Health Facilities Research Articles

Factors associated with unfavourable treatment outcomes among tuberculosis patients at health facilities of Maseru, Lesotho

Tuberculosis (TB) treatment success rates (TSR) remain low in Lesotho. The country achieved TSR of 76% in 2020, which is far below the World Health Organization’s 95% target set for 2030. This study determined the level of treatment success and factors associated with unfavourable treatment outcomes. This descriptive cross-sectional study used patient records to perform descriptive and logistic regression analyses. Sixty-one per cent of the 336 TB patients were male. Two hundred and eighty-nine had favourable outcomes, of which 10% died in the course of treatment. Patients ≤ 44 years old, and those with supported treatment, had lower odds of unfavourable treatment outcomes, respectively, adjusted odds ration [aOR] = 0.39 (95% CI: 0.19–0.78) and aOR = 0.22 (95% CI: 0.08–0.62), p 0.05.Contribution: The death of patients while on TB treatment needs to be addressed, including heightened advocacy for supported treatment.

Coexistence and food sources of adult mosquitoes (Diptera: Culicidae) in a rural health center in Piura, Peru 2024.

Motivation for the study. Rural health facilities could be potential foci of transmission and scenarios of zoonosis during epidemic outbreaks of dengue and other arbovirosis due to the coexistence of mosquito species that feed on different vertebrates. Main findings. Aedes aegypti feeds on Homo sapiens sapiens. Culex quinquefasciatus feeds on Homo sapiens sapiens and Canis familiaris. Both coexist in health care areas of the Querecotillo health center. Implications. Molecular techniques should be integrated into vector control to understand feeding patterns in natural conditions and information on probable reservoirs. This study aimed to determine the coexistence and food sources of adult mosquitoes (Diptera: Culicidae) in a rural health center in Piura, Peru by using a descriptive cross-sectional design. Entomological techniques were used to capture and identify mosquitoes, and molecular biotechnology techniques were used to identify food sources. A total of 793 specimens of the Culex and Aedes genera were found coexisting, 789 (99.5%) were Culex quinquefasciatus, 607 (76.9%) were males and 182 (23.1%) were females. Likewise, 4 (100%) corresponded to Aedes aegypti females. The food sources of Aedes aegypti were Homo sapiens sapiens, and Homo sapiens sapiens and Canis familiaris were the food sources of Culex quinquefasciatus. This study provides evidence that rural health centers could be acting as foci of arbovirosis, with the risk that people who come for different ailments could contract diseases transmitted by C. quinquefasciatus and A. aegypti.

Analysis of the Availability of Laboratory Tests to the Number of Requests for Tests and Its Implications on Patient Satisfaction

This study aims to analyze the availability of laboratory tests based on the number of test requests and their implications for patient satisfaction. Health laboratories are a vital component of healthcare services, providing accurate laboratory test results to support patient diagnosis and treatment. The availability of fast and accurate laboratory tests plays a crucial role in speeding up diagnosis and treatment, which ultimately impacts patient satisfaction. However, many healthcare facilities face challenges in providing adequate laboratory test availability, such as limitations in equipment, expertise, and inefficient procedures. This study employs a literature review approach to collect, analyze, and synthesize information from various relevant sources. The findings reveal that the availability of fast and accurate laboratory services can enhance patient satisfaction, while limitations in availability can lead to dissatisfaction and increased waiting times. Therefore, effective laboratory management is essential to improve service quality and patient experience in hospitals. This research is expected to provide valuable insights for improving the healthcare system, particularly in laboratory management.

