General outpatient department in tertiary care institute: A model to be adopted by medical colleges

Indian Model of Integrated Healthcare (IMIH): a conceptual framework for a coordinated referral system in resource-constrained settings

INTRODUCTION

With the escalating burden of chronic disease and multimorbidity in India, owing to its ageing population and overwhelming health needs, the Indian Health care delivery System (HDS) is under constant pressure due to rising public expectations and ambitious new health goals. The three tired HDS should work in coherence to ensure continuity of care, which needs a coordinated referral system. This calls for optimising health care through Integrated care (IC). The existing IC models have been primarily developed and adopted in High-Income Countries. The present study attempts to review the applicability of existing IC models and frame a customised model for resource-constrained settings.

METHODS

A two-stage methodology was used. Firstly, a narrative literature review was done to identify gaps in existing IC models, as per the World Health Organization framework approach. The literature search was done from electronic journal article databases, and relevant literature that reported conceptual and theoretical concepts of IC. Secondly, we conceptualised an IC concept according to India's existing HDS, validated by multiple rounds of brainstorming among co-authors. Further senior co-authors independently reviewed the conceptualised IC model as per national relevance.

RESULTS

Existing IC models were categorised as individual, group and disease-specific, and population-based models. The limitations of having prolonged delivery time, focusing only on chronic diseases and being economically expensive to implement, along with requirement of completely restructuring and reorganising the existing HDS makes the adoption of existing IC models not feasible for India. The Indian Model of Integrated Healthcare (IMIH) model proposes three levels of integration: Macro, Meso, and Micro levels, using the existing HDS. The core components include a Central Gateway Control Room, using existing digital platforms at macro levels, a bucket overflow model at the meso level, a Triple-layered Concentric Circle outpatient department (OPD) design, and a three-door OPD concept at the micro level.

CONCLUSION

IMIH offers features that consider resource constraints and local context of LMICs while being economically viable. It envisages a step toward UHC by optimising existing resources and ensuring a continuum of care. However, health being a state subject, various socio-political and legal/administrative issues warrant further discussion before implementation.

Initiation of the First Preventive Health and Screening Outpatient Department in a Tertiary Teaching Hospital in India

Background The Preventive Health and Screening Outpatient Department (OPD) was started in Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India with the vision of promoting health (primordial and primary prevention), counseling, screening, early diagnosis, and treatment and referral services (secondary prevention). The objective of the study is to describe the process of establishing the Preventive Health and Screening OPD in a tertiary hospital in Delhi and illustrate the functioning of the newly established OPD. Methodology This study is based on observation of the day-to-day functioning of the OPD, record checking of registers, and reviewing the records of the hospital registration system. Here, we describe the functioning of the OPD from its initiation in October 2021 until December 2022. Results The routine services provided at the OPD include health promotion and education, especially focusing on non-communicable diseases, screening, diagnosis, treatment, lifestyle counseling; general OPD services; growth monitoring and counseling; group discussion for harms of tobacco usage; counseling for tobacco cessation, hepatitis B, and dT vaccination; group counseling for antenatal women; and screening for breast cancer. A few events such as the breast cancer screening camp and the non-communicable disease screening camp were also conducted under the purview of the new OPD. Such OPDs are the need of the hour for the provision of comprehensive healthcare, including promotive and preventive healthcare, along with curative health services, at tertiary healthcare levels. Conclusions Healthcare services are incomplete without the preventive, promotive, and screening components of healthcare. For mainstreaming health promotion and preventive healthcare, Preventive Health and Screening OPDs are essential at hospitals. The benefits of prevention extend beyond managing chronic diseases and longer lives.

Specialty preferences and factors affecting future career choice among medical graduates in Saudi

Aims:

Our study was conducted to study the future specialty choices and the influencing factors among Saudi medical students.

Settings and Design:

Convenience study.

Methods and Materials:

An online questionnaire was sent to medical students during the period from February to April 2019 with the aim of analyzing the most desired specialty, the reasons behind choosing, and the different factors playing a role in choosing those specialties.

Statistical Analysis Used:

The results were analyzed by the Statistical Package for Social Sciences software version 21. Differences in means were analyzed using t-test. The Chi-square test was used to identify significant differences among groups with a significance level set a P ≥ 0.05.

Results:

A convenience sample of 579 students has completed the survey. Most of the students did not receive any advice for choosing their specialty preferred. The three most desired specialties by both genders (males/females) are surgery, internal medicine, and cardiac surgery, respectively. The data revealed that nearly 42% of students did not receive any advice regarding their preferred career. Interesting cases, challenging, good lifestyle, and impact on patient quality of life were important reasons in selecting all specialties.

Conclusion:

A variety of factors appear to inspire medical students to choose a future career intention in Saudi Arabia. Some career measures and guidance are needed by university mentors and health policymakers to encourage those specialties that are scarce in Saudi Arabia.