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Hasan MJ, Rafi MA, Nishat NH, Islam I, Afrin N, Ghosh B, Kabir E, Akhter SZ, Poushi MZ, Shahnoor SAB, Fardous J, Tabassum T, Islam S, Kalam SB, Aslam MT, Joarder T. Patient self-referral patterns in a developing country: characteristics, prevalence, and predictors. BMC Health Serv Res 2024; 24:651. [PMID: 38773557 PMCID: PMC11110194 DOI: 10.1186/s12913-024-11115-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/14/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Efficient healthcare delivery and access to specialized care rely heavily on a well-established healthcare sector referral system. However, the referral system faces significant challenges in developing nations like Bangladesh. This study aimed to assess self-referral prevalence among patients attending tertiary care hospitals in Bangladesh and identify the associated factors. METHODS This cross-sectional study was conducted at two tertiary care hospital, involving 822 patients visiting their outpatient or inpatient departments. A semi-structured questionnaire was used for data collection. The patients' mode of referral (self-referral or institutional referral) was considered the outcome variable. RESULTS Approximately 58% of the participants were unaware of the referral system. Of all, 59% (485 out of 822) of patients visiting tertiary care hospitals were self-referred, while 41% were referred by other healthcare facilities. The primary reasons for self-referral were inadequate treatment (28%), inadequate facilities (23%), critical cases (14%), and lack of expert physicians (8%). In contrast, institutional referrals were mainly attributed to inadequate facilities to treat the patient (53%), inadequate treatment (47%), difficult-to-treat cases (44%), and lack of expert physicians (31%) at the time of referral. The private facilities received a higher proportion of self-referred patients compared to government hospitals (68% vs. 56%, p < 0.001). Among patients attending the study sites through institutional referral, approximately 10% were referred from community clinics, 6% from union sub-centers, 25% from upazila health complexes, 22% from district hospitals, 22% from other tertiary care hospitals, and 42% from private clinics. Patients visiting the outpatient department (adjusted odds ratio [aOR] 3.3, 95% confidence interval [CI] 2.28-4.82, p < 0.001), residing in urban areas (aOR 1.29, 95% CI 1.04-1.64, p = 0.007), belonging to middle- and high-income families (aOR 1.34, 95% CI 1.03-1.62, p = 0.014, and aOR 1.98, 95% CI 1.54-2.46, p = 0.005, respectively), and living within 20 km of healthcare facilities (aOR 3.15, 95% CI 2.24-4.44, p-value < 0.001) exhibited a higher tendency for self-referral to tertiary care facilities. CONCLUSIONS A considerable number of patients in Bangladesh, particularly those from affluent urban areas and proximity to healthcare facilities, tend to self-refer to tertiary care centers. Inadequacy of facilities in primary care centers significantly influences patients to opt for self-referral.
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Affiliation(s)
| | - Md Abdur Rafi
- Tropical Disease and Health Research Center, Dhaka, 1100, Bangladesh
| | | | - Ima Islam
- Dhaka Medical College and Hospital, Dhaka, 1100, Bangladesh
| | - Nusrat Afrin
- Dhaka Medical College and Hospital, Dhaka, 1100, Bangladesh
| | - Bikona Ghosh
- Dhaka Medical College and Hospital, Dhaka, 1100, Bangladesh
| | - Etminan Kabir
- Dhaka Medical College and Hospital, Dhaka, 1100, Bangladesh
| | | | | | | | - Jannatul Fardous
- Tropical Disease and Health Research Center, Dhaka, 1100, Bangladesh
| | - Tamanna Tabassum
- Tropical Disease and Health Research Center, Dhaka, 1100, Bangladesh
| | - Sadia Islam
- Delta Medical College & Hospital, Dhaka, 1216, Bangladesh
| | | | | | - Taufique Joarder
- SingHealth Duke-NUS Global Health Institute, Singapore, 169857, Singapore
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Apenteng BA, Adewoye A, Owens C, Opoku ST, Kimsey L, Peden A, Shehaj B. Examining the relationship between rural residents' satisfaction with local hospital's COVID-19 response and intention to use the hospital. J Rural Health 2024; 40:259-267. [PMID: 37468945 DOI: 10.1111/jrh.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/21/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE The COVID-19 pandemic highlighted the importance of having emergency and acute care services close to home and emerged as an opportunity for hospital-community engagement. This study examined whether rural residents' satisfaction with their local hospital's pandemic response was associated with improved community perception of the hospital and an intention to use it in the future. METHODS Data for the study were obtained from a survey of rural residents of 6 Georgia rural communities and analyzed using multivariable logistic regression and mediation analyses. RESULTS Rural residents' satisfaction with their local hospital's pandemic response was associated with an improved perception of the hospital. Improvement in the perception of rural hospitals following the pandemic was found to partially mediate a positive association between community residents' satisfaction with hospital pandemic response and the intention to use the hospital when needed. CONCLUSION The COVID-response efforts may have given rural hospitals an opportunity to influence public perception.
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Affiliation(s)
- Bettye A Apenteng
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
- Center for Public Health Practice and Research, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Aishat Adewoye
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Charles Owens
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
- Center for Public Health Practice and Research, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Samuel T Opoku
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
- Center for Public Health Practice and Research, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Linda Kimsey
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
- Center for Public Health Practice and Research, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Angie Peden
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
- Center for Public Health Practice and Research, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Blerta Shehaj
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
- Center for Public Health Practice and Research, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
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Wang Q, Tzortzi JN. Design guidelines for healing gardens in the general hospital. Front Public Health 2023; 11:1288586. [PMID: 38106892 PMCID: PMC10722422 DOI: 10.3389/fpubh.2023.1288586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Despite being recognized as a cost-effective method to enhance physical and mental health, Healing Gardens remain insufficiently popularized in outdoor spaces of hospitals. This paper aims to introduce a new perspective and offer guidelines for their implementation within general hospitals. Methods A methodology is proposed for formulating hospital-specific guidelines, encompassing the extraction of successful Healing Garden features from case studies, definition of key components grounded in theoretical frameworks, validation of essential features through user questionnaires, and comprehensive site analyses. Results The methodology was applied in a case study at Zhongnan Hospital in Wuhan. This research presents a novel perspective and robust methodology for implementing Healing Gardens in general hospital settings, potentially improving physical and mental health in a cost-efficient manner. Discussion This work aims to encourage the adoption of Healing Gardens as preventive medical tools in more healthcare settings. By providing a comprehensive methodology and a case study illustration, this research endeavors to stimulate broader acceptance and utilization of Healing Gardens in healthcare environments.
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Affiliation(s)
| | - Julia Nerantzia Tzortzi
- Department of Architecture, Built Environment and Construction Engineering, Politecnico di Milano, Milan, Italy
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Xie W, Liu J, Huang Y, Xi X. Capturing What Matters with Patients' Bypass Behavior? Evidence from a Cross-Sectional Study in China. Patient Prefer Adherence 2023; 17:591-604. [PMID: 36919186 PMCID: PMC10008354 DOI: 10.2147/ppa.s395928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/18/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND In China, bypassing is becoming increasingly prevalent. Such behavior, as going directly to upper-level health-care facilities without a primary care provider (PCP) referral when facing non-critical diseases, contrasts to "expanding the role of PCPs as the first-contact of care", may cause unneglectable damage to the healthcare system and people's physical health. OBJECTIVE To examine the relationship between patient experience in primary health-care clinics (PHCs) and their bypass behavior. METHODS A cross-sectional study was designed for data collection. From July 2021 to August 2021, we conducted a questionnaire survey nationally. Fifty-three investigators were dispatched to 212 pre-chosen PHCs, around which 1060 interviewees were selected to gather information, using a convenience sampling. The primary independent variable was scores measured by Chinese Primary Care Assessment Tool (PCAT-C) to quantify patients' experience at PHCs. The dependent variable was a binary variable measured by a self-developed instrument to identify whether participants actually practiced bypassing. Covariates were well-screened determinants of patients' bypass behavior including socio-demographic factors, policy factors, and health-care suppliers. Binary logistic regression analysis was employed to evaluate the association of patients' experience with their bypass behavior. FINDINGS A total of 928 qualified questionnaires were obtained. The first contact dimension (OR 0.961 [95% CI 0.934 to 0.988], P = 0.005) and continuity dimension (OR 1.034 [95% CI 1.000 to 1.068], P = 0.047) of patients' experience were significantly associated with patients' bypass behavior (P < 0.05). In addition, age (OR 1.072, [95% CI 1.015-1.132], P = 0.013) and gender (OR 2.044, [95% CI 1.139-3.670], P = 0.017) also made a statistically significant difference. CONCLUSION Enhancement in patient experience at PHCs may help reduce their bypass behavior. Specifically, efforts are needed to improve primary care accessibility and utilization. The positive correlation between bypassing rates and continuity scores may require more attention on strengthening PCPs' technical quality besides the quality of interpersonal interactions.
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Affiliation(s)
- Wenwen Xie
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, People’s Republic of China
| | - Jiayuan Liu
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, People’s Republic of China
| | - Yuankai Huang
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, People’s Republic of China
| | - Xiaoyu Xi
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, People’s Republic of China
- Correspondence: Xiaoyu Xi, Email
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Self-referrals and associated factors among laboring mothers at Dilla University Referral Hospital, Dilla, Gedeo Zone, Ethiopia: a cross-sectional study. BMC Womens Health 2022; 22:417. [PMID: 36221100 PMCID: PMC9552507 DOI: 10.1186/s12905-022-02002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND When medical cases are difficult to manage at the level of primary health care units (PHCU), formal referral assists patients transferring to a higher level of care. In contrast, self-referral and bypassing are synonymously used in literature to describe the phenomenon of patients skipping their units to get basic medical services, even though they are close to their residence. Though proper and timely referral prevents the majority of deaths from obstetric complications in developing countries, more than 50% of referrals are self-referral trends. Such patient practice is increasingly becoming a concern for many health-care systems. OBJECTIVE To assess the magnitude of self-referrals and associated factors among laboring mothers at Gedeo Zone, Ethiopia. METHODS Facility-based cross-sectional study was conducted from August 1-September 30/2021 among laboring mothers at Dilla University Referral Hospital. A systematic random sampling technique was used to select 375 laboring mothers. Data were collected using a face-to-face interview with a structured questionnaire. Data were entered into a computer using Epi-Data 4.6 statistical program and then exported to STATA version 16 for analysis. In bivariate analysis variables with a p-value ≤ 0.25 were selected as a candidate variable for the multivariable analysis. P-value < 0.05 at 95% confidence interval considered as a statistically significant associations in the multivariable analysis. RESULT 375 eligible mothers participated in the study, with a response rate of 98.16%. The magnitude of self-referrals among laboring mothers was 246 (65.6%) with 95% CI (0.60-0.70). Time ≥ 30 min to reach nearby facilities (AOR = 1.74, 95% CI, 1.08, 2.81), having no medicine supplies at nearby facilities (AOR = 1.75, 95% CI, 1.08, 2.82), having no equipment and supplies at nearby facilities (AOR = 1.70, 95% CI, 1.03, 2.78), having ANC visits ˃ 3 times (AOR = 0.29, 95% CI, 0.15, 0.55) and having poor perception of health provider technical competence at nearby facilities (AOR = 2.97, 95% CI, 1.83, 4.79) were found as significant factors for self-referral. CONCLUSION The magnitude of self-referral was high. Frequent Antenatal visits were protective, however time to reach the nearest facilities, perception towards health care providers, medicine, equipment and supplies at the nearest facilities were positive influencing factors. Government stakeholders should keep working on improving the quality of health service, especially at primary health care units(PHCU).
