Type Of Health Facility Research Articles

Chondrosarcoma of the Mobile Spine in the Elderly: A National Cancer Database Study

BackgroundThe current research on geriatric patients with spinal chondrosarcoma is limited. This study aimed to investigate the demographics, patterns of care, and survival of geriatric patients with chondrosarcoma of the mobile spine. MethodsThe National Cancer Database was queried from 2008 to 2018 for geriatric patients (60-89 years) with chondrosarcoma of the mobile spine. The primary outcome of this study was overall survival (OS). The secondary outcome was treatment utilization patterns. Survival analyses were conducted using log-rank tests and Cox proportional hazards regressions. Logistic regression models were utilized to assess correlations between baseline variables and treatment utilization. ResultsThe database retrieved 122 patients. While 43.7% of the patients presented with tumors exceeding 5cm in size, the incidence of regional lymph node involvement or distant metastases was relatively low, affecting only 5% of the patients. Furthermore, 22.3% of the patients had tumors graded as 3-4. The five-year OS rate was 52.9% (95% confidence interval 42-66.6). The mortality risk was significantly associated with age, tumor grade and stage, and treatment plan. Most patients (79.5%) underwent surgery, while 35.9% and 4.2% were treated with radiotherapy and chemotherapy, respectively. Age, race, comorbidities, geographical region, tumor stage, and healthcare facility type significantly correlated with treatment utilization. ConclusionSurgical resection significantly lowered the mortality risk in geriatric patients with spinal chondrosarcomas. Demographic and geographical factors significantly dictated treatment plans. Further studies are required to assess the role of radiotherapy and chemotherapy in treating these patients in the modern era.

Analysis of Factors Influencing BPJS Membership Status in the Independent (PBPU) and Non-Worker Segments

Introduction: Universal Health Coverage (UHC) is a significant agenda outlined in the SDG 2030. In order to achieve UHC, Indonesia established the Social Security Management Agency (BPJS) in 2014. Nearly a decade after its establishment, BPJS experienced a financial deficit in its first six years, followed by a surplus during the COVID-19 pandemic. This has impacted the sustainability of BPJS Health. One of the factors contributing to the financial deficit is the non-compliance of participants in paying BPJS contributions, particularly in the Non-Wage Earner/Self-Employed/Independent (PBPU) and Non-Worker segments who are required to pay contributions individually. When participants fail to pay contributions for six consecutive months, their membership status is converted to inactive. From the 2022 BPJS Sample Data, it was found that 799,384 out of 2,305,435 (34.67%) participants had inactive membership status. Objective: This study aims to analyze the factors influencing BPJS membership status in the Independent and Non-Worker segments. Method: The method that used in this study is quantitative analysis of secondary data from the 2022 BPJS Sampel Data with the Linear Probability Model (LPM), Logit and Probit Models. The analysis is conducted using STATA to obtain univariate, bivariate and multivariate analyses. Result: From a sample of 545,507 participants, if was found that 54.20% had inactive membership status. Factors such as age, gender, marital status, treatment class, healthcare facility type, and participant segmentation affect membership status. The LPM regression results indicate that the factors leading to inactive membership status are being of productive age, male, belonging to class 1 and 2, utilizing primary healthcare facilities, and being in the Independent segment. Conclusion: Therefore, stateholders such as the central government and BPJS need to collaborate in efforts to reduce the number of inactive membership statuses.

Increasing electricity access for health facilities in Ghana through solar powered mini-grids—a GIS-based energy system modelling approach

The research aims to identify which healthcare facilities (HCFs) in Ghana are suitable for electrification using photovoltaic mini-grids to increase their energy self-sufficiency and reliability of services provided. Additionally, the study categorises the HCFs in two groups: those with and without or with poor access to electricity supply, identify settlements within their catchment area, and determine the electricity demand for identified HCF sites and their surrounding communities. The research assesses the most suitable mini-grid system setup to electrify identified HCF sites and the impact of including the demand of surrounding communities into the energy system modelling. Finally, the study aims to determine the accumulated solar mini-grid potential to electrify all identified HCF sites. The study findings highlight the importance of integrated planning between the health and energy sectors to ensure high-quality health services. Solar mini-grids are identified as a promising solution for electrifying HCFs and improving energy self-sufficiency. However, it is recommended to avoid transferring findings between different types of health facilities due to their unique characteristics. The study also emphasizes the importance of balancing the energy flow and stabilizing the energy system through the combination of HCFs and surrounding communities’ demand. It is crucial to assess the electricity demand carefully based on context-specific characteristics, such as the type of HCF and the number of households considered. Overall, the study provides valuable insights into the potential of solar mini-grids to increase energy self-sufficiency in HCFs and the importance of careful planning and context-specific assessments.

