Outpatient Health Care Services Research Articles

Promotion of Physical Activity by Health Professionals (PROMOTE-PA): protocol for effectiveness outcomes in a hybrid type I effectiveness-implementation cluster randomised controlled trial

Promotion of physical activity by health professionals can increase physical activity participation among patients, however, implementing physical activity promotion within hospital systems is lacking. The Promotion of Physical Activity by...

Does supplemental private health insurance impact health care utilization and seeking behavior of residents covered by social health insurance? Evidence from China National Health Services Survey

BackgroundSupplemental private health insurance (PHI) plays a crucial role in complementing China’s social health insurance (SHI). However, the effectiveness of incorporating PHI as supplementary coverage lacks conclusive evidence regarding its impact on healthcare utilization and seeking behavior among SHI-covered individuals. Therefore, investigating the effects of supplementary PHI on health care utilization and seeking behavior of residents covered by social health insurance is essential to provide empirical evidence for informed decision-making within the Chinese healthcare system.MethodsData from the 2018 China National Health Services Survey were analyzed to compare outpatient and inpatient healthcare utilization and choices between PHI purchasers and non-purchasers across three SHI schemes: urban employee-based basic medical insurance (UEBMI), urban resident-based basic medical insurance (URBMI), and the new rural cooperative medical scheme (NRCMS). Using the Andersen Healthcare Services Utilization Behavior Model as the theoretical framework,binary logistic regression and multinomial logistic regression (MNL) models were employed to assess the impact of PHI on healthcare utilization and provider preferences.ResultsAmong UEBMI, URBMI, and NRCMS participants with PHI, outpatient visit rates were 17.9, 19.8, and 21.7%, and inpatient admission rates were 12.4, 9.9, and 12.9%, respectively. Participants without PHI exhibited higher rates for outpatient visits (23.6, 24.3, and 25.6%) and inpatient admissions (15.2, 12.8, and 14.5%). Binomial logistic regression analyses revealed a higher probability of outpatient visits and inpatient admissions among UEBMI participants with PHI (p < 0.05). NRCMS participants with PHI showed a lower probability of outpatient visits but a higher probability of inpatient admissions (p < 0.05). Multinomial logistic regression indicated that NRCMS participants with PHI were more likely to choose higher-level hospitals, with a 17% increase for county hospitals and 27% for provincial or higher-level hospitals compared to primary care facilities.ConclusionThe findings indicate that the possession of PHI correlated with increased utilization of outpatient and inpatient healthcare services among participants covered by UEBMI. Moreover, for participants under the NRCMS, the presence of PHI is linked to a proclivity for seeking outpatient care at higher-level hospitals and heightened utilization of inpatient services. These results underscore the nuanced influence of supplementary PHI on healthcare-seeking behavior, emphasizing variations across individuals covered by distinct SHI schemes.

Assessing the Access and Affordability of Mental Healthcare Services for Adolescents in the United States

Adolescent mental health is a worsening crisis in the United States. Adding to the problem is the ability of parents and caregivers to find timely and affordable mental healthcare services for this population, one that is vulnerable to suicide, substance abuse and other devastating outcomes due to mental health issues. This research project evaluates the access and affordability of outpatient mental healthcare services for adolescents in the U.S., as well as possible causes and solutions for identified mental healthcare delivery issues. An anonymous survey developed by the author was distributed and completed specifically by parents and caregivers in the U.S., who have sought mental healthcare services for adolescents between 10-19 years of age. Survey results indicate that there are indeed problems within the insurance and medical professional industry with regard to parity between timely and affordable access to mental healthcare services compared to services for physical medical healthcare for adolescents. This causes additional stress for parents and caregivers seeking critical help for their children, while the child’s mental health status declines during this time. One could argue that ethically, access to mental healthcare should not be any more difficult or costly to families than access to physical medical healthcare.

Adverse childhood event subtypes and routine diabetes care utilization among U.S. adults with Type 2 diabetes.

