Utilize Health Care Facilities Research Articles

Barriers and facilitators to healthcare facility utilization by non-Ebola patients during the 2018–2020 Ebola outbreak in the Democratic Republic of Congo

BackgroundAn Ebola Virus Disease (EVD) outbreak occurred in North Kivu between 2018 and 2020. This eastern province of the Democratic Republic of Congo was also grappling with insecurity caused by several armed groups. This study aimed to explore the barriers and facilitators to utilizing Healthcare Facilities (HCFs) by non-Ebola patients during the crisis.MethodsA qualitative case study was conducted in Beni and Butembo with 24 relatives of 15 deceased non-EVD patients, 47 key informants from healthcare workers (HCWs), as well as community leaders. Semi-structured interviews were conducted to explore three key areas: (i) the participants’ illness history, care pathway, care, and social support; (ii) their perceptions of how EVD affected the care outcome; and (iii) their opinions on the preparedness, supply, use, and quality of healthcare before and during the outbreak. All interviews were recorded, transcribed verbatim, and thematically analysed using Atlas-ti 8.0.ResultsNine of the 15 deaths were female and their ages ranged from 7 to 79 years. The causes of death were non-communicable (13) or infectious (2) diseases. Conspiracy theories, failure to establish security, and the concept of the ''Ebola business'' were associated with misinformation and lower levels of trust in government and HCFs. The negative perceptions, fear of being identified as an Ebola case, apprehension about the triage unit, and inadequacy of personal protective equipment resulted in a preference for private or informal HCFs. For half of the deceased’s relatives, the Ebola outbreak hastened their death. Conversely, community involvement, employing familiar, neutral, and credible HCWs, and implementing a free care policy increased the number of visits. These results were observable despite a lack of funds, overstretched HCWs, and long waiting time.ConclusionsOur findings can inform policies before and during future outbreaks to enhance the resilience of routine HCFs by maintaining dialogue between HCWs and patients, and rebuilding confidence in HCFs. Quantitative studies including context analysis are essential to identify the determinants of care-seeking during such a crisis.

Financial hardship and healthcare utilization among older cancer survivors with comorbidities.

349 Background: Financial burden among older cancer survivors (65y+) is understudied, particularly with regard to how comorbidities may affect financial burden and healthcare utilization despite Medicare eligibility. We assessed the relationship between financial hardship (FH), healthcare utilization, and comorbidities among cancer survivors. Methods: The University of Alabama at Birmingham tumor registry was used to identify patients diagnosed at ≥65y with lymphoma, breast, colorectal, prostate, or lung cancer types and received curative-intent treatment from 2000 to 2019. Patients were surveyed on FH, healthcare utilization, and comorbid conditions. FH was defined as having answered ‘Yes’ to experiencing material, psychological, or behavioral hardship in the past year. Visits to a primary care physician (PCP), oncologist, non-oncology specialist, or emergency department (ED) in the past 2 years were self-reported. A modified Common Terminology Criteria for Adverse Events (CTCAE) grading system captured 45 self-reported comorbidities. A CTCAE of 3 or 4 was considered severe. Multivariable models were used to determine the differences in risk of any FH between severe vs. non-severe CTCAE and to determine differences in healthcare utilization. All models were adjusted for age at survey completion, years from diagnosis to survey, sex, race, income, stage, distance travelled to medical center. Results: Among the 759 survivors included, median age was 77 (IQR=73-82), a majority identified as White (82%), half were female (53%) and a third reported annual income of less than 20,000 (32%). Breast (33%) was the most common cancer type followed by prostate (26%), lung (17%), colorectal (15%), and lymph (9%). Moderate or Severe comorbidities were reported by 46% of participants. FH was most commonly associated with coronary heart disease (18-47%), chronic obstructive pulmonary disease (20-57%), and myocardial infarction (25-60%) across all cancer types. Overall, patients with severe comorbidities had a higher risk of any FH (RR, 1.50; 95%CI, 1.15, 1.97), ED visits (IRR, 2.20; 95%CI, 1.22, 3.95), specialists (IRR, 1.52; 95%CI, 1.25, 1.87), and PCP (IRR 1.15; 95%CI, 1.01, 1.30). Those with severe comorbidities and financial hardship had higher utilization of PCP (p < 0.003), but not other types of utilization. Conclusions: Older patients with severe comorbidities were at increased risk of financial hardship while also utilizing healthcare facilities at a higher rate than those with fewer comorbidities. While those with severe comorbidities and financial hardship utilized their PCP more often, they did not utilize all healthcare facilities more than those with fewer comorbidities. Financial burden and high healthcare utilization remain after entering into cancer survivorship but is exacerbated by additional comorbid conditions.