Antenatal care component utilization and associated factors among pregnant women in Ethiopia: Multilevel analysis of Ethiopian Mini Demographic and Health survey 2019.

Maternal and neonatal health are among the top prioritised agendas of global health care with due emphasis given to developing countries, where the burden is profound. Antenatal care accompanied by its recommended components is highly beneficial for both maternal health and birth outcome. The objective of this study was to identify the proportion of pregnant women who received adequate Antenatal care components and associated factors among Ethiopian women. We used a nation-wide data from Mini Ethiopian Demographic and Health Survey (MEDHS) of 2019. All women of age 15-49 and who had at least one ANC visit, who were either permanent residents of the selected households or visitors who slept in the household the night before the survey, were eligible to be interviewed. Since we utilised multilevel logistic regression model, the STATA output had two components, the fixed effect and the random effect. In our model, the fixed effect part was displayed by odds ratio while the random effect was addressed by variance and intra-cluster correlation (ICC). From the total women with at least one antenatal care (ANC) visit 55.41% (95% CI 53.60%, 57.20%) of them received adequate components of the care. In the final model after adjusting for the cluster and individual level variables, attending primary (AOR = 1.45; 95% CI: 1.15 to 1.84), secondary (AOR = 2.21; 95% CI: 1.51 to 3.24) and higher education (AOR = 2.42; 95% CI: 1.38 to 4.26) were significantly associated with higher odds of receiving adequate components of ANC. Similarly, wealth index of middle (AOR = 1.51; 95% CI: 1.06, 2.14), richer (AOR = 1.92; 95% CI: 1.32, 2.80), and richest (AOR = 3.86; 95% CI: 2.35, 6.33) compared to poorest index and having two or more ANC visits were significantly associated with receiving adequate components of ANC. On the other hand, being from Oromia region, from female headed household and protestant religion were negatively associated with receiving adequate components of ANC. The proportion of women who received adequate ANC component was much lower compared to the universal recommendation for every woman on ANC visit. Educational status, wealth index, number of ANC visit, region of residence and type of health facility were significantly associated with the odds of receiving adequate components of ANC. The government should pay attention to those without any formal education, encouraging pregnant women to receive the optimum number of ANC visits, and devising techniques to address those in poorest wealth index so that the proportion of adequate components of ANC will be increased.

Factors associated with the timely diagnosis of malaria and the utilization of types of healthcare facilities: a retrospective study in the Republic of Korea.

This study aimed to analyze trends in the timely diagnosis of malaria cases over the past 10 years in relation to the utilization of different types of healthcare facilities. The study included 3,697 confirmed and suspected cases of malaria reported between January 1, 2013, and December 31, 2022, in the national integrative disease and healthcare management system. Some cases lacking a case report or with information missing from the case report were excluded from the analysis. A generalized linear model with a Poisson distribution was constructed to estimate risk ratios and 95% confidence intervals adjusted for other variables, such as distance. When cases involving diagnosis >5 days after symptom onset in confirmed patients (5DD) were examined according to the type of healthcare facility, the risk ratio of 5DD cases was found to be higher for tertiary hospitals than for public health facilities. Specifically, the risk ratio was higher when the diagnosis was established at a tertiary hospital, even after a participant had visited primary or secondary hospitals. In an analysis adjusted for the distance to each participant's healthcare facility, the results did not differ substantially from the results of the crude analysis. It is imperative to improve the diagnostic capabilities of public facilities and raise awareness of malaria at primary healthcare facilities for effective prevention and control.