Predictors of CD4 cell count progression over time among adolescents and young adults transitioning to adult-oriented HIV care in Southern Ethiopia from 2017 to 2021: a retrospective cohort study

BackgroundHuman immunodeficiency virus (HIV), a viral infection impacting CD4 cells, requires an understanding of factors influencing CD4 cell counts to reduce acquired immunodeficiency syndrome(AIDS)-related morbidity and mortality. Despite its importance, no studies have examined predictors of CD4 cell count progression post-transition to adult-oriented HIV care in Ethiopia. This study aimed to identify predictors affecting CD4 cell count trends among adolescents and young adults transitioning to adult-oriented HIV care. Therefore, this study aimed to identify the predictors that affect the trends of CD4 cell count over time among adolescents and young adults who transitioned to adult-oriented HIV care.MethodsA retrospective cohort study was conducted among 206 adolescents and young adults who transitioned to adult-oriented HIV care and had at least two CD4 cell counts in eight selected health facilities in Southern Ethiopia. These facilities were chosen due to their high volume of people living with HIV. A multivariable linear mixed effect model was fitted to identify the predictors of CD4 cell count progression through time. Multi-collinearity between variables was checked using the variance inflation factor. Model comparisons were done using Akaike and Bayesian information criteria. Regression coefficients with 95% confidence intervals (CI) and P-value ≤ 0.05 were used to measure the strength of association and significance level.ResultsThe average CD4 cell count was raised by 6.7 cells/mm3 every six months among the study participants. Transitioning at the age of 18 or older (β = 204.71; 95% CI = 81.86347, 327.5574; P < 0.001), being rural residents (β= -119.776; 95% CI = -215.362, -24.189; P < 0.014), having World Health Organization (WHO) stage III & IV HIV (β= -182.161; 95% CI = -318.475, -45.847; P < 0.009), were the predictors for CD4 cell count progression over time.ConclusionBased on the identified predictors of CD4 cell count progression over time among HIV-positive adolescents and young adults transitioning to adult-oriented HIV care in southern Ethiopia, such as observation time, age at transition, residence, and WHO staging, the study highlights the need for interventions focused on tailored support. Specifically, these interventions should target individuals transitioning with less ART time, those younger than 18, those residing in rural areas, and those with advanced WHO staging, to improve their CD4 cell counts over time.

An observational analysis of the impact of deltamethrin + piperonyl butoxide insecticide-treated nets on malaria case incidence and entomological indicators in Ebonyi State, Nigeria, 2017–2021

BackgroundIntense pyrethroid resistance threatens the effectiveness of the primary vector control intervention, insecticide-treated nets (ITNs), in Nigeria, the country with the largest malaria burden globally. In this study, the epidemiological and entomological impact of a new type of ITN (piperonyl-butoxide [PBO] ITNs) distributed in Ebonyi State were evaluated. The epidemiological impact was also compared to the impact of standard pyrethroid-only ITNs in Cross River State.MethodsA controlled interrupted time series analysis was conducted on monthly malaria incidence data collected at the health facility level, using a multilevel mixed-effects negative binomial model. Data were analysed two years before and after the PBO ITN campaign in Ebonyi State (December 2017 to November 2021). A pre-post analysis, with no comparison group, was used to assess the impact of PBO ITNs on human biting rates and indoor resting density in Ebonyi during the high transmission season immediately before and after the PBO ITN campaign.ResultsIn Ebonyi, PBO ITNs were associated with a 46.7% decrease (95%CI: -51.5, -40.8%; p < 0.001) in malaria case incidence in the 2 years after the PBO ITN distribution compared to a modelled scenario of no ITNs distributed, with a significant decrease from 269.6 predicted cases per 1000 population to 143.6. In Cross River, there was a significant 28.6% increase (95%CI: -10.4, 49.1%; p < 0.001) in malaria case incidence following the standard ITN distribution, with an increase from 71.2 predicted cases per 1000 population to 91.6. In Ebonyi, the human biting rate was 72% lower (IRR: 0.28; 95%CI 0.21, 0.39; p < 0.001) and indoor resting density was 73% lower (IRR: 0.27; 95%CI 0.21, 0.35; p < 0.001) after the PBO ITNs were distributed.ConclusionsThe epidemiological and entomological impact of the PBO ITNs underscore the impact of these ITNs in areas with confirmed pyrethroid resistance. These findings contribute to ongoing research on the impact of new types of ITNs in Nigeria, providing critical evidence for the Nigeria National Malaria Elimination Programme and other countries for future ITN procurement decisions as part of mass ITN campaign planning and malaria programming.