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Lu S, Li Y, Gao H, Zhang Y. Difference in bypass for inpatient care and its determinants between rural and urban residents in China. Int J Equity Health 2022; 21:132. [PMID: 36100917 PMCID: PMC9469557 DOI: 10.1186/s12939-022-01734-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 08/25/2022] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background
Bypass for inpatient care is an event of excessive demand. Though primary care facilities provide inpatient care in China, local residents may choose more distant higher-level hospital for inpatient care services. Given the differences in accessibility of hospitals and socioeconomic development between urban and rural areas, this study aims to estimate the rate of bypass for inpatient care and explore the factors predictive of bypass among rural and urban residents in China.
Methods
The rates of bypass for inpatient care were estimated using data from 1352 hospitalized patients, obtained from the 2018 Sixth National Health Service Survey of Hubei, China. Bypass for inpatient care was identified if the patient was hospitalized in a hospital for a certain disease that should be treated at primary care facilities in accordance with government requirement. Anderson’s Behavioral Model of Health Services Use was used as a theoretical framework for determining the factors of bypass. Logistic regression was used to identify the relationship between bypass for inpatient care and predisposing, enabling, and need characteristics for urban and rural residents.
Results
The rate of bypass for inpatient care was 73.8%. This rate for inpatient care (91.3%) in cities is higher than that in rural areas (56.2%). Age were associated with bypass for both rural (OR, 0.982; 95% CI, 0.969–0.995) and urban (OR, 0.947; 95% CI, 0.919–0.976) patients. The patients whose closest healthcare facility was hospitals were more likely to have bypass behavior in rural (OR, 26.091; 95% CI, 7.867–86.537) and urban (OR, 8.323; 95% CI, 2.936–23.591) areas than those living closest to township/community health centers. Signing a family doctor was not helpful for retaining patients at primary care facility. Among rural patients, those with circulatory (OR, 2.378; 95% CI, 1.328–4.258), digestive (OR, 2.317; 95% CI, 1.280–4.192), or skin and bone (OR, 1.758; 95% CI, 1.088–2.840) system diseases were more likely to show bypass behavior than those with respiratory diseases.
Conclusions
Bypass for inpatient care is sizable, and urban residents have a higher bypass rate for inpatient care than rural residents in China. More actionable measures in strengthening and leading patients to primary care are needed. Gradual establishment of a referral system is recommended. Inpatient care for circulatory, digestive, or skin and bone system diseases may be prioritized to be improved at primary care facilities in rural China.
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Medarević A. Performance evaluation of general public hospitals in territories of the Former Yugoslavia: An ecological study using the Pabon Lasso model. Int J Health Plann Manage 2022; 37:2106-2121. [PMID: 35332583 DOI: 10.1002/hpm.3453] [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: 11/20/2021] [Revised: 02/08/2022] [Accepted: 02/23/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Measuring hospital performance is an area of great importance due to limited resources. Additionally, hospital activities are vital during emergencies providing care under pressure of external factors. AIM This study aimed at analysing performances of general public hospitals from territories of the Former Yugoslavia. METHOD This ecological study includes 99 hospitals from 6 territories based on annual reports of institutions in charge of territorial health data. The Pabon Lasso method was used, considering hospitals in the third quadrant of the plot as top-performing in the territory. A particular focus was on performance changes during the pandemic caused by SARS-COV-2 coronavirus. RESULTS AND CONCLUSION There is considerable heterogeneity in the length of stay, bed occupancy and turnover rate between territories. The proportion of top-performing hospitals varied between 20% and 43%, providing between 16% and 69% of inpatients episodes within the territory. However, countries did not differ in how their hospitals were distributed across the four quadrants of the Pabon Lasso plot. Comparison of Croatian and Kosovar data from 2019 to 2020 suggested a significant decrease in turnover and occupancy rates, but most hospitals retained their plot quartiles from the previous year. This supports the finding that there were no significant changes in hospital performance based on the Pabon Lasso method. The analysis showed significant room for performance improvement and highlighted the ability of the Croatian and Kosovar hospitals and their health systems to maintain efficiency during emergencies.
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Zhang JG, Wang H, Gu XF, Wang XY, Wang WJ, Du LB, Cao HL, Zhang X, Shi JH, Zhao YQ, Ma L, Liu YY, Huang JX, Cao J, Fan YP, Li L, Feng CY, Zhu Q, Du JC, Wang XH, Han BB, Qiao YL. Status and associated factors of cross-regional healthcare-seeking among patients with advanced colorectal cancer in China: a multicenter cross-sectional study. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:342. [PMID: 35433943 PMCID: PMC9011287 DOI: 10.21037/atm-22-1003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
Background The imbalanced allocation of medical resources leads to the occurrence of cross-regional healthcare-seeking in China. Due to the low cure rate, advanced colorectal cancer (CRC) patients may seek cross-regional healthcare for high-level medical facilities. Investigating status of cross-regional healthcare-seeking and its associated factors among advanced CRC patients is important for policymakers to understand access to health services and improve the quality of oncology services. Methods From March 2020 to March 2021, a cross‑sectional, nation-wide, hospital-based, multi-center survey was conducted. Nineteen hospitals in seven regions were selected by multi-stage stratified sampling. All eligible CRC patients in the selected hospitals were invited to participate in the current study. The outcome variable, cross-regional healthcare-seeking, was defined as seeking health facilities outside the local administration policy of medical insurance. The demographics, clinical information, and medical treatment history of each eligible CRC patient in stage III or IV, were collected through the patients' self-reporting or medical records by trained interviewers. Univariate and multivariate logistic analyses were used to explore the associated factors of cross-regional healthcare-seeking. All statistical analyses were conducted using SAS 9.4. Results A total of 4,589 individuals with advanced CRC were included. The average age of the patients was 60.1±11.6 years, and 59.5% were males. About 37.5% of the patients suffered from metastatic CRC at first diagnosis. Approximately 36.5% of the patients had sought cross-regional health care previously, and among them, 31.9% had encountered problems. The most common problems included complicated procedures (95.3%), unreimbursed expenses of outpatient service (71.0%), and reimbursement delay (59.4%). Logistic regression analysis showed that patients who completed undergraduate or above [odds ratio (OR) =1.40, 95% confidence interval (CI): 1.13-1.73], had an annual household income of more than 100,000 Chinse Yuan (CNY) (OR =1.46, 95% CI: 1.21-1.78), and had metastasis at diagnosis (OR =1.33, 95% CI: 1.18-1.51) were more likely to seek cross-regional health care. Conclusions About one third of advanced CRC patients seek cross-regional health care, and 31.9% had encountered problems. There is a need to simplify procedures of reimbursement, optimize direct settlement system and referral mechanisms in order to improve the equality of health services.
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Affiliation(s)
- Jian-Gong Zhang
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
| | - Hong Wang
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
| | - Xiao-Fen Gu
- Department of Student Affairs, Affiliated Tumor Hospital, Xinjiang Medical University, Ürümqi, China
| | - Xiao-Yang Wang
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
| | - Wen-Jun Wang
- School of Nursing, Jining Medical University, Jining, China
| | - Ling-Bin Du
- Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - He-Lu Cao
- Department of Preventive Health, Xinxiang Central Hospital, Xinxiang, China
| | - Xi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ji-Hai Shi
- The Clinical Epidemiology of Research Center, Department of Dermatological, The First Affiliated Hospital of Baotou Medical College, Baotou, China
| | - Yu-Qian Zhao
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Ma
- Public Health School, Dalian Medical University, Dalian, China
| | - Yun-Yong Liu
- Liaoning Office for Cancer Control and Research, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Juan-Xiu Huang
- Department of Gastroenterology, Wuzhou Red Cross Hospital, Wuzhou, China
| | - Ji Cao
- Department of Cancer Prevention and Control Office, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan-Ping Fan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Li
- Department of Clinical Research, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Chang-Yan Feng
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Qian Zhu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Jing-Chang Du
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Xiao-Hui Wang
- Department of Public Health, Gansu Provincial Cancer Hospital, Lanzhou, China
| | - Bin-Bin Han
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China.,Center for Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zittleman L, Curcija K, Nease DE, Fisher M, Miriam Dickinson L, Thomas JF, Espinoza A, Sutter C, Ancona J, Holtrop JS, Westfall JM. Increasing Capacity for Treatment of Opioid Use Disorder in Rural Primary Care Practices. Ann Fam Med 2022; 20:18-23. [PMID: 35074763 PMCID: PMC8786417 DOI: 10.1370/afm.2757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/06/2021] [Accepted: 05/26/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation describes the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado. METHODS Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado (IT MATTTRs) was a multilevel implementation study that included a practice-focused intervention to improve awareness, adoption, and use of buprenorphine treatment for OUD. Participating PCP teams received the IT MATTTRs Practice Team Training and support. Practices' implementation of treatment components was assessed before and after training. Practice-reported and population-level data from the Prescription Drug Monitoring Program were obtained to describe changes in delivery of treatment after training. RESULTS Forty-two practices received team training. Practices reported an average of 4.7 treatment-related components in place at baseline compared with 13.0 at 12-month follow-up (F[2,56] = 31.17, P <.001). The proportion of participating practices providing or referring patients for treatment increased from 18.8% to 74.4%. The increase in number of people with a prescription for buprenorphine was significantly greater in the study region over a 4-year period compared with the rest of the state (Wald χ2 = 15.73, P <.001). CONCLUSIONS The IT MATTTRs training for PCP teams in OUD treatment with buprenorphine addressed elements beyond clinician waiver training to make implementation feasible and effectively increased implementation and delivery of this treatment in rural Colorado.
