Receiving Health Care Services Research Articles

Effects of disability on adverse health outcomes and anthropometric deficits among under-five children in South Asian countries: evidence from multiple indicator cluster surveys

Children with disabilities face an increased risk of adverse health outcomes and poor anthropometric deficits, although the focus on them is limited in the South Asian context thus far and need newer and more evidence. This study investigates the effects of disability on adverse health outcomes and anthropometric deficits among 2-4 years aged children in South Asian countries. We analyzed data from 93,180 children aged 2-4 years across Bangladesh, Nepal, Pakistan, and Afghanistan using Multiple Indicator Cluster Surveys (2017-2023). Disability status was the primary exposure, and outcomes included adverse health outcome (acute respiratory infection, diarrhea, fever), anthropometric deficit (stunting, wasting, underweight), and healthcare service sources during adverse health events (care received from skilled healthcare personnel, care received from non-professional personnel, and care received from health facility workers other than skilled healthcare personnel). Using multilevel and multinomial logistic regression models, we examined associations between exposure and outcome variables, adjusting for covariates. We found average disability prevalence in South Asia was 8.7% (8.3-9.0; n=8072), varying from 3.4% (3.0-3.8; n=446) in Bangladesh to 12.3% (11.4-13.3; n=1259) in Afghanistan. Common health issues included fever (n=24,982, 26.8%, 26.2-27.4) and diarrhea (n=14,081, 15.1%, 14.7-15.6), while prevalent poor anthropometric deficits were stunting (n=39,766, 42.7%, 42.0-43.3) and underweight (n=22,390, 24.0%, 23.5-24.5). Children with disability had 1.30 (95% CI: 1.21-1.40) to 1.60 (95% CI: 1.47-1.75) times and 1.17 (95% CI: 1.05-1.29) to 1.39 (95% CI: 1.30-1.48) times higher likelihoods of adverse health outcomes and anthropometric deficits, respectively, with variations observed among countries and different disability types. Individuals with disability were 1.16 (95% CI: 1.00-1.35) to 1.26 (95% CI: 1.01-1.58) times more likely to receive healthcare services from skilled healthcare personnel compared to health facility workers other than skilled healthcare personnel. This study findings emphasizes the need for community-level awareness programs to improve anthropometric well-being and healthcare of the children with disability. This research did not receive any specific funds.

Documentation of social determinants of health across individuals from different racial and ethnic groups in home healthcare.

Home healthcare (HHC) enables patients to receive healthcare services within their homes to manage chronic conditions and recover from illnesses. Recent research has identified disparities in HHC based on race or ethnicity. Social determinants of health (SDOH) describe the external factors influencing a patient's health, such as access to care and social support. Individuals from racially or ethnically minoritized communities are known to be disproportionately affected by SDOH. Existing evidence suggests that SDOH are documented in clinical notes. However, no prior study has investigated the documentation of SDOH across individuals from different racial or ethnic backgrounds in the HHC setting. This study aimed to (1) describe frequencies of SDOH documented in clinical notes by race or ethnicity and (2) determine associations between race or ethnicity and SDOH documentation. Retrospective data analysis. We conducted a cross-sectional secondary data analysis of 86,866 HHC episodes representing 65,693 unique patients from one large HHC agency in New York collected between January 1, 2015, and December 31, 2017. We reported the frequency of six SDOH (physical environment, social environment, housing and economic circumstances, food insecurity, access to care, and education and literacy) documented in clinical notes across individuals reported as Asian/Pacific Islander, Black, Hispanic, multi-racial, Native American, or White. We analyzed differences in SDOH documentation by race or ethnicity using logistic regression models. Compared to patients reported as White, patients across other racial or ethnic groups had higher frequencies of SDOH documented in their clinical notes. Our results suggest that race or ethnicity is associated with SDOH documentation in HHC. As the study of SDOH in HHC continues to evolve, our results provide a foundation to evaluate social information in the HHC setting and understand how it influences the quality of care provided. The results of this exploratory study can help clinicians understand the differences in SDOH across individuals from different racial and ethnic groups and serve as a foundation for future research aimed at fostering more inclusive HHC documentation practices.

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

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.

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.

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.

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.

