past one year. Pretested semistructured questionnaires were used to enquire about household and healthcare expenditures. Out-of-pocket (OoP) expenditure included only direct costs of healthcare. Sevety seven 77 (12%) participants could not provide expenditures, hence were excluded from analysis. More than 10% of total household expenditure on healthcare was considered catastrophic.Results:Majority of the participants had used public sector health facilities for outpatient (57%) and inpatient (51.5%) care. Public sector facilities were utilized more often for communicable diseases and gynaecological problems whereas private sector services were used more commonly for accidents and non-communicable diseases. Mean healthcare expenditure on outpatient and inpatient healthcare services was Indian Rupees (INR) 8501 and INR 53889 respectively. Expenditure in private sector was significantly higher compared to the public sector facilities. Catastrophic expenditure was incurred by 7% of the households while seeking outpatient care and by 53% while seeking inpatient care. To pay for outpatient and inpatient care, 23.3% and 61.5% of the participants respectively had to borrow money or sell their assets.Conclusions:Healthcare expenditure places households under considerable financial strain in rural areas of Punjab in India. Improvements of public hospitals may increase their utilization and decrease financial burden.

Health insurance coverage and inpatient services choice among rural-to-urban migrants from a nationwide cross-sectional survey in China: does location matter?

BackgroundIn China, rural-to-urban migrants can participate in the new rural cooperative medical scheme (NCMS) from their hometown, or in urban residents or employee-based health-care insurance from the place they live. This study aimed to investigate the association between the location they enrolled in for the insurance and whether migrants used local inpatient services. MethodsData were taken from 2014 cross-sectional survey of National Migrant Dynamics Monitoring Survey in China, representing migrants aged 15–60 years who did not have the local “Hukou” (ie, government household registration) and had been living in local cities for more than 1 month. We used multivariate logistic regression to estimate the association between different insurance coverage and choice in locations for inpatient care among migrants, controlling for individual gender, age, marital status, education, income, occupation, commercial health-care insurance, migration types, years of migration, and community urbanicity. FindingsOf 170 904 rural-to-urban migrants aged 15–60 years, 68·6% enrolled in the NCMS from their hometown, 5·0% and 12·7% enrolled respectively in urban residents and employee-based insurance from the local city, and 13·7% had no insurance. In total, 3·1% used inpatient services during the previous year. Among them, 70·5% used inpatient services from the city they lived in. Regression analyses showed that enrolment in the urban employee-based insurance was associated with 1·79 times the odds of using local inpatient services (95% CI 1·44–2·21), and urban residents insurance coverage was associated with 1·50 times the odds of using local inpatient services (1·09–2·05) compared with NCMS coverage from hometown. Additionally, compared with those covered by NCMS, migrants without insurance were also more likely to use inpatient services in the local city (odds ratio 1·77, 1·44–2·17). InterpretationParticipation in the local urban insurance programmes seemed to be significantly linked with increased preference for local inpatient health-care services, while the majority of migrants were covered only by rural insurance from their hometown, which might affect their access to and preference for local health-care services. FundingNational Nature Science Foundation of China (71403007).

DESIGNING THE MINIMUM DATA SET OF PSYCHIATRIC EMERGENCY RECORD

Introduction: 
 Psychiatric emergencies are acute mental health disturbances, behavior and social relationship that require immediate intervention. The major role of psychiatric emergency services is to provide mental health care services for patients with acute mental health problems. Design emergency psychiatry core dataset has improved the coordination and integration of services and improved the outcomes for the patient with severe and persistent mental illness with complex needs. So the aim of this study was to design data elements (DEs) in emergency psychiatry for Iran.
 
 Methods:
 This is an applied study. Emergency psychiatry (DEs) collected via literature review and then psychologist and psychiatrist (16 experts) assign the score from 0 to 5 to them according to the value of each data element. (DEs) selected as core Emergency psychiatry (DEs) that were achieved 4 or 5 scores from 75% specialist.
 
 Results:
 According to the literature review, 110 (DEs) included studying. 13 experts (8 psychologists, 8 Clinical Psychologist) evaluated psychiatric emergency (DEs) set. The average work experience of psychiatrists and psychologists was 16 years and their work experience ranged from 2 to 25 years (table 1). according to the experts opinion, 54 (DEs) with at least 75% of the agreement were identified as the psychiatric emergency (DEs). Emergency psychiatric (DEs) and average agreement of each of them were: demographic characteristics (6 DEs with an agreement average of 82.5%), history of mental illness (9 DEs with an agreement average of 79%), family history of psychology (3 DEs with an average agreement of 77.08%), medical history (1 DEs with an average agreement of 81.25 %) Assessment of mental status ( 20 DEs with an average agreement of 82%), assessment of the self harm risk or harm risk for others ( 13 DEs with an average agreement of 93.6%) and diagnosis and treatment (3 DEs with an average agreement of 81.25%).
 Conclusion:
 Given the importance of psychiatric disorder and lack of the national system for gathering psychiatric information, perform the same study abut psychiatric data element is very important. The results of this study can be used for design psychiatric emergency forms and gather accurate and complete patient information.

