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Sarani A, Tavan A, Bahaadinbeigy K, Aminzadeh M, Moradi SM, Khademipour G, Farahmandnia H. Identifying mitigation strategies of comprehensive health centers against dust hazard: a qualitative study in Iran. BMC Emerg Med 2024; 24:72. [PMID: 38658837 PMCID: PMC11044318 DOI: 10.1186/s12873-024-00993-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Exposure to dust can disrupt healthcare services and severely affect all activity domains of the health system. The aim of this study was to explore mitigation strategies for comprehensive health centers against dust hazard. METHOD The present study was conducted using a qualitative design with a conventional content analysis approach in 2023. The participants in this study were managers and staff of comprehensive health centers and experts in health in disasters and emergencies in Kerman, Bam, Regan, and Ahvaz. Data were collected through interviews. Data collection continued until data saturation. The collected data were analyzed based on the steps proposed by Graneheim and Lundman. Participants' statements, after recording and transcribing, were categorized into semantic units. Data were analyzed by using MAXQDA software version 2020. RESULTS The analysis of the data with 23 participants revealed 106 Codes, 13 sub- categories and 5 main categories including: (A) reducing the impact of dust hazards, (B) management functions, (C) empowerment and performance improvement, (D) maintaining and promoting safety, and (E) Inter-sectoral coordination to implement mitigation strategies. CONCLUSION The findings showed that the mitigation strategies and solutions can be used by health policymakers and planners to reduce the impact of dust hazard, empower and motivate healthcare staff, develop training protocols to enhance risk perception of the staff and members of the community, create the necessary infrastructure for adoption of effective mitigation strategies in healthcare centers to create resilience and continue service delivery.
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Affiliation(s)
- Arezoo Sarani
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Asghar Tavan
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- The Australian College of Rural and Remote Medicine, Brisbane, QLD, Australia
- Medical Informatics Research Center, Institute for Futures Studies in Health Kerman University of Medical Sciences, Kerman, Iran
| | - Mohsen Aminzadeh
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Mobin Moradi
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Gholamreza Khademipour
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hojjat Farahmandnia
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Mekonen B, Dugassa S, Feleke SM, Dufera B, Gidisa B, Adamu A, Mandefro A, Tasew G, Golassa L. Widespread pfhrp2/3 deletions and HRP2-based false-negative results in southern Ethiopia. Malar J 2024; 23:108. [PMID: 38632640 PMCID: PMC11025231 DOI: 10.1186/s12936-024-04904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Rapid diagnostic tests (RDTs) play a significant role in expanding case management in peripheral healthcare systems. Histidine-rich protein-2 (HRP2) antigen detection RDTs are predominantly used to diagnose Plasmodium falciparum infection. However, the evolution and spread of P. falciparum parasite strains with deleted hrp2/3 genes, causing false-negative results, have been reported. This study assessed the diagnostic performance of HRP2-detecting RDTs for P. falciparum cases and the prevalence of pfhrp2/3 deletions among symptomatic patients seeking malaria diagnosis at selected health facilities in southern Ethiopia. METHODS A multi-health facilities-based cross-sectional study was conducted on self-presenting febrile patients seeking treatment in southern Ethiopia from July to September 2022. A purposive sampling strategy was used to enroll patients with microscopically confirmed P. falciparum infections. A capillary blood sample was obtained to prepare a blood film for microscopy and a RDT using the SD Bioline™ Malaria Pf/Pv Test. Dried blood spot samples were collected for further molecular analysis. DNA was extracted using gene aid kits and amplification was performed using nested PCR assay. Exon 2 of hrp2 and hrp3, which are the main protein-coding regions, was used to confirm its deletion. The diagnostic performance of RDT was evaluated using PCR as the gold standard test for P. falciparum infections. RESULTS Of 279 P. falciparum PCR-confirmed samples, 249 (89.2%) had successful msp-2 amplification, which was then genotyped for hrp2/3 gene deletions. The study revealed that pfhrp2/3 deletions were common in all health centres, and it was estimated that 144 patients (57.8%) across all health facilities had pfhrp2/3 deletions, leading to false-negative PfHRP2 RDT results. Deletions spanning exon 2 of hrp2, exon 2 of hrp3, and double deletions (hrp2/3) accounted for 68 (27.3%), 76 (30.5%), and 33 (13.2%) of cases, respectively. The study findings revealed the prevalence of P. falciparum parasites lacking a single pfhrp2-/3-gene and that both genes varied across the study sites. This study also showed that the sensitivity of the SD Bioline PfHRP2-RDT test was 76.5% when PCR was used as the reference test. CONCLUSION This study confirmed the existence of widespread pfhrp2/3- gene deletions, and their magnitude exceeded the WHO-recommended threshold (> 5%). False-negative RDT results resulting from deletions in Pfhrp2/3- affect a country's attempts at malaria control and elimination. Therefore, the adoption of non-HRP2-based RDTs as an alternative measure is required to avoid the consequences associated with the continued use of HRP-2-based RDTs, in the study area in particular and in Ethiopia in general.
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Affiliation(s)
- Bacha Mekonen
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
- Malaria and NTDs Research Team, Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
| | - Sisay Dugassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sindew Mekasha Feleke
- Malaria and NTDs Research Team, Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Boja Dufera
- Malaria and NTDs Research Team, Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Bedasa Gidisa
- Malaria and NTDs Research Team, Armeur Hansen Research Institute, Addis Ababa, Ethiopia
| | - Aderaw Adamu
- Department of Medical Laboratory Science, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Aynalem Mandefro
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Malaria and NTDs Research Team, Bacterial, Parasitic, and Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Lemu Golassa
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
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Volerman A, Carlson B, Wan W, Murugesan M, Asfour N, Bolton J, Chin MH, Sripipatana A, Nocon RS. Utilization, quality, and spending for pediatric Medicaid enrollees with primary care in health centers vs non-health centers. BMC Pediatr 2024; 24:100. [PMID: 38331758 PMCID: PMC10851548 DOI: 10.1186/s12887-024-04547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Limited research has explored the performance of health centers (HCs) compared to other primary care settings among children in the United States. We evaluated utilization, quality, and expenditures for pediatric Medicaid enrollees receiving care in HCs versus non-HCs. METHODS This national cross-sectional study utilized 2012 Medicaid Analytic eXtract (MAX) claims to examine children 0-17 years with a primary care visit, stratified by whether majority (> 50%) of primary care visits were at HCs or non-HCs. Outcome measures include utilization (primary care visits, non-primary care outpatient visits, prescription claims, Emergency Department (ED) visits, hospitalizations) and quality (well-child visits, avoidable ED visits, avoidable hospitalizations). For children enrolled in fee-for-service Medicaid, we also measured expenditures. Propensity score-based overlap weighting was used to balance covariates. RESULTS A total of 2,383,270 Medicaid-enrolled children received the majority of their primary care at HCs, while 18,540,743 did at non-HCs. In adjusted analyses, HC patients had 20% more primary care visits, 15% less non-primary care outpatient visits, and 21% less prescription claims than non-HC patients. ED visits were similar across the two groups, while HC patients had 7% lower chance of hospitalization than non-HC. Quality of care outcomes favored HC patients in main analyses, but results were less robust when excluding managed care beneficiaries. Total expenditures among the fee-for-service subpopulation were lower by $239 (8%) for HC patients. CONCLUSIONS In this study of nationwide claims data to evaluate healthcare utilization, quality, and spending among Medicaid-enrolled children who receive primary care at HCs versus non-HCs, findings suggest primary care delivery in HCs may be associated with a more cost-effective model of healthcare for children.
