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Cabalar I, Le TH, Silber A, O'Hara M, Abdallah B, Parikh M, Busch R. The Role of Blood Testing in Prevention, Diagnosis, and Management of Chronic Diseases: A Review. Am J Med Sci 2024:S0002-9629(24)01169-8. [PMID: 38636653 DOI: 10.1016/j.amjms.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/06/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
Blood tests are vital to prevention, diagnosis, and management of chronic diseases. Despite this, it can be challenging to construct a comprehensive view of the clinical importance of blood testing because relevant literature is typically fragmented across different disease areas and patient populations. This lack of collated evidence can also make it difficult for primary care providers to adhere to best practices for blood testing across different diseases and guidelines. Thus, this review article synthesizes the recommendations for, and importance of, blood testing across several common chronic conditions encountered in primary care and internal medicine, including cardiovascular diseases, diabetes mellitus, chronic kidney disease, vitamin D deficiency, iron deficiency, and rheumatoid arthritis. Future research is needed to continue improving chronic disease management through clearer dissemination and awareness of clinical guidelines among providers, and better access to blood testing for patients (e.g., via pre-visit laboratory testing).
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Affiliation(s)
- Imelda Cabalar
- Division of Rheumatology, Department of Medicine, Adventist HealthCare Fort Washington Medical Center, Fort Washington, MD, USA.
| | - Thu H Le
- Division of Nephrology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
| | | | | | | | | | - Robert Busch
- Division of Community Endocrinology, Department of Medicine, Albany Medical Center, Albany, NY, USA.
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Cerruti B, Garavaldi D, Lerario A. Patient's punctuality in an outpatient clinic: the role of age, medical branch and geographical factors. BMC Health Serv Res 2023; 23:1385. [PMID: 38082271 PMCID: PMC10714636 DOI: 10.1186/s12913-023-10379-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The efficiency of the management of an outpatient clinic largely depends on the administration of patient flows and waiting times increase costs and affect clinical quality. In this study, we verify if the visit acceptance times are influenced by demographic or geographical factors in a large cohort of patients referred to a city and suburban private outpatient multidisciplinary clinic. METHODS We included all scheduled visits of patients aged from 18 to 75 years who arrived in 2021, 2022 and 2023 in our private outpatient clinics, consisting of 34 medical clinics scattered in Milan metropolitan city and hinterland. The variables collected were age, visit time, check-in time, address of the medical clinic and its distance from the closest underground station, patient typology (new business vs. follow-up patient), and the medical branch of the visit. Outcome is'punctuality', defined as check-in time minus visit time (in minutes). RESULTS We considered a sample of 410.808 visits from January 2021 to April 2023. The majority of patients check-in early (84.4%) and we found that the percentage of punctual patients increases linearly with age. Earlier hours in the morning show the worst punctuality pattern as well as Blood Draws in the analysis of different medical branches. We also observed that patients who already had some activity recorded in our systems show the worst pattern of punctuality. No particular differences emerged considering the geographical location of the clinics. CONCLUSIONS Younger patients have worse punctuality than older patients. Moreover, earlier hour slots are the most disadvantaged and the medical specialty has an influence on the arrival habits. This data should be considered for better clinical quality and efficiency.
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Buss LF, Spitzer D, Watson JC. Can I have blood tests to check everything is alright? BMJ 2023; 382:e075728. [PMID: 37407075 DOI: 10.1136/bmj-2023-075728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
- Lewis F Buss
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK
| | - David Spitzer
- Cranwich Road Surgery, 62 Cranwich Road, London N16 5JF, UK
| | - Jessica C Watson
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK
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Hafidz F, Adiwibowo IR, Kusila GR, Oktavia A, Saut B, Jaya C, Siregar DR, Dhanalvin E, Tania I, Johana J, Ruby M, Baros WA. Knowledge, attitudes, and practices related to COVID-19 in Indonesia: A post delta variant wave cross-sectional study. Front Public Health 2023; 11:1072196. [PMID: 37124827 PMCID: PMC10133525 DOI: 10.3389/fpubh.2023.1072196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/16/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Public information and regulations related to the coronavirus disease 2019 (COVID-19) have been widely published and continuously changed. The Indonesian government has responded to the emerging evidence by regularly updating its unprecedented and preventive measures against the transmission of COVID-19 to the public. It is important to understand how the public responded to these updates. This study aimed to investigate the knowledge, attitudes, and practices of Indonesians toward COVID-19 after the emergence of the delta variant wave. Methods A cross-sectional study was conducted among the adult population of non-healthcare workers in Indonesia through an online questionnaire using the SurveyMonkey platform. A total of 1,859 respondents completed this survey from September to October 2021. The knowledge, attitudes, and practices data were analyzed descriptively to find their frequency and percentage. A multivariate analysis was conducted to confirm the factors affecting the respondents' knowledge, attitudes, and practices with a p-value of <0.05 set as significant. Results Being female, having a higher education level, and having a higher frequency of access to COVID-19 news showed significant impacts on knowledge, attitudes, and practices (p<0.001). Older age stratification influenced the knowledge level (p<0.05) but had no significant effect on people's attitudes and practices toward COVID-19. Respondents' perceived probability of being exposed to COVID-19 (p < 0.05) and their COVID-19 infection frequency (p < 0.001) significantly influenced their knowledge. Household income and respondents' knowledge significantly affected their attitudes toward COVID-19. Furthermore, only their attitudes had a significant impact on the respondents' practices. Perceived severity, perceived susceptibility, and vaccination status did not significantly influence their knowledge, attitudes, and practices (p > 0.05). Conclusion After more than a year of the COVID-19 pandemic, Indonesians maintain their high level of knowledge, attitudes, and practices. COVID-19 disinformation must be combatted by strengthening authorized media, empowering communities, and improving governance among institutions during and post-pandemic.
