Health Care Services Research Articles

Consumers’ recommendations for improving access to healthcare services to adolescents with disabilities in Ghana

IntroductionIn Ghana, Adolescents with mobility and visual impairments and their families, encounter healthcare disparities, including socio-economic, physical, structural and attitudinal challenges, compared to the general population. Nonetheless, there is limited motivation to understand how to improve healthcare access for these marginalized consumers (i.e., adolescents with disabilities and their families). Consequently, the study explored marginalized consumers’ recommendations for improving access to healthcare services, described in Ghana’s Act 715. Informed by the qualitative descriptive design, forty-five (45) participants were purposively recruited and interviewed, adopting a semi-structured interview guide. Data gathered were subjected to content analysis and interpreted via lenses of the theory of dimensions of healthcare access.ResultsThe study’s findings were layered within areas of improving policy-practice interphase. Consumers called on policy makers to restructure the NHIS to cover indirect costs of accessing healthcare services for adolescents with disabilities. In respect of improving practice, it was also suggested that training and education on disability phenomenon must be extended to all cadres of healthcare workers including administrative staff, who provided services to this marginalized social unit. Participants further recommended enhancing the availability of healthcare workers and services as well as ensuring respect and protection of human rights within healthcare facilities.

Impact of COVID-19 on healthcare programs in Zimbabwe: a mixed methods study

BackgroundThe COVID-19 pandemic disrupted healthcare services. Understanding similar epidemic-related disruptions on a broader scope in our local setting is critical for the effective planning of essential services. The study determined the impact of Coronavirus disease(COVID-19) on healthcare programs in Zimbabwe.MethodsA mixed-methods study compared healthcare service delivery trends from the Ministry of Health and Child Care before, during and post the pandemic. It employed two methods of data collection: Key informant interviews (KII) and secondary data analysis from the Zimbabwe District Health Information Systems 2 (DHIS2). Purposive sampling obtained key informants for interviews whilst 18 healthcare service indicators were identified from the national database. Statistical analysis consisted of an interrupted time series analysis of those indicators preceded by visualization to appreciate trend change. An inductive approach was used to code and identify basic themes which were then triangulated against DHIS2 findings.ResultsThe study revealed that COVID-19 had a negative impact on health service delivery; increasing disruptions of critical healthcare services, maternal and child health, reproductive health issues, and other specialist services were prominent. The rise in maternal and child mortality cases and caesarean sections could be directly linked to the decline in service delivery during the pandemic. Mitigation strategies that were introduced during the pandemic included the use of community-based services, outreach services, capacity building, and de-congestion of public services.ConclusionsThe pandemic disrupted healthcare delivery, causing service usage to decline due to lockdowns. Response strategies included community services, capacity building, and stakeholder engagement. Future readiness requires epidemic plans, enhanced resources, a multisectoral approach, workforce training, and public education.

The impact of ongoing armed conflict on Sudan’s healthcare system: narrative review

BackgroundThe ongoing armed conflict in Sudan, which began on April 15, 2023, has severely impacted the nation's health care system, exacerbating existing vulnerabilities and creating new public health challenges. Objective: This rapid review aims to assess the impact of this conflict on health services and evaluate the health consequences for Sudan's population.MethodsA rapid review protocol guided the search and defined the inclusion and exclusion criteria. Electronic databases (PubMed, MEDLINE, Google Scholar, and Global Health) were searched for relevant articles from April 2023 to November 2024. Articles focusing on the impact of armed conflict on health care services were included. Data extraction and narrative synthesis were used to report the findings. Results: Thirty articles met the inclusion criteria. Key findings include the closure of 70% of healthcare facilities in war-affected states, severe shortages of medical supplies, and significant disruptions in essential health services. This conflict has increased the risk of infectious diseases, malnutrition, and mental health issues. Violations of humanitarian corridors have impeded aid delivery, and the healthcare financing system is strained by reduced government contributions and rising out-of-pocket expenses. The humanitarian crisis has led to increased displacement, with over six million internally displaced persons and 1.57 million refugees in neighboring countries. ConclusionThe conflict in Sudan has critically undermined the healthcare system, resulting in severe public health challenges. There is an urgent need for coordinated international intervention to strengthen health systems, ensure essential services, and address the root causes of conflict. Sustainable solutions must focus on immediate relief and long-term resilience, leveraging lessons from other conflict-affected regions to support Sudan’s healthcare recovery and reform.