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Affiliation(s)
- Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
| | - Bradley Carlson
- University of Chicago Pritzker School of Medicine, 924 E 57th St, Chicago, IL, 60637, USA
| | - Wen Wan
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Manoradhan Murugesan
- Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Nour Asfour
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Joshua Bolton
- Health Resources and Services Administration (Affiliation at Time Research Conducted), 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Marshall H Chin
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Alek Sripipatana
- Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Robert S Nocon
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S Los Robles Ave, Pasadena, CA, 91101, USA
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Gras Valenti P, Sánchez Payá J, Rodríguez Díaz JC, Llorens Soriano P, Merino Lucas E, Chico Sánchez P. [Positioning proposal on the recommendations for the use of masks in health centers after the cessation of the mandatory use in Spain]. Rev Esp Salud Publica 2024; 98:e202402001. [PMID: 38333916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/30/2023] [Indexed: 02/10/2024] Open
Abstract
Since the beginning of the COVID-19 pandemic in March 2020, the use of masks has been a fundamental pillar for controlling the transmission of SARS-CoV-2 in different areas. Its mandatory nature has been regulated by different regulations, and its effectiveness in reducing the transmission of SARS-CoV-2 and other respiratory viruses has been strongly proven. In this regard, the beneficial impact stands out in healthcare centers where it has been shown to reduce the transmission of respiratory infections, both in patients and healthcare professionals. This document proposes recommendations for the use of masks in health centers at the current time when we find ourselves with an end to the mandatory use of masks in Spain. They are aimed at healthcare professionals, patients and companions/visitors and aim to protect them from acquiring acute respiratory infections as a result of the complex relationships established in the healthcare field.
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Affiliation(s)
- Paula Gras Valenti
- Unidad de Epidemiología; Servicio de Medicina Preventiva; Hospital General Universitario Dr. Balmis.Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - José Sánchez Payá
- Unidad de Epidemiología; Servicio de Medicina Preventiva; Hospital General Universitario Dr. Balmis.Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Juan Carlos Rodríguez Díaz
- Servicio de Microbiología; Hospital General Universitario Dr. Balmis. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Pere Llorens Soriano
- Servicio de Urgencias; Hospital General Universitario Dr. Balmis. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Esperanza Merino Lucas
- Unidad de Enfermedades Infecciosas; Hospital General Universitario Dr. Balmis. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Pablo Chico Sánchez
- Unidad de Epidemiología; Servicio de Medicina Preventiva; Hospital General Universitario Dr. Balmis.Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
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Schneider JL, Rivelli JS, Vaughn KA, Thompson JH, Petrik AF, Escaron AL, Coronado GD. Implementing an enhanced mailed FIT program to improve CRC screening at a federally qualified health center: experiences of patients and staff. Transl Behav Med 2023; 13:757-767. [PMID: 37210075 PMCID: PMC10538470 DOI: 10.1093/tbm/ibad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
Colorectal cancer (CRC) is a leading cause of cancer death in the USA. Screening programs in federally qualified health centers (FQHCs) are essential to reducing CRC-related mortality and morbidity among underserved populations. Centralized, population-based mailed fecal immunochemical test (FIT) programs can improve CRC screening rates, but barriers to implementation remain. We qualitatively explored barriers and facilitators to implementation of a mailed FIT program at a large, urban FQHC that employed advance notification "primers" (live calls and texts) and automated reminders. We interviewed 25 patients and 45 FQHC staff by telephone about their experience with the program. Interviews were transcribed, coded, and content analyzed using NVivo.12. Patients and staff found advance notifications conveyed through live phone calls or text messages to be acceptable and motivational for FIT completion. Live phone primers were helpful in addressing patients' questions and misconceptions about screening, particularly for patients new to screening. Advance notifications sent by text were considered timely and useful in preparing patients for receipt of the FIT. Barriers to implementation included lack of receipt of primers, reminders, or the mailed FIT itself due to inaccurate patient contact information within the FQHC medical record; lack of systems for documenting mailed FIT outreach to coordinate with clinical care; and lack of local caller identification for primers and reminders. Our findings demonstrate that an enhanced mailed FIT program using primers and reminders was acceptable. Our findings can help other FQHCs implement and optimize their mailed FIT programs.
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Affiliation(s)
- Jennifer L Schneider
- Science Program Department, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Jennifer S Rivelli
- Science Program Department, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Katherine A Vaughn
- Science Program Department, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Jamie H Thompson
- Science Program Department, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Amanda F Petrik
- Science Program Department, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
| | - Anne L Escaron
- AltaMed Institute for Health Equity, AltaMed Health Services Corporation, 2040 Camfield Avenue, Los Angeles, CA 90040, USA
| | - Gloria D Coronado
- Science Program Department, Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, USA
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Beiter D, Koy S, Flessa S. Improving the technical efficiency of public health centers in Cambodia: a two-stage data envelopment analysis. BMC Health Serv Res 2023; 23:912. [PMID: 37641129 PMCID: PMC10463960 DOI: 10.1186/s12913-023-09570-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/17/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Cambodia is undergoing a series of reforms with the objective of reaching universal health coverage. Information on the causes of inefficiencies in health facilities could pave the way for a better utilization of limited resources available to ensure the best possible health care for the population. OBJECTIVES The purpose of this study is to evaluate the technical efficiency of health centers and the determinants for inefficiencies. METHODS This cross-sectional study used secondary data from a costing study on 43 health centers in six Cambodian provinces (2016-2017). Firstly, the Data Envelopment Analysis method with output-orientation was applied to calculate efficiency scores by selecting multiple input and output variables. Secondly, a tobit regression was performed to analyze potential explanatory variables that could influence the inefficiency of health centers. RESULTS Study findings showed that 18 (43%) health centers were operating inefficiently with reference to the variable returns to scale efficiency frontier and had a mean pure technical efficiency score of 0.87. Overall, 22 (51%) revealed deficits in producing outputs at an optimal scale size. Distance to the next referral hospital, size and quality performance of the health centers were significantly correlated with health center inefficiencies. CONCLUSION Differences in efficiency exist among health centers in Cambodia. Inefficient health centers can improve their technical efficiency by increasing the utilization and quality of health services, even if it involves higher costs. Technical efficiency should be continuously monitored to observe changes in health center performance over time.
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Affiliation(s)
- Dominik Beiter
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh, Cambodia.
| | - Sokunthea Koy
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh, Cambodia
| | - Steffen Flessa
- Department of General Business Administration and Health Care Management, University of Greifswald, Greifswald, Germany
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Ferreira AP, Furtado SRC, Carceroni LL, Amâncio GPDO, Zuba PP, Pereira HMB, Pereira DAG. Variation in sociodemographic, clinical and functional characteristics of patients with chronic venous insufficiency in a single public health center. J Vasc Nurs 2023; 41:72-76. [PMID: 37356873 DOI: 10.1016/j.jvn.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 04/16/2023] [Accepted: 05/03/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES Describe and analyze the sociodemographic, clinical and functional characteristics of individuals with chronic venous insufficiency (CVI) and compare the clinical severity with levels of mobility. METHODS Exploratory cross-sectional study in a single public health center. The study cohort comprised 99 individuals. INTERVENTIONS Clinical, sociodemographic and physical activity level questionnaires were applied; we also evaluated ankle amplitude and sural triceps function. Descriptive statistics, independent t test and one-way ANOVA with post hoc Least Significant Difference (LSD) were performed. RESULTS Ninety-nine participants (87.9% woman) with an average age with an average age of 60.6 ± 14 years who where recruited to the study. The cohort was composed of individuals were moderately active, 80% exhibited symptoms of the disease and approximately 40% reported reduced mobility. Individuals who had reduced mobility and less physical activity showed reduced ankle amplitude and muscle function (p <0.05). CONCLUSION CVI impacts on functional capacity, even in individuals with less severe disease.