Drug Prescription Indicators in Outpatient Services in Social Security Organization Facilities in Iran.

The aim of this study was to estimate drug prescription indicators in outpatient services provided at Iran Social Security Organization (SSO) healthcare facilities. Data on all prescribed drugs for outpatient visits from 2017 to 2018 were extracted from the SSO database. The data were categorized into 4 main subgroups: patient characteristics, provider characteristics, service characteristics, and type of healthcare facility. Logistic regression models were used to detect risk factors for inappropriate drug prescriptions. SPSS and IBM Modeler software were utilized for data analysis. In 2017, approximately 150 981 752 drug items were issued to outpatients referred to SSO healthcare facilities in Iran. The average number of drug items per outpatient prescription was estimated at 3.33. The proportion of prescriptions that included an injection was 17.5%, and the rate of prescriptions that included an antibiotic was 37.5%. Factors such as patient sex and age, provider specialty, type of facility, and time of outpatient visit were associated with the risk of inappropriate prescriptions. In this study, all drug prescription criteria exceeded the recommended limits set by the World Health Organization. To improve the current prescription patterns throughout the country, it would be beneficial to provide providers with monthly and annual reports and to consider implementing some prescription policies for physicians.

Indonesian air medical evacuation: Analyzing readiness and proposing an integrated standard procedure.

Indonesia still faces challenges in providing healthcare services, and it is crucial to develop an air medical evacuation services system for at least two reasons. Firstly, Indonesia is an archipelagic country and a popular tourist destination. Secondly, there are still significant disparities in the number and types of healthcare facilities and health workers nationwide. To respond to the current situation, the healthcare providers and government have made some efforts regarding air medical evacuation but are showing an unintegrated system. This qualitative study aimed to explore the current implementation of air medical evacuation in Indonesia and to propose an integrated standard procedure that all related stakeholders can adopt at the national and regional levels. The study used a multi-case design analysis, collecting both primary and secondary data. Secondary data was gathered through desk studies to learn related policies and previous studies. Primary data was collected through observation and in-depth interviews with relevant stakeholders, including regulators, service providers, practitioners, and non-governmental organizations. The study found that there is currently a regulatory gap for the implementation of air medical evacuation services in Indonesia. The readiness of the Health Human Resources (HHR) is limited in terms of qualification and competency, and the definitive infrastructure of air medical evacuation requires improvement since the providers continue to use the airport for civil transportation. Besides, the interaction pattern between stakeholders needs to be integrated into standardized procedures. Therefore, the study recommends proposing an integrated standard procedure and actionable recommendations to advocate for all stakeholders.

Availability and stock-outs of paediatric antiretroviral treatment formulations at health facilities in Kenya and Uganda.

The large number of deaths among children with HIV is driven by poor antiretroviral treatment (ART) coverage among this cohort. The aim of the study was to assess the availability and stock-outs of paediatric and adult ART formulations in Kenya and Uganda across various regions and types of health facilities. A survey on availability and stock-outs of paediatric ART at health facilities was adapted from the standardized Health Action International-WHO Medicine Availability Monitoring Tool. All preferred and limited-use formulations, and three phased-out formulations according to the 2021 WHO optimal formulary list were included in the survey, as well as a selection of adult ART formulations suitable for older children, adolescents, and adults. Availability data were collected in June-July 2022 and stock-out data were obtained over the previous year from randomly selected public and private-not-for-profit (PNFP) facilities registered to dispense paediatric ART across six districts per country. All data were analysed descriptively. In total, 144 health facilities were included (72 per country); 110 were public and 34 PNFP facilities. Overall availabilities of preferred paediatric ART formulations were 52.2% and 63.5% in Kenya and Uganda, respectively, with dolutegravir (DTG) 10 mg dispersible tablets being available in 70.2% and 77.4% of facilities, respectively, and abacavir/lamivudine dispersible tablets in 89.8% and 98.2% of facilities. Of note, availability of both formulations was low (37.5% and 62.5%, respectively) in Kenyan PNFP facilities. Overall availabilities of paediatric limited-use products were 1.1% in Kenya and 1.9% in Uganda. At least one stock-out of a preferred paediatric ART formulation was reported in 40.0% of Kenyan and 74.7% of Ugandan facilities. Nevirapine solution stock-outs were reported in 43.1% of Ugandan facilities, while alternative formulations for postnatal HIV prophylaxis were not available. Recommended DTG-based first-line ART for children across all ages was reasonably available at health facilities in Kenya and Uganda, with the exception of Kenyan PNFP facilities. Availability of paediatric ART formulations on the limited-use list was extremely low across both countries. Stock-outs were reported regularly, with the high number of reported stock-outs of neonatal ART formulations in Uganda being most concerning.