Vaccination Barriers in Brazil: Exploring Hesitancy, Access, and Missed Opportunities in a Cohort of Children (2017–2018)—National Vaccination Coverage Survey Results (2020–2021)

Background/Objectives: In recent years, Brazil has experienced declining vaccination coverage, raising concerns about vaccine hesitancy and barriers to access. This research analyzes the reasons for non-vaccination among children born in 2017 and 2018 in a metropolitan area of the state of São Paulo in 2020 and 2021. Methods: Data were obtained from a retrospective cohort of children born in 2017 and 2018, living in Campinas, monitored during the first 24 months by vaccination records. A stratified and clustered sample by census sector was performed according to socioeconomic conditions. The reasons for non-vaccination were obtained from interviews with the children’s guardians. Results: A total of 1775 caregivers were interviewed, and 63.1% of children had complete vaccination coverage, with lower socioeconomic groups presenting the highest rates for non-vaccination. The study identified three main groups for non-vaccination: vaccine hesitancy (e.g., fear of side effects, misinformation) in 1.7% of respondents, access difficulties (e.g., service location, financial constraints) in 7.9%, and missed opportunities (e.g., lack of vaccines, administrative barriers) in 16.4%. Conclusions: The findings indicate that the main reported barriers to childhood vaccination are missed opportunities in healthcare services, often due to vaccine shortages or administrative issues, along with social vulnerabilities. Vaccine hesitancy stems from misinformation and fear of side effects. Despite these challenges, families persist in seeking vaccination. However, coverage remains below the national targets, particularly in the second year of life. Targeted public health interventions are urgently needed to improve vaccine confidence, accessibility, and healthcare system efficiency.

Nonlinear Relationship Between Vital Signs and Hospitalization/Emergency Department Visits Among Older Home Healthcare Patients and Critical Vital Sign Cutoff for Adverse Outcomes: Application of Generalized Additive Model.

Previous studies have focused on identifying risk factors for older adults receiving home healthcare services without considering vital signs. This may provide important information on deteriorating health conditions that may lead to hospitalization and/or emergency department (ED) visits. Thus, it is important to understand the relationship between vital signs and hospitalization and/or ED visits and critical vital sign points for mitigating the higher risks of hospitalization and/or ED visits. This secondary data analysis uses cross-sectional data from a large, urban home healthcare organization (n = 61,615). A generalized additive model was used to understand the nonlinear relationship between each vital sign and hospitalization and/or ED visits through three unadjusted and adjusted models, and to identify a critical vital sign point related to a higher risk of hospitalization and/or ED visits. A significant nonlinear relationship (effective degree of freedom >2.0) was found between systolic, diastolic blood pressure, heart rate, hospitalization, and/or ED visits. The critical inflection point for systolic blood pressure was 120.36 (SE 3.625, p < .001), diastolic blood pressure was 72.00 (SE 3.108, p < .001), and heart rate was 83.24 (SE 1.994, p = .052). Among all vital signs, the risk of hospitalization and/or ED visits sharply increased when an older adult's heart rate surpassed 83.24 bpm. Our findings reveal that vital signs may serve as a critical indicator of a patient's clinical condition, especially related to hospitalization and/or ED visit. Clinicians need to be cognizant of these critical thresholds for each vital sign and monitor any deviations from baseline to preempt adverse outcomes.