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Affiliation(s)
- Ana Paula Ferreira
- Universidade Federal de Minas Gerais - UFMG, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Belo Horizonte, MG, Brazil; Faculty of Medical and Health Sciences (SUPREMA), Juiz de Fora, MG, Brazil
| | - Sheyla Rossana Cavalcanti Furtado
- Universidade Federal de Minas Gerais - UFMG, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Belo Horizonte, MG, Brazil
| | | | | | - Priscila Penasso Zuba
- Multiprofessional Health Residency - Clinical Hospital, Universidade Federal de Minas Gerais - UFMG, MG, Brazil
| | | | - Danielle Aparecida Gomes Pereira
- Universidade Federal de Minas Gerais - UFMG, Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, Belo Horizonte, MG, Brazil.
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Amate-Fortes I, Guarnido-Rueda A. Inequality, public health, and COVID-19: an analysis of the Spanish case by municipalities. Eur J Health Econ 2023; 24:99-110. [PMID: 35266076 PMCID: PMC8906523 DOI: 10.1007/s10198-022-01455-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/21/2022] [Indexed: 05/02/2023]
Abstract
The main objective of this work is to analyze whether inequality in income distribution has an effect on COVID-19 incidence and mortality rates during the first wave of the pandemic, and how the public health system mitigates these effects. To this end, the case of 819 Spanish municipalities is used, and a linear cross-sectional model is estimated. The results obtained allow us to conclude that a higher level of income inequality generates a higher rate of infections but not deaths, highlighting the importance of the Spanish National Health Service, which does not distinguish by income level. Likewise, early detection of infection measured by the number of primary care centers per 100,000 inhabitants, access to health care for the treatment of the most severe cases, unemployment as a proxy for job insecurity, climatic conditions, and population density are also important factors that determine how COVID-19 affects the population.
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Affiliation(s)
- Ignacio Amate-Fortes
- Associate Professor of Applied Economics, Department of Economics and Business, University of Almeria, Carretera de Sacramento, s/n 04120, Almeria, Spain.
| | - Almudena Guarnido-Rueda
- Associate Professor of Applied Economics, Department of Economics and Business, University of Almeria, Carretera de Sacramento, s/n 04120, Almeria, Spain
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Nosheen F, Malik N, Mehmood Z, Jabeen F, Mahmood A, Ibrahim M, Bokhari A, Mubashir M, Chuah LF, Show PL. Biomedical waste management associated with infectious diseases among health care professionals in apex hospitals of a typical south asian city. Environ Res 2022; 215:114240. [PMID: 36103930 DOI: 10.1016/j.envres.2022.114240] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/20/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
Biomedical waste from healthcare activities poses a higher hazard of infection and damage than other types of trash. The main objective of the study was to assess the awareness knowledge and practices of biomedical waste management (BMWM) among health care professionals in the health care units. The cross-sectional study was carried out to access the awareness, knowledge and practices of health care professionals for BMWM. Using a qualitative approach, the study was escorted in two Apex hospitals i.e. the Allied Hospital and the District Head Quarter Hospital, Faisalabad, Pakistan from August 5, 2019 to October 15, 2019. More than 90% of respondents knew the phrase BMWM, but just 35.4% had awareness about biomedical waste regulations. About 71.6% of the respondents were familiar with biomedical waste's color-coding segregation. The study concludes gap in the awareness, knowledge and practices for BMWM. The sanitary workers of the hospitals had no knowledge about BMWM and the BMWM/healthcare waste management rule 2005 established in Pakistan due to the lack of training regarding waste management and the segregation process. Some of the staff members were aware of the BMWM practices under the rules and regulations of Pakistan but were unable to implement at their work place. It is necessary to dispose of the biomedical waste according to the established terms and conditions of BMWM rules (2005) of Pakistan. Weak structure of BMWM was observed at the study sites due to the lack of training, liabilities and absence of penalties against improper biomedical waste disposal as violation of the rules and regulations. It's a dire need of the time to consider the biomedical waste as hazardous waste and make policies for its safe disposal and ensure the implementation of the policies in all the medical centers of Pakistan.
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Affiliation(s)
- Farhana Nosheen
- Department of Home Economics, Government College University Faisalabad, Pakistan
| | - Nazia Malik
- Department of Sociology, Government College University Faisalabad, Pakistan
| | - Zaid Mehmood
- Department of Sociology, Government College University Faisalabad, Pakistan
| | - Fariha Jabeen
- Department of Environmental Sciences, Government College University Faisalabad, Pakistan
| | - Abid Mahmood
- Department of Environmental Sciences, Government College University Faisalabad, Pakistan.
| | - Muhammad Ibrahim
- Department of Environmental Sciences, Government College University Faisalabad, Pakistan.
| | - Awais Bokhari
- Department of Chemical Engineering, COMSATS University Islamabad, Lahore Campus, 54000, Pakistan; Sustainable Process Integration Laboratory, SPIL, NETME Centre, Faculty of Mechanical Engineering, Brno University of Technology, VUT Brno, Technická 2896/2, 616 00, Brno, Czech Republic
| | - Muhammad Mubashir
- Department of Petroleum Engineering, School of Engineering, Asia Pacific University of Technology and Innovation, 57000, Kuala Lumpur, Malaysia.
| | - Lai Fatt Chuah
- Faculty of Maritime Studies, Universiti Malaysia Terengganu, Terengganu, Malaysia
| | - Pau Loke Show
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500 Semenyih, Selangor, Malaysia; Zhejiang Provincial Key Laboratory for Subtropical Water Environment and Marine Biological Resources Protection, Wenzhou University, Wenzhou 325035, China; Department of Sustainable Engineering, Saveetha School of Engineering, SIMATS, Chennai, India 602105.
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Getachew N, Erkalo B, Garedew MG. Data quality and associated factors in the health management information system at health centers in Shashogo district, Hadiya zone, southern Ethiopia, 2021. BMC Med Inform Decis Mak 2022; 22:154. [PMID: 35705966 PMCID: PMC9202091 DOI: 10.1186/s12911-022-01898-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor quality routine data contributes to poor decision-making, inefficient resource allocation, loss of confidence in the health system, and may threaten the validity of impact evaluations. For several reasons in most developing countries, the routine health information systems in those countries are described as ineffective. Hence, the aim of this study is to determine the quality of data and associated factors in the routine health management information system in health centers of Shashogo district, Hadiya Zone. METHODS A facility-based cross-sectional study was conducted from June 1, 2021, to July 1, 2021, and 300 participants were involved in the study through simple random sampling. The data was collected with a self-administered questionnaire by trained data collectors. After checking its completeness, the data was entered into EPI data version 3.1 and exported to SPSS version 25 for statistical analysis. Finally, variables with p < 0.05 during multivariable analysis were considered significant variables. RESULT A total of 300(100%) participant were included in the interview and HMIS data quality was 83% in Shashogo district health centers. The data quality in terms of accuracy, completeness, and timeliness was 79%, 86%, and 84%, respectively. Conducting supportive supervision [AOR 3.5 (1.4, 8.9)], checking accuracy [AOR 1.3 (1.5, 3.5)], filling registrations [AOR 2.7 (1.44, 7.7)], and confidence level [AOR 1.9 (1.55, 3.35)] were all rated positively found to be factors associated with data quality. CONCLUSION The overall level of data quality in Shashogo district health centers was found to be below the national expectation level. All dimensions of data quality in the district were below 90% in data accuracy, content completeness, and timeliness of data. Conducting supportive supervision, checking accuracy, filling registrations and confidence level were found to be factors associated with data quality. Hence, all stakeholders should give all necessary support to improve data quality in routine health information systems to truly attain the goal of providing good quality data for the decision-making process by considering the identified factors.
