Private Health Care Providers Research Articles

User-defined ecosystems in health and social care

Purpose People with complex health conditions must often navigate landscapes of uncoordinated public, private and voluntary health-care providers to obtain the care they need. Complex health conditions frequently transcend the scope of typical health-care service systems. The purpose of this paper is to explore and characterize such unique assemblages of actors and services as “user-defined ecosystems”. Design/methodology/approach Building on literature on customer ecosystems, this paper introduces the concept of the user-defined ecosystem (UDE). Using an abductive approach, the authors apply the concept in an interpretive, qualitative study of ten families with special needs children. Findings This study uncovers complex UDEs, where families actively combine a broad range of services. These ecosystems are unique for each family and extend beyond the scope of designed service ecosystems. Thus, the families are forced to assume an active, coordinating role. Research limitations/implications This paper shows how to identify ecosystems from the user’s point of view, based on the selected user unit (such as a family) and the focal value-creating function of the ecosystem for the user. Social implications This paper highlights how service providers can support and adapt to UDEs and, thus, contribute to user value and well-being. This can be used to understand users’ perspectives on service and systems in health and social care. Originality/value This study develops the concept of the UDE, which represents a customer-focused perspective on actor ecosystems and contrasts it with a provider-focused and a distributed perspective on ecosystems. This study demonstrates the practical usefulness of the conceptualization and provides a foundation for further research on the user’s perspective on ecosystems.

Advances and Pitfalls of Specialized Pain Care through Public and Private Health Care Providers in Catalonia and the Balearic Islands: A Physician's Survey.

Optimal diagnosis and treatment of pain require a multidisciplinary approach that demands considerable coordination and forethought. A cross-sectional physician survey based on an online questionnaire was carried out to assess the adoption of multidisciplinary working patterns, compare the public and private models, and provide an update on the resources and organization of specialized pain care in Catalonia and the Balearic Islands. Active pain practitioners identified through the Catalan Health Service and Pain Society databases were sent an invitation in December 2020. Of the 321 physicians contacted, 91 (28.3%) answered and 71 provided complete responses (commonly anesthesiologists, representing 92 different sites; some worked at public and private sites). Up to 78.7% reported working in pain management teams, but only 53.5% were regularly involved in teaching or research activities. Thus, the proportion of multidisciplinary sites lies somewhere in-between. Median wait times were significantly shorter and within the recommended standards in private practices (e.g., 15 vs. 90 days in public practices for noncancer patients). In turn, private practices were slightly less staffed and equipped, albeit the differences did not reach statistical significance. Respondents made a median of 530 regular and 30 emergency visits per year, of which 190 involved interventional procedures. They offered a wide range of pharmacological and interventional therapies, although psychotherapy and the most sophisticated procedures were only available in ≤50% of sites. Pain clinicians and facilities are reasonably available in Catalonia, but barely more than half are truly multidisciplinary. Public and private practices differ in some aspects; the latter seems to be more accessible, but it is restricted to patients who can afford it. Compared to previous reports, this update shows both advances and outstanding issues. Multidisciplinary care could be expanded by incorporating more psychologists and some interventional procedures. The public practices should reduce wait times.

Is Profit Motive Infecting Indian Private Health Care Sector? An Analysis of Unincorporated Healthcare Providers

Indian healthcare system is dominated by private sector; its importance is growing with implementation of ‘Ayushman Bharat’, flagship programme of Indian government. Though 62% and 75% of inpatient and outpatient cases in India are treated in private sector, the information about the economy of private healthcare providers is very limited. To the author’s best knowledge, this is the first attempt to address the issue with empirical evidence for the private healthcare providers from a nationally representative survey data for India. Private healthcare sector is estimated to provide employment to 2.34 million persons annually and generate gross value added (GVA) of ₹473.3 billion. Treatment cost on an average is much high in private sector as compared to the public sector. But supply-side data show that average annual receipt per annum is six times higher than average operating cost per annum for unincorporated private healthcare providers in India, indicating underlying profit motive. Analysis of factor payments shows that 55% of GVA of unincorporated private hospitals is gross operating surplus (or profit), followed by emoluments paid to employees and workers (42%). These factors potentially cause over-charging in private sector. Context-specific and appropriate regulatory mechanisms are very much needed to ensure quality of services and control medical inflation.