Predictors of co-occurring mental and substance use disorders among clients admitted for substance use treatment

Purpose This study aims to determine the predictors of co-occurring mental health and substance use disorders (CMSUD) among patients admitted for substance use disorder treatment. Design/methodology/approach Analysis was done on the 2020 national Treatment Episode Data Set for Admissions (TEDS-A). Among 1,416,357 records, 636,522 with complete client-level data were randomly split into training and validation data sets for cross validation. Findings There were 445,566 and 190,956 records of admissions in the training and validation data, respectively. The predictive model was validated (training area under the curve [AUC] 0.6508, confidence interval [CI] 0.6492–0.6524; validation AUC 0.6522, CI 0.6498–0.6547) and the prediction was accurate (Brier Score 0.23). Those more likely to have co-occurring mental and substance use disorders included younger people compared to those ≥50 y/o, female, being arrested at least twice, unemployment, less substance use in past month, age at first substance use ≤20 years, having had a spouse, having veteran status, being homeless, higher substance use treatment episodes and history of medication-assisted opioid use disorder treatment. Research limitations/implications The lower likelihood of CMSUD in Hispanic, Black and individuals with lower education may be due to inadequate access to healthcare services. Originality/value The identification of predictors of CMSUD will help in the development of efficient screening measures and implementation of preventive and early interventions. Robust statistical analysis was utilized in this research. Despite the exclusion of numerous records with missing data, a substantial study population was still included in the study.

Identifying Mild-to-Moderate Atopic Dermatitis Using a Generic Machine Learning Approach: A Danish National Health Register Study.

Atopic dermatitis is a chronic skin disease, causing itching and recurrent eczematous lesions. In Danish national register data, adults with atopic dermatitis can only be identified if they have a hospital-diagnosed atopic dermatitis. The purpose of this study was to develop a machine learning model to identify all patients with atopic dermatitis by proxy, using data for contacts with primary care, prescription medication, and hospital contacts not related to skin diseases. Individuals redeeming a prescription for dermatological preparations were extracted as potential patients with atopic dermatitis. Individuals with a registered hospital diagnosis of atopic dermatitis were classified as "Known AD", "Other skin disease" (registrations of other dermatological diagnosis codes indicating other skin disease), or "Uncertain AD status"' (no hospital diagnosis registered). Patients categorized as "Known AD" and "Other skin disease" were used to develop the model. All uses of healthcare services 2 years prior to hospital diagnosis were used as potential predictors. The data were split into training and validation sets (70/30). From 1996 to 2022, 385,135 individuals had uncertain atopic dermatitis status. The most important predictors were corticosteroid prescriptions for dermatological use, consultations with dermatologist, and age. Of the 385,135 individuals, the model predicted that 230,522 individuals likely have atopic dermatitis.

Navigating the diagnosis and treatment of primary progressive aphasia: Lived experience of a rural patient.

Frontotemporal dementias (FTD) are a group of early-onset neurodegenerative disorders that primarily affect the frontal and temporal lobes, leading to changes in behavior, motor abilities, communication, and executive functions. Primary progressive aphasias (PPA), the language variant of FTD, specifically impair speech and language abilities. The heterogeneous presentation of FTD, particularly PPA, complicates differential diagnosis and treatment selection for healthcare professionals. These challenges are further exacerbated for patients in rural areas due to limited access to specialized healthcare services. This cross-sectional, descriptive case study examines a 76-year-old male patient diagnosed with agrammatic primary progressive aphasia (nfvPPA) living in a rural area in the U.S. We conducted a semi-structured interview with his caregiver to explore the lived experience of being diagnosed and treated for PPA in a rural setting and to identify challenges encountered during the diagnostic and therapeutic processes. Several critical barriers were identified, including poor interprofessional communication, inadequate practitioner-patient and caregiver communication, limited access to educational resources, inconsistent intervention and follow-ups, and restricted healthcare services. To improve the patient and caregiver experience, we propose a collaborative management model centered around speech-language pathologists with expertise in FTD/PPA. This model aims to facilitate smoother navigation of the healthcare system and improve patient outcomes. Effective care management requires clear and continuous communication among providers, patients, caregivers, and other professionals. Additionally, educating and supporting FTD/PPA patients and their families is essential. Research gaps in rural areas regarding diagnosis and treatment outcomes further hinder care, underscoring the need for targeted studies to enhance clinical practices and improve the quality of life for both patients and caregivers.