Governance Structure and Exit: Evidence from California Hospitals

Most inpatient and emergency health care services in the U.S. are delivered by non-profit organizations. To understand the impact of policies that are designed to affect competitive outcomes in hospital markets, it’s important to understand whether the “non-profit” structure changes the behavior and competitive conduct of firms. Given the complexity of the product space within which hospitals operate, we focus on more easily interpreted decisions within the hospital market: entry and exit. Using comprehensive administrative data for the universe of California hospitals from 1980 to 2013, we document the observed entry and exit behavior. We estimate flexible exit policy functions and demonstrate a difference in behavior between for-profit and non-profit firms that exists after accounting for several observable characteristics of hospitals. We find differences in observed behavior: this is a finding that strongly suggests that there are differences in the underlying objective function of the various firms.

Has equity in government subsidy on healthcare improved in China? Evidence from the China\u2019s National Health Services Survey

BackgroundMonitoring the equity of government healthcare subsidies (GHS) is critical for evaluating the performance of health policy decisions. China’s low-income population encounters barriers in accessing benefits from GHS. This paper focuses on the distribution of China’s healthcare subsidies among different socio-economic populations and the factors that affect their equitable distribution. It examines the characteristics of equitable access to benefits in a province of northeastern China, comparing the equity performance between urban and rural areas.MethodsBenefit incidence analysis was applied to GHS data from two rounds of China’s National Health Services Survey (2003 and 2008, N = 27,239) in Heilongjiang province, reflecting the information in 2002 and 2007 respectively. Concentration index (CI) was used to evaluate the absolute equity of GHSs in outpatient and inpatient healthcare services. A negative CI indicates disproportionate concentration of GHSs among the poor, while a positive CI indicates the GHS is pro-rich, a CI of zero indicates perfect equity. In addition, Kakwani index (KI) was used to evaluate the progressivity of GHSs. A positive KI denotes the GHS is regressive, while a negative value denotes the GHS is progressive.ResultsCIs for inpatient care in urban and rural residents were 0.2036 and 0.4497 respectively in 2002, and those in 2007 were 0.4433 and 0.5375. Likewise, CIs for outpatient care are positive in both regions in 2002 and 2007, indicating that both inpatient and outpatient GHSs were pro-rich in both survey periods irrespective of region. In addition, KIs for inpatient services were −0.3769 (urban) and 0.0576 (rural) in 2002 and those in 2007 were 0.0280 and 0.1868. KIs for outpatient service were -0.4278 (urban) and -0.1257 (rural) in 2002, those in 2007 were −0.2572 and −0.1501, indicating that equity was improved in GHS in outpatient care in both regions but not in inpatient services.ConclusionsThe benefit distribution of government healthcare subsidies has been strongly influenced by China’s health insurance schemes. Their compensation policies and benefit packages need reform to improve the benefit equity between outpatient and inpatient care both in urban and rural areas.

Equity in the Use of Health Care Services: Case of Turkey

Equity in the use of health care services is an issue which has increasingly been on the health policy agenda in recent years in almost all countries. The aim of this study is to examine equity in the use of health care services in Turkey (separately for outpatient and inpatient care services) using “Health Surveys” for the years 2008, 2010 and 2012 obtained from the Turkish Statistical Institute by employing the Gini index. The results indicate that individuals belonging to the lower income group in the use of health services in Turkey are disadvantaged and, which implies the existence of inequity. The change of the Gini index by years indicates that 2010 is the year when the inequity is at its lowest level. It is observed that the degree of inequity for outpatient and inpatient health care services increased after 2010. However, the level of inequity for outpatient care continued to decline after 2010. In 2012, it is observed that the degree of inequity at its highest level for inpatient health care services.

Inequity in access to inpatient healthcare services for non-communicable diseases in India and the role of out-of-pocket payments.

