National Health Care Delivery System Research Articles

Integrating traditional medicine into a modern health care system

Traditional Medicine collectively referred to as complementary and alternative medicine (CAM) when commonly used outside their traditional context, alongside other medical systems, including Western biomedicine.The World Health Organization officially promoted traditional medicine in developing countries in 1978, there have been increasing interests among developing countries in integrating traditional medicine into a national health care system. Integrating traditional medicine into a modern health care system, moreover, can benefit industrialized nations as well. The contributions of Traditional and Modern Scientific Medicines to health care delivery have attracted a great deal attention in most communities worldwide. Traditional Chinese medicine, Ayurveda, Kampo, traditional Korean medicine, and Unani have been practiced in some areas of the world and have blossomed into orderly-regulated systems of medicine. More than 80% of the world’s population in over 170 of WHO’s 194 Member States currently use some form of traditional medicine, such as herbal medicine, yoga, Ayurveda, acupuncture and acupressure, and indigenous therapies.To generate awareness about traditional medicine, since the 1980s, a number of publications on self-health care have been developed to inform people about the benefits and uses of traditional medicine. Some of the areas of focused research include studies on the development of anticancer drugs, cardiovascular diseases such as arteriosclerosis and angina pectoris, respiratory diseases such as bronchial asthma, obesity, diabetes and other metabolic disorders, and basic studies on acupuncture therapeutic mechanisms for various bone and joint and spinal disorders, and on different kinds of composition of the human body. To ensure the safety, standardization, efficacy and quality of traditional medicines, the practitioners must follow the same stringent standards and regulations for production and use of traditional medicines as are followed for allopathic medicines. This study aims to summarize the advancements made in understanding the efficacy, effectiveness of Traditional Medicine. Traditional and local knowledge systems need to be protected, preserved, and studied as different ways to approach modern healthcare, science, and technology at large. Significant challenges exist in integrating the differing perspectives. Traditional knowledge is derived from years of history and experience and is preserved through long, complex narrations lacking the traditionally rigorous scientific scrutiny required by modern medicine. Modern scientists are prone to quickly dismiss its merit, considering it to be irrelevant as a result. For many, traditional medicine is the first port of call, and practitioners of traditional medicine have played an important role in treating chronic illnesses. These traditional medicines and practices have been preserved, organized and modernized during the past several decades, and have been fully integrated into the national health-care delivery systems from the central to the most peripheral administrative levels.

Survival by first-line therapy and prognostic group among men with metastatic castration-resistant prostate cancer.

Metastatic castration-resistant prostate cancer (mCRPC) is a heterogeneous disease with prognoses varying from months to years at time of castration-resistant diagnosis. Optimal first-line therapy for those with different prognoses is unknown. We conducted a retrospective cohort study of men in a national healthcare delivery system receiving first-line therapy for mCRPC (abiraterone, enzalutamide, docetaxel, or ketoconazole) from 2010 to 2017, with follow-up through 2019. Using commonly drawn prognostic labs at start of mCRPC therapy (hemoglobin, albumin, and alkaline phosphatase), we categorized men into favorable, intermediate, or poor prognostic groups depending on whether they had none, one to two, or all three laboratory values worse than designated laboratory cutoffs. We used Kaplan-Meier methods to examine prostate specific antigen (PSA) progression-free and overall survival (OS) according to prognostic group and first-line therapy, and multivariable cox regression to determine variables associated with survival outcomes. Among 4135 patients, median PSA progression-free survival (PFS) was 6.9 months (95% confidence interval [CI] 6.6-7.3), and median OS 18.8 months (95% CI 18.0-19.6), ranging from 5.7 months (95% CI 4.8-7.0) in the poor prognosis group to 31.3 months (95% CI 29.7-32.9) in the favorable group. OS was similar regardless of initial treatment received for favorable and intermediate groups, but worse for those in the poor prognostic group who received ketoconazole (adjusted hazard ratio 2.07, 95% CI 1.2-3.6). PSA PFS was worse for those who received ketoconazole compared to abiraterone across all prognostic groups (favorable HR 1.76, 95% CI 1.34-2.31; intermediate HR 1.78, 95% CI 1.41-2.25; poor HR 8.01, 95% CI 2.93-21.9). Commonly drawn labs at mCRPC treatment start may aid in predicting survival and response to therapies, potentially informing discussions with care teams. First-line treatment selection impacts disease progression for all men with mCRPC regardless of prognostic group, but impacted OS only for men with poor prognosis at treatment start.