Health insurance financing and patient retention in care at diabetics and hypertension clinics in Dar es Salaam and Pwani regions, Tanzania. A cohort study.

Hypertension and diabetes are chronic conditions that cause major morbidity and mortality worldwide. Whether health insurance financing is associated with improved retention in chronic care in Tanzania, is unknown. Our study establishes the effect of health insurance on retention and the determinants for retention in care among patients attending diabetes and hypertension clinics. We used a Cohort design to study participants enrolled in a cluster-randomized trial of integrated management of HIV, diabetes, and hypertension compared with standard vertical care in the INTE-AFRICA trial. Fifteen health facilities in Dar es Salam and Pwani regions were enrolled, with 1716 participants. Our sample size had 95% power to detect a 50% to 60% retention difference between the insured and uninsured groups (95% CI). We compared proportions using χ2 tests and obtained prevalence and rate ratios by Generalised Linear Models. We studied 1716 participants for 1612.3 Person-years (PY). At the study's end, 1351 persons were alive and retained in care. Among the insured participants (26.0%), females accounted for 65.9%. Middle-aged adults contributed 58.8% of insured participants. We observed high retention rates (retention incidence rate IR: 83.80/100 PY; 95% CI (79.40-88.40)). There was no difference in retention among insured and uninsured patients (adjusted rate ratio aRR: 1.00; 95% CI, 0.94-1.06). Being middle-aged or senior-aged adults compared to young adults, having diabetes alone or hypertension alone compared to both conditions, having the comorbidity of diabetes or hypertension with HIV compared to a single condition, and attending health centres and hospitals compared to dispensaries were significantly associated with retention in care. This study showed no effect of health insurance on retention in diabetic and hypertension care clinics. However, age, medical diagnosis, morbidity, and type of health facility attended were associated with retention in care.

Assessing the accuracy of health facility typology in representing the availability of health services: a case study in Mali

IntroductionUsing health facility types as a measure of service availability is a common approach in international standards for health system policy and planning. However, this proxy may not accurately reflect...

Characteristics of hospitalized patients with confirmed COVID-19 and their hospital management

Objective: To determine the risk factors of mortality among hospitalized COVID-19 patients. Methods: This retrospective study used hospitalization records collected by the Indonesia Health Social Security Administrator Agency (Badan Penyelenggara Jaminan Sosial Kesehatan-BPJS Kesehatan). A total of 38277 eligible patients with confirmed COVID-19 were analyzed. The dependent variable of the study was the discharge status (death or recovery) of COVID-19. Independent variables were history of morbidity and disease-related occurrence, type of room health facilities, length of stay and demographic variables (sex, age). The analyses use bivariate and multivariate logistic regression to determine the dominating variable associated with all these variables. Results: Of the 38 277 inpatients with PCR-confirmed COVID-19, 31051 (81.1%) were discharged and 7226 (18.9%) died. Risk of death was positively associated with older age (aOR 5.74, 95% CI 4.20-7.87 for 19-64 years old; aOR 13.75, 95% CI 9.99-18.92 for 65 years above), male sex (aOR 1.13, 95% CI 1.07-1.19), treated in ICU without ventilator (aOR 5.84, 95% CI 5.41-6.30) and had comorbid respiratory diseases (aOR 5.39, 95% CI 4.93-5.90), but negatively associated with hospital stay of 15 days or longer (aOR 0.39, 95% CI 0.36-0.43). Conclusions: COVID-19 related death during hospitalization was associated with duration and type of treatment, and existing medical condition among the inpatient individuals during COVID-19 pandemic in DKI Jakarta. The findings of the study suggest importance of appropriate and timely medical intervention and care.