Sociodemographic status of elderly & pattern of health care utilization for respiratory diseases in NCR

Elderly population is increasing progressively all over the world. Diseases of respiratory system are important cause of morbidity & mortality in elderly. Health-care utilization is an important element of health care.Cross-sectional study of elderly aged 60yrs & above was conducted in urban & rural area of NCR & Ghaziabad district of Uttar Pradesh. First part included socio-demographic characteristics and self-reported co-morbidities. This first part screened out suspected respiratory cases and they were asked questionnaire regarding health care utilization. In urban 282/1522(18.5%) & in rural. 298/1503 (19.8%) were found to be suffering actually from respiratory illness. For chronic respiratory illness allopathic services were used by 91.8% (259/282) urban & 75.5% (225/298) rural elderly. Urban area were utilizing services of private health care providers most commonly. In our study 36.6% (109/298) & 20.5% (61/298) rural elderly were taking over the counter treatment from medical stores or going to a quack for acute & chronic respiratory illness respectively. During acute illness 60.7% (181/298) rural elderly choose health care service due to belief but during chronic illness only 51.3% (153/298) elderly stated it as a reason for choosing health care service. Affordability as a reason for selection of particular health service increased from 23.2% (69/298) in acute illness to 36.9% (110/298) in chronic illness.Majority of elderly are illiterate & dependent on family for support. Private health care services are preferred especially by urban elderly. Public healthcare services are used more for chronic illness than acute illness.

Practitioner perspectives on best practice in non-treatment factors that support the delivery of repetitive transcranial magnetic stimulation (rTMS) for depression.

Accessible SummaryWhat is known about the subject? The practices of mental health nurses in the administration of repetitive transcranial magnetic stimulation (rTMS) treatments for depression in outpatient clinic are crucial for patient outcomesTo date, most research has focused directly on procedural aspects of treatment delivery with limited focus on the delivery of holistic care and treatment.There is a lack of best practice guidance based on the experiences of those involved in clinical delivery to inform and improve rTMS practices What this paper adds to existing knowledge? This study provides unique insights into service and personalized non‐treatment factors associated with rTMS delivery that may reduce stress and improve the experiences of rTMS patientsIt reviews and updates understanding of the factors that contribute to the delivery of effective rTMS. What are the implications for practice? The need to apply findings for the development of best practice guidanceFactors to improve practice include (a) rTMS machine demonstrations; (b) constructive, individualized, friendly, and therapeutic conversations; (c) a relaxing, comfortable, 'homely' physical environment; (d) long term supportive management; and (e) careful engagement of nursing and support staff.

EXPLORING RELATIONSHIP POWER IN SUPPLY CHAIN SUSTAINABILITY PRACTICES: A CASE STUDY OF A SOUTH AFRICAN HOSPITAL GROUP

Buyers and suppliers of healthcare products and services are more dependent on each other than ever before for the provision of scarce and unique resources, which highlights the need to implement supply chain sustainability practices. Firms controlling these resources hold excessive power over others. This study adopted resource dependence theory as a theoretical lens to explore the role of relationship power in supply chain sustainability practices between a South African private healthcare provider and its suppliers. The study employed a generic qualitative single-case study design. Semi-structured interviews were used to collect data from 12 participants at various levels of the case organisation’s hierarchy. The main findings revealed several types of environmental and social practice used in the supply chain of the private healthcare provider. Some of the environmental practices were effective waste management and recycling, while the social practices included supplier selection and periodic reviews. The healthcare provider exercised extensive power over its suppliers to implement these practices. By exploring the advantages and disadvantages of sustainability practices, the findings showed that relationship power acted as a driver of supply chain sustainability. Mutual commitment, continuous communication, and training support these practices. Healthcare managers must be aware of the importance of relationship power for supply chain sustainability practices implementation, and are advised to invest time and effort in building buyer—supplier relationships to aid sustainability. This study expands the literature on relationship power in supply chain sustainability practices in an underexplored developing country healthcare context. Keywords Sustainability; supply chain relationships; power; private hospital; single case-study

Effects of a temporary suspension of community-based health insurance in Kwara State, North-Central, Nigeria.