Diversity Management: Practical Application in a Healthcare Organization.

If you are not confused, you don't know what's going on. -Jack Welch In commenting on the business environment today (1994), Jack Welch could have been talking about healthcare organizations experiencing the double-barreled assault on two sweeping changes simultaneously. Not only are hospitals preparing for yet-to-be-determined changes in national healthcare delivery systems but they are doing so in the midst of shifting demographics in both the population and employee base. While many make the case for managing diversity, we would like to go one step further in offering a framework for developing an organization's ability to build an inclusive environment that gets the best from its staff and provides the best service to its customers.

Determinants of Bone-Modifying Agent Prescribing for Metastatic Castration-Resistant Prostate Cancer in a National Health Care Delivery System.

Despite guidelines recommending bone-modifying agents (BMAs) to decrease skeletal-related events (SREs) in men with metastatic castration-resistant prostate cancer (mCRPC), BMAs are underutilized. In this retrospective cohort study, we report the factors associated with BMA use in a national health care delivery system. We used the Veterans Affairs Corporate Data Warehouse to identify men with mCRPC between 2010 and 2017. BMA prescribing frequency was evaluated, and the association between patient- and disease-specific factors with BMA use was assessed using multivariable logistic regression. Among 3,980 men identified with mCRPC (mean age 73.5 years, 29% Black), 47% received a BMA; median time to BMA from start of mCRPC treatment was 102 days. Factors associated with BMA use included previous BMA use (adjusted odds ratio [aOR], 7.81 [95% CI, 6.48 to 9.47]), diagnosis code for bone metastases (aOR, 1.26 [95% CI, 1.08 to 1.46]), and concomitant corticosteroid use (aOR, 1.53 [95% CI, 1.29 to 1.82]). Decreased BMA use was associated with advancing age (aOR, 0.85 per 10 years [95% CI, 0.78 to 0.92]), Charlson comorbidity index ≥2 (aOR, 0.76 [95% CI, 0.63 to 0.93]), Black race (aOR, 0.83 [95% CI, 0.70 to 0.98]), and decreased estimated glomerular filtration rate (eGFR; aOR, 0.19 [95% CI, 0.11 to 0.32] for eGFR 0-29 mL/minutes; aOR, 0.76 [95% CI, 0.64 to 0.91] for 30-59 mL/minutes). Patients who are older, Black, or have more comorbidities are less likely to receive guideline concordant care to prevent SREs. These observations highlight the unique challenges of caring for patients with mCRPC and the need for future studies to increase BMA use in these populations.

Outcomes after definitive radiation therapy for localized prostate cancer in a national health care delivery system.

Accurate information regarding real-world outcomes after contemporary radiation therapy for localized prostate cancer is important for shared decision-making. Clinically relevant end points at 10years among men treated within a national health care delivery system were examined. National administrative, cancer registry, and electronic health record data were used for patients undergoing definitive radiation therapy with or without concurrent androgen deprivation therapy within the Veterans Health Administration from 2005 to 2015. National Death Index data were used through 2019 for overall and prostate cancer-specific survival and identified date of incident metastatic prostate cancer using a validated natural language processing algorithm. Metastasis-free, prostate cancer-specific, and overall survival using Kaplan-Meier methods were estimated. Among 41,735 men treated with definitive radiation therapy, the median age at diagnosis was 65years and median follow-up was 8.7years. Most had intermediate (42%) and high-risk (33%) disease, with 40% receiving androgen deprivation therapy as part of initial therapy. Unadjusted 10-year metastasis-free survival was 96%, 92%, and 80% for low-, intermediate-, and high-risk disease. Similarly, unadjusted 10-year prostate cancer-specific survival was 98%, 97%, and 90% for low-, intermediate-, and high-risk disease. The unadjusted overall survival was lower across increasing disease risk categories at 77%, 71%, and 62% for low-, intermediate-, and high-risk disease (p<.001). These data provide population-based 10-year benchmarks for clinically relevant end points, including metastasis-free survival, among patients with localized prostate cancer undergoing radiation therapy using contemporary techniques. The survival rates for high-risk disease in particular suggest that outcomes have recently improved.