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Affiliation(s)
- Linda Zittleman
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, Colorado
| | - Kristen Curcija
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, Colorado
| | - Donald E Nease
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, Colorado
| | - Mary Fisher
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, Colorado
| | - L Miriam Dickinson
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, Colorado
| | - John F Thomas
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, Colorado.,University of Colorado School of Public Health, Department of Epidemiology, Aurora, Colorado
| | - Ashley Espinoza
- High Plains Research Network, Community Advisory Council, University of Colorado School of Medicine, Department of Family Medicine, Denver, CO
| | - Christin Sutter
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, Colorado
| | - Jennifer Ancona
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, Colorado
| | - Jodi Summers Holtrop
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, Colorado
| | - John M Westfall
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, Colorado.,Robert Graham Center, Washington, DC
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Mustafa A, Shekhar C, Shri N. A situation analysis of child delivery facilities at primary health centers (PHCs) in rural India and its association with likelihood of selecting PHC for child delivery. BMC Health Serv Res 2021; 21:1210. [PMID: 34749723 PMCID: PMC8577031 DOI: 10.1186/s12913-021-07254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary Health Centers (PHCs) are crucial in providing primary and secondary level healthcare services in rural India. Despite immense efforts and huge funding, a very small proportion of deliveries are carried out at PHCs. The present study aims to explore the availability of facilities at PHCs and its association with likelihood of delivering the child at PHC. METHODS We extracted PHC level health infrastructure data from Health Management and Information system (HMIS) and created 'Facility Index' using exploratory factor analysis. We merged the 'Facility Index' with data of the 4th National Family Health Survey (NFHS-4) to explore the relationship between availability of facilities and healthcare-seeking behavior. Bivariate analysis and multilevel logistic regressions were employed to analyze the association between Facility Index and the likelihood of delivering the child at PHC. RESULTS Availability of facilities (Facility Index) was found to be positively associated with utilization of PHC for childbirth but up to only a certain level of Facility Index. Women living in districts with 'good' Facility index were having 2.45 (OR = 2.45; 95% CI: 2.12-2.84) times higher odds of delivering the child at PHC compared to women living in districts with 'very poor' Facility Index; however, the odds ratio decreased to 2.11 (95% CI: 1.83-2.43) for 'Very Good' Facility Index. The regression line and predicted probabilities also exhibited similar results. CONCLUSION Based on the findings, we conclude that improvement in availability and quality of facilities might help in improving healthcare utilization from PHCs up to a certain level.
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Affiliation(s)
- Akif Mustafa
- International Institute for Population Sciences (IIPS), Mumbai, 400088, India.
| | - Chander Shekhar
- Department of Fertility Studies, International Institute for Population Sciences (IIPS), Mumbai, India
| | - Neha Shri
- International Institute for Population Sciences (IIPS), Mumbai, 400088, India
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11
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Greenwood-Ericksen M, Kamdar N, Lin P, George N, Myaskovsky L, Crandall C, Mohr NM, Kocher KE. Association of Rural and Critical Access Hospital Status With Patient Outcomes After Emergency Department Visits Among Medicare Beneficiaries. JAMA Netw Open 2021; 4:e2134980. [PMID: 34797370 PMCID: PMC8605483 DOI: 10.1001/jamanetworkopen.2021.34980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Rural US residents disproportionately rely on emergency departments (ED), yet little is known about patient outcomes after ED visits to rural hospitals or critical access hospitals (CAHs). OBJECTIVE To compare 30-day outcomes after rural vs urban ED visits and in CAHs, a subset of rural hospitals. DESIGN, SETTING, AND PARTICIPANTS This propensity-matched, retrospective cohort study used a 20% sample of national Medicare fee-for-service beneficiaries from January 1, 2011, to October 31, 2015. Rural and urban ED visits were matched on demographics, patient prior use of EDs, comorbidities, and diagnoses. Thirty-day outcomes overall and stratified by 25 common ED diagnoses were evaluated, with similar analysis of CAHs vs non-CAHs. Data were analyzed from February 15, 2020, to May 17, 2021. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day all-cause mortality. Secondary outcomes were ED revisits with and without hospitalization. RESULTS The matched cohort included 473 152 rural and urban Medicare beneficiaries with a mean (SD) age of 75.1 (7.9) years (59.1% and 59.3% women, respectively; 86.9% and 87.1% White, respectively). Medicare beneficiaries at rural vs urban EDs experienced similar all-cause 30-day mortality (3.9% vs 4.1%; effect size, 0.01), ED revisits (18.1% vs 17.8%; effect size, 0.00), and ED revisits with hospitalization (6.0% vs 8.1%; effect size, 0.00). Rural ED visits were associated with more transfer (6.2% vs 2.0%; effect size, 0.22) and fewer hospitalizations (24.7% vs 39.2; effect size, 0.31). Stratified by diagnosis, patients in rural EDs with life-threatening illnesses experienced more transfer with 30-day mortality similar to that of patients in urban EDs. In contrast, mortality differed for patients in rural EDs with symptom-based diagnoses, including chest pain (odds ratio [OR], 1.54 [95% CI, 1.25-1.89]), nausea and vomiting (OR, 1.68 [95% CI, 1.26-2.24), and abdominal pain (OR, 1.73 [95% CI, 1.42-2.10]). All findings were similar for CAHs. CONCLUSIONS AND RELEVANCE The findings of this cohort study of rural ED care suggest that patient mortality for potentially life-threatening conditions is comparable to that in urban settings. Further research is needed to understand the sources of greater rural ED mortality for symptom-based conditions. These findings underscore the importance of ensuring access to treatment of life-threatening conditions at local EDs in rural communities, which are increasingly endangered by hospital closures.
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Affiliation(s)
- Margaret Greenwood-Ericksen
- Department of Emergency Medicine, University of New Mexico, Albuquerque
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan, Ann Arbor
| | - Paul Lin
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Naomi George
- Department of Emergency Medicine, University of New Mexico, Albuquerque
- Division of Critical Care, Department of Emergency Medicine, University of New Mexico, Albuquerque
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico, Albuquerque
| | - Nicholas M. Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City
- Department of Anesthesia–Critical Care Medicine, University of Iowa, Iowa City
| | - Keith E. Kocher
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan, Ann Arbor
- Department of Learning Health Sciences, University of Michigan, Ann Arbor
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12
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Elliott BM, Bissett IP, Harmston C. Prehospital barriers for rural New Zealand parents in paediatric appendicitis: a qualitative analysis. ANZ J Surg 2021; 91:2130-2138. [PMID: 34459562 DOI: 10.1111/ans.17158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/29/2021] [Accepted: 08/08/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Appendicitis is the most common reason children undergo emergency general surgery. Worse appendicitis outcomes have been demonstrated in rural, lower socioeconomic, and indigenous populations. These findings are hypothesised to be a result of differential access and delay in presentation to hospital. However, no qualitative study has investigated why prehospital delay may exist. METHODS We conducted individual, semi-structured interviews with the parents of 11 rural children who presented with acute appendicitis between June 2019-January 2020. Utilising grounded theory methodology, we created an exploratory framework. RESULTS Participating families travelled a mean distance of 50.4 km to access hospital, and the median prehospital symptom duration was 42 h. Families with reduced financial or social resources were more likely to 'watch and wait' due to the increased relative burden of access. Key considerations were travel, organising childcare and parental income loss in a rural environment. Structural healthcare barriers further dissuaded prompt access and subsequent engagement. These included poor cultural safety, maldistribution of rural health services, and contradictory public health messages. Several families sought informal community-based health advice to mitigate these barriers, leading to earlier hospital presentation. CONCLUSION Prehospital delay in rural families occurred most frequently due to an extended decision-making phase where families evaluated the costs and benefits of accessing hospital-level care. The utilisation of informal community expertise and whānau advocacy helped circumvent reduced access to health facilities. Cultural safety remains problematic and hinders engagement with Māori families.
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Affiliation(s)
- Brodie M Elliott
- Department of General Surgery, Whangarei Hospital, Northland, New Zealand.,Department of Surgery, University of Auckland
| | - Ian P Bissett
- Department of Surgery, University of Auckland.,Consultant General and Colorectal Surgeon, Auckland Hospital, New Zealand
| | - Christopher Harmston
- Department of General Surgery, Whangarei Hospital, Northland, New Zealand.,Department of Surgery, University of Auckland.,Consultant General and Colorectal Surgeon, Whangarei Hospital, Whangarei, New Zealand
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13
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Li C, Chen Z, Khan MM. Bypassing primary care facilities: health-seeking behavior of middle age and older adults in China. BMC Health Serv Res 2021; 21:895. [PMID: 34461884 PMCID: PMC8406824 DOI: 10.1186/s12913-021-06908-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With economic development, aging of the population, improved insurance coverage, and the absence of a formal referral system, bypassing primary healthcare facilities appear to have become more common. Chinese patients tend to visit the secondary or tertiary healthcare facilities directly leading to overcrowding at the higher-level facilities. This study attempts to analyze the factors associated with bypassing primary care facilities among patients of age 45 years or older in China. METHODS Random effects logistic models were used to examine bypassing of primary health facilities among rural-urban patients. Data from 2011 to 2015 waves of the China Health and Retirement Longitudinal Study were used. RESULTS Two in five older patients in China bypass primary health centers (PHC) to access care from higher-tier facilities. Urban patients were nearly twice as likely as rural patients to bypass PHC. Regardless of rural-urban residence, our analysis found that a longer travel time to primary facilities compared to higher-tier facilities increases the likelihood of bypassing. Patients with higher educational attainment were more likely to bypass PHCs. In rural areas, patients who reported their health as poor or those who experienced a recent hospitalization had a higher probability of bypassing PHC. In urban areas, older adults (age 65 years or older) were more likely to bypass PHC than the younger group. Patients with chronic conditions like diabetes also had a higher probability of bypassing. CONCLUSIONS The findings indicate the importance of strengthening the PHCs in China to improve the efficiency and effectiveness of the health system. Significantly lower out-of-pocket costs at the PHC compared to costs at the higher tiers had little or no impact on increasing the likelihood of utilizing the PHCs. Improving service quality, providing comprehensive person-centered care, focusing on family health care needs, and providing critical preventive services will help increase utilization of PHCs as well as the effectiveness and efficiency of the health system.
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Affiliation(s)
- Changle Li
- Department of Health Economics, School of Health Management, Inner Mongolia Medical University, Hohhot, China.,Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall 116, Athens, GA, 30602, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall 116, Athens, GA, 30602, USA.,Centre for Health Economics, School of Economics, University of Nottingham Ningbo China, Ningbo, China
| | - M Mahmud Khan
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall 116, Athens, GA, 30602, USA.