Introductiona subsidized community health insurance programme in Kwara State, Nigeria was temporarily suspended in 2016 in anticipation of the roll-out of a state-wide health insurance scheme. This article reports the adverse consequences of the scheme´s suspension on enrollees´ healthcare utilization.Methodsa mixed-methods study was carried out in Kwara State, Nigeria, in 2018 using a semi-quantitative cross-sectional survey amongst 600 former Kwara community health insurance clients, and in-depth interviews with 24 clients and 29 participating public and private healthcare providers in the program. Both quantitative and qualitative data were analyzed and triangulated.Resultsmost of former enrollees (95.3%) kept utilizing programme facilities after the suspension, mainly because of the high quality of care. However, majority of the enrollees (95.8%) reverted to out-of-pocket payment while 67% reported constraints in payment for healthcare services after suspension of the program. In the absence of insurance, the most common coping mechanisms for healthcare payment were personal savings (63.3%), donations from friends and families (34.7%) and loans (11.8%). Being a male enrollee (odd ratio=1.61), living in a rural community (odd ratio =1.77), exclusive usage of Kwara Community Health Insurance Programme (KCHIP) prior to suspension (odd ratio=1.94) and suffering an acute illness (odd ratio=3.38) increased the odds of being financially constrained in accessing healthcare.Conclusionafter the suspension of the scheme, many enrollees and health facilities experienced financial constraints. These underscore the importance of sustainable health insurance schemes as a risk-pooling mechanism to sustain access to good quality health care and financial protection from catastrophic health expenditures.

The Role of the Biotechnology Industry in Addressing Health Inequities in Africa: Strengthening the Entire Health Care Value Chain

There are many misconceptions surrounding health care in Africa, a continent of 54 sovereign countries and a population exceeding 1.2 billion souls which is growing at the fastest rate in the world. Enormous diversity has direct impact on the notion, practices, and availability of health care on the continent. There are no satisfactory generalizations about the state of health and the strength of health care systems for the continent as a whole. Indeed, differences between neighboring countries are enormous, as well as among population groups within countries. There is a significant mix of public, private, and faith-based health care providers. In most African countries, 60 percent of health providers fall into the latter two categories (IFC, 2008). Moreover, movements towards national and private risk pooling for payment of health care are underway in only a few countries, but virtually all modern African constitutions declare health care as a human right and aspire to some form of Universal Health Coverage (UHC). Despite these principles, Africans endure a dual burden of communicable and non-communicable disease. In the face of these challenges, Africans are confronted with out-of-pocket payment for health services – when it is available at all – and challenging logistics for accessing and maintaining consistency of care. The patient journey for Africans is a winding path, often exacerbated by an additional reliance on the importation of talent, pharmaceuticals and vaccines, medical and diagnostic tools, and digital support of the health systems. The health care value chain in Africa is incomplete. Each of Providers, Payers and Producers need further development. When any of these is weak or missing, there cannot be a sustainable health system. The issue, therefore, is not scientific or clinical competence; it is capacity and the necessity to promote a comprehensive and integrated health care ecosystem – including the Producer segment. To address the Producer link, more direct engagement by the global biopharmaceutical industry in assisting and investing in the advancement of indigenous laboratory and clinical development, product production and distribution, and the advancement of human capital necessary to achieve health care sovereignty for the continent is necessary. There is all the more reason to do so as humanity enters the age of genomic and precision medicine. There is a pathway for African health care to leapfrog as it has done in telecommunications.

Erenumab Decreases Headache-Related Sick Leave Days and Health Care Visits: A Retrospective Real-World Study in Working Patients with Migraine.

