Receiving Health Care Research Articles

THE EFFECT OF PATIENT EXPECTATIONS AND SATISFACTION ON REGIONAL TRUST IN HEALTH TOURISM: A PRIVATE HOSPITAL EXAMPLE

In this study, the effect of health tourists' expectations and satisfaction on their sense of trust in Turkey was examined. In line with the purpose of the research, the sample of the study consists of 178 patients whose structure was determined by the simple random sampling method among the patients in the institution in order to receive health care services. The data were analyzed with the SPSS program. 52.8% of the 178 tourists participating in the research were female and 47.2% were male. In terms of the age variable, 41.6% of the tourists were between the ages of 18-30, 36.5% were between the ages of 31-45, and 21.9% were aged 46 and over. When the educational status variable of the tourists is examined, it was determined that 42.7% of them are primary school graduates, 14.6% were high school graduates, 33.1% were university graduates, and 9.6% were master's and doctorate degrees. As a result of the analysis, it has been determined that meeting the expectations and satisfaction of the participating health tourists has a statistically significant and positive effect on the sense of trust in Turkey. In line with these results, as the expectations of the patients are met and their satisfaction increases, their confidence in Turkey increases

Deployment to Military Bases With Open Burn Pits and Respiratory and Cardiovascular Disease

Many veterans who served in Afghanistan and Iraq during Operations Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) were deployed to military bases with open burn pits and exposed to their emissions, with limited understanding of the long-term health consequences. To determine the association between deployment to military bases where open burn pits were used for waste disposal and the subsequent risk of developing respiratory and cardiovascular diseases. This retrospective observational cohort study used Veterans Health Administration medical records and declassified deployment records from the Department of Defense to assess Army and Air Force veterans who were deployed between 2001 and 2011 and subsequently received health care from the Veterans Health Administration, with follow-up through December 2020. Data were analyzed from January 2023 through February 2024. Duration of deployment to military bases with open burn pits. Diagnosis of asthma, chronic obstructive pulmonary disease, interstitial lung disease, hypertension, myocardial infarction, congestive heart failure, ischemic stroke, and hemorrhagic stroke. The study population included 459 381 OEF and OIF veterans (mean [SD] age, 31.6 [8.7] years; 399 754 [87.0%] male). Median (IQR) follow-up from end of deployment was 10.9 (9.4-12.7) years. For every 100 days of deployment to bases with burn pits, veterans experienced increased adjusted odds for asthma (adjusted odds ratio [aOR], 1.01; 95% CI, 1.01-1.02), chronic obstructive pulmonary disease (aOR, 1.04; 95% CI, 1.02-1.07), hypertension (aOR, 1.02; 95% CI, 1.02-1.03), and ischemic stroke (aOR, 1.06; 95% CI, 0.97-1.14). Odds of interstitial lung disease, myocardial infarction, congestive heart failure, or hemorrhagic stroke were not increased. Results based on tertiles of duration of burn pit exposures were consistent with those from the continuous exposure measures. In this cohort study, prolonged deployment to military bases with open burn pits was associated with increased risk of developing asthma, COPD, and hypertension. The results also point to a possible increased risk in ischemic stroke. The novel ability to use integrated data on deployment and health outcomes provides a model for additional studies of the health impact of environmental exposures during military service.

Guidelines for conscientious objection in Spain: a proposal involving prerequisites and protocolized procedure

Healthcare professionals often face ethical conflicts and challenges related to decision-making that have necessitated consideration of the use of conscientious objection (CO). No current guidelines exist within Spain’s healthcare system regarding acceptable rationales for CO, the appropriate application of CO, or practical means to support healthcare professionals who wish to become conscientious objectors. As such, a procedural framework is needed that not only assures the appropriate use of CO by healthcare professionals but also demonstrates its ethical validity, legislative compliance through protection of moral freedoms and patients’ rights to receive health care. Our proposal consists of prerequisites of eligibility for CO (individual reference, specific clinical context, ethical justification, assurance of non-discrimination, professional consistency, attitude of mutual respect, assurance of patient rights and safety) and a procedural process (notification and preparation, documentation and confidentiality, evaluation of prerequisites, non-abandonment, transparency, allowance for unforeseen objection, compensatory responsibilities, access to guidance and/or consultative advice, and organizational guarantee of professional substitution). We illustrate the real-world utility of the proposed framework through a case discussion in which our guidelines are applied.