Family-Centered Care and Delayed or Missed Pediatric Preventive Care due to the COVID-19 Pandemic

ObjectiveTo examine the association between family-centered care and its components with delayed or missed preventive care due to the COVID-9 pandemic among US children. MethodsThis is a cross-sectional study using nationally representative data from the 2021 National Survey of Children’s Health (NSCH). Children were eligible if they received health care services in the past 12 months (n = 42,649; 79.3%). We excluded children with missing data, for a final sample of 40,511 (93.7% of the eligible sample). Children were deemed to have received family-centered care if caregivers responded “always” or “usually” to all five measures of family-centered care. Poisson regression was used to ascertain weighted prevalence ratios (PRs) and 95% confidence intervals (CIs). Predisposing, enabling, and need factors of health care services use were evaluated as potential confounders. ResultsApproximately 86.7% of children received family-centered care during the pandemic, with significant racial and ethnic differences, findings consistent with pre-pandemic data. In multivariable analyses adjusted for the child’s race and age, family-centered care was associated with a 30% reduced likelihood of delayed or missed preventive care (95% CI: 0.64–0.78). Individual components of family-centered care were associated with a 26%−43% reduced likelihood of delayed or missed preventive care. ConclusionsFamily-centered care and its components were associated with a reduced likelihood of delayed or missed pediatric preventive care. Our findings highlight the important role of health care providers in curbing the negative effects of the COVID-19 pandemic on pediatric preventive care utilization and emphasize the need to expand family-centered care among racial and ethnic minority groups.

Cultural Challenges Faced By Women in Accessing Maternal Healthcare Services

Women in Pakistan face numerous cultural challenges in accessing maternal healthcare services. The study aims to see what cultural barriers women face in seeking health care services and decision-making. The objective was to study the challenges, women's autonomy, women's health-seeking behavior, and food taboos, that limit access to women attending healthcare services. Using Exploratory methodology, in-depth interviews were held with 24 such women in Jhang Sayedan Islamabad, in May 2023. Findings suggested that although women do want to receive healthcare services, cultural barriers often make it difficult for such women to access healthcare services and food taboos are sometimes useful, but they sometimes also affect women's health negatively. Other challenges such as lack of knowledge, not having the right to decision-making, limited support, hierarchy, and taboos need to be tackled. Men are crucial in deciding a woman's medical requirements and determining whether they need medical assistance or not.

Access to healthcare services and confidence in healthcare professionals’ management of malaria: the views of Francophone sub-Saharan African Immigrants living in western Canada

BackgroundThere is a paucity of knowledge about the healthcare attitudes and practices of French-speaking immigrants originating from Sub-Saharan Africa (FISSA) living in minority settings. The purpose of this study was to characterize FISSA healthcare experiences and confidence in the malaria-related knowledge of health professionals in Edmonton.MethodsA structured survey was used to examine a cohort of 382 FISSA (48% female; 52% male) living in Edmonton. FISSA general healthcare attitudes, experiences and satisfaction with the Canadian healthcare system were studied. Healthcare Competency Perception (HCP) was characterized by using an index score. Statistical analyses were performed to evaluate the impact of healthcare experiences and other outcomes.ResultsIntriguingly, while only 42% of FISSA had a French-speaking family physician, 83% (197/238) of those who had received health care services in Alberta found that access to medical treatment was easy, and 77% (188/243) were satisfied with received care. Although 70% (171/243) of FISSA did not receive services in French, 82% (199/243) surprisingly reported having good levels of comprehension during their visits. Satisfaction with care was associated with having a family physician (p = 0.018) and having health insurance (p = 0.041). Nevertheless, confidence in the healthcare system’s ability to treat malaria effectively was significantly lower, with only 39% (148/382) receiving a positive score on the HCP index.ConclusionThis study provides an important insight into FISSA experience with and perception of the Alberta’s healthcare system.

