Number Of Doctor Consultations Research Articles

The Role of Self-Management in Pessary Therapy for Pelvic Organ Prolapse-A retrospective cohort study.

This study investigated pessary self-management (PSM). The primary outcome was how often PSM was taught to patients with pelvic organ prolapse (POP). Secondary outcomes were associations of PSM with treatment continuation, side effects, changing to surgery, and number of doctor consultations in the first year after treatment initiation compared with clinical management (CM). A retrospective cohort study was conducted in 300 patients visiting three Dutch medical centres in 2019, and receiving a pessary for POP. The t test, Chi-squared test and logistic regression were performed to compare PSM with CM and to identify factors associated with treatment continuation. A total of 35% of patients received PSM instructions, of which 92% were able to perform PSM successfully. Treatment was continued by 83% of patients practicing PSM and 75% of patients having CM (p = 0.16), side effects occurred in 26% and 39% respectively (p = 0.18). Pain or discomfort was associated with treatment discontinuation (p < 0.01). In a subgroup analysis of patients who had a pessary suitable for PSM, treatment continuation was significantly higher in the PSM group (97%) than in the CM group (74%; p < 0.01). Pessary self-management was only taught to 35% of patients who received a pessary, although the ability to perform PSM was high (92%). Treatment discontinuation was significantly lower in the PSM subgroup, when assessing the subgroup of patients using a pessary suitable for PSM. The large number of patients using a pessary suitable for PSM in the CM group implies that there is a lot to gain by promoting PSM.

Factor analysis related to the length of stay of covid-19 patients in emergency installations

The Emergency Department is the main door to medical services for patients suffering from illnesses and injuries, which can be life-threatening and require immediate treatment. In such circumstances, the actions taken must be effective and efficient. The length of stay is an effective indicator for evaluating the emergency department's performance and quality of care. Length of Stay is associated with the time of arrival, the time of laboratory examination, the time of radiological examination, and the number of doctor consultations. This research is a non-experimental quantitative survey using a retrospective research design. Data collection was carried out by observing the medical record file of each COVID-19 patient who visited the emergency room of dr. Soebandi Jember Hospital from when the patient arrived at the emergency room until he left the emergency room. The population of this study was 270 respondents, who were all COVID-19 patients, using simple random sampling techniques. The study's findings revealed a significant relationship between the patient's arrival time (0.000), laboratory examination time (0.000), radiological examination time (0.000), and length of stay in COVID-19 patients at dr. Soebandi Jember Hospital's Emergency Installation. According to the findings of this study, there was no significant relationship between the number of doctor consultations and the length of stay in COVID-19 patients (0.813). Laboratory examination time is the most dominant factor in the length of stay of COVID-19 patients in the emergency room, with a regression coefficient value of 0.173 (p-value less than 0.005).

Factors affecting the duration of gestation among women taking prenatal care at Gondar referral hospital, Ethiopia.

BackgroundPregnant women taking prenatal care is vital for the health of the mother and the fetus. The duration of pregnancies provides a useful measure of a woman's natural length of pregnancy and may help in predicting an individual woman's due date. The objective of this study was to understand the factors affecting the duration of gestation among women taking prenatal care in Gondar referral hospital, Ethiopia.MethodsA quantitative research design using secondary data available in the form of antenatal care (ANC) cards in the Gondar teaching referral hospital data set. Kaplan–Meier estimate was used to explain the median survival time of duration of gestation. A multivariate AFT model was performed to identify the factors related to the duration of gestation among women.ResultsThe mean time of the length of pregnancy was 39.5 weeks. The factors such as, the age of women, number of children, number of doctor consultations, and the stage of gestation were found to be statistically significant (p < 0.05) for the survival time of time to birth of pregnant women in Ethiopia. Weibull AFT model was found to be the best model for predicting the time to birth of pregnant women in Ethiopia.ConclusionWe did not see associations between length of gestation and blood pressure and bleeding during early pregnancy. We also did not find an association with the presence of disease, which has been associated with the length of pregnancy. The frequency of visiting a doctor during the gestation period enhances the length of the gestation period. The shorter gestation period from the due date is dangerous to the health of both mother and her fetus.

The variation of arthroplasty procedures in the OECD Countries: analysis of possible influencing factors by linear regression.