Recovery Rates of Diagnostic Cardiac Procedural Volume in Oceania 1 Year Into COVID-19: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID 2)

The aim of this study was to assess the recovery rates of diagnostic cardiac procedure volumes in the Oceania Region, midway through the coronavirus disease 2019 (COVID-19) pandemic. A survey was performed comparing procedure volumes between March 2019 (pre-pandemic), April 2020 (during first wave of COVID-19 pandemic), and April 2021 (1 year into the COVID-19 pandemic). A total of 31 health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, as well as teaching and non-teaching hospitals. A comparison was made with 549 centres in 96 countries in the rest of the world (RoW) outside of Oceania. The total number and median percentage change in procedure volume were measured between the three timepoints, compared by test type and by facility. A total of 11,902 cardiac diagnostic procedures were performed in Oceania in April 2021 as compared with 11,835 pre-pandemic in March 2019 and 5,986 in April 2020; whereas, in the RoW, 499,079 procedures were performed in April 2021 compared with 497,615 pre-pandemic in March 2019 and 179,014 in April 2020. There was no significant difference in the median recovery rates for total procedure volumes between Oceania (-6%) and the RoW (-3%) (p=0.81). While there was no statistically significant difference in percentage recovery been functional ischaemia testing and anatomical coronary testing in Oceania as compared with the RoW, there was, however, a suggestion of poorer recovery in anatomical coronary testing in Oceania as compared with the RoW (CT coronary angiography -16% in Oceania vs-1% in RoW, and invasive coronary angiography-20% in Oceania vs-9% in RoW). There was no statistically significant difference in recovery rates in procedure volume between metropolitan vs regional (p=0.44), public vs private (p=0.92), hospital vs outpatient (p=0.79), or teaching vs non-teaching centres (p=0.73). Total cardiology procedure volumes in Oceania normalised 1 year post-pandemic compared to pre-pandemic levels, with no significant difference compared with the RoW and between the different types of health care facilities.

Assessment of occupational stress among certified registered anesthetists in the Greater Accra region.

Work-related stress is a prevailing concern within the community of Certified Registered Anesthetists (CRAs), significantly impacting both the health and professional performance of these individuals. This study aimed to assess work-related stress and its influencing factors among CRAs practicing in the Greater Accra region was examined. Using convenience sampling techniques, data were gathered from 140 participants via a Google form questionnaire distributed through WhatsApp. Descriptive statistics were employed to analyze the collected data, focusing on frequencies and proportions for categorical variables. For continuous variables, bivariate analysis (Chi-square) and ordinal logistic regression were conducted using STATA 16. A p-value <0.05 was considered significant. Among the 140 CRAs, 20 individuals (14.3%) reported experiencing mild stress levels according to the Weiman Occupational Stress Scale. Approximately 3 out of 4 CRAs (73.6%) reported having moderate stress levels, and 12.1% reported severe stress levels. This indicated that the majority of CRAs experienced moderate levels of stress, which was notably affected by the type of health facility and the use of inadequate or sub-standard equipment in the hospitals. Based on these findings, the study recommends educational programs and counseling for CRAs to heighten awareness of the demanding nature of their job. Additionally, it suggests the provision of proper resources and standard equipment for CRAs. Facility-level motivation for CRAs is also advised to alleviate their stress. Finally, the study proposes further investigations into the factors contributing to work-related stress among CRAs.

