Provider-related Factors Research Articles

Factors Impacting Vaccine Uptake Among Adult Medicaid Beneficiaries: A Systematic Literature Review

Abstract Vaccine uptake is suboptimal among adult Medicaid beneficiaries. To evaluate factors affecting vaccine uptake among adult Medicaid beneficiaries and/or affecting healthcare providers who vaccinate adult Medicaid beneficiaries, we conducted a systematic literature review in Embase, Medline, Database of Abstracts of Reviews of Effects, and the Cochrane Library for articles published from January 2005 through July 2022 and relevant conferences. For included studies, data were extracted on the study characteristics, patient and provider cost barriers, patient and provider perceived risks/benefits, and other barriers faced by patients and providers. Quality assessments were conducted using a checklist from the Joanna Briggs Institute. 21 studies analyzing patient-related factors (14 studies) and/or provider-related factors (8 studies). Reviewed studies indicate that vaccine uptake is influenced by insurance benefit and cost-coverage policies, including cost-sharing; access to vaccination services; and vaccine education and awareness. Financial factors, including reimbursement for vaccine acquisition and administration, influence providers’ vaccination practices for Medicaid beneficiaries. Our findings suggest that reducing or eliminating vaccination cost-sharing, promoting vaccine education and awareness about the importance and safety of vaccines, increasing access, and exploring reimbursement rates equivalent with other public or private insurance plans could mitigate barriers to vaccination for the adult Medicaid population.

Dr Associate Professor

Background: Most women do not desire pregnancy immediately after delivery and are highly motivated to accept family planning methods. The post partum intrauterine device is one of the family planning methods that can address this need. According to prior reports intrauterine device use has been very low from the contraceptive method mix. Objective: To assess barriers to postpartum intra uterine device uptake among mothers who delivered at two public hospitals in Addis Ababa, Ethiopia. Method: It is an institution based cross-sectional study. Simple random sampling method was used to select study participants. Descriptive statistics and regression analysis were used to determine the presence and strength of association between uptake of post partum intrauterine device and independent variables. Result: In this study the uptake of postpartum intrauterine contraceptive device was 11% (95%CI=8.0, 14). The stated barriers for the none uptake of post partum intrauterine device were fear and concern (61.6%), religions value for family planning (16.9%), husband and relative opinion (7%), culture norm (5%) and health provider related factor (5% (17/367)). Parity and mode of delivery were significantly associated post partum intrauterine device uptake. The odds of intrauterine contraceptive device utilization for mothers with previous number of deliveries of ?3 and 1-2 were 35 (AOR=34.8, 95%CI=7.33, 165.4) and 4 (AOR=4.2, 95%CI=1.47, 12.07) times higher than those with no previous delivery. In addition, assisted vaginal delivery had 11 (AOR=11.06, 95%CI=3.26, 37.5) times increased odds of intrauterine contraceptive device uptake than SVD. Conclusion and recommendations: The uptake of post partum intrauterine device was low (11%). The main barriers identified for the low uptake were fear and concern to myth and misconceptions, religions value for family planning, husband and relative opinion, culture norm and health provider related factors. To identify and address reasons for gaps in knowledge and to clear public misconceptions and fears further large scale studies are recommended. Key-words: PPIUD, Contraception, post partum, Ethiopia.

Barriers and enablers to effective weight management for people living with overweight and obesity: A rapid scoping review.

A scoping review was conducted to identify barriers and enablers to effective weight management in healthcare settings for people living with overweight and obesity in English-speaking high-income countries. Peer-reviewed and gray literature were systematically searched in June 2024. Data were analyzed using inductive thematic analysis. Of the 15,684 unique articles identified and screened for relevance, 216 studies were included. Healthcare-related barriers and enablers to weight management were organized under three themes: a) healthcare provider-related factors, b) provision of care, and c) policy/funding. Prominent barriers included healthcare provider knowledge deficits and low prioritization of obesity management, mainly in the primary care setting. Weight management beyond the primary care setting was found to be especially challenging, with poor referral pathways, service fragmentation, lack of multidisciplinary practice, and restricted eligibility criteria, hindering the accessibility of services. Developing consistent policies and guidelines, improving the education of healthcare providers, and increasing funding to provide low-cost comprehensive care, were identified as enablers to access and uptake of weight management services. Considerable overlap in the identified barriers existed across healthcare providers and settings. A whole health system approach to minimize barriers and strengthen enablers to weight management services is needed, to address rising obesity rates.

