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Muharram FR, Multazam CECZ, Harmadha WS, Andrianto A, Salsabilla SA, Dakota I, Andriantoro H, Firman D, Montain MM, Prakoso R, Anggraeni D. Distribution of catheterisation laboratories in Indonesia 2017-2022: a nationwide survey. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 26:100418. [PMID: 38764713 PMCID: PMC11101891 DOI: 10.1016/j.lansea.2024.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/06/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
Background Geographical terrains of Indonesia pose a major hindrance to transportation. The difficulty of transportation affects the provision of acute time-dependent therapy such as percutaneous coronary intervention (PCI). Also, Indonesia's aging population would have a significant impact on the prevalence of acute coronary syndrome in the next decade. Therefore, the analysis and enhancement of cardiovascular care are crucial. The catheterisation laboratory performs PCI procedures. In the current study, we mapped the number and distribution of catheterisation laboratories in Indonesia. Methods A direct survey was used to collect data related to catheterisation laboratory locations in July 2022. The population data was sourced from the Ministry of Home Affairs. The recent growth of catheterisation laboratories was examined and evaluated based on geographical areas. The main instruments for comparing regions and changes throughout time are the ratio of catheterisation laboratories per 100,000 population and the Gini index (a measure of economic and healthcare inequality. Gini index ranges from 0 to 1, with greater values indicating more significant levels of inequality). Regression analysis was carried out to see how the number of catheterisation laboratories was affected by health demand (prevalence) and economic capacity (Gross Domestic Regional Product [GDRP] per Capita). Findings The number of catheterisation laboratories in Indonesia significantly increased from 181 to 310 during 2017-2022, with 44 of the 119 new labs built in an area that did not have one. Java has the most catheterisation laboratories (208, 67%). The catheterisation laboratory ratio in the provinces of Indonesia ranges from 0.0 in West Papua and Maluku to 4.46 in Jakarta; the median is 1.09 (IQR 0.71-1.18). The distribution remains a problem, as shown by the high catheterisation laboratory Gini index (0.48). Regression shows that distribution of catheterisation laboratories was significantly affected by GDRP and the prevalence of heart disease. Interpretation The number of catheterisation laboratories in Indonesia has increased significantly recently, however, maldistribution remains a concern. To improve Indonesia's cardiovascular emergency services, future development of catheterisation laboratories must be better planned considering the facility's accessibility and density. Funding Airlangga Research Fund - Universitas Airlangga.
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Affiliation(s)
- Farizal Rizky Muharram
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - Andrianto Andrianto
- Faculty of Medicine, Airlangga University, Soetomo General Hospital, Surabaya, Indonesia
| | | | - Iwan Dakota
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, West Jakarta, Indonesia
| | - Hananto Andriantoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, West Jakarta, Indonesia
| | - Doni Firman
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, West Jakarta, Indonesia
| | - Maya Marinda Montain
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, West Jakarta, Indonesia
| | - Radityo Prakoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, West Jakarta, Indonesia
| | - Dilla Anggraeni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, West Jakarta, Indonesia
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National registry of Myocardial Infarction: Strategies for a developing country. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bahiru E, Temu T, Mwanga J, Ndede K, Vusha S, Gitura B, Farquhar C, Bukachi F, Huffman MD. Facilitators, context of and barriers to acute coronary syndrome care at Kenyatta National Hospital, Nairobi, Kenya: a qualitative analysis. Cardiovasc J Afr 2018; 29:177-182. [PMID: 29750227 PMCID: PMC6107733 DOI: 10.5830/cvja-2018-013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/15/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The prevalence of ischaemic heart disease and its acute manifestation, acute coronary syndrome (ACS), is growing throughout sub-Saharan Africa, including Kenya. To address this increasing problem, we sought to understand the facilitators, context of and barriers to ACS care at Kenyatta National Hospital, with the aim of improving the quality of care of ACS. METHODS We conducted in-depth interviews with healthcare providers involved in the management of ACS patients from January to February 2017 at Kenyatta National Hospital in Nairobi, Kenya. We selected an initial sample of key participants for interviewing and used a snowballing technique to identify additional participants until we achieved saturation. After transcription of audio recordings of the interviews, two authors conducted data coding and analysis using a framework approach. RESULTS We conducted 16 interviews with healthcare providers. Major themes included the need to improve the diagnostic and therapeutic capabilities of the hospital, including increasing the number of ECG machines and access to thrombolytics. Participants highlighted an overall wide availability of other guideline-directed medical therapies, including antiplatelets, beta-blockers, statins, anticoagulants and ACE inhibitors. All participants also stated the need for and openness to accepting future interventions for improvement of quality of care, including checklists and audits to improve ACS care at Kenyatta National Hospital. CONCLUSION Major barriers to ACS care at Kenyatta National Hospital include inadequate diagnostic and therapeutic capabilities, lack of hospital-wide ACS guidelines, undertraining of healthcare providers and delayed presentation of patients seeking care. We also identified potential targets, including checklists and audits for future improvements in quality of care from the perspective of healthcare providers.