Adverse childhood events (ACEs) have significant impacts on adulthood health, including greater risk of Type 2 diabetes (T2D). While there is a known connection to increased use of outpatient and emergency healthcare services, the potential role of ACEs in routine diabetes care utilization remains unclear. This study uses ACE subtypes to explain pathways to routine diabetes care utilization among adults with T2D. Cross-sectional data were obtained from the 2019 Behavioral Risk Factor Surveillance System, a survey of a representative sample of U.S. adults. Eligible participants resided in a state that completed both the Adverse Childhood Experiences (ACEs) and Diabetes modules and were diagnosed with non-gestational diabetes (N = 9,904), of whom the majority were presumed to have T2D. Confirmatory factor analysis was used to test the measurement model for three ACE factors: household dysfunction, physical and emotional abuse, and sexual abuse. Structural equation modeling was used to relate factors to four routine diabetes care utilization outcomes. Factor loadings were strong, and fit indices indicated good measurement model and full structural model fits. In the full structural equation model, household dysfunction was associated with decreased likelihood of meeting frequency recommendations for A1C testing (β = -0.22, p < .05) and foot exams (β = -0.29, p < .01). Physical and emotional abuse were associated with greater likelihood of meeting A1C testing frequency recommendations (β = 0.21, p < .05). Specific types of ACEs may differentially relate to routine diabetes care utilization in adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exploring Differences in Elderly Satisfaction with Outpatient Services at Suak Ribee and Meutulang Community Health Centers

Background: Elderly individuals are vulnerable groups with high morbidity and mortality rates. Some of them suffer from degenerative diseases that are chronic in nature, thus requiring high-quality healthcare services. As preliminary data collected through interviews with 10 elderly patients revealed, 3 individuals expressed dissatisfaction with healthcare services due to long waiting times for medication collection. Additionally, 3 individuals reported dissatisfaction with the services provided by healthcare personnel at the Community Health Center. This study aims to demonstrate the differences in the level of satisfaction among elderly patients in outpatient care between the general clinic and the elderly clinic at the Community Health Center. Methods: This study employed a cross-sectional design. The research was conducted in July 2023 with a sample size of 148 elderly individuals. The data was collected through interviews with the elderly who visited the Community Health Center. Two Community Health Centers were included as research sites: Meutulang Community Health Center to assess satisfaction with healthcare services at the general clinic, and Suak Ribee Community Health Center to assess satisfaction with healthcare services at the elderly clinic. Results: The study findings indicated that the average patient satisfaction score at the elderly clinic was 28.07, whereas the average patient satisfaction score at the general clinic was 27.17. Statistical testing revealed a p-value of 0.024. Conclusion: This study concludes that there is a difference in the level of satisfaction among elderly patients who utilize outpatient healthcare services at the elderly clinic and those at the general clinic of the Community Health Center. It is recommended that Community Health Centers without an elderly clinic unit as part of their outpatient services should consider providing such services, thereby focusing more on the elderly population.

Health Care Use Among Patients Retroactively Insured via a Hospital-Based Insurance Linkage Program.

Over 25% of the 27 million uninsured individuals in the United States are eligible for Medicaid. Many hospitals have insurance linkage programs that assist eligible patients with enrollment, but little is known about the impact of these programs on care utilization. This research assessed health care utilization and health outcomes among patients enrolled in Medicaid via a hospital-based insurance linkage program. This retrospective cohort study included adults aged 18-64 admitted to the hospital from 2016 to 2021. Those who obtained insurance retroactively via insurance linkage (RI) were compared with those who presented with Medicaid (MI) or remained uninsured (UI). The primary outcome was the presence of at least one visit with a primary care provider (PCP) in the 12months following index admission. Secondary outcomes included having an assigned PCP, ED revisits, and hospital readmissions. For patients with diabetes and hypertension, 12-month hemoglobin A1c (HbA1c) and blood pressure (BP) readings were tracked. Of 3882 patients admitted with no insurance, 2905 (74.8%) were enrolled in insurance (RI). In multivariable analysis, RI patients were 14% more likely (OR 1.14, p = 0.020) to have completed at least one PCP visit by 12months after index admission compared to those with preexisting Medicaid (MI), and uninsured patients were 29% less likely (OR 0.71, p = 0.003). MI and RI patients also had more ED revisits (p < 0.001) and greater 12-month reductions in blood pressure (p < 0.001) compared with uninsured patients. Hospital-based insurance linkage reached three-quarters of uninsured patients and was associated with increased utilization of acute and outpatient health care services. An acute care encounter represents an opportunity to connect patients to insurance, a key step toward improving their health outcomes.