Barriers to oral health care for persons with disabilities: An overview of systematic reviews.

Nearly one billion individuals globally live with disabilities, facing greater risk of dental issues. Systematic reviews have identified barriers to oral health care for persons with disabilities (PWDs), but a comprehensive synthesis to inform health-policy guidelines is lacking. This overview addresses this gap by summarizing the key barriers to oral health care access for PWDs. (1) summarize key findings on the barriers PWDs encounter in seeking dental and oral healthcare, (2) evaluate the influence of disabilities on accessibility to dental and oral health services, and (3) identify facilitators to improve access and inform future health policy. Systematic review of systematic reviews of both cross-sectional and evaluative studies that identified barriers to oral health care access for PWDs. A comprehensive search of databases was conducted from inception to 24 February 2024, using specific keywords and Boolean operators. Data extraction and quality assessment were performed using AMSTAR 2 to ensure transparency and reliability. Five systematic reviews were included. These reviews highlighted financial constraints, provider reluctance, access difficulties, systemic barriers, and patient-related factors as major obstacles. Methodological variations across reviews were noted, affecting the transparency and reliability of findings. Barriers to oral health care access for PWDs include financial, provider-related, access-related, systemic, and patient-related factors. Addressing these barriers, particularly in developing countries, should be a priority for future research and interventions.

Assessing the Factors Leading to Missed Breast Cancer Diagnoses in Mammography Among Pakistani Women: A Prospective Cross-Sectional Study.

Objective To determine the frequency of false-negative mammograms, and identify the factors contributing to missed breast cancer diagnoses in Pakistani women. Materials and methods This descriptive, prospective cross-sectional study was conducted at a tertiary care hospital from December 15, 2020, to December 10, 2023, including 150 women aged 30 to 60 who underwent bilateral mammography and concurrent breast ultrasound. The study analyzed the frequency and causes of false negatives, categorizing them into patient-related, tumor-related, technical-related, and provider-related factors. Stratification was performed based on age groups and Breast Imaging Reporting and Data System (BI-RADS) scores, and statistical significance was assessed using Chi-square tests. Results The study found a 5.1% frequency of false-negative mammograms. Lesion-related factors were seen in 59 (39.7%) patients; patient-related factors were seen in 40 (26.7%) patients; provider-related factors were seen in 29 (19.3%) patients; and technical-related factors were seen in 22 (26.7%) patients. Conclusion Dense breast tissue significantly contributes to missed breast cancer diagnoses in Pakistani women. While lesion-related, provider-related, and technical-related factors uniformly affect mammography outcomes, addressing patient-specific challenges - particularly in younger women with dense breasts - is crucial. The study suggests incorporating supplementary imaging modalities, like ultrasound, in routine screening for better detection, potentially informing national breast cancer screening guidelines in Pakistan.

Barriers to the treatment of clubfoot in low- and middle-income countries: A guide to improve compliance

The Ponseti method of clubfoot treatment is ideal for low- and middle-income countries since it is minimally invasive and easily implementable through non-surgeon providers. However, variables related to the socioeconomic status of the community, patient-related factors, treatment provider-related factors, and health system-related factors may influence the outcome of this deformity. These barriers need a two-pronged approach, a top-down (involvement at the policy level) as well as a bottom-up method (involvement at an individual level). Improving the knowledge level of the caregiver as well as the provider and addressing the issues regarding financial constraints will help in eliminating various barriers to the treatment of clubfoot. Furthermore, regular audits help in identifying the efficacy of various solutions employed as well as identifying new barriers to treatment. Integration at the policy level with the involvement of governmental as well as non-governmental organisations helps to remove health system-level bottlenecks.