Demographic, social, and clinical aspects associated with access to COVID-19 health care in Pará province, Brazilian Amazon

Internal social disparities in the Brazilian Amazon became more evident during the COVID-19 pandemic. The aim of this work was to examine the demographic, social and clinical factors associated with access to COVID-19 health care in Pará Province in the Brazilian Amazon. This was an observational, cross-sectional, analytical study using a quantitative method through an online survey conducted from May to August 2023. People were eligible to participate if they were current residents of Pará, 18-years-old or older, with self-reported diagnoses of COVID-19 through rapid or laboratory tests. Participants completed an electronic survey was developed using Research Electronic Data Capture (REDCap) software—The adapted questionnaire “COVID-19 Global Clinical Platform: Case Report Form for Post-COVID Condition”. Questions focused on access to COVID-19 treatment, demographic characteristics, COVID-19 vaccine and clinical characteristics. Respondent-driven sampling was applied to recruit participants. Multiple logistic regression was utilized to identify the associated factors. Overall, a total of 638 participants were included. The average age was 31.1 years. Access to COVID-19 health care was 68.65% (438/638). The participants most likely to access health care were those with moderate or severe COVID-19 (p = 0.000; OR: 19.8) and females (p = 0.001; OR: 1.99). Moreover, participants who used homemade tea or herbal medicines were less likely to receive health care for COVID-19 in health services (p = 0.002; OR: 0.54). Ensuring access to healthcare is important in a pandemic scenario.

Reducing Pain and Anxiety in the Blood Collection Unit: The Impact of the Child-Friendly Design.

Purpose: The study aimed to examine the effect of a child-friendly design on the pain and anxiety levels during blood draw in children aged 1-3 years and the satisfaction levels of their parents toward the environment in which they receive health care services. Methods: The nonrandomized study was conducted with 158 children aged 1-3 years and their parents. Data were obtained with the "Personal Information Form," "Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale," "Visual Analog Scale (VAS) Anxiety Scale," and "Parental Satisfaction Scale-VAS." Data were collected from the control group before the design and from the intervention group after the design. Results: During the blood draw, the VAS Anxiety score of the children in the intervention group was 3.17 ± 1.44 and that of the control group was 7.00 ± 2.51 (t = 246.500, p < .001). The FLACC score was 3.94 ± 1.65 in the intervention group and 7.32 ± 2.51 in the control group (t = 915.000, p < .001). The mean satisfaction scores of the parents in the intervention group for the environment where they received health care were 10.00 ± 0.00, and those of the parents in the control group were 4.85 ± 1.68 (test = -11.561, p < .001). Conclusion: The child-friendly design effectively reduced children's pain and anxiety levels during blood draws and increased parents' satisfaction with the environment in which health care was received. Practical Implications: Implementing a child-friendly design in blood collection units is recommended to alleviate the pain and anxiety associated with children's blood draws, thereby enhancing parental satisfaction with the care provided.

PREVALENCE OF OCULAR FOREIGN BODIES AMONG PATIENTS RECEIVING HEALTH CARE SERVICES AT JINJA REGIONAL REFERRAL HOSPITAL EYE CLINIC JINJA, UGANDA. A CROSS-SECTIONAL STUDY.