The impact of birth preparedness and complication readiness (BPCR) on maternal outcomes among postpartum mothers

<pre><strong><em>Background: </em></strong><em>Birth preparedness and complications readiness (BPCR) is a strategy to prevent three late causes of maternal death. Previous study results focused on BPCR intermediate outcomes, such as utilizing healthcare facilities during pregnancy and delivery,</em><em> rather than maternal outcomes like maternal near miss, morbidity, and mortality.</em><em></em></pre><pre><strong><em>Objectives:</em></strong><em> This study examined the correlation between BPCR practices and maternal outcomes among postpartum mothers</em><em></em></pre><pre><strong><em>Methods: </em></strong><em>This cross-sectional research was conducted on postpartum mothers in the working area of the Sumberbaru Primary Health Service, Jember Regency, which was carried out from April to June 2023. A total of 78 postpartum mothers were selected using simple random sampling. The interview instrument was adopted from the BPCR JHPIEGO questionnaire, and maternal outcome observations were made using the MCH book. Data were analyzed using the chi-square test to examine the relationship between BPCR and maternal outcome. The level of statistical significance was set to p-value < 0.05</em><em></em></pre><p><strong><em>Results: </em></strong><em>The results of this study indicated that 69.2% of postpartum mothers had less prepared BPCR practices, and for most postpartum women, 55.1% recovered. There was a relationship between BPCR practices and maternal outcomes among postpartum mothers (p-value<0.05). Postpartum mothers with well-prepared BPCR practices had a 3.48 times higher chance of experiencing a complete recovery in maternal outcomes than those with less prepared BPCR practices.</em></p><pre><strong><em>Conclusions: </em></strong><em>The practice of BPCR in postpartum mothers is in the poor category; most mothers' maternal outcomes are in the fully recovered category. BPCR is an essential factor influencing maternal outcomes, so increasing counseling for mothers and families regarding BPCR is necessary to ensure more optimal maternal outcomes.</em><em></em></pre><p><em> </em></p>

Ethnicity and health insurance disparities in rectal carcinoma.

e13732 Background: Ethnicity and insurance coverage affect healthcare delivery in rectal carcinoma (RC). RC pts (pts) with Medicaid or no insurance are more likely to present with distant stage RC compared to Medicare/private insurance pts, and have a worse prognosis even when stage is accounted for. To combat such issues, federal law requires that non-profit hospitals, which make up 58% of all community hospitals, to provide charity care, or financial assistance, to those eligible. As insurance status, ethnicity and race have been found to independently affect colon cancer care, we expect similar results for RC in our limited but diverse cohort. Methods: Trinitas Medical Center RWJBH is an urban, community hospital that predominantly treats a minority population and provides financial assistance to eligible underinsured pts. Due to this assistance, or Charity Care, we can provide access to cancer care for many who would not ordinarily have such means. With institutional IRB approval, we completed a retrospective chart review of 59 pts diagnosed with Stage I-IV RC from 2017-2023. We assessed ethnicity, insurance carriers and treatment choices. Results: We reviewed 59 pts with the following ethnic distribution: 22 Hispanic (H), 21 White (W), 11 Black (B) and 5 Asian (A) pts. The median age at diagnosis with RC was 57 in H, 64 in B, 71 in W and 71 in A pts. B pts were found to be diagnosed with more advanced disease: 36% at Stage III and 45% at Stage IV, with none diagnosed at Stage I or II. H pts had comparatively fewer distant stage diagnoses (23% at Stage III, 18% at Stage IV). Neoadjuvant chemotherapy and radiation therapy to 20 of 59 pts treated at our center, 15 of whom subsequently received surgery. Four of five of these declined surgical intervention post neoadjuvant therapy. H pts had the following primary insurance carriers: 36% Medicaid, 36% Medicare, 27% Charity care. 62% of W pts had Medicare and 14% Medicaid. 27% had B pts had Medicare, 27% Medicaid and 9% had Charity care. 50% of the 59 pts had Charity care, with most pts in this group being H. Conclusions: Research suggests that immigrants utilize healthcare facilities less than U.S. citizens and programs like Charity care may be underutilized. In our RC cohort, 38 of 59 (64%) pts were racial minorities, of these 50% received Charity care. Most did not receive screening prior to a diagnosis of rectal cancer and many applied for Charity Care only after their diagnosis. Despite offering significant financial assistance to our pts, we suggest education to immigrants regarding insurance coverage, broader screening efforts and the ability to offer improved subspecialty care to RC pts. In particular, we look to target B and H who present at younger ages and are not Medicare eligible. We believe this will lead to earlier staging of RC, which should lead to improved survival for minority pts.