Evaluation of a risk-sharing agreement for atezolizumab treatment in patients with non-small cell lung cancer: a strategy to improve access in low-income countries.

Using immune checkpoint inhibitors (IO) is a promising approach to maximize clinical benefits for patients with non-small cell lung cancer (NSCLC). PD-L1 expression serves as a predictive factor for treatment outcomes with IO. However, the high cost of this treatment creates significant barriers to access. Substantial evidence demonstrates the sustained clinical benefits experienced by patients who respond to immunotherapy. While IOs show promise in NSCLC treatment, their high cost poses access barriers. This study focused on a prospective cost analysis conducted at a high-specialty health facility to assess the economic implications of implementing a risk-sharing agreement (RSA) for atezolizumab in NSCLC. The study included 30 patients with advanced NSCLC, with the pharmaceutical company funding the initial cycles. If patients responded, a government program covered costs until disease progression. A median progression-free survival of 4.67 months across populations, rising to 9.4 months for responders. The 2-year overall survival rate for the response group was 64%, significantly higher than for non-response. Without an RSA, a total treatment cost of $881 859.36 ($29 395.31/patient) was reported, compared to $530 467.12 ($17 682.24/patient) with an RSA, representing a 40% cost reduction. In responders, the average cost per year of life per patient dropped by 22%. Risk-sharing, assessed through non-parametric tests, showed a statistically significant difference in pharmacological costs (P < .001). Implementing RSAs can optimize resource allocation, making IO treatment more accessible, especially in low-income countries.

The Influence of Satisfaction on Service Quality and Intention to Recommend Mediated by Patient Loyalty

The purpose of this study is how the role of the Hospital as one of the health service facilities has a very strategic role in efforts to accelerate the improvement of the health of the Indonesian people. This strategic role is owned because the hospital is a technology-intensive health facility. This role is increasingly prominent considering the emergence of changes in disease epidemiology, changes in demographic structure, developments in science and technology, changes in the socio-economic structure of society, and services that are of better quality, friendly and able to meet the needs that demand changes in health service patterns in Indonesia. The analysis method is carried out through explanatory research, with the application of PLS / SEM. The concepts and problems studied look at the causal relationship, then explain the variables that cause the problems studied. The research sample was 384 respondents who had received services at a government tertiary hospital in Batam City. The findings of this study were patient satisfaction with the quality of service had a significant positive effect on patient loyalty. Patient satisfaction with the quality of service had a significant positive effect on the intention to recommend. Patient loyalty had a significant positive effect on the intention to recommend. Patient satisfaction with the quality of service had a significant positive effect on the intention to recommend with the mediation of patient loyalty

Factors Influencing the Utilization of Health Services for JKN-KIS Participants (Study: Grilled Pematang III.B Health Center, Mesuji Makmur District, Ogan Komering Ilir Regency)

This study aims to determine whether there is an influence of the level of knowledge of JKN-KIS participants, the attitude of health workers and the accessibility of health facilities simultaneously on the utilization of health services for JKN-KIS participants at Community Health Centers and their networks.The method used in this study is a quantitative method. Minimum of 99 samples from JKN-KIS participants in the work area of ​​Pematang Panggang III.b Health Center, Mesuji Makmur District, Ogan Komering Ilir Regency. In this study, there were two hypothesis tests, namely the Partial Significance Test (T-Test) and the Simultaneous Test (F-Test). The data analysis technique used descriptive statistical analysis techniques; multiple linear regression analysis. The results showed that the level of knowledge of JKN-KIS participants did not have a significant effect on the utilization of health services at the Pematang Panggang III.b Health Center, Mesuji Makmur District and its network. The accessibility of health facilities had a positive and significant effect on the utilization of health services for JKN-KIS participants at the Pematang Panggang III.b Health Center, Mesuji Makmur District. The level of knowledge of JKN-KIS participants, the attitude of health workers and the accessibility of health facilities simultaneously had a positive and significant effect on the utilization of health services for JKN-KIS participants at the Pematang Panggang III.b Health Center, Mesuji Makmur District, Prosperous Mesuji.