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Influence of Geographic Access on Surgical Center Readmissions After Index Congenital Heart Surgery. J Pediatr 2021; 234:195-204.e3. [PMID: 33774056 PMCID: PMC8981557 DOI: 10.1016/j.jpeds.2021.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the impact of geographic access to surgical center on readmission risk and burden in children after congenital heart surgery. STUDY DESIGN Children <6 years old at discharge after congenital heart surgery (Risk Adjustment for Congenital Heart Surgery-1 score 2-6) were identified using Pediatric Health Information System data (46 hospitals, 2004-2015). Residential distance from the surgery center, calculated using ZIP code centroids, was categorized as <15, 15-29, 30-59, 60-119, and ≥120 miles. Rurality was defined using rural-urban commuting area codes. Geographic risk factors for unplanned readmissions to the surgical center and associated burden (total hospital length of stay [LOS], costs, and complications) were analyzed using multivariable regression. RESULTS Among 59 696 eligible children, 19 355 (32%) had ≥1 unplanned readmission. The median LOS was 9 days (IQR 22) across the entire cohort. In those readmitted, median total costs were $31 559 (IQR $90 176). Distance from the center was inversely related but rurality was positively related to readmission risk. Among those readmitted, increased distance was associated with longer LOS, more complications, and greater costs. Compared with urban patients, highly rural patients were more likely to have an unplanned readmission but had fewer average readmission days. CONCLUSIONS Geographic measures of access differentially affect readmission to the surgery center. Increased distance from the center was associated with fewer unplanned readmissions but more complications. Among those readmitted, the most isolated patients had the greatest readmission costs. Understanding the contribution of geographic access will aid in developing strategies to improve care delivery to this population.
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Gabrani J, Schindler C, Wyss K. Perspectives of Public and Private Primary Healthcare Users in Two Regions of Albania on Non-Clinical Quality of Care. J Prim Care Community Health 2021; 11:2150132720970350. [PMID: 33243061 PMCID: PMC7705804 DOI: 10.1177/2150132720970350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Aiming to tackle the rise of non-communicable diseases and an ageing population, Albania is engaged in boosting primary healthcare services and quality of care. The patients’ perspectives on their experience with public and private providers are, however, missing, although their viewpoints are critical while shaping the developing services. Consequently, we analyze perceptions of users of primary healthcare as it relates to non-clinical quality of care and the association to sociodemographic characteristics of patients and the type of provider. Methods: A facility-based survey was conducted in 2018 using the World Health Organization responsiveness questionnaire which is based on a 4-point scale along with 8 non-clinical domains of quality of care. The data of 954 patients were analyzed through descriptive statistics and linear mixed regression models. Results: Similar mean values were reported on total scale of the quality of care for private and public providers, also after sociodemographic adjustments. The highest mean score was reported for the domain “communication” (3.75) followed by “dignity” (3.65), while the lowest mean scores were given for “choice” (2.89) and “prompt attention” (3.00). Urban governmental PHC services were rated significantly better than private outpatient clinics in “coordination of care” (2.90 vs 2.12, P < .001). In contrast, private outpatient clinics were judged significantly better than urban PHC clinics in “confidentiality” (3.77 vs 3.38, P = .04) and “quality of basic amenities” (3.70 vs 3.02, P < .001). “Autonomy” was reported as least important attribute of quality. Conclusion: While the perception of non-clinical care quality was found to be high and similar for public and private providers, promptness and coordination of care require attention to meet patient’s expectations on good quality of care. There is a need to raise the awareness on autonomy and the involvement of patients’ aspects concerning their health.
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Affiliation(s)
- Jonila Gabrani
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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16
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Amoro VA, Abiiro GA, Alatinga KA. Bypassing primary healthcare facilities for maternal healthcare in North West Ghana: socio-economic correlates and financial implications. BMC Health Serv Res 2021; 21:545. [PMID: 34078379 PMCID: PMC8173790 DOI: 10.1186/s12913-021-06573-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/21/2021] [Indexed: 12/11/2022] Open
Abstract
Background Bypassing primary health care (PHC) facilities for maternal health care is an increasing phenomenon. In Ghana, however, there is a dearth of systematic evidence on bypassing PHC facilities for maternal healthcare. This study investigated the prevalence of bypassing PHC facilities for maternal healthcare, and the socio-economic factors and financial costs associated with bypassing PHC facilities within two municipalities in Northwestern Ghana. Methods A quantitative cross-sectional design was implemented between December 2019 and March 2020. Multistage stratified sampling was used to select 385 mothers receiving postnatal care in health facilities for a survey. Using STATA 12 software, bivariate analysis with chi-square test and binary logistic regression models were run to determine the socio-economic and demographic factors associated with bypassing PHC facilities. The two-sample independent group t-test was used to estimate the mean differences in healthcare costs of those who bypassed their PHC facilities and those who did not. Results The results revealed the prevalence of bypassing PHC facilities as 19.35 % for antenatal care, 33.33 % for delivery, and 38.44 % for postnatal care. The municipality of residence, ethnicity, tertiary education, pregnancy complications, means of transport, nature of the residential location, days after childbirth, age, and income were statistically significantly (p < 0.05) associated with bypassing PHC facilities for various maternal care services. Compared to the non-bypassers, the bypassers incurred a statistically significantly (P < 0.001) higher mean extra financial cost of GH₵112.09 (US$19.73) for delivery, GH₵44.61 (US$7.85) for postnatal care and ₵43.34 (US$7.65) for antenatal care. This average extra expenditure was incurred on transportation, feeding, accommodation, medicine, and other non-receipted expenses. Conclusions The study found evidence of bypassing PHC facilities for maternal healthcare. Addressing this phenomenon of bypassing and its associated cost, will require effective policy reforms aimed at strengthening the service delivery capacities of PHC facilities. We recommend that the Ministry of Health and Ghana Health Service should embark on stakeholder engagement and sensitization campaigns on the financial consequences of bypassing PHC facilities for maternal health care. Future research, outside healthcare facility settings, is also required to understand the specific supply-side factors influencing bypassing of PHC facilities for maternal healthcare within the study area.
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Affiliation(s)
| | - Gilbert Abotisem Abiiro
- Department of Health Services, Policy, Planning, Management and Economics, School of Public Health, University for Development Studies, Tamale, Ghana.,Department of Planning, Faculty of Planning and Land Management, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - Kennedy A Alatinga
- Department of Community Development, Faculty of Planning and Land Management, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
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17
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Mukudu H, Otwombe K, Moloto C, Fusheini A, Igumbor J. Perceived quality of primary healthcare post-National Health Insurance pilot implementation. Health SA 2021; 26:1580. [PMID: 34192067 PMCID: PMC8182563 DOI: 10.4102/hsag.v26i0.1580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/02/2021] [Indexed: 11/01/2022] Open
Abstract
Background Contracting private medical practitioners for the National Health Insurance pilot project in 2012 by the National Department of Health in South Africa was envisaged to reduce workload at referral district hospitals by reducing self-referral by clients as the perceived quality of care at the primary healthcare level improves. Aim To describe the effect of contracting private medical practitioners at primary healthcare facilities on the self-referral rate of clients at district hospitals as a proxy for perceived quality of care in a National Health Insurance pilot district. Setting The study was set in Tshwane National Health Insurance pilot district compared to Ekurhuleni district. Methods We compared findings before and after implementing the National Health Insurance private medical practitioners contracting between a pilot and a non-pilot district. A quasi-experimental ecological study design was used to compare district hospital outpatient department indicators of clients follow-up, self-referral, self-referral rate and referred in the two districts from June 2012 to May 2014 using single and controlled interrupted time-series analyses. Results Controlled interrupted time series analysis found decreases in self-referral rate (-1.8 [-2.2, -1.1] [p < 0.0001]) and the initial trend of headcounts of self-referral (-516 [-969, -66] [p = 0.0260]), but an increase in headcounts of referred clients (1293 [77, 2508] [p = 0.0376]) in the pilot compared with the non-pilot district. Conclusion We concluded that the implementation of contracting private medical practitioners in primary healthcare facilities might have resulted in an improved perceived quality of care at primary health care facilities. However, the higher number of outpatient department headcounts for follow-up and the increase in referred cases in the pilot district would need to be investigated.
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Affiliation(s)
- Hillary Mukudu
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caiphus Moloto
- Health Directorate, Health Information Management, Department of Health, Johannesburg, South Africa
| | - Adam Fusheini
- Department of Preventive and Social Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Jude Igumbor
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Watson D, Hughes K, Robinson E, Billette J, Bombak AE. Patient Recommendations for Providers to Avoid Stigmatizing Weight in Rural-Based Women With Low Income. J Patient Cent Res Rev 2021; 8:20-30. [PMID: 33511250 DOI: 10.17294/2330-0698.1752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Weight stigma has become widespread within health care and disproportionately affects women, who are under greater appearance-based scrutiny than men. It is also well established that rural-based individuals with low incomes suffer greater health disparities compared with urban, higher-income counterparts, yet studies examining recommendations for nonstigmatizing health care among higher-weight women from low-income rural settings are lacking. This study examined the experiences and recommendations of higher-weight, low-income, rural women, with the aim of improving health care for similar populations. Methods In-depth, semi-structured interviews were conducted in a rural region of the Midwestern United States to explore participants' recommendations for redressing stigma within health care. All participants (n=25) self-identified as higher-weight, low-income, rural women. Results All participants experienced or were aware of weight stigma within health care. Themes identified from responses were understanding patients and their situations, offering options and supplemental information, communicating effectively, taking time, and having a positive attitude. Patient recommendations focused on correcting physician biases, rapport-building, and providing holistic care. Conclusions The findings suggest that weight stigma is prevalent within health care provided to low-income women in rural U.S. Midwest and that there are specific communication and training approaches that may reduce the prevalence of weight stigma in health care.
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Affiliation(s)
- Declan Watson
- Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - Katherine Hughes
- School of Health Sciences, Central Michigan University, Mount Pleasant, MI
| | - Emma Robinson
- Department of Sociology, University of New Brunswick, Fredericton, Canada
| | | | - Andrea E Bombak
- Department of Sociology, University of New Brunswick, Fredericton, Canada
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Liang LL, Huang N, Shen YJ, Chen AYA, Chou YJ. Do patients bypass primary care for common health problems under a free-access system? Experience of Taiwan. BMC Health Serv Res 2020; 20:1050. [PMID: 33208148 PMCID: PMC7677770 DOI: 10.1186/s12913-020-05908-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background A common challenge for free-access systems is that people may bypass primary care and seek secondary care through self-referral. Taiwan’s government has undertaken various initiatives to mitigate bypass; however, little is known about whether the bypass trend has decreased over time. This study examined the extent to which patients bypass primary care for treatment of common diseases and factors associated with bypass under Taiwan’s free-access system. Methods This repeated cross-sectional study analyzed data from Taiwan’s National Health Insurance Research Database. A random sample of 1 million enrollees was drawn repeatedly from the insured population during 2000–2017. To capture visits beyond the community level, the bypass rate was defined as the proportion of self-referred visits to the top two levels of providers, namely academic medical centers and regional hospitals, among all visits to all providers. Subgroup analyses were conducted for visits with a single diagnosis. Logistic regressions were used to investigate factors associated with bypass. Results The standardized bypass rate for all diseases analyzed exhibited a decreasing trend. In 2017, it was low for common cold (0.7–1.3%), moderate for hypertension (14.0–29.5%), but still high for diabetes (32.0–47.0%). Moreover, the likelihood of bypass was higher for male, patients with higher salaries or comorbidities, and in areas with more physicians practicing in large hospitals or less physicians working in primary care facilities. Conclusions Although the bypass trend has decreased over time, continuing efforts may be required to reduce bypass associated with chronic diseases. Both patient sociodemographic and market characteristics were associated with the likelihood of bypass. These results may help policymakers to develop strategies to mitigate bypass. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05908-w.