Abstract A064: Patient-provider trust and immigration experiences and h. pylori knowledge among Asian Americans

Abstract Background: Asian Americans experience a disproportionately higher prevalence of Helicobacter pylori (H. pylori) infection. However, there persists limited awareness about H. pylori infection and the associated factors among this population. Methods: To assess the level of H. pylori-related knowledge and its association with immigration and provider-related factors, we conducted a cross-sectional pilot study involving 131 Asian American individuals aged 30-75 in the greater Philadelphia and NYC areas. Participants administered a questionnaire covering topics including migration experiences, provider characteristics, medical encounters, and other relevant covariates. Poisson regression was used to evaluate the relationship between these factors and H. pylori knowledge scores. Results: Among all participants, 78% (102/131) were not racially concordant with their PCP, and 39% (51/131) had limited English proficiency. Vietnamese participants had the highest mean H. pylori knowledge score (10.8, SD: 1.4), followed by Chinese (7.2, SD: 4.7) and Korean (5.7, SD: 4.4). In the crude model, racial concordance with PCPs showed a positive relationship (IRR: 1.33, 95% CI: 1.14–1.56) with knowledge scores, while length of immigration demonstrated a weak negative relationship (IRR: 0.98, 95% CI: 0.97–0.99). In the adjusted model, personal health experiences (aIRR: 1.3, 95% CI: 1.10–1.54) and patient-provider communication (aIRR: 1.71, 95% CI: 1.43–2.06) as key determinants of H. pylori knowledge. Conclusion: H. pylori knowledge in Asian Americans is influenced by immigration experiences and the trust between patients and providers, which affects information exchange, medical comprehension, and treatment adherence. Therefore, interventions aimed at improving H. pylori knowledge within the Asian American community should prioritize fostering trust between patients and their healthcare providers. This trust serves as a crucial foundation for facilitating informed decision-making and implementing preventive measures against gastric cancer. Citation Format: Zhiqing E. Liu, Jerry Kai-Chun Fu, Wenyue Lu, Phuong Do, Kathy Zhou, Ellen Kim, Yin Tan, Lin Zhu, Grace X. Ma. Patient-provider trust and immigration experiences and h. pylori knowledge among Asian Americans [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A064.

Did they receive it? Direct Benefit Transfer to tuberculosis patients in Raigarh district, Chhattisgarh, India - A mixed methods study

BackgroundNutrition support plays critical role in patient centered care of TB. India launched a direct benefit scheme Nikshay Poshan Yojana (NPY) in 2018. However, there is sparse evidence of its implementation status in Chhattisgarh. ObjectivesTo determine the proportion receiving the NPY incentives, its timeliness and factors associated with non-payment and delays, and to assess utilization patterns of Direct Benefit Transfer (DBT) among the beneficiaries. MethodsIt was a mixed-method study, with quantitative component of (Cross-sectional) followed by qualitative component (Descriptive). The data of all tuberculosis patients notified during April 2021toMarch 2022 in Raigarh, Chhattisgarh, India, were extracted from Nikshay-Portal. Beneficiaries registered for treatment in last quarter of 2021–2022, were also contacted to assess the utilization patterns of DBT. Eighteen health care providers (HCPs) were interviewed one-on-one to assess their perception regarding challenges in implementation of NPY and possible solutions. ResultsOf 2161 TB patients started on TB treatment, 1912(88.8 %) received at least one benefit. More than half (59.6 %; 1140/1912) of the TB patients who received at least one benefit, received their first benefit within 56 days of notification. Among 255 who responded for utilization pattern of DBT, nearly one third (n = 73,28.6 %) reported to have utilized DBT for buying food. The main challenges for non-receipt/delay in benefits were: difficulty opening bank accounts; “dormant” account policy; changing of Indian Financial System Code (IFSC) of rural and nationalized merged banks; poor internet connectivity; and shortage of human resources or workforce not distributed according to geographic location. ConclusionNearly nine out of ten patients received at least one benefit under NPY. However, its utilization for treatment purposes was limited. Bank related, patient related and provider related factors posed major challenges in smooth implementation of the scheme. To improve the scheme's coverage, flexible account opening policies with offline Nikshay-Portal features are required.