Factors associated with public and private healthcare utilization for outpatient care among older adults in India: A Wagstaff's decomposition of Anderson's behavioural model.

In India, an expanding ageing population will become a public health alarm, putting additional pressure on the healthcare system. Therefore, the current study aimed to examine the factors associated with outpatient healthcare choices among older Indian adults. We used data from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-2018). A total of 34,588 individuals (age 45years and over) who accessed outpatient healthcare services in the last 12months during the survey were included in this research. A bivariate chi-square test was used to present the percentage distribution of types of outpatient healthcare utilisation by background characteristics. Multinomial logistic regression and Wagstaff's decomposition analyses were employed to explore the interplay of outpatient healthcare utilisation and allied predisposing, enabling, and need factors and examine these factors' contributions to the wealth-based inequalities in public, private, and other healthcare utilisation. Outpatient healthcare utilisation varied significantly according to socioeconomic and demographic factors. The findings suggest that consumption quintiles, place of residence, education, and health insurance were significant determinants of private and public healthcare utilisation and contributed to wealth-based inequalities in healthcare choices. The current study emphasises the need to strengthen and promote public healthcare services.

Factors affecting utilization of outpatient healthcare services among the elderly population in Butiama and Musoma districts, Tanzania: A community-based cross-sectional study.

In Tanzania and Sub-Saharan Africa, the elderly population has grown significantly due to improved quality of life, subsequently leading to prolonged life expectancy. Despite global development initiatives, elders still face insufficient care. Through a community-based investigation, this study assessed outpatient department (OPD) healthcare utilization and its determinants among the elderly in Butiama and Musoma districts, Tanzania. This study involved 415 elderly individuals aged 60 or older in Tanzania's Butiama and Musoma districts. Structured questionnaires were used to gather data, and the results were analyzed using SPSS 22. Univariate analysis utilized descriptive statistics, bivariate analysis involved cross-tabulation data, and multivariate logistic regression identified factors influencing OPD service utilization. Approximately 43.4% of participants used OPD services in the past year. Divorced or separated individuals were over two times more likely to utilize OPD services compared to single participants. This association was statistically significant (OR 1.958; 95% CI 1.001-3.829; p = 0.05). About 74.5% of surveyed elders held a positive perception of OPD utilization. Although not statistically significant (p>0.05), individuals with a positive perception had 1.167 times higher odds of using OPD services (95% CI 0.746-1.826). This study highlights a low overall utilization rate of OPD healthcare services among the elderly. Elderly individuals aged 80 years or older, along with widowed or divorced individuals, encounter specific barriers when accessing healthcare services. Positive perceptions play a crucial role in influencing healthcare utilization. It is essential to proactively offer tailored support and conduct further research, specifically addressing the distinct needs of divorced and widowed individuals when seeking healthcare services.

Price tag of glaucoma care is minor compared with the total direct and indirect costs of glaucoma: Results from nationwide survey and register data.