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Affiliation(s)
- Li-Lin Liang
- Department of Business Management, National Sun Yat-sen University, No. 70, Lienhai Rd, Kaohsiung, 804, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, No.155, Section 2, Li-Nong Street, Taipei, 112, Taiwan
| | - Yi-Jung Shen
- Institute of Hospital and Health Care Administration, National Yang-Ming University, No.155, Section 2, Li-Nong Street, Taipei, 112, Taiwan
| | - Annie Yu-An Chen
- RAND Corporation, 1766 Main Street, Santa Monica, CA, USA.,Pardee RAND Graduate School, 1766 Main Street, Santa Monica, CA, USA
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang-Ming University, No.155, Sec. 2, Li-Nong St., Beitou Dist, Taipei, 112, Taiwan.
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Zhou Z, Zhao Y, Shen C, Lai S, Nawaz R, Gao J. Evaluating the effect of hierarchical medical system on health seeking behavior: A difference-in-differences analysis in China. Soc Sci Med 2020; 268:113372. [PMID: 32979776 DOI: 10.1016/j.socscimed.2020.113372] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/08/2020] [Accepted: 09/13/2020] [Indexed: 12/15/2022]
Abstract
The unbalanced allocation of healthcare resources and the underutilization of primary care facilities are the core problems that restrict the current healthcare reforms in China. In order to encourage residents to go to primary care facilities, China implemented the Hierarchical Medical System (HMS) in 2015. This study aims to evaluate the effect of HMS on health seeking behavior in China using panel data. Statistics for the study were derived from China Family Panel Studies (CFPS) 2012, 2014, 2016 and 2018, and China health and family planning statistical yearbook 2012, 2014, 2016 and 2018. We employed the difference-in-differences (DID) model with multiple periods. In total, 61,932 residents were incorporated for a final sample covered 25 provinces. The results indicated that the implementation of HMS had a significantly positive effect on the probability of urban residents going to primary care facilities for contact. However, the effect of HMS was not significant for rural residents. Basic health insurance was a significant factor for directing residents to primary care facilities. Self-assessed health, chronic disease, economic level and educational status were also found to be focal factors of health seeking behavior. In conclusion, the introduction of HMS has led to improved health seeking behavior and is worth putting more effort into. For policy makers, basic medical insurance is still an important health policy that enables systematic health seeking behavior. Initiatives to continue to expand the adjustment range of economic incentives should be adopted to promote the implementation of HMS. However, the effect of HMS in chronic disease is poor and efforts to formulate chronic disease as a breakthrough to HMS should be carried out. Moreover, the government should increase the publicity of HMS.
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Affiliation(s)
- Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Yaxin Zhao
- School of Public Health, Health Science Center, Xi'an Jiaotong University, No.76 West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Rashed Nawaz
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
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Performance and Sociodemographic Determinants of Excess Outpatient Demand of Rural Residents in China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165963. [PMID: 32824533 PMCID: PMC7460206 DOI: 10.3390/ijerph17165963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/26/2022]
Abstract
Excess healthcare utilization is rapidly rising in rural China. This study focused on excess outpatient demand (EOD) and aimed to measure its performance and sociodemographic determinants among China’s rural residents. A total of 1290 residents from four counties in central China were enrolled via multistage cluster random sampling. EOD is the condition in which the level of hospital a patient chooses is higher than the indicated level in the governmental guide. A multilevel logistic regression was used to examine the sociodemographic determinants of EOD. Residents with EOD accounted for 85.83%. The risk of EOD was 51.17% and value was 5.69. The value of EOD in diseases was higher than that in symptoms (t = −21.498, p < 0.001). Age (OR = 0.489), educational level (OR = 1.986) and hospital distance difference (OR = 0.259) were the main sociodemographic determinants of EOD. Excess outpatient demand was evident in rural China, but extreme conditions were rare. Results revealed that age, educational level and hospital distance were the main sociodemographic determinants of EOD. The capacity of primary healthcare institutions, universality of common disease judgement and understanding of institution’s scope of disease curing capabilities of residents should be improved to reduce EOD.
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Bell G, Macarayan EK, Ratcliffe H, Kim JH, Otupiri E, Lipsitz S, Hirschhorn L, Awoonor-Williams JK, Nimako BA, Ofosu A, Leslie H, Bitton A, Schwarz D. Assessment of Bypass of the Nearest Primary Health Care Facility Among Women in Ghana. JAMA Netw Open 2020; 3:e2012552. [PMID: 32785634 PMCID: PMC7424402 DOI: 10.1001/jamanetworkopen.2020.12552] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Recent reports have highlighted that expanding access to health care is ineffective at meeting the goal of universal health coverage if the care offered does not meet a minimum level of quality. Health care facilities nearest to patient's homes that are perceived to offer inadequate or inappropriate care are frequently bypassed in favor of more distant private or tertiary-level hospital facilities that are perceived to offer higher-quality care. OBJECTIVE To estimate the frequency with which women in Ghana bypass the nearest primary health care facility and describe patient experiences, costs, and other factors associated with this choice. DESIGN, SETTING, AND PARTICIPANTS This nationally representative survey study was conducted in 2017 and included 4203 households to identify women in Ghana aged 15 to 49 years (ie, reproductive age) who sought primary care within the last 6 months. Women who sought care within the past 6 months were included in the study. Data were analyzed from 2018 to 2019. EXPOSURES Bypass was defined as a woman's report that she sought care at a health facility other than the nearest facility. MAIN OUTCOMES AND MEASURES Sociodemographic characteristics, reasons why women sought care, reasons why women bypassed their nearest facility, ratings for responsiveness of care, patient experience, and out-of-pocket costs. All numbers and percentages were survey-weighted to account for survey design. RESULTS A total of 4289 women met initial eligibility criteria, and 4207 women (98.1%) completed the interview. A total of 1993 women reported having sough health care in the past 6 months, and after excluding those who were ineligible and survey weighting, the total sample included 1946 women. Among these, 629 women (32.3%) reported bypassing their nearest facilities for primary care. Women who bypassed their nearest facilities, compared with women who did not, were more likely to visit a private facility (152 women [24.5%] vs 202 women [15.6%]) and borrow money to pay for their care (151 women [24.0%] vs 234 women [17.8%]). After adjusting for covariates, women who bypassed reported paying a mean of 107.2 (95% CI, 79.1-135.4) Ghanaian Cedis (US $18.50 [95% CI, $13.65-$23.36]) for their care, compared with a mean of 58.6 (95% CI, 28.1-89.2) Ghanaian Cedis (US $10.11 [95% CI, $4.85-15.35]) for women who did not bypass (P = .006). Women who bypassed cited clinician competence (136 women [34.3%]) and availability of supplies (93 women [23.4%]) as the most important factors in choosing a health facility. CONCLUSIONS AND RELEVANCE The findings of this survey study suggest that bypassing the nearest health care facility was common among women in Ghana and that available services at lower levels of primary care are not meeting the needs of a large proportion of women. Among the benefits women perceived from bypassing were clinician competence and availability of supplies. These data provide insights to policy makers regarding potential gaps in service delivery and may help to guide primary health care improvement efforts.
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Affiliation(s)
- Griffith Bell
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Erlyn K. Macarayan
- Lancet Commission on High Quality Health Systems, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hannah Ratcliffe
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - June-Ho Kim
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine & Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Easmon Otupiri
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stuart Lipsitz
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Anthony Ofosu
- Policy Planning Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana
| | - Hannah Leslie
- Lancet Commission on High Quality Health Systems, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine & Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Dan Schwarz
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Ocholla IA, Agutu NO, Ouma PO, Gatungu D, Makokha FO, Gitaka J. Geographical accessibility in assessing bypassing behaviour for inpatient neonatal care, Bungoma County-Kenya. BMC Pregnancy Childbirth 2020; 20:287. [PMID: 32397969 PMCID: PMC7216545 DOI: 10.1186/s12884-020-02977-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/30/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Neonatal mortality rate in Kenya continues to be unacceptably high. In reducing newborn deaths, inequality in access to care and quality care have been identified as current barriers. Contributing to these barriers are the bypassing behaviour and geographical access which leads to delay in seeking newborn care. This study (i) measured geographical accessibility of inpatient newborn care, and (ii), characterized bypassing behaviour using the geographical accessibility of the inpatient newborn care seekers. METHODS Geographical accessibility to the inpatient newborn units was modelled based on travel time to the units across Bungoma County. Data was then collected from 8 inpatient newborn units and 395 mothers whose newborns were admitted in the units were interviewed. Their spatial residence locations were geo-referenced and were used against the modelled travel time to define bypassing behaviour. RESULTS Approximately 90% of the sick newborn population have access to nearest newborn units (< 2 h). However, 36% of the mothers bypassed their nearest inpatient newborn facility, with lack of diagnostic services (28%) and distrust of health personnel (37%) being the major determinants for bypassing. Approximately 75% of the care seekers preferred to use the higher tier facilities for both maternal and neonatal care in comparison to sub-county facilities which mostly were bypassed and remained underutilised. CONCLUSION Our findings suggest that though majority of the population have access to care, sub-county inpatient newborn facilities have high risk of being bypassed. There is need to improve quality of care in maternal care, to reduce bypassing behaviour and improving neonatal outcome.