Translational Herbal Medicines Availability: A Necessity to Ensure Medicine Security in Nigeria

Background: Over 80% of people in Africa receive care from Traditional African Medicine (TAM), which is part of our socioeconomic and cultural legacy. Nigerian traditional herbal medicine has made signifificant contribution to the primary health care needs of Nigerians from time immemorial. However, there is signifificant room for improvement in its development and utilization. In most communities, they have served as the primary and, in some cases, the only source of healthcare for many millions of people. This is because they are accessible and reasonably priced. They are trusted by a vast majority of the populace, having been embraced culturally. Due to the current economic set back in Nigeria and other developing countries, the affffordability of these herbal medicines have made them to be in high demand as alternatives for primary health needs of majority of the populace. Asignifificant amount of efffforts have been made to translate herbs used locally into standardised dosage forms, however there is still a lot to be done in this regard. Herbal medicines, whose potency, effiffifficacy and safety have been scientififically validated can help to achieve the goal of ensuring that everyone has access to healthcare. Methods: A review of translational herbal medicines available in Nigeria was centered on emphasizing the necessity of translational herbal medicine. This will ensure availability and affffordability of drugs, which will in turn lead to medicine security in Nigeria. Results:Recommendations were made to encourage the use of translational herbal medicine to ensure medicine security in Nigeria. Conclusion: For the benefits of herbal medicine to be maximized, individuals must be informed about the likely benefits and risks of supplementing their use of conventional medicine with Herbal Medicine. In addition, herbal medicinal products must be standardized to render them more acceptable such that they can be integrated into the national health care delivery system.

Level of Trust in Health Care Systems During COVID-19 Pandemic Among Health Care Workers of Pakistan.

This survey aimed to evaluate the levels of trust and satisfaction among healthcare workers towards the national healthcare delivery system and whether it has been affected by the global disruption created by COVID-19. This was an analytical cross-sectional study that took place from January to October 2021 at a tertiary level health care facility in Rawalpindi, Pakistan, using an online data collection tool. Our sample included 10, 133 healthcare workers of all cadres. Our study found a significant level of distrust of healthcare workers towards multiple aspects of the healthcare delivery system, particularly towards government agencies and other members of healthcare delivery. We noted a significant gender disparity between male and female respondents with males showing more trust than female healthcare workers. We conclude that significant efforts need to be made by policymakers in the government to alleviate this trust deficit before it worsens.

Lessons Leanrt Of The First Public Sector ISO 15189 Accredited Laboratory In Ghana

Background: Accreditation of public sector medical laboratories in developing countries such as Ghana have been described as an almost impossible task despite major efforts to establish and maintain efficient quality laboratory management systems. The Pathology Division of the 37 Military Hospital provides evidence of an efficient approach to accreditation to ISO 15189 in Ghana and the need to make medical laboratory accreditation an integral part of the national healthcare delivery system.Methods: The laboratory adopted the Strengthening Laboratory Management Towards Accreditation (SLMTA) programme. After implementation the laboratory accelerated the process towards accreditation using an approach involving senior management in allaccreditation activities, use of specific teams to focus on key improvement projects coordinated by an efficient mentorship programme. The laboratory was finally assessed by the Southern African Development Community for Accreditation Services to meeting the requirement of ISO 15189.Results: The Pathology Division of the 37 Military Hospital attained accreditation for its Haematology and Chemical Pathology departments making it the first public sector laboratory in Ghana to meet the requirement of ISO 15189. There has been an observedimprovement in confidence of personnel and a culture for quality and meeting standards in support of quality healthcare delivery.Conclusion: ISO 15189 accreditation of medical laboratories is possible for all public sector laboratories in Ghana and the approach is scalable scalable especially for tertiary level laboratories. Accreditation ensures a culture for quality which is critical in supportof quality patient care and must be an important aspect of national healthcare delivery systems.