Delay in the Diagnosis of Patients With Head and Neck Cancer: Impact of Different Patient- and Healthcare Provider-Related Factors.

Background In our setup, head and neck cancer (HNC) is the most common, and patients frequently present at an advanced stage, which results in dismal outcomes. Delays on the part of the patient (such as resistance to seeking treatment) or the provider (such as misdiagnosis or an extended wait period for consultation) may be the cause of a late presentation. The presentation stage may vary depending on several factors, including age, gender, smoking status, job status, and education. Objectives The study aims to identify factors that lead to advanced-stage presentations of HNCs and to determine the delays brought on by patient- or healthcare provider-related factors and how these factors affect HNC disease staging among biopsy-proven HNC patients. Materials and methods Participants in the study were those who initially presented with a biopsy-verified HNC at the cancer clinic of the department of otolaryngology-head and neck surgery atPakistan Institute of Medical Sciences (PIMS), Islamabad. Patients answered questions on their first symptom presentation, past healthcare professional visits, and intervals between visits on a Cancer Symptom Interval Measure (C-SIM) questionnaire. For every patient, clinical and demographic information was gathered. TNM staging was completed. The test of significance was applied where applicable. Results Age, gender, education level, and smoking status had no bearing on the presentation stage. Patients without jobs present at a statistically significant higher stage (p = 0.038). The most prevalent histological form of HNC was squamous cell carcinoma 79 (82.29%), with theoral cavity and larynx being the most common sites of the disease30 (31.25%) and 29 (30.21%) respectively. Patients took an average of 5.28 ± 9.12 months from the onset of symptoms to their first appointment with a healthcare provider. Prior to diagnosis, the majority of patients saw three or more healthcare providers (range: 1-8). The duration from the initial visit to a healthcare provider to the initiation of treatment was 3.06 ± 5.88 months. Based on the stage at presentation, there were no discernible variations in the times to presentation (p>0.05). Conclusion Significant delays and high stage of presentation are caused by unemployment. The majority of the delay was caused by the patient's tardiness in seeing a medical practitioner, yet the presentation stage was not greatly impacted by this delay.

51406 Exploring the Impact of Healthcare Provider-Related Factors on Patient Satisfaction in Atopic Dermatitis Care Settings

51406 Exploring the Impact of Healthcare Provider-Related Factors on Patient Satisfaction in Atopic Dermatitis Care Settings

Patient-related factors drive high rates of reported antibiotic allergies: A qualitative study

BackgroundUnnecessary antibiotic avoidance due to allergy fears has adverse cost and health implications however, the problem is difficult to resolve because patient and provider-related factors leading to avoidance are multifactorial. We use qualitative research methods to explore patient perspectives of antibiotic allergy and testing to reach the heart of the problem. ObjectiveTo reveal factors leading patients to report antibiotic allergy, and determine what education is required to prevent the cycle of erroneous allergy reporting. MethodsThe 29 patients were a sample of convenience recruited from a tertiary public hospital in Western Australia between March 2020 until August 2020; 18 were inpatients and 11 outpatients, with a median age of 64.2 years, and 15 (55%) were female. Semi-structured interviews assessed patients’ understanding and knowledge of three topics: (1) antibiotic allergy, (2) antibiotic allergy testing, and (3) outcomes of testing. Interview transcripts underwent thematic analysis by two researchers, independently. ResultsThree main, overlapping themes emerged as influential across topics: (1) Severity of the Index Reaction, (2) Trust in family and health care providers, and (3) Health literacy. Patients were largely unaware of the benefits of confirmatory testing, and the detrimental health consequences of unnecessary avoidance. Patients displayed trust in health care providers’ expertise and assumed that medical records were accurate to prevent prescribing errors. ConclusionsThe findings provide evidence for an effective patient education strategy and highlight failures among hospital and primary health providers to recognise the potential harm of unverified antibiotic allergy. Healthcare professionals are influential at multiple steps of a patient's healthcare journey and addressing unconfirmed antibiotic allergy should be taken at each opportunity.