IJCM_204A: A qualitative research to identify the barriers and facilitating factors in the utilization of healthcare services by a Particularly Vulnerable Tribal Group (PVTG) in Udupi District

Background: Udupi district hosts two major Particularly Vulnerable Tribal Groups (PVTG) namely Malaikudiya and Koraga. Koraga tribes are declining in number and deprived of availability of healthcare services and accessibility to healthcare facilities. There are a lot of barriers such as lack of awareness and social stigma amalgamate the existing conditions of Koraga tribes in Udupi district. Research studies pertaining to this problem has been seldom done. Objective: We aim to explore the barriers and facilitating factors in accessing healthcare services by a Particularly Vulnerable Tribal Group (PVTG) in Udupi district. Methodology: We conducted qualitative research through 8 in-depth interviews with AMOs from PHC and CHC, ITDP staff and NGO workers, and 3 focus group discussions with community health nurses, ASHA workers, and Koraga community leaders from Udupi district. We explored the major facilitators and barriers that influence the utilization of health care services by the PVTG. Results: On the beneficiaries’ point of view, lack of awareness, distance to health facilities, poor public transportation, perceived negative behavior of hospital staff, lack of infrastructure, unwelcoming neighbourhood approaches, and economic instability were the main barriers to utilizing healthcare facilities. On the stakeholders (providers) point of view, availability of healthcare facilities, government policies and schemes and NGO activities are the facilitating factors. Conclusion: Our study highlights the barriers to utilizing health facilities; these are not always driven by factors linked to the PVTG members’ socio- economic status but also depend significantly on the quality of the health services and other contextual factors. Although the government has made efforts to improve the rural healthcare system through national-level programs, our qualitative study shows that there are a number of barriers which lessens the effectiveness of the programs to enhance the utilization of healthcare facilities by the PVTG in the study area.

Tharu And Buksa Tribes’ Attitudes Toward Child And Maternal Health And Educational Services In Uttarakhand: A Qualitative Study

Despite the government of India's admirable efforts to assist tribal people and help them develop, they are unable to resolve their problems. Even today, many tribal problems persist in India. The aim of this paper is to explore attitudes and barriers toward child health, maternal health, and educational services in two tribal populations, i.e., the Tharu and the Buksa, in Uttarakhand. In March 2016, qualitative research was conducted through a self-developed questionnaire. This interview schedule is being used to assess the concept and usage of child and maternal healthcare services and educational services with samples aged 25 to 50 years from the Tharu (50) and the Buksa (50) tribes of Uttarakhand. The study found that the primary barriers to utilizing healthcare facilities are direct and indirect financial barriers; travel distances to medical facilities; subpar public transportation; hospital staff members perceived to act negatively toward patients; and inadequate infrastructure. The location of schools, weak economic conditions, lack of awareness, medium of language, geographical conditions, and discrimination were found to be the barriers to utilizing educational services. The study's conclusion draws attention to the obstacles that patients face in using healthcare facilities; these obstacles are not always caused by the patient's socioeconomic situation but also heavily dependent on other contextual factors and the standard of the medical care being provided. The difficulties in using educational services are also highlighted.

Regional Disparities of Facility-Based Childbirth in Indonesia

Specifically, the characteristics of regions in Indonesia are unique. The situation is because the division of the region refers to the main islands. The study aims to analyze regional disparities of childbirth services in Indonesia. Meanwhile, the analysis in this study uses raw data from the 2017 Indonesian Demographic Health Survey (IDHS). The IDHS used stratification and multistage random sampling. The sample used in this study was 17,769 women aged 15 - 49 years with live births in the last 5 years. The study employed all region (7 regions) in the analysis, and analyzed data using the binary logistic regression test. The result shows national average of the utilization of healthcare facilities for delivery in Indonesia is 72.0 %. The 3 highest-ranking regions were in the Java-Bali region with 89.5 %, Sumatra region 73.5 %, and Kalimantan region 69.1 %. The study shows a significant disparity between all regions than the Papua region, except for Kalimantan and Sulawesi regions. Sumatra region has 1.475 times more possibilities to utilize healthcare facilities for delivery than the Papua region. The Java-Bali region has 3.010 times more potential to use healthcare facilities for delivery than the Papua region. The Nusa Tenggara region has 1.891 times more opportunities to use healthcare facilities for delivery than the Papua region. At the same time, the Maluku region has lower utilization than the Papua region. Maluku region has the possibility of 0.304 times utilizing healthcare facilities for delivery than the Papua region. The study concluded that there were significant disparities between regions in using healthcare facilities for delivery in Indonesia.
 HIGHLIGHTS
 