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Affiliation(s)
- Nigusu Getachew
- Department of Health Policy and Management, Faculty of Public Health, Health Institute, Jimma University, P.O. Box 378, Jimma, Ethiopia.
| | - Bereket Erkalo
- Department of Health Policy and Management, Faculty of Public Health, Health Institute, Jimma University, P.O. Box 378, Jimma, Ethiopia
| | - Muluneh Getachew Garedew
- Department of Health Policy and Management, Faculty of Public Health, Health Institute, Jimma University, P.O. Box 378, Jimma, Ethiopia
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Aceves B, Ezekiel-Herrera D, Marino M, Datta R, Lucas J, Giebultowicz S, Heintzman J. Disparities in HbA1c testing between aging US Latino and non-Latino white primary care patients. Prev Med Rep 2022; 26:101739. [PMID: 35295668 PMCID: PMC8918837 DOI: 10.1016/j.pmedr.2022.101739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/19/2022] [Accepted: 02/16/2022] [Indexed: 01/12/2023] Open
Abstract
US Latinos disproportionately face diabetes-related disparities compared to non-Latino Whites. A number of barriers, including linguistic and cultural discordance, have been consistently linked to these disparities. Glycated hemoglobin (HbA1c) testing is used to assess glycemic control among individuals living with diabetes. This study aimed to compare HbA1c levels and corresponding testing rates among non-Latino Whites and Latinos with both English and Spanish preference from a national cohort of primary care patients within community health centers. We analyzed electronic health records from patients who turned 50 years of age (n = 66,921) and were diagnosed with diabetes during or prior to the study period. They also must have been under observation for at least one year from January 1, 2013 to December 31, 2017. We calculated the rates of HbA1c tests each person received over the number of years observed and used covariate-adjusted negative binomial regression to estimate incidence rate ratios for Spanish preferring Latinos and English preferring Latinos compared to non-Latino Whites. Spanish preferring Latinos (rate ratio = 1.23, 95% CI = 1.16-1.30), regardless of HbA1c level, had higher testing rates than non-Latino Whites and English preferring Latinos. English preferring Latinos with controlled HbA1c levels had higher rates of HbA1c testing compared to non-Latino whites. Overall, the Latinos with Spanish preference maintained higher HbA1c testing rates and had disproportionately higher rates of uncontrolled HbA1c levels compared to non-Latino whites. Future efforts should focus on understanding effective approaches to increasing engagement among Spanish preferring Latinos and addressing organizational-level barriers, given HbA1c disparities.
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Affiliation(s)
- Benjamin Aceves
- Social Interventions Research and Evaluation Network, University of California, San Francisco, United States
| | - David Ezekiel-Herrera
- Department of Family Medicine, Oregon Health & Science University, United States
- Corresponding author: 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States.
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, United States
| | - Roopradha Datta
- Department of Family Medicine, Oregon Health & Science University, United States
| | - Jennifer Lucas
- Department of Family Medicine, Oregon Health & Science University, United States
| | | | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, United States
- OCHIN, Inc, United States
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Bourget MMM, Cassenote AJF, Scheffer MC. Physician turnover in primary health care services in the East Zone of São Paulo City, Brazil: incidence and associated factors. BMC Health Serv Res 2022; 22:147. [PMID: 35120507 PMCID: PMC8815273 DOI: 10.1186/s12913-022-07517-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The shortage and high turnover of physicians is a recurrent problem in health care systems; this is especially harmful to the expansion and full operation of primary health care (PHC). The aim of this paper is to analyze incidence and associated factors with physician turnover in primary health care services in the East Zone of São Paulo City. METHODS This is a retrospective cohort study of 1378 physicians over a 15 years' time period based on physicians' administrative records from two distinct secondary databases. Physicians' individual characteristics were analyzed including graduation and specialization. Survival analysis techniques such Kaplan-Meier and Cox Regression were used to analyze the termination of contract. RESULTS One thousand three hundred seventy-eight physicians were included in the study of which 130 [9.4%(CI95 8.0-11.1%)] remained in the PHC services. The mean and median time until the occurrence of the physician leaving the service was 2.14 years (CI95% 1.98-2.29 years) and 1.17 years [(CI95% 1.05-1.28 years)]. The probability of contract interruption was 45% in the first year and 68% in the second year. Independent factors associated with TEC were identified: workload of 40 h/week HR = 1.71 [(CI95% 1.4-2.09), p < 0.001]; initial salary ≤1052 BGI HR = 1.87 [(CI95 1.64-2.15), p < 0.001]; time since graduation ≤2 years HR =1.36 [(CI95 1.18-1.56), p < 0.001]; and the conclusion of residency in up to 3 years after leaving the service HR = 1.69 [(CI95 1.40-2.04), p < 0.001]. CONCLUSIONS The time of employment of the physician in PHC was relatively short, with a high probability of TEC in the first year. Modifiable factors such as working hours, starting salary, time since graduation from medical school and need to enter in a residency program were associated with TEC. In pointing out that modifiable factors are responsible for long term employment or the end of contract of physicians in PHC services of the Unified Health System in the periphery of a metropolitan area, the study provides support for the planning, implementation and management of policies and strategies aimed at attracting and retaining physicians in suburban, priority or underserved regions.
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Affiliation(s)
- Monique M M Bourget
- Program of Collective Health, Faculty of Medicine of the São Paulo University (FMUSP), São Paulo, SP, Brazil.
| | - Alex J F Cassenote
- Department of Gastroenterology, Faculty of Medicine of the São Paulo University (FMUSP), São Paulo, SP, Brazil
- Brazilian Medical Demography Research Group, Faculty of Medicine of the São Paulo University (FMUSP), São Paulo, SP, Brazil
- Department of Preventative Medicine, Faculty of Medicine of the São Paulo University (FMUSP), São Paulo, SP, Brazil
- Evidence Based Medicine Discipline, Santa Marcelina Faculty, São Paulo, SP, Brazil
| | - Mário C Scheffer
- Program of Collective Health, Faculty of Medicine of the São Paulo University (FMUSP), São Paulo, SP, Brazil
- Brazilian Medical Demography Research Group, Faculty of Medicine of the São Paulo University (FMUSP), São Paulo, SP, Brazil
- Department of Preventative Medicine, Faculty of Medicine of the São Paulo University (FMUSP), São Paulo, SP, Brazil
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Hasan MZ, Dinsa GD, Berman P. A practical measure of health facility efficiency: an innovation in the application of routine health information to determine health worker productivity in Ethiopia. Hum Resour Health 2021; 19:96. [PMID: 34353335 PMCID: PMC8340541 DOI: 10.1186/s12960-021-00636-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND A simple indicator of technical efficiency, such as productivity of health workers, measured using routine health facility data, can be a practical approach that can inform initiatives to improve efficiency in low- and middle-income countries. This paper presents a proof of concept of using routine information from primary healthcare (PHC) facilities to measure health workers' productivity and its application in three regions of Ethiopia. METHODS In four steps, we constructed a productivity measure of the health workforce of Health Centers (HCs) and demonstrated its practical application: (1) developing an analytical dataset using secondary data from health management information systems (HMIS) and human resource information system (HRIS); (2) principal component analysis and factor analysis to estimate a summary measure of output from five indicators (annual service volume of outpatient visits, family planning, first antenatal care visits, facility-based deliveries by skilled birth attendants, and children [< 1 year] with three pentavalent vaccines); (3) calculating a productivity score by combining the summary measure of outputs and the total number of health workers (input), and (4) implementing regression models to identify the determinant of productivity and ranking HCs based on their adjusted productivity score. RESULTS We developed an analytical dataset of 1128 HCs; however, significant missing values and outliers were reported in the data. The principal component and factor scores developed from the five output measures were highly consistent (correlation coefficient = 0.98). We considered the factor score as the summary measure of outputs for estimating productivity. A very weak association was observed between the summary measure of output and the total number of staff. The result also highlighted a large variability in productivity across similar health facilities in Ethiopia, represented by the significant dispersion in summary measure of output occurring at similar levels of the health workers. CONCLUSIONS We successfully demonstrated the analytical steps to estimate health worker productivity and its practical application using HMIS and HRIS. The methodology presented in this study can be readily applied in low- and middle-income countries using widely available data-such as DHIS2-that will allow further explorations to understand the causes of technical inefficiencies in the health system.