Perceptions of Shared decision making in cognitive impairment of LTC recipients

AbstractBackgroundShared decision‐making (SDM) plays a dominant model in healthcare systems in bringing numerous benefits to healthcare settings, healthcare providers, and patients. Promoting SDM in long‐term care (LTC) is also crucial since the LTC recipients were vulnerable to cognitive impairments and received healthcare services from diverse health professionals. This study aimed to assess the perceptions of LTC recipients toward SDM in situations of cognitive impairment.MethodA survey and one‐to‐one interview were provided to LTC recipients which explored the role of patients and family members in the decision‐making process related to their health care in the condition of cognitive impairments.ResultThirty‐eight LTC recipients participated in the SDM survey. The participants had a mean age of 77.9 (years) and were diagnosed as eligible LTC recipients for 9.01 (years). In general, most participants expected their healthcare providers to share knowledge about their diseases, and information for medical treatments. The participants described their health symptoms to their healthcare providers in as much detail as possible when they arrived at the hospital since they understood their important role in engaging decisions related to their health. In particular, 65.8% preferred to have been informed about their health conditions, and diseases. 42.1% believed that they, family member(s), and their doctor(s) should be involved together in deciding the best option(s) for their treatment. 52.6% thought that they should be played as the most important person in deciding their treatments for their own health even in those with cognitive impairments.ConclusionThis study revealed the potential of implementing the SDM model in the LTC system, especially under the condition of cognitive impairments. The LTC recipients desire to be involved in the decision‐making process related to their health even if they are in cognitive impairments. Implementing the SDM model in the LTC system potentially results in promising person‐centred care, especially for enhancing the self‐control of the recipients with cognitive impairment and their families.

Preferences and Perspectives of Black Male Barbershop Patrons on Receiving Health Care in Nontraditional Settings.

Non-Hispanic Black men experience a disproportionate rate of morbidity and mortality from hypertension, cardiovascular disease, and other chronic conditions in the United States. Studies have demonstrated the efficacy of community-based health outreach in settings not traditionally utilized for health care. Understanding how potential future participants view health care services in nontraditional settings is a necessary step to ascertain the success of these interventions in the real world. Our study objective was to explore the preferences of Black male barbershop patrons regarding health care-provided services in these nontraditional settings. We recruited patrons of a Black-owned barbershop in the San Francisco Bay Area. Study participants were asked to complete a survey assessing individual attitudes and preferences toward the idea of receiving health care services in traditional and nontraditional settings. Among non-Hispanic Black males (n=17), 81% agreed or strongly agreed that they would prefer to receive health care in traditional clinics. Receiving care at the pharmacy (56% agreed or strongly agreed) and the patient's own home (53% agreed or strongly agreed) were the next most preferred locations. A minority of participants agreed or strongly agreed that they preferred to receive health care in nontraditional settings: 47% for barbershops, 19% for churches, and 6% for grocery stores. Participants expressed preference for traditional over nontraditional settings, despite listing barriers that may be addressed, in part, by nontraditional settings. One potential reason for this is simply a lack of familiarity. Establishing and normalizing nontraditional clinical settings may allow for enhanced acceptance within Black communities, ultimately increasing health care access.

Abstract 18508: Usability of Novel Automated Software for Guiding Remote Titration of Antiarrhythmic Drugs

Introduction: We tested the first novel software application to accurately measure QTc using a machine learning algorithm from a mobile ECG and recommend patient-specific antiarrhythmic drug (AAD) dosing. The software was developed to address disparities in AAD hospitalizations that disproportionately affect minority patients. We evaluated the usability of the software interface using the validated Post-Study System Usability Questionnaire (PSSUQ) and mobile Health App Usability Questionnaire (MAUQ). Methods: Ten medical providers, 16 clinic staff, and 16 patients tested the novel software interface for remote titration of Sotalol and Dofetilide medications, followed by the validated PSSUQ and MAUQ surveys. An observer also evaluated each step of the software for completion and noted any challenges. Results: Providers rated the software interface highly, with an overall mean PSSUQ of 6.9 ± 0.2 and MAUQ of 6.8 ± 0.2, and 100% strongly agree on information quality (PSSUQ questions 7-12). Clinic staff and patients provided the highest ratings for system usefulness, with an overall PSSUQ mean of 6.4 ± 1.2 and MAUQ mean of 6.0 ± 1.2, ease of app use and user satisfaction, mean of 6.3 ± 1.1 and 5.9 ± 1.3 respectively. Eighty percent of users found the system easy to use and were satisfied, with 76% rating the app as an acceptable way to receive healthcare services and felt comfortable communicating with their providers using the app. Conclusion: The novel automated software application, designed to improve access to antiarrhythmic drugs and reduce healthcare disparities, received high usability ratings, indicating feasibility for remote administration of antiarrhythmic drugs.