Challenges for healthcare Managers in 2023

Introduction: Managers in the field of healthcare face many challenges that are specific to this area and are caused by the dynamic and constantly changing healthcare environment. Research sample and research objective: The main research objective was to evaluate significant aspects of financing and organizing healthcare systems, summarize assumptions for the successful functioning of a healthcare system, assess factors influencing healthcare spending, and predict the challenges that healthcare managers will face in 2023 at both the micro (individual healthcare facilities) and macro (healthcare system in Slovakia) levels. The research sample was selected by deliberate selection and consisted of 109 respondents: healthcare managers (n=16), experts from the field of health management (n=15), experts from the field of human resources (n=19), directors of health facilities (n=10), medical (n=28) and paramedical staff (n=21). Methods: Statistical testing was carried out using the methods of inferential statistics: the independent samples t-test was used to compare mean scores between two groups (RQ1 and RQ2) and a one-way analysis of variance (ANOVA) to compare mean scores among three groups (RQ 3). Results: We found out there are no differences in the respondents’ opinions on the challenges for healthcare managers in 2023 based on their job titles, the type of health facility in which they work or according to the length of practice. Conclusion: According to the respondents, the most current trends and challenges for Slovak healthcare are: the need for qualified medical personnel, a focus on retaining employees and solving the growing costs of healthcare.

МНЕНИЕ ПАЦИЕНТОВ О ДОСТУПНОСТИ, КАЧЕСТВЕ И РЕЗУЛЬТАТИВНОСТИ МЕДИЦИНСКОЙ ПОМОЩИ

Relevance. He current healthcare strategy of Russia, among other significant priorities, highlights the achievement of high indicators of accessibility, quality and effectiveness of medical care. One of the tools for assessing the level of achievement of these indicators, including in dynamics, is the study of patients' opinions. Many authors note the importance of taking into account the opinion of patients about the care provided for the development and adoption of management decisions. However, there is a lack of scientific data on patients' opinions on the availability, quality and effectiveness of medical care, taking into account the different profile of services and the type of health care facilities. Objective. To study the opinion of patients about the accessibility, quality and effectiveness of medical care. Materials and methods. A multicenter sociological study was carried out in medical organizations of the Ivanovo, Yaroslavl and Moscow regions. The research method is a sociological survey. Respondents were offered the questionnaire "Patients' Opinion on the Availability, Quality and Effectiveness of Medical Care", which included 15 closed-ended questions. A sample population formed by random selection. Statistical processing of the material provided for the formation of a database in spreadsheets, the calculation of relative values and the reliability of their difference according to the student’s criterion. An analytical method was used to compare the data and formulate conclusions. Results. The sociological survey showed a "depression" of patients' opinions about health care, which is manifested in the high frequency of negative assessments of accessibility (23, 5 per 100 respondents), quality (19,5 per 100 respondents) and effectiveness of medical care (14,5 per 100 respondents) in general. There are differences in the assessment of patients by the profile of services and types of institutions, which makes it necessary to form a set of measures to correct deviations and conduct regular patient surveys on the principle of monitoring in order to assess their effectiveness. The frequency of patients' positive opinions on the availability of medical care was higher in the pediatric profile of services (60,2 per 100 respondents), preventive services (63,8 per 100 respondents), inpatient services (67,0 per 100 respondents), in the Moscow region (49,7 per 100 respondents). Conclusion. The theoretical significance of the data for assessing patients' opinions about the accessibility, quality and effectiveness of medical care is associated with the possibility of identifying and structuring existing problems in health care. This makes it possible to identify problems and contradictions that are clearly invisible and related to the emotional perception of care by patients, as well as to identify opportunities and directions for improving medical care.

Electronic aggregated data collection on cervical cancer screening in Bangladesh since 2014: what the data tells us?

IntroductionTo reduce the high prevalence of cervical cancers among the Bangladeshi women, the Government of Bangladesh established a national cervical cancer screening programme in 2005 for women aged 30 to 60 years. The District Health Information System Version 2 (DHIS2) based electronic aggregated data collection system is used since the year 2013. This study summarises data from the year 2014 to 2022 to assess the effectiveness of the electronic data collection system in understanding the outcome of the screening programme.MethodsThis is a descriptive study based on secondary data extracted in MS Excel from the DHIS2-based electronic repository of the national cervical cancer screening programme of Bangladesh. The respondents were women aged 30–60 years, screened for cervical cancer using VIA (Visual Inspection of cervix with Acetic acid) method in 465 government health facilities. The data were collected on the participants’ residential location, month and year of screening, name and type of health facilities performing VIA, and VIA screening results.ResultsThe national screening programme reported a total 3.36 million VIA tests from 465 government hospitals in 8 years (2014 to 2022). The national average VIA-positivity rate was 3.6%, which varied from 1.4 to 9.5% among the districts. This national screening programme witnessed an exponential growth, year after year, with 83.3% increase in VIA test from 2014 to 2022. The primary and the secondary care hospitals were the highest collective contributors of VIA tests (86.2%) and positive cases (77.8%). The VIA-positivity rates in different hospital types varied widely, 7.0% in the medical university hospital, 5.7% in the medical college hospitals, 3.9% in the district/general hospitals, and 3.0% in the upazila health complexes.ConclusionsA national cervical cancer screening programme using VIA method and a DHIS2-based electronic data collection backbone, is effective, sustainable, and useful to understand the screening coverage, VIA positivity rate and geographic distribution of the participants and case load to initiate policy recommendations and actions. Decentralization of the screening programme and more efforts at the primary and secondary care level is required to increase screening performances.