Analysis of Risk Factors for the Quality of Health Services in Primary Health Facilities: An Observational Study in North Bengkulu Regency, Indonesia

Primary health care (PHC) is crucial for overall health system performance, particularly in developing nations. However, variations in the quality of PHC services in Indonesia, particularly in North Bengkulu Regency, raise concerns. This study aimed to identify and analyze risk factors associated with suboptimal quality of health services in these facilities. This observational, cross-sectional study was conducted in 20 primary health centers (PHCs) in North Bengkulu Regency. A multi-stage random sampling technique was used to select 400 patients and 80 healthcare providers. Data were collected using validated questionnaires assessing various dimensions of service quality (tangibles, reliability, responsiveness, assurance, and empathy), patient satisfaction, and potential risk factors (socio-demographic, facility-related, and provider-related). Descriptive statistics, bivariate analysis, and multivariate logistic regression were used for data analysis. The study found a significant association between perceived service quality and patient satisfaction. Socio-demographic factors (lower education and income), facility-related factors (inadequate staffing and lack of essential medicines), and provider-related factors (insufficient communication and perceived lack of empathy) were identified as risk factors for lower service quality. The quality of health services in North Bengkulu PHCs is influenced by a complex interplay of patient, facility, and provider factors. Interventions targeting these risk factors, such as community education, capacity building for providers, and improvements in resource allocation, may improve PHC service quality and patient satisfaction in this region.

Autism-Friendly Healthcare: A Narrative Review of the Literature.

Disparities in healthcare access, delivery, and outcomes exist between autistic and non-autistic individuals.Autism-friendly healthcare initiatives aim to facilitate and improve the healthcare experience of autistic individuals by addressing commonly encountered challenges. While there is no consensus regarding the definition of autism-friendly healthcare, in this narrative review, we examine previously published research to determine the most important components of autism-friendly healthcare. Patient-related factors, provider-related factors, and system-related factors should be addressed. Proactivity, flexibility, andcollaboration should guide the process of transforming the healthcare system. Finally, multiple strategies can be utilized as appropriate to the setting and individuals.

Evaluating perceived barriers to optimal care in head and neck cancer: A mixed-methods study.

6079 Background: Head and neck cancer (HNC) is a complex disease that requires multidisciplinary care and poses significant challenges for patients and healthcare providers. Despite the availability of evidence-based guidelines, achieving optimal HNC care faces many barriers. This mixed-methods study explores the perceived barriers by patients and clinicians to optimal HNC care. Methods: The Association of Cancer Care Centers (ACCC) collaborated with the Head and Neck Cancer Alliance and the American Society for Radiation Oncology (ASTRO), along with an expert steering committee of multidisciplinary roles representing diverse cancer care centers, to evaluate the current landscape of HNC care delivery. Using an explanatory sequential design, ACCC conducted patient (n= 247) and provider (n=206) surveys and four focus groups which included patients with HNC and clinicians to capture barriers to optimal HNC care. Results: Barriers were classified as patient-related, provider-related, and system-related factors. Survey highlights include: 32% of patients received multimodal treatment including surgery, radiation, and medications; 50% of clinicians were at centers that utilized multidisciplinary clinics for HNC; 60% of patients “strongly agreed” they were satisfied with their care; 48% of patients felt members of their treatment team communicated and coordinated care “very well”; and 56% of patients “strongly agreed” clinicians explained their diagnosis comprehensibly. Clinicians and patients differed in their perspectives on how care was delivered in a few areas: 52% of clinicians vs. 40% of patients agreed that side effects of treatment were explained in ways that patients could understand; 29% of clinicians vs. 21% of patients felt that emotional concerns and mental health needs were addressed. Clinicians identified key areas that needed improvement to provide more effective care: financial resources (62%), dedicated navigation (45%), and coordination across members of the care team (45%). Qualitative analysis of focus group responses identified travel logistics to care centers, inadequate health insurance coverage, and lack of dental insurance delaying care as major systems-related barriers to optimal HNC care. Conclusions: This study revealed insights into the delivery of optimal care in HNC in the US, including being a high-volume center, having dedicated HNC nurse navigators, and multidisciplinary meetings for care coordination. Multifactorial barriers to optimal HNC care were also identified and will be used to inform future educational programming and the development of interventions to improve care.