Total hip and knee replacements (THR, TKR) are among the most common surgeries but incidence rates vary between OECD countries. Previous studies suggested economic factors to be most influential but did not take into account health care system related factors. Hence we analysed the possible influence of healthcare system related factors on the operation rate. We used OECD data for 27 countries and calculated Age-Standardized Incidence Rates (ASIR). In order to determine possible explanatory variables on the ASIRs we performed a stepwise blockwise linear regression. The ASIR of hip and knee replacement varies widely. We identified statistically significant determinants which influence the ASIR of THR in a positive manner: incidence and length of stay of coxarthrosis, ASIR of knee replacement, health expenditures, number of nurses and an etatistic social insurance. Diabetes prevalence, gross domestic product and number of doctor consultations, however, have a negative influence on the ASIR. TKR rate is positively influenced by health expenditures and incidence rate of gonarthrosis, negatively by the number of primary practitioners. We observed strong geographic disparities in the frequency of THR and THR that cannot be explained by age structure of the countries. Economic factors seem to play a secondary role while healthcare related factors have a greater influence.

Epidemiological characteristics of the first 53 laboratory-confirmed cases of COVID-19 epidemic in Hong Kong, 13 February 2020.

BackgroundCOVID-19, caused by SARS-CoV-2, first appeared in China and subsequently developed into an ongoing epidemic. Understanding epidemiological factors characterising the transmission dynamics of this disease is of fundamental importance.AimsThis study aimed to describe key epidemiological parameters of COVID-19 in Hong Kong.MethodsWe extracted data of confirmed COVID-19 cases and their close contacts from the publicly available information released by the Hong Kong Centre for Health Protection. We used doubly interval censored likelihood to estimate containment delay and serial interval, by fitting gamma, lognormal and Weibull distributions to respective empirical values using Bayesian framework with right truncation. A generalised linear regression model was employed to identify factors associated with containment delay. Secondary attack rate was also estimated.ResultsThe empirical containment delay was 6.39 days; whereas after adjusting for right truncation with the best-fit Weibull distribution, it was 10.4 days (95% CrI: 7.15 to 19.81). Containment delay increased significantly over time. Local source of infection and number of doctor consultations before isolation were associated with longer containment delay. The empirical serial interval was 4.58–6.06 days; whereas the best-fit lognormal distribution to 26 certain-and-probable infector–infectee paired data gave an estimate of 4.77 days (95% CrI: 3.47 to 6.90) with right-truncation. The secondary attack rate among close contacts was 11.7%.ConclusionWith a considerable containment delay and short serial interval, contact-tracing effectiveness may not be optimised to halt the transmission with rapid generations replacement. Our study highlights the transmission risk of social interaction and pivotal role of physical distancing in suppressing the epidemic.

Why Do Japan and South Korea Record Very Low Levels of Perceived Health Despite Having Very High Life Expectancies?

Japan and Korea follow a unique trend in which, despite reporting two of the highest life expectancies (LEs) among the Organization for Economic Co-operation and Development (OECD) countries, the proportion of people with good self-rated health (SRH) is disproportionately low. We sought to explain this high-LE-low-SRH paradox by examining associations among LE, the prevalence of good SRH, and healthcare utilization. Our hypothesis was that countries with more frequent healthcare use would demonstrate poorer SRH and that SRH would not show a meaningful association with LE among developed countries. This study extracted data from Health at a Glance 2017 by the OECD for 26 countries with valid and comparable information on LE, SRH, and the number of doctor consultations per capita. Correlations among LE, good SRH, and number of doctor consultations per capita were analyzed. The number of annual doctor consultations per capita and the prevalence of good SRH were closely correlated (correlation coefficient=−0.610); excluding outliers produced a higher correlation coefficient (−0.839). Similar patterns were observed when we replaced good SRH with poor SRH. Meanwhile, the correlation coefficient between annual per capita doctor consultations and LE was quite low (−0.216). Although good SRH is closely related to better LE at the individual level, this was not true at the national level. Frequent use of healthcare in Japan and Korea was strongly correlated with poorer SRH, without any meaningful correlation with LE.

EFFICIENCY OF PHARMACEUTICAL CONSUMPTION IN TURKEY: BENCHMARKING WITH OECD BY DEA

After 1980s, consumers begin to focus more health-conscious behaviours and attitudes including the concept of consuming pharmaceutical products. Pharmaceutical consumption attitude is a natural outcome of this trend. In this research, it is aimed to analyze Turkey’s benchmarking position among OECD countries in terms of pharmaceutical consumption efficiency. 15 OECD countries’ 5 years (2008-2012) analyzed by DEA-Malmquist TFP with the output-oriented and variable returns to scale methods. TC index shows that Turkey had created more pharmaceutical consumption and longer life expectancy by using same amount of number of physicians, number of pharmacists, total public and private health insurance expenditures and number of doctor consultations. By the way, Turkey had embraced efficiency growth with the rate of 0.4 percent. However, total efficiency level of Turkey got damaged by reason of its administrative limitations.