Purpose of the study The purpose of the study was to determine the prevalence of ocular foreign bodies among patients receiving health care services at JRRH to provide a baseline source of data for public education. Objectives The general objective was to determine the prevalence of OFBs among patients receiving health care services seen at the eye department of JRRH and the specific objectives were to determine the predisposing causes to OFBs, the possible treatment, and the complications of OFBs among patients receiving health care services at JRRH. Study methodology The study adopted a cross-sectional quantitative research design. Simple random sampling methods were used to select respondents who participated in the study and a total of 40 respondents were interviewed. Self-administered questionnaires were used to collect data from the respondents. Results During the study, it was found that farming was the most common activity carried out by respondents at the time they sustained ocular foreign body constituting 30% (12/40) of all activities resulting to the vegetative type of foreign body on lead, 55%. The majority of the respondents were from the rural 65% and 35% from urban settings, with the most affected age being 20-25 years. Conclusions In JRRH, the prevalence of OFB among patients is high with the majority of the cases being easily treatable with good prognosis. Recommendation The study recommends using eye protective gear by people involved in activities where OFBs may traumatize their eyes. Health education on OFBs should be adopted by the relevant authorities that is the DHECT. Training of more eye health workers should done by the Government to technically manage OFBs.

KNOWLEDGE, ATTITUDE, AND PRACTICES OF SELF-MEDICATION AMONG ADULT PATIENTS AGED 18 YEARS AND ABOVE RECEIVING HEALTH CARE SERVICES IN THE EYE CLINIC OF JINJA REGIONAL REFERRAL HOSPITAL. A CROSS-SECTIONAL STUDY.

Purpose of the study This was to determine the knowledge, attitude, and practices of self-medication among adult patients aged 18 years and above receiving health care services in the eye clinic of Jinja Regional Referral Hospital, carried out from November 2022 to April 2023. Study methods A cross-sectional descriptive study design employing both quantitative and qualitative methods of data collection was used in the form of a questionnaire, 30 patients aged 18 years and above who agreed to be included in the study were used. Results Concerning knowledge about self-medication, it revealed that respondents could identify OTC drugs they always use, data analysis and interpretation revealed that respondents’ attitude towards the use of self-medication is still high (50%). Concerning practices of self-medication, between 1st December 2022-1st March 2023, the majority (43.5%) had practiced between January and February 2023, 30% had practiced within the last two weeks according to the time frame of the study, and only 26.1% had last used in December 2022, which showed that self-medication practice is still high within the region. Conclusion Given these findings, there is still a high need to sensitize the population about the knowledge of OTC drugs, the dangers associated with frequent and prolonged use of these drugs, and how to use them safely. Recommendations The government through the Ministry of Health should sensitize the population about the risk factors of wrong use of OTC drugs and the dangers of traditional medicines. It should also extend its health facilities to all areas of the country, and as well make them active by providing drugs and qualified personnel and as well improve the services of the already existing facilities so that people can get help.

Assessment of the Level of Knowledge About Risk Factors, Prevention, and Treatment of Gestational Diabetes Mellitus in a Community Sample From Saudi Arabia.

Introduction Gestational diabetes mellitus (GDM) is a common disease affecting pregnant females, and it carries a major risk of short and long-term health problems for both mothers and their offspring. Multiple factors like advanced maternal age, obesity, and unhealthy lifestyle can increase the risk of GDM. The current guidelines recommend screening all pregnant females for risk factors during the first trimester with subsequent testing of the blood glucose level at 24 weeks gestation. Lack of awareness about GDM is a main contributing factor in the delay in screening and diagnosis of GDM with subsequent fetal and maternal complications. This study aims to identify the level of knowledge about GDM among the adult population in the Kingdom of Saudi Arabia (KSA). Material and methods A descriptive cross-sectional questionnaire-based study was conductedto identify the level of knowledge about risk factors, prevention, and treatment of GDM in a community sample from Saudi Arabia. A self-administered electronic questionnaire was designed, tested for validity and reliability, and distributed through social media platforms. It consisted of 18 questions asking about the socio-demographic characteristics, the type of hospital in which the participant receives their medical care, whether the participant heard about GDM or not, and if they knowsomeone with GDM, in addition to questions to assess the level of knowledge about risk factors, complications, prevention, and treatment of GDM. The total score of knowledge was calculated. The multivariate regression analysis test was employed to analyze the relationship between various demographic variables and the level of knowledge about GDM among the study population. A p-value of 0.05 or less was considered statistically significant. Results A total of 539 (100%) participants completed the questionnaire: 263 (48.8%) of them were in the age category (18-25 years), 440 (81.6%) of them were females, 307 (57%) had a bachelor's degree, 275 (51%) were single, 454 (84.2%) had heard about GDM, and 258 (47.9%) of them have or know someone with GDM. The total score of knowledge revealed excellent, good, fair, and poor levels among 334 (62%), 140 (26%), 49 (9%), and 16 (3%) of participants, respectively. The multivariable linear regression model revealed that participants who received health care from governmental hospitals heard about GDMand had or knew someone with GDM were positively associated with a higher level of knowledge. Conclusions The findings revealed that among participants, 62% showed excellent knowledge about GDM, although, the other 38% had non-optimal levels of knowledge. Awareness campaigns are recommended to improve the level of knowledge about this disease, its risk factors, treatment, and complications.

Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial.

Alcohol and other substance use disorders usually begin with substance use in adolescence. Pediatric primary care offices, where most adolescents receive health care, are a promising venue for early identification of substance use and for brief intervention to prevent associated problems and the development of substance use disorder. This study tests the effects of a computer-facilitated screening and brief intervention (cSBI) system (the CRAFFT [Car, Relax, Alone, Forget, Family/Friends, Trouble] Interactive System [CRAFFT-IS]) on heavy episodic drinking, riding with a driver who is substance impaired, or driving while substance impaired among adolescents aged 14 to 17 years presenting for a well visit at pediatric primary care practices. We are conducting a cluster randomized controlled trial of the CRAFFT-IS versus usual care and recruiting up to 40 primary care clinicians at up to 20 pediatric primary care practices within the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings network. Clinicians are randomized 1:1 within each practice to implement the CRAFFT-IS or usual care with a target sample size of 1300 adolescent patients aged 14 to 17 years. At study start, intervention clinicians complete web-based modules, trainer-led live sessions, and mock sessions to establish baseline competency with intervention counseling. Adolescents receive mailed recruitment materials that invite adolescents to complete an eligibility survey. Eligible and interested adolescents provide informed assent (parental permission requirement has been waived). Before their visit, enrolled adolescents seeing intervention clinicians complete a self-administered web-based CRAFFT screening questionnaire and view brief psychoeducational content illustrating substance use-associated health risks. During the visit, intervention clinicians access a computerized summary of the patient's screening results and a tailored counseling script to deliver a motivational interviewing-based brief intervention. All participants complete previsit, postvisit, and 12-month follow-up study assessments. Primary outcomes include past 90-day heavy episodic drinking and riding with a driver who is substance impaired at 3-, 6-, 9-, and 12-month follow-ups. Multiple logistic regression modeling with generalized estimating equations and mixed effects modeling will be used in outcomes analyses. Exploratory aims include examining other substance use outcomes (eg, cannabis and nicotine vaping), potential mediators of intervention effect (eg, self-efficacy not to drink), and effect moderation by baseline risk level and sociodemographic characteristics. The AAP Institutional Review Board approved this study. The first practice and clinicians were enrolled in August 2022; as of July 2023, a total of 6 practices (23 clinicians) had enrolled. Recruitment is expected to continue until late 2024 or early 2025. Data collection will be completed in 2025 or 2026. Findings from this study will inform the promotion of high-quality screening and brief intervention efforts in pediatric primary care with the aim of reducing alcohol-related morbidity and mortality during adolescence and beyond. ClinicalTrials.gov NCT04450966; https://www.clinicaltrials.gov/study/NCT04450966. DERR1-10.2196/55039.

Value of pharmacy services for common illness symptoms covered by universal coverage at drugstore compared to outpatient services at a hospital in Thailand.