The estimations of the economic burden of glaucoma have focused on comparing different treatment modalities; hence, the total direct and indirect costs of glaucoma at population level are not well known. To estimate the direct and indirect costs of glaucoma and its treatment in Finland. Economic and glaucoma data were collected from the cross-sectional nationwide Health 2000 health examination survey linked to multiple national registers, which allowed a 13-year follow-up between 1999-2011 among survey participants. Direct costs covered eye- and non-eye-related hospitalizations and outpatient visits, outpatient health care services, and travel costs among participants aged 30 years or older, adjusted for age and sex. Indirect costs covered premature retirement and productivity losses among participants aged 30-64 years. Glaucoma patients (n = 192) were compared with non-glaucomatous population (n = 6,952). The annual additional total direct costs were EUR 2,660/glaucoma patient, EUR 1,769/glaucoma patient with medication, and EUR 3,979/operated glaucoma patient compared with persons without glaucoma. The respective additional total indirect costs were EUR 4,288, EUR 3,246, and EUR 12,902 per year. In total, the additional annual direct and indirect expenditures associated with glaucoma in Finland were EUR 202 million (0.86% of total expenditures of health care) and EUR 71 million (0.03% of the Finnish gross domestic product) arising mainly from non-eye-related hospitalizations and productivity losses, respectively. Glaucoma is associated with an increased health care consumption mainly due to non-eye-related health care, which can be explained by the vision loss as well as increased number of co-morbidities among glaucoma patients. Therefore, glaucoma constitutes a major economic burden for the health care system and society, highlighting the importance of early glaucoma interventions. The difference in direct and indirect costs between glaucoma treatment groups is explained by the uneven distribution of co-morbidities.

Socioeconomic inequality in unmet outpatient healthcare needs among people living in urban informal settlements in Sanandaj city, Iran

BackgroundThe growing trend of informal settlements is a serious humanitarian crisis. Unmet need for health care services is an indicator to measure the state of equality and access to healthcare services. This study, for the first time in Iran, examined the prevalence of unmet needs for outpatient healthcare services and related socioeconomic inequalities among residents of informal settlements in Sanandaj city.MethodsThis cross-sectional study was conducted on informal settlements of Sanandaj city with a sample size of 1345 people. Data were collected using a questionnaire. Multivariate logistic regression was used to determine significant predictors of unmet needs for healthcare services. Concentration index (C) and concentration curve (CC) were calculated to measure inequality in the prevalence of unmet needs for healthcare services.ResultsThe prevalence of unmet needs for outpatient healthcare services was 31.7%. Financial and physical barriers were the most common reasons for not using the needed services. The highest unmet need was related to dental (80.6%) and rehabilitation services (78.8%). Being elderly with about 2.3 times (OR: 2.37, 95% CI: 1.19–4.75), not having a job with about 1.7 times (OR: 1.70, 95% CI: 1.13–2.57) and having a low economic status with about 4 times (OR: 4.46, 95% CI: 2.39–9.70) increased the odds of experiencing unmet need for outpatient healthcare services. The value of concentration index showed that unmet need for outpatient healthcare services was significantly concentrated among people with lower economic status (C= -0.330, 95% CI: -0.432 to -0.227).ConclusionThe unmet need is high among people living in informal settlements of Sanandaj city and a significant part of the residents of these settlements does not have access to required healthcare services. Regardless of the needs of people living in these settlements, who constitute a large population of Iran, access to universal health coverage is not possible in such areas. Removing the identified obstacles and causes behind the unmet needs requires the interdisciplinary participation of all actors, including the government, the nation, and civil society.

Availability of Testing for Sexually Transmitted Infections and HIV in U.S. Outpatient Mental Healthcare Settings.