Healthcare Provider-Related Factors in the Diagnostic Delay of Cervical Cancer: A Cross-Sectional Study.

Background and objective Cervical cancer is the second most common malignancy among Indian women. In 2018, the World Health Organization (WHO) called for global action toward the elimination of cervical cancer through the triple-intervention strategy. One of its pillars is ensuring 70% screening coverage of eligible women with a high-performance test at least twice in their lifetime. Various factors contribute to the delayed diagnosis of cervical cancer, increasing the burden of the disease. In this study, we aimed to determine the healthcare provider (HCP)-related factors in the diagnostic delay of advanced cervical cancer. Methods This prospective cross-sectional study was conducted over two months in the cancer clinic of the Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. We interviewed 384 women diagnosed with advanced cervical cancer [the International Federation of Gynecology and Obstetrics (FIGO) stage IB3-IVB] by using a questionnaire to capture data inputs regarding the various healthcare services they had received in the past 10 years along with details of HCPs. The collected data were analyzed using the software STATA version 17.0. Results Among 384 participants, 185 (48.1%) had interacted with an HCP in the past 10 years; 157 (40.8%) of them had visited a healthcare facility.Among these 185 women, only 22.16% had been advised to undergo screening, and only 15.18% had been tested despite several having access to primary health centers within 10 km of their residence. The lack of screening guidance by HCPs accounted for 78% of delayed diagnoses of cervical cancer. Conclusions Based on our findings, a deficiency in screening guidance in the asymptomatic period by healthcare providers across various levels of our healthcare system contributed significantly to the delayed diagnosis of cervical cancer.

Providers’ and survivors’ perspectives on the availability and accessibility of surgery in gastrointestinal cancer care

BackgroundSurgery is essential for gastrointestinal (GI) cancer treatment. Many patients lack access to surgical care that optimizes outcomes. Scarce availability and/or low accessibility of appropriate resources may be the reason for this, especially in economically disadvantaged areas. This study aimed to investigate providers’ and survivors’ perspectives on barriers and facilitators to the availability and accessibility of surgical care. MethodsSemistructured interviews informed by surgical disparities and access-to-care conceptual frameworks with purposively selected GI cancer providers and survivors in Alabama and Mississippi were conducted. Survivors were within 3 years of diagnosis of stage I to III esophageal, pancreatic, or colorectal cancer. Transcripts were analyzed using inductive thematic and content analysis techniques. Intercoder agreement was reached at 90 %. ResultsThe 27 providers included surgeons (n = 11), medical oncologists (n = 2), radiation oncologists (n = 2), a primary care physician (n = 1), nurses (n = 8), and patient navigators (n = 3). This study included 36 survivors with ages ranging from 44 to 87 years. Of the 36 survivors, 21 (58.3 %) were male, and 11 (30.6 %) identified as Black. Responses were grouped into 3 broad categories: (i) transportation/geographic location, (ii) specialized care/testing, and (iii) patient-/provider-related factors. The barriers included lack and cost of transportation, reluctance to travel because of uneasiness with urban centers, low availability of specialized care, overburdened referral centers, provider-related referral biases, and low health literacy. Facilitators included availability of charitable aid, centralizing multidisciplinary care, and efficient appointment scheduling. ConclusionIn the Deep South, barriers and facilitators to the availability and accessibility of GI surgical cancer care were identified at the health system, provider, and patient levels, especially for rural residents. Our data suggest targets for improving the use of surgery in GI cancer care.