 Indonesia has made many efforts in shifting labor into health care facilities. However, this increase is still lacking, and in some cases, the community still feels that the health services received are not expected
 The characteristics of regions in Indonesia are unique. Economic and development movements between regions keep the development gap between areas continuing. Disparity as a result of this development also affects the accessibility of the community to health service facilities
 The study proved there were disparities between regions in using healthcare facilities for delivery in Indonesia
 
 GRAPHICAL ABSTRACT

A qualitative study of the barriers to utilizing healthcare services among the tribal population in Assam.

ObjectiveWe aim to explore the barriers to accessing modern healthcare services in two tribal populations in Assam.MethodsIn March 2018, we conducted qualitative research through 60 in-depth interviews with men and women aged 15 to 50 from Bodo and Rabha tribes in Udalguri and Baksa districts of Assam. We interviewed a group of health-service providers from public health facilities to understand the demand-supply balance in those facilities.FindingsOn the demand side, direct and indirect financial obstacles, distance to health facilities, poor public transportation, perceived negative behavior of hospital staff, and lack of infrastructure were the main barriers to utilizing healthcare facilities. On the supply side, doctors and nurses in government health facilities were overburdened by demand due to a lack of human resources.ConclusionsOur study highlights the barriers to utilizing health facilities; these are not always driven by factors linked to the patient’s socio-economic status but also depend significantly on the quality of the health services and other contextual factors. Although the government has made efforts to improve the rural healthcare system through national-level programs, our qualitative study shows that these programs have not been successful in enhancing the rural healthcare system in the study area.

The barrier to maternity care in rural Indonesia

The purpose of this study was to analyse the barriers to healthcare utilization for delivery in rural Indonesia. The included subjects were women aged 15–49 years who had given birth in the last 5 years in rural Indonesia. The sample size was 9046 women. The variables analysed included the utilization of healthcare facilities, age, education, work, marital status, parity, wealth, health insurance, autonomy of family finances, autonomy of health, knowledge of pregnancy, and antenatal care (ANC). The barriers were determined by binary logistic regression. Women with higher education were 2.288 times more likely to utilize healthcare facilities for delivery than women with no education. Multiparous women were 1.582 times more likely to use healthcare facilities for delivery than grand multiparous women. The richest women were 4.732 times more likely to use healthcare facilities for delivery than the poorest women. Women who were covered by health insurance were 1.363 times more likely to utilize healthcare facilities for delivery than women who did not have insurance. Women who knew the danger signs of pregnancy were 1.497 times more likely to use healthcare facilities for delivery than women who did not know the danger signs. Women who underwent ANC ≥ 4 times were 1.976 times more likely to use healthcare facilities for delivery than women who underwent ANC < 4 times. There were six factors that were identified as barriers to the utilization of healthcare facilities for delivery in rural Indonesia. These six factors were low education, high parity, poverty, not having health insurance, not knowing the danger signs of pregnancy, and ANC < 4 times.

Maternal Socioeconomic Factors Affecting Birth Weight of New Born Babies Born in Combined Military Hospital Dhaka

Background: Low birth weight is one of the deleterious outcomes of pregnancy. To identify the factors contributing to LBW is therefore of paramount importance. But a very little attention had been paid to address the riddle. This effort is to candle the light on maternal socioeconomic factors on birth weight.&#x0D; Objective: To delineate the pattern of birth weight of newborn babies delivered in CMH Dhaka and ascertains selected demographic, socio-economic characteristics of the mothers.&#x0D; Methods &amp; Materials: This cross-sectional study was conducted in Combined Military Hospital Dhaka from September to December 2011 on 110 respondents. Data were collected by interview using semi- structured questionnaire. Data were checked, edited, coded, categorized, cleaned and analyzed using software (SPSS version 16)&#x0D; Results: All the mothers were educated. Mothers who passed SSC exam, 35.5% were highest. Lowest education level was primary, 10%. SSC and below educated mother gave birth to 16.75 LBW babies. The average birth weight babies, 94.74% were delivered by HSC and higher educated mothers. All LBW babies were born other than officer's family. The mean monthly income was Tk 16533. 33% LBW babies born who had family income _&lt; Tk. 10,000, 52.3% higher birth weight babies had family income _&gt; Tk. 20000 but results was not statistically significant (p&gt;.05).&#x0D; Conclusion: All these findings suggest that a substantial evidence of socioeconomic factors like family income, maternal education and social status has an effect on birth weight. Utilizing health care facilities, better training, educating mother, addressing demographic factors, condition can be improved.&#x0D; Anwer Khan Modern Medical College Journal Vol. 10, No. 2: July 2019, P 138-142