People with mental illnesses experience higher incidence of sexually transmitted illnesses (STIs) and HIV, and estimates show fewer than 50% have received testing. The purpose of this study was to examine the prevalence of STI/HIV testing among United States outpatient mental healthcare service providers. Data from the National Mental Health Services Survey (NMHSS) was used to determine the rates of STI and HIV testing amongst 9,267 outpatient mental healthcare service providers in the U.S. Regression analyses were used to assess whether the likelihood a service provider offered STI or HIV testing was associated with service provider characteristics (facility type, services offered, accepted payments) and state-level incidence of STIs and HIV. We found 7.79% and 6.64% of outpatient mental healthcare service providers provided STI and HIV testing, respectively, with lowest rates in community mental health centers and partial hospitalization facilities. Providing dual-diagnosis for severe mental illness and substance use disorders was an independent predictor of STI testing (aOR = 2.17, [1.72-2.75] and HIV testing (aOR = 2.61, [2.07-3.30]. Higher state-level incidence of STIs and HIV were associated with higher rates of STI testing (β = 0.28, p = .047) and HIV testing (β = 0.48, p < .001). Preventing STIs and HIV among patients living with mental illness is a key priority of multiple national initiatives. Despite this, fewer than 10% of outpatient mental healthcare service providers responding to the NMHSS offered STI and HIV testing. Existing service co-delivery models may be one promising method for implementing STI/HIV testing within outpatient mental health settings.

Use of outpatient healthcare services before and after the onset of unemployment

Abstract Background The onset of unemployment may entail adverse health effects and, thus, increase the need for healthcare services. On the other hand, the onset of unemployment may weaken access to the healthcare services, which may as such decrease the overall use of healthcare services. The aim was to examine the use of outpatient healthcare services in different sectors of healthcare before and after the onset of unemployment and to study whether job loss affected the use of these services. Methods Longitudinal individual-level register-based data was utilized on all individuals living in the City of Oulu, Finland, who became unemployed in 2017 (N = 1,999), their propensity matched controls (N = 1,999), and unmatched controls (N = 58,459) in a quasi-experimental design. Use of outpatient healthcare services was examined in one-month periods from 12 months before to 12 months after the onset of unemployment. Several socio-demographic factors, along with sickness and employment histories, were used for propensity score matching. Difference-in-differences analysis was used to measure the differences in the use of outpatient healthcare services between the unemployed and their matched controls. Results The use of healthcare services decreased significantly after the onset of unemployment. This was due to a decrease in the use of occupational healthcare services. No change related to job loss was observed in the use of public or private healthcare services. The number of healthcare visits increased again after the unemployment ended. Difference-in-differences analyses showed that compared to propensity score matched controls, becoming unemployed reduced the use of healthcare services. Conclusions When access to occupational healthcare services ceases, other healthcare services do not appear to fill the gap among those who become unemployed. Adequate healthcare services should be guaranteed to all population groups equally based on need, irrespective of the labour market status. Key messages • The overall use of outpatient healthcare services decreases significantly after job loss in Finland because of a decrease in the use of occupational healthcare services. • Adequate and easily accessible healthcare services should be guaranteed to all population groups equally based on need, irrespective of the labour market status or other socio-demographic factors.

Risk of developing psychiatric disease among adult patients with skin disease: A 9-year national register follow-up study in Norway.

The existing association between skin disease and psychiatric comorbidity has gained attention during the last decades. Stress and mental illness can directly or indirectly affect skin disease, while dermatological conditions, known to impair life quality and mental well-being, can promote psychiatric conditions. The aim of this study was to assess the risk of developing psychiatric disease among adult dermatological patients over a period of time. The secondary objective was to see which psychiatric disorders developed most commonly, and which skin diseases posed the greatest risk for later mental health issues. Adult dermatological patients were followed for 9years (2008-2016) using the Norwegian Patient Registry, for both outpatient and inpatient specialist healthcare services. Dermatological patients were identified during the first 2years and were then followed for psychiatric comorbidity prospectively for the next 7years.Cox regression models were applied to estimate the risks of psychiatric disorders among patients with skin diseases. Estimates were adjusted for age and gender differences. Hazard risk ratios (HR) with 95% CI are reported. Dermatological patients developed depressive disorders most frequently (4.1% vs. 2.3% in non-dermatological participants), followed by anxiety disorders (3.3% vs. 1.8%), and adjustment disorders (2.6% vs. 1.5%). Developing depressive disorders showed the highest HR among dermatological patients, HR (95% CI)=2.5 (2.4-2.5), followed by disorders related to alcohol use, HR (95% CI)=2.2 (2.1-2.5), and anxiety disorders, HR (95% CI)=2.1 (2.1-2.2). Papulosquamous disorders were the skin conditions with the highest HR for developing a mental health condition, with depressive disorder having HR (95% CI)=2.6 (2.5-2.9); anxiety disorders at HR (95% CI)=2.9 (2.7-3.1); and disorders related to alcohol use at HR (95% CI)=3.2 (2.8-3.6). The study demonstrates that having a skin disease doubles to triples the risk of developing a psychiatric illness within 7years, especially depression, anxiety, and alcohol use compared with the general population.