Analisis Kebutuhan Tenaga Keperawatan Dengan Metode Workload Indicator Staff Need (WISN) Di Ruang Rawat Inap RSUD dr. R.M. Djoelham Binjai

The WISN method is a resource management tool that calculates staff needs based on workload for certain staff categories and clearly the facility and type of health facility. This tool can be applied nationally, regionally, in health facilities, namely it is easy to use both technically, comprehensive, realistic and makes it easy to determine variations in human resource needs in various types of health services such as community health centers and hospitals. The aim of this research is to analyze the need for nursing staff based on workload using the Workload Indicator Staff Need (WISN) method in the Inpatient Room at RSUD dr. R.M. Djoelham Binjai in 2023. The research design used was descriptive research using observational techniques. The population in this study were all nurses in the Inpatient Room at RSUD dr. R.M. Djoelham Binjai, numbering 61 nurses, this population sampling was carried out using purposive sampling. The number of samples to be studied was 61 people. Data analysis was carried out using the WISN analysis. After the data was obtained from filling out the questionnaire by the researcher based on observations, recording and adjustments were made to the work documentation carried out by the nursing staff in the Inpatient Room. The results of research based on WISN method calculations show that the need for nursing staff in the Inpatient Room at RSUD dr. R.M. Djoelham Binjai still lacks 3 nursing staff. The conclusion was that there was an influence between working time, activities of nursing staff, workload standards, slack factors and calculations of nursing staff needs for nursing staff on the need for nursing staff in the Inpatient Room at RSUD dr. R.M. Djoelham Binjai, it is recommended that the Head of the Inpatient Room need to evaluate the division of tasks so that the nursing service process can be carried out well and improve the quality of service in the Inpatient Room at RSUD dr. R.M. Djoelham Binjai

Quantification of factors influencing differences in the Case Mix Index and their significance for health systems sustainability

Case Mix Index (CMI) represents a standard indicator of hospital disease seriousness at both the national and international level. CMI is structured to compute hospital payments and not to follow up disease seriousness. It is considerably related to the data accuracy as well as patients’ medical records. The main aim of the study was to quantify the factors influencing the differences in CMI depending on the types of healthcare facilities, their geographical location, as well as the procedural aspects within the Slovak healthcare system. We use data published by the Institute for Economic and Social Reforms, which continuously surveys the quality and outputs of healthcare provided in the Slovak Republic. The data comes from multiple datasets that are issued by healthcare authorities and stakeholders is the Slovak Republic such as insurance companies, the Ministry of Health of the Slovak Republic, the Ministry of Finance of the Slovak Republic, healthcare facilities, the National Health Information Centre etc. Regression analysis indicates that the positive impact on the Case Mix Index is possessed by the Operating experience of doctors and Overall inpatients satisfaction; whilst the negative impact on Case Mix Index values is documented for variables Total rehospitalisation within 30 d, Intensive care unit mortality, Economy, and Transparency.