Drug stores is an option that people can receive health care services for their common illnesses. This is the first study aims to estimate cost savings for 16 common illness symptoms to the Thailand's health system. This study gathered retrospective secondary data from several studies and surveyed the median cost of medicines. Cost savings of care provided by pharmacists at drug stores in comparison to out-patient department (OPD) services at hospitals were quantified using cost of illness approach. The average number of hospital visits for treatment for 16 common illness symptoms was 2,356 visits per month. The estimation of the cost savings per visit from three perspectives, including government, patient, and societal, at tertiary care hospitals were 12.7-19.4, 12.7-25.6, and 18.9-25.6 USD, and at secondary care hospitals were 6.0-12.7, 6.0-18.9, and 12.2-18.9 USD. Every $1 reimbursed at drug stores will save additional costs in Thailand's health system, ranging from $0.04 to $0.24 and $0.02 to $0.16 at tertiary care hospitals and secondary hospitals, respectively. Pharmacy services for 16 common illness symptoms can clearly save costs.

Health Care Contact Days Among Older Cancer Survivors.

Health care contact days-days spent receiving health care outside the home-represent an intuitive, practical, and person-centered measure of time consumed by health care. We linked 2019 Medicare Current Beneficiary Survey and traditional Medicare claims data for community-dwelling older adults with a history of cancer. We identified contact days (ie, spent in a hospital, emergency department, skilled nursing facility, or inpatient hospice or receiving ambulatory care including an office visit, procedure, treatment, imaging, or test) and described patterns of total and ambulatory contact days. Using weighted Poisson regression models, we identified factors associated with contact days. We included 1,168 older adults representing 4.51 million cancer survivors (median age, 76.4 years, 52.8% women). The median (IQR) time from cancer diagnosis was 65 (27-126) months. In 2019, these adults had mean (standard deviation) total contact days of 28.4 (27.6) and ambulatory contact days of 24.2 (23.6). These included days for tests (8.0 [8.8]), imaging (3.6 [4.1]), visits with any clinicians (12.4 [11.5]), and visits with primary care clinicians (4.4 [4.7]), and nononcology specialists (7.1 [9.4]) specifically. Sixty-four percent of days with a nonvisit ambulatory service (eg, a test) were not on the same day as a clinician visit. Factors associated with more total contact days included younger age, lower income, more chronic conditions, poor self-rated health, and tendency to "go to doctor as soon as feel bad." Older adult cancer survivors spent nearly 1 month of the year receiving health care outside the home. This care was largely ambulatory, often delivered by nononcologists, and varied by factors beyond clinical characteristics. These results highlight the need to recognize patient burdens and improve survivorship care delivery, including through care coordination.

Managing Multiple Chronic Conditions during COVID-19 Among Patients with Social Health Risks.

Optimal care for persons with multiple chronic conditions (MCC) requires primary and specialty care continuity, access to multiple providers, social risk assessment, and self-management support. The COVID-19 pandemic abruptly changed primary care delivery to increase reliance on telehealth and virtual care. We report on the experiences of individuals with MCC and their family caregivers on managing their health and receiving health care during the initial pandemic. Semistructured qualitative interviews with 30 patients (19 English speaking, 11 Spanish speaking) plus 9 accompanying care partners, who had 2+ primary care encounters between March 1, 2020, and November 30, 2020, 2+ chronic conditions, and 1 or more self-reported social risks. Questions focused on access to and experiences with care, roles for care partners, and self-management during the first 6 months of the pandemic. Participants experienced substantial changes in care delivery. The most commonly reported changes were a shift to more virtual relative to in-person care and shifting roles for care partners. Changes fostered new perspectives on self-management and an appreciation of personal resilience and self-reliance. Virtual care was an acceptable complement to in-person care, though not a substitute for periodic in-person visits. It was more acceptable for English speakers and with a usual provider. New models of care delivery that recognize patient and family resilience and resourcefulness, emphasize provider continuity, and combine virtual and in-person care may support self-management for individuals with MCC and social needs.

Partners in Care: Consumer Experiences With Professional Services.