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Affiliation(s)
- Md Zabir Hasan
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Girmaye D Dinsa
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Public Health and Health Policy, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Peter Berman
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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S N, H S, J Z, M S. Designing a data set for postpartum recall registry of women with gestational diabetes in recent pregnancy and its implementation in Iranian urban health centers. Diabetes Metab Syndr 2021; 15:1-6. [PMID: 33271466 DOI: 10.1016/j.dsx.2020.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Gestational diabetes has serious short and long-term consequences for both mother and child. Designing a standard data set and implementing a recall registry system provides opportunities for early interventions in women with a history of gestational diabetes. The present study aims to draft a data set for the gestational diabetes recall registry and its establishment in urban health centers. METHODS To design a data set for gestational diabetes postpartum recall registry a qualitative study has been done from April to June of 2019. In this stage, Information need assessment, Identification of data elements, development of registry software, and field-testing were done. Web-based software was designed in NET language and using a Visual Studio programming environment. Implementation of the postpartum recall registry was started in 6 health centers of Ahvaz city from August 2019. RESULTS During six months 163 women with gestational diabetes in current pregnancy were registered. The final data set for the postpartum recall registry included six main groups, 23 subclasses, and 188 data elements. Mandatory data were included 115 elements. CONCLUSION A data set was finalized using a standard method and implemented in urban health centers for six months. Implementing a postpartum registry with standard elements can help manage data and plan for future interventions to reduce modifiable risk factors in this population.
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Affiliation(s)
- Nouhjah S
- Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Shahbazian H
- Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Zarei J
- Department of Health Information Technology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Sharifi M
- Ahvaz Health Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Assoumou SA, Nolen S, Hagan L, Wang J, Eftekhari Yazdi G, Thompson WW, Mayer KH, Puro J, Zhu L, Salomon JA, Linas BP. Hepatitis C Management at Federally Qualified Health Centers during the Opioid Epidemic: A Cost-Effectiveness Study. Am J Med 2020; 133:e641-e658. [PMID: 32603791 PMCID: PMC8041089 DOI: 10.1016/j.amjmed.2020.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/21/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The opioid epidemic has been associated with an increase in hepatitis C virus (HCV) infections. Federally qualified health centers (FQHCs) have a high burden of hepatitis C disease and could serve as venues to enhance testing and treatment. METHODS We estimated clinical outcomes and the cost-effectiveness of hepatitis C testing and treatment at US FQHCs using individual-based simulation modeling. We used individual-level data from 57 FQHCs to model 9 strategies, including permutations of HCV antibody testing modality, person initiating testing, and testing approach. Outcomes included life expectancy, quality-adjusted life-years (QALY), hepatitis C cases identified, treated and cured; and incremental cost-effectiveness ratios. RESULTS Compared with current practice (risk-based with laboratory-based testing), routine rapid point-of-care testing initiated and performed by a counselor identified 68% more cases after (nonreflex) RNA testing in the first month of the intervention and led to a 17% reduction in cirrhosis cases and a 22% reduction in liver deaths among those with cirrhosis over a lifetime. Routine rapid testing initiated by a counselor or a clinician provided better outcomes at either lower total cost or at lower cost per QALY gained, when compared with all other strategies. Findings were most influenced by the proportion of patients informed of their anti-HCV test results. CONCLUSIONS Routine anti-HCV testing followed by prompt RNA testing for positives is recommended at FQHCs to identify infections. If using dedicated staff or point-of-care testing is not feasible, then measures to improve immediate patient knowledge of antibody status should be considered.
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Affiliation(s)
- Sabrina A Assoumou
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, MA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA.
| | - Shayla Nolen
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, MA
| | - Liesl Hagan
- Prevention Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Jianing Wang
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, MA
| | | | - William W Thompson
- Prevention Branch, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA; Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Lin Zhu
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA
| | | | - Benjamin P Linas
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, MA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, MA; Department of Epidemiology, Boston University School of Public Health, MA
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Kilany M, Wells R, Morrissey JP, Domino ME. Are There Performance Advantages Favoring Federally Qualified Health Centers in Medical Home Care for Persons with Severe Mental Illness? Adm Policy Ment Health 2020; 48:121-130. [PMID: 32424452 DOI: 10.1007/s10488-020-01050-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To identify whether medical homes in FQHCs have advantages over other group and individual medical practices in caring for people with severe mental illness. Models estimated the effect of the type of medical home on monthly service utilization, medication adherence, and total Medicaid spending over a 4-year period for adults aged 18 or older with a major depressive disorder (N = 65,755), bipolar disorder (N = 19,925), or schizophrenia (N = 8501) enrolled in North Carolina's Medicaid program. Inverse probability of treatment weights (IPTW) were used to adjust for nonrandom assignment of patients to practices. Generalized estimating equations for repeated measures were used with gamma distributions and log links for the continuous measures of medication adherence and spending, and binomial distributions with logit links for binary measures of any outpatient or any emergency department visits. Adults with major depression or bipolar disorders in FQHC medical homes had a lower probability of outpatient service use than their counterparts in individual and group practices. The probability of emergency department use, medication adherence, and total Medicaid spending were relatively similar across the three settings. This study suggests that no one type of medical practice setting-whether FQHC, other group, or individual-consistently outperforms the others in providing medical home services to people with severe mental illness.
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Affiliation(s)
- Mona Kilany
- American Institutes for Research, Washington, D.C., USA
| | - Rebecca Wells
- The University of Texas School of Public Health, Houston, USA
| | - Joseph P Morrissey
- Professor Emeritus, Department of Health Policy and Management, The Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Marisa Elena Domino
- Department of Health Policy and Management, The Gillings School of Global Public Health, Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 1105B McGavran-Greenberg Hall, CB#7411, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA.