SPATIAL DISTRIBUTION AND ACCESSIBILITY OF HEALTHCARE FACILITIES IN NIGER STATE, NIGERIA

The provision of adequate basic healthcare services is becoming increasingly difficult due to rapid population growth and lack of available resources. One of the imperatives of healthcare provision is a concern for both social and spatial justice. This study examines the spatial distribution and accessibility of healthcare facilities in Niger State. Secondary data were collected from the Niger State Ministry of Health and the National Population Commission. ArcGIS 10.4.1 software was used to create distribution maps of healthcare facilities throughout the state. The results of the study indicated that healthcare facilities in Niger State were not evenly distributed across the state. Niger East had the most accessible healthcare facilities, followed by Niger South. Despite having a sufficient number of healthcare facilities that meet the minimum global average recommended by the World Health Organization (WHO) in-terms of population ratio, the distribution of these facilities per population ratio were also not evenly distributed across the State with Niger North having the least healthcare facilities per population ratio which needs to be addressed to meet the WHO-recommended threshold. Moreover, several local government areas, including Muya, Agwara, Mashegu, Edati, Gbako, and Katcha, had no secondary healthcare facilities, indicating that healthcare accessibility in Niger North and Niger South was significantly limited. The study highlights the need for more well-equipped general hospitals in currently inadequate areas and the provision of primary healthcare facilities, particularly in rural areas throughout the State. Overall, the findings suggest that healthcare accessibility in Niger State is a critical issue that requires immediate attention.

Identifying optimal locations for the development of health facilities towards the attainment of universal health coverage using geospatial techniques in Kishapu district, Tanzania

Two hours of travel time specified by the World Health Organization (WHO) to access quality health services is among the most important criteria for the Universal Health Coverage. However, locations of health facilities (HF) in many developing countries fail to realise this target due to a lack of appropriate models considering the local environment. This work used the central-place theory to explore locations of HF in Kishapu and their accessibility status based on two means of transport in the AccessMod tool: walking only and the combination of walking-and-motor devices. The results of the walking scenario indicated that the travel times to the health centres and hospitals exceeded 2 hours, and a direct relationship existed between the facility level and the travel time spent to access it. The combined transport (walking and motorized) showed that dispensaries are easily accessible (14.5 minutes) compared to health centres (42.8 minutes) and hospitals (67.3 minutes). To address the challenge, we have developed a model revealing optimal sites with quick access for HF construction and improvement using Multi-Criteria-Evaluation and Analytical-Hierarchy Process methods weighting five criteria including distance from settlements (44% weight), roads (26% weight), existing health facilities (16% weight), rivers (9% weight) and railway (5% weight). A test of the model with both means of transport shows that at all places proposed to be optimal allow patitents to travel in less than two hours, indicating that the proposed model can effectively and efficiently solve the challenge of allocating HF in society.

Parents', Families', Communities' and Healthcare Professionals' Experiences of Care Following Neonatal Death in Healthcare Facilities in LMICs: A Systematic Review and Meta-Ethnography.

Ninety-eight percent of neonatal deaths worldwide occur in low- and middle-income countries (LMICs), yet there is little bereavement care guidance available for these settings. To explore parents', families' and healthcare professionals' experiences of care after neonatal death in healthcare facilities in LMICs. Four databases were searched for peer-reviewed literature, meeting the inclusion criteria of qualitative studies exploring the experiences of people who provided or received bereavement care following neonatal death in a LMIC healthcare setting. Data were collected by two independent reviewers, collated through line-by-line coding and then reciprocal and refutational translation, and analysed through Noblit and Hare's seven-step meta-ethnography approach to create first-, second- and third-order themes. Seven first-order themes extracted from the literature included emotional responses, social relationships, staff and systems, religion, connecting with the baby, coping strategies and economic concerns. From these data, three third-order themes arose: The individual, the healthcare setting and the community/context. Overarching themes in bereavement care shape grief responses and are often similar across geographical locations. Analysing these similarities allows a deeper understanding of the important elements of bereavement care and may be helpful to inform the creation of high-quality, bereavement care guidelines suitable for use in LMIC settings.