COVID-19 Vaccine Accessibility, Perceptions, and Attitudes in the LGBTQ+ Community.

Lesbian, gay, bisexual, transgender, and queer populations have historically experienced challenges accessing, trusting, and receiving health care services, which can negatively impact successful uptake of the COVID-19 vaccine series among this population. This research aimed to examine the perceptions and attitudes regarding the acceptability, accessibility, and efficacy of the COVID-19 vaccine among persons who self-identify within this community. A multidisciplinary, community-focused mixed-methods study was conducted. The quantitative portion of the study was conducted via an online survey throughout the United States for 2 months. The quantitative portion of the study consisted of multiple online focus group sessions after the completion of the survey. The online survey had an sample of 3868 participants, with 31 participants in the focus groups. High levels of acceptability toward COVID-19 vaccines were found within this community. Concerns highlighted included the need for culturally competent care, side effects of the vaccine, and unknown effects of the vaccine with hormone replacement therapy. Racial and ethnic minority, transgender, and nonbinary participants reported higher levels of uncertainty about vaccination. Findings demonstrate that most lesbian, gay, bisexual, transgender, and queer individuals felt comfortable with the COVID-19 vaccine, had a positive experience with the vaccination process, and believe that the vaccine can protect them and others from COVID-19. When developing future COVID-19 vaccination strategies and rollouts, public health officials should consider prioritizing lesbian, gay, bisexual, transgender, and queer individuals and other marginalized populations by partnering with local organizations to identify trusted organizations.

Predictive Analytics in Healthcare: Empowering Consultation with Machine Learning

The Smart Healthcare and Online Consultation initiative intends to offer patients a quick and convenient online platform for seeking medical advice and services. Real-time video consultations, appointment scheduling, prescription administration, and health records management are just a few of the capabilities available on the platform. To deliver individualized and superior healthcare services, the initiative to use cutting-edge such as AI, ML, and data analytics. By giving patients an easy and affordable way to receive healthcare services remotely, the Smart Healthcare and Online Consultation initiative has the potential to completely transform the healthcare sector.

Use of Care Guides to Reduce Emergency Department Visits by High-Frequency Utilizers

BackgroundHigh-frequency utilizers are defined as patients who present 10 or more times to the emergency department in a rolling 12-month period. High-frequency utilizers contribute to emergency department overcrowding and misuse of resources, and reduce the efficiency of health care systems. Care guides have proven to be an effective tool in reducing high-frequency utilizers. ObjectiveThe objective of this quality improvement project was to determine if implementing a care guide for high-frequency utilizers to address the core needs of the patient and facilitate resources through case management consultation decreases the number of visits and the cost of unreimbursed care to the emergency department from high-frequency utilizers. MethodsWe implemented care guides for high-frequency utilizers in September 2014. Prior to initiating the care guides, we educated the physicians, nurses, case managers, and social workers in the emergency department. ResultsFollowing the implementation of the care guides, there was a steady decline in the number of high-frequency utilizers (338 in 2013–68 in 2021), the number of total emergency department visits by high-frequency utilizers (6025 in 2013–1033 in 2021), and unreimbursed care ($2,068,063 in 2013–$589,298 in 2021). ConclusionThe use of care guides was a successful strategy in reducing emergency department visits and the cost of unreimbursed care by high-frequency utilizers by providing them with the education and resources they require to receive health care services in appropriate settings.

Exploring Veteran cultural competency in Canadian health care services

LAY SUMMARY On leaving the military, Canadian Armed Forces Veterans begin receiving health care services in the civilian community. Health care providers may not understand the military culture from which Veterans come and how military service can affect health and well-being. The purpose of this study was to identify what civilian health care providers need to know and do to provide culturally competent care to Canadian Veterans. Veterans and health care providers (family physicians and an occupational therapist) were interviewed, and specific knowledge, skills, and abilities were identified as important when establishing a quality health care relationship. This information can be used to develop resources for health care providers when beginning work with Veterans and their families, as well as for Veterans themselves as they transition to receiving care in civilian systems.