EFFICIENCY OF PHARMACEUTICAL CONSUMPTION IN TURKEY: BENCHMARKING WITH OECD BY DEA

After 1980s, consumers begin to focus more health-conscious behaviours and attitudes including the concept of consuming pharmaceutical products. Pharmaceutical consumption attitude is a natural outcome of this trend. In this research, it is aimed to analyze Turkey’s benchmarking position among OECD countries in terms of pharmaceutical consumption efficiency. 15 OECD countries’ 5 years (2008-2012) analyzed by DEA-Malmquist TFP with the output-oriented and variable returns to scale methods. TC index shows that Turkey had created more pharmaceutical consumption and longer life expectancy by using same amount of number of physicians, number of pharmacists, total public and private health insurance expenditures and number of doctor consultations. By the way, Turkey had embraced efficiency growth with the rate of 0.4 percent. However, total efficiency level of Turkey got damaged by reason of its administrative limitations.

Healthcare resource utilisation by patients with coronary heart disease receiving a lifestyle-focused text message support program: an analysis from the TEXT ME study.

The 'Tobacco, Exercise and Diet Messages' (TEXT ME) study was a 6-month, single-centre randomised clinical trial (RCT) that found a text message support program improved levels of cardiovascular risk factors in patients with coronary heart disease (CHD). The current analyses examined whether receipt of text messages influenced participants' engagement with conventional healthcare resources. The TEXT ME study database (N=710) was linked with routinely collected health department databases. Number of doctor consultations, investigations and cardiac medication prescriptions in the two study groups were compared. The most frequently accessed health service was consultations with a General Practitioner (mean 7.1, s.d. 5.4). The numbers of medical consultations, biochemical tests or cardiac-specific investigations were similar between the study groups. There was at least one prescription registered for statin, ACEI/ARBs and β-blockers in 79, 66 and 50% of patients respectively, with similar refill rates in both the study groups. The study identified TEXT ME text messaging program did not increase use of Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) captured healthcare services. The observed benefits of TEXT ME reflect direct effects of intervention independent of conventional healthcare resource engagement.

The impact of minimum wages on population health: evidence from 24 OECD countries.

This study examines the relationship between minimum wages and several measures of population health by analyzing data from 24 OECD countries for a time period of 31years. Specifically, I test for health effects as a result of within-country variations in the generosity of minimum wages, which are measured by the Kaitz index. The paper finds that higher levels of minimum wages are associated with significant reductions of overall mortality rates as well as in the number of deaths due to outcomes that have been shown to be more prevalent among individuals with low socioeconomic status (e.g., diabetes, disease of the circulatory system, stroke). A 10% point increase of the Kaitz index is associated with significant declines in death rates and an increase in life expectancy of 0.44years. Furthermore, I provide evidence for potential channels through which minimum wages impact population health by showing that more generous minimum wages impact outcomes such as poverty, the share of the population with unmet medical needs, the number of doctor consultations, tobacco consumption, calorie intake, and the likelihood of people being overweight.

Is treatment “intensity” associated with healthier lifestyle choices? An application of the dose response function

Healthy lifestyle choices and doctor consultations can be substitutes or complements in the health production function. In this paper we consider the relation between the number of doctor consultations and the frequency of patient physical activity. We use a novel application of the Dose-Response Function model proposed by Hirano and Imbens (2004) to deal with treatment endogeneity under the no unmeasured confounding assumption. Our application takes account of unobserved heterogeneity and uses dynamic non-linear models for the treatment and outcome variables of interest. Using seven waves of the British Household Panel Survey, we find that higher treatment intensity and frequency of physical activity are inversely related. We show that accounting for both treatment selection and unobserved heterogeneity halves the size of this relationship. An additional doctor consultation is associated with a 0.5 percentage point reduction in the probability of undertaking vigorous physical activity. Our results hold for a sub-sample visiting the doctor for health check-ups, and are shown to be robust using instrumental variables.

Building a National Electronic Medical Record Exchange System – Experiences in Taiwan