IntroductionThe prevalence of migraine is highest among working age individuals, and this disease is associated with an increased number of sick leaves and health care visits, as well as lost productivity. Erenumab, the first monoclonal antibody targeting the calcitonin gene-related peptide (CGRP) pathway, is effective in decreasing the monthly number of migraine days, but evidence of its impact on the number of sick leave days and health care visits in patients with migraine is limited.MethodsThis retrospective registry study focused on occupationally active patients with migraine treated with erenumab at a Finnish private health care provider, Terveystalo. Erenumab responders, defined as patients who had at least two unique prescriptions of erenumab and no prescription of other CGRP inhibitor (CGRPi), were followed for 12 months prior to and after erenumab treatment initiation (index), and the change in the number of headache-related and all-cause sick leave days, health care visits and prescriptions for other medications during this period were assessed from the registry data. The same outcomes were assessed in an age- and sex-matched control group of migraine patients not receiving CGRPi to control for potential changes in patient behavior and health care practices during the COVID-19 pandemic.ResultsAltogether, 162 patients who were entitled to employer-sponsored health care received erenumab and met the 12-month follow-up requirements. In the responder group (n = 82; 50.1%) headache-related sick leave days were reduced by 73.9% (p = 0.035) and health care visits by 44.6% (p < 0.001) in the 12 months following treatment initiation compared to the period of 12 months prior to treatment. All-cause sick leave days were reduced by 19.4% and all-cause health care visits by 13.5%, but these changes were not statistically significant. Triptan prescriptions decreased by 30.4% (p = 0.012) and other prophylactic treatments by 31.5% (p = 0.004). No significant changes were observed in the corresponding outcomes in the migraine control group during the same period.ConclusionsThe results of this registry study suggest that in addition to the effect on the monthly number of migraine days documented in clinical trials, erenumab can significantly reduce the number of headache-related sick leave days and health care visits in employed patients with migraine managed in routine clinical practice.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40120-021-00303-x.

Is value-based payment for healthcare feasible under Ghana\u2019s National Health Insurance Scheme?

BackgroundEffective payment mechanisms for healthcare are critical to the quality of care and the efficiency and responsiveness of health systems to meet specific population health needs. Since its inception, Ghana’s National Health Insurance Scheme (NHIS) has adopted fee-for-service, diagnostic-related groups and capitation methods, which have contributed to provider reimbursement delays, rising costs and poor quality of care rendered to the scheme’s clients. The aim of this study was to explore stakeholder perceptions of the feasibility of value-based payment (VBP) for healthcare in Ghana. Value-based payment refers to a system whereby healthcare providers are paid for the value of services rendered to patients instead of the volume of services.MethodsThis study employed a cross-sectional qualitative design. National-level stakeholders were purposively selected for in-depth interviews. The participants included policy-makers (n = 4), implementers (n = 5), public health insurers (n = 3), public and private healthcare providers (n = 7) and civil society organization officers (n = 1). Interviews were audio-recorded and transcribed. Data analysis was performed using both deductive and inductive thematic analysis. The data were analysed using QSR NVivo 12 software.ResultsGenerally, participants perceived VBP to be feasible if certain supporting systems were in place and potential implementation constraints were addressed. Although the concept of VBP was widely accepted, study participants reported that efficient resource management, provider motivation incentives and community empowerment were required to align VBP to the Ghanaian context. Weak electronic information systems and underdeveloped healthcare infrastructure were seen as challenges to the integration of VBP into the Ghanaian health system. Therefore, improvement of existing systems beyond healthcare, including public education, politics, data, finance, regulation, planning, infrastructure and stakeholder attitudes towards VBP, will affect the overall feasibility of VBP in Ghana.ConclusionValue-based payment could be a feasible policy option for the NHIS in Ghana if potential implementation challenges such as limited financial and human resources and underdeveloped health system infrastructure are addressed. Governmental support and provider capacity-building are therefore essential for VBP implementation in Ghana. Future feasibility and acceptability studies will need to consider community and patient perspectives.

Using Human-Centered Design to Develop, Launch, and Evaluate a National Digital Health Platform to Improve Reproductive Health for Rwandan Youth.