Prediction of Mental Disorders Deprived by Family

Introduction: The family was the place and the fi rst to meet the basic needs of human beings, has fi ve tasks in health. The inability of the family perform its tasks will be a problem in a family member suffering from a mental disorder, so allow the deprivation occurred. The aim of this study was to formulate the possibility of deprivation of people with mental disorders by family.Methods: The study design was cross sectional. Study subjects by 45 families who have family members with mental disorders from four clusters at health centres of Bacem Ponggok and Sutojayan of Kabupaten Blitar, selected by cluster random sampling with rapid survey. Analysis using nominal regression with α = 0.05.Results: Two tasks the family that affect was deprived of the ability of families caring for patients with signifi cant value 0.009 and the ability of families utilizing health care facilities with signifi cant value of 0.034. The possibility of patients to be deprived by family was formulated. Conclusion: Influences family task was 37.1% (Nagelkerke = 0.371) whereas 62.9% influenced by other factors. To minimize the occurrence of deprived be expected to treat patients with a family of faith, love, and use of health service facilities.

An Analysis of Work-Related Musculoskeletal Disorders Among Butchers in Kano Metropolis, Nigeria.

BackgroundButchering is often associated with high rates of work-related musculoskeletal disorders (WRMSDs). However, published work on the prevalence of WRMSDs among butchers in Nigeria is scarce. This is important because meat processing practices differ across geographical and cultural locations. This study was therefore aimed at analyzing WRMSDs among butchers in Kano metropolis.MethodsSociodemographic and work-settings information was obtained from 102 male cattle butchers (age, 37.49 ± 11.68 years) through survey. Information on the prevalence and pattern of musculoskeletal disorders was obtained from the respondents using the Standardized Nordic Questionnaire. Additional information on health seeking practices was also obtained using a pro forma. Associations between the prevalence of WRMSDs and each of the sociodemographic data and work settings were explored using Chi-square analysis. The level of significance was set at p < 0.05.ResultsThe 12-month and point prevalence rates of WRMSDs among butchers in this study were 88.2% and 74.5%, respectively. Whereas lower back complaints (66.7%) were the overall and lower body quadrant's most commonly reported WRMSDs among the butchers surveyed, wrist/hand complaints were the leading upper quadrant's (45.1%) most commonly reported WRMSDs among the respondents. There were significant associations between age and majority of WRMSDs in the body regions. Only 23.3% of the 90 individuals who had WRMSD visited the hospital to seek redress for their WRMSD.ConclusionThe prevalence of WRMSDs is high among butchers in Kano Metropolis. Few individuals with WRMSD utilize healthcare facilities. Age is a major risk factor in this setting.

ANALISIS KEMAMPUAN PENDANAAN PEMERINTAH DAERAH DALAM RANGKA MEMBERIKAN JAMINAN KESEHATAN BAGI MASYARAKAT MISKIN

In the year 2010 the number of citizens who have health coverage reaching 139 424 348 or 59.07 percent of Indonesia's population, while the remaining 40.93 percent do not have health insurance. Province of Nangroe Aceh Darussalam and South Sulawesi entire population already have health insurance, while that of South Sumatera and Bali respectively reached 99.60 percent and 99.56 percent. Health insurance needs to be evaluated, whether based on capitation funding awarded in accordance with the number of people, .or diverted to improving the quality of health services in health centers, hospitals, incentives for medical personnel, provision of medicines, as well as the procurement of medical equipments in accordance with the local government, so that the whole communities to utilize health care facilities specified.