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Affiliation(s)
- Firdaus Hafidz
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- *Correspondence: Firdaus Hafidz
| | - Insan Rekso Adiwibowo
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center for Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Gilbert Renardi Kusila
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ayunda Oktavia
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
| | - Benjamin Saut
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
| | - Citra Jaya
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
| | | | - Erzan Dhanalvin
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
| | - Indira Tania
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
| | - Johana Johana
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
| | - Mahlil Ruby
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
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Hafidz F, Adiwibowo IR, Kusila GR, Ruby M, Saut B, Jaya C, Baros WA, Revelino D, Dhanalvin E, Oktavia A. Out-of-pocket expenditure and catastrophic costs due to COVID-19 in Indonesia: A rapid online survey. Front Public Health 2023; 11:1072250. [PMID: 37033026 PMCID: PMC10081577 DOI: 10.3389/fpubh.2023.1072250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background The Corona Virus Disease 2019 (COVID-19) pandemic has created a substantial socioeconomic impact, particularly in developing countries such as Indonesia. Purposes/objectives This study aimed to describe the COVID-19-related out-of-pocket spending of Indonesian citizens and the proportion of whom experienced catastrophic health spending during the COVID-19 pandemic using the patient's perspective. Methodology We conducted a rapid cross-sectional online survey across provinces in Indonesia to capture participants' experiences due to COVID-19. Data were collected between September 23rd to October 7th of 2021 including demographics, income, and expenditures. Descriptive statistics were used to analyze the respondents' characteristics. Patients's perspective of total cost was estimated from out-of-pocket of COVID-19 direct costs and compared them to total expenditure. If the proportion of COVID-19 total costs exceeded 40% of the total expenditure, the respondents were deemed to have faced catastrophic costs. Results A total of 1,859 respondents answered the questionnaire. The average monthly income and expenditure of respondents were 800 USD, and 667 USD respectively. The monthly expenditure was categorized into food expenditure (367 USD) and non-food expenditure (320 USD). The average of COVID-19-related monthly expenditure was 226 USD, including diagnostic expenditure (36 USD), preventive expenditure (58 USD), medical expenditure (37 USD for COVID-19 treatment; and 57 USD for post-COVID-19 medical expenses), and non-medical expenditure (30 USD). Analysis showed that 18.6% of all respondents experienced catastrophic costs while 38.6% of the respondents who had COVID-19 treatment experienced catastrophic costs. Conclusion The high proportion of catastrophic costs among respondents suggests the need for COVID-19 social protection, especially for COVID-19 diagnostic and prevention costs. The survey findings have led the government to increase the benefit coverage other than medical costs at the hospitals.
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Affiliation(s)
- Firdaus Hafidz
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- *Correspondence: Firdaus Hafidz
| | - Insan Rekso Adiwibowo
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Gilbert Renardi Kusila
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mahlil Ruby
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
| | - Benyamin Saut
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
| | - Citra Jaya
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
| | | | - Dedy Revelino
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
| | - Erzan Dhanalvin
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
| | - Ayunda Oktavia
- Badan Penyelenggara Jaminan Sosial Kesehatan, Jakarta, Indonesia
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McKenzie BA. Rational use of diagnostic and screening tests. J Small Anim Pract 2021; 62:1016-1021. [PMID: 34196003 DOI: 10.1111/jsap.13393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/14/2021] [Accepted: 05/24/2021] [Indexed: 12/30/2022]
Abstract
Veterinarians have a vast and ever-expanding array of diagnostic tests available to them. However, this abundance can be an embarrassment of riches that confounds diagnosis and undermines patient care if we do not make critical and informed decisions about the selection and interpretation of the tests we employ. Effective use of diagnostic tests requires a deliberate and informed approach. We must consider the strengths and weaknesses of the tests themselves and the clinical context, and we must be wary of the many biases that skew our use and interpretation of diagnostic tests. Understanding sensitivity and specificity, likelihood, prevalence and predictive value, the basic principles of Bayesian reasoning, and the cognitive biases that drive inappropriate testing are all critical to ensuring our use of imaging and laboratory testing improves patient outcomes.