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Affiliation(s)
- Ian A. Ocholla
- Department of Geomatics Engineering and Geospatial Information System, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00100, Nairobi, Kenya
| | - Nathan O. Agutu
- Department of Geomatics Engineering and Geospatial Information System, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00100, Nairobi, Kenya
| | - Paul O. Ouma
- Department of Geomatics Engineering and Geospatial Information System, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00100, Nairobi, Kenya
| | - Daniel Gatungu
- Research and Innovation Directorate, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
| | | | - Jesse Gitaka
- Research and Innovation Directorate, Mount Kenya University, P.O. Box 342-01000, Thika, Kenya
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Pillay I, Mahomed OH. Prevalence and determinants of self referrals to a District-Regional Hospital in KwaZulu Natal, South Africa: a cross sectional study. Pan Afr Med J 2019; 33:4. [PMID: 31303949 PMCID: PMC6607454 DOI: 10.11604/pamj.2019.33.4.16963] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/14/2018] [Indexed: 11/12/2022] Open
Abstract
Introduction Self-referrals to inappropriate levels of care result in an increased patient waiting time, overburdening of higher levels of care, reduced primary healthcare utilisation rate and increasing healthcare costs. Furthermore, self-referral places an additional encumbrance on various levels of care as allocation of resources and infrastructure cannot be accurately planned, based on the facility catchment population. The aim of this study was to determine the prevalence and determinants of patient self-referral at the out-patient department of Stanger Hospital, KwaZulu-Natal between January and June 2017. Methods A cross-sectional study was conducted at the out-patient department in Stanger Hospital, using interviewer administered questionnaires to collect information from 385 patients, through convenience sampling, between January and June 2017. Multivariable regression analysis was used to test for factors associated with self-referral. Results of the 385 patients interviewed 36% (n = 138) were self-referrals. Most of the self-referrals were male (51.5%) and of the African race (57.2%). Five institutional factors namely: care received from healthcare workers (91.3%); waiting times (88.4%); help offered (87%); treatment and attitude of healthcare workers (63%) and availability of medication (55.8%) were considered as the main drivers of self-referral. Multivariable regression analysis established a significant positive association between patient self-referral and age (40 years and below), attitude of healthcare workers, quality of care received form healthcare workers, waiting times and the availability of diagnostic tests. Conclusion This study indicates that most patients attending Stanger Hospital do comply with the prescribed referral pathway, however a significant proportion still bypass the referral system.
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Affiliation(s)
- Ishandree Pillay
- Stanger Hospital and Discipline of Public Health Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Ozayr Haroon Mahomed
- Discipline of Public Health Medicine; University of KwaZulu Natal, Durban, South Africa
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Kuperman EF, Linson EL, Klefstad K, Perry E, Glenn K. The Virtual Hospitalist: A Single-Site Implementation Bringing Hospitalist Coverage to Critical Access Hospitals. J Hosp Med 2018; 13:759-763. [PMID: 30255859 DOI: 10.12788/jhm.3061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND On-site hospitalist care can improve patient care, but it is economically infeasible for small critical access hospitals (CAHs). A telemedicine "virtual hospitalist" may expand CAH capabilities at a fractional cost of an on"site provider. OBJECTIVE To evaluate the impact of a virtual hospitalist on transfers from a CAH to outside hospitals. DESIGN, SETTING, PATIENTS A 6-month pilot program providing "virtual hospitalist" coverage to patients at a CAH in rural Iowa. MEASUREMENTS The primary outcome was the rate of outside transfers from the CAH Emergency Department (ED). The secondary outcomes included transfer from either the ED or the inpatient wards, daily census, length of stay, transfers after admission, virtual hospitalist time commitment, and patient and staff satisfaction. The preceding 24-week baseline was compared with 24 weeks after implementation, excluding a 2-week transition period. RESULTS At baseline, there were 947 ED visits and 176 combined inpatient and observation encounters, compared to 930 and 176 after implementation, respectively. Outside transfers from the ED decreased from 16.6% to 10.5% (157/947 to 98/930, P < .001), and transfers at any time decreased from 17.3% to 11.9% (164/947 to 111/930, P < .001). Daily census, length of stay, and transfers after admission were unchanged. Time commitment for a virtual hospitalist was 35 minutes per patient per day. The intervention was well received by the CAH staff and patients. CONCLUSIONS The virtual hospitalist model increased the percentage of ED patients who could safely receive their care locally. A single virtual hospitalist may be able to cover multiple CAHs simultaneously. FUNDING Development of this project was funded through the University of Iowa Hospitalist group and the Signal Center for Health Innovations at UI Health Ventures. Virtual hospitalist clinical time was paid for by the CAH on a fractional basis of a traditional hospitalist based on projected patient volumes through analysis of baseline data. Patients were not directly billed for virtual hospitalist service but were charged for the services provided by CAH providers.
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Affiliation(s)
- Ethan F Kuperman
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
| | - Eric L Linson
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Kate Klefstad
- University of Iowa Health Ventures, Coralville, Iowa, USA
| | - Evelyn Perry
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Kevin Glenn
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Effect of Patient Experience on Bypassing a Primary Care Gatekeeper: a Multicenter Prospective Cohort Study in Japan. J Gen Intern Med 2018; 33:722-728. [PMID: 29352418 PMCID: PMC5910334 DOI: 10.1007/s11606-017-4245-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/22/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND To discuss how best to implement the gatekeeping functionality of primary care; identifying the factors that cause patients to bypass their primary care gatekeepers when seeking care should be beneficial. OBJECTIVE To examine the association between patient experience with their primary care physicians and bypassing them to directly obtain care from higher-level healthcare facilities. DESIGN AND METHODS This prospective cohort study was conducted in 13 primary care clinics in Japan. We assessed patient experience of primary care using the Japanese version of Primary Care Assessment Tool (JPCAT), which comprises six domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. The primary outcome was the patient bypassing their usual primary care physician to seek care at a hospital, with this occurring at least once in a year. We used a Bayesian hierarchical model to adjust clustering within clinics and individual covariates. KEY RESULTS Data were analyzed from 205 patients for whom a physician at a clinic served as their usual primary care physician. The patient follow-up rate was 80.1%. After adjustment for patients' sociodemographic and health status characteristics, the JPCAT total score was found to be inversely associated with patient bypass behavior (odds ratio per 1 SD increase, 0.44; 95% credible interval, 0.21-0.88). The results of various sensitivity analyses were consistent with those of the primary analysis. CONCLUSIONS We found that patient experience of primary care in Japan was inversely associated with bypassing a primary care gatekeeper to seek care at higher-level healthcare facilities, such as hospitals. Our findings suggest that primary care providers' efforts to improve patient experience should help to ensure appropriate use of healthcare services under loosely regulated gatekeeping systems; further studies are warranted.
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Wright B, Potter AJ, Trivedi AN, Mueller KJ. The Relationship Between Rural Health Clinic Use and Potentially Preventable Hospitalizations and Emergency Department Visits Among Medicare Beneficiaries. J Rural Health 2017; 34:423-430. [PMID: 28685852 DOI: 10.1111/jrh.12253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/03/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE High rates of potentially preventable hospitalizations and emergency department (ED) visits indicate limited primary care access. Rural Health Clinics (RHCs) are intended to increase access to primary care. The goal of this study was to evaluate the role of RHCs and their impact on potentially preventable hospitalizations and ED visits among Medicare beneficiaries based on actual individual-level utilization patterns. METHODS With Medicare Part A and Part B claims data from 2007 to 2010, we constructed a series of individual-level negative binomial regression models to examine the relationship between RHC use and the number of potentially preventable hospitalizations and ED visits. FINDINGS RHC use was associated with a 27% increase in potentially preventable hospitalizations and a 24% increase in potentially preventable ED visits among older Medicare enrollees. Among younger, disabled Medicare beneficiaries, RHC use was associated with a 14% increase in potentially preventable hospitalizations and an 18% increase in potentially preventable ED visits. Potentially preventable hospitalizations and ED visits were more common among beneficiaries who were black or who had more chronic conditions. CONCLUSIONS The results of our study highlight that the Medicare population using RHCs is at especially high risk for potentially preventable hospitalizations and ED visits. The mechanisms behind this are not well understood and should receive continued attention from policy makers and researchers.
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Affiliation(s)
- Brad Wright
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa.,Public Policy Center, University of Iowa, Iowa City, Iowa
| | - Andrew J Potter
- Department of Political Science and Criminal Justice, California State University, Chico, California
| | - Amal N Trivedi
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island.,Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | - Keith J Mueller
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa.,Public Policy Center, University of Iowa, Iowa City, Iowa
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Scott DM, Friesner DL, Undem T, Anderson G, Sem K, Peterson CD. Perceived sustainability of community telepharmacy in North Dakota. J Am Pharm Assoc (2003) 2017; 57:362-368.e5. [DOI: 10.1016/j.japh.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/18/2017] [Accepted: 02/05/2017] [Indexed: 11/26/2022]
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Okoli H, Obembe T, Osungbade K, Adeniji F, Adewole D. Self-referral patterns among federal civil servants in oyo state, South-Western Nigeria. Pan Afr Med J 2017; 26:105. [PMID: 28491236 PMCID: PMC5409987 DOI: 10.11604/pamj.2017.26.105.11483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/24/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Primary health care is widely accepted as the first point of care; yet, individuals requiring healthcare engage in self-referrals to higher levels of care thereby by-passing primary care. Little is known of the extent to which self-referrals are carried out when care is needed. This study thus sought to determine the prevalence of self-referral, its patterns and factors influencing self-referrals amongst federal civil servants in Southwestern Nigeria. METHODS A cross-sectional study was carried out among 300 federal civil servants who were interviewed using validated and pre-tested interviewer-administered semi structured questionnaires. Data was analyzed using univariate and Chi-square test at level of significance set at P <0.05. RESULTS Mean age of the respondents was 39.96 ± 9.1 years with majority being married (80.7%); 90.7% completed tertiary education (and 76.7 % were middle grade (7-12) level officers. Most (60.0%) of the respondents had ever engaged in self-referral. Malaria was the commonest health problem (39.7%) for self-referral to secondary or tertiary facilities. Desire for quality service (35.7%) and competent staff (35.2%) were the commonest reasons for self-referral to a higher level of health care. More female respondents (76.0%) compared to male respondents (64.0%) significantly engaged in self-referral (p = 0.02, X2 = 5.14). Respondents having good knowledge of referral practices engaged less in self-referral compared to those with poor knowledge. (p = 0.02, X2 = 5.43). CONCLUSION Having good knowledge of referral practices and being male are positively associated with referral practices. Creating awareness and improving knowledge on referral practices with special emphasis on women population are desirable strategies for encouraging the use of primary health care as first of point of contact with health systems.
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Affiliation(s)
- Henry Okoli
- Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Taiwo Obembe
- Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kayode Osungbade
- Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Folashayo Adeniji
- Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - David Adewole
- Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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An agent-based simulation model of patient choice of health care providers in accountable care organizations. Health Care Manag Sci 2016; 21:131-143. [PMID: 27704322 DOI: 10.1007/s10729-016-9383-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
Abstract
Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers. This simulation focuses on Medicare beneficiaries and their congestive heart failure (CHF) outcomes. We place the patient agents in an ACO delivery system model in which provider agents decide if they remain in an ACO and perform a quality improving CHF disease management intervention. Illustrative results show that allowing patients to choose their providers reduces the yearly payment per CHF patient by $320, reduces mortality rates by 0.12 percentage points and hospitalization rates by 0.44 percentage points, and marginally increases provider participation in ACO. This study demonstrates a model capable of quantifying the effects of patient choice in a theoretical ACO system and provides a potential tool for policymakers to understand implications of patient choice and assess potential policy controls.