Stillbirths: A high magnitude public health issue in India

A stillbirth is a baby born with no signs of life at or after 28 weeks’ gestation, while preterm births are those which occur between 28 weeks to 32 weeks of gestation. Approximately 3.2 million stillbirths occur annually in low- and middle-income countries. The aim of this paper is to review the present status of the stillbirths and identify the un-derlying factors of stillbirths in India. A search of PubMed and other search engines were conducted to retrieve the literature pertaining to neonatal and perinatal health in India. Four priority areas were used to select the studies: overview (prevalence of the stillbirths), challenges in mapping the potential causes of stillbirths, socio-cultural fac-tors associated with stillbirths, and government response towards stillbirths. It was found that women face many difficulties due to accessibility, availability, affordability and quality issues when utilizing healthcare facilities dur-ing pregnancy. Several studies based on stillbirths also revealed the social aspects of perinatal grief. Stillbirths are bounded by high family pressures and social stigma. A review also revealed that half of all stillbirths occur in India, Pakistan, Nigeria, China and Bangladesh alone. These countries also account for a high number of maternal and newborn deaths. India has highest number of stillbirths in the world – the rates range from 20 to 66 per 1000 births in different states. It was also found that healthcare and socio-cultural factors contribute to the increase in the num-ber of stillbirths in India. These issues highlight the need for urgent action and interventions to be taken by the gov-ernment and other organization to improve the situation of stillbirths in India. Early neonatal deaths and stillbirths usually have obstetric causes, and are largely preventable if good quality obstetric care is made available at the right time. Initiatives for strengthening the information management system at the grassroots level to report stillbirths on a regular basis are necessary to improve the neonatal health indicators in India. South East Asia Journal of Public Health 2013; 3(1): 3-9 DOI: http://dx.doi.org/10.3329/seajph.v3i1.17704

Assessment of the proportion of neonates and children in low and middle income countries with access to a healthcare facility: A systematic review

BackgroundComprehensive antenatal, perinatal and early postnatal care has the potential to significantly reduce the 3.58 million neonatal deaths that occur annually worldwide. This paper systematically reviews data on the proportion of neonates and children < 5 years of age that have access to health facilities in low and middle income countries. Gaps in available data by WHO region are identified, and an agenda for future research and advocacy is proposed.MethodsFor this paper, "utilization" was used as a proxy for "access" to a healthcare facility, and the term "facility" was used for any clinic or hospital outside of a person's home staffed by a "medical professional". A systematic literature search was conducted for published studies of children up to 5 years of age that included the neonatal age group with an illness or illness symptoms in which health facility utilization was quantified. In addition, information from available Demographic and Health Surveys (DHS) was extracted.ResultsThe initial broad search yielded 2,239 articles, of which 14 presented relevant data. From the community-based neonatal studies conducted in the Southeast Asia region with the goal of enhancing care-seeking for neonates with sepsis, the 10-48% of sick neonates in the studies' control arms utilized a healthcare facility. Data from cross-sectional surveys involving young children indicate that 12 to 86% utilizing healthcare facilities when sick. From the DHS surveys, a global median of 58.1% of infants < 6 months were taken to a facility for symptoms of ARI.ConclusionsThere is a scarcity of data regarding the access to facility-based care for sick neonates/young children in many areas of the world; it was not possible to generalize an overall number of neonates or young children that utilize a healthcare facility when showing signs and symptoms of illness. The estimate ranges were broad, and there was a paucity of data from some regions. It is imperative that researchers, advocates, and policy makers join together to better understand the factors affecting health care utilization/access for newborns in different settings and what the barriers are that prevent children from being taken to a facility in a timely manner.

Oral Narcotic Protocol to Reduce Narcotic Injections in Refractory Migraine Patients

Refractory headache patients who require narcotic injections for acute attacks frequently utilize health care facilities. The experience is often unpleasant and costly to the patient and health care system. We have developed an oral narcotic protocol for home administration. The patient starts with an antiemetic suppository, followed in 30 minutes by oral metoclopramide. After controlling nausea and vomiting, the patient administers a high dose of oral narcotic plus a hypnotic. The dosing of the narcotic analgesics incorporates seldom-used, but well-published pharmacokinetics. This protocol allows the patient to successfully treat a severe headache without using a health care facility. Eleven patients in our practice were prescribed the oral narcotic protocol. Their need for narcotic injections at our office or emergency department was monitored for up to 1 year before and after the start of the protocol. Combined office visits were reduced from 81 to 53 (34.6%) and emergency department visits from 47 to 26 (44.7%). An annual cost savings of $1960 for office visits and $3024 for emergency department visits was realized. This was offset by an oral narcotic protocol medication cost of only $392. This treatment method has been well accepted by patients and has proven to be a safe and cost-effective approach to treating refractory migraine patients.