Aluedemokratia ja lautakuntainstituution uudelleenmäärittely – vertailu hyvinvointialueiden lautakunnista ja toimielinmalleista

Regional Democracy and the Redefinition of Government Committees – Comparing the Committees and Committee Models of the Finnish Wellbeing Service Counties The purpose of this study is to analyze the government structures of the Finnish wellbeing service counties as the responsibility of rescue, social and healthcare services was transferred to the new self-governing regional level of Finnish public administration in January 2023. The theoretical framework is built on institutional theory and the article revives the academic discussion of the institutional arrangements of the Finnish municipalities, that was active in the turn of the century. By analyzing the committee structures, compositions and functions from the administrative regulations and using the concept of municipal parliamentarism as an analytical tool, the study shows that there are in fact two distinct institutional models of organizing the county governments.

Use of psychotropic medications in the specialist health service for mental health care and substance use disorders in 2012-23.

Data on the use of psychotropic medications in specialist mental health services and interdisciplinary specialised treatment for substance use disorders (SUDs) are useful both as cross-sectional indicators and as time series data for monitoring trends. The figures can help form a basis for evaluating rational use of medications in hospitals. Purchasing data for anxiolytics, antidepressants, mood stabilisers and antipsychotics from the Hospital Pharmacies Drug Statistics for the period 2012-23 were used. The data are sourced from sales to specialist mental health clinics and for SUD treatment. Defined daily doses and the number of defined daily doses per 100 bed-days were used as units of measurement. Use of anxiolytics increased by 127% from 2012 to 2023, while decreasing by 24% for antidepressants. The use of mood stabilisers and lithium decreased by 26% and 16%, respectively. Total use of antipsychotics increased by 29%, while rising by 79% for depot injections. Significant changes in medication use were observed during the reference period. Further studies are needed to identify the causes and effects of the changed prescribing patterns.

Mapping barriers, enablers and implementation determinants to shared models of care for physical health and sexual wellbeing among young people with mental health difficulties using the Consolidated Framework for Implementation Research: A scoping review protocol

Background Approximately one in eight people live with mental health difficulties, with onset commonly occurring in youth. It is critical to ensure care addresses all aspects of health, including physical health and sexual wellbeing needs, to achieve positive recovery outcomes. Connecting primary and secondary healthcare providers and service users through shared models of care is a critical aspect of this. The objectives of this scoping review will be to 1) identify and describe the implementation of shared models of care which address the mental health of young people and their physical health and/or sexual wellbeing needs, and 2) identify the determinants of implementing these models of care. Protocol Following Joanna Briggs Institute guidelines, studies will be included if they describe shared models of care for young people (aged 10–25) in any healthcare setting, specifically addressing mental health and physical health or sexual wellbeing needs. The review will employ the Consolidated Framework for Implementation Research (CFIR) to organise and assess findings. A librarian developed the search strategy, which will be applied to Web of Science, Medline, Embase, CINAHL, and PsycINFO databases. Two independent reviewers will screen titles, abstracts and full texts, followed by data extraction and critical appraisal of included studies. Discrepancies at all stages will be resolved through discussion or by a third reviewer. Screening results will be summarised in a PRISMA flow diagram. Narrative summaries, supported by tables and figures where applicable, will address the review’s objectives. Findings will undergo thematic analysis, with implementation determinants mapped deductively to CFIR. Discussion Findings will inform the adaptation of implementation strategies to support the implementation of policy for improving healthcare delivery to young people with mental health difficulties. Registration Open Science Framework (osf.io/rj783).