TAMA LAW: A Perspective Review on its Implementation in the Philippines

A law was passed in 1997 with the goal of enhancing the quality of medical services to the Filipinos by expanding and incorporating traditional and alternative health care into the national health care delivery system. The act is known as Republic Act No. 8423 or the "Traditional and Alternative Medicine Act (TAMA) of 1997." Over two decades old, the majority of the expected health benefits and policy implications of the act are still undefined. This perspective review aims to examine the progress of the act TAMA Law in the Philippines and identify the gaps and lapses with its implementation. In assessing the gathered literature about TAMA Law from various databases, it is organized based on Governance (Technical data for safety, legislation, administrative organization), Traditional Use and Scientific Validity, Human Resources (Education, Practitioners, Public Access to Information), Monitoring Process (Utilization, Provision, Quality Management, and Product Surveillance), and the tools for treatment (herbs, devices, medicine). Given the prevalence of traditional and alternative medicine in the Philippines, suggestions on stronger and more precise regulations for these products must be established to assure and guarantee the safety and efficiency of these products for consumers to have an additional source of health care.

A Case Study of Complementary Alternative Medicines in Primary Healthcare in Ghana

Background: The embryonic field of complementary alternative medicine in Ghana is gradually taking shape. Alternative medicine in Ghana is an important system of medical practice with legislation currently pending for promulgation.&#x0D; Objectives: To support this embryonic industry for potential role into our primary healthcare and public health system, there is a need for robust health care policy in the area of standardization coupled with strong political willpower and research in Ghana. The aim of this case study is to reflect the role of complementary alternative medicine in primary healthcare in Ghana.&#x0D; Methods: The study incorporates a mixed method engaged in integrated data analysis to investigate the challenges of practitioners of complementary alternative medicines as primary healthcare givers. Additionally, it evaluates the pull factors that drive consumers to complementary alternative remedies from the perspectives of the practitioners and finally, to evaluate the opinions of practitioners on consumers’ push factors from mainstream medicine using Ghana as a case model.&#x0D; Results: This study demonstrates that there is a role of complementary alternative medicine in primary healthcare delivery as well as the public health system. However, there are multifactorial challenges in the sector as respondents outlined lack of standardization, disunity and mistrust between complementary alternative medicine and mainstream medical practice. Some of these opposing forces prevent recognition of these remedies into the national healthcare delivery system. &#x0D; Conclusion: While our findings demonstrate that there is a role of complementary alternative medicines in our public health and primary healthcare in Ghana, we recommend collaboration between complementary alternative and conventional medical practitioners for improvement of quality of life the consumers. We are of the view that, unhealthy competition between the two medical systems should be controlled.

Correlation between hemorrhage risk prediction score and severe maternal morbidity

Obstetrical hemorrhage is a leading cause of severe maternal morbidity, a key indicator of a nation's healthcare delivery system and often associated with a high rate of preventability. Limited data suggest that a patient's hemorrhage risk score may be associated with risk for maternal morbidity such as severe hemorrhage, intensive care unit admission, or transfusion. Little is known regarding the relationship between hemorrhage risk score and nontransfusion-related morbidity. We sought to evaluate the association between a patient's California Maternal Quality Care Collaborative admission hemorrhage risk score and severe maternal morbidity. This was a retrospective cohort of delivery admissions from 2018 to 2019 in a single healthcare network. Admission risk scores were assigned to each patient using the California Maternal Quality Care Collaborative criteria. Rates of transfusion- and nontransfusion-associated severe maternal morbidity were compared across low-, medium-, and high-risk strata. We defined severe maternal morbidity as the presence of any International Classification of Diseases diagnosis or procedure codes outlined by the Centers for Disease Control and Prevention, need for intensive care unit admission, or prolonged postpartum hospital length of stay. A multivariable logistic regression was used to assess the association between hemorrhage risk score and severe maternal morbidity. In the overall cohort, severe maternal morbidity occurred in 2.4% (n=517) of all deliveries. Excluding cases requiring transfusion, 0.6% (n=131) of cases still had a severe maternal morbidity event. The incidence of severe maternal morbidity was 1.6% (n=264) in patients categorized as low risk for hemorrhage compared with 2.5% (n=118) and 13.6% (n=135) in patients who were categorized as medium or high risk for hemorrhage, respectively (P<.001). Patients classified as high risk had a significant association with both severe maternal morbidity (adjusted odds ratio, 8.8; 95% confidence interval, 7.0-11) and nontransfusion-associated severe maternal morbidity (adjusted odds ratio, 3.6; 95% confidence interval, 2.2-5.9). In addition to predicting the risk for obstetrical hemorrhage and transfusion, our findings indicate that the California Maternal Quality Care Collaborative admission hemorrhage risk tool predicts risk for transfusion- and nontransfusion-associated severe maternal morbidity. Our findings imply that despite awareness and the identification of patients at high risk for obstetrical hemorrhage on admission, significant hemorrhage-associated morbidity persisted. Our data indicate that the identification of risk alone may be insufficient to reduce morbidity and imply that further work is needed to investigate and implement new practices in response to a patient's score stratum.