Covid-19 and Its Impact on Colorectal Cancer Diagnosis in Romania: A Single-Centered 5-year Retrospective Cohort Study.

Background: Colorectal cancer, 3rd in incidence and 2nd in mortality among cancers worldwide, represents the most common malignant tumor of the digestive tract. In Romania, it is the most frequently diagnosed type of cancer (approximately 0.06% of the population/year). During the COVID-19 pandemic the legislation preventing the SARS-CoV-2 viral transmission impairing access to outpatient healthcare services combined with patients fear of SARS-CoV-2 infection had consequences on the diagnosis and treatment of all other pathologies. Methods: A 5-year retrospective cohort study was conducted in a tertiary hospital in Arad, Romania, and included 1329 newly diagnosed colorectal cancer patients. For statistical analysis, Fisher's exact test was used for categorical data and the unpaired test with Welch's correction for continuous data. Results: The age on diagnosis decreased during the early COVID-19 pandemic to 68.50 (95% CI [67.90 69.11]) years, with the highest percentage (7.41%) of early onset colorectal cancer patients, a steady post-pandemic increase in the percentage of male (52.71% in 2019 to 62.20% in 2022) and urban (54.18% in 2018 to 70.10% in 2022) patients, admitted to the hospital due to an emergency presentation (peaking at 83.95% in 2020) and requiring a longer hospitalization period (10.03 [95% CI (8.76-11.30)] days in 2020 to 8.37 [95% CI (7.44-9.30)] days in 2022). The most common colo-rectal cancer diagnosis of patients in our reference population was malignant neoplasm of the rectum (ICD-10 code C20.0), while the most common complications were peritumoral adherence-related disorder, occlusion, and perforation, encountered in patients with comorbidities such as arterial hypertension, ischemic cardiomyopathy, diabetes mellitus, obesity, and non-alcoholic steatohepatitis. Conclusions: Regional particularities should be analyzed to better target the population at risk and to better direct the necessary healthcare resources towards the reference population, especially during crisis periods similar to the COVID-19 pandemic.

Impact of pension income on healthcare utilization of older adults in rural China

ObjectiveIn China, rural residents experience poorer health conditions and a higher disease burden compared to urban residents but have lower healthcare services utilization. Rather than an insurance focus on enhanced healthcare services utilization, we aim to examine that whether an income shock, in the form of China’s New Rural Pension Scheme (NRPS), will affect outpatient, inpatient and discretionary over-the-counter drug utilization by over 60-year-old rural NRPS residents.MethodsProviding a monthly pension of around RMB88 (USD12.97), NRPS covered all rural residents over 60 years old. Fuzzy regression discontinuity design (FRDD) was employed to explore the NRPS causal effect on healthcare services utilization, measured by outpatient and inpatient visits and discretionary over-the-counter drug purchases. The nationwide China Health and Retirement Longitudinal Study (CHARLS) 2018 provided the data.ResultsWithout significant changes in health status and medication needs, 60-plus-year-old NRPS recipients significantly increased the probability of discretionary OTC drug purchases by 33 percentage points. NRPS had no significant effect on the utilization of outpatient and inpatient utilization. The increase in the probability of discretionary OTC drug purchases from the NRPS income shock was concentrated in healthier and low-income rural residents. Robustness tests confirmed that FRDD was a robust estimation method and our results are robust.ConclusionNRPS was an exogenous income shock that significantly increased the probability of discretionary over-the-counter drug purchases among over 60-year-old rural residents, but not the utilization of inpatient or outpatient healthcare services. Income remains an important constraint for rural residents to improve their health. We recommend policymakers consider including commonly used over-the-counter drugs in basic health insurance reimbursements for rural residents; provide health advice for rural residents to make discretionary over-the-counter drug purchases; and to mount an information campaign on over-the-counter drug purchasing in order to increase the health awareness of rural residents.