Fall prevention among adult surgical patients in Tabriz, Iran: a best practice implementation project.

Falling out of bed is the most common unintentional cause of injury among patients and is a major safety problem in health care facilities. Current practices for fall prevention may not always be aligned with established best practices, leading to variability in patient outcomes. This uncertainty underscores the need to assess and improve compliance with best practice guidelines for fall prevention. This project aimed to improve fall prevention in the surgical ward of a general hospital in Tabriz, Iran. This study was guided by the JBI Evidence Implementation Framework. A baseline audit was conducted using eleven audit criteria representing best practices for fall prevention. After the implementation of improvement strategies, a follow-up audit was conducted to evaluate changes in practice. The results revealed significant improvements, notably, fall risk assessment upon admission (87% to 92%), fall risk assessment upon ward transfer (39% to 79%), patient participation in fall risk assessment (26% to 68%), reassessment upon change in condition (53% to 74%), communicating fall prevention information to at-risk patients and their families/caregivers (42% to 63%), engagement of patients (100% to 100%), implementation of targeted strategies (89% to 92%), post-fall assessment and interventions (82% to 87%), revising patient fall risk status and reviewing care management plan (41% to 74%), fall prevention information to patients and their families/caregivers upon discharge (44% to 66%), and person-centered education of health care professionals (77% to 81%). The use of standard clinical audit tools in hospitals can improve the quality of patient care and increase the effectiveness of interventions by identifying weaknesses in the patient care process. http://links.lww.com/IJEBH/A283.

Experiences and challenges of nurses in initiating antiretroviral drugs among adolescents living with HIV and AIDS in Thaba-Tseka, Lesotho

Background: Lesotho has the second-highest HIV and AIDS prevalence globally and is the country’s second leading cause of death. Despite increasing ART coverage, adolescents remain left behind and face high mortality because of delayed ART initiation. This study aimed to explore the experiences and challenges of nurses when initiating adolescents living with HIV on ART in Thaba-Tseka, Lesotho. Methods: A qualitative descriptive research design and twelve in-depth interviews were conducted among nurses from a hospital in the Thaba-Tseka district. Participants were selected purposively until data saturation was reached. Data were transcribed verbatim and analysed manually using the thematic analysis approach. The findings were presented in themes and sub-themes. Individual face-to-face interviews were conducted in English and Sesotho from May to August 2021. Results: The key findings in this study involved adolescents’ attendance at the health care facility, ART initiation process, HIV stigma influencing the uptake of ART, poor ART follow-up and socio-economic factors affecting adherence to ART. Conclusion: The themes uncovered in this study provide valuable insights into the gaps in ART initiation, and highlight the challenges encountered by nurses during this process among adolescents in Lesotho. The experiences and obstacles shared by nurses during ART initiation cover a range of issues, collectively demonstrating their engagement in HIV and ART care. These findings emphasise the critical role of policymakers and health care providers in devising customised ART initiation interventions for adolescents. Addressing these challenges will be crucial for enhancing ART uptake and adherence among adolescents living with HIV in Lesotho.

Are people with HIV at advanced disease stages being left behind? A global survey.