Consumer experience is a key driver of successful health and education outcomes. Yet, the key factors influencing consumer experiences with care are not fully understood. The aim of this study was to understand, from the perspective of people receiving health care or education services, factors that determine positive and negative experiences with care. We interviewed people who received services, including occupational therapists, and analyzed recordings of the interviews using content analysis. Themes emerged from positive experiences with care on a continuum from "Acknowledges Me" to "Shares Problem Solving." Themes from negative experiences were also on a continuum from "Lacks Curiosity" to "Disregards." A fifth theme emerged from occupational therapists, describing "transformational insights" regarding how their personal experiences receiving care affected their practice. The findings from this study align with core OT constructs and advances understanding of authentic partnerships with people receiving professional services.

The Effect of Counseling on Pregnant Women's Knowledge and Attitude Regarding Complication Prevention

Pregnancy complications are health problems that occur during pregnancy. These health problems can involve problems with the mother's health, the baby's health or even both. Some pregnant women have health problems that arise during pregnancy, while there are also some women who have health problems before pregnancy which can lead to complications during pregnancy. Therefore, it is important for women to receive health care before and during pregnancy to reduce the risk of pregnancy complications. Objective: To determine the effect of counseling on the level of knowledge and attitudes of pregnant women regarding preventing complications in the Hu'u Poskesdes work area in 2023. Method: The design of this research is a pre-experimental design with a one group pretest-posttest design. The sample in this study was 33 pregnant women respondents. Sampling in this research was carried out using a probability sampling method, namely the random sampling technique providing equal opportunities for each element or member of the population to be selected as a sample. Data collection was carried out by filling out the pre-test and post-test questionnaires after a week of the pre-test, where before being given the post-test intervention was given in the form of counseling through lectures/slides.The analysis used is the Wilcoxon Signed Ranks Test analysis. Results: From the univariate results before providing education on preventing complications, it was in the good category (15.2%), sufficient (63.6%), poor (21.2%) and after providing education on preventing complications, it was in the good category (54.5%), sufficient. (42.4%), less (3.0%). Attitudes before were positive = 16 (48.5%) and negative = 17 (51.5%), while after attitudes were positive as many as 24 (72.7%) and negative as many as 9 (27.3%). Test the results of the Wilcoxon Signed Ranks Test analysis with a P-value of knowledge level of 0.01 P of 0.01&lt;0.05 and P-value of attitudes of pregnant women of P=0.046 P of 0.046 &lt;0.05. Conclusions: Counseling has an influence on the level of knowledge and attitudes of pregnant women regarding preventing complications in pregnancy.

Environmental Metagenomic Analysis of "ESKAPE" Pathogens in the Pediatric Intensive Care Unit of General Hospital Yogyakarta Indonesia

Healthcare-associated infections (HAIs) are infections that occur while receiving health care, develop in a hospital or other healthcare facility, and first appear 48 hours or more after hospital admission, or within 30 days after having received health care. HAIs are linked to high mortality rates, prolonged stays, increased hospital overhead costs, and financial burdens on patients. Bacterial transmission from medical personnel or the environment, or patient-to-patient contact are all potential causes of these infections. A molecular epidemiology approach is needed to examine the contribution of risk factors and the distribution of "ESKAPE" pathogens within the hospital environment. In this study, we conducted a comprehensive analysis of the distribution of ESKAPE bacterial pathogens in the environment of pediatric intensive care units over a 30-day time interval using shotgun metagenomics. We collected samples from handwashing sinks, the floor around patients, and ventilator screens and tubes in the pediatric intensive care unit (PICU) of General Hospital, Yogyakarta, Indonesia in March 2022. We determine taxonomic profiles and also detect resistome, and virulome distribution of ESKAPE pathogens on various environmental surfaces through shotgun metagenomic sequencing. The microbiomes of the floor, sink, and mechanical ventilator exhibit a diverse composition of microbial communities, featuring significant species richness based on Shannon and Simpson’s index. These microbiomes encompass a wide array of microbial species, including ESKAPE bacterial pathogens, as well as profiles related to resistome and virulome. ESKAPE pathogens, especially Acinetobacter baumannii, predominated in the PICU environment. Most virulome have been associated with metabolism/nutrition and adhesion. Noteworthy findings include resistome genes characterized by mechanisms like efflux pumps (MDR) and alterations in antibiotic targets.