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Weigel PAM, Ullrich F, Ward MM. Rural Bypass of Critical Access Hospitals in Iowa: Do Visiting Surgical Specialists Make a Difference? J Rural Health 2016; 34 Suppl 1:s21-s29. [PMID: 27677870 DOI: 10.1111/jrh.12220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/09/2016] [Accepted: 08/29/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Rural bypass for elective surgical procedures is a challenge for critical access hospitals, yet there are opportunities for rural hospitals to improve local retention of surgical candidates through alternative approaches to developing surgery lines of business. In this study we examine the effect of visiting surgical specialists on the odds of rural bypass. METHODS Discharge data from the 2011 State Inpatient Databases and State Ambulatory Surgery Databases for Iowa were linked to outreach data from the Office of Statewide Clinical Education Programs and Iowa Physician Information System to model the effect of surgeon specialist supply on rural patients' decision to bypass rural critical access hospitals. FINDINGS Patients in rural communities with a local general surgeon were more likely to be retained in a community than to bypass. Those in communities with visiting general surgeons were more likely to bypass, as were those in communities with visiting urologists and obstetricians. Patients in communities with visiting ophthalmologists and orthopedic surgeons were at higher odds of being retained for their elective surgeries. CONCLUSION In addition to known patient and local hospital factors that have an influence on bypass behavior among rural patients seeking elective surgery, availability of surgeon specialists also plays an important role in whether patients bypass or not. Visiting ophthalmologists and orthopedic surgeons were associated with less bypass, as was having local general surgeons. Visiting general surgeons, urologists, and obstetricians were associated with greater odds of bypass.
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Affiliation(s)
- Paula A M Weigel
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
| | - Fred Ullrich
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
| | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
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Assessing Patient bypass Behavior Using Taxi Trip Origin–Destination (OD) Data. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2016. [DOI: 10.3390/ijgi5090157] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sanders SR, Erickson LD, Call VRA, McKnight ML. Middle-Aged and Older Adult Health Care Selection. J Appl Gerontol 2016; 36:441-461. [PMID: 26316268 DOI: 10.1177/0733464815602108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study assesses the prevalence of primary-care physician (PCP) bypass among rural middle-aged and older adults. Bypass is a behavior where people travel beyond local providers to obtain health care. This article applies a precise Geographic Information System (GIS)-based measure of bypass and examines the role of community and non-health-care-related characteristics on bypass. Our results indicate that bypass behavior among rural middle-aged and older adults is multifaceted. In addition to the perceived quality of local primary care, dissatisfaction with local services, such as shopping, creates an effect that increases the likelihood of bypass, whereas strong community ties decrease the likelihood of bypass. The results suggest that the "outshopping theory," where respondents select services in larger regional economic centers rather than local "mom and pop" providers, now extends to older adult health care selection.
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Phillips J, Hustedde C, Bjorkman S, Prasad R, Sola O, Wendling A, Bjorkman K, Paladine H. Rural Women Family Physicians: Strategies for Successful Work-Life Balance. Ann Fam Med 2016; 14:244-51. [PMID: 27184995 PMCID: PMC4868563 DOI: 10.1370/afm.1931] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/03/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Women family physicians experience challenges in maintaining work-life balance while practicing in rural communities. We sought to better understand the personal and professional strategies that enable women in rural family medicine to balance work and personal demands and achieve long-term career satisfaction. METHODS Women family physicians practicing in rural communities in the United States were interviewed using a semistructured format. Interviews were recorded, professionally transcribed, and analyzed using an immersion and crystallization approach, followed by detailed coding of emergent themes. RESULTS The 25 participants described a set of strategies that facilitated successful work-life balance. First, they used reduced or flexible work hours to help achieve balance with personal roles. Second, many had supportive relationships with spouses and partners, parents, or other members of the community, which facilitated their ability to be readily available to their patients. Third, participants maintained clear boundaries around their work lives, which helped them to have adequate time for parenting, recreation, and rest. CONCLUSIONS Women family physicians can build successful careers in rural communities, but supportive employers, relationships, and patient approaches provide a foundation for this success. Educators, employers, communities, and policymakers can adapt their practices to help women family physicians thrive in rural communities.
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Affiliation(s)
- Julie Phillips
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Carol Hustedde
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - Sarah Bjorkman
- Yale University School of Medicine, New Haven, Connecticut
| | - Rupa Prasad
- University of Miami Miller School of Medicine, Miami, Florida
| | - Orlando Sola
- Mount Sinai Hospital Family Medicine Residency Program, Chicago, Illinois
| | - Andrea Wendling
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Kurt Bjorkman
- Yale University School of Medicine, New Haven, Connecticut
| | - Heather Paladine
- Columbia University College of Physicians and Surgeons, New York, New York
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Fleming LC, Ansumana R, Bockarie A, Alejandre J, Bangura U, Jimmy DH, Waters N, Baghi H, Stenger D, Jacobsen KH. Inpatient healthcare provider bypassing by women and their children in urban Bo, Sierra Leone. Pan Afr Med J 2016; 23:146. [PMID: 27279971 PMCID: PMC4885720 DOI: 10.11604/pamj.2016.23.146.8706] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/28/2016] [Indexed: 11/14/2022] Open
Abstract
Introduction Bypassing refers to a person's decision to seek care at a healthcare facility that is not the nearest one of its type to the person's home. Methods This study examined inpatient care facility bypassing in urban Bo, Sierra Leone using data from 1,980 women with children 15 years of age and younger who were interviewed in 2010-2011. The locations of residential structures and hospitals were identified using a geographic information system (GIS), and the road distances from participating households to the nearest and preferred inpatient care facilities were measured. Results Nine inpatient care facilities serve Bo residents, but more than 70% of the participating women reported that the city's main public hospital (Bo Government Hospital), located in the city center, was their preferred inpatient care provider. Participants resided within a median distance of 0.9 km (Interquartile range (IQR): 0.6, 1.8) from their closest inpatient facility, but they would travel a median distance of 2.4 km (IQR: 1.0, 3.3) to reach their preferred providers. About 87% of the women would bypass their nearest inpatient care facility to access care at a preferred provider. Bypassing rates were similar for various demographic and socioeconomic groups, but higher for women living farther from the city center. Conclusion Although Bo has a diverse healthcare marketplace, access to affordable advanced care options is limited. Most women in Bo would choose to bypass facilities nearer to their homes to seek the low-cost and comprehensive care offered by Bo Government Hospital.
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Affiliation(s)
- Lila C Fleming
- George Mason University, Fairfax, VA, United States of America
| | - Rashid Ansumana
- Mercy Hospital Research Laboratory, Kulanda Town, Bo, Sierra Leone
| | - Alfred Bockarie
- Mercy Hospital Research Laboratory, Kulanda Town, Bo, Sierra Leone
| | - Joel Alejandre
- United State Naval Research Laboratory, Washington, DC, United States of America
| | - Umaru Bangura
- Mercy Hospital Research Laboratory, Kulanda Town, Bo, Sierra Leone
| | | | - Nigel Waters
- George Mason University, Fairfax, VA, United States of America
| | | | - David Stenger
- United State Naval Research Laboratory, Washington, DC, United States of America
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Visser CA, Marincowitz GJO, Govender I, Ogunbanjo GAO. Reasons for and perceptions of patients with minor ailments bypassing local primary health care facilities. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2015.1102538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Khan-Gates JA, Ersek JL, Eberth JM, Adams SA, Pruitt SL. Geographic Access to Mammography and Its Relationship to Breast Cancer Screening and Stage at Diagnosis: A Systematic Review. Womens Health Issues 2015; 25:482-93. [PMID: 26219677 PMCID: PMC4933961 DOI: 10.1016/j.whi.2015.05.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 05/24/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A review was conducted to summarize the current evidence and gaps in the literature on geographic access to mammography and its relationship to breast cancer-related outcomes. METHODS Ovid, Medline, and PubMed were searched for articles published between January 1, 2000, and April 1, 2013, using Medical Subject Headings and key terms representing geographic accessibility and breast cancer-related outcomes. Owing to a paucity of breast cancer treatment and mortality outcomes meeting the criteria (N = 6), outcomes were restricted to breast cancer screening and stage at diagnosis. Studies included one or more of the following types of geographic accessibility measures: capacity, density, distance, and travel time. Study findings were grouped by outcome and type of geographic measure. RESULTS Twenty-one articles met the inclusion criteria. Fourteen articles included stage at diagnosis as an outcome, five included mammography use, and two included both. Geographic measures of mammography accessibility varied widely across studies. Findings also varied, but most articles found either increased geographic access to mammography associated with increased use and decreased late-stage at diagnosis or no association. CONCLUSION The gaps and methodologic heterogeneity in the literature to date limit definitive conclusions about an underlying association between geographic mammography access and breast cancer-related outcomes. Future studies should focus on the development and application of more precise and consistent measures of geographic access to mammography.
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Affiliation(s)
- Jenna A Khan-Gates
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois.
| | - Jennifer L Ersek
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Swann A Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Sandi L Pruitt
- Department of Clinical Science, Southwestern University, Dallas, Texas
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Hauenstein EJ, Glick DF, Kane C, Kulbok P, Barbero E, Cox K. A Model to Develop Nurse Leaders for Rural Practice. J Prof Nurs 2014; 30:463-73. [DOI: 10.1016/j.profnurs.2014.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Indexed: 12/29/2022]
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Sanders SR, Erickson LD, Call VRA, McKnight ML, Hedges DW. Rural health care bypass behavior: how community and spatial characteristics affect primary health care selection. J Rural Health 2014; 31:146-56. [PMID: 25219792 DOI: 10.1111/jrh.12093] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE (1) To assess the prevalence of rural primary care physician (PCP) bypass, a behavior in which residents travel farther than necessary to obtain health care, (2) To examine the role of community and non-health-care-related characteristics on bypass behavior, and (3) To analyze spatial bypass patterns to determine which rural communities are most affected by bypass. METHODS Data came from the Montana Health Matters survey, which gathered self-reported information from Montana residents on their health care utilization, satisfaction with health care services, and community and demographic characteristics. Logistic regression and spatial analysis were used to examine the probability and spatial patterns of bypass. RESULTS Overall, 39% of respondents bypass local health care. Similar to previous studies, dissatisfaction with local health care was found to increase the likelihood of bypass. Dissatisfaction with local shopping also increases the likelihood of bypass, while the number of friends in a community, and commonality with community reduce the likelihood of bypass. Other significant factors associated with bypass include age, income, health, and living in a highly rural community or one with high commuting flows. CONCLUSIONS Our results suggest that outshopping theory, in which patients bundle services and shopping for added convenience, extends to primary health care selection. This implies that rural health care selection is multifaceted, and that in addition to perceived satisfaction with local health care, the quality of local shopping and levels of community attachment also influence bypass behavior.