Understanding the impact of the COVID-19 pandemic on accessibility and delivery of mental health care services in Canada.

Understanding the impact of the COVID-19 pandemic on accessibility and delivery of mental health care services in Canada.

Program Evaluation Study of CBT Interventions for Older Adults in Adult Day Health Care Center at Los Angeles, California

This study evaluated the effectiveness of CBT interventions including supportive presence and socialization for immigrant older participants who suffered from depression and anxiety and attended an Adult Health Care Center (ADHC) at Los Angeles, California. The evaluation strived to study patients at the ADHC who receive daytime health care service for at least a year consistently. The Patient Health Questionnaire-9 (PHQ-9) was utilized to measure and monitor the severity level of depressive symptoms. The Generalized Anxiety Disorder-7 (GAD-7) was also used to measure and monitor the severity level of anxiety symptoms. Of the eighty-five participants (N=85) were selected to be involved in this study, sixty-nine were women, and men account for sixteen. The findings support the hypothesis of this study which states that the CBT intervention of the Adult Day Health Care in L.A, CA will reduce symptoms of anxiety/depression among older immigrant clients. It appears that the comprehensive nature of the CBT intervention in the ADHC, which includes supportive presence and socialization, individual therapy, and case management, is effective at improving symptoms of anxiety and depression among the participants.

Health workers’ motivation was significantly higher in private hospitals than public hospitals influenced by intrinsic and extrinsic factors in Northwest Ethiopia

BackgroundMotivation of health workers is crucial for providing high-quality healthcare services and improving the performance of health facilities. However, less attention has been given to this aspect of workplace climate in hospital settings, and there is scant evidence on the level of health workers’ motivation on healthcare delivery. Therefore, this study aimed to assess the motivation of health workers and its determinants at public and private hospitals in Bahir Dar City, Northwest Ethiopia.MethodsA facility-based comparative cross-sectional study was conducted from November 3rd to December 4th, 2021. A simple random sampling technique was used to select 472 study participants. Motivational status was measured using the mean of 14 items on a Likert scale. Descriptive statistics were computed to present results using tables and figures. Bi-variable and multivariable logistic regressions were performed to identify factors associated with motivational status. Strength of association was measured using adjusted odds ratios with the corresponding 95% confidence intervals and statistical significance was declared at p-values less than 0.05.ResultsA total of 458 health workers participated in our study the health workers’ motivational status was found to be 56.3% (95% CI: 52–60.7%). A significant difference in motivational status was observed between private (62.3%) and public hospitals (50.4%) (χ2 = 6.532, p = 0.011). Working in private hospitals (AOR = 1.52; 95% CI: 1.03–2.23), good collegial relationships (AOR = 1.61; 95% CI: 1.1–2.32), job satisfaction (AOR = 1.49; 95% CI: 1.02–2.20), a favorable work environment (AOR = 1.56; 95% CI: 1.06–2.30), and educational status (AOR = 0.4; 95% CI: 0.17–0.94) were significantly associated with higher health workers’ motivational status.ConclusionThe motivational status of health workers was significantly higher in private hospitals than in public hospitals. The proportion of motivated health workers was low, which poses challenges in maintaining a regulated health workforce within the health system. Working in private hospitals, job satisfaction, working environment, higher educational status, and collegial relationships were predictors of motivational status. Therefore, public hospitals should promptly implement both intrinsic and extrinsic motivational strategies.