Individual and health care provider factors influencing stroke self-management behavior: A cross-sectional study

Background This study aimed to examine individual- and health service provider-related factors that influence the self-management behavior of patients with stroke. Methods This cross-sectional study investigated a cohort of 110 ischemic stroke patients in the neurology outpatient department of Universitas Airlangga Hospital from February 2023 to May 2023. Data were obtained using the following three distinct questionnaires: the general demographic questionnaire, health care provider questionnaire, and modified stroke self-management behavior questionnaire. Results Chi-square test results indicated a significant correlation between age (p = 0.023) and information availability (p = 0.000) with self-management behavior in patients with stroke. However, no significant correlations were observed between gender (p = 1.107), residence (p = 0.859), availability of access (p = 0.093), availability of health facilities (p = 0.065), and collaboration among health workers (p = 0.641) with self-management behavior in patients with stroke. Ordinal logistic regression analysis results indicated that age significantly influenced self-management behavior in patients with stroke (p = 0.034; OR = 2.49). Discussion The presence of reliable information within the hospital setting is expectedly complemented by a strong level of literacy among patients with stroke, thereby facilitating the enhancement of their self-management practices.

Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa.

The COVID-19 pandemic had a profound effect on the health sector globally and in South Africa (SA). To review the effects of COVID-19 on maternal, perinatal and reproductive health outcomes and service utilisation in SA. Three routine national data collection systems were sourced: the District Health Information System, the Saving Mothers reports of the National Committee on Confidential Enquiry into Maternal Deaths and the Saving Babies reports from the National Perinatal Morbidity and Mortality Committee using data from the Perinatal Problem Identification Program. There were 35% and 8% increases in maternal and stillbirth mortality rates, respectively, in 2020 and 2021, which correlated with the COVID-19 waves. However, in 2022, rates returned to pre-COVID levels. Antenatal visits and facility births showed little change, but there was a shift to more rural provinces. The use of oral and injectable contraceptives and termination of pregnancy services decreased markedly in 2020 and 2021, with a sustained shift to long-acting reversible contraceptives. The increase in maternal deaths was predominantly due to COVID-19 respiratory complications, but also an increase in obstetric haemorrhage. Stillbirths increased significantly (10%) for birthweights between 2 000 g and 2 499 g, categorised mostly as unexplained stillbirths or preterm labour, but no increase in neonatal deaths was observed. Administrative avoidable factors increased by 24% in the 2020 - 2022 triennium, but there was no increase in patient/community level or healthcare provider-related avoidable factors during the pandemic years. COVID-19 caused a marked increase in maternal death and stillbirth rates in 2020 and 2021 due to both direct effects of the virus and indirect effects on functioning of the health system. The continued, although modified, health-seeking behaviour of women and the rapid return to pre-COVID-19 mortality rates demonstrates enormous resilience in women and the health system.

Referral to periodontist by a general dentist- A general guideline

A quality periodontal program requires coordinated efforts between the patient, general dentist, hygienist and the periodontist. The sharing of ideas, alternative approaches to treatment and collective responsibility, generally results in the best treatment for an individual patient. This article addresses the question of how best to manage periodontal disease in the general practice, when to consider referral, ways to maximize the patient's receptiveness to additional treatment, and making referrals as effective as possible. Specifically, the role of disease characteristics, patient and provider-related factors, attitudes towards periodontal referral guidelines and perceptions of dental education are explored.

The diagnostic pathway for patients with interstitial lung disease: a mixed-methods study of patients and physicians

ObjectivesThe diagnostic process for patients with interstitial lung diseases (ILD) remains complex. The aim of this study was to characterise the diagnostic care pathway and identify barriers and potential solutions...