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Affiliation(s)
- Scott R Sanders
- Department of Sociology, Brigham Young University, Provo, Utah
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Allan DP. Catchments of general practice in different countries--a literature review. Int J Health Geogr 2014; 13:32. [PMID: 25174719 PMCID: PMC4150420 DOI: 10.1186/1476-072x-13-32] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 08/04/2014] [Indexed: 11/25/2022] Open
Abstract
The purpose of this paper is to review the current research on catchment areas of private general practices in different developed countries because healthcare reform, including primary health care, has featured prominently as an important political issue in a number of developed countries. The debates around health reform have had a significant health geographic focus. Conceptually, GP catchments describe the distribution, composition and profile of patients who access a general practitioner or a general practice (i.e. a site or facility comprising one or more general practitioners). Therefore, GP catchments provide important information into the geographic variation of access rates, utilisation of services and health outcomes by all of the population or different population groups in a defined area or aggregated area. This review highlights a wide range of diversity in the literature as to how GP catchments can be described, the indicators and measures used to frame the scale of catchments. Patient access to general practice health care services should be considered from a range of locational concepts, and not necessarily constrained by their place of residence. An analysis of catchment patterns of general practitioners should be considered as dynamic and multi-perspective. Geographic information systems provide opportunities to contribute valuable methodologies to study these relationships. However, researchers acknowledge that a conceptual framework for the analysis of GP catchments requires access to real world data. Recent studies have shown promising developments in the use of real world data, especially from studies in the UK. Understanding the catchment profiles of individual GP surgeries is important if governments are serious about patient choice being a key part of proposed primary health reforms. Future health planning should incorporate models of GP catchments as planning tools, at the micro level as well as the macro level, to assist policies on the allocation of resources so that opportunities for good health outcomes for all groups within society, especially those who have been systematically denied equitable access, are maximised.
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Affiliation(s)
- Donald P Allan
- Discipline of Public Health, School of Health Sciences, Faculty of Medicine, Nursing & Health Sciences, Flinders University, Health Sciences Building, Registry Road, Bedford Park, SA 5042, Australia.
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Kippenbrock T, Buron B, Odell E, Narcisse MR. Minimal Changes and Missed Opportunities: A Decade Look at Nurse Practitioners in the Lower Mississippi River Delta States. J Prof Nurs 2014; 30:266-72. [DOI: 10.1016/j.profnurs.2013.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Indexed: 10/26/2022]
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Kirchhoff AC, Hart G, Campbell EG. Rural and urban primary care physician professional beliefs and quality improvement behaviors. J Rural Health 2014; 30:235-43. [PMID: 24528129 DOI: 10.1111/jrh.12067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE We evaluated whether primary care physicians (PCPs) from urban and rural practices differ on attitudes and behaviors related to quality improvement (QI) activities, patient relationships, and professionalism/self-regulation. METHODS Data from a national survey that assessed physician attitudes and behaviors based on the Physician Charter on Medical Professionalism were used. Of the 1,891 survey respondents, N = 840 were PCPs (n = 274 family medicine (response rate = 67.5%); n = 257 general internal medicine (60.8%); and n = 309 pediatricians (72.7%)). Using Rural-Urban Commuting Area (RUCA) codes, PCPs were classified as urban and rural according to their practice ZIP code. FINDINGS A total of n = 691 physicians were urban and n = 127 rural. Attitudes regarding participating in QI did not differ by practice location; however, rural PCPs were more likely to have reviewed an other physician's records for QI than urban PCPs (65.6% vs 48.0%, P < .001). Rural physicians were more likely to agree that physicians should talk with their patients about the cost of care than urban PCPs (40.5% vs 29.2%, P = .02). While all PCPs endorsed attitudes regarding the importance of professional behaviors (eg, reporting impaired/incompetent colleagues, disclosing medical errors) at generally similar levels, their behaviors differed. More rural physicians had a personal knowledge of an impaired/incompetent physician than urban physicians (20.7% vs 12.7%, P = .02). CONCLUSIONS PCPs from rural and urban areas share similar attitudes regarding the importance of participating in QI and fulfilling professional responsibilities. However, certain behaviors (eg, knowledge of impaired colleagues) do differ. These results should be confirmed in larger studies of rural PCPs.
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Affiliation(s)
- Anne C Kirchhoff
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
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Jacobsen KH, Ansumana R, Abdirahman HA, Bockarie AS, Bangura U, Meehan KA, Jimmy DH, Malanoski AP, Sundufu AJ, Stenger DA. Considerations in the selection of healthcare providers for mothers and children in Bo, Sierra Leone: reputation, cost and location. Int Health 2013; 4:307-13. [PMID: 24029678 DOI: 10.1016/j.inhe.2012.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The factors that influence the selection of a healthcare provider once the decision to seek care has been made can be summarized using a triad of cost, location and reputation. The goal of this study was to identify which of these factors is the primary consideration when women in urban Bo, Sierra Leone, select a healthcare provider for themselves or their children. We interviewed 1091 mothers during a household census of two neighbourhoods of Bo in April 2010. Reputation was the top consideration for about half of the women, cost was the second most common priority, and the location of the healthcare facility was the primary consideration for less than 7% of the participants. The majority of women said they would select a new provider if cost was not a barrier. Socioeconomic characteristics were not significant predictors of whether cost, location or reputation was selected as the highest-ranked consideration. This evidence for the importance of reputation in healthcare decision-making even in low-resource areas highlights the need for health systems to address issues of quality and responsiveness, and not just cost, in order to increase access to and utilization of health services.
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Affiliation(s)
- Kathryn H Jacobsen
- Department of Global & Community Health, George Mason University, Fairfax, VA, USA
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Wajid A, White F, Karim MS. Community health workers and health care delivery: evaluation of a women's reproductive health care project in a developing country. PLoS One 2013; 8:e75476. [PMID: 24086541 PMCID: PMC3783381 DOI: 10.1371/journal.pone.0075476] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/20/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As part of the mid-term evaluation of a Women's Health Care Project, a study was conducted to compare the utilization of maternal and neonatal health (MNH) services in two areas with different levels of service in Punjab, Pakistan. METHODS A cross-sectional survey was conducted to interview Married Women of Reproductive Age (MWRA). Information was collected on MWRA knowledge regarding danger signs during pregnancy, delivery, postnatal periods, and MNH care seeking behavior. After comparing MNH service utilization, the two areas were compared using a logistic regression model, to identify the association of different factors with the intervention after controlling for socio-demographic, economic factors and distance of the MWRA residence to a health care facility. RESULTS The demographic characteristics of women in the two areas were similar, although socioeconomic status as indicated by level of education and better household amenities, was higher in the intervention area. Consequently, on univariate analysis, utilization of MNH services: antenatal care, TT vaccination, institutional delivery and use of modern contraceptives were higher in the intervention than control area. Nonetheless, multivariable analysis controlling for confounders such as socioeconomic status revealed that utilization of antenatal care services at health centers and TT vaccination during pregnancy are significantly associated with the intervention. CONCLUSIONS Our findings suggest positive changes in health care seeking behavior of women and families with respect to MNH. Some aspects of care still require attention, such as knowledge about danger signs and neonatal care, especially umbilical cord care. Despite overall success achieved so far in response to the Millennium Development Goals, over the past two decades decreases in maternal mortality are far from the 2015 target. This report identifies some of the key factors to improving MNH and serves as an interim measure of a national and global challenge that remains a work in progress.
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Affiliation(s)
- Abdul Wajid
- College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
- * E-mail:
| | - Franklin White
- School of Public Health and Social Policy, University of Victoria, BC, Canada
- Community Health and Epidemiology, Dalhousie University, NS, Canada
- Pacific Health & Development Sciences Inc., Victoria, BC, Canada
| | - Mehtab S. Karim
- School of Public Policy, George Mason University, Arlington, Virginia, United States of America
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Odell E, Kippenbrock T, Buron W, Narcisse MR. Gaps in the primary care of rural and underserved populations: The impact of nurse practitioners in four Mississippi Delta states. J Am Assoc Nurse Pract 2013; 25:659-66. [PMID: 24170675 DOI: 10.1111/1745-7599.12023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - William Buron
- University of AR for Medical Sciences; Little Rock Arkansas
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Friesner DL, Scott DM, Rathke AM, Peterson CD, Anderson HC. Do remote community telepharmacies have higher medication error rates than traditional community pharmacies? Evidence from the North Dakota Telepharmacy Project. J Am Pharm Assoc (2003) 2011; 51:580-90. [DOI: 10.1331/japha.2011.10115] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Simpson KR. An Overview of Distribution of Births in United States Hospitals in 2008 with Implications for Small Volume Perinatal Units in Rural Hospitals. J Obstet Gynecol Neonatal Nurs 2011; 40:432-9. [DOI: 10.1111/j.1552-6909.2011.01262.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Pathman DE, Ricketts TC. Interdependence of General Surgeons and Primary Care Physicians in Rural Communities. Surg Clin North Am 2009; 89:1293-302, vii-viii. [DOI: 10.1016/j.suc.2009.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Associations Between Self-reported Quality of Care and County Characteristics Are Largely Similar in Rural and Urban Settings. Qual Manag Health Care 2009; 18:257-67. [DOI: 10.1097/qmh.0b013e3181bee1ce] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Friesner D, Scott DM. Exploring the formation of patient satisfaction in rural community telepharmacies. J Am Pharm Assoc (2003) 2009; 49:509-18. [PMID: 19589763 DOI: 10.1331/japha.2009.08110] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To apply a previously validated patient satisfaction questionnaire within rural community telepharmacies in an effort to identify the underlying factors determining satisfaction with those services and to assess whether the latent structure(s) of patient satisfaction varies depending on delivery mode or communityspecific factors. DESIGN Descriptive, nonexperimental, cross-sectional study. SETTING Eight rural community telepharmacy sites (seven in North Dakota and one in Minnesota) in fall 2005. PATIENTS 400 potential participants in rural communities (response rate 24% [n = 96]) whose primary community pharmacy is a telepharmacy site. INTERVENTION PATIENTS visiting a pharmacy to have at least one prescription filled were asked to complete a survey and mail responses to the investigators. The survey contained 37 questions, the first 20 of which were adapted from a well-established, validated survey instrument. MAIN OUTCOME MEASURE Patient satisfaction with rural community telepharmacy services; patient responses to 20 questions in the survey were used as main outcome variables. RESULTS Applying factor analysis to the data yielded a single dimension of patient satisfaction. CONCLUSION A previous application of this instrument in a traditional community pharmacy setting yielded two interrelated latent constructs ("friendly explanation" and "managing therapy"). Our analysis suggests that the formation of patient satisfaction in rural community telepharmacies is much simpler in that patients form a single construct exhibiting high mean and median values. Anecdotal evidence from the literature suggests that the formation of a single construct reflects patients' desire to retain a point of access to health care in their communities.
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Affiliation(s)
- Daniel Friesner
- Department 2660, North Dakota State University, Fargo, ND 58108-6050, USA.
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