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Affiliation(s)
- B A McKenzie
- Adobe Animal Hospital, 4470 El Camino Real, Los Altos, CA, 94022, USA
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Shirazi M, Masoudian Y, Feizabad E, Golshahi F, Ghaemi M. Creating a novel strategy to reduce unnecessary laboratory testing based on healthcare cost analysis in high-risk pregnancies and delivery ward. J Clin Lab Anal 2021; 35:e23759. [PMID: 33745154 PMCID: PMC8128318 DOI: 10.1002/jcla.23759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/02/2021] [Accepted: 02/25/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Inappropriate request for laboratory tests is a challenging problem and an important cause for additional healthcare costs. Indeed, it may have further ambiguity for the clinicians. This study aimed to design an education-based program to reduce unnecessary laboratory testing orders and the associated costs. MATERIALS AND METHODS In this interventional prospective study that took place in an educational hospital, the type and frequency of selected laboratory testing requested by gynecology, and obstetrics residents in the patients with gestational diabetes mellitus, preeclampsia, preterm labor, and premature preterm rupture of the membrane as well as cesarean section and normal vaginal delivery were analyzed periodically in a 1-year interval. At the same time, continuous educational supports and monitoring were performed. The results were compared before and after interventions. RESULTS The educational intervention regardless of the etiologies of the admission, decreased the requested laboratory testing significantly (p < 0.001), except for CBC. Indeed, no near misses or delays in treatment were observed. Cost analysis showed a 31.3% reduction of expenses per inpatient day due to the decrease in the number of daily laboratory testing ordered. CONCLUSIONS Appropriate education and continuous monitoring of the residents could reduce the unrequired laboratory testing as well as healthcare costs.
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Affiliation(s)
- Mahboobeh Shirazi
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Maternal, Fetal & Neonatal Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Yusuf Masoudian
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Feizabad
- Maternal, Fetal & Neonatal Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Golshahi
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghaemi
- Vali-e-Asr Reproductive Health Research Center, (VRHRC), Tehran University of Medical Sciences, Tehran, Iran
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Patients' attitudes towards cost feedback to doctors to prevent unnecessary testing: a qualitative focus group study. Public Health 2020; 185:338-340. [PMID: 32726730 DOI: 10.1016/j.puhe.2020.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES There is a need to improve efficiency in healthcare delivery without compromising quality of care. One approach is the development and evaluation of behavioural strategies to reduce unnecessary use of common tests. However, there is an absence of evidence on patient attitudes to the use of such approaches in the delivery of care. Our objective was to explore patient acceptability of a nudge-type intervention that aimed to modify blood test requests by hospital doctors. STUDY DESIGN Single-centre qualitative study. METHODS The financial costs of common blood tests were presented to hospital doctors on results reports for 1 year at a hospital. Focus group discussions were conducted with recent inpatients at the hospital using a semi-structured question schedule. Discussions were transcribed and analysed using qualitative content analysis to identify and prioritise common themes explaining attitudes to the intervention approach. RESULTS Three focus groups involving 17 participants were conducted. Patients were generally apprehensive about the provision of blood test cost feedback to doctors. Attitudes were organised around themes representing beliefs about blood tests, the impact on doctors and their autonomy, and beliefs about unnecessary testing. Patients thought that blood tests were important, powerful and inexpensive, and cost information could place doctors under additional pressure. CONCLUSION The findings identify predominantly positive beliefs about testing and negative attitudes to the use of financial costs in the decision-making of hospital doctors. Public discussion and education about the possible overuse of common tests may allow more resources to be allocated to evidence-based healthcare, by reducing the perception that such strategies to improve healthcare efficiency negatively impact on quality of care.
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Gamsizkan Z, Sungur MA, Çayır Y. Blood Analysis Requests of Patients’ and Clinical Reflections in Primary Care. EURASIAN JOURNAL OF FAMILY MEDICINE 2020. [DOI: 10.33880/ejfm.2020090205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The aim of the study is to determine the factors that may affect the demands of patients who come with the request to have a blood test without any chronic disease or a planned examination check.
Methods: The data of this descriptive, cross-sectional study, were collected with a questionnaire that was prepared to examine the opinions of the patients who claim to have a blood test by coming to the family health center without any complaints. Patients over 18 years of age, who did not have any chronic disease and had no scheduled examination appointments were included in the study.
Results: A total of 278 patients who wanted to have a blood test within the 6-months period were included in the study. Female patients who wanted to have a blood test were significantly more than male patients. When we look at the causes of patients who wanted to have a blood test; 61.2% (n=170) patients stated that they are concerned about their health and 6.1% (n=17) stated that they were affected by media warnings. There was no significant relationship between the frequency of blood test requests of patients and their age, gender, education, and general health status.
Conclusion: Patients with high expectations and anxiety may be more willing to perform blood tests at inappropriate intervals. Family physicians, whose primary role is preventive medicine, have consultancy and information duties in order to protect their patients from the risk of over-examination and diagnosis.
Keywords: blood tests, patient, screening, routine diagnostic tests
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Affiliation(s)
- Zerrin Gamsizkan
- Duzce University, Medical Faculty, Department of Family Medicine
| | | | - Yasemin Çayır
- Atatürk University, Medical Faculty, Department of Family Medicine
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