A lack of access to evidence-based, unbiased, and youth-friendly family planning and reproductive health (FP/RH) information and care limit young people's ability to prevent unplanned pregnancies and HIV and sexually transmitted infections. This threat-ens their health and is a significant cause of school drop-out, limiting young peoples' well-being, future potential, and employment opportunities. To address these challenges facing youth, YLabs used an end-to-end human-centered design (HCD) approach to create CyberRwanda, a digital platform aiming to improve the health and livelihoods of adolescents (aged 12-19 years) in Rwanda. From 2016 to 2020, CyberRwanda was designed and piloted using an HCD approach in partnership with more than 1,000 youth, parents, teachers, and public and private health care providers. During the problem recognition phase, HCD revealed participants' beliefs, behavioral preferences, and experiences as they relate to FP/RH specifically and their broader life experiences, motivations, and challenges. Several phases of analog, digital, and live prototyping with youth and key stakeholders were used to codesign, test, and refine the intervention for implementation. CyberRwanda is a direct-to-consumer platform where adolescents can learn integrated, age-appropriate health, and skills-building information through edutainment behavior change stories and a robust frequently asked questions library, order health products online, and be linked to CyberRwanda's network of private and public health care providers who have been trained to provide adolescent-friendly care. The HCD process resulted in significant pivots to the design of the digital platform and the implementation model. Using HCD provided a structured methodology to combine technical FP/RH expertise and visual and product design expertise to codesign and iteratively develop a digital health intervention with and for Rwandan youth.

The Effects of Cost-Sharing On Healthcare Services Provision in Public Hospitals in Kenya: A Case Study of Kangundo District, Eastern Kenya

Purpose: The focus of this study was to determine the effects of cost-sharing on healthcare services provided in public hospitals in Kenya by examining a case study of Kangundo District Hospital in the Eastern Provision of Kenya&#x0D; Design/ Methodology/Approach: The study was conducted out in Kangundo District, Eastern Kenya which covers an area of 178.2 km. A survey research design was used to collect data and was supplemented by field research (qualitative approach). 150 household heads were sampled to generate quantitative data while 10 health care providers from Kangundo District Hospital were interviewed as key informants. A standardized questionnaire was used to interview household heads in the three research sites. Multi-stage cluster sampling was used to select household heads while non-probability (purposive) sampling was used in the selection of the three locations and three sub-locations, respectively.&#x0D; Findings: The study established that the introduction of cost-sharing has not led to diverting demand of health care from public to private health care providers in Kangundo District, though patients still utilized private health care facilities in the district.&#x0D; Contribution to policy and practice: There is a need for Situational analysis on Health Insurance programs as a supplement to cost-sharing in health care in order to strengthen the quality of policy decision making regarding access and equity in health care.&#x0D; Originality/Value: This study is the first to empirically establish the Effects Of Cost-Sharing On Healthcare Services Provision In Public Hospitals In Kenya

Bottom-Up Approach to Establish Coordination Mechanisms for Disaster Preparedness Among Largely Private Health-Care Providers in Central Tokyo

In Japan, despite its private-dominant and disjointed health-care system, national initiatives to coordinate various types of health-care facilities are lacking. Municipal governments manage this task with limited resources. This study describes a successful example of a bottom-up approach to create city-wide collaboration for disaster preparedness. In Minato City, located in central Tokyo, a group of physicians created a project involving a city-wide disaster medical care drill. The city Public Health Center, in charge of health-care systems including disaster medicine, helped the group to increase proponents of the project. The city-wide disaster drill started in November 2017; thereafter, the drills were held every year. Participation in drills by various health-care personnel helped establish a city-wide system for disaster medical care, coordination mechanisms among stakeholders, increased motivation among health-care personnel, and development of in-hospital systems. This approach is flexible and applicable to various forms of health-care systems in other areas.

Engaging Private Health Care Providers to Identify Individuals with TB in Nepal.

In Nepal, 47% of individuals who fell ill with TB were not reported to the National TB Program in 2018. Approximately 60% of persons with TB initially seek care in the private sector. From November 2018 to January 2020, we implemented an active case finding intervention in the Parsa and Dhanusha districts targeting private provider facilities. To evaluate the impact of the intervention, we reported on crude intervention results. We further compared case notification during the implementation to baseline and control population (Bara and Siraha) notifications. We screened 203,332 individuals; 11,266 (5.5%) were identified as presumptive for TB and 8077 (71.7%) were tested for TB. Approximately 8% had a TB diagnosis, of whom 383 (56.2%) were bacteriologically confirmed (Bac+). In total, 653 (95.7%) individuals were initiated on treatment at DOTS facilities. For the intervention districts, there was a 17%increase for bacteriologically positive TB and 10% for all forms TB compared to baseline. In comparison, the change in notifications in the control population were 4% for bacteriologically positive, and −2% all forms. Through engagement of private sector facilities, our intervention was able to increase the number of individuals identified with TB by over 10% in the Parsa and Dhanusha districts.