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Adissu G, Biks GA, Tamirat KS. Patient satisfaction with antiretroviral therapy services and associated factors at Gondar town health centers, Northwest Ethiopia: an institution-based cross-sectional study. BMC Health Serv Res 2020; 20:93. [PMID: 32028951 PMCID: PMC7006073 DOI: 10.1186/s12913-020-4934-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022] Open
Abstract
Background The Human Immunodeficiency Virus (HIV) with which over 37 million peoples are living is the leading cause of morbidity and mortality worldwide. The rapid expansion of antiretroviral treatment has dramatically reduced HIV related deaths and transmissions. Patient satisfaction could be an indispensable parameter used to measure patients’ desired fulfillment by the services. Hence, this study aimed to determine the level of patient satisfaction with antiretroviral therapy services and determinants at Gondar town health centers. Methods An institution-based cross-sectional study was conducted from November 1 to 30, 2018. The systematic random sampling technique was used to select 663 HIV/AIDS patients on antiretroviral therapy follow-ups. Data were collected using a pretested interviewer-administered questionnaire and patient medical document reviews. Summary statistics such as means, medians and proportions were calculated and presented in the form of tables, graphs, and texts. Bivariate and multivariable logistic regression analysis was fitted and adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed to assess the strength of association. Variables with p-value 0.05 at multivariable logistic regression considered significant determinants of patient satisfaction. Results The overall patient satisfaction with antiretroviral therapy services was 75.4% (95%CI, 71.9 to 79%). Patients’ age 38–47 years (AOR = 5.90, 95%CI: 3.38,10.31) and ≥ 48 years (AOR = 2.66, 95%CI:1.38,5.12), absence of signs and directions to ART clinic (AOR = 0.53,95%CI:0.35,0.82), Azezo health center (AOR = 2.68,95%CI:1.47,4.66) and Teda health center (AOR = 4.44,95%CI:1.73,11.30), and travel that took more than 1 h (AOR = 0.56;95% CI:0.32,0.97) were determinants of patient satisfaction with the services. Conclusion The overall patient satisfaction with antiretroviral therapy service was lower than the national target of 85% with the marked difference among health centers. Older age, absence of signs and directions to ART clinics, and longer travel from home to health centers were factors influencing patient satisfaction with antiretroviral treatments. This suggests that further improvement of accessibility is likely needed to increase patient satisfaction.
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Affiliation(s)
- Getaneh Adissu
- Federal Democratic Republic of Ethiopia, Pharmaceuticals Fund and Supply Agency, Addis Ababa, Ethiopia
| | - Gashaw Andarge Biks
- Department of Health System and Policy, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Institute of Public Health Science, University of Gondar, Gondar, Ethiopia.
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Brugueras S, Roldán L, Rodrigo T, García-García JM, Caylà JA, García-Pérez FJ, Orcau À, Mir Viladrich I, Penas-Truque A, Millet JP. Organization of Tuberculosis Control in Spain: Evaluation of a Strategy Aimed at Promoting the Accreditation of Tuberculosis Units. Arch Bronconeumol 2020; 56:90-8. [PMID: 31171411 DOI: 10.1016/j.arbres.2019.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/03/2019] [Accepted: 04/26/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Well-coordinated multidisciplinary teams are essential for better tuberculosis (TB) control. Our objective was to evaluate the impact of Spanish Society of Pneumology (SEPAR) accreditation of TB Units (TBU) and to determine differences between the accredited and non-accredited centers. MATERIAL AND METHODS DESIGN Observational descriptive study based on a self-administered survey from October 2014 to February 2018 completed by 139 heads of respiratory medicine departments collected by SEPAR, before and after TBU accreditation. VARIABLES demographic, epidemiological and contact tracing (CT) variables, among others. ANALYSIS basic descriptive analysis, and calculation of medians for continuous variables and proportions for categorical variables. The variables were compared using the Chi-squared test and logistic regression. RESULTS The response rate was 54.7% and 43.2% in the pre- and post-TBU accreditation period, respectively. No differences were observed in the care and coordination variables between the pre- and post-accreditation survey, nor in the organization when only accredited centers were analyzed. When we compared the accredited and non-accredited centers, significant differences were detected in the collection of the final conclusion, management of resistance, coordination with other departments, contact tracing, and directly observed treatment. CONCLUSIONS The approach of different professionals with regard to TB has been addressed. Positive aspects and areas for improvement have been detected, and better results were observed in the accredited versus non-accredited centers. A closer supervision of TBUs is necessary to improve their effectiveness.
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Modica C, Lewis JH, Bay C. Colorectal Cancer: Applying the Value Transformation Framework to increase the percent of patients receiving screening in Federally Qualified Health Centers. Prev Med Rep 2019; 15:100894. [PMID: 31198660 PMCID: PMC6556543 DOI: 10.1016/j.pmedr.2019.100894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/07/2019] [Accepted: 05/12/2019] [Indexed: 11/29/2022] Open
Abstract
Background Colorectal cancer is the second leading cause of cancer death in the U.S. and third-most common cancer in both men and women. Colorectal cancer screening (CRCS) rates remain low, particularly among vulnerable patients receiving care at federally qualified health centers. Through its Value Transformation Framework, the National Association of Community Health Centers provides a systematic approach to improving CRCS by transforming health center infrastructure, care delivery, and people systems—to improve health outcomes, patient and staff experiences, and lower costs (Quadruple Aim). Methods We combined the Value Transformation Framework, evidence-based CRCS interventions, and the Learning Community Model to drive system improvements and implement evidence-based practices. Multi-disciplinary teams at 8 health centers in Georgia and Iowa participated for 1-year with Primary Care Association support. Results Pre−/post- 1-year-intervention data showed, within health centers, raw percentage of eligible patients screened for CRC increased from 33.2% (13.5%–61.7%) in January 2017 to 46.5% (14.2%–81.5%) in December 2017, with an overall 13.3 percentage point average increase. This translates into an average increase of 3.3 (95% CI: 1.7, 5.0) eligible patients screened per month per health center over the year or 317 additional patients meeting CRCS guidelines. Specific interventions associated with higher CRCS rates included standing orders, sharing performance data, and electronic health record alerts. Conclusion Findings support a three-pronged approach for improving CRCS: The Value Transformation Framework's evidence-based recommendations, with actionable CRC interventions, offered in a learning community. These results guide methodological approaches to improving CRCS in health centers through a multi-level, multi-modality quality improvement and transformation approach.
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Affiliation(s)
- Cheryl Modica
- National Association of Community Health Centers, 7501 Wisconsin Avenue, Suite 1100W, Bethesda, MD 20814, United States of America
| | - Joy H Lewis
- A.T. Still University, School of Osteopathic Medicine in Arizona, 5850 E. Still Circle, Mesa, AZ 85206, United States of America
| | - Curt Bay
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, 5850 E. Still Circle, Mesa, AZ 85206, Mesa, AZ 85206, United States of America
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Bobo FT, Woldie M, Wordofa MA, Tsega G, Agago TA, Wolde-Michael K, Ibrahim N, Yesuf EA. Technical efficiency of public health centers in three districts in Ethiopia: two-stage data envelopment analysis. BMC Res Notes 2018; 11:465. [PMID: 30001735 PMCID: PMC6044096 DOI: 10.1186/s13104-018-3580-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/06/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of the study was to measure technical and scale efficiency of public health centers in three districts of Jimma zone, Ethiopia. A two-stage data envelopment analysis was used. First, we estimated technical and scale efficiency of the health centers. In the second stage, institutional and environmental factors were against technical efficiency of the health centers to identify factors associated to efficiency of the health centers. RESULTS Eight out of the 16 health centers in the study were found to be technically efficient, with an average score of 90% (standard deviation = 17%). This indicates that on average they could have reduce their utilization of all inputs by about 10% without reducing output. On the other hand, 8 out of 16 health centers were found to be scale efficient, with an average scale efficiency score of 94% (standard deviation = 9%). The inefficient health centers had an average scale score of 89%; implying there is potential for increasing total outputs by about 11% using the existing capacity/size. Catchment population and number of clinical staff were found to be directly associated with efficiency, while the number of nonclinical staff was found to be inversely associated with efficiency.