Growing evidence suggests that non-communicable diseases (NCDs) result in considerable economic burden for individuals and households. With the poor facing a greater burden of NCDs than the rich in India, we undertook this study to analyse the horizontal equity in utilization and vertical equity in out-of-pocket expenditure for NCD care. We used data of 1 4 large Indian states from the National Sample Survey 60th round to compute hospitalization rates for NCDs. Mean per capita consumption expenditure (MPCE) was computed and used as a proxy measure for socioeconomic status. Out-of-pocket payment as a proportion of MPCE was estimated by wealth quintile (Q) to assess the vertical equity in payments. Concentration index (CoI) was computed to measure the extent of equity, and its 95% confidence interval was estimated to assess statistical significance. Overall, NCD hospitalizations in public facilities in India were used more by the poor (Col -0.041 ), while the rich used proportionately more services in the private sector (CoI 0.174). Out-of-pocket expenditure in public facilities was consistently lower than that in private facilities in urban and rural areas. The mean out-of-pocket expenditure for inpatient services for NCDs was found to be more among the rich in both public (Q5 ₹13 016, Q1 ₹4197) and private (Q5 ₹22 974, Q1 ₹8225) facilities. Public facilities are utilized more by poorer individuals. Strengthening the capacity of the public sector to deliver NCD care is required to meet equitable outcomes.

Nursing practice with triage decision making for COPD patients of a telemedicine centre – An ethnographic approach

Introduction: The collaboration reform has increased the responsibility of Norwegian municipalities for health care services for patients with chronic diseases; whereas chronic obstructive pulmonary disease (COPD) represents a large group [1]. This change, associated to the reform, requires establishing new clinical pathways. Telemedicine (TM) has demonstrated potential in advanced nursing practice in terms of efficacy and quality of care [2]. Through TM, nurses can determine patient’s health status and follow-up supported by a decision aid software program. To date, there is little research investigating how nurses working in municipal health care services make clinical decisions based on a triage to assess COPD patient’s health status. This research presents an ethnographic study with three nurses working in a telemedicine center (TMC) in Southern Norway as part of a European project, namely United4Health. Patients used a tablet at home with video camera for video consultations and a pulse oximeter device for transference of clinical measurements (oxygen saturation and heart rate). The aim of the study was to investigate how nurses in a TMC using video consultations made decisions on COPD patient’s health status using triage as part of the decision making process. Methods: The data collection was made through participatory observations, field notes and focus group interview including three nurses working in a TMC from October 2015 to February 2016 in southern Norway. The collected data is currently being analysed using qualitative content analysis [3]. Results and discussion: Preliminary results showed that nurses working in the TMC found the triage useful as part of the decision making process that allowed identifying health problems and prioritising the patients need for help. However, the nurses often used workarounds and made decisions according to their own knowledge and experience when interpreting the software recommendation; in these cases, the triage model was seen just as guidance. In addition, this interpretation was not only based on the daily triage assigned to each patient, but also on the content of past triaging and earlier nurses’ documentation for each patient. This indicated that triaging a chronic patient is complex, time consuming and relies on the nurses’ previous knowledge concerning both patients’ medical history and life. Furthermore, video consultation was important for the nurses as a visualisation of the patient, and it was a significant additional component to the triage recommendation and nurses’ own decision. Video consultation follow-up was often replaced by telephone calls because of frequent technical problems. This led to important visual information for the decision making process was not possible to be observed by nurses, which could have negatively influenced the decision outcome.

Inpatient and outpatient health care utilization and expenditures among older adults aged 50 years and above in India

Background: Social and economic inequality in utilization of health care services, as well as high out of pocket expenditures are prevalent in overall Indian population. The situation among older adults will be much more critical as they require long-term health care services. The objective of this study is to assess the utilization of outpatient and inpatient care among older adults and incurred out of pocket health expenditure. It also tried to explore the association between socioeconomic factors on receiving health care services and out of pocket health expenditure among older adults in India.Data source: The data from the Study on Global Ageing and Adult Health (SAGE) Wave 1 was used, which was conducted in 2007-08 in India. Respondents aged 50 and above are taken as older adult population. The final sample size was 7150 respondents aged 50 years and above.Results: The percentage of older adults aged 50 years and above receiving outpatient and inpatient health care service were 87.5% and 14.6% respectively. The use of private health facilities was high compared to government health facility. High utilization of outpatient among women and high use of inpatient care among men were found, which was insignificant after adjusting for other variables. Socioeconomic characteristics also play an important role in access to health care among older adults. Place of residence, marital status, caste, education and presence of morbidity were related to the utilization of health care services. Place of residence, education and wealth quintile were also significantly associated with health expenditures.Conclusion: Requirement of long-term health care among older adult population may result in increasing burden of health care expenditures. Socioeconomic characteristics also play an important role in access to health care among older adults. Developing quality and affordable health care services for older adults to ensure equity in accessibility and affordablility will be a major task for the public health system in India.

Pathways and access to mental health care services by persons living with severe mental disorders and epilepsy in Uganda, Liberia and Nepal: a qualitative study.