Impact of Service Quality on In-Patients' Satisfaction, Perceived Value, and Customer Loyalty: A Mixed-Methods Study from a Developing Country.

PurposeRecent literature on healthcare quality demands more contextualized and patient-perspective research, as models from developed countries are not suitable for developing countries. Moreover, research on private healthcare services in Vietnam has long been underestimated by academia, but it has significant economic and commercial value. Hence, this study explores the dimensions of service quality in private healthcare and how they impact in-patient satisfaction, perceived value, and customer loyalty in Vietnam.MethodsThis mixed-method study had a sample size of five inpatients for the qualitative phase and 368 inpatients for the quantitative phase from hospitals in Vietnam. The qualitative analysis explores service quality dimensions in private healthcare and incorporates them with the literature to develop a conceptual model. The quantitative phase tests the relationship between each construct in the conceptual model via structural equation modeling.ResultsThe four dimensions of service quality were emotion, function, social influence, and trust. Most of these dimensions have a significant impact on customer perceived value and satisfaction. However, emotion does not significantly influence customer perceived value, and function does not considerably impact customer satisfaction. In addition, social influence is an underrepresented variable in the service quality literature, but it has the most substantial impact on customer perceived value and customer satisfaction. The quantitative results also confirm that customer satisfaction and customer perceived value significantly impact customer loyalty (word-of-mouth and revisit intention); however, customer perceived value does not significantly impact customer satisfaction.ConclusionThe study suggests that private healthcare providers and the government in Vietnam should allocate resources to improve service quality. Practitioners should invest in social branding and e-services to reach out to their customers. Future research should focus on a cost-benefit analysis and compare the effectiveness of service quality dimensions on customer behavioral intention.

Evaluation of Patient-Oriented Medicines Supply Information on Russian Healthcare Providers’ Websites

Aims: To evaluate the Russian Federation healthcare providers’ websites compliance to legal requirements on availability of patient-oriented medicines supply information and compare the evaluation results between public and private healthcare facilities.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: The evaluation of compliance to legal requirements to medicines supply information on public and private healthcare providers’ websites available on the Internet was conducted in September 2021.&#x0D; Methodology: The study included a simple random sample of 66 websites of Russian healthcare providers containing two groups: public (n=33) and private (n=33) healthcare facilities’ websites. The compliance evaluation was performed by checking the availability of 4 medicines lists on the websites: (1) essential medicines list; (2) list of medicines for the most expensive chronic diseases to treat; (3) list of medicines that are prescribed only by shared decision of healthcare facility medical commission; (4) list of medicines that are dispensed for certain social groups with no charge or with 50% discount in outpatient care settings.&#x0D; Results: The difference of availability of the first list was 90.9% (95% CI 77.7%–97.4%) vs. 33.3% (95% CI 19.2%–50.3%) on public and private healthcare facilities’ website, respectively, P&lt;.001. The difference of that in the second list was 42.4% (95% CI 26.8%–59.3%) vs. 15.2% (95% CI 6.0%–30.1%), P&lt;.028. For the third no statistical significance was revealed (P&gt;.05). For the fourth list the difference was 66.7% (95% CI 49.7%–80.8%) vs. 21.2% (95% CI 10.0%–37.2%), P&lt;.001.&#x0D; Conclusion: It is required to improve the supervision approaches for both public and private healthcare facilities for better patient-oriented medicines supply information provision. The problem may be solved by the implementation of a centralized government policy repository with regularly updated lists, requirements, and best practices.