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Affiliation(s)
- Firew Tekle Bobo
- Department of Public Health, Wollega University, Nekemte, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- Fenot Project of Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Gebeyehu Tsega
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | | | | | - Nuraddis Ibrahim
- Department of Biomedical Science, Jimma University, Jimma, Ethiopia
| | - Elias Ali Yesuf
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
- CIHLMU Center for International Health, Ludwig-Maximilians-Universität München, Munich, Germany
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Beyene KG, Beza SW. Self-medication practice and associated factors among pregnant women in Addis Ababa, Ethiopia. Trop Med Health 2018; 46:10. [PMID: 29743807 DOI: 10.1186/s41182-018-0091-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Self-medication which is the act of obtaining and using one or more medicines without medical supervision is a common practice among pregnant women. Unless proper caution is taken, it may result in maternal and fetal adverse outcomes. In Ethiopia, information on self-medication practice during pregnancy is scanty. Hence, this study aimed to assess self-medication practice and associated factors among pregnant women in government health centers in Addis Ababa. Methods An institution-based mixed study design using a sequential explanatory approach was employed among 617 pregnant women and nine key informants in Addis Ababa from May 8, 2017, to June 30, 2017. Multi-stage sampling technique was used to select study participants, and purposive sampling technique was used to select the key informants. The quantitative data were collected using a structured interview questionnaire and analyzed using Statistical Product and Service Solutions (SPSS) version 23.0 whereas semi-structured questionnaire was used for in-depth interviews. Binary logistic regression was used for quantitative data analysis, and thematic analysis method was used for qualitative data. Results The prevalence of self-medication practice was 26.6%. Previous medication use (Adjusted odds ratio (AOR) = 4.20, 95% CI 2.70-6.53), gestational period (AOR = 0.63, 95% CI 0.41-0.98), education on self-medication (AOR = 0.36, 95% CI 0.21-0.62), previous pregnancy and delivery related problems (AOR = 1.71, 95% CI 1.06-2.76), and knowledge about risk of self-medication (AOR = 0.64, 95% CI 0.42-0.97) were significantly associated with self-medication practice. Lack of attention and priority of program designers, absence of strategies and guidelines; weak screening mechanisms, and regulatory enforcement were cited by the key informants as contributing factors for self-medication practices. Conclusions Considerable proportion of pregnant women practiced self-medication, including medicines categorized to have high risks. Gestational period, previous medication use, education on self-medication, previous pregnancy- and delivery-related problems, and knowledge were significantly associated with self-medication practice. In addition, there are correctable gaps in program designing, screening of pregnant women, regulatory enforcement, and strategies and guidelines. Hence, necessary measures at all levels must be taken to reduce risks of self-medication during pregnancy.
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Momtazan M, Mohammadi MJ, Tabahfar R, Rezaee S, Valipour A, Jamei F, Yari A, Karimyan A, Geravandi S. Risk factors accelerating hypothyroidism in pregnant women referred to health centers in Abadan, Iran. Data Brief 2017; 14:15-19. [PMID: 28761912 PMCID: PMC5522916 DOI: 10.1016/j.dib.2017.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/30/2017] [Accepted: 07/10/2017] [Indexed: 12/01/2022] Open
Abstract
The present work contains data obtained during the analysis of pregnant women referred to Abadan Health Centers Organization (Abadan HCO) with confirmed acute hypothyroidism diagnosis. From among all pregnant women referred to Abadan HCO, 600 were chosen consisting of 120 pregnant women from each of the health centers in quintuple areas. In this paper, the effects of family history, occupation, death, abortion, type of diabetes, smoking, lithium consumption, allergy, radiotherapy, ovarian cysts (OC) and oral contraceptive pills (OCP) consumption have been studied (Yassaee et al., 2014) [1]. After completion of the questionnaires by the patients, the obtained coded data were fed into ECSELL software. Statistical analysis of the data was carried out using Special Package for Social Sciences version 16 (SPSS 16).
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Affiliation(s)
- Mahboobeh Momtazan
- Student Research Committee, Abadan School of Medical Sciences, Abadan, Iran
| | | | - Raha Tabahfar
- Student Research Committee, Abadan School of Medical Sciences, Abadan, Iran
| | - Soraya Rezaee
- Student Research Committee, Abadan School of Medical Sciences, Abadan, Iran
| | | | - Fatemeh Jamei
- Student Research Committee, Abadan School of Medical Sciences, Abadan, Iran
| | - Ahmad Reza Yari
- Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
| | - Azimeh Karimyan
- Abadan School of Medical Sciences, Abadan, Iran
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Geravandi
- Razi Teaching Hospital, Clinical Research Development Center, Razi Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Abstract
BACKGROUND Access to healthcare services has an essential role in promoting health equity and quality of life. Knowing where the places are and how much of the population is covered by the existing healthcare network is important information that can be extracted from Geographical Information Systems (GIS) and used in effective healthcare planning. The aim of this study is to measure the geographic accessibility of population to existing Healthcare Centers (HC), and to estimate the number of persons served by the health network of Mozambique. METHODS Health facilities' locations together with population, elevation, and ancillary data were used to model accessibility to HC using GIS. Two travel time scenarios used by population to attend HC were considered: (1) Driving and; and (2) Walking. Estimates of the number of villages and people located in the region served, i.e. within 60 min from an HC, and underserved area, i.e. outside 60 min from an HC, are provided at national and province level. RESULTS The findings from this study highlight accessibility problems, especially in the walking scenario, in which 90.2 % of Mozambique was considered an underserved area. In this scenario, Maputo City (69.8 %) is the province with the greatest coverage of HC. On the other hand, Tete (93.4 %), Cabo Delgado (93 %) and Gaza (92.8 %) are the provinces with the most underserved areas. The driving scenario was less problematic, with about 66.9 % of Mozambique being considered a served area. We also found considerable regional disparities at the province level for this scenario, ranging from 100 % coverage in Maputo City to 48.3 % in Cabo Delgado. In terms of population coverage we found that the problem of accessibility is more acute in the walking scenario, in which about 67.3 % of the Mozambican population is located in underserved areas. For the driving scenario, only 6 % of population is located in underserved areas. CONCLUSIONS This study highlights critical areas in Mozambique in which HC are lacking when assessed by walking and driving travel time distance. The majority of Mozambicans are located in underserved areas in the walking scenario. The mapped outputs may have policy implications and can be used for future decision making processes and analysis. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
| | - Pedro Cabral
- NOVA IMS, Universidade Nova de Lisboa, 1070-312, Lisboa, Portugal
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Tamir K, Wasie B, Azage M. Tuberculosis infection control practices and associated factors among health care workers in health centers of West Gojjam zone, Northwest Ethiopia: a cross-sectional study. BMC Health Serv Res 2016; 16:359. [PMID: 27503430 PMCID: PMC4977729 DOI: 10.1186/s12913-016-1608-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 07/30/2016] [Indexed: 11/13/2022] Open
Abstract
Background Tuberculosis (TB) remains a major global health problem. The emerging epidemic of multi- and extensively drug-resistant (M/XDR) TB further imperils health workers, patients and public health. Health facilities with inadequate infection control are risky environments for the emergence and transmission of TB. There was no study that presented data on infection control practices of health care workers. This study aimed to assess tuberculosis infection control practices and associated factors among health care workers in West Gojjam Zone, Northwest Ethiopia. Methods Institution based quantitative cross-sectional study triangulated with qualitative observation and key informant interview was conducted. Six hundred sixty two health care workers were selected by multistage random sampling method. Self-administered structured questionnaire was used to collect quantitative data. Observation checklists and key informant interview guides were used to collect qualitative data. Quantitative data were entered in to Epi Info version 3.5.3 and analyzed using SPSS version 20. Odds ratio with 95 % confidence interval was used to identify factors associated with TB infection control practice of health care workers. Qualitative data were translated, transcribed, analyzed and triangulated with the quantitative findings. Results The proportion of proper TB infection control (TBIC) practices was 38 %. Qualitative data showed that administrative, environmental and personal respiratory protection control measures were not practiced well. Knowledge on the presence of TBIC plan [AOR = 4.25, 95 % CI: 2.46 - 7.35], knowledge on the presence of national guideline [AOR = 8.95, 95 % CI: 4.35 - 18.40] and working department of the health care workers were independent predictors of TBIC practices. Conclusions The proportion of proper TBIC practices of health care workers was low. TBIC practices were determined by knowing the presence of TBIC plan and national guideline and working department. Hence, supportive supervision and trainings should be given to health care workers who are working other than TB clinics to improve the knowledge of TBIC plan and guidelines. Health centers shall prepare TBIC plans and orient all health care workers.