Knowledge, attitude and perception of complementary and alternative system of medicine in Tamilnadu and Pudhucherry, South India.

Complementary and Alternate medicine (CAM) remains as the major source of healthcare for majority of the Indian population. This widespread resource needs to be strengthened, adequately trained and effectively utilized in the national health care delivery system for delivering an integrated and effective health care system. A cross sectional study was conducted involving 200 adults in two different settings-a community setting (n=100), and a hospital setting (n=100). A semi-structured questionnaire was used. Both in the community and in the hospital, siddha (80%) was the most well-known system of medicine, followed by Yoga (72%) and Naturopathy in the study population. However, the knowledge about the various available CAM therapies still seemed to be limited. Opinion on the integrated approach along with conventional medicine was welcoming. Still more awareness about these systems is required to facilitate integrative medicine in healthcare settings.

Improving Access to Safe Anesthetic Care in Rural and Remote Communities in Affluent Countries.

Inadequate access to anesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. This report summarizes the challenges facing the provision of anesthesia services in rural and remote regions. The current landscape of anesthesia providers and their training is described. We also explore innovative strategies and emerging technologies that could better support physician-led anesthesia care teams working in rural and remote areas. Ultimately, we believe that it is the responsibility of specialist anesthesiologists and academic health sciences centers to facilitate access to high-quality care through partnership with other stakeholders. Professional medical organizations also play an important role in ensuring the quality of care and continuing professional development. Enhanced collaboration between academic anesthesiologists and other stakeholders is required to meet the challenge issued by the World Health Organization to ensure access to essential anesthesia and surgical services for all.

Greek (Unani) Aspect of Preventive &amp; Social Medicine

There are number of systems of medicine prevailing in this world. The Greek (Unani) system of Medicine is one of them. The classic period of Greek Medicine was from 460-136 BC. The medieval period to which Greek medicine belong is 500-1500 AD. The golden period of Greek medicine is considered from 800 to 1300 AD (Park K, 2011) Greek medicine was reintroduced in 1351 AD by Arabs. Athens which was learning centre shifted to Alexandria as Arab - Persian medicine. It flourished in India under the patronage of Mughal Emperors, suffered a setback during the British rule but soon regained its momentum by endless efforts of Nizam of Hyderabad, Azizi family of Lucknow and Sharifi family of Delhi. At present Greek system of medicine has now been regarded and recognized as one of the Indian systems of medicine and forms an integral part of national healthcare delivery system (P. Siddiqui, 2009). How to cite this article:Ashraf SMS. Greek (Unani) Aspect of Preventive & Social Medicine. J Integ Comm Health 2019; 8(1): 13-20. DOI: https://doi.org/10.24321/2319.9113.201903