Use of outpatient healthcare services before and after the onset of unemployment: A register-based propensity score matched study from Finland.

The aim was to examine the use of outpatient healthcare services in different sectors of healthcare before and after the onset of unemployment and to study whether job loss affected the use of these services. Longitudinal individual-level register-based data was utilized on all individuals living in the City of Oulu, Finland, who became unemployed in 2017 (N = 1,999), their propensity matched controls (N = 1,999), and unmatched controls (N = 58,459) in a quasi-experimental design. Use of outpatient healthcare services was examined in one-month periods from 12 months before to 12 months after the onset of unemployment. Several socio-demographic factors, along with sickness and employment histories, were used for matching. Difference-in-differences analysis was used to measure the differences in the use of outpatient healthcare services between the unemployed and their matched controls. The use of health services decreased significantly after the onset of unemployment. This was due to a decrease in the use of occupational health services. No change related to job loss was observed in the use of public or private healthcare services. The number of healthcare visits increased again after the unemployment ended. Difference-in-differences analyses showed that compared to propensity score matched controls, becoming unemployed reduced the use of health services. When access to occupational healthcare services ceases, other health services do not appear to fill the gap among those who become unemployed. Adequate healthcare services should be guaranteed to all population groups equally based on need, irrespective of the labour market status.

Proposing and Empirically Investigating a Mobile-Based Outpatient Healthcare Service Delivery Framework Using Stimulus–Organism–Response Theory

The emergency departments (EDs) of tertiary hospitals (THs) are significantly overcrowded, while primary healthcare centers (PHCCs) are underutilized. Therefore, the Chinese government is attempting to reduce outpatient flow from THs and establish a referral system between the EDs of THs and PHCCs. First, in this article, we propose a mobile-based outpatient healthcare service delivery framework (MOHSDF), which can help divert the flow of outpatients toward the PHCCs before they visit the EDs of THs. Second, this article examines that the MOHSDF-specific characteristics, including performance attributes (e.g., effort expectancy and performance expectancy), communicative power (e.g., interactivity), and perceived government support, are the stimuli that can help build an organism (e.g., initial trust and internal satisfaction). This organism will result in the behavioral intent to prescribe treatment using the MOHSDF. The data are collected from 292 TH physicians in Hefei, China, and analyze using Smart-PLS. All the proposed hypotheses are accepted, excluding two direct and one mediating relationship. These insignificant direct relationships are between performance attributes and internal satisfaction. Moreover, internal satisfaction does not mediate the relationship between effort expectancy and behavioral intent to prescribe treatment using the MOHSDF. This article has significant implications for researchers, government healthcare authorities, policymakers, and m-health service providers.

Analysis of Compatibility between the Need and Utilization of Health Services in West of Iran: Panel of Two Cross-Sectional Studies

Background: Individuals with the same needs are eligible to use required healthcare services, which is rarely taken into account in health systems. The present research evaluated this issue by investigating the determinants of the need for outpatient healthcare services and subsequent utilization in Kermanshah, western Iran.&#x0D; Methods: This was a before-after cross-sectional study which used two utilization surveys before (2006) and after (2015) the Health Transformation Plan (HTP) in Iran. The surveys were performed in a multi-stage sampling manner, and the data were obtained through face-to-face interviews with household members. 2626 (before) and 2089 (after) subjects who were ≤15 years old completed the surveys before and after the HTP, respectively, and were included in the analysis. The logistic regression was used to analyze the determinants of the needs and utilization of outpatient healthcare services.&#x0D; Results: The need for outpatient healthcare services increased from 19.73% before the HTP to 27.09% after it. The utilization of such services in this period also increased from 44.78% to 57.95%. The logistic regression analysis showed that most factors caused an inverse relationship between the studied outcomes before and after HTP, except for supplementary insurance, which increased both the need for outpatient services and subsequent use.&#x0D; Conclusion: Despite the increased utilization of outpatient services, it seems that some groups still have insufficient access to required healthcare services. Future healthcare reform in Iran must provide enough healthcare services to vulnerable groups.