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Affiliation(s)
- Kassahun Tamir
- MNCH Case Team, Health Promotion and Disease Prevention Process, Amhara Regional Health Bureau, P.O. Box: 495, Bahir Dar, Ethiopia.
| | - Belaynew Wasie
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Muluken Azage
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Jafry MA, Jenny AM, Lubinga SJ, Larsen-Cooper E, Crawford J, Matemba C, Babigumira JB. Examination of patient flow in a rural health center in Malawi. BMC Res Notes 2016; 9:363. [PMID: 27456090 PMCID: PMC4960743 DOI: 10.1186/s13104-016-2144-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 06/30/2016] [Indexed: 11/26/2022] Open
Abstract
Background Malawi, like many low-income countries, is facing a severe health worker shortage. A potential stop-gap solution to this crisis is improving the efficiency of health center operations. Given the lack of research on center efficiency in rural health centers in Malawi, we conducted a study to identify deficiencies in center organization and barriers to patient flow. Methods We performed a time-motion survey at a rural health center in Ntaja, Malawi over a period of 1 week. We used a standardized questionnaire to collect information on the amount of time a patient spent with each health worker, the number of center staff that attended to each patient, and the total time spent at the center. Additionally, at the end of the visit, we conducted an exit survey to collect demographic information and data on perception of quality of care with the center visit for all patients. Results A total of 1018 patients were seen over the five-day study. The average total time spent at the center by the patients was 123 min (2–366 min). Adults had an average total time spent at the center of 111 min (2–366 min) and children 134 min (7–365 min). Patient waiting time (PWT) was higher in the early morning hours ranging from 157 min (between 06:00 and 08:00) to 53 min (between 14:00 and 16:00). Health worker contact time (HCT) was higher for adults (2.3 min) than children (1.7 min). Shorter wait times were associated with higher perceptions of quality of service. Conclusion Despite shortages in health workers and funds, opportunities are available to increase efficiency in rural health centers. By removing bottlenecks to increase the productivity of health workers, centers in low-income countries can treat more patients and improve service quality. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-2144-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M A Jafry
- University of Washington, Seattle, WA, USA.
| | - A M Jenny
- Global Medicines Program, University of Washington, Seattle, WA, USA
| | - S J Lubinga
- Global Medicines Program, University of Washington, Seattle, WA, USA.,Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA
| | | | | | | | - J B Babigumira
- Global Medicines Program, University of Washington, Seattle, WA, USA.,Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA
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Sharma R, Lebrun-Harris LA, Ngo-Metzger Q. Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents. Medicare Medicaid Res Rev 2014; 4:mmrr2014-004-03-a05. [PMID: 25243096 DOI: 10.5600/mmrr.004.03.a05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). DATA SOURCES Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS' Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA's Uniform Data System) and number of low-income residents (American Community Survey). STUDY DESIGN We estimated access to primary care in each HRR by "health center penetration" (health center patients as a proportion of low-income residents). We calculated total Medicare spending (adjusted for population size, local input prices, and health risk). We assessed clinical quality by preventable hospital admissions, hospital readmissions, and emergency department visits. We sorted HRRs by health center penetration rate and compared spending and quality measures between the high- and low-penetration deciles. We also employed linear regressions to estimate spending and quality measures as a function of health center penetration. PRINCIPAL FINDINGS The high-penetration decile had 9.7% lower Medicare spending ($926 per capita, p=0.01) than the low-penetration decile, and no different clinical quality outcomes. CONCLUSIONS Compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings. Limited evidence suggests that these savings do not compromise clinical quality.
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Affiliation(s)
- Ravi Sharma
- Health Resources and Services Administration-Bureau of Primary Health Care
| | - Lydie A Lebrun-Harris
- Health Resources and Services Administration-Office of Planning, Analysis and Evaluation
| | - Quyen Ngo-Metzger
- Agency for Healthcare Research and Quality-Center for Primary Care, Prevention, and Clinical Partnerships
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Tamborero G, Esteva M, March S, Guillén M. [Managerial autonomy in primary care: position of health professionals in Mallorca]. Aten Primaria 2014; 47:99-107. [PMID: 24953173 PMCID: PMC6985615 DOI: 10.1016/j.aprim.2014.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 04/06/2014] [Accepted: 04/08/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the knowledge, perceptions, expectations and attitudes of Primary Care (PC) professionals in Mallorca on managerial autonomy. DESIGN Cross-sectional study based on an ad hoc, anonymous questionnaire, distributed online, from June-July 2013. LOCATION PC Mallorca. PARTICIPANTS PC healthcare professionals (n=1,097). MEASUREMENTS Knowledge of self-management skills, requirements, and future scenarios of the centers with management autonomy (CMA); impact of self-management, commitment and willingness to take risks, and to become a CMA. RESULTS Response rate: 49.8% (546/1097), with 10.9% showing a high level of knowledge of self-management. The core competencies of a CMA were internal organizational capacity (87.5%) and selection of staff (81.1%). The CMA future was envisaged with motivated and involved professionals (72.6%), efficient results (66%), better quality of care (59.4%), and better training (52.8%). The benefits of self-management were considered important, for individual practitioners and for the improvement of PC in Mallorca (46.8%). The main requirements of the CMA were to have: trained managers (92.6%), budget allocation systems (87.5%), and appropriate management contracts (86.1%). They preferred that the CMA should depend on the Administration (62.7%), and had a personal interest in becoming a CMA (56.9%), but without taking on excessive commitments (waiving statutory regime, financial risk). CONCLUSIONS These data provide hitherto unknown information of great importance, which could contribute to a more rational planning and participatory implementation of CMA in our midst.
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Affiliation(s)
- Gaspar Tamborero
- Centro de Salud del Coll d'en Rabassa, Gerencia de Atención Primaria de Mallorca, Ibsalut, Palma de Mallorca, España.
| | - Magdalena Esteva
- Gabinete Técnico, Gerencia de Atención Primaria de Mallorca, Ibsalut, Palma de Mallorca, España
| | - Sebastià March
- Gabinete Técnico, Gerencia de Atención Primaria de Mallorca, Ibsalut, Palma de Mallorca, España
| | - Mireia Guillén
- Gabinete Técnico, Gerencia de Atención Primaria de Mallorca, Ibsalut, Palma de Mallorca, España
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Abstract
OBJECTIVE To identify the impact of the Health Center Growth Initiative on access to care for low-income adults. DATA SOURCES Data on federal funding for health centers are from the Bureau of Primary Health Care's Uniform Data System (2000-2007), and individual-level measures of access and use are derived from the National Health Interview Survey (2001-2008). STUDY DESIGN We estimate person-level models of access and use as a function of individual- and market-level characteristics. By using market-level fixed effects, we identify the effects of health center funding on access using changes within markets over time. We explore effects on low-income adults and further examine how those effects vary by insurance coverage. DATA COLLECTION We calculate health center funding per poor person in a health care market and attach this information to individual observations on the National Health Interview Survey. Health care markets are defined as hospital referral regions. PRINCIPAL FINDINGS Low-income adults in markets with larger funding increases were more likely to have an office visit and to have a general doctor visit. These results were stronger for uninsured and publicly insured adults. CONCLUSIONS Expansions in federal health center funding had some mitigating effects on the access declines that were generally experienced by low-income adults over this time period.
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