A Narrative Review on Iran’s Medical Tourism Growth and its Global Positioning

Health tourism has emerged as both a lucrative industry and a strategic way for countries to attract international visitors. Among its various branches, medical tourism plays a particularly important role in shaping the growth of the broader tourism sector. In recent years, Iran has become a key destination for medical travelers in the Middle East, drawing an increasing number of foreign patients seeking quality healthcare services. This narrative review explores the growth of medical tourism in Iran, analyzing the factors contributing to its rise and the country’s position within the global landscape. The review begins by discussing the broader concept of health tourism, emphasizing medical tourism as a vital subfield., then turns to the specific motivations driving patients to choose Iran, as well as the distinctive features of the country’s medical tourism landscape. It also presents relevant statistical insights and assesses how this growing sector contributes to the vitality of Iran’s overall tourism industry. The review concludes by highlighting the challenges faced by Iran’s medical tourism sector, such as infrastructure limitations and competition from other destinations, while suggesting strategic measures to enhance its global positioning. The findings underscore Iran’s potential to significantly contribute to the global medical tourism market with targeted investment and systematic development.

Is There Value Without Context? A Survey Evaluating How Laboratory Test Results Are Presented to Patients in Canada.

Although direct reporting of laboratory test results to patients improves engagement and utilization of healthcare services, this assumes that results are presented in a manner that can be comprehended and acted upon by patients. To evaluate the practice of patient reporting across Canadian laboratories, a voluntary survey was distributed. 22 responses were received from laboratories and laboratory networks nationwide, representative of the range of Canadian laboratory and patient demographics. Despite the Connected Care for Canadians Act being passed in June 2024, one-third of respondents do not provide results to patients. Of those that do, results largely replicate physician reports and are heterogeneous between labs, with different strategies used to present data and flag abnormalities. A minority of labs suppress some testing from patient receipt, modify reports to improve patient comprehension, or provide graphs to support interpretation and trending. Laboratory professionals largely agreed that there are benefits in modifying reports to aid in patient comprehension but expressed concern that patient health literacy is currently in adequate. This may lead to increased anxiety, misinterpretation of results, follow-up questions, self-diagnosis, and undue stress until a healthcare provider could be consulted. Collaboration with patients and healthcare providers is necessary to develop guidelines on meaningful direct-to-patient reporting.

O MONITORAMENTO DOS SINAIS VITAIS PARA A TOMADA DE DECISÕES TERAPÊUTICAS

Introduction: Monitoring vital signs is a fundamental component of clinical practice, playing a crucial role in the early detection of changes in a patient’s health status and in guiding therapeutic decision-making. Vital signs such as body temperature, heart rate, blood pressure, and respiratory rate provide essential information about the functioning of vital systems and may indicate the presence of acute or chronic conditions. Objective: To understand the importance of vital sign monitoring in therapeutic decision-making. Methodology: This research is based on a literature review using the databases Google Scholar and Scientific Electronic Library Online (SciELO). A total of 24 scientific articles were analyzed, following inclusion criteria: full publications, in Portuguese, indexed in the mentioned databases, and published within the last nine years. The Health Sciences Descriptors (DeCS) used were: vital signs, evaluation of therapeutic intervention outcomes, and clinical deterioration. Results and Discussion: Systematic monitoring of vital signs is directly linked to patient safety. This practice plays a key role in preventing adverse health events and contributes to the efficiency of healthcare services by optimizing resource use and minimizing the costs associated with avoidable complications. Final Considerations: Vital sign monitoring is an essential practice in hospital and intensive care settings, where patients are more vulnerable. Technological advancements have significantly improved the accuracy and effectiveness of this monitoring through the development of electronic devices and remote monitoring systems. Thus, the importance of monitoring vital signs lies in its ability to provide continuous and accurate data, which are fundamental for maintaining homeostasis and promoting patient safety.