BackgroundAccess to mental health care services for patients with neuropsychiatric disorders remains low especially in post-conflict, low and middle income countries. Persons with mental health conditions and epilepsy take many different paths when they access formal and informal care for their conditions. This study conducted across three countries sought to provide preliminary data to inform program development on access to care. It thus sought to assess the different pathways persons with severe mental disorders and epilepsy take when accessing care. It also sought to identify the barriers to accessing care that patients face.MethodsSix in depth interviews, 27 focus group discussions and 77 key informants’ interviews were conducted on a purposively selected sample of health care workers, policy makers, service users and care takers in Uganda, Liberia and Nepal. Data collected along predetermined themes was analysed using Atlas ti software in Uganda and QSR Nvivo 10 in Liberia and NepalResultsIndividual’s beliefs guide the paths they take when accessing care. Unlike other studies done in this area, majority of the study participants reported the hospital as their main source of care. Whereas traditional healers lie last in the hierarchy in Liberia and Nepal, they come after the hospital as a care option in Uganda. Systemic barriers such as: lack of psychotropic medicines, inadequate mental health specialists and services and negative attitudes of health care workers, family related and community related barriers were reported.ConclusionAccess to mental health care services by persons living with severe mental disorders and epilepsy remains low in these three post conflict countries. The reasons contributing to it are multi-faceted ranging from systemic, familial, community and individual. It is imperative that policies and programming address: negative attitudes and stigma from health care workers and community, regular provision of medicines and other supplies, enhancement of health care workers skills. Ultimately reducing the accessibility gap will also require use of expert clients and families to strengthen the treatment coalition.

Incidence of knee injuries : Numbers for outpatient and inpatient care in Germany

Musculoskeletal illnesses and injuries are among the most common ailments in the Federal Republic of Germany. In 2008 they generated costs of nearly 29billion euros. Figures about their incidence and prevalence are necessary for ademand-oriented planning of future patient-centred care. Pseudonymised data of 3.8million people insured by AOK Baden-Württemberg between 2008 and 2013 were evaluated. The diagnoses were assigned to nine injury groups. For outpatient care confirmed diagnoses were considered, and for inpatient care both primary and secondary diagnoses were considered. For all patients with structural knee injuries, it was evaluated whether they made use of one of five eligible treatment paradigms either in the quarter in which they were injured or in the following quarter. 418,257 patients were treated in 2013 for at least one new-onset injury (10.9 % of all insurees); 86,783 insurees (2.3 % of all insurees) had anewly occurring knee injury. The vast majority of the patients were treated by specialist doctors. While magnetic resonance imaging clearly increased during the observation period, the incidence of surgical therapy did not change. Striking are the different age distributions regarding the types of injuries, with ahigh injury incidence amongst young men and asignificant increase in injuries between 2008 and 2013, especially amongst women. For the first time, the data quantify the knee injury incidences of alarge cohort in Germany. They show which inpatient and outpatient health care services have been claimed and that an age- and gender-adapted prevention and an increased awareness are needed.

Clinical Outcomes, Utilization, and Charges in Persons With Neck Pain Receiving Guideline Adherent Physical Therapy

In efforts to decrease practice variation, clinical practice guidelines for neck pain have been published. The purpose of this study was to determine the effect of receiving guideline adherent physical therapy (PT) on clinical outcomes, health care utilization, and charges for health care services in patients with neck pain. A retrospective review of 298 patients with neck pain receiving PT from 2008 to 2011 was performed. Clinical outcomes, utilization, and charges were compared between patients who received guideline adherent care and nonadherent care. Patients in the adherent care group experienced a lower percentage improvement in pain score compared to nonadherent care group (p = .01), but groups did not significantly differ on percentage improvement in disability (p = .32). However, patients receiving adherent care had an average 3.6 fewer PT visits (p < .001) and less charges for PT (p < .001). Additionally, patients receiving adherent care had 7.3 fewer visits to other health care providers (p < .001), one less prescription medication (p = .02) and 43% fewer diagnostic images (p = .02) but did not differ in their charges to other health care providers (p = .68) during the calendar year of undergoing PT. Although receiving guideline adherent care demonstrated positive effects on health care utilization and financial outcomes, there appears to be a trade-off with clinical outcomes.

Impact of Patient Welfare Support in Terms of Satisfaction Level to Lower Socio- Economic Class getting In-Patient Health Care Services from Private Hospitals of Karachi, Pakistan

Impact of Patient Welfare Support in Terms of Satisfaction Level to Lower Socio- Economic Class getting In-Patient Health Care Services from Private Hospitals of Karachi, Pakistan