A substantial percentage of people with HIV are still admitted for care at advanced disease stages. Here, we investigate the availability of the supplies and infrastructure required to provide care for this population in healthcare facilities and explore correlations with local demand. AIDS Healthcare Foundation's partner facilities were invited to respond to a survey addressing the availability of services to support clients with advanced HIV. We present results per continent and according to gross national income per capita using frequencies and percentages. We generated country-level scores taking the average percentage of facilities with available resources on 10 key items and used Spearman's correlation to investigate relationships between country scores and local demand, depicted by the percentages of people with HIV newly enrolled in care with a CD4 T-cell count <200/mm3 in 2022. A total of 643 facilities from 37 countries responded to the survey between September and December 2021. Overall, services requiring more costly equipment and/or supplies were less frequently available. Facilities in Africa, Asia, and Latin America/Caribbean and those with lower gross national income had a somewhat lower availability of diagnostic and therapeutic resources. Availability of services was not correlated with local demand: 14 countries (42%) had scores below the 50% percentile despite having >20% of newly enrolled people with HIV with a CD4 T-cell count <200/mm3. Appropriate care can mitigate the morbidity and mortality associated with advanced HIV. We found that the healthcare services recommended by the World Health Organization as essential to support clients with advanced HIV are often unavailable in facilities providing HIV care, despite high local demand.

Importance and Application of Quality Tools in Healthcare Facilities

Wherever we go and whatever we buy we always look for quality. Every organization, company, industry, and institution is trying and struggling to give quality services and products, and to overcome the struggle, management experts have given many tools to improve quality for better outcomes. They are PDCA, 5 S, Histogram, flow chart, run chart, control chart, Brainstorming, Why-Why analysis, Pareto chart, Check sheet, Gantt chart, Scatter chart, Fishbone chart, Mistake proofing, and Six Sigma. This review aims to explain the importance and application of these Quality tools in healthcare facilities.

Exploring the Effect of Road Network Structure on Inter-Regional Accessibility in a Diverse Road Network

Abstract. Accessibility analyses quantify the level of access to certain areas or opportunities, such as employment and healthcare facilities. Since public data is often aggregated at the level of regions, such as administrative units, it is useful to quantify accessibility between regions. Many factors influence inter-regional accessibility, most notably the accessibility metric used, and the way in which regions are chosen. This paper investigates the effects of road network structure on accessibility, using a previously developed inter-regional accessibility model that bases its accessibility metric on travel distance via the road network. This paper considers an area within the City of Tshwane municipality in South Africa. We investigate the effects of road structure in two ways. Firstly, regions are chosen based on the road network structure, which is done by extending a previously developed road network clustering algorithm for this novel use. Different spatial scales of regionalisation are considered, and the accessibility between these regions is compared to the accessibility between administrative units within the study area. Secondly, the effect of road network homogeneity on accessibility is investigated, where homogeneity corresponds to a uniform concentration of roads across a region. The results show that although road network homogeneity does not significantly correlate with accessibility, the way in which regions are chosen and their spatial scale has a strong effect on the results of the accessibility model. Our novel method of obtaining regions thus provides fresh insights into road-based accessibility within the City of Tshwane.

Factors Associated with Cesarean Section in Primiparous Women at the Bernard Kouchner Communal Medical Centre in Coronthie, Conakry, Guinea

&amp;lt;i&amp;gt;Objective&amp;lt;/i&amp;gt;: to analyse the factors associated with Caesarean section in primiparous women. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: This was a 12-month (1 January to 31 December 2022) retrospective case-control study conducted at the Bernard Kouchner Communal Medical Centre (CMC) in Coronthie. Correctly completed records of primiparous women with a singleton pregnancy were included, with a live foetus in cephalic presentation having been delivered (by Caesarean section or vaginal delivery) from 28 weeks&amp;apos; gestation with a weight ≥ 1000 g. The &amp;quot;cases&amp;quot; consisted of records from primiparous women who had undergone caesarean section. The &amp;quot;controls&amp;quot; were composed by matching each &amp;quot;case&amp;quot; with the record of a patient who had undergone vaginal delivery, according to the order in the delivery register. Socio-demographic, clinical and obstetric characteristics were analysed and compared. A univariate analysis comparing cases to controls and a multivariate analysis looking for an association between maternal determinants were performed. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: The prevalence of caesarean section in primiparous women was 31%. The average age of primiparous women was 24 ± 5 years. The 20-24 age group was the most represented in both groups, with 35% of caesareans and 42% of vaginal deliveries. The factors significantly associated with caesarean section in primiparous women were advanced maternal age (OR=1.13 CI=1.07-1.20), prolonged pregnancy (OR=25.1 CI =3.23 - 5.40), arterial hypertension (OR=4.98 CI= 2.24 -11.6), premature rupture of membranes (OR= 4.25 CI: 2.27 - 8.05), haemorrhagic complications (OR=8.56 CI=3.05 - 26.6), foetal distress (OR=68.4 CI=18.3 - 45.1) and macrosomia (OR=12.7 CI= 4.83 - 38.6). &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: correct antenatal care and delivery by qualified personnel could help prevent some of these factors and thus reduce the caesarean section rate among primiparous women in our health facility.