Qualitative analysis of community pharmacy–based COVID-19 immunization service operations

BackgroundThe unprecedented coronavirus disease 2019 (COVID-19) pandemic has generated worldwide impacts while positioning community pharmacies as easily accessible immunizers to rollout the COVID-19 vaccine. ObjectivesThis study describes community pharmacists’ experiences, success stories, and lessons learned from providing COVID-19 immunization services. MethodsThis study was conducted in February to March 2022 using semistructured interviews with licensed pharmacists practicing full-time in Alabama community pharmacies. Transcribed interviews’ content analysis was conducted by 2 independent coders in ATLAS.ti software. ResultsNineteen interviews were completed. Pharmacists’ experiences in the implementation of COVID-19 immunization services are described across 4 themes: (1) on-site and off-site immunization locations, (2) roles and responsibilities of pharmacy personnel, (3) vaccine storage and administration, and (4) vaccine waste reduction and immunization uptake strategies. This study found that pharmacists’ ability to adapt is vital to maintaining their ability to offer immunization services and other services. Pharmacists’ capacity for adapting is exemplified through their ability to acclimate to becoming a primary hub of outpatient health care services, accommodating to COVID-19 social distancing and vaccine guidelines, and disseminating a novel vaccine with varying supply and demand. In addition, pharmacies gathered and maintained waitlists of patients and adopted an appointment-based model as to predict, plan, and provide for patients. Pharmacists also used reactive techniques and workflow aspects to dissuade COVID-19 vaccine waste such as in contacting interested patients on waitlists or switching to a walk-in acceptance model. The COVID-19 pandemic elicited unprecedented alterations to the legal, health care responsibilities granted to pharmacy staff with participants describing pharmacy technicians as making a considerable impact to pharmacies’ workflow. ConclusionsPharmacists stepped up as frontline providers during a time of public health emergency with their diverse experiences granting policy makers and researchers much to learn from as, in their communities, pharmacists have continued to increase access to care during a national health crisis.

Geographic variation in the utilisation of specialist healthcare for patients with severe mental illness in Norway: a population-based registry study

PurposeThe aim of this study is to measure geographic variations in mental healthcare service utilisation among patients with severe mental illness in Norway.MethodWe analysed data from the Norwegian patient registry for 2014–2018 for patients with severe mental illness. The outcomes measured in this study were: outpatient contact, admission, bed days and total contact rates. Total contacts were calculated as the sum of observed outpatient contacts plus four times the hospital bed days for each hospital catchment area based on the Norwegian health director’s report on clinical activity and patient treatment cost. Geographic variations were measured using extreme quotient (EQ), coefficient of variation (CV) and systematic component of variation (SCV). Maps, figures, and tables were used to visualise geographic variation.ResultsThe geographic variations saw a six-fold increase in the outpatient contact rate and a three-fold increase in the admission rate between the areas with lowest rate and areas with the highest rate. However, there was low geographic variation in calculated total contact rates (Eqs. 5 − 95 =1.77). The low-level geographic variation in the total calculated contact rate was also confirmed with an SCV of less than three.ConclusionThe levels of geographic variations in the utilisation of outpatient and inpatient mental healthcare services among patients with severe mental illness are high. However, the geographic variation in total services provided by hospital catchment areas calculating the two service modalities together using their treatment cost ratio, is low. This may reflect the relatively equal performance of hospital catchment areas in terms of resource utilisation regardless which service modality they prioritise. Factors contributing to high geographic variation in individual service modalities need further investigation.