Utilization Of Medical Facilities Research Articles

Mapping the Accessibility of Medical Facilities of Wuhan during the COVID-19 Pandemic

In December 2019, the coronavirus disease 2019 (COVID-19) pandemic attacked Wuhan, China. The city government soon strictly locked down the city, implemented a hierarchical diagnosis and treatment system, and took a series of unprecedented pharmaceutical and non-pharmaceutical measures. The residents’ access to the medical resources and the consequently potential demand–supply tension may determine effective diagnosis and treatment, for which travel distance and time are key indicators. Using the Application Programming Interface (API) of Baidu Map, we estimated the travel distance and time from communities to the medical facilities capable of treating COVID-19 patients, and we identified the service areas of those facilities as well. The results showed significant differences in service areas and potential loading across medical facilities. The accessibility of medical facilities in the peripheral areas was inferior to those in the central areas; there was spatial inequality of medical resources within and across districts; the amount of community healthcare centers was insufficient; some communities were underserved regarding walking distance; some medical facilities could be potentially overloaded. This study provides reference, in the context of Wuhan, for understanding the spatial aspect of medical resources and residents’ relevant mobility under the emergency regulation, and re-examining the coordination of emergency to improve future planning and utilization of medical facilities at various levels. The approach can facilitate policymakers to assess potential loading of medical facilities, identify low-accessibility areas, and deploy new medical facilities. It also implies that the accessibility analysis can be rapid and relevant even only with open-source data.

The Long-Term Trends of the Association Between Falls Among the Elderly in Taiwan and their Utilization of Medical Facilities

Summary Background Every year many adults aged 65 and over, suffer falls. This study used longitudinal data to investigate the long-term trend of falls among the elderly in Taiwan, and the association between falls and the utilization of medical facilities. Methods This study included 1653 elderly adults who completed questionnaires for a nationwide survey at different times. The data were analyzed with Chi-square test, independent-sample t-test, one-way ANOVA, Scheffe's post-hoc analysis and Generalized Estimating Equations (GEE), using SPSS 19.0 and Stata version SE 11.0. Results The proportion of elderly who had fallen has been increased 1.6 times from 1999 to 2007. The probability of using the traditional Chinese medicine (TCM) clinics (RR = 1.44) for those who had fallen was higher, as well as these of using the ER (RR = 1.81) and hospital (RR = 1.89), and the number of days hospitalized (RR = 1.85). There was no significant difference in their use of western medicine clinics (P > 0.05). Conclusion The government should provide appropriate medical care and services to reduce the incidence of falls in elderly and their uses of medical resources, thus improving elderly adults' quality of life.

Utilization of Health Care Facilities by Pregnant Women Approaching Government Hospitals in Nainital District Uttarakhand

The present study was conducted on 120 pregnant women attending the OPD of two government hospitals in Nainital with the objective to analyze the utilization of medical facilities by pregnant women...

Use of Marijuana in Patients with Sickle Cell Disease Increased the Frequency of Hospitalization for Acute Painful Vaso-Occlusive Crises

Introduction : Recently, there has been general interest in using marijuana as an analgesic for various types of pain. Cannabis is known to relieve severe nausea and vomiting. Anecdotally, medical marijuana has analgesic effects in patients with chronic and neuropathic pain other than sickle cell pain, decreases the frequency of migraine headache, has anti-spastic effect in multiple sclerosis, and may relieve some of the signs and symptoms of amyotrophic lateral sclerosis and Crohn's disease. Its role in epilepsy is controversial. On the negative side long-term cannabis use is associated with periodontal disease, maternal marijuana use at 20 weeks gestation was strongly associated with spontaneous pre-term birth independent of maternal cigarette smoking and illegal synthetic cannabinoids (K2/spice) were associated with catatonia and myocardial infarction in adolescents. Studies in the transgenic sickle cell mouse showed that cannabinoid receptor-specific mechanisms ameliorate pain via inhibition of mast cell activation and neurogenic inflammation. A questionnaire study from the United Kingdom showed that 36% of the patients with sickle cell disease (SCD) have used cannabis in the previous 12 months to relieve symptoms. Another longitudinal questionnaire study in Jamaica found that marijuana was not related to the clinical severity of SCD. The objective of this study is to report the epidemiological and clinical features of the patients with SCD who were found to be taking marijuana by using random urine drug screening from 1994 to 2009. The frequency of vaso-occlusive crises (VOCs) in these patients was compared to patents with SCD whose urine drug screening showed no marijuana. The terms marijuana and cannabinoid will be used interchangeably in this Abstract. Patients & Methods: A total of 270 random urine drug screen tests were done on 72 patients representing 10% of our patients with SCD during the period of the study. Written consent was obtained from the patients for enrollment in the study that was approved by the IRB. Types of SCD were determined by routine lab tests. Urine samples, collected randomly, were analyzed for the presence of amphetamine, benzodiazepines, opiates, barbiturate, cannabinoid, propoxyphene, methadone and phencyclidine. Samples were classified as either positive or negative for cannabinoid. Statistical analysis included the two-tailed student's t, Fisher exact and the Chi Square tests. Results: Thirty-seven of the 72 patients tested positive for cannabinoid in their urine and 35 patients tested negative. Table 1 shows the major epidemiological and clinical feature of the patients studied. There was no significant difference in ages of men and women who used or did not use marijuana (p > 0.05). However, males who used marijuana were significantly younger (p < 0.001) than males who did not (Table 1). Moreover, the ages of females who tested positive for cannabinoid were not significantly different from women who tested negative (Table 1). The patients who tested positive for cannabinoids also tested positive for other illicit drugs more often than patients who tested negative. Positivity for benzodiazepines, cocaine and phencyclidine were significantly higher in patients who used marijuana than the nonusers. Notably, there was no significant difference in the use of opioids consumed by users and non-users of marijuana. Similarly, there was no significant difference in the frequency of complications of SCD between users and non-users of marijuana (Table 1). The most important aspect of the study is the effect of marijuana use on the frequency of utilization of medical facilities. Patients in the marijuana cohort were admitted to the hospital for VOCs more frequently (Table 1) than the control group: 2,443 versus1,602 admissions respectively (p < 0.05). Conclusion: Together these data suggest that patients in the marijuana cohort were more often in severe pain that required treatment in the hospital for VOCs than non-users. This difference could be due to the quality of the marijuana used, the neuronal effects of marijuana and the severity of pain in the users of marijuana. The role of marijuana in the treatment of sickle cell pain seems more complex than thought. Further controlled trials are needed to clarify this issue. Table 1 Table 1. Disclosures No relevant conflicts of interest to declare.