Penerapan Jaminan Asuransi Kesehatan terhadap Perlindungan Pegawai Negeri Sipil (PNS)

Study aims to determine the implementation of health insurance carried out by BPJS Kesehatan, and can be used as a consideration in formulating and designing policies for implementing health insurance for Civil Servants (PNS) and also to find out the obstacles faced by BPJS Kesehatan Langkat Branch. The type of research used is descriptive qualitative research. The conclusions of this study in brief are: (1) The implementation of health insurance at the Langkat Branch of Health BPJS is in accordance with the law on state civil servants that civil servants are entitled to receive pension security, old age security, health insurance, work accident insurance and death security. And the implementation of health insurance for civil servants at BPJS Kesehatan Langkat Branch is in accordance with Law No. 24 of 2011, which stipulates that BPJS Kesehatan functions to organize a health insurance program with the aim of ensuring that participants receive health care benefits and protection in meeting basic health needs. (2) Obstacles found in the Langkat Branch of BPJS Health are delays in service to participants, health facilities obtained are not in accordance with the fees paid, lack of participant data collection. The solution to the obstacles in the Langkat Branch Health BPJS needs to be improved in the service system because what participants need is fast, accurate service and can provide convenience in participant administration.&#x0D; Keywords: Insurance, Health Insurance, Civil Servants, Services, Protection.

In-hospital outcomes in unhoused patients with cardiogenic shock in the United States: Insights from The National Inpatient Sample 2011-2019.

Unhoused patients face significant barriers to receiving health care in both the inpatient and outpatient settings. For unhoused patients with heart failure who are in extremis, there is a lack of data regarding in-hospital outcomes and resource utilization in the setting of cardiogenic shock (CS). Unhoused patients hospitalized with CS have increased mortality and decreased use of invasive therapies as compared to housed patients. The National Inpatient Sample (NIS) database was queried from 2011 to 2019 for relevant ICD-9 and ICD-10 codes to identify unhoused patients with an admission diagnosis of CS. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for prespecified and significantly different baseline characteristics (p < .05). We identified a weighted sample of 1 202 583 adult CS hospitalizations, of whom 4510 were unhoused (0.38%). There was no significant difference in the comorbidity adjusted odds of mortality between groups. Unhoused patients had lower odds of receiving mechanical circulatory support, left heart catheterization, percutaneous coronary intervention, or pulmonary artery catheterization. Unhoused patients had higher adjusted odds of infectious complications, undergoing intubation, or requiring restraints. These data suggest that, despite having fewer traditional comorbidities, unhoused patients have similar mortality and less access to more aggressive care than housed patients. Unhoused patients may experience under-diuresis, or more conservative care strategies, as evidenced by the higher intubation rate in this population. Further studies are needed to elucidate long-term outcomes and investigate systemic methods to ameliorate barriers to care in unhoused populations.