Current Scenario of Teledentistry in Public Healthcare in India

India is the largest democracy and the second most populated nation in the world. Although with 190,000 dentists, India ranks top in the absolute number of dental graduates, rural Indians and urban slums remain deprived of quality dental healthcare due to unequal distribution and access. About 1,000 telemedicine nodes have been established by Government/Private/Trust agencies to reinforce the national healthcare delivery system in India however an organised and dedicated teledentistry network is non-existent but for the Collaborative Digital Diagnosis System (CollabDDS). CollabDDS was developed in India for tele-consultation, diagnosis, remote education and as a data repository. It is a remote expert dental programme served between three dental schools with the Centre for Dental Education and Research at the All India Institute of Medical Sciences in New Delhi. There are some major challenges which exist and need to be addressed including lack of government initiatives, reimbursement schemes, data protection laws, technical infrastructure, advanced biological sensors, bandwidth support, orientation among doctors, and linguistic diversity, along with patients’ fear and unfamiliarity. With an area of 3,287 million km2, an urban-rural divide, inaccessible areas, the country is an ideal setting for the provision of eHealth. This paper highlights the present status, challenges and future of teledentistry in India.

Quality Measures in Foot and Ankle Care

Category: Ankle, Ankle Arthritis, Arthroscopy, Bunion, Diabetes, Hindfoot, Trauma Introduction/Purpose: National healthcare delivery systems are shifting to value-based models. Understanding quality measures used to assess performance is important as they may be operationalized in alternative payment models, such as bundled payment programs, or quality reporting programs, such as the Merit-Based Incentive Payment System. Previous literature has shown that quality measures in other orthopaedic subspecialties disproportionately focus on effective clinical care or processes of care, while ignoring patient outcomes. We completed a systematic review of quality measures and candidate quality measures that address foot and ankle care to identify gaps in current measures and to inform future measure development initiatives. Methods: We conducted a systematic review of the National Quality Forum, the Agency for Healthcare Research and Quality, and the Physician Quality Reporting System for quality measures related to foot and ankle care. We also reviewed candidate quality measures from clinical practice guidelines (CPG) in the literature meeting Institute of Medicine CPG criteria. Measures were classified by clinical entity, Donabedian domain (structure, process, or outcome), and the National Quality Strategy (NQS) priority that they addressed. Results: We identified 12 quality measures and 16 candidate measures. Quality measures addressed NQS priorities of “Effective Clinical Care” (33%), “Communication and Coordination of Care” (58%), “Patient Safety” (25%), “Community and Population Health” (8%), and “Person and Caregiver Centered Experience and Outcomes” (8%). All candidate measures addressed “Effective Clinical Care”. Furthermore, 83% of quality measures and 94% of candidates were process measures, 17% of quality and 6% of candidate were outcome measures, and there were no structure measures. Diabetic foot care was the most commonly addressed clinical entity for both quality measures (58%) and candidate measures (69%). Conclusion: Foot and ankle quality measures and candidate measures disproportionately assess effective clinical care and processes of healthcare delivery. Additionally, few clinical disorders within the field are included, focusing primarily on diabetic foot care. Currently only two outcome measures exist, leaving an opportunity for outcome measure development. These patterns are reflected in candidate measures, suggesting that the narrow focus of quality measures will continue unless efforts are made to develop more comprehensive measures. Additional measures that address a broader array of clinical disorders across the spectrum of NQS priorities and Donabedian domains are needed to prepare for a quality-based healthcare system.

Integration for coexistence? Implementation of intercultural health care policy in Ghana from the perspective of service users and providers

ObjectiveIn spite of the World Health Organization's recommendations over the past decades, Ghana features pluralistic rather than truly integrated medical system. Policies about the integration of complementary medicine into the national health care delivery system need to account for individual-level involvement and cultural acceptability of care rendered by health care providers. Studies in Ghana, however, have glossed over the standpoint of the persons of the illness episode about the intercultural health care policy framework. This paper explores the health care users, and providers’ experiences and attitudes towards the implementation of intercultural health care policy in Ghana. MethodsIn-depth interviews, augmented with informal conversations, were conducted with 16 health service users, 7 traditional healers and 6 health professionals in the Sekyere South District and Kumasi Metropolis in the Ashanti Region of Ghana. Data were thematically analysed and presented based on the a posteriori inductive reduction approach. ResultsFindings reveal a widespread positive attitude to, and support for integrative medical care in Ghana. However, inter-provider communication in a form of cross-referrals and collaborative mechanisms between healers and health professionals seldom occurs and remains unofficially sanctioned. Traditional healers and health care professionals are skeptical about intercultural health care policy mainly due to inadequate political commitment for provider education. The medical practitioners have limited opportunity to undergo training for integrative medical practice. We also find a serious mistrust between the practitioners due to the “diversity of healing approaches and techniques.” Weak institutional support, lack of training to meet standards of practice, poor registration and regulatory measures as well as negative perception of the integrative medical policy inhibit its implementation in Ghana. ConclusionIn order to advance any useful intercultural health care policy in Ghana, the government's total commitment in informed training and provider education, enforcement of regulatory instrument and improved community engagement is needed. Evidence-based incorporation of traditional medical therapies into clinical practice will provide safer, faster and more effective health care for the underserved and resource-poor, particularly in the rural areas.