대구.경북 거주환자의 서울지역 의료이용 변화추이

This study was conducted to investigate the changes in patterns of Daegu- and Gyeongbuk-based patients` use of medical care facilities located in Seoul. The `Patient Survey` data issued by the Ministry of Health and Welfare for 2002, 2005, and 2008 were used. Among all discharged patients residing in Daegu and Gyeongbuk, 133,456 who used medical facilities in Daegu, Gyeongbuk, and Seoul were selected. Among patients residing in Daegu, 2.2% used medical facilities in Seoul in 2002, 3.7% in 2005, and 3.5% in 2008. The corresponding rates among patients living in Gyeongbuk were 5.6%(2002), 7.1%(2005), and 7.3%(2008). Regarding the ICD-10 disease groups, the use of medical facilities in Seoul by patients residing in either Daegu or Gyeongbuk increased in 2005 right after the introduction of the KTX high-speed train service, covering various disease groups, but decreased again in 2008. `Neoplasm` cases, however, showed a progressive rising trend during the years studied. Multivariate data analysis for the three years showed that sex, age, payment type, hospital type, residence, year, and disease groups were all significantly associated with the utilization of medical facilities in Seoul. The major results are : First, use of medical facilities in Seoul by Gyeongbuk patients was 2.4-fold higher than that by Daegu patients, but with respect to 2005 and 2008 vs. 2002, use of medical facilities in Seoul by Daegu resident patients` showed a larger increase than that by Gyeongbuk`s patients. Second, for patients residing in the two regions, use of medical facilities in Seoul was highest for `congenital malformations, deformations and chromosomal abnormalities`, followed by `neoplasms`. Third, for patients residing in the two regions, general hospitals comprise the primary factor in the use of medical facilities in Seoul. The study shows that local medical facilities should individually exert more efforts to improve the quality of their medical services. Relevant authorities should likewise help these facilities develop their own unique services and respective specialization.

Evaluation of complex activities in daily living of elderly Japanese with visual impairment

This study was conducted to determine whether elderly subjects with visual impairment differ in the performance of complex activities in daily living from those without visual impairment. The study subjects were residents in two homes for the aged in Japan, and consisted of 37 elderly people with visual impairment, and 42 elderly people, serving as controls; ages ranged from 64 to 95 years. Complex activities of the subjects were ascertained by interview using a 46-item questionnaire. The visually impaired elderly had lower performance levels for telephone use (p = 0.007), shopping (p = 0.049), cleaning up one's room (p = 0.001), and utilization of medical facilities (p = 0.001) in instrumental ADL (IADL); for interest in TV or radio (p = 0.004) and religious faith (p = 0.042) in "enriching activities"; and for visiting behaviors (p < 0.05) in "social role". The performances of complex activities by the elderly with visual impairment were diminished in specific categories, but not overall, and this may be attributable to poor mobility and/or more passive attitudes in their daily activities.

Comparison of medical care utilization patterns between beneficiaries of medical aid and medical insurance

A household survey was conducted to compare the patterns of morbidity and medical care utilization between medical aid beneficiaries and medical insurance beneficiaries. The study population included 285 medical aid beneficiaries that were completely surveyed and 386 medical insurance benficiaries selected by simple random sampling from a Dong(Township) in Taegu. Well-trained surveyers mainly interviewed housewives with a structured questionnaire. The morbidity rates of acute illness during the 15-day period, were 63 per 1,000 medical aid beneficiaries and 62 per 1,000 medical insurance beneficiaries. The rates for chronic illness were 123 per 1,000 medical aid beneficiaries and 73 per 1,000 medical insurance beneficiaries. The most common type of acute illness in medical aid and medical insurance beneficiaries was respiratory disease. In medical aid beneficiaries, musculoskeletal disease was most common, but in medical insurance beneficiaries, gastrointestinal disease was most common. The mean duration of acute illness of medical aid beneficiaries was 3.8 days and that of medical insurance beneficiaries was 6.8 days. During the one year period, mean duration of medical aid beneficiaries chronic illnesses was 11.5 months which was almost twice as long compared to medical insurance beneficiaries. Pharmacy was most preferrable facility among the acute illness patient in medical aid beneficiaries, but acute cases of medical insurance beneficiaries visited the clinic most commonly. Chronic cases of both groups visited the clinic most frequently. There were some findings suggesting that much unmet need existed among the medical aid beneficiaries. In acute cases, the average number of days of medical aid users utilized medical facilities was less than medical insurance users. On the other hand, the length of medical care utilization of chronic cases was reversed. Geographical accessibility was the most important factors in utilization of medical facilities. Almost half of the study population answered the questions about source of funds on medical security correctly. Most respondents considered that the objective of medical security was afford ability. The chief complaint on hospital utilization was the complicated administrative procedures. These findings suggest that there were some problems in the medical aid system, especially in the referral system.