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Affiliation(s)
- Ehete Bahiru
- Northern Pacific Global Health Research Fellowship Training Consortium, University of Washington, Seattle, WA; and Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, USA.
| | - Tecla Temu
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Julia Mwanga
- Department of Medicine, University of Nairobi, Nairobi, Kenya
| | - Kevin Ndede
- Department of Medicine, University of Nairobi, Nairobi, Kenya
| | - Sophie Vusha
- Organization International Centre for Reproductive Health Kenya (ICRHK), Kenya
| | - Bernard Gitura
- Division of Cardiology, Department of Medicine, Kenyatta National Hospital, Nairobi, Kenya
| | - Carey Farquhar
- Departments of Global Health, Epidemiology and Medicine, University of Washington, Seattle, WA, USA
| | - Frederick Bukachi
- Department of Medical Physiology, University of Nairobi, Nairobi, Kenya
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
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Obaya M, Yehia M, Hamed L, Fattah AA. Comparative study between elderly and younger patients with acute coronary syndrome. THE EGYPTIAN JOURNAL OF CRITICAL CARE MEDICINE 2015. [DOI: 10.1016/j.ejccm.2015.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Fredriksson M, Eldh AC, Vengberg S, Dahlström T, Halford C, Wallin L, Winblad U. Local politico-administrative perspectives on quality improvement based on national registry data in Sweden: a qualitative study using the Consolidated Framework for Implementation Research. Implement Sci 2014; 9:189. [PMID: 25544124 PMCID: PMC4307376 DOI: 10.1186/s13012-014-0189-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 12/04/2014] [Indexed: 12/22/2022] Open
Abstract
Background Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement’s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data. Methods Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed. Results The politicians’ and administrators’ perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians’ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations. Conclusions The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators. Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0189-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mio Fredriksson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
| | - Ann Catrine Eldh
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden. .,School of Health and Social Science, Dalarna University, 791 88, Falun, Sweden.
| | - Sofie Vengberg
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
| | - Tobias Dahlström
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
| | - Christina Halford
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
| | - Lars Wallin
- School of Health and Social Science, Dalarna University, 791 88, Falun, Sweden. .,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83, Huddinge, Sweden.
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22, Uppsala, Sweden.
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Pirkle CM, Dumont A, Zunzunegui MV. Medical recordkeeping, essential but overlooked aspect of quality of care in resource-limited settings. Int J Qual Health Care 2012; 24:564-7. [PMID: 22798693 DOI: 10.1093/intqhc/mzs034] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Medical recordkeeping is essential to assuring quality health care. Records aid in the medical management of patients while serving epidemiological purposes. Medical recordkeeping is often inadequate in resource-limited settings, which threatens the quality of health care. In this study, by way of example, we make the case for increased attention to medical recordkeeping by illustrating how poor charting and archiving can threaten the quality of care. We make suggestions to improve the adequacy of medical recordkeeping by emphasizing recent technological innovations applied to resource-limited settings and the need to instil a culture of recordkeeping.
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Affiliation(s)
- Catherine M Pirkle
- The Department of Social and Preventive Medicine, Université de Montréal, Montréal, Canada.
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Butala NM, Desai MM, Linnander EL, Wong YR, Mikhail DG, Ott LS, Spertus JA, Bradley EH, Aaty AA, Abdelfattah A, Gamal A, Kholeif H, el-Baz M, Allam AH, Krumholz HM. Gender differences in presentation, management, and in-hospital outcomes for patients with AMI in a lower-middle income country: evidence from Egypt. PLoS One 2011; 6:e25904. [PMID: 22022463 PMCID: PMC3192760 DOI: 10.1371/journal.pone.0025904] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 09/13/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many studies in high-income countries have investigated gender differences in the care and outcomes of patients hospitalized with acute myocardial infarction (AMI). However, little evidence exists on gender differences among patients with AMI in lower-middle-income countries, where the proportion deaths stemming from cardiovascular disease is projected to increase dramatically. This study examines gender differences in patients in the lower-middle-income country of Egypt to determine if female patients with AMI have a different presentation, management, or outcome compared with men. METHODS AND FINDINGS Using registry data collected over 18 months from 5 Egyptian hospitals, we considered 1204 patients (253 females, 951 males) with a confirmed diagnosis of AMI. We examined gender differences in initial presentation, clinical management, and in-hospital outcomes using t-tests and χ(2) tests. Additionally, we explored gender differences in in-hospital death using multivariate logistic regression to adjust for age and other differences in initial presentation. We found that women were older than men, had higher BMI, and were more likely to have hypertension, diabetes mellitus, dyslipidemia, heart failure, and atrial fibrillation. Women were less likely to receive aspirin upon admission (p<0.01) or aspirin or statins at discharge (p = 0.001 and p<0.05, respectively), although the magnitude of these differences was small. While unadjusted in-hospital mortality was significantly higher for women (OR: 2.10; 95% CI: 1.54 to 2.87), this difference did not persist in the fully adjusted model (OR: 1.18; 95% CI: 0.55 to 2.55). CONCLUSIONS We found that female patients had a different profile than men at the time of presentation. Clinical management of men and women with AMI was similar, though there are small but significant differences in some areas. These gender differences did not translate into differences in in-hospital outcome, but highlight differences in quality of care and represent important opportunities for improvement.
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Affiliation(s)
- Neel M Butala
- Yale School of Medicine, New Haven, Connecticut, United States of America.
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