The Integration of Chinese Material Medica into the Chinese Health Care Delivery System, an Update.

Integration of Traditional Chinese medicine, including Chinese materia medica (CMM), into the national healthcare delivery system, is now an essential national policy in China and is increasing rapidly. This case study summarizes the profile of integration of CMM in China, describing markets, industries, management mechanisms, education, research and development, human resources and international cooperation related to Traditional Chinese medicine, and CMM in particular. It provides a basis for policies for integrating TM into national healthcare systems to save costs and improve the general health of the population. By the end of 2014, the overall sale value of CMM exceeded $US120bn, representing 31% of the total pharmaceutical industry markets in China. More than 200 CMM formulated drugs and 1100 prepared CMM are now on the national 'Essential Drug List' and the financial budget for CMM from the Chinese government in 2014 was approximately $US4.66bn, almost double that of 2011, indicating an increasing and long-term commitment to integrated medicine in China.

National Healthcare Delivery Systems Influence Lung Transplant Outcomes for Cystic Fibrosis

Successful lung transplantation (LTx) depends on multiple components of healthcare delivery and performance. Therefore, we conducted an international registry analysis to compare post-LTx outcomes for cystic fibrosis (CF) patients using the UNOS registry in the United States and the National Health Service (NHS) Transplant Registry in the United Kingdom. Patients with CF who underwent lung or heart-lung transplantation in the United States or United Kingdom between January 1, 2000 and December 31, 2011 were included. The primary outcome was all-cause mortality. Kaplan-Meier analysis and Cox proportional hazards regression evaluated the effect of healthcare system and insurance on mortality after LTx. 2,307 US LTx recipients and 451 individuals in the United Kingdom were included. 894 (38.8%) US LTx recipients had publically funded Medicare/Medicaid insurance. US private insurance and UK patients had improved median predicted survival compared with US Medicare/Medicaid recipients (p < 0.001). In multivariable Cox regression, US Medicare/Medicaid insurance was associated with worse survival after LTx (US private: HR0.78,0.68-0.90,p = 0.001 and UK: HR0.63,0.41-0.97, p = 0.03). This study in CF patients is the largest comparison of LTx in two unique health systems. Both the United States and United Kingdom have similar early survival outcomes, suggesting important dissemination of best practices internationally. However, the performance of US public insurance is significantly worse and may put patients at risk.

Determinants of Physicians’ Acceptance of New Medicaid Patients

Medicaid plays a significant role in the healthcare of millions of U.S. families and individuals, and office-based physician practices are an important part of the national health care delivery system. Yet access to these providers has been and continues to be a challenge for Medicaid beneficiaries. Exacerbating the issue is the recent expansion of insurance coverage under the Affordable Care Act. This study explores this national conundrum from the physicians’ perspective. The impact of practice characteristics, compensation and performance measures are examined on physicians’ propensity to accept new Medicaid patients. This study draws upon data from the 2008 Health Tracking Physician Survey restricted-use file and is the first to provide for a comprehensive look at the determinants of physician acceptance. The approach is rooted in the economic theory of control, agency theory. The most significant factors found to be associated with diminished physician propensity for Medicaid access include: no present participation, having an ownership interest in the practice, operating as a one- or two-physician sized practice, operating as a primary care physician, low relative geographic physician reimbursement, lacking supportive clinical information technology and gender. Knowing what determinants are associated with physicians’ decision may provide opportunities for public policy solutions.