Evaluation of Maternal Fetal Outcomes of Pregnant Women and Mothers with Suspected Infection by SARS-CoV-2 Treated at the Municipal Hospital of São Bernardo do Campo (HMU-SBC), Brazil.

The impact of Covid-19 infection on pregnancy and perinatal outcomes is not fully known. To describe the risk factors and perinatal outcome of pregnant women with suspected COVID-19 infection. We evaluated medical records of women with suspected or confirmed SARS-CoV-2 infection who received health care services at the University Hospital of São Bernardo do Campo from March 1 to July 31, 2020, and personal, clinical, and laboratory data of these women and their newborns. Of the 219 women identified, 29% were asymptomatic. Considering the total population, 26% and 17% had obesity and hypertensive syndrome, respectively. Fever measured in the emergency room was the main reason for hospitalization. The presence or not of flu-like symptoms did not impact on perinatal outcomes. Pregnant women requiring hospitalization had newborns with lower birth weight (p < 0.01), shorter length (p = 0.02), and smaller head circumference (p = 0.03), and, in these cases, a higher number of cesarean section deliveries was observed. COVID-19 infection did not affect the prognosis of pregnancy and newborns. However, the worst clinical outcome, requiring hospitalization, had an impact on the anthropometric measurements of newborns.

Health Tourism Prevalence among Western Balkans Citizens During the COVID-19 Pandemic Period

Background: This study seeks to evaluate the prevalence of and the association between receiving medical care abroad and the level of trust that citizens from the Western Balkans—Albania, Bosnia and Herzegovina, Kosovo and Montenegro—have in their healthcare systems. Methods: The study is cross-sectional and was carried out during three months (July 25-October 30, 2021) through a self-reported questionnaire administered through the Google Forms platform. The study included approximately two-thousand citizens (N=2,356) aged eighteen (18) to seventy (70). Results: More than one-third (37.2%) of respondents stated that they or a relative had received healthcare services abroad during the last twelve (12) months. Citizens of Montenegro had the highest prevalence of receiving healthcare services abroad at 43.8%, followed by those from Bosnia and Herzegovina at 39%. No statistically significant difference was found in the level of trust in the healthcare system in the country between those who received healthcare services abroad (4.41±2.88) (out of 10) and those who did not (4.48±2.81) (t= -0.587, p=0.557). Conclusion: We ultimately conclude that more than one-third of the participants in our study have traveled abroad for healthcare purposes, with females, those living in urban areas, and those who have previously had a negative healthcare experience in their home country all being more likely to rely on health tourism.

Challenges of patients with multiple sclerosis in receiving health care services in Iran.

Background: Multiple sclerosis (MS) is a debilitating, non-traumatic, neurological disorder in young adults and can reduce quality of life (QoL) by interfering with the ability to work, leisure activities, and routine living tasks. Various studies have shown the dissatisfaction of people with MS in different areas of care services. Regarding the patients' weakness with care and services, we sought to identify the challenges for patients with MS in receiving care and services in Iran. Methods: This cross-sectional study was conducted in 2016-2018 using a researcher-made questionnaire (designed by MS Specialists in an MS research center). The questionnaire examined the care challenges in four areas: 1) costs of medication, hospitalization, and rehabilitation services, 2) family support, insurance system, and job protection, 3) access to transportation system and treatment team, 4) quality of the provided care and services. Results: Completed questionnaires were received from 945 respondents. The mean age of responders was 35.92 years. In total, 731 (77.8) participants were women and 208 (22.2) were men. Academic education was reported among 615 (65.3) participants and 367 (40.2) were employed during the study, while 99 (10.5) of the subjects were not able to walk a minimum of 20 meters. The prioritization of care services challenges was as follows: the cost of pharmaceutical services (49.1), lack of telephone counseling (47.4), uninsured home rehabilitation (44.7), lack of qualified care centers (41.2), and rehabilitation costs (40.2). Conclusion: We found that patients who could not walk at least 20 meters and unemployed individuals had more problems and lower QoL. The patients who had non-academic education had more challenges with the cost of medication, transportation, and lack of familial support. This study shows the challenges of MS patients in receiving health care in Iran that vary in age, education, employment, and ability to walk. As the abovementioned challenges are of great importance in determining the QoL of people with MS, an appropriate solution is provided in this study to overcome these challenges.