MedFusionAI: A Deep Learning Framework for Multi-Modal Health Data Fusion to Predict Chronic Disease Risks

Chronic diseases are still one of the most common causes of death worldwide, so early and precise predictive models should be developed to help improve patient disease management and healthcare service delivery. With multi-modal medical data, including more prevalent structured sources like Electronic Health Records (EHR) and lab tests, to unstructured sources like clinical notes, wearable sensor streams, and medical imaging, the potential for AI-driven health analytics is enormous. Current methods, however, are plagued with limitations including: (1) dependence on single-modality data; (2) poor consideration of the missing data problem; and (3) suboptimal modelling of the inter-modality relationship, which can lead to suboptimal performance. These problems demonstrate the necessity for a standard and solid mechanism to integrate multiple disparate data sources effectively. This paper presents MedFusionAI, a novel deep learning framework for multi-modal medical data fusion in the chronic disease risk prediction task context. The proposed model utilizes dedicated modality-specific encoders: MLP for EHR, LSTM for sequential lab and measurements from wearable devices, CNN models for various medical images, and ClinicalBERT for text to extract salient features. A mixed fusion approach, combining early concatenation and attention-based modality weighting, is employed to consider individual and cross-modality interactions—the final prediction comes from a softmax-based classification head. Experiments on benchmark healthcare datasets show that MedFusionAI effectively outperforms previous baselines and fusion models with a 98.76% accuracy and high precision, recall, and AUC-ROC across all risk classes. The framework also provides interpretability features to enable clinicians to understand the contributions of features. MedFusionAI provides an interpretable, scalable, and reliable solution for clinical decision support systems for the timely visibility of chronic disease risks, improving preventive care.

Quality of care for newly diagnosed patients with rheumatoid arthritis in South Korea: A nationwide cohort study.

This study aimed to evaluate the quality of care in newly diagnosed RA patients by analyzing conventional disease-modifying antirheumatic drugs (cDMARDs) treatment patterns and healthcare utilization using a nationwide claims database. This retrospective cohort study was conducted using the Korean Health Insurance Review and Assessment database. Study subjects were those newly diagnosed with RA (ICD-10 code M05, M06) and were prescribed a cDMARD in 2014, with follow-up until 2018. Demographic and clinical information, the level of healthcare facilities (LOH) at which the first prescription claim was made, and subsequent healthcare service utilization were collected. We also analyzed the initial pattern in cDMARD prescription and its retention rate. A total of 21,136 patients were analyzed. Diagnosis of seronegative RA (n = 14,571, 68.9%) was more common than seropositive RA. Seropositive RA was most often discovered in tertiary general hospitals (n = 2,230, 34.0%), whereas seronegative RA was most diagnosed in primary care clinics (n = 7,539, 51.7%) (P < 0.001). The most prescribed initial cDMARD was hydroxychloroquine as monotherapy (n = 9,867, 46.7%). However, methotrexate, a well-established first-line cDMARD, was prescribed in 5,447 (25.8%) patients. The discontinuation rate of cDMARD was higher in seronegative than seropositive patients (65.3% vs. 90.3%) and in patients first diagnosed in community LOH (P for trend < 0.001). The mean number of visits to any outpatient clinics (35/year) was substantially higher than that of the general population. Yet, the number of outpatient visits for RA management was only 2.8/year. The quality of care for newly diagnosed RA patients in South Korea can be improved. Further education on accurate diagnosis and effective treatment is necessary to improve the quality of care provided by other specialists and general practitioners.

GESTANTES NEGRAS E MORTALIDADE MATERNA: PERSPECTIVAS PARA A MEDICINA DE FAMÍLIA

INTRODUCTION: Maternal mortality is an indicator of the quality of healthcare, and according to epidemiological studies, the highest percentage of deaths occurs among Black women.Therefore, the main objective is to analyze the impact of family medicine on the prevention of avoidable deaths among Black pregnant women. METHODOLOGY: This is an integrative literature review based on data from the Virtual Health Library (BVS) and the Scientific Electronic Library Online (SciELO). RESULTS AND DISCUSSION: Understanding the importance of prenatal care as a tool for reducing health complications is essential and is one of the standards established by the Ministry of Health. Health professionals must be attentive to the relevance of clinical-obstetric care. FINAL CONSIDERATIONS: In this context, it is necessary to understand that the quality of healthcare services influences maternal morbidity and mortality, which, in addition to the biopsychosocial connection, are directly related to color/race.