There are currently 501 hospitals and about 20,000 clinics in Taiwan. The National Health Insurance (NHI) system, which is operated by the NHI Administration, uses a single-payer system and covers 99.9% of the nation's total population of 23,000,000. Taiwan's NHI provides people with a high degree of freedom in choosing their medical care options. However, there is the potential concern that the available medical resources will be overused. The number of doctor consultations per person per year is about 15. Duplication of laboratory tests and prescriptions are not rare either. Building an electronic medical record exchange system is a good method of solving these problems and of improving continuity in health care.In November 2009, Taiwan's Executive Yuan passed the ‘Plan for accelerating the implementation of electronic medical record systems in medical institutions’ (2010–2012; a 3-year plan). According to this plan, a patient can, at any hospital in Taiwan, by using his/her health insurance IC card and physician's medical professional IC card, upon signing a written agreement, retrieve all important medical records for the past 6 months from other participating hospitals. The focus of this plan is to establish the National Electronic Medical Record Exchange Centre (EEC). A hospital's information system will be connected to the EEC through an electronic medical record (EMR) gateway. The hospital will convert the medical records for the past 6 months in its EMR system into standardized files and save them on the EMR gateway. The most important functions of the EEC are to generate an index of all the XML files on the EMR gateways of all hospitals, and to provide search and retrieval services for hospitals and clinics. The EEC provides four standard inter-institution EMR retrieval services covering medical imaging reports, laboratory test reports, discharge summaries, and outpatient records. In this system, we adopted the Health Level 7 (HL7) Clinical Document Architecture (CDA) standards to generate clinical documents and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing (XDS) profile for the communication infrastructure.By December of 2014, the number of hospitals that provide an inter-institution EMR exchange service had reached 321. Hospitals that had not joined the service were all smaller ones with less than 100 beds.Inter-institution EMR exchange can make it much easier for people to access their own medical records, reduce the waste of medical resources, and improve the quality of medical care. The implementation of an inter-institution EMR exchange system faces many challenges. This article provides Taiwan's experiences as a reference.

ESTIMATING THE NUMBER OF VISITS TO THE DOCTOR

Summary The frequency of doctor consultations has direct consequences for health care budgets, yet little statistical analysis of the determinants of doctor visits has been reported. We consider the distribution of the number of visits to the doctor and, in particular, we model its dependence on a number of demographic factors. Examination of the Australian 1995 National Health Survey data reveals that generalized linear Poisson or negative binomial models are inadequate for modelling the mean as a function of covariates, because of excessive zero counts, and a mean-variance relationship that varies enormously over covariate values. A negative binomial model is used, with parameter values estimated in subgroups according to the discrete combinations of the covariate values. Smoothing splines are then used to smooth and interpolate the parameter values. In effect the mean and the shape parameters are each modelled as (different) functions of gender, age and geographical factors. The estimated regressions for the mean have simple and intuitive interpretations. However, the dependence of the (negative binomial) shape parameter on the covariates is more difficult to interpret and is subject to influence by extreme observations. We illustrate the use of the model by estimating the distribution of the number of doctor consultations in the Statistical Local Area of Ryde, based on population numbers from the 1996 census.

Smoking, respiratory disease and health service utilisation: the paradox

We compared need for and utilisation of health services among young, healthy smokers who did not want to quit “the non-motivated”, and “motivated smokers”, relative to never-smokers. This cross-sectional study included 9915 Hong Kong police officers. We assessed smoking status, differentiating non-motivated from motivated smokers. Need was measured as the number of respiratory symptoms, and utilisation as the number of doctor consultations. All smokers had significantly more respiratory symptoms, but relatively lower utilisation. After adjusting for other factors, the odds ratio for utilisation was 0.77 (95% CI 0.64–0.93) for motivated smokers and 0.62 (95% CI 0.50–0.77) for non-motivated, relative to never-smokers (p for trend<0.001). Young, relatively healthy smokers, particularly the non-motivated, utilise less health services relative to the amount of symptoms. This has implications for planning smoking cessation services.

Personality, well-being and health correlates of trait emotional intelligence

Emotional intelligence (EI), personality, alexithymia, life satisfaction, social support and health related measures were assessed in Canadian ( N=500) and Scottish ( N=204) groups. EI was found to be negatively associated with alexithymia and alcohol consumption and positively associated with life satisfaction and social network size and quality. The relative strengths of EI and personality as regression predictors of health-related outcomes were investigated for a subgroup of Scots ( N range 99–111). The results of these analyses show that EI is more strongly associated than personality with social network size, but social network quality, life satisfaction, alcohol consumption, number of doctor consultations and health status are more strongly related to personality. More work is required to investigate the possible existence of other variables which, as with social network size are predicted better by trait EI than by personality.

Duration Dependence and Dispersion in Count-Data Models

This article explores the relation between nonexponential waiting times between events and the distribution of the number of events in a fixed time interval. It is shown that within this framework the frequently observed phenomenon of overdispersion—that is, a variance that exceeds the mean—is caused by a decreasing hazard function of the waiting times, whereas an increasing hazard function leads to underdispersion. Using the assumption of iid gamma-distributed waiting times, a new count-data model is derived. Its use is illustrated in two applications, the number of births and the number of doctor consultations.

Duration Dependence and Dispersion in Count-Data Models

This article explores the relation between nonexponential waiting times between events and the distribution of the number of events in a fixed time interval. It is shown that within this framework the frequently observed phenomenon of overdispersion—that is, a variance that exceeds the mean—is caused by a decreasing hazard function of the waiting times, whereas an increasing hazard function leads to underdispersion. Using the assumption of iid gamma-distributed waiting times, a new count-data model is derived. Its use is illustrated in two applications, the number of births and the number of doctor consultations.