423 Patient Perspective on the Use of the Independent Sector to Maintain Elective NHS Services During the COVID-19 Pandemic

IntroductionCOVID-19 resulted in the suspension of planned treatments for patients worldwide leaving millions suffering the physical and mental effects of delay. Reports indicate that when services have been re-established, patients have been afraid to take up appointments. Hospitals put processes in place to counter this, notably separating emergency and elective patient cohorts. Most notably seen by the co-operation between the NHS and independent private healthcare providers in March 2020 at the height of the pandemic. We undertook a study to ascertain the perceptions of NHS patients who underwent elective treatment at independent ‘cold’ sites during the COVID-19 pandemic.MethodA cross-sectional study with structured telephone interviews of patients who had planned elective treatments at ‘cold’ independent hospitals between March and September 2020. 1150 patients were identified, and a 20% sample formed a 230 patient study group, with 158 (70%) agreeing to participate.Results30% of patients delayed their treatment due to COVID related concerns, with 76% of these only accepting treatment because this was at a ‘cold’ site. 46% of patients perceived treatment at a ‘cold’ site as the most important factor contributing to their safety. 153 patients (97%) supported the paid arrangement between the NHS and the independent sector to provide separate ‘cold’ sites for elective treatments.DiscussionSafely restarting elective services to allow important planned treatments to take place, as was the pandemic continues, is a priority. Our study indicates that physical separation of patient pathways impacted most on patient confidence, and that the use of ‘cold’ sites is a viable option.

Health Seeking Behaviour among Past and Current Tuberculosis Patients in a Low-Income Country

In Nepal, the estimated incident cases are 0.07 million, of them, 0.03 million people are diagnosed and enrolled in the treatment annually, and numbers of undiagnosed people living with tuberculosis (TB) might be a threat to achieving END TB strategy targets. Understanding health-seeking behaviour and care pathways is crucial to reducing missed cases and decreasing TB transmission. The objective of the study was to identify the health-seeking behavior of TB patients and understand the reasons behind TB diagnostic and treatment delays in Nepal. This was a cross-sectional, population-based survey carried out in 99 clusters of 55 districts (total of 77) of Nepal. Primary Sampling Units were Village Development Committees or Municipalities and wards selected using systematic proportional to population size method. Of the total 54,200 people who attended in the survey, 1,825 had a history of TB and asked their health-seeking practice. 62% and 72% of the TB patients utilised the government health facilities for diagnosis and treatment. 18% of the TB patients said that they received diagnosis services, and 16% of patients took their treatment from outside of the country, especially India, due to fear of stigma and easy access to the services. The majority of the TB patients utilised government health facilities to receive diagnosis and treatment services. Some of the participants sought TB services from private health care providers, and a significant proportion of participants received them from India due to difficulty in accessing local services and fear of stigma and discrimination. Keywords: Community Based Directly Observed Treatment, Health Seeking Behaviour, Prevalence Survey, Tuberculosis.

The role of general practitioners in managing the COVID-19 pandemic in a private healthcare system.

BackgroundThe canton of Vaud’s public health authorities, in Switzerland, invited general practitioners (GPs) to participate in managing suspected COVID-19 patients and continue caring for their non-COVID-19 patients. However, this course of action was not mandatory. The present study’s objective was to describe and understand how involved GPs were in dealing with the COVID-19 pandemic’s first wave.MethodsThis mixed-methods study combined a retrospective quantitative survey and a qualitative explanatory investigation. All of the canton’s GPs were invited to participate in the quantitative survey via an online questionnaire including sections on: specific organization regarding COVID-19 activities and suspected COVID-19 patients, activities relating to non-COVID-19 patients, consequences on the practice’s professional staff, and opinions about the public health authorities’ pandemic crisis management. The qualitative investigation involved interviews with 10 volunteer GPs.ResultsThe participation rate was 41%. One third of GPs chose not to reorganize their practice for the specific management of suspected COVID-19 patients. The number of weekly activities and interventions decreased by over 50% at 44% of practices, mostly due to a lack of patients. Even in an extraordinary crisis, GPs maintained their choice of whether to become involved, as their private and independent status allowed them to do. However, those who chose to be involved felt frustrated that the public health authorities did not recognize them as major health providers in the management of the pandemic.ConclusionThis study illustrated the complexity and limitations of a primary care system based completely on private healthcare providers.

The surveillance of systemic cancer therapy access amidst the COVID-19 pandemic: the power of good data.

The surveillance of systemic cancer therapy access amidst the COVID-19 pandemic: the power of good data.