Pregnant women’s satisfaction with the quality of antenatal care and the continued willingness to use health facility care in Lusaka district, Zambia

BackgroundAntenatal healthcare (ANC) reduces maternal and neonatal deaths in low-middle-income countries. Satisfaction with ANC services and perception of quality of care are critical determinants of service utilization. The study aimed to assess pregnant women’s satisfaction with ANC and identify sociodemographic factors associated with satisfaction and their continued willingness to use or recommend the facility to relatives or friends, in Lusaka district, Zambia.MethodsThis was a cross-sectional study involving 499 pregnant women in Lusaka district. A combination of stratified, multistage, and systematic sampling procedures was used in selecting health facilities and pregnant women. This allowed the researcher to assess exposure and status simultaneously among individuals of interest in a population. Structured survey instruments and face-face-interview techniques were used in collecting data among pregnant women who were receiving ANC in selected health facilities.ResultsOverall, the proportion of pregnant women who were fully satisfied with ANC was 58.9% (n = 292). Pregnant women’s satisfaction score ranged from physical aspects (40.9 - 58.3%), interpersonal aspects (54.3 - 57.9%) to technical aspects of care (46.9 - 58.7%). Husbands’ employment status (OR = 0.611, 95%CI = 0.413 – 0.903, p = 0.013), monthly household income level of > 3000 - ≤6000 Kwacha (OR = 0.480, 95%CI = 0.243 – 0.948, p = 0.035 were significantly associated with the interpersonal aspects and the physical aspects of care, respectively. Besides, pregnant women who were in their third trimester (above 33 weeks), significantly predicted satisfaction with the physical environment of antenatal care (OR = 3.932, 95%CI = 1.349 – 11.466, p = 0.012). In terms of the type of health facility, women who utilized ANC from Mtendere (OR = 0.236, 95% CI = 0.093 – 0.595, p = 0.002) and N’gombe (OR = 0.179, 95% CI = 0.064 – 0.504, p = 0.001) clinics were less satisfied with the physical environment of care. Place of residence and educational attainment showed significant association with ‘willingness to return‘. N’gombe clinic (n = 48, 77.4%) received the lowest consideration for ‘future care’.ConclusionDrawing on Donabedian framework on assessing quality of healthcare, we posit that pregnant women’s satisfaction with the quality of antenatal care was low due to concerns about the physical environment of health facilities, the interpersonal relationships between providers and pregnant women as well as the technical aspects of care. All these accounted for pregnant women’s dissatisfaction with the quality of care, and the indication of unwillingness to return or recommend the health facilities to colleagues. Consistent with Donabedian framework, we suggest that the codes and ethics of healthcare must be upheld. We also call for policy initiatives to reshape the physical condition of ANC clinics and to reinforce healthcare providers’ focus on the ‘structures’ and the ‘processes’ relevant to care in addition to the ‘outcomes’.

Exploring disparities of teleconsultation readiness: A comparative analysis of healthcare facilities in Indonesia.

To investigate the implementation of teleconsultation and assess the level of readiness for its adoption among various types of healthcare facilities. This cross-sectional study involved medical doctors working in a public hospital, a private hospital, and community health centers in Yogyakarta, Indonesia. We recruited 29 medical specialists from various departments in two hospitals and 27 heads of community health centers. The readiness items were categorized into sections that encompassed various readiness areas such as core, technological, motivational, learning, work culture, and policy readiness. Data were analyzed using a one-way analysis of variance and the Kruskal-Wallis test to evaluate differences in levels of readiness across healthcare facilities. A logistic regression analysis was conducted to further assess factors predicting the implementation of teleconsultation. Variations in technological readiness were observed between the community health centers and the public hospital (p = 0.006) and the private hospital (p = 0.007). Differences in learning readiness were found between the public hospitals and private hospitals (p = 0.01). There were also disparities in cultural readiness between the public hospital and the private hospital (p = 0.04) and between public hospital and community health centers (p = 0.01). Logistic regression revealed an association between technological readiness and the use of video teleconsultation (OR = 1.13; p = 0.017). The private hospital was more likely to implement video-based teleconsultation than was the public hospital (OR = 2.68; p = 0.003) or community health centers (OR = 3.13; p ≤ 0.001). Significant differences in technology readiness were identified among community health centers, public hospitals, and private hospitals. Future policy implementation should focus on customizing technology use and providing cultural training to help healthcare institutions with different technological readiness levels.