Experiences of Sexual and Gender Minorities with Health Care in the Philippines: A Qualitative Study.

There is limited availability and accessibility of health care facilities and services tailored to the specific health care needs of sexual and gender minorities (SGMs) in the Philippines. The purpose of this study was to describe SGMs' experiences with health care services in the Philippines. Using a phenomenological design, interviews were conducted with participants recruited online through SGM networks and organizations. Individual, online-recorded interviews were conducted with 14 participants who were at least 18 years old, were Filipino nationals residing in the Philippines, self-identified as SGM, could comprehend and write in Filipino, and received any health care service within the past year. Data were entered and analyzed using the NVivo software. Three major themes emerged: patient-centered communication and relationship, holistic care, and caring environment. Participants identified the significance of genuine, affirming, and respectful communication in building positive relationships and continuing engagement with health care. Holistic care is embedded in clinical competence, gender sensitivity, continuity of care, and collaborative practice with other disciplines. A caring environment minimizes gender-related stigma and discrimination and promotes acceptance of diverse sexual identities. Filipino SGMs face several multifaceted health care concerns and challenges stemming at the individual, institutional, and societal levels. Sexual and gender biases, stigma, and discrimination are major barriers to health care among SGMs. Promotion of culturally and gender-sensitive care among Filipino SGMs should involve training of health care providers and creation of programs and policies to understand and respect SGMs while considering social, cultural, and political influences on their health and well-being.

Hospital-Level Variation in COVID-19 Treatment Among Hospitalized Adults in the United States: A Retrospective Cohort Study.

Retrospective cohort study. To characterize variation in dexamethasone and remdesivir use over time among hospitals. Little is known about hospital-level variation in COVID-19 drug treatments in a large and diverse network in the United States. We selected individuals hospitalized with COVID-19 across 163 hospitals between February 23, 2020 and October 31, 2021 from using the HCA CHARGE, an electronic health record repository from a network of community health care facilities in the United States. We quantified receipt of dexamethasone, remdesivir, and combined use of dexamethasone and remdesivir during the hospital stay. We used 2-level logistic regression models to determine the intraclass correlation coefficient (ICC) at the hospital level, adjusting for patient and hospital characteristics. The ICC shows the proportion of total variation in drug use accounted for by hospitals. Among 161,667 individuals hospitalized with COVID-19, 73.0% were treated with dexamethasone, 49.1% with remdesivir, and 45.0% with both dexamethasone and remdesivir. The proportion of variation in dexamethasone use was 12.7% (adjusted ICC: 0.127), 8.5% for remdesivir, and 11.3% for combined drug use, indicating low interhospital variation. In the fully adjusted models, between-facility variation in dexamethasone use declined from 34.1% in February-March 2020 to 11.3% in January-March 2021 and then increased to 17.3% in July-October 2021. The variation in remdesivir use remained relatively stable during the study period. During the first 2 years of the pandemic, there was relatively consistent use of dexamethasone and remdesivir across the hospitals examined. Consistent adoption and implementation of treatment guidelines across the hospitals examined may have led to a decrease in variation in drug usage over time.

Accessibility and Optimization of Rural Healthcare Facilities From the Perspective of the Rural Living Circle

Accessibility and Optimization of Rural Healthcare Facilities From the Perspective of the Rural Living Circle