Patient Priorities–Aligned Care for Older Adults With Multiple Conditions

Older adults with multiple conditions receive health care that may be burdensome, of uncertain benefit, and not focused on what matters to them. Identifying and aligning care with patients' health priorities may improve outcomes. To assess the association of receiving patient priorities care (PPC) vs usual care (UC) with relevant clinical outcomes. In this nonrandomized controlled trial with propensity adjustment, enrollment occurred between August 21, 2020, and May 14, 2021, with follow-up continuing through February 26, 2022. Patients who were aged 65 years or older and with 3 or more chronic conditions were enrolled at 1 PPC and 1 UC site within the Cleveland Clinic primary care multisite practice. Data analysis was performed from March 2022 to August 2023. Health professionals at the PPC site guided patients through identification of values, health outcome goals, health care preferences, and top priority (ie, health problem they most wanted to focus on because it impeded their health outcome goal). Primary clinicians followed PPC decisional strategies (eg, use patients' health priorities as focus of communication and decision-making) to decide with patients what care to stop, start, or continue. Main outcomes included perceived treatment burden, Patient-Reported Outcomes Measurement Information System (PROMIS) social roles and activities, CollaboRATE survey scores, the number of nonhealthy days (based on healthy days at home), and shared prescribing decision quality measures. Follow-up was at 9 months for patient-reported outcomes and 365 days for nonhealthy days. A total of 264 individuals participated, 129 in the PPC group (mean [SD] age, 75.3 [6.1] years; 66 women [48.9%]) and 135 in the UC group (mean [SD] age, 75.6 [6.5] years; 55 women [42.6%]). Characteristics between sites were balanced after propensity score weighting. At follow-up, there was no statistically significant difference in perceived treatment burden score between groups in multivariate models (difference, -5.2 points; 95% CI, -10.9 to -0.50 points; P = .07). PPC participants were almost 2.5 times more likely than UC participants to endorse shared prescribing decision-making (adjusted odds ratio, 2.40; 95% CI, 0.90 to 6.40; P = .07), and participants in the PPC group experienced 4.6 fewer nonhealthy days (95% CI, -12.9 to -3.6 days; P = .27) compared with the UC participants. These differences were not statistically significant. CollaboRATE and PROMIS Social Roles and Activities scores were similar in the 2 groups at follow-up. This nonrandomized trial of priorities-aligned care showed no benefit for social roles or CollaboRATE. While the findings for perceived treatment burden and shared prescribing decision-making were not statistically significant, point estimates for the findings suggested that PPC may hold promise for improving these outcomes. Randomized trials with larger samples are needed to determine the effectiveness of priorities-aligned care. ClinicalTrials.gov Identifier: NCT04510948.

Study on Pattern of Self-Management Practices in Patients of Diabetes in Rural Population in Aligarh

Self care involves all decisions which individuals, families,take for their own health particularly their own physical andmental well being. Staying fit, exercising, avoiding hazardous behavior etc. will all compound to self care.The aim ofthis study is to find the pattern of self care management practices in patients of Diabetes. A cross sectional study wasdone in registered villages of Rural Health Training Centre and 316 population was covered. All patients of the selectednon communicable diseases above 18 years of age were selected who gave their consent. Self care practice assessmentwas done by including: Diabetes specific section including SDSCA measure - Summary of Diabetes Self- Care ActivitiesQuestionnaire. The findings showed that the prevalence of self-care practices in patients of diabetes was not very high.Slightly more than 50% diabetics were following good levels of self-care practices. Individual levels of self-care practiceslike medication, physical activity/ exercise, adequate diet, risky behaviours of tobacco intake and alcohol consumption,monitoring blood pressure/ blood sugar/ symptoms of COPD, weight management etc. showed varied prevalence.Mostly the patients with any non-communicable disease were found adherent to their medications. In patients ofdiabetes; age group, presently attending any health facility for disease management and receiving health care provider’sadvice for lifestyle modifications were associated significantly with self-care practices.

Study on Pattern of Self-Management Practices in Patients of Diabetes in Rural Population in Aligarh

Self care involves all decisions which individuals, families,take for their own health particularly their own physical andmental well being. Staying fit, exercising, avoiding hazardous behavior etc. will all compound to self care.The aim ofthis study is to find the pattern of self care management practices in patients of Diabetes. A cross sectional study wasdone in registered villages of Rural Health Training Centre and 316 population was covered. All patients of the selectednon communicable diseases above 18 years of age were selected who gave their consent. Self care practice assessmentwas done by including: Diabetes specific section including SDSCA measure - Summary of Diabetes Self- Care ActivitiesQuestionnaire. The findings showed that the prevalence of self-care practices in patients of diabetes was not very high.Slightly more than 50% diabetics were following good levels of self-care practices. Individual levels of self-care practiceslike medication, physical activity/ exercise, adequate diet, risky behaviours of tobacco intake and alcohol consumption,monitoring blood pressure/ blood sugar/ symptoms of COPD, weight management etc. showed varied prevalence.Mostly the patients with any non-communicable disease were found adherent to their medications. In patients ofdiabetes; age group, presently attending any health facility for disease management and receiving health care provider’sadvice for lifestyle modifications were associated significantly with self-care practices.